reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.09 - Covered Services - Family Peer Support Services

Current through Register Vol. 51, No. 14, July 12, 2024
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 identify and articulate concerns, needs, and vision for the future of the
				  participant;
(3) Ensuring family
				  and participant opinions and perspectives are incorporated into the CFT process
				  and POC:
(a) Through communication with the
				  care coordinator and team members; and
(b) By attending CFT meetings with the family
				  to support family decision-making and choice of options;
(4) Listening to the family express needs and
				  concerns and offering suggestions for engagement in the treatment process;
(5) Helping the family identify
				  and engage its own natural support system and facilitating the family attending
				  peer support groups and other FSO activities throughout the POC process;
(6) Working with the family:
(a) To organize and prepare for meetings in
				  order to maximize participation in meetings;
(b) By informing the family about options and
				  possible outcomes in selecting services and supports to assist with informed
				  decision-making; and
(c) By
				  supporting the family in meetings at school and other locations in the
				  community and during court hearings;
(7) Empowering the family to make choices to
				  achieve desired outcomes for the participant as well as the entire family;
				  and
(8) Helping the family to
				  acquire the skills and knowledge needed to attain greater self-sufficiency and
				  maximum autonomy and assisting the family to develop the skills and confidence
				  to independently identify, seek out and access resources that will assist in:
(a) Managing and mitigating the participant's
				  behavioral health condition or conditions;
(b) Preventing the development of secondary
				  or other chronic conditions;
(c)
				  Promoting optimal physical and behavioral health; and
(d) Addressing and encouraging activities
				  related to health and wellness.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.10 - Covered Services - Respite Services

Current through Register Vol. 51, No. 14, July 12, 2024
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;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.11 - Covered Services - Expressive and Experiential Behavioral Services

Current through Register Vol. 51, No. 14, July 12, 2024
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.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.12 - Covered Services - Intensive In-Home Services

Current through Register Vol. 51, No. 14, July 12, 2024
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;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.13 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
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;
(f)
				  Part of another service paid for by the State; or
(g) Provided without a valid required license
				  or appropriate credentials as specified in this chapter;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.14 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
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 party for these services; and
(c) Submit a request for payment in a manner
				  approved by the Program, which includes a certification of the:
(i) Date or dates of service;
(ii) Participant's name and Medicaid
				  number;
(iii) Provider's name,
				  location, and provider identification number;
(iv) Type, procedure code or codes, and unit
				  or units of covered services provided; and
(v) Amount of reimbursement
				  requested.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.15 - Recovery and Reimbursements

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement are set forth in COMAR
					 10.09.36.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.16 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
Cause for suspension or removal and imposition of sanctions
					 is as set forth in COMAR
					 10.09.36.08 and 10.21.10.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.17 - Appeal Procedures for Providers

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures for providers are those set forth in
					 COMAR 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.18 - Appeal Procedures for Applicants and Participants

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures for applicants and participants are those
					 set forth in COMAR 10.01.04,
					 10.09.24.13, and 10.09.70.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.19 - Recodified

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.20 - Recodified

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter
				  applies to providers organized to deliver mental health case management
				  services for children and youth.
B.
				  The purpose of mental health case management care coordination is to assist
				  participants in gaining access to needed medical, mental health, social
				  educational and other services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.03 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				  participant shall be eligible for care coordination services if the recipient:
(1) Is in a federal eligibility category for
				  Maryland Medical Assistance according to COMAR 10.09.24, which governs the
				  determination of eligibility for the Maryland Medical Assistance Program;
				  and
(2) Meets the criteria of
				  either §B(1) or (2) of this regulation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.04 - Participant Eligibility - Levels of Intensity

Current through Register Vol. 51, No. 14, July 12, 2024
A. In addition to meeting the eligibility
				  criteria outlined under Regulation .03 of this chapter, participants shall be
				  classified according to the levels of intensity listed in Regulation .05, 06,
				  or .07 of this chapter, based on the severity of the participant's behavioral
				  health or co-occurring disorder, along with assessed strengths and
				  needs.
B. The Department or its
				  designee shall review participant levels of care to confirm these are
				  appropriate to the participants' needs.
C. Participants may not remain at Level III
				  for longer than 6 consecutive months unless approved by the Department or its
				  designee.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.05 - Participant Eligibility - Level I-General Care Coordination

