reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.05 - Covered Services for Residential Habilitation

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Department shall reimburse residential
				  habilitation services providers for those services listed below, exclusive of
				  room and board. These regulations do not limit payments, within the fiscal
				  guidelines of the Department, for room, board, and normal living expenses for
				  waiver participants.
B.
				  Habilitation. The services shall be provided as required and recommended in the
				  IHP. Residential habilitation services providers shall provide, as a minimum,
				  the following:
(1) A program of habilitation
				  which shall:
(a) Be specified in the
				  IHP,
(b) Provide training in the
				  development of self-help, daily living, self-advocacy, and survival skills,
				  and
(c) Use the principles of the
				  Developmental Model;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.06 - Covered Services for Day Habilitation

Current through Register Vol. 51, No. 14, July 12, 2024
A. Day habilitation services shall be
				  provided that are required and recommended in the waiver participant's IHP by
				  licensed day habilitation programs and shall include the services listed in
				  Regulation .05 of this chapter and in §B-D of this regulation.
B. Transportation.
(1) Transportation services shall be arranged
				  for participants by the day habilitation services center staff. The center
				  shall maximize the use of the following types of transportation services in an
				  effort to achieve the least costly, yet appropriate, means of transportation
				  for its participants:
(a) Persons who live
				  within walking distance of the day habilitation services center, and who are
				  sufficiently mobile, shall be encouraged to walk;
(b) Transportation supplied by family,
				  friends, neighbors, or volunteers;
(c) Free community transportation
				  services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.07 - Covered Services for Environmental Modifications

Current through Register Vol. 51, No. 14, July 12, 2024
A. Environmental modifications shall be
				  provided on a limited, one-time-only basis to the extent necessary to enable
				  waiver participants with physical infirmities or disabilities to live safely in
				  community homes as an alternative to institutionalization.
B. The environmental modifications are
				  limited to:
(1) Installation of bathing and
				  toilet-area grab bars in the home of a waiver participant who has physical
				  infirmities or disabilities, when these mechanisms are not already
				  installed;
(2) Minor remodeling of
				  the home to make it physically accessible for a waiver participant;
(3) Construction of access ramps and railings
				  for a waiver participant who uses a wheelchair or who has limited ambulatory
				  ability;
(4) Installation of
				  detectable warnings on walking surfaces;
(5) Adaptations to the electrical, telephone,
				  and lighting systems;
(6)
				  Life-saving equipment for waiver participants;
(7) Widening of doorways and halls for
				  wheelchair use; and
(8)
				  Installation of chair glides along stairways.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.08 - Covered Services for Respite Care

Current through Register Vol. 51, No. 14, July 12, 2024
A. Respite care may only be provided to
				  waiver participants who receive residential habilitation or residential option
				  services in their home or in an individual family care home.
B. When respite care is received in a:
(1) State residential center, it is limited
				  to a total of 45 days within any 12-month period;
(2) Community residence, it is limited to 14
				  consecutive days at a time and to a total of 28 days within any 12-month
				  period.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.08-1 - Covered Services for Supported Employment

Current through Register Vol. 51, No. 14, July 12, 2024
A. Supported employment services are
				  available to waiver participants:
(1) Who
				  previously resided in a State residential center or nursing facility;
(2) For whom competitive employment at or
				  above the minimum wage is unlikely; and
(3) Who, because of their disability, need
				  ongoing post-employment support to perform in a work setting.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.08-2 - Covered Services for Residential Option Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Residential option services are available
				  as an alternative to residential habilitation for those waiver participants
				  who:
(1) Have followed DDA's application
				  procedures according to COMAR 10.22.11;
(2) Are determined by DDA to be able to live
				  safely in a home of the waiver participant's choosing and who are in need of at
				  least one residential option service; and
(3) Elect, or have an authorized
				  representative elect in the waiver participant's behalf, to receive residential
				  option services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.08-3 - Assistive Technology and Adaptive Equipment

Current through Register Vol. 51, No. 14, July 12, 2024
A. This technology and equipment includes the
				  assistive technology and adaptive equipment necessary to enable a waiver
				  participant to live in the community and to participate in community
				  activities, when this technology and equipment is not otherwise covered by the
				  Program.
