Chapter 30. Statewide Evaluation and Planning Services
Regulation .01 Purpose.LinkCopy Citation
The purpose of this chapter is to codify policy regarding comprehensive evaluations performed for the purpose of determining eligibility for services or informing individuals of available services or as required for Geriatric Evaluation Services (GES) or Preadmission Screening and Resident Review (PASRR).
Regulation .02 Definitions.LinkCopy Citation
A.
The following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Comprehensive evaluation” means the assessment performed by a nurse or social worker, or both, using the tools designated by the Department, of a participant’s medical, social, and functional status by:
(a)
Direct observation of the participant;
(b)
Contact, as appropriate, with the participant's representative; and
(c)
Financial eligibility screening.
(2)
“Department” means Maryland Department of Health.
(3)
“Financial eligibility screening” means the determination of whether an individual qualifies financially as a participant.
(4)
“Geriatric Evaluation Services (GES)” means the assessment that is required to admit an individual to a State facility or Veteran’s Administration hospital.
(5)
“Nurse” means a person who is licensed as a registered nurse in the jurisdiction in which services are provided.
(6)
“Nurse practitioner” means a person who is licensed as a nurse practitioner in the jurisdiction in which services are provided.
(7)
“Participant” means a Medicaid recipient or an individual who would be able to establish financial eligibility under the Program within 6 months of admission to a nursing facility, whose needs may not be adequately met in an episodic ambulatory care setting, and who may require continuing institutional or community based long-term care services.
(8)
“Plan of care” means the written long term care plan composed of a comprehensive evaluation of the participant’s health status including:
(a)
Pertinent diagnoses;
(b)
Psychosocial status;
(c)
Functional status; and
(d)
Type of services recommended.
(9)
“Preadmission Screening and Resident Review (PASRR)” means the screening or reviewing of all individuals with mental illness or intellectual disability who apply to or reside in Medicaid-certified nursing facilities.
(10)
“Program” has the same meaning as defined in COMAR 10.09.36.
(11)
“Provider” means a local health department, or when necessary, a contracted agency:
(a)
Providing the comprehensive evaluation through an appropriate agreement with the Department and identified as a Program provider by the issuance of an individual account number;
(b)
Employing nurses and social workers to provide the comprehensive evaluation; and
(c)
Demonstrating experience in providing assessment and evaluation services and in developing plans of care.
(12)
“Provider agreement” means a contract between the Department and the provider of STEPS specifying the:
(a)
Services to be performed;
(b)
Methods of operation; and
(c)
Financial and legal requirements which shall be in force before Program participation.
(13)
“Psychiatrist” means a person who is licensed as a psychiatrist in the jurisdiction in which services are provided.
(14)
“Psychologist” means a person who is licensed as a psychologist in the jurisdiction in which services are provided.
(15)
“Social worker” means a person who is licensed as a social worker in the jurisdiction in which services are provided.
Regulation .03 Licensing Requirements.LinkCopy Citation
The following health professionals providing services under this regulation shall be licensed to practice in the jurisdiction in which services are rendered:
(1)
Nurses;
(2)
Nurse practitioners;
(3)
Psychiatrists;
(4)
Psychologists; and
(5)
Social workers.
Regulation .04 Conditions for Participation.LinkCopy Citation
Specific requirements for participation in the Program are that providers shall:
A.
Ensure that all individuals performing services under Regulation .05 of this chapter meet the licensure requirements as provided in Regulation .03 of this chapter;
B.
Have existing policies and procedures concerning the completion of comprehensive evaluations, and expedition of those evaluations when necessary, that the provider has agreed to perform;
C.
Develop, as appropriate, agreements in order to facilitate access to services and coordinate with local public agencies and other providers;
D.
If approved as a provider of comprehensive evaluations, inform participants of the results of the comprehensive evaluation and of available services; and
E.
Ensure completion, at least every other year, of training on the tools designated by the Department for the purposes of the comprehensive evaluation, by all nurses and social workers providing services under this chapter.
Regulation .05 Covered Services.LinkCopy Citation
A.
The Program reimburses for completed comprehensive evaluations, which include assessment by a nurse, social worker, or both.
B.
The comprehensive evaluation or designated form is to be completed within the following time frames:
(1)
3 business days for all Geriatric Evaluation Services (GES) and Preadmission Screening and Resident Review (PASRR) for individuals transferring from a hospital to a nursing facility;
(2)
5 business days for all other PASRR; and
(3)
15 calendar days for all other purposes.
C.
The comprehensive evaluation shall be completed in-person.
D.
