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<regulation prefix="Regulation" num=".16" citation="COMAR 10.09.90.16" title_num="10" subtitle_num="09" chapter_num="90" heading="Limitations.">
  <paragraph num="A.">
    <text>Care coordination services are facilitative in nature.</text>
  </paragraph>
  <paragraph num="B.">
    <text>A restriction may not be placed on a qualified recipient’s option to receive mental health case management services.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Care coordination services do not restrict or otherwise affect:</text>
    <paragraph num="(1)">
      <text>Eligibility for Title XIX benefits or other available benefits or programs, except as limited by §E of this regulation;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The freedom of a participant or, if the participant is a minor, the minor’s parent or guardian to select from all available services for which the participant is found to be eligible; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>A participant’s free choice among qualified providers or, if the participant is a minor, the minor’s parent or guardian’s free choice among qualified providers.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The CCO may not bill the Program for:</text>
    <paragraph num="(1)">
      <text>The direct delivery of an underlying medical, educational, social, or other service to which a participant has been referred;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Activities integral to the administration of foster care programs;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Activities not consistent with the definition of case management services under Section 6052 of the federal Deficit Reduction Act of 2005 (P.L. 109—171);</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Activities for which third parties are liable to pay;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Activities delivered as part of institutional discharge planning; or</text>
    </paragraph>
    <paragraph num="(6)">
      <text>A 15-minute unit of service for telephonic contact, unless the provider has delivered at least 8 minutes of service.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Reimbursement may not be made for care coordination services if the participant is receiving a comparable care coordination service under another Program authority.</text>
  </paragraph>
  <paragraph num="F.">
    <text>A participant’s care coordinator may not be the participant’s family member or a direct service provider for the participant.</text>
  </paragraph>
  <paragraph num="G.">
    <text>Units of services for all levels of care coordination shall be 15 minutes of contact, which may include face-to-face and, with the exception of §G(4) of this regulation, non-face-to-face contacts with the participant, or, if the participant is a minor, with the minor’s parent or guardian, and indirect collateral contacts on behalf of the participant with other community providers, as per the following:</text>
    <paragraph num="(1)">
      <text>For participants in Level I — General Coordination, allows a maximum of 12 units of service per month, with a minimum of two units of face-to-face contact;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>For participants in Level II — Moderate Care Coordination, allows a maximum of 30 units of service per month, with a minimum of four units of face-to-face contact;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>For participants in Level III — Intensive Care Coordination, allows a maximum of 60 units of service per month, with a minimum of six units of face-to-face contact; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>For Level I and Level II, four additional units of service above and beyond the monthly maximum may be billed during the first month of service to the participant and every 6 months thereafter to allow for comprehensive assessment and reassessment of the participant, which shall be performed as a face-to-face service.</text>
    </paragraph>
  </paragraph>
</regulation>