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10.09.81.00.htm 10.09.81.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 81 Increased Community Services (ICS) Program Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.81.01.htm 10.09.81.01. 01 Purpose.. The purpose of the Increased Community Services (ICS) Program is to enable certain nursing facility residents to access home and community-based services by allowing those nursing facility residents to contribute to the cost of care through a monthly assessment and thus enabling those individuals to live at home with ICS and other Medicaid services instead of in a nursing facility.
10.09.81.02.htm 10.09.81.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Activities of daily living" means bathing, eating, toileting, dressing, and mobility including transfer.2) "Adult Evaluation and Review Services (AERS) means an entity within the local health department which, in accordance with this chapter and COMAR 10.09.30, evaluates ICS applicants and participants.3) "Agency-employed attendant" means an attendant
10.09.81.03.htm 10.09.81.03. 03 Participant Eligibility.. A. General Requirements.. 1) To be eligible for participation in the ICS Program, an applicant or participant shall be determined by the Department to meet the conditions of §B—E of this regulation.2) A participant's eligibility for ICS services shall be reevaluated by the Department every 12 months or more frequently if needed due to a significant change in the participant's condition, needs, or financial status.3) The Department shall h
10.09.81.04.htm 10.09.81.04. 04 Conditions for Provider Participation ― General Requirements.. A. To participate as a provider of a service covered under Regulations .22―37 of 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) Meet the licensure and certification requirements specified in this chapter, if applicable;.
10.09.81.05.htm 10.09.81.05. 05 Specific Conditions for Provider Participation ― Participant Training.. To participate in the ICS Program as a provider of participant training under Regulation .22 of this chapter, a provider shall:A. Be a self-employed trainer or an agency that employs qualified trainers in accordance with §B and C of this regulation;B. Demonstrate experience in the skill being taught; and. C. Be willing to meet at the participant's home to provide services..
10.09.81.06.htm 10.09.81.06. 06 Specific Conditions for Provider Participation ― Family Training.. To participate in the ICS Program as a provider of family training services under Regulation .23 of this chapter, a provider shall:A. Be:. 1) One of the following self-employed professionals:. a) Registered nurse or nurse practitioner licensed according to COMAR 10.27.01 and 10.27.07;. b) Occupational therapist licensed according to COMAR 10.46.01;.
10.09.81.07.htm 10.09.81.07. 07 Specific Conditions for Provider Participation ― Case Management Services.. To participate in the ICS Program as a provider of case management services under Regulation .24 of this chapter, a provider shall:A. Be enrolled as a case management provider in accordance with COMAR 10.09.55.15-3;. B. Accept all referrals from the Department, or other designated agency; and. C. Be monitored by the Department..
10.09.81.08.htm 10.09.81.08. 08 Specific Conditions for Provider Participation ― Transition Services.. To participate in the ICS Program as a provider of transition services under Regulation .25 of this chapter, a provider shall be the case management provider in accordance with Regulation .07 of this chapter and shall:A. Assist individuals to transition from a nursing facility to a community-based residence; and. B. Arrange and coordinate the services necessary to facilitate the transition..
10.09.81.09.htm 10.09.81.09. 09 Specific Conditions for Provider Participation ― Environmental Assessments.. To participate in the ICS Program as a provider of environmental assessments under Regulation .26 of this chapter, a provider shall:A. Be a licensed occupational therapist, or an agency or professional group employing a licensed occupational therapist;B. Receive a referral from the participant's case manager, based on services preauthorized in the plan of service; andC. Document the provider'
10.09.81.10.htm 10.09.81.10. 10 Specific Conditions for Provider Participation ― Environmental Accessibility Adaptations.. A. To participate in the ICS Program as a provider of environmental accessibility adaptations under Regulation .27 of this chapter, a provider shall:1) Be the store, vendor, or contractor, from which the adaptation is purchased;. 2) Provide or arrange for any required installation, servicing, or training; and. 3) Provide services according to a written schedule indicating an estimated
10.09.81.11.htm 10.09.81.11. 11 Specific Conditions for Provider Participation ― Personal Emergency Response Systems.. To participate in the ICS Program as a provider of personal emergency response systems under Regulation .28 of this chapter, a provider shall:A. Be the store, vendor, organization, or company which sells, rents, installs, services, or runs the device or service;B. Provide or arrange for any installation, servicing, training, or monitoring required for the device or system; and
10.09.81.12.htm 10.09.81.12. 12 Specific Conditions for Provider Participation ― Assistive Technology.. To participate in the ICS Program as a provider of assistive technology services under Regulation .29 of this chapter, a provider shall:A. Be one of the following entities:. 1) The store, vendor, organization, or company which sells or rents the equipment or system; or. 2) A Maryland Medical Assistance Program provider of disposable medical supplies and durable medical equipment under COMAR 10.09.12;
10.09.81.13.htm 10.09.81.13. 13 Specific Conditions for Provider Participation ― Attendant Care Services.. A. To participate in the ICS Program as a provider of attendant care services under Regulation .30 of this chapter, unless otherwise exempted under §F of this regulation, an attendant shall:1) Be a participant-employed or agency-employed attendant;. 2) Be at least 18 years old;. 3) Be legally eligible for employment rendering attendant care services in the State;.
