Md. Code Regs. 10.09.54.01

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

Section 10.09.54.01 - Definitions

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

B. Terms Defined.

(1) "Activities of daily living" means tasks or activities that include, but are not limited to:

(a) Bathing and completing personal hygiene routines;

(b) Dressing and changing clothes;

(c) Eating;

(d) Toileting, including:

(i) Bladder and bowel requirements;

(ii) Routines associated with the achievement or maintenance of continence; and

(iii) Incontinence care;

(e) Mobility, including:

(i) Transferring from a bed, chair, or other structure;

(ii) Moving, turning, and positioning the body while in bed or in a wheelchair; and

(iii) Moving about indoors or outdoors.

(2) "Area agency" has the meaning stated in Human Services Article, §10-101(b), Annotated Code of Maryland.

(3) "Assisted living services provider" means a provider licensed by the Department in accordance with COMAR 10.07.14.

(4) "Case management" means services which assist an applicant or a participant in gaining access to the waiver services covered under this chapter, as well as to other services under the Medical Assistance Program.

(5) "Case manager" means an individual performing case management services under a waiver program.

(6) Community Setting.

(a) "Community setting" means the area, district, locality, neighborhood, or vicinity where a group of people live which provides participants with opportunities to:

(i) Seek employment and work in competitive integrated settings;

(ii) Engage in community life;

(iii) Control personal resources; and

(iv) Receive services.

(b) "Community setting" does not mean:

(i) Hospitals;

(ii) Nursing facilities;

(iii) Institutions for mental diseases;

(iv) Intermediate care facilities for individuals with intellectual disabilities;

(v) Community-based residential facilities for individuals with intellectual or developmental disabilities licensed under COMAR 10.22.02;

(vi) Prisons;

(vii) Residential treatment centers; or

(viii) Any establishment that furnishes food, shelter, and some treatment or services to four or more persons unrelated to the proprietor.

(7) "Department" means the Maryland Department of Health and Mental Hygiene, or its authorized agent acting on behalf of the Department.

(8) "Family member" means an adult who:

(a) Lives with or provides care to the participant; and

(b) Is not paid to provide the care.

(9) "Home" means the participant's place of residence in a community setting.

(10) "Home and Community-Based Options Waiver" means the program implemented under this chapter in accordance with the document for this waiver and any amendments to it submitted by the Department and approved by the Secretary of Health and Human Services, which authorizes the waiver of certain specified statutory requirements limiting coverage for home and community-based services under the Maryland Medical Assistance Program.

(11) "Instrumental activities of daily living" means tasks or activities that include, but are not limited to:

(a) Preparing meals;

(b) Performing light chores that are incidental to the personal assistance services provided to the participant;

(c) Shopping for groceries;

(d) Nutritional planning;

(e) Traveling as needed;

(f) Managing finances and handling money;

(g) Using the telephone or other appropriate means of communication;

(h) Reading; and

(i) Planning and making decisions.

(12) "Maryland Department of Aging" has the meaning stated in Human Services Article, Title 10, Annotated Code of Maryland.

(13) "Medicaid" means the Medical Assistance Program.

(14) "Medical Assistance Program" means the Program administered by Maryland under Title XIX of the Social Security Act, which provides comprehensive medical and other health-related care for categorically eligible and medically needy recipients.

(15) "Medical day care" means a program of medically supervised, health-related services provided in an ambulatory setting to medically handicapped adults who, due to their degree of impairment, need health maintenance and restorative services supportive to their community living in accordance with COMAR 10.09.07.

(16) "Medically necessary" means that the service or benefit is:

(a) Directly related to diagnostic, preventative, curative, ameliorative, palliative or rehabilitative treatment of an illness, injury, disability, or health condition;

(b) Consistent with current accepted standards of good medical practice;

(c) The most cost efficient service that can be provided without sacrificing effectiveness or access to care; and

(d) Not primarily for the convenience of the participant, the participant's family, or the provider.

(17) "Nursing facility" means a facility which is participating in the Maryland Medical Assistance Program as a nursing facility pursuant to COMAR 10.09.10.

(18) "Participant" means an individual who:

(a) Has been determined to meet the qualifications for participation in the waiver as specified in Regulation .03 of this chapter; and

(b) Is enrolled with the Department to receive Medicaid services.

(19) "Person-centered" means that the plan reflects what is important to the individual, what is important for his or her health and welfare, and is developed with input from the individual and the individual's representative when applicable.

(20) "Plan of service" means the written, person-centered support plan developed by the applicant or participant with support from the case manager and the individual's representative, when applicable.

(21) "Principal" means a person who:

(a) Has a direct or indirect ownership or control interest of 5 percent or more in the provider;

(b) Is an officer, director, agent, or managing employee of the entity; or

(c) Was described in §B(20)(a) of this regulation, but is no longer so described because of a transfer of ownership or control interest to an immediate family member or a member of the household of the person who continues to maintain an interest described in §B(20)(a) of this regulation.

(22) "Program" means the Medical Assistance Program.

(23) "Provider" has the same meaning stated in COMAR 10.09.36.

(24) "Provider agreement" means a contract between the Department and the provider for rendering the services under this chapter.

(25) "Recipient" means an individual who is certified by the Department as eligible for, and is receiving, Medical Assistance benefits.

(26) "Reportable event " means an allegation of, or an actual occurrence of, an incident that may pose an immediate or serious risk, or has potential to adversely affect the physical or mental health, safety, or well-being of a waiver applicant or participant, or complaints regarding administrative service or quality of care issues.

(27) "Room and board" means rent or mortgage, utilities, maintenance, furnishings, and food, which are provided in or associated with an individual's place of residence.

(28) "State Plan" means a comprehensive, written commitment by a State Medicaid agency, submitted under §1902(a) of the Social Security Act, to administer or supervise the administration of the Medical Assistance Program in accordance with federal requirements.

(29) "Telehealth" has the meaning stated in COMAR 10.09.49.02.

(30) "Waiver applicant" means an individual who is applying for participation in the waiver, to receive the services covered under this chapter.

(31) "Waiver" means the Home and Community-Based Options Waiver as implemented through this chapter.

Md. Code Regs. 10.09.54.01

Regulations.01 adopted as an emergency provision effective July 22, 1993 (20:16 Md. R. 1275); adopted permanently effective October 26, 1993 (20:21 Md. R. 1654)
Regulations.01 adopted effective 41:8 Md. R. 471, eff.4/28/2014 ; amended effective 50:23 Md. R. 1004, eff. 11/27/2023