Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 22 - DEVELOPMENTAL DISABILITIES › Chapter 10.22.01 - Definitions › Section 10.22.01.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this
				  subtitle, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Administration" means the Developmental
				  Disabilities Administration of the Department of Health and Mental
				  Hygiene.
(2) "Alternative living
				  unit (ALU)" means a residence owned, leased, or operated by a licensee that:
(a) Provides residential services for
				  individuals who, because of a developmental disability, require specialized
				  living arrangements;
(b) Admits not
				  more than 3 individuals; and
(c)
				  Provides 10 or more hours of supervision per unit, per week.
(3) "Assistive technology" means
				  the technology necessary to enable the individual to live successfully in the
				  community.
(4) "Aversive technique"
				  means the use of painful or noxious stimuli to the body, which is intrusive to
				  the individual's physical, mental, or emotional well-being, used to terminate
				  challenging or maladaptive behavior.
(5) "Barrier" means an obstacle preventing or
				  inhibiting an individual from receiving services and supports in the most
				  integrated setting appropriate to meet the individual's needs.
(6) "Behavior plan (BP)" means a plan
				  designed to modify behavior through the use of clinically accepted
				  techniques.
(7) Behavioral
				  Consultation.
(a) "Behavioral consultation"
				  means on-site observation, assessment, and evaluation of the interaction
				  between the individual and the individual's caregiver in the context of the
				  individual's existing programs.
(b)
				  "Behavioral consultation" includes:
(i)
				  Recommendations regarding the structure of the program and appropriate
				  activities and services; and
(ii)
				  Consultation, as needed, with clinical professionals.
(8) "Behavioral emergency" means a
				  situation in which an individual's behavior appears to present imminent danger
				  to the individual or to others.
(9)
				  "Behavioral respite" means relief services provided by a community residential
				  licensee to meet an individual's behavioral needs.
(10) "Care provider" means an individual who
				  is responsible for the daily operation of an individual family care home as
				  defined in §B(26) of this regulation.
(11) "Challenging behavior" means those
				  behaviors exhibited by an individual which:
(a) Are harmful, destructive, or socially
				  unacceptable; and
(b) Necessitate
				  being addressed in the individual's individual plan.
(12) "Chemical restraint" means the use of an
				  injectable medication as an intervention in a behavioral emergency.
(13) "Community supported living arrangement
				  home" means a residence:
(a) Which is rented
				  or owned by an individual or the individual's family or proponent or held in
				  trust for an individual;
(b) Where
				  an individual lives as a roommate without the individual's name appearing on
				  the lease or title; or
(c) Where
				  the licensee is the guarantor of rental or mortgage payments for an individual
				  receiving CSLA services.
(14) Community Supported Living Arrangements.
(a) "Community supported living arrangements
				  (CSLA)" means services to assist an individual in nonvocational activities
				  necessary to enable that individual to live in the individual's own home,
				  apartment, family home, or rental unit, with
(i) No more than two other nonrelated
				  recipients of these services; or
(ii) Members of the same family regardless of
				  their number.
(b)
				  "Community supported living arrangements (CSLA)" includes personal support
				  services, as defined under the Administration's Home and Community-Based
				  Services Waiver with the Centers for Medicare and Medicaid Services, including
				  but not limited to the following services:
(i) Personal assistance services;
(ii) Supports that enhance the individual's
				  opportunity for community participation and to exercise choice and control over
				  the individual's own life;
(iii)
				  Training, habilitation, and other services necessary to assist the individual
				  in achieving and maintaining increased integration, interdependence, and
				  productivity; and
(iv) 24-hour
				  emergency assistance.
(c) "Community supported living arrangements
				  (CSLA)" also includes other services set forth in the Administration's Home and
				  Community-Based Services Waiver with the Centers for Medicare and Medicaid
				  Services as distinct from personal support services, including but not limited
				  to the following:
(i) Assistive
				  technology;
(ii) Adaptive
				  equipment;
(iii) Resource
				  coordination;
(iv) Environmental
				  modifications;
(v) Respite;
				  and
(vi) Other services as approved
				  by the Secretary or the Secretary's designee.
(15) "Department" means the Department of
				  Health and Mental Hygiene.
