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10.09.56.00.htm 10.09.56.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 56 Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder Authority: Health-General Article, §2-104(b) 15-103, 15-105, and 15-130, Annotated Code of Maryland
10.09.56.01.htm 10.09.56.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) Active Treatment.. a) "Active treatment" means, according to 42 CFR §483.440(a) a continuous active treatment program which includes aggressive, consistent implementation of a program of specialized and generic training, treatment, health services, and related services that is directed toward the:i) Acquisition of the behaviors necessary for the individual to function wi
10.09.56.02.htm 10.09.56.02. 02 Participant Eligibility.. A. Medical Eligibility for the Autism Waiver.. 1) To be medically eligible for the services covered under the chapter, an applicant shall be certified by the licensed psychologist or certified school psychologist, who is a member of the participant’s multidisciplinary team and is employed by the local Infants and Toddlers Program, the local school system, the Program, or the Program’s designee, to need ICF-ID level of care using the standardiz
10.09.56.03.htm 10.09.56.03. 03 Care Planning Process.. A. Multidisciplinary Team.. 1) A multidisciplinary team shall be convened by the local school system or local lead agency in accordance with COMAR 10.09.52 to:a) Assess or reassess an applicant's or participant's need and eligibility for Autism Waiver services;b) Review the applicant's or participant's IEP or IFSP, as necessary; and. c) Develop or review, and revise as necessary, the applicant's or participant's Autism Waiver plan of care.
10.09.56.04.htm 10.09.56.04. 04 Conditions for Participation ― General.. To provide Autism Waiver services, the provider:. A. Shall be approved in accordance with the requirements specified in this chapter;. B. Shall have a provider agreement in effect, signed with the Program;. C. Shall meet all the conditions for participation specified in COMAR 10.09.36, except as otherwise specified in this chapter;D. Shall assure that professional employees who render or delegate services under this chapter have
10.09.56.05.htm 10.09.56.05. 05 Specific Conditions for Participation ― Residential Habilitation Services.. To provide the services covered under Regulation .11 of this chapter, the provider agency shall:. A. Provide services in a facility that meets the following requirements:. 1) Complies with regulations governing residential programs licensed under the:. a) Developmental Disabilities Administration including COMAR 10.22.02 and 10.22.08; or. b) Governor's Office for Children including COMAR 14.31.06;.
10.09.56.06.htm 10.09.56.06. 06 Specific Conditions for Participation ― Intensive Individual Support Services.. To provide the service covered under Regulation .15 of this chapter, the provider shall:. A. Have at least 3 years of experience in providing habilitation services to children with autism;. B. Employ a full-time program director, to assure adequate coordination and supervision of the covered services, who shall either:1) Hold a valid Maryland certificate as a special education supervisor, pri
10.09.56.06-1.htm 10.09.56.06-1. 06-1 Specific Conditions for Participation ― Therapeutic Integration Services.. To provide one or more of the services covered under Regulation .14 of this chapter, the provider shall:A. Have at least 3 years of experience in providing habilitation services to children with autism spectrum disorder or other developmental disabilities;B. Employ a full-time program director to assure adequate coordination and supervision of the covered services, who shall:1) Hold a valid Maryland
10.09.56.06-2.htm 10.09.56.06-2. 06-2 Specific Conditions for Participation Intensive Therapeutic Integration Services.. To provide one or more of the services covered under Regulation .14-1 of this chapter, the provider shall:A. Meet all the conditions of Regulation .06-1 of this chapter; and. B. Have an on-site direct care worker for every participant receiving one-to-one intervention for intensive therapeutic integration.
