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

Active Treatment.

“Applicant” means an individual who is applying as a participant in the Autism Waiver.

“Autism” has the meaning stated in §C of this regulation.

“Autism Waiver” means the Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder.

“Certified special educator” means a professional who holds an appropriate certificate as defined by COMAR 13A.12.01.02.

“Department” means the Maryland Department of Health, or its authorized agents acting on behalf of the Department.

“Developmentally disabled” means a condition, as specified in 42 CFR §435.1010 for persons with related conditions, resulting in a severe, chronic disability which meets all of the following conditions:

“Early intervention services” means services that:

“Eligible person” means an individual who meets the qualifications, as specified in Regulation .02 of this chapter, for participation in the Autism Waiver.

“Family” means adults who:

“HIPAA” means the Health Insurance Portability and Accountability Act of 1996 developed to improve portability of health insurance coverage, reduce healthcare fraud and abuse, and protect individual privacy of personal health records.

“Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder” means the program implemented under this chapter in accordance with the document, and any amendments to it, submitted by the Department to, and approved by, the Secretary of the U. S. Department of Health and Human Services, which authorizes the waiver, pursuant to §1915(c) of Title XIX of the Social Security Act, of certain specified statutory requirements limiting coverage for home and community-based services under the Medical Assistance Program.

“ICF-ID level of care” means an assessment that an individual needs the level of services provided in an intermediate care facility for the intellectually disabled and persons with related conditions (ICF-ID), including active treatment.

“Individualized education program (IEP)” means a written statement for a student with a disability that is developed, reviewed, and revised in accordance with 20 U.S.C. §1414 and COMAR 10.09.52.

“Individualized family service plan (IFSP)” means a written, individualized plan for early intervention and other services for an infant or toddler, in accordance with COMAR 10.09.40, 10.09.50, and 13A.13.01.

“Intermediate care facility for individuals with intellectual disabilities (ICF-IID)” means an institution licensed by the Department under COMAR 10.07.20 that:

“Local lead agency” means the agency designated by the local governing authority in each jurisdiction to administer the interagency system of early intervention services under the direction of the State Department of Education.

“Local school system” means the public local education agency in each jurisdiction.

“Medicaid” means the Medical Assistance Program.

“Medical Assistance Program” has the meaning stated in COMAR 10.09.36.01B.

“Multidisciplinary team” means the IEP team or IFSP participants, consistent with the Individuals with Disabilities Education Act (IDEA), which is convened for a participant.

Parent.

“Participant” means an eligible person who is enrolled in the Autism Waiver.

“Positive behavior intervention” means a range of intervention strategies that are designed to prevent problem behaviors while teaching socially appropriate alternative behaviors.

“Program” means the Medical Assistance Program, as stated in COMAR 10.09.36.01B.

“Provider” means an individual, association, partnership, corporation, or unincorporated group that:

“Provider agreement” means a contract between the Program and a provider.

“Qualified diagnostician” means an individual whose license or certification permits diagnosis of Autism Spectrum Disorder.

“Recipient” means an individual who is certified by the Department as eligible to receive Program benefits.

“Reportable event policy” means a process developed to protect the health and safety of waiver participants in the community by identifying, documenting, and resolving complaints and incidents.

“Retainer payment” means payment made to providers of residential habilitation services while the participant is hospitalized or absent from the residential habilitation program.

“Room and board” means rent or mortgage, utilities, maintenance, furnishings, and food which are provided in or associated with an individual's place of residence.

“Service coordinator” means the individual who provides case management services for Autism Waiver participants in accordance with COMAR 10.09.52.

“Special educator” means a professional who holds an appropriate certificate as defined by COMAR 13A.12.01.02.

“State Department of Education (MSDE)” means the agency responsible for ensuring that all children with disabilities residing in the State are identified, assessed, and provided with a free, appropriate public education consistent with State and federal laws.

“State fiscal year” means the 12-month period of July 1 through June 30 over which the State budgets its spending.

“State Plan” means the plan for the Medical Assistance Program as submitted by the Department and approved by the Secretary of the U.S. Department of Health and Human Services according to Title XIX of the Social Security Act, as modified or amended.

