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    Maryland Register
    Issue Date:  January 5, 2018
    Volume 45• Issue 1 • Pages 22—24
    Title 10
    10.09.59 Specialty Mental Health Services
    Authority: Health-General Article, §§2-104(b), 2-105(b), 15-103, and 15-105, Annotated Code of Maryland
    Notice of Proposed Action
    The Secretary of Health proposes to amend Regulations .03—.05, .07, and .09 under COMAR 10.09.59 Specialty Mental Health Services.
    Statement of Purpose
    The purpose of this action is to add:
    (1) References to COMAR 10.63 Community-Based Behavioral Health Programs and Services, the Behavioral Health Administrations’ new regulations for licensing and service descriptions, which will replace COMAR 10.21 Mental Hygiene Regulations effective April 1, 2018;
    (2) Some specific service requirements under COMAR 10.21, which will be repealed on March 31, 2018;
    (3) Pediatric Primary Care Mental Health Specialists to the list of approved individual practitioner providers who may participate in the public mental health system; and
    (4) Requirements for providers of psychiatric rehabilitative services to identify by National Provider Identifier (NPI) on the claim the ordering provider, who shall be an individual enrolled in the Program with an active status on the date of service, in order for the claim to be paid.
    Comparison to Federal Standards
    There is no corresponding federal standard to this proposed action.
    Estimate of Economic Impact
    The proposed action has no economic impact.
    Economic Impact on Small Businesses
    The proposed action has minimal or no economic impact on small businesses.
    Impact on Individuals with Disabilities
    The proposed action has no impact on individuals with disabilities.
    Opportunity for Public Comment
    Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through February 5, 2018. A public hearing has not been scheduled.
    .03 General Conditions for Provider Participation.
       To participate in the Program, a provider shall:
       A. (text unchanged)
       B. Meet the conditions for licensure and practice as set forth in COMAR 10.63.01, 10.63.02, and 10.63.06;
       [[B.] C.[C.] D. (text unchanged)
    .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) (text unchanged)
          (2) Demonstrate, by training and experience, the competency to provide mental health services as one of the following:
              (a)—(b) (text unchanged)
              (c) A pediatric nurse practitioner with a PMHS;
              [(c)] (d)[(h)] (i) (text unchanged)
       B. Community Mental Health Program Providers. To participate in the Program as a community-based mental health program provider, the provider shall be approved under [COMAR 10.21.16 and] COMAR 10.63.01, 10.63.02, and 10.63.06[, whichever is applicable,] and possess certification by the [Office of Health Care Quality] Behavioral Health Administration as:
          (1) A psychiatric rehabilitation program serving adults in compliance with[:] COMAR;
               [(a) COMAR 10.21.17 if approved and COMAR 10.63.01 if licensed;
               (b) If serving adults, COMAR 10.21.21 if approved and if licensed; and
               (c) If serving children, COMAR 10.21.29 if approved and if licensed;
          (2) A psychiatric rehabilitation program serving minors in compliance with COMAR;
          [(2)] (3) A mobile treatment program in compliance with:
              [(a) COMAR 10.21.17 and 10.21.19 if approved; and
              (b) COMAR 10.63.01 and if licensed; or]
              (a) COMAR;
              (b) The requirement for a multidisciplinary team consisting of, at a minimum:
                  (i) A program director that is a mental health professional;
                  (ii) A psychiatrist;
                  (iii) A licensed registered nurse;
                  (iv) At least one licensed social worker or licensed graduate social worker;
                  (v) At least one mental health professional who may include the staff identified in §B(3)(b)(iii) and (iv) of this regulation; and
             (c) The requirement for sufficient staffing to fulfill the following service requirements including:      
                  (i) Initial and continuing psychiatric evaluation, diagnosis, and individual treatment planning;
                  (ii) Medication services;
                  (iii) Independent living skills assessment and training;
                  (iv) Health promotion and training;
                  (v) Interactive therapies;
                  (vi) Crisis intervention services; and
                  (vii) Support, linkage, and advocacy; or
          [(3)] (4) An outpatient mental health clinic in compliance with:
              [(a) COMAR 10.21.17 and 10.21.20 if approved; and
              (b) COMAR 10.63.01 and if licensed.]
              (a) COMAR; and
              (b) Staffing requirements as described in COMAR10.63.03.05 and including:
                 (i) A program director who is a licensed mental health professional or has a master’s degree in a related field and is employed by the OMHC and is on-site for at least 20 hours per week;
                 (ii) A medical director as described in COMAR;
                 (iii) A multidisciplinary licensed mental health professional staff as described in COMAR, including representatives of two different mental health professions, both of whom shall be on-site 50 percent of the OMHC’s regularly scheduled hours;
                 (iv) Graduate level students and interns, who may deliver services under supervision of a licensed mental health professional and when a licensed mental health professional co-signs all documentation of contact with participants.
