In this chapter, the following terms have the meanings indicated. Terms Defined. Active Treatment. “Active treatment” means, according to 42 CFR §483.440(a), a continuous active treatment program which includes aggressive, consistent implementation of a program of specialized and generic training, treatment, health services, and related services that is directed toward the: Acquisition of the behaviors necessary for the individual to function with as much self-determination and independence as possible; or Prevention or deceleration of regression or loss of current optimal functional status. “Active treatment” does not mean, according to 42 CFR §483.440(a), services to maintain generally independent individuals who are able to function with little supervision or in the absence of a continuous active treatment program. “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: Is attributable to: Cerebral palsy or epilepsy; or A condition such as autism, except for mental illness, which is found to be closely related to intellectual disability because the condition results in impairment of general intellectual functioning or adaptive behavior similar to that of intellectually disabled individuals, and requires treatment or services similar to those required for intellectually disabled individuals; Is manifested before the individual is 22 years old; Is likely to continue indefinitely; and Results in substantial functional limitations in three or more of the following areas of major life activities: Self-care; Understanding and use of language; Learning; Mobility; Self-direction; Capacity for independent living; or Other areas of major life activities. “Early intervention services” means services that: Are designed to meet the developmental needs of infants and toddlers with disabilities; Are provided under public supervision and in conformity with an individualized family service plan; and Meet applicable State and federal standards. “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: Live with or provide care to the participant; and Are not paid to provide the care. “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: Is primarily for the diagnosis, treatment, or rehabilitation of individuals with intellectual disabilities or persons with related conditions; and Provides, in a protected residential setting, ongoing evaluation, planning, 24-hour supervision, coordination, and integration of health or rehabilitative services to help each individual function at the individual's greatest ability. “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. “Parent” means the adult representative of a minor applicant or participant. “Parent” includes: A natural or adoptive parent; A legal guardian; A person acting in the place of a parent, such as a grandparent or stepparent, with whom the participant lives, including those relatives or stepparents who are foster parents; An individual appointed as the parent surrogate in accordance with Education Article, §8-412, Annotated Code of Maryland, for matters within the scope of the Individuals with Disabilities Education Act (IDEA); and Any other person who is legally responsible for the participant's welfare. “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: Is approved as meeting the conditions for waiver participation specified in this chapter; and Has enrolled with the Program to provide one or more of the waiver services covered under this chapter. “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. “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): Qualitative impairment in social interaction, as manifested by at least two of the following: Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction; Failure to develop peer relationships appropriate to developmental level; A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (for example, by a lack of showing, bringing, or pointing out objects of interest); Lack of social or emotional reciprocity; Qualitative impairments in communication as manifested by at least one of the following: Delay in, or total lack of, the development of spoken language, not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime; In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others; Stereotyped and repetitive use of language or idiosyncratic language; Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level; Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus; Apparently compulsive adherence to specific, nonfunctional routines or rituals; Stereotyped and repetitive motor mannerisms (for example, hand or finger flapping or twisting, or complex whole body movements); Persistent preoccupation with parts or objects. “Autism” includes: Delays or abnormal functioning in at least one of the following areas, with onset before age 3 years: Social interaction; Language as used in social communication; or Symbolic or imaginative play; An individual's behavior that is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder; Pervasive Developmental Disorder Not Otherwise Specified (including Atypical Autism, Rett's Disorder, and Asperger's Disorder). Medical Eligibility for the Autism Waiver. 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: Chairman of the multidisciplinary team, who is the official representative of the local school system or local lead agency; and Team's 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. Technical Eligibility for the Autism Waiver. An applicant or participant shall be determined by the multidisciplinary team to meet the waiver’s technical eligibility-criteria if the individual: 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: Home Care for Disabled Children under a Model Waiver, in accordance with COMAR 10.09.27; Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver, in accordance with COMAR 10.09.26; or Any other Medicaid waiver program under §1915(c) of Title XIX of the Social Security Act. Medical Assistance Eligibility. 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 eligible for Autism Waiver services as optionally categorically needy in accordance with 42 CFR §435.217 if the individual's countable income does not exceed 300 percent of the applicable payment rate for Supplemental Security Income (SSI), and the individual's countable resources do not exceed the SSI resource standard for one. For the purpose of determining financial eligibility for the optionally categorically needy, the individual is treated as an assistance unit of one. For the purpose of determining countable income for the optionally categorically needy, income is determined based on the income regulations in COMAR 10.09.24 which are applicable to aged, blind, or disabled individuals who are institutionalized, with the exceptions specified in §C(4) of this regulation. For the purpose of determining countable resources for the optionally categorically needy, resources are determined based on the resource regulations set forth in COMAR 10.09.24.08 and .10 which are applicable to aged, blind, or disabled persons who are institutionalized, with the exceptions specified in §C(4) of this regulation. 