In this chapter, the following terms have the meanings indicated. Terms Defined. “Administrative service organization (ASO)” has the meaning stated in COMAR 10.09.59.01. “ASO system” means the electronic system available to providers which the ASO utilizes to manage Maryland’s Public Behavioral Health System as defined in COMAR 10.09.59.01. “Care management tool” means a system that helps accomplish administrative tasks of the health home, including maintaining a list of health home participants and scheduling and tracking participants clinical appointments. “Care plan” means a written plan of action that is developed and modified to address a patient's specific behavioral, somatic, and social service needs, which is maintained in the individual's medical record and satisfies the following conditions: Meets the requirements of COMAR 10.47.01.04C; or Meets the requirements of COMAR 10.21.21.06C. “Caregiver” means a family member, guardian, or other individual who is not paid to provide care to the participant and who helps the participant achieve and maintain wellness. “Chesapeake Regional Information System for Our Patients (CRISP) means the electronic notification system health home providers are required to use in order to access participant hospital encounter data. “Department” means the Maryland Department of Health, the State agency designated to administer the Maryland Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C §1396 et seq. “Full-time equivalent (FTE)” means an employee who works 40 hours per week. “Health home” means a provider designated to offer enhanced care coordination and management services to individuals affected by, or at risk for, chronic conditions, operating under the conditions of this chapter. “Health Information Technology” means electronic systems equipped for the exchange of health data to link services, facilitate communication between health team members and individuals and family caregivers, and enable quality reporting and the review of health outcomes. “Managed care organization (MCO)” has the meaning stated in Health-General Article, §15-101, Annotated Code of Maryland. “Medical Assistance Program” has the meaning stated in COMAR 10.09.36.01. “Mental health case management” means services covered under COMAR 10.09.45 and COMAR 10.09.90 which assist participants in gaining access to the full range of mental health services, and necessary medical, social, financial assistance, counseling, educational, housing, and other support services. “Minor” means an individual who is younger than 18 years old. “Mobile treatment services (MTS) program” means a program approved under COMAR 10.63.03.04. “Opioid treatment program (OTP)”, formerly referred to as opioid maintenance therapy (OMT) programs, means a program approved to provide opioid maintenance therapy under COMAR 10.63.03.19. “Participant” means an individual enrolled in a health home funded by the Medical Assistance Program. “Provider” means an individual, association, partnership, corporation, unincorporated group, or any other person authorized, licensed, or certified to provide health services. “Psychiatric rehabilitation program (PRP)” means a program approved under COMAR 10.63.03.09 for adults, COMAR 10.63.03.10 for minors, or both. A PRP serving adults and participating as a health home shall be approved pursuant to COMAR 10.63.03.09. A PRP serving minors and participating as a health home shall be approved pursuant to COMAR 10.63.03.10. An MTS program participating as a health home shall be approved pursuant to COMAR10.63.03.04. An OTP participating as a health home shall be approved to provide opioid maintenance therapy pursuant to COMAR 10.63.03.19. An individual is eligible for health home services if the individual: Is a recipient of Maryland Medical Assistance; and Meets the following criteria: Receives outpatient mental health rehabilitation or treatment services with a PRP or MTS program for a serious and persistent mental illness or serious emotional disturbance, and is not currently receiving: 1915(i) waiver services; or Mental health case management; or Receives treatment with an OTP for an opioid substance use disorder and is at risk for additional chronic conditions based on: Current alcohol use, tobacco use, or other non-opioid use; or A history of alcohol, tobacco, or other non-opioid substance dependence. A health home participant that is no longer receiving services from their PRP, MTS program, or OTP provider may continue to receive health home services for up to 6 months for the purposes of reengagement or transition to another level of care. To be eligible as a health home, a provider shall: Meet the conditions for provider participation in the Medical Assistance Program, as set forth in COMAR 10.09.36.03; Meet the approval requirements set forth in Regulation .02 of this chapter; Be accredited by, or demonstrate evidence of having started the accreditation process from, an approved accrediting body as a health home; 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; 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; 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: CRISP; or The State’s ASO; 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; Directly provide, or subcontract for the provision of, health home services to all participants; Maintain an electronic database with the ability to, at minimum: Maintain an up-to-date list of all health home participants and their contact information; and Record and review clinical appointments; Maintain a file for each participant that includes: A form signed by the participant consenting to participate in the health home, including the program’s data-sharing elements; An initial assessment of the participant’s health and social