“Waiver plan of care” means the written, individualized treatment plan developed for a participant, which identifies the waiver services covered under this chapter.

“Autism” means autism spectrum disorder, which is diagnosed when an individual has a total of six or more of the following items under §C(1)(a), (b), and (c) of this regulation, with at least two from §C(1)(a) and one each from §C(1)(b) and (c):

“Autism” includes:

To be medically eligible for the services covered under the chapter, an applicant shall be certified by the licensed psychologist, licensed social worker, licensed clinical professional counselor, certified school psychologist, or approved service coordinator employed or contracted by the local lead agency, the local education agency, the State, or the State’s designee to need ICF-IID level of care using the standardized process for determination of eligibility for level of care in an ICF-IID.

Every 12 months, or more frequently if determined necessary by the service coordinator or multidisciplinary team due to a significant change in the participant’s condition or needs, a participant’s medical need for ICF-IID level of care shall be reevaluated by the licensed psychologist, licensed social worker, licensed clinical professional counselor, certified school psychologist, or approved service coordinator employed or contracted by the local lead agency, the local education agency, the State, or the State’s designee, as part of the multidisciplinary team process and using the form for determination of eligibility for level of care in an ICF-IID.

The form certifying ICF-IID level of care shall be signed by the:

Is between 1 year old and the end of the school year in which the individual turns 21 years old;

Is determined to be developmentally disabled and is diagnosed with autism spectrum disorder, every 3 years or more often as requested by MSDE, by a qualified diagnostician using an evaluation methodology considered sufficient by the multidisciplinary team;

Uses at least one waiver service monthly, not including family consultation, unless otherwise authorized by the State Department of Education;

Has an IFSP or IEP;

If the child has an IEP, receives 15 hours or more per week of special education and related services and requires a more intensive therapeutic program than other students or is currently participating in an approved Home and Hospital Program pursuant to the procedures of COMAR 13A.03.05 and 13A.05.01;

Is identified through the public education or early intervention service system as being potentially qualified for and needing Autism Waiver services;

Can be safely maintained in the community with the assistance of Autism Waiver services;

Chooses, or the parent or parents of a minor child chooses on the child’s behalf, to receive Autism Waiver services as an alternative to services in an (ICF-IID), and documents that choice on the consent form for Autism Waiver services; and

Is not enrolled in:

Categorically Needy. A recipient is eligible for Autism Waiver services if the recipient is eligible for Medicaid in the community according to the categorically needy regulations in COMAR 10.09.24 or 10.09.11.

Optionally Categorically Needy.

An individual is not eligible to receive Autism Waiver services if a disposal of assets or establishment of a trust results in a penalty under COMAR 10.09.24.08-1 or .08-2, until the penalty period expires.

All provisions of COMAR 10.09.24 which are applicable to aged, blind, or disabled institutionalized persons are applicable to Autism Waiver applicants and participants, with the following exceptions:

Post Eligibility Determination of Available Income. The participant's or parents' income may not be applied toward the costs of the participant's:

If an applicant is verified by the multidisciplinary team and the State Department of Education:

Every 12 months, or more often if there is a significant change in the participant's condition or needs:

A multidisciplinary team shall be convened by the local school system or local lead agency in accordance with COMAR 10.09.52 to:

The multidisciplinary team shall include:

Upon initial review, or if the participant's status changes, the service coordinator shall conduct a risk assessment to ensure the applicant can be safely maintained in a home and community-based setting utilizing Autism Waiver services.

A risk assessment shall be conducted by the service coordinator using the Autism Waiver Risk Assessment form.

Identifies the specific Autism Waiver services to be provided to the participant, as covered under this chapter;

Specifies for each identified Autism Waiver service the:

Identifies medical conditions that require a written, signed emergency protocol.