B. The following items or
				  services are included:
(1) Equipment needed
				  to adapt the waiver participant's or family's vehicle;
(2) Purchase or rental of certain types of
				  medical equipment to allow greater independence for a waiver
				  participant;
(3) A prompted
				  assisted living system for a waiver participant; and
(4) Assessments, specialized training, and
				  upkeep and repair needed in conjunction with the use of these devices and
				  equipment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.08-4 - Covered Services for Intensive Behavior Management

Current through Register Vol. 51, No. 14, July 12, 2024
Services shall be provided in accordance with COMAR
					 10.22.10.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.08-5 - Covered Services for Medical Day Care

Current through Register Vol. 51, No. 14, July 12, 2024
A. Unit of service means a day of care in
				  which the participant is certified present at the medical day care center for a
				  minimum of 4 hours.
B. Medical day
				  care services shall be provided in accordance with COMAR 10.09.07.
C. Medical day care services may be covered
				  for not more than 5 days per week.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.09 - Conditions for Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
The Department shall reimburse for services in Regulations
					 .04-.08-5 of this chapter when they are:
A. Provided to waiver participants;
B. With the exception of medical day care
				  services, contained in the waiver participant's plan of care, approved
				  initially and within 12 months after that by a:
(1) Licensed physician;
(2) Licensed physician's assistant or
				  licensed nurse practitioner in accordance with applicable law; or
(3) Qualified developmental disabilities
				  professional; and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.10 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. These
				  regulations do not cover the following services:
(1) Services available to waiver participants
				  through programs funded under the Rehabilitation Act of 1973, § 110,
				  Public Law 94-142, or Education of the Handicapped Act, § 602(16) and
				  (17);
(2) Services which are not
				  part of a waiver participant's plan of care as established by a:
(a) Licensed physician;
(b) Licensed physician's assistant or
				  licensed nurse practitioner in accordance with applicable law; or
(c) Qualified developmental disabilities
				  professional;
(3)
				  Services which are not included in Regulations .04-.08-5 of this chapter;
				  and
(4) Medical day care services
				  which are not provided in accordance with COMAR 10.09.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.11 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. Waiver
				  participants shall meet the eligibility conditions of §B of this
				  regulation, as well as Regulation .12 of this chapter.
B. To be eligible for services under the Home
				  and Community Based Services Waiver for the Developmentally Disabled, a person
				  shall:
(1) Be a recipient who, immediately
				  before placement pursuant to these regulations, is residing in a:
(a) State residential center;
(b) Nursing facility and who is determined
				  through the Preadmission Screening Annual Resident Review (PASARR) process to:
(i) Have a developmental disability,
				  and
(ii) Be in need of specialized
				  services pursuant to 42 CFR
				  §
														483.136; or
(c) Chronic care or nursing facility bed at a
				  chronic care facility; or
(d)
				  Community setting and who is determined by DDA to be at risk of placement in a
				  State residential center or in a chronic care or nursing facility bed at a
				  chronic care facility, in accordance with DDA's process for eligibility
				  determinations and for determination of service priority categories;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.12 - Medical Assistance Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definitions. In this regulation, the
				  following terms have the meanings indicated:
(1) "Aged" means a person who is 65 years old
				  or older.
(2) "Blind" means having
				  a condition in which a person is certified by an ophthalmologist as having
				  either central visual acuity of 20/200 or less in the better eye with
				  correcting glasses, or a field defect in which the peripheral field has
				  contracted to such an extent that the widest diameter of the visual field
				  subtends an angular distance of not greater than 20 degrees.