10.09.81.14.htm 10.09.81.14. 14 Specific Conditions for Provider Participation ― Nursing Supervision of Attendants.. A. To participate in the ICS Program as a provider of nursing supervision of attendants under Regulation .31 of this chapter, a provider shall be:1) A self-employed registered nurse or nurse practitioner licensed according to COMAR 10.27.01 and 10.27.07; or2) An agency or clinic which employs registered nurses or nurse practitioners licensed according to COMAR 10.27.01 and 10.27.07.
10.09.81.15.htm 10.09.81.15. 15 Specific Conditions for Provider Participation ― Home Delivered Meals.. To participate in the ICS Program as a provider of home-delivered meals under Regulation .32 of this chapter, a provider shall:A. Be approved and monitored by the Department; and. B. Use a cooking facility or food preparation site that:. 1) Has a food service license issued by the local health department, in accordance with COMAR 10.15.03, or an appropriate license from the state in wh
10.09.81.16.htm 10.09.81.16. 16 Specific Conditions for Provider Participation ― Dietitian and Nutritionist Services.. To participate in the ICS Program as a provider of dietitian and nutritionist services under Regulation .33 of 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
10.09.81.17.htm 10.09.81.17. 17 Specific Conditions for Participation ― Behavior Consultation Services.. To participate in the ICS Program as a provider of behavior consultation services, as specified in Regulation .34 of 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, or consultation to, the individual rendering behavior consultation servic
10.09.81.18.htm 10.09.81.18. 18 Specific Conditions for Provider Participation ― Medical Day Care.. To participate in the ICS Program as a provider of medical day care services under Regulation .35 of this chapter, a provider shall:A. Be licensed according to COMAR 10.12.04; and. B. Meet the requirements of COMAR 10.09.07..
10.09.81.19.htm 10.09.81.19. 19 Specific Conditions for Participation ― Senior Center Plus.. To participate in the ICS Program as a provider of Senior Center Plus services, as specified in Regulation .36 of 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
10.09.81.20.htm 10.09.81.20. 20 Specific Conditions for Participation ― Assisted Living.. A. To participate in the ICS Program as an assisted living services provider, 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:a) At the Level 2 moderate level of care or Level 3 high level of care; and. b) For the level of care needed by each participant residing in the facility, including any needed r
10.09.81.21.htm 10.09.81.21. 21 Covered Services ― General.. The Maryland Medical Assistance Program shall reimburse for the services specified in Regulations .22―37 of this chapter when, pursuant to the requirements of this chapter, these services have been preapproved by the Department in the participant's plan of service and documented as:A. Necessary to prevent institutionalization in a nursing facility; and. B. Cost-neutral to the ICS Program, in accordance with Regulation .38E of this chapter..
