1. A. The Program under this regulation does not cover the following:

   1. (1) Any Medicaid State Plan services which are provided by medical professionals employed by or under contract with the residential habilitation provider;
   2. (2) Room and board;
   3. (3) Direct or indirect payments to the participant's immediate family;
   4. (4) Routine care and supervision which a family is expected to provide;
   5. (5) Activities or supervision reimbursed by a source other than Medicaid; and
   6. (6) The facility's maintenance, upkeep, and improvement.

2. B. The residential habilitation program shall:

   1. (1) Provide community-based, intensive residential placements for participants who cannot live at home at the present time because they require highly supervised and supportive environments;
   2. (2) Provide a home-like, safe, 24-hour, therapeutic living environment of treatment, intervention, training, supportive care, and oversight;
   3. (3) Be designed to assist Autism Waiver participants in acquiring, retaining, and improving the self-help, socialization, and adaptive skills necessary to reside successfully in home and community-based settings;

   4. (4) Work closely with the participant's service coordinator to provide transition services for each participant in placement to allow, as appropriate, for the:

      1. (a) Participant's eventual return to the family (natural, adoptive, or surrogate); or
      2. (b) Participant to acquire the skills and resources for group or independent living; and
   5. (5) Coordinate with the participant's educational, health, and medical service providers.

3. C. A participant's placement in residential habilitation services shall be:

   1. (1) Preauthorized by the multidisciplinary team; and
   2. (2) Reviewed by the multidisciplinary team at least annually.

4. D. Residential habilitation services shall be received in facilities located in the State which are:

   1. (1) Licensed group homes;
   2. (2) Licensed alternative living units; or
   3. (3) Community-based residential facilities approved by the State Department of Education for special education services.

5. E. Intensity Levels.

   1. (1) Residential habilitation services are provided and reimbursed at a regular or intensive level for a participant.

   2. (2) To be approved by the multidisciplinary team for the intensive level of residential habilitation services, the participant must need:

      1. (a) Awake overnight staffing; and
      2. (b) At minimum, 4 hours of one-on-one staffing.

6. F. Services.

   1. (1) A residential habilitation program shall provide all of the services listed in §F(2)—(12) of this regulation, as necessary for the participant.
   2. (2) Habilitation. The residential rehabilitation program shall provide training to assist a participant to acquire, retain, or improve skills in a wide variety of areas that directly affect the ability to reside as independently as possible.
   3. (3) Behavior Shaping and Management. The residential rehabilitation program shall train, supervise, and assist the participant, which may include psychiatric or psychological interventions, in appropriate communication and expression of emotions and desires, compliance, assertiveness, acquisition of socially appropriate behaviors, and reduction of inappropriate behaviors.
   4. (4) Daily Living Skills. The residential rehabilitation program shall train or assist the participant in dressing, personal hygiene, self-administration of medications, proper use of appliances and adaptive or assistive devices, home safety, first aid, and emergency procedures.
   5. (5) Self-Direction. The residential rehabilitation program shall train the participant in identifying and responding to dangerous or threatening situations, making decisions and choices affecting the participant's life, and initiating changes in living arrangements or life activities.
   6. (6) Functional Living Skills Training. The residential rehabilitation program shall train the participant in self-reliance, money management, and money handling and purchases.

   7. (7) Socialization. The residential rehabilitation program shall train, supervise, or assist the participant to facilitate the participant's involvement in general community activities and establishment of relationships with peers, which may:

      1. (a) Not include participation in activities which are solely diversional or recreational in nature; and

      2. (b) Include:

         1. (i) Assisting the participant with learning and practicing skills of cooperation and participation;
         2. (ii) Assisting the participant to identify and participate in activities of interest; and
         3. (iii) Providing specific training activities necessary to assist the participant to participate in activities of interest on an ongoing basis.

   8. (8) Mobility. The residential rehabilitation program shall train, supervise, and assist the participant to:

      1. (a) Enhance movement within the participant's living, working, or education environment;
      2. (b) Master the use of adaptive aids and equipment; and
      3. (c) Access and use public transportation, independent travel, or other movement within the community.
   9. (9) Transportation. The residential rehabilitation program shall provide transportation for the participant to recreation, leisure activities, or skills training.

   10. (10) Crisis Intervention and Planning. The residential rehabilitation program shall include:

       1. (a) Planning for crises in the participant's residential habilitation placement; and
       2. (b) Making the necessary behavioral or environmental interventions to stabilize and preserve the participant's residential habilitation placement, or resolve an intensive behavioral episode.
   11. (11) Medication Management, Monitoring, and Training. The residential rehabilitation program shall provide, as needed and appropriate, medication management, monitoring, and training in accordance with the Maryland Nurse Practice Act and COMAR 10.27.11.

   12. (12) Transition Services. The residential rehabilitation program shall provide training and experiential learning activities for a participant in a residential habilitation placement, which:

       1. (a) Assist with developing discharge planning goals for the participant;
       2. (b) Assist the participant in making the transition to home, the next planned placement, or independent living;
       3. (c) Are responsive to the participant's individualized developmental and behavioral needs; and
       4. (d) Promote self-reliance and age-appropriate behavior.

7. G. A supervisor who has been trained in accordance with Regulation .04E(3) of this chapter shall:

   1. (1) Train and provide ongoing supervision to the direct care worker rendering residential habilitation services;
   2. (2) Supervise the direct care worker when crisis intervention services are rendered to evaluate the nature of the crisis and intervene to reduce the likelihood of reoccurrence;
   3. (3) Plan and regularly review the participant’s therapeutic activities and behavior plan;
   4. (4) Meet regularly with the participant and family and observe the participant in the residential habilitation setting; and
   5. (5) Develop and identify on the individualized treatment plan, the goals, interventions, and tasks that the residential habilitation direct care worker is implementing.
8. H. A unit of service for residential habilitation shall be on a per diem basis.

