1. A. The day habilitation services covered under this regulation shall be provided in a nonresidential setting, separate from the home or facility in which the participant resides.

2. B. The covered services, as defined in this chapter shall include:

   1. (1) Habilitative or rehabilitative services to assist a participant in acquiring, regaining, retaining, or improving the self-help skills related to activities of daily living and the social and adaptive skills, which are necessary to reside successfully in home and community-based settings;
   2. (2) Meals furnished as part of the program;

   3. (3) Any of the following additional services which are provided at the provider's site, are medically necessary to prevent the participant's institutionalization, and are not otherwise covered for the participant by the Program or another payer:

      1. (a) Nursing supervision, in accordance with the Maryland Nurse Practice Act and COMAR 10.27.11 for any medication administration or other delegated nursing functions provided to the participant by a qualified direct care worker; and
      2. (b) Behavior intervention services; and
   4. (4) Transportation between a participant's residence and the provider's site, or between habilitation sites if the participant receives habilitation services in more than one place.
3. C. Day habilitation services shall regularly be provided 4 or more hours per day on a regularly scheduled basis for 1 or more days per week, unless provided as an adjunct to other day activities included in the participant's waiver plan of care.
4. D. Day habilitation services shall focus on enabling the participant to regain, attain, or maintain the participant's maximum functional level.
5. E. The provider shall provide services in collaboration with the participant's other BI waiver services, clinical treatment, rehabilitation, and health and medical services.

6. F. Levels of Service.

   1. (1) Services provided in a day habilitation program shall be provided and reimbursed at one of three levels of service, as preauthorized in the participant's waiver plan of care approved by the BHA.
   2. (2) Level 1 requires a minimum of 1:6 staff to participant ratio. The participant shall meet nursing facility or special hospital level of care.
   3. (3) Level 2 requires a minimum of 1:4 staff to participant ratio. The participant shall meet nursing facility or special hospital level of care.
   4. (4) Level 3 requires a minimum of 1:1 staff to participant ratio. The participant shall meet special hospital level of care.
7. G. The program under this regulation does not cover recreational activities which are not related to specific treatment goals or are solely diversional.

Authority: Health-General Article, §§2-104(b), 15-103, 15-105, and 15-141.2, Annotated Code of Maryland

Effective date:

Regulations .01—.16 adopted as an emergency provision effective July 1, 2003 (30:14 Md. R. 933); adopted permanently effective December 11, 2003 (30:24 Md. R. 1740)

Regulation .01B amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .01B amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective October 6, 2008 (35:20 Md. R. 1774)

Regulation .01B amended effective January 6, 2014 (40:26 Md. R. 2163); May 18, 2020 (47:10 Md. R. 516); May 1, 2023 (50:8 Md. R. 338)

Regulation .02B amended effective January 25, 2010 (37:2 Md. R. 67)

Regulation .02C, D amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .03 amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .03B, E amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .03B, F amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .03F amended effective October 14, 2013 (40:20 Md. R. 1652)

Regulation .04 amended effective May 18, 2020 (47:10 Md. R. 516); May 18, 2020 (47:10 Md. R. 516)

Regulation .04A amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .04B amended effective April 9, 2007 (34:7 Md. R. 698); May 1, 2023 (50:8 Md. R. 338)

Regulation .04C amended effective May 1, 2023 (50:8 Md. R. 338)

Regulation .05 amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .05 amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective October 6, 2008 (35:20 Md. R. 1774)

Regulation .05 amended effective January 6, 2014 (40:26 Md. R. 2163); May 18, 2020 (47:10 Md. R. 516); May 1, 2023 (50:8 Md. R. 338)

Regulation .06 amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .06E adopted as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); adopted permanently effective October 6, 2008 (35:20 Md. R. 1774)

Regulation .07C amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .07D amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .08E amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .08F amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .09C amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .09-1 adopted effective April 9, 2007 (34:7 Md. R. 698)

Regulation .09-1 amended effective May 18, 2020 (47:10 Md. R. 516); May 1, 2023 (50:8 Md. R. 338)

Regulation .09-1C amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .09-2 adopted as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); adopted permanently effective October 6, 2008 (35:20 Md. R. 1774)

Regulation .10B amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .11C amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .11C, D amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .12A amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .12A, C amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective October 6, 2008 (35:20 Md. R. 1774)

Regulation .12C amended effective May 1, 2023 (50:8 Md. R. 338); March 3, 2025 (52:4 Md. R. 218); June 8, 2026 (53:11 Md. R. 485)

Regulation .13 amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective October 6, 2008 (35:20 Md. R. 1774)