The Attendant Care Program provides financial reimbursement to assist individuals with severe chronic or permanent physical disabilities who require attendant care services or ongoing additional supports to direct their own care and select their own service providers. Reimbursement may be available for attendant care services or ongoing additional supports that are provided in the home, school, workplace, or other community locations. In this chapter, the following terms have the meanings indicated. Terms Defined. “Annual adjusted gross income” means the total taxable and nontaxable annual income, less 100 percent of total unreimbursed medical expenses as defined by COMAR 07.03.17.33, of: The eligible applicant; and The applicant's spouse. “Applicant” means an individual who has submitted an application to participate in the Program in order to receive reimbursement of the cost of attendant care services or ongoing additional supports. “Attendant” means an individual or provider agency who provides attendant care services to a participant. “Attendant care agreement” means a written agreement developed by the Department that: Provides: The effective date for reimbursable services; and The terms for reimbursement under the Program; and Is signed by the participant and the Program Director at the time of initial enrollment and at the request of the Program Director if any circumstances change for the individual or the program. “Attendant care services” means any of the following services for an individual, which are deemed necessary by an attending physician or by a registered nurse or certified nurse practitioner serving the individual including: Activities of daily living such as: Dressing; Preparing food and assisting with eating; Bathing and personal hygiene; Assisting with routine bodily functions, including bowel and urinary care; and Moving into, out of, or turning in bed; or Instrumental activities of daily living such as: Laundering and other clothing care; Cleaning house; and Performing other services of daily care, including shopping and transportation. “Attending physician” means an individual who is authorized to practice medicine in this State and who has provided medical treatment to an applicant. “Certification of service form” means a document designated by the Department that verifies the participant's receipt of attendant care services for billing purposes. “Department” means the Department of Disabilities. “Duplicative services” means comparable care services or ongoing additional supports provided through any other federal or State assistance programs, such as but not limited to the programs described in COMAR 07.06.12, 10.09.04, or 10.09.20. “Episodic” means when an impairment or medical condition varies in frequency, intensity and duration and renders the person unable to engage in major life activities when onset. “Financial assistance” means reimbursement by the Department of the eligible percentage of the cost paid by a participant for attendant care services or ongoing additional supports. “Fiscal payment schedule” means the list of 12 1-month periods, established annually by the Program Director, in which Attendant Care Program benefits are provided, and participants are required to submit certification of service forms and receipts for reimbursement processing. “Home visit” means a visit by the Program Director or designee to the home of the Program participant. “Ongoing additional supports” means a continual support that increases an eligible individual’s independent performance of an essential activity of daily living, self-care, or mobility, and is requested by a Participant and approved by the Department. “Participant” means an eligible and enrolled individual in the Program. “Permanent physical disability” means a medical condition that substantially affects an individual's ability to perform physical activities such as walking, standing, transferring, seeing, or hearing. “Program” means the Attendant Care Program. “Program Director” means the individual designated by the Secretary to oversee the day-to-day operations of the Program. “Review of financial or programmatic eligibility” means initiating verification that the participant remains eligible within 1 calendar year since the completion of the most recent review or more frequently if requested by the Department or the individual. “Severe chronic disability” means a recurring medical condition that substantially limits an individual's mobility or ability to perform activities of daily living, instrumental activities of daily living, or self-care: Permanently; or On an ongoing basis or episodically, as defined by Regulation .02B(10) of this chapter. “Sliding reimbursement scale” means the percentage breakdown of maximum financial assistance afforded to a Program participant based upon adjusted gross income and household size. “Standard assessment of functional capability” means the document designated by the Department to evaluate an applicant's: Ability to perform essential activities of daily living and self-care; Mobility; Need for assistance with instrumental activities of daily living; and Need for attendant care services or ongoing additional supports. “Receipts” means proof of payment made for an approved service designated by the Department. To be eligible for the Program, an applicant: Shall be a resident of Maryland; Shall be at least 18 years old and younger than 65 years old at the time of initial enrollment in the Program; Shall be determined by the applicant's attending physician, registered nurse, or certified nurse practitioner to have a severe chronic or permanent physical disability that: Precludes or impairs the independent performance of essential activities of daily living, instrumental activities of daily living, self-care, or mobility as determined by the standard assessment of functional capability form; and Is subject to eligibility review at a frequency determined by the Department; May not have an annual adjusted gross income greater than $119,999.00; May not be receiving duplicative services as defined in Regulation .02B of this chapter; Shall meet the requirements of Regulation .04B(1) or (2) of this chapter; and Shall agree to abide by the Program requirements by signing an attendant care agreement form at the time of initial enrollment and at the request of the Program Director if any circumstances change for the individual or the Program. The Program Director, or designee, shall initiate an annual review of financial or programmatic eligibility for each participant at least once every 12 months from completion of the last review, or more frequently if needed. Participation in the Program may be denied to eligible applicants in accordance with Regulation .04 of this chapter. The Program Director shall limit Program participation to the number of participants whom the Program's budget can serve. If sufficient funds are not available, the Department may limit the rate of payment under the sliding reimbursement scale. The Program Director shall limit Program participation to achieve the following demographic: At least 50 percent of the participants shall be: Self-employed or competitively employed with compensation; Actively seeking employment and reasonably be expected to become employed within 6 months of the date of application approval, which the Program Director may extend once for an additional 