Nursing services will be offered as standalone waiver services including Nurse Consultation, Nurse Health Case Management, and Nurse Case Management and Delegation Services.
Scope
Nurse Case Management and Delegation Services
Provides individuals a licensed Registered Nurse (the “RN Case Manager & Delegating Nurse” or “RN CM/DN”) who: (1) provides health case management services (as defined below); and delegates nursing tasks for an unlicensed individual to perform acts that may otherwise be performed only by an RN or Licensed Practical Nurse (LPN), as appropriate and in accordance with applicable regulations. At a minimum, Nurse Health Case Management services includes:
- Performance of a comprehensive nursing assessment of the individual identifying his or her health, medical appointment, and nursing needs;
- Review of the Health Risk Screening Tool (HRST) at Level 3 or above, both on an annual basis and when any significant changes in the health of the individual occurs, to assist the individual to understand his or her health needs and to develop a plan for obtaining health services in the community;
- Completion of the Medication Administration Screening Tool, both on an annual basis and when any significant changes in the health of the individual occurs, to determine the level of support needed for medication administration;
- Review the individual’s health services and supports to promote quality client outcomes and cost-effective care according to the Maryland Board of Nursing regulations;
- Providing recommendations to the individual, caregivers under delegation of the RN, and the team for health care services that are available in the community;
- Communicating with the individual and his or her person-centered planning team members in order that the team can coordinate services and supports to meet the individual’s health needs;
- Develop health care plans and protocols, as needed, that direct the paid direct support staff in the provision of health services to be performed that include (a) administration of medications, (b) performance of medical and nursing treatments, (c) activities of daily living (ADL) performance, and (d) identifying and intervening in an emergency;
- Completion of training, supervision, evaluation and remediation on all health services provided under the delegation of the RN by the paid staff as identified in the Nursing Care Plans;
- Monitoring services delivered under delegation of the RN by direct support staff for compliance with the Nursing Care Plan; and
- Monitoring health data obtained by direct support staff under the delegation of the RN and as directed in the
Nursing Care Plan.
Delegation of Nursing Tasks services include:
- Assessment of (a) the needs and abilities of the individual; (b) direct care staff performance of delegated nursing tasks; and (c) the environment of service or care delivery;
- Delegation of the performance of nursing tasks (i.e., acts of a licensed nurse that include medication administration and treatment administration) to unlicensed direct care staff that may be Certified Medication Technicians (“CMT”), Certified Nursing Assistant (“CNA”), or other Unlicensed Assistive Personnel (“UAP”) in accordance with applicable Maryland Board of Nursing regulations;
- Training, supervision, and remediation of unlicensed direct care staff who provide health services under the delegation of the RN (e.g., administration of medication, treatments, and Activities of Daily Living (ADL) care, health monitoring) as required by applicable Maryland Board of Nursing regulations; and
- Provision of On-Call service, to paid direct support staff that are performing delegated nursing tasks, while delegation is occurring, for up to 24 hours per day, 365 days per year as required by applicable Maryland Board of Nursing regulations.
In provision of Nurse Health Case Management and Delegation Services, the RN CM/DN will collaborate with the DDA licensed provider agency or Self-Directed Service individual in the development of policies and procedures required for delegation of any nursing tasks in accordance with COMAR 10.27.11. The frequency of assessment is minimally every 45 days but may be more frequent based on the MBON 10.27.11 regulation and the prudent nursing judgment of the delegating RN in meeting conditions for delegation. This is a person-centered assessment and evaluation by the RN that determines duration and frequency of each assessment.
(Setting and Location)
Services can be held at our main office headquarters are located at 229 Washington Blvd S. Laurel, Maryland, MD 20707 and our residential homes and provided in a variety of settings in the community as defined in the individual’s person-centered plan.
(Staffing Training)
- Possess a valid Maryland and/or Compact Registered Nurse license;
- Successful completion of the DDA RN Case Manager/Delegating Nurse (CM/DN) Orientation;
- Be active on the DDA registry of DD RN CM/DNs;
- Complete the online HRST Rater and Reviewer training;
- Attend mandatory DDA trainings;
- Attend a minimum of two (2) DDA provided nurse quarterly meetings per fiscal year;
- Pass a criminal background investigation and any other required background checks and credentials verifications;
- Possess a valid driver’s license, if the operation of a vehicle is necessary to provide services;
- Have automobile insurance for all automobiles that are owned, leased, and/or hired and used in the provision of services;
- Complete required orientation and training designated by DDA;
- Complete necessary pre/in-service training based on the Person-Centered Plan and DDA required training prior to service delivery.
Verification of Provider Qualifications
Entity Responsible for Verification:
- DDA for approval of providers
- Nursing Service Agency for verification of staff member’s licenses, certifications, and training
Frequency of Verification:
Frequency of Verification:
- DDA – Initial and at least every three years
- Nursing Services Provider – prior to service delivery and continuing thereafter