Sec. 10.09.81.35. Covered Services — Medical Day Care

A. Definition. “Unit of service” means a day of service rendered by a qualified provider to a participant in accordance with COMAR 10.09.07.

B. The ICS Program reimburses for a day of care which includes the following services:

(1) Health care services supervised by the director, medical director, or health director, which emphasize primary prevention, early diagnosis and treatment, rehabilitation and continuity of care, including the following:

(a) Participation in the development of the individual participant's plan of care;

(b) Participation in the determination of the participant's medical, psychosocial, and functional status;

(c) Consultation with the participant's personal physician; and

(d) Consultation with staff regarding a participant's condition and health care needs;

(2) Nursing services performed by a registered nurse or by a licensed practical nurse under the supervision of a registered nurse which include:

(a) The evaluation of the needs of the participants for nursing care;

(b) The supervision of any nursing staff;

(c) Preventive and maintenance services;

(d) Observation and monitoring of participant's condition;

(e) Rehabilitative services;

(f) The teaching and training activities in appropriate self-care techniques;

(g) The supervision of medication normally self-administered;

(h) The provision of health education;

(i) Discharge planning; and

(j) Nursing services that may be delegated to other staff in accordance with COMAR 10.27.11;

(3) Physical therapy services, performed by or under supervision of a licensed physical therapist, that:

(a) Are of a diagnostic, rehabilitative, therapeutic, or maintenance nature, and are provided based on the assessment by the physician that the:

(i) Participant will improve significantly in a reasonable and generally predictable period of time; or

(ii) Services are necessary for the establishment of a safe and effective maintenance program required in connection with a specific disease state;

(b) Are directly related to the physician's written plan of care which specifies:

(i) Part or parts to be treated;

(ii) Type of modalities or treatments to be rendered;

(iii) Expected results of physical therapy treatments; and

(iv) Frequency and duration of treatment;

(c) The complexity of the services, or the condition of a participant, require the judgment, knowledge, and skills of a licensed physical therapist; and

(d) The services are considered to be an effective treatment according to accepted standards of medical practice;

(4) Occupational therapy services, performed by an occupational therapist, that meet the following conditions:

(a) The treatment requires the special skills of an occupational therapist;

(b) The services are directly related to the physician's written plan of care which specifies the:

(i) Treatment to be rendered;

(ii) Frequency and duration of the treatment; and

(iii) Expected results;

(c) The treatment is provided with the expectation that there will be a significant practical improvement in a participant's level of functioning within a reasonable period of time; and

(d) The services fall within one or more of the following categories:

(i) Evaluation and reevaluation of a participant's level of functioning by administering diagnostic and prognostic tests;

(ii) Selection and teaching of task-oriented therapeutic activities designed to restore physical function;

(iii) Teaching of compensatory techniques to improve the level of independence in the activities of daily living;

(iv) Training in the use of supportive and adaptive equipment, and assistive devices required for independent performance according to COMAR 10.09.12; and

(v) Improvement of mobility skills;

(5) Personal care services which include assistance with activities of daily living;

(6) Nutrition services which include the following:

(a) Meals and snacks as specified under COMAR 10.12.04.19;

(b) Therapeutic diets as specified under COMAR 10.12.04.19; and

(c) Dietary counseling and education;

(7) Social work services performed by a licensed, certified social worker, or licensed social work associate which include:

(a) Screening and interviewing, or assisting designated staff with screening and interviewing prospective participants to determine the general appropriateness of the individual for the full assessment process for medical day care services;

(b) Ongoing services to include:

(i) Identifying the emotional and social needs of participants during the rendering of medical day care services;

(ii) Maintaining linkages with community support resources for the participant including relatives, friends, and other care providers;

(iii) Counseling to improve the participant's response to the plan of care, chronic condition, and prospects for recovery or stabilization, but does not include diagnosing or treating mental disorders;

(iv) Counseling a participant and a participant's family in the availability and utilization of public and private community services, referral to, and coordination of these services;

(v) Assisting participants in obtaining health care services that are not available through the medical day care center, such as vision care, podiatry, or medical equipment;

(vi) Counseling participants to assist with acclimation to the medical day care center's services and to promote active involvement in their plan of care;

(vii) Coordinating and implementing group and family counseling in conjunction with plan of care goals;

(viii) Writing notes in the participant's records that reflect the social work activities performed; and

(ix) Participating in the multidisciplinary team meetings; and

(c) Discharge planning and referral services including:

(i) Written procedures for discharge, referral, and follow-up;

(ii) A discharge summary with post discharge goals;

(iii) Recommendations for continuing care; and

(iv) Referral to appropriate community service agencies and health care providers to facilitate the participant's return to more independent living;

(8) Activity programs in accordance with COMAR 10.12.04.14C; and

(9) Transportation services that:

(a) Are provided or arranged for a participant by the medical day care staff;

(b) Maximize the following types of transportation services:

(i) Walking, for a person who lives within walking distance of the medical day care center and who is sufficiently mobile;

(ii) Family-supplied transportation provided by friends, neighbors, or volunteers; and

(iii) Public transportation services;

(c) Are procured by the provider after options described in §B(9)(b) of this regulation have been exhausted;

(d) Are the responsibility of the provider to:

(i) Arrange contractual agreements with transportation providers to meet the transportation needs of the participants; and

(ii) Group participants, where possible, in the same taxi, van or specially equipped vehicles, to minimize the cost of transportation;

(e) Are provided in accordance with a primary transportation plan and a back-up plan;

(f) Are documented, indicating the type of transportation used by each participant;

(g) Are scheduled to ensure that a participant's one-way transit time does not exceed 1 hour as specified under COMAR 10.12.04.27; and

(h) Are included in the day of care for:

(i) Trips and outings which are part of the activities program; and

(ii) A participant's medical appointment escorted by center staff.

C. The day care service shall be:

(1) Authorized in the participant's plan of service;

(2) Medically necessary;

(3) Adequately described in progress notes in the participant's medical record, signed and dated by the individual providing care; and

(4) Provided to participants documented to be present at the medical day care center a minimum of 4 hours a day.