reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.10-1 - Specific Conditions for Participation - Respite Care

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program as a provider of respite care
					 services under Regulation .18-1 of this chapter a provider shall be enrolled as
					 a provider of:
A. Assisted living
				  services under this chapter; or
B.
				  Nursing facility services under COMAR 10.09.10.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.11 - Specific Conditions for Provider Participation - Case Management Services

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the program as a provider of case
					 management services under this chapter a provider shall:
A. Be an area agency or other entity
				  designated by the Department through a process approved by the Centers for
				  Medicare and Medicaid Services in accordance with § 1915(b)(4) of the
				  Social Security Act; and
B. Agree
				  to be monitored by the Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.12 - Covered Services - General

Current through Register Vol. 51, No. 14, July 12, 2024
The Program shall reimburse for the services specified in
					 Regulations .13-.19 of this chapter when, pursuant to the requirements of this
					 chapter, these services have been pre-approved by the Department in the
					 participant's plan of service, and billed in accordance with the payment
					 procedures in Regulation .22 of this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.13 - Covered Services - Assisted Living Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Assisted living services shall include the
				  provision of:
(1) A structured, supportive
				  environment in a home-like setting;
(2) Personal assistance and chore services
				  including:
(a) Assisting the participant, as
				  necessary, with performing activities of daily living and instrumental
				  activities of daily living, including cuing the participant to perform these
				  activities;
(b) Routine
				  housekeeping, laundry, household care, and chore services needed to maintain
				  the facility as a clean, sanitary, and safe environment; and
(c) Menu planning, food shopping, and meal
				  preparation and serving;
(3) Basic personal hygiene supplies,
				  including but not limited to:
(a)
				  Soap;
(b) Bathroom
				  tissue;
(c) Paper towels;
(d) Toothpaste;
(e) Toothbrush; and
(f) Shampoo;
(4) 24-hour supervision of participants to
				  assure health and safety;
(5)
				  Assistance with medication administration, in accordance with COMAR 10.27.11
				  and COMAR 10.07.14;
(6)
				  Recreational and social activities of a nontherapeutic and nonhabilitative
				  nature which are confined to the assisted living facility and are for the
				  purpose of socialization;
(7)
				  Reminding the participant of medical appointments;
(8) Assistance with transportation
				  arrangements to needed services;
(9) Conferring with the participant's case
				  manager about the participant's status and service needs, as
				  necessary;
(10) Assisting the
				  participant in accessing needed medical or mental health services in emergency
				  situations; and
(11) Other services
				  specified for assisted living programs in COMAR 10.07.14.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.14 - Covered Services - Behavior Consultation Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. A provider
				  may bill for the length of a home visit to a participant, upon completion of
				  the services specified in §C of this regulation.
B. Behavior consultation services may be
				  preauthorized by a participant's plan of service when:
(1) A participant or the participant's
				  representative request the service due to an identified behavioral issue;
				  or
(2) The participant's behavior
				  is:
(a) Potentially dangerous to the
				  participant's or another person's health and functioning; or
(b) Placing the participant at risk of
				  institutionalization due to health and safety concerns.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.15 - Covered Services - Senior Center Plus

Current through Register Vol. 51, No. 14, July 12, 2024
A. A day of service is covered by the Program
				  when the participant attends for at least 4 hours, not including transportation
				  to and from the center.
B. Senior
				  Center Plus services include a program of structured group recreational
				  activities, supervised care, assistance with activities of daily living and
				  instrumental activities of daily living, and enhanced socialization provided in
				  an out-of-home, outpatient setting. Social and recreational activities designed
				  for elderly, disabled individuals, as well as one nutritious meal shall be
				  available at the center.
C. This
				  program is designed to promote the participants' optimal functioning and to
				  have a positive impact on the participants' orientation and cognitive
				  ability.
D. A provider may choose
				  to provide transportation to and from the site of the Senior Center Plus
				  services. These transportation services may:
(1) Not be included in the provider's daily
				  rate negotiated with the Maryland Department of Aging; and
(2) Be reimbursed through some other funding
				  source for transportation services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.16 - Covered Services - Family Training

