Sec. 10.21.21.05. Eligibility, Screening, and Initiation of Service

A. Eligibility. An individual is eligible for PRP services if:

(1) The individual is in need of program services to enable the individual to improve or restore independent living and social skills necessary to support the individual's:

(a) Recovery;

(b) Ability to make informed decisions and choices; and

(c) Participation in community life;

(2) The individual meets medical necessity criteria for PRP services;

(3) The individual agrees to apply for medical assistance, as appropriate; and

(4) The services are preauthorized, as needed, by the Administration's administrative services organization (ASO), according to the provisions of COMAR 10.21.17.04A.

B. Screening. Within 10 working days of receipt by the program of a complete referral for PRP services:

(1) Staff assigned by the program director shall conduct a screening assessment to determine whether rehabilitation services are medically needed by the individual;

(2) If, following the screening assessment under §B(1) of this regulation, the program director determines that the program's services are not appropriate for an individual who has been referred, the program director shall, in writing:

(a) Inform the individual of the determination and the reason;

(b) Provide the individual with recommendations for alternative services, if appropriate; and

(c) With proper consent, notify the referral source, the family, or others designated by the individual of the determination and of any recommendations for other services;

(3) Unless the program director has notified the individual of the determination under §B(2) of this regulation, the program director shall notify the individual whether the program:

(a) Accepts the individual, in which case, the program director shall identify a date that the program can initiate services to the individual;

(b) Will accept the individual, following an updated review of the individual's eligibility status, when program capacity permits, in which case the program director shall inform the individual of the:

(i) Individual's placement on a waiting list, if any; and

(ii) Estimated date services may be initiated; or

(c) Will accept the individual following the individual's discharge or release from an inpatient facility, RTC, or detention center;

(4) If the individual is placed on a waiting list under §B(3)(b) of this regulation, the program staff shall discuss with the individual:

(a) The option of remaining on the program's waiting list until the date established under §B(3)(b) of this regulation; and

(b) Alternative services that are available.

C. Entitlements and Fees. PRP staff assigned by the program director shall:

(1) Determine if the individual has, or may be eligible, for federal or State entitlements;

(2) Assist the individual, if necessary, to apply for all entitlements for which the individual may be eligible if the individual does not have entitlements;

(3) Document in the individual's medical record:

(a) That the individual has all entitlements; or

(b) The outcome of the entitlement application;

(4) Discuss with the individual the charges for services, and, when applicable, the process for determining ability to pay; and

(5) Provide written documentation to the individual regarding the charges for services and the process for determining ability to pay.