Md. Code Regs. 10.09.45.03

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.45.03 - Participant Eligibility

A. A recipient is eligible for mental health case management 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) Has a serious and persistent mental health disorder and is:

(a) In, at risk of, or needs continued community treatment to prevent, inpatient psychiatric treatment;

(b) At risk of, or needs continued community treatment to prevent, being homeless; or

(c) At risk of incarceration or who will be released from a detention center or prison.

B. Waiver of Specific Diagnostic Criteria. The specific diagnostic criteria may be waived if an individual is:

(1) Committed as not criminally responsible and is conditionally released from a Mental Hygiene Administration (MHA) facility, according to the provisions of Health-General Article, Title 12, Annotated Code of Maryland; or

(2) In a MHA facility, or is a MHA-funded individual in a psychiatric inpatient hospital who requires community services, excluding individuals who are eligible for Developmental Disabilities Administration's residential services.

C. Eligible individuals transitioning from institutions as described in either §B(1) or (2) of this regulation to a community-based setting may receive case management services for up to 180 consecutive days of the covered stay in the institution.

D. Levels of Care.

(1) In addition to meeting the eligibility criteria outlined under §§A and B of this regulation, participants shall be classified according to the levels of care listed in §D(2) or (3) of this regulation.

(2) Level I-General. For a maximum of 2 units of service per month and based on the severity of the participant's mental illness, the participant shall meet at least one of the following conditions:

(a) The participant is not linked to mental health and medical services;

(b) The participant lacks basic supports for shelter, food, and income;

(c) The participant is transitioning from one level of care to another level of care; or

(d) The participant needs case management services to maintain community-based treatment and services.

(3) Level II-Intensive. For a maximum of 5 units of service per month and based on the severity of the participant's mental illness, the participant shall meet two or more of the following conditions:

(a) The participant is not linked to mental health and medical services;

(b) The participant lacks basic supports for shelter, food, and income;

(c) The participant is transitioning from one level of care to another level of care; or

(d) The participant needs case management services to maintain community-based treatment and services.

E. A participant may not be enrolled in Mental Health Case Management for Adults while receiving services under COMAR 10.09.90 or 10.09.33.

Md. Code Regs. 10.09.45.03

Regulations .03 amended effective 41:19 Md. R. 1077, eff.10/1/2014