32.03.04.14

.14 Mandatory and Optional Services.

A. A provider shall elect to participate in either the Standard Congregate Housing Services Plan or the Individualized Congregate Housing Services Plan.

B. Meals.

(1) A Standard Congregate Housing Services Plan provider shall provide at least two nutritionally balanced meals daily.

(2) An Individualized Congregate Housing Services Plan provider shall offer a service package that includes at least one nutritionally balanced meal daily.

(3) All meals served to participants shall be prepared by a licensed food service establishment in an approved food preparation facility that complies with the requirements of COMAR 10.15.03.

(4) At least one meal a day shall be offered in a congregate setting.

(5) If a participant requests that a meal be delivered to the participant's apartment, the provider shall deliver it at no additional charge if the provider determines that the participant is unable to participate in a congregate meal due to a temporary mental or physical condition.

(6) A provider or its food service contractor shall prepare in advance a weekly menu of the meals to be serviced.

(7) If more than one food service contractor is retained by a provider to prepare meals for participants in a facility, the provider shall assure that menus are coordinated to avoid duplication and to maintain overall nutritional balance.

(8) A provider shall retain copies of weekly menus at the facility for a period of 1 year and shall have the menus available during monitoring visits conducted by the Department. If a substitution is made for an item on the approved menu, the substitution shall be documented on the menu.

(9) A provider shall keep a record of participants' attendance at each congregate meal provided, investigate a participant's failure to attend a meal, and document why the participant did not attend. Records of meal attendance and documentation of why a participant did not attend shall be kept for at least 3 months.

(10) If a provider contracts with another entity to provide meal services for the participants, the provider shall solicit competitive bids from qualified food service establishments at least once every 3 years. Competitive bidding may be waived by the Department if the meals are provided by a food service establishment that is under contract with:

(a) The owner or management of the facility, if the provider is not the owner or manager; or

(b) The local area agency on aging to provide congregate or home-delivered meals pursuant to Title III C of the federal Older Americans Act, 42 U.S.C. §§3030e — 3030g-22.

(11) If a provider contracts with another entity to provide meals to participants, the provider shall arrange for participants to meet periodically with the other entity to discuss menus and other concerns.

C. Housekeeping and Laundry.

(1) A provider shall provide the supplies and equipment necessary for housekeeping required by this regulation.

(2) A provider may require that its participants provide laundry supplies and pay for the cost of operating laundry equipment to clean the participants' laundry.

(3) A Standard Congregate Housing Services Plan provider shall provide a minimum of 1.5 hours per week of general housekeeping and laundry services for each participant.

(4) A Standard Congregate Housing Services Plan provider shall clean a participant's apartment and change the bed linens at least weekly. If a temporary condition requires cleaning an apartment or changing bed linens more often than weekly in order to maintain a clean, safe, and sanitary living environment, a provider shall do so on a temporary basis.

(5) A Standard Congregate Housing Services Plan provider shall provide laundry services to participants at least weekly.

(6) An Individualized Congregate Housing Services Plan provider shall offer at least one service package that includes at least 1.5 hours per week of assistance with housekeeping and laundry.

(7) An Individualized Congregate Housing Services Plan provider may offer service packages that provide 3, 6, or 9 hours per week of any combination of personal assistance services and weekly housekeeping and laundry services.

D. Personal Assistance Services.

(1) If a participant needs and wants personal assistance services, a Standard Congregate Housing Services Plan provider shall provide the services. At a minimum a Standard Congregate Housing Services Plan provider shall have staff available at a facility to provide 1.5 hours per week of personal assistance services for each participant at the facility.

(2) An Individualized Congregate Housing Services Plan provider shall offer at least one service package that includes at least 3 hours of personal assistance services weekly.

E. Service Management.

(1) A Standard Congregate Housing Services Plan provider shall provide service management as part of the services provided to participants.

(2) An Individualized Congregate Housing Services Program provider shall offer at least one service package that includes service management.

F. Optional Services. A provider may provide:

(1) Assistance with instrumental activities of daily living;

(2) Assistance with arrangements for regular health care appointments;

(3) A service to escort a participant to a health care appointment;

(4) Meal delivery to a participant's apartment, for a nominal fee, if:

(a) A participant elects not to participate in the congregate meal program; and

(b) The provider has sufficient staff to provide this service;

(5) Opportunities for individual or group activities in accordance with participants' interests, abilities, and needs;

(6) Assistance with completing and submitting benefit applications;

(7) Assistance with securing additional services needed;

(8) Subject to the prior approval of the Department and in accordance with §G of this regulation, medication reminders or administration; and

(9) Subject to the prior approval of the Department, other services participants may need if a provider has an adequate number of staff with the qualifications necessary to provide the proposed services.

G. Medications.

(1) Medication shall be self-administered by a participant unless a provider successfully demonstrates to the Department that the provider and its staff have the qualifications to offer medication reminders or administer medications.

(2) A provider approved by the Department to offer as an optional service medication reminders may:

(a) Remind a participant to take medication; or

(b) Provide physical assistance with opening and removing medications from a container.

(3) A provider approved by the Department to offer as an optional service the administration of medications shall:

(a) Assure that staff who administer medications do so under the supervision of a registered nurse pursuant to COMAR 10.27.11;

(b) Assure that all staff responsible for medication administration complete a Medication Administration Training Program approved by the Board of Nursing pursuant to Health-General Article, §8-6A-01(f), Annotated Code of Maryland;

(c) Assure that every 2 years all staff responsible for medication administration complete a clinical update refresher course; and

(d) For each participant whose medication is administered by staff of the provider, arrange for an on-site review by a delegating registered nurse at least every 45 days pursuant to COMAR 10.27.11.