Md. Code Regs. 10.09.46.05

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

Section 10.09.46.05 - Conditions for Provider Participation - General

General requirements for participation in the Medical Assistance Program as a provider of BI waiver services are that the provider, with the exception of a medical day care provider, shall:

A. Be approved by the BHA as meeting the requirements and able to provide the services specified in this chapter;

B. Have a provider agreement in effect;

C. Meet all the conditions for participation in COMAR 10.09.36, except as otherwise specified in this chapter;

D. Have demonstrated experience in the provision of services to individuals with TBI as evidenced by:

(1) Having:

(a) A history of serving adults with traumatic brain injury for at least the past 2 years;

(b) A program of specialized services appropriate for the needs of individuals with traumatic brain injury; and

(c) Availability of licensed healthcare professionals with experiences in the provision of services to individuals with traumatic brain injury to supervise, train, or consult with program staff regarding the needs of waiver participants; or

(2) Accreditation by CARF for the provision of brain injury services;

E. Verify the licenses or credentials of all agencies and individuals who render services on the provider's behalf under this chapter, and have a copy of the licenses or credentials available for inspection;

F. Assure that direct care workers who render services under this chapter:

(1) Receive oversight from an appropriately licensed or certified health care professional; and

(2) Are determined by the provider as qualified to meet the participants' needs;

G. Provide an annual continuing education program approved by BHA for all staff working with waiver participants on the needs of individuals with BI that may include:

(1) Types of brain injury;

(2) Behavioral, emotional, cognitive, and physical changes after brain injury; and

(3) Strategies for compensation and remediation of deficits caused by a brain injury;

H. Provide services in accordance with the requirements of Regulation .04 of this chapter and all applicable federal, State, and local laws and regulations;

I. Agree to provide and bill BHA or its authorized representative for only those services covered under this chapter which have been preauthorized in the participant's waiver plan of care;

J. Be ineligible to participate in the BI Waiver if the provider or any of its current or previous principals have overpayments that remain due and owing to the Department;

K. Provide services in person, except as authorized by the Department; and

L. If providing services via virtual supports, comply with the requirements established in Regulation .09-1 of this chapter.

Md. Code Regs. 10.09.46.05

Regulations .05 adopted as an emergency provision effective July 1, 2003 (30:14 Md. R. 933); adopted permanently effective December 11, 2003 (30:24 Md. R. 1740)
Regulation .05 amended effective April 9, 2007 (34:7 Md. R. 698)
Regulation .05 amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective October 6, 2008 (35:20 Md. R. 1774); amended effective 47:10 Md. R. 516, eff. 5/18/2020; amended effective 50:8 Md. R. 338, eff. 5/1/2023