.01 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) “Administrator” means the individual licensed by the Board of Examiners of Nursing Home Administrators who is responsible for the operation of the nursing home.

(2) “Attending physician” means an individual licensed to practice medicine in the State who:

(a) Admits residents to the nursing home; and

(b) Is responsible for the overall care of a resident.

(3) “Audiologist” means an individual who holds a Maryland license issued by the State Board of Audiologists, Hearing Aid Dealers, and Speech-Language Pathologists.

(4) “Authorized prescriber” has the meaning stated in Health Occupations Article, §12-101, Annotated Code of Maryland.

(5) “Certified medicine aide” means an individual who meets the requirements as stated in COMAR 10.39.01 and 10.39.03.

(6) “Certified social worker” means an individual licensed to practice as a certified social worker in this State.

(7) “Charge nurse” means the registered or licensed practical nurse who is responsible for day-to-day operations of a unit in the nursing home on which residents live.

(8) “Chemical restraint” means the administration of any drug that is used for discipline or convenience and not required to treat medical symptoms.

(9) “Comprehensive care facility” means a nursing home that admits residents requiring medical services and nursing services rendered by or under the supervision of a registered nurse, who:

(a) Are advanced in age; or

(b) Have a disease or a disability.

(10) “Concurrent review” means daily rounds by a licensed nurse which include:

(a) Appraisal and observation of all residents by the licensed nurse to determine any change in each resident’s physical or mental status;

(b) If there is a change in the resident’s physical or mental status, an evaluation by the licensed nurse of the resident’s medications, laboratory values relating to the resident, and clinical data relating to the resident, including the resident’s:

(i) Hydration and nutritional needs;

(ii) Skin integrity;

(iii) Noted weight changes; and

(iv) Appetite;

(c) Evaluation of injuries sustained by the resident that result from an accident or incident involving the resident; and

(d) Any other relevant parameters affecting or reflecting the resident’s physical and mental status.

(11) “Culture change facility” means a nursing home where physical environment and operational changes have been made to establish person-valued and person-directed care activities and services.

(12) “Deficiency” means a condition existing in a nursing home or an action or inaction by the nursing home staff that results in potential for more than minimal harm, actual harm, or serious and immediate threat to one or more residents.

(13) “Dentist” means an individual licensed to practice dentistry in this State.

(14) “Department” means the Maryland Department of Health.

(15) “Dietetic service supervisor” means a person who:

(a) Is a qualified dietitian;

(b) Is a graduate of a dietetic technician program approved by the American Dietetic Association;

(c) Is a certified dietary manager who has successfully completed the required course and maintains certification as required by the certifying board for the Dietary Managers Association;

(d) Is a graduate of a State-approved course that provided 90 or more hours of classroom instruction in food service supervision and has experience as a supervisor in a health care institution with consultation from a dietitian; or

(e) Has training and experience in food service supervision and management in a military service equivalent in content to §B(15)(b) and (d) of this regulation.

(16) “Dietitian-nutritionist” means an individual who:

(a) Is licensed by the Maryland Board of Dietetic Practice to practice dietetics;

(b) Has met the certifying requirements for registration as a dietitian as administered by the Commission on Dietetic Registration; and

(c) Maintains the continuing education requirements of registration.

(17) “Discharge” means the removal of a resident from a nursing home when the releasing nursing home is no longer responsible for the resident’s care.

(18) “Discipline” means the medical, rehabilitative, nursing, dietetic, activities and social service components affiliated with the operation of a nursing home.

(19) “Distinct part extended care facility” means a portion of a nursing home that is licensed as an extended care facility.

(20) “Extended care facility” means a nursing home that offers sub-acute care and provides medical treatment services for residents who require inpatient care but who do not currently require continuous hospital services.

(21) “Facility” means a nursing home.

(22) “Fire authorities” means the official fire safety agency including the State Fire Marshal or local fire marshals or fire departments as appropriate.

(23) “Full time” means 40 hours per week or the standard work week adopted by the nursing home.

(24) “Geriatric nursing assistant” means a CNA who has successfully completed the requirements for a GNA set forth in 42 CFR §§483.151—483.156 and COMAR 10.39.01.

(25) “Grant” means the award of money to an individual or an organization to:

(a) Study an aspect for the geriatric population; or

(b) Provide a service to nursing home residents or their families.

(26) “Health officer” means the health officer or the designated representative in each of the 23 counties and the Commissioner of Health in Baltimore City.

(27) “HVAC” means heating, ventilation and air conditioning.

(28) “Infection preventionist” means a licensed healthcare worker who:

(a) Manages the infection prevention and control program in the nursing home; and

(b) Has completed a minimum of 15 contact hours of infection prevention and control training that is approved by the:

(i) Department’s Office of Infectious Disease Epidemiology and Outbreak Response; and

(ii) Office of Health Care Quality.

