<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.09.69.05" title_num="10" subtitle_num="09" chapter_num="69" heading="Benefits.">
  <text>A REM participant is eligible for the following:</text>
  <paragraph num="A.">
    <text>Fee-for-service Medical Assistance benefits available to a Medical Assistance participant not enrolled in an MCO;</text>
  </paragraph>
  <paragraph num="B.">
    <text>Services described in Regulations .10 and .11 of this chapter when determined medically necessary by the Department;</text>
  </paragraph>
  <paragraph num="C.">
    <text>A case management assessment performed by a REM case manager who shall:</text>
    <paragraph num="(1)">
      <text>Gather all relevant information needed to determine the participant’s condition and needs including the participant’s medical records;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Consult with the participant's current service providers; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Evaluate the relevant information and complete a needs analysis including medical, psychosocial, environmental, and functional assessments; and</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Case management services performed by a REM case manager who shall:</text>
    <paragraph num="(1)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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:</text>
      <paragraph num="(a)">
        <text>Includes the participant's health status and needs for medical, health-related, housing, and social services including, but not limited to:</text>
        <paragraph num="(i)">
          <text>All pertinent diagnoses including the REM qualifying diagnosis;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Type, frequency, and duration of services;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Treatment goals for each type of service;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Medical equipment and supplies;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Medication;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Social support structure;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Current service providers;</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>Assigned level of care;</text>
        </paragraph>
        <paragraph num="(ix)">
          <text>Nutritional status;</text>
        </paragraph>
        <paragraph num="(x)">
          <text>Education or vocational information;</text>
        </paragraph>
        <paragraph num="(xi)">
          <text>Current living arrangement; and</text>
        </paragraph>
        <paragraph num="(xii)">
          <text>Emergency plan, if appropriate; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Is developed in consultation with the interdisciplinary team;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Implement the plan of care and assist the participant in gaining access to medically necessary services by linking the participant to those services;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Monitor a participant's receipt of EPSDT services as specified in COMAR 10.67.06; and</text>
    </paragraph>
    <paragraph num="(7)">
      <text>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.</text>
    </paragraph>
  </paragraph>
</regulation>