(3) "Child" means an individual who is
				  younger than 21 years old.
(4)
				  "Community spouse" means an individual who:
(a) Lives in the community outside a medical
				  institution;
(b) Is not determined
				  to meet the criteria for participation in the Waiver for Individuals with
				  Developmental Disabilities or any other waiver under § 1915(c) of Title
				  XIX of the Social Security Act; and
(c) Is married to an institutionalized
				  spouse.
(5) "Continuous
				  period of institutionalization" means:
(a) At
				  least 30 consecutive days of institutional care in a nursing facility or other
				  medical institution; or
(b) A
				  determination that a spouse meets the criteria for participation in the Waiver
				  for Individuals with Developmental Disabilities or any other waiver under
				  § 1915(c) of Title XIX of the Social Security Act.
(6) "Disabled" means the inability to perform
				  any substantial gainful activity by reason of a medically determinable physical
				  or mental impairment which is expected to result in death, or which has lasted
				  or can be expected to last for a continuous period of not less than 12
				  months.
(7) "Institutionalized
				  spouse" means an individual who is married to a community spouse and who:
(a) Is an inpatient in a nursing facility or
				  other medical institution with a length of stay exceeding 30 days; or
(b) Is determined to meet the criteria for
				  participation in the Waiver for Individuals with Developmental Disabilities or
				  any other waiver under § 1915(c) of the Social Security Act.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.13 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request
				  for Payment.
(1) All requests for payment of
				  services rendered shall be submitted according to procedures established by the
				  Department. Payment requests which are not properly prepared or submitted may
				  not be processed, but shall be returned unpaid to the provider.
(2) Requests for payment shall be submitted
				  as set forth in COMAR
				  10.09.36.04A.
(3) Requests for payment shall
				  include all units of service rendered to a waiver participant during the
				  billing period.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.14 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement are as specified in COMAR
					 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.15 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
Cause for suspension or removal and imposition of sanctions
					 is as specified in COMAR 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.16 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Appeal
				  procedures for providers are as specified in COMAR 10.09.36.
B. Persons filing appeals contending that
				  they were not informed of their choice of services or that they were denied the
				  service of their choice may file an appeal requesting a fair hearing under
				  provisions contained in 42 CFR Part 431, Subpart E.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.17 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations shall be interpreted as specified in
					 COMAR 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.27 - Home Care for Disabled Children Under a Model Waiver › Section 10.09.27.01 - 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) "Certified nursing assistant" means an
				  individual who:
(a) Is certified by the
				  Maryland Board of Nursing; and
(b)
				  Performs nursing tasks delegated by a registered nurse or licensed practical
				  nurse pursuant to Health Occupations Article, Title 8, Annotated Code of
				  Maryland.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.27 - Home Care for Disabled Children Under a Model Waiver › Section 10.09.27.02 - Licensing Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
Providers shall meet all licensing requirements specified
					 in COMAR 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.27 - Home Care for Disabled Children Under a Model Waiver › Section 10.09.27.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. General
				  requirements for participation in the Medical Assistance Program are that
				  providers shall meet all conditions for participation specified in COMAR
				  10.09.36.
