Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management
Section 10.09.69.11 - Covered Optional Services - Private Duty Nursing, Certified Nursing Assistant, Certified Nursing Assistant Certified as a Certified Medication Technician, Home Health Aide and Home Health Aide Certified as a Certified Medication Technician
Universal Citation: MD Code Reg 10.09.69.11
Current through Register Vol. 51, No. 19, September 20, 2024
A. The Program shall cover shift nursing services provided by an RN or LPN when:
(1) The services are more individualized and
continuous than what is available under the home health program;
(2) The services are delivered to the
participant in the participant's home, in school, or in other normal life
activity setting or settings which occur outside the participant's
home;
(3) Services are provided to
a REM participant who is 21 years old or older;
(4) Services are determined medically
necessary for a participant after the provider has completed an initial nursing
assessment that reflects the participant's need for an awake and alert
caregiver;
(5) The participant has
at least one caregiver willing and able to accept responsibility for the
participant's care when the nurse, CNA, or HHA is not available;
(6) The caregiver provides documentation of
each of the following when applicable:
(a) The
caregiver's work schedule along with commuting times;
(b) The caregiver's school attendance as
defined in Regulation .02 of this chapter along with commuting times;
and
(c) Emergency circumstances, as
determined by the Department, including but not limited to the inability of the
primary caregiver to provide care due to hospitalization or an acute
debilitating illness for up to a 60-day period;
(7) Services are provided only in the absence
of the willing and able caregiver during the sleeping hours and during the
times documented in §A(6) of this regulation;
(8) Services are rendered in accordance with
Health Occupations Article, Title 8, Annotated Code of Maryland;
(9) Sufficient documentation concerning the
services provided is maintained by the RN or LPN including:
(a) 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
(b) Signed and dated progress notes which are
reviewed monthly by the RN supervisor;
(10) The nurse's shift is limited to not more
than a total of 60 hours per week or 16 consecutive hours and the nurse is off
8 or more hours before starting another shift unless otherwise authorized by
the Department;
(11) Services are
rendered by an RN or an LPN who is certified in cardiopulmonary resuscitation
and the certification is renewed every 2 years; and
(12) Monthly supervisory visits of an RN or
an LPN are:
(a) Conducted and documented by an
RN supervisor; and
(b) Based on
acceptable standards of practice.
B. The Program shall cover services provided by a CNA or CNA-CMT when:
(1) The CNA or
CNA-CMT 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;
(2)
The CNA-CMT has completed the training and has been certified by the Maryland
Board of Nursing as a CMT;
(3)
Services are of a scope that is more individual and continuous than what is
available under the home health program;
(4) The services provided include but are not limited
to:
(a) Assistance with activities of daily
living when performed in conjunction with other delegated nursing services;
or
(b) Other health care services
properly delegated by an RN or an LPN pursuant to Health Occupations Article,
Title 8, Annotated Code of Maryland;
(5) Services are rendered by a CNA or CNA-CMT who is
certified in cardiopulmonary resuscitation and the certification is renewed
every 2 years;
(6) The CNA's or
CNA-CMT"s shift is limited to not more than a total of 60 hours per week or 16
consecutive hours and the CNA or CNA-CMT has 8 hours or more off before
starting another shift unless otherwise authorized by the Department;
(7) Sufficient documentation concerning the
services provided is maintained by the CNA or CNA-CMT including:
(a) 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
(b) Signed and dated progress notes which are
reviewed every 2 weeks by the RN supervisor;
(8) Supervisory visits are conducted and documented
every 2 weeks by an RN;
(9) The
services are included in the REM participant's plan of care developed by the
case manager; and
(10) Services
are preauthorized by the Department.
C. The Program shall cover services provided by a HHA or HHA-CMT when:
(1) 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;
(2) The HHA-CMT has completed the training
and has been certified by the Maryland Board of Nursing as a CMT;
(3) Services are more individualized and
continuous than what is available under the home health program;
(4) The services provided include but are
not limited to:
(a) Assistance with
activities of daily living when performed in conjunction with other delegated
nursing services; or
(b) Other
health care services properly delegated by an RN or LPN pursuant to Health
Occupations Article, Title 8, Annotated Code of Maryland;
(5) Services are rendered by a HHA or
HHA-CMT who is certified in cardiopulmonary resuscitation and the certification
is renewed every 2 years;
(6) The
HHA's or HHA-CMT's shift is limited to not more than a total of 60 hours per
week or 16 consecutive hours and the HHA or HHA-CMT has 8 hours or more off
before starting another shift unless otherwise authorized by the
Department;
(7) Sufficient
documentation is maintained by the HHA or HHA-CMT including:
(a) 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
(b) Signed and dated progress notes which are
reviewed every 2 weeks by the RN supervisor;
(8) Supervisory visits are conducted and documented
every 2 weeks by an RN;
(9) The
services are included in the REM participant's plan of care developed by the
case manager; and
(10) Services
are preauthorized by the Department.
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
