1. A. General requirements for participation in the Program are that a provider shall:

   1. (1) Comply with requirements set forth in COMAR 10.09.36; and
   2. (2) If delivering services via telehealth, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department.

2. B. To participate in the Program as a residential substance use disorder provider, the provider shall:

   1. (1) Be in compliance with COMAR 10.63.03 as applicable to each ASAM level of care;
   2. (2) Be in compliance with all ASAM requirements for each applicable level of care;
   3. (3) Demonstrate competence in the ability to deliver a minimum of three evidence-based practice services;
   4. (4) Complete all required documentation associated with the application process;
   5. (5) Maintain verification of licenses and credentials, including background checks, of all professionals employed by or under contract with the provider in their respective personnel files;
   6. (6) Maintain staffing within each ASAM level of care as described in §§C—G of this regulation;
   7. (7) Increase staffing within each ASAM level of care at a ratio to correspond with the participant census to meet required ASAM level of service delivery for each patient;

   8. (8) Maintain adequate documentation of each clinical contact with a participant as part of the medical record, which includes, at a minimum:

      1. (a) An individualized treatment plan;
      2. (b) The date of all clinical encounters with start and end times and a description of services provided;
      3. (c) Documentation of all clinical services received by the participant;
      4. (d) Progress notes updated on each day services are provided;
      5. (e) An individualized discharge plan; and
      6. (f) An official e-Signature, or a legible signature, along with the printed or typed name of the individual providing care, with the appropriate degree or title on all clinical progress notes;
   9. (9) Maintain adequate documentation indicating that the participant continues to meet the medical necessity criteria for the applicable ASAM level of care;

   10. (10) Make the documentation required under this subtitle, or necessary to substantiate compliance with this subtitle, available as requested to carry out required activities, to the:

       1. (a) Department;
       2. (b) ASO;
       3. (c) Core Service Agency;
       4. (d) Local addictions authority;
       5. (e) Local behavioral health authority;
       6. (f) Office of Inspector General of the Department; and
       7. (g) Office of the Attorney General Medicaid Fraud Control Unit; and
   11. (11) Comply with all federal statutes and regulations, including the Health Insurance Portability and Accountability Act, 42 U.S.C. §1320D et seq., and implementing regulations at 45 CFR Parts 160 and 164.04 Participant Eligibility and Referral.

3. C. A residential, low-intensity level 3.1 provider shall:

   1. (1) Provide therapeutic services for a minimum of 5 hours per week;

   2. (2) Coordinate aftercare services through:

      1. (a) Peer support; or
      2. (b) A licensed provider;

   3. (3) At a minimum, maintain the following staff:

      1. (a) A part-time program director on-site 20 hours per week;

      2. (b) A clinical director serving the program 20 hours per week who:

         1. (i) May also be the program director;
         2. (ii) Is responsible for the supervision of the program’s clinical services, counselors, peer support staff, and coordination of all care provided by outside programs; and
         3. (iii) Is identified under COMAR 10.09.59.04 as an individual practitioner provider or certified and approved by the Board of Professional Counselors and Therapists as a supervisor;
      3. (c) A licensed or certified counselor on-site 40 hours per week;
      4. (d) Peer support staff; and

      5. (e) At least one staff member on duty between 11 p.m. and 7 a.m. who is:

         1. (i) Certified in cardiopulmonary resuscitation;
         2. (ii) Certified in Narcan administration; and
         3. (iii) Trained in crisis intervention.

4. D. A residential, medium intensity level 3.3 provider shall:

   1. (1) Have sufficient physician, physician assistant, or nurse practitioner services to:

      1. (a) Provide initial diagnostic work-up;
      2. (b) Provide identification of medical and surgical problems for referral; and
      3. (c) Handle medical emergencies when necessary;
   2. (2) Provide therapeutic activities from 20 to 35 hours per week;

   3. (3) Coordinate aftercare services through:

      1. (a) Peer support; or
      2. (b) Licensed provider;

   4. (4) Have at least one staff member:

      1. (a) Certified in cardiopulmonary resuscitation;
      2. (b) Trained in crisis intervention; and
      3. (c) On duty between 11 p.m. and 7 a.m.;
   5. (5) Have a part-time facility director on-site 20 hours per week; and

   6. (6) At a minimum, maintain the following staff:

      1. (a) A physician, nurse practitioner, or physician assistant on-site 4 hours per week and 1 hour on call;
      2. (b) A psychiatrist or psychiatric nurse practitioner available 3 hours per week;
      3. (c) A registered nurse or licensed practical nurse on-site 40 hours per week; and

      4. (d) An on-site multi-disciplinary team consisting of:

         1. (i) A clinical supervisor;
         2. (ii) A licensed mental health clinician;
         3. (iii) A certified counselor under direct supervision of a counselor approved by the Board of Professional Counselors and Therapists as a supervisor; and
         4. (iv) Peer support staff.

