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10.21.25.00.htm 10.21.25.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 21 MENTAL HYGIENE REGULATIONS Chapter 25 Fee Schedule ― Mental Health Services ― Community-Based Programs and Individual Practitioners Authority: Health-General Article, §10-901, 15-103, and 15-105; Title 16, Subtitles 1 and 2; Annotated Code of Maryland
10.21.25.01.htm 10.21.25.01. 01 Scope.. This chapter establishes the fees that the Department reimburses for mental health services that are rendered by a provider to an individual who receives Medicaid-reimbursable or State-supported services.
10.21.25.02.htm 10.21.25.02. 02 General Reimbursement.. A. The Department shall reimburse the lower of the amount billed or the fee established under this chapter, after the application of an individual's copayment, based on the ability-to-pay determination according to Regulation .03 of this chapter.B. The Department may reimburse for non-Medicaid-reimbursable mental health services to the extent that State resources permit.C. According to the provisions of this chapter, the Department shall reimbu
10.21.25.03.htm 10.21.25.03. 03 Definitions.. A. In this chapter, terms have the meanings stated in COMAR 10.21.17, COMAR 10.63.01.02, and this regulation.B. Terms Defined.. 1) "Ability-to-pay schedule" means the schedule adopted, according to the provisions of Health-General Article, Title 16, Subtitle 2, Annotated Code of Maryland, by the Secretary to evaluate and establish the extent of a consumer's ability to pay for services rendered.2) "Administration" means the Behavioral Health Administration..
10.21.25.03-1.htm 10.21.25.03-1. 03-1 General Reimbursement Conditions.. A. Claims Submission. In order to be reimbursed by the Department, an approved provider shall submit a claim when the provider has:1) Obtained authorization to provide the services for which the claim is being submitted;. 2) Delivered the service;. 3) Documented provision of service as required; and. 4) Complied with any regulatory preconditions for the delivery of the service.. B. Claims Retraction. The Department may retract a
10.21.25.03-2.htm 10.21.25.03-2. 03-2 Supplemental Rates.. Providers who billed for services rendered from July 1, 2013 until the effective date of these regulations may resubmit their claims and be reimbursed for these services as set forth in Regulations .05―12 of this chapter.
10.21.25.04.htm 10.21.25.04. 04 Ability to Pay.. A. Except if an individual is a Medicaid recipient:. 1) A provider shall provide to the Administration's designee the information needed to assess an individual's ability to pay;2) The Administration's designee shall assess the individual's ability to pay and determine the required copayment; and3) The provider shall make collections of the copayment according to the requirements in Health-General Article, §16-201―16-204, Annotated Code of Maryland.
10.21.25.05.htm 10.21.25.05. 05 Fee Schedule ― Treatment Services ― Diagnosis and Therapy.. A. Diagnostic Interview. The Department shall reimburse a provider for a face-to-face diagnostic interview, as follows:1) For a child or adolescent, when rendered by a provider with demonstrated competency to provide mental health services to children or adolescents:a) OMHC . $190.23;. b) Physician . $151.68;. c) Psychologist . $121.08;. d) Other mental health professionals . $106.01;. 2) For an adult:.
10.21.25.06.htm 10.21.25.06. 06 Fee Schedule ― Additional Treatment Services.. A. Psychological Testing. The Department shall reimburse a psychologist for conducting psychological testing, up to a maximum of 8 hours per year per individual as follows:1) OMHC psychologist . $99.02 per hour;. 2) Other psychologist . $99.02 per hour;. 3) OMHC psychologist associate . $27.55 per hour;. 4) Other psychologist associate . $27.55 per hour.. B. Occupational Therapy. The Department shall reimburse an occupational the
10.21.25.07.htm 10.21.25.07. 07 Fee Schedule ― Special OMHC Services.. A. Treatment Planning. The Department shall reimburse an OMHC for providing an OMHC-enrolled individual with one face-to-face treatment planning meeting every 6 months, at the rate of $82.87 per planning meeting.B. Multifamily Group Therapy. The Department shall reimburse an OMHC for providing multifamily group therapy, with the identified patient, for families of:
10.21.25.08.htm 10.21.25.08. 08 Fee Schedule ― Treatment Services ― Programs.. A. Therapeutic Nursery Programs. The Department shall reimburse a program approved under COMAR 10.21.18 to provide therapeutic nursery services to eligible children, younger than 5 years old, at a rate of $42.20 per day, for a minimum of 3 days per week, 3 hours per day.B. Mobile Treatment Services. The Department shall reimburse a program for mobile treatment services delivered to an individual:1) For a minimum of four
10.21.25.09.htm 10.21.25.09. 09 Fee Schedule ― Support Services.. A. Psychiatric Rehabilitation Program (PRP) Services. The Department shall reimburse a PRP for providing face-to-face rehabilitation services to an individual with a serious emotional disturbance (SED) or serious and persistent mental disorder (SPMD) by a monthly rate that is based on a minimum and maximum range of services, when the PRP submits monthly supporting encounter data after services are provided to the individual, within which the prov
10.21.25.10.htm 10.21.25.10. 10 Fee Schedule ― Services ― Traumatic Brain Injury (TBI) Waiver Program.. A. Residential Habilitation Services. The Department shall reimburse a program approved under COMAR 10.09.46 to provide residential habilitation services to an individual who is enrolled in the TBI Waiver Program:1) At the following rates:. a) Level I . $192.76 per day;. b) Level II . $255.24 per day;. c) Level III . $353.11 per day;. 2) According to the need for the level of support documented in an individu
10.21.25.11.htm 10.21.25.11. 11 Fee Schedule ― Services ― Emergency Department.. The Department shall reimburse an emergency department for providing emergency mental health services to an individual who is enrolled in the public mental health system, for services rendered by an appropriately privileged physician or certified registered nurse practitioner—psychiatric as follows:A. For a problem focused history, a problem focused examination, and straightforward medical decision making . $22.27;
10.21.25.12.htm 10.21.25.12. 12 Evaluation and Management Services ― Including Medication Management.. A. New Patients. The Department shall reimburse for evaluation and management services for new patients, including medication management:1) For a problem focused history, or a problem focused examination, and straightforward medical decision making of minor complexity:a) OMHC . $48.70;. b) Physician . $48.70;. c) Certified registered nurse practitioner—psychiatric . $48.70;. 2) For an expanded proble
10.21.25.13.htm 10.21.25.13. 13 Crisis Therapy.. The Department shall reimburse an OMHC for crisis therapy, as follows:. A. For a child or adolescent, when rendered by a provider with demonstrated competency to provide mental health services to children or adolescents:1) For the first 60 minutes . $118.37;. 2) For an additional period of 30 minutes . $61.77;. B. For an adult:. 1) For the first 60 minutes . $100.10;. 2) For an additional period of 30 minutes . $54.16..
10.21.25.9999.htm 10.21.25.9999. Administrative History Effective date:. Regulations .01―08 adopted as an emergency provision effective July 1, 1997 (24:18 Md. R. 1293) adopted permanently effective October 20, 1997 (24:21 Md. R. 1449) ―Chapter revised as an emergency provision effective July 1, 1998 (25:14 Md. R. 1123). Chapter revised effective October 1, 1998 (25:18 Md. R. 1435 and 25:19 Md. R. 1506). Chapter revised as an emergency provision effective March 1, 2000 (27:4 Md. R. 451) revised permanen
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