<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.09.56.04" title_num="10" subtitle_num="09" chapter_num="56" heading="Conditions for Participation — General.">
  <text>To provide Autism Waiver services, the provider:</text>
  <paragraph num="A.">
    <text>Shall be approved in accordance with the requirements specified in this chapter;</text>
  </paragraph>
  <paragraph num="B.">
    <text>Shall have a provider agreement in effect, signed with the Program;</text>
  </paragraph>
  <paragraph num="C.">
    <text>Shall meet all the conditions for participation specified in COMAR 10.09.36, except as otherwise specified in this chapter;</text>
  </paragraph>
  <paragraph num="D.">
    <text>Shall assure that professional employees who render or delegate services under this chapter have the appropriate experience and health-related license or professional certification to meet the participant's needs, including equivalency review by an accredited agency for credentials obtained outside of the United States, before rendering services to any Autism Waiver participant;</text>
  </paragraph>
  <paragraph num="E.">
    <text>Shall assure that direct care workers who render services under this chapter:</text>
    <paragraph num="(1)">
      <text>Meet the minimum age requirement, set forth by service, before rendering services to any Autism Waiver participant;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Receive adequate and appropriate training, within 60 days of employment and annually thereafter, pertaining to care for children with autism spectrum disorder including:</text>
      <paragraph num="(a)">
        <text>Training concerning abuse, neglect, and exploitation;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Positive behavioral interventions and restraints rendered by a MSDE approved trainer;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Reportable event policy; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>HIPAA;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Work under the ongoing supervision of a qualified professional employee of the provider who has annual training in:</text>
      <paragraph num="(a)">
        <text>Abuse, neglect, exploitation;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Positive behavioral interventions and appropriate use of restraints rendered by a MSDE-approved trainer;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Reportable event policy; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>HIPAA;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Are approved by the provider as qualified to meet the participant's needs;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Are approved by the participant's parents; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Have volunteer or employment experience working with children with autism spectrum disorder or other developmental disabilities as a service provider or as a family member for a minimum of 100 hours, that may include:</text>
      <paragraph num="(a)">
        <text>Internships;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Post high school educational experience with developmental disabilities;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Shadowing experienced staff;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Employment with a developmental disabilities agency; or</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Fulfilling the community service requirement through volunteering with a child with autism or another developmental disability;</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Shall be required to have a professional on-call at all times, and employ or contract with certain professionals for consultation as needed when providing:</text>
    <paragraph num="(1)">
      <text>Residential habilitation services;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Intensive individual support services; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Therapeutic integration services;</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Shall employ on-call professionals and professional consultants:</text>
    <paragraph num="(1)">
      <text>Who are:</text>
      <paragraph num="(a)">
        <text>Board-certified behavior analysts;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Certified school psychologists;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Certified special educators;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Individuals with a masters or doctorate degree in special education or a related field and 5 years experience in providing training or consultation in autism spectrum disorder or other developmental disabilities;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Licensed certified social workers;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Licensed professional counselors;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Nurse psychotherapists;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Physicians;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Psychologists;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Occupational therapists;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Physical therapists;</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Registered nurses; or</text>
      </paragraph>
      <paragraph num="(m)">
        <text>Speech therapists; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Who have:</text>
      <paragraph num="(a)">
        <text>Experience providing services to children with autism spectrum disorder or other developmental disabilities;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A background in behavior management techniques; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Knowledge of the specific children being served by the provider.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Shall verify the licenses, credentials, and references of all individuals who render or delegate services on the provider's behalf under this chapter, and have a copy of the licenses, credentials, and at least three written references available for inspection;</text>
  </paragraph>
  <paragraph num="I.">
    <text>Shall maintain current, written, and signed contracts with all contractors providing waiver services on behalf of the provider that include:</text>
    <paragraph num="(1)">
