COMAR 10.09.16

Chapter 16 Behavioral Health Crisis Services

This Maryland Medicaid chapter governs reimbursement and provider participation requirements for two behavioral health crisis service types: mobile crisis teams and behavioral health crisis stabilization centers. Providers must meet licensure standards under COMAR 10.63, maintain 24/7 availability, document all participant contacts, and follow specific staffing and service delivery requirements. Crisis stabilization centers must also maintain withdrawal management and medication-assisted treatment initiation capabilities and accept both voluntary and emergency-petition individuals. Reimbursement is capped at 23 hours 59 minutes per stay for stabilization center services.

Code of Maryland Regulations

Chapter 16 Behavioral Health Crisis Services

Administrative History

Effective date: May 27, 2024 (51:10 Md. R. 525)

Regulation .07C
 amended effective July 7, 2025 (52:13 Md. R. 655)

Regulation .07D
 adopted effective July 7, 2025 (52:13 Md. R. 655)

Authority

Health-General Article, §§2-104(b), 2-105(b), 15-103, and 15-105, Annotated Code of Maryland

.01 Definitions.

A.
 In this chapter, the following terms have the meanings indicated.

B.
 Terms Defined.

(1)
 “Administrative Services Organization (ASO)” means the contractor procured by the State to provide the Department with administrative support services to operate the Maryland Public Behavioral Health System.

(2)
 “Behavioral Health Administration (BHA)” means the administration within the Department that establishes regulatory requirements that behavioral health programs are to maintain in order to become licensed by the Department.

(3)
 “Core Service Agency” means the local mental health authority responsible for planning, managing, and monitoring public mental health services at the local level.

(4)
 “Crisis” means the experience of stress, emotional or behavioral symptoms, difficulties with substance use, or a traumatic event that compromises an individual’s ability to function within their current family and living situation, school, workplace, or community, as defined by the individual experiencing the crisis.

(5)
 “Crisis intervention” means the ability to perform or provide crisis assessment, crisis de-escalation, psychoeducation, brief behavioral support, and referral and linkage to appropriate services and supports.

(6)
 “Department” means the Maryland Department of Health, as defined in 
COMAR 10.09.36.01
, or its authorized agents acting on behalf of the Department.

(7)
 “Licensed mental health professional” means a:

(a)
 Psychiatrist;

(b)
 Licensed psychologist;

(c)
 Psychiatric nurse practitioner (CRNP-PMH);

(d)
 Clinical nurse specialist in psychiatric and mental health nursing (APRN-PMH);

(e)
 Licensed certified social worker-clinical (LCSW-C);

(f)
 Licensed clinical alcohol and drug counselor (LCADC);

(g)
 Licensed clinical marriage and family therapist (LCMFT);

(h)
 Licensed clinical professional art therapist (LCPAT);

(i)
 Licensed clinical professional counselor (LCPC); or

(j)
 Properly supervised:

(i)
 Licensed master social worker (LMSW);

(ii)
 Licensed graduate alcohol and drug counselor (LGADC);

(iii)
 Licensed graduate marriage and family therapist (LGMFT);

(iv)
 Licensed graduate professional art therapist (LGPAT);

(v)
 Licensed graduate professional counselor (LGPC);

(vi)
 Licensed certified social worker (LCSW); or

(vii)
 Psychology associate.

(8)
 “Medical Assistance” has the meaning stated in 
COMAR 10.09.24.02
.

(9)
 “Medically necessary” has the meaning stated in 
COMAR 10.09.36.01
.

(10)
 “Participant” means an individual who is certified as eligible for, and is receiving, Medical Assistance benefits.

(11)
 “Program” has the meaning stated in 
COMAR 10.09.36.01
.

(12)
 “Provider” means an organization or an individual practitioner furnishing the services covered under this chapter which, through appropriate agreement with the Department, has been identified as a Program provider by the issuance of a provider account number.

Cross References

10.09.16.04A

.02 License Requirements.

To participate in the Program, a provider shall meet the license requirements stated in 
COMAR 10.09.36.02
, 
10.63.01.05
, and 
10.63.02.03
.