6 months; or Attending an institution of postsecondary, higher education, or apprenticeship training program; and Not more than 50 percent of the participants shall be: At risk of placement in a nursing home, as certified by the attending physician, if attendant care services are not received in the community; or Residents of a nursing facility or similar institution who are seeking to transition into the community and will be capable of living in the community if attendant care services are received. The Program Director shall seek to achieve the demographic in §B absent a limited or situational waiver from the Secretary. Notwithstanding the above, an applicant found ineligible or properly disenrolled from the Program shall be required to observe a waiting period prior to reapplication of not less than: 1 year for reason of disability or financial eligibility; or 3 years upon a finding of fraud or misuse of program funds. Applicants to the Program shall be encouraged to complete an application for medical assistance and utilize personal care services under the following programs, if applicable: Examples of such services or programs include: Community Personal Assistance Services; Community First Choice Program; or A Home and Community-Based Waiver. The Program is entitled to evaluate whether such services are duplicative. An applicant shall apply for financial assistance by submitting a completed and signed Program application, to include the standard assessment of functional capability, to the Department. The Program Director or designee shall determine an applicant's eligibility in accordance with Regulation .03 of this chapter and the regulations governing this Program as a whole. The Program Director shall approve applications and enroll eligible applicants for financial assistance based upon the availability of Program funds. Waiting List. The Program Director shall establish a waiting list of eligible applicants if: Program funds are not available; or The demographics of the Program do not meet the requirements under Regulation .04B of this chapter. As funds allow, the Program shall enroll applicants on the waiting list generally in the following order: Individuals meeting the criteria under Regulation .04B(1) of this chapter in order of the earlier application approval date; and Individuals meeting the criteria under Regulation .04B(2) of this chapter in order of the earlier application approval date. With the explicit written consent of the Secretary, and after obtaining a waiver of the proportionality requirement set forth in Regulation .04B(1) of this chapter as necessary, in limited emergency circumstances, the Program Director may prioritize certain individuals meeting the criteria under Regulation .04B(2)(a) of this chapter before other individuals meeting the criteria under .04B(2)(a) of this chapter. A participant shall submit a signed certification of service form and receipts for attendant care services or ongoing additional supports in accordance with the Program's fiscal payment schedule. Reimbursement shall be made in compliance with the attendant care agreement and Regulation .04A of this chapter. The Department may return improperly completed forms to the participant without making payment. The Department may return the certification of service form to the participant without making payment if more than 2 months have passed since the date of service. The Department reserves the right to deny reimbursement of expenses that it determines are not representative of ongoing additional supports or attendant care services. A participant shall: Select, hire, train, supervise, terminate, and pay the attendant, including payment of applicable federal and State employment taxes; Maintain accurate records of hours and days that attendant care services are provided; Prepare and submit all billing forms in accordance with the Fiscal Payment Schedule; Reimburse the Department for any overpayment; Reimburse the Department for any outstanding advanced payment; Submit all required documentation to determine continued eligibility for participation in the Program at least once every 12 months, or more often as requested by the Program Director; and Comply with the attendant care agreement requirements, and provide a signed copy to the Department at the initial eligibility determination and at the request of the Department at any time thereafter. A participant shall employ an attendant who is 18 years old or older, and who is not a spouse or the representative payee of the participant. A participant shall notify the Program Director within 14 days of any changes in circumstances that affect eligibility for the Program for financial assistance Pursuant to Human Services Article, §1-201, Annotated Code of Maryland, the Program may not release information about a participant or an applicant. The Department shall establish a quality assurance plan to review Program administration and ensure compliance with this chapter. Home visits may be conducted as a part of the quality assurance plan. The Secretary of the Department or a designee of the Secretary may terminate enrollment if: A participant no longer meets the eligibility requirements; A participant refuses to comply with the requirements of this chapter; or Sufficient Program funds are not available. The Program Director shall establish a sliding reimbursement scale to determine a participant's reimbursement rate. The participant's reimbursement rate shall be based on: The participant's adjusted annual gross income; The number of persons dependent on household income including the participant's spouse, and minors younger than 18 years old; and The participant's cost of attendant care services. A participant eligible in the category set forth in Regulation .04B(1) of this chapter shall pay a minimum of 2 percent of the cost of attendant care services, unless the Program Director determines that the minimum copayment causes the participant financial hardship and issues a written waiver of the copayment. A participant eligible in the category set forth in Regulation .04B(2) of this chapter shall pay a minimum of 5 percent of the cost of attendant care services, unless the Program Director determines that the minimum copayment causes the participant financial hardship and issues a written waiver of the copayment. An applicant or participant may appeal eligibility and termination determinations by requesting an appeal hearing which shall be held in accordance with COMAR 28.02.01. If the Program notifies an applicant or participant of an action to deny, delay, suspend, reduce, or terminate assistance, the Program Director or designee shall give written notification of the right to appeal and the procedures for requesting an appeal hearing to the applicant or participant. Human Services Article, §§7-401—7-406, Annotated Code of Maryland Effective date: September 21, 2009 (36:19 Md. R. 1437) Regulation .02B amended effective August 18, 2014 (41:16 Md. R. 947) Regulation .03A, B amended effective August 18, 2014 (41:16 Md. R. 947) Regulation .04C,D, E adopted effective August 18, 2014 (41:16 Md. R. 947) Regulation .09A amended effective August 18, 2014 (41:16 Md. R. 947) Regulation .13C amended effective August 18, 2014 (41:16 Md. R. 947) Regulation .13D adopted effective August 18, 2014 (41:16 Md. R. 947) Chapter revised effective August 18, 2025 (52:16 Md. R. 848)