Md. Code Regs. 10.09.84.04

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.84.04 - Participant Eligibility

A. To participate in the Program, a participant shall:

(1) Be determined by the Department to need the level of care provided in a hospital, nursing facility, an intermediate care facility for individuals with intellectual disabilities, an institution providing psychiatric services for individuals younger than 21 years old, or an institution for mental diseases for individuals 65 years old or older;

(2) Be eligible for Medicaid under an eligibility group defined in COMAR 10.09.24, except for Regulations .03C, .03-1 - .03-3, and .05-2; and

(3) Reside at home.

B. To be eligible for participation, a participant shall have an active plan of service. The plan of service shall:

(1) Be based on:

(a) The evaluation and recommended plan of care; and

(b) Consultation with the applicant or participant;

(2) Address the applicant's or participant's health and safety needs;

(3) Specify the items and services needed to safely support the participant in the community, including:

(a) A plan for receiving personal assistance services in case of an emergency; and

(b) Specific requests for items or services that substitute for human assistance;

(4) Specify the provider agency providing personal assistance services; and

(5) Include the signature of the:

(a) Participant or, when applicable, the individual's representative;

(b) Supports planner; and

(c) Personal assistance provider agency listed within the plan of service.

C. A participant's eligibility for services shall be re-evaluated by the Department every 12 months, or more frequently if needed due to a significant change in the participant's condition or needs.

D. Participant eligibility shall be terminated if the participant:

(1) No longer meets the required level of care;

(2) No longer resides at home;

(3) Is without services for 30 consecutive calendar days;

(4) Voluntarily chooses, or the participant's legal representative chooses on the participant's behalf, to disenroll from the Program;

(5) Moves to another state;

(6) Is an inpatient for 30 consecutive days or more in an institutional setting, including but not limited to a chronic hospital or nursing facility; or

(7) Dies.

Md. Code Regs. 10.09.84.04

Regulation .04 amended effective 42:11 Md. R. 724, eff.6/8/2015; amended effective 43:7 Md. R. 449, eff.4/11/2016