<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.09.33.05" title_num="10" subtitle_num="09" chapter_num="33" heading="Health Home Provider Staff.">
  <paragraph num="A.">
    <text>Health Home Staffing Requirements.</text>
    <paragraph num="(1)">
      <text>Health Home Care Manager.</text>
      <paragraph num="(a)">
        <text>At minimum, the health home shall maintain health home care manager staff at a ratio of .5 FTE per 125 participants.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Up to a staffing level of 1 FTE, the health home care manager shall be a:</text>
        <paragraph num="(i)">
          <text>Nurse practitioner meeting the conditions of COMAR 10.27.07; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Registered nurse licensed pursuant to COMAR 10.27.01 and meeting the conditions of COMAR 10.27.09.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>A health home employing more than 1 FTE health home care manager may employ a physician’s assistant licensed pursuant to COMAR 10.32.03.04 to fulfill the additional care manager roles.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Health Home Director.</text>
      <paragraph num="(a)">
        <text>At minimum, the health home shall maintain a health home director at a ratio of .5 FTE per 125 health home participants.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A health home requiring a health home director and health home care manager of .5 FTE each  may employ 1 FTE individual to serve in both roles, provided that individual meets the requirements for both positions.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A health home requiring more than .5 FTE health home director, may choose to designate a lead health home director and fulfill the additional FTE requirement with key management staff who meet the requirements of §A(2)(d)(i) or (ii) of this regulation.</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The health home director shall:</text>
        <paragraph num="(i)">
          <text>Possess a Bachelor’s degree from an accredited university and 2 years experience in health administration;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Possess a Master’s degree from an accredited university in a related field;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Be licensed as a Registered Nurse with the Maryland Board of Nursing; or</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Be licensed as a Physician or be licensed as a Nurse Practitioner.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Physician or Nurse Practitioner Consultant.</text>
      <paragraph num="(a)">
        <text>At minimum, the health home shall maintain physician or nurse practitioner services at a ratio of one and one half (1.5) hours per health home participant per 12-month period.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The physician shall meet the conditions of COMAR 10.32.01.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The nurse practitioner shall meet the conditions of COMAR 10.27.07.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Administrative Support Staff.</text>
      <paragraph num="(a)">
        <text>The health home shall maintain administrative support at a level sufficient to meet the service provision and reporting requirements of the health home.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Administrative support for the health home may be one or a combination of the following:</text>
        <paragraph num="(i)">
          <text>Administrative support staff; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>An electronic care management tool that addresses the administrative health home tasks.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>A health home with fewer than 125 participants may form a consortium to share health home staff and costs, contingent upon geographic proximity and Department approval of a plan detailing the proposed collaboration.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Should staffing levels drop below the levels required by this regulation for more than 60 days, the health home shall:</text>
    <paragraph num="(1)">
      <text>Report this to the Department; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Demonstrate that steps have been taken to reach the required staffing levels.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Health home staff members shall be dedicated to health home duties at a level of .5 FTE minimally, and staffing requirements may not be divided among staff at levels below .5 FTE each.</text>
  </paragraph>
  <paragraph num="E.">
    <text>To begin offering health home services, a provider shall have in place a health home director and health home care manager at levels of .5 FTE each, minimally. Additional staff required to meet the staffing levels specified in §§A—D of this regulation shall be hired within 30 days of beginning service provision.</text>
  </paragraph>
</regulation>