Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 1
Subtitle 07 - HOSPITALS
Chapter 10.07.02 - Nursing Homes
Section 10.07.02.01 - Definitions
Universal Citation: MD Code Reg 10.07.02.01
Current through Register Vol. 51, No. 19, September 20, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Administrator" means the individual
licensed by the Board of Examiners of Nursing Home Administrators who is
responsible for the operation of the nursing home.
(2) "Attending physician" means an individual
licensed to practice medicine in the State who:
(a) Admits residents to the nursing home;
and
(b) Is responsible for the
overall care of a resident.
(3) "Audiologist" means an individual who
holds a Maryland license issued by the State Board of Audiologists, Hearing Aid
Dealers, and Speech-Language Pathologists.
(4) Authorized prescriber has the meaning
stated in Health Occupations Article, §12-101, Annotated
Code of Maryland.
(5) "Certified
medicine aide" means an individual who meets the requirements as stated in
COMAR 10.39.01 and 10.39.03.
(6)
"Certified social worker" means an individual licensed to practice as a
certified social worker in this State.
(7) "Charge nurse" means the registered or
licensed practical nurse who is responsible for day-to-day operations of a unit
in the nursing home on which residents live.
(8) "Chemical restraint" means the
administration of any drug that is used for discipline or convenience and not
required to treat medical symptoms.
(9) "Comprehensive care facility" means a
nursing home that admits residents requiring medical services and nursing
services rendered by or under the supervision of a registered nurse, who:
(a) Are advanced in age; or
(b) Have a disease or a disability.
(10) "Concurrent review" means
daily rounds by a licensed nurse which include:
(a) Appraisal and observation of all
residents by the licensed nurse to determine any change in each resident's
physical or mental status;
(b) If
there is a change in the resident's physical or mental status, an evaluation by
the licensed nurse of the resident's medications, laboratory values relating to
the resident, and clinical data relating to the resident, including the
resident's:
(i) Hydration and nutritional
needs;
(ii) Skin
integrity;
(iii) Noted weight
changes; and
(iv)
Appetite;
(c) Evaluation
of injuries sustained by the resident that result from an accident or incident
involving the resident; and
(d) Any
other relevant parameters affecting or reflecting the resident's physical and
mental status.
(11)
"Culture change facility" means a nursing home where physical environment and
operational changes have been made to establish person-valued and
person-directed care activities and services.
(12) "Deficiency" means a condition existing
in a nursing home or an action or inaction by the nursing home staff that
results in potential for more than minimal harm, actual harm, or serious and
immediate threat to one or more residents.
(13) "Dentist" means an individual licensed
to practice dentistry in this State.
(14) "Department" means the Maryland
Department of Health.
(15)
"Dietetic service supervisor" means a person who:
(a) Is a qualified dietitian;
(b) Is a graduate of a dietetic technician
program approved by the American Dietetic Association;
(c) Is a certified dietary manager who has
successfully completed the required course and maintains certification as
required by the certifying board for the Dietary Managers
Association;
(d) Is a graduate of a
State-approved course that provided 90 or more hours of classroom instruction
in food service supervision and has experience as a supervisor in a health care
institution with consultation from a dietitian; or
(e) Has training and experience in food
service supervision and management in a military service equivalent in content
to §B(15)(b) and (d) of this regulation.
(16) "Dietitian-nutritionist" means an
individual who:
(a) Is licensed by the
Maryland Board of Dietetic Practice to practice dietetics;
(b) Has met the certifying requirements for
registration as a dietitian as administered by the Commission on Dietetic
Registration; and
(c) Maintains the
continuing education requirements of registration.
(17) "Discharge" means the removal of a
resident from a nursing home when the releasing nursing home is no longer
responsible for the resident's care.
(18) "Discipline" means the medical,
rehabilitative, nursing, dietetic, activities and social service components
affiliated with the operation of a nursing home.
(19) "Distinct part extended care facility"
means a portion of a nursing home that is licensed as an extended care
facility.