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: COMAR 10.09.24.04J(1), (2), and (3); COMAR 10.09.24.04K; COMAR 10.09.24.06B(2)(a)(ii); COMAR 10.09.24.08G(1); COMAR 10.09.24.08H; COMAR 10.09.24.09; COMAR 10.09.24.10; and COMAR 10.09.24.10-1. Post Eligibility Determination of Available Income. The participant's or parents' income may not be applied toward the costs of the participant's: Autism Waiver services; or Room and board in a residential habilitation facility. Autism Waiver Eligibility. If an applicant is verified by the multidisciplinary team and the State Department of Education: To meet all of the criteria specified in §§A—C of this regulation, the participant’s service coordinator, the representative of the local school system or local lead agency, the representative of the State Department of Education, and the Program shall certify Autism Waiver eligibility and the Program shall establish the effective date for enrollment; or Not to meet all of the criteria specified in §§A—C of this regulation: The service coordinator, the representative of the local school system or local lead agency, and the representative of the State Department of Education shall certify the Autism Waiver eligibility determination; and The applicant, or the parent or parents of a minor child, shall be informed in writing by the Department for ineligibility, and the right to appeal and request a fair hearing, in accordance with COMAR 10.01.04 and 10.09.24.13, and 42 CFR Part 431, Subpart E. Every 12 months, or more often if there is a significant change in the participant's condition or needs: The multidisciplinary team and the State Department of Education shall verify whether the participant remains eligible for the Autism Waiver by meeting all of the criteria specified in §§A—C of this regulation; The service coordinator, the representative of the local school system or local lead agency, and the representative of the State Department of Education shall certify the redetermination of Autism Waiver eligibility; and If the multidisciplinary team and the State Department of Education verify that the participant no longer meets all of the eligibility criteria specified in §§A—C of this regulation, the: Participant's eligibility shall be terminated, as of the effective date established by the multidisciplinary team and the State Department of Education, and Participant, or the parent or parents of a minor child, shall be informed in writing of the determination, the reason or reasons for ineligibility, and the right to appeal and request a fair hearing, in accordance with COMAR 10.01.04 and 10.09.24.13, and 42 CFR Part 431, Subpart E. Multidisciplinary Team. A multidisciplinary team shall be convened by the local school system or local lead agency in accordance with COMAR 10.09.52 to: Assess or reassess an applicant's or participant's need and eligibility for Autism Waiver services; Review the applicant's or participant's IEP or IFSP, as necessary; and Develop or review, and revise as necessary, the applicant's or participant's Autism Waiver plan of care. The multidisciplinary team shall include: The applicant's or participant's service coordinator who shall attend at least one statewide Autism Waiver training session per year; The applicant's or participant's parent or parents; A chairman who is the official representative of the local school system or local lead agency; Other appropriate professionals representing the local school system or local lead agency, as necessary and consistent with the Individuals with Disabilities Education Act (IDEA); and Other service providers and individuals, as appropriate. Risk Assessment. 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. A participant’s Autism Waiver plan of care or plan of care addendum: 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: Description of the specific service to be provided; Service start date; Estimated duration; Approved frequency and units of services to be delivered; and Provider; and Identifies medical conditions that require a written, signed emergency protocol. To provide Autism Waiver services, the provider: Shall be approved in accordance with the requirements specified in this chapter; Shall have a provider agreement in effect, signed with the Program; Shall meet all the conditions for participation specified in COMAR 10.09.36, except as otherwise specified in this chapter; 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; Shall assure that direct care workers who render services under this chapter: 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: Training concerning abuse, neglect, and exploitation; Positive behavioral interventions and restraints rendered by a MSDE approved trainer; Reportable event policy; and HIPAA; Work under the ongoing supervision of a qualified professional employee of the provider who has annual training in: Abuse, neglect, exploitation; Positive behavioral interventions and appropriate use of restraints rendered by a MSDE-approved trainer; Reportable event policy; and HIPAA; 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: Internships; Post high school educational experience with developmental disabilities; Shadowing experienced staff; Employment with a developmental disabilities agency; or Fulfilling the community service requirement through volunteering with a child with autism or another developmental disability; 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: Residential habilitation services; Intensive individual support services; and Therapeutic integration services; Shall employ on-call professionals and professional consultants: Who are: Board-certified behavior analysts; Certified school psychologists; Certified special educators; 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; Licensed certified social workers; Licensed professional counselors; Nurse psychotherapists; Physicians; Psychologists; Occupational therapists; Physical therapists; Registered nurses; or Speech therapists; and Who have: Experience providing services to children with autism spectrum disorder or other developmental disabilities; A background in behavior management techniques; and Knowledge of the specific children being served by the provider. 