.03 Provider Requirements for Participation.

A.
 A provider shall meet all conditions for participation as set forth in 
COMAR 10.09.36.03
.

B.
 To participate in the Program, a provider of behavioral health crisis services shall:

(1)
 Meet the conditions for licensure and practice as set forth in 
COMAR 10.63.01
, 
10.63.02
, and 
10.63.06
;

(2)
 Have clearly defined and written patient care policies;

(3)
 Maintain, either manually or electronically, adequate documentation of each contact with a participant as part of the medical record, which, at a minimum, meets the following requirements:

(a)
 Includes the date of service with service start and end times;

(b)
 Includes the participant’s primary behavioral health complaint or reason for the visit;

(c)
 Includes a brief description of the service provided, including progress notes;

(d)
 Includes an official e-Signature, or a legible signature, along with the printed or typed name, and appropriate title of each individual providing services, including each separate member of the mobile crisis team;

(e)
 Is made available to the Department or its designee as requested; and

(f)
 Complies with all federal statutes and regulations, including but not limited to the Health Insurance Portability and Accountability Act, 42 U.S.C. §1320D et seq., and implementing regulations at 45 CFR Part 2 and 45 CFR Parts 160 and 164.04.

C.
 To participate in the Program, a mobile crisis team provider shall:

(1)
 Comply with 
COMAR 10.63.03.20
;

(2)
 Be available to provide services outlined in 
Regulation .05 of this chapter
 24 hours a day, 7 days a week;

(3)
 Provide a timely response with a two-person team as described in 
COMAR 10.63.03.20
;

(4)
 Comply with staffing and supervision requirements as described in 
COMAR 10.63.03.20F
; and

(5)
 Ensure all crisis team staff members receive training as required and approved by the Department.

D.
 To participate in the Program, a behavioral health crisis stabilization center provider shall:

(1)
 Comply with 
COMAR 10.63.03.21
;

(2)
 Be open and accessible to walk-ins 24 hours a day, 7 days a week;

(3)
 Comply with the staffing requirements described in 
COMAR 10.63.03.21E
;

(4)
 Maintain the ability to initiate withdrawal management capabilities for all substances as well as initiate medication assisted treatment for opioid use disorder; and

(5)
 Equally accept individuals presenting due to an emergency petition and individuals presenting voluntarily.

.04 Participant Eligibility.

A.
 A participant is eligible for mobile crisis team services and behavioral health crisis stabilization center services if they are experiencing a crisis as defined in 
Regulation .01 of this chapter
.

B.
 A participant is eligible for behavioral health crisis services if the service is appropriate to the specific provider type listed in 
Regulation .05 of this chapter
.

.05 Covered Services.

A.
 The Department shall reimburse for the services in §§B—C of this regulation when these services have been documented, pursuant to the requirements in this chapter, as necessary.

B.
 Mobile crisis team services shall:

(1)
 Comply with 
COMAR 10.63.03.20
;

(2)
 Consist of an in-person response by at minimum a two-person team;

(3)
 Include an initial assessment by a licensed mental health professional, which may be rendered via telehealth only when the licensed mental health professional functions as a third team member;

(4)
 Involve the following interventions and objectives:

(a)
 Crisis intervention and stabilization of the individual’s behavioral health crisis;

(b)
 Safety planning; and

(c)
 Referrals to community supports, including behavioral health providers, health providers, or social and other services; and

(5)
 Include mobile crisis follow-up outreach by means of telephone, telehealth, or in-person contact with the individual served, family members, caregivers, or referred providers.

C.
 Behavioral health crisis stabilization center services shall:

(1)
 Comply with 
COMAR 10.63.03.21
;

(2)
 Consist of an initial nursing assessment and physical exam by a registered nurse in collaboration with a physician or psychiatric nurse practitioner;

(3)
 Include an initial evaluation by an approved physician or psychiatric nurse practitioner in accordance with 
COMAR 10.63.03.21F
;

(4)
 Include a crisis assessment completed by a licensed mental health professional; and

(5)
 Involve the following interventions and objectives:

(a)
 Crisis intervention and stabilization of the individual’s behavioral health crisis;

(b)
 Safety planning;

(c)
 Pharmacological interventions, including the ability to initiate withdrawal management capabilities for all substances, and initiate medications for medication assisted treatment for opioid use disorder; and

(d)
 Referrals to community-based services or to higher levels of care as clinically indicated.

