Title 13. Miscellaneous Health Care Programs — Subtitle 49. Behavioral Health Care Coordination Value-Based Purchasing Pilot Program. [Effective Until December 1, 2027]
Statutes in effect as of October 1, 2026.
Md. Code Ann., Health-Gen. § 13-4901 (2026)
Title 13. Miscellaneous Health Care Programs
Subtitle 49. Behavioral Health Care Coordination Value-Based Purchasing Pilot Program. [Effective Until December 1, 2027]
§ 13–4901LinkCopy Citation
(a)
In this subtitle the following words have the meanings indicated.
(b)
“Behavioral health care coordination” means a person–centered, team–based activity designed to:
(1)
Assess and meet the needs of an individual with a behavioral health condition; and
(2)
Help the individual navigate the health care system effectively and efficiently.
(c)
“Pilot Program” means the Behavioral Health Care Coordination Value–Based Purchasing Pilot Program.
(d)
“Value–based purchasing” means financially incentivizing providers to meet specified outcome measures.
Md. Code Ann., Health-Gen. § 13-4902 (2026)
Title 13. Miscellaneous Health Care Programs
Subtitle 49. Behavioral Health Care Coordination Value-Based Purchasing Pilot Program. [Effective Until December 1, 2027]
§ 13–4902LinkCopy Citation
There is a Behavioral Health Care Coordination Value–Based Purchasing Pilot Program in the Department.
Md. Code Ann., Health-Gen. § 13-4903 (2026)
Title 13. Miscellaneous Health Care Programs
Subtitle 49. Behavioral Health Care Coordination Value-Based Purchasing Pilot Program. [Effective Until December 1, 2027]
§ 13–4903LinkCopy Citation
The purpose of the Pilot Program is to establish and implement an intensive care coordination model using value–based purchasing in the specialty behavioral health system.
Md. Code Ann., Health-Gen. § 13-4904 (2026)
Title 13. Miscellaneous Health Care Programs
Subtitle 49. Behavioral Health Care Coordination Value-Based Purchasing Pilot Program. [Effective Until December 1, 2027]
§ 13–4904LinkCopy Citation
(a)
The Department shall administer the Pilot Program.
(b)
The Department shall identify at least 500 adults whose behavioral health condition or functioning places them at risk of hospital emergency department utilization or inpatient psychiatric hospital admission.
(c)
The Pilot Program shall be operational for a 3–year period.
(d)
A provider or network of providers selected to participate in the Pilot Program shall:
(1)
Be licensed and in good standing with the Maryland Medical Assistance Program;
(2)
Have experience in providing community–based care coordination to specialty behavioral health program recipients;
(3)
Use an electronic medical record for documenting care coordination activities and outcomes collection; and
(4)
Have an automated data exchange with the State–designated health information exchange.
(e)
The Department shall:
(1)
Provide reimbursement on a per member per month basis for the behavioral health care coordination activities that are not otherwise covered by the Maryland Medical Assistance Program;
(2)
Collect outcomes data on recipients of health care services under the Pilot Program; and
(3)
Evaluate the effectiveness of the value–based purchasing model by analyzing the following outcome measures:
(i)
A comparison of the following data elements before and after enrollment of recipients of health care services under the Pilot Program:
(1)
Emergency department utilization for both behavioral and somatic health purposes;
(2)
Inpatient hospitalization for both behavioral and somatic health purposes; and
(3)
Total health care expenditures;
(ii)
Outcomes for recipients with and without primary care services coordinated by a behavioral health provider; and
(iii)
Recognized clinical quality metrics which may include patient experience measures.
Md. Code Ann., Health-Gen. § 13-4905 (2026)
Title 13. Miscellaneous Health Care Programs
Subtitle 49. Behavioral Health Care Coordination Value-Based Purchasing Pilot Program. [Effective Until December 1, 2027]
§ 13–4905LinkCopy Citation
If necessary to implement the Pilot Program, the Department shall apply to the Centers for Medicare and Medicaid Services for an amendment to the State’s § 1115 HealthChoice Demonstration.
Md. Code Ann., Health-Gen. § 13-4906 (2026)
Title 13. Miscellaneous Health Care Programs
Subtitle 49. Behavioral Health Care Coordination Value-Based Purchasing Pilot Program. [Effective Until December 1, 2027]
§ 13–4906LinkCopy Citation
(a)
For each of fiscal years 2025 through 2027, the Governor may include in the annual budget bill an appropriation of $600,000 for the Pilot Program.
(b)
Beginning in fiscal year 2026, the Department may allocate a percentage of the annual appropriation required under subsection (a) of this section to reimbursement paid based on the achievement of the outcome measures described in § 13–4904(e)(3) of this subtitle.
(c)
In fiscal year 2027, the Department may increase the percentage of the annual appropriation required under subsection (a) of this section allocated to reimbursement paid in accordance with subsection (b) of this section over the percentage allocated in fiscal year 2026.
Md. Code Ann., Health-Gen. § 13-4907 (2026)
Title 13. Miscellaneous Health Care Programs
Subtitle 49. Behavioral Health Care Coordination Value-Based Purchasing Pilot Program. [Effective Until December 1, 2027]
§ 13–4907LinkCopy Citation
On or before November 1, 2027, the Department shall report to the Governor and, in accordance with § 2–1257 of the State Government Article, the General Assembly on the Department’s findings and recommendations from the Pilot Program.