Md. Code Regs. 10.09.06.04

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.06.04 - Conditions for Participation

A. General requirements for participation in the Program are that a provider shall:

(1) Comply with requirements set forth in COMAR 10.09.36; and

(2) If delivering services via telehealth, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department.

B. To participate in the Program as a residential substance use disorder provider, the provider shall:

(1) Be in compliance with COMAR 10.63.03 as applicable to each ASAM level of care;

(2) Be in compliance with all ASAM requirements for each applicable level of care;

(3) Demonstrate competence in the ability to deliver a minimum of three evidence-based practice services;

(4) Complete all required documentation associated with the application process;

(5) Maintain verification of licenses and credentials, including background checks, of all professionals employed by or under contract with the provider in their respective personnel files;

(6) Maintain staffing within each ASAM level of care as described in §§C-G of this regulation;

(7) Increase staffing within each ASAM level of care at a ratio to correspond with the participant census to meet required ASAM level of service delivery for each patient;

(8) Maintain adequate documentation of each clinical contact with a participant as part of the medical record, which includes, at a minimum:

(a) An individualized treatment plan;

(b) The date of all clinical encounters with start and end times and a description of services provided;

(c) Documentation of all clinical services received by the participant;

(d) Progress notes updated on each day services are provided;

(e) An individualized discharge plan; and

(f) An official e-Signature, or a legible signature, along with the printed or typed name of the individual providing care, with the appropriate degree or title on all clinical progress notes;

(9) Maintain adequate documentation indicating that the participant continues to meet the medical necessity criteria for the applicable ASAM level of care;

(10) Make the documentation required under this subtitle, or necessary to substantiate compliance with this subtitle, available as requested to carry out required activities, to the:

(a) Department;

(b) ASO;

(c) Core Service Agency;

(d) Local addictions authority;

(e) Local behavioral health authority;

(f) Office of Inspector General of the Department; and

(g) Office of the Attorney General Medicaid Fraud Control Unit; and

(11) Comply with all federal statutes and regulations, including the Health Insurance Portability and Accountability Act, 42 U.S.C. § 1320D et seq., and implementing regulations at 45 CFR Parts 160 and 164.04 Participant Eligibility and Referral.

C. A residential, low-intensity level 3.1 provider shall:

(1) Provide therapeutic services for a minimum of 5 hours per week;

(2) Coordinate aftercare services through:

(a) Peer support; or

(b) A licensed provider;

(3) At a minimum, maintain the following staff:

(a) A part-time program director on-site 20 hours per week;

(b) A clinical director serving the program 20 hours per week who:

(i) May also be the program director;

(ii) Is responsible for the supervision of the program's clinical services, counselors, peer support staff, and coordination of all care provided by outside programs; and

(iii) Is identified under COMAR 10.09.59.04 as an individual practitioner provider or certified and approved by the Board of Professional Counselors and Therapists as a supervisor;

(c) A licensed or certified counselor on-site 40 hours per week;

(d) Peer support staff; and

(e) At least one staff member on duty between 11 p.m. and 7 a.m. who is:

(i) Certified in cardiopulmonary resuscitation;

(ii) Certified in Narcan administration; and

(iii) Trained in crisis intervention

D. A residential, medium intensity level 3.3 provider shall:

(1) Have sufficient physician, physician assistant, or nurse practitioner services to:

(a) Provide initial diagnostic work-up;

(b) Provide identification of medical and surgical problems for referral; and

(c) Handle medical emergencies when necessary;

(2) Provide therapeutic activities from 20 to 35 hours per week;

(3) Coordinate aftercare services through:

(a) Peer support; or

(b) Licensed provider;

(4) Have at least one staff member:

(a) Certified in cardiopulmonary resuscitation;

(b) Trained in crisis intervention; and

(c) On duty between 11 p.m. and 7 a.m.;

(5) Have a part-time facility director on-site 20 hour per week; and

(6) At a minimum, maintain the following staff:

(a) A physician, nurse practitioner, or physician assistant on-site 4 hours per week and 1 hour on call;

(b) A psychiatrist or psychiatric nurse practitioner available 3 hours per week;

(c) A registered nurse or licensed practical nurse on-site 40 hours per week; and

(d) An on-site multi-disciplinary team consisting of:

(i) A clinical supervisor;

(ii) A licensed mental health clinician;

(iii) A certified counselor under direct supervision of a counselor approved by the Board of Professional Counselors and Therapists as a supervisor; and

(iv) Peer support staff.