Cross References

10.09.16.03C(2)

10.09.16.04B

10.09.16.06A(1)

10.09.16.06A(7)

.06 Limitations.

A.
 The Program does not cover the following:

(1)
 Services not delivered in compliance with 
Regulation .05 of this chapter
;

(2)
 Services not medically necessary;

(3)
 Investigational or experimental drugs and procedures;

(4)
 Services solely for the purpose of:

(a)
 Prescribing medication;

(b)
 Administering medication;

(c)
 Drug or supply pick-up;

(d)
 Collecting laboratory specimens;

(e)
 Interpreting laboratory tests or panels; or

(f)
 Administering injections;

(5)
 Separate reimbursement to an employee of a program for services that have been provided by and reimbursed directly to a program;

(6)
 Services provided to or for the primary benefit of individuals other than the participant;

(7)
 Mobile crisis team services rendered by telehealth with the exception of those specified as permissible via telehealth in 
Regulation .05 of this chapter
;

(8)
 Behavioral health crisis stabilization center services rendered by telehealth with the exception of those specified in 
COMAR 10.63.03.21
;

(9)
 Services provided to participants in a hospital inpatient setting; and

(10)
 Services rendered but not appropriately documented.

B.
 Providers may not be reimbursed by the Program for:

(1)
 Behavioral health crisis stabilization center services exceeding 23 hours 59 minutes;

(2)
 Presumptive and definitive drug testing when billed by a behavioral health crisis stabilization center; or

(3)
 Transportation costs.

.07 Payment Procedures.

A.
 General policies governing payment procedures that are applicable to all providers are set forth in 
COMAR 10.09.36.04
.

B.
 Billing time limitations for claims submitted under this chapter are set forth in 
COMAR 10.09.36.06
.

C.
 For dates of service June 1, 2024 through June 30, 2024, rates for the services outlined in this chapter shall be as follows:

(1)
 For services delivered through a mobile crisis team:

(a)
 Mobile crisis team services — $111.80 per 15-minute unit increment; and

(b)
 Mobile crisis follow-up outreach — $111.80 per 15-minute unit increment.

(2)
 For services delivered through a behavioral health crisis stabilization center:

(a)
 Behavioral health crisis stabilization services — $721.21 per diem; and

(b)
 Office-based evaluation and management services, according to 
COMAR 10.09.02.07D
.

D.
 For dates of service beginning July 1, 2024, rates for the services outlined in this chapter shall be as follows:

(1)
 For services delivered through a mobile crisis team:

(a)
 Mobile crisis team services — $115.15 per 15-minute unit increment; and

(b)
 Mobile crisis follow-up outreach — $115.15 per 15-minute unit increment.

(2)
 For services delivered through a behavioral health crisis stabilization center:

(a)
 Behavioral Health Crisis Stabilization Center — $742.85 per diem; and

(b)
 Office-based evaluation and management services, according to 
COMAR 10.09.02.07D
.

.08 Recovery and Reimbursement.

Recovery and reimbursement are as set forth in 
COMAR 10.09.36.07
.

.09 Cause for Suspension or Removal and Imposition of Sanctions.

Cause for suspension or removal and imposition of sanctions are as set forth in 
COMAR 10.09.36.08
.

.10 Appeal Procedures for Providers.

Appeal procedures for providers are as set forth in 
COMAR 10.09.36.09
.

.11 Appeal Rights — Denial of Services.

Appeal procedures for applicants and participants are as set forth in 
COMAR 10.01.04
.

.12 Interpretive Regulation.

State regulations are interpreted as set forth in 
COMAR 10.09.36.10
.