Chapter 90. Mental Health Case Management: Care Coordination for Children and Youth

“1915(i)” means the 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families program defined in COMAR 10.09.89.

“Care coordination” means services which assist participants in gaining access to a full range of behavioral health services and, as necessary, any medical, social, financial assistance, counseling, educational, housing, and other support services.

“Care coordination organization (CCO)” means an entity with a minimum of 3 years of experience providing care coordination services that:

“Care coordinator” means an individual employed through the care coordination organization who is responsible for providing care management services to benefit participants and families, including, but not limited to:

“Child and family team (CFT)” means the group of individuals, including both formal and informal supports and inclusive of the youth and the youth’s family, responsible for the creation and implementation of the plan of care.

“Co-occurring disorder” means a diagnosis based on the current Diagnostic and Statistical Manual published by the American Psychiatric Association where the participant is indicated as having both a mental illness and substance use disorder.

“Core service agency” has the meaning stated in COMAR 10.21.17.

“Department” has the meaning stated in COMAR 10.09.36.01 and refers to the Department or its designee.

“Medical Assistance Program” has the meaning stated in COMAR 10.09.36.01.

“Mental Health Case Management: Care Coordination for Children and Youth” has the same meaning as “care coordination” as defined in this regulation.

“Mental health professional” has the meaning stated in COMAR 10.21.17.02.

“Mental health services” means those services described in COMAR 10.09.70.

“Minor” means a child or adolescent younger than 16 years old.

“Natural supports” means any individual who plays a positive, but nonprofessional, role in someone’s plan of care.

“Participant” means an individual who meets the qualifications for participation in care coordination that are specified in Regulation .03 of this chapter.

“Plan of care (POC)” means the individualized plan for supports and services prepared according to the requirements outlined in this chapter for a specific participant in care coordination, including a POC developed for 1915(i) participants pursuant to COMAR 10.09.89.

“Program” has the meaning stated in COMAR 10.09.36.01.

“Provider” means the care coordination provider.

“Recipient” has the meaning stated in COMAR 10.09.36.01.

“Residential treatment center (RTC)” has the meaning stated in COMAR 10.07.04.

“Serious emotional disturbance (SED)” has the meaning stated in COMAR 10.21.17.02.

“Young adult” means an individual who is 18 years old or older but not older than 21 years old.

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

Meets the criteria of either §B(1) or (2) of this regulation.

Shall:

Shall:

Is currently enrolled in Level II or Level III Care Coordination services under this chapter; and

Has stabilized to the point that Level I is most appropriate.

Inpatient psychiatric or substance use services;

RTC; or

1915(i) services under COMAR 10.09.89;

Psychiatric hospitalizations; or

Repeated visits or admissions to:

Is currently enrolled in Level III Care Coordination services under this chapter; and

Has stabilized to the point that Level II is most appropriate;

Is currently enrolled in Level I Care Coordination services under this chapter; and

Has experienced one of the following adverse childhood experiences during the preceding 6 months:

The participant has been enrolled in the 1915(i) program for 6 months or less;

The participant is currently enrolled in Level I or Level II Care Coordination services under this chapter and has experienced one of the following adverse childhood experiences during the preceding 6 months:

The participant meets the following conditions:

Transitioning from a residential treatment center; or

Living in the community, be 6 through 21 years old, and have:

Be referred directly from one of the following:

If living in the community, meet one or more of the following criteria in the past 12 months:

The local core service agencies shall select child and youth CCOs through a competitive procurement process, at least once every 5 years.

Regional CCOs may be procured at the mutual agreement of local core service agencies so long as the local core service agencies demonstrate that there is sufficient provider capacity to serve the children and youth in a particular region.

Be approved by the Department as a CCO;

Commit to coordination with all agencies involved in the participant’s POC; and

Work with the State and local child- and family-serving agencies to develop a network of clinical and natural supports in the community to address strengths and needs identified in each POC.

Before employment, submit an application for a child care criminal history record check to the Criminal Justice Information System Central Repository, Department of Public Safety and Correctional Services (DPSCS), in accordance with Family Law Article, §5-561, Annotated Code of Maryland;

Request that DPSCS send the report to:

Review the results of the background checks;

Store background checks in a secure manner consistent with State and federal law; and

Maintain written documentation in the individual’s personnel file that the director and all direct service provider staff including, but not limited to, volunteers, interns, and students, meet the criteria set forth in this regulation.

