# COMAR Title 10 — Maryland Department of Health

## 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

**Administrative History:** Effective date:

**Administrative History:** 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)

**Administrative History:** Regulations .01—.03 and .06 amended and Regulation .12 repealed as an emergency provision effective December 9, 1994 (21:26 Md.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)

**Administrative History:** Regulation .01B amended effective August 27, 2007 (34:17 Md. R. 1507)

**Administrative History:** Regulation .09A amended effective August 27, 2007 (34:17 Md. R. 1507)

**Administrative History:** Regulation .10A amended effective August 27, 2007 (34:17 Md. R. 1507)

**Administrative History:** Regulations .01—.18 under Case Management for Individuals with Developmental Disability repealed and new Regulations .01—.12 under Targeted Case Management for People with Intellectual and Developmental Disabilities adopted effective July 8, 2013 (40:13 Md. R. 1074)

**Administrative History:** Chapter name, Targeted Case Management for People with Intellectual and Developmental Disabilities amended to be Targeted Case Management for People with Developmental Disabilities effective June 8, 2015 (42:11 Md. R. 723)

**Administrative History:** Regulation .01B amended effective June 8, 2015 (42:11 Md. R. 723); December 27, 2021 (48:26 Md. R. 1111)

**Administrative History:** Regulation .02 amended effective December 27, 2021 (48:26 Md. R. 1111)

**Administrative History:** Regulation .03 amended effective December 27, 2021 (48:26 Md. R. 1111)

**Administrative History:** Regulation .03B amended effective June 20, 2016 (43:12 Md. R. 666)

**Administrative History:** Regulation .04 amended effective June 8, 2015 (42:11 Md. R. 723); December 27, 2021 (48:26 Md. R. 1111)

**Administrative History:** Regulation .05 amended effective June 8, 2015 (42:11 Md. R. 723); December 27, 2021 (48:26 Md. R. 1111)

**Administrative History:** Regulation .06 amended effective June 8, 2015 (42:11 Md. R. 723); December 27, 2021 (48:26 Md. R. 1111)

**Administrative History:** Regulation .07 amended effective June 8, 2015 (42:11 Md. R. 723); December 27, 2021 (48:26 Md. R. 1111)

**Administrative History:** Regulation .08 amended effective June 8, 2015 (42:11 Md. R. 723); June 20, 2016 (43:12 Md. R. 666); December 27, 2021 (48:26 Md. R. 1111)

**Administrative History:** Regulation .08B amended effective August 14, 2017 (44:16 Md. R. 809); February 12, 2018 (45:3 Md. R. 156); December 31, 2018 (45:26 Md. R. 1243); December 30, 2019 (46:26 Md. R. 1164); August 21, 2023 (50:16 Md. R. 276); September 16, 2024 (51:18 Md. R. 809); November 24, 2025 (52:23 Md. R. 1139)

**Administrative History:** Regulation .10 amended effective June 8, 2015 (42:11 Md. R. 723)

#### Regulation .01 Definitions.

*COMAR 10.09.48.01*

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” means provision of core services to individuals receiving ongoing DDA funding for comprehensive community services.

  (4) “Community resources” means generic, local, State, or federal programs, services, benefits, and supports.

  (5) “Comprehensive assessment” means an assessment of the applicant’s needs and supports to enable the DDA to determine the applicant’s eligibility for DDA funding of comprehensive community services.

  (6) Comprehensive Community Services.

    (a) “Comprehensive community services” means services funded by the DDA for residential, day, employment, or supports services.

    (b) “Comprehensive community services” does not mean funding for low intensity support services or coordination of community services.

  (7) “Contact” means a face-to-face meeting, phone conversation, or written correspondence related to the covered services in this chapter.

  (8) “Coordination of community services” means the provision of targeted case management services that assist participants in gaining access to the full range of medical assistance services, as well as access to any additional needed generic, medical, social, habilitative, employment, recreational, housing, financial, counseling, legal, educational, and other support services.

  (9) “Coordinator of community services” means an individual employed by the coordination of community services agency to assist participants in selecting, obtaining, and monitoring the most responsive and appropriate services and supports.

  (10) “Coordination of community services supervisor” means an individual who is employed to oversee coordination of community services and performance of coordinators of community services.

