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10.09.26.00.htm 10.09.26.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 26 Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.26.01.htm 10.09.26.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Alternative living unit" means a residence that:. a) Provides residential services for individuals who, because of developmental disabilities, require specialized living arrangements;b) Admits not more than 3 individuals; and. c) Provides 10 or more hours of supervision per unit per week.. 2) "Appropriate evaluation" means the assessment of an individual by qualif
10.09.26.02.htm 10.09.26.02. 02 Licensing Requirements.. A. Providers of residential habilitation services shall be licensed pursuant to COMAR 10.22.03 or 10.22.14.B. Providers of day habilitation or supported employment services shall be licensed pursuant to COMAR 10.22.12 or 10.22.13.C. Providers of services coordination services shall be licensed by the Department pursuant to COMAR 10.22.09.D. Providers of residential option services shall be licensed pursuant to COMAR 10.22.11.04..
10.09.26.03.htm 10.09.26.03. 03 Conditions for Participation.. A. General requirements for participation in the Medical Assistance Program are that the providers:. 1) Meet all conditions for participation specified in COMAR 10.09.36, except as otherwise specified in this regulation;2) Meet the licensure requirements as provided in Regulation .02 of this chapter;. 3) Have a provider agreement in effect with the Developmental Disabilities Administration and the Medical Assistance Program;4) Verify the licenses of
10.09.26.04.htm 10.09.26.04. 04 Covered Services for Services Coordination.. The Department shall reimburse for services coordination which shall include the following:. A. Convening the interdisciplinary team and conducting the team meeting for the development and revision of the ISP;B. Assisting the waiver participant in identifying, negotiating, and obtaining needed services that are agreed upon and specified in the ISP;
10.09.26.05.htm 10.09.26.05. 05 Covered Services for Residential Habilitation.. A. The Department shall reimburse residential habilitation services providers for those services listed below, exclusive of room and board. These regulations do not limit payments, within the fiscal guidelines of the Department, for room, board, and normal living expenses for waiver participants.B. Habilitation. The services shall be provided as required and recommended in the IHP. Residential habilitation services pro
10.09.26.06.htm 10.09.26.06. 06 Covered Services for Day Habilitation.. A. Day habilitation services shall be provided that are required and recommended in the waiver participant's IHP by licensed day habilitation programs and shall include the services listed in Regulation .05 of this chapter and in §B―D of this regulation.B. Transportation.. 1) Transportation services shall be arranged for participants by the day habilitation services center staff. The center shall maximize the use of the
10.09.26.07.htm 10.09.26.07. 07 Covered Services for Environmental Modifications.. A. Environmental modifications shall be provided on a limited, one-time-only basis to the extent necessary to enable waiver participants with physical infirmities or disabilities to live safely in community homes as an alternative to institutionalization.B. The environmental modifications are limited to:. 1) Installation of bathing and toilet-area grab bars in the home of a waiver participant who has physical infirmities or disa
10.09.26.08.htm 10.09.26.08. 08 Covered Services for Respite Care.. A. Respite care may only be provided to waiver participants who receive residential habilitation or residential option services in their home or in an individual family care home.B. When respite care is received in a:. 1) State residential center, it is limited to a total of 45 days within any 12-month period;. 2) Community residence, it is limited to 14 consecutive days at a time and to a total of 28 days within any 12-month period.
10.09.26.08-1.htm 10.09.26.08-1. 08-1 Covered Services for Supported Employment.. A. Supported employment services are available to waiver participants:. 1) Who previously resided in a State residential center or nursing facility;. 2) For whom competitive employment at or above the minimum wage is unlikely; and. 3) Who, because of their disability, need ongoing post-employment support to perform in a work setting.B. Supported employment services are designed to assist a waiver participant with accessing and main
10.09.26.08-2.htm 10.09.26.08-2. 08-2 Covered Services for Residential Option Services.. A. Residential option services are available as an alternative to residential habilitation for those waiver participants who:1) Have followed DDA's application procedures according to COMAR 10.22.11;. 2) Are determined by DDA to be able to live safely in a home of the waiver participant's choosing and who are in need of at least one residential option service; and3) Elect, or have an authorized representative ele
10.09.26.08-3.htm 10.09.26.08-3. 08-3 Assistive Technology and Adaptive Equipment.. A. This technology and equipment includes the assistive technology and adaptive equipment necessary to enable a waiver participant to live in the community and to participate in community activities, when this technology and equipment is not otherwise covered by the Program.B. The following items or services are included:. 1) Equipment needed to adapt the waiver participant's or family's vehicle;. 2) Purchase or rental of
10.09.26.08-4.htm 10.09.26.08-4. 08-4 Covered Services for Intensive Behavior Management.. Services shall be provided in accordance with COMAR 10.22.10..
