Sec. 10.22.17.02. Definitions

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

B. Terms Defined.

(1) "Add-on component" means one or more units of service, each one of which includes funding for direct service and other nondirect costs not covered by the sum of the provider and individual components.

(2) "Administration" means the Developmental Disabilities Administration.

(3) "Agreement" means a legal document setting forth the rights and responsibilities of the Administration and the provider under the fee payment system.

(4) "Appropriate evaluation" means the assessment of an individual by a qualified developmental disability professional using accepted professional standards to document the presence of a:

(a) Developmental disability as defined in Health-General Article, §7-101(e), Annotated Code of Maryland; or

(b) Severe, chronic disability that qualifies the individual for support services as defined in Health-General Article, §7-403(c), Annotated Code of Maryland.

(5) "Attendance day" means, for:

(a) Day habilitation and vocational services, when the individual is present in the program for at least 4 hours a day during a regularly scheduled period of operation, with 6 to 8 hours per day as the service goal, and with Administration approval of fewer than 6 hours per day provided the individual plan indicates this lower level of service is necessary;

(b) Residential programs, as of October 1, 2001, when the individual is present for at least 6 hours in the home or spends the night in the home, which is the primary residence for the individual; and

(c) Supported employment, when the individual is engaged in supported employment for at least 4 hours a day, with 6 to 8 hours per day as the service goal, and with Administration approval of fewer than 6 hours per day provided the individual plan indicates this lower level of service is necessary.

(6) "Copayment" means that portion of the provider's charge for services for which the individual is responsible.

(7) "Cost report" means a document on a form approved by the Administration that details a provider's allowable operating expenses for a single fiscal year using prescribed cost centers.

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

(9) "Day habilitation" means services for individuals with developmental disabilities licensed under COMAR 10.22.07 and for purposes of COMAR 10.09.26 includes prevocational services.

(10) "Direct services" means staff services provided directly to the individual.

(11) "Existing service" means a service continuously provided to an individual by the same provider beginning on or before June 30, 1998.

(12) "Existing supported employment service" means a service provided continuously to an individual by the same provider beginning before July 1, 2001.

(13) "Fee payment system" means the system for rate setting and reimbursement for services provided by licensed residential, day habilitation, vocational, and supported employment programs.

(14) "Fiscal management services (FMS)" means a person approved by the Administration and designated as an Organized Health Care Delivery System under COMAR 10.22.20 that:

(a) Assists individuals and families in managing their funds and paying for services; and

(b) Is responsible for submitting financial reports to the individual and Administration.

(15) "Funding level" means the total annual amount of money awarded by the Administration under the fee payment system or under a contract for a day habilitation, vocational, or residential program.

(16) "Individual" means a person who receives services funded by the Administration from a residential, day habilitation, vocational, or supported employment program.

(17) "Individual component" means one of the two parts of the rate that is based on an assessment of an individual's level of need as documented in the approved individual information form.

(18) "Individual indicator rating scale" means the instrument, approved by the Administration, to assess an individual's level of need.

(19) "Individual information form" means the form, approved by the Administration, used for documenting the results of an assessment using the individual indicator rating scale.

(20) "Individual plan (IP)" means the written plan of specific action that is developed and modified by an individual's team.

(21) "Individual's team" means:

(a) The individual;

(b) The individual's proponent;

(c) Representatives of the licensee;

(d) The resource coordinator; and

(e) Others the individual may choose to develop the IP.

(22) "New individuals" means those individuals starting service with a new provider.

(23) "Personal needs allowance" means the amount per month that a provider must allow an individual to retain from their monthly income for personal needs.

(24) "Professional services" means services provided by an individual authorized to perform these services under the Health Occupations Article, Annotated Code of Maryland.

(25) "Provider" means a person that is licensed and funded by the Administration to provide services to individuals under COMAR 10.22.08 or 10.22.07.

(26) "Provider component" means one of two parts of the rate that reimburses providers for indirect expenses.

(27) "Rate" means the reimbursement amount for an attendance day of service.

(28) "Regional director" means the designee of the Director of the Administration who is responsible for the administration of services in an assigned area of the State.

(29) "Residential program" means services for individuals with developmental disabilities licensed under COMAR 10.22.08.

(30) "Self-directed services" means services, as approved by the Administration:

(a) That an individual arranges; and

(b) For which the individual reimburses the provider.

(31) "Service approval" means the Administration's written approval for an individual to receive services from a provider.

(32) "Supplemental security income (SSI)" means income paid to the aged, blind, or disabled under Title XVI of the Social Security Act.

(33) "Supplemental services" means preauthorized services that directly benefit the individual and are not covered by the rate.

(34) "Support broker" means a person employed by individuals and families, who have been determined eligible by the Administration, that helps them:

(a) Decide what services and supports are best for them; and

(b) Access and manage the chosen services and supports.

(35) Supported Employment.

(a) "Supported employment" means services licensed under COMAR 10.22.07 when the individual is employed outside of the individual's home.

(b) "Supported employment" includes volunteer work when the volunteer work is for job training and preparation.

(36) “Unit of service” means:

(a) For day habilitation, vocational and supported employment programs awake direct support services, 1 hour;

(b) For residential programs:

(i) For awake direct support services, 1hour;

(ii) A preauthorized unit of service available to the individual and identified in the approved service funding plan; or

(iii) For support services other than awake direct support services, the provider cost multiplied by the number of approved hours and divided by the rate; or

(c) For professional services, 1 hour.

(37) "Utilization review" means the examination of an individual indicator rating scale to ascertain if the service needs level is appropriate and to verify that the indicated level of service is being provided.

(38) "Vocational services" means services provided by a licensed provider under COMAR 10.22.07 that are provided outside of the individual's home and for purposes of COMAR 10.09.26 are part of habilitation services.