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; Shall maintain current, written, and signed contracts with all contractors providing waiver services on behalf of the provider that include: 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; With the exception of environmental accessibility adaptation providers, shall submit to a preemployment criminal background investigation; 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; If an agency, shall require supervisory and direct care employees of provider agencies to: 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; If an agency, shall: 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; If self-employed, shall: 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. 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: 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; Shall have adequate liability insurance; 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; 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; 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; 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; Unless a risk to health and safety exists, shall agree not to terminate services for a participant without providing: 30 days written notice to the participant, parent or guardian, and service coordinator; and Assistance in the discharge planning process; 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; Is not eligible if the provider or its principals within the past 24 months have: 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: Failure to meet contractual obligations; or Fraudulent billing practices; Shall maintain written quarterly records documenting face-to-face supervision of direct care employees and direct observation of the participant that includes: 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; 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; Shall implement and follow the Reportable Event policy in accordance with the Department's established policy by: 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; May not: Render direct services to the provider's own child; or Render supervision to the direct care worker of the provider's own child; 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; 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: 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; Shall satisfactorily complete all aspects of the Autism Waiver provider applications process; Shall notify the Program within 15 days of occurrence of any change to contact information; Shall maintain communications with the program by maintaining a working telephone and answering machine, facsimile machine, and e-mail account; 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; Shall, when transportation is provided: 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 Shall comply with all administrative policies, procedures, transmittals, and guidelines issued by the Department or its designee. To provide the services covered under Regulation .11 of this chapter, the provider agency shall: Provide services in a facility that meets the following requirements: Complies with regulations governing residential programs licensed under the: Developmental Disabilities Administration including COMAR 10.22.02 and 10.22.08; or Governor's Office for Children including COMAR 14.31.06; 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. Have at least 3 years of experience in providing habilitation services to children who have autism spectrum disorder or other developmental disabilities; Employ a full-time program director, to assure adequate coordination and supervision of the covered services, who has either: 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; Provide round-the-clock staffing which: 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, Have on call 24 hours a day a designated supervisor for the direct care workers, who: 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; Demonstrate the necessary staff capacity to provide intensive residential habilitation services when needed by participants; Employ or contract with certain professionals who meet provider qualifications in accordance with Regulation .04G(1) and (2) of this chapter for consultation; Have at least one professional on call 24 hours a day, 7 days a week for crisis intervention who meets provider qualifications in accordance with Regulation .04G(1) and (2) of this chapter; Demonstrate the capability and capacity of providing Autism Waiver residential habilitation services by submitting documentation of experience and a written implementation plan which includes at a minimum policies and procedures regarding: 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; Assure the provision of services in the least restrictive environment in the community that is appropriate to participants' needs; Provide documented evidence of integration of the residential habilitation program with other community-based services received by Autism Waiver participants; Document arrangements for the provision of medical services needed by participants, including helping them to get to medical appointments and to obtain services in an emergency; For initial approval and as a condition of occupancy of any facility used by the program, submit written documentation from responsible approval or licensing authorities verifying that the facility is in compliance with applicable health, fire safety, and zoning regulations; 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; Assure that the participant's needs are met for shelter, food, clothing, and furnishings; Maintain daily contact logs completed on the same day the service is provided and reflective of the individual plan’s goals and community-based activities from Regulation .11F of this chapter; and 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 residential habilitation individual plan. To provide the service covered under Regulation .15 of this chapter, the provider shall: Have at least 3 years of experience in providing habilitation services to children with autism; Employ a full-time program director, to assure adequate coordination and supervision of the covered services, who shall either: 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; Employ direct care workers who meet provider qualifications in accordance with Regulation .04E of this chapter; Employ or contract with certain professionals for consultation as needed who meet provider qualifications in accordance with Regulation .04G(1) and (2) of this chapter; Assure supervision of direct care workers by a: 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; Have at least one