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10.09.61.00.htm 10.09.61.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 61 Medical Day Care Services Waiver Authority: Health-General Article, §2-104(b) 15-103, and 15-111, Annotated Code of Maryland
10.09.61.01.htm 10.09.61.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Adult Evaluation and Review Services (AERS) means an entity within the local health department which, in accordance with the waiver, this chapter, and COMAR 10.09.30, assesses waiver applicants and participants.2) "Authorized representative" means a spouse, legal guardian, parent, individual with power of attorney, or other individual designated in writing to
10.09.61.02.htm 10.09.61.02. 02 Medical Assistance Eligibility.. A. Categorically Needy. An individual is eligible for waiver services as categorically needy if the individual is receiving Medical Assistance as a:1) Recipient of Supplemental Security Income (SSI). 2) Member of a low income family with children, as described in §1931 of the Social Security Act; or. 3) Recipient eligible in another mandatory or optional categorically needy coverage group covered in the community under the State Plan.
10.09.61.03.htm 10.09.61.03. 03 Participant Eligibility.. A. Medical Eligibility.. 1) To be eligible for the services covered under COMAR 10.09.07, a waiver applicant or participant shall be certified by the Department or its designee as needing nursing facility services, pursuant to COMAR 10.09.10.2) The initial assessment for enrollment to the Program shall be conducted by AERS and submitted to the Department or its designee for certification.3) For the purpose of enrollment, the assessment o
10.09.61.04.htm 10.09.61.04. 04 Waiver Eligibility.. A. Based on the criteria established in Regulations .02 and .03 of this chapter, an applicant's eligibility for services under this chapter shall be established by the Department, and waiver eligibility may not begin before the latest of the following five dates:1) Waiver application date;. 2) Effective date of medical certification for the waiver's institutional level of care;. 3) Date that the applicant's written waiver service plan is established;.
10.09.61.05.htm 10.09.61.05. 05 Annual Cap and Registry for Waiver Participation.. A. For each State fiscal year beginning on July 1, the Department shall establish a cap, approved by CMS, for the number of unduplicated individuals who may receive the services covered under this chapter, based on available State and federal funding.B. The annual cap for waiver participation may be revised, based on the Department's updated estimates of participants' Program expenditures for the State fiscal year, as comp
10.09.61.06.htm 10.09.61.06. 06 Conditions for Provider Participation.. A. Conditions for provider participation are those set forth in COMAR 10.09.07.. B. Providers shall maintain a service plan for each participant that includes:. 1) Name, address, and telephone number of the participant;. 2) Medical Assistance number of the participant;. 3) Name and telephone number of the participant's personal physician and of any managed care organization with which the participant is enrolled;4) Dated signatures of th
10.09.61.07.htm 10.09.61.07. 07 Covered Services.. Covered services are those set forth in COMAR 10.09.07..
10.09.61.08.htm 10.09.61.08. 08 Limitations.. Limitations are those set forth in COMAR 10.09.07..
10.09.61.09.htm 10.09.61.09. 09 Payment Procedures.. Payment procedures are those set forth in COMAR 10.09.07..
10.09.61.10.htm 10.09.61.10. 10 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.
10.09.61.11.htm 10.09.61.11. 11 Cause for Suspension or Removal and Imposition of Sanctions.. A. Cause for suspension or removal and imposition of sanctions for providers shall be in accordance with COMAR 10.09.36.B. If the Department determines that a provider has failed to accurately assess the rehabilitative, cognitive, behavioral, and functional abilities and deficits, or medical service needs of an applicant or consumer, and to accurately convey such an assessment to the Department for purposes of obtain
10.09.61.12.htm 10.09.61.12. 12 Interpretive Regulation.. State regulations are interpreted as set forth in COMAR 10.09.36.10..
10.09.61.9999.htm 10.09.61.9999. Administrative History Effective date:. Regulations .01―12 adopted as an emergency provision effective July 1, 2008 (35:17 Md. R. 1482) adopted permanently effective October 6, 2008 (35:20 Md. R. 1775)Regulation .01B amended effective February 15, 2016 (43:3 Md. R. 273). Regulation .03B amended effective February 15, 2016 (43:3 Md. R. 273).
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