       C. (text unchanged)
       D. Other Licensed or Approved Mental Health Providers. To participate in the Program as a specialty mental health provider not defined in §§A—C of this regulation, a provider shall be approved pursuant to COMAR as a:
          (1) (text unchanged)
          (2) Residential treatment center in compliance with:
              (a) COMAR 10.07.04 and 10.09.29; [or] and
              (b) COMAR 10.21.06;
          (3) Hospital in compliance with COMAR [10.09.06] 10.09.92—10.09.95;
          (4) Non-hospital-based mental health psychiatric day treatment provider in compliance with:
              [(a) COMAR 10.21.17 and 20.21.02 if approved; and
              (b) COMAR 10.63.01 and if licensed;]
              (a) COMAR;
              (b) Staffing requirements described in and including:
                 (i) A multidisciplinary team employed at least on a part-time basis; and
                 (ii) A program director;
             (c) Service requirements as described in and including:
                 (i) An individual treatment plan developed by the multi-disciplinary team within 4 working days of admission;
                 (ii) Psychopharmacological treatment;
                 (iii) Occupational therapy;
                 (iv) Activity therapy; and
                 (v) Other necessary medical, psychological, and social services; and
            (d) COMAR for requirements of the physical environment;
          (5)—(8) (text unchanged)
    .05 Eligibility.
       A. A participant is eligible for specialty mental health services if:
          [A.] (1) [B.] (2) (text unchanged)
       B. Individuals are eligible for Psychiatric Rehabilitation Programs for adults if the individual:
          (1) Has been referred for psychiatric rehabilitation program services by a licensed mental health professional who:
              (a) Is enrolled as a provider in the Program with an active status on the date of service;
              (b) Is unaffiliated with the psychiatric rehabilitation program; and 
              (c) Provides inpatient, residential treatment center, or outpatient mental health services to the individual;
          (2) Has a diagnosis listed in COMAR; and
          (3) Is in need of program services in order to improve or restore independent living and social skills necessary to support the individual’s recovery, ability to make informed decisions and choices, and participation in community life.
       C. Individuals are eligible for Psychiatric Rehabilitation Programs for minors if the individual:
          (1) Has been referred for psychiatric rehabilitation program services by a licensed mental health professional who:
              (a) Is enrolled as a provider in the Program with an active status on the date of service;
              (b) Is unaffiliated with the psychiatric rehabilitation program; and
              (c) Provides inpatient, residential treatment center, or outpatient mental health services to the minor;
         (2) Is currently in, and remains in, active mental health treatment;
         (3) Has the appropriate consent to participate in psychiatric rehabilitation program services;
         (4) Has a diagnosis listed in COMAR and severe functional impairments in at least one life domain;
         (5) With psychiatric rehabilitation program services, is expected to have reduced symptoms of their mental illness or functional behavioral impairment as a result of their mental illness based on the clinical evaluation and ongoing treatment plan; and
         (6) Is at risk for requiring a higher level of care, or is returning from a higher level of care.
       D. Individuals are eligible for Mobile Treatment Services if it is assessed that the individual will benefit from mobile treatment services and the individual is:
          (1) Experiencing homelessness;
          (2) Unable or unwilling to use, on a continuing basis, community-based mental health services that are prescribed for the individual; or
          (3) In an institution or inpatient facility and would be able to reside in a community setting if the individual received MTS and other appropriate support services.
    .07 Limitations.
       The Program does not cover the following:
       A.—S. (text unchanged)
       T. Services rendered but not appropriately documented; [and]
       U. Services reimbursed by the ASO not included in this chapter[.];
       V. Mobile Treatment or ACT Services without a minimum of four face to face in person services provided per month;
       W. Services rendered by community based specialty mental health programs with an immediate family member of an employee of the program serving on the governing body, board of directors, or advisory committee, whichever applies; and
       X. Psychiatric rehabilitation services referred by:
          (1) A licensed mental health professional who is not enrolled in the Program with an active states on the date of service; or
          (2) An entity, facility, or another provider that is not a licensed mental health professional.
    .09 Payment Procedures.
       A.—H. (text unchanged)
       I. Psychiatric rehabilitation programs shall identify the mental health professional who referred the individual to psychiatric rehabilitation services by recording the individual practitioner’s National Provider Identifier (NPI) number on the claim.
    Secretary of Health