# COMAR Title 10 — Maryland Department of Health

## Subtitle 09 — Medical Care Programs

### Chapter 56 — Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder

#### Regulation .06-1 Specific Conditions for Participation — Therapeutic Integration Services.

*COMAR 10.09.56.06-1*

To provide one or more of the services covered under Regulation .14 of this chapter, the provider shall:

A. Have at least 3 years of experience in providing habilitation services to children with autism spectrum disorder or other developmental disabilities;

B. Employ a full-time program director to assure adequate coordination and supervision of the covered services, who shall:

  (1) Hold a valid Maryland certificate as a special education supervisor, principal, or special educator, and have at least 3 years of successful teaching experience, as verified by former employers, in regular or special education, or both, as appropriate for the director's assignment; or

  (2) Have at least 3 years of relevant experience with counseling or supervision, as appropriate for the director's assignment;

C. Employ direct care workers who meet provider qualifications in accordance with Regulation .04E of this chapter;

D. Have on site at least one direct care worker for every three participants on the waiver, with more staffing as necessary based on participants’ needs;

E. Designate an on-site supervisor for the direct care workers who is:

  (1) A licensed psychologist;

  (2) A certified school psychologist;

  (3) A certified special educator;

  (4) A licensed certified social worker;

  (5) A licensed professional counselor;

  (6) A board-certified behavioral analyst;

  (7) A licensed or certified as a music, art, drama, dance, or recreation therapist; or

  (8) An individual with a master's or doctorate degree in special education or a related field and at least 5 years experience in providing training or consultation in the area of autism spectrum disorder or other developmental disabilities;

F. Employ or contract with certain professionals for consultation in accordance with Regulation .04G(1) and (2) of this chapter;

G. Have at least one professional on call at all times for crisis intervention in accordance with Regulation .04G(1) and (2) of this chapter;

H. Demonstrate the capability and capacity of providing therapeutic integration services by submitting documentation of experience and a written implementation plan which includes at a minimum policies and procedures regarding:

  (1) Abuse, neglect, and exploitation;

  (2) Positive behavior interventions and restraints;

  (3) Implementation of treatment plans;

  (4) Emergency backup plans;

  (5) Transportation of participants;

  (6) Maintenance of required documentation;

  (7) Training and supervision of staff;

  (8) Quality assurance; and

  (9) HIPAA;

I. Provide documented evidence of services in the least restrictive environment in the community that is appropriate to a participant's needs;

J. Provide documented evidence of integration of the covered services with other community-based services received by participants;

K. Document arrangements to obtain medical services for participants in an emergency;

L. For initial approval and as a condition of occupancy of any facility used by the program:

  (1) Submit written documentation from responsible agency or licensing authorities verifying that the facility is in compliance with applicable health, fire safety, and zoning regulations; and

  (2) Allow an on-site review by the MSDE;

M. For continued approval, maintain written documentation of compliance with applicable health, fire safety, and zoning regulations as a condition of occupancy of any facility used by the program;

N. Provide the treatment plan to the participant's service coordinator within 30 calendar days of initiation of service and at least annually or more frequently if the treatment plan changes;

O. Maintain daily contact logs completed on the same day the service is provided and reflective of individual plan goals and activities; and

P. Maintain and make available for review by the State, documentation of the 6-month review and update of each participant’s status relative to each goal in the therapeutic integration treatment plan.