Md. Code Regs. 10.09.56.01

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.56.01 - Definitions

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

B. Terms Defined.

(1) Active Treatment.

(a) "Active treatment" means, according to 42 CFR § 483.440(a), a continuous active treatment program which includes aggressive, consistent implementation of a program of specialized and generic training, treatment, health services, and related services that is directed toward the:

(i) Acquisition of the behaviors necessary for the individual to function with as much self-determination and independence as possible; or

(ii) Prevention or deceleration of regression or loss of current optimal functional status.

(b) "Active treatment" does not mean, according to 42 CFR § 483.440(a), services to maintain generally independent individuals who are able to function with little supervision or in the absence of a continuous active treatment program.

(2) "Applicant" means an individual who is applying as a participant in the Autism Waiver.

(3) "Autism" has the meaning stated in §C of this regulation.

(4) "Autism Waiver" means the Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder.

(5) "Certified special educator" means a professional who holds an appropriate certificate as defined by COMAR 13A.12.01.02C.

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

(7) "Developmentally disabled" means a condition, as specified in 42 CFR § 435.1010 for persons with related conditions, resulting in a severe, chronic disability which meets all of the following conditions:

(a) Is attributable to:

(i) Cerebral palsy or epilepsy; or

(ii) A condition such as autism, except for mental illness, which is found to be closely related to intellectual disability because the condition results in impairment of general intellectual functioning or adaptive behavior similar to that of intellectually disabled individuals, and requires treatment or services similar to those required for intellectually disabled individuals;

(b) Is manifested before the individual is 22 years old;

(c) Is likely to continue indefinitely; and

(d) Results in substantial functional limitations in three or more of the following areas of major life activities:

(i) Self-care;

(ii) Understanding and use of language;

(iii) Learning;

(iv) Mobility;

(v) Self-direction;

(vi) Capacity for independent living; or

(vii) Other areas of major life activities.

(8) "Early intervention services" means services that:

(a) Are designed to meet the developmental needs of infants and toddlers with disabilities;

(b) Are provided under public supervision and in conformity with an individualized family service plan; and

(c) Meet applicable State and federal standards.

(9) "Eligible person" means an individual who meets the qualifications, as specified in Regulation .02 of this chapter, for participation in the Autism Waiver.

(10) "Family" means adults who:

(a) Live with or provide care to the participant; and

(b) Are not paid to provide the care.

(11) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996 developed to improve portability of health insurance coverage, reduce healthcare fraud and abuse, and protect individual privacy of personal health records.

(12) "Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder" means the program implemented under this chapter in accordance with the document, and any amendments to it, submitted by the Department to, and approved by, the Secretary of the U. S. Department of Health and Human Services, which authorizes the waiver, pursuant to § 1915(c) of Title XIX of the Social Security Act, of certain specified statutory requirements limiting coverage for home and community-based services under the Medical Assistance Program.

(13) "ICF-ID level of care" means an assessment that an individual needs the level of services provided in an intermediate care facility for the intellectually disabled and persons with related conditions (ICF-ID), including active treatment.

(14) "Individualized education program (IEP)" means a written statement for a student with a disability that is developed, reviewed, and revised in accordance with 20 U.S.C. § 1414 and COMAR 10.09.52.

(15) "Individualized family service plan (IFSP)" means a written, individualized plan for early intervention and other services for an infant or toddler, in accordance with COMAR 10.09.40, 10.09.50, and 13A.13.01.

(16) "Intermediate care facility for individuals with intellectual disabilities (ICF-IID)" means an institution licensed by the Department under COMAR 10.07.20 that:

(a) Is primarily for the diagnosis, treatment, or rehabilitation of individuals -with intellectual disabilities or persons with related conditions; and

(b) Provides, in a protected residential setting, ongoing evaluation, planning, 24-hour supervision, coordination, and integration of health or rehabilitative services to help each individual function at the individual's greatest ability.

(17) "Local lead agency" means the agency designated by the local governing authority in each jurisdiction to administer the interagency system of early intervention services under the direction of the State Department of Education.

(18) "Local school system" means the public local education agency in each jurisdiction.

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

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

(21) "Multidisciplinary team" means the IEP team or IFSP participants, consistent with the Individuals with Disabilities Education Act (IDEA), which is convened for a participant.

(22) Parent.

