ROBERT L. EHRLICH, JR, Governor                                Ch. 4

(I) THE COMMUNITY CHOICE PROGRAM SHALL INCLUDE:

(1)     ADULTS WHO ARE DUALLY ELIGIBLE;

(2)      ADULT MEDICAID RECIPIENTS WHO MEET THE NURSING HOME
LEVEL OF CARE STANDARD; AND

(3)      MEDICAID RECIPIENTS OVER 65 YEARS OF AGE.

(J) (1) INDIVIDUALS ELIGIBLE FOR THE COMMUNITY CHOICE PROGRAM
SHALL HAVE THE RIGHT TO ELECT TO RECEIVE SERVICES UNDER THE COMMUNITY
CHOICE PROGRAM OR AN APPROVED PROGRAM OF ALL-INCLUSIVE CARE FOR THE
ELDERLY.

(2)      IF AN INDIVIDUAL ELIGIBLE FOR THE COMMUNITY CHOICE
PROGRAM REQUIRES HOSPICE CARE, THE INDIVIDUAL SHALL ELECT TO RECEIVE
HOSPICE CARE FROM A LICENSED HOSPICE PROGRAM UNDER A SEPARATE
ARRANGEMENT AND PAYMENT FOR HOSPICE CARE PROVIDED TO THE INDIVIDUAL
SHALL BE MADE DIRECTLY TO THE HOSPICE PROGRAM BY THE DEPARTMENT UNDER
THE MEDICAID-ESTABLISHED RATE FOR HOSPICE CARE REIMBURSEMENT.

(3)      IF AN INDIVIDUAL ELIGIBLE FOR THE COMMUNITY CHOICE
PROGRAM REQUIRES SPECIALTY MENTAL HEALTH SERVICES, THE INDIVIDUAL
SHALL ELECT TO RECEIVE SPECIALTY MENTAL HEALTH SERVICES FROM AN
APPROVED MENTAL HEALTH PROVIDER UNDER A SEPARATE ARRANGEMENT, AND
PAYMENT FOR SPECIALTY MENTAL HEALTH SERVICES PROVIDED TO THE
INDIVIDUAL SHALL BE MADE DIRECTLY TO THE MENTAL HEALTH PROVIDER BY THE
DEPARTMENT UNDER THE MEDICAID-ESTABLISHED RATE FOR SPECIALTY MENTAL
HEALTH SERVICES.

(K) (1) EACH COMMUNITY CARE ORGANIZATION SHALL MEET ALL
REQUIREMENTS FOR CERTIFICATION BY THE DEPARTMENT.

(2) EACH COMMUNITY CARE ORGANIZATION SHALL:

(I)      HAVE A QUALITY ASSURANCE PROGRAM, SUBJECT TO
APPROVAL BY THE SECRETARY, WHICH SHALL:

1. PROVIDE FOR AN ENROLLEE GRIEVANCE SYSTEM,
INCLUDING AN ENROLLEE HOTLINE;

2.       PROVIDE FOR A PROVIDER GRIEVANCE SYSTEM,
INCLUDING A PROVIDER HOTLINE;

3.       PROVIDE FOR AN ENROLLEE SATISFACTION SURVEY; AND

4.       PROVIDE FOR A CONSUMER ADVISORY BOARD TO
RECEIVE REGULAR INPUT FROM ENROLLEES AND SUBMIT AN ANNUAL REPORT OF
THE ADVISORY BOARD TO THE SECRETARY;

(II)     SUBMIT SERVICE-SPECIFIC DATA IN A FORMAT SPECIFIED BY
THE SECRETARY;

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