Md. Code Regs. 10.21.25.08

Current through Register Vol. 51, No. 12, June 14, 2024

Section 10.21.25.08 - Fee Schedule - Treatment Services - Programs

A. Therapeutic Nursery Programs. The Department shall reimburse a program approved under COMAR 10.21.18 to provide therapeutic nursery services to eligible children, younger than 5 years old, at a rate of $42.20 per day, for a minimum of 3 days per week, 3 hours per day.

B. Mobile Treatment Services. The Department shall reimburse a program for mobile treatment services delivered to an individual:

(1) For a minimum of four face-to-face services, and according to a treatment plan that outlines the expected type and frequency of services;

(2) At the rate of:

(a) $839.45 per month; or

(b) If the individual is a Medicare recipient, $643.58 per month, if the program has:

(i) Delivered services according to the provision of §A(1) of this regulation; and

(ii) Billed applicable Medicare reimbursed services;

(3) For enhanced support, when the need for short-term one-to-one support is documented and approved by the Administration or its designee:

(a) At the rate of $12.91 per hour;

(b) Up to a maximum of $129.10 per day;

(c) Not to exceed 30 days per calendar year.

(4) For evidence-based programs, assertive community treatment (ACT), at the rate of:

(a) For Medicaid recipients and other individuals meeting eligibility criteria for uninsured, $$1,183.34 per month; or

(b) If the individual has Medicare only, $1,049.31 per month.

C. Partial Hospitalization. For programs approved under COMAR 10.21.02 or licensed under COMAR 10.63.03.08, the Department shall reimburse:

(1) A non-hospital-based partial hospitalization (psychiatric day treatment) program, for services provided to an eligible Medicaid recipient:

(a) For a full day, a minimum of 6.5 hours of therapeutic activities per day ... $203.68 per day;

(b) For a half day, or intensive, outpatient services, when the services are delivered by a multidisciplinary team, for a minimum of 4 hours of therapeutic activities, including at least two group therapies ... $110.85 per day;

(2) HSCRC programs that meet the minimum requirements of COMAR 10.21.02, at the rate established by the HSCRC;

(3) OMHC, for intensive outpatient services provided to a Medicaid recipient in a psychiatric day treatment program:

(a) For adults ... $129.69;

(b) For children and adolescents ... $154.17; and

(4) For physician services, at the rates established under Regulation .06D of this chapter.

D. The Department may not reimburse a partial hospitalization program (psychiatric day treatment) or an OMHC intensive outpatient mental health program on the same day that an intensive outpatient program or service is provided for substance abuse treatment.

E. Residential Crisis Services. The Department shall reimburse a provider for residential crisis services delivered to an individual, as follows:

(1) As an alternative to inpatient admission or to shorten the length of inpatient stay:

(a) For clinical services ... $$252.34 per day;

(b) For room and board ... $12.59 per day;

(2) Treatment foster care ... $162.25 per day; and

(3) For physician services, at the rates established for services rendered to an individual in an inpatient setting under Regulation .05D of this chapter.

Md. Code Regs. 10.21.25.08

Regulations .08 adopted as an emergency provision effective July 1, 1997 (24:18 Md. R. 1293); adopted permanently effective October 20, 1997 (24:21 Md. R. 1449)
Regulation .08B amended effective December 19, 2005 (32:25 Md. R. 1942)
Regulation .08H adopted effective December 19, 2005 (32:25 Md. R. 1942)
Regulation .08 amended effective June 27, 2011 (38:13 Md. R. 755)
Regulations .08 amended as an emergency provision effective July 1, 2007 (34:17 Md. R. 1506); amended permanently effective October 8, 2007 (34:20 Md. R. 1739)
Regulations.08, amended as an emergency provision effective July 1, 2008 (35:21 Md. R. 1822)
Regulations.08, amended as an emergency provision effective December 22, 2008 (36:2 Md. R. 97); amended permanently effective March 23, 2009 (36:6 Md. R. 491)
Regulation .08 amended effective January 7, 2013 (39:26 Md. R. 1664);41:2 Md. R. 91, eff. 2/3/2014 ; amended effective 43:26 Md. R. 1445, eff. 1/2/2017