Md. Code Regs. 10.09.81.02

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

Section 10.09.81.02 - Definitions

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

B. Terms Defined.

(1) "Activities of daily living" means bathing, eating, toileting, dressing, and mobility including transfer.

(2) "Adult Evaluation and Review Services (AERS)" means an entity within the local health department which, in accordance with this chapter and COMAR 10.09.30, evaluates ICS applicants and participants.

(3) "Agency-employed attendant" means an attendant who is employed by, or under contract with, an attendant care provider agency.

(4) "Applicant" means an individual who has submitted to the Department an application for the ICS Program.

(5) "Assessment fee" means the fee the participant is required to pay as a condition of eligibility for the ICS Program and Medical Assistance benefits.

(6) "Assistance" means that another individual:

(a) Physically performs an activity for the participant;

(b) Physically helps the participant to perform an activity;

(c) Is present while the participant performs an activity because the participant's safety or health may be jeopardized if the activity is not monitored or performed due to the participant's physical or mental status; or

(d) Cues or encourages the participant to perform the activity.

(7) "Assisted living services provider" means a provider licensed by the Department in accordance with COMAR 10.07.14 and enrolled in the Maryland Medical Assistance Program to provide the services covered under Regulation .37 of this chapter.

(8) "Attendant" means an individual who provides a participant with attendant care services.

(9) "Attendant care provider agency" means an agency that is enrolled in the Maryland Medical Assistance Program to provide the services covered under Regulation .30 of this chapter.

(10) "Attendant Care Services" means assistance with activities of daily living, instrumental activities of daily living, and performance of delegated nursing functions.

(11) "Case management agency" means an agency enrolled by the Maryland Medical Assistance Program to provide case management services to ICS applicants and participants.

(12) "Case management services" means services that assist an applicant or a participant to gain access to ICS services, Medicaid State Plan services, and other community services.

(13) "Delegated nursing functions" means services, other than assistance with activities of daily living and instrumental activities of daily living, provided to a participant by:

(a) An enrolled attendant under the supervision of an enrolled licensed registered nurse in accordance with COMAR 10.27.11; or

(b) A nurse practitioner in accordance with COMAR 10.27.07.

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

(15) "Determination" means a decision by the Department regarding an applicant's or participant's eligibility for the ICS Program.

(16) "Fiscal intermediary" means an agency that is under contract with the Department to provide fiscal intermediary services.

(17) "Fiscal intermediary services" means certain employer-related payroll functions, such as State and federal tax withholding and Social Security withholding, performed on behalf of participants who elect to use the participant-employed model of attendant care services.

(18) Home.

(a) "Home" means the place where the participant resides.

(b) "Home" does not include a hospital, nursing facility, or other institution that is regulated under:

(i) COMAR 10.22.03 for licensed community-based residential facilities for individuals with intellectual or developmental disabilities; or

(ii) COMAR 10.21.22 for residential rehabilitation programs for individuals with serious or chronic mental illness.

(19) "Increased Community Services (ICS) Program" means the Medicaid home and community-based services program implemented under this chapter in accordance with the HealthChoice Section 1115 Waiver approved by the Centers for Medicare and Medicaid Services.

(20) "Instrumental activities of daily living" means tasks or activities that include:

(a) Preparing a light meal;

(b) Performing light chores;

(c) Shopping for groceries;

(d) Traveling beyond a walking distance;

(e) Managing finances and handling money;

(f) Using the telephone; and

(g) Planning and making decisions.

(21) "Maryland Medical Assistance Program" means the Program administered by the State under Title XIX of the Social Security Act, which provides comprehensive medical and other health-related care for low income and medically indigent persons.

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

(23) "Medical day care" means medically supervised, health-related services provided in an ambulatory setting to medically disabled adults who, because of the degree of impairment, need health maintenance and restorative services that support their community living.

(24) "Medical day care center" means a facility operated for the purpose of providing medical day care services in an ambulatory care setting to medically disabled adults who do not require 24-hour inpatient care, but because of the degree of impairment, are not capable of full-time independent living.

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

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

(b) Consistent with currently 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 consumer, family, or provider.

(26) "Nurse" means an individual who is currently licensed to practice nursing in the State.

(27) "Nurse monitor" means a registered nurse who provides nursing supervision of attendants in accordance with COMAR 10.27.11 and this chapter.

(28) "Nursing facility" means an institution which is licensed by the Department under COMAR 10.07.02.

(29) "Nursing facility services" means services provided to individuals who do not require hospital care, but who, because of a mental or physical condition, require skilled nursing care and related services, rehabilitative services, or, on a regular basis, health-related care and services above the level of room and board.

(30) "Nursing supervision" means a nurse monitor's supervision of an attendant in accordance with COMAR 10.27.11 and this chapter.

(31) "Participant" means an individual who meets the qualifications for participation in the ICS program as specified in Regulation .03 of this chapter and is enrolled with the Department to receive ICS services.

(32) "Participant-employed attendant" means an attendant who does not work for an attendant care provider agency and who may be chosen, trained, supervised, and fired by the participant.

(33) "Participant-employed model" means the delivery of attendant care services when:

(a) An ICS participant chooses the attendant who will render services;

(b) The attendant is an enrolled Medicaid provider; and

(c) The participant utilizes services of a fiscal intermediary.

(34) "Plan of care" means the recommended or revised recommended service plan developed by AERS after an evaluation of an applicant or participant.

(35) "Plan of service" means the written plan that:

(a) Is developed jointly by the applicant or participant and the case manager;

(b) Is based upon:

(i) The AERS evaluation;

(ii) The AERS plan of care; and

(iii) The case manager's face-to-face interview with the applicant or participant;

(c) Addresses the applicant's or participant's needs and desires; and

(d) Specifies the type, amount, frequency, costs, and duration of all ICS and other Medicaid services required to safely support the participant in the community.

(36) "Provider" means an entity which is enrolled in the Maryland Medical Assistance Program to provide one or more of the services covered under Regulations .22-.37 of this chapter.

(37) "Quality plan" means the plan developed by the Department to address quality assurance and oversight for the ICS program.

(38) "Registered nurse" means an individual licensed to practice as a registered nurse under Health Occupations Article, Title 8, Annotated Code of Maryland.

(39) "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.

(40) "State Plan" means the document approved by the Centers for Medicare and Medicaid Services describing the nature and scope of the Maryland Medical Assistance Program in accordance with federal requirements at § 1902(a) of Title XIX of the Social Security Act.

Md. Code Regs. 10.09.81.02