E. A residential, high intensity level 3.5 provider shall:

(1) Have sufficient physician, physician assistant, or nurse practitioner services to:

(a) Provide initial diagnostic work-up;

(b) Provide identification of medical and surgical problems for referral; and

(c) Handle medical emergencies when necessary;

(2) Provide a minimum of 36 hours of therapeutic activities per week;

(3) Coordinate aftercare services through:

(a) Peer support; or

(b) A licensed provider;

(4) Have at least one staff member:

(a) Certified in cardiopulmonary resuscitation;

(b) Trained in crisis intervention; and

(c) On duty between 11 p.m. and 7 a.m.;

(5) Have a part-time facility director on-site 20 hour per week; and

(6) At a minimum, have the following staff:

(a) A physician, nurse practitioner, or physician assistant on-site 1 hour per week;

(b) A psychiatrist or psychiatric nurse practitioner available 1 hour per week;

(c) An on-site multi-disciplinary team consisting of:

(i) A clinical supervisor;

(ii) A licensed mental health clinician;

(iii) Certified counselors under direct supervision of a counselor approved by the Board of Professional Counselors and Therapists as a supervisor; and

(iv) Peer support staff.

F. A residential, intensive level 3.7 provider shall:

(1) Have sufficient physician, physician assistant, or nurse practitioner services to:

(a) Provide initial diagnostic work-up;

(b) Provide identification of medical and surgical problems for referral; and

(c) Handle medical emergencies when necessary;

(2) Provide a minimum of 36 hours of therapeutic activities per week;

(3) Coordinate aftercare services through:

(a) Peer support; or

(b) Licensed provider;

(4) Have at least two staff members:

(a) Certified in cardiopulmonary resuscitation;

(b) Trained in crisis management; and

(c) On duty between 11 p.m. and 7 a.m.;

(5) Have a part-time facility director on-site 20 hour per week; and

(6) At a minimum, have on staff a:

(a) Physician, nurse practitioner, or physician assistant on-site 5 hours per week and 2 hours on call;

(b) Psychiatrist or psychiatric nurse practitioner available 8 hours per week;

(c) Nurse on-site 168 hours per week, with a minimum of 56 hours provided by a registered nurse;

(d) On-site Multi-disciplinary team consisting of:

(i) A clinical supervisor;

(ii) A licensed mental health clinician;

(iii) Certified counselors under direct supervision of a counselor approved by the Board of Professional Counselors and Therapists as a supervisor; and

(iv) Peer support staff.

G. A withdrawal management service level 3.7-WM provider shall:

(1) Have a part-time facility director on-site 20 hour per week;

(2) Coordinate aftercare services through:

(a) Peer support; or

(b) Licensed provider; and

(3) At a minimum, have on staff:

(a) A physician, nurse practitioner, or physician assistant on-site 20 hours per week and 4 hours on call;

(b) A psychiatrist or psychiatric nurse practitioner available 8 hours per week;

(c) A registered nurse on-site 56 hours per week;

(d) A licensed practical nurse on-site 112 hours per week; and

(e) An on-site multi-disciplinary team consisting of:

(i) A clinical supervisor;

(ii) A licensed mental health clinician;

(iii) Certified counselors under direct supervision of a counselor approved by the Board of Professional Counselors and Therapists as a supervisor; and

(iv) Peer support staff.