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program
				  covers family training when the service is approved in the plan of service and
				  rendered to a family member by a qualified provider, not including the time
				  spent planning, preparing, setting up or following up after the
				  training.
B. The training and
				  counseling services may not include services rendered:
(1) On a group basis or in a classroom
				  setting; or
(2) To a family member
				  of a participant residing in a licensed assisted living facility.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.17 - Covered Services - Dietitian and Nutritionist Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Dietitian
				  and nutritionist services shall include:
(1)
				  The provision of nutrition care plan outcomes and approaches;
(2) Nutrition care planning, nutrition
				  assessment, and dietetic instruction; and
(3) Services within the scope of practice of
				  the nutritionist's or dietitian's license, as defined by:
(a) Health Occupations Article, Title V,
				  Annotated Code of Maryland; and
(b)
				  Regulations under COMAR 10.56 for the Board of Dietetic Practice.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.18 - Covered Services - Medical Day Care Services

Current through Register Vol. 51, No. 14, July 12, 2024
A provider shall render medical day care services in
					 accordance with COMAR 10.09.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.18-1 - Covered Services - Respite Care

Current through Register Vol. 51, No. 14, July 12, 2024
Respite care services shall:
(A) Be provided to participants who, due to
					 physical or cognitive impairments, are unable to care for themselves;
(B) Be furnished on a short-term
					 basis because of the absence or need for relief of an individual normally
					 providing the care;
(C) Provide a
					 period of rest and renewal, which contributes to maintaining the participant at
					 home in the community;
(D) Be
					 provided at planned intervals, in a time of crisis, or as needed;
(E) Include the participant's room and board;
(F) Include overnight care; and
(G) Include the following
					 services:
(1) Supervising participants with
					 cognitive impairments to ensure the individual's health and safety;
(2) Assisting participants with functional
					 impairments to perform activities of daily living or instrumental activities of
					 daily living; and
(3) Delegated
					 nursing functions, such as medication assistance or administration by
					 appropriately trained, certified, and supervised staff.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.19 - Covered Services - Case Management Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Case management services shall be targeted
				  to address the individualized needs of the participant and be sensitive to the
				  educational background, culture, and general environment of the
				  participant.
B. Case management
				  services include time spent by a qualified provider conducting any of the
				  following activities:
(1) Assisting with the
				  initial or annual waiver eligibility process;
(2) Assisting with the application and
				  supporting the individual in maintaining all public and private benefits,
				  resources, and entitlements;
(3)
				  Conducting an assessment of needs, and developing a person-centered plan of
				  service, to include all services needed to live safely in the
				  community;
(4) Assisting the
				  participant with referrals, access, and coordination of services, both Medicaid
				  and non-Medicaid, to address the participant's needs including, but not limited
				  to:
(a) Behavioral health;
(b) Educational services;
(c) Disposable medical supplies and durable
				  medical equipment;
(d)
				  Housing;
(e) Medical services;
				  and
(f) Social services;
(5) Monitoring the provision of
				  services to determine if services are received in accordance with the plan of
				  services;
(6) Facilitating
				  referrals to other programs if the individual is denied waiver services;
				  and
(7) Using information
				  technology systems developed by the Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.20 - Conditions for Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
The Program shall reimburse for the services specified in
					 Regulations .13-.19 of this chapter, if provided in accordance with the
					 requirements of this chapter and if the service:
A. Is recommended on the participant's plan
				  of service as necessary in order to:
(1)
				  Prevent the applicant's or participant's admission to an institution;
				  or
(2) Assure the health and safety
				  of an applicant or participant in the community;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.21 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Reimbursement
				  may be made by the Program only when the requirements of this chapter are
				  met.
B. The Program may not
				  reimburse the following combinations of services for a participant for the same
				  date of service:
(1) Senior Center Plus and
				  Medical Day Care under this chapter;
(2) Assisted living services under this
				  chapter and personal assistance services under COMAR 10.09.20 or COMAR
				  10.09.84;
(3) Assisted living
				  services and respite care under this chapter; or
(4) Respite care under this chapter and
				  personal assistance services covered under COMAR 10.09.20 or COMAR
				  10.09.84.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.22 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request for
				  Payment. To receive payment as a provider of services covered under Regulations
				  .13-.19 of this chapter, a provider shall submit claims in accordance with
				  procedures outlined in the Department's billing manual.
B. Billing time limitations for the services
				  covered under this chapter are set forth in COMAR 10.09.36.06.
C. Payments.
(1) Payments shall be made directly to a
				  qualified provider.
(2) Providers
				  shall be paid the lesser of:
(a) The
				  provider's customary charge to the general public unless the service is free to
				  individuals not covered by Medicaid, or
(b) The rate established in §D of this
				  regulation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.23 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement are as set forth in COMAR
					 10.09.36.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.24 - 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 10.09.36.08.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.25 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures are those set forth in COMAR 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.26 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations are 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 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.27 - Implementation Date