services needs, as described in Regulation .06B(1)(a) of this chapter; and 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: The participant’s health home goals; Time frames for meeting the health home goals; Proposed interventions for meeting the health home goals; Relevant community networks and supports; Optimal clinical outcomes for the participant; and Signatures of: The participant or the participant’s parent or guardian; and The nurse care manager to whom the participant has been assigned in the health home; Safeguard the confidentiality of the participants’ records in accordance with State and federal laws and regulations; 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; Be responsible for meeting all health home service requirements, including services performed by a business or individual subcontracted to provide such services; Convene health home staff meetings every 6 months, at minimum, to plan and implement goals and objectives of functioning as a health home; Collaborate with MCOs and the ASO to improve participant outcomes; and Agree to participate in federal and State-required evaluation activities, including: Using the ASO system to: Submit encounters documenting participants’ services at least monthly; Generate monthly reports documenting: Health home service delivery; and Participants’ health and social outcomes; and Update participant diagnoses and outcomes every 6 months; and Completing and submitting to the Department a program assessment every 6 months to demonstrate that: All staffing and other regulatory requirements are being met; and A quality improvement plan is being implemented. Health Home Staffing Requirements. Health Home Care Manager. At minimum, the health home shall maintain health home care manager staff at a ratio of .5 FTE per 125 participants. Up to a staffing level of 1 FTE, the health home care manager shall be a: Nurse practitioner meeting the conditions of COMAR 10.27.07; or Registered nurse licensed pursuant to COMAR 10.27.01 and meeting the conditions of COMAR 10.27.09. 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. Health Home Director. At minimum, the health home shall maintain a health home director at a ratio of .5 FTE per 125 health home participants. 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. 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. The health home director shall: Possess a Bachelor’s degree from an accredited university and 2 years experience in health administration; Possess a Master’s degree from an accredited university in a related field; Be licensed as a Registered Nurse with the Maryland Board of Nursing; or Be licensed as a Physician or be licensed as a Nurse Practitioner. Physician or Nurse Practitioner Consultant. 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. The physician shall meet the conditions of COMAR 10.32.01. The nurse practitioner shall meet the conditions of COMAR 10.27.07. Administrative Support Staff. The health home shall maintain administrative support at a level sufficient to meet the service provision and reporting requirements of the health home. Administrative support for the health home may be one or a combination of the following: Administrative support staff; or An electronic care management tool that addresses the administrative health home tasks. 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. Should staffing levels drop below the levels required by this regulation for more than 60 days, the health home shall: Report this to the Department; and Demonstrate that steps have been taken to reach the required staffing levels. 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. 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. The Department covers the services in §§B—G of this regulation when these services have been documented, pursuant to the requirements in this chapter, as necessary. Comprehensive Care Management. The health home shall collaborate to provide comprehensive care management services including: An initial assessment performed prior to the patient's enrollment, which includes: A comprehensive assessment of the participant's physical health, mental health, chemical dependency, and social service needs, signed off on by a physician or nurse practitioner, if no such assessment has been performed in the preceding 6-month period; and Requesting records from the participant's primary care physician and other providers; Development of a care plan within 30 days following enrollment, in accordance with Regulation .04J(3) of this chapter; Delineation of roles, which includes: Assigning each staff member clear roles and responsibilities; and Ensuring that participant care plans identify providers and specialists involved in the participant's care; and Monitoring and reassessment, which includes: Monitoring and documenting participant health status and progress toward care plan goals; Monitoring population health status and service use to determine adherence to or variance from treatment guidelines; and Outcomes evaluation and reporting, which includes using eMedicaid and other available HIT tools such as electronic health records. Care Coordination and Health Promotion. The health home shall coordinate and provide access to: High-quality health care services; Preventive and health promotion services, including education regarding: Mental illness; Substance use disorders; and Chronic physical health conditions; Mental health and substance abuse services; Chronic disease management services; and Long-term care supports and services. The health home shall coordinate services and support, including: Appointment scheduling; Referrals and follow-up monitoring; Hospital discharge processes; and Communication with other providers and supports, including