Md. Code Regs. 10.21.25.09

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

Section 10.21.25.09 - Fee Schedule - Support Services

A. Psychiatric Rehabilitation Program (PRP) Services. The Department shall reimburse a PRP for providing face-to-face rehabilitation services to an individual with a serious emotional disturbance (SED) or serious and persistent mental disorder (SPMD), by a monthly rate that is based on a minimum and maximum range of services, when the PRP submits monthly supporting encounter data after services are provided to the individual, within which the provider shall meet the needs of the individual, as follows:

(1) Assessment ... $61.62;

(2) PRP services to an employed individual in a supported employment program, delivered at the job site, at a rate of $107.62 per month, for:

(a) A minimum of two services per month;

(b) A maximum of 30 services per month;

(c) A minimum of 15 minutes per service; and

(d) A maximum of one service per day.

B. Additional PRP Services. In addition to the services outlined in §A of this regulation, the Department shall reimburse a PRP for providing face-to-face rehabilitation services to an individual with SED or SPMD by a monthly rate that is based on a minimum and maximum range of services, within which the provider shall meet the needs of the individual, as follows:

(1) PRP Community Psychiatric Support Services delivered to an individual with an SED or an SPMD, whose functioning is severely impaired, and who is living with a parent, guardian, or relative who is legally responsible for the individual's care, as follows:

(a) When on-site and off-site services are delivered to an individual by one PRP, $426.99 per month for:

(i) A minimum of three and a maximum of 30 services per month, on-site or off-site;

(ii) On-site services, at a minimum of 60 minutes per service;

(iii) Off-site services, at a minimum of 15 minutes per service; and

(iv) A maximum of one on-site or one off-site service per day; or

(b) When on-site and off-site services are delivered to an individual by two PRPs, a PRP may receive reimbursement for either on-site or off-site services, but not both, as follows:

(i) On-site services, at a rate of $183.22 per month, for a minimum of two services and a maximum of 30 services per month, at a minimum of 60 minutes per service;

(ii) Off-site services, at a rate of $243.76 per month, for a minimum of two services and a maximum of 30 services per month, at a minimum of 15 minutes per service; and

(iii) Limited to reimbursement for one on-site and one off-site service per day;

(2) PRP supported living for services delivered to an individual with an SED or an SPMD, whose functioning is severely impaired, and who is living independently or with individuals who are not legally responsible for their care, as follows:

(a) When services are delivered to an individual by one PRP, $760.88 per month as follows:

(i) A minimum of six and a maximum of 30 services per month, on-site or off-site;

(ii) On-site services, at a minimum of 60 minutes per service;

(iii) Off-site services, at a minimum of 15 minutes per service; and

(iv) Limited to one on-site and off-site service per day; or

(b) When on-site and off-site services are delivered to an individual by two PRPs, a PRP may receive reimbursement for either on-site or off-site services, but not both, as follows:

(i) On-site services, at a rate of $259.37 per month, for a minimum of three services and a maximum of 30 services per month, at a minimum of 60 minutes per service;

(ii) Off-site services, at a rate of $501.51 per month, for a minimum of five services and a maximum of 30 services per month and a minimum of 15 minutes per service; and

(iii) Limited to reimbursement for one on-site or off-site service per day;

(3) PRP services delivered to individuals in residential rehabilitation programs (RRPs) as follows:

(a) General support:

(i) On-site, at a rate of $447.70 per month, for a minimum of four services, up to 30 services per month, at a minimum of 60 minutes per service;

(ii) Off-site, at a rate of $1,202.13 per month, for a minimum of 13 services, up to 30 services per month, at a minimum of 15 minutes per service; or

(iii) Any combination of on-site or off-site PRP services, at a rate of $1,649.83 per month, for a minimum of 17 services, up to 30 services per month, at a minimum of 30 minutes per service; or

(b) Intensive support:

(i) On-site, at a rate of $447.70 per month, for a minimum of four services, up to 30 services per month, at a minimum of 60 minutes per service;

(ii) Off-site, at a rate of $3,123.17 per month, for a minimum of 19 services, up to 30 services per month, at a minimum of 15 minutes per service; or

(iii) Any combination of on-site or off-site PRP services, at a rate of $3,570.87 per month, for a minimum of 23 services, up to 30 services per month, at a minimum of 30 minutes per service; or

(4) PRP services delivered to individuals when transitioning from inpatient level of care to the community, any combination of on-site or off-site PRP services, at a rate of $447.70 per month, for a minimum of 4 services, up to 30 services per month, at a minimum of 60 minutes per service.

C. RRP Services. The Department shall reimburse an RRP for providing services to an individual with a serious and persistent mental disorder and whose functioning is severely impaired, as follows:

(1) Room and board ... $12.59 per day;

(2) A provider may collect additional fees from an individual not covered by the rate established in §B(1) of this regulation to cover a portion of costs of food, shelter, and other household expenses associated with an individual's basic needs in an RRP residence, not to exceed the provider's cost of care.

D. Mental Health Vocational Programs (MHVP). The Department shall reimburse a program that is approved for mental health vocational services for providing supported employment services to an individual with a mental disorder:

(1) If the service is authorized by the Administration or its designee;

(2) If the program documents an individual's application to the Division of Rehabilitation Services (DORS) and has documentation of the decision on the application; and

(3) At the following rates, per individual approved for supported employment services:

(a) Completion of vocational assessment, individual supported employment plan, referral to DORS, and education regarding entitlements and work incentives, not more than three times per year ... $430.49;

(b) Job placement of the individual, not more than three times per year ... $1,075.14;

(c) Intensive job coaching, if not otherwise reimbursed, at a maximum of $7.40 per 15 minutes, up to a lifetime maximum of $2,750 per individual; and

(d) Extended MHVP support ... $349.77 per month.

