<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".18" citation="COMAR 10.09.84.18" title_num="10" subtitle_num="09" chapter_num="84" heading="Covered Services — Items or Services that Substitute for Human Assistance.">
  <paragraph num="A.">
    <text>The program covers items or services that increase a participant’s independence or substitute for human assistance, to the extent that expenditures would otherwise be made for the human assistance.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Each item or service shall:</text>
    <paragraph num="(1)">
      <text>Be preauthorized in the participant’s plan of service as necessary to:</text>
      <paragraph num="(a)">
        <text>Prevent the participant’s institutionalization; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Ensure the participant’s health, safety, and independence;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Specifically relate to ADLs or IADLs within the approved plan of service;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Comply with policies and procedure guidance defined by the Department;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Meet necessary standards of manufacture, design, usage, and installation, if applicable;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Be provided in accordance with applicable State and local building codes and pass required inspections, if applicable; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Not be prescribed primarily to provide comfort or convenience.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Each item or service shall be confirmed by the Program as not covered for the participant by:</text>
    <paragraph num="(1)">
      <text>Medicaid under the State Plan as durable medical equipment or pharmacy services under COMAR 10.09.03, 10.09.12, or 10.09.67;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Medicare; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Any other third-party payer.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The Program covers home-delivered meals provided during meal periods that personal assistance services are not provided. Home-delivered meals shall be:</text>
    <paragraph num="(1)">
      <text>Delivered to the participant’s home;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Intended for consumption at home;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Nutritionally adequate for the participant’s age based on the Recommended Dietary Allowance (RDA) or Dietary Reference Intake (DRI), as established by the Food and Nutrition Board of the National Research Council and demonstrated by having the menus certified in writing by a physician, dietitian, or nutritionist; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>At least one-third of the RDA, DRI, or therapeutic diet requirements ordered by the participant’s physician, dietitian, or nutritionist, including any ordered nutritional supplements.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Technology that substitutes for human assistance includes:</text>
    <paragraph num="(1)">
      <text>Environmental controls for the home or automobile;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Personal computers, software, or accessories;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Augmentative communication devices;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Maintenance or repair of technology devices;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Self-help aids that assist with activities of daily living or instrumental activities of daily living; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Assessments and training in the use of assistive technology.</text>
    </paragraph>
  </paragraph>
</regulation>