Chapter 63. Community Violence Prevention Services
Regulation .01 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Certified violence prevention professional” means a prevention professional who meets the requirements of Regulation .02 of this chapter.
(2)
“Community violence” means intentional acts of interpersonal violence committed in public areas by individuals who are not family members or intimate partners of the victim.
(3)
“Community violence prevention services” means evidence-based, trauma-informed, supportive, and nonpsychotherapeutic services provided by a certified violence prevention professional, within or outside a clinical setting, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that an individual who is the victim of community violence will commit or promote violence.
(4)
“Department” means the Maryland Department of Health, the single 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.
(5)
“Interpersonal violence” means the intentional use of physical force or power against another individual by an individual or a small group of individuals.
(6)
“Provider” means the entity who through appropriate agreement with the Department has been identified as a Program provider by the issuance of an individual account number.
Regulation .02 Certification Requirements.LinkCopy Citation
A.
An individual rendering services under this chapter shall complete an accredited training and certification program for certified violence prevention professionals, approved by the Department.
B.
An accredited training and certification program for certified violence prevention professionals shall:
(1)
Consist of at least 35 hours of initial training, addressing the following topics:
(a)
The profound effects of trauma and violence and the basics of trauma-informed care;
(b)
Community violence prevention strategies, including conflict mediation and retaliation prevention related to community violence;
(c)
Case management and advocacy practices; and
(d)
Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996; and
(2)
Require at least 6 hours of continuing education every 2 years.
Regulation .03 Conditions for Participation.LinkCopy Citation
A.
General requirements for participation in the Program are that a provider shall:
(1)
Meet all conditions for participation as set forth in COMAR 10.09.36.03; and
(2)
If rendering services via telehealth, comply with COMAR 10.09.49 and any sub regulatory guidance issued by the Department.
B.
Specific requirements for participation in the Program as a community violence prevention service provider are that a provider shall:
(1)
Maintain documentation that an individual rendering community violence prevention services under this chapter meets the certification requirements as provided in Regulation .02 of this chapter and maintain documentation of certification;
(2)
Maintain an affiliation with at least one trauma Primary Adult Resource Center (PARC), level I, or level II licensed short-term general hospital or children’s hospital in Maryland through which the provider entity is authorized to provide community violence prevention services to beneficiaries in the hospital; and
(3)
Ensure that the certified violence prevention professional is providing community violence prevention services in compliance with any applicable standard of care, rule, regulation, and State or federal law.
Regulation .04 Covered Services.LinkCopy Citation
A.
Effective July 1, 2023, the Department shall reimburse for community violence prevention services as described in §B of this regulation when these services:
(1)
Are medically necessary; and
(2)
Rendered to a participant who:
(a)
Has been exposed to community violence or has a personal history of injury resulting from community violence;
(b)
Is at an elevated risk of violent injury or retaliation resulting from another act of community violence, as determined by a certified or licensed health care provider or social services provider; and
(c)
Has been referred by a certified or licensed health care provider to a certified violence prevention professional to receive community violence prevention services.
B.
Community violence prevention services shall include one or more of the following interventions:
(1)
Mentorship;
(2)
Conflict mediation;
(3)
Crisis intervention;
(4)
Referrals to certified or licensed health care professionals or social services providers;
(5)
Patient education; and
(6)
Screening services.
C.
The Program shall cover a maximum of 100 30-minute units of services in a rolling 12-month period.
Regulation .05 Limitations.LinkCopy Citation
Under this chapter, the Program does not cover services:
A.
Following an episode of intimate partner violence or domestic violence;
B.
Delivered by a provider that is not affiliated with a trauma PARC, level I, or level II licensed short-term general hospital or children’s hospital in Maryland; and
C.
Provided in excess of 100 30-minute units of services in a rolling 12-month period.
Regulation .06 Payment Procedures.LinkCopy Citation
A.
General policies governing payment procedures that are applicable to all providers are set forth in COMAR 10.09.36.04.
B.
The provider shall charge the Program the provider’s customary charge to the general public for similar services. If the service is free to individuals not covered by Medicaid:
(1)
The provider:
(a)
May charge the Program; and
(b)
Shall be reimbursed in accordance with §G of this regulation; and
(2)
The provider’s reimbursement is not limited to the provider’s customary charge.
C.
The Program will reimburse a provider for covered services:
(1)
The lesser of the provider’s customary charge to the general public unless the service is free to individuals not covered by Medicaid; or
(2)
In accordance with §G of this regulation.
D.
The provider may not bill the Program or the participant for:
(1)
Completion of forms and reports;
(2)
Broken or missed appointments;
(3)
Professional services rendered by mail; or
(4)
Providing a copy of a program participant’s medical record when requested by another provider on behalf of the participant.
E.
Payments for services rendered to a Program participant shall be made directly to a qualified provider or program.
F.
Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.06.
G.
Reimbursement.
(1)
Payments shall be made in 30-minute units of service.
(2)
Effective July 1, 2023, rates for the services outlined in this chapter shall be reimbursed at $32.76 per unit.
Chapter annotations
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
History: Effective date: November 13, 2023 (50:22 Md. R. 974)