Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 07 - HOSPITALS › Chapter 10.07.02 - Nursing Homes › Section 10.07.02.01 - 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) "Administrator" means the individual
				  licensed by the Board of Examiners of Nursing Home Administrators who is
				  responsible for the operation of the nursing home.
(2) "Attending physician" means an individual
				  licensed to practice medicine in the State who:
(a) Admits residents to the nursing home;
				  and
(b) Is responsible for the
				  overall care of a resident.
(3) "Audiologist" means an individual who
				  holds a Maryland license issued by the State Board of Audiologists, Hearing Aid
				  Dealers, and Speech-Language Pathologists.
(4) Authorized prescriber has the meaning
				  stated in Health Occupations Article, §
											12-101, Annotated
				  Code of Maryland.
(5) "Certified
				  medicine aide" means an individual who meets the requirements as stated in
				  COMAR 10.39.01 and 10.39.03.
(6)
				  "Certified social worker" means an individual licensed to practice as a
				  certified social worker in this State.
(7) "Charge nurse" means the registered or
				  licensed practical nurse who is responsible for day-to-day operations of a unit
				  in the nursing home on which residents live.
(8) "Chemical restraint" means the
				  administration of any drug that is used for discipline or convenience and not
				  required to treat medical symptoms.
(9) "Comprehensive care facility" means a
				  nursing home that admits residents requiring medical services and nursing
				  services rendered by or under the supervision of a registered nurse, who:
(a) Are advanced in age; or
(b) Have a disease or a disability.
(10) "Concurrent review" means
				  daily rounds by a licensed nurse which include:
(a) Appraisal and observation of all
				  residents by the licensed nurse to determine any change in each resident's
				  physical or mental status;
(b) If
				  there is a change in the resident's physical or mental status, an evaluation by
				  the licensed nurse of the resident's medications, laboratory values relating to
				  the resident, and clinical data relating to the resident, including the
				  resident's:
(i) Hydration and nutritional
				  needs;
(ii) Skin
				  integrity;
(iii) Noted weight
				  changes; and
(iv)
				  Appetite;
(c) Evaluation
				  of injuries sustained by the resident that result from an accident or incident
				  involving the resident; and
(d) Any
				  other relevant parameters affecting or reflecting the resident's physical and
				  mental status.
(11)
				  "Culture change facility" means a nursing home where physical environment and
				  operational changes have been made to establish person-valued and
				  person-directed care activities and services.
(12) "Deficiency" means a condition existing
				  in a nursing home or an action or inaction by the nursing home staff that
				  results in potential for more than minimal harm, actual harm, or serious and
				  immediate threat to one or more residents.
(13) "Dentist" means an individual licensed
				  to practice dentistry in this State.
(14) "Department" means the Maryland
				  Department of Health.
(15)
				  "Dietetic service supervisor" means a person who:
(a) Is a qualified dietitian;
(b) Is a graduate of a dietetic technician
				  program approved by the American Dietetic Association;
(c) Is a certified dietary manager who has
				  successfully completed the required course and maintains certification as
				  required by the certifying board for the Dietary Managers
				  Association;
(d) Is a graduate of a
				  State-approved course that provided 90 or more hours of classroom instruction
				  in food service supervision and has experience as a supervisor in a health care
				  institution with consultation from a dietitian; or
(e) Has training and experience in food
				  service supervision and management in a military service equivalent in content
				  to §B(15)(b) and (d) of this regulation.
(16) "Dietitian-nutritionist" means an
				  individual who:
(a) Is licensed by the
				  Maryland Board of Dietetic Practice to practice dietetics;
(b) Has met the certifying requirements for
				  registration as a dietitian as administered by the Commission on Dietetic
				  Registration; and
(c) Maintains the
				  continuing education requirements of registration.
(17) "Discharge" means the removal of a
				  resident from a nursing home when the releasing nursing home is no longer
				  responsible for the resident's care.
(18) "Discipline" means the medical,
				  rehabilitative, nursing, dietetic, activities and social service components
				  affiliated with the operation of a nursing home.
(19) "Distinct part extended care facility"
				  means a portion of a nursing home that is licensed as an extended care
				  facility.