(16)
				  "Developmental disability" means a severe chronic disability of an individual
				  that:
(a) Is attributable to a physical or
				  mental impairment, other than the sole diagnosis of mental illness, or to a
				  combination of mental and physical impairments;
(b) Is likely to continue
				  indefinitely;
(c) Is manifested in
				  an individual younger than 22 years old;
(d) Results in an inability to live
				  independently without external support or continuing and regular assistance;
				  and
(e) Reflects the need for a
				  combination and sequence of special, interdisciplinary, or generic care,
				  treatment, or other services that are individually planned and coordinated for
				  the individual.
(17)
				  "Director" means Director of the Developmental Disabilities Administration or
				  the Director's designee.
(18)
				  "Eligible for individual support services" means an individual with a severe
				  chronic disability that is:
(a) Attributable
				  to a physical or mental impairment other than the sole diagnosis of mental
				  illness, or to a combination of mental and physical impairments; and
(b) Likely to continue
				  indefinitely.
(19)
				  "Environmental modification" means physical adaptations to an individual's home
				  that are provided to enable the individual to live safely at home.
(20) "Foreign corporation" means an entity
				  that is properly organized, chartered, and incorporated under the laws of a
				  state other than Maryland.
(20-1) "Forensic residential center (FRC)" means a facility
					 that is:
(a) Licensed to provide a
				  continuum of integrative services to individuals with intellectual
				  disabilities:
(i) Ordered by the court for an
				  evaluation or to be confined;
(ii)
				  Court-committed for care or treatment to the Department as incompetent to stand
				  trial or not criminally responsible who are dangerous as a result of
				  intellectual disabilities; or
(iii)
				  On conditional release and returned to the facility either voluntarily or on
				  hospital warrant;
(b) A
				  related institution as defined in Health-General Article, §19-301(o),
				  Annotated Code of Maryland; and
(c)
				  Not an extended care or comprehensive rehabilitation facility.
(21) "Functional analysis" means a
				  method of investigation which involves the systematic, experimental
				  manipulation of analogue conditions, and precise measurement of challenging
				  behavior, in order to determine the behavioral consequences which maintain the
				  challenging behavior.
(22)
				  "Functional assessment" means a nonexperimental method, such as systematic
				  observations and questionnaires, designed to assist in the formulation of an
				  educated guess concerning the behavioral consequences which maintain
				  challenging behavior.
(23) "Generic
				  services" means services which are available to the community at
				  large.
(24) "Goal" means measurable
				  supports or training to achieve an outcome.
(25) "Group home" means a residence owned,
				  leased, or operated by a licensee that:
(a)
				  Provides residential services for individuals who, because of a developmental
				  disability, require specialized living arrangements;
(b) Admits at least four, but not more than
				  eight individuals; and
(c) Provides
				  10 or more hours of supervision per week.
(26) "Individual" means a person eligible to
				  receive services from the Developmental Disabilities Administration.
(27) "Individual family care (IFC) home"
				  means a private, single family residence which provides a home for up to three
				  individuals with developmental disabilities, who are unrelated to the care
				  provider.
(28) "Individual plan
				  (IP)" means a plan that specifies assessments, services, supports, and training
				  required by the individual.
(29)
				  "Integrated work setting" means an environment in which individuals with
				  developmental disabilities and individuals without developmental disabilities
				  work together.
(30) "Licensed
				  capacity" means the number of individuals for whom a licensee is authorized to
				  provide services at a single site.
(31) "Licensed certified social worker" means
				  a person authorized to practice social work under Health Occupations Article,
				  Title 19, Annotated Code of Maryland.
(32) "Licensed health care practitioner"
				  means a person licensed to provide health care within the scope of Health
				  Occupations Article, Annotated Code of Maryland.
(33) "Licensed or certified professional
				  counselor" means a person who is authorized to practice professional counseling
				  under Health Occupations Article, Title 17, Annotated Code of
				  Maryland.
(34) "Licensed physician"
				  means a person who is authorized to practice medicine under Health Occupations
				  Article, Title 14, Annotated Code of Maryland.
(35) "Licensed psychologist" means a person
				  who is authorized to practice psychology under Health Occupations Article,
				  Title 18, Annotated Code of Maryland.
