10.09.07.03

.03 Conditions for Participation.

Requirements for providing medical day care services are that the providers shall:

A. Meet the licensure requirements as provided in Regulation .02 of this chapter;

B. Meet the requirements of COMAR 10.09.36;

C. Be open to participants at least 6 hours a day, 5 days a week, and post hours of operation;

D. Verify the licenses and credentials for all professionals employed by or contracting with the medical day care center;

E. Provide or arrange for the provision of any covered service, as specified in Regulation .05 of this chapter, or any other service which is required by a plan of care;

F. Demonstrate to the satisfaction of the Program that a need exists for medical day care in the service area and that the provider has the necessary expertise to deliver the service;

G. Have policies and procedures as required under COMAR 10.12.04;

H. Maintain medical records for each participant which shall include, as a minimum, the following:

(1) An application for admission;

(2) The medical day care center's plan of care as required under §M(3)—(4) of this regulation;

(3) The current home and community based services waiver service plan or the approved medical day care preauthorization form for the participant;

(4) Medical orders for all services rendered which may include, but is not limited to, the:

(a) Type and duration of service;

(b) Frequency of service; and

(c) Dosage and frequency of medications when prescribed;

(5) The medical history, chronic illnesses, principal and significant diagnoses, prognoses, prescribed medications, special diets, allergies, and assessments of the recipient's physical and mental status specifying the general types of activities the recipient can and cannot do;

(6) The documentation of daily nursing observations for the first 5 days of attendance, and monthly after the first 5 days of attendance; and

(7) The initial social history, ADCAPS assessment, and, when needed, social service and activity progress notes;

I. Have an emergency plan for each participant which includes, as a minimum, an easily located file on each participant, listing:

(1) The name and telephone number of the participantís primary care provider;

(2) The advance directive in accordance with Health-General Article, §5-602, if requested or made by the participant;

(3) All allergies identified by the participant or the participantís primary care provider;

(4) The treatments or medications for a participant's conditions; and

(5) The name and telephone number of a family member, caregiver, or friend to be notified in case of emergency;

J. Provide training for medical day care staff in emergency procedures, including cardiopulmonary resuscitation and first aid;

K. Have accurate daily attendance records that are easily retrievable and available for review by the Program;

L. Have accurate daily transportation records that are easily retrievable and available for review by the Program, and shall include, as a minimum, each participant's transportation plan;

M. Establish a multidisciplinary team who shall:

(1) Assess the participant to determine the appropriateness of the medical day care center's care, interventions, and activities;

(2) Determine the medical, psychosocial, and functional status of each participant by:

(a) Establishing the ADCAPS evaluations on the date of admission; and

(b) Completing the assessment with an initial plan of care within 30 days, after which the ADCAPS evaluations shall be conducted every 4 months;

(3) Develop an individual plan of care in conjunction with the service plan; and

(4) Review and update with the participant or participantís representative, the individual plan of care semi-annually or more frequently when a significant change in condition is identified or reported;

N. Have a quality assurance program which includes, as a minimum, health care audits and utilization reviews that:

(1) Consist of a review of medical records on all participants that evaluate the appropriateness of admissions, the efficiency, adequacy, and coordination of provided services, and the length of stay and discharge practices, as needed;

(2) Include the following elements:

(a) Development of outcome criteria for presenting problems common to the medical day care center's participants;

(b) Description of actual outcomes as abstracted from the medical day care center's medical records for all the participants served over a specific time period for each presenting problem for which outcome criteria have been developed;

(c) Evaluation of actual outcomes compared with the outcome criteria to identify problem areas or reasons for suboptimal care;

(d) Documented submission of recommended corrective action to the program director; and

(e) Reassessment of the appropriateness of the recommended corrective action as revealed by the outcomes of the next audit; and

(3) Is signed and dated by the program director or designee; and

O. Have a signed and dated corrective action plan transferring the participant to the appropriate service, if it is determined that the medical day care center's program is not appropriate for an individual participant.