5. E. A residential, high intensity level 3.5 provider shall:

   1. (1) Have sufficient physician, physician assistant, or nurse practitioner services to:

      1. (a) Provide initial diagnostic work-up;
      2. (b) Provide identification of medical and surgical problems for referral; and
      3. (c) Handle medical emergencies when necessary;
   2. (2) Provide a minimum of 36 hours of therapeutic activities per week;

   3. (3) Coordinate aftercare services through:

      1. (a) Peer support; or
      2. (b) A licensed provider;

   4. (4) Have at least one staff member:

      1. (a) Certified in cardiopulmonary resuscitation;
      2. (b) Trained in crisis intervention; and
      3. (c) On duty between 11 p.m. and 7 a.m.;
   5. (5) Have a part-time facility director on-site 20 hours per week; and

   6. (6) At a minimum, have the following staff:

      1. (a) A physician, nurse practitioner, or physician assistant on-site 1 hour per week;
      2. (b) A psychiatrist or psychiatric nurse practitioner available 1 hour per week;

      3. (c) An on-site multi-disciplinary team consisting of:

         1. (i) A clinical supervisor;
         2. (ii) A licensed mental health clinician;
         3. (iii) Certified counselors under direct supervision of a counselor approved by the Board of Professional Counselors and Therapists as a supervisor; and
         4. (iv) Peer support staff.

6. F. A residential, intensive level 3.7 provider shall:

   1. (1) Have sufficient physician, physician assistant, or nurse practitioner services to:

      1. (a) Provide initial diagnostic work-up;
      2. (b) Provide identification of medical and surgical problems for referral; and
      3. (c) Handle medical emergencies when necessary;
   2. (2) Provide a minimum of 36 hours of therapeutic activities per week;

   3. (3) Coordinate aftercare services through:

      1. (a) Peer support; or
      2. (b) Licensed provider;

   4. (4) Have at least two staff members:

      1. (a) Certified in cardiopulmonary resuscitation;
      2. (b) Trained in crisis management; and
      3. (c) On duty between 11 p.m. and 7 a.m.;
   5. (5) Have a part-time facility director on-site 20 hours per week; and

   6. (6) At a minimum, have on staff a:

      1. (a) Physician, nurse practitioner, or physician assistant on-site 5 hours per week and 2 hours on call;
      2. (b) Psychiatrist or psychiatric nurse practitioner available 10 hours per week;
      3. (c) Nurse on-site 168 hours per week, with a minimum of 56 hours provided by a registered nurse;

      4. (d) On-site multi-disciplinary team consisting of:

         1. (i) A clinical supervisor;
         2. (ii) A licensed mental health clinician;
         3. (iii) Certified counselors under direct supervision of a counselor approved by the Board of Professional Counselors and Therapists as a supervisor; and
         4. (iv) Peer support staff.

7. G. A withdrawal management service level 3.7-WM provider shall:

   1. (1) Have a part-time facility director on-site 20 hours per week;

   2. (2) Coordinate aftercare services through:

      1. (a) Peer support; or
      2. (b) Licensed provider; and

   3. (3) At a minimum, have on staff:

      1. (a) A physician, nurse practitioner, or physician assistant on-site 20 hours per week and 4 hours on call;
      2. (b) A psychiatrist or psychiatric nurse practitioner available 8 hours per week;
      3. (c) A registered nurse on-site 56 hours per week;
      4. (d) A licensed practical nurse on-site 112 hours per week; and

      5. (e) An on-site multi-disciplinary team consisting of:

         1. (i) A clinical supervisor;
         2. (ii) A licensed mental health clinician;
         3. (iii) Certified counselors under direct supervision of a counselor approved by the Board of Professional Counselors and Therapists as a supervisor; and
         4. (iv) Peer support staff.

Authority: Health-General Article, §§2-104(b), 7.5-204(c), 7.5-205(d), 15-105(b), and 15-141.2, Annotated Code of Maryland

Effective date: September 11, 2017 (44:18 Md. R. 865)

Regulation .02B amended effective April 4, 2022 (49:7 Md. R. 465); October 16, 2023 (50:20 Md. R. 886)

Regulation .03C amended effective April 4, 2022 (49:7 Md. R. 465)

Regulation .04 amended effective December 31, 2018 (45:26 Md. R. 1242)

Regulation .04A amended effective October 16, 2023 (50:20 Md. R. 886)

Regulation .06 amended effective December 31, 2018 (45:26 Md. R. 1242)

Regulation .06F adopted effective October 16, 2023 (50:20 Md. R. 886)

Regulation .07 amended effective December 30, 2019 (46:26 Md. R. 1164); October 16, 2023 (50:20 Md. R. 886)

Regulation .09 amended effective October 16, 2023 (50:20 Md. R. 886); September 16, 2024 (51:18 Md. R. 808)

Regulation .09C amended effective December 31, 2018 (45:26 Md. R. 1242); December 30, 2019 (46:26 Md. R. 1164); April 4, 2022 (49:7 Md. R. 465)

Regulation .09D—E amended effective April 4, 2022 (49:7 Md. R. 465); November 24, 2025 (52:23 Md. R. 1138)