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<regulation prefix="Regulation" num=".14" citation="COMAR 32.03.04.14" title_num="32" subtitle_num="03" chapter_num="04" heading="Mandatory and Optional Services.">
  <paragraph num="A.">
    <text>A provider shall elect to participate in either the Standard Congregate Housing Services Plan or the Individualized Congregate Housing Services Plan.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Meals.</text>
    <paragraph num="(1)">
      <text>A Standard Congregate Housing Services Plan provider shall provide at least two nutritionally balanced meals daily.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An Individualized Congregate Housing Services Plan provider shall offer a service package that includes at least one nutritionally balanced meal daily.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>All meals served to participants shall be prepared by a licensed food service establishment in an approved food preparation facility that complies with the requirements of COMAR 10.15.03.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>At least one meal a day shall be offered in a congregate setting.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>If a participant requests that a meal be delivered to the participant's apartment, the provider shall deliver it at no additional charge if the provider determines that the participant is unable to participate in a congregate meal due to a temporary mental or physical condition.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>A provider or its food service contractor shall prepare in advance a weekly menu of the meals to be serviced.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>If more than one food service contractor is retained by a provider to prepare meals for participants in a facility, the provider shall assure that menus are coordinated to avoid duplication and to maintain overall nutritional balance.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>A provider shall retain copies of weekly menus at the facility for a period of 1 year and shall have the menus available during monitoring visits conducted by the Department. If a substitution is made for an item on the approved menu, the substitution shall be documented on the menu.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>A provider shall keep a record of participants' attendance at each congregate meal provided, investigate a participant's failure to attend a meal, and document why the participant did not attend. Records of meal attendance and documentation of why a participant did not attend shall be kept for at least 3 months.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>If a provider contracts with another entity to provide meal services for the participants, the provider shall solicit competitive bids from qualified food service establishments at least once every 3 years. Competitive bidding may be waived by the Department if the meals are provided by a food service establishment that is under contract with:</text>
      <paragraph num="(a)">
        <text>The owner or management of the facility, if the provider is not the owner or manager; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The local area agency on aging to provide congregate or home-delivered meals pursuant to Title III C of the federal Older Americans Act, 42 U.S.C. §§3030e — 3030g-22.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(11)">
      <text>If a provider contracts with another entity to provide meals to participants, the provider shall arrange for participants to meet periodically with the other entity to discuss menus and other concerns.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Housekeeping and Laundry.</text>
    <paragraph num="(1)">
      <text>A provider shall provide the supplies and equipment necessary for housekeeping required by this regulation.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A provider may require that its participants provide laundry supplies and pay for the cost of operating laundry equipment to clean the participants' laundry.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>A Standard Congregate Housing Services Plan provider shall provide a minimum of 1.5 hours per week of general housekeeping and laundry services for each participant.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>A Standard Congregate Housing Services Plan provider shall clean a participant's apartment and change the bed linens at least weekly. If a temporary condition requires cleaning an apartment or changing bed linens more often than weekly in order to maintain a clean, safe, and sanitary living environment, a provider shall do so on a temporary basis.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>A Standard Congregate Housing Services Plan provider shall provide laundry services to participants at least weekly.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>An Individualized Congregate Housing Services Plan provider shall offer at least one service package that includes at least 1.5 hours per week of assistance with housekeeping and laundry.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>An Individualized Congregate Housing Services Plan provider may offer service packages that provide 3, 6, or 9 hours per week of any combination of personal assistance services and weekly housekeeping and laundry services.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Personal Assistance Services.</text>
    <paragraph num="(1)">
      <text>If a participant needs and wants personal assistance services, a Standard Congregate Housing Services Plan provider shall provide the services. At a minimum a Standard Congregate Housing Services Plan provider shall have staff available at a facility to provide 1.5 hours per week of personal assistance services for each participant at the facility.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An Individualized Congregate Housing Services Plan provider shall offer at least one service package that includes at least 3 hours of personal assistance services weekly.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Service Management.</text>
    <paragraph num="(1)">
      <text>A Standard Congregate Housing Services Plan provider shall provide service management as part of the services provided to participants.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An Individualized Congregate Housing Services Program provider shall offer at least one service package that includes service management.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Optional Services. A provider may provide:</text>
    <paragraph num="(1)">
      <text>Assistance with instrumental activities of daily living;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Assistance with arrangements for regular health care appointments;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>A service to escort a participant to a health care appointment;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Meal delivery to a participant's apartment, for a nominal fee, if:</text>
      <paragraph num="(a)">
        <text>A participant elects not to participate in the congregate meal program; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The provider has sufficient staff to provide this service;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Opportunities for individual or group activities in accordance with participants' interests, abilities, and needs;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Assistance with completing and submitting benefit applications;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Assistance with securing additional services needed;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Subject to the prior approval of the Department and in accordance with §G of this regulation, medication reminders or administration; and</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Subject to the prior approval of the Department, other services participants may need if a provider has an adequate number of staff with the qualifications necessary to provide the proposed services.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Medications.</text>
    <paragraph num="(1)">
      <text>Medication shall be self-administered by a participant unless a provider successfully demonstrates to the Department that the provider and its staff have the qualifications to offer medication reminders or administer medications.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A provider approved by the Department to offer as an optional service medication reminders may:</text>
      <paragraph num="(a)">
        <text>Remind a participant to take medication; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Provide physical assistance with opening and removing medications from a container.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>A provider approved by the Department to offer as an optional service the administration of medications shall:</text>
      <paragraph num="(a)">
        <text>Assure that staff who administer medications do so under the supervision of a registered nurse pursuant to COMAR 10.27.11;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Assure that all staff responsible for medication administration complete a Medication Administration Training Program approved by the Board of Nursing pursuant to Health-General Article, §8-6A-01(f), Annotated Code of Maryland;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Assure that every 2 years all staff responsible for medication administration complete a clinical update refresher course; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>For each participant whose medication is administered by staff of the provider, arrange for an on-site review by a delegating registered nurse at least every 45 days pursuant to COMAR 10.27.11.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>