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10.09.84.00.htm 10.09.84.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 84 Community First Choice Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.84.01.htm 10.09.84.01. 01 Purpose.. The purpose of Community First Choice is to provide certain home and community-based services and supports, as an alternative to institutional placements, to individuals who have been determined to require an institutional level of care.
10.09.84.02.htm 10.09.84.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Activities of daily living (ADLs) 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) Mobility, including:. i) Transferring from a bed, chair, or other structure;. ii) Moving, turning, and positioning the body while in bed or in a wheelchair; and.
10.09.84.03.htm 10.09.84.03. 03 Requirements for Provider Licensing or Certification.. The following health professionals providing services under this chapter shall be licensed to practice in the jurisdiction in which services are rendered:A. Physicians;. B. Registered nurses;. C. Licensed practical nurses;. D. Certified medication technicians;. E. Certified nursing assistants;. F. Occupational therapists;. G. Physical therapists;. H. Speech pathologists;. I. Nutritionists; and. J. Dietitians..
10.09.84.04.htm 10.09.84.04. 04 Participant Eligibility.. A. To participate in the Program, a participant shall:. 1) Be determined by the Department to need the level of care provided in a hospital, nursing facility, an intermediate care facility for individuals with intellectual disabilities, an institution providing psychiatric services for individuals younger than 21 years old, or an institution for mental diseases for individuals 65 years old or older;2) Be eligible for Medicaid under an eligibility g
10.09.84.05.htm 10.09.84.05. 05 Conditions for Provider Participation ― General Requirements.. A. To participate as a provider of a service covered under this chapter, a provider:. 1) Shall meet all of the conditions for participation as a Medicaid provider as set forth in COMAR 10.09.36, except as otherwise specified in this chapter;2) Shall obtain written verification of the qualifications of all individuals who render services on the provider’s behalf and provide a copy of the current license or credent
10.09.84.06.htm 10.09.84.06. 06 Specific Conditions for Provider Participation ― Personal Assistance.. A. Personal assistance service providers shall:. 1) Be licensed as a Residential Service Agency under COMAR 10.07.05;. 2) Employ a registered nurse who shall:. a) Assess each new participant who requires personal assistance services;. b) Participate in developing the worker instructions and in assigning appropriate personnel;.
10.09.84.07.htm 10.09.84.07. 07 Specific Conditions for Provider Participation ― Supports Planning.. To participate in the Program as a supports planning provider under Regulation .15 of this chapter, a provider shall:A. Be free from conflicts of interest;. B. Agree to be monitored by the Department; and. C. Be:. 1) Identified by the Department through a solicitation process; or. 2) The area agency on aging that is enrolled to provide case management services under COMAR 10.09.54.
10.09.84.08.htm 10.09.84.08. 08 Specific Conditions for Provider Participation ― Consumer Training.. To participate in the Program as a provider of consumer training under Regulation .16 of this chapter, a provider shall:A. Be a self-employed trainer or an agency that employs qualified trainers in accordance with §B of this regulation;B. Have demonstrated experience with the skill being taught; and. C. Be willing to meet at the participant’s home to provide services..
10.09.84.09.htm 10.09.84.09. 09 Specific Conditions for Provider Participation ― Personal Emergency Response Systems.. To participate in the Program as a provider of personal emergency response systems under Regulation .17 of this chapter, a provider shall:A. Be the store, vendor, organization, or company which sells, rents, installs, services, or operates the device or service;B. Provide or arrange for any installation, maintenance, training, or monitoring required for the device or system;
10.09.84.10.htm 10.09.84.10. 10 Specific Conditions for Provider Participation ― Items or Services that Substitute for Human Assistance.A. To participate in the program as a provider of items or services that substitute for human assistance, the provider shall:1) Be approved and monitored by the Department;. 2) Provide or arrange for any installation, maintenance, training, or monitoring required for the proper operation of the device or system, if applicable; and3) Receive a referral fro
10.09.84.11.htm 10.09.84.11. 11 Specific Conditions for Provider Participation ― Environmental Assessments.. To participate in the Program as a provider of environmental assessments under Regulation .19 of this chapter, the 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 supports planner, based on services preauthorized in the plan of service; and
10.09.84.12.htm 10.09.84.12. 12 Specific Conditions for Provider Participation ― Nurse Monitoring.. To participate in the Program as a nurse monitoring provider under Regulation .20 of this chapter, a provider shall:A. Be 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;B. Employ or contract with registered nurses who hold a current professional license to practice in Maryland;
10.09.84.13.htm 10.09.84.13. 13 Covered Services ― General.. The Program shall reimburse for the services specified in Regulations .14―21 of this chapter, when, pursuant to the requirements of this chapter, these services have been preauthorized by the Department in the participant’s plan of service, billed in accordance with the payment procedures in Regulation .24 of this chapter, and documented as necessary to prevent institutionalization.
10.09.84.14.htm 10.09.84.14. 14 Covered Services ― Personal Assistance.. A. The Program covers personal assistance services that are approved in the plan of service and rendered to a participant by a qualified provider in the participant’s home or a community setting.B. The Program covers the following services when provided by a personal assistance provider:. 1) Assistance with activities of daily living;. 2) Delegated nursing functions if this assistance is:.
