1. A. An eligible individual may not receive services from a health home provider that is not the individual’s PRP, MTS, or OTP provider.

2. B. Health home services do not restrict or otherwise affect:

   1. (1) Eligibility for Title XIX benefits or other available benefits or programs, except as limited by §E of this regulation;
   2. (2) The freedom of a participant to select from all available services for which the participant is found to be eligible; or
   3. (3) A participant’s free choice among providers in the Medical Assistance Program.

3. C. The Department may not reimburse the health home provider for:

   1. (1) Activities that have already been billed to or counted towards a service requirement for another Medical Assistance Program or other program;
   2. (2) Activities not consistent with the definition of health home services under this chapter;
   3. (3) Activities delivered as part of institutional discharge planning that are not comprehensive transitional care services delivered by the health home;
   4. (4) A participant’s health home monthly rate more than once per month;
   5. (5) A participant’s health home monthly rate when the intake encounter is utilized by the provider as one of the two required monthly service encounters;

   6. (6) A participant’s health home monthly rate when the provider counts two encounters as having the same date of service, unless:

      1. (a) The modality of the two encounters is different because one was an individual encounter and one was a group encounter; or
      2. (b) The encounters are distinguishable by both the time at which they were rendered and the subject matter discussed; or
   7. (7) The health home monthly rate when the two required services were both rendered as group services.

4. D. The Department may not reimburse for monthly health home services unless the individual receiving health home services:

   1. (1) Is Medicaid eligible at the time of service delivery and engaged in treatment or rehabilitation with either OTP or PRP or MTS services;
   2. (2) Is enrolled as a health home member at the billing health home provider; and
   3. (3) Has received a minimum of two health home services in the stated month that has been documented in the ASO system.
5. E. Reimbursement will not be made for health home services if the participant is receiving a comparable service under another Medical Assistance Program or other program.
6. F. A participant’s health home provider may not be the participant’s family member.

Authority: Health-General Article, §§2-104(b), 7.5-204, 7.5-205(d), 7.5-402, 8-204(c), 15-103, and 15-105(b), Annotated Code of Maryland

Effective date: September 30, 2013 (40:19 Md. R. 1544)

Regulation .01B amended effective July 7, 2014 (41:13 Md. R. 752); November 13, 2023 (50:22 Md. R. 973); May 11, 2026 (53:9 Md. R. 412)

Regulation .02 amended effective November 13, 2023 (50:22 Md. R. 973)

Regulation .04 amended effective November 24, 2014 (41:23 Md. R. 1372)

Regulation .04P amended effective May 11, 2026 (53:9 Md. R. 412)

Regulation .06B amended effective November 13, 2023 (50:22 Md. R. 973)

Regulation .06C, H amended effective May 11, 2026 (53:9 Md. R. 412)

Regulation .07 amended effective May 11, 2026 (53:9 Md. R. 412)

Regulation .07A amended effective November 13, 2023 (50:22 Md. R. 973)

Regulation .08C amended effective April 4, 2022 (49:7 Md. R. 465), May 11, 2026 (53:9 Md. R. 412)

Regulation .08D amended effective May 11, 2026 (53:9 Md. R. 412)

Regulation .09 amended effective April 4, 2022 (49:7 Md. R. 465)

Regulation .09B amended effective May 11, 2026 (53:9 Md. R. 412)

Regulation .09C amended effective October 24, 2016 (43:21 Md. R. 1166); January 1, 2018 (44:26 Md. R. 1215); December 30, 2019 (46:26 Md. R. 1164); November 13, 2023 (50:22 Md. R. 973); September 16, 2024 (51:18 Md. R. 808); November 10, 2025 (52:22 Md. R. 1095)