Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
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 who is employed by, or under
				  contract with, an attendant care provider agency.
(4) "Applicant" means an individual who has
				  submitted to the Department an application for the ICS Program.
(5) "Assessment fee" means the fee the
				  participant is required to pay as a condition of eligibility for the ICS
				  Program and Medical Assistance benefits.
(6) "Assistance" means that another
				  individual:
(a) Physically performs an
				  activity for the participant;
(b)
				  Physically helps the participant to perform an activity;
(c) Is present while the participant performs
				  an activity because the participant's safety or health may be jeopardized if
				  the activity is not monitored or performed due to the participant's physical or
				  mental status; or
(d) Cues or
				  encourages the participant to perform the activity.
(7) "Assisted living services provider" means
				  a provider licensed by the Department in accordance with COMAR 10.07.14 and
				  enrolled in the Maryland Medical Assistance Program to provide the services
				  covered under Regulation .37 of this chapter.
(8) "Attendant" means an individual who
				  provides a participant with attendant care services.
(9) "Attendant care provider agency" means an
				  agency that is enrolled in the Maryland Medical Assistance Program to provide
				  the services covered under Regulation .30 of this chapter.
(10) "Attendant Care Services" means
				  assistance with activities of daily living, instrumental activities of daily
				  living, and performance of delegated nursing functions.
(11) "Case management agency" means an agency
				  enrolled by the Maryland Medical Assistance Program to provide case management
				  services to ICS applicants and participants.
(12) "Case management services" means
				  services that assist an applicant or a participant to gain access to ICS
				  services, Medicaid State Plan services, and other community services.
(13) "Delegated nursing functions" means
				  services, other than assistance with activities of daily living and
				  instrumental activities of daily living, provided to a participant by:
(a) An enrolled attendant under the
				  supervision of an enrolled licensed registered nurse in accordance with COMAR
				  10.27.11; or
(b) A nurse
				  practitioner in accordance with COMAR 10.27.07.
(14) "Department" means the Maryland
				  Department of Health and Mental Hygiene, or its authorized agent acting on
				  behalf of the Department.
(15)
				  "Determination" means a decision by the Department regarding an applicant's or
				  participant's eligibility for the ICS Program.
(16) "Fiscal intermediary" means an agency
				  that is under contract with the Department to provide fiscal intermediary
				  services.
(17) "Fiscal intermediary
				  services" means certain employer-related payroll functions, such as State and
				  federal tax withholding and Social Security withholding, performed on behalf of
				  participants who elect to use the participant-employed model of attendant care
				  services.
(18) Home.
(a) "Home" means the place where the
				  participant resides.
(b) "Home"
				  does not include a hospital, nursing facility, or other institution that is
				  regulated under:
(i) COMAR 10.22.03 for
				  licensed community-based residential facilities for individuals with
				  intellectual or developmental disabilities; or
(ii) COMAR 10.21.22 for residential
				  rehabilitation programs for individuals with serious or chronic mental
				  illness.
(19)
				  "Increased Community Services (ICS) Program" means the Medicaid home and
				  community-based services program implemented under this chapter in accordance
				  with the HealthChoice Section 1115 Waiver approved by the Centers for Medicare
				  and Medicaid Services.
(20)
				  "Instrumental activities of daily living" means tasks or activities that
				  include:
(a) Preparing a light
				  meal;
(b) Performing light
				  chores;
(c) Shopping for
				  groceries;
(d) Traveling beyond a
				  walking distance;
(e) Managing
				  finances and handling money;
(f)
				  Using the telephone; and
(g)
				  Planning and making decisions.
(21) "Maryland Medical Assistance Program"
				  means the Program administered by the State under Title XIX of the Social
				  Security Act, which provides comprehensive medical and other health-related
				  care for low income and medically indigent persons.
(22) "Medicaid" means the Maryland Medical
				  Assistance Program.
(23) "Medical
				  day care" means medically supervised, health-related services provided in an
				  ambulatory setting to medically disabled adults who, because of the degree of
				  impairment, need health maintenance and restorative services that support their
				  community living.
(24) "Medical day
				  care center" means a facility operated for the purpose of providing medical day
				  care services in an ambulatory care setting to medically disabled adults who do
				  not require 24-hour inpatient care, but because of the degree of impairment,
				  are not capable of full-time independent living.
(25) "Medically necessary" means the service
				  or benefit is:
(a) Directly related to
				  diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative
				  treatment of an illness, injury, disability, or health condition;
(b) Consistent with currently accepted
				  standards of good medical practice;
(c) The most cost efficient service that can
				  be provided without sacrificing effectiveness or access to care; and
(d) Not primarily for the convenience of the
				  consumer, family, or provider.
(26) "Nurse" means an individual who is
				  currently licensed to practice nursing in the State.
(27) "Nurse monitor" means a registered nurse
				  who provides nursing supervision of attendants in accordance with COMAR
				  10.27.11 and this chapter.
(28)
				  "Nursing facility" means an institution which is licensed by the Department
				  under COMAR 10.07.02.
(29) "Nursing
				  facility services" means services provided to individuals who do not require
				  hospital care, but who, because of a mental or physical condition, require
				  skilled nursing care and related services, rehabilitative services, or, on a
				  regular basis, health-related care and services above the level of room and
				  board.
(30) "Nursing supervision"
				  means a nurse monitor's supervision of an attendant in accordance with COMAR
				  10.27.11 and this chapter.
(31)
				  "Participant" means an individual who meets the qualifications for
				  participation in the ICS program as specified in Regulation .03 of this chapter
				  and is enrolled with the Department to receive ICS services.
(32) "Participant-employed attendant" means
				  an attendant who does not work for an attendant care provider agency and who
				  may be chosen, trained, supervised, and fired by the participant.
(33) "Participant-employed model" means the
				  delivery of attendant care services when:
(a)
				  An ICS participant chooses the attendant who will render services;
(b) The attendant is an enrolled Medicaid
				  provider; and
(c) The participant
				  utilizes services of a fiscal intermediary.
(34) "Plan of care" means the recommended or
				  revised recommended service plan developed by AERS after an evaluation of an
				  applicant or participant.
(35)
				  "Plan of service" means the written plan that:
(a) Is developed jointly by the applicant or
				  participant and the case manager;
(b) Is based upon:
(i) The AERS evaluation;
(ii) The AERS plan of care; and
(iii) The case manager's face-to-face
				  interview with the applicant or participant;
(c) Addresses the applicant's or
				  participant's needs and desires; and
(d) Specifies the type, amount, frequency,
				  costs, and duration of all ICS and other Medicaid services required to safely
				  support the participant in the community.
(36) "Provider" means an entity which is
				  enrolled in the Maryland Medical Assistance Program to provide one or more of
				  the services covered under Regulations .22-.37 of this chapter.
(37) "Quality plan" means the plan developed
				  by the Department to address quality assurance and oversight for the ICS
				  program.
(38) "Registered nurse"
				  means an individual licensed to practice as a registered nurse under Health
				  Occupations Article, Title 8, Annotated Code of Maryland.
(39) "Room and board" means rent or mortgage,
				  utilities, maintenance, furnishings, and food, which are provided in, or
				  associated with, an individual's place of residence.
(40) "State Plan" means the document approved
				  by the Centers for Medicare and Medicaid Services describing the nature and
				  scope of the Maryland Medical Assistance Program in accordance with federal
				  requirements at § 1902(a) of Title XIX of the Social Security
				  Act.