Current through Register Vol. 51, No. 14, July 12, 2024
The participant as described in Regulation .03A of this
					 chapter shall meet at least two of the following conditions:
A. The participant is not linked to
				  behavioral health, health insurance, or medical services;
B. The participant lacks basic supports for
				  education, income, shelter, or food;
C. The participant is transitioning from one
				  level of intensity to another level of intensity of services;
D. The participant needs care coordination
				  services to obtain and maintain community-based treatment and
				  services;
E. The participant:
(1) Is currently enrolled in Level II or
				  Level III Care Coordination services under this chapter; and
(2) Has stabilized to the point that Level I
				  is most appropriate.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.06 - Participant Eligibility - Level II-Moderate Care Coordination

Current through Register Vol. 51, No. 14, July 12, 2024
The participant as described in Regulation .03A of this
					 chapter shall meet three or more of the following conditions:
A. The participant is not linked to
				  behavioral health services, health insurance, or medical services;
B. The participant lacks basic supports for
				  education, income, food, or transportation;
C. The participant is homeless or at-risk for
				  homelessness;
D. The participant is
				  transitioning from one level of intensity to another level of intensity
				  including transitions out of the following levels of service:
(1) Inpatient psychiatric or substance use
				  services;
(2) RTC; or
(3) 1915(i) services under COMAR
				  10.09.89;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.07 - Participant Eligibility - Level III - Intensive Care Coordination

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  participant shall meet at least one of the following conditions:
(1) The participant has been enrolled in the
				  1915(i) program for 6 months or less;
(2) The participant is currently enrolled in
				  Level I or Level II Care Coordination services under this chapter and has
				  experienced one of the following adverse childhood experiences during the
				  preceding 6 months:
(a) Emotional, physical,
				  or sexual abuse;
(b) Serious
				  emotional or physical neglect; or
(c) Significant family disruption or
				  stressors;
(3) The
				  participant meets the following conditions:
(a) The participant has a behavioral health
				  disorder amenable to active clinical treatment, diagnosed through a
				  face-to-face psychosocial assessment by a licensed mental health
				  professional,
(b) There is clinical
				  evidence the minor has a SED and continues to meet the service intensity needs
				  and medical necessity criteria for the duration of their enrollment;
(c) A comprehensive psychosocial assessment
				  performed by a licensed mental health professional finds that the participant
				  exhibits a significant impairment in functioning, representing potential
				  serious harm to self or others, across settings, including the home, school, or
				  community;
(d) The psychosocial
				  assessment supports the completion of the Early Childhood Service Intensity
				  Instrument (ECSII) for youth ages 0-5 or the Child and Adolescent Service
				  Intensity Instrument (CASH) for youth ages 6-21, by which the participant
				  receives a score of:
(i) 3 on the ECSII;
				  or
(ii) 3 or higher on the
				  CASH;
(e) Youth with a
				  score of 3, 4, or 5 on the CASH also shall meet the conditions outlined in
				  §B of this regulation; and
(f)
				  Youth with a score of 3 or 4 on the ECSII also shall meet the conditions
				  outlined in §C of this regulation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.08 - Conditions for Provider Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. Selection of CCOs.
(1) The local core service agencies shall
				  select child and youth CCOs through a competitive procurement process, at least
				  once every 5 years.
(2) Regional
				  CCOs may be procured at the mutual agreement of local core service agencies so
				  long as the local core service agencies demonstrate that there is sufficient
				  provider capacity to serve the children and youth in a particular
				  region.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.09 - Conditions for Provider Participation - Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. General Requirements. To be eligible to be
				  approved as a care coordination organization, an entity shall meet all of the:
(1) Conditions for participation as set forth
				  in COMAR 10.09.36.03; and
(2) Medical Assistance provisions listed in
				  COMAR designated for their provider type.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.10 - Mental Health Case Management Care Coordination Provider Staff