(a) "Parent" means the adult representative of a minor applicant or participant.

(b) "Parent" includes:

(i) A natural or adoptive parent;

(ii) A legal guardian;

(iii) A person acting in the place of a parent, such as a grandparent or stepparent, with whom the participant lives, including those relatives or stepparents who are foster parents;

(iv) An individual appointed as the parent surrogate in accordance with Education Article, § 8-412, Annotated Code of Maryland, for matters within the scope of the Individuals with Disabilities Education Act (IDEA); and

(v) Any other person who is legally responsible for the participant's welfare.

(23) "Participant" means an eligible person who is enrolled in the Autism Waiver.

(24) "Program" means the Medical Assistance Program, as stated in COMAR 10.09.36.01B.

(25) "Positive behavior intervention" means a range of intervention strategies that are designed to prevent problem behaviors while teaching socially appropriate alternative behaviors.

(26) "Provider" means an individual, association, partnership, corporation, or unincorporated group that:

(a) Is approved as meeting the conditions for waiver participation specified in this chapter; and

(b) Has enrolled with the Program to provide one or more of the waiver services covered under this chapter.

(27) "Provider agreement" means a contract between the Program and a provider.

(28) "Qualified diagnostician" means an individual whose license or certification permits diagnosis of Autism Spectrum Disorder.

(29) "Recipient" means an individual who is certified by the Department as eligible to receive Program benefits.

(30) "Reportable event policy" means a process developed to protect the health and safety of waiver participants in the community by identifying, documenting, and resolving complaints and incidents.

(31) "Retainer payment" means payment made to providers of residential habilitation services while the participant is hospitalized or absent from the residential habilitation program.

(32) "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.

(33) "Service coordinator" means the individual who provides case management services for Autism Waiver participants in accordance with COMAR 10.09.52.

(34) "Special educator" means a professional who holds an appropriate certificate as defined by COMAR 13A.12.01.02B.

(35) "State Department of Education (MSDE)" means the agency responsible for ensuring that all children with disabilities residing in the State are identified, assessed, and provided with a free, appropriate public education consistent with State and federal laws.

(36) "State fiscal year" means the 12-month period of July 1 through June 30 over which the State budgets its spending.

(37) "State Plan" means the plan for the Medical Assistance Program as submitted by the Department and approved by the Secretary of the U.S. Department of Health and Human Services according to Title XIX of the Social Security Act, as modified or amended.

(38) "Waiver plan of care" means the written, individualized treatment plan developed for a participant, which identifies the waiver services covered under this chapter.

C. Autism.

(1) "Autism" means autism spectrum disorder, which is diagnosed when an individual has a total of six or more of the following items under §C(1)(a), (b), and (c) of this regulation, with at least two from §C(1)(a) and one each from §C(1)(b) and (c):

(a) Qualitative impairment in social interaction, as manifested by at least two of the following:

(i) Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction;

(ii) Failure to develop peer relationships appropriate to developmental level;

(iii) A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (for example, by a lack of showing, bringing, or pointing out objects of interest);

(iv) Lack of social or emotional reciprocity;

(b) Qualitative impairments in communication as manifested by at least one of the following:

(i) Delay in, or total lack of, the development of spoken language, not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime;

(ii) In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others;

(iii) Stereotyped and repetitive use of language or idiosyncratic language;

(iv) Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level;

(c) Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(i) Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus;

(ii) Apparently compulsive adherence to specific, nonfunctional routines or rituals;

(iii) Stereotyped and repetitive motor mannerisms (for example, hand or finger flapping or twisting, or complex whole body movements);

(iv) Persistent preoccupation with parts or objects.

(2) "Autism" includes:

(a) Delays or abnormal functioning in at least one of the following areas, with onset before age 3 years:

(i) Social interaction;

(ii) Language as used in social communication; or

(iii) Symbolic or imaginative play;

(b) An individual's behavior that is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder;

(c) Pervasive Developmental Disorder Not Otherwise Specified (including Atypical Autism, Rett's Disorder, and Asperger's Disorder).

Md. Code Regs. 10.09.56.01

Regulations .01C as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487)
Regulation .01B amended effective April 16, 2012 (39:7 Md. R. 492); amended effective 43:7 Md. R. 449, eff.4/11/2016; amended effective 47:10 Md. R. 516, eff. 5/18/2020