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10.09.80.00.htm 10.09.80.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 80 Community-Based Substance Use Disorder Services Authority: Health-General Article, §2-104(b) 7.5-205(d)15-103(a)1) and 15-105(b) Annotated Code of Maryland
10.09.80.01.htm 10.09.80.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Administrative Service Organization (ASO) means the contractor procured by the State to provide the Department with administrative support services to operate the Maryland Public Behavioral Health System.2) “Behavioral Health Administration” means the administration within the Department that establishes regulatory requirements that behavioral health p
10.09.80.02.htm 10.09.80.02. 02 License Requirements.. To participate in the Program, a provider shall meet the license requirements stated in COMAR 10.09.36.02.
10.09.80.03.htm 10.09.80.03. 03 Conditions for Provider Participation.. A. A provider shall be in compliance with COMAR 10.09.36.03.. B. A provider of community-based substance use disorder services shall include:. 1) Community-based substance use disorder providers that:. a) Are licensed by the Department as community-based substance use disorder providers pursuant to the requirements listed in Regulation .05 of this chapter; andb) Maintain verification of licenses and credentials of all professionals e
10.09.80.04.htm 10.09.80.04. 04 Participant Eligibility and Referral.. A. A participant may self-refer or be referred to substance use disorder treatment by a:. 1) Provider;. 2) Family member;. 3) Caregiver; or. 4) Local health authority.. B. An individual is eligible for substance use disorder services if:. 1) The individual meets the Department’s medical necessity criteria; and. 2) The service is appropriate to the specific provider type or community-based substance use disorder providers listed in Reg
10.09.80.05.htm 10.09.80.05. 05 Covered Services.. A. Comprehensive substance use disorder assessment at a minimum shall:. 1) Be reviewed and approved by a licensed physician or licensed practitioner of the healing arts, within the scope of his or her practice under State law; and2) Include:. a) An assessment of the following areas:. i) Drug and alcohol use; and. ii) Substance use disorder treatment history;. b) Referrals for physical and mental health services; and.
10.09.80.06.htm 10.09.80.06. 06 Limitations.. A. The Program under this chapter does not cover the following:. 1) Community-based substance use disorder services not specified in Regulation .05 of this chapter;. 2) Community-based substance use disorder services not approved by a licensed physician or other licensed practitioner of the healing arts, within the scope of his or her practice under State law;3) Services not identified by the Department as medically necessary or listed in Regulation .05 of t
10.09.80.07.htm 10.09.80.07. 07 Authorization Requirements.. A. For services outlined in Regulation .05 of this chapter, the community-based substance use disorder program shall notify the ASO and obtain authorization to provide substance use disorder services from the ASO.B. The ASO agent shall authorize services that are:. 1) Medically necessary; and. 2) Of a type, frequency, and duration that are consistent with expected results and cost-effectiveness.C. No payment shall be rendered for services that
10.09.80.08.htm 10.09.80.08. 08 Payment Procedures.. A. General policies governing payment procedures that are applicable to all providers are set forth in COMAR 10.09.36.04.B. Billing time limitations for claims submitted under this chapter are set forth in COMAR 10.09.36.06.C. Unless the care is free to other patients, a provider shall bill the Program their usual and customary charge to the general public.D. Effective July 1, 2016, rates for the services outlined in this regulation shall be as follows:.
10.09.80.09.htm 10.09.80.09. 09 Recovery and Reimbursement.. Recovery and reimbursement shall be as set forth in COMAR 10.09.36.07..
10.09.80.10.htm 10.09.80.10. 10 Cause for Suspension or Removal and Imposition of Sanctions.. A. Causes for suspension or removal and imposition of sanctions shall be as set forth in COMAR 10.09.36.08.B. The Department shall give to the provider reasonable written notice of the Department’s intention to impose sanctions. In the notice, the Department shall:1) Establish the:. a) Effective date of the proposed action; and. b) Reasons for the proposed action; and. 2) Advise the provider of the right to appeal..
10.09.80.11.htm 10.09.80.11. 11 Appeal Procedures.. Appeals procedures shall be as set forth in accordance with COMAR 10.09.36.09..
10.09.80.12.htm 10.09.80.12. 12 Interpretive Regulation.. This chapter shall be interpreted as set forth in COMAR 10.09.36.10..
10.09.80.9999.htm 10.09.80.9999. Administrative History Effective date:. Regulations .01―09 adopted as an emergency provision effective January 1, 2010 (37:6 Md. R. 474) adopted permanently effective May 31, 2010 (37:11 Md. R. 765) ―Chapter revised effective December 22, 2014 (41:25 Md. R. 1480). Regulation .01B amended effective October 26, 2015 (42:21 Md. R. 1302). Regulation .02 amended effective October 26, 2015 (42:21 Md. R. 1302). Regulation .03 amended effective October 26, 2015 (42:21 Md. R. 1302).
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