Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder
Section 10.09.56.01 - Definitions
Universal Citation: MD Code Reg 10.09.56.01
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) Active Treatment.
(a) "Active treatment" means, according to
42 CFR § 483.440(a), a continuous
active treatment program which includes aggressive, consistent implementation
of a program of specialized and generic training, treatment, health services,
and related services that is directed toward the:
(i) Acquisition of the behaviors necessary
for the individual to function with as much self-determination and independence
as possible; or
(ii) Prevention or
deceleration of regression or loss of current optimal functional
status.
(b) "Active
treatment" does not mean, according to
42 CFR § 483.440(a), services to
maintain generally independent individuals who are able to function with little
supervision or in the absence of a continuous active treatment
program.
(2) "Applicant"
means an individual who is applying as a participant in the Autism
Waiver.
(3) "Autism" has the
meaning stated in §C of this regulation.
(4) "Autism Waiver" means the Home and
Community-Based Services Waiver for Children with Autism Spectrum
Disorder.
(5) "Certified special
educator" means a professional who holds an appropriate certificate as defined
by COMAR 13A.12.01.02C.
(6)
"Department" means the Maryland Department of Health and Mental Hygiene, or its
authorized agents acting on behalf of the Department.
(7) "Developmentally disabled" means a
condition, as specified in 42 CFR § 435.1010 for persons
with related conditions, resulting in a severe, chronic disability which meets
all of the following conditions:
(a) Is
attributable to:
(i) Cerebral palsy or
epilepsy; or
(ii) A condition such
as autism, except for mental illness, which is found to be closely related to
intellectual disability because the condition results in impairment of general
intellectual functioning or adaptive behavior similar to that of intellectually
disabled individuals, and requires treatment or services similar to those
required for intellectually disabled individuals;
(b) Is manifested before the individual is 22
years old;
(c) Is likely to
continue indefinitely; and
(d)
Results in substantial functional limitations in three or more of the following
areas of major life activities:
(i)
Self-care;
(ii) Understanding and
use of language;
(iii)
Learning;
(iv) Mobility;
(v) Self-direction;
(vi) Capacity for independent living;
or
(vii) Other areas of major life
activities.
(8)
"Early intervention services" means services that:
(a) Are designed to meet the developmental
needs of infants and toddlers with disabilities;
(b) Are provided under public supervision and
in conformity with an individualized family service plan; and
(c) Meet applicable State and federal
standards.
(9) "Eligible
person" means an individual who meets the qualifications, as specified in
Regulation .02 of this chapter, for participation in the Autism
Waiver.
(10) "Family" means adults
who:
(a) Live with or provide care to the
participant; and
(b) Are not paid
to provide the care.
(11)
"HIPAA" means the Health Insurance Portability and Accountability Act of 1996
developed to improve portability of health insurance coverage, reduce
healthcare fraud and abuse, and protect individual privacy of personal health
records.
(12) "Home and
Community-Based Services Waiver for Children with Autism Spectrum Disorder"
means the program implemented under this chapter in accordance with the
document, and any amendments to it, submitted by the Department to, and
approved by, the Secretary of the U. S. Department of Health and Human
Services, which authorizes the waiver, pursuant to § 1915(c) of Title XIX
of the Social Security Act, of certain specified statutory requirements
limiting coverage for home and community-based services under the Medical
Assistance Program.
(13) "ICF-ID
level of care" means an assessment that an individual needs the level of
services provided in an intermediate care facility for the intellectually
disabled and persons with related conditions (ICF-ID), including active
treatment.
(14) "Individualized
education program (IEP)" means a written statement for a student with a
disability that is developed, reviewed, and revised in accordance with
20 U.S.C. § 1414 and COMAR 10.09.52.
(15) "Individualized family service plan
(IFSP)" means a written, individualized plan for early intervention and other
services for an infant or toddler, in accordance with COMAR 10.09.40, 10.09.50,
and 13A.13.01.
(16) "Intermediate
care facility for individuals with intellectual disabilities (ICF-IID)" means
an institution licensed by the Department under COMAR 10.07.20 that:
(a) Is primarily for the diagnosis,
treatment, or rehabilitation of individuals -with intellectual disabilities or
persons with related conditions; and
(b) Provides, in a protected residential
setting, ongoing evaluation, planning, 24-hour supervision, coordination, and
integration of health or rehabilitative services to help each individual
function at the individual's greatest ability.
(17) "Local lead agency" means the agency
designated by the local governing authority in each jurisdiction to administer
the interagency system of early intervention services under the direction of
the State Department of Education.
(18) "Local school system" means the public
local education agency in each jurisdiction.
(19) "Medicaid" means the Medical Assistance
Program.
(20) "Medical Assistance
Program" has the meaning stated in COMAR
10.09.36.01B.
(21) "Multidisciplinary team"
means the IEP team or IFSP participants, consistent with the Individuals with
Disabilities Education Act (IDEA), which is convened for a
participant.
