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10.09.20.00.htm 10.09.20.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 20 Community Personal Assistance Services Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.20.01.htm 10.09.20.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Activities of daily living” means tasks or activities that include, but are not limited to:. a) Bathing and completing personal hygiene routines;. b) Dressing and changing clothes;. c) Eating;. d) Mobility, including:. i) Transferring from a bed, chair, or other structure;. ii) Moving, turning, and positioning the body while in bed or in a wheelchair; and.
10.09.20.02.htm 10.09.20.02. 02 Requirements for Provider Licensing or Certification.. The following health professionals providing services under this chapter shall be licensed to practice in the jurisdiction in which services are rendered:A. Registered nurses;. B. Licensed practical nurses;. C. Certified medication technicians; and. D. Certified nursing assistants..
10.09.20.03.htm 10.09.20.03. 03 Participant Eligibility.. A. To participate in the Program, the participant shall:. 1) Be determined by the Department to need assistance with one or more activities of daily living;. 2) Be eligible for Medicaid under an eligibility coverage group described in COMAR 10.09.24, except for Regulations .03C, .03-1―03-3, and .05-2; and3) Reside at home.. B. To be eligible for participation, a participant shall have an active plan of service. The plan of service shall:1) Be based on:.
10.09.20.04.htm 10.09.20.04. 04 Conditions for Provider Participation ― General Requirements.. A. To participate as a provider of a service covered under this chapter, a provider:. 1) Shall meet all of the conditions for participation as a Medicaid provider as set forth in COMAR 10.09.36, except as otherwise specified in this chapter;2) Shall verify the qualifications of all individuals who render services on the provider’s behalf and provide a copy of the current license or creden3) Shall implement the re
10.09.20.05.htm 10.09.20.05. 05 Specific Conditions for Provider Participation ― Personal Assistance.. A. Personal assistance service providers shall:. 1) Be licensed as a residential service agency under COMAR 10.07.05;. 2) Employ a registered nurse who shall:. a) Assess each new participant who requires personal assistance services;. b) Participate in developing the worker instructions and in assigning appropriate personnel;.
10.09.20.06.htm 10.09.20.06. 06 Specific Conditions for Provider Participation ― Supports Planning.. To participate in the Program as a supports planning provider under Regulation .10 of this chapter, a provider shall:A. Be free from conflicts of interest;. B. Agree to be monitored by the Department; and. C. Be:. 1) Identified by the Department through a solicitation process; or. 2) The area agency on aging that is enrolled to provide case management services under COMAR 10.09.54.
10.09.20.07.htm 10.09.20.07. 07 Specific Conditions for Provider Participation ― Nurse Monitoring.. To participate in the Program as a nurse monitoring provider under Regulation .11 of this chapter, a provider shall:A. Be designated by the Department through a process approved by the Centers for Medicare and Medicaid Services in accordance with §1915(b)4) of the Social Security Act;B. Employ or contract with registered nurses who hold a current professional license to practice in Maryland;
10.09.20.08.htm 10.09.20.08. 08 Covered Services ― General.. The Program shall reimburse for the services specified in Regulations .09―11 of this chapter, when, pursuant to the requirements of this chapter, these services have been preauthorized by the Department in the participant’s plan of service, billed in accordance with the payment procedures in Regulation .14 of this chapter, and documented as necessary to prevent institutionalization.
10.09.20.09.htm 10.09.20.09. 09 Covered Services ― Personal Assistance.. A. The Program covers personal assistance services that are approved in the plan of service and rendered to a participant by a qualified provider in the participant’s home or a community setting.B. The Program covers the following services when provided by a personal assistance provider:. 1) Assistance with activities of daily living;. 2) Delegated nursing functions if this assistance is:.
10.09.20.10.htm 10.09.20.10. 10 Covered Services ― Supports Planning.. A. Supports planning services shall:. 1) Address the individualized needs of the participant;. 2) Be sensitive to the educational background, culture, and general environment of the participant;. 3) Support the participant to self-direct services and exercise as much control as desired to select, train, supervise, schedule, determine duties of, and dismiss the personal assistance provider; and
10.09.20.11.htm 10.09.20.11. 11 Covered Services ― Nurse Monitoring.. A. The Program covers the following services when provided by a nurse monitor:. 1) Being available to give instruction and to answer questions;. 2) Complying with the Department’s reportable events policy; and. 3) Maintaining an up-to-date client profile in an electronic database designated by the Department.. B. The Program covers nurse monitoring services according to the following schedule:. 1) Contact with the parti
10.09.20.12.htm 10.09.20.12. 12 Conditions for Reimbursement.. The Program shall reimburse for the services specified in Regulations .09―11 of this chapter, if provided in accordance with the requirements of this chapter, and if the service:A. Is recommended on the participant’s plan of service as necessary to assure the health and safety of an applicant or participant in the community;B. Has been preauthorized by the Department in the participant’s plan of service;. C. Is provided to an enrolled participant;.
10.09.20.13.htm 10.09.20.13. 13 Limitations.. A. The Department shall establish a budget for personal assistance services that may be included in the participant’s plan of service, based on each participant’s assessed need.B. The Program does not cover the following services:. 1) Service primarily for the purpose of housekeeping unrelated to the participant’s activities of daily living, such as:a) Cleaning of the floor and furniture in areas not occupied by the participant;.
10.09.20.14.htm 10.09.20.14. 14 Payment Procedures.. A. Request for Payment ― Personal Assistance. To receive payment as a personal assistance provider agency under Regulation .09 of this chapter, a provider and its workers shall use the telephonic time-keeping system approved by the Department to:1) Document time; and. 2) Submit claims.. B. Request for Payment ― All Other Covered Services. To receive payment as a provider of services covered under Regulations .10 and .11 of this chapter, a provider shall submi
10.09.20.15.htm 10.09.20.15. 15 Recovery and Reimbursement.. Recovery and reimbursement procedures shall be as set forth in COMAR 10.09.36.07..
10.09.20.16.htm 10.09.20.16. 16 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions shall be as set forth in COMAR 10.09.36.08.
10.09.20.17.htm 10.09.20.17. 17 Appeal Procedures ― Providers.. Appeal procedures shall be as set forth in:. A. COMAR 10.09.36.09; and. B. COMAR 10.01.03..
10.09.20.18.htm 10.09.20.18. 18 Appeal Procedures ― Applicants and Participants.. Appeal procedures for applicants and participants are those set forth in:. A. COMAR 10.09.24.13; and. B. COMAR 10.01.04..
10.09.20.19.htm 10.09.20.19. 19 Interpretive Regulation.. Interpretive regulatory requirements shall be as set forth in COMAR 10.09.36.10..
10.09.20.20.htm 10.09.20.20. 20 Implementation Date.. This chapter shall be implemented October 1, 2015..
10.09.20.9999.htm 10.09.20.9999. Administrative History Effective date: June 27, 1980 (7:13 Md. R. 1279). Regulation .01F-1―F-3 and .06E adopted, and Regulations .05B; .06B, D; and .07B, B-1, C amended as an emergency provision effective July 1, 1986 (13:15 Md. R. 1729) emergency status expired November 30, 1986Regulation .01F-1―F-3 adopted effective December 1, 1986 (13:21 Md. R. 2321). Regulation .01F-4―F-6 adopted effective July 1, 1988 (15:13 Md. R. 1554).
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