Plain Text Law

Regulation .03 Participant Eligibility.

Regulation .03 Participant Eligibility.Copy Citation

A.
To participate in the Program, the participant shall:
(1)
Be determined by the Department to need assistance with one or more activities of daily living;
(2)
Be eligible for Medicaid under an eligibility coverage group described 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 services needed to safely support the participant in the community, including a plan for receiving personal assistance services in case of an emergency;
(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 personal assistance 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.