Md. Code Regs. 10.09.80.05

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

Section 10.09.80.05 - Covered Services

A. Comprehensive substance use disorder assessment at a minimum shall:

(1) Be delivered through:

(a) A BHA licensed substance use disorder treatment provider; or

(b) An opioid treatment program;

(2) Be completed before providing the community based behavioral health services listed in §§B-I of this regulation;

(3) Be reviewed and approved by a licensed physician or licensed practitioner of the healing arts, within the scope of his or her practice under State law; and

(4) Include:

(a) An assessment of the following areas:

(i) Drug and alcohol use; and

(ii) Substance use disorder treatment history;

(b) Referrals for physical and mental health services; and

(c) Recommendation for the appropriate level of substance use disorder treatment;

B. Peer recovery support services shall:

(1) Be included as part of a written individualized treatment plan that includes specific individualized goals;

(2) Be delivered through a BHA licensed:

(a) Outpatient substance use disorder treatment provider in compliance with COMAR 10.63.03.06, 10.63.03.03 or 10.63.03.07; or

(b) Opioid treatment program in compliance with COMAR 10.63.03.19;

(3) Be provided by staff who, at a minimum:

(a) Maintains active certification by BHA or its designee;

(b) Self-identifies as an individual with life experience of being diagnosed with behavioral health concerns, including substance use disorders, addictive disorders, or mental health concerns;

(c) Completes ongoing training as approved by BHA or its designee; and

(d) Receives supervision by:

(i) A registered peer supervisor approved by BHA or its designee; or

(ii) An individual practitioner as defined in COMAR 10.09.59.04A(2) or a certified alcohol and drug counselor who is approved to supervise by the relevant board and who must be an approved registered peer supervisor on or after September 1, 2023; and

(4) Be provided directly to the participant either in-person or via telehealth.

C. Level 1 group and individual substance use disorder counseling shall:

(1) Comply with COMAR 10.63.03.06;

(2) Be delivered through:

(a) A BHA licensed substance use disorder treatment provider; or

(b) An opioid treatment program;

(3) Include services for participants who require less than 9 hours weekly for adults and 6 hours weekly for adolescents;

(4) Include a written individualized treatment plan, with the participation of the participant based on the comprehensive assessment that shall:

(a) Be reviewed and approved by a licensed physician or licensed practitioner of the healing arts, within the scope of his or her practice under State law; and

(b) Include:

(i) Participant treatment plan goals;

(ii) Referrals to ancillary services, if needed; and

(iii) Referral to recovery support services, if needed; and

(5) Include family members, if necessary, as long as the participant is also present in a Level 1 group counseling session.

D. Level 2.1 Intensive Outpatient services shall:

(1) Comply with COMAR 10.63.03.03;

(2) Be delivered through a BHA licensed substance use disorder treatment provider only;

(3) Include services for participants who require outpatient treatment for 9 or more hours weekly for an adult and 6 or more hours weekly for an adolescent;

(4) Include a written individualized treatment plan, with the participation of the participant based on the comprehensive assessment that shall:

(a) Be reviewed and approved by a licensed physician or licensed practitioner of the healing arts, within the scope of his or her practice under State law; and

(b) Include:

(i) Participant treatment plan goals; and

(ii) Specific interventions that reflect the amounts, frequencies and intensities appropriate to the objective of the treatment plan; and

(5) Include a discharge plan, which includes written recommendations to assist the participant with continued recovery efforts, as well as appropriate referral services.

E. Level 2.5 partial hospitalization services shall:

(1) Comply with COMAR 10.63.03.07;

(2) Be delivered through a BHA licensed substance use disorder treatment provider;

(3) Include services for participants who require a minimum of 20 hours weekly of structured outpatient treatment delivered in the following ways:

(a) Half day sessions with a minimum of 2 hours per day of services; or

(b) Full day sessions with a minimum of 6 hours per day of services;

(4) Include a written individualized treatment plan, with the participation of the participant based on the comprehensive assessment that shall:

(a) Be reviewed and approved by a licensed physician or licensed practitioner of the healing arts, within the scope of his or her practice under State law; and

(b) Include:

(i) Participant treatment plan goals; and

(ii) Specific interventions that reflect the amounts, frequencies and intensities appropriate to the objective of the treatment plan; and

(5) Include a discharge plan, which includes written recommendations to assist the participant with continued recovery efforts, as well as appropriate referral services.

