Sec. 10.09.45.04. Conditions for Mental Health Case Management Provider Participation

A. The local core service agencies shall select mental health case management providers through a competitive procurement process, at least once every 5 years.

B. Mental health case management services may be provided by local health departments according to COMAR 10.04.04, which allows the Director of the MHA to utilize the local health departments as vendors unless the health officer believes the service provided by alternate vendors would be preferable.

C. Providers of mental health case management shall:

(1) Be approved or licensed in Maryland as a community mental health provider under COMAR 10.21.19, 10.21.20, 10.21.21, or 10.21.29, or have 3 years experience as a mental health case management provider; and

(2) Have at least 3 years experience providing mental health services, including serving high risk populations, to adults with serious mental illness.

D. General Requirements. To be eligible to be approved as a mental health case management service provider, an entity shall meet all of the:

(1) Conditions for participation as set forth in COMAR 10.09.36.03; and

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

E. Specific Requirements. A mental health case management service provider:

(1) May not place restrictions on the qualified recipient's right to elect to or decline to:

(a) Receive mental health case management as authorized by the Department or the Department's designee; and

(b) Choose a community support specialist or associate, as approved by the Department or the Department's designee, and other medical care providers;

(2) Shall employ appropriately qualified individuals as community support specialists, community support specialist associates, and community support specialist supervisors with relevant work experience, including experience with the target population, including but not limited to adults with a serious and persistent mental disorder;

(3) Shall assure that:

(a) A participant's initial assessment is completed within 20 days after the participant has been authorized by the ASO and determined eligible for, and has elected to receive, mental health case management services; and

(b) An initial care plan is completed within 10 days after completion of the initial assessment;

(4) Shall maintain a file for each participant which includes all of the following:

(a) An initial referral and intake form with identifying information, including, but not limited to, the individual's name and Medicaid identification number;

(b) A written agreement for services signed by the participant or the participant's legally authorized representative and by the participant's community support specialist;

(c) An assessment as specified in Regulation .06 of this chapter;

(d) A care plan, updated at a minimum of every 6 months, which contains at a minimum:

(i) A description of the participant's strengths and needs;

(ii) The diagnosis established as evidence of the participant's eligibility for services under this chapter;

(iii) The goals of case management services, with expected target dates;

(iv) The proposed intervention;

(v) Designation of the community support specialist with primary responsibility for implementation of the care plan; and

(vi) Signatures of the community support specialist, participant, or the participant's legally authorized representative, and significant others, if appropriate;

(e) An ongoing record of contacts made on the participant's behalf, which includes all of the following:

(i) Date and subject of contact;

(ii) Individual contacted;

(iii) Signature of community support specialist or community support specialist associate making the contact;

(iv) Nature, content, and unit or units of service provided;

(v) Place of service;

(vi) Whether goals specified in the care plan have been achieved;

(vii) The timeline for obtaining needed services;

(viii) The timeline for reevaluation of the plan; and

(ix) The need for and occurrences of coordination with other case managers; and

(f) Monthly summary notes, which reflect progress made towards the participant's stated goals;

(5) Shall have formal written policies and procedures, approved by the Department, or the Department's designee, which specifically address the provision of mental health case management services to participants in accordance with the requirements of this chapter;

(6) Shall be available to participants and, as appropriate, their families for 24 hours a day, 7 days a week in order to refer:

(a) Participants to needed services and supports; and

(b) In a psychiatric emergency, participants to mental health treatment and evaluation services in order to prevent the participant from accessing a higher level of care;

(7) Shall document in the participant's case management records if the participant declines case management services;

(8) May not provide other services to participants which would be viewed by the Department as a conflict of interest;

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

(10) Shall maintain information on current resources for mental health, medical, social, financial assistance, vocational, educational, housing, and other support services;

(11) Shall safeguard the confidentiality of the participant's records in accordance with State and federal laws and regulations governing confidentiality;

(12) Shall comply with the Department's fiscal reporting requirements and submit reports in the manner specified by the Department;

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

(14) Shall assure the amount, duration, and scope of the case management activities are documented in a participant's care plan, which includes mental health case management activities before discharge and after discharge when transitioning from an institution, to facilitate a successful transition into the community.