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10.09.48.00.htm 10.09.48.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 48 Targeted Case Management for People with Developmental Disabilities Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.48.01.htm 10.09.48.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Annually” means within 365 days.. 2) “Applicant” means the individual who files an application for services with the DDA.. 3) Community Coordination Services.. a) “Community coordination services” means resource coordination services provided to individuals receiving ongoing DDA funding for community services.b) "Community coordination services" includes:.
10.09.48.02.htm 10.09.48.02. 02 License Requirements.. The provider shall meet all applicable license requirements as set forth in COMAR 10.22.02 unless otherwise authorized by the Developmental Disabilities Administration.
10.09.48.03.htm 10.09.48.03. 03 Participant Eligibility.. To be eligible for services covered under this chapter, a participant or applicant shall:. A. Be Medicaid eligible; and;. B. Either:. 1) Have applied for services from the Developmental Disabilities Administration but not yet had their eligibility determined; or2) Be eligible for funding from the DDA as set forth in COMAR 10.22.12, and meet one of the following conditions:a) Be determined to have a developmental disability as set forth in COMAR 1
10.09.48.04.htm 10.09.48.04. 04 Conditions for Participation ― General.. A. In this chapter, targeted case management services are referred to as coordination of community services.B. Providers shall meet all the conditions for participation as set forth in COMAR 10.09.36.03.. C. Administrative and Professional Requirements. To participate in the Program as a provider of services covered under this chapter, the provider shall:1) Be incorporated in the State in good standing with the Maryland Departme
10.09.48.05.htm 10.09.48.05. 05 Conditions for Participation ― Staff Requirements.. A. Staff Capability Requirements. The provider shall:. 1) Employ only appropriately qualified personnel as set forth in this regulation;. 2) Maintain sufficient staff required to meet the needs of the service population;. 3) Have administrative and supervisory staff to ensure the quality of coordination of community services;4) Have a management capability team, each member of which has at least 3 years of experience provid
10.09.48.06.htm 10.09.48.06. 06 Covered Services.. A. Only core services shall be authorized for payment by DDA as covered coordination of community services.B. The coordinator of community services shall provide the core services listed in this regulation to every participant assigned to the coordinator.C. Comprehensive Assessment. Coordination of community services shall include a comprehensive assessment of the individual’s needs and supports to determine eligibility, in accordance with COMAR 10.22
10.09.48.07.htm 10.09.48.07. 07 Limitations.. A. Restrictions may not be placed on a qualified recipient’s option to receive coordination of community services.B. DDA coordination of community services does not restrict or otherwise affect eligibility for Title XIX benefits or other available benefits or programs.C. DDA coordination of community services may not be:. 1) Provided as an integral and inseparable part of another covered Program service;. 2) Provided as an administrative function;.
10.09.48.08.htm 10.09.48.08. 08 Payment Procedures.. A. Request for Payment.. 1) Requests for payment for the services covered under this chapter shall be submitted by an approved provider according to procedures set forth in COMAR 10.09.36.04.2) Billing time limitations for services covered under this chapter are the same as those set forth in COMAR 10.09.36.06.B. Payment Rates.. 1) Providers shall be reimbursed within 45 business days of approved invoice for services rendered based on the rates set for
10.09.48.09.htm 10.09.48.09. 09 Recovery and Reimbursement.. Recovery and reimbursement shall be as set forth in COMAR 10.09.36.07..
10.09.48.10.htm 10.09.48.10. 10 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions shall be as set forth in COMAR 10.09.36.08 and 10.22.03.
10.09.48.11.htm 10.09.48.11. 11 Appeal Procedures.. A. Appeal procedures for providers shall be as set forth in COMAR 10.09.36.09.. B. Appeal procedures for participants shall be as set forth in COMAR 10.01.04..
10.09.48.12.htm 10.09.48.12. 12 Interpretive Regulation.. State regulations shall be interpreted as set forth in COMAR 10.09.36.10..
10.09.48.9999.htm 10.09.48.9999. Administrative History Effective date:. Regulations .01―18 adopted as an emergency provision effective June 23, 1992 (19:14 Md. R. 1276) adopted permanently effective October 12, 1992 (19:20 Md. R. 1815)Regulations .01―03 and .06 amended and Regulation .12 repealed as an emergency provision effective December 9, 1994 (21:26 Md. R. 2183) adopted permanently effective March 27, 1995 (22:6 Md. R. 474)Regulation .01B amended effective August 27, 2007 (34:17 Md. R. 1507).
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