F. Ambulatory withdrawal management service shall:

(1) Comply with COMAR 10.63.03.18;

(2) Be delivered through a BHA licensed substance use disorder treatment provider;

(3) Include the following services as medically necessary:

(a) Administration and monitoring of medication, including administration and monitoring of psychotropic medication by qualified staff, as necessary; and

(b) Managing withdrawal symptoms; and

(4) Include a participant progress note added to the participant's record after each session.

G. Buprenorphine and other medication assisted treatment delivered by a BHA licensed substance use disorder treatment provider that employs a practitioner who holds a DEA registration with Schedule III authority in compliance with 21 U.S.C. § 823 shall include the following:

(1) Services delivered by a DEA registered practitioner with Schedule III authority, including:

(a) Pharmacological interventions, including the use of FDA-approved opiate agonist and partial agonist treatment medications to provide treatment, support, and recovery to opioid-addicted participants;

(b) At a minimum, medical services required to be provided by the Program that:

(i) Ensure that participants receive a dose adequate to alleviate withdrawal symptoms;

(ii) Employ dose increases and behavior therapy before mandatory detoxification for participants continuing to use drugs;

(iii) Establish participant dosing based on an individual need;

(iv) Provide flexible dosage tapering and withdrawal management with dosage reductions at the participant's request;

(c) Ordering and administering non-narcotic drugs; and

(2) Services provided by alcohol and drug counselors and other staff as appropriate, including:

(a) Substance use disorder and related counseling as recommended in the individualized treatment plan; and

(b) Point of care presumptive drug testing that shall be:

(i) Presumptive in nature and performed at the point of care; and

(ii) Capable of being read by direct optical observation only.

H. For dates of service before January 1, 2023, BHA licensed substance use disorder treatment providers rendering buprenorphine and other medication assisted treatment are required to comply with requirements for DATA 2000 waived providers.

I. Opioid maintenance therapy services delivered through the use of methadone or buprenorphine by opioid treatment programs shall comply with 10.63.03.19 and include:

(1) An individualized treatment plan that shall be reviewed and approved by a licensed physician or licensed practitioner of the healing arts, within the scope of his or her practice under State law;

(2) The following services:

(b) Point of care presumptive drug testing;

(c) Definitive drug testing when completed by a laboratory;

(d) Substance use disorder and related counseling as recommended in the individualized treatment plan;

(e) Periodic medication management;

(f) Medical services, including, but not limited to, those required to be provided by the Program that ensure that participants receive a dose adequate to alleviate withdrawal symptoms; and

(g) Ordering and administering non-narcotic drugs;

(3) A discharge plan, which includes written recommendations to assist the participant with continued recovery efforts, as well as appropriate referral services; and

(4) Guest dosing arrangements with other opioid treatment programs, as medically necessary.

J. Medication assisted treatment induction service delivered by opioid treatment programs shall include the following services, as medically necessary:

(1) Pharmacological interventions, including the use of one of the following FDA-approved opiate agonist and partial agonist treatment medications to provide treatment, support, and recovery to opioid-addicted participants:

(a) Buprenorphine; or

(b) Methadone;

(2) Medical services, including, but not limited to, those required to be provided by the Program that ensure that participants receive a dose adequate to alleviate withdrawal symptoms; and

(3) Ordering and administering non-narcotic drugs.

Md. Code Regs. 10.09.80.05

Regulations .05 adopted as an emergency provision effective January 1, 2010 (37:6 Md. R. 474); adopted permanently effective May 31, 2010 (37:11 Md. R. 765)
Regulation .05 amended effective 42:21 Md. R. 1302, eff.10/26/2015; amended effective 44:7 Md. R. 356, eff. 4/10/2017; amended effective 44:19 Md. R. 897, eff. 9/25/2017; amended effective 49:23 Md. R. 996, eff. 11/14/2022; amended effective 50:9 Md. R. 379, eff. 5/15/2023; amended effective 51:15 Md. R. 708, eff. 8/5/2024.