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 10.09.46.09-1 - Covered Services - Individual Support Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Individual
				  support services, as defined in Regulation .01B of this chapter, shall be
				  provided in a participant's own home or their community.
B. The service involves the training and
				  development of compensatory strategies and skills such that a waiver
				  participant may learn to initiate and complete activities on their own to fully
				  engage in their community, live independently, and compensate for cognitive and
				  behavioral deficits related to short term memory, planning, attention,
				  concentration, impulse control, and judgment, with the intended goal of
				  minimizing the level of staff support the individual needs over time and
				  preventing institutionalization.
C.
				  The provider shall provide services in collaboration with the participant's
				  other TBI waiver services, clinical treatment, and health and medical
				  services.
D. Individual support
				  services shall be provided as pre-authorized by BHA and included in the waiver
				  plan of care and provided in 15-minute units.
E. Services may be provided in-person or via
				  virtual supports as determined appropriate by the Department.
F. Providers delivering services via virtual
				  supports:
(1) Shall ensure the participant's
				  rights of privacy, dignity, and respect, and freedom from coercion and
				  restraint; and
(2) May provide
				  direct support via virtual supports according to the following requirements and
				  restrictions:
(a) Virtual supports do not
				  isolate the participant from integration in the community or interacting with
				  people without disabilities;
(b)
				  The use of virtual supports is based on the participant's preferences, has been
				  agreed to by the participant and their team, and is outlined in the Plan of
				  Service (POS);
(c) Virtual supports
				  may not be used for the provider's convenience;
(d) The use of virtual supports and the
				  service delivery method shall be documented per State requirements, policies,
				  and guidance;
(e) Text messaging
				  and emailing do not constitute virtual supports;
(f) The virtual supports shall comply with
				  the requirements of the Health Insurance Portability and Accountability Act of
				  1996 (HIPAA), as amended by the Health Information Technology for Economic and
				  Clinical Health (HITECH) Act, and their applicable regulations to protect the
				  privacy and security of the participant's protected health
				  information;
(g) ISS may not be
				  provided entirely via virtual supports;
(h) Virtual supports shall allow flexibility
				  of service delivery and supplement in-person direct supports as recommended and
				  monitored by the case manager;
(i)
				  The provider shall develop, maintain, and enforce written policies, approved by
				  BHA, which address their procedures for ensuring:
(i) The participant's rights of privacy,
				  dignity, and respect, and freedom from coercion and restraint;
(ii) The virtual supports meet applicable
				  information security standards; and
(iii) Their provision of virtual supports
				  complies with applicable laws governing individuals' right to
				  privacy;
(j) The provider
				  shall train direct support staff on their policies and advise participants and
				  their person-centered planning teams regarding the policies that indicate how a
				  participant's needs, including health and safety, will be addressed safely via
				  virtual supports;
(k) The virtual
				  supports shall meet all federal and State requirements, policies, guidance, and
				  regulations;
(l) The provider shall
				  ensure that virtual supports are accessible to the participant and provide
				  in-person trainings, prior to the initiation of virtual services, to help the
				  participant learn to use the required technology independently; and
(m) Video cameras/monitors are not permitted
				  in bedrooms and bathrooms.