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<section article="ghg" article_name="Health - General" number="15-132" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs">
  <level label="a">
    <level label="1">
      <text>In this section the following terms have the meanings indicated.</text>
    </level>
    <level label="2">
      <text>“Assisted living program” has the meaning stated in § 19–1801 of this article.</text>
    </level>
    <level label="3">
      <text>“Assisted living services” means services provided by an assisted living program as defined in regulations adopted by the Department.</text>
    </level>
    <level label="4">
      <text>“Case management services” means services that assist waiver eligible individuals in gaining access to needed waiver services and other needed medical, social, housing, and other supportive services.</text>
    </level>
    <level label="5">
      <text>“Health related care and services” includes:</text>
      <level label="i">
        <text>24–hour supervision and observation by a licensed care provider;</text>
      </level>
      <level label="ii">
        <text>Medication administration;</text>
      </level>
      <level label="iii">
        <text>Inhalation therapy;</text>
      </level>
      <level label="iv">
        <text>Bladder and catheter management;</text>
      </level>
      <level label="v">
        <text>Assistance with suctioning; or</text>
      </level>
      <level label="vi">
        <text>Assistance with treatment of skin disorders and dressings.</text>
      </level>
    </level>
    <level label="6">
      <text>“Home health care services” means those services defined in § 19–401 of this article and in 42 C.F.R. 440.70.</text>
    </level>
    <level label="7">
      <text>“Medically and functionally impaired” means an individual who is assessed by the Department to require services provided by a nursing facility as defined in this section, and who, but for the receipt of these services, would require admission to a nursing facility within 30 days.</text>
    </level>
    <level label="8">
      <text>“Nursing facility” means a facility that provides skilled nursing care and related services, rehabilitation services, and health related care and services above the level of room and board needed on a regular basis in accordance with § 1919 of the federal Social Security Act.</text>
    </level>
    <level label="9">
      <text>“Waiver” means a home– and community–based services waiver under § 1915(c) of the federal Social Security Act, submitted by the Department to the Centers for Medicare and Medicaid Services.</text>
    </level>
    <level label="10">
      <text>“Waiver services” means the services covered under an approved waiver that:</text>
      <level label="i">
        <text>Are needed and chosen by an eligible waiver participant as an alternative to admission to or continued stay in a nursing facility;</text>
      </level>
      <level label="ii">
        <text>Are part of a plan of service approved by the program;</text>
      </level>
      <level label="iii">
        <text>Assure the waiver participant’s health and safety in the community; and</text>
      </level>
      <level label="iv">
        <text>Cost no more per capita to receive services in the community than in a nursing facility.</text>
      </level>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <text>If authorized by the Centers for Medicare and Medicaid Services, an individual shall be determined medically eligible to receive services if the individual requires:</text>
      <level label="i">
        <text>Skilled nursing care or other related services;</text>
      </level>
      <level label="ii">
        <text>Rehabilitation services; or</text>
      </level>
      <level label="iii">
        <text>Health–related services above the level of room and board that are available only through nursing facilities, including individuals who because of severe cognitive impairments or other conditions:</text>
        <level label="1">
          <level label="A">
            <text>Are currently unable to perform at least two activities of daily living without hands–on assistance or standby assistance from another individual; and</text>
          </level>
        </level>
        <level label="B">
          <text>Have been or will be unable to perform at least two activities of daily living for a period of at least 90 days due to a loss of functional capacity; or</text>
        </level>
        <level label="2">
          <text>Need substantial supervision for protection against threats to health and safety due to severe cognitive impairment.</text>
        </level>
      </level>
    </level>
    <level label="2">
      <text>The Department shall adopt regulations to carry out the provisions of this subsection.</text>
    </level>
  </level>
  <level label="c">
    <text>The Department’s waiver shall include the following:</text>
    <level label="1">
      <text>A cap on waiver participation of not fewer than 7,500 individuals;</text>
    </level>
    <level label="2">
      <text>A plan for waiver participation of not fewer than 7,500 individuals;</text>
    </level>
    <level label="3">
      <text>Financial eligibility criteria which include:</text>
      <level label="i">
        <text>The current federal and State medical assistance long–term care rules for using services provided by a nursing facility, per §§ 1902, 1919, and 1924 of the federal Social Security Act, and applicable regulations adopted by the Department;</text>
      </level>
      <level label="ii">
        <text>Medically needy individuals using services provided by a nursing facility under the current federal and State medical assistance eligibility criteria governed by regulations adopted by the Department and § 1919 of the federal Social Security Act; and</text>
      </level>
      <level label="iii">
        <text>Categorically needy individuals with income up to 300% of the applicable payment rate for supplemental security income;</text>
      </level>
    </level>
    <level label="4">
      <text>Waiver services that include at least the following:</text>
      <level label="i">
        <text>Assisted living services;</text>
      </level>
      <level label="ii">
        <text>Case management services;</text>
      </level>
      <level label="iii">
        <text>Family training;</text>
      </level>
      <level label="iv">
        <text>Dietitian and nutritionist services;</text>
      </level>
      <level label="v">
        <text>Medical day care services; and</text>
      </level>
      <level label="vi">
        <text>Senior center plus services;</text>
      </level>
    </level>
    <level label="5">
      <text>The opportunity to provide eligible individuals with waiver services under this section as soon as they are available without waiting for placement slots to open in the next fiscal year;</text>
    </level>
    <level label="6">
      <text>An increase in participant satisfaction;</text>
    </level>
    <level label="7">
      <text>The forestalling of functional decline;</text>
    </level>
    <level label="8">
      <text>A reduction in Medicaid expenditures by reducing utilization of services; and</text>
    </level>
    <level label="9">
      <text>The enhancement of compliance with the decision of the United States Supreme Court in the case of Olmstead v. L.C. (1999) by offering cost–effective community–based services in the most appropriate setting.</text>
    </level>
  </level>
  <level label="d">
    <text>This section may not be construed to affect, interfere with, or interrupt any services reimbursed through the Program under this title.</text>
  </level>
  <level label="e">
    <level label="1">
      <level label="i">
        <text>If the Department maintains a waiting list or registry, each month the Department shall send a waiver application:</text>
        <level label="1">
          <text>If there are fewer than 600 individuals on the waiting list or registry, to all individuals on the waiting list or registry; and</text>
        </level>
        <level label="2">
          <text>If there are 600 or more individuals on the waiting list or registry, to at least 600 individuals on the waiting list or registry.</text>
        </level>
      </level>
      <level label="ii">
        <text>A waiver application sent under subparagraph (i) of this paragraph shall state clearly and conspicuously that:</text>
        <level label="1">
          <text>The applicant must submit the application within 6 weeks after receiving the application; and</text>
        </level>
        <level label="2">
          <text>The applicant is required to meet all of the eligibility criteria for participation in the waiver within 6 months after submitting the application.</text>
        </level>
      </level>
    </level>
    <level label="2">
      <text>If a person determined to be eligible to receive waiver services under this section desires to receive waiver services and an appropriate placement is available, the Department shall authorize the placement.</text>
    </level>
  </level>
  <level label="f">
    <text>The Department, in consultation with representatives of the affected industry and advocates for waiver candidates, and with the approval of the Department of Aging, shall adopt regulations to implement this section.</text>
  </level>
</section>
