Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 22 - DEVELOPMENTAL DISABILITIES › Chapter 10.22.17 - Fee Payment System for Licensed Residential and Day Programs › Section 10.22.17.02 - 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) "Add-on component" means one or more
				  units of service, each one of which includes funding for direct service and
				  other nondirect costs not covered by the sum of the provider and individual
				  components.
(2) "Administration"
				  means the Developmental Disabilities Administration.
(3) "Agreement" means a legal document
				  setting forth the rights and responsibilities of the Administration and the
				  provider under the fee payment system.
(4) "Appropriate evaluation" means the
				  assessment of an individual by a qualified developmental disability
				  professional using accepted professional standards to document the presence of
				  a:
(a) Developmental disability as defined in
				  Health-General Article, §7-101(e), Annotated Code of Maryland;
				  or
(b) Severe, chronic disability
				  that qualifies the individual for support services as defined in Health-General
				  Article, §7-403(c), Annotated Code of Maryland.
(5) "Attendance day" means, for:
(a) Day habilitation and vocational services,
				  when the individual is present in the program for at least 4 hours a day during
				  a regularly scheduled period of operation, with 6 to 8 hours per day as the
				  service goal, and with Administration approval of fewer than 6 hours per day
				  provided the individual plan indicates this lower level of service is
				  necessary;
(b) Residential
				  programs, as of October 1, 2001, when the individual is present for at least 6
				  hours in the home or spends the night in the home, which is the primary
				  residence for the individual; and
(c) Supported employment, when the individual
				  is engaged in supported employment for at least 4 hours a day, with 6 to 8
				  hours per day as the service goal, and with Administration approval of fewer
				  than 6 hours per day provided the individual plan indicates this lower level of
				  service is necessary.
(6) "Copayment" means that portion of the
				  provider's charge for services for which the individual is
				  responsible.
(7) "Cost report"
				  means a document on a form approved by the Administration that details a
				  provider's allowable operating expenses for a single fiscal year using
				  prescribed cost centers.
(8)
				  "Department" means the Department of Health and Mental Hygiene.
(9) "Day habilitation" means services for
				  individuals with developmental disabilities licensed under COMAR 10.22.07 and
				  for purposes of COMAR 10.09.26 includes prevocational services.
(10) "Direct services" means staff services
				  provided directly to the individual.
(11) "Existing service" means a service
				  continuously provided to an individual by the same provider beginning on or
				  before June 30, 1998.
(12)
				  "Existing supported employment service" means a service provided continuously
				  to an individual by the same provider beginning before July 1, 2001.
(13) "Fee payment system" means the system
				  for rate setting and reimbursement for services provided by licensed
				  residential, day habilitation, vocational, and supported employment
				  programs.
(14) "Fiscal management
				  services (FMS)" means a person approved by the Administration and designated as
				  an Organized Health Care Delivery System under COMAR 10.22.20 that:
(a) Assists individuals and families in
				  managing their funds and paying for services; and
(b) Is responsible for submitting financial
				  reports to the individual and Administration.
(15) "Funding level" means the total annual
				  amount of money awarded by the Administration under the fee payment system or
				  under a contract for a day habilitation, vocational, or residential
				  program.
(16) "Individual" means a
				  person who receives services funded by the Administration from a residential,
				  day habilitation, vocational, or supported employment program.
(17) "Individual component" means one of the
				  two parts of the rate that is based on an assessment of an individual's level
				  of need as documented in the approved individual information form.
(18) "Individual indicator rating scale"
				  means the instrument, approved by the Administration, to assess an individual's
				  level of need.
(19) "Individual
				  information form" means the form, approved by the Administration, used for
				  documenting the results of an assessment using the individual indicator rating
				  scale.
(20) "Individual plan (IP)"
				  means the written plan of specific action that is developed and modified by an
				  individual's team.
(21)
				  "Individual's team" means:
(a) The
				  individual;
(b) The individual's
				  proponent;
(c) Representatives of
				  the licensee;
(d) The resource
				  coordinator; and
(e) Others the
				  individual may choose to develop the IP.
(22) "New individuals" means those
				  individuals starting service with a new provider.
(23) "Personal needs allowance" means the
				  amount per month that a provider must allow an individual to retain from their
				  monthly income for personal needs.
(24) "Professional services" means services
				  provided by an individual authorized to perform these services under the Health
				  Occupations Article, Annotated Code of Maryland.
(25) "Provider" means a person that is
				  licensed and funded by the Administration to provide services to individuals
				  under COMAR 10.22.08 or 10.22.07.
(26) "Provider component" means one of two
				  parts of the rate that reimburses providers for indirect expenses.
(27) "Rate" means the reimbursement amount
				  for an attendance day of service.
(28) "Regional director" means the designee
				  of the Director of the Administration who is responsible for the administration
				  of services in an assigned area of the State.
(29) "Residential program" means services for
				  individuals with developmental disabilities licensed under COMAR
				  10.22.08.
(30) "Self-directed
				  services" means services, as approved by the Administration:
(a) That an individual arranges;
				  and
(b) For which the individual
				  reimburses the provider.
(31) "Service approval" means the
				  Administration's written approval for an individual to receive services from a
				  provider.
(32) "Supplemental
				  security income (SSI)" means income paid to the aged, blind, or disabled under
				  Title XVI of the Social Security Act.
(33) "Supplemental services" means
				  preauthorized services that directly benefit the individual and are not covered
				  by the rate.
(34) "Support broker"
				  means a person employed by individuals and families, who have been determined
				  eligible by the Administration, that helps them:
(a) Decide what services and supports are
				  best for them; and
(b) Access and
				  manage the chosen services and supports.
(35) Supported Employment.
(a) "Supported employment" means services
				  licensed under COMAR 10.22.07 when the individual is employed outside of the
				  individual's home.
(b) "Supported
				  employment" includes volunteer work when the volunteer work is for job training
				  and preparation.
(36)
				  "Unit of service" means:
(a) For day
				  habilitation, vocational and supported employment programs awake direct support
				  services, 1 hour;
(b) For
				  residential programs:
(i) For awake direct
				  support services, 1hour;
(ii) A
				  preauthorized unit of service available to the individual and identified in the
				  approved service funding plan; or
(iii) For support services other than awake
				  direct support services, the provider cost multiplied by the number of approved
				  hours and divided by the rate; or
(c) For professional services, 1
				  hour.
(37) "Utilization
				  review" means the examination of an individual indicator rating scale to
				  ascertain if the service needs level is appropriate and to verify that the
				  indicated level of service is being provided.
(38) "Vocational services" means services
				  provided by a licensed provider under COMAR 10.22.07 that are provided outside
				  of the individual's home and for purposes of COMAR 10.09.26 are part of
				  habilitation services.