reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.44 - Programs of All-Inclusive Care for the Elderly (PACE) › Section 10.09.44.18 - Subcontractual Relationships

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Consistent with this chapter, the PACE provider, in performing its obligations
				  under this chapter and the PACE program agreement, may either engage its own
				  employees and agents or utilize the services of persons, firms, and other
				  entities by means of contractual relationships.
B. The PACE provider shall have a contractor
				  agreement for all services which are not provided directly by the PACE provider
				  through its own employees and agents.
C. A contractor agreement may not diminish or
				  alter the legal responsibility of the PACE provider to the Department to assure
				  that all obligations under this chapter and the PACE program agreement are
				  carried out.
D. All service
				  contractor agreements require preapproval by the Department.
E. If there are proposed changes in a
				  contractor agreement with any contractor, the full contractor agreement shall
				  be submitted to the Department for prior approval.
F. If the Department determines that
				  termination or expiration of a PACE provider's contractual relationship
				  materially affects the PACE provider's ability to carry out its
				  responsibilities under the PACE provider agreement, the Department may
				  terminate the PACE provider agreement.
G. The PACE provider may contract for any
				  health care services not furnished directly by PACE in its benefit package to a
				  health care provider that is licensed, certified, and meets Medicaid and
				  Medicare participation requirements.
H. Contractors shall be legally and
				  professionally qualified to furnish the services set forth in the contractor
				  agreement in return for the compensation set forth in the contractor
				  agreement.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.44 - Programs of All-Inclusive Care for the Elderly (PACE) › Section 10.09.44.19 - Internal Grievance Procedure

Current through Register Vol. 51, No. 14, July 12, 2024
The PACE provider shall comply with the grievance
					 procedures described at 42 CFR § 460.120 -124.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.44 - Programs of All-Inclusive Care for the Elderly (PACE) › Section 10.09.44.20 - Third-Party Liability

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  PACE provider shall identify and collect money owing from responsible third
				  parties liable for the cost of health care services furnished by the PACE
				  provider to its participants.
B.
				  Upon request from the Department, the PACE provider shall convey any
				  information regarding third-party liability to the Department and the U.S.
				  Department of Health and Human Services.
C. If both the Department and the PACE
				  provider have a right of subrogation, the Department and the PACE provider
				  shall coordinate settlement negotiation, ensuring that the funds available are
				  prorated to allow sufficient compensation to settle each party's claim
				  amount.
D. For insurance coverage
				  identified by the PACE provider with a retroactive effective date, the PACE
				  provider shall ensure that procedures are in place for the collection of funds
				  from either the provider or the insurance carrier for claims paid by the PACE
				  provider during the coverage period, for up to 2 years from the date of health
				  care services provided to the participant.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.44 - Programs of All-Inclusive Care for the Elderly (PACE) › Section 10.09.44.21 - Payment Rates and Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  The Department shall:
(1) Pay the PACE
				  provider for each participant based on the fixed capitation payment or payments
				  specified in the provider agreement for the PACE provider benefit package;
				  and
(2) Calculate the PACE
				  provider's capitation payment or payments as a percentage of the cost to the
				  program specified in the provider agreement of providing the same benefit
				  package on a fee-for-service basis to an actuarially equivalent nonenrolled
				  group of recipients.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.44 - Programs of All-Inclusive Care for the Elderly (PACE) › Section 10.09.44.22 - Payment for Emergency Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The PACE provider shall be responsible for
				  prompt payment for all emergency services received by participants.
B. If a claim is submitted to the PACE
				  provider within 9 months of the date of service, the PACE provider shall
				  reimburse a hospital emergency facility and provider, without requiring prior
				  authorization or approval for payment from the PACE provider, for:
(1) Emergency services;
(2) Medical screening services rendered at an
				  emergency facility to meet the requirements of the federal Emergency Medical
				  Treatment and Active Labor Act; and
(3) Medically necessary and appropriate
				  services if:
(a) The PACE provider
				  authorized, referred, or otherwise allowed the participant to use the emergency
				  facility; and
(b) The services are
				  related to the condition for which the participant was allowed to use the
				  emergency facility.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.44 - Programs of All-Inclusive Care for the Elderly (PACE) › Section 10.09.44.23 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
Cause for suspension or removal and imposition of sanctions
					 under this chapter are set forth in COMAR
					 10.09.36.08D.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.44 - Programs of All-Inclusive Care for the Elderly (PACE) › Section 10.09.44.24 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  PACE provider shall comply with
				  42 CFR §
											460.122.
