Mental Hygiene Administration Policy

Medical Assistance Ineligible Outpatient Mental Health Services

July 9, 2002

Effective July 1, 2002, the requirements for accessing outpatient mental health services for non-Medicaid recipients (formerly called Grey Zone) changed. In order for a provider to be eligible for reimbursement through Maryland Health Partners (MHP) an individual must be an active participant in the Maryland Pharmacy Assistance (MPA) program. However, there is recognition that there are certain groups of individuals that may not have Pharmacy Assistance who are priority populations for the Public Mental Health System (PMHS). These individuals should be seen and services will be reimbursed through MHP in the usual manner even if they are not currently enrolled in the MPA program. The priority groups are:

1. Individuals who have been discharged from a psychiatric facility (either state, general hospital or private hospital).

2. An individual in the community on a conditional release status through the Department of Health and Mental Hygiene (DHMH).

3. An individual released from incarceration.

4. An individual who is homeless.

In addition, there are individuals who may need services but approval must be obtained from the Core Service Agency (CSA) of the individual's residence. These groups are:

1. An individual presenting with an urgent need.

2. An individual whose Pharmacy Assistance application is pending.

For these individuals, the provider must register the individual with the CSA. The CSA will authorize the services and provide the required information to MHP. A procedure, including a form to be used statewide outlining how to obtain CSA approval and further billing instructions will be forthcoming in the next week. In the interim, please send a memo to the applicable CSA with the following information:

Provider Name:

Consumer information:

Name:

Address:

Social Security Number:

DOB:

Annual Income:

Source of Income:

Presenting Problem:

Type of Services, CPT Code, Number of Services requested, Frequency.