professional on call at all times for crisis intervention who meets provider qualifications in accordance with Regulation .04G(1) and (2) of this chapter; Demonstrate the capability and capacity of providing intensive individual support services by submitting documentation of experience and a written implementation plan which includes at a minimum policies and procedures regarding: 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; Assure the provision of services in the least restrictive environment in the community that is appropriate to a participant's needs; Provide documented evidence of integration of the covered services with other community-based services received by Autism Waiver participants; Document arrangements to obtain medical services for participants in an emergency; Provide the treatment plan to the participant's service coordinator within 30 calendar days of initiation of service, and at least annually thereafter, or more frequently if the treatment plan changes; Document goals related to transportation and the participant’s needs on the treatment plan when transportation will be provided; Maintain daily contact logs completed on the same day the service is provided and reflective of treatment plan goals and activities; and 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 intensive individual support services treatment plan. To provide one or more of the services covered under Regulation .14 of this chapter, the provider shall: Have at least 3 years of experience in providing habilitation services to children with autism spectrum disorder or other developmental disabilities; Employ a full-time program director to assure adequate coordination and supervision of the covered services, who shall: 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; Employ direct care workers who meet provider qualifications in accordance with Regulation .04E of this chapter; 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; Designate an on-site supervisor for the direct care workers who is: 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; Employ or contract with certain professionals for consultation in accordance with Regulation .04G(1) and (2) of this chapter; Have at least one professional on call at all times for crisis intervention in accordance with Regulation .04G(1) and (2) of this chapter; 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: 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; Provide documented evidence of services in the least restrictive environment in the community that is appropriate to a participant's needs; Provide documented evidence of integration of the covered services with other community-based services received by participants; Document arrangements to obtain medical services for participants in an emergency; For initial approval and as a condition of occupancy of any facility used by the program: 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; 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; 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; Maintain daily contact logs completed on the same day the service is provided and reflective of individual plan goals and activities; and 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. To provide one or more of the services covered under Regulation .14-1 of this chapter, the provider shall: Meet all the conditions of Regulation .06-1 of this chapter; and Have an on-site direct care worker for every participant receiving one-to-one intervention for intensive therapeutic integration. The respite care provider shall have adequate liability insurance and be appropriately bonded. A professional who provides respite care services or supervises a direct care worker rendering the services shall be: 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. An agency that provides respite care services shall employ direct care workers who meet qualifications in accordance with Regulation .04E of this chapter. A respite care provider shall demonstrate the capability and capacity of providing respite care services by submitting documentation of experience and a written implementation plan which includes at a minimum policies and procedures regarding: 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. Documentation of Service. 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. To provide the services covered under Regulation .17 of this chapter, a consultant shall be: 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 The provider shall have training and at least 2 years of experience, which: 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. The provider shall develop a plan with goals and interventions and submit the plan to the participant’s service coordinator within 30 calendar days of initiation of service delivery, and at least annually thereafter, or more frequently if the instructional plan changes. The provider shall demonstrate the capability and capacity of providing family consultation services by submitting documentation of experience and a written implementation plan. The provider shall maintain family contact logs completed on the same day the service is provided that are reflective of the family plan, goals and activities. The provider shall maintain and make available for review by the State, documentation of the 6-month review and update the status relative to each goal in the family plan. To provide the services covered under Regulation .18 of this chapter, the provider shall: Be the store, vendor, contractor, or builder from which the adaptation is purchased; Be able to install the adaptation, if necessary; Be able to service or maintain the adaptation, as necessary; and If construction is involved: Have the appropriate State license as a contractor or builder; and Be appropriately and adequately bonded. To provide the services covered under Regulation .19 of this chapter, the provider shall: Be an individual with a bachelor’s degree; and Have 3 years of full-time experience serving adults with autism disabilities. Adult life planning service providers shall work with the participants and the participants families to develop a treatment plan incorporating the principles of self-determination, person-centered planning, decision making, and planning for adulthood. The provider shall submit the treatment plan to the participant's service coordinator within 30 calendar days of initiation of service delivery, and at least annually thereafter, or more frequently if the plan changes. At the completion of each year of adult life planning services, the provider shall provide a report of documented evidence of progress towards self-determination, community