Md. Code Regs. 10.09.84.18

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

Section 10.09.84.18 - Covered Services - Items or Services that Substitute for Human Assistance

A. The program covers items or services that increase a participant's independence or substitute for human assistance, to the extent that expenditures would otherwise be made for the human assistance.

B. Each item or service shall:

(1) Be preauthorized in the participant's plan of service as necessary to:

(a) Prevent the participant's institutionalization; and

(b) Ensure the participant's health, safety, and independence;

(2) Specifically relate to ADLs or IADLs within the approved plan of service;

(3) Comply with policies and procedure guidance defined by the Department;

(4) Meet necessary standards of manufacture, design, usage, and installation, if applicable;

(5) Be provided in accordance with applicable State and local building codes and pass required inspections, if applicable; and

(6) Not be prescribed primarily to provide comfort or convenience.

C. Each item or service shall be confirmed by the Program as not covered for the participant by:

(1) Medicaid under the State Plan as durable medical equipment or pharmacy services under COMAR 10.09.03, 10.09.12, or 10.09.67;

(2) Medicare; or

(3) Any other third-party payer.

D. The program covers home-delivered meals provided during meal periods that personal assistance services are not provided. Home-delivered meals shall be:

(1) Delivered to the participant's home;

(2) Intended for consumption at home;

(3) Nutritionally adequate for the participant's age based on the Recommended Dietary Allowance (RDA) or Dietary Reference Intake (DRI), as established by the Food and Nutrition Board of the National Research Council and demonstrated by having the menus certified in writing by a physician, dietitian, or nutritionist; and

(4) At least one-third of the RDA, DRI, or therapeutic diet requirements ordered by the participant's physician, dietitian, or nutritionist, including any ordered nutritional supplements.

E. Technology that substitutes for human assistance includes:

(1) Environmental controls for the home or automobile;

(2) Personal computers, software, or accessories;

(3) Augmentative communication devices;

(4) Maintenance or repair of technology devices;

(5) Self-help aids that assist with activities of daily living or instrumental activities of daily living; and

(6) Assessments and training in the use of assistive technology.

Md. Code Regs. 10.09.84.18

Effective date: 41:5 Md. R. 343, eff.3/17/2014 ; amended effective 44:2 Md. R. 84, eff. 1/30/2017; amended effective 45:3 Md. R. 156, eff. 2/12/2018