Sec. 10.22.01.01. Definitions

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

B. Terms Defined.

(1) "Administration" means the Developmental Disabilities Administration of the Maryland Department.

(2) "Alternative living unit (ALU)" means a residence owned, leased, or operated by a licensee that:

(a) Provides residential services for individuals who, because of a developmental disability, require specialized living arrangements;

(b) Admits not more than 3 individuals; and

(c) Provides 10 or more hours of supervision per unit, per week.

(3) "Assistive technology" means the technology necessary to enable the individual to live successfully in the community.

(4) "Aversive technique" means the use of painful or noxious stimuli to the body, which is intrusive to the individual's physical, mental, or emotional well-being, used to terminate challenging or maladaptive behavior.

(5) "Barrier" means an obstacle preventing or inhibiting an individual from receiving services and supports in the most integrated setting appropriate to meet the individual's needs.

(6) "Behavior plan (BP)" means a plan designed to modify behavior through the use of clinically accepted techniques.

(7) Behavioral Consultation.

(a) "Behavioral consultation" means on-site observation, assessment, and evaluation of the interaction between the individual and the individual's caregiver in the context of the individual's existing programs.

(b) "Behavioral consultation" includes:

(i) Recommendations regarding the structure of the program and appropriate activities and services; and

(ii) Consultation, as needed, with clinical professionals.

(8) "Behavioral emergency" means a situation in which an individual's behavior appears to present imminent danger to the individual or to others.

(9) "Behavioral respite" means relief services provided by a community residential licensee to meet an individual's behavioral needs.

(10) "Care provider" means an individual who is responsible for the daily operation of an individual family care home as defined in §B(26) of this regulation.

(11) "Challenging behavior" means those behaviors exhibited by an individual which:

(a) Are harmful, destructive, or socially unacceptable; and

(b) Necessitate being addressed in the individual's individual plan.

(12) "Chemical restraint" means the use of an injectable medication as an intervention in a behavioral emergency.

(13) "Community supported living arrangement home" means a residence:

(a) Which is rented or owned by an individual or the individual's family or proponent or held in trust for an individual;

(b) Where an individual lives as a roommate without the individual's name appearing on the lease or title; or

(c) Where the licensee is the guarantor of rental or mortgage payments for an individual receiving CSLA services.

(14) Community Supported Living Arrangements.

(a) "Community supported living arrangements (CSLA)" means services to assist an individual in nonvocational activities necessary to enable that individual to live in the individual's own home, apartment, family home, or rental unit, with:

(i) No more than two other nonrelated recipients of these services; or

(ii) Members of the same family regardless of their number.

(b) “Community supported living arrangements (CSLA)” includes personal support services, as defined under the Administration’s Home and Community-Based Services Waiver with the Centers for Medicare and Medicaid Services, including but not limited to the following services:

(i) Personal assistance services;

(ii) Supports that enhance the individual’s opportunity for community participation and to exercise choice and control over the individual’s own life;

(iii) Training, habilitation, and other services necessary to assist the individual in achieving and maintaining increased integration, interdependence, and productivity; and

(iv) 24-hour emergency assistance.

(c) “Community supported living arrangements (CSLA)” also includes other services set forth in the Administration’s Home and Community-Based Services Waiver with the Centers for Medicare and Medicaid Services as distinct from personal support services, including but not limited to the following:

(i) Assistive technology;

(ii) Adaptive equipment;

(iii) Resource coordination;

(iv) Environmental modifications;

(v) Respite; and

(vi) Other services as approved by the Secretary or the Secretary’s designee.

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

(16) "Developmental disability" means a severe chronic disability of an individual that:

(a) Is attributable to a physical or mental impairment, other than the sole diagnosis of mental illness, or to a combination of mental and physical impairments;

(b) Is likely to continue indefinitely;

(c) Is manifested in an individual younger than 22 years old;

(d) Results in an inability to live independently without external support or continuing and regular assistance; and

(e) Reflects the need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services that are individually planned and coordinated for the individual.

(17) "Director" means Director of the Developmental Disabilities Administration or the Director's designee.

(18) "Eligible for individual support services" means an individual with a severe chronic disability that is:

(a) Attributable to a physical or mental impairment other than the sole diagnosis of mental illness, or to a combination of mental and physical impairments; and

(b) Likely to continue indefinitely.

(19) "Environmental modification" means physical adaptations to an individual's home that are provided to enable the individual to live safely at home.

(20) "Foreign corporation" means an entity that is properly organized, chartered, and incorporated under the laws of a state other than Maryland.

(20-1) "Forensic residential center (FRC)" means a facility that is:

(a) Licensed to provide a continuum of integrative services to individuals with intellectual disabilities:

(i) Ordered by the court for an evaluation or to be confined;

(ii) Court-committed for care or treatment to the Department as incompetent to stand trial or not criminally responsible who are dangerous as a result of intellectual disabilities; or

(iii) On conditional release and returned to the facility either voluntarily or on hospital warrant;

(b) A related institution as defined in Health-General Article, §19-301(o), Annotated Code of Maryland; and

(c) Not an extended care or comprehensive rehabilitation facility.

(21) "Functional analysis" means a method of investigation which involves the systematic, experimental manipulation of analogue conditions, and precise measurement of challenging behavior, in order to determine the behavioral consequences which maintain the challenging behavior.