(20) "Extended care
facility " means a nursing home that offers sub-acute care and provides medical
treatment services for residents who require inpatient care but who do not
currently require continuous hospital services.
(21) "Facility" means a nursing
home.
(22) "Fire authorities" means
the official fire safety agency including the State Fire Marshal or local fire
marshals or fire departments as appropriate.
(23) "Full time" means 40 hours per week or
the standard work week adopted by the nursing home.
(24) "Geriatric nursing assistant" means a
CNA who has successfully completed the requirements for a GNA set forth in
42 CFR §§ 483.151 -
483.156 and COMAR
10.39.01.
(25) "Grant" means the
award of money to an individual or an organization to:
(a) Study an aspect for the geriatric
population; or
(b) Provide a
service to nursing home residents or their families.
(26) "Health officer" means the health
officer or the designated representative in each of the 23 counties and the
Commissioner of Health in Baltimore City.
(27) "HVAC" means heating, ventilation and
air conditioning.
(28) "Infection
preventionist" means a licensed healthcare worker who:
(a) Manages the infection prevention and
control program in the nursing home; and
(b) Has completed a minimum of 15 contact
hours of infection prevention and control training that is approved by the:
(i) Department's Office of Infectious Disease
Epidemiology and Outbreak Response; and
(ii) Office of Health Care Quality.
(29) "Licensed bachelor
social worker (LBSW)" means an individual authorized to practice bachelor
social work under Health Occupations Article, Title 19, Annotated Code of
Maryland.
(30) "Licensed certified
social worker (LCSW)" means an individual authorized to practice certified
social work under Health Occupations Article, Title 19, Annotated Code of
Maryland.
(31) "Licensed certified
social worker-clinical (LCSW-C)" means an individual authorized to practice
clinical social work under Health Occupations Article, Title 19, Annotated Code
of Maryland.
(32) "Licensed master
social worker" means an individual authorized to practice master social work
under Health Occupations Article, Title 19, Annotated Code of
Maryland.
(33) "Licensed or
certified professional health care practitioner" means a nurse practitioner,
physician assistant, or other practitioner licensed or certified under the
Health Occupations Article, Annotated Code of Maryland.
(34) Licensed pharmacist" means an individual
who is licensed by the Board to practice pharmacy as defined in Health
Occupations Article, §12-101(l),
Annotated Code of Maryland.
(35)
"Licensed practical nurse" means an individual authorized to practice licensed
practical nursing under Health Occupations Article, Title 8, Annotated Code of
Maryland.
(36) "Management firm"
means an organization, under contract with an applicant for a license or a
current licensee, that is intended to have or has full responsibility and
control for the day-to-day operations of the nursing home.
(37) "MDS Care Area Assessment" means the
investigation of triggered care areas, to determine if the care area or areas
require interventions and care planning.
(38) "Medical director" means an individual
licensed to practice medicine in this State who, pursuant to a written
agreement, is responsible for the overall coordination of the medical care in
the nursing home to ensure the adequacy and appropriateness of the medical
services provided to residents and to maintain surveillance of the health
status of employees.
(39) "Minimum
Data Set (MDS)" means a core set of screening, clinical, and functional status
elements, including common definitions and coding categories, which:
(a) Forms the foundation of a comprehensive
assessment for all nursing home and swing bed residents; and
(b) Standardize communication about resident
problems and conditions:
(i) Within these
facilities;
(ii) Between these
facilities; and
(iii) Between these
facilities and outside agencies.
(40) "New nursing home" means a nursing home
that does not yet have plans approved by the Department at the time of the
adoption of this chapter.
(41)
"NFPA" means National Fire Protection Association.
(42) "Nurse" means a licensed practical nurse
or registered nurse licensed in the State as defined in Health Occupations
Article, §8-101, Annotated
Code of Maryland.
(43) Nurse
practitioner has the meaning stated in Health Occupations Article, §8-101(k),
Annotated Code of Maryland.
