Md. Code Regs. 10.09.04.01

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.04.01 - Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Activities of daily living" means functions normally associated with mobility, eating, elimination, body hygiene and dressing.

(2) "Attending" means the role of an individual who establishes the plan of treatment and certifies the necessity for home health services for a participant following a hospitalization.

(3) "Case coordinator" means a licensed health professional designated by a home health agency to coordinate the care of a participant.

(4) "Certified nurse midwife (CNM)" means an individual who meets licensure requirements and conditions for participation as a certified nurse midwife set forth in COMAR 10.09.01.

(5) "Department" means the State Department of Health and Mental Hygiene, the single State agency designated to administer the Maryland Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq.

(6) "Health team" means the physician or nonphysician practitioner and the home health agency personnel who render services listed in Regulation .04B of this chapter to a participant.

(7) "Electronic Visit Verification (EVV)" has the meaning stated in COMAR 10.09.36.03-2.

(8) "Face-to-face" means contact with a participant that occurs in person or via audio-visual telehealth in accordance with COMAR 10.09.49.

(9) "Health team" means the physician or nonphysician practitioner and the home health agency personnel who render services listed in Regulation .04B of this chapter to a participant.

(10) "Home" means the place of residence occupied by the participant, including a domiciliary level facility, but other than a hospital, nursing facility, or other medical institution.

(11) "Home health agency" means a public or private agency or organization, or part of an agency or organization, that meets the requirements for participation in Medicare.

(12) "Home health aide" means a person who meets the requirements of COMAR 10.07.10, and has received instruction from, and renders services under the supervision of, a registered nurse.

(13) "In person" means contact with a participant that occurs in the physical presence of the participant and the provider.

(14) "Intermittent" means services which are furnished on a medically predictable recurring basis.

(15) "Licensed nurse" means a person who is licensed as a registered nurse or as a licensed practical nurse in the jurisdiction in which the service is provided.

(16) "Medicaid average rate" means the average projected per diem rate established for the Department's fiscal year as specified in COMAR 10.09.10.07B(2) multiplied by 30.

(17) "Medically necessary" means that 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 current 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.

(18) "Medical supplies" means items which are generally recognized under accepted standards of medical practice as serving a therapeutic or diagnostic purpose and are medically necessary to enable home health agency personnel to carry out effectively the care the physician has ordered for the treatment or diagnosis of the patient's illness or injury, and which are accounted for in billing records.

(19) "Medicare" means the insurance program administered by the federal government under Title XVIII of the Social Security Act, 42 U.S.C. 1395 et seq.

(20) "Newborn early discharge assessment" means a visit to the newborn infant and postpartum mother to observe and assess the health status of both the newborn and the mother.

(21) "Nonphysician practitioner" means an individual who:

(a) Is licensed as a certified nurse practitioner, clinical nurse specialist, a certified nurse-midwife, or a physician assistant in the jurisdiction in which the service is provided; and

(b) Works in collaboration with or under the supervision of the ordering practitioner.

(22) "Occupational therapist" means a person who is licensed or registered as an occupational therapist in the jurisdiction in which the service is provided.

(23) "Participant" means a person who is certified as eligible for and is receiving Medical Assistance benefits.

(24) "Part-time" means services, usually furnished during several visits per week, but not exceeding one visit per discipline per day, unless unusual circumstances are documented by the physician, which are reasonable and necessary to the treatment of an illness or injury.

(25) "Physical therapist" means a person who is licensed or registered as a physical therapist in the jurisdiction in which the service is provided.

(26) "Physician" means an individual who meets the licensure requirements and conditions for participation set forth in COMAR 10.09.02.

(27) "Physician assistant" means an individual who meets license requirements and conditions for participation set forth in COMAR 10.09.55.

(28) "Program" means the Maryland Medical Assistance Program.

(29) "Progress note" means a dated, written notation by a member of the health team which summarizes facts about the care given and the patient's response during a given period of time, specifically addresses the established goals of treatment, is consistent with the patient plan of care, is written immediately following each visit, and is part of the provider's permanent record for the participant.

(30) "Provider" means a person or an organization who meets the requirements of Regulations .03 and .04 of this chapter and who, through an appropriate agreement with the Department, has been identified as a Program provider by the issuance of an individual account number.

(31) "Speech-language pathologist" means a person who is licensed as a speech-language pathologist in the jurisdiction in which the service is provided.

(32) "Supervision" means authoritative procedural guidance by a qualified person for the accomplishment of a function or activity with initial direction and periodic evaluation of the act of accomplishing the function or activity.

(33) "Support system" means a family member, friend, neighbor, or any person who renders services, which would otherwise be covered under Regulation .04 of this chapter, to the participant.

(34) "Telehealth" has the meaning stated in COMAR 10.09.49.02.

(35) "Visit" means the time spent rendering a covered service to a participant at home by an individual employed by a home health agency.

(36) "Witness" means a person who on behalf of the participant is able to personally verify at the time of service that the participant received home health care.

Md. Code Regs. 10.09.04.01

Regulations.01B amended, as an emergency provision effective July 17, 1990 (17:16 Md. R. 1984); adopted permanently effective November 1, 1990 (17:20 Md. R. 2427)
Regulation .01B amended effective November 12, 1990 (17:22 Md. R. 2656)
Regulation .01B amended effective December 27, 2010 (37:26 Md. R. 1787);40:19 Md. R. 1544, eff. 9/30/2013 ; amended effective 48:12 Md. R. 470, eff. 6/14/2021; amended effective 50:23 Md. R. 1004, eff. 11/27/2023