This chapter establishes the Medicaid and State-funded fee schedule that Maryland's Behavioral Health Administration uses to reimburse community-based mental health programs and individual licensed practitioners for outpatient, partial hospitalization, mobile treatment, psychiatric rehabilitation, residential crisis, and related mental health services. Providers must bill using current CPT codes, obtain required authorizations, maintain specified documentation, and comply with claims-submission and copayment-collection requirements. The chapter does not set fees for inpatient facilities regulated by the Health Services Cost Review Commission, federally qualified health centers, or home health agencies.
View official sourceCode of Maryland Regulations Chapter 25 Fee Schedule — Mental Health Services — Community-Based Programs and Individual Practitioners Administrative History Effective date: Regulations .01 — .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) —————— Chapter revised as an emergency provision effective July 1, 1998 (25:14 Md. R. 1123) Chapter revised effective October 1, 1998 (25:18 Md. R. 1435 and 25:19 Md. R. 1506) Chapter revised as an emergency provision effective March 1, 2000 (27:4 Md. R. 451); revised permanently effective June 26, 2000 (27:12 Md. R. 1139) Regulation .01D 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) Regulation .02B 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) Regulation .02B amended as an emergency provision effective July 1, 2003 (30:17 Md. R. 1202); amended permanently effective October 27, 2003 (30:21 Md. R. 1529) Regulation .04A , 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) Regulation .05A , D 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) Regulation .06A 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) 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) Regulation .10A , D 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) Regulation .11A 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) Regulation .14 adopted as an emergency provision effective July 1, 2003 (30:17 Md. R. 1202); adopted permanently effective October 27, 2003 (30:21 Md. R. 1529) —————— Chapter revised as an emergency provision effective February 1, 2004 (31:5 Md. R. 446); revised permanently effective June 7, 2004 (31:11 Md. R. 857) Regulation .08B amended effective December 19, 2005 (32:25 Md. R. 1942) Regulation .08H adopted effective December 19, 2005 (32:25 Md. R. 1942) —————— Chapter revised as an emergency provision effective July 1, 2006 (33:15 Md. R. 1274); emergency status extended at 34:4 Md. R. 397; revised permanently effective February 26, 2007 (34:4 Md. R. 400) Regulations .02, .03, and .05 — .10 amended as an emergency provision effective July 1, 2008 (35:21 Md. R. 1822) Regulations .02, .03, and .05 — .10 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 .03 amended effective January 2, 2017 (43:26 Md. R. 1445) Regulation .03B amended effective January 7, 2013 (39:26 Md. R. 1664); February 3, 2014 (41:2 Md. R. 91) Regulation .03-1 adopted as an emergency provision effective December 22, 2008 (36:2 Md. R. 97); adopted permanently effective March 23, 2009 (36:6 Md. R. 491) Regulation .03-1 amended effective June 27, 2011 (38:13 Md. R. 755) Regulation .03-2 adopted as an emergency provision effective December 22, 2008 (36:2 Md. R. 97); emergency status expired June 19, 2009 Regulation .03-2 amended effective January 7, 2013 (39:26 Md. R. 1664); February 3, 2014 (41:2 Md. R. 91) Regulations .05 — .11 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 .05 — .11 amended effective January 7, 2013 (39:26 Md. R. 1664); February 3, 2014 (41:2 Md. R. 91) Regulation .08 amended effective June 27, 2011 (38:13 Md. R. 755) Regulation .08C amended effective January 2, 2017 (43:26 Md. R. 1445) 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); December 11, 2014 (41:24 Md. R. 1427) Regulation .09J adopted effective December 11, 2014 (41:24 Md. R. 1427) Regulation .11 amended effective February 3, 2014 (41:2 Md. R. 91) Regulation .12 adopted effective February 3, 2014 (41:2 Md. R. 91) Regulation .13 adopted effective February 3, 2014 (41:2 Md. R. 91) Authority Health-General Article, §§10-901, 15-103, and 15-105; Title 16, Subtitles 1 and 2; Annotated Code of Maryland .01 Scope. This chapter establishes the fees that the Department reimburses for mental health services that are rendered by a provider to an individual who receives Medicaid-reimbursable or State-supported services. .02 General Reimbursement. A. The Department shall reimburse the lower of the amount billed or the fee established under this chapter, after the application of an individual's copayment, based on the ability-to-pay determination according to Regulation .03 of this chapter . B. The Department may reimburse for non-Medicaid-reimbursable mental health services to the extent that State resources permit. C. According to the provisions of this chapter, the Department shall reimburse a mental health services provider: (1) That is: (a) A community-based