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter shall be implemented January 6,
					 2014.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.55 - Physician Assistants › Section 10.09.55.02 - License and Certification Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. The provider shall meet all license
				  requirements as set forth in COMAR 10.09.36.02.
B. A physician assistant applying for
				  provider status shall:
(1) Be licensed to
				  practice as a physician assistant in Maryland or in the state or jurisdiction
				  in which the service is provided;
(2) Be in compliance with requirements set
				  forth in COMAR 10.32.03;
(3) If
				  practicing in Maryland, have a delegation agreement with a supervising
				  physician that outlines the physician assistant's duties within the medical
				  practice or facility which has been filed with and approved by the Board of
				  Physicians; and
(4) If practicing
				  in Maryland, have a delegation agreement with a supervising physician that
				  documents the specialized training, education, and experience of the physician
				  assistant for performing advanced duties.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.55 - Physician Assistants › Section 10.09.55.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  A physician assistant shall:
(1) Meet all
				  general provider requirements set forth in COMAR 10.09.36; and
(2) If delivering services via telehealth,
				  comply with COMAR 10.09.49 and any subregulatory guidance issued by the
				  Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.55 - Physician Assistants › Section 10.09.55.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Program covers medically necessary services rendered to participants in
				  accordance with:
(1) The functions allowed
				  under:
(a) The Physician Assistant's Practice
				  Act;
(b) COMAR 10.32.03;
				  and
(c) The physician assistant's
				  written delegation agreement with a physician; or
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.55 - Physician Assistants › Section 10.09.55.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
The Program does not cover the following under these
					 regulations:
A. Services not
				  encompassed by the physician assistant's written delegation agreement with the
				  physician, if required by the state in which services are provided;
B. Services not medically
				  necessary;
C. Services prohibited
				  by the Board;
D. Services
				  prohibited in the state in which services are provided;
E. Physician assistant services included as
				  part of the cost of an inpatient facility, hospital outpatient department, or
				  freestanding clinic;
F. Visits by
				  or to the physician assistant solely for the purpose of the following:
(1) Prescription, drug, or food supplement
				  pickup;
(2) Recording of an
				  electrocardiogram;
(3) Ascertaining
				  the patient's weight;
(4)
				  Interpretation of laboratory tests or panels; or
(5) Prescribing or administering oral
				  medications;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.55 - Physician Assistants › Section 10.09.55.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  provider shall submit the request for payment in the format designated by the
				  Department.
B. The Department
				  reserves the right to return to the provider, before payment, all invoices not
				  properly signed, completed, and accompanied by any properly completed forms
				  required by the Department.
C. The
				  provider shall charge the Program the provider's customary charge to the
				  general public for similar services and charge the provider's acquisition cost
				  for injectable drugs or dispensed medical supplies. If the service is free to
				  individuals not covered by Medicaid:
(1) The
				  provider:
(a) May charge the Program;
				  and
(b) Shall be reimbursed in
				  accordance with §D of this regulation; and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.55 - Physician Assistants › Section 10.09.55.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement are as set forth in COMAR
					 10.09.36.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.55 - Physician Assistants › Section 10.09.55.08 - 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 10.09.36.08.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.55 - Physician Assistants › Section 10.09.55.09 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Providers filing appeals from administrative decisions made
					 in connection with these regulations shall do so according to COMAR
					 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.55 - Physician Assistants › Section 10.09.55.10 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations shall be interpreted in conformity with
					 COMAR 10.09.36.10.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.01 - 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) Active Treatment.
(a) "Active treatment" means, according to
				  42 CFR §
													483.440(a), a continuous
				  active treatment program which includes aggressive, consistent implementation
				  of a program of specialized and generic training, treatment, health services,
				  and related services that is directed toward the:
(i) Acquisition of the behaviors necessary
				  for the individual to function with as much self-determination and independence
				  as possible; or
(ii) Prevention or
				  deceleration of regression or loss of current optimal functional
				  status.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.02 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. Medical
				  Eligibility for the Autism Waiver.
(1) To be
				  medically eligible for the services covered under the chapter, an applicant
				  shall be certified by the licensed psychologist or certified school
				  psychologist, who is a member of the participant's multidisciplinary team and
				  is employed by the local Infants and Toddlers Program, the local school system,
				  the Program, or the Program's designee, to need ICF-IID level of care using the
				  standardized process for determination of eligibility for level of care in an
				  ICF-IID.
(2) Every 12 months, or
				  more frequently if determined necessary by the service coordinator or
				  multidisciplinary team due to a significant change in the participant's
				  condition or needs, a participant's medical need for ICF-IID level of care
				  shall be reevaluated by the licensed psychologist or certified school
				  psychologist on the multidisciplinary team, as part of the multidisciplinary
				  team process and using the form for determination of eligibility for level of
				  care in an ICF-IID.
(3) The form
				  certifying ICF-IID level of care shall be signed by the:
(a) Chairman of the multidisciplinary team,
				  who is the official representative of the local school system or local lead
				  agency; and
(b) Team's licensed
				  psychologist or certified school psychologist.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.03 - Care Planning Process