integration, and coordination with adult services. The provider shall maintain Adult Life Planning contact logs completed on the same day the service is provided and reflective of the Adult Life Planning treatment plan goals and activities. The Program under this regulation does not cover the following: 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. The residential habilitation program shall: 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: Participant's eventual return to the family (natural, adoptive, or surrogate); or Participant to acquire the skills and resources for group or independent living; and Coordinate with the participant's educational, health, and medical service providers. A participant's placement in residential habilitation services shall be: Preauthorized by the multidisciplinary team; and Reviewed by the multidisciplinary team at least annually. Residential habilitation services shall be received in facilities located in the State which are: Licensed group homes; Licensed alternative living units; or Community-based residential facilities approved by the State Department of Education for special education services. Intensity Levels. 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: Awake overnight staffing; and At minimum, 4 hours of one-on-one staffing. Services. 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: Not include participation in activities which are solely diversional or recreational in nature; and Include: Assisting the participant with learning and practicing skills of cooperation and participation; Assisting the participant to identify and participate in activities of interest; and Providing specific training activities necessary to assist the participant to participate in activities of interest on an ongoing basis. Mobility. The residential rehabilitation program shall train, supervise, and assist the participant to: Enhance movement within the participant's living, working, or education environment; Master the use of adaptive aids and equipment; and Access and use public transportation, independent travel, or other movement within the community. 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: Planning for crises in the participant's residential habilitation placement; and Making the necessary behavioral or environmental interventions to stabilize and preserve the participant's residential habilitation placement, or resolve an intensive behavioral episode. 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: Assist with developing discharge planning goals for the participant; Assist the participant in making the transition to home, the next planned placement, or independent living; Are responsive to the participant's individualized developmental and behavioral needs; and Promote self-reliance and age-appropriate behavior. A supervisor who has been trained in accordance with Regulation .04E(3) of this chapter shall: 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. A unit of service for residential habilitation shall be on a per diem basis. Therapeutic integration services under this regulation: 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: General therapeutic and therapeutic recreational services; Behavioral management; Planning for crises with the participant during a session; Socialization groups; and One or more of art, music, dance, or activity therapies, as appropriate for participants; Shall have a supervisor who has been trained in accordance with Regulation .04E(3) of this chapter that: Trains and provides ongoing supervision to the direct care worker rendering therapeutic integration services; Supervises the direct care worker when crisis intervention services are rendered to evaluate the nature of the crisis and intervenes to reduce the likelihood of reoccurrence; Plans and regularly reviews the participant’s therapeutic activities and behavior plan; Meets regularly with the participant and family and observes the participant in the community setting; and Develops and identifies, on the individualized treatment plan, the goals, interventions, and tasks that the therapeutic integration direct care worker is implementing; Shall, when transportation is provided: Have individualized goals for transportation for the participant on the participant’s treatment plan; and Document the start and stop times transportation is provided for each day that a participant is transported; 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 community setting. 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 community setting. Intensive therapeutic integration services under this regulation: 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: General therapeutic and therapeutic recreational services; Behavioral management; Planning for crises with the participant during a session; Socialization groups; and One or more of art, music, dance, or activity therapies, as appropriate for participants; Shall have a supervisor who has been trained in accordance with Regulation .04E(3) of this chapter that: Trains and provides ongoing supervision to the direct care worker rendering therapeutic integration services; Supervises the direct care worker when crisis intervention services are rendered to evaluate the nature of the crisis and intervenes to reduce the likelihood of reoccurrence; Plans and regularly reviews the participant’s therapeutic activities and behavior plan; Meets regularly with the participant and family and observes the participant in the community setting; Develops intervention on an individualized basis and identifies the interventions on an individualized treatment plan; and Identifies, in the treatment plan, the goals and tasks that the intensive therapeutic integration direct care worker is implementing; and Shall, when transportation is provided: Have individualized goals for transportation for the participant on the participant’s treatment plan; and Document the start and stop times transportation is provided for each day that a participant is transported. 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 community setting. 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 community setting. Intensive individual support services: 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: Have individualized goals for transportation for the participant on the participant's plan; and Document the start and stop times transportation is provided for each day that a participant is transported; Are intended to: Prevent or defuse crises; Promote developmental and social skills growth; Provide the participant with behavior management skills; Give the participant a sense of security and safety; Assist the participant with maintaining self-sufficiency and impulse control; Improve the participant's positive self-expression and interpersonal communication; Improve the participant's ability to function and cooperate in the home and community; Reverse negative behaviors and attitudes; and Foster stabilization; and Include: One-on-one support, assistance, oversight, and intervention; Time-structuring activities; Immediate behavioral reinforcements; Time-out strategies; and Crisis intervention techniques. 