Sec. 10.09.59.05. Eligibility

A. A participant is eligible for specialty mental health services if:

(1) The individual meets the Department’s medical necessity criteria; and

(2) The service is appropriate to the specific provider type or community-based mental health provider listed in Regulation .04 of this chapter.

B. Individuals are eligible for Psychiatric Rehabilitation Programs for adults if the individual:

(1) Has been referred for psychiatric rehabilitation program services by a licensed mental health professional who:

(a) Is enrolled as a provider in the Program with an active status on the date of service;

(b) Facilitates an informed choice of psychiatric rehabilitation program providers; and

(c) Currently provides inpatient, residential treatment center, or outpatient mental health services to the individual;

(2) Has a diagnosis listed in COMAR 10.09.70.02L; and

(3) Is in need of program services in order to improve or restore independent living and social skills necessary to support the individual’s recovery, ability to make informed decisions and choices, and participation in community life.

C. Individuals are eligible for Psychiatric Rehabilitation Programs for minors if the individual:

(1) Has been referred for psychiatric rehabilitation program services by a licensed mental health professional who:

(a) Is enrolled as a provider in the Program with an active status on the date of service;

(b) Facilitates an informed choice of psychiatric rehabilitation program providers; and

(c) Currently provides inpatient, residential treatment center, or outpatient mental health services to the minor;

(2) Is currently in, and remains in, active mental health treatment;

(3) Has the appropriate consent to participate in psychiatric rehabilitation program services;

(4) Has a diagnosis listed in COMAR 10.09.70.02L and severe functional impairments in at least one life domain;

(5) With psychiatric rehabilitation program services, is expected to have reduced symptoms of their mental illness or functional behavioral impairment as a result of their mental illness based on the clinical evaluation and ongoing treatment plan; and

(6) Is at risk for requiring a higher level of care, or is returning from a higher level of care.

D. Individuals are eligible for Mobile Treatment Services if it is assessed that the individual will benefit from mobile treatment services and the individual is:

(1) Experiencing homelessness;

(2) Unable or unwilling to use, on a continuing basis, community-based mental health services that are prescribed for the individual; or

(3) In an institution or inpatient facility and would be able to reside in a community setting if the individual received MTS and other appropriate support services.