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Multidisciplinary Team.
(1) A
				  multidisciplinary team shall be convened by the local school system or local
				  lead agency in accordance with COMAR 10.09.52 to:
(a) Assess or reassess an applicant's or
				  participant's need and eligibility for Autism Waiver services;
(b) Review the applicant's or participant's
				  IEP or IFSP, as necessary; and
(c)
				  Develop or review, and revise as necessary, the applicant's or participant's
				  Autism Waiver plan of care.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.04 - Conditions for Participation - General

Current through Register Vol. 51, No. 14, July 12, 2024
To provide Autism Waiver services, the provider:
A. Shall be approved in accordance with the
				  requirements specified in this chapter;
B. Shall have a provider agreement in effect,
				  signed with the Program;
C. Shall
				  meet all the conditions for participation specified in COMAR 10.09.36, except
				  as otherwise specified in this chapter;
D. Shall assure that professional employees
				  who render or delegate services under this chapter have the appropriate
				  experience and health-related license or professional certification to meet the
				  participant's needs, including equivalency review by an accredited agency for
				  credentials obtained outside of the United States, before rendering services to
				  any Autism Waiver participant;
E.
				  Shall assure that direct care workers who render services under this chapter:
(1) Have at least a high school degree or
				  GED, including equivalency review by an accredited agency for credentials
				  obtained outside of the United States, before rendering services to any Autism
				  Waiver participant;
(2) Receive
				  adequate and appropriate training, within 60 days of employment and annually
				  thereafter, pertaining to care for children with autism spectrum disorder
				  including:
(a) Training concerning abuse,
				  neglect, and exploitation;
(b)
				  Positive behavioral interventions and restraints rendered by a MSDE approved
				  trainer,
(c) Reportable event
				  policy; and
(d) HIPAA;
(3) Work under the ongoing
				  supervision of a qualified professional employee of the provider who has annual
				  training in:
(a) Abuse, neglect,
				  exploitation;
(b) Positive
				  behavioral interventions and appropriate use of restraints rendered by a
				  MSDE-approved trainer,
(c)
				  Reportable event policy; and
(d)
				  HIPAA;
(4) Are approved
				  by the provider as qualified to meet the participant's needs;
(5) Are approved by the participant's
				  parents; and
(6) Have volunteer or
				  employment experience working with children with autism spectrum disorder or
				  other developmental disabilities as a service provider or as a family member
				  for a minimum of 100 hours, that may include:
(a) Internships;
(b) Post high school educational experience
				  with developmental disabilities;
(c) Shadowing experienced staff;
(d) Employment with a developmental
				  disabilities agency; or
(e)
				  Fulfilling the community service requirement through volunteering with a child
				  with autism or another developmental disability;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.05 - Specific Conditions for Participation - Residential Habilitation Services