B. Specific requirements
				  for participation in the Program as a provider of home care services are as
				  follows:
(1) The home care case management
				  provider shall:
(a) Have a written agreement
				  with each participant which includes the following:
(i) A description of the types, amount,
				  frequency, and duration of home care services to be provided to the participant
				  as ordered by the principal physician and specified in the approved plan of
				  care;
(ii) A statement that the
				  participant or responsible representatives shall have access to the individual
				  plan of care and shall be involved in its development and periodic
				  review;
(iii) The name, address,
				  telephone number, and Medical Assistance number of the participant;
(iv) The dated signatures of the participant
				  or legally authorized representative, and the provider
				  representative;
(v) A statement
				  that utilization of available services and selection among approved enrolled
				  providers is subject to participant choice;
(vi) A statement that services will at all
				  times be provided without discrimination with regard to race, color, age, sex,
				  national origin, marital status, or physical or mental handicap.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.27 - Home Care for Disabled Children Under a Model Waiver › Section 10.09.27.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program
				  reimburses for home care services which include the following:
(1) Shift nursing services provided by a
				  licensed registered nurse or a licensed practical nurse if:
(a) The complexity of the service or the
				  condition of a participant requires the judgment, knowledge, and skills of a
				  licensed nurse for a shift of 4 or more continuous hours;
(b) The services are delivered to the
				  participant in the participant's home or other setting when normal life
				  activities take the participant outside the home;
(c) Services are provided to a model waiver
				  participant who is 21 years old or older;
(d) Services are rendered in accordance with
				  COMAR 10.09.53;
(e) Services are
				  rendered in accordance with Health Occupations Article, Title 8, Annotated Code
				  of Maryland;
(f) Sufficient
				  documentation concerning the services provided is maintained by the registered
				  nurse or licensed practical nurse, including:
(i) 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
(ii) Signed and dated progress notes which
				  are reviewed monthly by the nurse supervisor;
(g) The nurse is not scheduled to work for
				  more than 16 consecutive hours and is off 8 or more hours before starting
				  another shift;
(h) Services are
				  rendered by a licensed registered or practical nurse certified in
				  cardiopulmonary resuscitation and the certification is renewed every 2
				  years;
(i) Services are
				  preauthorized in accordance with the criteria set forth in COMAR
				  10.09.53.06A;
				  and
(j) Supervisory visits are
				  conducted at least monthly in the participant's home or another site where the
				  participant is receiving nursing services with a minimum of two visits per year
				  with the primary nurse present;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.27 - Home Care for Disabled Children Under a Model Waiver › Section 10.09.27.05 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Requirements. Model waiver participants shall meets the financial eligibility
				  requirements under §B, C, or D of this regulation and the nonfinancial
				  requirements of §§E and F of this regulation.
B. Categorically needy eligibility recipients
				  of supplemental security income benefits under Title XVI of the Social Security
				  Act are eligible for medical assistance benefits as categorically needy
				  individuals as specified in COMAR 10.09.24.
C. Optional Categorically Needy Eligibility.
				  Individuals who do not qualify for supplemental security income benefits may
				  apply for eligibility under the provision of this section and applicable
				  sections of COMAR 10.09.24, as follows:
(1)
				  COMAR 10.09.24, exclusive of Regulations .06, .08L, .09, and .10, applies for
				  the purpose of determining eligibility as an optional categorically needy
				  individual.
(2) An individual is
				  eligible for medical assistance benefits as an optional categorically needy
				  individual if they comply with the requirements of §C(1) of this
				  regulation, including the requirement that resources not exceed the applicable
				  standard for supplemental security income eligibility, and if the income of the
				  individual before the disregards specified in §C(3) of this regulation
				  does not exceed 300 percent of the supplemental security income benefit amount
				  payable under §1611(b)(i) of the Social Security Act to an individual in
				  their own home who has no income or resources.
(3) Disregards. The following disregards are
				  subtracted from income computed according to COMAR
				  10.09.24.07A-K in
				  order to determine the amount of the income of recipients qualifying under this
				  section to be applied toward the cost of services specified in Regulation .04
				  of this chapter.
(a) The amount of the
				  medically needy income standard for one person established under COMAR
				  10.09.24.07;
(b) Amounts for incurred expenses for medical
				  or remedial care that are not subject to payment by a third party, including:
(i) Medicare and other health insurance
				  premiums, deductibles, or co-insurance charges, and
(ii) Necessary medical or remedial care
				  recognized under State law but not covered under the Program.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.27 - Home Care for Disabled Children Under a Model Waiver › Section 10.09.27.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Payment
				  procedures as set forth in COMAR 10.09.36 apply.
