A fee schedule is a complete listing of service codes and fees used to pay services within the PBHS system. Optum Maryland has provided a listing of Mental Health, Substance Use Disorder and other specific levels of care by fee schedules for Providers to use.
Effective July 1, 2020
Effective July 1, 2019 - June 30, 2020
2018
2016 - 2017
The combination of services rules provide an outline of the types of services that may be provided to an individual within the same day, week or course of treatment. These rules outline the interventions that may be implemented in combination and involve the use of two or more coordinated interventions by the same or differing providers.
The state of Maryland has implemented the electronic Provider Revalidation and Enrollment Portal (ePREP). This resource enables online provider enrollment, re-enrollment, revalidation, information updates, and demographic changes. For resources to assist you with ePREP, visit the Maryland Department of Health Provider Enrollment information page.
To create a user profile or log into an existing account for Maryland Medicaid’s ePREP portal, visit ePREP.health.maryland.gov. After enrollment at Maryland Medicaid, register with Optum using Incedo Provider Portal.
The Maryland Public Behavioral Health System (PBHS) is committed to facilitating the participant’s recovery through treatment and rehabilitation services that are in the least restrictive and intensive level of care necessary to provide safe and effective treatment and meet the participant’s biopsychosocial needs. The continuum of care is a fluid treatment pathway, where participants may enter treatment at any level and receive services, in more or less intensive settings or levels of care, as their changing clinical needs dictate. Optum will implement this philosophy while facilitating participant choice in the treatment process.
For more information regarding covered diagnoses and priority population, please see the below. The diagnosis are also listed in COMAR 10.09.70
Optum authorizes services for the Public Behavioral Health System. Below are a few examples of specialized services that are available for Maryland individuals that meet the Medical Necessity Criteria (MNC). If you would like more information regarding all covered services, please review our Provider Manual for full description and MNC.
It is the policy of Optum to offer members with complex and high risk behavioral /medical conditions the enhanced services of an Intensive Case Management (ICM) program. This program is available to all Optum members as a value-added service, contingent on available program resources. It does not replace or conflict with the Medicaid approved service of Targeted Case Management. Criteria that must be met to be eligible for intensive case management include, but are not limited to, multiple hospitalizations within the past year and/or a co-morbid medical diagnosis.
To refer a member to ICM, please call 800-888-1965 for more information.
The Maryland Public Behavioral Health System (PBHS) emphasizes communication between mental health providers, medical care providers, and substance related disorder providers. Optum has embraced this integrated philosophy and provides key services that will enable better coordination of care for an individual’s treatment teams. With the consent of the individual through a completion of a release of information (ROI) form, the treating behavioral health provider(s) communicate directly with the medical care provider on a regular basis in order to coordinate behavioral health and somatic health care. Interdisciplinary and interdepartmental conference calls, data sharing, treatment planning, and outreach to participants are all options for coordinating care on high-risk participants. To assist in this coordination of care, Optum also communicates with the HealthChoice Managed Care Organizations (MCOs), the Maryland Department of Health and local stakeholders regarding high-risk participants with co-occurring behavioral health conditions and medical disorders.
To learn more about Care Coordination, please review the Provider Manual or the PCP Toolkit on our Non-Behavioral Health provider page.
The 1915(i) services are intensive behavioral health services for children, youth, and families and builds upon the prior 1915(c) RTC waiver that allowed states to provide home and community-based care to participant’s that would otherwise be institutionalized. Included in the 1915(i) program are an array of diagnostic and therapeutic mental health services, including 24-hour availability of mental health and/or crisis services, which are provided to the child or adolescent and family using a wraparound approach that includes intensive care coordination with an individualized plan of care. Specialized services not otherwise available through the Medicaid program include mobile crisis stabilization, respite services, intensive in home services, expressive and experiential behavioral services, and family and peer support services.