mental health program that is approved by the Department; or (b) An appropriately credentialed individual practitioner who contracts with the Department's Medical Assistance Program; (2) For specific services that are delivered to: (a) Medicaid recipients; or (b) Individuals for whom, because of the severity of their mental illness and their financial need, the cost of mental health services is subsidized, in whole or in part, by State general funds for services not reimbursed under a grant or a contract. D. This chapter does not establish fees for services that are provided by: (1) A federally qualified health center; (2) An inpatient facility regulated by the Health Services Cost Review Commission, to an inpatient or resident of the facility; or (3) A home health agency licensed under COMAR 10.09.04 . E. The mental health service provider shall bill services using: (1) The procedural terminology codes contained in the most current Physician's Current Procedural Terminology (CPT) manual published by the American Medical Association and incorporated by reference in COMAR 10.09.09.07D ; and (2) If there is no current CPT code for the service, a customized code published by the Administration. F. The mental health service provider, by submitting a claim for reimbursement for service, certifies that the service is medically necessary, has been delivered and meets the description and intent of the CPT code which is contained on its claim for reimbursement. G. Medicare Recipients. (1) If a provider renders services to individuals who are Medicare recipients, the provider shall comply with all federal Medicare requirements. (2) If a provider does not comply with all Medicare requirements, the provider may not seek reimbursement by the PMHS. .03 Definitions. A. In this chapter, terms have the meanings stated in COMAR 10.21.17 , COMAR 10.63.01.02 , and this regulation. B. Terms Defined. (1) “Ability-to-pay schedule” means the schedule adopted, according to the provisions of Health-General Article, Title 16, Subtitle 2, Annotated Code of Maryland, by the Secretary to evaluate and establish the extent of a consumer's ability to pay for services rendered. (2) “Administration” means the Behavioral Health Administration. (2-1) “Assertive Community Treatment Program (ACT)” means an evidence-based practice program approved by the Administration under its regulations. (3) “Core service agency (CSA)” has the meaning stated in COMAR 10.63.01.02 . (3-1) “Day habilitation” has the meaning stated in COMAR 10.09.46 . (3-2) “Emergency department” means an organized hospital-based facility that provides unscheduled episodic services, 24 hours per day, 7 days per week, to individuals who present for immediate medical attention. (4) Emergency Service. (a) “Emergency service” means a service that is provided to an individual who presents a danger to the life or safety of the individual or another. (b) “Emergency service” does not include a residential or mobile crisis service. (5) “Enhanced support” means short-term, in-home services, in addition to other services to an individual, provided by a program to support the individual to remain in the community: (a) For mobile treatment services: (i) Under COMAR 10.21.19 if approved; and (ii) Under COMAR 10.63.03.04 if licensed; (b) For adult psychiatric rehabilitation services: (i) Under COMAR 10.21.21 if approved; and (ii) Under COMAR 10.63.03.09 if licensed; or (c) For outpatient mental health services; (i) Under COMAR 10.21.20 if approved; and (ii) Under COMAR 10.63.03.05 if licensed. (5-1) “Evidence-based practice (EBP)” is an Administration-approved practice that applies to certain clinical or rehabilitative interventions provided by public mental health service providers. (5-2) “Family psychoeducation” is an evidence-based practice approved by the Administration under its regulations. (6) “Fee” means the dollar amount, established by the Secretary, that a provider may charge an individual who receives services under this chapter for a unit of service, before the application of an ability-to-pay determination. (7) “Individual practitioner” means: (a) A marriage and family therapist who is licensed and legally authorized to practice clinical marriage and family therapy in the state in which the service is rendered; (b) A nurse psychotherapist who is: (i) Licensed and legally authorized to practice as a nurse psychotherapist in the state in which the service is rendered; and (ii) Certified by the Maryland Board of Nursing or an equivalent board of nursing in another state as a nurse psychotherapist, and demonstrates, by training and experience, the competency to provide the mental health services; (c) A certified registered nurse practitioner psychiatric mental health (CRNP-PMH) who is: (i) Licensed and legally authorized to practice as a certified registered nurse practitioner — psychiatric in the state in which the service is rendered to perform independently the services set forth in COMAR 10.27.07 ; and (ii) Certified by the Maryland Board of Nursing or an equivalent board of nursing