Current through Register Vol. 51, No. 14, July 12, 2024
To provide the services covered under Regulation .11 of
					 this chapter, the provider agency shall:
A. Provide services in a facility that meets
				  the following requirements:
(1) Complies with
				  regulations governing residential programs licensed under the:
(a) Developmental Disabilities Administration
				  including COMAR 10.22.02 and 10.22.08; or
(b) Governor's Office for Children including
				  COMAR 14.31.06;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.06 - Specific Conditions for Participation - Therapeutic Integration Services

Current through Register Vol. 51, No. 14, July 12, 2024
To provide the service covered under Regulation .15 of this
					 chapter, the provider shall:
A. Have
				  at least 3 years of experience in providing habilitation services to children
				  with autism;
B. Employ a full-time
				  program director, to assure adequate coordination and supervision of the
				  covered services, who shall either:
(1) Hold a
				  valid Maryland certificate as a special education supervisor, principal, or
				  special educator, and have at least 3 years of successful teaching experience,
				  as verified by former employers, in regular or special education, or both, as
				  appropriate for the director's assignment; or
(2) Have at least 3 years of relevant
				  experience with counseling or supervision, as appropriate for the director's
				  assignment;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.06-1 - Specific Conditions for Participation - Therapeutic Integration Services

Current through Register Vol. 51, No. 14, July 12, 2024
To provide one or more of the services covered under
					 Regulation . 14 of this chapter, the provider shall:
A. Have at least 3 years of experience in
				  providing habilitation services to children with autism spectrum disorder or
				  other developmental disabilities;
B. Employ a full-time program director to
				  assure adequate coordination and supervision of the covered services, who
				  shall:
(1) Hold a valid Maryland certificate
				  as a special education supervisor, principal, or special educator, and have at
				  least 3 years of successful teaching experience, as verified by former
				  employers, in regular or special education, or both, as appropriate for the
				  director's assignment; or
(2) Have
				  at least 3 years of relevant experience with counseling or supervision, as
				  appropriate for the director's assignment;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.06-2 - Specific Conditions for Participation - Intensive Therapeutic Integration

Current through Register Vol. 51, No. 14, July 12, 2024
To provide one or more of the services covered under
					 Regulation .14-1 of this chapter, the provider shall:
A. Meet all the conditions of Regulation
				  .06-1 of this chapter; and
B. Have
				  an on-site direct care worker for every participant receiving one-to-one
				  intervention for intensive therapeutic integration;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.07 - Specific Conditions for Participation - Respite Care

Current through Register Vol. 51, No. 14, July 12, 2024
A. The respite care provider shall have
				  adequate liability insurance and be appropriately bonded.
B. A professional who provides respite care
				  services or supervises a direct care worker rendering the services shall be:
(1) Certified in accordance with COMAR
				  13A.12.01 as a psychologist or special educator; or
(2) Licensed as a psychologist, social
				  worker, registered nurse, professional counselor, or occupational therapist;
				  or
(3) A qualified developmental
				  disabilities professional in accordance with COMAR
				  10.09.26.01B(28);
(4) Certified nationally by the Behavior
				  Analyst Certification Board as a Board Certified Behavior Analyst; or
(5) An individual with a master's degree or
				  doctorate degree in special education or a related field and at least 5 years
				  experience in providing training or consultation in the area of autism spectrum
				  disorder or other developmental disabilities.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.08 - Specific Conditions for Participation - Family Consultation

Current through Register Vol. 51, No. 14, July 12, 2024
A. To provide the
				  services covered under Regulation .17 of this chapter, a consultant shall be:
(1) Certified in accordance with COMAR
				  13A.12.01 as a psychologist, special educator, or speech therapist;
(2) Licensed as a psychologist, certified
				  social worker, nurse psychotherapist, speech therapist, professional counselor,
				  marriage and family therapist, or occupational therapist;
(3) Nationally certified as a Board Certified
				  Behavior Analyst; or
(4) An
				  individual with a master's or doctorate degree from an accredited university in
				  special education or a related field and have at least 5 years experience
				  providing training or consulting in the area of autism spectrum disorder;
				  and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.09 - Specific Conditions for Participation - Environmental Accessibility Adaptations