(20) "Extended care
				  facility " means a nursing home that offers sub-acute care and provides medical
				  treatment services for residents who require inpatient care but who do not
				  currently require continuous hospital services.
(21) "Facility" means a nursing
				  home.
(22) "Fire authorities" means
				  the official fire safety agency including the State Fire Marshal or local fire
				  marshals or fire departments as appropriate.
(23) "Full time" means 40 hours per week or
				  the standard work week adopted by the nursing home.
(24) "Geriatric nursing assistant" means a
				  CNA who has successfully completed the requirements for a GNA set forth in
				  42 CFR §§
												483.151 -
				  483.156 and COMAR
				  10.39.01.
(25) "Grant" means the
				  award of money to an individual or an organization to:
(a) Study an aspect for the geriatric
				  population; or
(b) Provide a
				  service to nursing home residents or their families.
(26) "Health officer" means the health
				  officer or the designated representative in each of the 23 counties and the
				  Commissioner of Health in Baltimore City.
(27) "HVAC" means heating, ventilation and
				  air conditioning.
(28) "Infection
				  preventionist" means a licensed healthcare worker who:
(a) Manages the infection prevention and
				  control program in the nursing home; and
(b) Has completed a minimum of 15 contact
				  hours of infection prevention and control training that is approved by the:
(i) Department's Office of Infectious Disease
				  Epidemiology and Outbreak Response; and
(ii) Office of Health Care Quality.
(29) "Licensed bachelor
				  social worker (LBSW)" means an individual authorized to practice bachelor
				  social work under Health Occupations Article, Title 19, Annotated Code of
				  Maryland.
(30) "Licensed certified
				  social worker (LCSW)" means an individual authorized to practice certified
				  social work under Health Occupations Article, Title 19, Annotated Code of
				  Maryland.
(31) "Licensed certified
				  social worker-clinical (LCSW-C)" means an individual authorized to practice
				  clinical social work under Health Occupations Article, Title 19, Annotated Code
				  of Maryland.
(32) "Licensed master
				  social worker" means an individual authorized to practice master social work
				  under Health Occupations Article, Title 19, Annotated Code of
				  Maryland.
(33) "Licensed or
				  certified professional health care practitioner" means a nurse practitioner,
				  physician assistant, or other practitioner licensed or certified under the
				  Health Occupations Article, Annotated Code of Maryland.
(34) Licensed pharmacist" means an individual
				  who is licensed by the Board to practice pharmacy as defined in Health
				  Occupations Article, §
											12-101(l),
				  Annotated Code of Maryland.
(35)
				  "Licensed practical nurse" means an individual authorized to practice licensed
				  practical nursing under Health Occupations Article, Title 8, Annotated Code of
				  Maryland.
(36) "Management firm"
				  means an organization, under contract with an applicant for a license or a
				  current licensee, that is intended to have or has full responsibility and
				  control for the day-to-day operations of the nursing home.
(37) "MDS Care Area Assessment" means the
				  investigation of triggered care areas, to determine if the care area or areas
				  require interventions and care planning.
(38) "Medical director" means an individual
				  licensed to practice medicine in this State who, pursuant to a written
				  agreement, is responsible for the overall coordination of the medical care in
				  the nursing home to ensure the adequacy and appropriateness of the medical
				  services provided to residents and to maintain surveillance of the health
				  status of employees.
(39) "Minimum
				  Data Set (MDS)" means a core set of screening, clinical, and functional status
				  elements, including common definitions and coding categories, which:
(a) Forms the foundation of a comprehensive
				  assessment for all nursing home and swing bed residents; and
(b) Standardize communication about resident
				  problems and conditions:
(i) Within these
				  facilities;
(ii) Between these
				  facilities; and
(iii) Between these
				  facilities and outside agencies.
(40) "New nursing home" means a nursing home
				  that does not yet have plans approved by the Department at the time of the
				  adoption of this chapter.
(41)
				  "NFPA" means National Fire Protection Association.
(42) "Nurse" means a licensed practical nurse
				  or registered nurse licensed in the State as defined in Health Occupations
				  Article, §
											8-101, Annotated
				  Code of Maryland.
(43) Nurse
				  practitioner has the meaning stated in Health Occupations Article, §
											8-101(k),
				  Annotated Code of Maryland.