school service providers. The health home shall assign each participant a health home care manager who is responsible for coordinating the participant's care and ensuring implementation of the care plan. The health home shall develop policies and procedures to facilitate collaboration between primary care, specialist, and behavioral health providers, community-based organizations, and, for minors, school-based providers. The health home shall follow security protocols to protect confidential health information. The health home shall assist participants with the implementation of their care plan, including: Health education specific to a participant's chronic conditions; Development of a plan for self-management; Medication review and education; and Substance use prevention, smoking cessation, obesity reduction, improved nutrition, and increased physical activity. A health home serving minors shall actively involve parents and families in providing services in accordance with §C(6) of this regulation, including: Identifying conditions for which the minor may be at risk due to family, physical, or social factors; and Working with the minor and parents and families to address the identified conditions. The health home shall use the ASO system to document, review, and report health promotion services delivered to each participant. Comprehensive Transitional Care. The health home shall provide services designed to: Streamline plans of care; Reduce avoidable hospital admissions; Ease the transition to long-term services; Interrupt patterns of frequent hospital emergency department use; and Ensure timely and proper follow-up care across settings, including from: An acute care setting to other settings; and A pediatric system of care to an adult system of care. The health home shall increase participants' and caregivers' ability to manage care and live safely in the community. The health home shall utilize CRISP to receive alerts of hospital admissions, discharges, or transfers among their health home participants. The health home shall follow up with participants within 2 business days of discharge with a home visit, phone call, or scheduling an on-site appointment. Individual and Family Support Services. Services shall include, but are not limited to: Advocating for individuals and families; Supporting participants in obtaining and adhering to medications and other prescribed treatments; Accessing resources that support participants, including providing referrals for: Community services; Social support services; Recovery services; and Transportation to medically necessary services; Improving participants' health literacy; Increasing the participant's ability to self-manage care; Facilitating participation in the ongoing revision of the treatment plan; and Providing information on advance directives and health care power of attorney. The health home shall utilize peer supports, support groups, and self-care programs to: Increase participants' and caregivers' knowledge of the participants' diseases; Increase caregivers' care-management capabilities; Promote participants' adherence to their plan of care; and Increase participants' self-management capabilities. The health home shall ensure that all communication shared with the participant, the participant's family, and caregivers is language, literacy, and culturally appropriate. Referral to Community and Social Support Services. The health home shall provide assistance in accessing and coordinating, as appropriate: Medical assistance; Disability benefits; Subsidized or supported housing; Personal needs support; Peer support; or Legal services. The health home shall assist in coordinating these services. Use of HIT to Link Services. The provider shall use HIT, including CRISP and the ASO system to: Facilitate communication between health home staff members, the participant, and their caregivers; and As appropriate, provide feedback to participants' other providers. Health home services provided by PRP, MTS, or OTP staff qualify as covered services. Enrollment. The health home shall enroll an individual only after the individual has been enrolled in the health home provider's applicable PRP, MTS, or OTP services. During enrollment, an OTP established as a health home shall identify eligible individuals under the OTP’s care and report the diagnoses related to qualifying risk factors set forth in Regulation .03A(2)(b) of this chapter in the ASO system. The health home shall provide the individual with a brief description of health home services, including: Explaining the data-sharing elements of the program; and Describing how the individual may opt out if desired. Following the provision of information in accordance with §A(3) of this regulation, the health home shall obtain the individual's consent to participate in the health home. Following consent to participate in accordance with §A(4) of this regulation, the health home shall complete the individual's online intake report through the ASO system thereby enrolling the individual into the health home. The health home shall: Notify a participant's other treatment providers about health home services; and Encourage other providers' participation in care coordination efforts. Participation. A health home participant shall receive a minimum of two health home services per month, as defined in Regulation .06 of this chapter and to be documented in the ASO system. An assigned health home care manager shall monitor the participant's care and health status and coordinate with other staff to provide appropriate health home services. Discharge. In the event of discharge, the health home shall create a discharge plan that includes referrals to appropriate services and providers. The health home shall report all