Md. Code Regs. 10.09.56.04

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

Section 10.09.56.04 - Conditions for Participation - General

To provide Autism Waiver services, the provider:

A. Shall be approved in accordance with the requirements specified in this chapter;

B. Shall have a provider agreement in effect, signed with the Program;

C. Shall meet all the conditions for participation specified in COMAR 10.09.36, except as otherwise specified in this chapter;

D. Shall assure that professional employees who render or delegate services under this chapter have the appropriate experience and health-related license or professional certification to meet the participant's needs, including equivalency review by an accredited agency for credentials obtained outside of the United States, before rendering services to any Autism Waiver participant;

E. Shall assure that direct care workers who render services under this chapter:

(1) Meet the minimum age requirement, set forth by service, before rendering services to any Autism Waiver participant;

(2) Receive adequate and appropriate training, within 60 days of employment and annually thereafter, pertaining to care for children with autism spectrum disorder including:

(a) Training concerning abuse, neglect, and exploitation;

(b) Positive behavioral interventions and restraints rendered by a MSDE approved trainer,

(c) Reportable event policy; and

(d) HIPAA;

(3) Work under the ongoing supervision of a qualified professional employee of the provider who has annual training in:

(a) Abuse, neglect, exploitation;

(b) Positive behavioral interventions and appropriate use of restraints rendered by a MSDE-approved trainer,

(c) Reportable event policy; and

(d) HIPAA;

(4) Are approved by the provider as qualified to meet the participant's needs;

(5) Are approved by the participant's parents; and

(6) Have volunteer or employment experience working with children with autism spectrum disorder or other developmental disabilities as a service provider or as a family member for a minimum of 100 hours, that may include:

(a) Internships;

(b) Post high school educational experience with developmental disabilities;

(c) Shadowing experienced staff;

(d) Employment with a developmental disabilities agency; or

(e) Fulfilling the community service requirement through volunteering with a child with autism or another developmental disability;

F. Shall be required to have a professional on-call at all times, and employ or contract with certain professionals for consultation as needed when providing:

(1) Residential habilitation services;

(2) Intensive individual support services; and

(3) Therapeutic integration services;

G. Shall employ on-call professionals and professional consultants:

(1) Who are:

(a) Board-certified behavior analysts;

(b) Certified school psychologists;

(c) Certified special educators;

(d) Individuals with a masters or doctorate degree in special education or a related field and 5 years experience in providing training or consultation in autism spectrum disorder or other developmental disabilities;

(e) Licensed certified social workers;

(f) Licensed professional counselors;

(g) Nurse psychotherapists;

(h) Physicians;

(i) Psychologists;

(j) Occupational therapists;

(k) Physical therapists;

(l) Registered nurses; or

(m) Speech therapists; and

(2) Who have:

(a) Experience providing services to children with autism spectrum disorder or other developmental disabilities;

(b) A background in behavior management techniques; and

(c) Knowledge of the specific children being served by the provider.

H. Shall verify the licenses, credentials, and references of all individuals who render or delegate services on the provider's behalf under this chapter, and have a copy of the licenses, credentials, and at least three written references available for inspection;

I. Shall maintain current, written, and signed contracts with all contractors providing waiver services on behalf of the provider that include:

(1) The scope of services to be performed;

(2) The requirement to comply with all applicable Medicaid regulations;

(3) The requirement to complete and maintain written documentation of service delivery, individualized for each participant on each day that the participant receives services;

(4) A clause that no monies shall be sought from the waiver participant or the participant's family if the contract is breached by either the provider or contractor; and

(5) A current copy of a provider license or certification and insurance as required in this chapter;

J. With the exception of environmental accessibility adaptation providers, shall submit to a preemployment criminal background investigation;

K. With the exception of respite care and environmental accessibility adaptations providers, shall submit separate, written treatment plans to service coordinators within 30 calendar days of the initiation of services in accordance with State guidelines for each individual service and at least once in each 12-month period thereafter, or more frequently if the treatment plan changes;

L. If an agency, shall require supervisory and direct care employees of provider agencies to:

(1) Submit an application for a child care criminal history record check to the Criminal Justice Information System Central Repository, Department of Public Safety and Correctional Services, in accordance with Family Law Article, § 5-561, Annotated Code of Maryland;

(2) Request the Department of Public Safety and Correctional Services to send the child care criminal history report to the Department's Division of Community Long Term Care; and

(3) Not have been convicted of, received probation before judgment for, or entered a plea of nolo contendere to, a felony or crime involving moral turpitude or theft, or have other criminal history that indicated behavior that is potentially harmful to participants;

M. If an agency, shall:

(1) Pay for the criminal background check;

(2) Request clearance from the Department for all applicants prior to an offer of employment; and

(3) Submit monthly Criminal Justice Information System's update reports to the Maryland State Department of Education;

N. If self-employed, shall:

(1) Submit an application for a criminal history record check to the Criminal Justice Information System Central Repository, Department of Public Safety and Correctional Services;

(2) Request the Department of Public Safety and Correctional Services to send the child care criminal history report to the Department's Division of Community Long Term Care;

(3) Pay for the criminal background check;

(4) Not have been convicted of, received probation before judgment for, or entered a plea of nolo contendere to, a felony or crime involving moral turpitude or theft, or have other criminal history that indicated behavior that is potentially harmful to participants; and

(5) Submit monthly Criminal Justice Information System's update reports to the State Department of Education.