B. Payments.
(1) Payments shall be made directly to a
				  qualified provider.
(2) Providers
				  shall be paid the lesser of:
(a) The
				  provider's customary charge to the general public unless the service is free to
				  individuals not covered by Medicaid; or
(b) The rate established according to the fee
				  schedule published by the Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.27 - Home Care for Disabled Children Under a Model Waiver › Section 10.09.27.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement shall be as specified in COMAR
					 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.27 - Home Care for Disabled Children Under a Model Waiver › Section 10.09.27.08 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
Cause for suspension or removal and imposition of sanctions
					 shall be as specified in COMAR 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.27 - Home Care for Disabled Children Under a Model Waiver › Section 10.09.27.09 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures shall be as specified in COMAR
					 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.27 - Home Care for Disabled Children Under a Model Waiver › Section 10.09.27.10 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations shall be interpreted as specified in
					 COMAR 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.28 - Applied Behavior Analysis Services › Section 10.09.28.01 - 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) Applied Behavior Analysis (ABA).
(a) "Applied behavior analysis (ABA)" means
				  the design, implementation, and evaluation of environmental modifications using
				  behavioral stimuli and consequences to produce socially significant
				  improvements in human behavior.
(b)
				  "Applied behavior analysis (ABA)" includes the direct observations,
				  measurement, and functional analysis of the relations between environment and
				  behavior.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.28 - Applied Behavior Analysis Services › Section 10.09.28.02 - Provider Qualifications and Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. To
				  participate in the Program, a provider shall:
(1) Meet all conditions for participation as
				  set forth in COMAR 10.09.36; and
(2) If delivering services via telehealth,
				  comply with COMAR 10.09.49 and any subregulatory guidance issued by the
				  Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.28 - Applied Behavior Analysis Services › Section 10.09.28.03 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				  participant shall meet the eligibility conditions set forth in §B of this
				  regulation.
B. To qualify for ABA
				  services, a participant shall:
(1) Be younger
				  than 21 years old;
(2) Live in the
				  community;
(3) Be diagnosed with an
				  ASD by a qualified health care professional;
(4) Exhibit the presence of maladaptive
				  behavior or developmental skills deficits that significantly interferes with
				  home, school, or community activities;
(5) Be medically stable and not require
				  24-hour medical or nursing monitoring or procedures provided in a hospital or
				  an ICF-IID;
(6) Have a
				  comprehensive diagnostic evaluation by a qualified health care
				  professional;
(7) Be referred for
				  ABA services by a licensed health care professional; and
(8) Have a completed ABA treatment plan that
				  shall:
(a) Be participant-centered and
				  family-centered, culturally competent, and based on individualized
				  goals;
(b) Consider the
				  participant's age, school attendance requirements, and other daily
				  activities;
(c) Be developed by:
(i) A licensed psychologist; or
(ii) An LBA;
(d) Ensure that the interventions are
				  consistent with ABA techniques;
(e)
				  Delineate both the frequency of baseline targeted behaviors and the behavior
				  intervention plan to address the behaviors;
(f) Identify long-term goals, short-term
				  goals, and objectives that:
(i) Are
				  behaviorally defined;
(ii) Are
				  customized to the participant;
(iii) Are measurable; and
(iv) Are based upon clinical
				  observations;
(g)
				  Identify the methods that will be used to measure achievement of behavior
				  goals, objectives, and estimated timeframes;
(h) Identify the schedule of services
				  planned, including number of hours per week and the providers responsible for
				  delivering the services;
(i)
				  Include:
(i) Care coordination involving the
				  participant's parent or caregiver and other professionals as
				  applicable;
(ii) Support and
				  training of the participant's parent or caregiver;
(iii) A plan for generalization;
				  and
(iv) Measurable discharge
				  criteria.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.28 - Applied Behavior Analysis Services › Section 10.09.28.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program
				  covers the ABA services set forth in §B of this regulation when the
				  services are:
(1) Medically
				  necessary;
(2) Preauthorized by the
				  Program or its designee;
(3)
				  Delivered in accordance with the participant's treatment plan; and
(4) Supported by documentation of consent to
				  treatment from the participant or the participant's parent or
				  guardian.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.28 - Applied Behavior Analysis Services › Section 10.09.28.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. ABA services are
				  only available to participants under the EPSDT program.
