Maryland Administrative Code

.08 Payment Procedures. A. General policies governing payment procedures that are applicable to all providers are set forth in COMAR 10.09.36.04. B. Billing time limitations for claims submitted under this chapter are set forth in COMAR 10.09.36.06. C. Unless the care is free to …

.09 Recovery and Reimbursement. Recovery and reimbursement shall be as set forth in COMAR 10.09.36.07.

.10 Cause for Suspension or Removal and Imposition of Sanctions. A. Causes for suspension or removal and imposition of sanctions shall be as set forth in COMAR 10.09.36.08. B. The Department shall give to the provider reasonable written notice of the Department’s intention to imp…

.11 Appeal Procedures. Appeals procedures shall be as set forth in accordance with COMAR 10.09.36.09.

.12 Interpretive Regulation. This chapter shall be interpreted as set forth in COMAR 10.09.36.10.

.01 Purpose. The purpose of the Increased Community Services (ICS) Program is to enable certain nursing facility residents to access home and community-based services by allowing those nursing facility residents to contribute to the cost of care through a monthly assessment and t…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Activities of daily living” means bathing, eating, toileting, dressing, and mobility including transfer. (2) “Adult Evaluation and Review Services (AERS)” means an entity …

.03 Participant Eligibility. A. General Requirements. (1) To be eligible for participation in the ICS Program, an applicant or participant shall be determined by the Department to meet the conditions of §§B — E of this regulation. (2) A participant's eligibility for ICS services …

.04 Conditions for Provider Participation — General Requirements. A. To participate as a provider of a service covered under Regulations .22 — .37 of this chapter, a provider shall: (1) Meet all of the conditions for participation as a Maryland Medical Assistance Program provider…

.05 Specific Conditions for Provider Participation — Participant Training. To participate in the ICS Program as a provider of participant training under Regulation .22 of this chapter, a provider shall: A. Be a self-employed trainer or an agency that employs qualified trainers in…

.06 Specific Conditions for Provider Participation — Family Training. To participate in the ICS Program as a provider of family training services under Regulation .23 of this chapter, a provider shall: A. Be: (1) One of the following self-employed professionals: (a) Registered nu…

.07 Specific Conditions for Provider Participation — Case Management Services. To participate in the ICS Program as a provider of case management services under Regulation .24 of this chapter, a provider shall: A. Be enrolled as a case management provider in accordance with COMAR…

.08 Specific Conditions for Provider Participation — Transition Services. To participate in the ICS Program as a provider of transition services under Regulation .25 of this chapter, a provider shall be the case management provider in accordance with Regulation .07 of this chapte…

.09 Specific Conditions for Provider Participation — Environmental Assessments. To participate in the ICS Program as a provider of environmental assessments under Regulation .26 of this chapter, a provider shall: A. Be a licensed occupational therapist, or an agency or profession…

.10 Specific Conditions for Provider Participation — Environmental Accessibility Adaptations. A. To participate in the ICS Program as a provider of environmental accessibility adaptations under Regulation .27 of this chapter, a provider shall: (1) Be the store, vendor, or contrac…

.11 Specific Conditions for Provider Participation — Personal Emergency Response Systems. To participate in the ICS Program as a provider of personal emergency response systems under Regulation .28 of this chapter, a provider shall: A. Be the store, vendor, organization, or compa…

.12 Specific Conditions for Provider Participation — Assistive Technology. To participate in the ICS Program as a provider of assistive technology services under Regulation .29 of this chapter, a provider shall: A. Be one of the following entities: (1) The store, vendor, organiza…

.13 Specific Conditions for Provider Participation — Attendant Care Services. A. To participate in the ICS Program as a provider of attendant care services under Regulation .30 of this chapter, unless otherwise exempted under §F of this regulation, an attendant shall: (1) Be a pa…

.14 Specific Conditions for Provider Participation — Nursing Supervision of Attendants. A. To participate in the ICS Program as a provider of nursing supervision of attendants under Regulation .31 of this chapter, a provider shall be: (1) A self-employed registered nurse or nurse…

.15 Specific Conditions for Provider Participation — Home Delivered Meals. To participate in the ICS Program as a provider of home-delivered meals under Regulation .32 of this chapter, a provider shall: A. Be approved and monitored by the Department; and B. Use a cooking facility…

.16 Specific Conditions for Provider Participation — Dietitian and Nutritionist Services. To participate in the ICS Program as a provider of dietitian and nutritionist services under Regulation .33 of this chapter, a provider shall be a: A. Dietitian or nutritionist who is licens…

.17 Specific Conditions for Participation — Behavior Consultation Services. To participate in the ICS Program as a provider of behavior consultation services, as specified in Regulation .34 of this chapter, a provider shall: A. Be: (1) A health services agency that: (a) Employs a…

.18 Specific Conditions for Provider Participation — Medical Day Care. To participate in the ICS Program as a provider of medical day care services under Regulation .35 of this chapter, a provider shall: A. Be licensed according to COMAR 10.12.04; and B. Meet the requirements of …

.19 Specific Conditions for Participation — Senior Center Plus. To participate in the ICS Program as a provider of Senior Center Plus services, as specified in Regulation .36 of this chapter, a provider shall: A. Be approved and monitored by the Maryland Department of Aging as a …

