Md. Code Regs. 32.03.04.01

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

Section 32.03.04.01 - Definitions

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

B. Terms Defined.

(1) Allowable Medical Expenses.

(a) "Allowable medical expenses" means the total recurring, nonreimbursable medical expenses an individual or a couple reasonably expects to pay out-of-pocket during the 12 months following the date on which a calculation is made to determine a subsidy amount.

(b) "Allowable medical expenses" does not include expenses:

(i) Paid by a source other than the participant, such as insurance, Medicare, grants, or charitable organizations; or

(ii) For medical day care or attendant care, unless prescribed by a physician.

(c) "Allowable medical expenses" may include recurring, nonreimbursable expenses for:

(i) Services of physicians and other health care professionals;

(ii) Hospital expenses;

(iii) Medical insurance premiums;

(iv) Prescription and nonprescription medicines;

(v) Dental expenses;

(vi) Eyeglasses; and

(vii) Payments on accumulated medical bills.

(2) Assets.

(a) "Assets" means all real and personal property, including:

(i) Checking and savings account balances;

(ii) Any automobiles in excess of one per family;

(iii) Certificates of deposit;

(iv) Stocks;

(v) Bonds; and

(vi) Revocable trusts.

(b) "Assets" does not include:

(i) Customary household goods;

(ii) Personal effects;

(iii) One automobile per family;

(iv) Irrevocable funeral trusts;

(v) Personal burial space; or

(vi) Life insurance with a cash surrender value of not more than $5,000.

(3) "Certificate" means a certificate issued by the Maryland Department of Aging authorizing a named provider to operate a congregate housing services program at a specified location.

(4) "Congregate housing services" means congregate meals, housekeeping, laundry, personal assistance services, and service management provided in an apartment building, which services are to promote independent living for:

(a) An individual 62 years old or older who has temporary or periodic difficulty with one more essential activities of daily living such as feeding, bathing, grooming, dressing, or transferring; and

(b) The spouse of an individual described in §B(4)(a) of this regulation who is 55 years old or older and who has temporary or periodic difficulty with one or more essential activities of daily living such as feeding, bathing, grooming, dressing, or transferring.

(5) "Congregate Housing Services Program" means the Program operated by the Department under the authority of Human Services Article, § 10-209, Annotated Code of Maryland, which, among other activities, certifies providers willing to provide congregate housing services to participants and subsidizes congregate housing services for low income seniors under:

(a) The Standard Congregate Housing Services Plan; and

(b) The Individualized Congregate Housing Services Plan.

(6) "Contact person" means an individual designated by a participant to receive information about the participant's needs or health.

(7) "Department" means the Maryland Department of Aging.

(8) "Elderly" means an individual who is 62 years old or older.

(9) "Emergency" means conditions that:

(a) Present a substantial risk of death or serious physical harm; and

(b) Require immediate action.

(10) "Essential activities of daily living" means the normal daily activities associated with independent living including feeding, bathing, grooming, dressing, and transferring.

(11) "Facility" means a specific senior housing building in which:

(a) A provider furnishes congregate housing services; or

(b) An applicant for a certificate intends to furnish congregate housing services.

(12) "Fee for service" means a single congregate housing service offered by a provider, the cost of which has been approved but not subsidized by the Department.

(13) "Feeding" means providing meals.

(14) "Fiscal year" means the 12-month period that constitutes the State fiscal year, beginning July 1 and ending on June 30.

(15) "Income" means the gross amount of all earned and unearned income from all sources, including:

(a) Employment;

(b) Annuities;

(c) Social Security benefits;

(d) Workers' Compensation;

(e) Pensions;

(f) Disability payments;

(g) Alimony;

(h) Interest;

(i) Dividends; and

(j) Net income from a business or profession.

(16) "Individualized Congregate Housing Services Plan" means a plan that offers participants a choice of different service packages, which may contain fewer, or more, services than the complete set of congregate housing services a Standard Congregate Housing Services Plan provider is required to provide.

(17) "Instrumental activities of daily living" means:

(a) Using the telephone;

(b) Interpreting and responding to mail;

(c) Shopping for personal needs;

(d) Remembering to take medication;

(e) Arranging for prescription refills;

(f) Making transportation arrangements; and

(g) Performing chores.

(18) "Net annual income" means total income projected to be received by an individual or couple in the 12 months after submission of an application for a program subsidy, minus any recurring, nonreimbursable medical expenses projected for the 12-month period that exceed 3 percent of the total income.

(19) "Net monthly income" means net annual income divided by 12.

(20) "Participant" means an individual who:

(a) Lives in an apartment in a facility; and

(b) Receives congregate housing services from a provider.

(21) "Personal assistance services" means services that assist a participant with feeding, bathing, grooming, or dressing.

(22) "Physically or mentally impaired" means having a physical or mental condition that prevents an individual from performing one or more essential activities of daily living.

(23) "Program" means the Congregate Housing Services Program.

(24) "Projected monthly income" means 1/12 of the income an individual or couple reasonably expects to receive during the 12 months after the date on which a subsidy calculation is made for the individual or couple.

(25) "Provider" means an individual or other legal entity certified by the Department to provide congregate housing services at a facility.

(26) "Secretary" means the Secretary of the Department.

(27) "Senior housing" means a multiple-family apartment building that:

(a) Provides housing under a landlord-tenant arrangement; and

(b) Is specifically designed to meet the physical or social needs of elderly individuals.

(28) "Service management" means the administrative services needed to insure an individual's access to congregate housing services including:

(a) Assessing participant needs;

(b) Determining eligibility;

(c) Documenting services received;

(d) Billing for services;

(e) Communicating with families and the contact person;

(f) Generally supervising participants;

(g) Discharge planning; and

(h) Supervising services provided by staff.

(29) "Service package" means a group of congregate housing services offered as a package by an Individualized Congregate Housing Services Plan provider that may include fewer, or more, services than the complete set of congregate housing services a Standard Congregate Housing Services Plan provider is required to provide.

(30) "Service plan" means a written plan developed by a provider in conjunction with an Individualized Congregate Housing Services Plan participant that identifies:

(a) The particular congregate housing services, and any optional services under Regulation .14F of this chapter, that the provider will provide to the participant;

(b) When the services will be provided; and

(c) Who will provide the services.

(31) "Standard Congregate Housing Services Plan" means a single plan that includes the complete set of congregate housing services including:

(a) Congregate meals;

(b) Housekeeping;

(c) Laundry;

(d) Personal assistance services; and

(e) Service management.

(32) "Subsidy" means the State funds paid by the Department to a provider for providing congregate housing services to a participant in accordance with a subsidy services agreement and this chapter.

(33) "Subsidy services agreement" means a grant agreement between a provider and the Department that specifies the obligations of both parties.

Md. Code Regs. 32.03.04.01

Regulation .01 amended effective 45:11 Md. R. 580, eff. 6/4/2018