Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.11 - Covered Optional Services - Private Duty Nursing, Certified Nursing Assistant, Certified Nursing Assistant Certified as a Certified Medication Technician, Home Health Aide and Home Health Aide Certified as a Certified Medication Technician

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program
				  shall cover shift nursing services provided by an RN or LPN when:
(1) The services are more individualized and
				  continuous than what is available under the home health program;
(2) The services are delivered to the
				  participant in the participant's home, in school, or in other normal life
				  activity setting or settings which occur outside the participant's
				  home;
(3) Services are provided to
				  a REM participant who is 21 years old or older;
(4) Services are determined medically
				  necessary for a participant after the provider has completed an initial nursing
				  assessment that reflects the participant's need for an awake and alert
				  caregiver;
(5) The participant has
				  at least one caregiver willing and able to accept responsibility for the
				  participant's care when the nurse, CNA, or HHA is not available;
(6) The caregiver provides documentation of
				  each of the following when applicable:
(a) The
				  caregiver's work schedule along with commuting times;
(b) The caregiver's school attendance as
				  defined in Regulation .02 of this chapter along with commuting times;
				  and
(c) Emergency circumstances, as
				  determined by the Department, including but not limited to the inability of the
				  primary caregiver to provide care due to hospitalization or an acute
				  debilitating illness for up to a 60-day period;
(7) Services are provided only in the absence
				  of the willing and able caregiver during the sleeping hours and during the
				  times documented in §A(6) of this regulation;
(8) Services are rendered in accordance with
				  Health Occupations Article, Title 8, Annotated Code of Maryland;
(9) Sufficient documentation concerning the
				  services provided is maintained by the RN or LPN including:
(a) Verification of the participant's receipt
				  of services as documented by the participant's signature or the signature of
				  the participant's witness on the provider's official forms; and
(b) Signed and dated progress notes which are
				  reviewed monthly by the RN supervisor;
(10) The nurse's shift is limited to not more
				  than a total of 60 hours per week or 16 consecutive hours and the nurse is off
				  8 or more hours before starting another shift unless otherwise authorized by
				  the Department;
(11) Services are
				  rendered by an RN or an LPN who is certified in cardiopulmonary resuscitation
				  and the certification is renewed every 2 years; and
(12) Monthly supervisory visits of an RN or
				  an LPN are:
(a) Conducted and documented by an
				  RN supervisor; and
(b) Based on
				  acceptable standards of practice.