<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".31" citation="COMAR 10.09.81.31" title_num="10" subtitle_num="09" chapter_num="81" heading="Covered Services — Nursing Supervision of Attendants.">
  <paragraph num="A.">
    <text>Definition. “Unit of service” means an hour of service rendered by a nurse monitor to a participant in the participant's home or another community-based setting.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Nursing supervision services include the following:</text>
    <paragraph num="(1)">
      <text>Development of the participant's plan for attendant care:</text>
      <paragraph num="(a)">
        <text>After consultation with the participant, family members, participant's personal physician, case manager, and other providers; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>In conformance with the participant's:</text>
        <paragraph num="(i)">
          <text>AERS evaluation;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>AERS plan of care; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Plan of service;</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Providing health-related information and training to the attendant concerning topics related to the care, or progress, of the participant, including:</text>
      <paragraph num="(a)">
        <text>The performance of the services in the participant's plan for attendant care; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Information that should be brought to the attention of the attendant care provider agency, the nurse monitor, personal physician, or case manager;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Ensuring that each attendant to be supervised by the provider meets the requirements in Regulation .13A, B, and D of this chapter;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Nursing supervision of the participant's medical condition and the care rendered by an attendant, including any delegated nursing functions performed by an attendant, in accordance with COMAR 10.27.11 and the schedule specified in §B(5) of this regulation, by reviewing the:</text>
      <paragraph num="(a)">
        <text>Participant's plan of service and specific plan for attendant care;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Interactions between the participant and the attendant;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Attendant's performance and ability to render the required services; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Participant's medical condition and need for attendant care services or for referral to other services;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Providing the necessary type and frequency of nursing supervision required in accordance with COMAR 10.27.11, with the exception of COMAR 10.27.11.04C, including visits to a participant's home or other service delivery site for observation at least every:</text>
      <paragraph num="(a)">
        <text>45 days if the attendant administers medications to the participant;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>3 months if the attendant assists the participant with self-administration of medications;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>4 months if the attendant does not administer medications or assist the participant with medication self-administration; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>At a greater frequency established by the nurse monitor due to the participant's medical condition or clinical status;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>Rendering a professional evaluation, in accordance with Regulation .13B(3) of this chapter, of a attendant's ability to carry out the participant's specific plan for attendant care; and</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Documenting an action plan to address health and safety or medical concerns, including missed nursing supervision visits, and providing a copy of the plan to the case management agency within 5 business days.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The services covered under this regulation may not include nursing services other than those services described in this regulation.</text>
  </paragraph>
</regulation>