Sec. 10.09.48.04. Conditions for Participation — General

A. In this chapter, targeted case management services are referred to as coordination of community services.

B. Providers shall meet all the conditions for participation as set forth in COMAR 10.09.36.03.

C. Administrative and Professional Requirements. To participate in the Program as a provider of services covered under this chapter, the provider shall:

(1) Be incorporated in the State in good standing with the Maryland Department of Assessments and Taxation unless operating as a local health department;

(2) Have a board of directors or local advisory board in accordance with COMAR 10.22.02;

(3) Be selected by DDA as an approved provider of coordination of community services, as evidenced by an executed DDA-approved contract;

(4) Be selected by DDA as a “most advantageous” provider for the State as a term that is defined in COMAR 21.01.02.01;

(5) Attend a DDA single point of entry session;

(6) Participate in all transition and rollout processes as determined by the DDA;

(7) Serve all individuals in the DDA-defined jurisdiction referred by the DDA;

(8) Maintain a standard 8-hour operational day Monday through Friday and have flexible staffing hours that include nights and weekends to accommodate the needs of individuals receiving services;

(9) Maintain a toll free number, unless otherwise authorized by the DDA, and an accessible communication system in accordance with the Americans with Disabilities Act of 1990;

(10) Maintain a communication system that is accessible for individuals with limited English proficiency;

(11) Provide alternative communication methods to serve the needs of individuals receiving services and their family members;

(12) Have a means for individuals, their families, community providers, and DDA staff to contact the coordination of community services designated staff directly in the event of an emergency and at times other than standard operating hours;

(13) Annually advise participants of their right to choose among qualified providers of services including coordination of community services;

(14) Comply with all State and federal statutes and regulations;

(15) Maintain a participant’s record for a minimum of 6 years after the record is made;

(16) Notify the DDA immediately in writing of any critical incidents that affect the health, safety, and welfare of an individual, as well as administrative and quality of care complaints as required by the DDA Policy on Reportable Incidents and Investigations; and

(17) Submit required documents and forms to DDA as requested.

D. Operational Requirements. To participate in the Program as a provider of services covered under this chapter, the provider shall:

(1) Submit a program service plan that includes:

(a) Scope of work; and

(b) Proposed staffing plan, including staff and staff-to-participant ratios;

(2) Complete and submit an initial and annual written quality assurance plan to the DDA which meets the requirements in COMAR 10.22.02.14 and includes the following:

(a) Customer service plan that includes strategies and services to meet the needs of participants, their families or caretakers, and providers; and

(b) Self-assessment, remediating, monitoring, reporting, and system improvements strategies, or other quality and compliance actions related to coordination of community services;

(3) Submit monthly service delivery statistical reports as defined by the Department by the 15th of each month unless otherwise directed by the Department;

(4) Submit quarterly updates, as defined by the Department, on progress on quality assurance plans by October 15, January 15, and April 15 of each year unless otherwise directed by the Department;

(5) Submit to the Department annually by July 15th the final quality plan summary reports;

(6) Maintain a thorough understanding and knowledge of:

(a) Eligibility requirements, application procedures, and scope of services of local, State, and federal resources and programs which are applicable to individuals eligible for DDA services;

(b) Medicaid, Medicaid waiver programs, and DDA eligibility requirements, application procedures, and service delivery systems; and

(c) Person-centered planning methodology and individualized plan development and monitoring;

(7) Coordinate services with multiple long-term service and support systems;

(8) Maximize resources to the greatest possible extent; and

(9) Obtain authorization from the DDA before providing any coordination of community services to any individual;

(10) In providing coordination of community services, meet the following requirements:

(a) All individuals referred for coordination of community services by the DDA shall be contacted within 3 business days of receipt of referral unless otherwise authorized by the DDA;

(b) A face-to-face meeting with the referred individual shall be arranged at a time and location convenient for the referred individual during the first contact;

(c) A face-to-face meeting shall occur within 7 business days of the initial contact unless the individual’s health or schedule conflicts;

(d) If applicable, the provider shall document in the case record reasons why face-to-face meetings did not occur within the required timeframe and share the document as requested by the DDA or its designee;

(e) Authorization for specific coordination of community services shall be based on referrals from the DDA regional office; and

(f) In the event of emergencies, the individual referred for coordination of community services by the DDA shall be contacted by the coordinator of community services as circumstances require or as requested by the DDA.

