COMAR 10.09.33.07. Health Home Participant Flow

A. Enrollment.

(1) The health home shall enroll an individual only after the individual has been enrolled in the health home provider's applicable PRP, MTS, or OTP services.

(2) During enrollment, an OTP established as a health home shall identify eligible individuals under the OTP’s care and report the diagnoses related to qualifying risk factors set forth in Regulation .03A(2)(b) of this chapter in the ASO system.

(3) The health home shall provide the individual with a brief description of health home services, including:

(a) Explaining the data-sharing elements of the program; and

(b) Describing how the individual may opt out if desired.

(4) Following the provision of information in accordance with §A(3) of this regulation , the health home shall obtain the individual's consent to participate in the health home.

(5) Following consent to participate in accordance with §A(4) of this regulation , the health home shall complete the individual's online intake report through the ASO system thereby enrolling the individual into the health home.

(6) The health home shall:

(a) Notify a participant's other treatment providers about health home services; and

(b) Encourage other providers' participation in care coordination efforts.

B. Participation.

(1) A health home participant shall receive a minimum of two health home services per month, as defined in Regulation .06 of this chapter and to be documented in the ASO system.

(2) An assigned health home care manager shall monitor the participant's care and health status and coordinate with other staff to provide appropriate health home services.

C. Discharge.

(1) In the event of discharge, the health home shall create a discharge plan that includes referrals to appropriate services and providers.

(2) The health home shall report all discharges and completion of discharge plans in the ASO system.