in another state as a certified registered nurse practitioner with a specialty in psychiatry pursuant to COMAR 10.27.07 and demonstrates, by training and experience, the competency to provide the mental health services; (d) An occupational therapist who: (i) Is licensed and legally authorized to practice as an occupational therapist in the state in which the service is rendered, and (ii) Demonstrates, by training and experience, the competency to provide mental health services; (e) A physician who: (i) Is licensed and legally authorized to practice as a physician in the state in which the service is rendered, and (ii) Demonstrates, by training and experience, the competency to provide mental health services; (f) A professional counselor who is licensed and legally authorized to practice as a clinical professional counselor in the state in which the service is rendered; (g) A psychologist who: (i) Is licensed and legally authorized to practice as a psychologist in the state in which the service is rendered, and (ii) Demonstrates, by training and experience, the competency to provide mental health services; or (h) A social worker who is licensed and legally authorized to practice as a clinical social worker in the state in which the service is rendered. (7-1) “Intensive outpatient services” means services that are delivered to an individual by a multidisciplinary team for a minimum of 3 hours of therapeutic activities, including at least two group therapies. (7-2) “Level I” means a level of service provided to an individual who is enrolled in the Traumatic Brain Injury Waiver Program, based on the requirements for intensity of services and staffing outlined in: (a) For individuals receiving residential habilitation services, COMAR 10.09.46.07D(2) ; (b) For individuals receiving day habilitation services, COMAR 10.09.46.08F(2) ; and (c) For individuals receiving supported employment services, COMAR 10.09.46.09C(2) . (7-3) “Level II” means a level of service provided to an individual who is enrolled in the Traumatic Brain Injury Waiver Program, based on the requirements for intensity of services and staffing outlined in: (a) For individuals receiving residential habilitation services, COMAR 10.09.46.07D(3) ; (b) For individuals receiving day habilitation services, COMAR 10.09.46.08F(3) ; and (c) For individuals receiving supported employment services, COMAR 10.09.46.09C(3) . (7-4) “Level III” means a level of service provided to an individual who is enrolled in the Traumatic Brain Injury Waiver Program, based on the requirements for intensity of services and staffing outlined in: (a) For individuals receiving residential habilitation services, COMAR 10.09.46.07D(4) ; (b) For individuals receiving day habilitation services, COMAR 10.09.46.08F(4) ; and (c) For individuals receiving supported employment services, COMAR 10.09.46.09C(4) . (7-5) “Local behavioral health authority (LBHA)” has the meaning stated in COMAR 10.63.01.02 . (8) Mental Health Program. (a) “Mental health program” means a program that provides a plan of mental health treatment or mental health rehabilitation, consisting of various therapeutic modalities, that is: (i) Approved by the Department under this subtitle or COMAR 10.09 to be eligible to receive State or federal funds; and (ii) Provided in the community. (b) “Mental health program” includes: (i) Non-hospital-based partial hospitalization (psychiatric day treatment) services under COMAR 10.21.02 if approved, and COMAR 10.63.03.08 if licensed; (ii) Therapeutic nursery programs under COMAR 10.21.18 ; (iii) Mobile treatment services under COMAR 10.21.19 if approved, and COMAR 10.63.03.04 if licensed; (iv) Outpatient mental health clinic (OMHC) services under COMAR 10.21.20 if approved, and COMAR 10.63.03.05 if licensed; (v) Psychiatric rehabilitation programs for adults under COMAR 10.21.21 if approved, and COMAR 10.63.03.09 if licensed, including supported living services; (vi) Residential rehabilitation programs under COMAR 10.21.22 if approved, and COMAR 10.63.04.05 if licensed; (vii) Home health services under COMAR 10.09.04 ; (viii) Supported employment programs under COMAR 10.21.28 if approved, and COMAR 10.63.03.16 if licensed; (ix) Respite care programs under COMAR 10.21.27 if approved, and COMAR 10.63.03.15 if licensed; (x) Residential crisis services programs under COMAR 10.21.26 if approved, and COMAR 10.63.04.04 if licensed; and (xi) Therapeutic and psychiatric rehabilitation services for minors under COMAR 10.21.29 if approved, and COMAR 10.63.03.10 if licensed. (9) Mobile Treatment. (a) “Mobile treatment” means a program approved under COMAR 10.21.19 , or licensed under COMAR 10.63.03.04 . (b) “Mobile treatment” does not include transporting an individual to a program site to receive services. (10) Off-Site. (a) “Off-site” means a location, other than a site defined in §B(11) of this regulation , to which mental health program staff travels to provide services to an individual. (b) “Off-site” includes, with respect to psychiatric rehabilitation program services, those