Md. Code Regs. 10.09.07.01 - Definitions
A. The following
terms have the meanings indicated.
B. Terms Defined.
(23)
(24) "Plan of care"
means a written plan established by the multidisciplinary team in accordance
with COMAR
10.12.04.22, based upon a medical
order and an assessment of the participant's health status and special care
requirements.
(1) "Adult Day Care Assessment and Planning
System (ADCAPS)" means a system that is comprised of a comprehensive assessment
completed by a registered nurse, which is designed to evaluate the
participant's strengths and needs, and to facilitate the development of a
problem list, service plan, and plan of care.
(2) "Adult Evaluation and Review Services
(AERS)" means an entity within the local health department which, in accordance
with the waiver, this chapter, and COMAR 10.09.30, assesses waiver applicants
and participants.
(3) "Advance
directive" has the meaning stated in Health-General Article, §
5-601,
Annotated Code of Maryland.
(4)
"Community Settings Questionnaire" means the participant survey, completed
annually or when a participant changes medical day care centers or sites, that
is part of the State's strategy to validate provider compliance with federal
requirements on home and community based settings.
(5) "Daily attendance record" means a daily
attendance account of the physical presence of each medical day care
participant that:
(a) Is designed by the
provider;
(b) Is signed and dated
by the staff designated to take attendance or by the medical day care director;
and
(c) Includes the name, medical
assistance number, date of service, and arrival and departure times, of each
participant, including documentation of time of temporary absences.
(6) "Department" means the
Department of Health and Mental Hygiene.
(7) "Home and community based services
waiver" means a program implemented by the Department and approved by the
Secretary of Health and Human Services, which authorizes the waiver of certain
specified federal statutory requirements limiting coverage for home and
community based services under the Maryland Medical Assistance
Program.
(8) "Licensed practical
nurse" means an individual licensed to practice licensed practical nursing
under Health Occupations Article, Title 8, Annotated Code of
Maryland.
(9) "Licensed social
worker" means an individual who is licensed to practice social work under
Health Occupations Article, Title 19, Annotated Code of Maryland.
(10) "Maintenance services" means the
periodic monitoring of medically stable patients and the services provided in
order to maintain their health care status.
(11) "Medical Assistance Program" means the
Program administered by Maryland under Title XIX of the Social Security Act,
which provides comprehensive medical and other health-related care for
categorically eligible and medically needy recipients.
(12) "Medical day care" means medically
supervised, health-related services provided in an ambulatory setting to
medically handicapped adults, who, due to their degree of impairment, need
health maintenance and restorative services supportive to their community
living.
(13) "Medical day care
center" means a facility operated for the purpose of providing medical day care
services in an ambulatory care setting to medically handicapped adults who do
not require 24-hour inpatient care, but, due to their degree of impairment, are
not capable of full-time independent living.
(14) "Medical director" means an individual
who is:
(a) Licensed to practice medicine
under Health Occupations Article, Title 14, Annotated Code of Maryland;
and
(b) Employed by the medical day
care center either as a staff member or by a contractual agreement.
(15) "Medically handicapped adult"
has the meaning stated in Health-General Article, §
14-301(c),
Annotated Code of Maryland.
(16)
"Medically necessary" means that a service or benefit is:
(a) Directly related to diagnostic,
preventive, curative, palliative, rehabilitative, or ameliorative 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
consumer, family, or provider.
(17) "Multidisciplinary team" means the group
consisting of members of the medical day care center's professional staff, the
participant, the participant's authorized representative, health care
professionals, and waiver case managers, as appropriate, that establishes and
updates the participant's service plan and plan of care.
(18) "Occupational therapist" means an
individual who practices occupational therapy under Health Occupations Article,
Title 10, Annotated Code of Maryland.
(19) "Occupational therapy" means medically
prescribed treatment concerned with improving or restoring functions which have
been impaired by illness or injury or, when function has been permanently lost
or reduced by illness or injury, concerned with improving the individual's
ability to perform those tasks for independent functioning.
(20) "Participant" means an individual:
(a) Who is a medically handicapped adult as
defined under §B(14) of this regulation and who is certified by the
Department or its designee as requiring nursing facility services, as defined
under COMAR 10.09.10, but whose condition does not require institutional care
if medical day care services or other services that provide alternatives to
institutional care are available;
(b) Who is enrolled in a home and community
based services waiver that includes medical day care as a waiver service;
and
(c) Whose disabilities and
needs cannot be satisfactorily and totally met in an episodic ambulatory care
setting but require participation at least 1 day a week in a day-long
rehabilitative or maintenance ambulatory care program which provides a mix of
medical and social services and is authorized in the participant's home and
community based services waiver service plan.
(21) "Personal care services" means
assistance with activities of daily living.
(22) "Physical therapist" means an individual
licensed to practice physical therapy under Health Occupations Article, Title
13, Annotated Code of Maryland.
(23) "Physical therapy" means treatment of
disease and injury through use of:
(a)
Therapeutic exercise and modalities of heat, cold, water, light, electricity,
massage and radiant energy (other than roentgen rays, radium or use of
electricity for cauterization in surgery); or
(b) Administration and interpretation of
tests and measurements of neuromuscular and musculoskeletal functions;
or
(c) Both §B(22)(a) and (b)
of this regulation.
(25) "Preventive
services" means those services designed to prevent the occurrence and/or
progression of disease at an early stage before complications and serious
disabilities develop.
(26) "Primary
care provider" means a physician, physician assistant, or nurse practitioner
who is the primary coordinator of care for the participant.
(27) "Program" means the Maryland Medical
Assistance Program.
(28) "Provider"
means a facility licensed under COMAR 10.12.04 furnishing medical day care
services through an appropriate agreement with the Department and identified as
a provider by the issuance of an individual account number.
(29) "Provider agreement" means a contract
between the Department of Health and Mental Hygiene and the provider of medical
day care, specifying the services to be performed, methods of operation,
financial and legal requirements which shall be in force before Program
participation in medical day care.
(30) "Recipient" means a person who is
certified for, and is receiving, Medical Assistance benefits.
(31) "Referral" means to direct a
participant, family member, or caretaker to the appropriate community agency or
health care provider, or to contact the agency or provider on the participant's
behalf, to facilitate access to needed services.
(32) "Registered nurse" means an individual
licensed to practice as a registered nurse under Health Occupations Article,
Title 8, Annotated Code of Maryland.
(33) "Secretary" means the Secretary of
Health and Mental Hygiene.
(34)
"Service Plan" means an approved document which specifies the type, amount,
frequency, and duration of all waiver and other Medicaid services required to
safely support the waiver participant in the community.
(35) "Significant change in condition" means
a change in the participant's physical, mental, or psychological status as
identified by the comprehensive assessment performed by a registered nurse.
(36) "Specially equipped vehicles"
means those vehicles used to transport participants with severe physical
disabilities that limit mobility.
(37) "Supervision" means initial direction or
periodic monitoring of the actual activity.
Notes
Regulation .01B amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1480); amended permanently effective December 15, 2008 (35:25 Md. R. 2150); amended effective 43:03 Md. R. 272, eff.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.