Md. Code Regs. 10.09.54.05

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

Section 10.09.54.05 - Specific Conditions for Provider Participation - Assisted Living

A. To participate in the program as a provider of assisted living services under this chapter a provider shall:

(1) Be licensed by the Department at the time that services are rendered, in accordance with COMAR 10.07.14, to provide assisted living services;

(2) Be or employ a manager who is qualified as:

(a) A licensed physician;

(b) A licensed registered nurse;

(c) A licensed practical nurse; or

(d) An individual with at least 3 years' experience in direct patient care in a private home, certified home, or health-related facility;

(3) Employ an alternate assisted living manager who meets the requirements as specified in §A(2) of this regulation.

(4) Have at least one staff person per eight residents on duty at all times during daytime hours, and have a staff-to-resident ratio at night which is adequate to provide the required services and maintain the facility in a safe and orderly condition, with additional staffing if required by the Department depending on residents' functional levels;

(5) Participate in training on the waiver billing process and other waiver requirements, as specified by the Department;

(6) Have the appropriate insurance coverage to cover the provider and its employees and vehicles if the provider chooses to transport participants to medical, social, recreational, and other services;

(7) Cooperate with other service providers and quality assurance monitors by:

(a) Facilitating on-site visits of authorized quality assurance monitors to review compliance with waiver and regulatory requirements;

(b) Facilitating a case manager's on-site visits to the facility, which shall occur at least quarterly, to review the facility, regulatory compliance, service provision, and participants' status and needs;

(c) Communicating with a participant's case manager concerning the participant's status, needs, and service provision;

(d) Informing the case manager within 1 working day of any significant change in the participant's status and service needs;

(e) Facilitating, as necessary and appropriate, the delivery of authorized waiver and State Plan services in the plan of service; and

(f) Facilitating waiver participant's relocation to comparable housing, if necessary, including transfer of all personal belongings and financial arrangements; and

(8) Submit claims consistent with the provisions of Regulation .22 of this chapter.

B. Bed Reservations. If bed reservations are offered to participants who are absent from an assisted living facility, the bed reservations policy shall:

(1) Be provided to all residents and, where appropriate, the resident's representative, at admission;

(2) Be fairly and consistently applied to all residents;

(3) Specify that the bed reservation service is not a Medicaid covered service;

(4) Clearly state that it is the resident's decision whether to reserve the bed; and

(5) Specify that the charges to participants for bed reservation days may not exceed the full Medicaid waiver per diem rate.

C. An assisted living provider may limit waiver participation to a designated unit or units only if approved by Department and the facility resident agreement contains the following provisions:

(1) The facility's participation in the Program is limited to one or more designated units and, in order to access Medicaid waiver benefits, the resident shall reside in a designated unit;

(2) A resident of a designated unit has a right to apply for the waiver at any time and access waiver benefits without restrictions by the provider when the resident is found eligible by the Program; and

(3) A resident not in a designated unit who is otherwise eligible or seeking eligibility for the waiver shall be given first consideration and, with all other factors equal, first priority in admission to a vacant bed in a designated unit.

Md. Code Regs. 10.09.54.05

Regulations .05 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)
Regulation .05A amended effective July 17, 2006 (33:14 Md. R. 1164)
Regulations .05 adopted effective 41:8 Md. R. 471, eff.4/28/2014