B. PACE provider appeal procedures under this
				  chapter are set forth in COMAR
				  10.09.36.09D.
C. PACE participant appeals are
				  set forth in COMAR
				  10.09.24.13D.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.44 - Programs of All-Inclusive Care for the Elderly (PACE) › Section 10.09.44.25 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
Interpretation of this regulation is subject to COMAR
					 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.45 - Mental Health Case Management › Section 10.09.45.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter
				  applies to providers organized to deliver mental health case management
				  services to adults.
B. The purpose
				  of mental health case management is to assist participants in gaining access to
				  needed medical, mental health, social, educational, and other
				  services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.45 - Mental Health Case Management › Section 10.09.45.03 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				  recipient is eligible for mental health case management services if the
				  recipient:
(1) Is in a federal eligibility
				  category for Maryland Medical Assistance according to COMAR 10.09.24, which
				  governs the determination of eligibility for the Maryland Medical Assistance
				  Program; and
(2) Has a serious and
				  persistent mental health disorder and is:
(a)
				  In, at risk of, or needs continued community treatment to prevent, inpatient
				  psychiatric treatment;
(b) At risk
				  of, or needs continued community treatment to prevent, being homeless;
				  or
(c) At risk of incarceration or
				  who will be released from a detention center or prison.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.45 - Mental Health Case Management › Section 10.09.45.04 - Conditions for Mental Health Case Management Provider Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. The local core
				  service agencies shall select mental health case management providers through a
				  competitive procurement process, at least once every 5 years.
B. Mental health case management services may
				  be provided by local health departments according to COMAR 10.04.04, which
				  allows the Director of the MHA to utilize the local health departments as
				  vendors unless the health officer believes the service provided by alternate
				  vendors would be preferable.
C.
				  Providers of mental health case management shall:
(1) Be approved or licensed in Maryland as a
				  community mental health provider under COMAR 10.21.19, 10.21.20, 10.21.21, or
				  10.21.29, or have 3 years experience as a mental health case management
				  provider; and
(2) Have at least 3
				  years experience providing mental health services, including serving high risk
				  populations, to adults with serious mental illness
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.45 - Mental Health Case Management › Section 10.09.45.05 - Mental Health Case Management Provider Staff

Current through Register Vol. 51, No. 14, July 12, 2024
Required Staff. The mental health case management provider
					 shall have staff that is sufficient in numbers and qualifications to provide
					 appropriate services to the participants served and shall include, at a
					 minimum:
A. A community support
				  specialist supervisor who:
(1) Is a mental
				  health professional who is licensed and legally authorized to practice under
				  the Health Occupations Article, Annotated Code of Maryland, and who is licensed
				  under Maryland Practice Boards in the profession of:
(a) Social work;
(b) Professional Counseling;
(c) Psychology;
(d) Nursing;
(e) Occupational Therapy; or
(f) Medicine;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.45 - Mental Health Case Management › Section 10.09.45.06 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Department shall reimburse for the services in §§C-I of this
				  regulation under mental health case management when these services have been
				  documented, pursuant to the requirements in this chapter, as
				  necessary.
B. Case management
				  services shall be coordinated with, and may not duplicate activities provided
				  as part of, institutional services and discharge planning activities.
C. Comprehensive Assessment and Periodic
				  Reassessment.
(1) Assessment or reassessment
				  involves the participant's stated needs and review of information concerning
				  the participant's mental health, social, familial, cultural, medical,
				  developmental, legal, vocational, and economic status to assist in the
				  formulation of a care plan.
(2) The
				  assessment or reassessment of the participant's stated needs and service needs
				  is conducted by the community support specialist and incorporates input from
				  the participant, family members, and friends of the participant, as
				  appropriate, and community service providers, such as mental health providers,
				  medical providers, social workers, and educators, if necessary.
(3) A home visit, or visit at another
				  location suitable to the participant's needs, by the community support
				  specialist or community support specialist associate is required every 90
				  days.
(4) After an initial
				  assessment, each participant shall be reassessed every 6 months.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.45 - Mental Health Case Management › Section 10.09.45.07 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Mental health
				  case management services are advisory in nature.
B. A restriction may not be placed on a
				  qualified recipient's option to receive mental health case management
				  services.