Meet the minimum age requirement, set forth by service, before rendering services to any Autism Waiver participant;

Receive adequate and appropriate training, within 60 days of employment and annually thereafter, pertaining to care for children with autism spectrum disorder including:

Work under the ongoing supervision of a qualified professional employee of the provider who has annual training in:

Are approved by the provider as qualified to meet the participant's needs;

Are approved by the participant's parents; and

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:

Residential habilitation services;

Intensive individual support services; and

Therapeutic integration services;

Who are:

Who have:

The scope of services to be performed;

The requirement to comply with all applicable Medicaid regulations;

The requirement to complete and maintain written documentation of service delivery, individualized for each participant on each day that the participant receives services;

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

A current copy of a provider license or certification and insurance as required in this chapter;

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;

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

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;

Pay for the criminal background check;

Request clearance from the Department for all applicants prior to an offer of employment; and

Submit monthly Criminal Justice Information System's update reports to the Maryland State Department of Education;

Submit an application for a criminal history record check to the Criminal Justice Information System Central Repository, Department of Public Safety and Correctional Services;

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;

Pay for the criminal background check;

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

Submit monthly Criminal Justice Information System’s update reports to the State Department of Education.

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

The criminal history does not indicate behavior that is potentially harmful to participants;

30 days written notice to the participant, parent or guardian, and service coordinator; and

Assistance in the discharge planning process;

Had a license or certificate suspended or revoked as a health care provider, health care facility, or provider of direct care services;

Been suspended or removed from participating as a Medicaid provider;

Undergone the imposition of sanctions under COMAR 10.09.36.08;

Been subject to disciplinary action including actions by providers or any of its principal's licensing board;

Been cited by a State agency for deficiencies which affect a participant's health and safety; or

Experienced a termination of a reimbursement agreement with or been barred from work or participation by a public or private agency due to:

Date and location of supervision;

Review, feedback, and oversight of the implementation of treatment plan goals;

Review, feedback, and oversight of the implementation of positive behavior intervention;

Review, feedback, and oversight of the scope of activities during service;

Review, feedback, and oversight of data collection;

Date and name of supervisor, name of employee, and name of the participant; and

Signature of supervisor;

Reporting incidents and complaints to the participant's service coordinator within 24 hours;

Submitting a written report within 7 calendar days on a form designated by the Department; and

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;

Render direct services to the provider's own child; or

Render supervision to the direct care worker of the provider's own child;

One training annually regarding the prevention, identification, and reporting of abuse, neglect, and exploitation;

One training annually regarding positive behavioral intervention and restraints; and

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;

Implement the provider’s transportation policy;

Identify the driver in daily contact notes or a transportation log;

Document the start and stop times transportation is provided for each day that a participant is transported;

Maintain a copy of the current automobile liability coverage and documentation of payment for the vehicle transporting a participant; and

Maintain a current copy of the valid State driver’s license and driving record for staff transporting a waiver participant; and

Complies with regulations governing residential programs licensed under the:

Has eight or fewer beds, unless approved by the State Department of Education to have up to 16 beds due to special needs of children;

Has no more than two individuals in a bedroom;

Provides opportunities for participants to have personal items in the participant's bedroom that reflect the participant's personal tastes;

Provides for input and participation of the participant into eating times, menus, and meal preparation, as appropriate for specific health conditions and in accordance with treatment standards;

Provides opportunities for participants to participate in community activities; and

Is located and integrated into a residential community.

A valid Maryland certificate as a special education supervisor, principal, or special educator, and 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

At least 3 years of relevant experience with counseling or supervision, as appropriate for the director's assignment;

Includes at all times at least one direct care staff person on site for every three children, with more staffing as necessary based on participants' needs; and

Unless the provider designates that it does not provide residential habilitation on weekends, is for 365 days a year,

Has at least a bachelor's degree in a human services field plus 3 years of experience in the area of autism spectrum disorder or other developmental disabilities, or an associate degree in human services plus 5 years of experience with persons with autism or other developmental disabilities; or

Meets the professional guidelines for a qualified intellectual disabilities professional or qualified developmental disabilities professional;

Abuse, neglect, and exploitation;

Positive behavior interventions and restraints;

Implementation of treatment plans;

Transportation of participants;

Maintenance of required documentation;

Training and supervision of staff;

