Sec. 10.09.53.03. Conditions for Participation

Requirements for participation for nursing services are that a provider shall:

A. Meet the general Medical Assistance provider requirements as specified in COMAR 10.09.36.03;

B. Be licensed as a:

(1) Residential service agency under COMAR 10.07.05; or

(2) Home health agency under COMAR 10.07.10;

C. Have on staff at least one registered nurse supervisor who:

(1) Provides and documents initial direction to the participant's caregivers and assigned nurse, CNA, or HHA regarding the provision of nursing services to the participant;

(2) Documents that each assigned nurse, CNA, or HHA providing home care services has the necessary skills to meet the participant's needs including knowledge of any medical equipment in use by the participant;

(3) Conducts and documents a monthly review of the progress notes to assure adequacy and quality of care;

(4) Makes supervisory visits in the participant's home or another site where the participant is receiving nursing services and regularly evaluates the assigned nurse’s performance of the nursing services in accordance with COMAR 10.27.09 and 10.27.10;

(5) Makes supervisory visits in the participant's home or another site where the participant is receiving CNA or HHA services and regularly evaluates their performance of the delegated nursing tasks in accordance with COMAR 10.27.11;

(6) Completes a note after each supervisory visit that becomes part of the participant's file;

(7) Provides and documents training to the participant's caregiver or caregivers and the individual or individuals providing backup to the caregiver or caregivers; and

(8) Develops an initial nursing care plan which is reevaluated 30 days after the initial assessment and modified as necessary to meet the participant's nursing needs;

D. Ensure that each nurse, CNA, or HHA rendering services to a participant:

(1) Has a valid, nontemporary, nursing license or certification to provide nursing, CNA, or HHA services in the jurisdiction in which services are rendered;

(2) Has completed a skills checklist and demonstration of competency on an annual basis that was observed, documented, and verified by the signature of the RN supervisor or an RN designated by the supervisor;

(3) Demonstrates to the provider's nurse supervisor sufficient specialized training and experience to deliver the level of service required by each participant to whom the nurse, CNA, or HHA renders direct care;

(4) Demonstrates to the provider's nurse supervisor, on a continuing basis, the ability to carry out competently the services specified in a participant's care plan, subject to review by the Department or its designee;

(5) Participates in the multidisciplinary team process, if appropriate, including attending team meetings, for children receiving home and community-based services under COMAR 10.09.27, and renders services in accordance with the plan of care recommended by the team and approved by the Department or its designee, including any subsequent revisions to that plan;

(6) Is currently certified in cardiopulmonary resuscitation (CPR) at the time services are rendered;

(7) Provides care and services in accordance with generally accepted nursing practices;

(8) Knows how to contact the provider and the registered nurse supervisor;

(9) Provides care according to the provider's policies for the delivery of services to participants as described in §E of this regulation;

(10) Has not been convicted of, received a probation before judgment for, or entered a plea of nolo contendere to a felony of any crime involving moral turpitude or theft, or have any other criminal history that indicates behavior which is potentially harmful to participants; and

(11) If a CNA or HHA, has completed the training and been certified by the Maryland Board of Nursing as a CMT;

E. Develop policies for the delivery of services to participants, including policies on the following:

(1) Skill assessments;

(2) Emergency procedures;

(3) Administration of drugs, including controlled substances;

(4) Clinical record maintenance;

(5) Job description and educational qualifications of all staff members;

(6) Clinical management;

(7) Infection control procedures;

(8) Disposal of biomedical waste;

(9) Maintenance of equipment;

(10) Supervision, including appropriate frequencies of direct supervision;

(11) Staffing and scheduling, including contingency plans for care of the participant in the absence of the caregiver, assigned nurse, CNA, or HHA;

(12) A quality assurance program;

(13) Procedures for resolution of complaints; and

(14) Coordination of care, when appropriate, including:

(a) Delineation of service responsibilities when other service providers are involved in a participant's care;

(b) Notification to participants of each service provider's responsibilities in these instances; and

(c) Development of a discharge plan when the participant, the participant's legal representative, or the provider terminates care;

F. Conduct a reference check on each nurse, CNA, or HHA rendering care to a participant consisting of:

(1) A documented face-to-face interview between agency representatives and the nurse, CNA, or HHA;

(2) Documented efforts at verification of past employment history; and

(3) A criminal background check to include, when caring for a child, an application for a child care criminal history record check to the Criminal Justice Information System Central Repository, Department of Public Safety and Correctional Services, in accordance with Family Law Article, §5-561, Annotated Code of Maryland;

G. Maintain a personnel folder at the agency's business office for each nurse, CNA, and HHA which shall include the following:

(1) Verification of current nursing license or certification;

(2) A copy of the current CPR certification;

(3) Documentation related to:

(a) The face-to-face interview;

(b) Verification that any nurse who serves a participant younger than 19 years old has past employment which shall include at least 1 year of clinical experience which includes pediatric direct patient care within the last 3 years; and

(c) Verification of the CNA or HHA’s past employment which shall include at least 1 year of clinical experience within the last 3 years;

(4) Written verification of a criminal background check; and

(5) Documentation of a completed skills checklist signed and dated by the registered nurse supervisor or the registered nurse supervisor designee and the assigned nurse, CNA, or HHA;

H. Provide the participant or the participant's caregiver with the following written information:

(1) Name and phone number of the provider's contact person; and

(2) Name of each nurse, CNA, or HHA assigned by the provider to render services to the participant;

I. Provide a mechanism for the timely investigation of written complaints such that:

(1) Disruption of service does not result from the filing of a complaint;

(2) Complete files are maintained on the source, category, and disposition of the complaint;

(3) A summary report of the complaint investigation is made available to the Department or the Department's designee;

(4) A summary report of the complaint investigation is made available for public inspection, upon request; and

(5) When a complaint investigation is not conducted, reasons are documented and forwarded with the complaint to the Department or the Department's designee;

J. Provide back-up services when the assigned nurse, CNA, or HHA is unable to provide the services;

K. Ensure a nurse, CNA, or HHA is not scheduled to work for more than a total of 60 hours per week or 16 consecutive hours and that the individual is off 8 or more hours before starting another shift unless otherwise authorized by the Department;

L. Demonstrate on a continuing basis the capacity to provide services to participants in the amount and level required in the participant's care plan including the development of a contingency plan to assure coverage;

M. Provide the participant or the participant's representative with:

(1) At least 14 days written notice of termination of services when it is the provider's decision to terminate and the medical condition remains unchanged; and

(2) A copy of a developed discharge plan if the participant, the participant's representative, or the provider elects to discontinue the provider's services to the participant;

N. Ensure that each nurse, CNA, or HHA rendering services to a participant:

(1) Completes a progress note for each shift which becomes part of the participant's permanent record;

(2) Is providing services which follow the participant's care plan; and

(3) Is providing services ordered by the participant's primary medical provider before the start of care and renewed every 60 days as indicated by the participant’s primary medical provider’s signed and dated orders;

O. Maintain sufficient documentation to demonstrate that the requirements of this chapter are met.