Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.81 - Increased Community Services (ICS) Program
Section 10.09.81.02 - Definitions
Universal Citation: MD Code Reg 10.09.81.02
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
bathing, eating, toileting, dressing, and mobility including
transfer.
(2) "Adult Evaluation and
Review Services (AERS)" means an entity within the local health department
which, in accordance with this chapter and COMAR 10.09.30, evaluates ICS
applicants and participants.
(3)
"Agency-employed attendant" means an attendant who is employed by, or under
contract with, an attendant care provider agency.
(4) "Applicant" means an individual who has
submitted to the Department an application for the ICS Program.
(5) "Assessment fee" means the fee the
participant is required to pay as a condition of eligibility for the ICS
Program and Medical Assistance benefits.
(6) "Assistance" means that another
individual:
(a) Physically performs an
activity for the participant;
(b)
Physically helps the participant to perform an activity;
(c) Is present while the participant performs
an activity because the participant's safety or health may be jeopardized if
the activity is not monitored or performed due to the participant's physical or
mental status; or
(d) Cues or
encourages the participant to perform the activity.
(7) "Assisted living services provider" means
a provider licensed by the Department in accordance with COMAR 10.07.14 and
enrolled in the Maryland Medical Assistance Program to provide the services
covered under Regulation .37 of this chapter.
(8) "Attendant" means an individual who
provides a participant with attendant care services.
(9) "Attendant care provider agency" means an
agency that is enrolled in the Maryland Medical Assistance Program to provide
the services covered under Regulation .30 of this chapter.
(10) "Attendant Care Services" means
assistance with activities of daily living, instrumental activities of daily
living, and performance of delegated nursing functions.
(11) "Case management agency" means an agency
enrolled by the Maryland Medical Assistance Program to provide case management
services to ICS applicants and participants.
(12) "Case management services" means
services that assist an applicant or a participant to gain access to ICS
services, Medicaid State Plan services, and other community services.
(13) "Delegated nursing functions" means
services, other than assistance with activities of daily living and
instrumental activities of daily living, provided to a participant by:
(a) An enrolled attendant under the
supervision of an enrolled licensed registered nurse in accordance with COMAR
10.27.11; or
(b) A nurse
practitioner in accordance with COMAR 10.27.07.
(14) "Department" means the Maryland
Department of Health and Mental Hygiene, or its authorized agent acting on
behalf of the Department.
(15)
"Determination" means a decision by the Department regarding an applicant's or
participant's eligibility for the ICS Program.
(16) "Fiscal intermediary" means an agency
that is under contract with the Department to provide fiscal intermediary
services.
(17) "Fiscal intermediary
services" means certain employer-related payroll functions, such as State and
federal tax withholding and Social Security withholding, performed on behalf of
participants who elect to use the participant-employed model of attendant care
services.
(18) Home.
(a) "Home" means the place where the
participant resides.
(b) "Home"
does not include a hospital, nursing facility, or other institution that is
regulated under:
(i) COMAR 10.22.03 for
licensed community-based residential facilities for individuals with
intellectual or developmental disabilities; or
(ii) COMAR 10.21.22 for residential
rehabilitation programs for individuals with serious or chronic mental
illness.
(19)
"Increased Community Services (ICS) Program" means the Medicaid home and
community-based services program implemented under this chapter in accordance
with the HealthChoice Section 1115 Waiver approved by the Centers for Medicare
and Medicaid Services.
(20)
"Instrumental activities of daily living" means tasks or activities that
include:
(a) Preparing a light
meal;
(b) Performing light
chores;
(c) Shopping for
groceries;
(d) Traveling beyond a
walking distance;
(e) Managing
finances and handling money;
(f)
Using the telephone; and
(g)
Planning and making decisions.
(21) "Maryland Medical Assistance Program"
means the Program administered by the State under Title XIX of the Social
Security Act, which provides comprehensive medical and other health-related
care for low income and medically indigent persons.
(22) "Medicaid" means the Maryland Medical
Assistance Program.
(23) "Medical
day care" means medically supervised, health-related services provided in an
ambulatory setting to medically disabled adults who, because of the degree of
impairment, need health maintenance and restorative services that support their
community living.
(24) "Medical day
care center" means a facility operated for the purpose of providing medical day
care services in an ambulatory care setting to medically disabled adults who do
not require 24-hour inpatient care, but because of the degree of impairment,
are not capable of full-time independent living.
(25) "Medically necessary" means the service
or benefit is:
(a) Directly related to
diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative
treatment of an illness, injury, disability, or health condition;
(b) Consistent with currently 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
consumer, family, or provider.
(26) "Nurse" means an individual who is
currently licensed to practice nursing in the State.
(27) "Nurse monitor" means a registered nurse
who provides nursing supervision of attendants in accordance with COMAR
10.27.11 and this chapter.
(28)
"Nursing facility" means an institution which is licensed by the Department
under COMAR 10.07.02.
(29) "Nursing
facility services" means services provided to individuals who do not require
hospital care, but who, because of a mental or physical condition, require
skilled nursing care and related services, rehabilitative services, or, on a
regular basis, health-related care and services above the level of room and
board.
(30) "Nursing supervision"
means a nurse monitor's supervision of an attendant in accordance with COMAR
10.27.11 and this chapter.
(31)
"Participant" means an individual who meets the qualifications for
participation in the ICS program as specified in Regulation .03 of this chapter
and is enrolled with the Department to receive ICS services.
(32) "Participant-employed attendant" means
an attendant who does not work for an attendant care provider agency and who
may be chosen, trained, supervised, and fired by the participant.
(33) "Participant-employed model" means the
delivery of attendant care services when:
(a)
An ICS participant chooses the attendant who will render services;
(b) The attendant is an enrolled Medicaid
provider; and
(c) The participant
utilizes services of a fiscal intermediary.
(34) "Plan of care" means the recommended or
revised recommended service plan developed by AERS after an evaluation of an
applicant or participant.
(35)
"Plan of service" means the written plan that:
(a) Is developed jointly by the applicant or
participant and the case manager;
(b) Is based upon:
(i) The AERS evaluation;
(ii) The AERS plan of care; and
(iii) The case manager's face-to-face
interview with the applicant or participant;
(c) Addresses the applicant's or
participant's needs and desires; and
(d) Specifies the type, amount, frequency,
costs, and duration of all ICS and other Medicaid services required to safely
support the participant in the community.
(36) "Provider" means an entity which is
enrolled in the Maryland Medical Assistance Program to provide one or more of
the services covered under Regulations .22-.37 of this chapter.
(37) "Quality plan" means the plan developed
by the Department to address quality assurance and oversight for the ICS
program.
(38) "Registered nurse"
means an individual licensed to practice as a registered nurse under Health
Occupations Article, Title 8, Annotated Code of Maryland.
(39) "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.
(40) "State Plan" means the document approved
by the Centers for Medicare and Medicaid Services describing the nature and
scope of the Maryland Medical Assistance Program in accordance with federal
requirements at § 1902(a) of Title XIX of the Social Security
Act.
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