Maryland’s Public Mental Health System (PMHS) Provider Manual (PDF) (Coming Soon)

ValueOptions^® Participating Provider Handbook
Note: Please reference the ValueOptions^® Participating Provider Handbook to review policies and procedures as well as administrative processes germane to all ValueOptions^® providers.

MATRIX SECTION

Chapter 1: Welcome to Maryland’s Public Mental Health System (PMHS)

• Overview
• Introduction
• Responsibilities
• ValueOptions^® Maryland Service Center
• Online Provider Services

Chapter 2: Participation in the State PMHS

• General Description
• Change of Status or Address
• Online Provider Directory
• Provider Terminations
• Consumer Referral

Chapter 3: Uninsured Eligible Consumers

• Coverage Groups
• Application/Registration Process
• Eligibility Requirements
• Financial Criteria
• Certification Period
• Recertification Process
• Pending Medical Assistance
• Uninsured Eligible Services

Chapter 4: General Information

• Provider Audits
• Alternative or Additional Services
• Authorization Requests
• Consumers with Private Insurance and Medical Assistance

Chapter 5: Service Descriptions

• 5.1 - Inpatient Hospital Psychiatric Services
• 5.2 - Residential Treatment Services
• 5.3 - Partial Hospitalization Services/Day Treatment
• 5.4 - Emergency Services in a Licensed Hospital Emergency Room
• 5.5 - Mobile Treatment Services (MTS)/Assertive Community Treatment
• 5.6 - Supported Employment Services
• 5.7 - Respite Services
• 5.8 - Enhanced Support Services
• 5.9 – Evidence-Based Practice (EBP) Services for Adults
• 5.10 – Therapeutic Behavioral Services (TBS) – Mental Health
• 5.11 – Residential Crisis Services
• 5.12 – Occupational Therapy Services
• 5.13 – Psychiatric Rehabilitation Program Services (PRP)
• 5.14 – Residential Rehabilitation Services (RRP)
• 5.15 – Interdisciplinary Team Treatment Planning
• 5.16 – Reserved for Future Use
• 5.17 – Outpatient Mental Health Services
• 5.18 – Intensive Outpatient Treatment Services
• 5.19 – Reserved for Future Use
• 5.20 – Psychological Testing Services
• 5.21 – Hospital Consultation Services
• 5.22 – Nursing Home Psychiatric Consultations

Chapter 6: Medical Necessity Criteria for use by Maryland PMHS

• 6.1 – Medical Necessity Intro and Table of Contents
• 6.2 – Level of Care I: Adult Inpatient Criteria
• 6.3 – Level of Care I: Child and Adolescent Inpatient Criteria
• 6.4 – Level of Care II: Residential Treatment Centers (RTC) and Community-Based RTC Level of Care, Child and Adolescent (RTC)
• 6.5 – Level of Care II: Residential Crisis Services- Adult and Child
• 6.6 – Level of Care III: Community-Based Residential Care- Adult
• 6.7 – Level of Care III: Residential Rehabilitation Program (RRP)- Intensive
• 6.8 – Level of Care IV: Psychiatric Partial Hospitalization- Adult and Child
• 6.9 – Level of Care V: Enhanced Support Services
• 6.10 – Level of Care V: Intensive Outpatient Treatment- Adult and Child
• 6.11 – Level of Care V: Psychiatric Rehabilitation Programs (PRP)- Adult
• 6.12 – Level of Care V:  Psychiatric Rehabilitation Programs (PRP) –Child and Adolescent
• 6.13 – Level of Care V:  Mobile Treatment- Adults
• 6.14 – Level of Care V: Mobile Treatment- Child and Adolescent
• 6.15 – Level of Care V: Therapeutic Behavioral Services- Child
• 6.16 – Level of Care VI: Outpatient Services
• 6.17 – Level of Care VI: Occupational Therapy Services
• 6.18 – Level of Care VI: Respite Care- Child and Adolescent
• 6.19 – Level of Care VI: Respite Care- Adult
• 6.20 – Level of Care IV Case Management- Child
• 6.21 – Level of Care IV Case Management- Adult
• 6.22 – Medical Necessity Criteria Appendices

Chapter 7: Deaf Services

Chapter 8: Forensic Services

Chapter 9: Grievances and Appeals

Chapter 10: Retrospective Review Process

Chapter 11: Coordination of Care

• Coordination with PCP and HealthChoice MCOs
• Rare and Expensive Case Management
• Coordination of Care Consumers with Severe and Persistent Mental Illness

Chapter 12: Laboratory Services

Chapter 13: Pharmacy

Chapter 14: Transportation

Chapter 15: Medicaid Waivers

• RTC Waiver
• Traumatic Brain Injury Waiver

Chapter 16: Claims and Billing:ACS Billing Manual (Temporary)

• Addendum: Emergency Petition Billing Manual
• Addendum: PMHS Explanation Codes for Claim System
• Addendum: HIPPA/VlaueOptions Maryland EOP Code Crosswalk

Chapter 17: Forms

Chapter 18: Outcomes Measurement System (OMS)

• OMS Introduction/Information
• OMS Tools

Appendices

• Appendix A: Certificate of Need for Services Rules and Guidelines
• Appendix B: Eligibility Verification Process
• Appendix C: Reserved for Future Use
• Appendix D: ValueOptions Maryland Glossary of Terms
• Appendix E: Medicaid Coverage Groups
• Appendix F: Reserved for Future Use
• Appendix G: Reserved for Future Use
• Appendix H: Medicaid and Medicare Issues
• Appendix I: Reserved for Future Use
• Appendix J: Reserved for Future Use
• Appendix K: Emergency Room Consultation Procedures
• Appendix L: Excluded Diagnoses
• Appendix M: State Approved Medicaid Provider Types for the PMHS
• Appendix N: OMS Interview Guide