Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.27 - Home Care for Disabled Children Under a Model Waiver
Section 10.09.27.01 - Definitions
Universal Citation: MD Code Reg 10.09.27.01
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) "Certified nursing assistant" means an
individual who:
(a) Is certified by the
Maryland Board of Nursing; and
(b)
Performs nursing tasks delegated by a registered nurse or licensed practical
nurse pursuant to Health Occupations Article, Title 8, Annotated Code of
Maryland.
(2)
"Department" means the Department as defined in COMAR 10.09.36.
(3) "Disabled child" means a chronically ill
or severely impaired child, younger than 22 years old, whose illness or
disability may not require 24-hour inpatient care, but which, in the absence of
home care services, may precipitate admission to or prolong stay in a hospital,
nursing facility, or other long term care facility.
(4) "Face-to-face" means contact with a
participant that occurs in-person or via audio-visual telehealth in accordance
with COMAR 10.09.49.
(5) "Home
care" means a comprehensive package of medical and health-related services
provided under the Program, pursuant to the authority of a model waiver for
certain disabled children, as an alternative to institutionalization.
(6) "Home care case management" means
locating, coordinating, and monitoring home care services for disabled children
and includes:
(a) Screening of referrals and
identification of individuals requiring home care services;
(b) Completing a comprehensive assessment to
determine the appropriateness of home care services;
(c) Convening the multidisciplinary team and
coordinating the development of a comprehensive plan of care;
(d) Determining individual case cost
effectiveness;
(e) Identifying and
maximizing informal sources of care;
(f) Ongoing monitoring of the delivery of
services specified in the plan of care to determine the appropriateness of the
type, amount, and duration of services rendered;
(g) Completing the semiannual utilization
review procedure specified in Regulation .03B(1)(c)(ii) of this chapter;
and
(h) Providing in-home
assessments as specified in Regulation .04A(2)(e) of this chapter.
(7) "Home care case manager" means
the agency administering a program of services for disabled children authorized
under Title V of the Social Security Act, or the agency's designee, which
provides or arranges for the provision of home care case management services
for participants, develops training and community education programs, and
establishes standards and procedures for quality assurance and
monitoring.
(8) "Home care
provider" means the principal physician or the individual or agency providing
nursing, home health aide services, medical supplies and equipment, or home
care case management services to disabled children.
(9) "Home health agency" means an agency
licensed by the Department in accordance with COMAR 10.07.10.
(10) "Home health aide" means an individual
who meets all the conditions of participation specified in:
(a) 42 CFR § 484.36 ; and
(b) Health Occupations Article, Title 8,
Annotated Code of Maryland.
(11) "Medical Assistance Program" means the
Medical Assistance Program as defined in COMAR 10.09.36.
(12) "Medical day care" has the meaning
stated in COMAR 10.09.07.
(13)
"Medical day care center" has the meaning stated in COMAR 10.09.07.
(14) "Medicare" means Medicare as defined in
COMAR 10.09.36.
(15) "Model Waiver"
means the document and any amendments to it submitted by the Department to, and
approved by, the Department of Health and Human Services which authorize the
waiver of certain statutory requirements limiting eligibility and covered
services under the Medicaid State plan pursuant to §1915(c) of the Social
Security Act.
(16)
"Multidisciplinary team" means the group consisting of the participant or the
participant's legal representative or representatives, or all of these, home
care providers, and the participant's principal physician or the physician
designated by the principal physician, and other providers of health-related
services, as appropriate, that establishes and updates the plan of care under
the overall direction and coordination of the home care case manager and
assesses the appropriateness of the participant's discharge to or continuation
of home care.
(17) "Necessary"
means necessary as defined in COMAR 10.09.36.
(18) "Nurse" means a person who is licensed
as a registered nurse or licensed practical nurse in the jurisdiction in which
services are provided.
(19)
"Nursing care plan" means a plan developed by a registered nurse that
identifies:
(a) The patient's diagnoses and
needs;
(b) The goals to be
achieved; and
(c) The interventions
required to meet the patient's medical condition.