(29) “Licensed bachelor social worker (LBSW)” means an individual authorized to practice bachelor social work under Health Occupations Article, Title 19, Annotated Code of Maryland.

(30) “Licensed certified social worker (LCSW)” means an individual authorized to practice certified social work under Health Occupations Article, Title 19, Annotated Code of Maryland.

(31) “Licensed certified social worker–clinical (LCSW-C)” means an individual authorized to practice clinical social work under Health Occupations Article, Title 19, Annotated Code of Maryland.

(32) “Licensed master social worker” means an individual authorized to practice master social work under Health Occupations Article, Title 19, Annotated Code of Maryland.

(33) “Licensed or certified professional health care practitioner” means a nurse practitioner, physician assistant, or other practitioner licensed or certified under the Health Occupations Article, Annotated Code of Maryland.

(34) “Licensed pharmacist” means an individual who is licensed by the Board to practice pharmacy as defined in Health Occupations Article, §12-101(l), Annotated Code of Maryland.

(35) “Licensed practical nurse” means an individual authorized to practice licensed practical nursing under Health Occupations Article, Title 8, Annotated Code of Maryland.

(36) “Management firm” means an organization, under contract with an applicant for a license or a current licensee, that is intended to have or has full responsibility and control for the day-to-day operations of the nursing home.

(37) “MDS Care Area Assessment” means the investigation of triggered care areas, to determine if the care area or areas require interventions and care planning.

(38) “Medical director” means an individual licensed to practice medicine in this State who, pursuant to a written agreement, is responsible for the overall coordination of the medical care in the nursing home to ensure the adequacy and appropriateness of the medical services provided to residents and to maintain surveillance of the health status of employees.

(39) “Minimum Data Set (MDS)” means a core set of screening, clinical, and functional status elements, including common definitions and coding categories, which:

(a) Forms the foundation of a comprehensive assessment for all nursing home and swing bed residents; and

(b) Standardize communication about resident problems and conditions:

(i) Within these facilities;

(ii) Between these facilities; and

(iii) Between these facilities and outside agencies.

(40) “New nursing home” means a nursing home that does not yet have plans approved by the Department at the time of the adoption of this chapter.

(41) “NFPA” means National Fire Protection Association.

(42) “Nurse” means a licensed practical nurse or registered nurse licensed in the State as defined in Health Occupations Article, §8-101, Annotated Code of Maryland.

(43) “Nurse practitioner” has the meaning stated in Health Occupations Article, §8-101(k), Annotated Code of Maryland.

(44) “Nursing care” has the meaning stated in Health-General Article, §19-301(k), Annotated Code of Maryland.

(45) “Nursing home” means a comprehensive care facility or extended care facility which offers nonacute inpatient care to residents:

(a) Who have a disease, chronic illness, condition, disability of advanced age, or terminal disease requiring maximal nursing care without continuous hospital services; and

(b) Who require medical services and nursing services rendered by or under the supervision of a licensed nurse together with convalescent, restorative, or rehabilitative services.

(46) “Nursing service personnel” means staff licensed or certified by the Maryland Board of Nursing.

(47) “Occupational therapist” means an individual who is licensed by the State Board of Occupational Therapy Practice to practice occupational therapy.

(48) “Occupational therapy assistant” means an individual who is currently licensed by the State Board of Occupational Therapy Practice as an occupational therapy assistant.

(49) “Ongoing pattern” means the occurrence of any potential for more than minimal harm or greater deficiency on two consecutive on-site visits as a result of:

(a) Annual surveys;

(b) Follow-up visits and unscheduled visits; or

(c) Complaint investigations.

(50) “Paid feeding assistant” means an individual who:

(a) Meets the requirements of Regulation .63 of this chapter; and

(b) Is paid by a nursing home to feed residents who are unable to perform the task themselves.

(51) “Physical restraint” means any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident’s body that the individual cannot remove easily which restricts freedom of movement or normal access to one’s body including but not limited to:

(a) Leg restraints;

(b) Arm restraints;

(c) Hand mitts;

(d) Soft ties or vests;

(e) Lap cushions; and

(f) Lap trays.

(52) “Physical therapist” means an individual licensed to practice physical therapy by the State Board of Physical Therapy Examiners.

(53) “Physician” means an individual licensed to practice medicine in this State.

(54) “Physician assistant” has the meaning stated in Health Occupations Article, §15-101(o), Annotated Code of Maryland.

(55) “Plan of correction” means a written response from the nursing home addressing each deficiency cited as a result of an inspection by the Department.

(56) “Positive tuberculin skin test” means a test provided as authorized by the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings.

(57) “Principal physician” means an individual licensed to practice medicine in this State who agrees to perform certain medical services under contract with a nursing home, consistent with the policies of the nursing home.

