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10.09.90.00.htm 10.09.90.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 90 Mental Health Case Management: Care Coordination for Children and Youth Authority: Health-General Article, §2-104(b) Annotated Code of Maryland
10.09.90.01.htm 10.09.90.01. 01 Scope.. A. This chapter applies to providers organized to deliver mental health case management services for children and youth.B. The purpose of mental health case management care coordination is to assist participants in gaining access to needed medical, mental health, social, educational, and other services.
10.09.90.02.htm 10.09.90.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “1915(i) means the 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families program defined in COMAR 10.09.89.2) “Care coordination” means services which assist participants in gaining access to a full range of behavioral health services and, as necessary, any medical, social, financial assistance, counseling, educational, housing, a
10.09.90.03.htm 10.09.90.03. 03 Participant Eligibility.. A. A participant shall be eligible for care coordination services if the recipient:. 1) Is in a federal eligibility category for Maryland Medical Assistance according to COMAR 10.09.24, which governs the determination of eligibility for the Maryland Medical Assistance Program; and2) Meets the criteria of either §B(1) or (2) of this regulation.. B. The participant:. 1) Shall:. a) Meet the diagnostic requirements of being either a:.
10.09.90.04.htm 10.09.90.04. 04 Participant Eligibility ― Levels of Intensity.. A. In addition to meeting the eligibility criteria outlined under Regulation .03 of this chapter, participants shall be classified according to the levels of intensity listed in Regulation .05, 06, or .07 of this chapter, based on the severity of the participant’s behavioral health or co-occurring disorder, along with assessed strengths and needs.B. The Department or its designee shall review participant levels of care t
10.09.90.05.htm 10.09.90.05. 05 Participant Eligibility ― Level I ― General Care Coordination.. The participant as described in Regulation .03A of this chapter shall meet at least two of the following conditions:A. The participant is not linked to behavioral health, health insurance, or medical services;. B. The participant lacks basic supports for education, income, shelter, or food;. C. The participant is transitioning from one level of intensity to another level of intensity of serD. The participant needs
10.09.90.06.htm 10.09.90.06. 06 Participant Eligibility ― Level II ― Moderate Care Coordination.. The participant as described in Regulation .03A of this chapter shall meet three or more of the following conditions:A. The participant is not linked to behavioral health services, health insurance, or medical services;B. The participant lacks basic supports for education, income, food, or transportation;. C. The participant is homeless or at-risk for homelessness;. D. The participant is tra
10.09.90.07.htm 10.09.90.07. 07 Participant Eligibility ― Level III ― Intensive Care Coordination.. A. The participant shall meet at least one of the following conditions:. 1) The participant has been enrolled in the 1915(i) program for 6 months or less;. 2) The participant is currently enrolled in Level I or Level II Care Coordination services under this chapter and has experienced one of the following adverse childhood experiences during the preceding 6 months:a) Emotional, physical, or sexual abuse;.
10.09.90.08.htm 10.09.90.08. 08 Conditions for Provider Participation.. A. Selection of CCOs.. 1) The local core service agencies shall select child and youth CCOs through a competitive procurement process, at least once every 5 years.2) Regional CCOs may be procured at the mutual agreement of local core service agencies so long as the local core service agencies demonstrate that there is sufficient provider capacity to serve the children and youth in a pa1) Be approved by the Department as a CCO;.
10.09.90.09.htm 10.09.90.09. 09 Conditions for Provider Participation ― Eligibility.. 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:.
10.09.90.10.htm 10.09.90.10. 10 Mental Health Case Management Care Coordination Provider Staff.. CCOs are required to maintain the following positions:. A. Care coordinator supervisor who:. 1) Is a mental health professional with a minimum of a Master’s degree and who is licensed and legally authorized to practice under Health Occupations Article, Annotated Code of Maryland, and who is licensed under Maryland Practice Boards in the profession of:a) Social work;. b) Professional Counseling;. e) Medicine;.
