<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 10.09.27.03" title_num="10" subtitle_num="09" chapter_num="27" heading="Conditions for Participation.">
  <paragraph num="A.">
    <text>General requirements for participation in the Medical Assistance Program are that providers shall meet all conditions for participation specified in COMAR 10.09.36.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Specific requirements for participation in the Program as a provider of home care services are as follows:</text>
    <paragraph num="(1)">
      <text>The home care case management provider shall:</text>
      <paragraph num="(a)">
        <text>Have a written agreement with each participant which includes the following:</text>
        <paragraph num="(i)">
          <text>A description of the types, amount, frequency, and duration of home care services to be provided to the participant as ordered by the principal physician and specified in the approved plan of care;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A statement that the participant or responsible representatives shall have access to the individual plan of care and shall be involved in its development and periodic review;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>The name, address, telephone number, and Medical Assistance number of the participant;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>The dated signatures of the participant or legally authorized representative, and the provider representative;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>A statement that utilization of available services and selection among approved enrolled providers is subject to participant choice;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>A statement that services will at all times be provided without discrimination with regard to race, color, age, sex, national origin, marital status, or physical or mental handicap.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Be available to participants in-person at least 8 hours a day, 5 days a week with established hours of operation.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Have written and implemented formalized policies and procedures developed before participation in the Program concerning the following areas:</text>
        <paragraph num="(i)">
          <text>Medical records for each participant which include at a minimum the application for home care, plan of care, orders for home care services, documentation of nursing observations at least every 30 days, social history, and home care cost worksheets establishing initial participant eligibility and continued eligibility on a quarterly basis;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Utilization review which includes the development of a home care review procedure completed every 6 months for all participants to evaluate the appropriateness of home care, the efficiency, adequacy, and coordination of home care services, with the objective of achieving the least costly yet appropriate delivery of services under the Program.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>Convene the multidisciplinary team which:</text>
        <paragraph num="(i)">
          <text>Upon receipt of the principal physician's orders assesses the appropriateness of home care for the participant;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Determines the medical, psychological, social, and functional status of each participant;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Develops an individual plan of care in conjunction with the principal physician's orders;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Coordinates at least one in-person meeting annually, unless otherwise authorized by the Department;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Unless otherwise excepted in §B(1)(d)(iv) of this regulation, may meet in-person or via telehealth; and</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Reviews and updates the individual plan of care in accordance with Regulation .01B(16) of this chapter.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>Provide for in-home assessments, via an in-person visit or telehealth, on a quarterly basis or as determined necessary by the principal physician.</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Conducts at least two in-person visits annually, unless otherwise authorized by the Department.</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Not be a provider of medical supplies and equipment or nursing services.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Shift private duty nursing, certified nursing assistant, and home health aide providers shall:</text>
      <paragraph num="(a)">
        <text>Meet all conditions for participation set forth in:</text>
        <paragraph num="(i)">
          <text>COMAR 10.09.53.03; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>COMAR 10.09.69;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Participate in interdisciplinary team meetings;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Ensure timesheets are signed by the individual rendering services;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Ensure a nurse, a certified nursing assistant, or a home health aide is not scheduled to work for more than 16 consecutive hours and the individual is off 8 or more hours before starting another shift unless otherwise authorized by the Department;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Provide for in-home assessments by the principal physician, on a quarterly basis or as determined necessary by the principal physician.</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Either be a:</text>
        <paragraph num="(i)">
          <text>Residential service agency licensed in accordance with COMAR 10.07.05; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Home health agency licensed in accordance with COMAR 10.07.10 which meets the conditions of participation specified in 42 CFR §484.36;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(g)">
        <text>Demonstrate the capacity to arrange for the provision of home health aide services in the amount and level required in the participant's plan of care including the establishment of a contingency plan to assure coverage as specified in the plan of care;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Demonstrate sufficient specialized training and experience in the care of individuals with disabilities necessary to deliver the level of services required by participants; and</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Demonstrate, on a continuing basis, the ability to competently carry out services in the plan of care subject to review by the home care case manager or the home care case manager's designee.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Medical day care providers shall meet all conditions for participation set forth in COMAR 10.09.07.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The provider of home care services shall:</text>
      <paragraph num="(a)">
        <text>Deliver services in-person unless expressly authorized to render services via telehealth; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>If delivering services via telehealth, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>