Md. Code Regs. 10.09.48.07

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

Section 10.09.48.07 - Limitations

A. Restrictions may not be placed on a participant's option to receive coordination of community services.

B. Coordination of community services provided under this chapter does not restrict or otherwise affect eligibility for Title XIX benefits or other available benefits or programs.

C. Coordination of community services may not be:

(1) Provided as an integral and inseparable part of another covered Program service;

(2) Provided as an administrative function;

(3) Rendered in connection with the implementation of another service authorized under § 1915(b) or § 1915(c) of the Social Security Act; or

(4) Provided as a substitute or in duplication of another service or support.

D. Unless otherwise approved by the Department, reimbursement may not be made for coordination of community services if the participant is receiving comparable case management services under any other State program.

E. A participant's coordination of community services provider may not also provide DDA-funded direct services, including meaningful day, support, and residential services for the participant.

F. Service Exclusions.

(1) Unless an individual is transitioning into the community, coordination of community services may not be provided to:

(a) Individuals between the ages of 22 and 64 who are served in institutions for mental disease; or

(b) Inmates or residents of public institutions.

(2) Services of more than 180 consecutive days of a covered stay in a medical institution will not be reimbursed unless an individual is transitioning from another Medicaid program into a DDA waiver program as authorized by the DDA.

G. An applicant is ineligible to be a provider if, within the preceding 10 years, the entity, its owner, or any member of its board of directors has had a provider license or certification revoked or suspended for more than 30 days, pursuant to Maryland or another state's regulations, or has been found by a court of law to have committed fraud, abuse, intentional or negligent tort, or a criminal act.

Md. Code Regs. 10.09.48.07

Regulations .07 adopted as an emergency provision effective June 23, 1992 (19:14 Md. R. 1276); adopted permanently effective October 12, 1992 (19:20 Md. R. 1815)
Regulations .07 under Case Management for Individuals with Developmental Disability repealed and new Regulations .07 under Targeted Case Management for People with Intellectual and Developmental Disabilities adopted effective July 8, 2013 (40:13 Md. R. 1074)
Regulation .07 amended effective 42:11 Md. R. 723, eff.6/8/2015; amended effective 48:26 Md. R.1111, eff. 12/27/2021