(58) “Protective device” means any device or equipment:

(a) That is prescribed by a physician;

(b) That limits, but does not eliminate the movement of the resident’s head, body, or limbs; and

(c) That:

(i) Shields a resident from self-injury;

(ii) Prevents a resident from aggravating an existing physical problem; or

(iii) Prevents a resident from precipitating a potential physical problem.

(59) “Qualified medical record practitioner” means an individual who:

(a) Has:

(i) Received a baccalaureate degree from an accredited college or university including or supplemented by a successful completion of a course in health record administration approved by the Council on Medical Education of the American Medical Association; and

(ii) Passed the national registration examination for registered record administrators; or

(b) Has:

(i) Received an associate of arts degree in health record technology from a college or university approved by the American Medical Association Council on Medical Education or an equivalent approved health record technology correspondence course of the American Medical Record Association; and

(ii) Passed the national accreditation examination for accredited record technicians.

(60) “Qualified social work consultant” means an individual who:

(a) Is a licensed certified social worker; and

(b) Has a minimum of 3 years’ experience in social work programs in a long-term care setting within the last 5 years.

(61) “Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system” means the standard nationwide system to which several types of health care providers submit CMS required resident information to the National Submissions Database.

(62) “Registered nurse” means an individual licensed to practice as a registered nurse in this State.

(63) Relocation.

(a) “Relocation” means the movement of a resident from one room to another within:

(i) The same Medicare-certified nursing home;

(ii) A Medicaid-only certified nursing home; or

(iii) A licensed-only nursing home.

(b) “Relocation” does not mean the movement of a resident if the effect of the movement is to move the resident from:

(i) The distinct part of the nursing home that is a skilled nursing facility to a distinct part of the nursing home that is not a skilled nursing facility; or

(ii) A bed that is certified for Medicaid to a distinct part of the nursing home that is a skilled nursing facility.

(64) “Resident” means an individual who:

(a) Resides in the nursing home; and

(b) Receives nursing services rendered by or under the supervision of a registered nurse.

(65) “Resident activities coordinator” means an individual who:

(a) Is a:

(i) Certified therapeutic recreation specialist;

(ii) Licensed occupational therapist; or

(iii) Licensed occupational therapy assistant; or

(b) Has 2 years of experience in a social or recreational program in a licensed health care setting within the last 5 years, 1 year of which was full time in a resident activities program with guidance from an individual identified in §B(73)(a) of this regulation.

(66) Resident Assessment Instrument (RAI).

(a) “Resident Assessment Instrument (RAI)” means a standardized and reproducible resident assessment process based on completion of Minimum Data Set (MDS) screening items, and including the MDS Care Area Assessment process, and related process for care planning and evaluation.

(b) “Resident Assessment Instrument (RAI)” includes:

(i) Minimum Data Set;

(ii) MDS Care Area Assessment Process; and

(iii) RAI utilization guidelines.

(67) “Resident’s representative” means a person with the authority to act on the resident’s behalf regarding the matter at issue.

(68) “Restraint” means any physical or chemical restraint as defined in this chapter.

(69) “Secretary” means the Secretary of Health.

(70) “Serious and immediate threat” means a situation in which immediate corrective action is necessary because a deficiency has caused or is likely to cause serious injury, harm, impairment to, or death of a resident receiving care in the nursing home.

(71) “Special care unit” means a nursing home unit that provides intensive specialized care, such as respiratory, rehabilitative, dementia, or dialysis care, continuously on a 24-hour basis.

(72) “Speech-language pathologist” means an individual licensed by the State Board of Audiologists, Hearing Aid Dispensers, and Speech-Language Pathologists.

(73) “Support personnel” means an aide who:

(a) Is assigned to a particular service such as:

(i) Nursing;

(ii) Dietary;

(iii) Physical therapy; or

(iv) Occupational therapy; and

(b) Has been approved by the manager of the services as having sufficient training and experience to perform the assigned duties.

(74) “Tuberculin skin test” means a test to diagnose tuberculosis infection using purified protein derivative (PPD) that is injected intradermally and read within 48—72 hours with results recorded in millimeters of induration.

(75) Tuberculosis in a Communicable Form.

(a) “Tuberculosis in a communicable form” means that an individual:

(i) Is presumed to have active pulmonary or laryngeal tuberculosis as evidenced by positive X-ray findings with or without positive acid-fast bacilli (AFB) sputum smear or positive AFB sputum culture; and

(ii) Has received chemotherapy for less than 14 days.

(b) “Tuberculosis in a communicable form” does not include:

(i) When the individual who has presumptive or confirmed active disease, has had three negative AFB smears, collected 8—24 hours apart, shows clinical improvement, and has received chemotherapy to which the strain is susceptible for at least 14 days; or

(ii) The individual who has inactive pulmonary scarring, calcification, or a normal chest X-ray.

(76) “Two-step tuberculin skin testing” means the administration of a second tuberculin skin test 1 to 3 weeks after the initial skin test is negative, to identify individuals with a past TB infection who may now have reduced skin reactivity.