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<< Mental Health Main • Application Information to Become a Provider • Budget Forms • Annual Reports • Other PMHS Provider Forms

For private practitioners
To apply to become a mental health provider as an independent licensed mental health practitioner or group mental health practice:

1. Contact Sarah Hawkins at the Carroll County Core Service Agency at (410) 876-4440.
2. Contact Value Options at (800) 888-1965 or marylandproviderrelations@valueoptions.com  for an application.
3. Contact Maryland Medical Assistance Administration at (410) 767-5503 to obtain a provider billing number.

For regulated programs

1. To apply to start a regulated program, please refer to the following chapters of the Code of Maryland Regulations (COMAR):
   1. Application and approval process (COMAR 10.21.16)
   2. Definitions and administrative requirements (COMAR 10.21.17)
   3. Therapeutic Nurseries (COMAR 10.21.18)
   4. Mobile Treatment Services (COMAR 10.21.19)
   5. Outpatient Mental Health Clinics (COMAR 10.21.20)
   6. Psychiatric Rehabilitation Programs (COMAR 10.21.21)
   7. Residential Rehabilitation Programs (COMAR 10.21.22)
   8. Residential Crisis Services (COMAR 10.21.26)
   9. Respite Care Services (COMAR 10.21.27)
   10. Mental Health Vocational Programs (COMAR 10.21.28)
   COMAR 10.21.16 and COMAR 10.21.17 apply to all regulated programs.
   
   
2. Contact Sarah Hawkins at the Carroll County Core Service Agency to discuss gaps in service delivery, needs, etc.
   
   
3. Complete New Provider Application Material and forward to the Carroll County Core Service Agency.
   
   
4. Complete the application as specified in the appropriate chapter of COMAR and send to the:
   Office of Health Care Quality
   Bland Bryant Building
   Spring Grove Hospital Center
   55 Wade Avenue
   Baltimore, Maryland 21228
   (410) 402-8060
   
   
5. Contact Maryland Medical Assistance Administration at (410) 767-5503 to obtain a provider billing number.

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Purchase-of-service contractors must submit a DHMH 432 budget package to the Carroll County Core Service Agency at least two weeks prior to the beginning of program operations. Instructions for these form may be found here.

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