Quality assurance;

Emergency back-up plans; and

HIPAA;

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

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

Licensed psychologist;

Certified school psychologist;

Certified special educator;

Licensed certified social worker;

Licensed professional counselor;

Board Certified Behavioral Analyst; or

Individual with a masters 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;

Abuse, neglect, and exploitation;

Positive behavior interventions and restraints;

Implementation of treatment plans:

Emergency backup plans;

Transportation of participants;

Maintenance of required documentation;

Training and supervision of staff;

Quality assurance; and

HIPAA;

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

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

A licensed psychologist;

A certified school psychologist;

A certified special educator;

A licensed certified social worker;

A licensed professional counselor;

A board-certified behavioral analyst;

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

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;

Abuse, neglect, and exploitation;

Positive behavior interventions and restraints;

Implementation of treatment plans;

Emergency backup plans;

Transportation of participants;

Maintenance of required documentation;

Training and supervision of staff;

Quality assurance; and

HIPAA;

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

Allow an on-site review by the MSDE;

Certified in accordance with COMAR 13A.12.01 as a psychologist or special educator; or

Licensed as a psychologist, social worker, registered nurse, professional counselor, or occupational therapist; or

A qualified developmental disabilities professional in accordance with COMAR 10.09.26.01B(28);

Certified nationally by the Behavior Analyst Certification Board as a Board Certified Behavior Analyst; or

An individual with a master's degree 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.

Abuse, neglect, and exploitation;

Positive behavior interventions and restraints;

Emergency backup plans;

Transportation of participants;

Maintenance of required documentation;

Training and supervision of staff;

Quality assurance; and

HIPAA.

Maintain daily contact logs completed on the same day the service is provided and reflective of interventions; and

Make documentation of services available for review by the State, when requested.

Certified in accordance with COMAR 13A.12.01 as a psychologist, special educator, or speech therapist;

Licensed as a psychologist, certified social worker, nurse psychotherapist, speech therapist, professional counselor, marriage and family therapist, or occupational therapist;

Nationally certified as a Board Certified Behavior Analyst; or

An individual with a master's or doctorate degree from an accredited university in special education or a related field and have at least 5 years experience providing training or consulting in the area of autism spectrum disorder; and

Is relevant to the family’s needs;

Is related to behavior intervention or how to keep the child safe in the home environment; and

Was involved with providing services to children with autism spectrum disorder as a service provider or as a family member.

Have the appropriate State license as a contractor or builder; and

Be appropriately and adequately bonded.

Be an individual with a bachelor’s degree; and

Have 3 years of full-time experience serving adults with autism disabilities.

Any Medicaid State Plan services which are provided by medical professionals employed by or under contract with the residential habilitation provider;

Room and board;

Direct or indirect payments to the participant's immediate family;

Routine care and supervision which a family is expected to provide;

Activities or supervision reimbursed by a source other than Medicaid; and

The facility's maintenance, upkeep, and improvement.

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;

Provide a home-like, safe, 24-hour, therapeutic living environment of treatment, intervention, training, supportive care, and oversight;

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;

Work closely with the participant's service coordinator to provide transition services for each participant in placement to allow, as appropriate, for the:

Coordinate with the participant's educational, health, and medical service providers.

Preauthorized by the multidisciplinary team; and

Reviewed by the multidisciplinary team at least annually.

Licensed group homes;

Licensed alternative living units; or

Community-based residential facilities approved by the State Department of Education for special education services.

Residential habilitation services are provided and reimbursed at a regular or intensive level for a participant.

To be approved by the multidisciplinary team for the intensive level of residential habilitation services, the participant must need:

A residential habilitation program shall provide all of the services listed in §F(2)—(12) of this regulation, as necessary for the participant.

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.

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.

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.

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.

Functional Living Skills Training. The residential rehabilitation program shall train the participant in self-reliance, money management, and money handling and purchases.

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:

Mobility. The residential rehabilitation program shall train, supervise, and assist the participant to:

Transportation. The residential rehabilitation program shall provide transportation for the participant to recreation, leisure activities, or skills training.

