Application for Non-Medicaid Private Practitioners and Treatment Programs for Reimbursement of Problem Gambling Treatment Services

The Maryland Department of Health, Behavioral Health Administration (BHA) will reimburse providers for the treatment of problem gambling through the designated Administrative Services Office (ASO) whether existing Medicaid providers or Non-Medicaid Providers.

If you are an existing Medicaid provider (whether a community-based provider or private practitioner) you must register with the ASO/Optum to participate in the PG Reimbursement program.

For Non-Medicaid providers and private practitioners, eligibility for reimbursement is assessed through an application process in this system.

Provider and Private Practitioners Eligibility
Providers eligible for reimbursement of this service must be either a private practitioner (individual or group) or a community-based provider. Private practitioners must be in good standing with the appropriate professional board(s). Community-based providers must either be a Federally Qualified Health Center or licensed in accordance with COMAR 10.63 as a substance use, mental health or integrated behavioral health program at the following levels of care:
● Ambulatory SUD programs for Level 1 and Level 2.1
● Residential SUD programs for Level 3.1, 3.3 and 3.5
● Outpatient Mental Health Clinic (OMHC)
● Mental Health Intensive Outpatient (MHIO)
● Federally Qualified Health Center (FQHC)

Private practitioners and community-based providers must ensure the staff is trained and competent to provide services to individuals with problem gambling and/or loved ones/ concerned others. The Maryland Center of Excellence on Problem Gambling is available to provide problem gambling training and clinical consultation at no cost to programs. Providers may contact the Center of Excellence on Problem Gambling at www.mdproblemgambling.com or phone (667) 214-2120 for further information.

Reimbursement:
•Gambling treatment services will be reimbursed at the same rates currently used under Medicaid.
•Payment through the designated ASO for gambling treatment services must be accepted as full reimbursement for these services.
•Reimbursement for problem gambling treatment will be subject to designated ASO auditing system.

Non-Medicaid Private practitioners and Providers must complete the following application and submit to the Maryland Center of Excellence for Problem Gambling for processing.

Private Practitioner

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