  (11) “Core services” means the following community services:

    (a) Comprehensive assessment;

    (b) Development of the person-centered plan;

    (c) Referrals and related activities; and

    (d) Monitoring and follow-up.

  (12) “Critical incident” means a reportable event that presents an immediate and serious threat of injury, harm, impairment, or death of an individual.

  (13) “Department” means the Maryland Department of Health, which is the single State agency designated to administer the Maryland Medical Assistance Program pursuant to Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.

  (14) “Developmental Disabilities Administration (DDA)” means that agency of the Department which, under Health General Article, Title 7, Annotated Code of Maryland, is charged with the responsibility for providing services to individuals with developmental disability.

  (15) “Developmental disability” has the same meaning as set forth in Health-General Article, §7-101, Annotated Code of Maryland.

  (16) “Entity” means a facility, agency, organization, department, office, corporation, partnership, group, or individual.

  (17) “Generic” means programs, services, or supports which are available to the community at large.

  (18) “Goal” means measurable activity that is required to achieve progress toward an outcome.

  (19) “Medicaid waiver programs” means any program under §1915(c) of the Social Security Act.

  (20) “Medical Assistance Program” means the program of comprehensive medical and other health-related care for indigent and medically indigent persons.

  (21) “Most integrated setting” means a setting that enables a participant with a disability to interact with nondisabled individuals other than staff to the fullest extent possible.

  (22) “Outcome” means tangible results of goals that reflect the desired quality of life as defined by the individual.

  (23) “Participant” means an individual who meets the qualifications for participation in coordination of community services as specified in Regulation .03 of this chapter.

  (24) Person-Centered Plan.

    (a) “Person-centered plan” means a written plan that is developed through a planning process driven by the participant with a developmental disability to:

      (i) Identify the participant’s goals and preferences;

      (ii) Identify services to support the participant in pursuing the participant’s personally defined outcomes in the most integrated community setting;

      (iii) Direct the delivery of services that reflect the participant’s personal preferences and choice; and

      (iv) Identify the participant’s specific needs that must be addressed to ensure the participant’s health and welfare.

    (b) “Person-centered plan” includes an individual plan as referenced in COMAR 10.22.

  (25) “Person-directed supports” means service and supports that empower the participant, and the legally authorized representative on the participant’s behalf, to direct the development and implementation of a plan of supports and services that meet the participant’s personal goals.

  (26) Place of Service.

    (a) “Place of service” means the place where participants receive services.

    (b) “Place of service” includes but is not limited to the participant’s home, day program, group home, alternate living arrangement, or place of employment.

  (27) “Program” means the Medical Assistance Program as defined in COMAR 10.09.36.01.

  (28) “Provider” means an entity that meets the conditions for participation specified in Regulation .04 of this chapter, and is authorized by DDA to provide coordination of community services.

  (29) “Reportable events” means specified incidents and complaints noted in the DDA Policy on Reportable Incidents and Investigations (PORII), as required under COMAR 10.22.02.01 and established to ensure the health, safety, and welfare of participants receiving services from DDA-funded providers.

  (30) “Representative” means a person who:

    (a) Is chosen by the participant to represent the participant’s needs and may include:

      (i) A family representative;

      (ii) An informal caregiver; or

      (iii) Any other individual chosen by the participant; or

    (b) Is recognized by the DDA as a legally appointed guardian qualified to act on the participant’s behalf with respect to services covered under this chapter.

  (31) “Service record” means all past and current health, eligibility, request for service change, service funding plan, person-centered plan, and coordination of community services documents and records.

  (32) “State programs” means programs, services, or supports offered by the State.

  (33) Targeted Case Management.

    (a) “Targeted case management” means an optional service allowed under federal Medicaid rules which includes services to assist target populations of Medicaid participants to gain access to needed medical, social, educational, and other services.

    (b) “Targeted case management” includes:

      (i) Performance of a comprehensive assessment and periodic reassessment of participant needs, to determine the need for any medical, educational, social, or other services;

      (ii) Provision of waiting list coordination services;

      (iii) Provision of community coordination services; and

      (iv) Provision of transition coordination services.

  (34) “Transition Coordination Services” means provision of core services to participants transitioning to the community from an institution.