Current through Register Vol. 51, No. 14, July 12, 2024
CCOs are required to maintain the following
					 positions:
A. Care coordinator
				  supervisor who:
(1) Is a mental health
				  professional with a minimum of a Master's degree and who is licensed and
				  legally authorized to practice under Health Occupations Article, Annotated Code
				  of Maryland, and who is licensed under Maryland Practice Boards in the
				  profession of:
(a) Social work;
(b) Professional Counseling;
(c) Psychology;
(d) Nursing; or
(e) Medicine;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.11 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Department shall reimburse for the care coordination services in this
				  regulation when these services have been documented, pursuant to the
				  requirements of this chapter, as necessary.
B. Care coordination services shall be
				  coordinated with, and may not duplicate activities provided as part of,
				  institutional services and discharge planning activities.
C. Care coordination may include contacts
				  that are directly related to identifying the needs and supports for helping the
				  participant to access services.
D.
				  The CCO shall engage in participant advocacy, including:
(1) Empowering the participant and, if the
				  participant is a minor, the minor's parent or guardian to secure needed
				  services;
(2) Taking any necessary
				  actions to secure services on the participant's behalf; and
(3) Encouraging and facilitating the
				  participant's decision making and choices leading to accomplishment of the
				  participant's goals or, if the participant is a minor, encouraging the parent
				  or guardian to carry out these decisions.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.12 - Covered Services - Plan of Care

Current through Register Vol. 51, No. 14, July 12, 2024
A. The POC shall contain, at minimum:
(1) A description of the participant's
				  strengths and needs;
(2) The
				  diagnosis or diagnoses established as evidence of the participant's eligibility
				  for services under this chapter;
(3) The goals of care coordination services
				  to address the behavioral health, medical, social, educational, and other
				  services needed by the participant, with expected target completion
				  dates;
(4) A crisis plan including
				  the proposed strategies and interventions for preventing and responding to
				  crises and the youth and family's definitions of what constitutes a
				  crisis;
(5) Designation of the care
				  coordinator with primary responsibility for implementation of the
				  POC;
(6) Signatures of the care
				  coordinator and other CFT members, if appropriate;
(7) Signatures of the participant and family
				  indicating that the participant and family have:
(a) Participated in the development of the
				  POC; and
(b) Had choice in the
				  selection of services, providers, and interventions when possible, in the care
				  coordination process of building the POC; and
(8) For 1915(i) participants, specified for
				  each recommended service, the following information as appropriate or as
				  required by the Department:
(a) Description of
				  the service;
(b) Service start
				  date;
(c) Estimated
				  duration;
(d) Frequency and units
				  of service as measured in 15 minute increments to be delivered;
(e) The specific need or goal that the
				  service is related to; and
(f) The
				  provider name and contact information.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.13 - Covered Services - Child and Family Team Meetings

Current through Register Vol. 51, No. 14, July 12, 2024
The CCO shall:
A.
				  Coordinate and facilitate the CFT, with CFT meetings convened at least every 45
				  calendar days or more frequently as clinically indicated;
B. Record and keep notes at every CFT meeting
				  that include the CFT members who were present, a summary of the discussion, any
				  changes to the POC, and action items for follow up, and share them with the CFT
				  members, including those who were not in attendance;
C. Update the POC to include change in
				  progress, services, or other areas within 5 calendar days of the CFT meeting;
				  and
D. Ensure that the care
				  coordinator:
(1) Facilitates CFT
				  meetings;
(2) Facilitates access to
				  the services and supports in the POC; and
(3) At the first meeting:
(a) Administers the appropriate assessments,
				  as designated by the Department;
(b) Works with the participant and family to
				  develop an initial crisis plan that includes response to immediate service
				  needs; and
(c) For 1915(i)
				  participants, provides an overview of the care coordination process.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.14 - Covered Services - Referral and Related Activities