10.09.81.22.htm 10.09.81.22. 22 Covered Services ― Participant Training.. A. Definition. "Unit of service" means an hour of service rendered one-on-one by a qualified provider to a participant, not including the time spent by the provider:1) Planning, preparing, or setting up the training;. 2) Following up after the training; or. 3) Traveling to and from the training.. B. Participant training includes instruction and skill building in such areas as how to recruit, select, train, direct, super
10.09.81.23.htm 10.09.81.23. 23 Covered Services ― Family Training.. A. Definitions.. 1) "Family member" means an individual who:. a) Lives with or provides assistance to the participant; and. b) Is not paid to provide the care.. 2) "Unit of service" means an hour of service rendered by a qualified provider to one or more family members at the same time in the participant's home or the provider's office, regardless of the number of family members trained at one time, not including the time spent by t
10.09.81.24.htm 10.09.81.24. 24 Covered Services ― Case Management.. A. Definition. "Unit of service" means a 15-minute increment of service rendered by a qualified provider to a participant or the participant's representative.B. 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.C. Case management services include time spent by a qualified provider cond
10.09.81.25.htm 10.09.81.25. 25 Covered Services ― Transition Services.. A. Definition. "Unit of service" means a one-time service that is:. 1) Not otherwise available under the ICS Program;. 2) Approved in the plan of service; and. 3) Rendered to a participant by a qualified provider to assist the participant in transitioning from a nursing facility or assisted living facility to independent living.B. Transition services may include some or all of the following:. 1) Security deposits;.
10.09.81.26.htm 10.09.81.26. 26 Covered Services ― Environmental Assessments.. A. Definition. "Unit of service" means the completion of:. 1) An on-site environmental assessment of the participant’s home; and. 2) A form approved by the Maryland Medical Assistance Program.. B. An environmental assessment may not be provided before the effective date of the participant's eligibility for ICS Program services.C. The service may be recommended by a multidisciplinary team in the plan of service for a participa
10.09.81.27.htm 10.09.81.27. 27 Covered Services ― Environmental Accessibility Adaptations.. A. Definition. "Unit of service" means one or more physical adaptations to a participant's home or place of residence which is completed as one job by a qualified provider and which constitute a single accessibility adaptation.B. If the owner of the home is the participant, environmental accessibility adaptations may be made only if approved by the participant, in the participant's plan of service.
10.09.81.28.htm 10.09.81.28. 28 Covered Services ― Personal Emergency Response Systems.. A. Definition. "Unit of service" means any of the following:. 1) Purchase and installation;. 2) Maintenance or repair; or. 3) Monthly cost of a covered system or rented device or equipment.. B. A personal emergency response system is an electronic device or system which enables a participant to secure help in an emergency and may include:1) A device connected to the participant's telephone or other device and pr
10.09.81.29.htm 10.09.81.29. 29 Covered Services ― Assistive Technology.. A. Definition. "Unit of service" means a device or appliance that is purchased as one item, including:1) Any required training in the use of the device; and. 2) An assessment for the use of the device, if the assessment is:. a) Performed directly by the provider; and. b) Routinely included as part of the provider's cost for the item.. B. Assistive technology includes nonexperimental technology or adaptive equipment, excluding service
10.09.81.30.htm 10.09.81.30. 30 Covered Services ― Attendant Care Services.. A. Definition. "Unit of service" means an hour of service that is in the plan of service and rendered to a participant by a qualified provider in the participant's home or in a community setting.B. Except as provided in §C of this regulation, the ICS Program covers the following attendant care services:1) Assistance with activities of daily living;. 2) Delegated nursing functions, such as assistance with the participant's a
10.09.81.31.htm 10.09.81.31. 31 Covered Services ― Nursing Supervision of Attendants.. A. Definition. "Unit of service" means an hour of service rendered by a nurse monitor to a participant in the participant's home or another community-based setting.B. Nursing supervision services include the following:. 1) Development of the participant's plan for attendant care:. a) After consultation with the participant, family members, participant's personal physician, case manager, and other providers; and
10.09.81.32.htm 10.09.81.32. 32 Covered Services ― Home-Delivered Meals.. A. Definition. "Unit of service" means one meal delivered to the participant's home, including the cost of the food, food preparation, and delivery.B. The meal shall be intended for consumption at home.. C. This service may not constitute the participant's full nutritional regimen of three meals per day.D. Each meal shall:. 1) Be nutritionally adequate for the participant's age based on the Recommended Dietary Allowance (R
10.09.81.33.htm 10.09.81.33. 33 Covered Services ― Dietitian and Nutritionist Services.. A. Definition. "Unit of service" means an hour of service rendered one-on-one by a qualified provider for a participant in the participant's home or the provider's office.B. Dietitian and nutritionist services shall include:. 1) The provision of a nutrition care plan as part of the ICS Program multidisciplinary team process;. 2) Nutrition care planning, nutrition assessment, and dietetic instruction; and.
