Sec. 10.09.46.01. Definitions

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

B. Terms Defined.

(1) “Applicant” means an individual who is applying as a participant in the BI waiver.

(2) “Behavior intervention” means services designed to assist individuals who exhibit challenging behaviors in acquiring skills, gaining social acceptance, and becoming full participants in the community, consistent with behavior support services program service plans set forth in COMAR 10.22.10.

(3) “Behavioral Health Administration (BHA)” means the administration of the Department that:

(a) Is charged with the responsibility for providing services to individuals with behavioral health conditions as defined by Health-General Article, Title 10, Annotated Code of Maryland;

(b) Is designated as the State’s lead agency for service delivery to individuals with brain injury; and

(c) Manages the BI waiver, in collaboration with the Program and in accordance with a memorandum of agreement signed with the Program.

(4) “Brain injury (BI)” means an insult to the brain caused by an external or internal mechanism that occurs after birth and is not related to congenital or degenerative disease, which results in cognitive, physical, behavioral, or emotional disability that is documented in the medical record.

(5) “CARF” means the Commission on Accreditation of Rehabilitation Facilities, a nonprofit accrediting body which promotes quality, value, and optimal outcomes of services through a consultative accreditation process that centers on enhancing the lives of individuals receiving services.

(6) Case Management.

(a) “Case management” means the services provided by a case manager who assists an individual in gaining access to needed medical, social, educational, and other services.

(b) “Case management” includes assessment, referral, coordination, and monitoring of the plan of care.

(7) “Case manager” means an individual who provides administrative case management services for BI waiver participants.

(8) “Day habilitation” means assistance with acquisition, retention, or improvement in self-help, socialization, and adaptive skills which takes place in a nonresidential setting, separate from the home or facility in which the individual resides, normally furnished 4 or more hours per day.

(9) “Department” means the Maryland Department of Health as stated in COMAR 10.09.36.01B, or its authorized agents acting on behalf of the Department.

(10) “Eligible individual” means an individual who is determined to meet the qualifications for participation in the BI waiver as specified in Regulation .03 of this chapter.

(11) “Health care professional” means an individual who is licensed and authorized by the Health Occupations Article to provide the health service for which the individual is privileged.

(12) “Home and community-based services waiver for individuals with brain injury (BI waiver)” means the program implemented under this chapter.

(13) “Individual support services (ISS)” means individual supports provided to a participant to support independence in the participant’s own home or community.

(14) “Medical day care” means medically supervised, health-related services provided in an ambulatory setting to medically handicapped individuals who, due to their degree of impairment, need health maintenance and restorative services supportive to their community living in accordance with COMAR 10.09.07.

(15) “Nursing facility level of care” means an assessment that an individual needs the level of services provided in a nursing facility, as defined in COMAR 10.09.10.01.

(16) “Participant” means an eligible individual who is enrolled in the BI Waiver.

(17) “Program” means the Medical Assistance Program, as stated in COMAR 10.09.36.01B, which exercises administrative discretion in the administration and supervision of the BI waiver and issues policies, rules, and regulations related to the BI waiver.

(18) “Provider” means an individual or an agency that:

(a) Is approved by the BHA and the Program as meeting the conditions for waiver participation specified in Regulations .05 and .06 of this chapter; and

(b) Has enrolled with the Program to provide one or more of the waiver services described under Regulations .07-.09 of this chapter.

(19) “Provider agreement” means a contract between the Program and a provider to provide services to waiver participants.

(20) “Residential habilitation” means assistance with acquisition, retention, or improvement in skills related to activities of daily living and the social and adaptive skills necessary to enable the individual to live in a noninstitutional setting.

(21) “Room and board” means rent or mortgage, utilities, maintenance, furnishings, and food, which are provided in or associated with an individual's place of residence.

(22) “State Plan” means a comprehensive, written commitment by a State Medicaid agency, submitted under §1902(a) of Title XIX of the Social Security Act and approved by the federal Centers for Medicare and Medicaid Services, to administer or supervise the administration of the Medical Assistance Program in accordance with federal requirements.

(23) “Supported employment” means activities needed to support paid work by individuals receiving waiver services, including supervision and training.

(24) “Utilization control agent” means the organization responsible for reviewing services to determine medical necessity according to professional standards and for conducting patient assessments.

(25) “Waiver plan of care” means a participant's written, individualized care plan as specified in Regulation .04 of this chapter.