(36) "Licensee" means an agency that has been
				  granted a license by the Administration to provide services to
				  individuals.
(37) "Management of
				  disruptive behavior" means the Administration-approved curriculum for managing
				  challenging or aggressive behavior.
(38) "Mechanical restraint" means a
				  mechanical device which restricts the free movement of an individual, such as a
				  safety coat or posey mittens.
(39)
				  "Mechanical support" means a mechanical device used to:
(a) Support an individual's proper body
				  position, balance, or alignment, such as splints, wedges, bolsters, or lap
				  trays; or
(b) Protect an individual
				  with a continuing medical condition from sustaining an injury, for example, the
				  use of protective head gear for an individual with epilepsy.
(40) "Most integrated setting"
				  means a setting that enables an individual with a disability to interact with
				  nondisabled individuals other than staff to the fullest extent
				  possible.
(41) "Natural supports"
				  means family, friends, co-workers, and community members who provide informal
				  assistance to the individual to enable the individual to live and work in the
				  community.
(42) "Outcome" means
				  tangible results of goals that reflect the desired quality of life as defined
				  by the individual.
(43) "Personal
				  assistance" means help with activities of daily living which does not have an
				  habilitation objective.
(44)
				  "Physical restraint" means a manual method used to restrict the free movement
				  of an individual, such as therapeutic hold.
(45) "Plan of correction (POC)" means the
				  licensee's proposed response to findings of noncompliance identified by the
				  Licensing and Certification Administration or the Administration.
(46) "PRN orders" means a preauthorized order
				  to administer a specific behavior management technique or medication to modify
				  behavior which is administered on an as-needed basis when a challenging
				  behavior is exhibited.
(47)
				  "Program service plan (PSP)" means the document submitted as part of the
				  licensure application that delineates the rationale, scope, staffing, training,
				  setting, and location for the services or supports to be provided.
(48) "Proponent" means a person who has a
				  legitimate interest in the welfare of an individual receiving services from a
				  licensee.
(49) "Psychology
				  associate" means a person who may perform psychological services under certain
				  conditions as specified in Health Occupations Article, Title 18, Annotated Code
				  of Maryland.
(50) "Record" means
				  the cumulative body of information the licensee has on file regarding an
				  individual.
(51) "Resource
				  coordinator" means a professional:
(a)
				  Designated by the Developmental Disabilities Administration;
(b) Not employed by a direct service
				  provider;
(c) Who has knowledge and
				  experience in community supports for individuals with developmental
				  disabilities; and
(d) Who meets the
				  requirements of COMAR 10.22.09.
(52) "Respite" means relief services provided
				  to the family or care provider to meet planned or emergency
				  situations.
(53) "Restrictive
				  technique" means a technique that is implemented to impede an individual's
				  physical mobility or limit free access to the environment, including but not
				  limited to physical, mechanical, or chemical restraints or medications used to
				  modify behavior.
(54) "Seclusion"
				  means the involuntary placement of an individual alone in a room.
(55) "State residential center (SRC)" means a
				  State owned and operated facility for individuals with intellectual
				  disabilities.
(56) "Supports" means
				  the assistance provided to individuals or their families to enable greater
				  participation in the community and enhanced quality of life.
(57) "Target behaviors" means those behaviors
				  identified by the team to be changed by implementing a behavior plan.
(58) "Team" means those persons, including
				  the individual, proponent, licensee representatives, resource coordinator, and
				  others involved in the development of the IP.
(59) "Temporary augmentation of staff" means
				  supplemental staff utilized on a time-limited basis to work with an individual
				  exhibiting challenging behavior.
(60) "Treating professional" means an
				  individual designated by the facility director who is involved in the
				  implementation of the IP.
(61)
				  "Verbal abuse" means disrespectful shouting, screaming, swearing, name calling,
				  or other verbal activity directed toward an individual.
(62) "Vocational assessment" means a method
				  of determining an individual's job and career preferences and the skills and
				  training necessary to accomplish these preferences.
(63) "Volunteer work" means work performed by
				  an individual without pay.
(64)
				  "Written plan of habilitation" means, for State residential centers, a
				  component of the IP as described in COMAR
				  10.22.05.02B(14)
				  and .03C.