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 10.09.81.35 - Covered Services - Medical Day Care
Universal Citation: MD Code Reg 10.09.81.35
Current through Register Vol. 51, No. 19, September 20, 2024
A. Definition. "Unit of service" means a day of service rendered by a qualified provider to a participant in accordance with COMAR 10.09.07.
B. The ICS Program reimburses for a day of care which includes the following services:
(1) Health care services supervised by the
director, medical director, or health director, which emphasize primary
prevention, early diagnosis and treatment, rehabilitation and continuity of
care, including the following:
(a)
Participation in the development of the individual participant's plan of
care;
(b) Participation in the
determination of the participant's medical, psychosocial, and functional
status;
(c) Consultation with the
participant's personal physician; and
(d) Consultation with staff regarding a
participant's condition and health care needs;
(2) Nursing services performed by a
registered nurse or by a licensed practical nurse under the supervision of a
registered nurse which include:
(a) The
evaluation of the needs of the participants for nursing care;
(b) The supervision of any nursing
staff;
(c) Preventive and
maintenance services;
(d)
Observation and monitoring of participant's condition;
(e) Rehabilitative services;
(f) The teaching and training activities in
appropriate self-care techniques;
(g) The supervision of medication normally
self-administered;
(h) The
provision of health education;
(i)
Discharge planning; and
(j) Nursing
services that may be delegated to other staff in accordance with COMAR
10.27.11;
(3) Physical
therapy services, performed by or under supervision of a licensed physical
therapist, that:
(a) Are of a diagnostic,
rehabilitative, therapeutic, or maintenance nature, and are provided based on
the assessment by the physician that the:
(i)
Participant will improve significantly in a reasonable and generally
predictable period of time; or
(ii)
Services are necessary for the establishment of a safe and effective
maintenance program required in connection with a specific disease
state;
(b) Are directly
related to the physician's written plan of care which specifies:
(i) Part or parts to be treated;
(ii) Type of modalities or treatments to be
rendered;
(iii) Expected results of
physical therapy treatments; and
(iv) Frequency and duration of
treatment;
(c) The
complexity of the services, or the condition of a participant, require the
judgment, knowledge, and skills of a licensed physical therapist; and
(d) The services are considered to be an
effective treatment according to accepted standards of medical
practice;
(4)
Occupational therapy services, performed by an occupational therapist, that
meet the following conditions:
(a) The
treatment requires the special skills of an occupational therapist;
(b) The services are directly related to the
physician's written plan of care which specifies the:
(i) Treatment to be rendered;
(ii) Frequency and duration of the treatment;
and
(iii) Expected
results;
(c) The
treatment is provided with the expectation that there will be a significant
practical improvement in a participant's level of functioning within a
reasonable period of time; and
(d)
The services fall within one or more of the following categories:
(i) Evaluation and reevaluation of a
participant's level of functioning by administering diagnostic and prognostic
tests;
(ii) Selection and teaching
of task-oriented therapeutic activities designed to restore physical
function;
(iii) Teaching of
compensatory techniques to improve the level of independence in the activities
of daily living;
(iv) Training in
the use of supportive and adaptive equipment, and assistive devices required
for independent performance according to COMAR 10.09.12; and
(v) Improvement of mobility skills;
(5) Personal care
services which include assistance with activities of daily living;
(6) Nutrition services which include the
following:
(a) Meals and snacks as specified
under COMAR
10.12.04.19C;
(b) Therapeutic diets as specified under
COMAR 10.12.04.19C;
and
(c) Dietary counseling and
education;
(7) Social
work services performed by a licensed, certified social worker, or licensed
social work associate which include:
(a)
Screening and interviewing, or assisting designated staff with screening and
interviewing prospective participants to determine the general appropriateness
of the individual for the full assessment process for medical day care
services;
(b) Ongoing services to
include:
(i) Identifying the emotional and
social needs of participants during the rendering of medical day care
services;
(ii) Maintaining linkages
with community support resources for the participant including relatives,
friends, and other care providers;
(iii) Counseling to improve the participant's
response to the plan of care, chronic condition, and prospects for recovery or
stabilization, but does not include diagnosing or treating mental
disorders;
(iv) Counseling a
participant and a participant's family in the availability and utilization of
public and private community services, referral to, and coordination of these
services;
(v) Assisting
participants in obtaining health care services that are not available through
the medical day care center, such as vision care, podiatry, or medical
equipment;
(vi) Counseling
participants to assist with acclimation to the medical day care center's
services and to promote active involvement in their plan of care;
(vii) Coordinating and implementing group and
family counseling in conjunction with plan of care goals;
(viii) Writing notes in the participant's
records that reflect the social work activities performed; and
(ix) Participating in the multidisciplinary
team meetings; and
(c)
Discharge planning and referral services including:
(i) Written procedures for discharge,
referral, and follow-up;
(ii) A
discharge summary with post discharge goals;
(iii) Recommendations for continuing care;
and
(iv) Referral to appropriate
community service agencies and health care providers to facilitate the
participant's return to more independent living;
(8) Activity programs in
accordance with COMAR
10.12.04.14C;
and
(9) Transportation services
that:
(a) Are provided or arranged for a
participant by the medical day care staff;
(b) Maximize the following types of
transportation services:
(i) Walking, for a
person who lives within walking distance of the medical day care center and who
is sufficiently mobile;
(ii)
Family-supplied transportation provided by friends, neighbors, or volunteers;
and
(iii) Public transportation
services;
(c) Are
procured by the provider after options described in §B(9)(b) of this
regulation have been exhausted;
(d)
Are the responsibility of the provider to:
(i) Arrange contractual agreements with
transportation providers to meet the transportation needs of the participants;
and
(ii) Group participants, where
possible, in the same taxi, van or specially equipped vehicles, to minimize the
cost of transportation;
(e) Are provided in accordance with a primary
transportation plan and a back-up plan;
(f) Are documented, indicating the type of
transportation used by each participant;
(g) Are scheduled to ensure that a
participant's one-way transit time does not exceed 1 hour as specified under
COMAR 10.12.04.27C;
and
(h) Are included in the day of
care for:
(i) Trips and outings which are part
of the activities program; and
(ii)
A participant's medical appointment escorted by center staff.
C. The day care service shall be:
(1) Authorized in the
participant's plan of service;
(2)
Medically necessary;
(3) Adequately
described in progress notes in the participant's medical record, signed and
dated by the individual providing care; and
(4) Provided to participants documented to be
present at the medical day care center a minimum of 4 hours a day.
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.
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