(44)
				  Nursing care has the meaning stated in Health-General Article, §
				  19-301(k), Annotated Code of Maryland.
(45) "Nursing home" means a comprehensive
				  care facility or extended care facility which offers nonacute inpatient care to
				  residents:
(a) Who have a disease, chronic
				  illness, condition, disability of advanced age, or terminal disease requiring
				  maximal nursing care without continuous hospital services; and
(b) Who require medical services and nursing
				  services rendered by or under the supervision of a licensed nurse together with
				  convalescent, restorative, or rehabilitative services.
(46) "Nursing service personnel" means staff
				  licensed or certified by the Maryland Board of Nursing.
(47) "Occupational therapist" means an
				  individual who is licensed by the State Board of Occupational Therapy Practice
				  to practice occupational therapy.
(48) "Occupational therapy assistant" means
				  an individual who is currently licensed by the State Board of Occupational
				  Therapy Practice as an occupational therapy assistant.
(49) "Ongoing pattern" means the occurrence
				  of any potential for more than minimal harm or greater deficiency on two
				  consecutive on-site visits as a result of:
(a) Annual surveys;
(b) Follow-up visits and unscheduled visits;
				  or
(c) Complaint
				  investigations.
(50)
				  "Paid feeding assistant" means an individual who:
(a) Meets the requirements of Regulation .63
				  of this chapter; and
(b) Is paid by
				  a nursing home to feed residents who are unable to perform the task
				  themselves.
(51)
				  "Physical restraint" means any manual method or physical or mechanical device,
				  material, or equipment attached or adjacent to the resident's body that the
				  individual cannot remove easily which restricts freedom of movement or normal
				  access to one's body including but not limited to:
(a) Leg restraints;
(b) Arm restraints;
(c) Hand mitts;
(d) Soft ties or vests;
(e) Lap cushions; and
(f) Lap trays.
(52) "Physical therapist" means an individual
				  licensed to practice physical therapy by the State Board of Physical Therapy
				  Examiners.
(53) "Physician" means
				  an individual licensed to practice medicine in this State.
(54) Physician assistant has the meaning
				  stated in Health Occupations Article, §
											15-101(o),
				  Annotated Code of Maryland.
(55)
				  "Plan of correction " means a written response from the nursing home addressing
				  each deficiency cited as a result of an inspection by the Department.
(56) "Positive tuberculin skin test" means a
				  test provided as authorized by the Guidelines for Preventing the Transmission
				  of Mycobacterium tuberculosis in Health-Care Settings.
(57) "Principal physician" means an
				  individual licensed to practice medicine in this State who agrees to perform
				  certain medical services under contract with a nursing home, consistent with
				  the policies of the nursing home.
(58) "Protective device " means any device or
				  equipment:
(a) That is prescribed by a
				  physician;
(b) That limits, but
				  does not eliminate the movement of the resident's head, body, or limbs;
				  and
(c) That:
(i) Shields a resident from
				  self-injury;
(ii) Prevents a
				  resident from aggravating an existing physical problem; or
(iii) Prevents a resident from precipitating
				  a potential physical problem.
(59) "Qualified medical record practitioner "
				  means an individual who:
(a) Has:
(i) Received a baccalaureate degree from an
				  accredited college or university including or supplemented by a successful
				  completion of a course in health record administration approved by the Council
				  on Medical Education of the American Medical Association; and
(ii) Passed the national registration
				  examination for registered record administrators; or
(b) Has:
(i)
				  Received an associate of arts degree in health record technology from a college
				  or university approved by the American Medical Association Council on Medical
				  Education or an equivalent approved health record technology correspondence
				  course of the American Medical Record Association; and
(ii) Passed the national accreditation
				  examination for accredited record technicians.
(60) "Qualified social work consultant" means
				  an individual who:
(a) Is a licensed certified
				  social worker; and
(b) Has a
				  minimum of 3 years' experience in social work programs in a long-term care
				  setting within the last 5 years.
(61) Quality Improvement and Evaluation
				  System (QIES) Assessment Submission and Processing (ASAP) system" means the
				  standard nationwide system to which several types of health care providers
				  submit CMS required resident information to the National Submissions
				  Database.
(62) "Registered nurse"
				  means an individual licensed to practice as a registered nurse in this
				  State.