  (35) “Unit of service” means 15 minutes of services covered under this chapter, excluding the comprehensive assessment.

  (36) “Waiting list” means participants found eligible for services in the crisis resolution, crisis prevention, or current request priority category as set forth in COMAR 10.22.12.07B.

  (37) “Waiting List Coordination Services” means provision of core services to participants on the DDA waiting list.

#### Regulation .02 Certification Requirements.

*COMAR 10.09.48.02*

The provider shall meet all applicable certification requirements as set forth in COMAR 10.22.02 unless otherwise authorized by the Developmental Disabilities Administration.

#### Regulation .03 Participant Eligibility.

*COMAR 10.09.48.03*

To be eligible for services covered under this chapter, a participant or applicant shall:

A. Apply to be a Medical Assistance Program participant or be Medical Assistance Program eligible; and

B. Either:

  (1) Have applied for services from the Developmental Disabilities Administration but not yet had their eligibility determined; or

  (2) 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 and currently on the DDA waiting list;

    (b) Be receiving comprehensive community services funded by the DDA; or

    (c) Be determined to have a developmental disability and in the process of transitioning to the community.

#### Regulation .04 Conditions for Participation — General.

*COMAR 10.09.48.04*

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 Department of Assessments and Taxation unless operating as a local health department;

  (2) Have a board of directors or local advisory board in accordance with COMAR 10.22.02;

  (3) Be selected by DDA as an approved provider of coordination of community services, as evidenced by an executed DDA-approved contract;

  (4) Participate in all transition and rollout processes as determined by the DDA;

  (5) Maintain a standard 8-hour operational day Monday through Friday and have flexible staffing hours that include nights and weekends to accommodate the needs of participants receiving coordination of community services;

  (6) Maintain a toll-free number, unless otherwise authorized by the DDA, and an accessible communication system in accordance with the Americans with Disabilities Act of 1990;

  (7) Maintain a communication system that is accessible for participants with limited English proficiency;

  (8) Provide alternative communication methods to serve the needs of participants receiving coordination of community services and their family members;

  (9) Have a means for participants, their families, community providers, and DDA staff to contact the coordination of community services designated staff directly in the event of an emergency and at times other than standard operating hours;

  (10) Annually advise participants of their right to choose among qualified providers of services including coordination of community services;

  (11) Comply with all State and federal statutes and regulations;

  (12) Maintain a participant’s record for a minimum of 6 years after the record is made;

  (13) Notify the DDA immediately in writing of any critical incidents that affect the health, safety, and welfare of a participant, as well as administrative and quality of care complaints as required by the DDA Policy on Reportable Incidents and Investigations; and

  (14) Submit required documents and forms to the Department as requested.

D. Operational Requirements. To participate in the Program as a provider of services covered under this chapter, the provider shall:

  (1) Submit a program service plan that includes:

    (a) Scope of work; and

    (b) Proposed staffing plan, including staff and staff-to-participant ratios;

  (2) Complete and submit an initial and annual written quality assurance plan to the DDA which meets the requirements in COMAR 10.22.02.14 and includes the following:

    (a) Customer service plan that includes strategies and services to meet the needs of participants, their families or caretakers, and providers; and

    (b) Self-assessment, remediating, monitoring, reporting, and system improvements strategies, or other quality and compliance actions related to coordination of community services;

  (3) Submit monthly service delivery statistical reports as defined by the Department by the 15th of each month unless otherwise directed by the Department;

  (4) Submit quarterly updates, as defined by the Department, on progress on quality assurance plans by October 15, January 15, and April 15 of each year unless otherwise directed by the Department;

  (5) Submit to the Department annually by July 15th the final quality plan summary reports unless otherwise directed by the Department;

  (6) Maintain a thorough understanding and knowledge of:

    (a) Eligibility requirements, application procedures, and scope of services of local, State, and federal resources and programs which are applicable to participants eligible for DDA services;

    (b) Medicaid, Medicaid waiver programs, and DDA eligibility requirements, application procedures, and service delivery systems; and

    (c) Person-centered planning methodology and person-centered plan development and monitoring;

  (7) Coordinate services with multiple long-term service and support systems;