services delivered to an individual: (i) In the individual's home, including a residential rehabilitation program residence; (ii) At a job site; or (iii) At another community location appropriate to the individual's needs. (c) “Off-site” does not include: (i) A juvenile detention center; or (ii) Any facility or group home that is licensed to provide rehabilitative or therapeutic services, or living skills. (11) “On-site” means a mental health program facility or other site to which a program has access and at which the program regularly delivers services to individuals who come to the site for the services. (11-1) Other Mental Health Professional. (a) “Other mental health professional” means an individual who is licensed, certified, or otherwise legally authorized to independently provide the mental health service. (b) “Other mental health professional” includes a: (i) Licensed certified social worker — clinical; (ii) Nurse psychotherapist; (iii) Licensed clinical professional counselor; (iv) Licensed clinical marriage and family therapist; or (v) Certified registered nurse practitioner — psychiatric mental health (CRNP-PMH). (12) “Outpatient mental health clinic (OMHC)” means a program approved under COMAR 10.21.20 or licensed under COMAR 10.63.03.05 . (13) “Partial hospitalization program” means a program approved under COMAR 10.21.02 or licensed under COMAR 10.63.03.08 . (14) “Program” means a mental health program as defined in §B(8) of this regulation . (15) “Provider” means: (a) A community-based mental health program as defined in §B(8) of this chapter; or (b) An individual practitioner as defined in §B(7) of this chapter. (16) “Psychiatric rehabilitation program for adults (PRP)” means a program approved under COMAR 10.21.21 or licensed under COMAR 10.63.03.09 . (16-1) “Residential crisis services (RCS)” means a program approved under COMAR 10.21.26 or licensed under COMAR 10.63.04.04 . (16-2) “Residential habilitation” has the meaning stated in COMAR 10.09.46 . (17) “Residential rehabilitation program (RRP)” means a program approved under COMAR 10.21.22 or licensed under COMAR 10.63.04.05 . (17-1) “Respite care” means services that are approved under COMAR 10.21.27 or licensed under COMAR 10.63.03.15 (18) “Secretary” means the Secretary of Health (19) “Serious emotional disturbance” means a condition that is: (a) Manifest in an individual younger than 18 years old; (b) Diagnosed according to a current diagnostic and statistical manual of the American Psychiatric Association that is recognized by the Secretary, excluding the following, unless it coexists with a diagnosable psychiatric disorder: (i) Developmental disorder; (ii) Substance abuse; and (iii) Disorder classified under the “V” code; and (c) Characterized by a functional impairment that substantially interferes with or limits the child's role or functioning in the family, school, or community activities, including the following: (i) Inability to achieve or maintain one or more developmentally appropriate social, behavioral communicative, or adaptive skills; or (ii) Episodic, recurrent, and continuous functional impairments. (20) “Serious and persistent mental disorder” means a disorder that is: (a) Manifest in an individual 18 years old or older; (b) Diagnosed, according to a current diagnostic and statistical manual of the American Psychiatric Association that is recognized by the Secretary, as: (i) Schizophrenic disorder; (ii) Major affective disorder; (iii) Other psychotic disorder; or (iv) Borderline or schizotypal personality disorders, with the exclusion of an abnormality that is manifested only by repeated criminal or otherwise antisocial conduct; and (c) Characterized by impaired role functioning, on a continuing or intermittent basis, for at least 2 years, including at least three of the following: (i) Inability to maintain independent employment; (ii) Social behavior that results in intervention by the mental health system; (iii) Inability, due to cognitive disorganization, to procure financial assistance to support living in the community; (iv) Severe inability to establish or maintain a personal social support system; (v) Need for assistance with basic living skills. (21) “Therapeutic and psychiatric rehabilitation services for minors” means a program approved under COMAR 10.21.29 or licensed under COMAR 10.63.03.10 . Cross References 10.21.25.02A .03-1 General Reimbursement Conditions. A. Claims Submission. In order to be reimbursed by the Department, an approved provider shall submit a claim when the provider has: (1) Obtained authorization to provide the services for which the claim is being submitted; (2) Delivered the service; (3) Documented provision of service as required; and (4) Complied with any regulatory preconditions for the delivery of the service. B. Claims Retraction. The Department may retract any payments made to any PMHS provider for paid claims if an audit indicates that: (1) The services were not provided; (2) The services were not medically necessary; (3) There is no documentation that the services were