§ 13-4904

§13–4904. IN EFFECT

// EFFECTIVE UNTIL NOVEMBER 30, 2027 PER CHAPTERS 290, 291, AND 369 OF 2023 //

(a) The Department shall administer the Pilot Program.

(b) The Department shall identify at least 500 adults whose behavioral health condition or functioning places them at risk of hospital emergency department utilization or inpatient psychiatric hospital admission.

(c) The Pilot Program shall be operational for a 3–year period.

(d) A provider or network of providers selected to participate in the Pilot Program shall:

(1) Be licensed and in good standing with the Maryland Medical Assistance Program;

(2) Have experience in providing community–based care coordination to specialty behavioral health program recipients;

(3) Use an electronic medical record for documenting care coordination activities and outcomes collection; and

(4) Have an automated data exchange with the State–designated health information exchange.

(e) The Department shall:

(1) Provide reimbursement on a per member per month basis for the behavioral health care coordination activities that are not otherwise covered by the Maryland Medical Assistance Program;

(2) Collect outcomes data on recipients of health care services under the Pilot Program; and

(3) Evaluate the effectiveness of the value–based purchasing model by analyzing the following outcome measures:

(i) A comparison of the following data elements before and after enrollment of recipients of health care services under the Pilot Program:

1. Emergency department utilization for both behavioral and somatic health purposes;

2. Inpatient hospitalization for both behavioral and somatic health purposes; and

3. Total health care expenditures;

(ii) Outcomes for recipients with and without primary care services coordinated by a behavioral health provider; and

(iii) Recognized clinical quality metrics which may include patient experience measures.