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<regulation prefix="Regulation" num=".01" citation="COMAR 10.09.46.01" title_num="10" subtitle_num="09" chapter_num="46" 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>“Applicant” means an individual who is applying as a participant in the BI waiver.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“Behavior intervention” means services designed to assist individuals who exhibit challenging behaviors in acquiring skills, gaining social acceptance, and becoming full participants in the community, consistent with behavior support services program service plans set forth in COMAR 10.22.10.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>“Behavioral Health Administration (BHA)” means the administration of the Department that:</text>
      <paragraph num="(a)">
        <text>Is charged with the responsibility for providing services to individuals with behavioral health conditions as defined by Health-General Article, Title 10, Annotated Code of Maryland;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Is designated as the State’s lead agency for service delivery to individuals with brain injury; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Manages the BI waiver, in collaboration with the Program and in accordance with a memorandum of agreement signed with the Program.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>“Brain injury (BI)” means an insult to the brain caused by an external or internal mechanism that occurs after birth and is not related to congenital or degenerative disease, which results in cognitive, physical, behavioral, or emotional disability that is documented in the medical record.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>“CARF” means the Commission on Accreditation of Rehabilitation Facilities, a nonprofit accrediting body which promotes quality, value, and optimal outcomes of services through a consultative accreditation process that centers on enhancing the lives of individuals receiving services.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Case Management.</text>
      <paragraph num="(a)">
        <text>“Case management” means the services provided by a case manager who assists an individual in gaining access to needed medical, social, educational, and other services.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Case management” includes assessment, referral, coordination, and monitoring of the plan of care.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>“Case manager” means an individual who provides administrative case management services for BI waiver participants.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Day habilitation” means assistance with acquisition, retention, or improvement in self-help, socialization, and adaptive skills which takes place in a nonresidential setting, separate from the home or facility in which the individual resides, normally furnished 4 or more hours per day.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Department” means the Maryland Department of Health as stated in COMAR 10.09.36.01B, or its authorized agents acting on behalf of the Department.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Eligible individual” means an individual who is determined to meet the qualifications for participation in the BI waiver as specified in Regulation .03 of this chapter.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“Health care professional” means an individual who is licensed and authorized by the Health Occupations Article to provide the health service for which the individual is privileged.</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Home and community-based services waiver for individuals with brain injury (BI waiver) means the program implemented under this chapter.</text>
    </paragraph>
    <paragraph num="(13)">
      <text>“Individual support services (ISS)” means assistance with acquisition, retention, or improvement in skills related to self-help, socialization, and/or adaptive skills furnished in the participant's home or community by a provider who does not have round-the-clock responsibility for the participant's health and welfare.</text>
    </paragraph>
    <paragraph num="(14)">
      <text>“Medical day care” means medically supervised, health-related services provided in an ambulatory setting to medically handicapped individuals who, due to their degree of impairment, need health maintenance and restorative services supportive to their community living in accordance with COMAR 10.09.07.</text>
    </paragraph>
    <paragraph num="(15)">
      <text>“Nursing facility level of care” means an assessment that an individual needs the level of services provided in a nursing facility, as defined in COMAR 10.09.10.01.</text>
    </paragraph>
    <paragraph num="(16)">
      <text>“Participant” means an eligible individual who is enrolled in the BI Waiver.</text>
    </paragraph>
    <paragraph num="(17)">
      <text>“Program” means the Medical Assistance Program, as stated in COMAR 10.09.36.01B, which exercises administrative discretion in the administration and supervision of the BI waiver and issues policies, rules, and regulations related to the BI waiver.</text>
    </paragraph>
    <paragraph num="(18)">
      <text>“Provider” means an individual or an agency that:</text>
      <paragraph num="(a)">
        <text>Is approved by the BHA and the Program as meeting the conditions for waiver participation specified in Regulations .05 and .06 of this chapter; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Has enrolled with the Program to provide one or more of the waiver services described under Regulations .07—.09 of this chapter.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(19)">
      <text>“Provider agreement” means a contract between the Program and a provider to provide services to waiver participants.</text>
    </paragraph>
    <paragraph num="(20)">
      <text>“Residential habilitation” means assistance with acquisition, retention, or improvement in skills related to activities of daily living and the social and adaptive skills necessary to enable the individual to live in a noninstitutional setting.</text>
    </paragraph>
    <paragraph num="(21)">
      <text>“Room and board” means rent or mortgage, utilities, maintenance, furnishings, and food, which are provided in or associated with an individual's place of residence.</text>
    </paragraph>
    <paragraph num="(22)">
      <text>“State Plan” means a comprehensive, written commitment by a State Medicaid agency, submitted under §1902(a) of Title XIX of the Social Security Act and approved by the federal Centers for Medicare and Medicaid Services, to administer or supervise the administration of the Medical Assistance Program in accordance with federal requirements.</text>
    </paragraph>
    <paragraph num="(23)">
      <text>“Supported employment” means activities needed to support paid work by individuals receiving waiver services, including supervision and training.</text>
    </paragraph>
    <paragraph num="(24)">
      <text>“Utilization control agent” means the organization responsible for reviewing services to determine medical necessity according to professional standards and for conducting patient assessments.</text>
    </paragraph>
    <paragraph num="(25)">
      <text>“Virtual supports” is an electronic method of service delivery used to maintain or improve a participant’s functional abilities, enhance interactions, support meaningful relationships, and promote their ability to live independently and meaningfully participate in their community.</text>
    </paragraph>
    <paragraph num="(26)">
      <text>“Waiver plan of care” means a participant's written, individualized care plan as specified in Regulation .04 of this chapter.</text>
    </paragraph>
  </paragraph>
</regulation>