The Department will reimburse for the services listed in §A of this regulation when they are:
(1)
Rendered to participants as defined in Regulation .02 of this chapter;
(2)
Completed within the time frame specified in §B of this regulation, unless the Department is notified, in writing, of circumstances that prevent completion within the specified time frame and a temporary, alternative schedule has been approved by the Department;
(3)
Adequately performed as reflected on the completed form specified by the Department and submitted to the Program as a condition for payment; and
(4)
Rendered by a provider approved to perform comprehensive evaluations.
Regulation .06 Limitations.LinkCopy Citation
A.
The comprehensive evaluation is advisory in nature and is designed to assist individuals in identifying and using appropriate long term care services.
B.
A restriction may not be placed on the qualified recipient’s option to receive the comprehensive evaluation.
C.
The comprehensive evaluation does not restrict or otherwise affect:
(1)
Eligibility for Title XIX benefits or other available benefits or programs;
(2)
The freedom of a recipient to select from all available services, including nursing home care, for which the individual is found to be eligible; or
(3)
The participant's free choice of qualified providers.
Regulation .07 Payment Procedures.LinkCopy Citation
A.
Request for Payment.
(1)
Requests for payment of services rendered shall be submitted according to procedures established by the Department. Payment requests which are not properly prepared or submitted may not be processed, but shall be returned unpaid to the provider.
(2)
Requests for payment shall be submitted on the form specified by the Department.
B.
Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.
C.
Effective July 1, 2022, payments for comprehensive evaluations shall be made in accordance with the fee schedule below:
Regulation .08 Recovery and Reimbursement.LinkCopy Citation
Recovery and reimbursement are as set forth in COMAR 10.09.36.07.
Regulation .09 Cause for Suspension or Removal and Imposition of Sanctions.LinkCopy Citation
Cause for suspension or removal and imposition of sanctions are as set forth in COMAR 10.09.36.08.
Regulation .10 Appeal Procedures.LinkCopy Citation
Providers filing appeals from administrative decisions made in connection with these regulations shall do so according to COMAR 10.09.36.09.
Regulation .11 Interpretive Regulation.LinkCopy Citation
Interpretive regulatory requirements are as set forth in COMAR 10.09.36.10.
Chapter annotations
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
History: Effective date:
History: Regulations .01—.11 adopted as an emergency provision effective October 21, 1986 (13:23 Md. R. 2477); emergency status extended at 14:2 Md. R. 125; adopted permanently effective January 27, 1987 (14:2 Md. R. 129)
History: Regulation .01B amended effective July 12, 1987 (14:14 Md. R. 1571); January 9, 1989 (15:27 Md. R. 3129)
History: Regulation .02 amended effective July 12, 1987 (14:14 Md. R. 1571); January 9, 1989 (15:27 Md. R. 3129)
History: Regulation .03 amended effective July 12, 1987 (14:14 Md. R. 1571); January 9, 1989 (15:27 Md. R. 3129)
History: Regulation .04 amended effective July 12, 1987 (14:14 Md. R. 1571); July 25, 1988 (15:15 Md. R. 1809); January 9, 1989 (15:27 Md. R. 3129)
History: Regulation .05 amended effective January 9, 1989 (15:27 Md. R. 3129)
History: Regulation .05D amended as an emergency provision effective July 1, 2001 (28:16 Md. R. 1480); amended permanently effective October 1, 2001 (28:19 Md. R. 1684)
History: Regulation .06 amended effective July 12, 1987 (14:14 Md. R. 1571); July 25, 1988 (15:15 Md. R. 1809); January 9, 1989 (15:27 Md. R. 3129)
History: Regulation .06B amended as an emergency provision effective January 28, 1991 (18:3 Md. R. 301); emergency status expired April 8, 1991 (18:9 Md. R. 1004)
History: Regulation .06B amended as an emergency provision effective April 9, 1991 (18:9 Md. R. 1005); amended permanently effective October 7, 1991 (18:18 Md. R. 2004)
History: Regulation .06C amended as an emergency provision effective December 4, 1990 (17:26 Md. R. 2973); emergency status extended at 18:4 Md. R. 444; amended permanently effective March 18, 1991 (18:5 Md. R. 594)
History: Regulation .06C amended as an emergency provision effective July 1, 2001 (28:16 Md. R. 1480); amended permanently effective October 1, 2001 (28:19 Md. R. 1684)
History: Regulation .06C amended effective December 26, 2011 (38:26 Md. R. 1697)
History: Regulation .09 amended effective January 24, 2011 (38:2 Md. R. 84)
History: Chapter revised effective December 11, 2023 (50:24 Md. R. 1041)