discharges and completion of discharge plans in the ASO system. An eligible individual may not receive services from a health home provider that is not the individual’s PRP, MTS, or OTP provider. Health home services do not restrict or otherwise affect: Eligibility for Title XIX benefits or other available benefits or programs, except as limited by §E of this regulation; The freedom of a participant to select from all available services for which the participant is found to be eligible; or A participant’s free choice among providers in the Medical Assistance Program. The Department may not reimburse the health home provider for: Activities that have already been billed to or counted towards a service requirement for another Medical Assistance Program or other program; Activities not consistent with the definition of health home services under this chapter; Activities delivered as part of institutional discharge planning that are not comprehensive transitional care services delivered by the health home; A participant’s health home monthly rate more than once per month; 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; A participant’s health home monthly rate when the provider counts two encounters as having the same date of service, unless: The modality of the two encounters is different because one was an individual encounter and one was a group encounter; or The encounters are distinguishable by both the time at which they were rendered and the subject matter discussed; or The health home monthly rate when the two required services were both rendered as group services. The Department may not reimburse for monthly health home services unless the individual receiving health home services: Is Medicaid eligible at the time of service delivery and engaged in treatment or rehabilitation with either OTP or PRP or MTS services; Is enrolled as a health home member at the billing health home provider; and Has received a minimum of two health home services in the stated month that has been documented in the ASO system. 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. A participant’s health home provider may not be the participant’s family member. The Department shall reimburse the health home for covered services according to the requirements in this chapter and the rate established in §C of this regulation. Request for Payment. The health home provider is authorized to bill for the intake and ongoing monthly rate for a participant when: The participant is receiving PRP, MTS, or OTP services; and The intake portion of the participant's ASO system file has been submitted and initial services have been delivered. After completing the required health home service provision reporting in the ASO system, the health home provider shall, within 30 days from the end of the month during which health home services were provided, submit a request for payment for all participants who received two health home services during that month. A health home provider shall bill the Department for the appropriate rate specified in §C of this regulation. The Department shall reimburse according to the following fee schedule: For dates of service from July 1, 2023 through December 31, 2023, at a monthly rate of $131.03 per participant; For dates of service from January 1, 2024 through June 30, 2024, at a monthly rate of $141.51; and For dates of service beginning July 1, 2024, at a monthly rate of $145.76. Recovery and reimbursement shall be as set forth in COMAR 10.09.36.07. Cause for suspension or removal from the Medical Assistance Program and imposition of sanctions shall be as set forth in COMAR 10.09.36.08. If the Department determines that a health home provider has failed to comply with the provisions of this chapter, the Department may initiate one or more of the following actions against the health home provider: Recovery of overpayment made by the Department; Withholding of payment by the Department; Reduction in payment by the Department, including a 10 percent reduction in reimbursement for services that are not billed within the time frame required by Regulation .09B(2) of this chapter; Suspension from being a health home provider; Removal from being a health home provider; or Disqualification from being a health home provider at any future time. Appeal procedures shall be as set forth in COMAR 10.09.36.09. State regulations shall be interpreted as set forth in COMAR 10.09.36.10. Health-General Article, §§2-104(b), 7.5-204, 7.5-205(d), 7.5-402, 8-204(c), 15-103, and 15-105(b), Annotated Code of Maryland Effective date: September 30, 2013 (40:19 Md. R. 1544) Regulation .01B amended effective July 7, 2014 (41:13 Md. R. 752); November 13, 2023 (50:22 Md. R. 973); May 11, 2026 (53:9 Md. R. 412) Regulation .02 amended effective November 13, 2023 (50:22 Md. R. 973) Regulation .04 amended effective November 24, 2014 (41:23 Md. R. 1372) Regulation .04P amended effective May 11, 2026 (53:9 Md. R. 412) Regulation .06B amended effective November 13, 2023 (50:22 Md. R. 973) Regulation .06C, H amended effective May 11, 2026 (53:9 Md. R. 412) Regulation .07 amended effective May 11, 2026 (53:9 Md. R. 412) Regulation .07A amended effective November 13, 2023 (50:22 Md. R. 973) Regulation .08C amended effective April 4, 2022 (49:7 Md. R. 465), May 11, 2026 (53:9 Md. R. 412) Regulation .08D amended effective May 11, 2026 (53:9 Md. R. 412) Regulation .09 amended effective April 4, 2022 (49:7 Md. R. 465) Regulation .09B amended effective May 11, 2026 (53:9 Md. R. 412) Regulation .09C amended effective October 24, 2016 (43:21 Md. R. 1166); January 1, 2018 (44:26 Md. R. 1215); December 30, 2019 (46:26 Md. R. 1164); November 13, 2023 (50:22 Md. R. 973); September 16, 2024 (51:18 Md. R. 808); November 10, 2025 (52:22 Md. R. 1095)