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10.09.54.00.htm 10.09.54.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 54 Home and Community-Based Options Waiver Authority: Health-General Article, §2-104(b) 15-103, 15-105, and 15-132, Annotated Code of Maryland
10.09.54.01.htm 10.09.54.01. 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) Toileting, including:. i) Bladder and bowel requirements;. ii) Routines associated with the achievement or maintenance of continence; and. iii) Incontinence care;.
10.09.54.02.htm 10.09.54.02. 02 Licensing and Certification Requirements.. A. Assisted living services providers shall be licensed by the Department in accordance with COMAR 10.07.14.B. The following health professionals providing services under this chapter shall be licensed to practice in the jurisdiction in which services are rendered:1) Physicians;. 2) Registered nurses;. 3) Licensed practical nurses;. 4) Occupational therapists;. 5) Physical therapists;. 6) Dietitians;. 7) Nutritionists;.
10.09.54.03.htm 10.09.54.03. 03 Participant Eligibility.. A. General Requirements.. 1) To be eligible for participation, an individual shall be determined by the Department to meet the conditions of §B―E of this regulation.2) Eligibility for waiver services shall be reevaluated every 12 months or more frequently if needed due to a significant change in the participant’s condition, needs, or financial status.B. Technical Eligibility. To be eligible for services covered under this chapter, an applicant or pa
10.09.54.04.htm 10.09.54.04. 04 Conditions for Provider Participation ― General Requirements.. A. To participate as a provider of a service covered under this chapter a provider shall:. 1) Meet all of the conditions for participation as a Maryland Medical Assistance Program provider as set forth in COMAR 10.09.36, except as otherwise specified in this chapter;2) Verify the qualifications of all individuals who render services on the provider’s behalf, and provide a copy of the current license or credentials
10.09.54.05.htm 10.09.54.05. 05 Specific Conditions for Provider Participation ― Assisted Living.. A. To participate in the program as a provider of assisted living services under this chapter a provider shall:1) Be licensed by the Department at the time that services are rendered, in accordance with COMAR 10.07.14, to provide assisted living services;2) Be or employ a manager who is qualified as:. a) A licensed physician;. b) A licensed registered nurse;. c) A licensed practical nurse; or.
10.09.54.06.htm 10.09.54.06. 06 Specific Conditions for Provider Participation ― Behavior Consultation.. To participate in the program as a provider of behavior consultation services under this chapter a provider shall:A. Be:. 1) A health services agency that:. a) Employs a qualified individual or individuals to render behavior consultation services; and. b) Assures supervision of the individual rendering behavior consultation services by a licensed mental health professional or by a bachelor's level nu
10.09.54.07.htm 10.09.54.07. 07 Specific Conditions for Provider Participation ― Senior Center Plus.. To participate in the program as a provider of Senior Center Plus services under this chapter a provider shall:A. Be approved and monitored by the Maryland Department of Aging as a nutrition service provider;. B. Meet all local and State requirements to operate as a nutrition site, which include but are not limited to inspection and approval of the facility by the local fire marshal, periodic fire drills, a
10.09.54.08.htm 10.09.54.08. 08 Specific Conditions for Provider Participation ― Family Training.. To participate in the Program as a provider of family training under this chapter a provider shall:. A. Be a self-employed trainer or an agency that employs qualified trainers in accordance with §B―D of this regulation;B. Have demonstrated experience with the skill being taught;. C. Be willing to meet at the participant's home to provide services; and. D. Employ licensed registered nurses, occupational
10.09.54.09.htm 10.09.54.09. 09 Specific Conditions for Provider Participation ― Dietitian and Nutritionist Services.. To participate in the program as a provider of dietitian and nutritionist services under this chapter a provider shall be a:A. Dietitian or nutritionist who is licensed in accordance with COMAR 10.56.01 and Health Occupations Article, Title 5, Annotated Code of Maryland; orB. Professional group or agency which employs an individual who is licensed in accordance with §A of this regulation.
10.09.54.10.htm 10.09.54.10. 10 Specific Conditions for Provider Participation ― Medical Day Care Services.. To participate in the program as a provider of medical day care services under this chapter a provider shall:A. Meet the licensure requirements as provided in COMAR 10.12.04; and. B. Meet the requirements of COMAR 10.09.07..
10.09.54.10-1.htm 10.09.54.10-1. 10-1 Specific Conditions for Participation ― Respite Care.. To participate in the Program as a provider of respite care services under Regulation .18-1 of this chapter a provider shall be enrolled as a provider of:A. Assisted living services under this chapter; or. B. Nursing facility services under COMAR 10.09.10..
10.09.54.11.htm 10.09.54.11. 11 Specific Conditions for Provider Participation ― Case Management Services.. To participate in the program as a provider of case management services under this chapter a provider shall:A. Be an area agency or other entity 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; andB. Agree to be monitored by the Department..
10.09.54.12.htm 10.09.54.12. 12 Covered Services ― General.. The Program shall reimburse for the services specified in Regulations .13―19 of this chapter when, pursuant to the requirements of this chapter, these services have been pre-approved by the Department in the participant’s plan of service, and billed in accordance with the payment procedures in Regulation .22 of this chapter.
