Sec. 10.09.26.01. Definitions

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

B. Terms Defined.

(1) "Alternative living unit" means a residence that:

(a) Provides residential services for individuals who, because of developmental disabilities, require specialized living arrangements;

(b) Admits not more than 3 individuals; and

(c) Provides 10 or more hours of supervision per unit per week.

(2) "Appropriate evaluation" means the assessment of an individual by qualified developmental disabilities professionals using accepted professional standards to document the presence of a:

(a) Developmental disability as defined in Health-General Article, §7-101(e), Annotated Code of Maryland; or

(b) Severe, chronic disability that qualifies the individual for support services as defined in Health-General Article, §7-403(c), Annotated Code of Maryland.

(3) "Chronic care facility" means an institution which:

(a) Falls within the jurisdiction of Health-General Article, §19-307(a)(1)(ii), Annotated Code of Maryland; and

(b) Is licensed pursuant to COMAR 10.07.01 or other applicable standards established by the state in which the service is provided.

(4) "Day habilitation services" means a program of habilitation and health-related services which is routinely provided during the day in a community setting for a minimum of 30 hours per week, not less than 5 days per week, according to an individually designed and implemented plan of services. On one of the 5 days the program may be provided for not less than 4 hours. The habilitation program may include scheduled training or skills development activities which are conducted at sites away from the day habilitation services center.

(5) "Day habilitation services center" means a facility or a site which provides day habilitation services to individuals with developmental disabilities who do not require 24-hour inpatient care, but who, due to the degree of disability, are not capable of full-time independent living.

(6) "Department" has the meaning Maryland Department of Health as stated in COMAR 10.09.36.

(7) "Developmental Disabilities Administration (DDA)" means that agency of the Maryland Department of Health which, under Health-General Article, Title 7, is charged with the responsibility for providing services to persons who are developmentally or otherwise disabled.

(8) "Developmental disability" means a severe chronic disability of an individual that:

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

(b) Is manifested before the individual attains the age of 22;

(c) Is likely to continue indefinitely;

(d) Results in an inability to live independently without external support or continuing and regular assistance; and

(e) Reflects the need for a combination and sequence of special interdisciplinary or generic care, treatment, or other services that are individually planned and coordinated for the individual.

(9) "Environmental modifications" means physical adaptation to a community residence, when documented in the Individualized Service Plan as being necessary to make the residence accessible and to meet the needs of the waiver participant being served in that setting.

(10) "Group home" means a residence that:

(a) Provides residential services for individuals who, because of developmental disability, require specialized living arrangements;

(b) Admits at least 4 but not more than 8 individuals; and

(c) Provides 10 or more hours of supervision per home, per week.

(11) "Habilitation services" means a program which assists an individual to acquire and maintain those life skills that enable the individual to cope more effectively with the demands of the individual's own person and environment, and to raise the level of the individual's physical, mental, social, and vocational functioning including, but not limited to, programs of treatment with training in self-help, daily living, and survival skills.

(12) Home.

(a) "Home" means a house or apartment:

(i) Which is rented or owned by the waiver participant or the waiver participant's family or proponent;

(ii) Which may be held in trust for the waiver participant, or the waiver participant may be a roommate without appearing on a lease or title; and

(iii) Where the waiver participant lives with not more than two other unrelated waiver participants.

(b) "Home" does not mean a house or apartment that is owned or rented by a provider, although the provider may be a guarantor of rental or mortgage payments.

(13) "Home and Community Based Services Waiver for the Developmentally Disabled" means the document and any amendments to it submitted by the single State agency for Title XIX and approved by the Secretary of Health and Human Services which authorize the waiver of statutory requirements limiting coverage for home and community based services under the Medical Assistance Program's State Plan.

(14) "Individual family care home (IFC)" means a private, single family residence licensed by the Department which:

(a) Under supervision, provides a home for individuals with developmental disabilities in a family atmosphere; and

(b) Provides habilitation services for one to three individuals who are not related to the caregiver.

(15) "Individual Habilitation Plan (IHP)" means the written plan of specific action as specified in COMAR 10.22.05, which is developed and modified by an appropriately constituted interdisciplinary team.

