The Rare and Expensive Case Management (REM) Program is Maryland’s, case managed, fee for service alternative to HealthChoice Managed Care Organization (MCO) participation. The REM Program is for individuals receiving Maryland Medical Assistance with a qualifying diagnosis that is rare in occurrence and expensive to treat. The purpose of the program is to provide community-based care coordination services for people with specialized health care needs, providing access to high quality, medically appropriate health care services in a cost effective setting outside of a managed care organization.
Population Served and Eligibility
- Must be eligible for Medical Assistance (Medicaid)
- Must have a REM qualifying diagnosis
- REM Intake Referral Form.
There is no age limitation, however some individuals may age out of the program depending on the diagnostic criteria. Additionally, individuals may not be eligible for the REM program if they already have Medicare.
The Coordinating Center provides care coordination services for the REM Program. In addition, participating individuals are eligible to receive all Medicaid covered services, as well as optional services, which may require preauthorization.
Basic services under the state plan include medically necessary:
- Physician visits
- Inpatient hospital services
- Home health services
- Radiology and lab services
- Durable medical equipment
- Disposable medical supplies
- Therapies, including PT/OT/SLP/Assistive Technology
Optional services may include medically necessary:
- Private duty nursing and nursing assistance
- Nutritional supplements
- Dental care
Referral and Application Process
Anyone can refer an individual for the REM program. Medicaid managed care organizations refer individuals when they identify those with REM qualifying diagnoses whose needs are outside the scope of the managed care organizations’ benefits and services.
- Download and print the REM Intake Referral Form.
- Review eligibility criteria.
- Meet with your physician. The REM application must be completed and signed by the referring physician and include proper medical documentation supportive of the qualifying diagnosis.
- Submit completed form and all supporting clinical information to the:
Maryland Department of Health REM Intake Unit
201 W. Preston Street, Room 210
Baltimore, Maryland 21201-2399
For questions, please call the REM Intake Unit at 1-800-565-8190.
For additional information, contact The Coordinating Center and ask to be connected to the REM Intake Department: 410-987-1048.