Md. Code Regs. 10.09.81.20

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

Section 10.09.81.20 - Specific Conditions for Participation - Assisted Living

A. To participate in the ICS Program as an assisted living services provider, 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:

(a) At the Level 2 moderate level of care or Level 3 high level of care; and

(b) For the level of care needed by each participant residing in the facility, including any needed resident-specific waiver in accordance with COMAR 10.07.14.09B;

(2) Meet the requirements of COMAR 10.07.14 for Assisted Living Programs;

(3) Be or employ a manager who is literate, able to communicate in English, and 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;

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

(5) Have at least one staff person per eight residents on duty at all times during daytime hours, and a staff-to-resident ratio at night sufficient to provide the required services and maintain the facility in a safe and orderly condition, and such additional staffing as required by the Department or the Maryland Department of Aging depending on residents' functional levels;

(6) Participate in training on the ICS Program billing process and other ICS Program requirements, as specified by the Department and the Maryland Department of Aging;

(7) Have appropriate insurance coverage for the provider and its employees and vehicles if the provider transports participants to medical, social, recreational, and other services;

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

(a) Facilitating on-site visits of authorized quality assurance monitors to review compliance with ICS 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 ICS and State Plan services in the plan of service; and

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

(9) Submit claims consistent with the provisions of Regulation .40 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 participant's payments for bed reservation days may not exceed the full Medicaid per diem rate for Level II or Level III assisted living services, as applicable.

C. Designated Units. An assisted living provider may limit Medicaid participation to designated units only if approved by the Maryland Department of Aging and the facility resident agreement contains the following provision: The facility's participation in the Maryland Medical Assistance Program is limited to one or more designated units and, in order to access Medicaid benefits, the resident shall reside in a designated unit.

Md. Code Regs. 10.09.81.20