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10.09.89.00.htm 10.09.89.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 89 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families Authority: Health-General Article, §2-104(b) Annotated Code of Maryland
10.09.89.01.htm 10.09.89.01. 01 Scope.. The purpose of this chapter is to implement a home and community-based services benefit for children and youth with serious emotional disturbances (SED) and their families, authorized under a 1915(i) Medicaid State Plan Amendment. Eligible participants are served by care coordination organizations through a wraparound service delivery model that utilizes child and family teams to create and implement individualized plans of care that are driven by the strengths and needs
10.09.89.02.htm 10.09.89.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “1915(c) means a federal waiver that allows states to provide home- and community-based care to individuals who would otherwise be institutionalized.2) “1915(i) means the 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families program described in this chapter.3) “Administrative services organization (ASO) has the meaning stated in COMAR 10.09.62.01..
10.09.89.03.htm 10.09.89.03. 03 Participant Eligibility.. A. For an applicant to be eligible for 1915(i) services, the applicant shall meet all of the criteria in §B―H of this regulation.B. The applicant shall be younger than 18 years old at the time of enrollment.. C. The applicant shall reside in a home-and community-based setting that is:. 1) Located in the 1915(i) service area; and. 2) Not any of the following excluded settings:. a) Therapeutic Group Home (TGH) licensed by the Office of Health Care Quali
10.09.89.04.htm 10.09.89.04. 04 Termination of Participant Enrollment.. A. A participant shall be disenrolled from the 1915(i) as of the date established by the Department, if the participant:1) No longer meets all of the criteria for 1915(i) eligibility specified in §A―H of Regulation .03 of this chapter;2) Voluntarily chooses to disenroll from the benefit, if the participant is 18 years old, or the participant’s family or medical guardian chooses to do so on behalf of a participant who is younger tha
10.09.89.05.htm 10.09.89.05. 05 1915(i) Model.. A. The 1915(i) shall provide community-based treatment to children with SED through a wraparound service delivery process.B. Enrollment in 1915(i) services qualifies and requires the participant to receive case management services through a CCO, pursuant to COMAR 10.09.90.C. Each participant shall have an individualized POC that is managed by the CCO, pursuant to COMAR 10.09.90:D. In partnership with the CFT, the CCO shall:. 1) Reevaluate the POC at
10.09.89.06.htm 10.09.89.06. 06 Conditions for Provider Participation.. A. The Department shall grant approval to providers to be eligible to receive Medicaid funds for 1915(i) services if the provider meets the requirements set forth in this chapter.B. Application. To provide 1915(i) services, a provider applicant shall:. 1) Submit an application to the Department on the form approved by the Department, with all questions answered and all required documents attached; and2) Attest that the provid
10.09.89.07.htm 10.09.89.07. 07 Denial, Emergency Suspension of Approval, and Disciplinary Action.. A. Denial of Approval.. 1) If the Department proposes to deny approval to an applicant under the provisions of this chapter, the Department shall give written notice of the proposed denial to the:a) Provider applicant;. b) Care coordination organization (CCO) and. c) Administrative service organization (ASO). 2) In the notice under §A(1) of this regulation, the Department shall include:.
