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 10.09.48.01 - 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) "Annually" means within 365
				  days.
(2) "Applicant" means the
				  individual who files an application for services with the DDA.
(3) "Community Coordination Services" means
				  provision of core services to individuals receiving ongoing DDA funding for
				  comprehensive community services.
(4) "Community resources" means generic,
				  local, State, or federal programs, services, benefits, and supports.
(5) "Comprehensive assessment" means an
				  assessment of the applicant's needs and supports to enable the DDA to determine
				  the applicant's eligibility for DDA funding of comprehensive community
				  services.
(6) Comprehensive
				  Community Services.
(a) "Comprehensive
				  community services" means services funded by the DDA for residential, day,
				  employment, or supports services.
(b) "Comprehensive community services" does
				  not mean funding for low intensity support services or coordination of
				  community services.
(7)
				  "Contact" means a face-to-face meeting, phone conversation, or written
				  correspondence related to the covered services in this chapter.
(8) "Coordination of community services"
				  means the provision of targeted case management services that assist
				  participants in gaining access to the full range of medical assistance
				  services, as well as access to any additional needed generic, medical, social,
				  habilitative, employment, recreational, housing, financial, counseling, legal,
				  educational, and other support services.
(9) "Coordinator of community services" means
				  an individual employed by the coordination of community services agency to
				  assist participants in selecting obtaining, and monitoring the most responsive
				  and appropriate services and supports.
(10) "Coordination of community services
				  supervisor" means an individual who is employed to oversee coordination of
				  community services and performance of coordinators of community
				  services.
(11) "Core services"
				  means the following community services:
(a)
				  Comprehensive assessment;
(b)
				  Development of the person-centered plan;
(c) Referrals and related activities;
				  and
(d) Monitoring and
				  follow-up.
(12)
				  "Critical incident" means a reportable event that presents an immediate and
				  serious threat of injury, harm, impairment, or death of an
				  individual.
(13) "Department" means
				  the Department of Health and Mental Hygiene, which is the single State agency
				  designated to administer the Maryland Medical Assistance Program pursuant to
				  Title XIX of the Social Security Act,
				  42 U.S.C. §
												1396 et seq.
(14) "Developmental Disabilities
				  Administration (DDA)" means that agency of the Department which, under Health
				  General Article, Title 7, Annotated Code of Maryland, is charged with the
				  responsibility for providing services to individuals with developmental
				  disability.
(15) "Developmental
				  disability" has the same meaning as set forth in HealthGeneral Article, §
				  7-101, Annotated Code of Maryland.
(16) "Entity" means a facility, agency,
				  organization, department, office, corporation, partnership, group, or
				  individual.
(17) "Generic" means
				  programs, services, or supports which are available to the community at
				  large.
(18) "Goal" means measurable
				  activity that is required to achieve progress toward an outcome.
(19) "Medicaid waiver programs" means any
				  program under § 1915(c) of the Social Security Act.
(20) "Medical Assistance Program" means the
				  program of comprehensive medical and other health-related care for indigent and
				  medically indigent persons.
(21)
				  "Most integrated setting" means a setting that enables a participant with a
				  disability to interact with nondisabled individuals other than staff to the
				  fullest extent possible.
(22)
				  "Outcome" means tangible results of goals that reflect the desired quality of
				  life as defined by the individual.
(23) "Participant" means an individual who meets the
				  qualifications for participation in coordination of community services as
				  specified in Regulation .03 of this chapter.
(24) Person-Centered Plan.
(a) "Person-centered plan" means a written
				  plan that is developed through a planning process driven by the participant
				  with a developmental disability to:
(i)
				  Identify the participant's goals and preferences;
(ii) Identify services to support the
				  participant in pursuing the participant's personally defined outcomes in the
				  most integrated community setting;
(iii) Direct the delivery of services that
				  reflect the participant's personal preferences and choice; and
(iv) Identify the participant's specific
				  needs that must be addressed to ensure the participant's health and
				  welfare.
(b)
				  "Person-centered plan" includes an individual plan as referenced in COMAR
				  10.22.
(25)
				  "Person-directed supports" means service and supports that empower the
				  participant, and the legally authorized representative on the participant's
				  behalf, to direct the development and implementation of a plan of supports and
				  services that meet the participant's personal goals.
(26) Place of Service.
(a) "Place of service" means the place where
				  participants receive services.
(b)
				  "Place of service" includes but is not limited to the participant's home, day
				  program, group home, alternate living arrangement, or place of
				  employment.
(27)
				  "Program" means the Medical Assistance Program as defined in COMAR 10.09.36.01.
(28) "Provider" means an entity
				  that meets the conditions for participation specified in Regulation .04 of this
				  chapter, and is authorized by DDA to provide coordination of community
				  services.
(29) "Reportable events"
				  means specified incidents and complaints noted in the DDA Policy on Reportable
				  Incidents and Investigations (PORII), as required under COMAR
				  10.22.02.01 and established to
				  ensure the health, safety, and welfare of participants receiving services from
				  DDA-funded providers.
(30)
				  "Representative" means a person who:
(a) Is
				  chosen by the participant to represent the participant's needs and may include:
(i) A family representative;
(ii) An informal caregiver; or
(iii) Any other individual chosen by the
				  participant; or
(b) Is
				  recognized by the DDA as a legally appointed guardian qualified to act on the
				  participant's behalf with respect to services covered under this
				  chapter.
(31) "Service
				  record" means all past and current health, eligibility, request for service
				  change, service funding plan, person-centered plan, and coordination of
				  community services documents and records.
(32) "Targeted case management" means an
				  optional service allowed under federal Medicaid rules which includes services
				  to assist target populations of Medicaid participants to gain access to needed
				  medical, social, educational, and other services.
(33) Targeted Case Management.
(a) "Targeted case management" means an
				  optional service allowed under federal Medicaid rules which includes services
				  to assist target populations of Medicaid participants to gain access to needed
				  medical, social, educational, and other services.
(b) "Targeted case management" includes:
(i) Performance of a comprehensive assessment
				  and periodic reassessment of participant needs, to determine the need for any
				  medical, educational, social, or other services;
(ii) Provision of waiting list coordination
				  services;
(iii) Provision of
				  community coordination services; and
(iv) Provision of transition coordination
				  services.
(34) "Transition Coordination Services" means
				  provision of core services to participants transitioning to the community from
				  an institution.
(35) "Waiting list"
				  means individuals found eligible for services in the crisis resolution, crisis
				  prevention, or current request priority category as set forth in COMAR
				  10.22.12.07B.
(36) "Waiting list" means
				  participants found eligible for services in the crisis resolution, crisis
				  prevention, or current request priority category as set forth in COMAR
				  10.22.12.07B.
(37) "Waiting List Coordination
				  Services" means provision of core services to participants on the DDA waiting
				  list.