Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.04 - Home Health Services › Section 10.09.04.01 - 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) "Activities of daily living" means
				  functions normally associated with mobility, eating, elimination, body hygiene
				  and dressing.
(2) "Attending" means
				  the role of an individual who establishes the plan of treatment and certifies
				  the necessity for home health services for a participant following a
				  hospitalization.
(3) "Case
				  coordinator" means a licensed health professional designated by a home health
				  agency to coordinate the care of a participant.
(4) "Certified nurse midwife (CNM)" means an
				  individual who meets licensure requirements and conditions for participation as
				  a certified nurse midwife set forth in COMAR 10.09.01.
(5) "Department" means the State Department of Health
				  and Mental Hygiene, the single State agency designated to administer the
				  Maryland Medical Assistance Program under Title XIX of the Social Security Act,
				  42 U.S.C.
				  1396 et seq.
(6) "Health team" means the physician or nonphysician
				  practitioner and the home health agency personnel who render services listed in
				  Regulation .04B of this chapter to a participant.
(7) "Electronic Visit Verification (EVV)" has
				  the meaning stated in COMAR
				  10.09.36.03-2.
(8) "Face-to-face" means contact with a
				  participant that occurs in person or via audio-visual telehealth in accordance
				  with COMAR 10.09.49.
(9) "Health
				  team" means the physician or nonphysician practitioner and the home health
				  agency personnel who render services listed in Regulation .04B of this chapter
				  to a participant.
(10) "Home" means
				  the place of residence occupied by the participant, including a domiciliary
				  level facility, but other than a hospital, nursing facility, or other medical
				  institution.
(11) "Home health
				  agency" means a public or private agency or organization, or part of an agency
				  or organization, that meets the requirements for participation in
				  Medicare.
(12) "Home health aide"
				  means a person who meets the requirements of COMAR 10.07.10, and has received
				  instruction from, and renders services under the supervision of, a registered
				  nurse.
(13) "In person" means
				  contact with a participant that occurs in the physical presence of the
				  participant and the provider.
(14)
				  "Intermittent" means services which are furnished on a medically predictable
				  recurring basis.
(15) "Licensed
				  nurse" means a person who is licensed as a registered nurse or as a licensed
				  practical nurse in the jurisdiction in which the service is provided.
(16) "Medicaid average rate" means the
				  average projected per diem rate established for the Department's fiscal year as
				  specified in COMAR
				  10.09.10.07B(2)
				  multiplied by 30.
(17) "Medically
				  necessary" means that the service or benefit is:
(a) Directly related to diagnostic, preventive, curative,
				  palliative, rehabilitative, or ameliorative treatment of an illness, injury,
				  disability, or health condition;
(b) Consistent with current accepted standards of good medical
				  practice;
(c) The most cost
				  efficient service that can be provided without sacrificing effectiveness or
				  access to care; and
(d) Not
				  primarily for the convenience of the consumer, family, or
				  provider.
(18) "Medical
				  supplies" means items which are generally recognized under accepted standards
				  of medical practice as serving a therapeutic or diagnostic purpose and are
				  medically necessary to enable home health agency personnel to carry out
				  effectively the care the physician has ordered for the treatment or diagnosis
				  of the patient's illness or injury, and which are accounted for in billing
				  records.
(19) "Medicare" means the
				  insurance program administered by the federal government under Title XVIII of
				  the Social Security Act, 42
				  U.S.C. 1395 et seq.
(20) "Newborn early discharge assessment"
				  means a visit to the newborn infant and postpartum mother to observe and assess
				  the health status of both the newborn and the mother.
(21) "Nonphysician practitioner" means an
				  individual who:
(a) Is licensed as a
				  certified nurse practitioner, clinical nurse specialist, a certified
				  nurse-midwife, or a physician assistant in the jurisdiction in which the
				  service is provided; and
(b) Works
				  in collaboration with or under the supervision of the ordering
				  practitioner.
(22)
				  "Occupational therapist" means a person who is licensed or registered as an
				  occupational therapist in the jurisdiction in which the service is
				  provided.
(23) "Participant" means
				  a person who is certified as eligible for and is receiving Medical Assistance
				  benefits.
(24) "Part-time" means
				  services, usually furnished during several visits per week, but not exceeding
				  one visit per discipline per day, unless unusual circumstances are documented
				  by the physician, which are reasonable and necessary to the treatment of an
				  illness or injury.
(25) "Physical
				  therapist" means a person who is licensed or registered as a physical therapist
				  in the jurisdiction in which the service is provided.
(26) "Physician" means an individual who
				  meets the licensure requirements and conditions for participation set forth in
				  COMAR 10.09.02.
(27) "Physician
				  assistant" means an individual who meets license requirements and conditions
				  for participation set forth in COMAR 10.09.55.
(28) "Program" means the Maryland Medical Assistance
				  Program.
(29) "Progress note" means
				  a dated, written notation by a member of the health team which summarizes facts
				  about the care given and the patient's response during a given period of time,
				  specifically addresses the established goals of treatment, is consistent with
				  the patient plan of care, is written immediately following each visit, and is
				  part of the provider's permanent record for the participant.
(30) "Provider" means a person or an
				  organization who meets the requirements of Regulations .03 and .04 of this
				  chapter and who, through an appropriate agreement with the Department, has been
				  identified as a Program provider by the issuance of an individual account
				  number.
(31) "Speech-language
				  pathologist" means a person who is licensed as a speech-language pathologist in
				  the jurisdiction in which the service is provided.
(32) "Supervision" means authoritative
				  procedural guidance by a qualified person for the accomplishment of a function
				  or activity with initial direction and periodic evaluation of the act of
				  accomplishing the function or activity.
(33) "Support system" means a family member, friend, neighbor, or
				  any person who renders services, which would otherwise be covered under
				  Regulation .04 of this chapter, to the participant.
(34) "Telehealth" has the meaning stated in
				  COMAR 10.09.49.02.
(35) "Visit"
				  means the time spent rendering a covered service to a participant at home by an
				  individual employed by a home health agency.
(36) "Witness" means a person who on behalf of the participant is
				  able to personally verify at the time of service that the participant received
				  home health care.