PROPOSAL
Maryland Register
Issue Date: October 13, 2017
Volume 44 • Issue 21 • Pages 1002—1003
MARYLAND DEPARTMENT OF HEALTH
Subtitle 09 MEDICAL CARE PROGRAMS
10.09.36 General Medical Assistance Provider Participation Criteria
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
Notice of Proposed Action
[17-248-P]
The Secretary of Health proposes to adopt new Regulation .03-1 under COMAR 10.09.36 General Medical Assistance Provider Participation Criteria.
Statement of Purpose
The purpose of this action is to implement the Centers for Medicare and Medicaid Services’ Community Settings Rule. The language enhances community integration requirements and qualities of settings where individuals receive Medicaid home and community-based services. The purpose of the rule is to increase opportunity for personal choices, integration in community life, dignity, privacy, and respect. The proposed regulation also includes a timeline for provider compliance.
Comparison to Federal Standards
There is a corresponding federal standard to this proposed action, but the proposed action is not more restrictive or stringent.
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:
The new requirements increase the rights of individuals with disabilities and promote dignity, autonomy, respect, and personal choice in settings in which individuals receive Medicaid-covered home and community-based services.
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.
.03-1 Conditions for Participation―Home and Community-Based Settings.
A. Providers of services under COMAR 10.09.84 shall comply with the provisions of §§D―F of this regulation and 42 CFR 441.301(c)(4).
B. Effective January 1, 2018, to be enrolled as a provider of services authorized under §§1915(c) or 1915(i) of the Social Security Act, the provider shall comply with the provisions of §§D―F of this regulation and 42 CFR 441.301(c)(4).
C. Providers of services authorized under §§1915(c) or 1915(i) of the Social Security Act that are enrolled Maryland Medicaid providers before January 1, 2018, shall comply with the provisions of §§D―F of this regulation on or before March 17, 2022.
D. The setting in which services are provided shall:
(1) Be integrated in and support full access to the greater community for individuals receiving Medicaid home and community-based services to the same degree of access as individuals not receiving Medicaid home and community-based services;
(2) Be selected by the individual from among setting options, including nondisability specific settings;
(3) Be identified and documented in the person-centered service plan and is based on the individual’s needs and preferences;
(4) Ensure an individual’s rights of:
(a) Privacy;
(b) Dignity and respect; and
(c) Freedom from coercion and restraint;
(5) Optimize, but not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to:(5) Optimize, but not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to:
(a) Daily activities;
(b) Physical environment; and(b) Physical environment; and
(c) With whom to interact; and
(6) Facilitate individual choice regarding services and supports, and who provides them.
E. In addition to the provisions of §D of this regulation, provider-owned or controlled settings shall meet the following conditions:
(1) The unit or dwelling is a specific physical place that can be owned, rented, or occupied under a legally enforceable agreement by the individual receiving services and the individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord tenant law of the State, county, city, or other designated entity;(1) The unit or dwelling is a specific physical place that can be owned, rented, or occupied under a legally enforceable agreement by the individual receiving services and the individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord tenant law of the State, county, city, or other designated entity;
(2) Each individual has privacy in their sleeping or living unit, as evidenced by the following:(2) Each individual has privacy in their sleeping or living unit, as evidenced by the following:
(a) Units have entrance doors lockable by the individual, with only appropriate staff having keys to doors;
(b) Individuals sharing units have a choice of roommates; and
(c) Individuals have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement;
(3) Individuals have the freedom and support to control their own schedules and activities;
(4) Individuals have access to food at any time;
(5) Individuals are able to have visitors of their choosing at any time; and
(6) The setting is physically accessible to the individual.
F. Any modification of the conditions under §§D and E of this regulation shall be supported by a specific assessed need and justified in the person-centered services plan in accordance with 42 CFR 441.301(c)(2)(xiii).
DENNIS SCHRADER
Secretary of Health
