Regulation .04 Conditions for Health Home Provider Participation.
Regulation .04 Conditions for Health Home Provider Participation.LinkCopy Citation
To be eligible as a health home, a provider shall:
A.
Meet the conditions for provider participation in the Medical Assistance Program, as set forth in COMAR 10.09.36.03;
B.
Meet the approval requirements set forth in Regulation .02 of this chapter;
C.
Be accredited by, or demonstrate evidence of having started the accreditation process from, an approved accrediting body as a health home;
D.
For PRP and MTS health homes serving minors, demonstrate a minimum of 3 years of experience serving minors, which may be achieved as an independent practice or as a member of a broader agency, with exceptions designated by the Department;
E.
At the time of enrollment as a health home, be registered or be able to provide documentation of starting the process of registration with CRISP in order to receive hospital encounter alerts;
F.
At the time of enrollment as a health home, be registered or be able to provide documentation of starting the process of registration with one of the following organizations in order to receive access to real-time pharmacy data for participants:
(1)
CRISP; or
(2)
The State’s ASO;
G.
At the time of enrollment as a health home, have an internal protocol for reviewing and responding to hospital encounter alerts and pharmacy use data;
H.
Directly provide, or subcontract for the provision of, health home services to all participants;
I.
Maintain an electronic database with the ability to, at minimum:
(1)
Maintain an up-to-date list of all health home participants and their contact information; and
(2)
Record and review clinical appointments;
J.
Maintain a file for each participant that includes:
(1)
A form signed by the participant consenting to participate in the health home, including the program’s data-sharing elements;
(2)
An initial assessment of the participant’s health and social services needs, as described in Regulation .06B(1)(a) of this chapter; and
(3)
A care plan, updated every 6 months, which may be combined with the existing MTS, PRP, or OTP care plan, and includes, at a minimum:
(a)
The participant’s health home goals;
(b)
Time frames for meeting the health home goals;
(c)
Proposed interventions for meeting the health home goals;
(d)
Relevant community networks and supports;
(e)
Optimal clinical outcomes for the participant; and
(f)
Signatures of:
(i)
The participant or the participant’s parent or guardian; and
(ii)
The nurse care manager to whom the participant has been assigned in the health home;
K.
Safeguard the confidentiality of the participants’ records in accordance with State and federal laws and regulations;
L.
Provide on-call and crisis intervention services by telephone 24 hours a day, 7 days a week to participants and, as appropriate, their caregivers, or if the participant is a minor, the minor’s parent or guardian;
M.
Be responsible for meeting all health home service requirements, including services performed by a business or individual subcontracted to provide such services;
N.
Convene health home staff meetings every 6 months, at minimum, to plan and implement goals and objectives of functioning as a health home;
O.
Collaborate with MCOs and the ASO to improve participant outcomes; and
P.
Agree to participate in federal and State-required evaluation activities, including:
(1)
Using the ASO system to:
(a)
Submit encounters documenting participants’ services at least monthly;
(b)
Generate monthly reports documenting:
(i)
Health home service delivery; and
(ii)
Participants’ health and social outcomes; and
(c)
Update participant diagnoses and outcomes every 6 months; and
(2)
Completing and submitting to the Department a program assessment every 6 months to demonstrate that:
(a)
All staffing and other regulatory requirements are being met; and
(b)
A quality improvement plan is being implemented.