Current through Register Vol. 51, No. 14, July 12, 2024
To provide the services covered under Regulation .18 of
					 this chapter, the provider shall:
A.
				  Be the store, vendor, contractor, or builder from which the adaptation is
				  purchased;
B. Be able to install
				  the adaptation, if necessary;
C. Be
				  able to service or maintain the adaptation, as necessary; and
D. If construction is involved:
(1) Have the appropriate State license as a
				  contractor or builder; and
(2) Be
				  appropriately and adequately bonded.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.10 - Specific Conditions for Participation - Adult Life Planning Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. To provide the
				  services covered under Regulation .19 of this chapter, the provider shall:
(1) Be an individual with a Master's Degree
				  in Human Services; and
(2) Have 5
				  years of full-time experience serving adults with autism
				  disabilities.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.11 - Covered Services - Residential Habilitation Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program under this regulation does not
				  cover the following:
(1) Any Medicaid State
				  Plan services which are provided by medical professionals employed by or under
				  contract with the residential habilitation provider;
(2) Room and board;
(3) Direct or indirect payments to the
				  participant's immediate family;
(4)
				  Routine care and supervision which a family is expected to provide;
(5) Activities or supervision reimbursed by a
				  source other than Medicaid; and
(6)
				  The facility's maintenance, upkeep, and improvement.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.14 - Covered Services - Therapeutic Integration Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Therapeutic integration services under
				  this regulation:
(1) Are provided at a
				  nonresidential setting separate from the home or facility where the participant
				  lives;
(2) Focus on expressive
				  therapies and therapeutic recreational activities;
(3) Include as important components the
				  development of socialization skills, enhancement of self-esteem, and behavior
				  management;
(4) Are especially
				  needed for participants who have problems with socialization, isolation,
				  hyperactivity, impulse control, and behavioral or other related
				  disorders;
(5) Are not solely
				  educational or recreational in nature, but have a therapeutic habilitative
				  orientation, as evidenced in written progress notes;
(6) Shall be culturally competent and
				  congruent with the participant's cultural norms;
(7) May include individual or group
				  counseling;
(8). Shall assure
				  coordination with the participant's other service providers, service
				  coordinator, and multidisciplinary team;
(9) Shall be guided by the participant's
				  individualized treatment plan;
(10)
				  Shall be based on an individualized written plan that identifies goals of the
				  specific therapeutic activities provided;
(11) Shall provide:
(a) General therapeutic and therapeutic
				  recreational services;
(b)
				  Behavioral management;
(c) Planning
				  for crises with the participant during a session;
(d) Socialization groups; and
(e) One or more of art, music, dance, or
				  activity therapies, as appropriate for participants;
(12) Shall have a supervisor who has been
				  trained in accordance with Regulation . 04E(3) of this chapter that:
(a) Trains and provides ongoing supervision
				  to the direct care worker rendering therapeutic integration services;
(b) Supervises the direct care worker when
				  crisis intervention services are rendered to evaluate the nature of the crisis
				  and intervenes to reduce the likelihood of reoccurrence;
(c) Plans and regularly reviews the
				  participant's therapeutic activities and behavior plan;
(d) Meets regularly with the participant and
				  family and observes the participant in the community setting; and
(e) Develops and identifies, on the
				  individualized treatment plan, the goals, interventions, and tasks that the
				  therapeutic integration direct care worker is implementing;
(13) Shall, when transportation is
				  provided:
(a) Have individualized goals for
				  transportation for the participant on the participant's treatment plan;
				  and
(b) Document the start and stop
				  times transportation is provided for each day that a participant is
				  transported;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.15 - Covered Services - Intensive Individual Support Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Intensive
				  individual support services:
(1) Are
				  intensive, one-on-one interventions with the participant provided by a direct
				  care worker;
(2) May be received by
				  the participant on a long-term basis;
(3) Are authorized in the participant's
				  Autism Waiver plan of care if the participant's behavior without this
				  intervention would require a more restrictive residential or treatment
				  setting;
(4) May be provided in the
				  participant's home or another setting except a residential or youth camp
				  facility;
(5) May be provided by
				  more than one direct care worker necessitating ongoing coordination between the
				  direct care workers;
(6) Are
				  goal-oriented and task-oriented, with interventions developed on an
				  individualized basis based on the participant's individualized treatment
				  plan;
(7) Use the home and
				  community environment as a learning experience and opportunity to illustrate
				  and model alternative ways for the participant to behave;
(8) Assist the participant in achieving
				  successful home and community living through structured support, reinforcement,
				  modeling, and behavior management, as evidenced in written progress
				  notes;
(9) Shall, when
				  transportation is provided:
(a) Have
				  individualized goals for transportation for the participant on the
				  participant's treatment plan; and
(b) Document the start and stop times
				  transportation is provided for each day that a participant is
				  transported;
(10) Are
				  intended to:
(a) Prevent or defuse
				  crises;
(b) Promote developmental
				  and social skills growth;
(c)
				  Provide the participant with behavior management skills;
(d) Give the participant a sense of security
				  and safety;
(e) Assist the
				  participant with maintaining self-sufficiency and impulse control;
(f) Improve the participant's positive
				  self-expression and interpersonal communication;
(g) Improve the participant's ability to
				  function and cooperate in the home and community;
(h) Reverse negative behaviors and attitudes;
				  and
(i) Foster stabilization;
				  and
(11) Include:
(a) One-on-one support, assistance,
				  oversight, and intervention;
(b)
				  Time-structuring activities;
(c)
				  Immediate behavioral reinforcements;
(d) Time-out strategies; and
(e) Crisis intervention techniques.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.16 - Covered Services - Respite Care