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. A professional who meets the provider qualifications of Regulation .04G(1)(a)—(f) of this chapter shall: 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. 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. 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. Respite care: Shall consist of one-on-one interventions with the participant; Shall be rendered by a qualified: Professional who meets the qualifications in Regulation .07B of this chapter; or Direct care worker who is supervised by a qualified professional; 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. Respite care may not: 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. 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. 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. Family consultation shall be provided as specified in the family consultation plan, and: 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. A participant's family: 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. 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: 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, as appropriate. 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: Dressing; Eating; Personal hygiene; Self-administration of medications; Proper use of appliances and adaptive or assistive devices; Home safety; First aid; and Emergency procedures. 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: Assisting the participant to identify activities of interest; Arranging for participation in those activities; and Identifying specific interventions necessary to assist the participant’s involvement in those activities on an ongoing basis. Mobility. The participant’s family shall receive consultation to assist the participant with: Enhancing movement within the participant's living arrangement; Mastering the use of adaptive aids and equipment; and Accessing and using public transportation, independent travel, or other movement within the community. Money Management. The participant’s family shall receive consultation to assist the participant with: Handling personal finances; Making purchases; and Meeting personal financial obligations. Family consultation does not include activities that are not covered under §C of this regulation. 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. 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. Environmental accessibility adaptations are those physical adaptations to the participant's home, which are reasonable and medically necessary to: Prevent the participant's institutionalization; Assure: The participant's health, welfare, and safety; and A safe, therapeutic environment; Prevent the participant's self-injurious behavior; and Enable the participant to function with greater independence in the home. Environmental accessibility adaptations include: 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. The environmental accessibility adaptations shall be preauthorized in the participant's plan of care and by the State Department of Education. All construction shall: Be provided in accordance with applicable State or local building codes; and Pass the required inspections. Window locks may only be used if there is no other way to prevent a participant's rapid movement into a potentially dangerous situation. With the added safety precautions, it shall be assured that the house has enough exits, so there are not fire or safety concerns. Several rooms may be secured, but not the whole house. As appropriate, the adaptations shall be approved by the fire department or fire marshal as meeting the fire safety requirements. This service is not covered for facilities where residential habilitation services are delivered. Excluded are those adaptations or improvements to the home, such as carpeting, roof repair, and central air conditioning, which: Are of general utility; Are not of direct medical or remedial benefit to the participant; or Add to the home's total square footage. Adult life planning services shall be provided as specified in the adult life planning treatment plan. Adult life planning services shall: 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. 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. 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. The Department shall reimburse for services under this chapter when the services are: Provided to a participant who meets the qualifications for eligibility specified in Regulation .02 of this chapter; Preauthorized in the participant's plan of care by the State Department of Education and the multidisciplinary team, as being reasonable and medically necessary to prevent institutionalization; Provided by an approved provider which meets the conditions for participation of this chapter; and Rendered pursuant to: 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. Reimbursement may be made by the Program only when all of the requirements of this chapter are met. Residential habilitation services may not be reimbursed for the same date of service as intensive individual support services, therapeutic integration services, intensive therapeutic integration services, or respite care. Therapeutic integration services, intensive therapeutic integration services, and intensive individual support services under this chapter and school health-related services under COMAR 10.09.50 may not be reimbursed for the same period of the same day. Therapeutic integration and intensive therapeutic integration services may not be rendered during the same week to a participant. Therapeutic integration and intensive therapeutic integration services may include transportation time when at least 2 units of service have been provided on-site, and the maximum units of service billed may not exceed 12 units. For dates of service before July 1, 2023, 24 units; or For dates of service on or after July 1, 2023, 12 units. Environmental accessibility adaptations may be reimbursed only if preauthorized by the State Department of Education. If an environmental accessibility adaptation is anticipated to cost over $500, at least two bids or prices shall be obtained, based on