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    Maryland Register
    Issue Date:  October 13, 2017
    Volume 44 • Issue 21 • Pages 1004—1006
    Title 10
    10.09.84 Community First Choice
    Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
    Notice of Proposed Action
    The Secretary of Health proposes to amend Regulations .02, .05—.07, .10, .15, .18, .19, .23, and .24 under COMAR 10.09.84 Community First Choice.
    Statement of Purpose
    The purpose of this action is to:
    (1) Clarify definitions;
    (2) Add participation requirements for all Community First Choice providers to be free from conflicts of interest and for personal assistance providers to conduct criminal history record checks on all direct service providers;
    (3) Clarify covered services related to transition services for supports planning, home delivered meals, technology that substitutes for human assistance, and environmental adaptations; and
    (4) Change the methodology for payment to a daily rate for participants who require more than 12 hours of service per day.
    Comparison to Federal Standards
    There is no corresponding federal standard to this proposed action.
    Estimate of Economic Impact
    The proposed action has no economic impact.
    Economic Impact on Small Businesses
    The proposed action has minimal or no economic impact on small businesses.
    Impact on Individuals with Disabilities
    The proposed action has an impact on individuals with disabilities as follows:
    This program exclusively serves individuals with disabilities. However, the impact will be minimal as the changes clarify existing policies and add a daily rate. The daily rate provides additional flexibility for participants within the existing service system.
    Opportunity for Public Comment
    Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through November 13, 2017. A public hearing has not been scheduled.
    .02 Definitions.
    A. (text unchanged)
    B. Terms Defined.
    (1)―(8) (text unchanged)
    (9) Community Setting.
    (a) (text unchanged)
    (b) “Community setting” does not mean:
    (i)—(iii) (text unchanged)
    (iv) Intermediate care facilities for individuals with intellectual disabilities; or
    [(v) Community-based residential facilities for individuals with intellectual or developmental disabilities licensed under COMAR 10.22.02; or]
    [(vi)] (v) (text unchanged)
    (10)—(12) (text unchanged)
    (13) Home.
    [(13)] (a) (text unchanged)
    (b) “Home” does not mean:
    (i) An assisted living program as defined in COMAR 10.07.14;
    (ii) A residential rehabilitation program licensed as a therapeutic group home under COMAR 10.21.07;
    (iii) An alternative living unit, group home, or individual family care home as defined in COMAR 10.22.01;
    (iv) Community-based residential facilities for individuals with intellectual or developmental disabilities licensed under COMAR 10.22.02; or
    (v) Any other provider-owned or controlled residence.
    (14)―(30) (text unchanged)
    (31) “Representative” means:
    (a) The person authorized by the individual[, on the form provided by the Department,] to serve as a representative in connection with the provision of Community First Choice services and supports;[ or]
    (b) The individual who signs the plan of service on the participant’s behalf;
    (c) Any individual who makes decisions on behalf of the participant related to the participant’s plan of service;
    (d) A legal guardian of the individual for the participant; or
    (e) The parent or foster parent of a dependent minor child.
    (32)―(34) (text unchanged)
    .05 Conditions for Provider Participation — General Requirements.
    A. To participate as a provider of a service covered under this chapter, a provider:
    (1)—(8) (text unchanged)
    (9) Shall verify Medicaid eligibility at the beginning of each month that services will be rendered; [and]
    (10) May not be a Medicaid provider or principal of a Medicaid provider that has overpayments that remain due to the Department; and
    (11) Shall be free from conflicts of interest.
    B.—C. (text unchanged)
    .06 Specific Conditions for Provider Participation — Personal Assistance.
    A. Personal assistance service providers shall:
    (1) Be licensed as a Residential Service Agency under COMAR 10.07.05 to provide Level Two or Level Three home care services;
    (2)(8) (text unchanged)
    (9) Submit a Medicaid provider application to the Department if the new owner chooses to participate in the Program; [and]
    (10) At least monthly, collect and maintain the participant’s signature, or that of the participant’s representative when applicable, verifying services rendered; and
    (11) Conduct a criminal history records check on all direct service workers including nurses, in accordance with the procedure for a State criminal history records check established under Health-General Article, Title 19, Subtitle 19, Annotated Code of Maryland.