  (8) Maximize resources to the greatest possible extent; and

  (9) Obtain authorization from the DDA before providing any coordination of community services to any participant;

  (10) In providing coordination of community services, meet the following requirements:

    (a) All participants referred for coordination of community services by the DDA shall be contacted within 3 business days of receipt of referral unless otherwise authorized by the DDA;

    (b) A face-to-face meeting with the referred participant shall be arranged at a time and location convenient for the referred individual during the first contact;

    (c) A face-to-face meeting shall occur within 7 business days of the initial contact unless the participant’s health or schedule conflicts;

    (d) If applicable, the provider shall document in the case record reasons why face-to-face meetings did not occur within the required timeframe and share the document as requested by the DDA or its designee;

    (e) Authorization for specific coordination of community services shall be based on referrals from the DDA regional office; and

    (f) In the event of emergencies, the participant referred for coordination of community services by the DDA shall be contacted by the coordinator of community services as circumstances require or as requested by the DDA.

E. Participant Record. The provider shall maintain a record on each participant which meets the Program’s requirements and which includes:

  (1) The name of the participant;

  (2) The dates of the coordination of community services;

  (3) The name of the provider agency and the name of agency employee providing the coordination of community service;

  (4) The name, address, and telephone number of the individual or individuals to be contacted in case of emergency;

  (5) A completed person-centered plan;

  (6) The comprehensive assessment as applicable;

  (7) Documentation that the coordinator of community services provided the participant with a choice among qualified providers of services, including coordination of community services;

  (8) Documentation that indicates whether the participant has declined services in the person-centered plan and the reason for declining;

  (9) Documentation that includes:

    (a) A schedule for obtaining needed services;

    (b) A timeline for re-evaluation of the person-centered plan not less than annually; and

    (c) The name and position of the individual responsible for completing tasks related to the person-centered plan;

  (10) Status of progress on participant-intended outcomes identified in the person-centered plan;

  (11) Documentation of coordination with other service systems, including:

    (a) Demonstrated need for other services systems; and

    (b) Dates of occurrences of coordination with other service systems; and

  (12) Documentation for each contact made by the coordinator of community services including:

    (a) Date and subject of contact;

    (b) Individual contacted;

    (c) Individual making the contact;

    (d) Contact method;

    (e) Nature and extent of coordination of community services provided;

    (f) Number of unit or units of service provided;

    (g) Place of service; and

    (h) Services referred.

F. Technology Requirements. To participate in the Program as a provider of services covered under this chapter, the provider shall:

  (1) Utilize an electronic information system which, at a minimum:

    (a) Maintains confidential individual case and billing records;

    (b) Provides documentation of coordination of community services and number of units provided for participants receiving services;

    (c) Maintain a permanent history log of all entries made to the record; and

    (d) Adheres to applicable State and federal laws; and

  (2) Adhere to the following information technology requirements:

    (a) Use the DDA’s designated data system unless another data system is approved annually by the DDA;

    (b) Ensure that all management information systems:

      (i) Are secure from improper use, alteration, or disclosure;

      (ii) Utilize industry best practices for secure connection to management information systems;

      (iii) Secure network connections with logon only from a secured location;

      (iv) Prohibit users from sharing user accounts;

      (v) Limit access to the system and related information based on job function; and

      (vi) Adhere to DDA information technology data security policies, standards, and procedures when using DDA managed systems;

    (c) Report security violations and actual or attempted security breaches affecting the managed systems with participant information immediately but not later than 48 hours after the violation or breach;

    (d) Maintain and update as necessary all electronic data systems to be compatible with those of the State and, if required, work with DDA to develop a system for developing protocols for data sharing and read-only access for the DDA and its designees; and

    (e) Obtain written approval from the DDA before posting on any public website information that describes DDA services.

G. Billing. To receive payment for services covered under this chapter, the provider shall:

  (1) Comply with Department’s requirements for submitting, processing, and reconciling claims for payment for services rendered under this chapter;

  (2) Be in good standing with the Maryland Department of Assessments and Taxation, and with its equivalent in every state in which the applicant provides services;

  (3) Permit the DDA or the Department or its agent, or any State or federal entity operating within its statutory authority to conduct audits and provide immediate access to all records upon request; and

  (4) Comply with audit requirements.

