Sec. 10.09.61.01. Definitions

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

B. Terms Defined.

(1) "Adult Evaluation and Review Services (AERS)" means an entity within the local health department which, in accordance with the waiver, this chapter, and COMAR 10.09.30, assesses waiver applicants and participants.

(2) "Authorized representative" means a spouse, legal guardian, parent, individual with power of attorney, or other individual designated in writing to the Department, authorized concerning the applicant's or recipient's eligibility under this chapter, to:

(a) Act on an applicant's or recipient's behalf; and

(b) Assist with the application or redetermination process and in other communication with the Department.

(3) "Centers for Medicare and Medicaid Services (CMS)" means the federal agency responsible for administering Medicare, Medicaid, and several other health related programs.

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

(5) "Eligibility" means an individual's qualification for participation in the Medical Day Care Services Waiver, in accordance with the requirements of this chapter.

(6) "Eligible" means that an individual is determined to meet the requirements of this chapter for eligibility as a Medical Day Care Services Waiver participant.

(7) "Medicaid" means the Maryland Medical Assistance Program administered by the State of Maryland under Title XIX of the Social Security Act, which provides comprehensive medical and other health-related care for categorically eligible and medically needy recipients.

(8) "Medical day care" means medically supervised, health-related services provided in an ambulatory setting to medically handicapped adults, who, because of their degree of impairment, need health maintenance and restorative services supportive to their community living.

(9) "Medical Day Care Services Waiver" means the program implemented under this chapter in accordance with the CMS-approved application for this waiver and any amendments to it submitted by the Department and approved by CMS.

(10) "Multidisciplinary team" means the group consisting of members of the medical day care center’s professional staff, the participant, the participant’s authorized representative, healthcare professionals, and waiver case managers, as appropriate, that establishes and updates the participant’s service plan and plan of care.

(11) "Nursing facility" means a facility that is participating in the Maryland Medical Assistance Program as a nursing facility pursuant to COMAR 10.09.10.

(12) "Participant" means an individual who:

(a) Meets the qualifications for participation in the waiver as specified in Regulations .02 through .04 of this chapter; and

(b) Is enrolled by the Department to receive waiver services.

(13) "Plan of care" means a written plan established by the multidisciplinary team in accordance with COMAR 10.12.04.22 and based on:

(a) A medical order; and

(b) An assessment of the participant’s health status and special care requirements.

(14) "Primary care provider" means a physician, physician assistant, or nurse practitioner who is the primary coordinator of care for the participant.

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

(16) "Provider" means a facility licensed under COMAR 10.12.04 furnishing medical day care services through an appropriate agreement with the Department, and identified as a Program provider by the issuance of an individual account number.

(17) "Recipient" means a person who is certified by the Department as eligible for, and is receiving, Medical Assistance benefits.

(18) "Service plan" means an approved document which specifies the type, amount, frequency, and duration of all waiver and other Medicaid services required to safely support the waiver participant in the community.

(19) "State Plan" means a comprehensive, written commitment by a State Medicaid agency, submitted under §1902(a) of the Social Security Act, to administer or supervise the administration of the Medical Assistance Program in accordance with federal requirements.

(20) "Supplemental Security Income (SSI)" means a federally administered program providing benefits to needy aged, blind, and disabled individuals under Title XVI of the Social Security Act, 42 U.S.C. §1381 et seq.

(21) "Waiver" means the Medical Day Care Services Waiver as implemented through this chapter.

(22) "Waiver applicant" means an individual who is applying for participation in the waiver to receive the services covered under this chapter.

(23) "Waiver year" means the State fiscal year from July 1 through June 30.