Current through Register Vol. 51, No. 14, July 12, 2024
A. Respite care:
(1) Shall consist of one-on-one interventions
				  with the participant;
(2) Shall be
				  rendered by a qualified:
(a) Professional who
				  meets the qualifications in Regulation .07B of this chapter; or
(b) Direct care worker who is supervised by a
				  qualified professional;
(3) Shall include assistance with activities
				  of daily living provided to participants who are unable to care for
				  themselves;
(4) Shall be furnished
				  on a short-term basis because of the absence of or need for relief of the
				  participant's family that normally provides the care;
(5) Shall be provided in the participant's
				  home or place of residence, or community setting, not including a residential
				  habilitation facility;
(6) May be
				  provided in a youth camp certified by the Department of Health and Mental
				  Hygiene under COMAR 10.16.06; and
(7) May be provided in a site licensed to
				  accommodate individuals for respite care by the Developmental Disabilities
				  Administration.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.17 - Covered Services - Family Consultation

Current through Register Vol. 51, No. 14, July 12, 2024
A. Family consultation shall be provided as
				  specified in the family consultation plan, and:
(1) Shall be based on family-oriented goals
				  to benefit the participant;
(2)
				  Shall be provided to one family at a time;
(3) May not include advocacy regarding a
				  participant's IEP; and
(4) May not
				  include training and supervision of direct care workers.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.18 - Covered Services - Environmental Accessibility Adaptations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Environmental
				  accessibility adaptations are those physical adaptations to the participant's
				  home, which are reasonable and medically necessary to:
(1) Prevent the participant's
				  institutionalization;
(2) Assure:
(a) The participant's health, welfare, and
				  safety; and
(b) A safe, therapeutic
				  environment;
(3) Prevent
				  the participant's self-injurious behavior; and
(4) Enable the participant to function with
				  greater independence in the home.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.19 - Covered Services - Adult Life Planning Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Adult life planning services shall be
				  provided as specified in the adult life planning treatment plan.
B. Adult life planning services shall:
(1) Result in the participant's transition
				  from Autism Waiver services to comparable, necessary adult life
				  services;
(2) Be based on the
				  participant's need for services and support after disenrollment from the Autism
				  Waiver; and
(3) Be provided only to
				  participants age 16 years old or older.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder › Section 10.09.56.20 - Conditions for Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
The Department shall reimburse for services under this
					 chapter when the services are:
A.
				  Provided to a participant who meets the qualifications for eligibility
				  specified in Regulation .02 of this chapter;
B. Preauthorized in the participant's plan of
				  care by the State Department of Education and the multidisciplinary team, as
				  being reasonable and medically necessary to prevent
				  institutionalization;
C. Provided
				  by an approved provider which meets the conditions for participation of this
				  chapter; and
D. Rendered pursuant
				  to:
(1) The relevant definition of covered
				  services in this chapter;
(2) All
				  other requirements specified in this chapter; and
(3) The Autism Waiver proposal and any
				  amendments to it approved by the Secretary of the U.S. Department of Health and
				  Human Services.