Current through Register Vol. 51, No. 14, July 12, 2024
A. The care coordinator shall ensure that the
				  participant or, if the participant is a minor, the minor's parent or guardian
				  has applied for, has access to, and is receiving the necessary services
				  available to meet the participant's needs, such as mental health services,
				  resource procurement, transportation, or crisis intervention.
B. The care coordinator shall take the
				  necessary action as defined by the Department when the services identified
				  under Regulation .13 of this chapter have not occurred.
C. The linkage process shall include:
(1)Community and natural support development
				  by contacting, with the participant's consent, members of the participant's
				  support network, including CFT members, for example, family, friends, and
				  neighbors, as appropriate, or, if the participant is a minor, the minor's
				  parent or guardian, to mobilize assistance for the participant;
(2) Crisis intervention by referral of the
				  participant or, if the participant is a minor, the minor's parent or guardian,
				  to services on an emergency basis when immediate intervention is
				  necessary;
(3) Arranging for the
				  participant's transportation to and from services;
(4) Outreach in an attempt to locate service
				  providers which can meet the participant's needs, or, if the participant is a
				  minor, the minor's parent or guardian's needs;
(5) Reviewing the POC with the participant
				  and the participant's CFT, as appropriate, or, if the participant is a minor,
				  with the minor's parent or guardian, so as to enable and facilitate their
				  participation in the plan's implementation; and
(6) Provision of health and wellness
				  education, information, and linkages to high-quality health care services,
				  preventive and health promotion resources, and chronic disease management
				  services with an emphasis on resources available in the family's community and
				  peer group.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.15 - Covered Services - Monitoring and Follow-Up Activities

Current through Register Vol. 51, No. 14, July 12, 2024
A. A CCO shall
				  monitor, as per standards set forth by the Department, the activities and
				  contacts that are considered necessary to ensure the POC is implemented and
				  adequately addresses the participant's needs, and include:
(1) The participant or, if the participant is
				  a minor, the minor's parent or guardian; and
(2) With proper consent:
(a) Family members and friends, if
				  appropriate;
(b) Other individuals
				  or agency representatives identified and approved as CFT members by the
				  participant or, if the participant is a minor, the minor's parent or guardian;
				  and
(c) Other service providers, if
				  any.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.16 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Care
				  coordination services are facilitative in nature.
B. A restriction may not be placed on a
				  qualified recipient's option to receive mental health case management
				  services.
C. Care coordination
				  services do not restrict or otherwise affect:
(1) Eligibility for Title XIX benefits or
				  other available benefits or programs, except as limited by §E of this
				  regulation;
(2) The freedom of a
				  participant or, if the participant is a minor, the minor's parent or guardian
				  to select from all available services for which the participant is found to be
				  eligible; or
(3) A participant's
				  free choice among qualified providers or, if the participant is a minor, the
				  minor's parent or guardian's free choice among qualified providers.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.17 - Preauthorization

