<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.09.45.04" title_num="10" subtitle_num="09" chapter_num="45" heading="Conditions for Mental Health Case Management Provider Participation.">
  <paragraph num="A.">
    <text>The local core service agencies shall select mental health case management providers through a competitive procurement process, at least once every 5 years.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Mental health case management services may be provided by local health departments according to COMAR 10.04.04, which allows the Director of the MHA to utilize the local health departments as vendors unless the health officer believes the service provided by alternate vendors would be preferable.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Providers of mental health case management shall:</text>
    <paragraph num="(1)">
      <text>Be approved or licensed in Maryland as a community mental health provider under COMAR 10.21.19, 10.21.20, 10.21.21, or 10.21.29, or have 3 years experience as a mental health case management provider; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Have at least 3 years experience providing mental health services, including serving high risk populations, to adults with serious mental illness.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>General Requirements. To be eligible to be approved as a mental health case management service provider, an entity shall meet all of the:</text>
    <paragraph num="(1)">
      <text>Conditions for participation as set forth in COMAR 10.09.36.03; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Medical Assistance provisions listed in COMAR designated for their provider type.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Specific Requirements. A mental health case management service provider:</text>
    <paragraph num="(1)">
      <text>May not place restrictions on the qualified recipient's right to elect to or decline to:</text>
      <paragraph num="(a)">
        <text>Receive mental health case management as authorized by the Department or the Department's designee; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Choose a community support specialist or associate, as approved by the Department or the Department's designee, and other medical care providers;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Shall employ appropriately qualified individuals as community support specialists, community support specialist associates, and community support specialist supervisors with relevant work experience, including experience with the target population, including but not limited to adults with a serious and persistent mental disorder;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Shall assure that:</text>
      <paragraph num="(a)">
        <text>A participant's initial assessment is completed within 20 days after the participant has been authorized by the ASO and determined eligible for, and has elected to receive, mental health case management services; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>An initial care plan is completed within 10 days after completion of the initial assessment;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Shall maintain a file for each participant which includes all of the following:</text>
      <paragraph num="(a)">
        <text>An initial referral and intake form with identifying information, including, but not limited to, the individual's name and Medicaid identification number;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A written agreement for services signed by the participant or the participant's legally authorized representative and by the participant's community support specialist;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>An assessment as specified in Regulation .06 of this chapter;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A care plan, updated at a minimum of every 6 months, which contains at a minimum:</text>
        <paragraph num="(i)">
          <text>A description of the participant's strengths and needs;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The diagnosis established as evidence of the participant's eligibility for services under this chapter;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>The goals of case management services, with expected target dates;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>The proposed intervention;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Designation of the community support specialist with primary responsibility for implementation of the care plan; and</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Signatures of the community support specialist, participant, or the participant's legally authorized representative, and significant others, if appropriate;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>An ongoing record of contacts made on the participant's behalf, which includes all of the following:</text>
        <paragraph num="(i)">
          <text>Date and subject of contact;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Individual contacted;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Signature of community support specialist or community support specialist associate making the contact;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Nature, content, and unit or units of service provided;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Place of service;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Whether goals specified in the care plan have been achieved;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>The timeline for obtaining needed services;</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>The timeline for reevaluation of the plan; and</text>
        </paragraph>
        <paragraph num="(ix)">
          <text>The need for and occurrences of coordination with other case managers; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(f)">
        <text>Monthly summary notes, which reflect progress made towards the participant's stated goals;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Shall have formal written policies and procedures, approved by the Department, or the Department's designee, which specifically address the provision of mental health case management services to participants in accordance with the requirements of this chapter;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Shall be available to participants and, as appropriate, their families for 24 hours a day, 7 days a week in order to refer:</text>
      <paragraph num="(a)">
        <text>Participants to needed services and supports; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>In a psychiatric emergency, participants to mental health treatment and evaluation services in order to prevent the participant from accessing a higher level of care;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>Shall document in the participant's case management records if the participant declines case management services;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>May not provide other services to participants which would be viewed by the Department as a conflict of interest;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Shall be knowledgeable of the eligibility requirements and application procedures of federal, State, and local government assistance programs which are applicable to participants;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Shall maintain information on current resources for mental health, medical, social, financial assistance, vocational, educational, housing, and other support services;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Shall safeguard the confidentiality of the participant's records in accordance with State and federal laws and regulations governing confidentiality;</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Shall comply with the Department's fiscal reporting requirements and submit reports in the manner specified by the Department;</text>
    </paragraph>
    <paragraph num="(13)">
      <text>Shall provide services in a manner consistent with the best interest of recipients and may not restrict an individual's access to other services; and</text>
    </paragraph>
    <paragraph num="(14)">
      <text>Shall assure the amount, duration, and scope of the case management activities are documented in a participant's care plan, which includes mental health case management activities before discharge and after discharge when transitioning from an institution, to facilitate a successful transition into the community.</text>
    </paragraph>
  </paragraph>
</regulation>