<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".15" citation="COMAR 10.09.56.15" title_num="10" subtitle_num="09" chapter_num="56" heading="Covered Services — Intensive Individual Support Services.">
  <paragraph num="A.">
    <text>Intensive individual support services:</text>
    <paragraph num="(1)">
      <text>Are intensive, one-on-one interventions with the participant provided by a direct care worker;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>May be received by the participant on a long-term basis;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Are authorized in the participant's Autism Waiver plan of care if the participant's behavior without this intervention would require a more restrictive residential or treatment setting;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>May be provided in the participant's home or another setting except a residential or youth camp facility;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>May be provided by more than one direct care worker necessitating ongoing coordination between the direct care workers;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Are goal-oriented and task-oriented, with interventions developed on an individualized basis based on the participant's individualized treatment plan;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Use the home and community environment as a learning experience and opportunity to illustrate and model alternative ways for the participant to behave;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Assist the participant in achieving successful home and community living through structured support, reinforcement, modeling, and behavior management, as evidenced in written progress notes;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Shall, when transportation is provided:</text>
      <paragraph num="(a)">
        <text>Have individualized goals for transportation for the participant on the participant's plan; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Document the start and stop times transportation is provided for each day that a participant is transported;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(10)">
      <text>Are intended to:</text>
      <paragraph num="(a)">
        <text>Prevent or defuse crises;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Promote developmental and social skills growth;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Provide the participant with behavior management skills;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Give the participant a sense of security and safety;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Assist the participant with maintaining self-sufficiency and impulse control;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Improve the participant's positive self-expression and interpersonal communication;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Improve the participant's ability to function and cooperate in the home and community;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Reverse negative behaviors and attitudes; and</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Foster stabilization; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(11)">
      <text>Include:</text>
      <paragraph num="(a)">
        <text>One-on-one support, assistance, oversight, and intervention;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Time-structuring activities;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Immediate behavioral reinforcements;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Time-out strategies; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Crisis intervention techniques.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Direct care workers and supervisors rendering intensive individual support services shall collaborate with the participant's family, providers of other waiver services, and other professionals working with the participant in the home or other community settings, including the schools.</text>
  </paragraph>
  <paragraph num="C.">
    <text>A professional who meets the provider qualifications of Regulation .04G(1)(a)—(f) of this chapter shall:</text>
    <paragraph num="(1)">
      <text>Train and provide ongoing supervision to the direct care worker rendering intensive individual support 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 as necessary to reduce the likelihood of reoccurrence;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Plan and regularly review the participant's therapeutic activities and behavior plans;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Meet regularly with the participant and family and observe the participant in the home setting;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Develop intervention on an individualized basis and identify the interventions on an individualized treatment plan; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Identify in the treatment plan goals and tasks that the intensive individual support services direct care worker is implementing.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>For dates of service before July 1, 2023, a unit of service is a 30-minute increment of service rendered to a participant by a qualified provider in the participant’s home or a community setting.</text>
  </paragraph>
  <paragraph num="E.">
    <text>For dates of service on or after July 1, 2023, a unit of service is a 15-minute increment of service rendered to a participant by a qualified provider in the participant’s home or a community setting.</text>
  </paragraph>
</regulation>