10.09.89.08.htm 10.09.89.08. 08 General Conditions for 1915(i) Services Provider Participation.. A. A provider of 1915(i) services shall:. 1) Provide the documentation required by the Department for initial approval and provider recertification, or as requested by the Department;2) Be approved by the Department as meeting the requirements of being able to provide the services set forth in this chapter;3) Have a provider agreement in effect, to include adherence to quality assurance, auditing, and mon
10.09.89.09.htm 10.09.89.09. 09 Covered Services ― Customized Goods and Services.. A. Customized goods and services are:. 1) Expenditures requested by the participant’s CCO and made by the CSA to support the POC for the participant and family for costs that are:a) Reasonable, defined as a cost that, in its nature and amount, does not exceed that which would be incurred by a prudent person under the circumstances prevailing at the time the decision was made to incur the cost; andb) Necessary, defined as
10.09.89.10.htm 10.09.89.10. 10 Covered Services ― Family Peer Support Services.. Family peer support services:. A. May be provided without the presence of the participant;. B. Are delivered by a family peer support partner employed by a family support organization (FSO). C. May include, but are not limited to:. 1) Explaining the role and function of the FSO to newly enrolled families and creating linkages to other peers and supports in the community;2) Working with the participant and family to iden
10.09.89.11.htm 10.09.89.11. 11 Covered Services ― Respite Services.. Respite services:. A. Include a set of specific short-term services documented in the POC that include:. 1) A schedule of the participant’s activities during respite;. 2) Medication monitoring, if needed;. 3) The frequency, duration, and intensity of staff support;. 4) Respite locations; and. 5) The aftercare plan or recommendations;. B. Include community-based respite services, which are provided in the participant’s home or other c
10.09.89.12.htm 10.09.89.12. 12 Covered Services ― Expressive and Experiential Behavioral Services.. A. Expressive and experiential behavioral services:. 1) May be provided to an individual or group;. 2) Provide sensory modalities to participants to assist in achieving POC objectives; and. 3) Include:. a) Art behavioral services;. b) Dance behavioral services;. c) Equine-assisted behavioral services;. d) Horticultural behavioral services;. e) Music behavioral services; or. f) Drama behavioral services..
10.09.89.13.htm 10.09.89.13. 13 Covered Services ― Mobile Crisis Response Services.. A. Mobile crisis response services (MCRS). 1) Are offered in response to urgent mental health needs;. 2) Are available on a short-term on-call basis 24 hours per day, 7 days per week;. 3) Are coordinated with the care coordinator and CFT, and are incorporated into the participant’s POC;4) Are short-term, individualized services that assist in de-escalating crises and stabilizing children and youth in their ho
10.09.89.14.htm 10.09.89.14. 14 Covered Services ― Intensive In-Home Services.. A. Intensive In-Home Services (IIHS). 1) Are strengths-based interventions with the child and his or her identified family that includes a series of components, such as:a) Functional assessments and treatment planning;. b) Individualized interventions;. c) Crisis response and intervention; or. d) Transition support;. 2) May be provided to the child alone, to other family members, or to the child and family members together;
10.09.89.15.htm 10.09.89.15. 15 Limitations.. A. Reimbursement shall be made by the Program only when all of the requirements of this chapter are met.B. The Program may not reimburse for:. 1) Services that are:. a) Provided by a member of the recipient’s immediate family or an individual who resides in the recipient’s home;b) Not preauthorized by the Department;. c) Not medically necessary;. d) Beyond the provider’s scope of practice;. e) Not appropriately documented;.
10.09.89.16.htm 10.09.89.16. 16 Payment Procedures.. A. Request for Payment.. 1) An approved provider shall submit requests for payment for the services covered under this chapter according to the procedures set forth in COMAR 10.09.36.04.2) The provider shall:. a) Bill the ASO in accordance with the payment methodology specified in this chapter;. b) Accept payment from the ASO as payment in full for the covered services rendered, and make no additional charge to the participant or any other par
10.09.89.17.htm 10.09.89.17. 17 Recovery and Reimbursements.. Recovery and reimbursement are set forth in COMAR 10.09.36.07..
10.09.89.18.htm 10.09.89.18. 18 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions is as set forth in COMAR 10.09.36.08 and 10.21.10.
10.09.89.19.htm 10.09.89.19. 19 Appeal Procedures for Providers.. Appeal procedures for providers are those set forth in COMAR 10.09.36.09..
10.09.89.20.htm 10.09.89.20. 20 Appeal Procedures for Applicants and Participants.. Appeal procedures for applicants and participants are those set forth in COMAR 10.01.04, 10.09.24.13, and 10.09.70.
10.09.89.9999.tx.htm 10.09.89.9999. Administrative History Effective date: October 1, 2014 (41:19 Md. R. 1077). Regulation .15B amended effective July 4, 2016 (43:13 Md. R. 712). Regulation .10F amended October 24, 2016 (43:21 Md. R. 1166). Regulation .11E amended October 24, 2016 (43:21 Md. R. 1166). Regulation .12C amended October 24, 2016 (43:21 Md. R. 1166). Regulation .13D amended October 24, 2016 (43:21 Md. R. 1166). Regulation .14F amended October 24, 2016 (43:21 Md. R. 1166).
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