provided; (4) The precondition for the delivery of the service was not met; or (5) The provider failed to comply with §H of this regulation . C. If the Department retracts funds from a provider under §B of this regulation , within 30 days following the retraction the Department shall provide notice and an opportunity for a hearing. D. Limitations. (1) The Department shall reimburse, for services delivered on the same service date for the same individual, an outpatient mental health center (OMHC) for a maximum of two therapy sessions subject to the following conditions: (a) Only one may be an individual therapy session; (b) Only one may be a group therapy session; and (c) Only one may be a family therapy session, either with or without the individual. (2) The Department may not reimburse an OMHC for the following services delivered to the same individual on the same service date: (a) Individual therapy with medication management session, and medication management session; (b) Diagnostic interview or assessment, and a treatment planning session; and (c) A diagnostic interview or assessment, and a therapy session. (3) For all other providers, the Department shall reimburse for only one service per service date. (4) Limitations Exception. The Department may provide an exception to the limitation rule on outpatient services if the ASO finds that the service: (a) Is medically necessary; (b) Is not duplicative; and (c) Has been preauthorized. E. The Department shall reimburse Psychiatric Rehabilitation Program services provided to a child residing in a therapeutic group home, as defined in COMAR 10.21.07 when the TGH certifies that its negotiated rate does not include payment for the PRP services. F. The Department may not reimburse outpatient mental health services provided to an individual when the individual is in a hospital or residential treatment center. G. The Department may not reimburse PRP providers until the PRP has met the minimum service encounters as defined in Regulation .09 of this chapter . H. For individual practitioners, when services are preauthorized, the following documentation is required before submitting for payment for services rendered: (1) For each individual served, the medical record, which shall include the following documentation: (a) A signed consent to treatment; (b) A comprehensive assessment that includes the: (i) Individual or family’s presenting problem; (ii) Individual or family’s history; (iii) Individual’s diagnosis; and (iv) Rationale for the diagnosis; and (c) An individualized treatment plan that includes the: (i) Problems, needs, strengths, and goals that are measurable; (ii) Interventions that are medically necessary; and (iii) Signatures of the individual, or if the individual is a minor, the guardian, and the treating mental health professional; and (2) Progress notes for each face-to-face contact including: (a) Date of service; (b) Start time and end time; (c) Location; (d) Summary of interventions provided; and (e) The treating mental health professional’s signature and date of service. I. Services rendered by an individual practitioner may only be reimbursed for the licensed mental health professionals authorized by the practice board to diagnose and treat psychiatric disorders as identified in this chapter of regulations. .03-2 Supplemental Rates. Providers who billed for services rendered from July 1, 2013 until the effective date of these regulations may resubmit their claims and be reimbursed for these services as set forth in Regulations .05 — .12 of this chapter. .04 Ability to Pay. A. Except if an individual is a Medicaid recipient: (1) A provider shall provide to the Administration's designee the information needed to assess an individual's ability to pay; (2) The Administration's designee shall assess the individual's ability to pay and determine the required copayment; and (3) The provider shall make collections of the copayment according to the requirements in Health-General Article, §§16-201 — 16-204, Annotated Code of Maryland. B. The Department shall furnish to a provider, on request, an ability-to-pay schedule, including periodic updates. .05 Fee Schedule — Treatment Services — Diagnosis and Therapy. A. Diagnostic Interview. The Department shall reimburse a provider for a face-to-face diagnostic interview, as follows: (1) For a child or adolescent, when rendered by a provider with demonstrated competency to provide mental health services to children or adolescents: (a) OMHC ... $190.23; (b) Physician ... $151.68; (c) Psychologist ... $121.08; (d) Other mental health professionals ... $106.01; (2) For an adult: (a) OMHC ... $170.32; (b) Physician ... $151.68; (c) Psychologist ... $121.08; (d) Other mental health professional ... $106.01. B. Individual Therapy. The Department shall reimburse a provider for an individual therapy session, as follows: (1) For a child or adolescent, when rendered by a provider with demonstrated competency to provide mental health services to children or adolescents: (a) For 30 minutes: (i) OMHC ... $59.19; (ii) Physician ... $50.05; (iii) Psychologist ... $40.09; (iv) Other mental health professional ... $34.98; (b) For 20 — 30 minutes, with biofeedback training: (i) OMHC ... $50.05; (ii) Physician ... $50.05; (iii) Psychologist ... $40.09; (iv) Other mental health professional ... $34.98; (c) For 45 minutes: (i) OMHC ... $105.20; (ii) Physician ... $90.94; (iii) Psychologist ... $72.65; (iv) Other mental health professional ... $63.77; (d) For 45 — 50 minutes, with biofeedback training: (i) OMHC ... $90.94; (ii) Physician ... $90.94; (iii) Psychologist ... $72.65; (iv) Other mental health professional ... $63.77; (e) For 60 minutes in an OMHC ... $105.20; (2) For an adult: (a) For 30 minutes: (i) OMHC ... $50.05; (ii) Physician ... $50.05; (iii) Psychologist ... $40.09; (iv) Other mental health professional ... $34.98; (b) For 20 — 30 minutes, with biofeedback training: (i) OMHC ... $50.05; (ii) Physician ... $50.05; (iii) Psychologist ... $40.09; (iv) Other mental health professional ... $34.98; (c) For 45 minutes: (i) OMHC ... $90.94; (ii) Physician ... $90.94; (iii) Psychologist ... $72.65; (iv) Other mental health professional ... $63.77; (d) For 45 — 50 minutes, with biofeedback training: (i) OMHC ... $90.94; (ii) Physician ... $90.94; (iii) Psychologist ... $72.65; (iv) Other mental health professional ... $63.77; (e) For 60 minutes in an OMHC ... $90.94. C. Family Therapy. The Department shall reimburse a provider for a family therapy session, as follows: (1) When the identified patient is a child or adolescent and the service is rendered by a provider with demonstrated competency to provide mental health services to children or adolescents: (a) Without the identified patient: (i) OMHC ... $104.13; (ii) Physician ... $85.02; (iii) Psychologist ... $69.96; (iv) Other mental health professional ... $53.81; (b) With the identified patient, for 20 — 30 minutes: (i) OMHC ... $58.65; (ii) Physician ... $58.65; (iii) Psychologist ... $46.82; (iv) Other mental health professional ... $41.17; (c) With the identified patient, for 45 — 60 minutes: (i) OMHC ... $107.62; (ii) Physician ... $94.71; (iii) Psychologist ... $76.41; (iv) Other mental health professional ... $65.64; (2) When the identified patient is an adult: (a) Without the identified patient for 45 — 60: (i) OMHC ... $90.14; (ii) Physician ... $85.02; (iii) Psychologist ... $69.96; (iv) Other mental health professional ... $53.81; (b) With the identified patient, for 45 — 60 minutes: (i) OMHC ... $94.71; (ii) Physician ... $94.71; (iii) Psychologist ... $76.41; (iv) Other mental health professional ... $65.64. D. Group Therapy. The Department shall reimburse a provider for each individual, up to a maximum of 10, in a group therapy session as follows: (1) When the identified patient is a child or adolescent and the service is rendered by a provider with demonstrated competency to provide mental health services to children or adolescents: (a) For 45 — 60 minutes: (i) OMHC ... $40.90; (ii) Physician ... $24.75; (iii) Psychologist ... $24.75; (iv) Other mental health professional ... $24.75; (b) For more than 75 minutes in an OMHC ... $50.58; (2) When the identified patient is an adult: (a) For 45 — 60 minutes: (i) OMHC ... $38.74; (ii) Physician ... $24.75; (iii) Psychologist ... $24.75; (iv) Other mental health professional ... $24.75; (b) For more than 75 minutes in an OMHC ... $50.58. Cross References 10.21.25.03-2 10.21.25.08E(3) .06 Fee Schedule — Additional Treatment Services. A. Psychological Testing. The Department shall reimburse a psychologist for conducting psychological testing, up to a maximum of 8 hours per year per individual as follows: (1) OMHC psychologist ... $99.02 per hour; (2) Other psychologist ... $99.02 per hour; (3) OMHC psychologist associate ... $27.55 per hour; (4) Other psychologist associate ... $27.55 per hour. B. Occupational Therapy. The Department shall reimburse an occupational therapist for providing services, as follows: (1) To an individual, payable in 15-minute increments, for face-to-face: (a) Therapeutic activities ... $11.83 per 15 minutes; (b) Self-care, home management training ... $11.83 per 15 minutes; (c) Community and work reintegration ... $11.83 per 15 minutes; (d) Development of cognitive skills ... $11.83 per 15 minutes; (e) Occupational therapy evaluation and re-evaluation ... $15.07 per 15 minutes; (2) For each individual, up to a maximum of 10, in a group therapy session of a minimum of 60 minutes ... $18.30. C. Physician Services. The Department shall reimburse for services rendered to a child, adolescent, or adult, by an appropriately privileged physician or certified registered nurse practitioner — psychiatric only, as follows: (1) The patient's primary care physician in an inpatient or partial hospital setting: (a) Initial care: (i) For a minimum of 30 minutes ... $108.43; (ii) For a minimum of 50 minutes ... $147.19; (iii) For a minimum of 70 minutes ... $216.47; (b) Subsequent care: (i) For a minimum of 15 minutes ... $41.71; (ii) For a minimum of 25 minutes ... $76.73; (iii) For a minimum of 35 minutes ... $110.63; (c) Discharge day management: (i) For 30 minutes or less ... $77.68; (ii) For more than 30 minutes ... $114.63; (d) For discharge data submission ... $21.53; (e) For individual therapy, in an inpatient setting: (i) For 30 minutes ... $43.78; (ii) For 45 minutes ... $82.30; (2) The patient's primary certified registered nurse practitioner — psychiatric, in an inpatient or partial hospital setting: (a) Initial care: (i) For a minimum of 30 minutes ... $108.43; (ii) For a minimum of 50 minutes ... $147.19; (iii) For a minimum of 70 minutes ... $216.47; (b) Subsequent care: (i) For a minimum of 15 minutes ... $41.71; (ii) For a minimum of 25 minutes ... $76.73; (iii) For a minimum of 35 minutes ... $110.63; (c) Discharge day management: (i) For 30 minutes or less ... $77.68; (ii) For more than 30 minutes ... $114.63; (d) For individual therapy, in an inpatient setting: (i) For 30 minutes ... $30.65; (ii) For 45 minutes ... $57.61; (3) For electroconvulsive therapy, in an inpatient setting: (a) Including monitoring ... $98.39; (b) Anesthesia ... $98.27; (4) A consultant physician, or a consultant certified registered nurse practitioner — psychiatric, in an inpatient or partial hospital setting, initial consult, for a minimum of: (a) 20 minutes ... $51.66; (b) 40 minutes ... $79.60; (c) 55 minutes ... $121.30; (d) 80 minutes ... $174.86; (e) 110 minutes ... $217.80; (5) A consultant physician or a consultant certified registered nurse practitioner — psychiatric, in an outpatient setting: (a) For a minimum of 15 minutes ... $51.49; (b) For a minimum of 30 minutes ... $96.74; (c) For a minimum of 40 minutes ... $131.91; (d) For a minimum of 60 minutes ... $194.98; (e) For a minimum of 80 minutes ... $237.73; .07 Fee Schedule — Special OMHC Services. A. Treatment Planning. The Department shall reimburse an OMHC for providing an OMHC-enrolled individual with one face-to-face treatment planning meeting every 6 months, at the rate of $82.87 per planning meeting. B. Multifamily Group Therapy. The Department shall reimburse an OMHC for providing multifamily group therapy, with the identified patient, for families of: (1) Children and adolescents, for 45 — 60 minutes, with the child present ... $41.98 per family; (2) Children and adolescents, for 20 — 30 minutes, with the child present ... $38.55 per family; (3) Adults, for 45 — 60 minutes, with the adult present ... $39.83 per family; (4) Adults, for 20 — 30 minutes, with the adult present ... $35.75 per family; C. Family Psychoeducation. The Department shall reimburse a provider, when the provider has been approved by the Administration to provide evidence-based services, for a family psychoeducation session with or without the identified adult, at a rate of $53.81 per family. D. Prolonged Services. The Department shall reimburse an OMHC for providing, on-site, prolonged services, face-to-face with the identified patient, as follows: (1) For 30 — 74 minutes ... $106.79; (2) For an additional period of 30 minutes ... $104.10. E. Venipuncture and Injection. The Department shall reimburse an OMHC for providing: (1) Routine venipuncture ... $14.94; (2) Therapeutic injection ... $14.94. F. Intensive Outpatient Services. The Department shall reimburse an OMHC for providing intensive outpatient services, when the services are delivered by a multidisciplinary team for a minimum of 3 hours of therapeutic activities, including needed physician services and at least two group therapies, as follows: (1) For children or adolescents ... $154.17 per day; (2) For adults ... $129.69 per day. G. Discharge Data Submission. The Department shall reimburse an OMHC $21.53 for discharge data submission. .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 . .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. Cross References 10.21.25.03-1G .10 Fee Schedule — Services — Traumatic Brain Injury (TBI) Waiver Program. A. Residential Habilitation Services. The Department shall reimburse a program approved under COMAR 10.09.46 to provide residential habilitation services to an individual who is enrolled in the TBI Waiver Program: (1) At the following rates: (a) Level I ... $192.76 per day; (b) Level II ... $255.24 per day; (c) Level III ... $353.11 per day; (2) According to the need for the level of support documented in an individual's waiver plan of care and approved by the Administration; and (3) According to the institutional level of care determined by the Department's utilization control agent. B. Day Habilitation Services. The Department shall reimburse a program approved under COMAR 10.09.46 to provide day habilitation services to an individual who is enrolled in the TBI Waiver Program: (1) At the following rates: (a) Level I ... $49.76 per day; (b) Level II ... $86.81 per day; (c) Level III ... $122.14 per day; (2) According to the need for the level of support documented in an individual's waiver plan of care and approved by the Administration; and (3) According to the institutional level of care determined by the Department's utilization control agent. C. Supported