Md. Code Regs. 10.09.07.01

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

Section 10.09.07.01 - Definitions

A. The following terms have the meanings indicated.

B. Terms Defined.

(1) "Adult Day Care Assessment and Planning System (ADCAPS)" means a system that is comprised of a comprehensive assessment completed by a registered nurse, which is designed to evaluate the participant's strengths and needs, and to facilitate the development of a problem list, service plan, and plan of care.

(2) "Adult Evaluation and Review Services (AERS)" means an entity within the local health department which, in accordance with the waiver, this chapter, and COMAR 10.09.30, assesses waiver applicants and participants.

(3) "Advance directive" has the meaning stated in Health-General Article, §5-601, Annotated Code of Maryland.

(4) "Community Settings Questionnaire" means the participant survey, completed annually or when a participant changes medical day care centers or sites, that is part of the State's strategy to validate provider compliance with federal requirements on home and community based settings.

(5) "Daily attendance record" means a daily attendance account of the physical presence of each medical day care participant that:

(a) Is designed by the provider;

(b) Is signed and dated by the staff designated to take attendance or by the medical day care director; and

(c) Includes the name, medical assistance number, date of service, and arrival and departure times, of each participant, including documentation of time of temporary absences.

(6) "Department" means the Department of Health and Mental Hygiene.

(7) "Home and community based services waiver" means a program implemented by the Department and approved by the Secretary of Health and Human Services, which authorizes the waiver of certain specified federal statutory requirements limiting coverage for home and community based services under the Maryland Medical Assistance Program.

(8) "Licensed practical nurse" means an individual licensed to practice licensed practical nursing under Health Occupations Article, Title 8, Annotated Code of Maryland.

(9) "Licensed social worker" means an individual who is licensed to practice social work under Health Occupations Article, Title 19, Annotated Code of Maryland.

(10) "Maintenance services" means the periodic monitoring of medically stable patients and the services provided in order to maintain their health care status.

(11) "Medical Assistance Program" means the Program administered by Maryland under Title XIX of the Social Security Act, which provides comprehensive medical and other health-related care for categorically eligible and medically needy recipients.

(12) "Medical day care" means medically supervised, health-related services provided in an ambulatory setting to medically handicapped adults, who, due to their degree of impairment, need health maintenance and restorative services supportive to their community living.

(13) "Medical day care center" means a facility operated for the purpose of providing medical day care services in an ambulatory care setting to medically handicapped adults who do not require 24-hour inpatient care, but, due to their degree of impairment, are not capable of full-time independent living.

(14) "Medical director" means an individual who is:

(a) Licensed to practice medicine under Health Occupations Article, Title 14, Annotated Code of Maryland; and

(b) Employed by the medical day care center either as a staff member or by a contractual agreement.

(15) "Medically handicapped adult" has the meaning stated in Health-General Article, §14-301(c), Annotated Code of Maryland.

(16) "Medically necessary" means that a 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.

(17) "Multidisciplinary team" means the group consisting of members of the medical day care center's professional staff, the participant, the participant's authorized representative, health care professionals, and waiver case managers, as appropriate, that establishes and updates the participant's service plan and plan of care.

(18) "Occupational therapist" means an individual who practices occupational therapy under Health Occupations Article, Title 10, Annotated Code of Maryland.

(19) "Occupational therapy" means medically prescribed treatment concerned with improving or restoring functions which have been impaired by illness or injury or, when function has been permanently lost or reduced by illness or injury, concerned with improving the individual's ability to perform those tasks for independent functioning.

(20) "Participant" means an individual:

(a) Who is a medically handicapped adult as defined under §B(14) of this regulation and who is certified by the Department or its designee as requiring nursing facility services, as defined under COMAR 10.09.10, but whose condition does not require institutional care if medical day care services or other services that provide alternatives to institutional care are available;

(b) Who is enrolled in a home and community based services waiver that includes medical day care as a waiver service; and

(c) Whose disabilities and needs cannot be satisfactorily and totally met in an episodic ambulatory care setting but require participation at least 1 day a week in a day-long rehabilitative or maintenance ambulatory care program which provides a mix of medical and social services and is authorized in the participant's home and community based services waiver service plan.

(21) "Personal care services" means assistance with activities of daily living.

(22) "Physical therapist" means an individual licensed to practice physical therapy under Health Occupations Article, Title 13, Annotated Code of Maryland.

(23) "Physical therapy" means treatment of disease and injury through use of:

(a) Therapeutic exercise and modalities of heat, cold, water, light, electricity, massage and radiant energy (other than roentgen rays, radium or use of electricity for cauterization in surgery); or

(b) Administration and interpretation of tests and measurements of neuromuscular and musculoskeletal functions; or

(c) Both §B(22)(a) and (b) of this regulation.

(24) "Plan of care" means a written plan established by the multidisciplinary team in accordance with COMAR 10.12.04.22, based upon a medical order and an assessment of the participant's health status and special care requirements.

(25) "Preventive services" means those services designed to prevent the occurrence and/or progression of disease at an early stage before complications and serious disabilities develop.

(26) "Primary care provider" means a physician, physician assistant, or nurse practitioner who is the primary coordinator of care for the participant.

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

(28) "Provider" means a facility licensed under COMAR 10.12.04 furnishing medical day care services through an appropriate agreement with the Department and identified as a provider by the issuance of an individual account number.

(29) "Provider agreement" means a contract between the Department of Health and Mental Hygiene and the provider of medical day care, specifying the services to be performed, methods of operation, financial and legal requirements which shall be in force before Program participation in medical day care.

(30) "Recipient" means a person who is certified for, and is receiving, Medical Assistance benefits.

(31) "Referral" means to direct a participant, family member, or caretaker to the appropriate community agency or health care provider, or to contact the agency or provider on the participant's behalf, to facilitate access to needed services.

(32) "Registered nurse" means an individual licensed to practice as a registered nurse under Health Occupations Article, Title 8, Annotated Code of Maryland.

(33) "Secretary" means the Secretary of Health and Mental Hygiene.

(34) "Service Plan" means an approved document which specifies the type, amount, frequency, and duration of all waiver and other Medicaid services required to safely support the waiver participant in the community.

(35) "Significant change in condition" means a change in the participant's physical, mental, or psychological status as identified by the comprehensive assessment performed by a registered nurse.

(36) "Specially equipped vehicles" means those vehicles used to transport participants with severe physical disabilities that limit mobility.

(37) "Supervision" means initial direction or periodic monitoring of the actual activity.

Md. Code Regs. 10.09.07.01

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 as an emergency provision effective July 1, 2008 (35:17 Md. R. 1480); amended permanently effective December 15, 2008 (35:25 Md. R. 2150); amended effective 43:03 Md. R. 272, eff.2/15/2016; amended effective 46:10 Md. R. 485, eff. 5/20/2019