<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".09" citation="COMAR 10.09.46.09" title_num="10" subtitle_num="09" chapter_num="46" heading="Covered Services — Supported Employment Services.">
  <paragraph num="A.">
    <text>The supported employment services covered under this regulation shall be provided in nonresidential community settings, separate from the home or facility in which the participant resides.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The covered services shall:</text>
    <paragraph num="(1)">
      <text>Include a work program that includes supports necessary for the participant to achieve desired outcomes established in the waiver plan of care;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Include rehabilitation activities needed to sustain the participant's job including support and training;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Consist of training, skill development, and paid employment for participants:</text>
      <paragraph num="(a)">
        <text>For whom competitive employment at or above the minimum wage is unlikely; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Who, because of disabilities, need intensive ongoing support to perform in a work setting;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Be provided to help individuals obtain and maintain paid work in integrated community settings; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Include transportation or the coordination of transportation between a participant's residence and the supported employment job site.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Levels of Service.</text>
    <paragraph num="(1)">
      <text>Services shall be provided and reimbursed at one of three levels of service, as preauthorized in the participant's waiver plan of care approved by the BHA.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Level 1 requires that staff members provide daily contacts to the waiver participant. The participant shall meet nursing facility or special hospital level of care.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Level 2 requires that staff members provide a minimum of 1 hour of direct support per day. The participant shall meet nursing facility or special hospital level of care.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Level 3 requires that staff members provide continuous support for a minimum of 4 hours of service per day. The participant shall meet special hospital level of care.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>When provided at a work site where individuals without disabilities are employed, services shall only include the adaptations, supervision, and training required by the participants as a result of their disabilities, not the supervisory activities rendered as a normal part of the business setting.</text>
  </paragraph>
  <paragraph num="E.">
    <text>The Program may not reimburse for the following:</text>
    <paragraph num="(1)">
      <text>Incentive payments, subsidies, or unrelated incentive payments made to an employer to encourage or subsidize the employer's participation in a supported employment program;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Payments that are passed through to participants in a supported employment program; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Payments for vocational training that is not directly related to a participant's supported employment program.</text>
    </paragraph>
  </paragraph>
</regulation>