C. Mental health case
				  management services do not restrict or otherwise affect:
(1) Eligibility for Title XIX benefits or
				  other available benefits or programs, except as limited by §E of this
				  regulation;
(2) The freedom of a
				  participant to select from all available services for which the participant is
				  found to be eligible; or
(3) A
				  participant's free choice among qualified providers.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.45 - Mental Health Case Management › Section 10.09.45.08 - Preauthorization

Current through Register Vol. 51, No. 14, July 12, 2024
All covered services under this chapter shall be
					 preauthorized and comply with the requirements of COMAR
					 10.09.70.07A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.45 - Mental Health Case Management › Section 10.09.45.09 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Program shall reimburse the provider according to the requirements in this
				  chapter and the fees established under COMAR 10.21.25.
B. Request for Payment.
(1) Requests for payment of mental health
				  case management services shall be submitted by an approved provider according
				  to procedures established by the Department. The Department reserves the right
				  to return to the provider, before payment, all invoices not properly signed and
				  completed.
(2) A provider shall
				  submit a request for payment on the invoice form designated by the Department.
				  A separate invoice shall be submitted for each participant. The completed form
				  shall indicate the:
(a) Date or dates of
				  service;
(b) Participant's name and
				  Medical Assistance number;
(c)
				  Provider's name, location, and provider number; and
(d) Nature, unit or units, and procedure code
				  or codes of covered services provided.
(3) A provider shall bill the Program for the
				  appropriate fee or fees specified in COMAR 10.21.25.
(4) The Program may not make direct payment
				  to recipients.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.45 - Mental Health Case Management › Section 10.09.45.10 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement are as set forth in COMAR
					 10.09.36.07A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.45 - Mental Health Case Management › Section 10.09.45.11 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
Cause for suspension or removal and imposition of sanctions
					 is as set forth in COMAR
					 10.09.36.08A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.45 - Mental Health Case Management › Section 10.09.45.12 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures are those set forth in COMAR
					 10.09.36.09A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.45 - Mental Health Case Management › Section 10.09.45.13 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations are interpreted as those set forth in
					 COMAR 10.09.36.10A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.02 - Medical Assistance Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. Financial eligibility for waiver
				  participants is determined according to the provisions of this regulation and
				  applicable sections of COMAR 10.09.24 Medical Assistance Eligibility, as cited
				  in this section.
B. Categorically
				  Needy. An individual is eligible for waiver services as categorically needy if
				  the individual is receiving Medical Assistance as:
(1) A recipient of Supplemental Security
				  Income (SSI);
(2) A member of a low
				  income family with children, as described in § 1931 of the Social Security
				  Act; or
(3) A recipient eligible in
				  another mandatory or optional categorically needy coverage group with full
				  Medical Assistance benefits, covered in the community under the State
				  Plan.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.03 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. Medical
				  Eligibility for the Waiver.
(1) To be
				  medically eligible for the services covered under this chapter, an applicant
				  shall be certified by the Program's utilization control agent to need nursing
				  facility level of care or special hospital level of care.
(2) Every 12 months, or more frequently if
				  determined necessary by the BHA or Program due to a significant change in the
				  participant's condition or need, a participant's medical need for nursing
				  facility level of care or special hospital level of care shall be reevaluated
				  by the Program's utilization control agent.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.04 - Program Model

Current through Register Vol. 51, No. 14, July 12, 2024
A. The program
				  services and supports shall:
(1) Maximize the
				  level of functioning of an individual with TBI through assistance and support
				  with independent living, self care skills, and social skills in an environment
				  which encourages the participant's ability to make decisions about the
				  individual's life and create opportunities for choice regarding home, school or
				  work, and community activities;
(2)
				  Promote the use of community resources to integrate the individual into the
				  community;
(3) Provide services
				  that are:
(a) Appropriate to the age of the
				  populations being served;
(b)
				  Offered at times and places suitable to the individuals served; and
(c) Coordinated by BHA's administrative case
				  manager with other medical rehabilitation, mental health, and primary care
				  services that the individual is receiving; and
(4) Assure that staff are available, on call,
				  24 hours per day, 7 days per week.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.05 - Conditions for Provider Participation - General

Current through Register Vol. 51, No. 14, July 12, 2024
General requirements for participation in the Medical
					 Assistance Program as a provider of BI waiver services are that the provider,
					 with the exception of a medical day care provider, shall:
