Md. Code Regs. 10.09.69.05

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.69.05 - Benefits

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.

Md. Code Regs. 10.09.69.05

Regulations .05 adopted as an emergency provision effective November 8, 1996 (23:25 Md. R. 1730)
Regulations .05 adopted effective March 10, 1997 (24:5 Md. R. 408)
Regulations .05 amended as an emergency provision effective July 1, 1997 (24:16 Md. R. 1151); emergency status expired December 31, 1997
Regulation .05 amended effective February 9, 1998 (25:3 Md. R. 144)
Regulation .05 amended as an emergency provision effective December 1, 2000 (27:26 Md. R. 2355); emergency status extended at 28:7 Md. R. 685; amended permanently effective June 25, 2001 (28:12 Md. R. 1109)
Regulations .05 adopted effective February 2, 2004 (31:2 Md. R. 84)
Regulation .05B, C amended effective November 6, 2006 (33:22 Md. R. 1732)
Regulation .05C, D amended effective October 5, 2009 (36:20 Md. R. 1528); amended and recodified from .04 effective 45:13 Md. R. 665, eff. 7/2/2018