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 10.09.27.03 - Conditions for Participation
Universal Citation: MD Code Reg 10.09.27.03
Current through Register Vol. 51, No. 19, September 20, 2024
A. General requirements for participation in the Medical Assistance Program are that providers shall meet all conditions for participation specified in COMAR 10.09.36.
B. Specific requirements for participation in the Program as a provider of home care services are as follows:
(1) The home care case management
provider shall:
(a) Have a written agreement
with each participant which includes the following:
(i) A description of the types, amount,
frequency, and duration of home care services to be provided to the participant
as ordered by the principal physician and specified in the approved plan of
care;
(ii) A statement that the
participant or responsible representatives shall have access to the individual
plan of care and shall be involved in its development and periodic
review;
(iii) The name, address,
telephone number, and Medical Assistance number of the participant;
(iv) The dated signatures of the participant
or legally authorized representative, and the provider
representative;
(v) A statement
that utilization of available services and selection among approved enrolled
providers is subject to participant choice;
(vi) A statement that services will at all
times be provided without discrimination with regard to race, color, age, sex,
national origin, marital status, or physical or mental handicap.
(b) Be available to participants
in-person at least 8 hours a day, 5 days a week with established hours of
operation.
(c) Have written and
implemented formalized policies and procedures developed before participation
in the Program concerning the following areas:
(i) Medical records for each participant
which include at a minimum the application for home care, plan of care, orders
for home care services, documentation of nursing observations at least every 30
days, social history, and home care cost worksheets establishing initial
participant eligibility and continued eligibility on a quarterly
basis;
(ii) Utilization review
which includes the development of a home care review procedure completed every
6 months for all participants to evaluate the appropriateness of home care, the
efficiency, adequacy, and coordination of home care services, with the
objective of achieving the least costly yet appropriate delivery of services
under the Program.
(d)
Convene the multidisciplinary team which:
(i)
Upon receipt of the principal physician's orders assesses the appropriateness
of home care for the participant;
(ii) Determines the medical, psychological,
social, and functional status of each participant;
(iii) Develops an individual plan of care in
conjunction with the principal physician's orders;
(iv) Coordinates at least one in-person
meeting annually, unless otherwise authorized by the Department;
(v) Unless otherwise excepted in
§B(1)(d)(iv) of this regulation, may meet in-person or via telehealth;
and
(vi) Reviews and updates the
individual plan of care in accordance with Regulation .01B(16) of this
chapter.
(e) Provide for
in-home assessments, via an in-person visit or telehealth, on a quarterly basis
or as determined necessary by the principal physician.
(f) Conducts at least two in-person visits
annually, unless otherwise authorized by the Department.
(g) Not be a provider of medical supplies and
equipment or nursing services.
(2) Shift private duty nursing, certified
nursing assistant, and home health aide providers shall:
(a) Meet all conditions for participation set
forth in:
(i) COMAR
10.09.53.03A;
or
(ii) COMAR 10.09.69;
(b) Participate in
interdisciplinary team meetings;
(c) Ensure timesheets are signed by the
individual rendering services;
(d)
Ensure a nurse, a certified nursing assistant, or a home health aide is not
scheduled to work for more than 16 consecutive hours and the individual is off
8 or more hours before starting another shift unless otherwise authorized by
the Department;
(e) Obtain the
participant's signature or the signature of the participant's witness on the
provider's official forms to verify receipt of service; and
(f) Either be a:
(i) Residential service agency licensed in
accordance with COMAR 10.07.05; or
(ii) Home health agency licensed in
accordance with COMAR 10.07.10 which meets the conditions of participation
specified in 42 CFR § 484.36 ;
(g) Demonstrate the capacity to arrange for
the provision of home health aide services in the amount and level required in
the participant's plan of care including the establishment of a contingency
plan to assure coverage as specified in the plan of care;
(h) Demonstrate sufficient specialized
training and experience in the care of individuals with disabilities necessary
to deliver the level of services required by participants; and
(i) Demonstrate, on a continuing basis, the
ability to competently carry out services in the plan of care subject to review
by the home care case manager or the home care case manager's
designee.
(3) Medical day
care providers shall meet all conditions for participation set forth in COMAR
10.09.07.
(4) The provider of home
care services shall:
(a) Deliver services
in-person unless expressly authorized to render services via telehealth;
and
(b) If delivering services via
telehealth, comply with COMAR 10.09.49 and any subregulatory guidance issued by
the Department.
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