(22) Parent.
(a) "Parent" means the adult representative
of a minor applicant or participant.
(b) "Parent" includes:
(i) A natural or adoptive parent;
(ii) A legal guardian;
(iii) A person acting in the place of a
parent, such as a grandparent or stepparent, with whom the participant lives,
including those relatives or stepparents who are foster parents;
(iv) An individual appointed as the parent
surrogate in accordance with Education Article, §8-412, Annotated Code of
Maryland, for matters within the scope of the Individuals with Disabilities
Education Act (IDEA); and
(v) Any
other person who is legally responsible for the participant's
welfare.
(23)
"Participant" means an eligible person who is enrolled in the Autism
Waiver.
(24) "Program" means the
Medical Assistance Program, as stated in COMAR
10.09.36.01B.
(25) "Positive behavior
intervention" means a range of intervention strategies that are designed to
prevent problem behaviors while teaching socially appropriate alternative
behaviors.
(26) "Provider" means an
individual, association, partnership, corporation, or unincorporated group
that:
(a) Is approved as meeting the
conditions for waiver participation specified in this chapter; and
(b) Has enrolled with the Program to provide
one or more of the waiver services covered under this chapter.
(27) "Provider agreement" means a
contract between the Program and a provider.
(28) "Qualified diagnostician" means an
individual whose license or certification permits diagnosis of Autism Spectrum
Disorder.
(29) "Recipient" means an
individual who is certified by the Department as eligible to receive Program
benefits.
(30) "Reportable event
policy" means a process developed to protect the health and safety of waiver
participants in the community by identifying, documenting, and resolving
complaints and incidents.
(31)
"Retainer payment" means payment made to providers of residential habilitation
services while the participant is hospitalized or absent from the residential
habilitation program.
(32) "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.
(33) "Service
coordinator" means the individual who provides case management services for
Autism Waiver participants in accordance with COMAR 10.09.52.
(34) "Special educator" means a professional
who holds an appropriate certificate as defined by COMAR
13A.12.01.02B.
(35) "State
Department of Education (MSDE)" means the agency responsible for ensuring that
all children with disabilities residing in the State are identified, assessed,
and provided with a free, appropriate public education consistent with State
and federal laws.
(36) "State fiscal
year" means the 12-month period of July 1 through June 30 over which the State
budgets its spending.
(37) "State
Plan" means the plan for the Medical Assistance Program as submitted by the
Department and approved by the Secretary of the U.S. Department of Health and
Human Services according to Title XIX of the Social Security Act, as modified
or amended.
(38) "Waiver plan of
care" means the written, individualized treatment plan developed for a
participant, which identifies the waiver services covered under this
chapter.
C. Autism.
(1) "Autism" means autism spectrum disorder,
which is diagnosed when an individual has a total of six or more of the
following items under §C(1)(a), (b), and (c) of this regulation, with at
least two from §C(1)(a) and one each from §C(1)(b) and (c):
(a) Qualitative impairment in social
interaction, as manifested by at least two of the following:
(i) Marked impairment in the use of multiple
nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures,
and gestures to regulate social interaction;
(ii) Failure to develop peer relationships
appropriate to developmental level;
(iii) A lack of spontaneous seeking to share
enjoyment, interests, or achievements with other people (for example, by a lack
of showing, bringing, or pointing out objects of interest);
(iv) Lack of social or emotional
reciprocity;
(b)
Qualitative impairments in communication as manifested by at least one of the
following:
(i) Delay in, or total lack of,
the development of spoken language, not accompanied by an attempt to compensate
through alternative modes of communication such as gesture or mime;
(ii) In individuals with adequate speech,
marked impairment in the ability to initiate or sustain a conversation with
others;
(iii) Stereotyped and
repetitive use of language or idiosyncratic language;
(iv) Lack of varied, spontaneous make-believe
play or social imitative play appropriate to developmental level;
(c) Restricted repetitive and
stereotyped patterns of behavior, interests, and activities, as manifested by
at least one of the following:
(i)
Encompassing preoccupation with one or more stereotyped and restricted patterns
of interest that is abnormal either in intensity or focus;
(ii) Apparently compulsive adherence to
specific, nonfunctional routines or rituals;
(iii) Stereotyped and repetitive motor
mannerisms (for example, hand or finger flapping or twisting, or complex whole
body movements);
(iv) Persistent
preoccupation with parts or objects.
(2) "Autism" includes:
(a) Delays or abnormal functioning in at
least one of the following areas, with onset before age 3 years:
(i) Social interaction;
(ii) Language as used in social
communication; or
(iii) Symbolic or
imaginative play;
(b) An
individual's behavior that is not better accounted for by Rett's Disorder or
Childhood Disintegrative Disorder;
(c) Pervasive Developmental Disorder Not
Otherwise Specified (including Atypical Autism, Rett's Disorder, and Asperger's
Disorder).
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