What is REM?
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.
REM Case Managers
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
201 W Preston Street, Room 210
Baltimore, MD 21201
Phone 1-800-565-8190 or 410-767-1903
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.
REM Program Information and Announcements