Crisis Intervention and Planning. The residential rehabilitation program shall include:

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.

Transition Services. The residential rehabilitation program shall provide training and experiential learning activities for a participant in a residential habilitation placement, which:

Train and provide ongoing supervision to the direct care worker rendering residential habilitation services;

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;

Plan and regularly review the participant’s therapeutic activities and behavior plan;

Meet regularly with the participant and family and observe the participant in the residential habilitation setting; and

Develop and identify on the individualized treatment plan, the goals, interventions, and tasks that the residential habilitation direct care worker is implementing.

Are provided at a nonresidential setting separate from the home or facility where the participant lives;

Focus on expressive therapies and therapeutic recreational activities;

Include as important components the development of socialization skills, enhancement of self-esteem, and behavior management;

Are especially needed for participants who have problems with socialization, isolation, hyperactivity, impulse control, and behavioral or other related disorders;

Are not solely educational or recreational in nature, but have a therapeutic habilitative orientation, as evidenced in written progress notes;

Shall be culturally competent and congruent with the participant's cultural norms;

May include individual or group counseling;

Shall assure coordination with the participant's other service providers, service coordinator, and multidisciplinary team;

Shall be guided by the participant's individualized treatment plan;

Shall be based on an individualized written plan that identifies goals of the specific therapeutic activities provided;

Shall provide:

Shall have a supervisor who has been trained in accordance with Regulation .04E(3) of this chapter that:

Shall, when transportation is provided:

Are provided at a nonresidential setting separate from the home or facility where the participant lives;

Shall have an on-site direct care worker for every participant receiving one-to-one interventions for intensive therapeutic integration;

Shall include expressive therapies and therapeutic recreational activities;

Shall include the development of socialization skills, enhancement of self-esteem, and behavior management;

Are for participants who require one-to-one interventions and also have problems with socialization, isolation, hyperactivity, impulse control, and behavioral or other related disorders;

Are not solely educational or recreational in nature, but have a therapeutic habilitative orientation, as evidenced in written progress notes;

Shall be culturally competent and congruent with the participant’s cultural norms;

Shall assure coordination with the participant’s other service providers, service coordinator, and multidisciplinary team;

Shall be based on the participant’s individualized written treatment plan that identifies goals of the specific therapeutic activities provided;

Shall provide:

Shall have a supervisor who has been trained in accordance with Regulation .04E(3) of this chapter that:

Shall, when transportation is provided:

Are intensive, one-on-one interventions with the participant provided by a direct care worker;

May be received by the participant on a long-term basis;

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;

May be provided in the participant's home or another setting except a residential or youth camp facility;

May be provided by more than one direct care worker necessitating ongoing coordination between the direct care workers;

Are goal-oriented and task-oriented, with interventions developed on an individualized basis based on the participant's individualized treatment plan;

Use the home and community environment as a learning experience and opportunity to illustrate and model alternative ways for the participant to behave;

Assist the participant in achieving successful home and community living through structured support, reinforcement, modeling, and behavior management, as evidenced in written progress notes;

Shall, when transportation is provided:

Are intended to:

Include:

Train and provide ongoing supervision to the direct care worker rendering intensive individual support services;

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;

Plan and regularly review the participant's therapeutic activities and behavior plans;

Meet regularly with the participant and family and observe the participant in the home setting;

Develop intervention on an individualized basis and identify the interventions on an individualized treatment plan; and

Identify in the treatment plan goals and tasks that the intensive individual support services direct care worker is implementing.

Shall consist of one-on-one interventions with the participant;

Shall be rendered by a qualified:

Shall include assistance with activities of daily living provided to participants who are unable to care for themselves;

Shall be furnished on a short-term basis because of the absence of or need for relief of the participant's family that normally provides the care;

Shall be provided in the participant's home or place of residence, or community setting, not including a residential habilitation facility;

May be provided in a youth camp certified by the Maryland Department of Health under COMAR 10.16.06; and

May be provided in a site licensed to accommodate individuals for respite care by the Developmental Disabilities Administration.

