Chapter 78. Home Visiting Services
Regulation .01 Definitions.LinkCopy Citation
A.
The following terms have the meanings indicated.
B.
Terms Defined.
(1)
“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.
(2)
“Evidence-based home visiting model” means a voluntary early childhood strategy program that includes focused, individualized, and culturally competent services for expectant parents, young children, and their families designed to enhance parenting and promote the growth and development of young children.
(3)
“Home” means the program participant’s place of service in a community setting defined by the evidence-based home visiting models.
(4)
“Home visiting program” means the organization or entity accredited by an evidence-based home visiting model to provide home visiting services under that model.
(5)
“Home visiting services” means services provided during the prenatal and postpartum periods in the program participant’s home by the home visiting program, including but not limited to:
(a)
Pregnancy education;
(b)
Child development education;
(c)
Diet and nutritional education;
(d)
Stress management;
(e)
Sexually transmitted diseases (STD) prevention education;
(f)
Tobacco use screening and cessation education;
(g)
Alcohol and other substance misuse screening and counseling;
(h)
Depression screening;
(i)
Postpartum depression education;
(j)
Domestic and intimate partner violence screening and education;
(k)
Breastfeeding support and education;
(l)
Guidance and education with regard to well woman visits to obtain recommended preventive services;
(m)
Maternal-infant safety assessment and education;
(n)
Counseling regarding postpartum recovery, family planning, and needs of a newborn;
(o)
Assistance for the family in establishing a primary source of care and a primary care provider;
(p)
Parenting skills, parent-child relationship building, and confidence building;
(q)
Child developmental screening at major developmental milestones from birth to two years old;
(r)
Facilitation of access to community or other resources that can improve birth-related outcomes such as:
(i)
Transportation;
(ii)
Housing;
(iii)
Alcohol, tobacco, and drug cessation; and
(iv)
WIC, SNAP, and intimate partner violence resources;
(s)
Monitoring for high blood pressure or other complications of pregnancy; and
(t)
Medical assessment of the postpartum mother and infant.
(6)
“Medically necessary” means that the service or benefit is:
(a)
Directly related to diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;
(b)
Consistent with current accepted standards of good medical practice;
(c)
The most cost-efficient service that can be provided without sacrificing effectiveness or access to care; and
(d)
Not primarily for the convenience of the consumer, family, or provider.
(7)
“Postpartum period” means the period that begins immediately after childbirth up to a period of time following childbirth as defined by the evidence-based home visiting model.
(8)
“Prenatal period” means the developmental period between conception and birth.
(9)
“Program” means the Maryland Medical Assistance Program.
(10)
“Program participant” means one of the following individuals enrolled in the evidence-based home visiting model:
(a)
Birthing parent;
(b)
Infant;
(c)
Child up to the age permitted under the evidence-based home visiting model; or
(d)
Other individuals, as recognized under the evidence-based home visiting model.
(11)
“Provider” means a qualified individual licensed or certified to deliver home visiting services as a part of an evidence-based home visiting model.
Regulation .02 Certification Requirements.LinkCopy Citation
The home visiting program provider shall have an active accreditation status from one of the following evidence-based home visiting models:
A.
Healthy Families America (HFA); or
B.
Nurse Family Partnership (NFP).
Regulation .03 Conditions for Participation.LinkCopy Citation
A.
General requirements for participation in the Program are that a provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03; and
B.
Specific requirements for participation in the home visiting program are that the provider shall provide proof of accreditation by one of the following evidence-based home visiting models:
(1)
Healthy Families America (HFA); or
(2)
Nurse Family Partnership (NFP).
Regulation .04 Covered Services.LinkCopy Citation
The Program covers home visiting services rendered in the program participant’s home when the services:
A.
Are rendered during the birthing parent’s prenatal period and postpartum periods; and
B.
If not rendered in person, comply with the telehealth requirements established in COMAR 10.09.49 and any subregulatory guidance issued by the Department.
Regulation .05 Limitations.LinkCopy Citation
The Program does not cover:
A.
Expenses including:
(1)
Administrative overhead;
(2)
Lactation consulting services; and
(3)
Program start-up costs for evidence-based model accreditation, initial training, or consultation; or
B.
Services that are not medically necessary.
Regulation .06 Payment Procedures.LinkCopy Citation
A.
The provider shall submit the request for payment in the format designated by the Department.
B.
The Program reserves the right to return to the provider, before payment, all invoices not properly signed, completed, and accompanied by properly completed forms required by the Program.
C.
The provider shall charge the Program the provider’s customary charge to the general public for similar services.
D.
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 §I of this regulation.
E.
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 §I of this regulation; and
(2)
The provider’s reimbursement is not limited to the provider’s customary charge.
F.
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.
G.
Payments for services rendered to a Program participant shall be made directly to a qualified provider.
H.
Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.06.
I.
Effective January 1, 2022, the Program shall reimburse a flat rate of $188 per home visit.
Regulation .07 Recovery and Reimbursement.LinkCopy Citation
Recovery and reimbursement regulations are set forth in COMAR 10.09.36.07.
Regulation .08 Cause for Suspension or Removal and Imposition of Sanctions.LinkCopy Citation
Cause for suspension or removal and imposition of sanctions are set forth in COMAR 10.09.36.08.
Regulation .09 Appeal Procedures.LinkCopy Citation
Providers filing appeals from administrative decisions made in connection with this chapter shall do so according to COMAR 10.09.36.09
Chapter annotations
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
History: Effective date: January 13, 2022 (49:1 Md. R. 13)