Authority: Health-General Article, §§2-104(b), 15-103, 15-105, and 15-130, Annotated Code of Maryland

Effective date: July 1, 2001 (28:12 Md. R. 1108)

Regulation .01C amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487)

Regulation .02A, B amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741)

Regulation .02B amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487)

Regulation .04 amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741)

Regulation .04D amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487)

Regulation .05A amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741)

Regulation .06 amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741)

Regulation .07C amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487)

Regulation .07C amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741)

Regulation .08A amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487)

Regulation .08A amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741)

Regulation .10F, G, H amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741)

Regulation .11C amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487)

Regulation .12 amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741)

Regulation .13 repealed as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); repealed permanently effective April 25, 2005 (32:8 Md. R. 741)

Regulation .14 amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741)

Regulation .15A, C amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741)

Regulation .16A amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741)

Regulation .21E amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487)

Regulation .21F amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741)

Regulation .22C amended as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487)

Chapter revised effective August 13, 2007 (34:16 Md. R. 1432)

Regulation .22D amended effective February 8, 2010 (37:3 Md. R. 176)

Chapter revised effective April 19, 2010 (37:8 Md. R. 615)

Regulation .01B amended effective April 16, 2012 (39:7 Md. R. 492); April 11, 2016 (43:7 Md. R. 449); May 18, 2020 (47:10 Md. R. 516)

Regulation .02 amended effective April 11, 2016 (43:7 Md. R. 449)

Regulation .02A amended effective September 16, 2024 (51:18 Md. R. 809)

Regulation .02A, B amended effective April 16, 2012 (39:7 Md. R. 492); May 18, 2020 (47:10 Md. R. 516)

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

Regulation .04 amended effective April 16, 2012 (39:7 Md. R. 492); April 11, 2016 (43:7 Md. R. 449); September 16, 2024 (51:18 Md. R.809)

Regulation .05 amended effective April 11, 2016 (43:7 Md. R. 449)

Regulation .05E amended effective October 14, 2013 (40:20 Md. R. 1652)

Regulation .05Q amended effective April 16, 2012 (39:7 Md. R. 492)

Regulation .06 amended effective April 11, 2016 (43:7 Md. R. 449)

Regulation .06E, M amended effective April 16, 2012 (39:7 Md. R. 492)

Regulation .06-1 amended effective April 11, 2016 (43:7 Md. R. 449)

Regulation .06-1P amended effective April 16, 2012 (39:7 Md. R. 492)

Regulation .06-2 adopted effective April 11, 2016 (43:7 Md. R. 449)

Regulation .07 amended effective April 16, 2012 (39:7 Md. R. 492); April 11, 2016 (43:7 Md. R. 449)

Regulation .08 amended effective April 16, 2012 (39:7 Md. R. 492); April 11, 2016 (43:7 Md. R. 449)

Regulation .10A amended effective September 16, 2024 (51:18 Md. R. 809)

Regulation .11E amended effective April 11, 2016 (43:7 Md. R. 449); May 18, 2020 (47:10 Md. R. 516)

Regulation .11G, H adopted effective April 11, 2016 (43:7 Md. R. 449)

Regulation .14 amended effective April 11, 2016 (43:7 Md. R. 449)

Regulation .14B amended effective September 16, 2024 (51:18 Md. R. 809)

Regulation .14C amended effective September 16, 2024 (51:18 Md. R. 809)

Regulation .14G amended effective September 16, 2024 (51:18 Md. R. 809)

Regulation .14-1 adopted effective April 11, 2016 (43:7 Md. R. 449)

Regulation .14-1B amended effective September 16, 2024 (51:18 Md. R.809)

Regulation .14-1C adopted effective September 16, 2024 (51:18 Md. R. 809)

Regulation .15 amended effective April 11, 2016 (43:7 Md. R. 449)

Regulation .15D amended effective September 16, 2024 (51:18 Md. R. 809)

Regulation .15E adopted effective September 16, 2024 (51:18 Md. R. 809)

Regulation .16C adopted effective April 11, 2016 (43:7 Md. R. 449)

Regulation .16C amended effective September 16, 2024 (51:18 Md. R.809)

Regulation .16D adopted effective September 16, 2024 (51:18 Md. R. 809)

Regulation .17 amended effective April 11, 2016 (43:7 Md. R. 449)

Regulation .17E amended effective September 16, 2024 (51:18 Md. R. 809)

Regulation .17F adopted effective September 16, 2024 (51:18 Md. R. 809)

Regulation .19 amended effective April 11, 2016 (43:7 Md. R. 449)

Regulation .19B, C amended effective September 16, 2024 (51:18 Md. R. 809)

Regulation .19D adopted effective September 16, 2024 (51:18 Md. R. 809)

Regulation .21 amended effective April 11, 2016 (43:7 Md. R. 449)

Regulation .21E, H amended effective May 18, 2020 (47:10 Md. R. 516); September 16, 2024 (51:18 Md. R. 809)

Regulation .21J adopted effective April 16, 2012 (39:7 Md. R. 492)

Regulation .22A, E amended effective November 27, 2023 (50:23 Md. R. 1004)

Regulation .22D amended effective October 31, 2011 (38:22 Md. R. 1346); April 11, 2016 (43:7 Md. R. 449)

Regulation .22D, E amended effective May 20, 2019 (46:10 Md. R. 486)

Regulation .22E amended effective September 16, 2024 (51:18 Md. R. 809)

Regulation .24 amended effective April 16, 2012 (39:7 Md. R. 492)