Md. Code Regs. 10.09.20.03

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.20.03 - Participant Eligibility

A. To participate in the Program, the participant shall:

(1) Be determined by the Department to need assistance with one or more activities of daily living;

(2) Be eligible for Medicaid under an eligibility coverage group described in COMAR 10.09.24, except for Regulations .03C, .03-1-.03-3, and .05-2; and

(3) Reside at home.

B. To be eligible for participation, a participant shall have an active plan of service. The plan of service shall:

(1) Be based on:

(a) The evaluation and recommended plan of care; and

(b) Consultation with the applicant or participant;

(2) Address the applicant's or participant's health and safety needs;

(3) Specify the services needed to safely support the participant in the community, including a plan for receiving personal assistance services in case of an emergency;

(4) Specify the provider agency providing personal assistance services; and

(5) Include the signature of the:

(a) Participant or, when applicable, the individual's representative;

(b) Supports planner; and

(c) Personal assistance provider agency listed within the plan of service.

C. A participant's eligibility for services shall be re-evaluated by the Department every 12 months, or more frequently if needed due to a significant change in the participant's condition or needs.

D. Participant eligibility shall be terminated if the participant:

(1) No longer meets the required level of care;

(2) No longer resides at home;

(3) Is without personal assistance services for 30 consecutive calendar days;

(4) Voluntarily chooses, or the participant's legal representative chooses on the participant's behalf, to disenroll from the Program;

(5) Moves to another state;

(6) Is an inpatient for 30 consecutive days or more in an institutional setting, including but not limited to a chronic hospital or nursing facility; or

(7) Dies.

Md. Code Regs. 10.09.20.03

Regulation .03A and B amended effective January 6, 1983 (9:26 Md. R. 2572); January 30, 1984 (11:2 Md. R. 113); April 6, 1986 (13:7 Md. R. 795)
Regulations .03A, B, amended as an emergency provision effective July 1, 1983 (10:13 Md. R. 1177); adopted permanently effective October 24, 1983 (10:21 Md. R. 1902)
Regulation .03A-1 adopted effective April 6, 1986 (13:7 Md. R. 795)
Regulation .03A-2 adopted effective July 1, 1988 (15:13 Md. R. 1554)
Regulation .03B-1 adopted effective July 1, 1988 (15:13 Md. R. 1554)
Regulations .03, amended as an emergency provision effective July 1, 1998 (25:15 Md. R. 1182); emergency status expired December 31, 1998
Regulations .03, amended effective September 6, 1999 (26:18 Md. R. 1376)
Regulation .03 amended effective January 31, 2005 (32:2 Md. R. 146); August 29, 2005 (32:17 Md. R. 1438)
Regulation .03A amended as an emergency provision effective July 1, 2006 (33:15 Md. R. 1274); amended permanently effective October 23, 2006 (33:21 Md. R. 1675)
Regulation .03A amended effective March 22, 2010 (37:6 Md. R. 477); adopted effective 43:5 Md. R. 385, eff.3/14/2016