Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.61 - Medical Day Care Services Waiver › Section 10.09.61.01 - 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) "Adult Evaluation and Review Services
				  (AERS)" means an entity within the local health department which, in accordance
				  with the waiver, this chapter, and COMAR 10.09.30, assesses waiver applicants
				  and participants.
(2) "Authorized
				  representative" means a spouse, legal guardian, parent, individual with power
				  of attorney, or other individual designated in writing to the Department,
				  authorized concerning the applicant's or recipient's eligibility under this
				  chapter, to:
(a) Act on an applicant's or
				  recipient's behalf; and
(b) Assist
				  with the application or redetermination process and in other communication with
				  the Department.
(3)
				  "Centers for Medicare and Medicaid Services (CMS)" means the federal agency
				  responsible for administering Medicare, Medicaid, and several other health
				  related programs.
(4) "Department"
				  means the Department of Health and Mental Hygiene.
(5) "Eligibility" means an individual's
				  qualification for participation in the Medical Day Care Services Waiver, in
				  accordance with the requirements of this chapter.
(6) "Eligible" means that an individual is
				  determined to meet the requirements of this chapter for eligibility as a
				  Medical Day Care Services Waiver participant.
(7) "Medicaid" means the Maryland Medical
				  Assistance Program administered by the State of Maryland under Title XIX of the
				  Social Security Act, which provides comprehensive medical and other
				  health-related care for categorically eligible and medically needy
				  recipients.
(8) "Medical day care"
				  means medically supervised, health-related services provided in an ambulatory
				  setting to medically handicapped adults, who, because of their degree of
				  impairment, need health maintenance and restorative services supportive to
				  their community living.
(9)
				  "Medical Day Care Services Waiver" means the program implemented under this
				  chapter in accordance with the CMS-approved application for this waiver and any
				  amendments to it submitted by the Department and approved by CMS.
(10) "Multidisciplinary team" means the group
				  consisting of members of the medical day care center's professional staff, the
				  participant, the participant's authorized representative, healthcare
				  professionals, and waiver case managers, as appropriate, that establishes and
				  updates the participant's service plan and plan of care.
(11) "Nursing facility" means a facility that
				  is participating in the Maryland Medical Assistance Program as a nursing
				  facility pursuant to COMAR 10.09.10.
(12) "Participant" means an individual who:
(a) Meets the qualifications for
				  participation in the waiver as specified in Regulations .02 through .04 of this
				  chapter; and
(b) Is enrolled by the
				  Department to receive waiver services.
(13) "Plan of care" means a written plan
				  established by the multidisciplinary team in accordance with COMAR
				  10.12.04.22 and based on:
(a) A medical order; and
(b) An assessment of the participant's health
				  status and special care requirements.
(14) "Primary care provider" means a
				  physician, physician assistant, or nurse practitioner who is the primary
				  coordinator of care for the participant.
(15) "Program" means the Maryland Medical
				  Assistance Program.
(16) "Provider"
				  means a facility licensed under COMAR 10.12.04 furnishing medical day care
				  services through an appropriate agreement with the Department, and identified
				  as a Program provider by the issuance of an individual account
				  number.
(17) "Recipient" means a
				  person who is certified by the Department as eligible for, and is receiving,
				  Medical Assistance benefits.
(18)
				  "Service plan" means an approved document which specifies the type, amount,
				  frequency, and duration of all waiver and other Medicaid services required to
				  safely support the waiver participant in the community.
(19) "State Plan" means a comprehensive,
				  written commitment by a State Medicaid agency, submitted under § 1902(a)
				  of the Social Security Act, to administer or supervise the administration of
				  the Medical Assistance Program in accordance with federal
				  requirements.
(20) "Supplemental
				  Security Income (SSI)" means a federally administered program providing
				  benefits to needy aged, blind, and disabled individuals under Title XVI of the
				  Social Security Act, 42
				  U.S.C. §
												1381 et seq.
(21) "Waiver" means the Medical Day Care
				  Services Waiver as implemented through this chapter.
(22) "Waiver applicant" means an individual
				  who is applying for participation in the waiver to receive the services covered
				  under this chapter.
(23) "Waiver
				  year" means the State fiscal year from July 1 through June 30.