Current through Register Vol. 51, No. 14, July 12, 2024
All covered services under this chapter shall be
					 preauthorized and comply with the requirements of COMAR 10.09.70.07 and COMAR
					 10.09.89 for services delivered to 1915(i) participants.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.18 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Program shall reimburse the provider according to the requirements in this
				  chapter and COMAR 10.09.89 for services delivered to 1915(i) participants, and
				  the fees established under COMAR 10.21.25.
B. Request for Payment.
(1) A provider shall submit requests for
				  payment of mental health case management services according to procedures
				  established by the Department.
(2)
				  A provider shall bill the Program for the appropriate fee under COMAR
				  10.21.25.
(3) The Program may not
				  make direct payment to recipients.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.19 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement are as set forth in COMAR
					 10.09.36.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.20 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
Cause for suspension or removal and imposition of sanctions
					 is as set forth in COMAR 10.09.36.08.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.21 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures are those set forth in COMAR 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth › Section 10.09.90.22 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations are interpreted as those set forth in
					 COMAR 10.09.36.10.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.91 - Hospital Presumptive Eligibility › Section 10.09.91.01 - Purpose and Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter establishes requirements for the determination
					 of presumptive eligibility by qualified hospitals effective October 1,
					 2014.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.91 - Hospital Presumptive Eligibility › Section 10.09.91.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated. B. Terms Defined.
(1) "Applicant" means an individual who has
				  applied for presumptive eligibility at a participating hospital.
(2) "Application" means the presumptive
				  eligibility application.
(3)
				  "Authorized representative" has the same meaning as set forth in COMAR
				  10.01.04.01.
(4) "Department"
				  means the Department of Health and Mental Hygiene which is the single State
				  agency designated to administer the Maryland Medical Assistance Program
				  pursuant to Title XIX of the Social Security Act,
				  42 U.S.C. §
												1396 et seq.
(5) "Determination" means a decision
				  regarding an applicant's presumptive eligibility.
(6) "Federal poverty level" means the poverty
				  guidelines updated periodically in the Federal Register by the U.S. Department
				  of Health and Human Services under the authority of
				  42 U.S.C. §
												9902(2).
(7) "Former foster care" means an individual
				  who:
(a) Is younger than 26 years old;
(b) Is not eligible and enrolled
				  for coverage under a mandatory Medical Assistance group other than childless
				  adult; and
(c) Was formerly in a
				  Maryland out-of-home placement, including categorical Medical Assistance:
(i) On attaining age 18 and leaving
				  out-of-home placement; or
(ii) On
				  attaining age 19-21 during extended out-of-home placement under COMAR
				  07.02.11.04B.
(8)
				  "Hospital" means an institution which:
(a)
				  Falls within the jurisdiction of Health-General Article, Title 19, Subtitle 3,
				  Annotated Code of Maryland; and
(b) Is licensed pursuant to COMAR 10.07.01 or
				  other applicable standards established by the state in which the service is
				  provided.
(9) "Income"
				  means property or a service received by an individual in cash or in-kind, which
				  can be applied directly, or by sale or conversion, to meet basic needs for
				  food, shelter, and medical expenses.
(10) "Incarcerated inmate in a public
				  institution" has the meaning stated in COMAR
				  10.09.24.05-5B.
(11) "Medical Assistance" means
				  the program administered by the State under Title XIX of the Social Security
				  Act, which provides comprehensive medical and other health-related care for
				  eligible individuals.
(12)
				  "Medicare" means the medical insurance program administered by the federal
				  government under Title XVIII of the Social Security Act, 42, §U.S.C. 1395
				  et seq.
(13) "Presumptive
				  eligibility" means temporary eligibility for Medical Assistance as determined
				  by participating hospitals in accordance with these regulations.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.91 - Hospital Presumptive Eligibility › Section 10.09.91.03 - Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. A hospital
				  eligible to make presumptive eligibility decisions shall:
(1) Participate as a Maryland Medical
				  Assistance Program provider in good standing; and
(2) Sign an agreement prepared by the
				  Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.91 - Hospital Presumptive Eligibility › Section 10.09.91.04 - Hospital or Hospital Staff Disqualifications

Current through Register Vol. 51, No. 14, July 12, 2024
A. A hospital qualified to make presumptive
				  eligibility decisions shall:
(1) Make
				  presumptive eligibility determinations in accordance with established
				  Departmental policies and procedures; and
(2) Disqualify individual hospital employees
				  who do not follow established Departmental regulations, policies and
				  procedures.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.91 - Hospital Presumptive Eligibility › Section 10.09.91.05 - Criteria

Current through Register Vol. 51, No. 14, July 12, 2024
A. An individual,
				  the individual's guardian, or a representative of the individual with personal
				  knowledge shall apply for presumptive eligibility through a participating
				  hospital.
B. An individual, the
				  individual's guardian, or a representative of the individual with personal
				  knowledge who applies for presumptive eligibility shall attest to:
(1) The citizenship requirements in COMAR
				  10.09.24.05;
(2) The residency requirements in COMAR
				  10.09.24.05-3;
(3) The individual's pregnancy status;
(4) The individual's family size;
				  and
(5) The individual's
				  household's gross monthly income.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.91 - Hospital Presumptive Eligibility › Section 10.09.91.06 - Populations Eligible

