# COMAR Title 10 — Maryland Department of Health

## Subtitle 22 — Developmental Disabilities

### Chapter 14 — Low Intensity Support Services (LISS) Program

**Authority:** Health-General Article, §§7-703, 7-708, 7-717, and 7-904, Annotated Code of Maryland

**Administrative History:** Effective date: July 23, 2012 (39:14 Md. R. 838)

**Administrative History:** Regulation .03B amended effective October 24, 2016 (43:21 Md. R. 1166)

**Administrative History:** Regulation .05 amended effective October 24, 2016 (43:21 Md. R. 1166)

**Administrative History:** Regulation .06 amended effective October 24, 2016 (43:21 Md. R. 1166)

**Administrative History:** Regulation .07 amended effective October 24, 2016 (43:21 Md. R. 1166)

**Administrative History:** Regulation .08 amended effective October 24, 2016 (43:21 Md. R. 1166)

**Administrative History:** Regulation .09A amended effective October 24, 2016 (43:21 Md. R. 1166)

**Administrative History:** Regulation .10 amended effective October 24, 2016 (43:21 Md. R. 1166)

**Administrative History:** Regulation .11 adopted effective October 24, 2016 (43:21 Md. R. 1166)

#### Regulation .01 Purpose.

*COMAR 10.22.14.01*

The purpose of this chapter is to establish a Low Intensity Support Services (LISS) Program in the Developmental Disabilities Administration (DDA).

#### Regulation .02 Rationale.

*COMAR 10.22.14.02*

A. The Program shall:

  (1) Assist a family to provide for the needs of a child or an adult with developmental disability living in the home; or

  (2) Support an adult with developmental disability living in the community.

B. Services shall be:

  (1) Flexible to meet the needs of individuals or families; and

  (2) Readily adaptive to changing needs.

C. The Program makes use of resources available in the community while, at the same time, building on the individual’s existing support network.

D. Services provide quick access to supports for family and individual.

#### Regulation .03 Definitions.

*COMAR 10.22.14.03*

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) “Administration” means the Developmental Disabilities Administration (DDA) under the Maryland Department of Health.

  (2) “Agency” means the selected licensed family and individual support program that administers the Program on behalf of the Administration.

  (3) “Camp” means a day camp, residential camp, travel camp, or trip camp that:

    (a) During a calendar year, accommodates seven or more campers who are unrelated to the operator;

    (b) Provides primarily recreational activities or has a substantial recreational component; and

    (c) Operates on private property or private facilities, whether leased or owned, public property, or public facilities.

  (4) “Child care” means the care or supervision for an individual, younger than 21 years old, who has a disability or other emotional, developmental, physical, educational, or medical need necessitating child care when the individual’s parent or legal guardian gives the individual’s care over to another for some portion of a 24-hour day as a supplement to the parent’s or guardian’s primary care of the child.

  (5) “Day care” means the care provided to an individual 21 years old or older, who has a disability or other emotional, developmental, physical, educational, or medical need necessitating care from an adult day care center.

  (6) “Eligible disability” means the individual has a severe chronic disability that:

    (a) Is attributable to a physical or mental impairment, other than the sole diagnosis of mental illness, or to a combination of physical and mental impairments; and

    (b) Is likely to continue indefinitely.

  (7) “Dietitian and nutritionist services” mean:

    (a) Nutrition care planning, nutrition assessment, and dietetic instruction; and

    (b) Services within the scope of practice of the nutritionist's or dietitian's license, as defined by:

      (i) Health Occupations Article, Title 5, Annotated Code of Maryland; and

      (ii) Regulations under COMAR 10.56 for the Board of Dietetic Practice.

  (8) “Health services” means services:

    (a) Provided by individuals regulated under the Health Occupations Article, Annotated Code of Maryland;

    (b) That the respective licensing Board approves as a valid treatment for the presenting problem; and

    (c) That include health assessments such as psychological, neuropsychological, dental, and speech-language assessments.

  (9) Housing Adaptations and Barrier Removals.

    (a) “Housing adaptations and barrier removals” means those physical adaptations or modifications to the individual’s or family’s home which are required to make it accessible to the individual because of the:

      (i) Physical structure of the residence; or

      (ii) Individual’s specific functional needs.

