<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".08" citation="COMAR 10.09.33.08" title_num="10" subtitle_num="09" chapter_num="33" heading="Limitations.">
  <paragraph num="A.">
    <text>An eligible individual may not receive services from a health home provider that is not the individual’s PRP, MTS, or OTP provider.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Health home services do not restrict or otherwise affect:</text>
    <paragraph num="(1)">
      <text>Eligibility for Title XIX benefits or other available benefits or programs, except as limited by §E of this regulation;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The freedom of a participant to select from all available services for which the participant is found to be eligible; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>A participant’s free choice among providers in the Medical Assistance Program.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The Department may not reimburse the health home provider for:</text>
    <paragraph num="(1)">
      <text>Activities that have already been billed to or counted towards a service requirement for another Medical Assistance Program or other program;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Activities not consistent with the definition of health home services under this chapter;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Activities delivered as part of institutional discharge planning that are not comprehensive transitional care services delivered by the health home;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>A participant’s health home monthly rate more than once per month;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>A participant’s health home monthly rate when the intake encounter is utilized by the provider as one of the two required monthly service encounters;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>A participant’s health home monthly rate when the provider counts two encounters as having the same date of service, unless:</text>
      <paragraph num="(a)">
        <text>The modality of the two encounters is different because one was an individual encounter and one was a group encounter; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The encounters are distinguishable by both the time at which they were rendered and the subject matter discussed; or</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>The health home monthly rate when the two required services were both rendered as group services.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The Department may not reimburse for monthly health home services unless the individual receiving health home services:</text>
    <paragraph num="(1)">
      <text>Is Medicaid eligible at the time of service delivery and engaged in treatment or rehabilitation with either OTP or PRP or MTS services;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Is enrolled as a health home member at the billing health home provider; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Has received a minimum of two health home services in the stated month that has been documented in the ASO system.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Reimbursement will not be made for health home services if the participant is receiving a comparable service under another Medical Assistance Program or other program.</text>
  </paragraph>
  <paragraph num="F.">
    <text>A participant’s health home provider may not be the participant’s family member.</text>
  </paragraph>
</regulation>