(44)
Nursing care has the meaning stated in Health-General Article, §
19-301(k), Annotated Code of Maryland.
(45) "Nursing home" means a comprehensive
care facility or extended care facility which offers nonacute inpatient care to
residents:
(a) Who have a disease, chronic
illness, condition, disability of advanced age, or terminal disease requiring
maximal nursing care without continuous hospital services; and
(b) Who require medical services and nursing
services rendered by or under the supervision of a licensed nurse together with
convalescent, restorative, or rehabilitative services.
(46) "Nursing service personnel" means staff
licensed or certified by the Maryland Board of Nursing.
(47) "Occupational therapist" means an
individual who is licensed by the State Board of Occupational Therapy Practice
to practice occupational therapy.
(48) "Occupational therapy assistant" means
an individual who is currently licensed by the State Board of Occupational
Therapy Practice as an occupational therapy assistant.
(49) "Ongoing pattern" means the occurrence
of any potential for more than minimal harm or greater deficiency on two
consecutive on-site visits as a result of:
(a) Annual surveys;
(b) Follow-up visits and unscheduled visits;
or
(c) Complaint
investigations.
(50)
"Paid feeding assistant" means an individual who:
(a) Meets the requirements of Regulation .63
of this chapter; and
(b) Is paid by
a nursing home to feed residents who are unable to perform the task
themselves.
(51)
"Physical restraint" means any manual method or physical or mechanical device,
material, or equipment attached or adjacent to the resident's body that the
individual cannot remove easily which restricts freedom of movement or normal
access to one's body including but not limited to:
(a) Leg restraints;
(b) Arm restraints;
(c) Hand mitts;
(d) Soft ties or vests;
(e) Lap cushions; and
(f) Lap trays.
(52) "Physical therapist" means an individual
licensed to practice physical therapy by the State Board of Physical Therapy
Examiners.
(53) "Physician" means
an individual licensed to practice medicine in this State.
(54) Physician assistant has the meaning
stated in Health Occupations Article, §15-101(o),
Annotated Code of Maryland.
(55)
"Plan of correction " means a written response from the nursing home addressing
each deficiency cited as a result of an inspection by the Department.
(56) "Positive tuberculin skin test" means a
test provided as authorized by the Guidelines for Preventing the Transmission
of Mycobacterium tuberculosis in Health-Care Settings.
(57) "Principal physician" means an
individual licensed to practice medicine in this State who agrees to perform
certain medical services under contract with a nursing home, consistent with
the policies of the nursing home.
(58) "Protective device " means any device or
equipment:
(a) That is prescribed by a
physician;
(b) That limits, but
does not eliminate the movement of the resident's head, body, or limbs;
and
(c) That:
(i) Shields a resident from
self-injury;
(ii) Prevents a
resident from aggravating an existing physical problem; or
(iii) Prevents a resident from precipitating
a potential physical problem.
(59) "Qualified medical record practitioner "
means an individual who:
(a) Has:
(i) Received a baccalaureate degree from an
accredited college or university including or supplemented by a successful
completion of a course in health record administration approved by the Council
on Medical Education of the American Medical Association; and
(ii) Passed the national registration
examination for registered record administrators; or
(b) Has:
(i)
Received an associate of arts degree in health record technology from a college
or university approved by the American Medical Association Council on Medical
Education or an equivalent approved health record technology correspondence
course of the American Medical Record Association; and
(ii) Passed the national accreditation
examination for accredited record technicians.
(60) "Qualified social work consultant" means
an individual who:
(a) Is a licensed certified
social worker; and
(b) Has a
minimum of 3 years' experience in social work programs in a long-term care
setting within the last 5 years.
(61) Quality Improvement and Evaluation
System (QIES) Assessment Submission and Processing (ASAP) system" means the
standard nationwide system to which several types of health care providers
submit CMS required resident information to the National Submissions
Database.
