Md. Code Regs. 14.11.01.02

Current through Register Vol. 51, No. 24, December 2, 2024

Section 14.11.01.02 - Definitions

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

B. Terms Defined.

(1) "Advanced payment" means a reimbursement payment that:

(a) Is requested by a participant for a future pay period; and

(b) Is not greater than the participant's approved maximum reimbursement.

(2) "Annual adjusted gross income" means the total taxable and nontaxable annual income, less 100 percent of total unreimbursed medical expenses as defined by COMAR 07.03.17.33, of:

(a) The eligible applicant; and

(b) The applicant's spouse.

(3) "Applicant" means an individual who has submitted an application to participate in the Program in order to receive reimbursement of the cost of attendant care services.

(4) "Attendant" means an individual who provides attendant care services to a participant.

(5) "Attendant care agreement" means a written agreement developed by the Department that:

(a) Provides:

(i) The effective date for reimbursable services; and

(ii) The terms for reimbursement under the Program; and

(b) Is signed by the participant and the Program Director at the time of initial enrollment and at the request of the Program Director if any circumstances change for the individual or the program.

(6) "Attendant care services" means any of the following services for an individual, which are deemed necessary by an attending physician or by a registered nurse or certified nurse practitioner serving the individual including:

(a) Activities of daily living such as:

(i) Dressing;

(ii) Preparing food and assisting with eating;

(iii) Bathing and personal hygiene;

(iv) Assisting with routine bodily functions, including bowel and urinary care; and

(v) Moving into, out of, or turning in bed; or

(b) Instrumental activities of daily living such as:

(i) Laundering and other clothing care;

(ii) Cleaning house; and

(iii) Performing other services of daily care, including shopping and transportation.

(7) "Attending physician" means an individual who is authorized to practice medicine in this State and who has provided medical treatment to an applicant.

(8) "Certification of service form" means a document designated by the Department that verifies the participant's receipt of attendant care services for billing purposes.

(9) "Department" means the Department of Disabilities.

(10) "Duplicative services" means comparable care services provided through any other federal or State assistance programs, such as but not limited to the programs described in COMAR 07.06.12, 10.09.04, or 10.09.20, at the same time and on the same day as services reimbursed by the Program.

(11) "Financial assistance" means reimbursement by the Department of the eligible percentage of the cost paid by a participant for attendant care services.

(12) "Fiscal payment schedule" means the list of 26 2-week periods, established annually by the Program Director, in which attendant care services are provided and certification of service forms and time sheets are due for reimbursement processing.

(13) "Home visit" means a visit by the Program Director or designee to the home of the Program participant.

(14) "Participant" means an eligible and enrolled individual in the Program.

(15) "Permanent physical disability" means a medical condition that substantially affects an individual's ability to perform physical activities such as walking, standing, transferring, seeing, or hearing.

(16) "Program" means the Attendant Care Program.

(17) "Program Director" means the individual designated by the Secretary to oversee the day-to-day operations of the Program.

(18) Review of financial eligibility means initiating verification that the participant remains financially eligible within one calendar year since the completion of the most recent review or more frequently if requested by the Department or the individual.

(19) "Severe chronic disability" means a recurring medical condition that substantially limits an individual's mobility or ability to perform activities of daily living, instrumental activities of daily living, or self-care:

(a) Permanently; or

(b) On an ongoing basis as a result of a serious medical condition.

(20) "Sliding reimbursement scale" means the percentage breakdown of maximum financial assistance afforded to a Program participant based upon adjusted gross income and household size.

(21) "Standard assessment of functional capability" means the document designated by the Department to evaluate an applicant's:

(a) Ability to perform essential activities of daily living and self-care;

(b) Mobility;

(c) Need for assistance with instrumental activities of daily living; and

(d) Need for attendant care services.

(22) "Time sheet" means a form designated by the Department to record the start and stop times for the delivery of attendant care services to the participant for billing and documentation purposes.

Md. Code Regs. 14.11.01.02

Regulation .02B amended effective 41:16 Md. R. 947, eff.8/18/2014