B. ABA services shall be delivered in a home
				  or community setting, including a clinic, when medically necessary.
C. The provider may not bill the Program for:
(1) Services that are:
(a) Provided in:
(i) A hospital;
(ii) An institution for mental
				  disease;
(iii) An
				  ICF-IID;
(iv) A crisis residential
				  program;
(v) A residential
				  treatment center;
(vi) A 24-hour,
				  365-day residential program funded with federal, State, or local government
				  funds; or
(vii) Nonconventional
				  settings, including but not limited to resorts, spas, and
				  camps;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.28 - Applied Behavior Analysis Services › Section 10.09.28.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The provider
				  shall follow all procedures in accordance with COMAR 10.09.36.
B. The Program shall provide fee-for-service
				  reimbursement for covered ABA services to the following ABA providers who meet
				  the conditions for participation set forth in Regulation .02 of this chapter:
(1) ABA program;
(2) Individual licensed psychologist;
				  and
(3) Individual
				  LBA.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.28 - Applied Behavior Analysis Services › Section 10.09.28.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement are as set forth in COMAR
					 10.09.36.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.28 - Applied Behavior Analysis Services › Section 10.09.28.08 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
Causes for suspension or removal and imposition of
					 sanctions shall be as set forth in COMAR 10.09.36.08.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.28 - Applied Behavior Analysis Services › Section 10.09.28.09 - Appeals Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures are as set forth in COMAR 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.28 - Applied Behavior Analysis Services › Section 10.09.28.10 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter shall be interpreted as set forth in COMAR
					 10.09.36.10.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.29 - Residential Treatment Center Services › Section 10.09.29.01 - 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) "Active treatment" means inpatient
				  psychiatric services which involve implementation of a professionally developed
				  and supervised individual plan of care described in
				  42 CFR §
												441.155, that is:
(a) Developed and implemented no later than
				  14 days after admission; and
(b)
				  Designed to achieve the recipient's discharge from inpatient status at the
				  earliest possible time.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.29 - Residential Treatment Center Services › Section 10.09.29.02 - Licensure Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. In
				  order to participate in the Program a provider shall:
(1) Be licensed by the Department in
				  accordance with requirements of Health-General Article, §19-308, Annotated
				  Code of Maryland;
(2) Meet the
				  standards established by COMAR 10.07.04; and
(3) Obtain other licenses as may be required
				  by applicable State and local laws.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.29 - Residential Treatment Center Services › Section 10.09.29.03 - General Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program as a residential treatment
					 center for emotionally disturbed children and adolescents, a provider
					 shall:
A. Meet the requirements for
				  participation as defined in 42 CFR §
											440.160 (inpatient
				  psychiatric services for individuals under 21 years old) and have acute
				  psychiatric services that meet the requirements of 42 CFR Part 441, Subpart D
				  (inpatient psychiatric services for individuals under 21 years old in
				  psychiatric facilities or programs).
B. Be accredited by the Joint Commission on
				  Accreditation of Healthcare Organizations.
C. Meet the applicable conditions and
				  requirements of Regulation .04 of this chapter.
D. Apply for participation in the Program by
				  completing the application form designated by the Program.
E. Be approved for participation and be
				  assigned a provider account number by the Department.
F. Have a current written agreement with the
				  Program.
G. Verify the licenses and
				  credentials of all professionals employed by or under contract with the
				  residential treatment center to provide services.
H. Verify the recipient's
				  eligibility.
I. Provide services
				  without regard to race, color, age, sex, national origin, marital status, or
				  physical or mental handicap, unless limitations are those specifically required
				  by 42 CFR Subpart D.
