Specialty Programs

Psychiatric Rehabilitation Program (PRP)

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 

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: 

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

PRP Provider Resources 

• Medical Necessity Criteria  
• FY2025 Fee Schedule
• PRP Form – Child and Adolescent 
• PRP Form – Adult 

Submit all referrals and supportive information for collaboration of care using standard referral document forms, clinical notes or prescription pads. 

PRP Provider Alerts 

PRP Fee Schedules

Substance Use Disorder (SUD) Programs

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 here. 

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 focus on medical monitoring due to pregnancy

SUD Fee Schedules

SUD Provider Alerts

8-507 Court-Ordered Treatment

Justice services are charged with monitoring and conducting HGI 8-505 court ordered evaluations and placing defendants into treatment under HG 8-507 court orders. 

To receive HG 8-507 treatment referrals, an SUD provider must demonstrate the following minimum qualifications have been met: 

• Active accreditation by an approved accrediting organization 
• A valid license under COMAR Title 10 Subtitle 63 
• Active and good standing status with Maryland Medicaid 
• If applicable, meet any specific program conditions established by MDH for the treatment of a specialty population 

Resources

• Certification Manual 

Maryland Recovery Network (MDRN) 

Maryland RecoveryNet (MDRN) develops partnerships with service providers statewide and funds access to clinical and recovery support services for individuals with substance use/co-occurring disorders treatment and recovery support needs. All MDRN participants receive care coordination through which they can access a menu of services, including: 

• Halfway house and recovery housing 
• Transportation 
• Employment services 
• Vital records, 
• Peer/recovery coaching 
• Medical and dental services 
• Other unmet needs as expressed by the client and/or identified by the care coordinator  

Resources

• Maryland RecoveryNet (MDRN) Provider Update Dec 2019 
• MDRN Initial 60 Day Housing Request 
• MDRN Provider Manual
• SUD Fee Schedule (Includes MDRN)
• MDRN License Application 

All services are designed to assist recipients in remaining engaged in their recovery while promoting independence, self-sufficiency, and stability. 

Enrollment

Participants must apply to the MDRN program and be approved by the Maryland RecoveryNet Regional Area Coordinator (RAC). Upon enrollment, the participant selects services from a list of providers which are then authorized by the MDRN RAC. 

Points of Contact

Maryland RecoveryNet Staff Contact Information 
Recovery Services Program Manager 
Patricia Konyeaso 
410-402-8595 
patricia.konyeaso@maryland.gov 

Problem Gambling

The Maryland Department of Health, in partnership with Carelon Maryland and the Maryland Center of Excellence on Problem Gambling, provides comprehensive support for individuals and their loved ones affected by gambling addiction.

Maryland residents have access to a full range of problem gambling services, including professional assessments, individual therapy, and group therapy. These services are offered through local outpatient mental health and substance use disorder programs, private practitioners, and the Maryland Center of Excellence on Problem Gambling, ensuring accessible care for all Marylanders in need of assistance.

Learn more about gambling resources and visit the Gambling Center of Excellence website. 

Gambling Fee Schedule

Mental Health Gambling

SUD Gambling

SUD Gambling Residential

Quick Links

• Problem Gambling Awareness Month and Screening Day_2022
• Problem Gambling 
• Problem Gambling Screening Tool 

Health Homes

Health Homes for individuals with chronic conditions was created to augment Maryland’s 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 substance use disorders.  

Health Homes will offer participants enhanced care coordination services from providers with whom they regularly receive care, 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, empowering participants to manage and prevent chronic conditions in order to improve health outcomes, while reducing avoidable hospital encounters.  

Health Homes provide six core services: 

1. Comprehensive care management 
2. Comprehensive transitional care 
3. Care coordination 
4. Individual and family support 
5. Health promotion 
6. 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 emotion 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  

View the full list of services.

MDH Quick links

• Active Health Home Provider List (updated July 2024) 
• Become a Health Home 

Medicaid Pharmacy Program

Maryland Medicaid Pharmacy

Main line: 833-325-0105

• Provider number: 1-800-932-3918
• The Antipsychotic Peer Review Program and to pre-certify antipsychotics for children: 1-855-283-0876
• Participant hotline: 1-800-492-5231

Website: mmppi.com (Maryland Medicaid Pharmacy Program)
Hours: Monday through Friday, 8 a.m. to 5 p.m.  

Provides services for the following programs: 

• Medical Assistance: Participants receive complete pharmacy services. 
• HealthChoice: For more information see Mental Health Formulary and Substance Use Disorder Medication Clinical Criteria Final. All other drugs are provided by HealthChoice Managed Care Organizations (MCOs). 
• Family Planning: Participants receive only contraceptives and sexually transmitted infections treatment. 
• Medicare Part D:  Fully dual eligible Medicare beneficiaries receive most drugs excluded from Medicare Coverage. All other drugs are provided by Medicare Prescription Drug Programs (PDPs) 

For Participants

Participants can learn more information about how the Pharmacy Program impacts them by clicking the button below to navigate to the Participant site. 

Intensive Behavioral Services – 1915(i)

The 1915(i) services are intensive behavioral health services for children, youth, and families. These services were built in addition to 1915(c), which allows states to provide home and community-based care to participants 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: 

• Respite services, both in-home/community-based and out-of-home 
• Intensive in-home services 
• Expressive and experiential behavioral services, such as therapy related to art, dance, music, drama, equine, and horticulture 
• Family and peer support services 

The full 1915(i) and TCM state plan can be viewed on the Maryland Medicaid State Plan page. You can learn more about 1915(i) on Medicaid.gov. 

Application process overview 

To contact Carelon’s 1915(i) liaison, email MD1915i@carelon.com.