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Maryland Choices “One Team – One Mission”. Regional CME Maryland Choices is …  The Northwest Regional Care Management Entity.

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Presentation on theme: "Maryland Choices “One Team – One Mission”. Regional CME Maryland Choices is …  The Northwest Regional Care Management Entity."— Presentation transcript:

1 Maryland Choices “One Team – One Mission”

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

3  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

4  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

5  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

6  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

7  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

8  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,  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

9  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

10  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

11  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

12  “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

13  Contact Joe Wilson at Maryland Choices  Referral Process can be conducted electronically (via /telephone).  When making a referral be prepared to call with:  Basic information about the youth (DOB/Address/MA Status)  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


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