    (b) “Housing adaptations and barrier removals” may include but are not limited to:

      (i) Visual fire alarms;

      (ii) Ramps;

      (iii) Grab bars or handrails;

      (iv) Stair glides;

      (v) Widening of doorways;

      (vi) Modification of bathroom or kitchen facilities to make them physically accessible;

      (vii) Specialized electrical and plumbing systems to accommodate the medical equipment and supplies which are necessary for the individual's welfare;

      (viii) Locks, buzzers, or other devices on doorways to prevent or stop wandering; and

      (ix) Home modifications to help a individual identify the physical environment.

  (10) “Most integrated setting” means a setting that enables individuals with disabilities to interact with non-disabled persons to the fullest extent possible.

  (11) “Program” means the Low Intensity Support Services Program that the Administration operates by contracting with approved Agencies.

  (12) “Random selection process” means a system used to identify the applicants who will be considered for funding during Round 1 and Round 2 of each fiscal year, by using an automated system that does not consider the identity or any other personal aspect of the applicants.

  (13) “Services” means low intensity support services as describe in this chapter.

  (14) Specialized Equipment and Assistive Technology.

    (a) “Specialized equipment and assistive technology” means non-experimental technology or adaptive equipment which:

      (i) Enables an individual to live in the community and to participate in community activities; and

      (ii) Meets applicable standards of manufacture, design, usage, and installation.

    (b) “Specialized Equipment and assistive technology” may include:

      (i) Environmental control units for participants' homes to allow spontaneous or programmed control of household appliances and other home devices;

      (ii) Devices with web-based operating systems, software, and computer accessories that enable participants to function more independently;

    (c) Maintenance and repair of the covered assistive technology devices and equipment, as necessary;

    (d) Augmentative communication and communication-enhancement devices;

    (e) Aids for daily living and self-help aids used in activities such as eating, bathing, cooking, dressing, toileting, and home maintenance; and

    (f) Equipment needed to adapt the individual's or family's automotive vehicle for personal transportation such as:

      (i) Adaptive driving aids;

      (ii) Hand controls; and

      (iii) Wheelchair lifts, and other lifts used for personal transportation.

  (15) “Therapy” means occupational, physical, speech, or behavioral therapy that is not funded by other State funded programs or by health insurance, including the Medical Assistance Program.

  (16) “Therapeutic summer program” means a set of services designed to provide medical, behavioral, or psychological therapies, such as speech, applied behavior analysis, and occupational, through a variety of activities, in a safe environment, which are recommended by a licensed professional, and provided by clinical staff with clinical oversight.

  (17) “Usual, customary, and reasonable” means the amount paid for a service in a geographic area that is based on what providers in the area typically charge for the same or similar service, so long as that charge is reasonable.

#### Regulation .04 Setting and Location.

*COMAR 10.22.14.04*

Services shall be provided within the individual’s home or a community setting in the most integrated setting.

#### Regulation .05 Application and Eligibility.

*COMAR 10.22.14.05*

A. An individual shall submit to the Department:

  (1) The completed LISS application form;

  (2) For applicants younger than 21 years old, one of the following, demonstrating that the applicant meets the eligibility requirements for LISS:

    (a) A finalized Individual Educational Program (IEP) from the current calendar year that identifies an eligible disability and that is in effect as of the date of the LISS application; or

    (b) A statement written by a licensed physician, confirming that the individual has an eligible disability;

  (3) For applicants 21 years old or older, one of the following, demonstrating that the applicant meets the eligibility requirements for LISS:

    (a) A statement written by a licensed physician within the last 3 years, confirming that the individual has an eligible disability;

    (b) A psychological evaluation completed by a licensed professional within the last 3 years, confirming that the individual has an eligible disability;

    (c) An evaluation completed by an Occupational Therapist, a Division of Rehabilitation Services evaluator, or another licensed professional within the last 3 years, confirming that the individual has an eligible disability; or

    (d) A finalized IEP dated within 3 years after the date on which the applicant exited the school system, confirming that the individual has an eligible disability; and

  (4) Upon request of the DDA, additional written evidence demonstrating that the criteria for specific services are met.