      <text>The scope of services to be performed;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The requirement to comply with all applicable Medicaid regulations;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The requirement to complete and maintain written documentation of service delivery, individualized for each participant on each day that the participant receives services;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>A clause that no monies shall be sought from the waiver participant or the participant's family if the contract is breached by either the provider or contractor; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>A current copy of a provider license or certification and insurance as required in this chapter;</text>
    </paragraph>
  </paragraph>
  <paragraph num="J.">
    <text>With the exception of environmental accessibility adaptation providers, shall submit to a preemployment criminal background investigation;</text>
  </paragraph>
  <paragraph num="K.">
    <text>With the exception of respite care and environmental accessibility adaptations providers, shall submit separate, written treatment plans to service coordinators within 30 calendar days of the initiation of services in accordance with State guidelines for each individual service and at least once in each 12-month period thereafter, or more frequently if the treatment plan changes;</text>
  </paragraph>
  <paragraph num="L.">
    <text>If an agency, shall require supervisory and direct care employees of provider agencies to:</text>
    <paragraph num="(1)">
      <text>Submit an application for a child care criminal history record check to the Criminal Justice Information System Central Repository, Department of Public Safety and Correctional Services, in accordance with Family Law Article, §5-561, Annotated Code of Maryland;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Request the Department of Public Safety and Correctional Services to send the child care criminal history report to the Department’s Division of Community Long Term Care; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Not have been convicted of, received probation before judgment for, or entered a plea of nolo contendere to, a felony or crime involving moral turpitude or theft, or have other criminal history that indicated behavior that is potentially harmful to participants;</text>
    </paragraph>
  </paragraph>
  <paragraph num="M.">
    <text>If an agency, shall:</text>
    <paragraph num="(1)">
      <text>Pay for the criminal background check;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Request clearance from the Department for all applicants prior to an offer of employment; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Submit monthly Criminal Justice Information System's update reports to the Maryland State Department of Education;</text>
    </paragraph>
  </paragraph>
  <paragraph num="N.">
    <text>If self-employed, shall:</text>
    <paragraph num="(1)">
      <text>Submit an application for a criminal history record check to the Criminal Justice Information System Central Repository, Department of Public Safety and Correctional Services;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Request the Department of Public Safety and Correctional Services to send the child care criminal history report to the Department’s Division of Community Long Term Care;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Pay for the criminal background check;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Not have been convicted of, received probation before judgment for, or entered a plea of nolo contendere to, a felony or crime involving moral turpitude or theft, or have other criminal history that indicated behavior that is potentially harmful to participants; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Submit monthly Criminal Justice Information System’s update reports to the State Department of Education.</text>
    </paragraph>
  </paragraph>
  <paragraph num="O.">
    <text>Shall have the option to request the Department to waive the provisions of §§L(3) and N(4) of this regulation if the applicant demonstrates that:</text>
    <paragraph num="(1)">
      <text>The conviction, probation before judgment, or plea of nolo contendere for a felony or any crime involving moral turpitude or theft was entered more than 10 years before the date of the provider’s or prospective employee’s application; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The criminal history does not indicate behavior that is potentially harmful to participants;</text>
    </paragraph>
  </paragraph>
  <paragraph num="P.">
    <text>Shall have adequate liability insurance;</text>
  </paragraph>
  <paragraph num="Q.">
    <text>Shall provide services in accordance with the requirements of the Autism Waiver plan of care, this chapter, the Autism Waiver, and all relevant federal, State, and local laws and regulations;</text>
  </paragraph>
  <paragraph num="R.">
    <text>Shall agree to submit claims for payment by the Program for only those services covered under this chapter which have been identified and documented in a participant's Autism Waiver plan of care;</text>
  </paragraph>
  <paragraph num="S.">
    <text>Shall agree to maintain and have available to the Department or the State Department of Education personnel records and written documentation describing waiver services rendered, including dates and hours of services provided to participants, for a period of 6 years, in a manner approved by the Department or its designee;</text>
  </paragraph>
  <paragraph num="T.">
    <text>Shall agree not to suspend, increase, or reduce services for a participant without a waiver plan of care or plan of care addendum from the service coordinator for that participant;</text>
  </paragraph>
  <paragraph num="U.">
    <text>Unless a risk to health and safety exists, shall agree not to terminate services for a participant without providing:</text>
    <paragraph num="(1)">
      <text>30 days written notice to the participant, parent or guardian, and service coordinator; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Assistance in the discharge planning process;</text>
    </paragraph>
  </paragraph>
  <paragraph num="V.">
    <text>Is not eligible to participate in the waiver if the provider or any of its principals were previously program providers, or if its principals were principals in program providers, that have overpayments that remain due and owing to the Department;</text>