J. Place no
				  restriction on a recipient's right to select providers of the recipient's
				  choice.
K. Have a written
				  individual plan of care for each recipient as specifically defined by
				  42 CFR §
											441.155, and developed by an
				  interdisciplinary team of physicians and other personnel as required in
				  42 CFR §
											441.156. The plan shall be reviewed every 30
				  days by the team to determine that services being provided are or were required
				  on an inpatient basis, and recommend changes in the plan as indicated by the
				  recipient's overall adjustment as an inpatient. The team shall be capable of:
(1) Assessing the recipient's immediate and
				  long-range therapeutic needs, developmental priorities, and personal strengths
				  and liabilities;
(2) Assessing the
				  potential resources of the recipient's family which includes the recipient's
				  parents, legal guardians, or others in whose care the recipient will be
				  released after discharge;
(3)
				  Setting treatment objectives; and
(4) Prescribing therapeutic modalities to
				  achieve the plan's objectives.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.29 - Residential Treatment Center Services › Section 10.09.29.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
The Program covers inpatient psychiatric services for the
					 diagnosis, active treatment, and care of recipients under 21 years old with
					 mental disease when the services are:
A. Medically necessary;
B. Performed under the direction of a
				  physician;
C. Certified as
				  necessary by an admissions team before the recipient's admission to the
				  residential treatment center;
D. In
				  the case of a recipient already residing in the residential treatment center,
				  certified as necessary by the team developing the individual plan of care in
				  accordance with 42 CFR
				  §
											441.153(b);
E. For the treatment of a mental illness
				  listed in COMAR
				  10.67.08.02M.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.29 - Residential Treatment Center Services › Section 10.09.29.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
The Program does not cover the following:
A. Services not specified in Regulation .04
				  of this chapter;
B. Services not
				  medically necessary;
C.
				  Investigational and experimental drugs and procedures;
D. A day of inpatient care solely for the
				  purpose of performing diagnostic tests that can be performed on an outpatient
				  basis;
E. Admissions with a primary
				  diagnosis of alcoholism, drug addiction, or severe brain damage, or the
				  following diagnoses in the ICD-9-CM,
(1)
				  294.0-Amnestic syndrome,
(2)
				  294.8-Other specified organic brain syndromes (chronic),
(3) 294.9-Unspecified organic brain syndromes
				  (chronic),
(4)
				  299.00-299.8-Psychoses with origin specific to childhood,
(5) 301.7-Antisocial personality
				  disorder,
(6)
				  302.70-302.79-Psychosexual dysfunction,
(7) 306.0-306.9-Physiological malfunction
				  arising from mental factor,
(8)
				  307.0-Special symptoms or syndromes, not elsewhere classified (NEC),
(9) 307.2 -Tics,
(10) 307.40-307.49-Specific disorders of
				  sleep of nonorganic origin,
(11)
				  307.9-Other and unspecified special symptoms or syndromes (NEC), or
(12) 316-Psychic factors associated with
				  disease classified elsewhere;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.29 - Residential Treatment Center Services › Section 10.09.29.06 - Preauthorization Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
The following procedures or services require
					 preauthorization:
A. Out-of-State
				  admissions. Adequate documentation shall be provided demonstrating that the
				  placement meets one of the conditions as follows:
(1) Effective services at an in-State
				  facility are not available;
(2) For
				  similar services, an inpatient placement is not currently available in
				  Maryland; or
(3) The recipient
				  resides out-of-State and the cost for the out-of-State service is comparable to
				  the cost of similar services in Maryland.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.29 - Residential Treatment Center Services › Section 10.09.29.08 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  If the recipient has insurance, or if any other person is obligated either
				  legally or contractually to pay for, or to reimburse, the recipient for any
				  services covered by this chapter, the provider shall seek payment from that
				  source. If payment is made by both the Program and the insurance or other
				  source, the provider shall report, within 15 days after the close of each
				  month, on a form designated by the Department, the amount paid by the Program,
				  and the insurance or the other source, whichever is less, and refund the total
				  amount of the lesser of the two payments reported to the Program at that
				  time.
