Maryland Choices“One Team – One Mission”

Regional CME

Maryland Choices is … The Northwest Regional Care Management

Entity.

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)

System of Care Development

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

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)

Wraparound Process

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).

PRTF Waiver Program

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

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

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.

PRTF Waiver - Eligibility

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.

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.

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)

PRTF Waiver - Program

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.

PRTF Waiver - Referral