Be available for participants receiving residential habilitation services;

Include the direct care worker's or the participant's room and board; or

Be rendered by a participant's parent.

Shall be based on family-oriented goals to benefit the participant;

Shall be provided to one family at a time;

May not include advocacy regarding a participant's IEP; and

May not include training and supervision of direct care workers.

Shall be trained by a qualified licensed or certified professional to provide intensive one-on-one interventions with the participant;

May be instructed in the treatment regimens, behavior intervention and modeling, skills training, and use of equipment specified in the participant's Autism Waiver plan of care;

Shall be provided with training updates as necessary to maintain the participant safely at home; and

Shall be present to receive family consultation services.

A participant’s family shall receive in-person, individualized consultation when providing the habilitation services listed in §C(2)—(8) of this regulation, as necessary for the participant.

Habilitation. The participant’s family shall receive consultation to assist the participant to acquire, retain, or improve skills in a wide variety of areas that directly affect the participant’s development and ability to reside as independently as possible, including communication skills.

Self-Direction. The participant’s family shall receive consultation to assist the participant in:

Behavior Shaping and Management. The participant’s family shall receive consultation to assist the participant with appropriate expression of emotions and desires, compliance, assertiveness, acquisition of socially appropriate behaviors, and the reduction of inappropriate behaviors.

Daily Living Skills. The participant’s family shall receive consultation to assist the participant, as appropriate, in:

Socialization. The participant’s family shall receive consultation which facilitates the participant’s involvement in family and community activities and establishing relationships with siblings and peers, which may include:

Mobility. The participant’s family shall receive consultation to assist the participant with:

Money Management. The participant’s family shall receive consultation to assist the participant with:

Prevent the participant's institutionalization;

Assure:

Prevent the participant's self-injurious behavior; and

Enable the participant to function with greater independence in the home.

Alarms or locks on doors, windows, or fences;

Protective padding on walls or floors;

Plexiglass on windows;

Outside gates and fences;

Brackets for appliances;

Raised electrical switches and sockets;

Safety screen doors; and

Individual tracking devices.

Be provided in accordance with applicable State or local building codes; and

Pass the required inspections.

Are of general utility;

Are not of direct medical or remedial benefit to the participant; or

Add to the home's total square footage.

Result in the participant's transition from Autism Waiver services to comparable, necessary adult life services;

Be based on the participant's need for services and support after disenrollment from the Autism Waiver; and

Be provided only to participants age 14 years old or older.

The relevant definition of covered services in this chapter;

All other requirements specified in this chapter; and

The Autism Waiver proposal and any amendments to it approved by the Secretary of the U.S. Department of Health and Human Services.

For dates of service before July 1, 2023, 24 units; or

For dates of service on or after July 1, 2023, 12 units.

For dates of service before July 1, 2023:

For dates of service on or after July 1, 2023:

Residential habilitation;

Intensive individual support services;

Family consultation;

Therapeutic integration;

Intensive therapeutic integration; or

Adult life planning services.

An approved provider shall submit requests for payment for the services covered under this chapter according to the procedures set forth in COMAR 10.09.36.04 or otherwise established by the Program.

The provider shall:

Payments by the Program or its designee may be withheld if the provider fails to submit requested evidence of services provided, staff qualifications, corrective action plans, or other types of documentation related to ensuring the health and safety of a participant.

Payments shall be released upon receipt and approval by the Program or its designee of the requested documentation.

An appeal by the provider under COMAR 10.01.03 does not stay the withholding of payments.

Payments shall be made only to a qualified provider for services covered under this chapter which are rendered to a participant.

Providers shall be paid the lesser of:

The Department shall publish a fee schedule for services covered under this chapter that shall be publicly available and updated at least annually or upon any changes made by the Department.

Subject to the limitations of the State budget, the Program’s rates as specified in this regulation shall increase by 4 percent each year through Fiscal Year 2026.

Effective July 1, 2022, the Program shall pay according to the following fee-for-service schedule:

Effective July 1, 2023, the Program shall pay according to the following fee-for-service schedule:

The number of participants served by the provider; and

The number and type of services provided.