Md. Code Regs. 10.09.35.01

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

Section 10.09.35.01 - Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Attending physician" means:

(a) A doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State; or

(b) A nurse practitioner who meets the qualifications set forth in COMAR 10.27.07.

(2) "Bereavement counseling" means counseling services provided to the participant's family after the participant's death.

(3) "Cap period" means the 12-month period beginning November 1 of each year and ending October 31 of the following year, which is used in the annual application of the limitation on reimbursement at the general inpatient and inpatient respite care rates.

(4) "Core services" means the hospice services that must routinely be provided directly by hospice employees, that is, nursing care, physician services, medical social services, and counseling.

(5) "Department" means the Department as defined in COMAR 10.09.36.01.

(6) "Election period" means a period for which a recipient may elect to receive hospice care in accordance with Regulation .04 of this chapter.

(7) "Health Maintenance Organization (HMO)" means an organization which has contracted with the Department to deliver specific health care services to recipients in accordance with COMAR 10.09.16.

(8) "Home" means that place of residence occupied by a participant. For purposes of hospice care, home may include a nursing facility.

(9) "Hospice" means a public agency or private organization or subdivision of either of these that:

(a) Is primarily engaged in providing care to terminally ill individuals;

(b) Meets all applicable State and local licensing and regulatory requirements; and

(c) Is participating in Medicare as a hospice care provider.

(10) "Hospice nurse practitioner" means a nurse practitioner who:

(a) Is an employee of the hospice; and

(b) Meets the qualifications set forth in COMAR 10.27.07.

(11) "Hospice physician" means a doctor of medicine or osteopathy who is:

(a) Employed by or contracted by the hospice; and

(b) Legally authorized to practice medicine and surgery by the State.

(12) "Hospital" means an institution which is participating in Medicare or in a Medical Assistance Program as a hospital.

(13) "Interdisciplinary group" means a group of provider employees who provide or supervise hospice care, and include at least a:

(a) Doctor of medicine or osteopathy;

(b) Registered nurse;

(c) Social worker; and

(d) Pastoral or other counselor.

(14) "Managed care organization (MCO)" has the meaning stated in Health-General Article, §15-101, Annotated Code of Maryland.

(15) "Medical Assistance Program" means a program of comprehensive medical and other health-related care for indigent and medically indigent persons, jointly financed by the federal and State governments and administered by states under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq.

(16) "Medicare" means Medicare as defined in COMAR 10.09.36.01.

(17) "Nursing facility" means a facility or a distinct part of a facility which is participating in a Medical Assistance Program as a nursing facility provider.

(18) "Participant" means a recipient who is eligible, has elected, and is receiving hospice care in accordance with the provisions of this chapter.

(19) "Plan of care" means a written, individualized care plan established and maintained for each recipient enrolled by a hospice provider.

(20) "Program" means the Maryland Medical Assistance Program.

(21) "Provider" means a hospice that meets the requirements of Regulation .03 of this chapter and which, through a provider agreement signed with the Department, has been identified as a Program provider by the issuance of an individual account number.

(22) "Provider agreement" means a contract between the Department and the provider.

(23) "Recipient" means recipient as defined in COMAR 10.09.36.01.

(24) "Representative" means a person who is, because of the recipient's mental or physical incapacity, authorized, in accordance with the State law to execute or revoke an election for hospice care, to advise concerning the plan of care, or to terminate medical care on behalf of the terminally ill individual.

(25) "Respite care" means short-term care furnished to a participant for the purpose of providing rest or relief for family members or other individuals routinely furnishing at-home care to the participant.

(26) "Room and board" means services provided to a participant who is a nursing facility resident.

(27) "Skilled nursing facility" means a nursing facility or a distinct part of a nursing facility which is participating in Medicare as a skilled nursing facility.

(28) "Terminally ill" means that the individual has a medical prognosis of a life expectancy of 6 months or less if the illness runs its normal course.

Md. Code Regs. 10.09.35.01

Regulation .01B amended effective 40:14 Md. R. 1174, eff.7/22/2013