Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.90 - Mental Health Case Management: Care Coordination for Children and Youth
Section 10.09.90.09 - Conditions for Provider Participation - Eligibility
Universal Citation: MD Code Reg 10.09.90.09
Current through Register Vol. 51, No. 19, September 20, 2024
A. General Requirements. To be eligible to be approved as a care coordination organization, an entity shall meet all of the:
(1) Conditions for participation as set forth
in COMAR 10.09.36.03; and
(2) Medical Assistance provisions listed in
COMAR designated for their provider type.
B. Specific Requirements. A CCO:
(1) May not place restrictions on the
qualified recipient's right to elect to or decline to:
(a) Receive care coordination as authorized
by the Department; and
(b) Choose a
care coordinator, as approved by the Department, and other care
providers;
(2) Shall
employ appropriately qualified individuals as care coordinators, and care
coordinator supervisors with relevant work experience, including experience
with the populations of focus, including but not limited to:
(a) Youth younger than 18 years old with a
serious emotional disturbance or co-occurring disorder; and
(b) Young adults with a serious emotional
disturbance or co-occurring disorder;
(3) Shall assign care coordinators to the
participant and family;
(4) Shall
schedule a face-to-face meeting with the participant and family within 72 hours
of notification of the participant's enrollment in Care Coordination
services;
(5) Shall convene the
first CFT meeting within 30 calendar days of notification of enrollment to
begin developing the POC;
(6) Shall
collect information gathered during the application process including results
from the physical examination, psychosocial and psychiatric screening,
assessments, evaluations, and information from the CFT, participant, and
family, and the identified supports to be incorporated as a part of POC
development process;
(7) For
1915(f) participants:
(a) Shall arrange for
the participant and family to meet with peer support partners within 30
calendar days of notification of enrollment to allow the participant and family
the opportunity to determine the role of peer support in the development and
implementation of the POC; and
(b)
Shall arrange for the participant and family to meet with the intensive in-home
service (IIHS) to develop the initial crisis plan within 1 week of enrollment
in the 1915(i);
(8)
Shall assure that:
(a) A participant's
initial assessment is completed within 10 calendar days after the participant
has been authorized by Department and determined eligible for, and has elected
to receive, care coordination services; and
(b) An initial POC is completed within 15
calendar days after completion of the initial assessment;
(9) Shall maintain an electronic health
record for each participant which includes all of the following:
(a) An initial referral and intake form with
identifying information, including, but not limited to, the individual's name
and Medicaid identification number;
(b) A written agreement for services signed
by the participant or the participant's legally authorized representative and
by the participant's care coordinator;
(c) An assessment as specified in Regulation
.07of this chapter; and
(d) A POC
as specified in Regulation .07D-E of this chapter;
(10) Shall have formal written policies and
procedures, approved by the Department, or the Department's designee, which
specifically address the provision of care coordination to participants in
accordance with the requirements of this chapter;
(11) Shall be available to participants and,
as appropriate, their families or, if the participant is a minor, the minor's
parent or guardian, for 24 hours a day, 7 calendar days a week, in order to
refer:
(a) Participants to needed services
and supports; and
(b) In the case
of a behavioral health emergency, participants to behavioral health treatment
and evaluation services in order to divert the participant's admission to a
higher level of care;
(12) Shall document in the participant's care
coordination records if the participant declines care coordination services or
if a service is terminated because it was not working;
(13) May not provide other services to
participants unless the Department approves how conflict of interest standards
would be safely addressed.
(14)
Shall be knowledgeable of the eligibility requirements and application
procedures of federal, State, and local government assistance programs that are
applicable to participants;
(15)
Shall maintain information on current resources for behavioral health, medical,
social, financial assistance, vocational, educational, housing, and other
support services including informal community resources;
(16) Shall safeguard the confidentiality of
the participant's records in accordance with State and federal laws and
regulations governing confidentiality;
(17) Shall comply with the Department's
fiscal and program reporting requirements and submit reports to the Department
in the manner specified by the Department;
(18) Shall provide services in a manner
consistent with the best interest of recipients and may not restrict an
individual's access to other services;
(19) Shall assure the amount, duration, and
scope of the care coordination activities are documented in a participant's
POC, which includes care coordination activities before discharge and after
discharge when transitioning from an institution, to facilitate a successful
transition into the community; and
(20) Shall commit to coordinating with all
agencies involved in the participant's POC.
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