Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.54 - Home and Community-Based Options Waiver
Section 10.09.54.01 - Definitions
Universal Citation: MD Code Reg 10.09.54.01
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) "Activities of daily living" means tasks
or activities that include, but are not limited to:
(a) Bathing and completing personal hygiene
routines;
(b) Dressing and changing
clothes;
(c) Eating;
(d) Toileting, including:
(i) Bladder and bowel requirements;
(ii) Routines associated with the achievement
or maintenance of continence; and
(iii) Incontinence care;
(e) Mobility, including:
(i) Transferring from a bed, chair, or other
structure;
(ii) Moving, turning,
and positioning the body while in bed or in a wheelchair; and
(iii) Moving about indoors or
outdoors.
(2)
"Area agency" has the meaning stated in Human Services Article, §10-101(b),
Annotated Code of Maryland.
(3)
"Assisted living services provider" means a provider licensed by the Department
in accordance with COMAR 10.07.14.
(4) "Case management" means services which
assist an applicant or a participant in gaining access to the waiver services
covered under this chapter, as well as to other services under the Medical
Assistance Program.
(5) "Case
manager" means an individual performing case management services under a waiver
program.
(6) Community Setting.
(a) "Community setting" means the area,
district, locality, neighborhood, or vicinity where a group of people live
which provides participants with opportunities to:
(i) Seek employment and work in competitive
integrated settings;
(ii) Engage in
community life;
(iii) Control
personal resources; and
(iv)
Receive services.
(b)
"Community setting" does not mean:
(i)
Hospitals;
(ii) Nursing
facilities;
(iii) Institutions for
mental diseases;
(iv) Intermediate
care facilities for individuals with intellectual disabilities;
(v) Community-based residential facilities
for individuals with intellectual or developmental disabilities licensed under
COMAR 10.22.02;
(vi)
Prisons;
(vii) Residential
treatment centers; or
(viii) Any
establishment that furnishes food, shelter, and some treatment or services to
four or more persons unrelated to the proprietor.
(7) "Department" means the
Maryland Department of Health and Mental Hygiene, or its authorized agent
acting on behalf of the Department.
(8) "Family member" means an adult who:
(a) Lives with or provides care to the
participant; and
(b) Is not paid to
provide the care.
(9)
"Home" means the participant's place of residence in a community
setting.
(10) "Home and
Community-Based Options Waiver" means the program implemented under this
chapter in accordance with the document for this waiver and any amendments to
it submitted by the Department and approved by the Secretary of Health and
Human Services, which authorizes the waiver of certain specified statutory
requirements limiting coverage for home and community-based services under the
Maryland Medical Assistance Program.
(11) "Instrumental activities of daily
living" means tasks or activities that include, but are not limited to:
(a) Preparing meals;
(b) Performing light chores that are
incidental to the personal assistance services provided to the
participant;
(c) Shopping for
groceries;
(d) Nutritional
planning;
(e) Traveling as
needed;
(f) Managing finances and
handling money;
(g) Using the
telephone or other appropriate means of communication;
(h) Reading; and
(i) Planning and making decisions.
(12) "Maryland Department of
Aging" has the meaning stated in Human Services Article, Title 10, Annotated
Code of Maryland.
(13) "Medicaid"
means the Medical Assistance Program.
(14) "Medical Assistance Program" means the
Program administered by Maryland under Title XIX of the Social Security Act,
which provides comprehensive medical and other health-related care for
categorically eligible and medically needy recipients.
(15) "Medical day care" means a program of
medically supervised, health-related services provided in an ambulatory setting
to medically handicapped adults who, due to their degree of impairment, need
health maintenance and restorative services supportive to their community
living in accordance with COMAR 10.09.07.
(16) "Medically necessary" means that the
service or benefit is:
(a) Directly related
to diagnostic, preventative, curative, ameliorative, palliative or
rehabilitative treatment of an illness, injury, disability, or health
condition;
(b) Consistent with
current accepted standards of good medical practice;
(c) The most cost efficient service that can
be provided without sacrificing effectiveness or access to care; and
(d) Not primarily for the convenience of the
participant, the participant's family, or the provider.
(17) "Nursing facility" means a facility
which is participating in the Maryland Medical Assistance Program as a nursing
facility pursuant to COMAR 10.09.10.
(18) "Participant" means an individual who:
(a) Has been determined to meet the
qualifications for participation in the waiver as specified in Regulation .03
of this chapter; and
(b) Is
enrolled with the Department to receive Medicaid services.
(19) "Person-centered" means that the plan
reflects what is important to the individual, what is important for his or her
health and welfare, and is developed with input from the individual and the
individual's representative when applicable.
(20) "Plan of service" means the written,
person-centered support plan developed by the applicant or participant with
support from the case manager and the individual's representative, when
applicable.
(21) "Principal" means
a person who:
(a) Has a direct or indirect
ownership or control interest of 5 percent or more in the provider;
(b) Is an officer, director, agent, or
managing employee of the entity; or
(c) Was described in §B(20)(a) of this
regulation, but is no longer so described because of a transfer of ownership or
control interest to an immediate family member or a member of the household of
the person who continues to maintain an interest described in §B(20)(a) of
this regulation.
(22)
"Program" means the Medical Assistance Program.
(23) "Provider" has the same meaning stated
in COMAR 10.09.36.
(24) "Provider
agreement" means a contract between the Department and the provider for
rendering the services under this chapter.
(25) "Recipient" means an individual who is
certified by the Department as eligible for, and is receiving, Medical
Assistance benefits.
(26)
"Reportable event " means an allegation of, or an actual occurrence of, an
incident that may pose an immediate or serious risk, or has potential to
adversely affect the physical or mental health, safety, or well-being of a
waiver applicant or participant, or complaints regarding administrative service
or quality of care issues.
(27)
"Room and board" means rent or mortgage, utilities, maintenance, furnishings,
and food, which are provided in or associated with an individual's place of
residence.
(28) "State Plan" means
a comprehensive, written commitment by a State Medicaid agency, submitted under
§1902(a) of the Social Security Act, to administer or supervise the
administration of the Medical Assistance Program in accordance with federal
requirements.
(29) "Telehealth" has
the meaning stated in COMAR 10.09.49.02.
(30) "Waiver applicant" means an individual
who is applying for participation in the waiver, to receive the services
covered under this chapter.
(31)
"Waiver" means the Home and Community-Based Options Waiver as implemented
through this chapter.
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