10.09.54.13.htm 10.09.54.13. 13 Covered Services ― Assisted Living Services.. A. Assisted living services shall include the provision of:. 1) A structured, supportive environment in a home-like setting;. 2) Personal assistance and chore services including:. a) Assisting the participant, as necessary, with performing activities of daily living and instrumental activities of daily living, including cuing the participant to perform these activities;b) Routine housekeeping, laundry, household care,
10.09.54.14.htm 10.09.54.14. 14 Covered Services ― Behavior Consultation Services.. A. A provider may bill for the length of a home visit to a participant, upon completion of the services specified in §C of this regulation.B. Behavior consultation services may be preauthorized by a participant's plan of service when:. 1) A participant or the participant’s representative request the service due to an identified behavioral issue; or2) The participant’s behavior is:.
10.09.54.15.htm 10.09.54.15. 15 Covered Services ― Senior Center Plus.. A. A day of service is covered by the Program when the participant attends for at least 4 hours, not including transportation to and from the center.B. Senior Center Plus services include a program of structured group recreational activities, supervised care, assistance with activities of daily living and instrumental activities of daily living, and enhanced socialization provided in an out-of-home, outpatient setting. S
10.09.54.16.htm 10.09.54.16. 16 Covered Services ― Family Training.. A. The Program covers family training when the service is approved in the plan of service and rendered to a family member by a qualified provider, not including the time spent planning, preparing, setting up or following up after the training.B. The training and counseling services may not include services rendered:. 1) On a group basis or in a classroom setting; or.
10.09.54.17.htm 10.09.54.17. 17 Covered Services ― Dietitian and Nutritionist Services.. A. Dietitian and nutritionist services shall include:. 1) The provision of nutrition care plan outcomes and approaches;. 2) Nutrition care planning, nutrition assessment, and dietetic instruction; and. 3) Services within the scope of practice of the nutritionist's or dietitian's license, as defined by:a) Health Occupations Article, Title V, Annotated Code of Maryland; and.
10.09.54.18.htm 10.09.54.18. 18 Covered Services ― Medical Day Care Services.. A provider shall render medical day care services in accordance with COMAR 10.09.07..
10.09.54.18-1.htm 10.09.54.18-1. 18-1 Covered Services ― Respite Care.. Respite care services shall:. A. Be provided to participants who, due to physical or cognitive impairments, are unable to care for themselves;B. Be furnished on a short-term basis because of the absence or need for relief of an individual normally providing the care;C. Provide a period of rest and renewal, which contributes to maintaining the participant at home inD. Be provided at planned intervals, in a time of crisis, or as needed;.
10.09.54.19.htm 10.09.54.19. 19 Covered Services ― Case Management Services.. A. Case management services shall be targeted to address the individualized needs of the participant and be sensitive to the educational background, culture, and general environment of the participant.B. Case management services include time spent by a qualified provider conducting any of the following activities:1) Assisting with the initial or annual waiver eligibility process;. 2) Assisting with the application and supporting t
10.09.54.20.htm 10.09.54.20. 20 Conditions for Reimbursement.. The Program shall reimburse for the services specified in Regulations .13―19 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 in order to:. 1) Prevent the applicant’s or participant’s admission to an institution; or. 2) Assure the health and safety of an applicant or participant in the community;.
10.09.54.21.htm 10.09.54.21. 21 Limitations.. A. Reimbursement may be made by the Program only when the requirements of this chapter are met.. B. The Program may not reimburse the following combinations of services for a participant for the same date of service:1) Senior Center Plus and Medical Day Care under this chapter;. 2) Assisted living services under this chapter and personal assistance services under COMAR 10.09.20 or COMAR 10.09.84;3) Assisted living services and respite care under this chapter; or.
10.09.54.22.htm 10.09.54.22. 22 Payment Procedures.. A. Request for Payment. To receive payment as a provider of services covered under Regulations .13―19 of this chapter, a provider shall submit claims in accordance with procedures outlined in the Department’s billing manual.B. Billing time limitations for the services covered under this chapter are set forth in COMAR 10.09.36.06.C. Payments.. 1) Payments shall be made directly to a qualified provider.. 2) Providers shall be paid the lesser of:.
10.09.54.23.htm 10.09.54.23. 23 Recovery and Reimbursement.. Recovery and reimbursement are as set forth in COMAR 10.09.36.07..
10.09.54.24.htm 10.09.54.24. 24 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions is as set forth in COMAR 10.09.36.08..
10.09.54.25.htm 10.09.54.25. 25 Appeal Procedures.. Appeal procedures are those set forth in COMAR 10.09.36.09..
10.09.54.26.htm 10.09.54.26. 26 Interpretive Regulation.. State regulations are interpreted as set forth in COMAR 10.09.36.10..
10.09.54.27.htm 10.09.54.27. 27 Implementation Date.. This chapter shall be implemented January 6, 2014..
10.09.54.9999.htm 10.09.54.9999. Administrative History Effective date:. Regulations .01―19 adopted as an emergency provision effective July 22, 1993 (20:16 Md. R. 1275) adopted permanently effective October 26, 1993 (20:21 Md. R. 1654) ―Chapter revised effective December 25, 2000 (27:25 Md. R. 2281) ―. Chapter revised effective June 21, 2004 (31:12 Md. R. 912). Regulation .05A amended effective July 17, 2006 (33:14 Md. R. 1164). Regulation .33C amended effective June 20, 2005 (32:12 Md. R. 1046) July 17
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