which the State Department of Education may approve the purchase. The Program may reimburse for a participant not more than: For dates of service before July 1, 2023: 1 unit per date of service for residential habilitation services at either the regular or intensive level; 40 units of therapeutic integration services per week; 30 units of intensive therapeutic integration services per week; 12 units or fewer than 2 units of therapeutic integration or intensive therapeutic integration services for a date of service; 50 units of intensive individual support services per week; 48 units of respite care for a date of service; 672 units of respite care per State fiscal year; 12 units of family consultation for a date of service; 80 units of family consultation per State fiscal year; A total of $2,000 for environmental accessibility adaptations over a 36-month period; 16 units of intensive individual support services per day; 30 units of adult life planning services per State fiscal year, for participants 16 years old or older; A lifetime maximum of 90 units of adult life planning services per participant, for participants 16 years old or older; and 15 units of retainer payment per calendar year at either the regular or intensive level when the participant is absent from the residential habilitation program for the purposes of family visitation, hospitalization, or other overnight stays; or For dates of service on or after July 1, 2023: 1 unit per date of service for residential habilitation services at either the regular or the intensive level; 80 units of therapeutic integration services per week; 60 units of intensive therapeutic integration services per week; 24 units or fewer than 2 units of therapeutic integration or intensive therapeutic integration services for a date of service; 160 units of intensive individual support services per week; 96 units of respite care for a date of service; 1344 units of respite care per State fiscal year; 24 units of family consultation for a date of service; 160 units of family consultation per State fiscal year; A total of $2,104 for environmental accessibility adaptations over a 36-month period; 32 units of intensive individual support services per day; 80 units of adult life planning services per State fiscal year, for participants 14 years old or older; 16 units of adult life planning services per date of service, for participants 14 years old or older; and 15 units of retainer payment per calendar year at either the regular or intensive level when the participant is absent from the residential habilitation program for the purposes of family visitation, hospitalization, or other overnight stays. Respite services may not be reimbursed for the same period of the same day as: Residential habilitation; Intensive individual support services; Family consultation; Therapeutic integration; Intensive therapeutic integration; or Adult life planning services. The Program does not reimburse transportation costs such as gas, maintenance, or other vehicle operating expenses. Adult life planning services under this chapter and school health-related services under COMAR 10.09.50 may not be reimbursed for the same period of the day. The Program does not reimburse for any autism waiver services for a participant whose residential placement in a 24-hour, 365-day residential program is funded with non-Medicaid federal, State, or local government funds. Request for Payment. 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: Bill the Program in accordance with the payment methodology specified in §§D and E of this regulation; Accept payment from the Program as payment in full for the services covered under this chapter and make no additional charge to the participant or any other party for these services; and Submit a request for payment in a manner approved by the Program, which includes the: Date or dates of service; Participant's name and Medicaid number; Provider's name, location, and Program identification number; Type, procedure code or codes, and unit or units of covered services provided; and Amount of reimbursement requested. Documentation Required. 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. Billing time limitations for the services covered under this chapter are the same as those set forth in COMAR 10.09.36.06. 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 provider's customary charge to the general public unless the service is free to individuals not covered by Medicaid; or The rate established according to the fee schedule published by the Department. Rates. 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: Residential habilitation services and retainer payments reimbursed at one of the following all-inclusive, maximum rates for a participant: $283.69 per unit for the regular level of service; or $567.45 per unit for the intensive level of service. Therapeutic integration services reimbursed at the maximum rate of $17.19 per unit. Intensive therapeutic integration services reimbursed at the maximum rate of $21.49 per unit. Intensive individual support services reimbursed at the maximum rate of $21.49 per unit. Respite care reimbursed at the maximum rate of $16.80 per unit. Family consultation reimbursed at the maximum rates of $70.55 per unit. Adult life planning services reimbursed at the maximum rate of $70.55 per unit. Environmental accessibility adaptations reimbursed at the maximum rate of $2,104 per 36-month period amount billed by the provider, which shall be the lesser of the: Amount authorized by the State Department of Education; or Actual cost of the job. Effective July 1, 2023, the Program shall pay according to the following fee-for-service schedule: Residential habilitation services and retainer payments reimbursed at one of the following all-inclusive, maximum rates for a participant: $283.69 per unit for the regular level of service; or $567.45 per unit for the intensive level of service. Therapeutic integration services reimbursed at the maximum rate of $8.5950 per unit. Intensive therapeutic integration services reimbursed at the maximum rate of $10.7450 per unit. Intensive individual support services reimbursed at the maximum rate of $10.7450 per unit. Respite care reimbursed at the maximum rate of $8.4000 per unit. Family consultation reimbursed at the maximum rate of $35.2750 per unit. Adult life planning services reimbursed at the maximum rate of $35.2750 per unit. Environmental accessibility adaptions reimbursed at the maximum rate of $2,104 per 36-month period amount billed by the provider, which shall be the lesser of the: Amount authorized by the State Department of Education; or Actual cost of the job. Recovery