Sec. 10.09.81.31. Covered Services — Nursing Supervision of Attendants

A. Definition. "Unit of service" means an hour of service rendered by a nurse monitor to a participant in the participant's home or another community-based setting.

B. Nursing supervision services include the following:

(1) Development of the participant's plan for attendant care:

(a) After consultation with the participant, family members, participant's personal physician, case manager, and other providers; and

(b) In conformance with the participant's:

(i) AERS evaluation;

(ii) AERS plan of care; and

(iii) Plan of service;

(2) Providing health-related information and training to the attendant concerning topics related to the care, or progress, of the participant, including:

(a) The performance of the services in the participant's plan for attendant care; and

(b) Information that should be brought to the attention of the attendant care provider agency, the nurse monitor, personal physician, or case manager;

(3) Ensuring that each attendant to be supervised by the provider meets the requirements in Regulation .13A, B, and D of this chapter;

(4) Nursing supervision of the participant's medical condition and the care rendered by an attendant, including any delegated nursing functions performed by an attendant, in accordance with COMAR 10.27.11 and the schedule specified in §B(5) of this regulation, by reviewing the:

(a) Participant's plan of service and specific plan for attendant care;

(b) Interactions between the participant and the attendant;

(c) Attendant's performance and ability to render the required services; and

(d) Participant's medical condition and need for attendant care services or for referral to other services;

(5) Providing the necessary type and frequency of nursing supervision required in accordance with COMAR 10.27.11, with the exception of COMAR 10.27.11.04C, including visits to a participant's home or other service delivery site for observation at least every:

(a) 45 days if the attendant administers medications to the participant;

(b) 3 months if the attendant assists the participant with self-administration of medications;

(c) 4 months if the attendant does not administer medications or assist the participant with medication self-administration; or

(d) At a greater frequency established by the nurse monitor due to the participant's medical condition or clinical status;

(6) Rendering a professional evaluation, in accordance with Regulation .13B(3) of this chapter, of a attendant's ability to carry out the participant's specific plan for attendant care; and

(7) Documenting an action plan to address health and safety or medical concerns, including missed nursing supervision visits, and providing a copy of the plan to the case management agency within 5 business days.

C. The services covered under this regulation may not include nursing services other than those services described in this regulation.