  </paragraph>
  <paragraph num="W.">
    <text>Is not eligible if the provider or its principals within the past 24 months have:</text>
    <paragraph num="(1)">
      <text>Had a license or certificate suspended or revoked as a health care provider, health care facility, or provider of direct care services;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Been suspended or removed from participating as a Medicaid provider;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Undergone the imposition of sanctions under COMAR 10.09.36.08;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Been subject to disciplinary action including actions by providers or any of its principal's licensing board;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Been cited by a State agency for deficiencies which affect a participant's health and safety; or</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Experienced a termination of a reimbursement agreement with or been barred from work or participation by a public or private agency due to:</text>
      <paragraph num="(a)">
        <text>Failure to meet contractual obligations; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Fraudulent billing practices;</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="X.">
    <text>Shall maintain written quarterly records documenting face-to-face supervision of direct care employees and direct observation of the participant that includes:</text>
    <paragraph num="(1)">
      <text>Date and location of supervision;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Review, feedback, and oversight of the implementation of treatment plan goals;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Review, feedback, and oversight of the implementation of positive behavior intervention;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Review, feedback, and oversight of the scope of activities during service;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Review, feedback, and oversight of data collection;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Date and name of supervisor, name of employee, and name of the participant; and</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Signature of supervisor;</text>
    </paragraph>
  </paragraph>
  <paragraph num="Y.">
    <text>Shall agree to keep all records available for inspection or audit by the Department or the Department's designee at any reasonable time during business hours;</text>
  </paragraph>
  <paragraph num="Z.">
    <text>Shall implement and follow the Reportable Event policy in accordance with the Department's established policy by:</text>
    <paragraph num="(1)">
      <text>Reporting incidents and complaints to the participant's service coordinator within 24 hours;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Submitting a written report within 7 calendar days on a form designated by the Department; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Notifying the local department of social services immediately if the provider has a reason to believe that the participant has been subject to abuse, neglect, self-neglect, or exploitation, in accordance with COMAR 07.06.04;</text>
    </paragraph>
  </paragraph>
  <paragraph num="AA.">
    <text>May not:</text>
    <paragraph num="(1)">
      <text>Render direct services to the provider's own child; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Render supervision to the direct care worker of the provider's own child;</text>
    </paragraph>
  </paragraph>
  <paragraph num="BB.">
    <text>With the exception of environmental accessibility adaptations providers and residential habilitation providers, shall submit to the service coordinator monthly service tracking forms for each participant served within 20 calendar days of the end of each month;</text>
  </paragraph>
  <paragraph num="CC.">
    <text>With the exception of environmental accessibility adaptations providers, shall attend at least one Autism Waiver training conducted by the State each year and shall participate in:</text>
    <paragraph num="(1)">
      <text>One training annually regarding the prevention, identification, and reporting of abuse, neglect, and exploitation;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>One training annually regarding positive behavioral intervention and restraints; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>All statewide Autism Waiver trainings during any year in which the provider is under recommendation for disenrollment from the waiver or has had Medicaid payments suspended;</text>
    </paragraph>
  </paragraph>
  <paragraph num="DD.">
    <text>Shall satisfactorily complete all aspects of the Autism Waiver provider applications process;</text>
  </paragraph>
  <paragraph num="EE.">
    <text>Shall notify the Program within 15 days of occurrence of any change to contact information;</text>
  </paragraph>
  <paragraph num="FF.">
    <text>Shall maintain communications with the program by maintaining a working telephone and answering machine, facsimile machine, and e-mail account;</text>
  </paragraph>
  <paragraph num="GG.">
    <text>Shall have status as a Maryland Medicaid Autism Waiver provider, including the Medicaid provider number, terminated if no services have been provided for 24 consecutive months;</text>
  </paragraph>
  <paragraph num="HH.">
    <text>Shall, when transportation is provided:</text>
    <paragraph num="(1)">
      <text>Implement the provider’s transportation policy;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Identify the driver in daily contact notes or a transportation log;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Document the start and stop times transportation is provided for each day that a participant is transported;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Maintain a copy of the current automobile liability coverage and documentation of payment for the vehicle transporting a participant; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Maintain a current copy of the valid State driver’s license and driving record for staff transporting a waiver participant; and</text>
    </paragraph>
  </paragraph>
  <paragraph num="II.">
    <text>Shall comply with all administrative policies, procedures, transmittals, and guidelines issued by the Department or its designee.</text>
  </paragraph>
</regulation>