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Maryland Choices

Maryland Choices. “One Team – One Mission”. Regional CME. Maryland Choices is … The Northwest Regional Care Management Entity. System of Care Development. Collaborative Partnerships With Local Management Boards (LMB) – 9 (NW Region) With Local Coordinating Councils (LCC) – 9 (NW Region)

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Maryland Choices

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  1. Maryland Choices “One Team – One Mission”

  2. Regional CME Maryland Choices is … • The Northwest Regional Care Management Entity.

  3. System of Care Development • Collaborative Partnerships • With Local Management Boards (LMB) – 9 (NW Region) • With Local Coordinating Councils (LCC) – 9 (NW Region) • Infrastructure – Collaborative Partnerships • Resource Development – Provider Engagement • Resource Development • With Local/Regional Providers of Services • RTC’s/Outpatient Clinics/Behavioral Health/Substance Abuse • With Faith Communities • With non-traditional providers (vocational/mentoring/support programs)

  4. Wraparound Process • Development, Implementation, Evaluation • With Funders • Governor’s Office for Children (for the NWRCME Contract) • With Partners and Stakeholders • Family Support Organizations • Child Serving Agencies (Public) – DJS, Schools, CWS, CSA • Service Providers • Innovations Institute

  5. Wraparound Process • Customized Fit – Integrating Wraparound Process • As the Northwest Regional Care Mgmt. Entity: • Within Medicaid Service Delivery Model (RTC Waiver Program) • Serving youth at highest level of need (RTC Eligible) • Making Wraparound Process available to youth and families across the state (through 3 Regional CME’s) • Powered by federal funds for services (Medicaid Dollars)

  6. PRTF Waiver Program • PRTF Waiver Program • Serves Children Eligible for “RTC Level of Care” • Eligibility Requirements • Medical • Financial • Technical • Youth Referred from: • School, DJS, DSS, Acute Inpatient Facilities, RTC’s • Referrals for Youth Transitioning Out of RTC • PRTF Waiver CANNOT be used as a “step-down” • Medical Eligibility REQUIRES documentation of severity, chronicity, and frequency of intensive needs (even while in an RTC setting).

  7. PRTF Waiver - Eligibility • Medical – Youth requires three elements of a Certificate of Need Evaluation Packet: • Psychiatric Assessment - MD States “Youth requires RTC level of care – but can safely be served within the community with a comprehensive Plan of Care.” • Psychosocial Assessment – Therapist/Licensed Mental Health Provider provides documentation of history of severity, chronicity, and persistence of emotional/behavioral difficulties which supports the recommendation for RTC Level of Care. • Medical – Full “H, P, and E” note stating youth’s health status. • ALL DOCUMENTS DATED WITHIN DAYS OF EACH OTHER. • ALL DOCUMENTS MUST BE DATED WITHIN 30 DAYS OF TIME OF SUBMISSION

  8. PRTF Waiver - Eligibility • Financial – Youth MUST complete an MA application • Application is REQUIRED – even if the youth already receives MA. • Application is completed based on the YOUTH’s information. • Youth CANNOT make/receive income > $ 2,022.00/month. • Youth CANNOT have assets in THEIR name > $ 2,000.00 • Referral Sources CAN begin this process with the family/youth. • The CME will assist the family in completing the MA Application – as well as gathering the necessary documentation

  9. PRTF Waiver - Eligibility • Technical – The youth/family MUST: • Sign Consent to Participate and Designate Their Choice to Pursue a Community-Based Alternative to RTC Placement. • Participate in developing a Provisional Plan of Care (including a crisis plan for maintaining youth in a community-based setting). • Demonstrate proof of identity and residence within the jurisdiction. • Meet with a care coordinator 2-3 times during the assessment/eligibility process.

  10. PRTF Waiver - Program • Participants in the PRTF Waiver Get: • Access to High Fidelity Wraparound Process • Access to Community-Based Services (at level of intensity appropriate for RTC Level of Care). • Enrollment for up to 2 years (pending recertification of need at the after 12 months of active participation) • Eligibility for RTC Placement should the youth’s needs require more than the family/community can manage at that time.

  11. PRTF Waiver - Program • High Fidelity Wraparound Process: • Engages Youth/Family • Develops a Team of Individuals (Providers and Natural Supports) • Develops/Implements/Monitors Comprehensive Plan of Care • Ensures Youth/Family Support as they create sustainable resources to manage the needs of the youth in the community.

  12. PRTF Waiver - Program • “Medicaid-Powered” Services • PMHS Services are Available to Waiver Participants • 5 Priority Services Available to Waiver Participants ONLY: • Peer-to-Peer Support (Caregiver and Youth) • Crisis Stabilization Services • Family Support/Training • Respite Care (In-home/Out of Home) • Behavioral Support Services (Expressive Therapies)

  13. PRTF Waiver - Referral • Contact Joe Wilson at Maryland Choices • Referral Process can be conducted electronically (via email/telephone). • When making a referral be prepared to call with: • Basic information about the youth (DOB/Address/MA Status) • Email Contact information for yourself, the caregiver, other professionals working with the youth or who may be able to produce elements of the eligibility package. • Any documentation you already have that could support the assessment/eligibility process.

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