<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.09.33.04" title_num="10" subtitle_num="09" chapter_num="33" heading="Conditions for Health Home Provider Participation.">
  <text>To be eligible as a health home, a provider shall:</text>
  <paragraph num="A.">
    <text>Meet the conditions for provider participation in the Medical Assistance Program, as set forth in COMAR 10.09.36.03;</text>
  </paragraph>
  <paragraph num="B.">
    <text>Meet the approval requirements set forth in Regulation .02 of this chapter;</text>
  </paragraph>
  <paragraph num="C.">
    <text>Be accredited by, or demonstrate evidence of having started the accreditation process from, an approved accrediting body as a health home;</text>
  </paragraph>
  <paragraph num="D.">
    <text>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;</text>
  </paragraph>
  <paragraph num="E.">
    <text>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;</text>
  </paragraph>
  <paragraph num="F.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>CRISP; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The State’s ASO;</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>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;</text>
  </paragraph>
  <paragraph num="H.">
    <text>Directly provide, or subcontract for the provision of, health home services to all participants;</text>
  </paragraph>
  <paragraph num="I.">
    <text>Maintain an electronic database with the ability to, at minimum:</text>
    <paragraph num="(1)">
      <text>Maintain an up-to-date list of all health home participants and their contact information; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Record and review clinical appointments;</text>
    </paragraph>
  </paragraph>
  <paragraph num="J.">
    <text>Maintain a file for each participant that includes:</text>
    <paragraph num="(1)">
      <text>A form signed by the participant consenting to participate in the health home, including the program’s data-sharing elements;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An initial assessment of the participant’s health and social services needs, as described in Regulation .06B(1)(a) of this chapter; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>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:</text>
      <paragraph num="(a)">
        <text>The participant’s health home goals;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Time frames for meeting the health home goals;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Proposed interventions for meeting the health home goals;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Relevant community networks and supports;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Optimal clinical outcomes for the participant; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Signatures of:</text>
        <paragraph num="(i)">
          <text>The participant or the participant’s parent or guardian; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The nurse care manager to whom the participant has been assigned in the health home;</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="K.">
    <text>Safeguard the confidentiality of the participants’ records in accordance with State and federal laws and regulations;</text>
  </paragraph>
  <paragraph num="L.">
    <text>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;</text>
  </paragraph>
  <paragraph num="M.">
    <text>Be responsible for meeting all health home service requirements, including services performed by a business or individual subcontracted to provide such services;</text>
  </paragraph>
  <paragraph num="N.">
    <text>Convene health home staff meetings every 6 months, at minimum, to plan and implement goals and objectives of functioning as a health home;</text>
  </paragraph>
  <paragraph num="O.">
    <text>Collaborate with MCOs and the ASO to improve participant outcomes; and</text>
  </paragraph>
  <paragraph num="P.">
    <text>Agree to participate in federal and State-required evaluation activities, including:</text>
    <paragraph num="(1)">
      <text>Using the ASO system to:</text>
      <paragraph num="(a)">
        <text>Submit encounters documenting participants’ services at least monthly;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Generate monthly reports documenting:</text>
        <paragraph num="(i)">
          <text>Health home service delivery; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Participants’ health and social outcomes; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Update participant diagnoses and outcomes every 6 months; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Completing and submitting to the Department a program assessment every 6 months to demonstrate that:</text>
      <paragraph num="(a)">
        <text>All staffing and other regulatory requirements are being met; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A quality improvement plan is being implemented.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>