<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.21.21.05" title_num="10" subtitle_num="21" chapter_num="21" heading="Eligibility, Screening, and Initiation of Service.">
  <paragraph num="A.">
    <text>Eligibility. An individual is eligible for PRP services if:</text>
    <paragraph num="(1)">
      <text>The individual is in need of program services to enable the individual to improve or restore independent living and social skills necessary to support the individual's:</text>
      <paragraph num="(a)">
        <text>Recovery;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Ability to make informed decisions and choices; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Participation in community life;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The individual meets medical necessity criteria for PRP services;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The individual agrees to apply for medical assistance, as appropriate; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The services are preauthorized, as needed, by the Administration's administrative services organization (ASO), according to the provisions of COMAR 10.21.17.04A.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Screening. Within 10 working days of receipt by the program of a complete referral for PRP services:</text>
    <paragraph num="(1)">
      <text>Staff assigned by the program director shall conduct a screening assessment to determine whether rehabilitation services are medically needed by the individual;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If, following the screening assessment under §B(1) of this regulation, the program director determines that the program's services are not appropriate for an individual who has been referred, the program director shall, in writing:</text>
      <paragraph num="(a)">
        <text>Inform the individual of the determination and the reason;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Provide the individual with recommendations for alternative services, if appropriate; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>With proper consent, notify the referral source, the family, or others designated by the individual of the determination and of any recommendations for other services;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Unless the program director has notified the individual of the determination under §B(2) of this regulation, the program director shall notify the individual whether the program:</text>
      <paragraph num="(a)">
        <text>Accepts the individual, in which case, the program director shall identify a date that the program can initiate services to the individual;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Will accept the individual, following an updated review of the individual's eligibility status, when program capacity permits, in which case the program director shall inform the individual of the:</text>
        <paragraph num="(i)">
          <text>Individual's placement on a waiting list, if any; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Estimated date services may be initiated; or</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Will accept the individual following the individual's discharge or release from an inpatient facility, RTC, or detention center;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>If the individual is placed on a waiting list under §B(3)(b) of this regulation, the program staff shall discuss with the individual:</text>
      <paragraph num="(a)">
        <text>The option of remaining on the program's waiting list until the date established under §B(3)(b) of this regulation; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Alternative services that are available.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Entitlements and Fees. PRP staff assigned by the program director shall:</text>
    <paragraph num="(1)">
      <text>Determine if the individual has, or may be eligible, for federal or State entitlements;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Assist the individual, if necessary, to apply for all entitlements for which the individual may be eligible if the individual does not have entitlements;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Document in the individual's medical record:</text>
      <paragraph num="(a)">
        <text>That the individual has all entitlements; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The outcome of the entitlement application;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Discuss with the individual the charges for services, and, when applicable, the process for determining ability to pay; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Provide written documentation to the individual regarding the charges for services and the process for determining ability to pay.</text>
    </paragraph>
  </paragraph>
</regulation>