10.09.84.15.htm 10.09.84.15. 15 Covered Services ― Supports Planning.. A. Supports planning services shall:. 1) Address the individualized needs of the participant;. 2) Be sensitive to the educational background, culture, and general environment of the participant;. 3) Support the participant to self-direct services and exercise as much control as desired to select, train, supervise, schedule, determine duties, and dismiss the personal assistance worker; and
10.09.84.16.htm 10.09.84.16. 16 Covered Services ― Consumer Training.. A. Consumer training includes instruction and skill building in such areas including, but not limited to, acquisition, maintenance, and enhancement of skills necessary for the participant to accomplish ADLs and IADLs.B. The topics covered by consumer training shall be:. 1) Targeted to the individualized needs of the participant receiving the training; and. 2) Sensitive of the educational background, culture, and general environmen
10.09.84.17.htm 10.09.84.17. 17 Covered Services ― Personal Emergency Response Systems.. A. The Program covers the following related to a device, system, or piece of equipment described under §B of this regulation:1) Purchase and installation;. 2) Monthly cost of a covered system or rented device or equipment, including monitoring, maintenance, and repair.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 b
10.09.84.18.htm 10.09.84.18. 18 Covered Services ― Items or Services that Substitute for Human Assistance.. A. The program covers items or services that increase a participant’s independence or substitute for human assistance, to the extent that expenditures would otherwise be made for the human assistance.B. Each item or service shall:. 1) Be preauthorized in the participant’s plan of service as necessary to:. a) Prevent the participant’s institutionalization; and.
10.09.84.19.htm 10.09.84.19. 19 Covered Services ― Environmental Assessments.. A. The Program covers an on-site environmental assessment of a home or residence where the participant lives or will live as a participant.B. An environmental assessment may not be provided before the effective date of the participant’s eligibility for services.C. The service may be recommended by a multidisciplinary team in the plan of service for a participant when an environmental assessment is considered necessary to:
10.09.84.20.htm 10.09.84.20. 20 Covered Services ― Nurse Monitoring.. A. The program covers the following services when provided by a nurse monitor:. 1) Being available to give instruction and to answer questions;. 2) Complying with the Department’s reportable events policy; and. 3) Maintaining an up-to-date client profile in an electronic database designated by the Department.. B. The Program covers nurse monitoring services according to the following schedule:. 1) Contact with the parti
10.09.84.21.htm 10.09.84.21. 21 Covered Services § Transition Services.. A. Definition. “Transition service” means a service that is:. 1) Not otherwise available under the Program;. 2) Approved in the plan of service; and. 3) Rendered to assist the participant in transitioning from an institution or a provider-owned residence to a home or community-based residence.B. Transition services may include all or some of the following:. 1) Security deposits;. 2) Essential furnishings and moving expenses;.
10.09.84.22.htm 10.09.84.22. 22 Conditions for Reimbursement.. The Program shall reimburse for the services specified in Regulations .14―21 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;. 2) Safely transition the applicant or participant from an institution, such as a nursing facility, i
10.09.84.23.htm 10.09.84.23. 23 Limitations.. A. Reimbursement for Personal Emergency Response System is limited to participants who:. 1) Live alone; or. 2) Have no regular caregiver for extended parts of the day and would otherwise require extensive routine supervision to ensure the participant’s health and safety.B. The Department shall establish a budget for personal assistance services and home-delivered meals that may be included in the participant’s plan of service, based on each p
10.09.84.24.htm 10.09.84.24. 24 Payment Procedures.. A. Request for Payment ― Personal Assistance. To receive payment as a personal assistance provider agency under Regulation .14 of this chapter, a provider and its workers shall use the telephonic timekeeping system approved by the Department to:1) Document time; and. 2) Submit claims.. B. Request for Payment ― All Other Covered Services. To receive payment as a provider of services covered under Regulations .15―21 of this chapter, a provider shall submit cla
10.09.84.25.htm 10.09.84.25. 25 Recovery and Reimbursement.. Recovery and reimbursement are as set forth in COMAR 10.09.36.07..
10.09.84.26.htm 10.09.84.26. 26 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions shall be as set forth in COMAR 10.09.36.08.
10.09.84.27.htm 10.09.84.27. 27 Appeal Procedures ― Providers.. Appeal procedures shall be as set forth in:. A. COMAR 10.09.36.09; and. B. COMAR 10.01.03..
10.09.84.28.htm 10.09.84.28. 28 Appeal Procedures ― Applicants and Participants.. Appeal procedures for applicants and participants are those set forth in:. A. COMAR 10.09.24.13; and. B. COMAR 10.01.04..
10.09.84.29.htm 10.09.84.29. 29 Interpretive Regulation.. Interpretive regulatory requirements shall be as set forth in COMAR 10.09.36.10..
10.09.84.9999.htm 10.09.84.9999. Administrative History Effective date: March 17, 2014 (41:5 Md. R. 343). Regulation .01 amended effective April 11, 2016 (43:7 Md. R. 449). Regulation .02B amended effective June 8, 2015 (42:11 Md. R. 724) April 11, 2016 (43:7 Md. R. 449). Regulation .03 amended effective June 8, 2015 (42:11 Md. R. 724) April 11, 2016 (43:7 Md. R. 449). Regulation .04 amended effective June 8, 2015 (42:11 Md. R. 724). Regulation .04A, B amended effective April 11, 2016 (43:7 Md. R. 449).
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