Md. Code Regs. 10.09.84.02

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

Section 10.09.84.02 - Definitions

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

B. Terms Defined.

(1) "Activities of daily living (ADLs)" means tasks or activities that include, but are not limited to:

(a) Bathing and completing personal hygiene routines;

(b) Dressing and changing clothes;

(c) Eating;

(d) Mobility, including:

(i) Transferring from a bed, chair, or other structure;

(ii) Moving, turning, and positioning the body while in bed or in a wheelchair; and

(iii) Moving about indoors or outdoors; and

(e) Toileting, including:

(i) Bladder and bowel requirements;

(ii) Routines associated with the achievement or maintenance of continence; and

(iii) Incontinence care.

(2) "Applicant" means an individual who is applying to receive services under this chapter.

(3) "Assistance" means that another individual:

(a) Physically performs the activity for the participant;

(b) Physically helps the participant to perform the activity;

(c) Monitors the participant's performance of the activity in order to ensure health and safety, or

(d) Cues or encourages the participant to perform the activity.

(4) "Case management services" means services which assist an applicant or a participant in gaining access to waiver and other covered Medicaid services.

(5) "Case manager" means a person performing case management services under a waiver program and acting in the role of the supports planner.

(6) "Certified medication technician (CMT)" means an individual, regardless of title, who:

(a) Completes a course in medication administration approved by the Maryland Board of Nursing;

(b) Is certified by the Maryland Board of Nursing under COMAR 10.39.04; and

(c) Performs medication administration tasks delegated by a nurse in accordance with COMAR 10.27.11.

(7) "Certified nursing assistant (CNA)" means an individual, regardless of title, who:

(a) Is certified by the Maryland Board of Nursing under COMAR 10.39.01; and

(b) Routinely performs delegated nursing tasks delegated by a nurse in accordance with COMAR 10.27.11.

(8) "Community First Choice" means the Medicaid home and community-based services program implemented under this chapter in accordance with the application and any amendments to it submitted by the Department and approved by the Secretary of Health and Human Services, which authorizes the provision of certain home and community-based services under the Maryland Medical Assistance Program.

(9) "Community setting" is the area, district, locality, neighborhood, or vicinity where a group of people live.

(a) "Community setting" means the area, district, locality, neighborhood, or vicinity where a group of people live which provides participants with opportunities to:

(i) Seek employment and work in competitive integrated settings;

(ii) Engage in community life;

(iii) Control personal resources; and

(iv) Receive services.

(b) "Community setting" does not mean:

(i) Hospitals;

(ii) Nursing facilities;

(iii) Institutions for mental diseases;

(iv) Intermediate care facilities for individuals with intellectual disabilities; or

(v) Other institutions.

(10) "Conflicts of interest" means real or seeming incompatibility between one's private interests and one's public or fiduciary duties.

(11) "Delegated nursing functions" means nursing services provided to a participant by an enrolled personal assistance worker under the supervision of a:

(a) Registered nurse in accordance with COMAR 10.27.11; or

(b) Nurse practitioner in accordance with COMAR 10.27.07.

(12) "Department" means the Maryland Department of Health and Mental Hygiene, or its authorized agent acting on behalf of the Department.

(13) Home.

(a) "Home" means the participant's place of residence in a community setting.

(b) "Home " does not mean:

(i) An assisted living program as defined in COMAR 10.07.14;

(ii) A residential rehabilitation program licensed as a therapeutic group home under COMAR 10.21.07;

(iii) An alternative living unit, group home, or individual family care home as defined in COMAR 10.22.01;

(iv) Community-based residential facilities for individuals with intellectual or developmental disabilities licensed under COMAR 10.22.02; or

(v) Any other provider-owned or controlled residence.

(14) "Institution" means an establishment that furnishes, in single or multiple facilities, food, shelter, and some treatment or services to four or more individuals unrelated to the proprietor.

(15) "Instrumental activities of daily living" means tasks or activities that include, but are not limited to:

(a) Preparing meals;

(b) Performing light chores that are incidental to the personal assistance services provided to the participant;

(c) Shopping for groceries;

(d) Nutritional planning;

(e) Traveling as needed;

(f) Managing finances and handling money;

(g) Using the telephone or other appropriate means of communication;

(h) Reading; and

(i) Planning and making decisions.

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

(17) "Medically necessary" means that the service or benefit is:

(a) Directly related to diagnostic, preventive, curative, ameliorative, palliative, or rehabilitative 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 participant, the participant's family, the provider, or the worker.

(18) "Nurse" means an individual who is currently licensed to practice nursing in the State under COMAR 10.27.01.

(19) "Nurse monitor" means a registered nurse who completes nursing assessments on participants and evaluates the delivery of care.

(20) "Nursing facility" means a facility which is participating in the Maryland Medical Assistance Program as a nursing facility pursuant to COMAR 10.09.10.

(21) "Participant" means an individual who:

(a) Has been determined to meet the qualifications for participation in Community First Choice as specified in Regulation .04 of this chapter; and

(b) Is enrolled with the Department to receive Medicaid services.

(22) "Personal assistance provider agency" means a public or private agency that:

(a) Employs or contracts with personal assistance workers; and

(b) Has been enrolled by the Program as a provider of personal assistance services.

(23) Personal Assistance Services.

(a) "Personal assistance services" means assistance specific to the functional needs of a participant with a chronic illness, medical condition, or disability.

(b) "Personal assistance services" includes:

(i) Assistance with activities of daily living and instrumental activities of daily living; and

(ii) The performance of delegated nursing function.

(24) "Plan of service" means the written support plan that:

(a) Reflects what is important to the individual and what is important for his or her welfare; and

(b) Is developed with support from the supports planner with input from the individual and, when applicable, the individual's representative.

(25) "Preauthorized" means approved by the Department or its designee before services can be rendered.

(26) "Program" means the Maryland Medicaid Program.

(27) "Provider" has the same meaning as defined in COMAR 10.09.36.

(28) "Provider agreement" means a contract between the Department and the provider for rendering the services under this chapter.

(29) "Quality plan" means the plan developed by the Department to address quality assurance and oversight.

(30) "Recommended plan of care" means the recommended service plan developed by a nurse after a face-to-face evaluation of an applicant or participant.

(31) "Representative" means:

(a) The person authorized by the individual to serve as a representative in connection with the provision of Community First Choice services and supports; or

(b) The individual who signs the plan of service on the participant's behalf;

(c) Any individual who makes decisions on behalf of the participant related to the participant's plan of service;

(d) A legal guardian of the individual for the participant; or

(e) The parent or foster parent of a dependent minor child.

(32) "Supports planner" means an individual who coordinates services, including:

(a) Supporting development of a plan of service;

(b) Interacting with third parties on behalf of, or in conjunction with, the applicant or participant; and

(c) Ensuring an accurate plan of service is provided to the Department.

(33) "Telephonic timekeeping system" means a system developed by the Department for workers to time stamp the start and finish of services provided to a participant.

(34) "Worker" means an individual who is employed by or contracts with a personal assistance provider agency to provide personal assistance services.

Md. Code Regs. 10.09.84.02

Regulation .02 amended effective 42:11 Md. R. 724, eff.6/8/2015; amended effective 43:7 Md. R. 449, eff.4/11/2016; amended effective 45:3 Md. R. 156, eff. 2/12/2018