Are convicted of, received probation before judgment for, or entered a plea of nolo contendere to a felony or a crime of moral turpitude or theft or have any other criminal history that indicates behavior which is potentially harmful to a participant;

Are cited on any professional licensing or certification boards or any other registries with a determination of abuse, misappropriation of property, financial exploitation, or neglect; or

Have an indicated finding of child abuse or neglect.

For criminal background checks:

For abuse and neglect findings:

Conditions for participation as set forth in COMAR 10.09.36.03; and

Medical Assistance provisions listed in COMAR designated for their provider type.

May not place restrictions on the qualified recipient’s right to elect to or decline to:

Shall employ appropriately qualified individuals as care coordinators, and care coordinator supervisors with relevant work experience, including experience with the populations of focus, including but not limited to:

Shall assign care coordinators to the participant and family;

Shall schedule a face-to-face meeting with the participant and family within 72 hours of notification of the participant’s enrollment in Care Coordination services;

Shall convene the first CFT meeting within 30 calendar days of notification of enrollment to begin developing the POC;

Shall collect information gathered during the application process including results from the physical examination, psychosocial and psychiatric screening, assessments, evaluations, and information from the CFT, participant, and family, and the identified supports to be incorporated as a part of POC development process;

For 1915(i) participants:

Shall assure that:

Shall maintain an electronic health record for each participant which includes all of the following:

Shall have formal written policies and procedures, approved by the Department, or the Department’s designee, which specifically address the provision of care coordination to participants in accordance with the requirements of this chapter;

Shall be available to participants and, as appropriate, their families or, if the participant is a minor, the minor’s parent or guardian, for 24 hours a day, 7 calendar days a week, in order to refer:

Shall document in the participant’s care coordination records if the participant declines care coordination services or if a service is terminated because it was not working;

May not provide other services to participants unless the Department approves how conflict of interest standards would be safely addressed.

Shall be knowledgeable of the eligibility requirements and application procedures of federal, State, and local government assistance programs that are applicable to participants;

Shall maintain information on current resources for behavioral health, medical, social, financial assistance, vocational, educational, housing, and other support services including informal community resources;

Shall safeguard the confidentiality of the participant’s records in accordance with State and federal laws and regulations governing confidentiality;

Shall comply with the Department’s fiscal and program reporting requirements and submit reports to the Department in the manner specified by the Department;

Shall provide services in a manner consistent with the best interest of recipients and may not restrict an individual’s access to other services;

Shall assure the amount, duration, and scope of the care coordination activities are documented in a participant’s POC, which includes care coordination activities before discharge and after discharge when transitioning from an institution, to facilitate a successful transition into the community; and

Shall commit to coordinating with all agencies involved in the participant’s POC.

Is a mental health professional with a minimum of a Master’s degree and who is licensed and legally authorized to practice under Health Occupations Article, Annotated Code of Maryland, and who is licensed under Maryland Practice Boards in the profession of:

Has a minimum of 1 year of experience in behavioral health working as a supervisor;

Has a minimum of 1 year of experience working with children and youth with mental health or co-occurring disorders;

Provides clinical consultation and training to care coordinators regarding mental health or co-occurring disorders;

Provides supervision of the POCs, and consultation to the CFT meetings, as needed;

Is employed or contracted at a ratio of one supervisor to no more than eight care coordinators; and

Meets training and certification requirements for care coordinator supervisors, as set by the Department; and

Has at least a:

Is employed by the CCO to provide care coordination services to participants; and

Provides management of the POC and facilitation of the CFT meetings.

Empowering the participant and, if the participant is a minor, the minor’s parent or guardian to secure needed services;

Taking any necessary actions to secure services on the participant’s behalf; and

Encouraging and facilitating the participant’s decision making and choices leading to accomplishment of the participant’s goals or, if the participant is a minor, encouraging the parent or guardian to carry out these decisions.

Providers shall use a child and youth assessment tool approved by the Department to perform participant assessments and reassessments.

Initial assessment or reassessment involves the participant’s stated needs and review of information concerning the participant’s mental health, social, familial, educational, cultural, medical, developmental, legal, vocational, and economic status to assist in the formulation of a POC.

The initial assessment or reassessment of the participant’s needs and progress shall be facilitated by the care coordinator and monitored by the CFT, which includes the participant, family members, and friends of the participant, as appropriate, or, if the participant is a minor, the minor’s parent or guardian, and community service providers, such as mental health providers, medical providers, social workers, and educators, as appropriate.

