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<regulation prefix="Regulation" num=".04" citation="COMAR 10.09.46.04" title_num="10" subtitle_num="09" chapter_num="46" heading="Program Model.">
  <paragraph num="A.">
    <text>The program services and supports shall:</text>
    <paragraph num="(1)">
      <text>Maximize the level of functioning of an individual with BI through assistance and support with independent living, self care skills, and social skills in an environment which encourages the participant's ability to make decisions about the individual's life and create opportunities for choice regarding home, school or work, and community activities;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Promote the use of community resources to integrate the individual into the community;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Provide services that are:</text>
      <paragraph num="(a)">
        <text>Appropriate to the age of the populations being served;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Offered at times and places suitable to the individuals served; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Coordinated by BHAs administrative case manager with other medical rehabilitation, mental health, and primary care services that the individual is receiving; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Assure that staff are available, on call, 24 hours per day, 7 days per week.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Development of the Initial Waiver Plan of Care. Before the start of waiver services:</text>
    <paragraph num="(1)">
      <text>A case manager shall meet with the participant or the participant's legal representative, in person or remotely, to develop the initial waiver plan of care;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The case manager, the participant, or the participant's legal representative shall sign the waiver plan of care to indicate approval of its recommendations; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The BHAs authorized representative shall review the initial waiver plan of care and sign to indicate approval if the plan of care is determined to be:</text>
      <paragraph num="(a)">
        <text>Sufficient to assure the participant's health and safety and meet the participant's needs in a community-based setting;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Feasible according to the specifications in the waiver plan of care; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Individually cost-neutral by costing the Program no more for the participant's waiver and other Program services than the participant would have cost the Program in the alternative nursing facility or special hospital setting.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Waiver Plan of Care.</text>
    <paragraph num="(1)">
      <text>The participant's waiver plan of care:</text>
      <paragraph num="(a)">
        <text>Preauthorizes the specific waiver services to be provided to the participant, as covered under Regulations .07—.09 of this chapter;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Is documented on the waiver plan of care form included in the approved waiver proposal;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Specifies for each preauthorized waiver service the following information, as appropriate:</text>
        <paragraph num="(i)">
          <text>Description of the specific service to be provided;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Level of service;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Service start date;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Estimated duration;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Approved frequency and units of service to be delivered;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Approved service delivery mode;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>The provider for that service, if known; and</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>Estimated unit costs and monthly costs;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>Describes other Program services recommended for the participant;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Evaluates the participant's total costs to the Program, to ensure the participant's cost-neutrality as compared to the cost to the Program for the individual in the alternative nursing facility or special hospital setting; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Is subject to the BHAs approval.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A participant shall be given freedom of choice among all qualified and available providers for each service included in the participant's waiver plan of care.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Periodic Review of the Waiver Plan of Care.</text>
    <paragraph num="(1)">
      <text>At least every 12 months or more frequently if determined necessary by the BHA:</text>
      <paragraph num="(a)">
        <text>A case manager and the participant or the participant's legal representative shall review the waiver plan of care and revise it as necessary;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The case manager and the participant or the participant's legal representative shall sign the waiver plan of care, as revised, to indicate approval of its recommendations; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The BHA or its authorized representative shall review the revised waiver plan of care, and if the plan of care is determined to meet all of the criteria specified in §C(3) of this regulation, sign to indicate approval.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Periodic reviews and updates shall take place to:</text>
      <paragraph num="(a)">
        <text>Determine the appropriateness and adequacy of the participant's services; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Ensure that the furnished services are consistent with the services needed for the participant's disability.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>