A. Be approved by the BHA as meeting the
				  requirements and able to provide the services specified in this chapter;
B. Have a provider agreement in
				  effect;
C. Meet all the conditions
				  for participation in COMAR 10.09.36, except as otherwise specified in this
				  chapter;
D. Have demonstrated
				  experience in the provision of services to individuals with TBI as evidenced
				  by:
(1) Having:
(a) A history of serving adults with
				  traumatic brain injury for at least the past 2 years;
(b) A program of specialized services
				  appropriate for the needs of individuals with traumatic brain injury;
				  and
(c) Availability of licensed
				  healthcare professionals with experiences in the provision of services to
				  individuals with traumatic brain injury to supervise, train, or consult with
				  program staff regarding the needs of waiver participants; or
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.06 - Conditions for Provider Participation - Specific

Current through Register Vol. 51, No. 14, July 12, 2024
A. Provider of Residential Habilitation or
				  Rehabilitation Services. To provide the services covered under Regulation .07
				  of this chapter, the provider agency shall:
(1) Operate a community-based program of
				  residential habilitation or rehabilitation services that is licensed by the
				  Department's Office of Health Care Quality under COMAR 10.22.08 for the
				  Community Residential Services Program;
(2) Meet the participant's needs for room and
				  board and clothing, although these services are not reimbursed by the Program;
				  and
(3) If the facility is covered
				  by § 1616(e) of the Social Security Act, comply with applicable State
				  standards that meet the requirements of 45 CFR Part 1937 for board and care
				  facilities.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.07 - Covered Services - Residential Habilitation Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The residential habilitation services
				  covered under this regulation shall be provided in a community-based
				  residential facility.
B. The
				  covered services shall include:
(1)
				  Habilitative services to assist a participant in acquiring, regaining,
				  retaining, or improving the self-help skills related to activities of daily
				  living and the socialization and adaptive skills which are necessary to reside
				  successfully in home and community-based settings;
(2) Supervision and support, up to 24 hours a
				  day, in a residence, based on the individual's plan of care; and
(3) Any of the following additional services
				  which are medically necessary to prevent the participant's institutionalization
				  and are not otherwise covered for the participant by the Program or another
				  payer:
(a) Nursing supervision, in accordance
				  with the Maryland Nurse Practice Act and COMAR 10.27.11 for any medication
				  administration or other delegated nursing functions provided to the participant
				  in the residence by a direct care worker; and
(b) Behavior intervention services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.08 - Covered Services - Day Habilitation Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The day habilitation services covered
				  under this regulation shall be provided in a nonresidential setting, separate
				  from the home or facility in which the participant resides.
B. The covered services, as defined in this
				  chapter shall include:
(1) Habilitative or
				  rehabilitative services to assist a participant in acquiring, regaining,
				  retaining, or improving the self-help skills related to activities of daily
				  living and the social and adaptive skills, which are necessary to reside
				  successfully in home and community-based settings;
(2) Meals furnished as part of the
				  program;
(3) Any of the following
				  additional services which are provided at the provider's site, are medically
				  necessary to prevent the participant's institutionalization, and are not
				  otherwise covered for the participant by the Program or another payer:
(a) Nursing supervision, in accordance with
				  the Maryland Nurse Practice Act and COMAR 10.27.11 for any medication
				  administration or other delegated nursing functions provided to the participant
				  by a qualified direct care worker; and
(b) Behavior intervention services;
				  and
(4) Transportation
				  between a participant's residence and the provider's site, or between
				  habilitation sites if the participant receives habilitation services in more
				  than one place.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.09 - Covered Services - Supported Employment Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The supported employment services covered
				  under this regulation shall be provided in nonresidential community settings,
				  separate from the home or facility in which the participant resides.
B. The covered services shall:
(1) Include a work program that includes
				  supports necessary for the participant to achieve desired outcomes established
				  in the waiver plan of care;
(2)
				  Include rehabilitation activities needed to sustain the participant's job
				  including support and training;
(3)
				  Consist of training, skill development, and paid employment for participants:
(a) For whom competitive employment at or
				  above the minimum wage is unlikely; and
(b) Who, because of disabilities, need
				  intensive ongoing support to perform in a work setting;
(4) Be provided to help individuals obtain
				  and maintain paid work in integrated community settings; and
(5) Include transportation or the
				  coordination of transportation between a participant's residence and the
				  supported employment job site.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.09-2 - Covered Services - Medical Day Care Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Covered medical day care services are
				  those set forth in COMAR 10.09.07.