Current through Register Vol. 51, No. 14, July 12, 2024
Presumptive eligibility may be established for the
					 following eligibility groups:
A.
				  Parents and other caretaker relatives whose household income is equal to or
				  less than 133 percent of the federal poverty level;
B. Pregnant women whose income is equal to or
				  less than 250 percent of the federal poverty level;
C. Adults without dependent children who are
				  older than 19 years old and younger than 65 years old, whose household income
				  is equal to or less than 133 percent of the federal poverty level;
D. Children who are younger than 19 years old
				  who are under 300 percent of the federal poverty level; or E. Former foster
				  care individuals who are younger than 26 years old.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.91 - Hospital Presumptive Eligibility › Section 10.09.91.07 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
An individual may not apply for presumptive eligibility in
					 Maryland if the individual:
A. Is
				  currently enrolled in the Maryland Medical Assistance Program or Medicare;
B. Is an incarcerated inmate in a
				  public institution as defined in COMAR
				  10.09.24.05-5B;
C. Had a prior presumptive eligibility period
				  during the last 12 months with the exception of pregnant women;
D. Does not meet the residency requirements
				  stated in COMAR
				  10.09.24.05-3; or
E. Does not meet the citizenship requirements
				  stated in COMAR 10.09.24.05.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.91 - Hospital Presumptive Eligibility › Section 10.09.91.08 - Certification Period

Current through Register Vol. 51, No. 14, July 12, 2024
A. Presumptive
				  eligibility begins on the day the hospital determines that the individual is
				  presumptively eligible.
B.
				  Presumptive eligibility ends on the earlier of:
(1) The day in which the individual is
				  determined eligible for Medical Assistance; or
(2) The last day of the month following the
				  month in which the hospital determined presumptive eligibility, if:
(a) An individual is found ineligible for
				  Medical Assistance; or
(b) An
				  individual failed to apply for Medical Assistance.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.91 - Hospital Presumptive Eligibility › Section 10.09.91.09 - Presumptive Eligibility Appeal Rights

Current through Register Vol. 51, No. 14, July 12, 2024
An individual or an organization does not have appeal
					 rights for presumptive eligibility determinations.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.92 - Acute Hospitals › Section 10.09.92.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. In
				  order to participate in the Program, a provider shall:
(1) Be licensed as a hospital by the
				  Department pursuant to Health-General Article, Title 19, Subtitle 3, Annotated
				  Code of Maryland; and
(2) Obtain
				  other licenses, as set forth in COMAR 10.07.01.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.92 - Acute Hospitals › Section 10.09.92.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  A provider shall meet all conditions for participation as set forth in COMAR
				  10.09.36.03.
B. To participate in
				  the Program as an acute hospital services provider, the provider shall:
(1) Meet the requirements of Title XLX of the
				  Social Security Act for participation as a hospital, as issued by the
				  Department of Health and Human Services;
(2) Directly provide or make available
				  through contractual arrangements or transfer agreements, medically necessary
				  covered services;
(3) Accept
				  payment by the Program as payment in full for the covered service;
(4) Make available to the Department or its
				  designee the participant's medical record for review and certification of
				  medical necessity for admission and continuation of stay;
(5) Maintain documentation of each contact
				  with the participant as part of the complete medical record, which, at a
				  minimum, includes:
(a) Date of
				  service;
(b) The participant's
				  chief medical complaint or reason for visit;
(c) A description of the services provided,
				  including:
(i) Progress notes;
(ii) Imaging studies;
(iii) Laboratory results;
(iv) Medication administration records;
				  and
(v) Discharge summary;
				  and
(d) A signature,
				  electronic or handwritten, along with the printed or typed name of the
				  individual providing care, with the appropriate title; and
(6) If the hospital provider is the only
				  hospital within the county, participate with each participating HealthChoice
				  Managed Care Organization in the county.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.92 - Acute Hospitals › Section 10.09.92.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program
				  covers the services listed in §B of this regulation according to the
				  conditions and requirements indicated.
B. The Program covers the following hospital
				  services:
(1) Medically necessary emergency
				  services as defined in COMAR
				  10.09.36.01, including triage,
				  related ancillary services, and when necessary, observation stays of a
				  participant who presents to a hospital emergency department;
(2) Medically necessary services performed in
				  an outpatient department of a hospital;
(3) Medically necessary services performed at
				  a freestanding medical facility;
(4) Medically necessary inpatient hospital
				  services meeting the following criteria:
(a)
				  Inpatient days, including preoperative days, determined to be medically
				  necessary by the Department or its designee;
(b) Admissions from an emergency department
				  resulting in a medically necessary inpatient stay; and
(c) Elective admissions that the Department
				  or its designee determines to be medically necessary;
(5) Inpatient stays determined to be
				  medically necessary due to an emergent condition by the Department or its
				  designee for a nonqualified alien;
(6) Administrative days, which may include
				  select ancillary services, determined to be necessary by the Department or its
				  designee; and
(7) Medically
				  necessary services performed in an acute rehabilitation hospital when the
				  participant meets the following criteria at the time of admission:
(a) Requires active and ongoing therapeutic
				  intervention of multiple therapy disciplines, one of which shall be physical or
				  occupational therapy;
(b) Requires
				  and can reasonably be expected to actively participate in, and benefit from,
				  the therapy, which generally consists of
(i)
				  At least 3 hours of therapy a day, at least 5 days a week; or
(ii) In well-documented cases, at least 15
				  hours of intensive rehabilitation therapy within a 7 day consecutive
				  period;
(c) Is
				  sufficiently stable to be able to actively participate in the therapy program;
				  and
(d) Requires supervision by a
				  licensed physician, who has specialized training and experience in inpatient
				  rehabilitation, which includes:
(i) Conducting
				  face-to-face visits with the patient at least 3 days a week to assess the
				  patient both medically and functionally; and
(ii) Modifying the course of treatment as
				  needed to maximize the participant's capacity to benefit from the
				  rehabilitation process.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.92 - Acute Hospitals › Section 10.09.92.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
The Program does not cover:
A. Hospital services, procedures, drugs, or
				  hospital admissions that are investigational or experimental;
B. Hospital services denied by Medicare as
				  not medically necessary;
C.
				  Inpatient admissions or outpatient visits solely for the administration of
				  injections, unless medical necessity and the participant's inability to take
				  appropriate oral medications is documented in the participant's medical
				  record;
D. Elective inpatient
				  admissions without preauthorization;
E. Elective inpatient admissions from the
				  emergency department for dialysis services that are the result of problems
				  occurring with placement in a freestanding dialysis facility;
F. Outpatient visits for one or more of the
				  following:
(1) Prescription drug or food
				  supplement pick up;
(2) Collection
				  of specimens for laboratory procedures;
(3) Recording of an
				  electrocardiogram;
(4) Ascertaining
				  the participant's weight; and
(5)
				  Administration of vaccines;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.92 - Acute Hospitals › Section 10.09.92.06 - Utilization Review

