Md. Code Regs. 10.09.53.04

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

Section 10.09.53.04 - Covered Services

A. The Program shall cover services rendered by a nurse, CNA, or HHA when the:

(1) Services are ordered by the participant's primary medical provider and renewed every 60 days after that;

(2) Services are directly related to the plan of care;

(3) Services are described in the nursing care plan and progress notes;

(4) Services are of a scope that is more individual and continuous than what is available under the home health program;

(5) Services are delivered in the recipient's home, or other setting when normal life activities take the recipient outside the home;

(6) Services include supervision of family caregivers in the home while family caregivers practice the skills necessary to provide care to the recipient in accordance with the established plan of care;

(7) Services are preauthorized in accordance with Regulation .06 of this chapter;

(8) Services are received by the participant as documented by the signature of the participant or the participant's representative on the nursing provider's official form;

(9) Services are determined medically necessary for a participant after the provider has completed an initial nursing assessment that reflects the participant's need for an awake and alert caregiver;

(10) Participant has at least one caregiver willing and able to accept responsibility for the participant's care when the nurse, CNA, or HHA is not available;

(11) Caregiver provides documentation of each of the following when applicable:

(a) The caregiver's work schedule along with commuting times;

(b) The caregiver's school attendance as defined in Regulation .02 of this chapter along with commuting times; and

(c) Emergency circumstances, as determined by the Department, including but not limited to the inability of the primary caregiver to provide care due to hospitalization or an acute debilitating illness for up to a 60-day period; and

(12) Services are provided only in the absence of the willing and able caregiver during sleeping hours and during the times documented in §A(11) of this regulation.

Md. Code Regs. 10.09.53.04

Regulations .04 adopted as an emergency provision effective May 5, 1993 (20:11 Md. R. 911); adopted permanently effective August 2, 1993 (20:15 Md. R. 1220)
Regulations .04 amended as an emergency provision effective June 1, 1994 (21:13 Md. R. 1152); amended permanently effective September 26, 1994 (21:19 Md. R. 1635)
Regulations .04 amended as an emergency provision effective January 1, 1997 (23:26 Md. R. 1856); amended permanently effective March 10, 1997 (24:5 Md. R. 408)
Regulation .04 amended effective March 10, 2008 (35:5 Md. R. 641);41:6 Md. R. 379, eff. 4/1/2014
Regulation .04A, C amended effective August 23, 1999 (26:17 Md. R. 1323); January 31, 2005 (32:2 Md. R. 146); amended effective 44:26 Md. R. 1214, eff. 1/1/2018; amended effective 51:12 Md. R. 619, eff. 6/24/2024.