10.09.81.34.htm 10.09.81.34. 34 Covered Services ― Behavior Consultation Services.. A. Definition. "Unit of service" means an hour of service rendered by a qualified individual during a home visit to a participant, not including:1) The time spent on related activities before or after the home visit; or. 2) The time spent on supervisory or consultative services to the provider.. B. A provider may bill for the length of a home visit to a participant, upon completion of the services specified in §D of th
10.09.81.35.htm 10.09.81.35. 35 Covered Services ― Medical Day Care.. A. Definition. “Unit of service” means a day of service rendered by a qualified provider to a participant in accordance with COMAR 10.09.07.B. The ICS Program reimburses for a day of care which includes the following services:. 1) Health care services supervised by the director, medical director, or health director, which emphasize primary prevention, early diagnosis and treatment, rehabilitation and continuity of care, incl
10.09.81.36.htm 10.09.81.36. 36 Covered Services ― Senior Center Plus.. A. Definition. "Unit of service" means a day of attendance by a participant 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 socialization provided in an out-of-home, outpatient setting. Social and
10.09.81.37.htm 10.09.81.37. 37 Covered Services ― Assisted Living Facility.. A. Definition. "Unit of service" means a day of service and does not include days that the participant was not residing in the provider's assisted living facility, meaning that the participant:1) Had not yet moved into the facility;. 2) Had moved out of the facility;. 3) Was an inpatient at a hospital, nursing facility, or other medical institution for one or more nights; or4) Was absent from the provider's facility for mor
10.09.81.38.htm 10.09.81.38. 38 Conditions for Reimbursement.. The Maryland Medical Assistance Program shall reimburse for the services specified in Regulations .22―37 of this chapter, if the service:A. Is recommended in the applicant’s or participant's plan of service as necessary in order to:. 1) Prevent admission to a nursing facility;. 2) Safely deinstitutionalize the individual from a nursing facility into the community; or. 3) Assure the participant’s health and safety in the community;.
10.09.81.39.htm 10.09.81.39. 39 Limitations.. A. Reimbursement may be made by the Maryland Medical Assistance Program only if the requirements of this chapter are met.B. The total reimbursement by the Maryland Medical Assistance Program for environmental accessibility adaptations and assistive technology combined is limited to the amount specified at Regulation .40C(4)f)ii) or (h)ii) of this chapter during the participant’s annual plan of service period, with exceptions allowed at the De
10.09.81.40.htm 10.09.81.40. 40 Payment Procedures ― General.. A. Request for Payment.. 1) An approved provider shall:. a) Submit a request for payment for the services covered under this chapter according to procedures set forth in COMAR 10.09.36.04; andb) Include the following information on the request:. i) Date or dates of service;. ii) Participant's name and Medical Assistance number;. iii) Provider's name, location, and identification number;.
10.09.81.41.htm 10.09.81.41. 41 Payment Procedures ― Rates.. A. Participant Training. A qualified provider shall bill the Department an all-inclusive rate not to exceed $39.11 for each hour of covered service.B. Family Training. A qualified provider shall bill the Department a rate for each hour of covered services not to exceed:1) Self-employed ― $25.90 per hour for family training services rendered by an appropriately licensed professional; and2) Agency-employed ― $37.75 per hour for family tr
10.09.81.42.htm 10.09.81.42. 42 Recovery and Reimbursement.. Recovery and reimbursement are as set forth in COMAR 10.09.36.07..
10.09.81.43.htm 10.09.81.43. 43 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..
10.09.81.44.htm 10.09.81.44. 44 Appeal Procedures for Providers.. Appeal procedures for providers are those set forth in COMAR 10.09.36.09..
10.09.81.45.htm 10.09.81.45. 45 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.
10.09.81.46.htm 10.09.81.46. 46 Interpretive Regulation.. State regulations are interpreted as set forth in COMAR 10.09.36.10..
10.09.81.9999.htm 10.09.81.9999. Administrative History Effective date: June 11, 2012 (39:11 Md. R. 687). Regulation .40C amended effective July 4, 2016 (43:13 Md. R. 712). Regulation .41 amended effective July 4, 2016 (43:13 Md. R. 712).
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