10.09.52.04

.04 Covered Services.

A. The Program shall reimburse for the services in §§B—D of this regulation when the services have been documented, pursuant to the requirements of this chapter, as medically necessary.

B. Initial IEP.

(1) Definition. ďUnit of serviceĒ means:

(a) A completed initial IEP, signed by all members of the IEP team; and

(b) At least one contact by the participantís service coordinator or IEP team in person or by telephone with the participant or the participantís parent, on the participantís behalf relating to development of the IEP.

(2) The covered services include convening and conducting an IEP team to:

(a) Perform a multidisciplinary assessment of the participant; and

(b) Develop an initial IEP.

C. Ongoing Service Coordination.

(1) Ongoing service coordination is provided by a participant's service coordinator.

(2) Definition. For purposes of this section, "unit of service" means:

(a) At least one contact per month by the service coordinator in person, by telephone, or by written progress notes or log with the participant or the participant's parent, on the participant's behalf relating to the child's ongoing service coordination; and

(b) The provision of all other necessary services covered under these regulations.

(3) As necessary, the Program shall include as covered services the following:

(a) Acting as a central point of contact relating to IEP services for a participant;

(b) Maintaining contact with:

(i) The child's direct service providers, as applicable, which may include, but not be limited to, the child's Maryland Medicaid Managed Care Program provider or the Rare and Expensive case management provider; and

(ii) A participant and the participant's parent through home visits, office visits, written notes, school visits, telephone calls, and follow-up service as necessary;

(c) Implementing the IEP by referring the participant to direct service providers, assisting the participant in gaining access to services specified in the IEP, and providing linkage to agreed-upon direct service providers of services;

(d) Discussing with direct service providers the services needed and available for the participant, assessing the quality and quantity of services being provided, following up to identify any obstacles to a participantís utilization of services, coordinating the service delivery, and performing ongoing monitoring to determine whether the services are being delivered in an integrated fashion as recommended in the IEP and meet the participantís current needs;

(e) Providing a participant and the participantís parent with information and direction that will assist them in successfully accessing and using the services recommended in the IEP;

(f) Informing a participantís parent of the participantís and the familyís rights and responsibilities in regard to specific programs and resources recommended in the IEP;

(g) Conducting, with a participantís parent at a meeting or by other means acceptable to the parent and the service coordinator, a periodic review of the participantís IEP every 6 months, or more frequently if warranted or the parent requests a review; and

(h) Reviewing at least annually at a meeting or by other means acceptable to the participantís parent and others involved in the review process:

(i) The degree of a participantís progress toward achieving the goals established in the IEP; and

(ii) Whether the goals or recommended services need to be revised.

(4) Administrative, supervisory, and monitoring services associated with the ongoing service coordination, including coordinating with the child's primary care provider, are included as part of the service.

D. IEP Review.

(1) Definition. ďUnit of serviceĒ means:

(a) A completed initial 60-day, interim, or annual IEP review as evidenced by a signed revised IEP or, if a revised IEP was not done, IEP team records documenting a meeting in which there is participation by at least two different disciplines; and

(b) At least one contact by the service coordinator or IEP team in person, by telephone, or by written progress notes or log with the participant or the participant's parent, on the participant's behalf.

(2) The covered services include convening and conducting an IEP team to:

(a) Perform a multidisciplinary reassessment of the participant's status and service needs; and

(b) Review and revise, as necessary, the participantís IEP.