ROBERT L. EHRLICH, JR., Governor

Ch. 4

[(13)] (14) "Waiver" means a home and community based services waiver
under § 1915(c) of the federal Social Security Act, submitted by the Department to the
[Health Care Financing Administration] CENTERS FOR MEDICARE AND MEDICAID
SERVICES, as required by subsections [(b) and (c)] (F) AND (G) (D) of this section.

[(14)] (15) "Waiver services" means the services covered under an
approved waiver that:

(i) Are needed and chosen by an eligible waiver participant as an
alternative to admission to or continued stay in a nursing facility;

(ii) Are part of a plan of care approved by the program;

(iii) Assure the waiver participant's health and safety in the
community; and

(iv) Cost no more per capita to receive services in the community
than in a nursing facility.

(B) ON OR BEFORE JULY 1, 2004, THE DEPARTMENT SHALL DEVELOP A
PROGRAM DESIGNED TO REDUCE THE NUMBER OF NURSING FACILITY BEDS
OCCUPIED BY MEDICAL ASSISTANCE LONG TERM CARE RECIPIENTS IN EACH
COUNTY AND BALTIMORE CITY AND TO ASSIST DUALLY ELIGIBLE NURSING FACILITY
RESIDENTS WHO CHOOSE TO OBTAIN LONG TERM CARE SERVICES IN THE
COMMUNITY.

(C) THE PROGRAM DEVELOPED UNDER SUBSECTION (B) OF THIS SECTION
SHALL INCLUDE:

(1) PROVISION OF SUPPORT SERVICES THAT ARE NECESSARY FOR AN
INDIVIDUAL WHO IS DUALLY ELIGIBLE FOR MEDICARE AND MEDICAID LONG TERM
CARE BENEFITS TO ACHIEVE MAXIMUM PARTICIPATION IN THE MAINSTREAM IN THE
MOST INTEGRATED SETTING POSSIBLE AND, ON A STATEWIDE BASIS, IMPROVE THE
CAPACITY OF COMMUNITIES TO SUPPORT INDIVIDUALS WHO ARE DUALLY ELIGIBLE
FOR MEDICARE AND MEDICAID LONG TERM CARE BENEFITS WITH LONG-TERM
CARE OPTIONS THAT ARE SELF DIRECTED; AND

(2) PROCEDURES OR PROGRAMS DESIGNED TO OFFSET THE LOSS OF
INCOME REALIZED BY A NURSING HOME ASSOCIATED WITH THE LOSS OF A DUALLY
ELIGIBLE NURSING FACILITY RESIDENT TO THE COMMUNITY THAT MAY INCLUDE:

(I) TAX CREDITS;

(II) GRANTS TOWARD CONVERSION OF A LICENSED NURSING
HOME BED TO AN ASSISTED LIVING BED, RESPITE CARE BED, OR FOR MEDICAL DAY
CARE; OR

(III) FROM A PORTION OF THE SAVINGS GENERATED FROM MOVING
DUALLY ELIGIBLE NURSING FACILITY RESIDENT TO THE COMMUNITY, AN
ADJUSTMENT IN MEDICAID REIMBURSEMENT FOR THE SICKEST RESIDENTS IN THE
FACILITY.

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