H. Freedom of Choice. The provider shall place no restrictions on the participant’s freedom of choice among:

  (1) Providers of coordination of community services;

  (2) Providers of community-based services for which the participant qualifies; and

  (3) Service delivery models available under the DDA’s Medicaid waiver programs.

I. Transfer of Service Records. For participants changing from one DDA-authorized coordination of community services provider to a different DDA-authorized coordination of community services provider, the outgoing provider shall:

  (1) Transfer the service record to the new provider; and

  (2) Share with the new provider the participant’s demographic information and the most recent person-centered plan within 5 business days of notification of transfer for the continued coordination of services.

J. Provision of Services. The provider may not exercise the agency’s authority to authorize or deny DDA or other State funded services.

#### Regulation .05 Conditions for Participation — Staff Requirements.

*COMAR 10.09.48.05*

A. Staff Capability Requirements. The provider shall:

  (1) Employ only personnel who are appropriately qualified as set forth in this regulation;

  (2) Maintain sufficient staff required to meet the needs of the participants whom the provider serves;

  (3) Have administrative and supervisory staff to ensure the quality of coordination of community services provided by the provider;

  (4) Have a management capability team, each member of which has at least 3 years of experience providing coordination of community services or management experience in human services; and

  (5) Maintain personnel files for each employee which includes documentation of staff qualifications as set forth in this regulation.

B. Staff Training Requirements.

  (1) All DDA-certified coordination of community services providers shall ensure through appropriate documentation that coordination of community services staff, supervisors, and quality assurance staff receive training, as required by DDA.

  (2) All coordination of community services staff shall receive training on procedures, protocols, processes, and regulations as required by the DDA.

C. Coordination of community services staff shall:

  (1) Receive required training as specified in COMAR 10.22, unless otherwise directed by the DDA, which shall be documented and made available upon request;

  (2) Comply with all State and federal statutes, regulations, and policies; and

  (3) Demonstrate competency-based skills and working knowledge in the following areas:

    (a) Negotiation and conflict management;

    (b) Crisis management;

    (c) Community resources including generic programs, local programs, State programs, and federal programs and resources;

    (d) Determining the most integrated setting appropriate to meet the participant’s needs;

    (e) Coordinating and facilitating planning meetings;

    (f) Assessing, planning, and coordinating services;

    (g) Assisting participants in gaining access to services and supports;

    (h) Monitoring the provision of services to participants;

    (i) Allied service delivery systems, including Medicaid, mental health, substance abuse, social services, juvenile justice, vocational rehabilitation, and corrections; and

    (j) Regulations governing services for participants with developmental disabilities.

D. Coordination of Community Services Supervisor. The coordination of community services supervisor shall:

  (1) Except as stated in §F of this regulation, meet one or more of the following education requirements:

    (a) An advanced degree from an accredited education program in human services and 1 year of experience as set forth in §C of this regulation; or

    (b) A bachelor’s degree from an accredited education program in human services with 3 years experience as set forth in §C of this regulation;

  (2) Demonstrate experience in one or more of the following:

    (a) Coordinating services for participants in Medicaid or waiver programs; or

    (b) Coordinating services for participants with intellectual or developmental disabilities;

  (3) Demonstrate experience in all of the following:

    (a) Social services intake and referral services;

    (b) Data collection, analysis, and reporting;

    (c) Staff supervision; and

    (d) Management or leadership;

  (4) Supervise the work of coordinators of community services; and

  (5) Monitor the quality of services.

E. Coordinator of Community Services. The coordinator of community services shall:

  (1) Except as stated in §F of this regulation, have:

    (a) A bachelor’s degree from an accredited education program in a human services field;

    (b) An associate’s degree with 2 years’ experience in a human services field; or

    (c) 7 years’ experience in a human services field;

  (2) Use all communication methodologies, strategies, devices, and techniques necessary, including sign language, assistive technology, or language interpreter services, to facilitate the involvement of the participant in the assessment, development, and monitoring of services and supports;

  (3) Ensure that each participant receives a person-centered plan that is designed to meet the individual’s needs in the most cost-effective manner; and

  (4) Annually advise participants of their right to choose among qualified providers of services including coordination of community services.