10.09.26.08-5.htm 10.09.26.08-5. 08-5 Covered Services for Medical Day Care.. A. Unit of service means a day of care in which the participant is certified present at the medical day care center for a minimum of 4 hours.B. Medical day care services shall be provided in accordance with COMAR 10.09.07.. C. Medical day care services may be covered for not more than 5 days per week..
10.09.26.09.htm 10.09.26.09. 09 Conditions for Reimbursement.. The Department shall reimburse for services in Regulations .04―08-5 of this chapter when they are:. A. Provided to waiver participants;. B. With the exception of medical day care services, contained in the waiver participant's plan of care, approved initially and within 12 months after that by a:1) Licensed physician;. 2) Licensed physician's assistant or licensed nurse practitioner in accordance with applicable law; or
10.09.26.10.htm 10.09.26.10. 10 Limitations.. A. These regulations do not cover the following services:. 1) Services available to waiver participants through programs funded under the Rehabilitation Act of 1973, §110, Public Law 94-142, or Education of the Handicapped Act, §602(16) and (17)2) Services which are not part of a waiver participant's plan of care as established by a:. a) Licensed physician;. b) Licensed physician's assistant or licensed nurse practitioner in accordance with applicable law; or
10.09.26.11.htm 10.09.26.11. 11 Participant Eligibility.. A. Waiver participants shall meet the eligibility conditions of §B of this regulation, as well as Regulation .12 of this chapter.B. To be eligible for services under the Home and Community Based Services Waiver for the Developmentally Disabled, a person shall:1) Be a recipient who, immediately before placement pursuant to these regulations, is residing in a:. a) State residential center;. b) Nursing facility and who is determined through
10.09.26.12.htm 10.09.26.12. 12 Medical Assistance Eligibility.. A. Definitions. In this regulation, the following terms have the meanings indicated:. 1) "Aged" means a person who is 65 years old or older.. 2) "Blind" means having a condition in which a person is certified by an ophthalmologist as having either central visual acuity of 20/200 or less in the better eye with correcting glasses, or a field defect in which the peripheral field has contracted to such an extent that the widest diameter of th
10.09.26.13.htm 10.09.26.13. 13 Payment Procedures.. A. Request for Payment.. 1) All requests for payment of services rendered shall be submitted according to procedures established by the Department. Payment requests which are not properly prepared or submitted may not be processed, but shall be returned unpaid to the provider.2) Requests for payment shall be submitted as set forth in COMAR 10.09.36.04A.. 3) Requests for payment shall include all units of service rendered to a waiver participant during t
10.09.26.14.htm 10.09.26.14. 14 Recovery and Reimbursement.. Recovery and reimbursement are as specified in COMAR 10.09.36..
10.09.26.15.htm 10.09.26.15. 15 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions is as specified in COMAR 10.09.36..
10.09.26.16.htm 10.09.26.16. 16 Appeal Procedures.. A. Appeal procedures for providers are as specified in COMAR 10.09.36.. B. Persons filing appeals contending that they were not informed of their choice of services or that they were denied the service of their choice may file an appeal requesting a fair hearing under provisions contained in 42 CFR Part 431, Subpart E.
10.09.26.17.htm 10.09.26.17. 17 Interpretive Regulation.. State regulations shall be interpreted as specified in COMAR 10.09.36..
10.09.26.9999.htm 10.09.26.9999. Administrative History Effective date:. Regulations .01―11 adopted as an emergency provision effective February 13, 1984 (11:5 Md. R. 455) emergency status extended at 11:7 Md. R. 621; adopted permanently effective August 12, 1984 (11:15 Md. R. 1330)Regulation .08A amended effective May 12, 1986 (13:9 Md. R. 1029) ―. Chapter revised effective February 20, 1989 (16:3 Md. R. 343) ―. Chapter revised as an emergency provision effective April 1, 1990 (17:8 Md. R. 969) amended permanen
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