Case management services are covered for enrollees who need additional services, such as following:
- Children with special health care needs
- Individuals with a physical disability
- Individuals with a developmental disability
- Pregnant and postpartum women
- Individuals who are homeless
- Individuals with HIV/AIDS
- Individuals with a need for substance abuse services
- Children in State-supervised care
If warranted, a case manager will be assigned to an enrollee when the results of the initial health screen are received by the MCO. You may receive a care plan when one of your enrollees is engaged in case management.
Member connections representatives are available to perform home visits as necessary as part of Maryland Physicians Care case management outreach program. The representative will be able to assist the enrollee with any access to care needs during the home visit.
For more information or to make a referral, contact our Special Needs Coordinator at 1-800-953-8854.
Rare and Expensive Case Management (REM)
The Department of Health and Mental Hygiene (DHMH) administers a Rare and Expensive Case Management (REM) program to address the special needs of waiver-eligible individuals diagnosed with rare and expensive medical conditions. The REM program, a part of the HealthChoice Program, was developed to ensure that individuals who meet specific criteria receive high-quality, medically necessary and timely access to health services. Qualifying diagnoses for inclusion in the REM program must meet the following criteria:
• Occurrence is generally fewer than 300 individuals per year
• Cost is generally more than $10,000 on average per year
• Need is for highly specialized and/or multiple providers/delivery systems
• Chronic condition
• Increased need for continuity of care
• Complex medical, habilitative and rehabilitative needs
For questions or to refer someone to the REM program, contact our REM case manager at email@example.com