# COMAR Title 10 — Maryland Department of Health

## Subtitle 09 — Medical Care Programs

### Chapter 89 — 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families

#### Regulation .12 Covered Services — Intensive In-Home Services.

*COMAR 10.09.89.12*

A. Intensive In-Home Services (IIHS):

  (1) Are strengths-based interventions with the child and his or her identified family that includes a series of components, such as:

    (a) Functional assessments and treatment planning;

    (b) Individualized interventions;

    (c) Crisis response and intervention; or

    (d) Transition support;

  (2) May be provided to the child alone, to other family members, or to the child and family members together;

  (3) Are intended to support a child to remain in his or her home and reduce hospitalizations and out-of-home placements or changes of living arrangements through focused intervention in the home and community; and

  (4) May be used in situations such as the start of a child's enrollment in the 1915(i), upon discharge from a hospital or residential treatment center, or to prevent or stabilize after a crisis situation.

B. Types of IIHS Providers. The Department may approve two types of IIHS providers:

  (1) Evidence-Based Practice (EBP)-IIHS providers, to include providers of EBPs as determined by the Department; and

  (2) Promising Practice IIHS providers (non-EBP), to include providers of the In-Home Intervention Program for Children (IHIP-C) and other promising practices, as determined by the Department.

C. An EBP-IIHS provider shall have a certificate or letter from the national or intermediate surveyor or developer of the particular evidence-based practice to demonstrate that the EBP-IIHS provider meets all requirements for Department-approved EBP-IIHS, to include participating in all fidelity monitoring activities.

D. A Non-EBP IIHS provider shall:

  (1) Be a Department-approved IHIP-C provider or have a certificate or letter from a national or intermediate purveyor or developer of another promising practice; and

  (2) Meet the requirements of §E of this regulation.

E. All non-EBP IIHS providers not approved by the Department as IHIP-C providers shall:

  (1) Ensure that there are Clinical Supervisors and staff who are responsible for creating, implementing, and managing the treatment plan with the child and family and the CFT;

  (2) Provide crisis response services for the participants on the IIHS provider's caseload and ensure that on-call and crisis intervention services are:

    (a) Provided by a licensed mental health professional trained in the intervention;

    (b) Available 24-hours per day, 7 days per week, during the hours the provider is not open to the individual enrolled in the treatment; and

    (c) In compliance with staffing, supervision, training, data collection, and fidelity monitoring requirements set forth by the purveyor, developer, or MDH and approved by the Department;

  (3) Employ Clinical Supervisors who:

    (a) Have a current license under the Health Occupations Article, Annotated Code of Maryland, as a:

      (i) Licensed certified social worker-clinical (LCSW-C);

      (ii) Licensed clinical professional counselor (LCPC);

      (iii) Psychologist;

      (iv) Psychiatrist;

      (v) Nurse psychotherapist; or

      (vi) Advanced practice registered nurse/psychiatric mental health (APRN-PMH); and

    (b) Have at least 3 years of experience in providing mental health treatment to children and families;

  (4) Employ mental health professionals who:

    (a) Have a current license under the Health Occupations Article, Annotated Code of Maryland, as a:

      (i) Licensed certified social worker (LCSW);

      (ii) LCSW-C;

      (iii) LCPC;

      (iv) Psychologist;

      (v) Psychiatrist;

      (vi) Nurse psychotherapist; or

      (vii) APRN-PMH.

    (b) Are supervised by a clinical lead supervisor;

    (c) See the child in-person at least once per 7 days while receiving IIHS services;

  (5) Employ in-home stabilizers who:

    (a) Support the implementation of the treatment plan, but are not responsible for creating it or modifying it;

    (b) Are at least 21 years old;

    (c) Have at least a high school diploma or equivalency; and

    (d) Have completed relevant, comprehensive, appropriate training before providing services, as outlined by the purveyor, developer, or the Department and approved by the Department;

  (6) Provide a minimum of one face-to-face contact with the participant per week of service;

  (7) Ensure a minimum of 50 percent of the mental health professionals' contacts with the participant or family, or both, is face-to-face; and

  (8) Ensure that a minimum of 50 percent of the mental health professionals' time is spent working outside the agency's office and in the participant's home or community, as documented in case notes.