E. Mental Health Vocational Programs - Evidence-Based Programs. The Department shall reimburse an MHVP evidence-based program:

(1) If the service is authorized by the Administration or its designee;

(2) If the program documents an individual's application to the Division of Rehabilitation Services (DORS) and has documentation of the decision on the application; and

(3) At the following rates, per individual approved for supported employment services:

(a) Completion of vocational assessment, individual supported employment plan, referral to DORS, and education regarding entitlements and work incentives not more than three times per year ... $430.49;

(b) Job placement of the individual not more than three times per year ... $1,075.14;

(c) Intensive job coaching, if not otherwise reimbursed, at a maximum of $7.40 per 15 minutes, up to a lifetime maximum of $2,750.00 per individual;

(d) Clinical service coordination at a rate of $107.62 per month, that is documented and includes, with the individual's consent, at a minimum:

(i) Monthly collaboration with the individual's treatment or psychiatric rehabilitation team; and

(ii) Face-to-face contact every 6 months with the individual's treating clinician or psychiatrist; and

(e) Extended PRP support to an individual in a supported employment program at a rate of $430.49 per month for:

(i) A minimum of three services per month;

(ii) A maximum of 30 services per month;

(iii) A minimum of 15 minutes per service; and

(iv) A maximum of one service per day.

F. Respite Care. The Department shall reimburse a program that is approved for respite care for providing services to a child or adolescent with a serious emotional disturbance, whose functioning is severely impaired, or an adult with a serious and persistent mental disorder, whose functioning is severely impaired, as follows:

(1) For children:

(a) General support in a facility ... $174.34 per day; or

(b) In-home respite, when the need for short-term, one-to-one support is documented or for in-home respite and approved by the CSA up to a maximum of 10 hours per day at a rate of ... $3.49 per 15 minutes;

(2) For adults, general support in a residential rehabilitation program ... $75.61 per day.

G. Enhanced Support. When the need for short-term, one-to-one support is documented and approved by the CSA, the Department shall reimburse an OMHC, PRP, RRP, or MTS for providing services to a child or adolescent with an SED or an adult with an SPMD, and whose functioning is seriously impaired, at the rate of $12.91 per hour up to a maximum of $129.10 per day, not to exceed 30 days per year.

H. Therapeutic Behavioral Services. The Department shall reimburse a therapeutic behavioral services provider, as defined in COMAR 10.09.34, as follows:

(1) One-to-one behavioral aide services to a child or adolescent ... $5.39 per 15 minutes;

(2) Initial assessment and development of a behavioral plan ... $105.51;

(3) Reassessment and development of a new behavioral plan ... $99.18.

I. Adult Mental Health Case Management. The Department shall reimburse a designated program that is approved by the Core Service Agency for mental health case management according to COMAR 10.09.45 for providing case management services to an adult with a serious and persistent mental health disorder as follows:

(1) Assessment ... $108.61;

(2) Case Management Service units, for a minimum of 60 minutes of face-to-face and non-face-to-face case management service at a rate of $108.61 per day for:

(a) General level up to 2 units per month; or

(b) Intensive level up to 5 units per month; and

(3) When an individual is referred to case management by the Administration or its designee, and is transitioning from an institute for mental disease or hospital, one transitional visit at a rate of $159.55.

J. Mental Health Case Management: Care Coordination for Children and Youth. The Department shall reimburse a designated program that is approved by the Core Service Agency to provide mental health case management services to a child or adolescent with a serious emotional disorder, according to COMAR 10.09.90, as follows:

(1) Case Management Service units, for a minimum of 15 minutes of face-to-face and non-face-to-face case management service at a rate of $20.19 per 15 minutes for:

(a) Level I - General Coordination up to 12 units of service per month, with a minimum of two units of face-to-face contact;

(b) Level II - Moderate Care Coordination up to 30 units of service per month, with a minimum of four units of face-to-face contact; and

(c) Level III - Intensive Care Coordination up to 60 units of service per month, with a minimum of six units of face-to-face contact; and

(2) For comprehensive assessment and reassessment case management service units, for Level I and Level II only, four additional face-to-face units of service above the monthly maximum may be billed during the first month of service to the participant and every 6 months thereafter.

Md. Code Regs. 10.21.25.09

Regulation .09A, B amended as an emergency provision effective July 1, 2002 (29:24 Md. R. 1915); amended permanently effective December 23, 2002 (29:25 Md. R. 1982)
Regulations .09 amended as an emergency provision effective July 1, 2008 (35:21 Md. R. 1822)
Regulations .09 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)
Regulations.09 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)
Regulation .09 amended effective January 7, 2013 (39:26 Md. R. 1664); February 3, 2014 (41:2 Md. R. 91)
Regulation .09I adopted as an emergency provision effective October 20, 2009 (36:24 Md. R. 1855); adopted permanently effective February 8, 2010 (37:3 Md. R. 176)
Regulation .09I amended effective June 27, 2011 (38:13 Md. R. 755)
Regulation .09 amended effective 41:24 Md. R. 1427, eff.12/11/2014