F. Education and Experience Waiver.

  (1) Coordination of Community Services Supervisor. Education and experience requirements may be waived if an individual has been employed as a coordination of community services supervisor for at least 1 year as of January 1, 2014.

  (2) Coordinator of Community Services. Education and experience requirements may be waived if an individual has been employed as a coordinator of community services for at least 1 year as of January 1, 2014.

G. An individual is ineligible for employment by a coordination of community services provider, agency, or entity in Maryland if the individual:

  (1) Is simultaneously employed by any MDH-licensed or MDH-certified provider agency;

  (2) Is on the Maryland Medicaid exclusion list;

  (3) Is on the federal List of Excluded Individuals/Entities (LEIE);

  (4) Is on the federal list of excluded parties as maintained by the System of Award Management (SAM.GOV);

  (5) Has been convicted of a crime of violence in violation of Criminal Law Article, §14-101, Annotated Code of Maryland;

  (6) Violates or has violated Health-General Article, §7-1102, Annotated Code of Maryland; or

  (7) Has been found guilty or been given Probation Before Judgment for a crime which would indicate behavior potentially harmful to individuals receiving services, as documented either through a criminal history records check or a criminal background check, pursuant to:

    (a) Health-General Article, §19-1902, et seq., Annotated Code of Maryland; and

    (b) COMAR 12.15.

#### Regulation .06 Covered Services.

*COMAR 10.09.48.06*

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 participant’s needs and supports to determine eligibility, in accordance with COMAR 10.22.12. The assessment shall be completed within 45 days after referral by the DDA and include:

  (1) A review of relevant medical and other records with the applicant or legal representative’s written consent;

  (2) A review of current providers of medical, social, or other support services, as appropriate;

  (3) Unless otherwise authorized by the DDA, a face-to-face assessment of the participant, preferably at the participant’s residence, to review:

    (a) Medical, developmental, and mental history, including current medications;

    (b) Nutritional status;

    (c) Emotional and behavioral status;

    (d) Health care coverage;

    (e) Living situation;

    (f) Personal support systems;

    (g) Participant goals and preferences;

    (h) Environmental, social, and functional status;

    (i) Educational history;

    (j) Employment and income status;

    (k) Health education;

    (l) Social support;

    (m) The most integrated setting appropriate to meet the participant’s needs; and

    (n) Any additional service needs;

  (4) Assistance with information-gathering such as obtaining professional evaluations and assessments necessary to document and recommend eligibility and priority for services; and

  (5) A completed assessment form as required by the DDA.

D. Person-Centered Plan.

  (1) The coordinator of community services shall facilitate the person-centered plan that is designed to meet the participant’s needs, preferences, goals, and outcomes in the most integrated setting and in the most cost effective manner.

  (2) The person-centered plan shall:

    (a) Be participant-centered, outcome-oriented, and person directed, as selected by participant;

    (b) Comply with the requirements set forth in COMAR 10.22.05;

    (c) Establish a plan for emergencies;

    (d) Be completed within 30 business days after initial contact with the participant, and, if necessary, updated or modified within 30 business days after service initiation;

    (e) Be developed and written in collaboration with the participant and his or her identified representatives as appropriate;

    (f) Provide services in the most integrated setting;

    (g) Identify services needed to accomplish intended outcomes and preferences;

    (h) Address risks and needs identified in the comprehensive assessment; and

    (i) Be updated or revised:

      (i) As the conditions or circumstances of the participant change or as requested by the participant; and

      (ii) Within 365 days of the initial person-centered plan or annually.

  (3) Specific requirements for the person-centered plan developed for participants receiving transition coordination services are that the person-centered plan shall:

    (a) Address challenges related to transitioning;

    (b) Focus on transition from the institutional setting to the community;

    (c) Identify services and supports that may be available;

    (d) Be outcome-oriented; and

    (e) Include the provision of services and supports.

E. Referral and Related Activities.

  (1) At the time of the initial meeting and any follow-up contacts, coordinators of community services shall provide information, make referrals, and assist participants with applications for services provided by:

    (a) Community organizations;

    (b) State programs; and

    (c) Federal programs.

