Sec. 10.09.30.01. Definitions

A. The following terms have the meanings indicated.

B. Terms Defined.

(1) "Case management" means a service which will assist recipients in gaining access to:

(a) The full range of Medical Assistance services for which the individual is qualified; and

(b) Other needed support services such as medical, social, housing, financial, adult day care, in-home aide, and counseling.

(2) "Case manager" means a licensed registered nurse or licensed social worker, as defined in Regulation .02 of this chapter, who is employed by the STEPS provider to provide STEPS case management services and who is selected as case manager by the participant.

(3) "Comprehensive evaluation" means the determination performed by a nurse or social worker, or both, using the uniform assessment form specified by the Department, of a participant's medical, social, and functional status by:

(a) Direct observation of the participant;

(b) Contact, as appropriate, with the participant's representative; and

(c) Financial eligibility screening.

(4) "Department" means Maryland Department of Health.

(5) "Financial eligibility screening" means the determination of whether an individual qualifies financially as a STEPS participant.

(6) "Medical Assistance Program" means a program of comprehensive medical and other health-related care for indigent and medically indigent persons.

(7) "Multidisciplinary assessment" means the review of the comprehensive evaluation and establishment of a recommended plan of care by the multidisciplinary team for the participant.

(8) "Multidisciplinary team" means the group composed of the nurse and social worker and, as appropriate, the participant or legally authorized representatives, or both, the participant's physician and providers of health related services.

(9) "Nurse" means a person who is licensed as a registered nurse in the jurisdiction in which services are provided.

(10) "Participant" means:

(a) For the purposes of the STEPS comprehensive evaluation and multidisciplinary assessment, a recipient or an individual who would be able to establish financial eligibility under the Program within 6 months of admission to a nursing home and:

(i) Who is certified by the Department or its designee as requiring nursing home care under the Program pursuant to COMAR 10.09.10 or COMAR 10.09.11 or who, as determined by the STEPS provider based on the data collected in the comprehensive evaluation, requires services consistent with the Program's description of the level of care and types of services rendered in comprehensive care facilities reimbursed under the Program, including participants who would require inpatient care if community based long term care services were not available; and

(ii) Whose disabilities and needs cannot be adequately met in an episodic ambulatory care setting but who requires continuing institutional or community based long-term care services;

(b) For the purposes of STEPS case management, a recipient who:

(i) Is recommended for STEPS case management in the plan of care developed as part of the STEPS multidisciplinary assessment, because case management is considered necessary to enable the individual to gain access to services;

(ii) Chooses to receive STEPS case management;

(iii) Is not receiving the same case management services under a U.S. Department of Health and Human Services §1915(b) or §1915(c) waiver;

(iv) Does not reside in a long-term care institution; and

(v) Is not a hospital inpatient;

(11) "Plan of care" means the written long term care plan composed of a comprehensive evaluation and multidisciplinary assessment of the participant's health status including:

(a) Pertinent diagnoses;

(b) Prognosis;

(c) Functional status; and

(d) Type and frequency of services required.

(12) "Program" means the Maryland Medical Assistance Program.

(13) "Provider" means:

(a) For the purposes of the STEPS comprehensive evaluation and multidisciplinary assessment, a health services agency:

(i) Providing the STEPS comprehensive evaluation and multidisciplinary assessment through an appropriate agreement with the Department and identified as a Program provider by the issuance of an individual account number;

(ii) Employing licensed registered nurses and licensed social workers to provide the STEPS comprehensive evaluation and multidisciplinary assessment services; and

(iii) Demonstrating experience in providing assessment and evaluation services and in developing plans of care for aged and chronically ill clients; and

(b) For the purposes of STEPS case management, a health services agency:

(i) Providing STEPS case management through an appropriate agreement with the Department and identified as a Program provider by the issuance of an individual account number;

(ii) Employing qualified licensed registered nurses and licensed social workers as case managers; and

(iii) Demonstrating experience in providing case management and in implementing plans of care for aged and chronically ill clients.

(14) "Provider agreement" means a contract between the Department and the provider of STEPS specifying the:

(a) Services to be performed;

(b) Methods of operation; and

(c) Financial and legal requirements which shall be in force before Program participation.

(15) "Recipient" means a person who is certified for, and is receiving, Medical Assistance benefits.

(16) "Social worker" means a person who is in compliance with the social work licensing requirements in the jurisdiction in which services are provided.

(17) "Statewide Evaluation and Planning Services (STEPS)" means long term care evaluation and planning services including:

(a) A comprehensive evaluation;

(b) Multidisciplinary assessment including the establishment of the plan of care; and

(c) Case management.