1. Program Definition and Services 

Case Management Services in Maryland assist individuals in accessing, coordinating, and managing medical, social, educational, and other necessary services. These services are tailored to meet the needs of specific populations, including individuals with serious mental illness, developmental disabilities, or rare and expensive medical conditions. Key functions include: 

• Comprehensive assessment of individual needs 

• Development of individualized care plans 

• Coordination and linkage to appropriate services 

• Monitoring and follow-up on service delivery 

• Advocacy to address barriers to care 

• Specific programs include: 

• Targeted Case Management (TCM): Supports individuals with mental health needs or developmental disabilities to access resources and entitlements 

• Rare and Expensive Case Management (REM): Provides care coordination for individuals with rare, high-cost medical conditions 

2. Regulations 

Case Management Services are governed by: 

• COMAR 10.09.45 (Mental Health Case Management) 

• COMAR 10.22.02 (Coordination of Community Services for Developmental Disabilities) 

• COMAR 10.09.90 (Rare and Expensive Case Management) 

3. Licensing or Certification 

Providers must be licensed or approved as follows: 

• Mental Health Case Management: Must be licensed as a community mental health provider under COMAR 10.21.19, 10.21.20, or have three years of experience providing mental health case management 

• Developmental Disabilities Case Management: Must be certified by the Developmental Disabilities Administration (DDA) to provide Coordination of Community Services 

• REM Providers: Must meet Medicaid requirements for participation in the REM program 

4. Responsible State Agency 

The Maryland Department of Health oversees case management services through its divisions: 

• Behavioral Health Administration (BHA) for mental health case management. 

• Developmental Disabilities Administration (DDA) for developmental disabilities case management. 

• Medicaid Division for REM program case management. 

5. Application Process 

The application process varies by program: 

• Mental Health Case Management: 

• Providers are selected through a competitive procurement process managed by local core service agencies every five years 

• Developmental Disabilities Case Management: 

• Submit an application to the DDA for certification. 

REM Program: 

• Complete the REM Intake Referral Form with supporting medical documentation signed by a physician and submit it to the Maryland Department of Health's REM Intake Unit 

6. Required Documentation 

Providers must prepare the following documentation: 

• Completed provider application 

• National Provider Identifier (NPI) printout from NPPES 

• Disclosure of Ownership and Control form 

• Provider Agreement 

• Policies and procedures addressing service delivery 

• Staff qualifications and training records 

• For REM: Physician-signed REM Intake Referral Form with supporting medical documentation 

7. Timeline for Approval 

Approval timelines vary by program: 

• Mental health case management providers must adhere to procurement schedules set by local core service agencies. 

• DDA certification timelines depend on agency review processes. 

• REM applications are reviewed upon submission; contact the REM Intake Unit for specific timelines. 

8. Pre-Application Process 

For some programs, a pre-application process is required: 

• Mental Health Case Management: Providers must demonstrate three years of experience in mental health services before applying through procurement processes 

• REM Program: Referral forms must be completed by a physician before submission 

9. Pre-Application Training 

While specific pre-application training is not mandated, providers must ensure staff are trained in: 

• Person-centered planning 

• Service coordination strategies 

• Crisis intervention techniques 

• Familiarity with Medicaid eligibility requirements and community resources 

10. Additional Notes 

• Providers must ensure availability to participants 24/7 for emergency referrals and crisis intervention 

• Case managers must regularly review care plans with participants to ensure progress toward goals 

• The REM program is a fee-for-service alternative to managed care organizations, designed for individuals with rare and expensive conditions outside standard MCO benefits