.20 Specific Conditions for Participation — Assisted Living. A. To participate in the ICS Program as an assisted living services provider, a provider shall: (1) Be licensed by the Department at the time that services are rendered, in accordance with COMAR 10.07.14, to provide ass…

.21 Covered Services — General. The Maryland Medical Assistance Program shall reimburse for the services specified in Regulations .22 — .37 of this chapter when, pursuant to the requirements of this chapter, these services have been preapproved by the Department in the participan…

.22 Covered Services — Participant Training. A. Definition. “Unit of service” means an hour of service rendered one-on-one by a qualified provider to a participant, not including the time spent by the provider: (1) Planning, preparing, or setting up the training; (2) Following up…

.23 Covered Services — Family Training. A. Definitions. (1) “Family member” means an individual who: (a) Lives with or provides assistance to the participant; and (b) Is not paid to provide the care. (2) “Unit of service” means an hour of service rendered by a qualified provider …

.24 Covered Services — Case Management. A. Definition. “Unit of service” means a 15-minute increment of service rendered by a qualified provider to a participant or the participant's representative. B. Case management services shall be targeted to address the individualized needs…

.25 Covered Services — Transition Services. A. Definition. “Unit of service” means a one-time service that is: (1) Not otherwise available under the ICS Program; (2) Approved in the plan of service; and (3) Rendered to a participant by a qualified provider to assist the participa…

.26 Covered Services — Environmental Assessments. A. Definition. “Unit of service” means the completion of: (1) An on-site environmental assessment of the participant’s home; and (2) A form approved by the Maryland Medical Assistance Program. B. An environmental assessment may no…

.27 Covered Services — Environmental Accessibility Adaptations. A. Definition. “Unit of service” means one or more physical adaptations to a participant's home or place of residence which is completed as one job by a qualified provider and which constitute a single accessibility …

.28 Covered Services — Personal Emergency Response Systems. A. Definition. “Unit of service” means any of the following: (1) Purchase and installation; (2) Maintenance or repair; or (3) Monthly cost of a covered system or rented device or equipment. B. A personal emergency respon…

.29 Covered Services — Assistive Technology. A. Definition. “Unit of service” means a device or appliance that is purchased as one item, including: (1) Any required training in the use of the device; and (2) An assessment for the use of the device, if the assessment is: (a) Perfo…

.30 Covered Services — Attendant Care Services. A. Definition. “Unit of service” means an hour of service that is in the plan of service and rendered to a participant by a qualified provider in the participant's home or in a community setting. B. Except as provided in §C of this …

.31 Covered Services — Nursing Supervision of Attendants. A. Definition. “Unit of service” means an hour of service rendered by a nurse monitor to a participant in the participant's home or another community-based setting. B. Nursing supervision services include the following: (1…

.32 Covered Services — Home-Delivered Meals. A. Definition. “Unit of service” means one meal delivered to the participant's home, including the cost of the food, food preparation, and delivery. B. The meal shall be intended for consumption at home. C. This service may not constit…

.33 Covered Services — Dietitian and Nutritionist Services. A. Definition. “Unit of service” means an hour of service rendered one-on-one by a qualified provider for a participant in the participant's home or the provider's office. B. Dietitian and nutritionist services shall inc…

.34 Covered Services — Behavior Consultation Services. A. Definition. “Unit of service” means an hour of service rendered by a qualified individual during a home visit to a participant, not including: (1) The time spent on related activities before or after the home visit; or (2)…

.35 Covered Services — Medical Day Care. A. Definition. “Unit of service” means a day of service rendered by a qualified provider to a participant in accordance with COMAR 10.09.07. B. The ICS Program reimburses for a day of care which includes the following services: (1) Health …

.36 Covered Services — Senior Center Plus. A. Definition. “Unit of service” means a day of attendance by a participant for at least 4 hours, not including transportation to and from the center. B. Senior Center Plus services include a program of structured group recreational acti…

.37 Covered Services — Assisted Living Facility. A. Definition. “Unit of service” means a day of service and does not include days that the participant was not residing in the provider's assisted living facility, meaning that the participant: (1) Had not yet moved into the facili…

.38 Conditions for Reimbursement. The Maryland Medical Assistance Program shall reimburse for the services specified in Regulations .22 — .37 of this chapter, if the service: A. Is recommended in the applicant’s or participant's plan of service as necessary in order to: (1) Preve…

.39 Limitations. A. Reimbursement may be made by the Maryland Medical Assistance Program only if the requirements of this chapter are met. B. The total reimbursement by the Maryland Medical Assistance Program for environmental accessibility adaptations and assistive technology co…

.40 Payment Procedures — General. A. Request for Payment. (1) An approved provider shall: (a) Submit a request for payment for the services covered under this chapter according to procedures set forth in COMAR 10.09.36.04; and (b) Include the following information on the request:…

.41 Payment Procedures — Rates. A. To receive payment as a provider of services covered under Regulations .23, .24, and .33—.37 of this chapter, a provider shall submit claims in accordance with procedures outlined in the Department's billing manual. B. Billing time limitations f…

.42 Recovery and Reimbursement. Recovery and reimbursement are as set forth in COMAR 10.09.36.07.