Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management
Section 10.09.69.05 - Benefits
Universal Citation: MD Code Reg 10.09.69.05
Current through Register Vol. 51, No. 19, September 20, 2024
A REM participant is eligible for the following:
A. Fee-for-service Medical Assistance benefits available to a Medical Assistance participant not enrolled in an MCO;
B. Services described in Regulations .10 and .11 of this chapter when determined medically necessary by the Department;
C. A case management assessment performed by a REM case manager who shall:
(1) Gather all relevant information to
determine the participant's condition and needs including the participant's
medical records;
(2) Consult with
the participant's current service providers; and
(3) Evaluate the relevant information and
complete a needs analysis including medical, psychosocial, environmental, and
functional assessments; and
D. Case management services performed by a REM case manager who shall:
(1) When
necessary, assist the REM participant, offering the participant a choice, if
possible, in selecting and obtaining a PCP, who may be a specialist to the
participant's condition, giving preference to any pre-established relationships
between the participant and the participant's PCP;
(2) Develop a plan of care in consultation
with the participant, the participant's family members as authorized by the
participant when possible, the PCP, and other providers rendering care that:
(a) Includes the participant's health status
and needs for medical, health-related, housing, and social services including,
but not limited to:
(i) All pertinent
diagnoses including the REM qualifying diagnosis;
(ii) Type, frequency, and duration of
services;
(iii) Treatment goals for
each type of service;
(iv) Medical
equipment and supplies;
(v)
Medication;
(vi) Social support
structure;
(vii) Current service
providers;
(viii) Assigned level of
care;
(ix) Nutritional
status;
(x) Education or vocational
information;
(xi) Current living
arrangement; and
(xii) Emergency
plan, if appropriate; and
(b) Is developed in consultation with the
interdisciplinary team;
(3) Implement the plan of care and assist the
participant in gaining access to medically necessary services by linking the
participant to those services;
(4)
Monitor service delivery, perform record reviews, and maintain contacts with
the participant, services providers, and family members to evaluate the
participant's condition and progress and to determine whether revision is
needed in the plan of care or in services' delivery;
(5) As necessary, initiate and implement
modifications to the plan of care and communicate these changes to the
participant, parents or caregivers, and pertinent health care
providers;
(6) Monitor a
participant's receipt of EPSDT services as specified in COMAR 10.09.67;
and
(7) Assist the participant with
the coordination of school health-related services such as the IEP or the IFSP
as described in COMAR 10.09.50.
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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