10.09.56.07.htm 10.09.56.07. 07 Specific Conditions for Participation ― Respite Care.. A. The respite care provider shall have adequate liability insurance and be appropriately bonded.. B. A professional who provides respite care services or supervises a direct care worker rendering the services shall be:1) Certified in accordance with COMAR 13A.12.01 as a psychologist or special educator; or. 2) Licensed as a psychologist, social worker, registered nurse, professional counselor, or occupational therapist; or
10.09.56.08.htm 10.09.56.08. 08 Specific Conditions for Participation ― Family Consultation.. A. To provide the services covered under Regulation .17 of this chapter, a consultant shall be:. 1) Certified in accordance with COMAR 13A.12.01 as a psychologist, special educator, or speech therapist;2) Licensed as a psychologist, certified social worker, nurse psychotherapist, speech therapist, professional counselor, marriage and family therapist, or occupational therapist;
10.09.56.09.htm 10.09.56.09. 09 Specific Conditions for Participation ― Environmental Accessibility Adaptations.. To provide the services covered under Regulation .18 of this chapter, the provider shall:. A. Be the store, vendor, contractor, or builder from which the adaptation is purchased;. B. Be able to install the adaptation, if necessary;. C. Be able to service or maintain the adaptation, as necessary; and. D. If construction is involved:.
10.09.56.10.htm 10.09.56.10. 10 Specific Conditions for Participation ― Adult Life Planning Services.. A. To provide the services covered under Regulation .19 of this chapter, the provider shall:. 1) Be an individual with a Master's Degree in Human Services; and. 2) Have 5 years of full-time experience serving adults with autism disabilities.. B. Adult life planning service providers shall work with the participants and the participants families to develop a treatment plan incorporating the
10.09.56.11.htm 10.09.56.11. 11 Covered Services ― Residential Habilitation Services.. A. The Program under this regulation does not cover the following:. 1) Any Medicaid State Plan services which are provided by medical professionals employed by or under contract with the residential habilitation provider;2) Room and board;. 3) Direct or indirect payments to the participant's immediate family;. 4) Routine care and supervision which a family is expected to provide;.
10.09.56.12.htm 10.09.56.12. 12 Repealed..
10.09.56.13.htm 10.09.56.13. 13 Repealed..
10.09.56.14.htm 10.09.56.14. 14 Covered Services ― Therapeutic Integration Services.. A. Therapeutic integration services under this regulation:. 1) Are provided at a nonresidential setting separate from the home or facility where the participant lives;2) Focus on expressive therapies and therapeutic recreational activities;. 3) Include as important components the development of socialization skills, enhancement of self-esteem, and behavior management;4) Are especially needed for participants who have
10.09.56.14-1.htm 10.09.56.14-1. 14-1 Covered Services ― Intensive Therapeutic Integration Services.. A. Intensive therapeutic integration services under this regulation:. 1) Are provided at a nonresidential setting separate from the home or facility where the participant lives;2) Shall have an on-site direct care worker for every participant receiving one-to-one interventions for intensive therapeutic integration;3) Shall include expressive therapies and therapeutic recreational activities;.
10.09.56.15.htm 10.09.56.15. 15 Covered Services ― Intensive Individual Support Services.. A. Intensive individual support services:. 1) Are intensive, one-on-one interventions with the participant provided by a direct care worker;. 2) May be received by the participant on a long-term basis;. 3) Are authorized in the participant's Autism Waiver plan of care if the participant's behavior without this intervention would require a more restrictive residential or treatment setting;4) May be provided in the
10.09.56.16.htm 10.09.56.16. 16 Covered Services ― Respite Care.. A. Respite care:. 1) Shall consist of one-on-one interventions with the participant;. 2) Shall be rendered by a qualified:. a) Professional who meets the qualifications in Regulation .07B of this chapter; or. b) Direct care worker who is supervised by a qualified professional;. 3) Shall include assistance with activities of daily living provided to participants who are unable to care for themselves;4) Shall be furnished on
10.09.56.17.htm 10.09.56.17. 17 Covered Services ― Family Consultation.. A. Family consultation shall be provided as specified in the family consultation plan, and:. 1) Shall be based on family-oriented goals to benefit the participant;. 2) Shall be provided to one family at a time;. 3) May not include advocacy regarding a participant's IEP; and. 4) May not include training and supervision of direct care workers.. B. A participant's family:. 1) Shall be trained by a qualified licensed or cer
10.09.56.18.htm 10.09.56.18. 18 Covered Services ― Environmental Accessibility Adaptations.. A. Environmental accessibility adaptations are those physical adaptations to the participant's home, which are reasonable and medically necessary to:1) Prevent the participant's institutionalization;. 2) Assure:. a) The participant's health, welfare, and safety; and. b) A safe, therapeutic environment;. 3) Prevent the participant's self-injurious behavior; and.