and reimbursement are set forth in COMAR 10.09.36.07 and include, but are not limited to: Providing waiver services without a valid required license or appropriate credentials as required; Employing staff or consultants that do not meet conditions for participation in accordance with Regulation .04 of this chapter to provide services to waiver participants; Lacking adequate documentation of services that were billed to the Program; Submitting claims for services not authorized in the participant's plan of care; and Providing services that are not in accordance with the requirements of this chapter and other applicable regulations and law. Cause for suspension or removal and imposition of sanctions is set forth in COMAR 10.09.36.08. In addition to the sanctions specified at COMAR 10.09.36.08, the Department may limit: The number of participants served by the provider; and The number and type of services provided. Appeal procedures for providers are those set forth in COMAR 10.09.36.09. Appeal procedures for applicants and participants are those set forth in COMAR 10.09.24.13 and 10.01.04. State regulations are interpreted as set forth in COMAR 10.09.36.10. Health-General Article, §§2-104(b), 15-103, 15-105, and 15-130, Annotated Code of Maryland Effective date: July 1, 2001 (28:12 Md. R. 1108) Regulation .01C amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487) Regulation .02A, B amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741) Regulation .02B amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487) Regulation .04 amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741) Regulation .04D amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487) Regulation .05A amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741) Regulation .06 amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741) Regulation .07C amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487) Regulation .07C amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741) Regulation .08A amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487) Regulation .08A amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741) Regulation .10F, G, H amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741) Regulation .11C amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487) Regulation .12 amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741) Regulation .13 repealed as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); repealed permanently effective April 25, 2005 (32:8 Md. R. 741) Regulation .14 amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741) Regulation .15A, C amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741) Regulation .16A amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741) Regulation .21E amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487) Regulation .21F amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741) Regulation .22C amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487) Chapter revised effective August 13, 2007 (34:16 Md. R. 1432) Regulation .22D amended effective February 8, 2010 (37:3 Md. R. 176) Chapter revised effective April 19, 2010 (37:8 Md. R. 615) Regulation .01B amended effective April 16, 2012 (39:7 Md. R. 492); April 11, 2016 (43:7 Md. R. 449); May 18, 2020 (47:10 Md. R. 516) Regulation .02 amended effective April 11, 2016 (43:7 Md. R. 449) Regulation .02A amended effective September 16, 2024 (51:18 Md. R. 809) Regulation .02A, B amended effective April 16, 2012 (39:7 Md. R. 492); May 18, 2020 (47:10 Md. R. 516) Regulation .03B amended effective May 18, 2020 (47:10 Md. R. 516) Regulation .04 amended effective April 16, 2012 (39:7 Md. R. 492); April 11, 2016 (43:7 Md. R. 449); September 16, 2024 (51:18 Md. R.809) Regulation .05 amended effective April 11, 2016 (43:7 Md. R. 449) Regulation .05E amended effective October 14, 2013 (40:20 Md. R. 1652) Regulation .05Q amended effective April 16, 2012 (39:7 Md. R. 492) Regulation .06 amended effective April 11, 2016 (43:7 Md. R. 449) Regulation .06E, M amended effective April 16, 2012 (39:7 Md. R. 492) Regulation .06-1 amended effective April 11, 2016 (43:7 Md. R. 449) Regulation .06-1P amended effective April 16, 2012 (39:7 Md. R. 492) Regulation .06-2 adopted effective April 11, 2016 (43:7 Md. R. 449) Regulation .07 amended effective April 16, 2012 (39:7 Md. R. 492); April 11, 2016 (43:7 Md. R. 449) Regulation .08 amended effective April 16, 2012 (39:7 Md. R. 492); April 11, 2016 (43:7 Md. R. 449) Regulation .10A amended effective September 16, 2024 (51:18 Md. R. 809) Regulation .11E amended effective April 11, 2016 (43:7 Md. R. 449); May 18, 2020 (47:10 Md. R. 516) Regulation .11G, H adopted effective April 11, 2016 (43:7 Md. R. 449) Regulation .14 amended effective April 11, 2016 (43:7 Md. R. 449) Regulation .14B amended effective September 16, 2024 (51:18 Md. R. 809) Regulation .14C amended effective September 16, 2024 (51:18 Md. R. 809) Regulation .14G amended effective September 16, 2024 (51:18 Md. R. 809) Regulation .14-1 adopted effective April 11, 2016 (43:7 Md. R. 449) Regulation .14-1B amended effective September 16, 2024 (51:18 Md. R.809) Regulation .14-1C adopted effective September 16, 2024 (51:18 Md. R. 809) Regulation .15 amended effective April 11, 2016 (43:7 Md. R. 449) Regulation .15D amended effective September 16, 2024 (51:18 Md. R. 809) Regulation .15E adopted effective September 16, 2024 (51:18 Md. R. 809) Regulation .16C adopted effective April 11, 2016 (43:7 Md. R. 449) Regulation .16C amended effective September 16, 2024 (51:18 Md. R.809) Regulation .16D adopted effective September 16, 2024 (51:18 Md. R. 809) Regulation .17 amended effective April 11, 2016 (43:7 Md. R. 449) Regulation .17E amended effective September 16, 2024 (51:18 Md. R. 809) Regulation .17F adopted effective September 16, 2024 (51:18 Md. R. 809) Regulation .19 amended effective April 11, 2016 (43:7 Md. R. 449) Regulation .19B, C amended effective September 16, 2024 (51:18 Md. R. 809) Regulation .19D adopted effective September 16, 2024 (51:18 Md. R. 809) Regulation .21 amended effective April 11, 2016 (43:7 Md. R. 449) Regulation .21E, H amended effective May 18, 2020 (47:10 Md. R. 516); September 16, 2024 (51:18 Md. R. 809) Regulation .21J adopted effective April 16, 2012 (39:7 Md. R. 492) Regulation .22A, E amended effective November 27, 2023 (50:23 Md. R. 1004) Regulation .22D amended effective October 31, 2011 (38:22 Md. R. 1346); April 11, 2016 (43:7 Md. R. 449) Regulation .22D, E amended effective May 20, 2019 (46:10 Md. R. 486) Regulation .22E amended effective September 16, 2024 (51:18 Md. R. 809) Regulation .24 amended effective April 16, 2012 (39:7 Md. R. 492)