  (2) Referral and related activities may include:

    (a) Assisting the participant with the completion of applications for services and programs;

    (b) Providing the participant with contact or other information for services provided by self-advocacy groups, recreation organizations, or social groups;

    (c) Assisting the participant with transitioning to new services, providers, or supports;

    (d) Assisting the participant with referrals, as needed; and

    (e) Providing education to participants and their families concerning:

      (i) The range of most integrated setting service and support options that may be appropriate to meet the participant’s needs and preferences;

      (ii) How to access services; and

      (iii) How to coordinate and advocate for services.

F. Monitoring and Follow-Up.

  (1) The coordinator of community services shall provide monitoring and follow-up activities, which shall include:

    (a) Assessment of:

      (i) Services being rendered as specified in the person-centered plan;

      (ii) The participant’s current circumstances;

      (iii) Progress toward goals and intended outcomes;

      (iv) The participant’s referral status; and

      (v) The participant’s needs and supports to maintain eligibility for Medicaid, Medicaid waiver programs, DDA services, and any other relevant benefits or services;

    (b) Identification of new medical, health services, or other needs;

    (c) Recommendation of new DDA priority category as the conditions or circumstances of the participant changes, or as requested by the DDA;

    (d) Requests for service change and modifications of the person-centered plan as necessary to meet health and safety needs, preferences, and goals;

    (e) Identification of new support or resource options;

    (f) Review and, if necessary, revision of the plan for emergencies;

    (g) Monitoring of any and all reportable incidents as defined in DDA’s reportable incident policy; and

    (h) Application or re-application for necessary programs or services to prevent or remedy a gap in eligibility.

  (2) Frequency of Monitoring and Follow-up Contact.

    (a) For participants receiving waiting list coordination services, monitoring and follow-up contact activities shall meet the following requirements:

      (i) For participants who meet the criteria for the crisis resolution priority category as set forth in COMAR 10.22.12.07, minimum monthly face-to-face contacts shall be made for the first 90 days, after which face-to-face contacts will be made quarterly;

      (ii) For participants who meet the criteria for the crisis prevention priority category as set forth in COMAR 10.22.12.07, minimum quarterly face-to-face contacts shall be made; and

      (iii) For participants who meet the criteria for the current request priority category as set forth in COMAR 10.22.12.07, minimum annual face-to-face contacts shall be made.

    (b) Participants on the DDA waiting list shall be monitored in accordance with §F(2)(a) of this regulation unless:

      (i) The participant’s priority category changes; or

      (ii) Additional units are authorized by DDA.

    (c) For participants receiving community coordination services, monitoring and follow-up activities shall be performed:

      (i) On a minimum quarterly basis;

      (ii) Face to face with the participant;

      (iii) In different services delivery settings; and

      (iv) At least one time in each service delivery setting.

    (d) For participants receiving transition coordination services, monitoring and follow-up activities shall be performed face-to-face at least once a month for the first 90 calendar days, after which face-to-face contacts shall be made quarterly.

  (3) Records of monitoring activities shall:

    (a) Be completed in a format approved by the DDA;

    (b) Include descriptions of the participant’s current circumstances, progress toward goals, intended outcomes, preferences, and referral status;

    (c) Document new support and resource options for intake and referral;

    (d) Be submitted using the electronic system provided by the Department; and

    (e) Document all reportable events as set in the DDA’s policy on reportable incidents and investigations.

#### Regulation .07 Limitations.

*COMAR 10.09.48.07*

A. Restrictions may not be placed on a participant’s option to receive coordination of community services.

B. Coordination of community services provided under this chapter does not restrict or otherwise affect eligibility for Title XIX benefits or other available benefits or programs.

C. 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;

  (3) Rendered in connection with the implementation of another service authorized under §1915(b) or 1915(c) of the Social Security Act; or

  (4) Provided as a substitute or in duplication of another service or support.

D. Unless otherwise approved by the Department, reimbursement may not be made for coordination of community services if the participant is receiving comparable case management services under any other State program.

E. A participant’s coordination of community services provider may not also provide DDA-funded direct services, including meaningful day, support, and residential services for the participant.

F. Service Exclusions.

  (1) Unless an individual is transitioning into the community, coordination of community services may not be provided to:

    (a) Individuals between the ages of 22 and 64 who are served in institutions for mental disease; or

    (b) Inmates or residents of public institutions.