(62) "Registered nurse"
means an individual licensed to practice as a registered nurse in this
State.
(63) Relocation.
(a) "Relocation" means the movement of a
resident from one room to another within:
(i)
The same Medicare-certified nursing home;
(ii) A Medicaid-only certified nursing home;
or
(iii) A licensed-only nursing
home.
(b) Relocation
does not mean the movement of a resident if the effect of the movement is to
move the resident from:
(i) The distinct part
of the nursing home that is a skilled nursing facility to a distinct part of
the nursing home that is not a skilled nursing facility; or
(ii) A bed that is certified for Medicaid to
a distinct part of the nursing home that is a skilled nursing
facility.
(64) "Resident" means an individual who:
(a) Resides in the nursing home;
and
(b) Receives nursing services
rendered by or under the supervision of a registered nurse.
(65) "Resident activities
coordinator " means an individual who:
(a) Is
a:
(i) Certified therapeutic recreation
specialist;
(ii) Licensed
occupational therapist; or
(iii)
Licensed occupational therapy assistant; or
(b) Has 2 years of experience in a social or
recreational program in a licensed health care setting within the last 5 years,
1 year of which was full time in a resident activities program with guidance
from an individual identified in §B(73)(a) of this regulation.
(66) Resident Assessment
Instrument (RAI).
(a) "Resident Assessment
Instrument (RAI)" means a standardized and reproducible resident assessment
process based on completion of Minimum Data Set (MDS) screening items, and
including the MDS Care Area Assessment process, and related process for care
planning and evaluation.
(b)
Resident Assessment Instrument (RAI) includes:
(i) Minimum Data Set;
(ii) MDS Care Area Assessment Process;
and
(iii) RAI utilization
guidelines.
(67) "Resident's representative" means a
person with the authority to act on the resident's behalf regarding the matter
at issue.
(68) "Restraint" means
any physical or chemical restraint as defined in this chapter.
(69) "Secretary" means the Secretary of
Health.
(70) "Serious and immediate
threat" means a situation in which immediate corrective action is necessary
because a deficiency has caused or is likely to cause serious injury, harm,
impairment to, or death of a resident receiving care in the nursing
home.
(71) "Special care unit"
means a nursing home unit that provides intensive specialized care, such as
respiratory, rehabilitative, dementia, or dialysis care, continuously on a
24-hour basis.
(72)
"Speech-language pathologist" means an individual licensed by the State Board
of Audiologists, Hearing Aid Dispensers, and Speech-Language
Pathologists.
(73) "Support
personnel" means an aide who:
(a) Is assigned
to a particular service such as:
(i)
Nursing;
(ii) Dietary;
(iii) Physical therapy; or
(iv) Occupational therapy; and
(b) Has been approved by the
manager of the services as having sufficient training and experience to perform
the assigned duties.
(74) "Tuberculin skin test" means a test to
diagnose tuberculosis infection using purified protein derivative (PPD) that is
injected intradermally and read within 48-72 hours with results recorded in
millimeters of induration.
(75)
Tuberculosis in a Communicable Form.
(a)
"Tuberculosis in a communicable form" means that an individual:
(i) Is presumed to have active pulmonary or
laryngeal tuberculosis as evidenced by positive X-ray findings with or without
positive acid-fast bacilli (AFB) sputum smear or positive AFB sputum culture;
and
(ii) Has received chemotherapy
for less than 14 days.
(b) Tuberculosis in a communicable form does
not include:
(i) When the individual who has
presumptive or confirmed active disease, has had three negative AFB smears,
collected 8-24 hours apart, shows clinical improvement, and has received
chemotherapy to which the strain is susceptible for at least 14 days;
or
(ii) The individual who has
inactive pulmonary scarring, calcification, or a normal chest X-ray.
(76) "Two-step
tuberculin skin testing" means the administration of a second tuberculin skin
test 1 to 3 weeks after the initial skin test is negative, to identify
individuals with a past TB infection who may now have reduced skin
reactivity.
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