<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.09.54.05" title_num="10" subtitle_num="09" chapter_num="54" heading="Specific Conditions for Provider Participation — Assisted Living.">
  <paragraph num="A.">
    <text>To participate in the program as a provider of assisted living services under this chapter a provider shall:</text>
    <paragraph num="(1)">
      <text>Be licensed by the Department at the time that services are rendered, in accordance with COMAR 10.07.14, to provide assisted living services;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Be or employ a manager who is qualified as:</text>
      <paragraph num="(a)">
        <text>A licensed physician;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A licensed registered nurse;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A licensed practical nurse; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>An individual with at least 3 years’ experience in direct patient care in a private home, certified home, or health-related facility;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Employ an alternate assisted living manager who meets the requirements as specified in §A(2) of this regulation.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Have at least one staff person per eight residents on duty at all times during daytime hours, and have a staff-to-resident ratio at night which is adequate to provide the required services and maintain the facility in a safe and orderly condition, with additional staffing if required by the Department depending on residents' functional levels;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Participate in training on the waiver billing process and other waiver requirements, as specified by the Department;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Have the appropriate insurance coverage to cover the provider and its employees and vehicles if the provider chooses to transport participants to medical, social, recreational, and other services;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Cooperate with other service providers and quality assurance monitors by:</text>
      <paragraph num="(a)">
        <text>Facilitating on-site visits of authorized quality assurance monitors to review compliance with waiver and regulatory requirements;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Facilitating a case manager's on-site visits to the facility, which shall occur at least quarterly, to review the facility, regulatory compliance, service provision, and participants' status and needs;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Communicating with a participant's case manager concerning the participant's status, needs, and service provision;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Informing the case manager within 1 working day of any significant change in the participant's status and service needs;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Facilitating, as necessary and appropriate, the delivery of authorized waiver and State Plan services in the plan of service; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Facilitating waiver participant's relocation to comparable housing, if necessary, including transfer of all personal belongings and financial arrangements; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(8)">
      <text>Submit claims consistent with the provisions of Regulation .22 of this chapter.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Bed Reservations. If bed reservations are offered to participants who are absent from an assisted living facility, the bed reservations policy shall:</text>
    <paragraph num="(1)">
      <text>Be provided to all residents and, where appropriate, the resident's representative, at admission;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Be fairly and consistently applied to all residents;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Specify that the bed reservation service is not a Medicaid covered service;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Clearly state that it is the resident's decision whether to reserve the bed; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Specify that the charges to participants for bed reservation days may not exceed the full Medicaid waiver per diem rate.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>An assisted living provider may limit waiver participation to a designated unit or units only if approved by Department and the facility resident agreement contains the following provisions:</text>
    <paragraph num="(1)">
      <text>The facility's participation in the Program is limited to one or more designated units and, in order to access Medicaid waiver benefits, the resident shall reside in a designated unit;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A resident of a designated unit has a right to apply for the waiver at any time and access waiver benefits without restrictions by the provider when the resident is found eligible by the Program; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>A resident not in a designated unit who is otherwise eligible or seeking eligibility for the waiver shall be given first consideration and, with all other factors equal, first priority in admission to a vacant bed in a designated unit.</text>
    </paragraph>
  </paragraph>
</regulation>