Skip to Main Content
<< Back | Return to Main COMAR Search Page

20 records match your request.

FileAbstract
10.09.46.00.htm 10.09.46.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 46 Home and Community-Based Services Waiver for Individuals with Brain Injury Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.46.01.htm 10.09.46.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Applicant" means an individual who is applying as a participant in the BI waiver.. 2) "Behavior intervention" means services designed to assist individuals who exhibit challenging behaviors in acquiring skills, gaining social acceptance, and becoming full participants in the community, consistent with behavior support services program service plans set for
10.09.46.02.htm 10.09.46.02. 02 Medical Assistance Eligibility.. A. Financial eligibility for waiver participants is determined according to the provisions of this regulation and applicable sections of COMAR 10.09.24 Medical Assistance Eligibility, as cited in this section.B. Categorically Needy. An individual is eligible for waiver services as categorically needy if the individual is receiving Medical Assistance as:1) A recipient of Supplemental Security Income (SSI). 2) A member of a low inco
10.09.46.03.htm 10.09.46.03. 03 Participant Eligibility.. A. Medical Eligibility for the Waiver.. 1) To be medically eligible for the services covered under this chapter, an applicant shall be certified by the Program's utilization control agent to need nursing facility level of care or special hospital level of care.2) Every 12 months, or more frequently if determined necessary by the MHA or Program due to a significant change in the participant's condition or need, a participant's medica
10.09.46.04.htm 10.09.46.04. 04 Program Model.. A. The program services and supports shall:. 1) Maximize the level of functioning of an individual with BI through assistance and support with independent living, self care skills, and social skills in an environment which encourages the participant's ability to make decisions about the individual's life and create opportunities for choice regarding home, school or work, and community activities;
10.09.46.05.htm 10.09.46.05. 05 Conditions for Provider Participation ― General.. General requirements for participation in the Medical Assistance Program as a provider of BI waiver services are that the provider, with the exception of a medical day care provider, shall:A. Be approved by the MHA as meeting the requirements and able to provide the services specified in this chapter;B. Have a provider agreement in effect;. C. Meet all the conditions for participation in COMAR 10.09.36, except as o
10.09.46.06.htm 10.09.46.06. 06 Conditions for Provider Participation ― Specific.. A. Provider of Residential Habilitation or Rehabilitation Services. To provide the services covered under Regulation .07 of this chapter, the provider agency shall:1) Operate a community-based program of residential habilitation or rehabilitation services that is licensed by the Department's Office of Health Care Quality under COMAR 10.22.08 for the Community Residential Services Program;2) Meet the participant's
10.09.46.07.htm 10.09.46.07. 07 Covered Services ― Residential Habilitation Services.. A. The residential habilitation services covered under this regulation shall be provided in a community-based residential facility.B. The covered services shall include:. 1) Habilitative services to assist a participant in acquiring, regaining, retaining, or improving the self-help skills related to activities of daily living and the socialization and adaptive skills which are necessary to reside successfully in home
10.09.46.08.htm 10.09.46.08. 08 Covered Services ― Day Habilitation Services.. A. The day habilitation services covered under this regulation shall be provided in a nonresidential setting, separate from the home or facility in which the participant resides.B. The covered services, as defined in this chapter shall include:. 1) Habilitative or rehabilitative services to assist a participant in acquiring, regaining, retaining, or improving the self-help skills related to activities of daily living
10.09.46.09.htm 10.09.46.09. 09 Covered Services ― Supported Employment Services.. A. The supported employment services covered under this regulation shall be provided in nonresidential community settings, separate from the home or facility in which the participant resides.B. The covered services shall:. 1) Include a work program that includes supports necessary for the participant to achieve desired outcomes established in the waiver plan of care;2) Include rehabilitation activities needed to sus
10.09.46.09-1.htm 10.09.46.09-1. 09-1 Covered Services ― Individual Support Services.. A. Individual support services, as defined in Regulation .01B of this chapter, shall be provided in a community setting, including the participant's home, excluding a community-based residential facility.B. Individual support services shall assist participants to live as independently as possible in their own homes.C. The provider shall provide services in collaboration with the participant's other BI waiver servi
10.09.46.09-2.htm 10.09.46.09-2. 09-2 Covered Services ― Medical Day Care Services.. A. Covered medical day care services are those set forth in COMAR 10.09.07.. B. A unit of service is a minimum of 4 hours present at the medical day care center..
10.09.46.10.htm 10.09.46.10. 10 Conditions for Reimbursement.. The Department shall reimburse for services covered under this chapter if the services are:. A. Provided to a participant who meets the qualifications for eligibility specified in Regulations .02 and .03 of this chapter;B. Preauthorized in the participant's waiver plan of care by the MHA, as being reasonable and medically necessary to prevent institutionalization;C. Provided by an approved provider which meets the conditions for particip
10.09.46.11.htm 10.09.46.11. 11 Limitations.. A. Reimbursement shall be made by the Program only if all of the requirements of this chapter are met.B. Reimbursement may not be made by the Program for a waiver service furnished before:. 1) Enrollment of the participant in the waiver;. 2) Development of the participant's waiver plan of care; and. 3) Inclusion of the specific service in the participant's approved waiver plan of care.. C. The Program shall reimburse for a participant not more than:.
10.09.46.12.htm 10.09.46.12. 12 Payment Procedures.. A. Request for Payment.. 1) An approved provider, with the exception of a medical day care provider, shall submit requests for payment to MHA or its authorized representative for the services covered under this chapter, according to procedures set forth in COMAR 10.09.36.04 or otherwise established by the Department. Medical day care providers shall submit requests for payment to the Department in accordance with COMAR 10.09.07.08.2) The provider shall:.
10.09.46.13.htm 10.09.46.13. 13 Recovery and Reimbursement.. Recovery and reimbursement under this chapter are as set forth in COMAR 10.09.36.07 and COMAR 10.09.07.09.
10.09.46.14.htm 10.09.46.14. 14 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions under this chapter are as set forth in COMAR 10.09.36.08.
10.09.46.15.htm 10.09.46.15. 15 Appeal Procedures.. A. Appeal procedures for applicants and participants are those set forth in COMAR 10.09.24.13 and COMAR 10.01.04.B. Provider appeal procedures under this chapter are set forth in COMAR 10.09.36.09..
10.09.46.16.htm 10.09.46.16. 16 Interpretive Regulation.. Interpretation of this regulation is subject to COMAR 10.09.36.10..
10.09.46.9999.htm 10.09.46.9999. Administrative History Effective date:. Regulations .01―16 adopted as an emergency provision effective July 1, 2003 (30:14 Md. R. 933) adopted permanently effective December 11, 2003 (30:24 Md. R. 1740)Regulation .01B amended effective April 9, 2007 (34:7 Md. R. 698). Regulation .01B amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481) amended permanently effective October 6, 2008 (35:20 Md. R. 1774)
<< Back | Return to Main COMAR Search Page