Md. Code Regs. 10.09.27.03

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

Section 10.09.27.03 - Conditions for Participation

A. General requirements for participation in the Medical Assistance Program are that providers shall meet all conditions for participation specified in COMAR 10.09.36.

B. Specific requirements for participation in the Program as a provider of home care services are as follows:

(1) The home care case management provider shall:

(a) Have a written agreement with each participant which includes the following:

(i) A description of the types, amount, frequency, and duration of home care services to be provided to the participant as ordered by the principal physician and specified in the approved plan of care;

(ii) A statement that the participant or responsible representatives shall have access to the individual plan of care and shall be involved in its development and periodic review;

(iii) The name, address, telephone number, and Medical Assistance number of the participant;

(iv) The dated signatures of the participant or legally authorized representative, and the provider representative;

(v) A statement that utilization of available services and selection among approved enrolled providers is subject to participant choice;

(vi) A statement that services will at all times be provided without discrimination with regard to race, color, age, sex, national origin, marital status, or physical or mental handicap.

(b) Be available to participants in-person at least 8 hours a day, 5 days a week with established hours of operation.

(c) Have written and implemented formalized policies and procedures developed before participation in the Program concerning the following areas:

(i) Medical records for each participant which include at a minimum the application for home care, plan of care, orders for home care services, documentation of nursing observations at least every 30 days, social history, and home care cost worksheets establishing initial participant eligibility and continued eligibility on a quarterly basis;

(ii) Utilization review which includes the development of a home care review procedure completed every 6 months for all participants to evaluate the appropriateness of home care, the efficiency, adequacy, and coordination of home care services, with the objective of achieving the least costly yet appropriate delivery of services under the Program.

(d) Convene the multidisciplinary team which:

(i) Upon receipt of the principal physician's orders assesses the appropriateness of home care for the participant;

(ii) Determines the medical, psychological, social, and functional status of each participant;

(iii) Develops an individual plan of care in conjunction with the principal physician's orders;

(iv) Coordinates at least one in-person meeting annually, unless otherwise authorized by the Department;

(v) Unless otherwise excepted in §B(1)(d)(iv) of this regulation, may meet in-person or via telehealth; and

(vi) Reviews and updates the individual plan of care in accordance with Regulation .01B(16) of this chapter.

(e) Provide for in-home assessments, via an in-person visit or telehealth, on a quarterly basis or as determined necessary by the principal physician.

(f) Conducts at least two in-person visits annually, unless otherwise authorized by the Department.

(g) Not be a provider of medical supplies and equipment or nursing services.

(2) Shift private duty nursing, certified nursing assistant, and home health aide providers shall:

(a) Meet all conditions for participation set forth in:

(i) COMAR 10.09.53.03A; or

(ii) COMAR 10.09.69;

(b) Participate in interdisciplinary team meetings;

(c) Ensure timesheets are signed by the individual rendering services;

(d) Ensure a nurse, a certified nursing assistant, or a home health aide is not scheduled to work for more than 16 consecutive hours and the individual is off 8 or more hours before starting another shift unless otherwise authorized by the Department;

(e) Obtain the participant's signature or the signature of the participant's witness on the provider's official forms to verify receipt of service; and

(f) Either be a:

(i) Residential service agency licensed in accordance with COMAR 10.07.05; or

(ii) Home health agency licensed in accordance with COMAR 10.07.10 which meets the conditions of participation specified in 42 CFR § 484.36 ;

(g) Demonstrate the capacity to arrange for the provision of home health aide services in the amount and level required in the participant's plan of care including the establishment of a contingency plan to assure coverage as specified in the plan of care;

(h) Demonstrate sufficient specialized training and experience in the care of individuals with disabilities necessary to deliver the level of services required by participants; and

(i) Demonstrate, on a continuing basis, the ability to competently carry out services in the plan of care subject to review by the home care case manager or the home care case manager's designee.

(3) Medical day care providers shall meet all conditions for participation set forth in COMAR 10.09.07.

(4) The provider of home care services shall:

(a) Deliver services in-person unless expressly authorized to render services via telehealth; and

(b) If delivering services via telehealth, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department.

Md. Code Regs. 10.09.27.03

Regulations .03 adopted as an emergency provision effective May 10, 1985 (12:11 Md. R. 1041); emergency status extended at 12:19 Md. R. 1843 and 13:6 Md. R. 669; adopted permanently effective March 10, 1986 (13:5 Md. R. 543)
Regulations .03 amended as an emergency provision effective March 11, 1991 (18:7 Md. R. 765); amended permanently effective July 1, 1991 (18:12 Md. R. 1339)
Regulation .03B amended effective August 25, 1986 (13:17 Md. R. 1922); July 1, 1989 (16:12 Md. R. 1336)
Regulation .03B amended effective July 17, 2006 (33:14 Md. R. 1163)
Regulation .03B amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective December 1, 2008 (35:24 Md. R. 2077); amended effective 50:16 Md. R. 725, eff. 8/21/2023