  (2) Services of more than 180 consecutive days of a covered stay in a medical institution will not be reimbursed unless an individual is transitioning from another Medicaid program into a DDA waiver program as authorized by the DDA.

G. An applicant is ineligible to be a provider if, within the preceding 10 years, the entity, its owner, or any member of its board of directors has had a provider license or certification revoked or suspended for more than 30 days, pursuant to Maryland or another state’s regulations, or has been found by a court of law to have committed fraud, abuse, intentional or negligent tort, or a criminal act.

#### Regulation .08 Payment Procedures.

*COMAR 10.09.48.08*

A. Request for Payment.

  (1) Requests for payment for the services covered under this chapter shall be submitted by a 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) The Department shall publish a fee schedule for services covered under this chapter, which shall be publicly available and updated at least annually or upon any changes made by the Department.

  (2) The Department's rates set forth in its fee schedule will apply to services covered under this chapter that are provided under either the traditional services delivery model or the self-directed services delivery model.

  (3) The Program's rates for covered services under this chapter shall increase on July 1 of each year, subject to the limitations of the State budget.

  (4) Providers shall be reimbursed within 45 business days of approved invoice for services rendered based on the rates set forth in §C(1) and (2) of this regulation.

  (5) For a comprehensive assessment, providers shall be reimbursed $450 per assessment.

  (6) For all other services rendered to Maryland Medicaid participants residing in counties other than those listed in §B(7) of this regulation, providers shall be reimbursed:

    (a) For dates of service January 1, 2023 through June 30, 2023, $24.56 per unit;

    (b) For dates of service July 1, 2023 through December 31, 2023, $25.54 per unit;

    (c) For dates of service January 1, 2024 through June 30, 2024, $27.50 per unit; and

    (d) For dates of service July 1, 2024 through June 30, 2025, $28.33 per unit.

  (7) Providers rendering services to Maryland Medicaid participants residing in Calvert, Charles, Frederick, Montgomery, and Prince George’s counties shall be reimbursed:

    (a) For dates of service January 1, 2023 through June 30, 2023, $25.86 per unit;

    (b) For dates of service July 1, 2023 through December 31, 2023, $26.89 per unit;

    (c) For dates of service January 1, 2024 through June 30, 2024, $28.96 per unit; and

    (d) For dates of service July 1, 2024 through June 30, 2025, $29.83 per unit.

C. Changes in Rates.

  (1) The rates are subject to the limitations of the State budget.

  (2) Unless otherwise authorized, the rates may be changed on July 1 of each year beginning July 1, 2015, based on legislative action, and subject to limitations of the State budget.

D. Payment Limitations.

  (1) Payment shall be made only to one provider for covered services rendered to a participant on a particular date of service.

  (2) Payment for the services covered under this chapter:

    (a) Shall be considered as payment in full; and

    (b) May not supplement or be supplemented by payment from other sources, such as the participant, family, a public program, or private agency.

  (3) For a comprehensive assessment, only one assessment may be reimbursed per participant, unless otherwise authorized by DDA.

  (4) Ongoing coordination of community services shall be billed on a scheduled determined by the Department.

E. Units of Services and Limitations.

  (1) All coordination of community services other than the initial comprehensive assessment shall be billed to DDA in units of service.

  (2) DDA shall provide payment for only those coordination of community services that were authorized by DDA before the provision of the service.

  (3) Each fiscal year, the coordinator of community services shall complete the core services for each participant.

#### Regulation .09 Recovery and Reimbursement.

*COMAR 10.09.48.09*

Recovery and reimbursement shall be as set forth in COMAR 10.09.36.07.

#### Regulation .10 Cause for Suspension or Removal and Imposition of Sanctions.

*COMAR 10.09.48.10*

Cause for suspension or removal and imposition of sanctions shall be as set forth in COMAR 10.09.36.08 and 10.22.03.

#### Regulation .11 Appeal Procedures.

*COMAR 10.09.48.11*

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.

#### Regulation .12 Interpretive Regulation.

*COMAR 10.09.48.12*

State regulations shall be interpreted as set forth in COMAR 10.09.36.10.