(63) Relocation.
(a) "Relocation" means the movement of a
				  resident from one room to another within:
(i)
				  The same Medicare-certified nursing home;
(ii) A Medicaid-only certified nursing home;
				  or
(iii) A licensed-only nursing
				  home.
(b) Relocation
				  does not mean the movement of a resident if the effect of the movement is to
				  move the resident from:
(i) The distinct part
				  of the nursing home that is a skilled nursing facility to a distinct part of
				  the nursing home that is not a skilled nursing facility; or
(ii) A bed that is certified for Medicaid to
				  a distinct part of the nursing home that is a skilled nursing
				  facility.
(64) "Resident" means an individual who:
(a) Resides in the nursing home;
				  and
(b) Receives nursing services
				  rendered by or under the supervision of a registered nurse.
(65) "Resident activities
				  coordinator " means an individual who:
(a) Is
				  a:
(i) Certified therapeutic recreation
				  specialist;
(ii) Licensed
				  occupational therapist; or
(iii)
				  Licensed occupational therapy assistant; or
(b) Has 2 years of experience in a social or
				  recreational program in a licensed health care setting within the last 5 years,
				  1 year of which was full time in a resident activities program with guidance
				  from an individual identified in §B(73)(a) of this regulation.
(66) Resident Assessment
				  Instrument (RAI).
(a) "Resident Assessment
				  Instrument (RAI)" means a standardized and reproducible resident assessment
				  process based on completion of Minimum Data Set (MDS) screening items, and
				  including the MDS Care Area Assessment process, and related process for care
				  planning and evaluation.
(b)
				  Resident Assessment Instrument (RAI) includes:
(i) Minimum Data Set;
(ii) MDS Care Area Assessment Process;
				  and
(iii) RAI utilization
				  guidelines.
(67) "Resident's representative" means a
				  person with the authority to act on the resident's behalf regarding the matter
				  at issue.
(68) "Restraint" means
				  any physical or chemical restraint as defined in this chapter.
(69) "Secretary" means the Secretary of
				  Health.
(70) "Serious and immediate
				  threat" means a situation in which immediate corrective action is necessary
				  because a deficiency has caused or is likely to cause serious injury, harm,
				  impairment to, or death of a resident receiving care in the nursing
				  home.
(71) "Special care unit"
				  means a nursing home unit that provides intensive specialized care, such as
				  respiratory, rehabilitative, dementia, or dialysis care, continuously on a
				  24-hour basis.
(72)
				  "Speech-language pathologist" means an individual licensed by the State Board
				  of Audiologists, Hearing Aid Dispensers, and Speech-Language
				  Pathologists.
(73) "Support
				  personnel" means an aide who:
(a) Is assigned
				  to a particular service such as:
(i)
				  Nursing;
(ii) Dietary;
(iii) Physical therapy; or
(iv) Occupational therapy; and
(b) Has been approved by the
				  manager of the services as having sufficient training and experience to perform
				  the assigned duties.
(74) "Tuberculin skin test" means a test to
				  diagnose tuberculosis infection using purified protein derivative (PPD) that is
				  injected intradermally and read within 48-72 hours with results recorded in
				  millimeters of induration.
(75)
				  Tuberculosis in a Communicable Form.
(a)
				  "Tuberculosis in a communicable form" means that an individual:
(i) Is presumed to have active pulmonary or
				  laryngeal tuberculosis as evidenced by positive X-ray findings with or without
				  positive acid-fast bacilli (AFB) sputum smear or positive AFB sputum culture;
				  and
(ii) Has received chemotherapy
				  for less than 14 days.
(b) Tuberculosis in a communicable form does
				  not include:
(i) When the individual who has
				  presumptive or confirmed active disease, has had three negative AFB smears,
				  collected 8-24 hours apart, shows clinical improvement, and has received
				  chemotherapy to which the strain is susceptible for at least 14 days;
				  or
(ii) The individual who has
				  inactive pulmonary scarring, calcification, or a normal chest X-ray.
(76) "Two-step
				  tuberculin skin testing" means the administration of a second tuberculin skin
				  test 1 to 3 weeks after the initial skin test is negative, to identify
				  individuals with a past TB infection who may now have reduced skin
				  reactivity.