Sec. 10.09.33.04. Conditions for Health Home Provider Participation

To be eligible as a health home, a provider shall:

A. Meet the conditions for provider participation in the Medical Assistance Program, as set forth in COMAR 10.09.36.03;

B. Meet the approval requirements set forth in Regulation .02 of this chapter;

C. Be accredited by, or demonstrate evidence of having started the accreditation process from, an approved accrediting body as a health home;

D. For PRP and MTS health homes serving minors, demonstrate a minimum of 3 years of experience serving minors, which may be achieved as an independent practice or as a member of a broader agency, with exceptions designated by the Department;

E. At the time of enrollment as a health home, be registered or be able to provide documentation of starting the process of registration with CRISP in order to receive hospital encounter alerts;

F. At the time of enrollment as a health home, be registered or be able to provide documentation of starting the process of registration with one of the following organizations in order to receive access to real-time pharmacy data for participants:

(1) CRISP; or

(2) The State’s ASO;

G. At the time of enrollment as a health home, have an internal protocol for reviewing and responding to hospital encounter alerts and pharmacy use data;

H. Directly provide, or subcontract for the provision of, health home services to all participants;

I. Maintain an electronic database with the ability to, at minimum:

(1) Maintain an up-to-date list of all health home participants and their contact information; and

(2) Record and review clinical appointments;

J. Maintain a file for each participant that includes:

(1) A form signed by the participant consenting to participate in the health home, including the program’s data-sharing elements;

(2) An initial assessment of the participant’s health and social services needs, as described in Regulation .06B(1)(a) of this chapter; and

(3) A care plan, updated every 6 months, which may be combined with the existing MTS, PRP, or OTP care plan, and includes, at a minimum:

(a) The participant’s health home goals;

(b) Time frames for meeting the health home goals;

(c) Proposed interventions for meeting the health home goals;

(d) Relevant community networks and supports;

(e) Optimal clinical outcomes for the participant; and

(f) Signatures of:

(i) The participant or the participant’s parent or guardian; and

(ii) The nurse care manager to whom the participant has been assigned in the health home;

K. Safeguard the confidentiality of the participants’ records in accordance with State and federal laws and regulations;

L. Provide on-call and crisis intervention services by telephone 24 hours a day, 7 days a week to participants and, as appropriate, their caregivers, or if the participant is a minor, the minor’s parent or guardian;

M. Be responsible for meeting all health home service requirements, including services performed by a business or individual subcontracted to provide such services;

N. Convene health home staff meetings every 6 months, at minimum, to plan and implement goals and objectives of functioning as a health home;

O. Collaborate with MCOs and the ASO to improve participant outcomes; and

P. Agree to participate in federal and State-required evaluation activities, including:

(1) Using eMedicaid or another Department-approved health information tool that feeds into eMedicaid to:

(a) Input information related to participants’ services and health at least monthly;

(b) Generate monthly reports documenting:

(i) Health home service delivery; and

(ii) Participants’ health and social outcomes; and

(c) Update participant diagnoses and outcomes every 6 months; and

(2) Completing and submitting to the Department a program assessment every 6 months to demonstrate that:

(a) All staffing and other regulatory requirements are being met; and

(b) A quality improvement plan is being implemented.