1. A. Care coordination services are facilitative in nature.
2. B. A restriction may not be placed on a qualified recipient’s option to receive mental health case management services.

3. C. Care coordination services do not restrict or otherwise affect:

   1. (1) Eligibility for Title XIX benefits or other available benefits or programs, except as limited by §E of this regulation;
   2. (2) The freedom of a participant or, if the participant is a minor, the minor’s parent or guardian to select from all available services for which the participant is found to be eligible; or
   3. (3) A participant’s free choice among qualified providers or, if the participant is a minor, the minor’s parent or guardian’s free choice among qualified providers.

4. D. The CCO may not bill the Program for:

   1. (1) The direct delivery of an underlying medical, educational, social, or other service to which a participant has been referred;
   2. (2) Activities integral to the administration of foster care programs;
   3. (3) Activities not consistent with the definition of case management services under Section 6052 of the federal Deficit Reduction Act of 2005 (P.L. 109—171);
   4. (4) Activities for which third parties are liable to pay;
   5. (5) Activities delivered as part of institutional discharge planning; or
   6. (6) A 15-minute unit of service for telephonic contact, unless the provider has delivered at least 8 minutes of service.
5. E. Reimbursement may not be made for care coordination services if the participant is receiving a comparable care coordination service under another Program authority.
6. F. A participant’s care coordinator may not be the participant’s family member or a direct service provider for the participant.

7. G. Units of services for all levels of care coordination shall be 15 minutes of contact, which may include face-to-face and, with the exception of §G(4) of this regulation, non-face-to-face contacts with the participant, or, if the participant is a minor, with the minor’s parent or guardian, and indirect collateral contacts on behalf of the participant with other community providers, as per the following:

   1. (1) For participants in Level I — General Coordination, allows a maximum of 12 units of service per month, with a minimum of two units of face-to-face contact;
   2. (2) For participants in Level II — Moderate Care Coordination, allows a maximum of 30 units of service per month, with a minimum of four units of face-to-face contact;
   3. (3) For participants in Level III — Intensive Care Coordination, allows a maximum of 60 units of service per month, with a minimum of six units of face-to-face contact; and
   4. (4) For Level I and Level II, four additional units of service above and beyond the monthly maximum may be billed during the first month of service to the participant and every 6 months thereafter to allow for comprehensive assessment and reassessment of the participant, which shall be performed as a face-to-face service.

Authority: Health-General Article, §2-104(b), Annotated Code of Maryland

Effective date: October 1, 2014 (41:19 Md. R. 1078)

Regulation .02B amended effective August 26, 2019 (46:17 Md. R. 726)

Regulation .03B amended effective August 26, 2019 (46:17 Md. R. 726)

Regulation .07 amended effective August 26, 2019 (46:17 Md. R. 726)

Regulation .07C amended effective November 14, 2022 (49:23 Md. R. 996)

Regulation .09B amended effective August 26, 2019 (46:17 Md. R. 726)

Regulation .12A amended effective August 26, 2019 (46:17 Md. R. 726)

Regulation .13D amended effective August 26, 2019 (46:17 Md. R. 726)

Regulation .16D amended effective April 13, 2015 (42:7 Md. R. 568)