MedicaidCoverageHigh impact
Updated Guidance- Statewide Coverage of Collaborative Care Model
Maryland Medicaid·MD · Family Medicine, General Practice, Internal Medicine +2 more·Provider Transmittal
Effective date
Oct 1, 2023
We identified it
Jun 20, 2026
Summary
Maryland Medicaid expanded Collaborative Care Model (CoCM) services statewide effective October 1, 2023, making them available to all HealthChoice MCO and Fee-For-Service beneficiaries with mild to moderate behavioral health diagnoses. Providers must now contact the Behavioral Health ASO before initiating CoCM services to verify the patient is not already receiving specialty behavioral health services, requiring coordination of care and Release of Information documentation.
Action Required
By December 13, 2023 (transmittal date - already in effect): (1) Billing and clinical teams must establish a process to contact the Behavioral Health ASO at 1-800-888-1965 BEFORE initiating CoCM services for any Medicaid patient to verify no active specialty behavioral health services exist. (2) Update patient intake forms and EMR workflows to document ASO contact attempts and clearance status. (3) Ensure providers obtain a 42 CFR Part 2-compliant Release of Information from all patients before coordinating care with the ASO. (4) Train billing staff to verify CoCM eligibility criteria (mild to moderate anxiety, depression, SUD, or clinically appropriate behavioral health diagnosis) prior to claim submission. (5) Implement billing system edits to flag claims with diagnosis codes F32.1, F33.0, F41.0, Z73.3 and other behavioral health diagnoses for ASO coordination verification. (6) Create internal documentation process to track ASO authorization status for each CoCM patient. Failure to coordinate with ASO prior to service initiation may result in claim denials or payment recovery. Reference PT 26-24 and PT 35-24 for additional CoCM billing guidance. Contact mdh.healthchoiceprovider@maryland.gov for clarification.