<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".02" citation="COMAR 10.07.09.02" title_num="10" subtitle_num="07" chapter_num="09" heading="Definitions.">
  <paragraph num="A.">
    <text>In this chapter, the following terms have the meanings indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Terms Defined.</text>
    <paragraph num="(1)">
      <text>Abuse of a Resident.</text>
      <paragraph num="(a)">
        <text>“Abuse of a resident” means:</text>
        <paragraph num="(i)">
          <text>The nontherapeutic infliction upon a resident of physical pain or injury, for example, striking a resident; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A persistent course of conduct intended to produce, or resulting in, mental or emotional distress to a resident, for example, verbal intimidation of a resident.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>“Abuse of a resident” does not mean the performance of an accepted medical procedure ordered by a physician or administered by another licensed health care professional practicing within the scope of the physician's or health care professional's license.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>“Abuse of funds” means the misappropriation of a resident's assets or income. Misappropriation includes spending the resident's assets or income:</text>
      <paragraph num="(a)">
        <text>Against or without the resident's consent, or, if the resident is incapable of giving consent and has no agent with authority to give consent, when the expenditure is not necessary for the direct and immediate benefit and welfare of the resident; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>For the use and benefit of a person other than the resident, if the resident or agent has not consented to the expense.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>“Agent” means a person who manages, uses, or controls the funds or assets that legally may be used to pay an applicant's or resident's share of costs or other charges for the facility's services.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“Certified” means the designation attached to a nursing facility that has met the requirements for participation as a skilled nursing facility in the Medicare Program or as a nursing facility in the Medicaid Program.</text>
    </paragraph>
    <paragraph num="(4-1)">
      <text>“Change in condition” means a significant change in the resident's physical, mental, or psychological status including, but not limited to:</text>
      <paragraph num="(a)">
        <text>Life-threatening conditions such as heart attack or stroke;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Clinical complications such as the:</text>
        <paragraph num="(i)">
          <text>Development of a pressure sore;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Onset or recurrent periods of delirium;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Onset of recurrent urinary tract infection;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Onset of depression; and</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Onset of aggressive or inappropriate behavior;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>The need to discontinue a medication or treatment because of:</text>
        <paragraph num="(i)">
          <text>Adverse consequences; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The need to begin a new form of treatment;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>Evaluation at or admission to a hospital; or</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Accidents that result in injury having the potential for requiring a physician's intervention.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>“Chemical restraint” means use of a psychopharmacologic drug to control behavior and not otherwise required to treat medical symptoms.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Comprehensive care facility” means a nursing facility that admits residents suffering from disease or disabilities or advanced age, who require medical and nursing services rendered by or under the supervision of a registered nurse.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>“Consent” means an express agreement by a resident who is capable of making an informed decision or, in cases when the resident is not capable, by the resident's representative.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Department” means the Maryland Department of Health.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Director” means the Director of the Office on Aging.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Disabled resident” means a nursing facility resident who lacks sufficient understanding or capacity to make or communicate a responsible or informed decision on health care or personal finances because of a physical or mental disability, or because of substance abuse.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“Discharge” means the:</text>
      <paragraph num="(a)">
        <text>Removal of a resident from a nursing facility when the releasing nursing facility is no longer responsible for the resident's care;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Movement of a resident from a certified bed to a noncertified bed;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Movement of a resident from a skilled nursing facility bed under the Medicare Program to a bed not certified under that Program; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Movement of a resident from a bed certified only for Medicaid to a distinct part of the facility that is a skilled nursing facility under the Medicare Program.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(12)">
      <text>“Emergency” means a situation in which the life, health, or safety of an individual is in imminent and serious jeopardy.</text>
    </paragraph>
    <paragraph num="(13)">
      <text>“Extended care facility” means a nursing facility that:</text>
      <paragraph num="(a)">
        <text>Provides treatment services for residents requiring inpatient care but who do not currently require continuous hospital services; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Admits residents who:</text>
        <paragraph num="(i)">
          <text>Require extensive restorative or rehabilitative services, or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Have a terminal disease requiring extensive nursing care.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(14)">
      <text>Involuntary Transfer or Discharge.</text>
      <paragraph num="(a)">
        <text>“Involuntary transfer or discharge” means a transfer or discharge of a resident that is initiated by a nursing facility without the consent of the resident or, when applicable, the resident's representative.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Involuntary discharge” includes a discharge as described in Regulation .12E of this chapter.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(15)">
      <text>“Licensee” means a person licensed by the Department to operate a comprehensive care facility or an extended care facility.</text>
    </paragraph>
    <paragraph num="(16)">
      <text>“Licensing and Certification Administration” means the survey and licensing agency, a unit of the Department of Health.</text>
    </paragraph>
    <paragraph num="(17)">
      <text>“Neglect” means failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness.</text>
    </paragraph>
    <paragraph num="(18)">
      <text>“Nursing facility” means a comprehensive care or extended care facility.</text>
    </paragraph>
    <paragraph num="(19)">
      <text>“Office” means the Office on Aging.</text>
    </paragraph>
    <paragraph num="(20)">
      <text>“Physical restraint” means a device, including material or equipment, attached or adjacent to a resident's body, that the resident cannot remove easily and that restricts the resident's freedom of movement.</text>
    </paragraph>
    <paragraph num="(21)">
      <text>Private Pay.</text>
      <paragraph num="(a)">
        <text>“Private pay” means a nursing facility's acceptance of payment from a source other than the Medical Assistance Program.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Private pay” includes reimbursement by the Medicare Program or other third-party insurer.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(22)">
      <text>Relocation.</text>
      <paragraph num="(a)">
        <text>“Relocation” means the movement of a resident from one room to another within:</text>
        <paragraph num="(i)">
          <text>The same Medicare-certified facility;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A Medicaid-only certified nursing facility; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>A licensed-only nursing facility.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>“Relocation” does not mean the movement of a resident if the effect of the movement is to move the resident from:</text>
        <paragraph num="(i)">
          <text>The distinct part of the nursing facility that is a skilled nursing facility to a distinct part of the nursing facility that is not a skilled nursing facility; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A bed that is certified for Medicaid to a distinct part of the nursing facility that is a skilled nursing facility.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(23)">
      <text>“Representative” means a person referenced in Regulation .03 of this chapter.</text>
    </paragraph>
    <paragraph num="(24)">
      <text>“Resident” means an individual who is admitted or remains in residence for overnight care in a nursing facility.</text>
    </paragraph>
    <paragraph num="(25)">
      <text>“Resident funds” means the assets and income of a resident or nursing home applicant that are under the use, ownership, management, or control of the resident or resident's agent.</text>
    </paragraph>
    <paragraph num="(26)">
      <text>“Residents' Bill of Rights” means the statement of basic rights of each resident of a nursing facility as set forth in:</text>
      <paragraph num="(a)">
        <text>Health-General Article, §§19-343—19-347 and 19-349—19-352, Annotated Code of Maryland;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Title XIX of the Social Security Act, 42 U.S.C. §1396(5)(c);</text>
      </paragraph>
      <paragraph num="(c)">
        <text>42 CFR §483.10 et seq.; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The regulations in this chapter.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(27)">
      <text>“Transfer” has the meaning as described in §B(11) of this regulation.</text>
    </paragraph>
  </paragraph>
</regulation>