<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".13" citation="COMAR 10.09.81.13" title_num="10" subtitle_num="09" chapter_num="81" heading="Specific Conditions for Provider Participation — Attendant Care Services.">
  <paragraph num="A.">
    <text>To participate in the ICS Program as a provider of attendant care services under Regulation .30 of this chapter, unless otherwise exempted under §F of this regulation, an attendant shall:</text>
    <paragraph num="(1)">
      <text>Be a participant-employed or agency-employed attendant;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Be at least 18 years old;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Be legally eligible for employment rendering attendant care services in the State;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Be able to communicate, read, write, and follow directions in English;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Be currently certified from a nationally recognized organization in the following areas:</text>
      <paragraph num="(a)">
        <text>Cardiopulmonary resuscitation; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Basic first aid;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>Receive instruction and training on the attendant care services required in the participant's plan of service from the nurse monitor before rendering services;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Be supervised by a nurse monitor in accordance with the requirements of Regulation .31 of this chapter;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Accept instruction and training from:</text>
      <paragraph num="(a)">
        <text>The participant;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The nurse monitor;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The case manager;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A treating physician;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Other involved professionals; or</text>
      </paragraph>
      <paragraph num="(f)">
        <text>A Department representative;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(9)">
      <text>Submit to a pre-employment criminal background investigation for which the individual shall:</text>
      <paragraph num="(a)">
        <text>Submit an application for a criminal history record check to the Criminal Justice Information System Office, Department of Public Safety and Correctional Services;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Direct the Department of Public Safety and Correctional Services to send the criminal history report to the Department; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Pay for the criminal history record check and report; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(10)">
      <text>Agree to submit written documentation of services rendered to each participant to the case manager on a form designated by the Department.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>To participate in the ICS Program as a provider of attendant care services under Regulation .30 of this chapter, unless otherwise exempted under §F of this regulation, an attendant may not:</text>
    <paragraph num="(1)">
      <text>Be a spouse;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Be a parent of a dependent child;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Be an individual who has full and unrestricted powers of guardianship;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Render services to any participant before being evaluated by a nurse monitor as able to:</text>
      <paragraph num="(a)">
        <text>Understand and carry out the attendant care services specified in the participant's plan of service; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Perform the required duties;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Unless meeting the conditions of §C of this regulation, have been convicted of, received a probation before judgment for, or entered a plea of nolo contendere to, a felony or any crime involving moral turpitude, drugs, or theft, or have any other criminal history that indicates behavior which is potentially harmful to participants; or</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Be listed on the Maryland Geriatric Nursing Assistants Registry or any other registry with a determination of abuse, misappropriation of property, or neglect.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>If requested by the provider applicant, the Department may waive the provisions of §B(5) of this regulation if the applicant demonstrates that:</text>
    <paragraph num="(1)">
      <text>The conviction, probation before judgment, or a plea of nolo contendere to a felony or any crime involving moral turpitude, drugs, or theft was entered more than 10 years before the date of the provider application; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The criminal history does not indicate behavior that is potentially harmful to participants.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>If required to perform any delegated nursing functions as defined in Regulation .02B of this chapter, an attendant who meets the requirements of §§A and B of this regulation, shall also:</text>
    <paragraph num="(1)">
      <text>Be certified as:</text>
      <paragraph num="(a)">
        <text>A nursing assistant in accordance with COMAR 10.39.01; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>If required to administer medications:</text>
        <paragraph num="(i)">
          <text>Certified medicine aide in accordance with COMAR 10.39.03; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Medication technician in accordance with COMAR 10.39.04;</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Be supervised by a nurse monitor; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Comply with the requirements of the Maryland Board of Nursing as set forth in COMAR 10.27.11.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>To participate in the ICS Program as an agency provider of attendant care services, a provider agency shall:</text>
    <paragraph num="(1)">
      <text>Be one of the following:</text>
      <paragraph num="(a)">
        <text>A public or private agency that has been approved by the Department of Human Services, in accordance with COMAR 07.06.14;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A Medicaid provider of:</text>
        <paragraph num="(i)">
          <text>Home health services under COMAR 10.09.04; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Personal care services under COMAR 10.09.20.03B; or</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>A residential services agency certified in accordance with COMAR 10.07.05;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Employ or contract with attendants, who meet the requirements in §§A — C of this regulation, in sufficient numbers to ensure that a qualified attendant is available to provide the attendant care services ordered in the plan of service;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Supervise each attendant who is employed by or under contract with the attendant care provider agency;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Employ or contract with licensed registered nurses to act as nurse monitors and provide nursing supervision, in accordance with Regulations .14 and .31 of this chapter;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Be available to give instructions to attendants and to answer questions during a normal working day, including having a nurse monitor available to respond to medical or health-related issues that are within the scope of the nurse's license;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Keep accurate records on each participant receiving attendant care services from the agency, which contain:</text>
      <paragraph num="(a)">
        <text>The plan of service;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Identification of each attendant providing services to the participant;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Dates and times when attendants worked;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Tasks the attendants performed;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Nurse monitors' instructions to the attendants; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Progress notes and observations on the attendant and the participant;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>Keep records and submit reports as required by the Department;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Maintain 24-hour availability by beeper for emergencies; and</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Submit written documentation of services rendered to each participant as required by the Maryland Medical Assistance Program and on a form designated by the Department.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Exemptions.</text>
    <paragraph num="(1)">
      <text>Subject to approval by the Department, participant-employed attendants may be exempted from the qualifications described at §A(2), (4), and (5) of this regulation at the request of the participant.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Providers that have been exempted from any qualification may only serve the participant or participants who have requested the exemption.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The Department may:</text>
      <paragraph num="(a)">
        <text>Grant exemptions; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Revoke exemptions for cause.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>