B. A unit of service is a minimum of 4 hours
				  present at the medical day care center.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.10 - Conditions for Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
The Department shall reimburse for services covered under
					 this chapter if the services are:
A.
				  Provided to a participant who meets the qualifications for eligibility
				  specified in Regulations .02 and .03 of this chapter;
B. Preauthorized in the participant's waiver
				  plan of care by the BHA, as being reasonable and medically necessary to prevent
				  institutionalization;
C. Provided
				  by an approved provider which meets the conditions for participation in
				  Regulations .05 and .06 of this chapter; and
D. Rendered pursuant to:
(1) The relevant definition of covered
				  services in Regulation .01 of this chapter;
(2) All other requirements specified in this
				  chapter and COMAR 10.09.36; and
(3)
				  The waiver proposal and any amendments to it approved by the Secretary of the
				  U.S. Department of Health and Human Services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.11 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Reimbursement
				  shall be made by the Program only if all of the requirements of this chapter
				  are met.
B. Reimbursement may not
				  be made by the Program for a waiver service furnished before:
(1) Enrollment of the participant in the
				  waiver;
(2) Development of the
				  participant's waiver plan of care; and
(3) Inclusion of the specific service in the
				  participant's approved waiver plan of care.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.12 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request for
				  Payment.
(1) An approved provider, with the
				  exception of a medical day care provider, shall submit requests for payment to
				  BHA or its authorized representative for the services covered under this
				  chapter, according to procedures set forth in COMAR
				  10.09.36.04 or otherwise
				  established by the Department. Medical day care providers shall submit requests
				  for payment to the Department in accordance with COMAR 10.09.07.08.
(2) The provider shall:
(a) Bill the Department in accordance with
				  the payment methodology specified in §C of this regulation;
(b) Accept payment from the Department as
				  payment in full for the services covered under this chapter and make no
				  additional charge for the covered services to the participant or any other
				  party; and
(c) Submit a request for
				  payment in a manner approved by the Department, which includes the:
(i) Date or dates of service;
(ii) Participant's name and Medicaid
				  number;
(iii) Provider's name,
				  location, and Program identification number;
(iv) Type, procedure code or codes, and unit
				  or units of covered services provided; and
(v) Amount of reimbursement
				  requested.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.13 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement under this chapter are as set
					 forth in COMAR
					 10.09.36.07D and
					 COMAR 10.09.07.09D.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.14 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
Cause for suspension or removal and imposition of sanctions
					 under this chapter are as set forth in COMAR
					 10.09.36.08D.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.15 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Appeal
				  procedures for applicants and participants are those set forth in COMAR
				  10.09.24.13D and
				  COMAR 10.01.04.
B. Provider appeal
				  procedures under this chapter are set forth in COMAR
				  10.09.36.09D.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury › Section 10.09.46.16 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
Interpretation of this regulation is subject to COMAR
					 10.09.36.10D.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.47 - Disproportionate Share Hospitals › Section 10.09.47.02 - Disproportionate Share Hospitals

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				  Maryland hospital is considered a disproportionate share hospital for purposes
				  of a disproportionate share payment if the hospital's:
(1) Medicaid inpatient utilization rate is at
				  least one standard deviation above the mean Medicaid inpatient utilization rate
				  for Maryland hospitals that are Medicaid providers; or
(2) Low-income utilization rate exceeds 25
				  percent.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.47 - Disproportionate Share Hospitals › Section 10.09.47.03 - Disproportionate Share Payment

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Free-Standing Acute General, Chronic, or Pediatric/Rehabilitation Hospitals.
(1) Except as set forth in §A(2) of this
				  regulation, the disproportionate share payment for disproportionate share
				  hospitals that are free-standing hospitals licensed as acute general, chronic,
				  or jointly as pediatric and rehabilitation equals an amount determined in
				  accordance with 42 CFR
				  §
												412.106, but only if the hospital
				  qualifies as a disproportionate share hospital under
				  42 CFR §
												412.106.
