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10.09.59.00.htm 10.09.59.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 59 Specialty Mental Health Services Authority: Health-General Article, §2-104(b) 2-105(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.59.01.htm 10.09.59.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Administrative services organization (ASO) means the contactor procured by the State to provide the Department with administrative support services to operate the Maryland Public Behavioral Health System.2) “Definitive drug test” means a drug screening test that includes:. a) The ability to identify individual drugs and distinguish between structural isomers, but not nece
10.09.59.02.htm 10.09.59.02. 02 License Requirements.. To participate in the Program, a provider shall meet the license requirements stated in COMAR 10.09.36.02.
10.09.59.03.htm 10.09.59.03. 03 General Conditions for Provider Participation.. To participate in the Program, a provider shall:. A. Meet the conditions for provider participation in the Medical Assistance Program as set forth in COMAR 10.09.36.03;B. Have clearly defined and written patient care policies; and. C. Maintain, either manually or electronically, adequate documentation of each contact with a participant as part of the medical record, which, at a minimum, meets the following requirements:
10.09.59.04.htm 10.09.59.04. 04 Provider Requirements for Participation.. A. Individual Practitioner Providers. To participate in the Program as an individual practitioner of specialty mental health services, the provider shall:1) Be licensed and legally authorized to practice independently by the appropriate Board to practice in the state in which the service is rendered; and2) Demonstrate, by training and experience, the competency to provide mental health services as one of the following:
10.09.59.05.htm 10.09.59.05. 05 Eligibility.. A participant is eligible for specialty mental health services if:. A. The individual meets the Department’s medical necessity criteria; and. B. The service is appropriate to the specific provider type or community-based mental health provider listed in Regulation .04 of this chapter.
10.09.59.06.htm 10.09.59.06. 06 Covered Services.. The ASO shall reimburse the following specialty mental health services rendered to participants when authorized by the ASO:A. Medically necessary specialty mental health services delivered by providers listed in Regulation .04 of this chapter, for which the primary diagnosis is listed in COMAR 10.09.70.02I or J;B. Telehealth services as defined in COMAR 10.09.49; and. C. Presumptive drug tests and definitive drug tests, when ordered by a spec
10.09.59.07.htm 10.09.59.07. 07 Limitations.. The Program does not cover the following:. A. Services not delivered in compliance with the COMAR references listed in Regulations .04 and .05 of this chapter;B. Services not medically necessary;. C. Investigational or experimental drugs and procedures;. D. Specialty mental health services for participants in an institution for mental disease as defined in 42 CFR §435.1009 unless the service is delivered through the Medicaid Emergency Psychiatric Demonstration;
10.09.59.08.htm 10.09.59.08. 08 Authorization Requirements.. A. The ASO shall establish a process, through a utilization review system, for authorization of specialty mental health services.B. The ASO shall authorize services that are:. 1) Medically necessary;. 2) Of a type, frequency, and duration that are consistent with expected results and cost-effective; and3) Delivered in a manner consistent with this chapter..
10.09.59.09.htm 10.09.59.09. 09 Payment Procedures.. A. Payment procedures shall be followed as specified in COMAR 10.09.36.04.. B. A provider shall deliver and document services in accordance with Department regulations in order to receive reimbursement.C. Unless the care is free to other patients, a provider shall bill the Program its usual and customary charge to the general public.D. The Department shall authorize supplemental payment on Medicare claims only if:.
10.09.59.10.htm 10.09.59.10. 10 Recovery and Reimbursement.. Recovery and reimbursement are as set forth in COMAR 10.09.36.07..
10.09.59.11.htm 10.09.59.11. 11 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions are as set forth in COMAR 10.09.36.08..
10.09.59.12.htm 10.09.59.12. 12 Appeal Procedures for Providers.. Appeal procedures for providers are as set forth in COMAR 10.09.36.09..
10.09.59.13.htm 10.09.59.13. 13 Appeal Rights ― Denial of Services.. Appeal procedures for applicants and participants are as set forth in COMAR 10.01.03 and 10.01.04..
10.09.59.14.htm 10.09.59.14. 14 Interpretive Regulation.. State regulations are interpreted as set forth in COMAR 10.09.36.10..
10.09.59.9999.htm 10.09.59.9999. Administrative History Effective date:. Regulations .01―11 adopted as an emergency provision effective February 3, 1995 (22:4 Md. R. 232) adopted permanently effective June 5, 1995 (22:11 Md. R. 821)Regulations .01 and .03―07 amended as an emergency provision effective July 1, 1997 (24:18 Md. R. 1291) emergency status expired December 31, 1997; amended permanently effective February 9, 1998 (25:3 Md. R. 144)Regulation .04 amended effective February 12, 1996 (23:3 Md. R. 168).
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