Employment Services. The Department shall reimburse a program approved under COMAR 10.09.46 to provide supported employment services to an individual who is enrolled in the TBI Waiver Program: (1) At the following rates: (a) Level I ... $29.53 per day; (b) Level II ... $49.76 per day; (c) Level III ... $122.14 per day; (2) According to the need for the level of support documented in an individual's waiver plan of care and approved by the Administration; and (3) According to the institutional level of care determined by the Department's utilization control agent. D. Individual Support Services. The Department shall reimburse a program approved under COMAR 10.09.46 to provide individual support services, as defined in COMAR 10.22.07 , to an individual who is enrolled in the TBI Waiver Program at a rate of $24.14 per hour, not to exceed 8 hours per day. .11 Fee Schedule — Services — Emergency Department. The Department shall reimburse an emergency department for providing emergency mental health services to an individual who is enrolled in the public mental health system, for services rendered by an appropriately privileged physician or certified registered nurse practitioner — psychiatric as follows: A. For a problem focused history, a problem focused examination, and straightforward medical decision making ... $22.27; B. For an expanded problem focused history, an expanded problem focused examination, and medical decision making of low complexity ... $43.80; C. For an expanded problem focused history, an expanded problem focused examination, and medical decision making of moderate complexity ... $65.29; D. For a detailed history, a detailed examination, and medical decision making of moderate complexity ... $124.63; E. For a comprehensive history, a comprehensive examination, and medical decision making of high complexity ... $182.80. .12 Evaluation and Management Services — Including Medication Management. A. New Patients. The Department shall reimburse for evaluation and management services for new patients, including medication management: (1) For a problem focused history, or a problem focused examination, and straightforward medical decision making of minor complexity: (a) OMHC ... $48.70; (b) Physician ... $48.70; (c) Certified registered nurse practitioner — psychiatric ... $48.70; (2) For an expanded problem focused history, or an expanded problem focused examination, and straightforward medical decision making: (a) OMHC ... $82.48; (b) Physician ... $82.48; (c) Certified registered nurse practitioner — psychiatric ... $82.48; (3) For a detailed history, or a detailed examination, and medical decision of low complexity: (a) OMHC ... $119.25; (b) Physician ... $119.25; (c) Certified registered nurse practitioner — psychiatric ... $119.25; (4) For a comprehensive history, or a comprehensive medical examination, with medical decision making of moderate complexity: (a) OMHC ... $181.64; (b) Physician ... $181.64; (c) Certified registered nurse practitioner — psychiatric ... $181.64; (5) For a comprehensive history, or a comprehensive medical examination, with medical decision making of high complexity: (a) OMHC ... $224.53; (b) Physician ... $224.53; (c) Certified registered nurse practitioner — psychiatric ... $224.53. B. Established Patients. The Department shall reimburse for evaluation and management services for established patients, including medication management: (1) For a history, or examination, where presenting problems are minimal, and straightforward medical decision making of minor complexity: (a) OMHC ... $22.72; (b) Physician ... $22.72; (c) Certified registered nurse practitioner — psychiatric ... $22.72; (2) For a problem focused history, or a problem focused examination, and straightforward medical decision making: (a) OMHC ... $48.70; (b) Physician ... $48.70; (c) Certified registered nurse practitioner — psychiatric ... $48.70; (3) For an expanded history, or an expanded examination, and medical decision of low complexity: (a) OMHC ... $80.11; (b) Physician ... $80.11; (c) Certified registered nurse practitioner — psychiatric ... $80.11; (4) For a detailed history, or a detailed medical examination, with medical decision making of moderate complexity: (a) OMHC ... $117.60; (b) Physician ... $117.60; (c) Certified registered nurse practitioner — psychiatric ... $117.60; (5) For a comprehensive history, or a comprehensive medical examination, with medical decision making of high complexity: (a) OMHC ... $157.64; (b) Physician ... $157.64; (c) Certified registered nurse practitioner — psychiatric ... $157.64. Cross References 10.21.25.03-2 .13 Crisis Therapy. The Department shall reimburse an OMHC for crisis therapy, as follows: A. For a child or adolescent, when rendered by a provider with demonstrated competency to provide mental health services to children or adolescents: (1) For the first 60 minutes ... $118.37; (2) For an additional period of 30 minutes ... $61.77; B. For an adult: (1) For the first 60 minutes ... $100.10; (2) For an additional period of 30 minutes ... $54.16.