(2) Free-standing hospitals that are approved
				  by the Program for reimbursement according to rates established by the HSCRC
				  receive a bad debt allowance, which is recognized as a disproportionate share
				  payment equal to or greater than the amount set forth in §A(1) of this
				  regulation, and an additional payment may not be made under this
				  chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.47 - Disproportionate Share Hospitals › Section 10.09.47.04 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
Except when the language of a specific regulation indicates
					 an intent by the Department to provide reimbursement for covered services to
					 Program recipients without regard to the availability of federal financial
					 participation, State regulations shall be interpreted in conformity with
					 applicable federal statutes and regulations.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.48 - Targeted Case Management for People with Developmental Disabilities › Section 10.09.48.02 - Certification Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
The provider shall meet all applicable certification
					 requirements as set forth in COMAR 10.22.02 unless otherwise authorized by the
					 Developmental Disabilities Administration.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.48 - Targeted Case Management for People with Developmental Disabilities › Section 10.09.48.03 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
To be eligible for services covered under this chapter, a
					 participant or applicant shall:
A.
				  Apply to be a Medical Assistance Program participant or be Medical Assistance
				  Program eligible; and
B. Either:
(1) Have applied for services from the
				  Developmental Disabilities Administration but not yet had their eligibility
				  determined; or
(2) Be eligible for
				  funding from the DDA as set forth in COMAR 10.22.12, and meet one of the
				  following conditions:
(a) Be determined to
				  have a developmental disability and currently on the DDA waiting
				  list;
(b) Be receiving
				  comprehensive community services funded by the DDA; or
(c) Be determined to have a developmental
				  disability and in the process of transitioning to the community.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.48 - Targeted Case Management for People with Developmental Disabilities › Section 10.09.48.04 - Conditions for Participation - General

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter, targeted case management
				  services are referred to as coordination of community services.
B. Providers shall meet all the conditions
				  for participation as set forth in COMAR 10.09.36.03.
C. Administrative and Professional
				  Requirements. To participate in the Program as a provider of services covered
				  under this chapter, the provider shall:
(1) Be
				  incorporated in the State in good standing with the Maryland Department of
				  Assessments and Taxation unless operating as a local health
				  department;
(2) Have a board of
				  directors or local advisory board in accordance with COMAR 10.22.02;
(3) Be selected by DDA as an approved
				  provider of coordination of community services, as evidenced by an executed
				  DDA-approved contract;
(4)
				  Participate in all transition and rollout processes as determined by the
				  DDA;
(5) Maintain a standard
				  8-hour operational day Monday through Friday and have flexible staffing hours
				  that include nights and weekends to accommodate the needs of participants
				  receiving coordination of community services;
(6) Maintain a toll-free number, unless otherwise
				  authorized by the DDA, and an accessible communication system in accordance
				  with the Americans with Disabilities Act of 1990;
(7) Maintain a communication system that is accessible
				  for participants with limited English proficiency;
(8) Provide alternative communication methods to serve
				  the needs of participants receiving coordination of community services and
				  their family members;
(9) Have a
				  means for participants, their families, community providers, and DDA staff to
				  contact the coordination of community services designated staff directly in the
				  event of an emergency and at times other than standard operating hours;
(10) Annually advise participants
				  of their right to choose among qualified providers of services including
				  coordination of community services;
(11) Comply with all State and federal
				  statutes and regulations;
(12)
				  Maintain a participant's record for a minimum of 6 years after the record is
				  made;
(13) Notify the DDA
				  immediately in writing of any critical incidents that affect the health,
				  safety, and welfare of a participant, as well as administrative and quality of
				  care complaints as required by the DDA Policy on Reportable Incidents and
				  Investigations; and
(14) Submit
				  required documents and forms to the Department as
				  requested.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.48 - Targeted Case Management for People with Developmental Disabilities › Section 10.09.48.05 - Conditions for Participation - Staff Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. Staff Capability Requirements. The
				  provider shall:
(1) Employ only personnel who
				  are appropriately qualified as set forth in this regulation;
(2) Maintain sufficient staff required to
				  meet the needs of the participants whom the provider serves;
(3) Have administrative and supervisory staff
				  to ensure the quality of coordination of community services provided by the
				  provider;
(4) Have a management
				  capability team, each member of which has at least 3 years of experience
				  providing coordination of community services or management experience in human
				  services; and
(5) Maintain
				  personnel files for each employee which includes documentation of staff
				  qualifications as set forth in this regulation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.48 - Targeted Case Management for People with Developmental Disabilities › Section 10.09.48.06 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Only
				  core services shall be authorized for payment by DDA as covered coordination of
				  community services.
