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 10.09.46.01 - 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) "Applicant" means an individual who is
				  applying as a participant in the TBI waiver.
(2) "Behavior intervention" means services
				  designed to assist individuals who exhibit challenging behaviors in acquiring
				  skills, gaining social acceptance, and becoming full participants in the
				  community, consistent with behavior support services program service plans set
				  forth in COMAR 10.22.10.
(3)
				  "Behavioral Health Administration (BHA)" means the administration of the
				  Department that:
(a) Is charged with the
				  responsibility for providing services to individuals with behavioral health
				  conditions as defined by Health-General Article, Title 10, Annotated Code of
				  Maryland;
(b) Is designated as the
				  State's lead agency for service delivery to individuals with brain injury;
				  and
(c) Manages the BI waiver, in
				  collaboration with the Program and in accordance with a memorandum of agreement
				  signed with the Program.
(4) "Brain injury (BI)" means an insult to the brain
				  caused by an external or internal mechanism that occurs after birth and is not
				  related to congenital or degenerative disease, which results in cognitive,
				  physical, behavioral, or emotional disability that is documented in the medical
				  record.
(5) "CARF" means the
				  Commission on Accreditation of Rehabilitation Facilities, a nonprofit
				  accrediting body which promotes quality, value, and optimal outcomes of
				  services through a consultative accreditation process that centers on enhancing
				  the lives of individuals receiving services.
(6) Case Management.
(a) "Case management" means the services
				  provided by a case manager who assists an individual in gaining access to
				  needed medical, social, educational, and other services.
(b) "Case management" includes assessment,
				  referral, coordination, and monitoring of the plan of care.
(7) "Case manager" means an individual who
				  provides administrative case management services for BI waiver
				  participants.
(8) "Day
				  habilitation" means assistance with acquisition, retention, or improvement in
				  self-help, socialization, and adaptive skills which takes place in a
				  nonresidential setting, separate from the home or facility in which the
				  individual resides, normally furnished 4 or more hours per day.
(9) "Department" means the Maryland
				  Department of Health as stated in COMAR
				  10.09.36.01B, or
				  its authorized agents acting on behalf of the Department.
(10) "Eligible individual" means an
				  individual who is determined to meet the qualifications for participation in
				  the BI waiver as specified in Regulation .03 of this chapter.
(11) "Health care professional" means an
				  individual who is licensed and authorized by the Health Occupations Article to
				  provide the health service for which the individual is privileged.
(12) "Home and community-based services
				  waiver for individuals with brain injury (BI waiver)" means the program
				  implemented under this chapter.
(13) "Individual support services (ISS)"
				  means assistance with acquisition, retention, or improvement in skills related
				  to self-help, socialization, and/or adaptive skills furnished in the
				  participant's home or community by a provider who does not have round-the-clock
				  responsibility for the participant's health and welfare.
(14) Medical day care" means medically
				  supervised, health-related services provided in an ambulatory setting to
				  medically handicapped individuals who, due to their degree of impairment, need
				  health maintenance and restorative services supportive to their community
				  living in accordance with COMAR 10.09.07.
(15) "Nursing facility level of care" means
				  an assessment that an individual needs the level of services provided in a
				  nursing facility, as defined in COMAR 10.09.10.01.
(16) "Participant" means an eligible
				  individual who is enrolled in the BI Waiver.
(17) "Program" means the Medical Assistance
				  Program, as stated in COMAR
				  10.09.36.01B,
				  which exercises administrative discretion in the administration and supervision
				  of the BI waiver and issues policies, rules, and regulations related to the BI
				  waiver.
(18) "Provider" means an
				  individual or an agency that:
(a) Is approved
				  by the BHA and the Program as meeting the conditions for waiver participation
				  specified in Regulations .05 and .06 of this chapter; and
(b) Has enrolled with the Program to provide
				  one or more of the waiver services described under Regulations .07-.09 of this
				  chapter.
(19) "Provider
				  agreement" means a contract between the Program and a provider to provide
				  services to waiver participants.
(20) "Residential habilitation" means
				  assistance with acquisition, retention, or improvement in skills related to
				  activities of daily living and the social and adaptive skills necessary to
				  enable the individual to live in a noninstitutional setting.
(21) "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.
(22) "State Plan" means a comprehensive,
				  written commitment by a State Medicaid agency, submitted under §1902(a) of
				  Title XIX of the Social Security Act and approved by the federal Centers for
				  Medicare and Medicaid Services, to administer or supervise the administration
				  of the Medical Assistance Program in accordance with federal
				  requirements.
(23) "Supported
				  employment" means activities needed to support paid work by individuals
				  receiving waiver services, including supervision and training.
(24) "Utilization control agent" means the
				  organization responsible for reviewing services to determine medical necessity
				  according to professional standards and for conducting patient
				  assessments.
(25) "Virtual
				  supports" is an electronic method of service delivery used to maintain or
				  improve a participant's functional abilities, enhance interactions, support
				  meaningful relationships, and promote their ability to live independently and
				  meaningfully participate in their community.
(26) "Waiver plan of care" means a
				  participant's written, individualized care plan as specified in Regulation .04
				  of this chapter.