CARF & Joint Commission Accreditation Consultancy

An Outpatient Mental Health Clinic (OMHC) is a community-based facility offering comprehensive, non-residential mental health services like individual, group, and family therapy, medication management, psychiatric evaluations, and crisis intervention for children, adolescents, and adults. OMHCs provide personalized, evidence-based treatment to improve mental well-being, restore functioning, prevent crises, and reduce the stigma associated with mental illness, often in collaboration with schools and other community agencies. OMHCs serv a diverse population including children, adolescents and adults.

Some of the services provided by OMHC programs include:

• Therapy/Counseling – individual, group and family therapy to address conditions like depression, anxiety and trauma.
• Psychiatric Services – Diagnosis, evaluations and medication management by a board certified and licensed psychiatrist or psych nurse practitioner or a prescriber.
• Psychoeducation – providing education on mental conditions, coping and other relevant topics

In order to be licensed, an outpatient mental health center shall:

A. Provide regularly-scheduled outpatient mental health treatment services in a community-based setting;

B. Provide, at a minimum, individual, group, and family therapy and medication management;

C. Employ a medical director, who:

1. Is a psychiatrist;
2. Has over-all responsibility for clinical services; and
3. Is on-site at least 20 hours per week; and

D. Employ multidisciplinary clinical treatment staff who is authorized to provide the services under Health Occupations Article, Annotated Code of Maryland.

In Maryland, a psychiatric rehabilitation program (PRP) is an accreditation-based licensed program that provides community-based comprehensive rehabilitation and recovery services and supports and promotes successful community integration and use of community resources. Services for the program are provided onsite, offsite, or a combination of both. It is available to both youth and adults and includes:

• Support to patients in developing community and independent living skills
• A focus on the participants’ recovery with the goal of the participant improving
• Facilitating the individual’s recovery and successful functioning

The program is also called Community Integration Program.

In order to be licensed, a psychiatric rehabilitation program for adults (PRP-A) shall:

A. Provide community-based comprehensive rehabilitation and recovery services and supports, including, but not limited to:

1. Community living skills;
2. Activities of daily living; and
3. Family and peer support;

B. Promote successful community integration and use of community resources;

C. Be under the direction of a rehabilitation specialist who is:

1. A licensed mental health professional;
2. Certified by the Commission on Rehabilitation Counselor Certification; or
3. Certified by the Psychiatric Rehabilitation Association; and

D. Employ the rehabilitation specialist in §C of this regulation:

1. At least 20 hours per week when the program serves less than 30 individuals; or
2. 40 hours per week when the program serves 30 individuals or more.

A. In order to be licensed under this subtitle, a psychiatric rehabilitation program for minors (PRP-M) shall provide community-based comprehensive rehabilitation services and supports designed to:

1. Promote resiliency; and
2. Facilitate the development or restoration of appropriate skills in an individual younger than 18 years old including but not limited to:
   (a)Self-care skills;
   (b) Social, peer, family, and teacher interactions; and
   (c) Semi-independent living skills; and
3. Promote successful integration into the community and the use of community resources.

B. The program shall be under the direction of a rehabilitation specialist who has a minimum of 2 years direct care experience working with youth with a serious emotional disorder and who is:

1. A licensed mental health professional; or
2. Certified by the Psychiatric Rehabilitation Association and has obtained the Psychiatric Rehabilitation Association Children’s Psychiatric Rehabilitation Certificate.

C. The PRP-M shall employ the rehabilitation specialist in §B of this regulation for:

1. At least 20 hours per week when the program serves less than 30 individuals; or
2. At least 40 hours per week when the program serves 30 individuals or more.

