Sec. 10.09.81.13. Specific Conditions for Provider Participation — Attendant Care Services

A. To participate in the ICS Program as a provider of attendant care services under Regulation .30 of this chapter, unless otherwise exempted under §F of this regulation, an attendant shall:

(1) Be a participant-employed or agency-employed attendant;

(2) Be at least 18 years old;

(3) Be legally eligible for employment rendering attendant care services in the State;

(4) Be able to communicate, read, write, and follow directions in English;

(5) Be currently certified from a nationally recognized organization in the following areas:

(a) Cardiopulmonary resuscitation; and

(b) Basic first aid;

(6) Receive instruction and training on the attendant care services required in the participant's plan of service from the nurse monitor before rendering services;

(7) Be supervised by a nurse monitor in accordance with the requirements of Regulation .31 of this chapter;

(8) Accept instruction and training from:

(a) The participant;

(b) The nurse monitor;

(c) The case manager;

(d) A treating physician;

(e) Other involved professionals; or

(f) A Department representative;

(9) Submit to a pre-employment criminal background investigation for which the individual shall:

(a) Submit an application for a criminal history record check to the Criminal Justice Information System Office, Department of Public Safety and Correctional Services;

(b) Direct the Department of Public Safety and Correctional Services to send the criminal history report to the Department; and

(c) Pay for the criminal history record check and report; and

(10) Agree to submit written documentation of services rendered to each participant to the case manager on a form designated by the Department.

B. To participate in the ICS Program as a provider of attendant care services under Regulation .30 of this chapter, unless otherwise exempted under §F of this regulation, an attendant may not:

(1) Be a spouse;

(2) Be a parent of a dependent child;

(3) Be an individual who has full and unrestricted powers of guardianship;

(4) Render services to any participant before being evaluated by a nurse monitor as able to:

(a) Understand and carry out the attendant care services specified in the participant's plan of service; and

(b) Perform the required duties;

(5) Unless meeting the conditions of §C of this regulation, have been convicted of, received a probation before judgment for, or entered a plea of nolo contendere to, a felony or any crime involving moral turpitude, drugs, or theft, or have any other criminal history that indicates behavior which is potentially harmful to participants; or

(6) Be listed on the Maryland Geriatric Nursing Assistants Registry or any other registry with a determination of abuse, misappropriation of property, or neglect.

C. If requested by the provider applicant, the Department may waive the provisions of §B(5) of this regulation if the applicant demonstrates that:

(1) The conviction, probation before judgment, or a plea of nolo contendere to a felony or any crime involving moral turpitude, drugs, or theft was entered more than 10 years before the date of the provider application; and

(2) The criminal history does not indicate behavior that is potentially harmful to participants.

D. If required to perform any delegated nursing functions as defined in Regulation .02B of this chapter, an attendant who meets the requirements of §§A and B of this regulation, shall also:

(1) Be certified as:

(a) A nursing assistant in accordance with COMAR 10.39.01; or

(b) If required to administer medications:

(i) Certified medicine aide in accordance with COMAR 10.39.03; or

(ii) Medication technician in accordance with COMAR 10.39.04;

(2) Be supervised by a nurse monitor; and

(3) Comply with the requirements of the Maryland Board of Nursing as set forth in COMAR 10.27.11.

E. To participate in the ICS Program as an agency provider of attendant care services, a provider agency shall:

(1) Be one of the following:

(a) A public or private agency that has been approved by the Department of Human Services, in accordance with COMAR 07.06.14;

(b) A Medicaid provider of:

(i) Home health services under COMAR 10.09.04; or

(ii) Personal care services under COMAR 10.09.20.03B; or

(c) A residential services agency certified in accordance with COMAR 10.07.05;

(2) Employ or contract with attendants, who meet the requirements in §§A-C of this regulation, in sufficient numbers to ensure that a qualified attendant is available to provide the attendant care services ordered in the plan of service;

(3) Supervise each attendant who is employed by or under contract with the attendant care provider agency;

(4) Employ or contract with licensed registered nurses to act as nurse monitors and provide nursing supervision, in accordance with Regulations .14 and .31 of this chapter;

(5) Be available to give instructions to attendants and to answer questions during a normal working day, including having a nurse monitor available to respond to medical or health-related issues that are within the scope of the nurse's license;

(6) Keep accurate records on each participant receiving attendant care services from the agency, which contain:

(a) The plan of service;

(b) Identification of each attendant providing services to the participant;

(c) Dates and times when attendants worked;

(d) Tasks the attendants performed;

(e) Nurse monitors' instructions to the attendants; and

(f) Progress notes and observations on the attendant and the participant;

(7) Keep records and submit reports as required by the Department;

(8) Maintain 24-hour availability by beeper for emergencies; and

(9) Submit written documentation of services rendered to each participant as required by the Maryland Medical Assistance Program and on a form designated by the Department.

F. Exemptions.

(1) Subject to approval by the Department, participant-employed attendants may be exempted from the qualifications described at §A(2), (4), and (5) of this regulation at the request of the participant.

(2) Providers that have been exempted from any qualification may only serve the participant or participants who have requested the exemption.

(3) The Department may:

(a) Grant exemptions; and

(b) Revoke exemptions for cause.