10.09.56.19.htm 10.09.56.19. 19 Covered Services ― Adult Life Planning Services.. A. Adult life planning services shall be provided as specified in the adult life planning treatment plan.B. Adult life planning services shall:. 1) Result in the participant's transition from Autism Waiver services to comparable, necessary adult life services;2) Be based on the participant's need for services and support after disenrollment from the Autism Waiver; and3) Be provided only to participants age 16 years old or older..
10.09.56.20.htm 10.09.56.20. 20 Conditions for Reimbursement.. The Department shall reimburse for services under this chapter when the services are:. A. Provided to a participant who meets the qualifications for eligibility specified in Regulation .02 of this chapter;B. Preauthorized in the participant's plan of care by the State Department of Education and the multidisciplinary team, as being reasonable and medically necessary to prevent institutionalization;C. Provided by an approved provider which meets th
10.09.56.21.htm 10.09.56.21. 21 Limitations.. A. Reimbursement may be made by the Program only when all of the requirements of this chapter are met.B. Residential habilitation services may not be reimbursed for the same date of service as intensive individual support services, therapeutic integration services, intensive therapeutic integration services, or respite care.C. Therapeutic integration services, intensive therapeutic integration services, and intensive individual support services un
10.09.56.22.htm 10.09.56.22. 22 Payment Procedures.. A. Request for Payment.. 1) An approved provider shall submit requests for payment for the services covered under this chapter according to the procedures set forth in COMAR 10.09.36.04 or otherwise established by the Program.2) The provider shall:. a) Bill the Program in accordance with the payment methodology specified in §C of this regulation;. b) Accept payment from the Program as payment in full for the services covered under this chapter an
10.09.56.23.htm 10.09.56.23. 23 Recovery and Reimbursement.. Recovery and reimbursement are set forth in COMAR 10.09.36.07 and include, but are not limited to:. A. Providing waiver services without a valid required license or appropriate credentials as required;B. Employing staff or consultants that do not meet conditions for participation in accordance with Regulation .04 of this chapter to provide services to waiver participants;C. Lacking adequate documentation of services that were billed to the Program;.
10.09.56.24.htm 10.09.56.24. 24 Cause for Suspension or Removal and Imposition of Sanctions.. A. Cause for suspension or removal and imposition of sanctions is set forth in COMAR 10.09.36.08.. B. In addition to the sanctions specified at COMAR 10.09.36.08, the Department may limit:. 1) The number of participants served by the provider; and. 2) The number and type of services provided..
10.09.56.25.htm 10.09.56.25. 25 Appeal Procedures for Providers.. Appeal procedures for providers are those set forth in COMAR 10.09.36.09..
10.09.56.26.htm 10.09.56.26. 26 Appeal Procedures for Applicants and Participants.. Appeal procedures for applicants and participants are those set forth in COMAR 10.09.24.13 and 10.01.04.
10.09.56.27.htm 10.09.56.27. 27 Interpretive Regulation.. State regulations are interpreted as set forth in COMAR 10.09.36.10..
10.09.56.9999.htm 10.09.56.9999. Administrative History Effective date: July 1, 2001 (28:12 Md. R. 1108). Regulation .01C amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376) emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487)Regulation .02A, B amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24) amended permanently effective April 25, 2005 (32:8 Md. R. 741)Regulation .02B amended a
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