Eligibility

State-funded and uninsured participants must meet additional eligibility criteria for an initial PRP request and Medical Necessity Criteria. The participant must meet ONE of the following FOUR eligibility criteria on the initial form:

• Stepdown from a state hospital and are on conditional release
• Discharge from an acute psychiatric hospitalization within the last six months
• Release from jail within the last six months
• Discharge from a residential rehabilitation program (RRP) within the last six months

PRP Provider Resources

• Medical Necessity Criteria
• PRP Form – Child and Adolescent
• PRP Form – Adult
• Priority Population Diagnosis Codes
• PRP Audit Tool

In Maryland, an IOP/OP is an accreditation-based licensed program that provides community-based treatment to individuals struggling with addiction and substance abuse disorders. IOPs provide structured, part-time treatment, often several hours a day, several days a week, for substance use disorders or mental health conditions, allowing clients to continue living in the community. Outpatient Programs (OPs) offer less frequent, lower-intensity support through individual or group counseling and other services as clients transition toward longer-term recovery or a standard aftercare plan. Both programs use evidence-based approaches to create personalized treatment plans addressing underlying issues and building recovery-focused life skills.

SUD specialty populations include adolescents, pregnant women, MDRN participants, and court-ordered care. An overview of the full spectrum of SUD services and levels of care can be found below.

Adolescents

• Lower threshold for residential care
• May need more focus on sustaining motivation for treatment
• Fewer biomedical issues

Pregnant women

• Lower threshold for residential care
• May need accommodations for other children
• May need more emphasis on medical monitoring due to pregnancy

Intensive Outpatient Treatment Level 2.1 Program.

A. To be licensed, an intensive outpatient treatment level 2.1 program shall provide structured outpatient substance-related disorder treatment based on a comprehensive assessment, for:

1. Individuals who meet the ASAM Criteria for level 2.1; and
2. Adults, from 9 to 20 hours weekly, and individuals younger than 18 years old for 6 to 20 hours weekly.

B. An intensive outpatient treatment level 2.1 program may provide the following services if the program’s license specifically authorizes the services:

1. A withdrawal management service as described in Regulation .18 of this chapter; and
2. An opioid treatment service as described in Regulation .19 of this chapter.

Outpatient Treatment Level 1 Program.

A. In order to be licensed under this subtitle, an outpatient treatment level 1 program shall provide outpatient substance-related disorder treatment based on a comprehensive assessment:

1. For individuals who: (a) Meet the ASAM Criteria for level 1; (b) Have a physical and emotional status that allows the individual to function in the individual’s usual environment; and
2. For adults, require services for fewer than 9 hours weekly, or, for individuals younger than 18 years old, require services for fewer than 6 hours weekly.

B. An outpatient treatment level 1 program may provide the following services if the program’s license specifically authorizes the services:

1. A withdrawal management service as described in Regulation .18 of this chapter; and
2. An opioid treatment service as described in Regulation .19 of this chapter.

Health Homes is a state Medicaid option, created by the Affordable Care Act, that provide comprehensive care coordination for individuals with chronic conditions to augment broader efforts to integrate somatic and behavioral health services.

The program targets populations with behavioral health needs who are at high risk for additional chronic conditions, including those with serious persistent mental illness, serious emotional disturbance, and opioid use disorder.

Health Homes will offer participants enhanced care coordination services with providers they regularly receive care from, including psychiatric rehabilitation programs, mobile treatment service providers, and opioid treatment programs. This is a community-based approach, not a residential program.

Health Homes are designed to enhance person-centered care. They empower participants to manage and prevent chronic conditions to improve health outcomes while reducing avoidable hospital encounters.

Health Homes provides six core services:

• Comprehensive care management
• Comprehensive transitional care
• Care coordination
• Individual and family support
• Health promotion
• Referral to community and social support

How to know if a participant is eligible for Health Homes

To be eligible, participants are required to meet the following criteria:

• Adults and children: Have Maryland Medicaid
• Adults: A diagnosis of a serious, persistent mental illness or substance use disorder
• Children: A diagnosis of a serious emotional disturbance

AND ONE OF THE FOLLOWING:

• Be enrolled in a psychiatric rehabilitation program (PRP)
• Be enrolled in a mobile treatment services (MTS) program
• Be enrolled in an opioid treatment program (OTP) AND have a history of alcohol, tobacco, or other non-opioid substance dependence or currently have alcohol, tobacco, or other non-opioid substance dependence

Please note: Individuals receiving services via 1915(i) or targeted mental health case management are excluded from Health Home participation.

