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 10.09.27.04 - Covered Services
Universal Citation: MD Code Reg 10.09.27.04
Current through Register Vol. 51, No. 19, September 20, 2024
A. The Program reimburses for home care services which include the following:
(1) Shift nursing services provided by a
licensed registered nurse or a licensed practical nurse if:
(a) The complexity of the service or the
condition of a participant requires the judgment, knowledge, and skills of a
licensed nurse for a shift of 4 or more continuous hours;
(b) The services are delivered to the
participant in the participant's home or other setting when normal life
activities take the participant outside the home;
(c) Services are provided to a model waiver
participant who is 21 years old or older;
(d) Services are rendered in accordance with
COMAR 10.09.53;
(e) Services are
rendered in accordance with Health Occupations Article, Title 8, Annotated Code
of Maryland;
(f) Sufficient
documentation concerning the services provided is maintained by the registered
nurse or licensed practical nurse, including:
(i) Verification of the participant's receipt
of services as documented by the participant's signature or the signature of
the participant's witness on the provider's official forms; and
(ii) Signed and dated progress notes which
are reviewed monthly by the nurse supervisor;
(g) The nurse is not scheduled to work for
more than 16 consecutive hours and is off 8 or more hours before starting
another shift;
(h) Services are
rendered by a licensed registered or practical nurse certified in
cardiopulmonary resuscitation and the certification is renewed every 2
years;
(i) Services are
preauthorized in accordance with the criteria set forth in COMAR
10.09.53.06A;
and
(j) Supervisory visits are
conducted at least monthly in the participant's home or another site where the
participant is receiving nursing services with a minimum of two visits per year
with the primary nurse present;
(2) Home care case management which includes:
(a) Arranging, monitoring, and coordinating
the health-related services necessary to meet the identified needs of the
participant as specified in the participant's plan of care;
(b) Establishing, in conjunction with the
other members of the multidisciplinary team, the plan of care necessary to
deinstitutionalize or maintain, or both of these, the participant at
home;
(c) Reviewing the plan of
care for appropriateness of the level, amount, type, quality, and frequency of
services provided as well as monitoring the cost effectiveness of home care for
each participant;
(d) Arranging for
scheduled reviews and approval of the plan of care by the principal physician;
and
(e) Providing for in-home
assessments, via an in-person visit or telehealth as authorized by the
Department, on a quarterly basis, or as determined necessary by the principal
physician;
(3)
Participation by the principal physician in the plan of care meetings
including:
(a) Prescribing home care
services; and
(b) Approving and
signing the plan of care;
(4) Home health aide services which include:
(a) The performance of simple procedures as
an extension of therapy services;
(b) Ambulation and exercise;
(c) Household services essential to health
care at home;
(d) Assistance with
medications that are ordinarily self-administered;
(e) Assistance with activities of daily
living when performed in conjunction with other delegated nursing
services;
(f) Other health care
services properly delegated by a licensed nurse pursuant to Health Occupations
Article, Title 8, Annotated Code of Maryland, if:
(i) The complexity of the service or the
condition of a participant requires the judgment, knowledge, and skills of a
home health aide for a shift of 4 or more continuous hours;
(ii) Services are provided by an unlicensed
individual who meets all the conditions of participation specified by the
Medicare program in 42 CFR § 484.36 and Health Occupations Article, Title
8, Annotated Code of Maryland;
(iii) Services are rendered by a home health
aide certified in cardiopulmonary resuscitation and the certification is
renewed every 2 years;
(iv) The
home health aide is not scheduled to work for more than 16 consecutive hours
and has 8 hours or more off before starting another shift;
(v) Sufficient documentation is maintained by
the home health aide including verification of the participant's receipt of
services as documented by the participant's signature or the signature of the
participant's witness on the provider's official forms; and signed and dated
progress notes which are reviewed every 2 weeks by the nurse
supervisor;
(vi) Supervisory visits
are conducted every 2 weeks and documented by a registered nurse with a minimum
of two visits with the primary aide present;
(vii) The services are included in the model
waiver participant's plan of care developed by the case manager; and
(viii) Services are preauthorized by the
Department;
(5)
Certified nursing assistant services if:
(a)
The certified nursing assistant is certified by the Maryland Board of Nursing
and meets all the requirements to render services pursuant to Health
Occupations Article, Title 8, Annotated Code of Maryland;
(b) The complexity of the service or the
condition of a participant requires the judgment, knowledge, and skills of a
certified nursing assistant for a shift of 4 or more continuous
hours;
(c) The services provided
include but are not limited to:
(i) Assistance
with activities of daily living when performed in conjunction with other
delegated nursing services; or
(ii)
Other health care services properly delegated by a licensed nurse pursuant to
Health Occupations Article, Title 8, Annotated Code of Maryland;
(d) Services are rendered by a
certified nursing assistant certified in cardiopulmonary resuscitation and the
certification is renewed every 2 years;
(e) The certified nursing assistant is not
scheduled to work for more than 16 consecutive hours and has 8 hours or more
off before starting another shift;
(f) Sufficient documentation concerning the
services provided is maintained by the certified nursing assistant including:
(i) Verification of the participant's receipt
of services as documented by the participant's signature or the signature of
the participant's witness on the provider's official forms; and
(ii) Signed and dated progress notes which
are reviewed every 2 weeks by the nurse supervisor;
(g) Supervisory visits are conducted every 2
weeks and documented by a registered nurse with a minimum of two visits with
the primary aide present;
(h) The
services are included in the model waiver participant's plan of care developed
by the case manager; and
(i)
Services are preauthorized by the Department;
(6) Delegated nursing services provided by a
certified nursing assistant or home health aide who is also a certified medical
technician when:
(a) The complexity of the
service or the condition of a participant requires the judgment, knowledge, and
skills of the certified nursing assistant or home health aide for at least 2 or
more continuous hours;
(b) The
services provided include but are not limited to:
(i) Assistance with activities of daily
living when performed in conjunction with other delegated nursing services;
or
(ii) Other nursing services
properly delegated by a nurse pursuant to Health Occupations Article, Title 8,
Annotated Code of Maryland, and in accordance with COMAR 10.27.11;
(c) Sufficient documentation is
maintained by the certified nursing assistant or home health aide, including
signed and dated progress notes which are reviewed by the nurse supervisor;
and
(d) Supervisory visits are
conducted and documented by a registered nurse supervisor in accordance with
COMAR 10.27.09 and 10.27.11; and
(7) Medical day care when services are:
(a) Included in the Model Waiver
participant's approved and signed plan of care; and
(b) Rendered in accordance with COMAR
10.09.07.
B. The Department will reimburse for the services listed in §A(1)-(2) and (4)-(6) of this regulation when they are:
(1)
Ordered by the participant's principal physician as part of a written home care
plan, which is included in the provider's permanent record for the participant
and is reviewed by the principal physician in accordance with Regulation
.01B(16) of this chapter;
(2)
Medically necessary;
(3) Adequately
described in progress notes in the participant's medical record, signed, and
dated by the individual providing care;
(4) Provided instead of institutional care to
recipients certified and annually recertified as requiring nursing facility
care under the Program as specified in COMAR 10.09.10 or 10.09.11;
and
(5) Provided in the amount,
duration, and frequency specified in the plan of care subject to approval by
the Program.
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