Sec. 10.09.29.03. General Conditions for Participation

To participate in the Program as a residential treatment center for emotionally disturbed children and adolescents, a provider shall:

A. Meet the requirements for participation as defined in 42 CFR §440.160 (inpatient psychiatric services for individuals under 21 years old) and have acute psychiatric services that meet the requirements of 42 CFR Part 441, Subpart D (inpatient psychiatric services for individuals under 21 years old in psychiatric facilities or programs).

B. Be accredited by the Joint Commission on Accreditation of Healthcare Organizations.

C. Meet the applicable conditions and requirements of Regulation .04 of this chapter.

D. Apply for participation in the Program by completing the application form designated by the Program.

E. Be approved for participation and be assigned a provider account number by the Department.

F. Have a current written agreement with the Program.

G. Verify the licenses and credentials of all professionals employed by or under contract with the residential treatment center to provide services.

H. Verify the recipient's eligibility.

I. Provide services without regard to race, color, age, sex, national origin, marital status, or physical or mental handicap, unless limitations are those specifically required by 42 CFR Subpart D.

J. Place no restriction on a recipient's right to select providers of the recipient's choice.

K. Have a written individual plan of care for each recipient as specifically defined by 42 CFR §441.155, and developed by an interdisciplinary team of physicians and other personnel as required in 42 CFR §441.156. The plan shall be reviewed every 30 days by the team to determine that services being provided are or were required on an inpatient basis, and recommend changes in the plan as indicated by the recipient's overall adjustment as an inpatient. The team shall be capable of:

(1) Assessing the recipient's immediate and long-range therapeutic needs, developmental priorities, and personal strengths and liabilities;

(2) Assessing the potential resources of the recipient's family which includes the recipient's parents, legal guardians, or others in whose care the recipient will be released after discharge;

(3) Setting treatment objectives; and

(4) Prescribing therapeutic modalities to achieve the plan's objectives.

L. Employ for purposes of developing an individual plan of care an interdisciplinary team which shall:

(1) Include as a minimum:

(a) A Board-eligible or Board-certified psychiatrist,

(b) A clinical psychologist who has a doctoral degree and a physician licensed to practice medicine or osteopathy, or

(c) A physician licensed to practice medicine or osteopathy with specialized training and experience in the diagnosis and treatment of mental diseases, and a psychologist who has a master's degree in clinical psychology or who has been certified by the State or by the State psychological association;

(2) Include one of the following:

(a) A psychiatric social worker,

(b) A registered nurse with specialized training or 1 year's experience in treating mentally ill individuals,

(c) An occupational therapist who is licensed, if required by the State, and who has specialized training or 1 year of experience in treating mentally ill individuals,

(d) A psychologist who has a master's degree in clinical psychology or who has been certified by the State or by the State psychological association.

M. Maintain adequate administrative and medical records for a minimum of 6 years and make them available upon request to the Department or its designee. Adequate administrative and medical records are defined as having documentation sufficient in quantity, scope, and detail to confirm that the residential treatment center services are provided in accordance with this regulation.

N. Not knowingly contract or employ a person, partnership, or corporation which has been disqualified from the Program to provide or supply services to Medical Assistance recipients unless prior written approval has been received from the Department.

O. Accept payment by the Department as payment in full for services rendered and make no additional charge to any person for covered service.

P. Agree that if the Program denies payment or requests repayment on the basis that an otherwise covered service was not medically necessary or preauthorized, the provider may not seek payment for that service from the recipient or his family.

Q. Agree that if the Program denies payment due to late billing, the provider may not seek payment from the recipient or his family.

R. Meet the requirements for admission to regional institutes for children and adolescents, established by COMAR 10.21.06.

S. Agree that if the Program denies payment due to the provider's failure to satisfy mandatory federal requirements as specified in 42 CFR Part 441, Subpart D-Inpatient Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs, the provider may not seek payment from the recipient or his family.

T. Comply with all requirements for the delivery of mental health services contained in COMAR 10.67.08.