O. Shall have the option to request the Department to waive the provisions of §§L(3) and N(4) of this regulation if the applicant demonstrates that:

(1) The conviction, probation before judgment, or plea of nolo contendere for a felony or any crime involving moral turpitude or theft was entered more than 10 years before the date of the provider's or prospective employee's application; and

(2) The criminal history does not indicate behavior that is potentially harmful to participants;

P. Shall have adequate liability insurance;

Q. Shall provide services in accordance with the requirements of the Autism Waiver plan of care, this chapter, the Autism Waiver, and all relevant federal, State, and local laws and regulations;

R. Shall agree to submit claims for payment by the Program for only those services covered under this chapter which have been identified and documented in a participant's Autism Waiver plan of care;

S. Shall agree to maintain and have available to the Department or the State Department of Education personnel records and written documentation describing waiver services rendered, including dates and hours of services provided to participants, for a period of 6 years, in a manner approved by the Department or its designee;

T. Shall agree not to suspend, increase, or reduce services for a participant without a waiver plan of care or plan of care addendum from the service coordinator for that participant;

U. Unless a risk to health and safety exists, shall agree not to terminate services for a participant without providing:

(1) 30 days written notice to the participant, parent or guardian, and service coordinator; and

(2) Assistance in the discharge planning process;

V. Is not eligible to participate in the waiver if the provider or any of its principals were previously program providers, or if its principals were principals in program providers, that have overpayments that remain due and owing to the Department;

W. Is not eligible if the provider or its principals within the past 24 months have:

(1) Had a license or certificate suspended or revoked as a health care provider, health care facility, or provider of direct care services;

(2) Been suspended or removed from participating as a Medicaid provider;

(3) Undergone the imposition of sanctions under COMAR 10.09.36.08H;

(4) Been subject to disciplinary action including actions by providers or any of its principal's licensing board;

(5) Been cited by a State agency for deficiencies which affect a participant's health and safety; or

(6) Experienced a termination of a reimbursement agreement with or been barred from work or participation by a public or private agency due to:

(a) Failure to meet contractual obligations; or

(b) Fraudulent billing practices;

X. Shall maintain written quarterly records documenting face-to-face supervision of direct care employees and direct observation of the participant that includes:

(1) Date and location of supervision;

(2) Review, feedback, and oversight of the implementation of treatment plan goals;

(3) Review, feedback, and oversight of the implementation of positive behavior intervention;

(4) Review, feedback, and oversight of the scope of activities during service;

(5) Review, feedback, and oversight of data collection;

(6) Date and name of supervisor, name of employee, and name of the participant; and

(7) Signature of supervisor;

Y. Shall agree to keep all records available for inspection or audit by the Department or the Department's designee at any reasonable time during business hours;

Z. Shall implement and follow the Reportable Event policy in accordance with the Department's established policy by:

(1) Reporting incidents and complaints to the participant's service coordinator within 24 hours;

(2) Submitting a written report within 7 calendar days on a form designated by the Department; and

(3) Notifying the local department of social services immediately if the provider has a reason to believe that the participant has been subject to abuse, neglect, self-neglect, or exploitation, in accordance with COMAR 07.06.04;

AA. May not:

(1) Render direct services to the provider's own child; or

(2) Render supervision to the direct care worker of the provider's own child;

BB. With the exception of environmental accessibility adaptations providers and residential habilitation providers, shall submit to the service coordinator monthly service tracking forms for each participant served within 20 calendar days of the end of each month;

CC. With the exception of environmental accessibility adaptations providers, shall attend at least one Autism Waiver training conducted by the State each year and shall participate in:

(1) One training annually regarding the prevention, identification, and reporting of abuse, neglect, and exploitation;

(2) One training annually regarding positive behavioral intervention and restraints; and

(3) All statewide Autism Waiver trainings during any year in which the provider is under recommendation for disenrollment from the waiver or has had Medicaid payments suspended;

DD. Shall satisfactorily complete all aspects of the Autism Waiver provider applications process;

EE. Shall notify the Program within 15 days of occurrence of any change to contact information;

FF. Shall maintain communications with the program by maintaining a working telephone and answering machine, facsimile machine, and e-mail account;

GG. Shall have status as a Maryland Medicaid Autism Waiver provider, including the Medicaid provider number, terminated if no services have been provided for 24 consecutive months;

HH. Shall, when transportation is provided:

(1) Implement the provider's transportation policy;

(2) Identify the driver in daily contact notes or a transportation log;

(3) Document the start and stop times transportation is provided for each day that a participant is transported;

(4) Maintain a copy of the current automobile liability coverage and documentation of payment for the vehicle transporting a participant; and

(5) Maintain a current copy of the valid State driver's license and driving record for staff transporting a waiver participant; and

II. Shall comply with all administrative policies, procedures, transmittals, and guidelines issued by the Department or its designee.

Md. Code Regs. 10.09.56.04

Regulation .04 amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741)
Regulations .04D 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 .04 amended effective April 16, 2012 (39:7 Md. R. 492); amended effective 43:7 Md. R. 449, eff.4/11/2016; amended effective 51:18 Md. R. 809, eff. 9/16/2024.