Sec. 10.09.52.04-2. Covered Services — Autism Waiver Service Coordination — Specific Requirements

A. Waiver Initial Assessment.

(1) Definition. For the purposes of this section, "unit of service" means:

(a) A completed initial waiver plan of care, approved by MSDE and signed by the service coordinator, the waiver participant or the parent or parents of a minor child, and all other members of the waiver multidisciplinary team; or

(b) The provision of all other services specified in §A(2) of this regulation.

(2) The covered services shall include:

(a) Convening, coordinating, and participating on the waiver multidisciplinary team to perform the initial assessment and develop the waiver participant's initial waiver plan of care;

(b) Assisting the waiver participant or the parent or parents of a minor child with scheduling and attending the appointments required for the waiver initial assessment;

(c) Informing the representative of the MSDE of the applicant’s ineligibility for the Autism Waiver.

(d) Assuring that the waiver participant or the parent or parents of a minor child are informed and understand their rights and responsibilities related to the Autism Waiver and Medicaid;

(e) Assisting waiver participants with the waiver enrollment process specified in COMAR 10.09.56; and

(f) Assisting with completion of forms and coordinating with the Department for determination of the waiver participant's Medicaid financial and technical eligibility in a timely fashion.

B. Waiver Ongoing Service Coordination.

(1) Definition. For the purposes of this section, a monthly "unit of service" means:

(a) At least one documented monthly contact by the waiver participant's service coordinator in person, by telephone, or through written progress notes with the waiver participant or parent;

(b) A quarterly visit to the waiver participant's residence, residential program, or day program, including at least one visit to the waiver participant's residence every 12 months; and

(c) The provision of all other necessary services specified in §B(2) of this regulation.

(2) The covered services shall include, as necessary:

(a) Acting as a central point of contact relating to a waiver participant;

(b) Coordinating Autism Waiver Service Coordination with the Department and MSDE;

(c) Referring the waiver participant to the Autism Waiver providers specified in the waiver plan of care;

(d) Assisting the waiver participant with gaining access to the Autism Waiver services preauthorized in the waiver plan of care according to the type, level, amount, frequency, and duration;

(e) Assisting with coordination of the Autism Waiver service delivery;

(f) Providing the waiver participant and the parent or parents with information and direction to assist them with accessing and using successfully the Autism Waiver services preauthorized in the waiver plan of care;

(g) Maintaining contact with the waiver participant's waiver and other service providers and with the waiver participant or parent through documented home visits, office visits, school visits, telephone calls, mailings, and follow-up services as necessary;

(h) Following up to identify any problems or obstacles to the waiver participant's appropriate receipt of the Autism Waiver services specified in the waiver plan of care;

(i) Assisting to resolve any conflicts or crises in delivery of the waiver participant's Autism Waiver services which jeopardize the waiver participant's community placement or the health and safety of the waiver participant or another individual;

(j) Making minor changes to the waiver participant's waiver plan of care as necessary, without reconvening the waiver multidisciplinary team, if the change is approved by MSDE and the waiver participant's parent or parents;

(k) Assuring that the necessary documentation is maintained in the waiver participant's case file, as specified in Regulation .03B(5)(e) of this chapter;

(l) Providing MSDE with required information in the established time frame on waiver participants enrolled in or being terminated from the Autism Waiver; and

(m) Monitoring on an ongoing basis:

(i) The appropriateness of the type, level, amount, frequency, duration, and quality of the Autism Waiver services received by a waiver participant;

(ii) Whether a waiver participant's Autism Waiver services are delivered in an integrated and coordinated fashion and adequately meet the waiver participant's current needs; and

(iii) The impact of the Autism Waiver services on the waiver participant's health, safety, development, relationships with family members and other persons, home environment, educational program, quality of life, and life satisfaction.

C. Waiver Reassessment.

(1) Definition. For the purposes of this section, "unit of service" means:

(a) A completed waiver plan of care review, with revisions as necessary, which is approved by MSDE and signed by the service coordinator, the waiver participant or the parent or parents of a minor child, and all other members of the waiver multidisciplinary team; or

(b) The provision of all other services specified in §C(2) of this regulation.

(2) The covered services shall include:

(a) Convening, coordinating, and participating on the waiver multidisciplinary team at least every 12 months to review, and revise as necessary, the waiver participant's waiver plan of care;

(b) Assisting waiver participants with the waiver's eligibility redetermination process, as specified in COMAR 10.09.56;

(c) Coordinating with the Department for redetermination of the waiver participant's Medicaid financial and technical eligibility in a timely fashion;

(d) Assisting the waiver participant or the parent or parents of a minor child with completion and submission of the application forms and accompanying documentation for the Medicaid financial and technical eligibility redetermination, before the deadline established by the Department;

(e) Completing a risk assessment within 45 days of receiving notification of eligibility by the Department using the Autism Waiver Risk Assessment form;

(f) Completing a risk assessment if the participant’s status changes, to ensure the applicant can be safely maintained in a home and community-based setting utilizing Autism Waiver services; and

(g) Providing written notice to a MSDE representative of the participant’s ineligibility for the Autism Waiver.