Code of Maryland Regulations (Last Updated: April 6, 2021) |
Title 10. Maryland Department of Health |
Part 2. |
Subtitle 09. MEDICAL CARE PROGRAMS |
Chapter 10.09.46. Home and Community-Based Services Waiver for Individuals with Brain Injury |
Sec. 10.09.46.05. Conditions for Provider Participation — General
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General requirements for participation in the Medical Assistance Program as a provider of BI waiver services are that the provider, with the exception of a medical day care provider, shall:
A. Be approved by the BHA as meeting the requirements and able to provide the services specified in this chapter;
B. Have a provider agreement in effect;
C. Meet all the conditions for participation in COMAR 10.09.36, except as otherwise specified in this chapter;
D. Have demonstrated experience in the provision of services to individuals with BI as evidenced by:
(1) Having:
(a) A history of serving individuals with brain injury for at least the past 2 years;
(b) A program of specialized services appropriate for the needs of individuals with brain injury; and
(c) Availability of licensed healthcare professionals with experiences in the provision of services to individuals with brain injury to supervise, train, or consult with program staff regarding the needs of waiver participants; or
(2) Accreditation by CARF for the provision of brain injury services;
E. Verify the licenses or credentials of all agencies and individuals who render services on the provider's behalf under this chapter, and have a copy of the licenses or credentials available for inspection;
F. Assure that direct care workers who render services under this chapter:
(1) Receive oversight from an appropriately licensed or certified health care professional; and
(2) Are determined by the provider as qualified to meet the participants' needs;
G. Provide an annual continuing education program approved by BHA for all staff working with waiver participants on the needs of individuals with BI that may include:
(1) Types of brain injury;
(2) Behavioral, emotional, cognitive, and physical changes after brain injury; and
(3) Strategies for compensation and remediation of deficits caused by a brain injury;
H. Provide services in accordance with the requirements of Regulation .04 of this chapter and all applicable federal, State, and local laws and regulations;
I. Agree to provide and bill BHA or its authorized representative for only those services covered under this chapter which have been preauthorized in the participant's waiver plan of care; and
J. Be ineligible to participate in the BI Waiver if the provider or any of its principals were previously Medicaid providers, or its principals were principals of Medicaid providers that have overpayments that remain due and owing to the Department.