MedicaidAdministrativeMedium impact
Proposed repeal of regulations .01 through .17 and adoption of new regulations .01 through .14 under COMAR 10.09.69 Managed Care Program: Rare and Expensive Case Management
Maryland Medicaid·MD · Pediatrics, General Practice, Internal Medicine·EPSDT Nursing Services
Effective date
Feb 2, 2004
We identified it
Jun 20, 2026
Summary
Maryland's Rare and Expensive Case Management (REM) program is updating regulations that govern managed care for patients with rare and expensive conditions, including EPSDT private duty nursing services. The changes clarify eligibility criteria, provider participation requirements, and service limitations while eliminating some duplicative services that remain available through fee-for-service Medicaid.
Action Required
Maryland providers: Review updated REM program regulations to understand revised eligibility criteria, enrollment procedures, and service limitations. Verify that patients with rare and expensive conditions meet new participation criteria. Note that acupuncture, behavioral management, chore services, convalescent care, emergency call systems, environmental modifications, CARP-accredited community rehabilitation, nursing facility services, specialized equipment/supplies, social work, and transportation services are no longer covered under REM but remain available through fee-for-service Medicaid.