(20) "Participant" means a recipient:
(a) Whose initial eligibility for services
under this chapter is established as a disabled child certified by the
Department or its designee as requiring nursing home care under the Program
pursuant to COMAR 10.09.10 or COMAR 10.09.11, or inpatient hospital care
pursuant to COMAR 10.09.92-10.09.95, but whose medical condition does not
require 24-hour inpatient care unless home care services are not
available;
(b) Who, once
eligibility is established, remains eligible for services under this chapter as
long as he or she continues to meet the certification and care requirements of
§B(15)(a) of this regulation, regardless of age;
(c) Who, but for the services listed in
Regulation .04 of this chapter, requires and would be receiving institutional
care reimbursed under the Program;
(d) Who, before receipt of services under
this chapter, was:
(i) A patient in a
hospital, nursing facility, or other long-term care facility; or
(ii) Formerly a patient in a hospital,
nursing facility, or other long-term facility who, upon discharge, has
continuously received other insurance reimbursement for skilled nursing or home
health aide services which has precluded the need for admission to the
waiver;
(e) Whose
disabilities and needs for home care cannot be adequately and appropriately
addressed through provider services otherwise available under the Program;
and
(f) Who meets the eligibility
requirements of these regulations or was receiving services under this chapter
as of December 1, 1988 or under COMAR 10.09.31 as of December 31, 1990 and
continues to meet the certification and care requirements specified in this
chapter.
(21) "Plan of
care" means the written home care plan which is:
(a) Composed of a comprehensive assessment of
the participant's health status including:
(i) All pertinent diagnoses;
(ii) Prognosis;
(iii) Functional status;
(iv) Level of activity permitted;
(v) Type, frequency, and duration of services
required;
(vi) Treatment goals for
each type of service;
(vii)
Medications; and
(viii)
Treatments;
(b)
Established by the multidisciplinary team;
(c) Approved, signed, and dated by the
participant's principal physician;
(d) Approved, signed, and dated by the
participant or the participant's legally authorized representative, or
both;
(e) Approved, signed, and
date by the Department; and
(f)
Revised 90 days after approval of the initial plan of care and semiannually
thereafter, unless the home care case manager decides that a different review
period is appropriate.
(22) "Principal physician" means the
specialty physician who is part of the interdisciplinary team and who approves
the plan of care for the participant.
(23) "Program" means the Program as defined
in COMAR 10.09.36.
(24) "Progress
note" means a dated written notation by a home care provider which:
(a) Summarizes facts about the care given and
the patient's responses during a given period of time;
(b) Specifically addresses the established
goals of treatment;
(c) Is
consistent with the participant's plan of care;
(d) Is written and signed during the course
of care; and
(e) Is provided to the
home care case management agency to become a part of the agency's permanent
record for the participant.
(25) "Provider" means a provider as defined
in COMAR 10.09.36.
(26) "Provider
agreement" means a contract between the Department and the provider of home
care, specifying the services to be performed, methods of operation, and
financial and legal requirements which shall be in force before Program
participation.
(27) "Recipient"
means a recipient as defined in COMAR 10.09.36.
(28) "Residential service agency" means an
agency licensed by the Department in accordance with COMAR 10.07.05.
(29) "Secretary" means the Secretary of
Health and Mental Hygiene.
(30)
"Specialty physician" means a licensed physician who meets one of the following
criteria:
(a) Has been declared board
certified, or board eligible, by a member board of the American Board of
Medical Specialties, and has demonstrated experience in the care of disabled
children; or
(b) Has been declared
board certified, or board eligible, by a specialty board approved by the
Advisory Board of Osteopathic Specialists and the Board of Trustees of the
American Osteopathic Association, and has demonstrated experience in the care
of disabled children.
(31) "Supervision" means:
(a) Authoritative procedural guidance by a
licensed registered nurse for the accomplishment of a function or activity;
and
(b) The process of critical
watching, directing, and evaluating an individual's performance.
(32) "Telehealth" has the meaning
stated in COMAR 10.09.49.02.
(33)
"Waiver enrollment process" means those procedures necessary to establish
participant eligibility pursuant to Regulation .05 of this chapter.
(34) "Witness" means the recipient or an
individual who, on behalf of the recipient, is able to personally verify that
the recipient received private duty nursing services, home health aide
services, or certified nursing assistant services.
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
