Regulation .03 Participant Eligibility.
Regulation .03 Participant Eligibility.LinkCopy Citation
A.
A participant shall be eligible for care coordination services if the recipient:
(1)
Is in a federal eligibility category for Maryland Medical Assistance according to COMAR 10.09.24, which governs the determination of eligibility for the Maryland Medical Assistance Program; and
(2)
Meets the criteria of either §B(1) or (2) of this regulation.
B.
The participant:
(1)
Shall:
(a)
Meet the diagnostic requirements of being either:
(i)
An individual younger than 18 years old with a serious emotional disturbance or co-occurring disorder; or
(ii)
A young adult with a serious emotional disturbance or co-occurring disorder enrolled in care coordination services continuously under this chapter since reaching age 18; and
(b)
Require community treatment and support in order to prevent or address:
(i)
Inpatient psychiatric or substance use treatment;
(ii)
Treatment in a RTC or residential substance use treatment facility;
(iii)
An out-of-home placement;
(iv)
Emergency room utilization due to multiple behavioral health stressors;
(v)
Homelessness or housing instability, or otherwise lacking in permanent, safe housing; or
(vi)
Arrest or incarceration due to multiple behavioral health stressors; or
(2)
Shall:
(a)
Meet the requirements of §B(1)(a); and
(b)
Need care coordination services to facilitate community treatment following:
(i)
Release from a detention center or correctional facility; or
(ii)
Discharge to the community from RTC placement or inpatient psychiatric unit.
C.
A participant that disenrolls after reaching 18 years of age and wishes to re-enroll in care coordination services at a later date shall do so pursuant to COMAR 10.09.45 if more than 120 calendar days has passed since disenrollment.