A Partial Hospitalization Program is an intensive, structured outpatient mental health program that offers a high level of care without requiring overnight stays, serving as a crucial alternative to full hospitalization or a step-down from inpatient treatment. PHPs provide a range of services, including individual and group therapy, medication management, and skill-building, to help patients stabilize acute symptoms and develop coping strategies to avoid relapse and return to a higher level of functioning.

A Partial Hospitalization Program is an intensive day treatment program for adults and children in need of psychiatric stabilization. Treatment focuses on relief of acute symptoms, establishment of healthy coping skills and collaboration with family and community support resources.

How do PHP program work?

• Daily Attendance – patients attend program during the day but return home in the evenings and weekends and maintain connections with their communities.
• Multidisciplinary Team – Treatment is provided by a team of professionals, including psychiatrists, social workers and nurses.
• Personalized Plans – Each person receives an individualized treatment plan tailored to their specific diagnosis, symptoms and needs.

Partial Hospitalization Treatment Level 2.5 Program.

A. A partial hospitalization treatment level 2.5 program shall provide structured outpatient substance-related disorder treatment based on a comprehensive assessment for:

1. Individuals who meet the ASAM Criteria for level 2.5; and
2. From 20 to 35 hours weekly.

B. A partial-hospitalization treatment-level 2.5 program may provide the following services if the program’s license specifically authorizes the services:

1. A withdrawal management service as described in Regulation .18 of this chapter; and
2. An opioid treatment service as described in Regulation .19 of this chapter.

Residential Rehabilitation Program (RRP) provides housing and supportive services to single individuals. The goal of residential rehabilitation is to provide services that will support an individual to transition to independent housing of their choice. Residential Rehabilitation Programs provide staff support around areas of personal needs such as medication monitoring, independent living skills, symptom management, stress management, relapse prevention planning with linkages to employment, education and/or vocational services, crisis prevention and other services that will help with the individual’s recovery.

In order to be licensed in Maryland, a residential rehabilitation program (RRP) shall:

A. Serve individuals with a mental disorder;

B. Be operated by a licensed PRP-A;

C. Lease or own the RRP sites;

D. Be approved by BHA for RRP funding;

E. Provide a home-like, supportive residential environment;

F. Provide services for no more than 3 individuals per RRP site, unless also licensed as a group home as provided in Regulation .03 of this chapter;

G. Promote the individual’s ability to engage and participate in appropriate community activities;

H. Enable the individual to develop the daily living skills needed for independent functioning;

I. Have:

1. On-site staffing, as needed to meet the needs of the individuals served; and
2. Staff that are available on call, 24 hours per day, 7 days per week;

J. Meet the site requirements as set out in Regulation .07 of this chapter, verified through an annual site inspection conducted by the CSA or LBHA, as appropriate;

K. Have a written policy regarding the development of and process for implementation of a managed intervention plan (MIP) for an individual receiving residential services who may be at risk of an unplanned discharge, which:

1. Is developed in collaboration with the individual, treatment team members, and CSA or LBHA, as appropriate; and
2. Includes a description of additional individualized services and supports that may be needed, and identification of temporary residential alternatives, if any; and

L. If an MIP is executed, develop a transition plan that:

1. Is created in collaboration with the individual, treatment team members, CSA or LBHA, as appropriate, and ASO; and
2. Includes the elements outlined in §K (2) of this regulation.

Application Requirements for Approval of a Residence to be Operated by a Program.

A program seeking a license in Maryland, a residential site shall submit to the CSA or LBHA a completed application that:

A. Is on the form required by the Administration with all required documents attached; and

B. Includes documentation that the residence:

1. Is owned or leased by the applicant; or
2. Will be owned or leased by the applicant; and
3. Is located in a building that will have continuous fire, liability, and hazard insurance coverage.

