The Program shall cover shift nursing services provided by an RN or LPN when: The services are more individualized and continuous than what is available under the home health program; The services are delivered to the participant in the participant's home, in school, or in other normal life activity setting or settings which occur outside the participant's home; Services are provided to a REM participant who is 21 years old or older; Services are determined medically necessary for a participant after the provider has completed an initial nursing assessment that reflects the participant’s need for an awake and alert caregiver; The participant has at least one caregiver willing and able to accept responsibility for the participant’s care when the nurse, CNA, or HHA is not available; The caregiver provides documentation of each of the following when applicable: The caregiver’s work schedule along with commuting times; The caregiver’s school attendance as defined in Regulation .02 of this chapter along with commuting times; and Emergency circumstances, as determined by the Department, including but not limited to the inability of the primary caregiver to provide care due to hospitalization or an acute debilitating illness for up to a 60-day period; Services are provided only in the absence of the willing and able caregiver during the sleeping hours and during the times documented in §A(6) of this regulation; Services are rendered in accordance with Health Occupations Article, Title 8, Annotated Code of Maryland; Sufficient documentation concerning the services provided is maintained by the RN or LPN including: Verification of the participant's receipt of services as documented by the participant's signature or the signature of the participant's witness on the provider's official forms; and Signed and dated progress notes which are reviewed monthly by the RN supervisor; The nurse's shift is limited to not more than a total of 60 hours per week or 16 consecutive hours and the nurse is off 8 or more hours before starting another shift unless otherwise authorized by the Department; Services are rendered by an RN or an LPN who is certified in cardiopulmonary resuscitation and the certification is renewed every 2 years; and Monthly supervisory visits of an RN or an LPN are: Conducted and documented by an RN supervisor; and Based on acceptable standards of practice. The Program shall cover service`s provided by a CNA or CNA-CMT when: The CNA or CNA-CMT is certified by the Maryland Board of Nursing and meets all the requirements to render services pursuant to Health Occupations Article, Title 8, Annotated Code of Maryland; The CNA-CMT has completed the training and has been certified by the Maryland Board of Nursing as a CMT; Services are of a scope that is more individual and continuous than what is available under the home health program; The services provided include but are not limited to: Assistance with activities of daily living when performed in conjunction with other delegated nursing services; or Other health care services properly delegated by an RN or an LPN pursuant to Health Occupations Article, Title 8, Annotated Code of Maryland; Services are rendered by a CNA or CNA-CMT who is certified in cardiopulmonary resuscitation and the certification is renewed every 2 years; The CNAs or CNA-CMTs shift is limited to not more than a total of 60 hours per week or 16 consecutive hours and the CNA or CNA-CMT has 8 hours or more off before starting another shift unless otherwise authorized by the Department; Sufficient documentation concerning the services provided is maintained by the CNA or CNA-CMT including: Verification of the participant's receipt of services as documented by the participant's signature or the signature of the participant's witness on the provider's official forms; and Signed and dated progress notes which are reviewed every 2 weeks by the RN supervisor; Supervisory visits are conducted and documented every 2 weeks by an RN; The services are included in the REM participant's plan of care developed by the case manager; and Services are preauthorized by the Department. The Program shall cover services provided by a HHA or HHA-CMT when: Services are provided by an unlicensed individual who meets all the conditions of participation specified by the Medicare program in 42 CFR §484.36 and Health Occupations Article, Title 8, Annotated Code of Maryland; The HHA-CMT has completed the training and has been certified by the Maryland Board of Nursing as a CMT; Services are more individualized and continuous than what is available under the home health program; The services provided include but are not limited to: Assistance with activities of daily living when performed in conjunction with other delegated nursing services; or Other health care services properly delegated by an RN or LPN pursuant to Health Occupations Article, Title 8, Annotated Code of Maryland; Services are rendered by a HHA or HHA-CMT who is certified in cardiopulmonary resuscitation and the certification is renewed every 2 years; The HHAs or HHA-CMTs shift is limited to not more than a total of 60 hours per week or 16 consecutive hours and the HHA or HHA-CMT has 8 hours or more off before starting another shift unless otherwise authorized by the Department; Sufficient documentation is maintained by the HHA or HHA-CMT including: Verification of the participant's receipt of services as documented by the participant's signature or the signature of the participant's witness on the provider's official forms; and Signed and dated progress notes which are reviewed every 2 weeks by the RN supervisor; Supervisory visits are conducted and documented every 2 weeks by an RN; The services are included in the REM participant's plan of care developed by the case manager; and Services are preauthorized by the Department.