Md. Code Regs. 10.09.46.09-1

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

Section 10.09.46.09-1 - Covered Services - Individual Support Services

A. Individual support services, as defined in Regulation .01B of this chapter, shall be provided in a participant's own home or their community.

B. The service involves the training and development of compensatory strategies and skills such that a waiver participant may learn to initiate and complete activities on their own to fully engage in their community, live independently, and compensate for cognitive and behavioral deficits related to short term memory, planning, attention, concentration, impulse control, and judgment, with the intended goal of minimizing the level of staff support the individual needs over time and preventing institutionalization.

C. The provider shall provide services in collaboration with the participant's other TBI waiver services, clinical treatment, and health and medical services.

D. Individual support services shall be provided as pre-authorized by BHA and included in the waiver plan of care and provided in 15-minute units.

E. Services may be provided in-person or via virtual supports as determined appropriate by the Department.

F. Providers delivering services via virtual supports:

(1) Shall ensure the participant's rights of privacy, dignity, and respect, and freedom from coercion and restraint; and

(2) May provide direct support via virtual supports according to the following requirements and restrictions:

(a) Virtual supports do not isolate the participant from integration in the community or interacting with people without disabilities;

(b) The use of virtual supports is based on the participant's preferences, has been agreed to by the participant and their team, and is outlined in the Plan of Service (POS);

(c) Virtual supports may not be used for the provider's convenience;

(d) The use of virtual supports and the service delivery method shall be documented per State requirements, policies, and guidance;

(e) Text messaging and emailing do not constitute virtual supports;

(f) The virtual supports shall comply with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended by the Health Information Technology for Economic and Clinical Health (HITECH) Act, and their applicable regulations to protect the privacy and security of the participant's protected health information;

(g) ISS may not be provided entirely via virtual supports;

(h) Virtual supports shall allow flexibility of service delivery and supplement in-person direct supports as recommended and monitored by the case manager;

(i) The provider shall develop, maintain, and enforce written policies, approved by BHA, which address their procedures for ensuring:

(i) The participant's rights of privacy, dignity, and respect, and freedom from coercion and restraint;

(ii) The virtual supports meet applicable information security standards; and

(iii) Their provision of virtual supports complies with applicable laws governing individuals' right to privacy;

(j) The provider shall train direct support staff on their policies and advise participants and their person-centered planning teams regarding the policies that indicate how a participant's needs, including health and safety, will be addressed safely via virtual supports;

(k) The virtual supports shall meet all federal and State requirements, policies, guidance, and regulations;

(l) The provider shall ensure that virtual supports are accessible to the participant and provide in-person trainings, prior to the initiation of virtual services, to help the participant learn to use the required technology independently; and

(m) Video cameras/monitors are not permitted in bedrooms and bathrooms.

Md. Code Regs. 10.09.46.09-1

Regulation .09-1 adopted effective April 9, 2007 (34:7 Md. R. 698); amended effective 47:10 Md. R. 516, eff. 5/18/2020; amended effective 50:8 Md. R. 338, eff. 5/1/2023