The Rare and Expensive Case Management (REM) Program provides specialized medical case management and support services for individuals living with medical conditions that are rare in occurrence or costly to treat. The program is designed for eligible individuals who receive Maryland Medicaid and choose to participate in the REM Program instead of enrolling in a Managed Care Organization (MCO) in the community.
Through this program, participants receive coordinated support that helps them access the medical care, services, and resources needed to manage complex health conditions. The goal of the REM Program is to ensure individuals receive appropriate care while supporting their overall health, independence, and quality of life.
Once enrolled, each participant is assigned a Clinical Care Coordinator, who is responsible for helping develop and manage a personalized Care Management Plan. This plan is created collaboratively with the participant, their family members or caregivers, and their healthcare providers. The plan outlines the services and resources needed to support the participant’s medical and personal goals.
Participants receive ongoing guidance and support from their Clinical Care Coordinator, including regular monthly contact and scheduled in-person visits in the home or community. These interactions help ensure that services remain appropriate, accessible, and responsive to the participant’s changing needs.
Covered Services
Participants enrolled in the REM Program receive access to comprehensive case management services provided by a licensed nurse or social worker serving as their Clinical Care Coordinator. The coordinator works closely with participants to help them navigate healthcare systems, manage services, and connect with appropriate providers.
In addition to case management, participants may access a variety of Medicaid-covered healthcare services, which may include:
- Physician and specialist visits
- Therapy services such as physical, occupational, or speech therapy
- Dental care
- Prescription medications and pharmacy services
Additional services may be available when medically necessary. For example, participants who meet eligibility requirements may receive optional services such as:
- Private duty nursing
- Nutritional supplements
- Medical equipment and supplies
All medically necessary services must be ordered by a healthcare provider with an active Maryland Medicaid number and may require prior authorization. Clinical Care Coordinators help guide participants through the process of accessing these services and understanding their care options.
Population Served and Eligibility
The REM Program is available to individuals who meet specific medical and financial eligibility criteria.
Participants must:
- Be eligible for community-based Maryland Medicaid
- Have a qualifying diagnosis recognized under the REM Program
- Meet age requirements associated with their qualifying diagnosis
The program generally serves individuals from birth through age 65, although the age range may vary depending on the specific medical condition.
Individuals may not qualify for the REM Program if they are already enrolled in Medicare.
Eligibility requirements are reviewed during the application process to determine whether the individual meets the criteria for enrollment.
How Clinical Care Coordinators Support Participants
Clinical Care Coordinators play a central role in helping participants manage their healthcare needs and access appropriate services. They provide ongoing guidance and coordination across healthcare providers, community programs, and support services.
Coordinators may assist participants with:
- Managing medications and addressing access concerns
- Identifying and connecting with appropriate healthcare providers
- Accessing transportation to medical appointments
- Linking participants with community resources and services
- Coordinating medical equipment, supplies, and support services
- Ensuring communication between healthcare providers and support teams
Through consistent guidance and advocacy, Clinical Care Coordinators help participants navigate complex healthcare systems while focusing on their personal health goals.
Services We Help Coordinate
The REM Program supports participants by coordinating a wide range of services that address both healthcare and daily living needs. These services may include:
Health and Medical Support
- Therapy services
- Private duty nursing
- Assistive technology
- Adaptive equipment
- Behavioral health services
Community and Social Support
- Community involvement opportunities
- Vocational or employment resources
- Community programs and services
Daily Living Support
- Transportation assistance
- Nutrition services
- Housing and utility resources
- Caregiver support and respite services
Planning and Resource Support
- Education and information services
- Future care planning
- Connections to Medicaid programs and additional resources
These coordinated services help participants maintain access to essential healthcare while addressing social and daily living needs.
How to Apply
Individuals interested in the REM Program must complete an application and submit supporting documentation.
The process generally includes the following steps:
- Download and complete the REM Intake Referral Form.
- Review the eligibility requirements to ensure the applicant meets program criteria.
- Meet with a physician, who must complete and sign the application and provide medical documentation confirming the qualifying diagnosis.
- Submit the completed application and supporting clinical information to the Maryland Department of Health REM Intake Unit for review.
Once the application is evaluated, individuals will be notified regarding their eligibility and potential enrollment in the program.
Rights and Responsibilities
Your REM Program Rights
As a participant in the REM Program, you have the right to:
- Expect that your personal health information will be protected and kept confidential in accordance with the Consent to Release Information and Notice of Privacy Practices.
- Receive care from providers who treat you with respect, dignity, and professionalism.
- Select your own Maryland Medicaid Fee-For-Service healthcare providers.
- Access quality healthcare services that support your medical needs and well-being.
Your REM Program Responsibilities
As a participant, you are responsible for:
- Renewing your Medicaid coverage each year when you receive your renewal notice.
- Actively participating in your care with your healthcare providers and case manager.
- Informing your case manager if your address, phone number, or other important information changes and may affect your services.
- Maintaining regular communication with your REM case manager and completing required monthly contacts and scheduled visits.
FAQs About This Program
How long does it take to know if I am accepted into the program?
Can I continue receiving services through my HealthChoice managed care organization if I enroll in the REM Program?
Will I still be able to see my current doctor after enrolling in the REM Program?
How long can I remain enrolled in the REM Program?
What are REM Case Management Services?
How can I file a complaint about the REM Program?
Compassionate Care is Within Reach
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