(22) "Functional assessment" means a nonexperimental method, such as systematic observations and questionnaires, designed to assist in the formulation of an educated guess concerning the behavioral consequences which maintain challenging behavior.

(23) "Generic services" means services which are available to the community at large.

(24) "Goal" means measurable supports or training to achieve an outcome.

(25) "Group home" means a residence owned, leased, or operated by a licensee that:

(a) Provides residential services for individuals who, because of a developmental disability, require specialized living arrangements;

(b) Admits at least four, but not more than eight individuals; and

(c) Provides 10 or more hours of supervision per week.

(26) "Individual" means a person eligible to receive services from the Developmental Disabilities Administration.

(27) "Individual family care (IFC) home" means a private, single family residence which provides a home for up to three individuals with developmental disabilities, who are unrelated to the care provider.

(28) "Individual plan (IP)" means a plan that specifies assessments, services, supports, and training required by the individual.

(29) "Integrated work setting" means an environment in which individuals with developmental disabilities and individuals without developmental disabilities work together.

(30) "Licensed capacity" means the number of individuals for whom a licensee is authorized to provide services at a single site.

(31) "Licensed certified social worker" means a person authorized to practice social work under Health Occupations Article, Title 19, Annotated Code of Maryland.

(32) "Licensed health care practitioner" means a person licensed to provide health care within the scope of Health Occupations Article, Annotated Code of Maryland.

(33) "Licensed or certified professional counselor" means a person who is authorized to practice professional counseling under Health Occupations Article, Title 17, Annotated Code of Maryland.

(34) "Licensed physician" means a person who is authorized to practice medicine under Health Occupations Article, Title 14, Annotated Code of Maryland.

(35) "Licensed psychologist" means a person who is authorized to practice psychology under Health Occupations Article, Title 18, Annotated Code of Maryland.

(36) "Licensee" means an agency that has been granted a license by the Administration to provide services to individuals.

(37) "Management of disruptive behavior" means the Administration-approved curriculum for managing challenging or aggressive behavior.

(38) "Mechanical restraint" means a mechanical device which restricts the free movement of an individual, such as a safety coat or posey mittens.

(39) "Mechanical support" means a mechanical device used to:

(a) Support an individual's proper body position, balance, or alignment, such as splints, wedges, bolsters, or lap trays; or

(b) Protect an individual with a continuing medical condition from sustaining an injury, for example, the use of protective head gear for an individual with epilepsy.

(40) "Most integrated setting" means a setting that enables an individual with a disability to interact with nondisabled individuals other than staff to the fullest extent possible.

(41) "Natural supports" means family, friends, co-workers, and community members who provide informal assistance to the individual to enable the individual to live and work in the community.

(42) "Outcome" means tangible results of goals that reflect the desired quality of life as defined by the individual.

(43) "Personal assistance" means help with activities of daily living which does not have an habilitation objective.

(44) "Physical restraint" means a manual method used to restrict the free movement of an individual, such as therapeutic hold.

(45) "Plan of correction (POC)" means the licensee's proposed response to findings of noncompliance identified by the Licensing and Certification Administration or the Administration.

(46) "PRN orders" means a preauthorized order to administer a specific behavior management technique or medication to modify behavior which is administered on an as-needed basis when a challenging behavior is exhibited.

(47) "Program service plan (PSP)" means the document submitted as part of the licensure application that delineates the rationale, scope, staffing, training, setting, and location for the services or supports to be provided.

(48) "Proponent" means a person who has a legitimate interest in the welfare of an individual receiving services from a licensee.

(49) "Psychology associate" means a person who may perform psychological services under certain conditions as specified in Health Occupations Article, Title 18, Annotated Code of Maryland.

(50) "Record" means the cumulative body of information the licensee has on file regarding an individual.

(51) "Resource coordinator" means a professional:

(a) Designated by the Developmental Disabilities Administration;

(b) Not employed by a direct service provider;

(c) Who has knowledge and experience in community supports for individuals with developmental disabilities; and

(d) Who meets the requirements of COMAR 10.22.09.

(52) "Respite" means relief services provided to the family or care provider to meet planned or emergency situations.

(53) "Restrictive technique" means a technique that is implemented to impede an individual's physical mobility or limit free access to the environment, including but not limited to physical, mechanical, or chemical restraints or medications used to modify behavior.

(54) "Seclusion" means the involuntary placement of an individual alone in a room.

(55) "State residential center (SRC)" means a State owned and operated facility for individuals with intellectual disabilities.

(56) "Supports" means the assistance provided to individuals or their families to enable greater participation in the community and enhanced quality of life.

(57) "Target behaviors" means those behaviors identified by the team to be changed by implementing a behavior plan.

(58) "Team" means those persons, including the individual, proponent, licensee representatives, resource coordinator, and others involved in the development of the IP.

(59) "Temporary augmentation of staff" means supplemental staff utilized on a time-limited basis to work with an individual exhibiting challenging behavior.

(60) "Treating professional" means an individual designated by the facility director who is involved in the implementation of the IP.

(61) "Verbal abuse" means disrespectful shouting, screaming, swearing, name calling, or other verbal activity directed toward an individual.

(62) "Vocational assessment" means a method of determining an individual's job and career preferences and the skills and training necessary to accomplish these preferences.

(63) "Volunteer work" means work performed by an individual without pay.

(64) "Written plan of habilitation" means, for State residential centers, a component of the IP as described in COMAR 10.22.05.02B(14) and .03C.