Maryland Register

Issue Date:  September 28, 2018

Volume 45 • Issue 20 • Page 926-927


Title 10 


10.09.06 Adult Residential Substance Use Disorder Services

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

Notice of Proposed Action


     The Secretary of Health proposes to amend Regulations .04.06, and .09 under COMAR 10.09.06 Adult Residential Substance Use Disorder Services.

Statement of Purpose

The purpose of this action is to add staffing, service, and billing requirements for substance use disorder (ASAM Level 3.1) providers, in accordance with the Department’s 1115 waiver amendment.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. Since these services will begin January 1, 2019, the total impact of this proposal on general funds in FY 2019 will be $4,722,990.61. In FY 2020, the total impact of this proposal on general funds for a full year of services will be $9,445,981.22. Therefore, the total magnitude reflects the sum of the economic impacts for FYs 2019 and 2020.

Currently, the Maryland Department of Health (MDH) pays for 3.1 services with State-funded grants through the Behavioral Health Administration (BHA). These grants totaled $6,242,482 in State funds for FY 17. Assuming a 20 percent increase in the number of treatment days reimbursed and that 66 percent of the grant funded reimbursement was specifically for therapeutic treatment (as opposed to room and board), the Department estimates an increase in expenditures for therapeutic treatment to be $5,230,575.67 (BHA and MA combined). The rate for ASAM level 3.1 therapeutic services was based on the staffing requirements for this level of care. This economic impact also accounts for the additional cost of room and board associated with increased treatment days; the Department estimates this will cost $4,215,405.55.



Revenue (R+/R-)


II. Types of Economic Impact.

Expenditure (E+/E-)




A. On issuing agency:



B. On other State agencies:


C. On local governments:




Benefit (+)
Cost (-)




D. On regulated industries or trade groups:



E. On other industries or trade groups:


F. Direct and indirect effects on public:


III. Assumptions. (Identified by Impact Letter and Number from Section II.)

A. and D. This amount assumes:

(1) The magnitude of economic impact for FY 2019 is equal to half the total economic impact for a full year of services;

(2) A 20 percent increase in the number of treatment days reimbursed due to expanded access;

(3) 66 percent of the grant funded reimbursement for FY 17 was specifically for the therapeutic portion of the rate and 33 percent was specifically for the room and board portion; and

(4) Regarding room and board, that the current breakdown of the patient population and the current rates for each of the three population groups receiving services in ASAM Level 3.3 are: Pregnant Women/Women with Children (10 percent —$70.72), 8507 (14 percent —$60.01), and the general population (76 percent —$45.84)

Economic Impact on Small Businesses

The proposed action has minimal or no economic impact on small businesses.

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499, or email to, or fax to 410-767-6483. Comments will be accepted through October 29, 2018. A public hearing has not been scheduled.

.04 Conditions for Participation

A. (text unchanged)

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

(1)—(5) (text unchanged)

(6) Maintain staffing within each ASAM level of care as described in [§§C—F§§C—G of this regulation;

(7)—(11) (text unchanged)

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

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

(2) Coordinate aftercare services through:

(a) Peer support; or

(b) A licensed provider;

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

(a) A part-time facility director on-site 20 hours per week;

(b) A supervisor who:

(i) Is on-site 40 hours per week;

(ii) May also be the facility director if 20 hours per week are spent as the facility director and 20 hours per week are spent as the supervisor;

(iii) Is responsible for the supervision of the facility’s clinical services, counselors, peer support staff, and coordination of all care provided by outside programs; and

(iv) Is identified under COMAR as an individual practitioner provider or certified and approved by the Board of Professional Counselors and Therapists as a supervisor;

(c) Peer support staff; and

(d) At least one staff member who is certified in cardiopulmonary resuscitation, and who has been trained in crisis intervention to be on duty between 11 p.m. and 7 a.m.

[C.] D.[F.] G. (text unchanged)

.06 Covered Services.

A. A residential, low intensity level 3.1 provider shall provide:

(1) Therapeutic substance use disorder treatment for a minimum of 5 hours per week; and

(2) Services in a structured environment in combination with low-intensity treatment and ancillary services to support and promote recovery.

[A.] B.[D.] E. (text unchanged)

.09 Payment Procedures.

A.—B. (text unchanged)

C. Effective July 1, 2017, rates for the services outlined in this chapter shall be as follows[.]:

(1) For ASAM Level 3.1, the provider shall receive $85 per diem;

[(1)] (2)—[(4)] (5) (text unchanged)

D. (text unchanged)

Secretary of Health