Current through Register Vol. 51, No. 14, July 12, 2024
A. Elective
				  Inpatient Preauthorization Reviews.
(1) The
				  hospital shall only request preauthorization for inpatient stays when such
				  services:
(a) Cannot be provided on an
				  outpatient basis; or
(b) Can only
				  be provided in a facility that is licensed as an acute hospital.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.92 - Acute Hospitals › Section 10.09.92.08 - District of Columbia Hospital Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A. Inpatient Services Rate Calculation.
(1) A hospital in the District of Columbia
				  shall:
(a) Bill its usual and customary
				  charges; and
(b) Be reimbursed for
				  covered services the lesser of its percentage of charges as calculated in
				  §A(2) of this regulation or its charges.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.92 - Acute Hospitals › Section 10.09.92.09 - Submitting Cost Reports for Freestanding Acute Rehabilitation Hospitals

Current through Register Vol. 51, No. 14, July 12, 2024
A. The provider
				  shall submit to the Department or its designee, in the form prescribed,
				  financial and statistical data within 5 months after the end of the provider's
				  fiscal year unless the Department grants the provider an extension or the
				  provider discontinues participation in the Program.
B. For hospitals who do not submit reports
				  within 5 months, for whom an extension has not been granted, and who are
				  reimbursed according to Medicare standards and principles for retrospective
				  cost reimbursement as described in 42 CFR § 413, the Department shall:
(1) Withhold from the provider a maximum of 5
				  percent of the current monthly interim payment starting the calendar month
				  after the calendar month in which the report is due and any subsequent calendar
				  months until the report has been submitted; and
(2) Refund withholdings at cost settlement.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.92 - Acute Hospitals › Section 10.09.92.11 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  General policies governing recovery and reimbursement procedures applicable to
				  all providers are set forth in COMAR 10.09.36.07.
B. If refund of a payment as specified in
				  §A of this regulation is not made, the Department shall reduce its current
				  payment to the provider by the amount of the duplicate payment, overpayment, or
				  third-party payment.