Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.07 - Medical Day Care Services › Section 10.09.07.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. The following
				  terms have the meanings indicated.
B. Terms Defined.
(1) "Adult Day Care Assessment and Planning
				  System (ADCAPS)" means a system that is comprised of a comprehensive assessment
				  completed by a registered nurse, which is designed to evaluate the
				  participant's strengths and needs, and to facilitate the development of a
				  problem list, service plan, and plan of care.
(2) "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.
(3) "Advance
				  directive" has the meaning stated in Health-General Article, §5-601,
				  Annotated Code of Maryland.
(4)
				  "Community Settings Questionnaire" means the participant survey, completed
				  annually or when a participant changes medical day care centers or sites, that
				  is part of the State's strategy to validate provider compliance with federal
				  requirements on home and community based settings.
(5) "Daily attendance record" means a daily
				  attendance account of the physical presence of each medical day care
				  participant that:
(a) Is designed by the
				  provider;
(b) Is signed and dated
				  by the staff designated to take attendance or by the medical day care director;
				  and
(c) Includes the name, medical
				  assistance number, date of service, and arrival and departure times, of each
				  participant, including documentation of time of temporary absences.
(6) "Department" means the
				  Department of Health and Mental Hygiene.
(7) "Home and community based services
				  waiver" means a program implemented by the Department and approved by the
				  Secretary of Health and Human Services, which authorizes the waiver of certain
				  specified federal statutory requirements limiting coverage for home and
				  community based services under the Maryland Medical Assistance
				  Program.
(8) "Licensed practical
				  nurse" means an individual licensed to practice licensed practical nursing
				  under Health Occupations Article, Title 8, Annotated Code of
				  Maryland.
(9) "Licensed social
				  worker" means an individual who is licensed to practice social work under
				  Health Occupations Article, Title 19, Annotated Code of Maryland.
(10) "Maintenance services" means the
				  periodic monitoring of medically stable patients and the services provided in
				  order to maintain their health care status.
(11) "Medical Assistance Program" means the
				  Program administered by 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.
(12) "Medical day care" means medically
				  supervised, health-related services provided in an ambulatory setting to
				  medically handicapped adults, who, due to their degree of impairment, need
				  health maintenance and restorative services supportive to their community
				  living.
(13) "Medical day care
				  center" means a facility operated for the purpose of providing medical day care
				  services in an ambulatory care setting to medically handicapped adults who do
				  not require 24-hour inpatient care, but, due to their degree of impairment, are
				  not capable of full-time independent living.
(14) "Medical director" means an individual
				  who is:
(a) Licensed to practice medicine
				  under Health Occupations Article, Title 14, Annotated Code of Maryland;
				  and
(b) Employed by the medical day
				  care center either as a staff member or by a contractual agreement.
(15) "Medically handicapped adult"
				  has the meaning stated in Health-General Article, §14-301(c), Annotated
				  Code of Maryland.
(16) "Medically
				  necessary" means that a 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.
(17) "Multidisciplinary team" means the group
				  consisting of members of the medical day care center's professional staff, the
				  participant, the participant's authorized representative, health care
				  professionals, and waiver case managers, as appropriate, that establishes and
				  updates the participant's service plan and plan of care.
(18) "Occupational therapist" means an
				  individual who practices occupational therapy under Health Occupations Article,
				  Title 10, Annotated Code of Maryland.
(19) "Occupational therapy" means medically
				  prescribed treatment concerned with improving or restoring functions which have
				  been impaired by illness or injury or, when function has been permanently lost
				  or reduced by illness or injury, concerned with improving the individual's
				  ability to perform those tasks for independent functioning.
(20) "Participant" means an individual:
(a) Who is a medically handicapped adult as
				  defined under §B(14) of this regulation and who is certified by the
				  Department or its designee as requiring nursing facility services, as defined
				  under COMAR 10.09.10, but whose condition does not require institutional care
				  if medical day care services or other services that provide alternatives to
				  institutional care are available;
(b) Who is enrolled in a home and community
				  based services waiver that includes medical day care as a waiver service;
				  and
(c) Whose disabilities and
				  needs cannot be satisfactorily and totally met in an episodic ambulatory care
				  setting but require participation at least 1 day a week in a day-long
				  rehabilitative or maintenance ambulatory care program which provides a mix of
				  medical and social services and is authorized in the participant's home and
				  community based services waiver service plan.
(21) "Personal care services" means
				  assistance with activities of daily living.
(22) "Physical therapist" means an individual
				  licensed to practice physical therapy under Health Occupations Article, Title
				  13, Annotated Code of Maryland.
(23) "Physical therapy" means treatment of
				  disease and injury through use of:
(a)
				  Therapeutic exercise and modalities of heat, cold, water, light, electricity,
				  massage and radiant energy (other than roentgen rays, radium or use of
				  electricity for cauterization in surgery); or
(b) Administration and interpretation of
				  tests and measurements of neuromuscular and musculoskeletal functions;
				  or
(c) Both §B(22)(a) and (b)
				  of this regulation.
(24) "Plan of care"
				  means a written plan established by the multidisciplinary team in accordance
				  with COMAR
				  10.12.04.22, based upon a medical
				  order and an assessment of the participant's health status and special care
				  requirements.
(25) "Preventive
				  services" means those services designed to prevent the occurrence and/or
				  progression of disease at an early stage before complications and serious
				  disabilities develop.
(26) "Primary
				  care provider" means a physician, physician assistant, or nurse practitioner
				  who is the primary coordinator of care for the participant.
(27) "Program" means the Maryland Medical
				  Assistance Program.
(28) "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 provider by the issuance of an individual account number.
(29) "Provider agreement" means a contract
				  between the Department of Health and Mental Hygiene and the provider of medical
				  day care, specifying the services to be performed, methods of operation,
				  financial and legal requirements which shall be in force before Program
				  participation in medical day care.
(30) "Recipient" means a person who is
				  certified for, and is receiving, Medical Assistance benefits.
(31) "Referral" means to direct a
				  participant, family member, or caretaker to the appropriate community agency or
				  health care provider, or to contact the agency or provider on the participant's
				  behalf, to facilitate access to needed services.
(32) "Registered nurse" means an individual
				  licensed to practice as a registered nurse under Health Occupations Article,
				  Title 8, Annotated Code of Maryland.
(33) "Secretary" means the Secretary of
				  Health and Mental Hygiene.
(34)
				  "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.
(35) "Significant change in condition" means
				  a change in the participant's physical, mental, or psychological status as
				  identified by the comprehensive assessment performed by a registered nurse.
(36) "Specially equipped vehicles"
				  means those vehicles used to transport participants with severe physical
				  disabilities that limit mobility.
(37) "Supervision" means initial direction or
				  periodic monitoring of the actual activity.