B. Eligibility.

  (1) To be eligible for the Program, an individual:

    (a) Shall be a Maryland resident and provide proof of address for the current calendar year;

    (b) Shall have an eligible diagnosis;

    (c) Shall provide proof of identity;

    (d) May not be enrolled in any Maryland Medicaid home and community-based services waiver at the time of the random selection process, except that this restriction does not apply to applicants enrolled in the Maryland Model Waiver Program;

    (e) May be enrolled in the Rare and Expensive Case Management (REM) Medicaid Program at the time of the random selection process;

    (f) Shall submit a fully completed LISS application by the due dates established by the DDA; and

    (g) Shall be selected by the random selection process.

  (2) An individual currently receiving DDA services, other than coordination of community services, may not receive LISS funding under this chapter.

  (3) An individual who received funding in Round 1 of the random selection process may not receive funding in Round 2 in the same fiscal year, even if the entire maximum amount of $2,000 was not awarded to the individual in Round 1.

C. The agency shall approve services for an eligible individual:

  (1) Who is selected by the random selection process; and

  (2) Whose requested services, items, and providers comply with the provisions of this chapter.

#### Regulation .06 Scope.

*COMAR 10.22.14.06*

A. Services funded under this program are intended to be, and are limited to, those that:

  (1) Enhance the individual’s health or increase safety in the home environment;

  (2) Support the individual to participate in the community;

  (3) Enable the individual to remain in the individual’s own home or with the individual’s family;

  (4) Strengthen the family’s ability to support the individual; or

  (5) Enable the individual to develop and maintain skills.

B. Services funded under this program may not duplicate services available to the individual in the community, education systems, or under an existing health plan, including Medical Assistance services.

C. To be approved for funding, requested services and items:

  (1) Shall be rendered by a provider whose administrative fee does not exceed 15 percent of the total cost of the item or service;

  (2) May not be provided by a legally responsible person, as defined in Health General Article, §7-701(c), Annotated Code of Maryland;

  (3) Shall be rendered by a provider who is licensed by the State to perform the service;

  (4) Shall be received:

    (a) Except in accordance with §C(4)(b) of this regulation, within the same fiscal year as the request; and

    (b) For summer camps, summer programs, and therapeutic programs, in June of the current fiscal year, or in July and August of the following fiscal year; and

  (5) Shall be approved in accordance with this chapter.

#### Regulation .07 Covered Services.

*COMAR 10.22.14.07*

A. Services include supports involving:

  (1) Attendant care services, including personal care;

  (2) Camps that are:

    (a) Approved by the MDH in accordance with COMAR 10.16.06;

    (b) Accredited by the Maryland State Department of Education;

    (c) Accredited by the American Camping Association certification;

    (d) Approved by a State governmental entity; or

    (e) Approved by the Developmental Disabilities Administration;

  (3) Child care that is provided in accordance with COMAR 13A.15, 13A.16, and 13A.18;

  (4) Community integration services, including recreation programs;

  (5) Counseling, individual and family;

  (6) Day care provided in accordance with Health General Article, §14-201(b) or §14-301(b), Annotated Code of Maryland;

  (7) Employment-related services;

  (8) Health services, including dietetic and nutritional services;

  (9) Housing adaptations and barrier removals provided that the applicant or the applicant’s family owns the property needing the adaptation;

  (10) Identification services;

  (11) Medical equipment purchase, rental, and repair;

  (12) Recreation programs;

  (13) Respite care and approved camps;

  (14) Services to mediate, provide advice, or support the person or family to address their needs;

  (15) Specialized equipment and assistive technology;

  (16) Therapeutic services;

  (17) Therapeutic summer programs;

  (18) Training and support for self-advocacy;

  (19) Transportation.

  (20) Tuition for post-secondary academic and vocational services;

  (21) Tutoring for post-secondary academic and vocational services; and

  (22) Repairs of vehicles that have been modified or adapted with specialized equipment to meet the needs of the eligible individual.

B. The Administration may approve other services that meet the requirements of Regulation .06 of this chapter.

C. The agency approving or procuring requested dietitian and nutritionist services referenced in §A(7) of this regulation shall be sensitive to the educational background, culture, religion, eating habits, preferences, and general environment of the individual.

D. To be approved for funding, all requested medical services, and therapies:

  (1) Shall be prescribed by a professional authorized to do so under the Health Occupations Article, Annotated Code of Maryland, in the relevant field;

  (2) Shall be provided or supervised by an organization authorized to do so under the Health Occupations Article, Annotated Code of Maryland, in the relevant field;

  (3) Shall be prescribed for treatment of a specified illness or condition, or for amelioration of the symptoms of a specified illness or condition;

  (4) Shall be a treatment that is approved by the:

    (a) Respective Health Occupations licensing board; and

    (b) The Federal Drug Administration (FDA), if the FDA regulates the treatment; and

  (5) May not be:

    (a) Related to the individual’s primary or secondary education; and

    (b) Covered by the individual’s IEP.