Coordination and Facilitation of the CFT. The care coordinator shall:

After an initial assessment, each participant shall be reassessed at a minimum of every 6 months.

After the initial assessment is completed, a POC shall be developed based on the information obtained through the comprehensive screening and assessment tools approved by the Department.

The CCO shall finalize the POC within 30 calendar days of notification of enrollment and submit it to the Department or its designee.

Development of and updates to the POC shall be youth- and family-directed and managed through CFT meetings.

The POC shall meet the requirements of Regulation .12 of this chapter.

The POC development process shall include:

After the POC is developed, the CCO shall update the POC as often as clinically indicated based on the strengths and needs of the participant but not less than:

A description of the participant’s strengths and needs;

The diagnosis or diagnoses established as evidence of the participant’s eligibility for services under this chapter;

The goals of care coordination services to address the behavioral health, medical, social, educational, and other services needed by the participant, with expected target completion dates;

A crisis plan including the proposed strategies and interventions for preventing and responding to crises and the youth and family’s definitions of what constitutes a crisis;

Designation of the care coordinator with primary responsibility for implementation of the POC;

Signatures of the care coordinator and other CFT members, if appropriate;

Signatures of the participant and family indicating that the participant and family have:

For 1915(i) participants, specified for each recommended service, the following information as appropriate or as required by the Department:

Date, start and end time, and subject of contact;

Individual contacted;

Electronic or scanned signature of care coordinator making the contact;

Nature, content, and unit or units of service provided;

Place of service;

Whether strategies and tasks specified in the POC have been achieved;

The timeline for obtaining needed services;

The timeline for reevaluation of the plan;

The need for and occurrences of coordination with child- and family-serving agencies and providers;

The names and contact information for the participant’s primary care provider, dentist, and other health care providers;

The medications that the participant is currently taking and the dosage and frequency of the medications; and

Monthly summary notes, which reflect progress made towards the identified needs and outcome measures.

Facilitates CFT meetings;

Facilitates access to the services and supports in the POC; and

At the first meeting:

Community and natural support development by contacting, with the participant’s consent, members of the participant’s support network, including CFT members, for example, family, friends, and neighbors, as appropriate, or, if the participant is a minor, the minor’s parent or guardian, to mobilize assistance for the participant;

Crisis intervention by referral of the participant or, if the participant is a minor, the minor’s parent or guardian, to services on an emergency basis when immediate intervention is necessary;

Arranging for the participant’s transportation to and from services;

Outreach in an attempt to locate service providers which can meet the participant’s needs, or, if the participant is a minor, the minor’s parent or guardian’s needs;

Reviewing the POC with the participant and the participant’s CFT, as appropriate, or, if the participant is a minor, with the minor’s parent or guardian, so as to enable and facilitate their participation in the plan’s implementation; and

Provision of health and wellness education, information, and linkages to high-quality health care services, preventive and health promotion resources, and chronic disease management services with an emphasis on resources available in the family’s community and peer group.

The participant or, if the participant is a minor, the minor’s parent or guardian; and

With proper consent:

Follow up any service referral within 7 calendar days to determine whether the participant, or, if the participant is a minor, the minor’s parent or guardian, made contact with the service provider that the participant was referred to; and

Monitor service provision on an ongoing basis, to ensure that the agreed-upon services are provided, are adequate in quantity and quality, and meet the participant’s needs and stated goals, or, if the participant is a minor, the parent’s or guardian’s stated needs and goals for the participant.

Eligibility for Title XIX benefits or other available benefits or programs, except as limited by §E of this regulation;

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

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.

The direct delivery of an underlying medical, educational, social, or other service to which a participant has been referred;

Activities integral to the administration of foster care programs;

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);

Activities for which third parties are liable to pay;

Activities delivered as part of institutional discharge planning; or

A 15-minute unit of service for telephonic contact, unless the provider has delivered at least 8 minutes of service.

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;

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;

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

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.

A provider shall submit requests for payment of mental health case management services according to procedures established by the Department.

A provider shall bill the Program for the appropriate fee under COMAR 10.21.25.

The Program may not make direct payment to recipients.

Only to a qualified provider for covered services rendered to a participant, as specified in these regulations; and

According to the requirements of this chapter and COMAR 10.09.89 for 1915(i) participants, and the fees established in COMAR 10.21.25.

Face-to-face and 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.