# COMAR Title 10 — Maryland Department of Health

## Subtitle 09 — Medical Care Programs

### Chapter 84 — Community First Choice

#### Regulation .23 Limitations.

*COMAR 10.09.84.23*

A. Reimbursement for Personal Emergency Response System is limited to participants who:

  (1) Live alone; or

  (2) Have no regular caregiver for extended parts of the day and would otherwise require extensive routine supervision to ensure the participant’s health and safety.

B. The Department shall establish a budget for personal assistance services and home-delivered meals that may be included in the participant’s plan of service, based on each participant’s assessed need.

C. The Program does not cover the following services:

  (1) Service primarily for the purpose of housekeeping unrelated to the participant’s activities of daily living, such as:

    (a) Cleaning of the floor and furniture in areas not occupied by the participant;

    (b) Laundry other than that incidental to services for the participant; and

    (c) Shopping for groceries or household items unless in the company of the participant;

  (2) Services provided by providers not approved for participation by the Department;

  (3) Expenses incurred while escorting participants:

    (a) To obtain medical diagnosis or treatment;

    (b) To or from the participant’s workplace; or

    (c) For participation in social or community activities;

  (4) Expenses related to room and board for either the participant or the worker;

  (5) Transition services more than 60 days post transition;

  (6) Personal assistance services provided outside the State for more than 30 days per calendar year;

  (7) Environmental adaptations to the home which:

    (a) Are of general maintenance, such as carpeting, roof repair, and central air conditioning;

    (b) Are not of direct medical or remedial benefit to the participant;

    (c) Add to the home’s total square footage; or

    (d) Modify the exterior of the home, other than the provision of ramps, lifts, sidewalks necessary to utilize a ramp or lift, and railings; or

  (8) Experimental technology or equipment.

D. Payment for supports planning and nurse monitoring services shall be limited to direct services to the participant and may not be made for:

  (1) Administrative overhead;

  (2) Travel;

  (3) Internal quality monitoring activities;

  (4) Staff supervision, training, or consultation; or

  (5) Services rendered by an individual supports planner or nurse monitor in excess of 7 hours per day unless preauthorized by the Department in writing.

E. Payment for environmental adaptations and technology that substitutes for human assistance is limited to a combined reimbursement of up to $15,000 over a 3-year period per participant.

F. For technology items or services above $1,000, multiple quotes from providers are required.