Md. Code Regs. 10.09.48.01

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

Section 10.09.48.01 - Definitions

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

B. Terms Defined.

(1) "Annually" means within 365 days.

(2) "Applicant" means the individual who files an application for services with the DDA.

(3) "Community Coordination Services" means provision of core services to individuals receiving ongoing DDA funding for comprehensive community services.

(4) "Community resources" means generic, local, State, or federal programs, services, benefits, and supports.

(5) "Comprehensive assessment" means an assessment of the applicant's needs and supports to enable the DDA to determine the applicant's eligibility for DDA funding of comprehensive community services.

(6) Comprehensive Community Services.

(a) "Comprehensive community services" means services funded by the DDA for residential, day, employment, or supports services.

(b) "Comprehensive community services" does not mean funding for low intensity support services or coordination of community services.

(7) "Contact" means a face-to-face meeting, phone conversation, or written correspondence related to the covered services in this chapter.

(8) "Coordination of community services" means the provision of targeted case management services that assist participants in gaining access to the full range of medical assistance services, as well as access to any additional needed generic, medical, social, habilitative, employment, recreational, housing, financial, counseling, legal, educational, and other support services.

(9) "Coordinator of community services" means an individual employed by the coordination of community services agency to assist participants in selecting obtaining, and monitoring the most responsive and appropriate services and supports.

(10) "Coordination of community services supervisor" means an individual who is employed to oversee coordination of community services and performance of coordinators of community services.

(11) "Core services" means the following community services:

(a) Comprehensive assessment;

(b) Development of the person-centered plan;

(c) Referrals and related activities; and

(d) Monitoring and follow-up.

(12) "Critical incident" means a reportable event that presents an immediate and serious threat of injury, harm, impairment, or death of an individual.

(13) "Department" means the Department of Health and Mental Hygiene, which is the single State agency designated to administer the Maryland Medical Assistance Program pursuant to Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq.

(14) "Developmental Disabilities Administration (DDA)" means that agency of the Department which, under Health General Article, Title 7, Annotated Code of Maryland, is charged with the responsibility for providing services to individuals with developmental disability.

(15) "Developmental disability" has the same meaning as set forth in HealthGeneral Article, § 7-101, Annotated Code of Maryland.

(16) "Entity" means a facility, agency, organization, department, office, corporation, partnership, group, or individual.

(17) "Generic" means programs, services, or supports which are available to the community at large.

(18) "Goal" means measurable activity that is required to achieve progress toward an outcome.

(19) "Medicaid waiver programs" means any program under § 1915(c) of the Social Security Act.

(20) "Medical Assistance Program" means the program of comprehensive medical and other health-related care for indigent and medically indigent persons.

(21) "Most integrated setting" means a setting that enables a participant with a disability to interact with nondisabled individuals other than staff to the fullest extent possible.

(22) "Outcome" means tangible results of goals that reflect the desired quality of life as defined by the individual.

(23) "Participant" means an individual who meets the qualifications for participation in coordination of community services as specified in Regulation .03 of this chapter.

(24) Person-Centered Plan.

(a) "Person-centered plan" means a written plan that is developed through a planning process driven by the participant with a developmental disability to:

(i) Identify the participant's goals and preferences;

(ii) Identify services to support the participant in pursuing the participant's personally defined outcomes in the most integrated community setting;

(iii) Direct the delivery of services that reflect the participant's personal preferences and choice; and

(iv) Identify the participant's specific needs that must be addressed to ensure the participant's health and welfare.

(b) "Person-centered plan" includes an individual plan as referenced in COMAR 10.22.

(25) "Person-directed supports" means service and supports that empower the participant, and the legally authorized representative on the participant's behalf, to direct the development and implementation of a plan of supports and services that meet the participant's personal goals.

(26) Place of Service.

(a) "Place of service" means the place where participants receive services.

(b) "Place of service" includes but is not limited to the participant's home, day program, group home, alternate living arrangement, or place of employment.

(27) "Program" means the Medical Assistance Program as defined in COMAR 10.09.36.01.

(28) "Provider" means an entity that meets the conditions for participation specified in Regulation .04 of this chapter, and is authorized by DDA to provide coordination of community services.

(29) "Reportable events" means specified incidents and complaints noted in the DDA Policy on Reportable Incidents and Investigations (PORII), as required under COMAR 10.22.02.01 and established to ensure the health, safety, and welfare of participants receiving services from DDA-funded providers.

(30) "Representative" means a person who:

(a) Is chosen by the participant to represent the participant's needs and may include:

(i) A family representative;

(ii) An informal caregiver; or

(iii) Any other individual chosen by the participant; or

(b) Is recognized by the DDA as a legally appointed guardian qualified to act on the participant's behalf with respect to services covered under this chapter.

(31) "Service record" means all past and current health, eligibility, request for service change, service funding plan, person-centered plan, and coordination of community services documents and records.

(32) "Targeted case management" means an optional service allowed under federal Medicaid rules which includes services to assist target populations of Medicaid participants to gain access to needed medical, social, educational, and other services.

(33) Targeted Case Management.

(a) "Targeted case management" means an optional service allowed under federal Medicaid rules which includes services to assist target populations of Medicaid participants to gain access to needed medical, social, educational, and other services.

(b) "Targeted case management" includes:

(i) Performance of a comprehensive assessment and periodic reassessment of participant needs, to determine the need for any medical, educational, social, or other services;

(ii) Provision of waiting list coordination services;

(iii) Provision of community coordination services; and

(iv) Provision of transition coordination services.

(34) "Transition Coordination Services" means provision of core services to participants transitioning to the community from an institution.

(35) "Waiting list" means individuals found eligible for services in the crisis resolution, crisis prevention, or current request priority category as set forth in COMAR 10.22.12.07B.

(36) "Waiting list" means participants found eligible for services in the crisis resolution, crisis prevention, or current request priority category as set forth in COMAR 10.22.12.07B.

(37) "Waiting List Coordination Services" means provision of core services to participants on the DDA waiting list.

Md. Code Regs. 10.09.48.01

Regulations .01 adopted as an emergency provision effective June 23, 1992 (19:14 Md. R. 1276); adopted permanently effective October 12, 1992 (19:20 Md. R. 1815)
Regulations .01 amended as an emergency provision effective December 9, 1994 (21:26 Md. R. 2183); adopted permanently effective March 27, 1995 (22:6 Md. R. 474)
Regulation .01B amended effective August 27, 2007 (34:17 Md. R. 1507)
Regulations .01 under Case Management for Individuals with Developmental Disability repealed and new Regulations .01 under Targeted Case Management for People with Intellectual and Developmental Disabilities adopted effective July 8, 2013 (40:13 Md. R. 1074)
Regulation .01 amended effective 42:11 Md. R. 723, eff.6/8/2015; amended effective 48:26 Md. R.1111, eff. 12/27/2021