E. To be approved for funding, all providers of housing adaptations and barrier removal services shall:

  (1) Be properly licensed or certified by the State to provide the service being rendered;

  (2) Be bonded as is legally required;

  (3) Obtain all required State and local permits;

  (4) Pass final required inspections; and

  (5) Perform all work in accordance with State and local building codes.

#### Regulation .08 Program Funding.

*COMAR 10.22.14.08*

A. The Program is not an entitlement program and does not create a right to funding.

B. Funding is not transferable, and the amount funded may not exceed the amount initially requested on the application.

C. Amount of Funding.

  (1) The agency may approve funding for an eligible individual for services up to $2,000 per fiscal year.

  (2) Requests for amounts exceeding $2,000 may not be considered.

D. The agency may not fund a request for services unless the service or support meets the requirements of this chapter.

E. Exclusions.

  (1) Treatments and therapies that are not generally accepted by the relevant scientific community may not be provided or funded.

  (2) The Program may not provide or fund the following:

    (a) Housing adaptations or improvements to an individual’s home that adds to the home’s total square footage; and

    (b) Adaptations or modifications that restrict an individual’s movement or jeopardize the individual’s welfare.

  (3) The Program may not provide or cover the following:

    (a) Cash;

    (b) Case management;

    (c) Gift cards;

    (d) Presents;

    (e) Toys, except those recommended by an individual authorized under the Health Occupations Article, Annotated Code of Maryland, for specified therapeutic purposes;

    (f) Vacations;

    (g) Vehicle gas, tires, registration fees, loan payments, insurance coverage, and penalties for violations, such as tickets and fines; and

    (h) Housing assistance, including eviction assistance, utility disconnection, and deposits.

#### Regulation .09 Appeals.

*COMAR 10.22.14.09*

A. Pursuant to Health-General Article, §7-406, Annotated Code of Maryland, and COMAR 10.22.16:

  (1) On any action or inaction of the Secretary under Regulations .01 — .08 of this chapter, other than non-selection through the random selection process, an applicant for services may request:

    (a) An informal hearing before the Secretary’s designee; and

    (b) The Secretary to review the decision of the informal hearing if that decision is not acceptable;

  (2) Informal hearings under §A(1)(a) of this regulation are conducted in accordance with COMAR 10.22.16; and

  (3) After a request for a review is made, the Secretary shall conduct the review in accordance with Title 10, Subtitle 2 of the State Government Article, Annotated Code of Maryland.

B. The Secretary may deny a request for hearing if the reason for the appeal is to contest a denial of services due to lack of available budgeted funds.

C. A person aggrieved by a final decision of the Secretary in a contested case as defined in State Government Article, §10-201, Annotated Code of Maryland, may take an appeal as allowed in State Government Article, §§10-215 and 10-216, Annotated Code of Maryland.

#### Regulation .10 Program Agencies — Eligibility and Responsibilities.

*COMAR 10.22.14.10*

A. The agency that administers the Program shall:

  (1) Be licensed under COMAR 10.22.06 as an Individual and Family Support Program;

  (2) Have been awarded a contract to administer the Program under the Administration’s competitive procurement process; and

  (3) Maintain an operational procedure manual that is approved by DDA.

B. Funding of Services. The agency shall fund services as follows:

  (1) Fund only services that meet the requirements of this chapter;

  (2) Fund services at the rates set forth in the contract;

  (3) Fund procured services based on the usual, customary, and reasonable rate for the service provided; and

  (4) Fund housing adaptations and barrier removals referenced in Regulation .07A(8) of this chapter, including the cost of the physical adaptation and associated costs for installation.

C. The agency shall deny funding if:

  (1) The applicant does not meet eligibility criteria;

  (2) The service or item requested is not permitted to be provided or funded by this chapter; or

  (3) The provider of the service does not meet the requirements of this chapter.

#### Regulation .11 Implementation Date.

*COMAR 10.22.14.11*

This chapter shall be implemented July 1, 2015.