Md. Code Regs. 10.09.53.01

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

Section 10.09.53.01 - Definitions

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

B. Terms Defined.

(1) "Caregiver" means a willing and able individual who is trained in providing care to the participant.

(2) "Certified medication technician (CMT)" means an individual, regardless of title, who:

(a) Completes a 20-hour course in medication administration approved by the Maryland Board of Nursing;

(b) Is certified by the Board under COMAR 10.39.04; and

(c) Performs medication administration tasks delegated by a nurse in accordance with COMAR 10.27.11.

(3) "Certified nursing assistant (CNA)" means an individual, regardless of title, who:

(a) Is certified by the Maryland Board of Nursing under COMAR 10.39.05; and

(b) Routinely performs nursing tasks delegated by a nurse in accordance with COMAR 10.27.11.

(4) "Delegated nursing services" has the meaning stated in COMAR 10.27.11.

(5) Employment.

(a) "Employment" means the condition of having paid work.

(b) "Employment" includes job training or classes required to obtain government licensure or certification to engage in an occupation or profession, and work to fulfill requirements to obtain Temporary Cash Assistance or other public benefits.

(6) "Department" has the meaning stated in COMAR 10.09.36.01.

(7) "Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)" means the provision of preventive health care under 42 CFR § 441.50 et seq., including medical and dental services, in order to assess growth and development and to detect and treat health problems in Medical Assistance recipients under 21 years old.

(8) "Electronic visit verification (EVV)" has the meaning stated in COMAR 10.09.36.03-2.

(9) "Emergency medical condition" means a health condition manifested by symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected by a prudent lay individual possessing an average knowledge of health and medicine to result in:

(a) Placing health in jeopardy;

(b) Serious impairment to bodily functions;

(c) Serious dysfunction of any bodily organ or part; or

(d) Development or continuance of severe pain.

(10) "Emergency service" means a service or care rendered to a recipient exhibiting an emergency medical condition as defined in §B(3) of this regulation.

(11) "EPSDT screen" means the complete package of various health screening procedures, required by the State periodicity schedule, or a partial screen, that an EPSDT participant receives.

(12) "Home" means the place of residence, occupied by the recipient, other than a residence or facility where private duty nursing services are included in the living arrangement by regulation or statute, or otherwise provided for payment.

(13) "Home health agency" means an agency licensed by the Department in accordance with COMAR 10.07.10.

(14) "Home health aide (HHA)" means an individual, regardless of title, who meets all the conditions of participation specified in:

(a) 42 CFR § 484.36 ; and

(b) Health Occupations Article, Title 8, Annotated Code of Maryland.

(15) "Medical Assistance Program" has the meaning stated in COMAR 10.09.36.01.

(16) "Medically necessary" has the meaning stated in COMAR 10.09.36.01.

(17) "Nurse" means a person who is licensed to practice as a registered nurse (RN) or licensed practical nurse (LPN) in the jurisdiction in which services are provided.

(18) "Nursing care plan" means a plan developed by a registered nurse that identifies the patient's diagnoses and needs, the goals to be achieved, and the interventions required to meet the patient's medical condition.

(19) "Participant" means a recipient who is eligible for and receiving services in accordance with the provisions of this chapter.

(20) "Plan of care" means an individualized care plan, written in collaboration with the participant or family, including the plan developed under COMAR 10.09.27 and 10.09.69, which outlines a plan of action to meet the goals or expected outcomes for the participant.

(21) "Preauthorization" means the approval required from the Department or its designee before services may be rendered.

(22) "Primary medical provider (PMP)" means the medical provider who functions as the principal medical provider to the participant including a physician, certified nurse midwife, or nurse practitioner.

(23) "Private duty nursing services" means skilled nursing services for recipients who require more individual and continuous care than is available under the home health program, and which are provided by a registered nurse or a licensed practical nurse, in a recipient's own home or another setting when normal life activities take the recipient outside his or her home.

(24) "Program" has the meaning stated in COMAR 10.09.36.01.

(25) "Progress note" means a signed and dated written notation by the home care nurse which:

(a) Summarizes facts about the care given and the participant's responses during a given period of time;

(b) Specifically addresses the established goals of treatment;

(c) Is consistent with the participant's plan of care; and

(d) Is written during the course of care.

(26) "Provider" has the meaning stated in COMAR 10.09.36.01.

(27) "Recipient" has the meaning stated in COMAR 10.09.36.01.

(28) "Residential service agency" means an agency licensed by the Department in accordance with COMAR 10.07.05.

(29) "School" means courses or classes for the acquisition of a General Education Diploma, high school diploma, associate's degree, or a first-time bachelor's degree.

(30) "Supervision" means authoritative, procedural guidance by a licensed registered nurse for the accomplishment of a function or activity, as well as the process of critical watching, directing, and evaluating another's performance.

(31) "Urgent service" means a service or care for a medical condition that is manifested by symptoms of sufficient severity that the absence of medical attention within 48 hours could reasonably be expected, by a prudent lay individual who possesses an average knowledge of health and medicine, to result in an emergency medical condition.

(32) "Witness" means the recipient or an individual who, on behalf of the recipient, is able to personally verify that the recipient received private duty nursing services.

Md. Code Regs. 10.09.53.01

Regulations.01 adopted as an emergency provision effective May 5, 1993 (20:11 Md. R. 911); adopted permanently effective August 2, 1993 (20:15 Md. R. 1220)
Regulations.01_.07 amended as an emergency provision effective June 1, 1994 (21:13 Md. R. 1152); amended permanently effective September 26, 1994 (21:19 Md. R. 1635)
Regulations.01_.06 amended as an emergency provision effective January 1, 1997 (23:26 Md. R. 1856); amended permanently effective March 10, 1997 (24:5 Md. R. 408)
Regulation .01B amended effective August 23, 1999 (26:17 Md. R. 1323); January 31, 2005 (32:2 Md. R. 146); August 27, 2007 (34:17 Md. R. 1507); March 10, 2008 (35:5 Md. R. 641);41:6 Md. R. 379, eff. 4/1/2014 ; amended effective 50:16 Md. R. 726, eff. 8/21/2023