E. Participant Record. The provider shall maintain a record on each participant which meets the Program’s requirements and which includes:

(1) The name of the participant;

(2) The dates of the coordination of community services;

(3) The name of the provider agency and the name of agency employee providing the coordination of community service;

(4) The name, address, and telephone number of the individual or individuals to be contacted in case of emergency;

(5) A completed individual plan;

(6) The comprehensive assessment as applicable;

(7) Documentation that the coordinator of community services provided the participant with a choice among qualified providers of services, including coordination of community services;

(8) Documentation that indicates whether the individual has declined services in the individual plan and the reason for declining;

(9) Documentation that includes:

(a) A schedule for obtaining needed services;

(b) A timeline for re-evaluation of the individual plan not less than annually; and

(c) The name and position of the individual responsible for completing tasks related to the individual plan;

(10) Status of progress on participant-intended outcomes identified in the individual plan;

(11) Documentation of coordination with other service systems, including:

(a) Demonstrated need for other services systems; and

(b) Dates of occurrences of coordination with other service systems; and

(12) Documentation for each contact made by the coordinator of community services including:

(a) Date and subject of contact;

(b) Individual contacted;

(c) Individual making the contact;

(d) Contact method;

(e) Nature and extent of coordination of community services provided;

(f) Number of unit or units of service provided;

(g) Place of service; and

(h) Services referred.

F. Technology Requirements. To participate in the Program as a provider of services covered under this chapter, the provider shall:

(1) Utilize an electronic information system which, at a minimum:

(a) Maintains confidential individual case and billing records;

(b) Provides documentation of coordination of community services and number of units provided for individuals receiving services;

(c) Maintain a permanent history log of all entries made to the record; and

(d) Adheres to applicable State and federal laws; and

(2) Adhere to the following information technology requirements:

(a) Use the DDA’s designated data system unless another data system is approved annually by the DDA;

(b) Ensure that all management information systems:

(i) Are secure from improper use, alteration, or disclosure;

(ii) Utilize industry best practices for secure connection to management information systems;

(iii) Secure network connections with logon only from a secured location;

(iv) Prohibit users from sharing user accounts;

(v) Limit access to the system and related information based on job function; and

(vi) Adhere to DDA information technology data security policies, standards, and procedures when using DDA managed systems;

(c) Report security violations and actual or attempted security breaches affecting the managed systems with participant information immediately but not later than 48 hours after the violation or breach;

(d) Maintain and update as necessary all electronic data systems to be compatible with those of the State and, if required, work with DDA to develop a system for developing protocols for data sharing and read-only access for the DDA and its designees; and

(e) Obtain written approval from the DDA before posting on any public website information that describes DDA services.

G. Billing. To participate in the Program as a provider of services covered under this chapter, the provider shall:

(1) Assist the DDA with billing, processing, and reconciling Medicaid claims as required by the Department;

(2) Be in good standing with the Maryland Department of Assessments and Taxation, and with its equivalent in every state in which the applicant provides services;

(3) Permit the DDA or the Department or its agent, or any State or federal entity operating within its statutory authority to conduct audits and provide immediate access to all records upon request; and

(4) Comply with audit requirements.

H. Freedom of Choice. The provider shall place no restrictions on the qualified participant’s freedom of choice among:

(1) Providers of coordination of community services;

(2) Providers of community-based services for which the participant qualifies; and

(3) Person-directed supports and services.

I. Transfer of Service Records. For participants changing from one DDA-authorized coordination of community services provider to a different DDA-authorized coordination of community services provider, the outgoing provider shall:

(1) Transfer the service record to the new provider; and

(2) Share with the new provider the participant’s demographic information and the most recent individual plan within 5 business days of notification of transfer for the continued coordination of services.

J. Provision of Services. The provider may not exercise the agency’s authority to authorize or deny DDA or other State funded services.