    B.―C. (text unchanged)
    .07 Specific Conditions for Provider Participation — Supports Planning.
    To participate in the Program as a supports planning provider under Regulation .15 of this chapter, a provider shall:
    [A. Be free from conflicts of interest;]
    [B.] A.[C.] B. (text unchanged)
    .10 Specific Conditions for Provider Participation — Items or Services that Substitute for Human Assistance.
    A.―C. (text unchanged)
    D. To participate as a provider of accessibility adaptations a provider shall:
    (1) Have a current license with the Maryland Home Improvement Commission; and
    (2) Be approved by the Department.
    .15 Covered Services — Supports Planning.
    A. (text unchanged)
    B. Supports planning services include [time spent by a qualified provider conducting any of] the following activities:
    (1)―(6) (text unchanged)
    (7) [Verifying the participant’s eligibility at the beginning of each month that personal assistance services will be rendered] Administering funds for transition services.
    .18 Covered Services — Items or Services that Substitute for Human Assistance.
    A.―C. (text unchanged)
    [D. Excluded from coverage under this regulation are adaptations or improvements to the home which:
    (1) Are of general maintenance, such as carpeting, roof repair, and central air conditioning;
    (2) Are not of direct medical or remedial benefit to the participant;
    (3) Add to the home’s total square footage; or
    (4) Modify the exterior of the home, other than the provision of ramps.]
    [E.] D. The program covers home-delivered meals provided during meal periods that personal assistance services are not provided. Home-delivered meals shall be:
    (1) Delivered to the participant’s home;
    (2) Intended for consumption at home;
    (3) Nutritionally adequate for the participant’s age based on the Recommended Dietary Allowance (RDA) or Dietary Reference Intake (DRI), as established by the Food and Nutrition Board of the National Research Council and demonstrated by having the menus certified in writing by the participant’s physician, dietitian, or nutritionist; and
    (4) At least one-third of the RDA, DRI, or therapeutic diet requirements ordered by the participant’s physician, dietitian, or nutritionist, including any ordered nutritional supplements.
    E. Technology that substitutes for human assistance includes:
    (1) Environmental controls for the home or automobile;
    (2) Personal computers, software, or accessories;
    (3) Augmentative communication devices;
    (4) Maintenance or repair of technology devices;
    (5) Self-help aids that assist with activities of daily living or instrumental activities of daily living; and
    (6) Assessments and training in the use of assistive technology.
    .19 Covered Services — Environmental Assessments and Adaptations.
    A. The Program covers an on-site environmental assessment and adaptations of a home or residence where the participant lives or will live as a participant.
    B. An environmental assessment or adaptation may not be provided before the effective date of the participant’s [eligibility for] enrollment in services.
    C. The [service] environmental assessment may be recommended by a multidisciplinary team in the plan of service for a participant when an environmental assessment is considered necessary to:
    (1)―(2) (text unchanged)
    D.―E. (text unchanged)
    .23 Limitations.
    A.―B. (text unchanged)
    C. The Program does not cover the following services:
    (1)―(4) (text unchanged)
    (5) Transition services more than 60 days post transition; [or]
    (6) Personal assistance services provided outside the State for more than [14] 30 days per calendar year[.];
    (7) Environmental adaptations to the home which:
    (a) Are of general maintenance, such as carpeting, roof repair, and central air conditioning;
    (b) Are not of direct medical or remedial benefit to the participant;
    (c) Add to the home’s total square footage; or
    (d) Modify the exterior of the home, other than the provision of ramps, lifts, sidewalks necessary to utilize a ramp or lift, and railings; or
    (8) Experimental technology or equipment.
    D. (text unchanged)
    E. Payment for environmental adaptations and technology that substitutes for human assistance is limited to a combined reimbursement of up to $15,000 over a 3-year period per participant.
    F. For technology items or services above $1,000, multiple quotes from providers are required.
    .24 Payment Procedures.
    A.—D. (text unchanged)
    E. Effective May 1, 2017, for personal assistance services up to 12 hours per day, payment will be made in 15-minute units of service. For individuals who are determined to need more than 12 hours of personal assistance per day, a daily rate for the service will be paid.
    [E.] F. (text unchanged)
    Secretary of Health