Maryland Register

Issue Date:  September 14, 2018

Volume 45 • Issue 19 • Pages 877—878



Title 10 


10.09.59 Specialty Mental Health Services

Authority: Health-General Article, §§2-104(b), 2-105(b), 15-103, 15-105, and 15-105.2 Annotated Code of Maryland

Notice of Proposed Action


     The Secretary of Health proposes to amend Regulations .04 and .07 under COMAR 10.09.59 Specialty Mental Health Services.

Statement of Purpose

The purpose of this action is to:

(1) Allow a psychiatrist in Assertive Community Treatment (ACT) and Mobile Treatment to provide services via telehealth, in accordance with 2018 SB 704 (Ch. 691);

(2) Add licensed clinical art therapists (LCPAT) to the list of licensed mental health professionals whose services Maryland Medicaid will reimburse;

(3) Remove occupational therapists from the specialty mental health chapter to eliminate duplication; and

(4) Remove references to BHA regulations under COMAR 10.21 which will be repealed later this year.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

The proposed action has no economic impact.

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, Maryland Department of Health, 201 W. Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to, or fax to 410-767-6483. Comments will be accepted through October 15, 2018. A public hearing has not been scheduled.

.04 Provider Requirements for Participation.

A. Individual Practitioner Providers. To participate in the Program as an individual practitioner of specialty mental health services, the provider shall:

(1) (text unchanged)

(2) Demonstrate, by training and experience, the competency to provide mental health services as one of the following:

(a)—(d) (text unchanged)

[(e) An occupational therapist]

[(f)] (e) (text unchanged)

[(g)] (f) A licensed certified counselor which includes:

(i) (text unchanged)

(ii) A licensed marriage and family therapist; [or]

(iii) A licensed counselor-alcohol and drug; or

(iv) A licensed clinical professional art therapist;

(h)—(i) (text unchanged)

B. Community Mental Health Program Providers. To participate in the Program as a community-based mental health program provider, the provider shall be approved under [COMAR 10.21.16 or] COMAR 10.63.01, 10.63.02, and 10.63.06[, whichever is applicable,] and possess licensure by the Behavioral Health Administration as:

(1) A psychiatric rehabilitation program serving adults in compliance with COMAR [10.21.21 or] [, whichever is applicable];

(2) A psychiatric rehabilitation program serving minors in compliance with COMAR [10.21.29 or][, whichever is applicable];

(3) A mobile treatment program [in compliance with] shall:

(a) Comply with COMAR [10.21.19 or], [whichever is applicable];

(b) [The requirement for] Consist of a multidisciplinary team [consisting of] including, at a minimum:

(i)—(v) (text unchanged)

(c) [The requirement for] Maintain sufficient staffing to fulfill the following service requirements including:

(i)—(vii) (text unchanged)

(4) A health care service provided through telemedicine is equivalent to the same health care service provided through an in-person visit if the service provided through telemedicine is provided by a fully integrated psychiatrist attached to an ACT or mobile treatment program, with the following exceptions:

(a) An ACT or mobile treatment program shall attempt to engage an individual via an in-person visit with a psychiatrist prior to disenrolling an individual due to disengagement;

(b) A psychiatrist shall engage with an individual via an in-person visit when an individual is transitioning from inpatient treatment; and

(c) A psychiatrist shall engage with an individual via an in-person visit when prescribing medications.

[(4)] (5) An outpatient mental health clinic in compliance with:

(a) COMAR [10.21.20 or][, whichever is applicable]; and

(b) (text unchanged)

C. (text unchanged)

D. Other Licensed or Approved Mental Health Providers. To participate in the Program as a specialty mental health provider not defined in §§A—C of this regulation, a provider shall be approved pursuant to COMAR as a:

(1) Targeted case management provider in compliance with:

(a) If serving children, COMAR 10.09.90; and

(b) If serving adults, COMAR 10.09.45;

(2) Residential treatment center in compliance with[:

(a)] COMAR 10.07.04 and 10.09.29; [and

(b) COMAR 10.21.06;]

(3) (text unchanged)

(4) Non-hospital-based mental health psychiatric day treatment provider in compliance with:

(a) COMAR [10.21.02 or][, whichever is applicable];

(b)—(d) (text unchanged)

(5)—(8) (text unchanged)

.07 Limitations.

The Program does not cover the following:

A.—U. (text unchanged)

V. Except as provided in Regulation .04B(4) of this chapter, Mobile Treatment or ACT Services without a minimum of four [face to face] in-person services provided per month;

W.—X. (text unchanged)

Secretary of Health