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 10.09.56.11 - Covered Services - Residential Habilitation Services
Universal Citation: MD Code Reg 10.09.56.11
Current through Register Vol. 51, No. 19, September 20, 2024
A. The Program under this regulation does not cover the following:
(1) Any Medicaid State
Plan services which are provided by medical professionals employed by or under
contract with the residential habilitation provider;
(2) Room and board;
(3) Direct or indirect payments to the
participant's immediate family;
(4)
Routine care and supervision which a family is expected to provide;
(5) Activities or supervision reimbursed by a
source other than Medicaid; and
(6)
The facility's maintenance, upkeep, and improvement.
B. The residential habilitation program shall:
(1) Provide community-based, intensive
residential placements for participants who cannot live at home at the present
time because they require highly supervised and supportive
environments;
(2) Provide a
home-like, safe, 24-hour, therapeutic living environment of treatment,
intervention, training, supportive care, and oversight;
(3) Be designed to assist Autism Waiver
participants in acquiring, retaining, and improving the self-help,
socialization, and adaptive skills necessary to reside successfully in home and
community-based settings;
(4) Work
closely with the participant's service coordinator to provide transition
services for each participant in placement to allow, as appropriate, for the:
(a) Participant's eventual return to the
family (natural, adoptive, or surrogate); or
(b) Participant to acquire the skills and
resources for group or independent living; and
(5) Coordinate with the participant's
educational, health, and medical service providers.
C. A participant's placement in residential habilitation services shall be:
(1)
Preauthorized by the multidisciplinary team; and
(2) Reviewed by the multidisciplinary team at
least annually.
D. Residential habilitation services shall be received in facilities located in the State which are:
(1) Licensed group
homes;
(2) Licensed alternative
living units; or
(3)
Community-based residential facilities approved by the State Department of
Education for special education services.
E. Intensity Levels.
(1) Residential habilitation services are
provided and reimbursed at a regular or intensive level for a
participant.
(2) To be approved by
the multidisciplinary team for the intensive level of residential habilitation
services, the participant must need:
(a) Awake
overnight staffing; and
(b) At
minimum, 4 hours of one-on-one staffing.
F. Services.
(1) A residential habilitation program shall
provide all of the services listed in §F(2)-(12) of this regulation, as
necessary for the participant.
(2)
Habilitation. The residential rehabilitation program shall provide training to
assist a participant to acquire, retain, or improve skills in a wide variety of
areas that directly affect the ability to reside as independently as
possible.
(3) Behavior Shaping and
Management. The residential rehabilitation program shall train, supervise, and
assist the participant, which may include psychiatric or psychological
interventions, in appropriate communication and expression of emotions and
desires, compliance, assertiveness, acquisition of socially appropriate
behaviors, and reduction of inappropriate behaviors.
(4) Daily Living Skills. The residential
rehabilitation program shall train or assist the participant in dressing,
personal hygiene, self-administration of medications, proper use of appliances
and adaptive or assistive devices, home safety, first aid, and emergency
procedures.
(5) Self-Direction. The
residential rehabilitation program shall train the participant in identifying
and responding to dangerous or threatening situations, making decisions and
choices affecting the participant's life, and initiating changes in living
arrangements or life activities.
(6) Functional Living Skills Training. The
residential rehabilitation program shall train the participant in
self-reliance, money management, and money handling and purchases.
(7) Socialization. The residential
rehabilitation program shall train, supervise, or assist the participant to
facilitate the participant's involvement in general community activities and
establishment of relationships with peers, which may:
(a) Not include participation in activities
which are solely diversional or recreational in nature; and
(b) Include:
(i) Assisting the participant with learning
and practicing skills of cooperation and participation;
(ii) Assisting the participant to identify
and participate in activities of interest; and
(iii) Providing specific training activities
necessary to assist the participant to participate in activities of interest on
an ongoing basis.
(8) Mobility. The residential rehabilitation
program shall train, supervise, and assist the participant to:
(a) Enhance movement within the participant's
living, working, or education environment;
(b) Master the use of adaptive aids and
equipment; and
(c) Access and use
public transportation, independent travel, or other movement within the
community.
(9)
Transportation. The residential rehabilitation program shall provide
transportation for the participant to recreation, leisure activities, or skills
training.
(10) Crisis Intervention
and Planning. The residential rehabilitation program shall include:
(a) Planning for crises in the participant's
residential habilitation placement; and
(b) Making the necessary behavioral or
environmental interventions to stabilize and preserve the participant's
residential habilitation placement, or resolve an intensive behavioral
episode.
(11) Medication
Management, Monitoring, and Training. The residential rehabilitation program
shall provide, as needed and appropriate, medication management, monitoring,
and training in accordance with the Maryland Nurse Practice Act and COMAR
10.27.11.
(12) Transition Services.
The residential rehabilitation program shall provide training and experiential
learning activities for a participant in a residential habilitation placement,
which:
(a) Assist with developing discharge
planning goals for the participant;
(b) Assist the participant in making the
transition to home, the next planned placement, or independent
living;
(c) Are responsive to the
participant's individualized developmental and behavioral needs; and
(d) Promote self-reliance and age-appropriate
behavior.
G. A supervisor who has been trained in accordance with Regulation .04E(3) of this chapter shall:
(1) Train and provide ongoing
supervision to the direct care worker rendering residential habilitation
services;
(2) Supervise the direct
care worker when crisis intervention services are rendered to evaluate the
nature of the crisis and intervene to reduce the likelihood of
reoccurrence;
(3) Plan and
regularly review the participant's therapeutic activities and behavior
plan;
(4) Meet regularly with the
participant and family and observe the participant in the residential
habilitation setting; and
(5)
Develop and identify on the individualized treatment plan, the goals,
interventions, and tasks that the residential habilitation direct care worker
is implementing.
H. A unit of service for residential habilitation shall be on a per diem basis.
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