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<regulation prefix="Regulation" num=".11" citation="COMAR 10.09.56.11" title_num="10" subtitle_num="09" chapter_num="56" heading="Covered Services — Residential Habilitation Services.">
  <paragraph num="A.">
    <text>The Program under this regulation does not cover the following:</text>
    <paragraph num="(1)">
      <text>Any Medicaid State Plan services which are provided by medical professionals employed by or under contract with the residential habilitation provider;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Room and board;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Direct or indirect payments to the participant's immediate family;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Routine care and supervision which a family is expected to provide;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Activities or supervision reimbursed by a source other than Medicaid; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>The facility's maintenance, upkeep, and improvement.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The residential habilitation program shall:</text>
    <paragraph num="(1)">
      <text>Provide community-based, intensive residential placements for participants who cannot live at home at the present time because they require highly supervised and supportive environments;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Provide a home-like, safe, 24-hour, therapeutic living environment of treatment, intervention, training, supportive care, and oversight;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Be designed to assist Autism Waiver participants in acquiring, retaining, and improving the self-help, socialization, and adaptive skills necessary to reside successfully in home and community-based settings;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Work closely with the participant's service coordinator to provide transition services for each participant in placement to allow, as appropriate, for the:</text>
      <paragraph num="(a)">
        <text>Participant's eventual return to the family (natural, adoptive, or surrogate); or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Participant to acquire the skills and resources for group or independent living; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Coordinate with the participant's educational, health, and medical service providers.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>A participant's placement in residential habilitation services shall be:</text>
    <paragraph num="(1)">
      <text>Preauthorized by the multidisciplinary team; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Reviewed by the multidisciplinary team at least annually.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Residential habilitation services shall be received in facilities located in the State which are:</text>
    <paragraph num="(1)">
      <text>Licensed group homes;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Licensed alternative living units; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Community-based residential facilities approved by the State Department of Education for special education services.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Intensity Levels.</text>
    <paragraph num="(1)">
      <text>Residential habilitation services are provided and reimbursed at a regular or intensive level for a participant.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>To be approved by the multidisciplinary team for the intensive level of residential habilitation services, the participant must need:</text>
      <paragraph num="(a)">
        <text>Awake overnight staffing; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>At minimum, 4 hours of one-on-one staffing.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Services.</text>
    <paragraph num="(1)">
      <text>A residential habilitation program shall provide all of the services listed in §F(2)—(12) of this regulation, as necessary for the participant.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Habilitation. The residential rehabilitation program shall provide training to assist a participant to acquire, retain, or improve skills in a wide variety of areas that directly affect the ability to reside as independently as possible.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Behavior Shaping and Management. The residential rehabilitation program shall train, supervise, and assist the participant, which may include psychiatric or psychological interventions, in appropriate communication and expression of emotions and desires, compliance, assertiveness, acquisition of socially appropriate behaviors, and reduction of inappropriate behaviors.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Daily Living Skills. The residential rehabilitation program shall train or assist the participant in dressing, personal hygiene, self-administration of medications, proper use of appliances and adaptive or assistive devices, home safety, first aid, and emergency procedures.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Self-Direction. The residential rehabilitation program shall train the participant in identifying and responding to dangerous or threatening situations, making decisions and choices affecting the participant's life, and initiating changes in living arrangements or life activities.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Functional Living Skills Training. The residential rehabilitation program shall train the participant in self-reliance, money management, and money handling and purchases.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Socialization. The residential rehabilitation program shall train, supervise, or assist the participant to facilitate the participant's involvement in general community activities and establishment of relationships with peers, which may:</text>
      <paragraph num="(a)">
        <text>Not include participation in activities which are solely diversional or recreational in nature; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Include:</text>
        <paragraph num="(i)">
          <text>Assisting the participant with learning and practicing skills of cooperation and participation;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Assisting the participant to identify and participate in activities of interest; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Providing specific training activities necessary to assist the participant to participate in activities of interest on an ongoing basis.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(8)">
      <text>Mobility. The residential rehabilitation program shall train, supervise, and assist the participant to:</text>
      <paragraph num="(a)">
        <text>Enhance movement within the participant's living, working, or education environment;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Master the use of adaptive aids and equipment; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Access and use public transportation, independent travel, or other movement within the community.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(9)">
      <text>Transportation. The residential rehabilitation program shall provide transportation for the participant to recreation, leisure activities, or skills training.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Crisis Intervention and Planning. The residential rehabilitation program shall include:</text>
      <paragraph num="(a)">
        <text>Planning for crises in the participant's residential habilitation placement; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Making the necessary behavioral or environmental interventions to stabilize and preserve the participant's residential habilitation placement, or resolve an intensive behavioral episode.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(11)">
      <text>Medication Management, Monitoring, and Training. The residential rehabilitation program shall provide, as needed and appropriate, medication management, monitoring, and training in accordance with the Maryland Nurse Practice Act and COMAR 10.27.11.</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Transition Services. The residential rehabilitation program shall provide training and experiential learning activities for a participant in a residential habilitation placement, which:</text>
      <paragraph num="(a)">
        <text>Assist with developing discharge planning goals for the participant;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Assist the participant in making the transition to home, the next planned placement, or independent living;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Are responsive to the participant's individualized developmental and behavioral needs; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Promote self-reliance and age-appropriate behavior.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>A supervisor who has been trained in accordance with Regulation .04E(3) of this chapter shall:</text>
    <paragraph num="(1)">
      <text>Train and provide ongoing supervision to the direct care worker rendering residential habilitation services;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Supervise the direct care worker when crisis intervention services are rendered to evaluate the nature of the crisis and intervene to reduce the likelihood of reoccurrence;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Plan and regularly review the participant’s therapeutic activities and behavior plan;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Meet regularly with the participant and family and observe the participant in the residential habilitation setting; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Develop and identify on the individualized treatment plan, the goals, interventions, and tasks that the residential habilitation direct care worker is implementing.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>A unit of service for residential habilitation shall be on a per diem basis.</text>
  </paragraph>
</regulation>