Md. Code Regs. 10.09.90.03

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.90.03 - Participant Eligibility

A. A participant shall be eligible for care coordination 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) Meets the criteria of either §B(1) or (2) of this regulation.

B. The participant:

(1) Shall:

(a) Meet the diagnostic requirements of being either:

(i) An individual younger than 18 years old with a serious emotional disturbance or co-occurring disorder; or

(ii) A young adult with a serious emotional disturbance or co-occurring disorder enrolled in care coordination services continuously under this chapter since reaching age 18; and

(b) Require community treatment and support in order to prevent or address:

(i) Inpatient psychiatric or substance use treatment;

(ii) Treatment in a RTC or residential substance use treatment facility;

(iii) An out-of-home placement;

(iv) Emergency room utilization due to multiple behavioral health stressors;

(v) Homelessness or housing instability, or otherwise lacking in permanent, safe housing; or

(vi) Arrest or incarceration due to multiple behavioral health stressors; or

(2) Shall:

(a) Meet the requirements of §A(1)(a); and

(b) Need care coordination services to facilitate community treatment following:

(i) Release from a detention center or correctional facility; or

(ii) Discharge to the community from RTC placement or inpatient psychiatric unit

C. A participant that disenrolls after reaching 18 years of age and wishes to re-enroll in care coordination services at a later date shall do so pursuant to COMAR 10.09.45 if more than 120 calendar days has passed since disenrollment

Md. Code Regs. 10.09.90.03

Regulations .03 adopted effective 41:19 Md. R. 1078, eff.10/1/2014 ; amended effective 46:17 Md. R. 726, eff. 8/26/2019