B. The
				  coordinator of community services shall provide the core services listed in
				  this regulation to every participant assigned to the coordinator.
C. Comprehensive Assessment. Coordination of
				  community services shall include a comprehensive assessment of the
				  participant's needs and supports to determine eligibility, in accordance with
				  COMAR 10.22.12. The assessment shall be completed within 45 days after referral
				  by the DDA and include:
(1) A review of
				  relevant medical and other records with the applicant or legal representative's
				  written consent;
(2) A review of
				  current providers of medical, social, or other support services, as
				  appropriate;
(3) Unless otherwise
				  authorized by the DDA, a face-to-face assessment of the participant, preferably
				  at the participant's residence, to review:
(a)
				  Medical, developmental, and mental history, including current
				  medications;
(b) Nutritional
				  status;
(c) Emotional and
				  behavioral status;
(d) Health care
				  coverage;
(e) Living
				  situation;
(f) Personal support
				  systems;
(g) Participant goals and
				  preferences;
(h) Environmental,
				  social, and functional status;
(i)
				  Educational history;
(j) Employment
				  and income status;
(k) Health
				  education;
(l) Social
				  support;
(m) The most integrated
				  setting appropriate to meet the participant's needs; and
(n) Any additional service
				  needs;
(4) Assistance
				  with information-gathering such as obtaining professional evaluations and
				  assessments necessary to document and recommend eligibility and priority for
				  services; and
(5) A completed
				  assessment form as required by the DDA.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.48 - Targeted Case Management for People with Developmental Disabilities › Section 10.09.48.07 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Restrictions may
				  not be placed on a participant's option to receive coordination of community
				  services.
B. Coordination of
				  community services provided under this chapter does not restrict or otherwise
				  affect eligibility for Title XIX benefits or other available benefits or
				  programs.
C. Coordination of
				  community services may not be:
(1) Provided
				  as an integral and inseparable part of another covered Program
				  service;
(2) Provided as an
				  administrative function;
(3)
				  Rendered in connection with the implementation of another service authorized
				  under § 1915(b) or § 1915(c) of the Social Security Act; or
(4) Provided as a substitute or in
				  duplication of another service or support.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.48 - Targeted Case Management for People with Developmental Disabilities › Section 10.09.48.08 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request for
				  Payment.
(1) Requests for payment for the
				  services covered under this chapter shall be submitted by a provider according
				  to procedures set forth in COMAR 10.09.36.04.
(2) Billing time limitations for services
				  covered under this chapter are the same as those set forth in COMAR
				  10.09.36.06.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.48 - Targeted Case Management for People with Developmental Disabilities › Section 10.09.48.09 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement shall be as set forth in COMAR
					 10.09.36.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.48 - Targeted Case Management for People with Developmental Disabilities › Section 10.09.48.10 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
Cause for suspension or removal and imposition of sanctions
					 shall be as set forth in COMAR
					 10.09.36.08 and 10.22.03.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.48 - Targeted Case Management for People with Developmental Disabilities › Section 10.09.48.11 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Appeal
				  procedures for providers shall be as set forth in COMAR 10.09.36.09.
B. Appeal procedures for participants shall
				  be as set forth in COMAR 10.04.01.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.48 - Targeted Case Management for People with Developmental Disabilities › Section 10.09.48.12 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations shall be interpreted as set forth in
					 COMAR 10.09.36.10.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.49 - Telehealth Services › Section 10.09.49.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter
				  applies to covered services delivered via synchronous telehealth and eligible
				  for reimbursement by the Maryland Medicaid Program.
B. The purpose of providing medically
				  necessary services via telehealth is to improve:
(1) Access to services, thus reducing
				  preventable hospitalizations and barriers to health care access;
(2) Access to outpatient and inpatient
				  subspecialty services, thus improving diagnostic clarification, treatment
				  recommendations, and planning for the individual;
(3) Health outcomes through timely disease
				  detection and treatment options; and
(4) Capacity and choice for ongoing treatment
				  in underserved areas of the State.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.49 - Telehealth Services › Section 10.09.49.03 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
Under the Telehealth Program, the Department shall
					 cover:
A. Medically necessary services
				  covered by the Maryland Medical Assistance Program rendered via telehealth that
				  shall be:
(1) Distinct from services provided
				  in person;
(2) Able to be delivered
				  using technology-assisted communication; and
(3) Clinically appropriate to be delivered
				  via telehealth;