- The participant must be 18 years of age or older and no longer enrolled in primary or secondary school.
- The level of staffing and meaningful activities provided to the participant under this Waiver program service must be based on the participant’s assessed level of service need. Based on the participant’s assessed need, the DDA may authorize a 1:1 and 2:1 staff-to-participant ratio.
- Community Development Services are separate and distinct from residential services. Participants may return home or to the provider operated site during time-limited periods of the day due to lack of accessible restrooms and public areas to support personal care, health, emotional, and behavioral needs as indicated in the Person-Centered Plan. Residential services cannot be billed during these times.
- If personal care assistance services are provided as part of this Waiver program service, then the personal care assistance may not comprise the entirety of the service. For purposes of this Waiver program service, personal care assistance means the provision of supports to assist a participant in performing activities of daily living and instrumental activities of daily living.
- For participants enrolled in the self-directed services delivery model, this Waiver program service includes:
- The costs of training the participant’s direct support staff, including First Aid and Cardiopulmonary Resuscitation certifications;
- Travel reimbursement, benefits and leave time for the participant’s direct support staff, subject to the following requirements:
- The reimbursement, benefits and leave time requested are:
- Within applicable reasonable and customary standards as established by the DDA policy; or
- Required for the participant’s compliance, as the employer of record, with applicable federal, State, or local laws; and
- Any reimbursement (e.g. mileage), benefit and leave time requested by the participant must comply with applicable federal, State, or local laws.
- The reimbursement, benefits and leave time requested are:
- Until the service transitions to the LTSSMaryland system, under the traditional service delivery model, a participant’s Person-Centered Plan may include a mix of employment and day related daily waiver services units such as Day Habilitation, Career Exploration, Employment Discovery and Customization, Supported Employment, and Employment Services provided on different days.
- Service may be provided in groups of no more than four (4) participants, all of whom have similar interests and goals outlined in their Person-Centered Plan, unless it is to participate in a time limited internship through Project Search, or a similar program approved by the DDA.
- If transportation is provided as part of this Waiver program service, then:
- The participant cannot receive Transportation services separately at the same time as provision of this Waiver program service;
- The Provider or participants self-directing their services must:
- Provide, or arrange for provision of, transportation to meet the needs of the participant identified in the participant’s person-centered plan; and
- Use the most cost-effective mode of transportation, with priority given to the use of public transportation; and
- Transportation services may not compromise the entirety of this Waiver program service.
- If direct support staff perform delegated nursing tasks as part of this Waiver program service, then:
- The participant must receive Nursing Support Services/Nurse Case Management and Delegation services under this Waiver program service; and
- The delegated nursing tasks:
- Must be provided by direct support staff who are currently certified as a Medication Technician by the Maryland Board of Nursing; and
- May not compromise the entirety of this Waiver program service.
- An individualized schedule will be used to provide an estimate of what the participant will do and where the participant will spend their time when in this service. Updates should be made as needed to meet the changing needs, desires and circumstances of the participant. The individualized schedule will be based on a Person-Centered Plan that clearly outlines how this time would be used.
- A legally responsible person or a relative (who is not a spouse)and of a participant may be paid to provide this service in accordance with the applicable requirements set forth in Appendix C-2.
- Prior to accessing DDA funding for this service, all other available and appropriate funding sources, including but not limited to those offered by Maryland’s State Plan, Division of Rehabilitation Services (“DORS”), State Department of Education, and Department of Human Services, must be explored and exhausted to the extent applicable . These efforts must be documented in the individual’s file.
- Until the service transitions to the LTSSMaryland system, Community Development Services daily service units are not available:
- On the same day a participant is receiving Career Exploration, Day Habilitation, Employment Discovery and Customization, Medical Day Care, or Supported Employment services under the Traditional Services delivery model; and
- At the same time as the direct provision of Community Living—Enhanced Supports, Community Living-Group Homes, Personal Supports, Respite Care Services, Shared Living, Supported Living, or Transportation services.
- Effective July 1, 2020, Community Development Services are not available at the same time as the direct provision of Career Exploration, Community Living—Enhanced Supports, Community Living-Group Homes, Day Habilitation, Employment Discovery and Customization, Employment Services, Medical Day Care, Nurse Consultation, Personal Supports, Respite Care Services, Shared Living, Supported Employment, Supported Living, or Transportation services.
- To the extent any listed services are covered under the Medicaid State Plan, the services under the waiver will be limited to additional services not otherwise covered under the Medicaid State Plan, but consistent with waiver objectives of avoiding institutionalization.
- Nursing Support Services/Nurse Case Management and Delegation Services as applicable, can be provided during activities so long as it is not the primary or only service provided. The scope of the Nursing Support Services/Nurse Case Management and Delegation Services are defined under the stand alone service in Appendix C.
- In the event that additional Nursing Support Services/Nurse Case Management and Delegation training supports are needed as indicated in the Health Risk Screening Tool (HRST) because of a change in the participant’s health status or after discharge from a hospital or skilled nursing facility, the request is reviewed by the DDA’s Regional Office and additional standalone Nursing Support Services/Nurse Case Management and Delegation Service support service hours can be authorized.
- Direct Support Professional staffing services may be provided in an acute care hospital for the purposes of supporting the participant’s personal, behavioral and communication supports not otherwise provided in that setting. Services may not be duplicative of hospital or short-term institutional services.
- The State has mechanisms in place to prevent duplicate billing for both institutional and home and community-based services.
- These necessary waiver services:
- Must be identified in the individual’s person-centered service plan;
- Must be provided the meet the individual’s needs and are not covered in such settings;
- Should not substitute for services that the setting is obligated to provide through its condition of participation under federal or State law, under another applicable requirement; and
- Should be designed to ensure smooth transitions between the setting and the home community-based setting and preserves the participant’s functional abilities.
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