Residential Site Requirements.

A program licensed to provide community-based behavioral health residential services under this chapter shall ensure that:

A. All areas of a residence, including storage areas:

1. Are safe;
2. Clean;
3. Free of hazards and clutter, and
4. Comply with the requirements of the Americans with Disabilities Act;

B. A residence has:

1. (1) No housing code or zoning violations;
2. Working smoke alarms or smoke detectors that meet local fire codes for residential dwellings;
3. Hot and cold running water:
4. Adequate light, heat, and ventilation; and
5. Sufficient, appropriate, and functional furnishings, equipment, supplies, and utensils comparable to those found in the residences of nondisabled individuals;

C. Each resident:

1. Has the resources to purchase or has access to food;
2. Has the resources to acquire an adequate supply of soap, towels, and toilet tissue;
3. Who self-administers medication, has access to a secure storage area for the resident’s medications;
4. Has access to a secure storage area for funds and valuables;
5. Has access to transportation;
6. Has access to a telephone in the residence; and
7. To the extent possible, may use personal possessions and preferences in furnishing and decorating the resident’s space.

D. The following emergency procedures are followed:

1. Posted near the telephone are telephone numbers for the: (a) Fire department, police, ambulance, and poison control center; and (b) Program’s on-call staff; and
2. An emergency evacuation procedure that is explained to and practiced by residents within 10 days after entering residence and, at a minimum, every 3 months after that;

E. Each bedroom has:

1. A minimum of 70 square feet for a single bedroom and a minimum of 120 square feet for a double bedroom;
2. An interior door, except for an efficiency apartment;
3. Closet space in or convenient to each bedroom for each individual using the bedroom;
4. Coverings for each window, for privacy;
5. A bed with a clean mattress and pillow for each resident using the bedroom;
6. At least two sets of bed linens per resident; and
7. Not more than two residents using the bedroom;

F. Each toilet and bathing area has:

1. A minimum of one full bathroom for every four residents; and
2. (At least one toilet, one basin, and one tub or shower connected to hot and cold water;
3. Easy access and conveniently located, not more than one floor level from living, dining, and sleeping rooms; and
4. Privacy for the individual using it; and

G. The program has a written relocation plan for each site that:

1. Specifies where residents may live temporarily if the CSA or LBHA determines that conditions in the approved residence pose an imminent risk to the health, safety, or welfare of a resident;
2. Is approved by the CSA or LBHA, as appropriate; and
3. Is updated annually.

An integrated behavioral health (IBH) program is a care model that delivers behavioral health services alongside medical care in a collaborative, team-based environment, often within primary care settings. This approach improves patient outcomes, reduces the stigma of mental health care, and increases access to services by co-locating providers like psychologists, psychiatrists, and care managers with primary care teams to address the whole person's health needs. IBH programs use tools to screen for mental health concerns, develop intervention protocols, and foster communication to ensure coordinated and effective treatment.

Integrated Behavioral Health Program.

A. To be licensed in Maryland, an integrated behavioral health program shall:

1. Meet the requirements for an: (a) Outpatient mental health center, as outlined in Regulation .05 of this chapter; and (b) Outpatient treatment level 1 program, as outlined in Regulation .06 of this chapter; and
2. Have the capacity to provide, as appropriate (a) Mental health evaluation and treatment services to individuals with mental health diagnoses; (b) Substance-related disorder evaluation and treatment services to individuals with a substance-related disorder; and (c) Integrated mental health and substance-related disorder evaluation and treatment services to individuals with both a substance use disorder and a mental health diagnosis.

B. An integrated behavioral health program may provide the following services if the program’s license specifically authorizes the services:

1. A withdrawal management service as described in Regulation .18 of this chapter; and
2. An opioid treatment service as described in Regulation .19 of this chapter.