Md. Code Regs. 10.09.06.04

Regulations .04 amended as an emergency provision effective April 1, 1977 (4:8 Md. R. 630); amended permanently effective August 17, 1977 (4:17 Md. R. 1299)
Regulations .04 amended as an emergency provision effective January 1, 1981 (7:26 Md. R. 2412); adopted permanently effective May 2, 1981 (8:8 Md. R. 721)
Regulation .04A amended, as an emergency provision effective February 1, 1984 (11:4 Md. R. 312); adopted permanently effective June 1, 1984 (11:10 Md. R. 863)
Regulations .04 amended as an emergency provision effective March 5, 1982 (9:7 Md. R. 709); emergency status extended at 9:11 Md. R. 1123; adopted permanently effective August 2, 1982 (9:15 Md. R. 1514)
Regulations .04A amended as an emergency provision effective July 2, 1984 (11:15 Md. R. 1327); emergency status extended at 11:19 Md. R. 1665 and 11:21 Md. R. 1809; emergency status expired October 14, 1984
Regulation .04 amended as an emergency provision effective July 2, 1979 (6:14 Md. R. 1204); adopted permanently effective November 2, 1979 (6:22 Md. R. 1779)
Regulation .04 amended as an emergency provision effective July 28, 1980 (7:16 Md. R. 1588); adopted permanently effective November 28, 1980 (7:24 Md. R. 2257)
Regulation .04 amended effective November 17, 1986 (13:23 Md. R. 2480); October 25, 2004 (31:21 Md. R. 1545)
Regulation .04A amended as an emergency provision effective August 1, 1982 (9:22 Md. R. 2195); adopted permanently effective February 8, 1983 (10:2 Md. R. 109)
Regulation .04A amended as an emergency provision effective October 21, 1982 (10:1 Md. R. 20); adopted permanently effective March 31, 1983 (10:6 Md. R. 558)
Regulations .04 amended as an emergency provision effective December 1, 1984 (11:25 Md. R. 2127); emergency status expired April 30, 1985
Regulation .04A amended as an emergency provision effective June 25, 1984 (11:14 Md. R. 1246), adopted permanently effective October 23, 1984 (11:21 Md. R. 1812)
Regulation .04A amended as an emergency provision effective February 13, 1985 (12:5 Md. R. 480); adopted permanently effective June 3, 1985 (12:11 Md. R. 1048)
Regulation .04A amended as an emergency provision effective July 1, 1986 (13:15 Md. R. 1729); adopted permanently effective October 6, 1986 (13:20 Md. R. 2210)
Regulation .04A amended as an emergency provision effective July 10, 1986 (13:16 Md. R. 1823); emergency status extended to February 10, 1987 (14:4 Md. R. 412)
Regulation .04A amended as an emergency provision effective September 2, 1986 (13:23 Md. R. 2477); adopted permanently effective January 1, 1987 (13:23 Md. R. 2480)
Regulation .04A amended effective May 2, 1981 (8:8 Md. R. 721); March 29, 1982 (9:6 Md. R. 614); October 15, 1984 (11:20 Md. R. 1742); May 1, 1985 (12:8 Md. R. 802); March 10, 1986 (13:5 Md. R. 542); March 23, 1987 (14:6 Md. R. 715); July 1, 1987 (14:13 Md. R. 1473); September 7, 1987 (14:14 Md. R. 1571); October 5, 1987 (14:20 Md. R. 2142); August 8, 1988 (15:16 Md. R. 1914)
Regulation .04B amended effective March 29, 1982 (9:6 Md. R. 614); July 1, 1982 (9:12 Md. R. 1223)
Regulations .04, .05B, .08B, and .10L amended as an emergency provision effective February 2, 2000 (27:4 Md. R. 451); amended permanently effective May 15, 2000 (27:9 Md. R. 858)
Regulation .04A amended effective May 14, 1990 (17:9 Md. R. 1090); June 22, 1992 (19:12 Md. R. 1134); January 30, 1995 (22:2 Md. R. 77); February 9, 1998 (25:3 Md. R. 144); January 5, 2004 (30:26 Md. R. 1914); June 28, 2010 (37:13 Md. R. 852)
Regulation .04B amended effective June 22, 1992 (19:12 Md. R. 1134); January 18, 1993 (20:1 Md. R. 27); February 9, 1998 (25:3 Md. R. 144); January 5, 2004 (30:26 Md. R. 1914); October 25, 2004 (31:21 Md. R. 1545)
Regulation .04C adopted effective January 5, 2004 (30:26 Md. R. 1914)
Regulation .04C amended effective October 25, 2004 (31:21 Md. R. 1545); July 18, 2005 (32:14 Md. R. 1275); March 27, 2006 (33:6 Md. R. 578)
Regulation .04C amended as an emergency provision effective July 1, 2006 (33:20 Md. R. 1610); amended permanently effective October 9, 2006 (33:20 Md. R. 1615)
Regulation .04C amended effective December 6, 2007 (34:24 Md. R. 2158); December 13, 2010 (37:25 Md. R. 1737)
Regulation .04D adopted effective January 5, 2004 (30:26 Md. R. 1914); repealed effective 44:7 Md. R. 354, eff. 4/10/2017; adopted effective 44:18 Md. R. 865, eff. 9/11/2017; amended effective 45:26 Md. R. 1242, eff. 12/31/2018; amended effective 50:20 Md. R. 886, eff. 10/16/2023