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<chapter num="63" heading="Community Violence Prevention Services" title_num="10" subtitle_num="09">
  <regulation prefix="Regulation" num=".01" heading="Definitions.">
    <paragraph num="A.">
      <text>In this chapter, the following terms have the meanings indicated.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Terms Defined.</text>
      <paragraph num="(1)">
        <text>“Certified violence prevention professional” means a prevention professional who meets the requirements of Regulation .02 of this chapter.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>“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.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>“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.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>“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.</text>
      </paragraph>
      <paragraph num="(5)">
        <text>“Interpersonal violence” means the intentional use of physical force or power against another individual by an individual or a small group of individuals.</text>
      </paragraph>
      <paragraph num="(6)">
        <text>“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.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".02" heading="Certification Requirements.">
    <paragraph num="A.">
      <text>An individual rendering services under this chapter shall complete an accredited training and certification program for certified violence prevention professionals, approved by the Department.</text>
    </paragraph>
    <paragraph num="B.">
      <text>An accredited training and certification program for certified violence prevention professionals shall:</text>
      <paragraph num="(1)">
        <text>Consist of at least 35 hours of initial training, addressing the following topics:</text>
        <paragraph num="(a)">
          <text>The profound effects of trauma and violence and the basics of trauma-informed care;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Community violence prevention strategies, including conflict mediation and retaliation prevention related to community violence;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Case management and advocacy practices; and</text>
        </paragraph>
        <paragraph num="(d)">
          <text>Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>Require at least 6 hours of continuing education every 2 years.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Conditions for Participation.">
    <paragraph num="A.">
      <text>General requirements for participation in the Program are that a provider shall:</text>
      <paragraph num="(1)">
        <text>Meet all conditions for participation as set forth in COMAR 10.09.36.03; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>If rendering services via telehealth, comply with COMAR 10.09.49 and any sub regulatory guidance issued by the Department.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Specific requirements for participation in the Program as a community violence prevention service provider are that a provider shall:</text>
      <paragraph num="(1)">
        <text>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;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>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</text>
      </paragraph>
      <paragraph num="(3)">
        <text>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.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Covered Services.">
    <paragraph num="A.">
      <text>Effective July 1, 2023, the Department shall reimburse for community violence prevention services as described in §B of this regulation when these services:</text>
      <paragraph num="(1)">
        <text>Are medically necessary; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Rendered to a participant who:</text>
        <paragraph num="(a)">
          <text>Has been exposed to community violence or has a personal history of injury resulting from community violence;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>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</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Has been referred by a certified or licensed health care provider to a certified violence prevention professional to receive community violence prevention services.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Community violence prevention services shall include one or more of the following interventions:</text>
      <paragraph num="(1)">
        <text>Mentorship;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Conflict mediation;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Crisis intervention;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Referrals to certified or licensed health care professionals or social services providers;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Patient education; and</text>
      </paragraph>
      <paragraph num="(6)">
        <text>Screening services.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>The Program shall cover a maximum of 100 30-minute units of services in a rolling 12-month period.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".05" heading="Limitations.">
    <text>Under this chapter, the Program does not cover services:</text>
    <paragraph num="A.">
      <text>Following an episode of intimate partner violence or domestic violence;</text>
    </paragraph>
    <paragraph num="B.">
      <text>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</text>
    </paragraph>
    <paragraph num="C.">
      <text>Provided in excess of 100 30-minute units of services in a rolling 12-month period.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".06" heading="Payment Procedures.">
    <paragraph num="A.">
      <text>General policies governing payment procedures that are applicable to all providers are set forth in COMAR 10.09.36.04.</text>
    </paragraph>
    <paragraph num="B.">
      <text>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:</text>
      <paragraph num="(1)">
        <text>The provider:</text>
        <paragraph num="(a)">
          <text>May charge the Program; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Shall be reimbursed in accordance with §G of this regulation; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>The provider’s reimbursement is not limited to the provider’s customary charge.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>The Program will reimburse a provider for covered services:</text>
      <paragraph num="(1)">
        <text>The lesser of the provider’s customary charge to the general public unless the service is free to individuals not covered by Medicaid; or</text>
      </paragraph>
      <paragraph num="(2)">
        <text>In accordance with §G of this regulation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>The provider may not bill the Program or the participant for:</text>
      <paragraph num="(1)">
        <text>Completion of forms and reports;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Broken or missed appointments;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Professional services rendered by mail; or</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Providing a copy of a program participant’s medical record when requested by another provider on behalf of the participant.</text>
      </paragraph>
    </paragraph>
    <paragraph num="E.">
      <text>Payments for services rendered to a Program participant shall be made directly to a qualified provider or program.</text>
    </paragraph>
    <paragraph num="F.">
      <text>Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.06.</text>
    </paragraph>
    <paragraph num="G.">
      <text>Reimbursement.</text>
      <paragraph num="(1)">
        <text>Payments shall be made in 30-minute units of service.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Effective July 1, 2023, rates for the services outlined in this chapter shall be reimbursed at $32.76 per unit.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="Authority">Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland</annotation>
    <annotation type="History" subtype="Administrative History">Effective date: November 13, 2023 (50:22 Md. R. 974)</annotation>
  </annotations>
</chapter>