10.09.90.11.htm 10.09.90.11. 11 Covered Services.. A. The Department shall reimburse for the care coordination services in this regulation when these services have been documented, pursuant to the requirements of this chapter, as necessary.B. Care coordination services shall be coordinated with, and may not duplicate activities provided as part of, institutional services and discharge planning activities.C. Care coordination may include contacts that are directly related to identifying the needs and sup
10.09.90.12.htm 10.09.90.12. 12 Covered Services ― Plan of Care.. A. The POC shall contain, at minimum:. 1) A description of the participant’s strengths and needs;. 2) The diagnosis or diagnoses established as evidence of the participant’s eligibility for services under this chapter;3) The goals of care coordination services to address the behavioral health, medical, social, educational, and other services needed by the participant, with expected target completion dates;4) A crisis plan includin
10.09.90.13.htm 10.09.90.13. 13 Covered Services ― Child and Family Team Meetings.. The CCO shall:. A. Coordinate and facilitate the CFT, with CFT meetings convened at least every 45 calendar days or more frequently as clinically indicated;B. Record and keep notes at every CFT meeting that include the CFT members who were present, a summary of the discussion, any changes to the POC, and action items for follow up, and share them with the CFT members, including those who were not in attC. Update the POC to incl
10.09.90.14.htm 10.09.90.14. 14 Covered Services ― Referral and Related Activities.. A. The care coordinator shall ensure that the participant or, if the participant is a minor, the minor’s parent or guardian has applied for, has access to, and is receiving the necessary services available to meet the participant’s needs, such as mental health services, resource procurement, transportation, or crisis intervention.B. The care coordinator shall take the necessary action as defined by the D
10.09.90.15.htm 10.09.90.15. 15 Covered Services ― Monitoring and Follow-Up Activities.. A. A CCO shall monitor, as per standards set forth by the Department, the activities and contacts that are considered necessary to ensure the POC is implemented and adequately addresses the participant’s needs, and include:1) The participant or, if the participant is a minor, the minor’s parent or guardian; and. 2) With proper consent:. a) Family members and friends, if appropriate;. b) Other individuals or a
10.09.90.16.htm 10.09.90.16. 16 Limitations.. A. Care coordination services are facilitative in nature.. B. A restriction may not be placed on a qualified recipient’s option to receive mental health case management services.C. Care coordination services do not restrict or otherwise affect:. 1) Eligibility for Title XIX benefits or other available benefits or programs, except as limited by §E of this regulation;2) The freedom of a participant or, if the participant is a minor, the minor’s parent or guardian to
10.09.90.17.htm 10.09.90.17. 17 Preauthorization.. All covered services under this chapter shall be preauthorized and comply with the requirements of COMAR 10.09.70.07 and COMAR 10.09.89 for services delivered to 1915(i) participants.
10.09.90.18.htm 10.09.90.18. 18 Payment Procedures.. A. The Program shall reimburse the provider according to the requirements in this chapter and COMAR 10.09.89 for services delivered to 1915(i) participants, and the fees established under COMAR 10.21.25.B. Request for Payment.. 1) A provider shall submit requests for payment of mental health case management services according to procedures established by the Department.2) A provider shall bill the Program for the appropriate fee under COMAR 10.21.25..
10.09.90.19.htm 10.09.90.19. 19 Recovery and Reimbursement.. Recovery and reimbursement are as set forth in COMAR 10.09.36.07..
10.09.90.20.htm 10.09.90.20. 20 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions is as set forth in COMAR 10.09.36.08..
10.09.90.21.htm 10.09.90.21. 21 Appeal Procedures.. Appeal procedures are those set forth in COMAR 10.09.36.09..
10.09.90.22.htm 10.09.90.22. 22 Interpretive Regulation.. State regulations are interpreted as those set forth in COMAR 10.09.36.10..
10.09.90.9999.htm 10.09.90.9999. Administrative History Effective date: October 1, 2014 (41:19 Md. R. 1078). Regulation .16D amended effective April 13, 2015 (42:7 Md. R. 568).
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