(16) "Individualized Service Plan (ISP)" means the document serving as the basis for effective and efficient services coordination for the client, developed by an interdisciplinary team with the input and approval of the client, or the client's representative, as appropriate, focusing upon the broad service areas needed by the client, and recorded and managed by the client's service coordinator.

(17) "Intensive behavior management" means a specialized program designed to serve waiver participants who have been identified as having emotional disturbance or maladaptive behavior of sufficient severity to prevent or jeopardize community living.

(18) "Interdisciplinary team" means a group convened by the waiver participant's service coordinator, which meets to design effective, efficient individualized plans and programs, with membership comprised of, but not limited to, the waiver participant, the waiver participant's family or representative, the waiver participant's service coordinator, representatives of providers, individuals with various professional skills which are relevant to the needs of the waiver participant, and other human services staff.

(19) "Medical Assistance Program" has the meaning stated in COMAR 10.09.36.

(20) "Medical day care" means medically supervised, health-related services provided in an ambulatory setting to medically handicapped adults who, because of their degree of impairment, need health maintenance and restorative services supportive to their community living.

(21) "Medically necessary" has the meaning stated in COMAR 10.09.36.01.

(22) "Nursing facility" means a facility or a distinct part of a facility which is participating in the Medical Assistance Program as a nursing facility provider under COMAR 10.09.10 or 10.09.11.

(23) "Physician" means an individual licensed to practice medicine in the state in which services are provided.

(24) "Plan of care" means the written, individualized plan of care developed for a waiver participant in accordance with the requirements under COMAR 10.09.48, 10.22.09, or 10.22.11.

(25) "Program" has the meaning stated in COMAR 10.09.36.

(26) "Provider" means an agency which is licensed or certified to furnish covered services under these regulations through an appropriate agreement with the Department.

(27) "Provider agreement" means the contract between the Department and the provider specifying the services to be performed, methods of operation, financial and legal requirements which shall be in force before Program participation is allowed.

(28) "Qualified developmental disabilities professional (QDPP)" means an individual who:

(a) Is a registered nurse, physician, or an individual with a bachelor's degree in a relevant discipline which may include, but not be limited to:

(i) Occupational therapy,

(ii) Physical therapy,

(iii) Psychology,

(iv) Social work,

(v) Recreation,

(vi) Education; and

(b) Has a minimum of 1 year full-time or equivalent experience working directly with persons with an intellectual disability or other developmental disability.

(29) "Recipient" has the meaning stated in COMAR 10.09.36.

(30) "Residential habilitation services" means that training provided in a group home, alternative living unit, or individual family care home to a waiver participant which promotes skills necessary for maximum independence in daily activities of living.

(31) "Residential option services" means one or more of the services described in Regulation .08-2 of this chapter which are intended to assist eligible waiver participants, regardless of the nature and severity of their disability, to live independently and successfully in the community by assisting them to perform activities of daily living and enabling them to live in homes of their choice, receive services from providers of their choice, and take into account the use of community resources and natural supports.

(32) "Respite care" means a service for waiver participants designed to provide time-limited and temporary relief for primary informal caregivers from the ongoing responsibility of providing care for waiver participants, as well as to provide a back-up service system in the event of a crisis or emergency involving a primary informal caregiver.

(33) "Room and board" means rent or mortgage, utilities, and food.

(34) "Service coordinator" means a case management professional who is a qualified developmental disabilities professional (QDDP) selected by the client and employed by a service coordination provider under this chapter to assist the client in gaining more efficient and effective access to the service delivery system.

(35) "Services coordination" means a service that consists of the following 3 major functions that are designed to assist an individual in obtaining the needed services and programs that the individual desires in order to gain as much control over the individual's own life as possible:

(a) Planning services;

(b) Coordinating services; and

(c) Monitoring service delivery to the individual.

(36) "State residential center" means a place that:

(a) Is owned and operated by this State;

(b) Provides residential services for individuals with an intellectual disability and who, because of an intellectual disability, require specialized living arrangements; and

(c) Admits 9 or more individuals with a diagnosis of an intellectual disability.

(37) "Supported employment" means paid work in a variety of regular work settings in which persons without disabilities are employed, and which are especially designed for individuals with developmental disabilities facing severe impediments to employment due to the nature and complexity of their disabilities, irrespective of age or vocational potential.

(38) "Waiver participant" means a recipient who meets the eligibility requirements of these regulations.