The Rare and Expensive Case Management (REM) Program is a case managed
fee for service alternative to HealthChoice Managed Care Organization
(MCO) participation for recipients with specified rare and expensive
conditions.
|
Criteria
for participation |
A person must be
eligible for HealthChoice in order to receive REM services. Also, the
REM Program is limited to individuals with certain qualifying conditions
or diseases. Information regarding these diseases may be obtained by calling 1-800-565-8190.
A REM case manager is either a
registered nurse or a licensed clinical social worker and has the
experience and knowledge to assist the best possible health care and
services available.
The main goal of the REM case manager is to help the recipient reach
his/her highest level of functioning capability. This is done through
service coordination, home visits and a variety of other case management
services. The following is a small sample of a REM case manager’s
services:
Assessment of recipient needs;
Patient education;
Family support services;
Development of treatment plan;
Coordination of provider services; and
Follow-up of recipient’s progress
|
How
Enrollment
is determined |
The Managed Care Organization, the
recipient’s doctor or any other concerned person, can refer a recipient
to the REM Program. Before a recipient can be referred to the REM
Program, the MCO must first identify the recipient as a potential REM
candidate. A recipient can also refer himself or herself. The referral
can take place at the time of diagnosis or anytime afterwards. MCOs must
justify enrolling the potential REM recipient by submitting a REM Intake
Referral Form with supporting documentation to:
-
The Maryland Department of Health and Mental
Hygiene
- Division
of Children's Services
- REM
Program
- 201
W.Preston Street, Room 210
-
Baltimore, MD 21201
- Phone
1-800-565-8190 or 410-767-1903
- Fax:
410-333-5426
Upon receipt of the Intake Referral Form, the REM Program has five (5)
business days to determine eligibility. When the decision is made, a
letter of approval or denial is sent to the MCO, the enrollment Broker
and the recipient. Once the recipient is accepted into the Program and
is disenrolled from the MCO, he/she is enrolled into REM.
|
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