B. If refund of a payment as
				  specified in §A, of this regulation, is not made, the Department will have
				  the right to reduce its current payment to the provider by the amount of the
				  duplicate payment, overpayment, or third-party payment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.29 - Residential Treatment Center Services › Section 10.09.29.09 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
A. If the
				  Department determines that a provider, any agent or employee of the provider,
				  or any person with an ownership interest in the provider has failed to comply
				  with applicable federal or State laws or regulations, the Department may
				  initiate one or more of the following actions against the responsible party:
(1) Suspension from the Program;
(2) Withholding of payment by the
				  Program;
(3) Removal from the
				  Program;
(4) Disqualification from
				  future participation in the Program, either as a provider or as a person
				  providing services for which Program payment will be claimed.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.29 - Residential Treatment Center Services › Section 10.09.29.10 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Providers filing appeals from administrative decisions made
					 in connection with these regulations shall do so according to COMAR
					 10.09.36.09A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.29 - Residential Treatment Center Services › Section 10.09.29.11 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
Except when the language of a specific regulation indicates
					 an intent by the Department to provide reimbursement for covered services to
					 program recipients without regard to the availability of federal financial
					 participation, State regulations shall be interpreted in conformity with
					 applicable federal statutes and regulations.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.29 - Residential Treatment Center Services › Section 10.09.29.12 - Cost Reporting

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  provider shall:
(1) Include, for purposes of
				  cost finding, direct and indirect costs applicable to recipient care;
(2) In the cost report, specifically identify
				  costs associated with related organizations;
(3) Maintain adequate financial records and
				  statistical data, according to generally accepted accounting principles and
				  procedures, which shall provide, as a minimum:
(a) Maintenance of:
(i) A chronological cash receipts and
				  disbursements journal in sufficient detail to show the exact nature of the
				  receipts and disbursements,
(ii) An
				  appropriate time reporting system for all personnel and proper payroll
				  authorizations and vouchers,
(iii)
				  Records on all assets capitalized and depreciation on the assets,
(iv) Appropriate records of client
				  days,
(v) Records on an accrual
				  basis,
(vi) A daily midnight bed
				  census by recipient name in a form prescribed by the Department, although use
				  of the prescribed form may be waived by the Department or its designee when a
				  provider demonstrates the ability to maintain a superior system of census
				  information,
(vii) Other records as
				  required by the Department, and
(viii) A Maryland Medical Assistance log on
				  forms prescribed by the Department;
(b) Proper reference to supporting invoices,
				  vouchers, or other forms of original evidence; and
(c) A provision for payment by check,
				  although when financial transactions involve numerous small expenditures, an
				  imprest petty cash fund may be established, provided adequate supporting
				  vouchers are maintained;
(4) Keep all records available for inspection
				  or audit by the Department or its designee at any reasonable time during normal
				  business hours, with records for each fiscal year's cost report to be retained
				  for 6 years after the filing date of the cost report specified in §A(5) of
				  this regulation;
(5) Submit
				  financial and statistical cost reports to the Department or its designee:
(a) In a prescribed form; and
(b) Within 3 months after the end of the
				  provider's fiscal year unless the:
(i)
				  Department grants the provider an extension, or
(ii) Provider discontinues participation in
				  the Program;
(6) Be considered for an extension as cited
				  in §A(5)(b)(i) of this regulation, which may be granted upon written
				  request by the provider, setting forth the specific reasons for the request, if
				  the Department determines, taking into consideration the totality of the
				  circumstances, that the request is reasonable; and
(7) If it discontinues participation, submit
				  financial and statistical data to the Department within 45 days after the
				  effective date of termination.