Maryland 2022 2022 Regular Session

Maryland Senate Bill SB868 Chaptered / Bill

Filed 06/07/2022

                     LAWRENCE J. HOGAN, JR., Governor Ch. 737 
 
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Chapter 737 
(Senate Bill 868) 
 
AN ACT concerning 
 
Developmental Disabilities Administration – Self–Directed Services 
(Self–Direction Act of 2022) 
 
FOR the purpose of requiring the Developmental Disabilities Administration to establish 
and provide training materials to coordinators of community services on 
self–directed services; requiring coordinators of community services to educate a 
certain recipient on self–directed services all models of services available to the 
recipient at certain times; providing for the services and manner of delivering 
services that the Administration provides to a recipient who receives self–directed 
services; requiring that home– and community–based services waiver recipients 
receive support broker services; requiring the Administration to submit a certain 
waiver application for a certain purpose by a certain date; requiring the 
Administration to leverage certain federal funding for a certain purpose; and 
generally relating to Developmental Disabilities Administration services. 
 
BY repealing and reenacting, with amendments, 
 Article – Health – General 
Section 7–101 
 Annotated Code of Maryland 
 (2019 Replacement Volume and 2021 Supplement) 
 
BY adding to 
 Article – Health – General 
Section 7–408 through 7–410 
 Annotated Code of Maryland 
 (2019 Replacement Volume and 2021 Supplement) 
 
 SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 
That the Laws of Maryland read as follows: 
 
Article – Health – General 
 
7–101. 
 
 (a) In this title the following words have the meanings indicated. 
 
 (b) “Administration” means the Developmental Disabilities Administration. 
 
 (c) (1) “Admission” means the process by which an individual with an 
intellectual disability is accepted as a resident in a State residential center. 
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 (2) “Admission” includes the physical act of the individual entering the 
facility. 
 
 (d) (1) “Alternative living unit” means a residence that: 
 
 (i) Provides residential services for individuals who, because of 
developmental disability, require specialized living arrangements; 
 
 (ii) Admits not more than 3 individuals; and 
 
 (iii) Provides 10 or more hours of supervision per unit, per week. 
 
 (2) “Alternative living unit” does not include a residence that is owned or 
rented by: 
 
 (i) 1 or more of its residents; or 
 
 (ii) A person who: 
 
 1. Is an agent for any of the residents; but 
 
 2. Is not a provider of residential supervision. 
 
 (e) “Claim” has the meaning stated in § 2–601 of this article. 
 
 (f) “Deputy Secretary” means the Deputy Secretary for Developmental 
Disabilities. 
 
 (g) “Developmental disability” means a severe chronic disability of an individual 
that: 
 
 (1) Is attributable to a physical or mental impairment, other than the sole 
diagnosis of mental illness, or to a combination of mental and physical impairments; 
 
 (2) Is manifested before the individual attains the age of 22; 
 
 (3) Is likely to continue indefinitely; 
 
 (4) Results in an inability to live independently without external support 
or continuing and regular assistance; and 
 
 (5) Reflects the need for a combination and sequence of special, 
interdisciplinary, or generic care, treatment, or other services that are individually planned 
and coordinated for the individual. 
 
 (h) “External support” means:   LAWRENCE J. HOGAN, JR., Governor Ch. 737 
 
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 (1) Periodic monitoring of the circumstances of an individual with respect 
to: 
 
 (i) Personal management; 
 
 (ii) Household management; and 
 
 (iii) The use of community resources; and 
 
 (2) Rendering appropriate advice or assistance that may be needed. 
 
 (i) “Fee–for–service” means a method for payment that requires a person to 
submit a claim for payment to the Department for each service performed. 
 
 (j) “Group home” means a residence that: 
 
 (1) Provides residential services for individuals who, because of 
developmental disability, require specialized living arrangements; 
 
 (2) Admits at least 4 but not more than 8 individuals; and 
 
 (3) Provides 10 or more hours of supervision per home, per week. 
 
 (k) “Habilitation” means a process by which a provider of services enables an 
individual to acquire and maintain life skills to cope more effectively with the demands of 
the individual’s own person and environment and to raise the level of the individual’s 
mental, physical, social, and vocational functioning. 
 
 (L) (1) “INDIVIDUAL–DIRECTED FAMILY AND FAMILY–DIRECTED GOODS 
AND SERVICES ” MEANS SERVICES , EQUIPMENT, THERAPIES, TRANSPORTATION 
ACTIVITIES, OR SUPPLIES FOR INDI VIDUALS WHO SELF –DIRECT SERVICES THAT : 
 
 (I) RELATE TO A NEED O R GOAL IDENTIFIED IN THE  
PERSON–CENTERED PLAN OF SERVICE; 
 
 (II) MAINTAIN OR INCREASE INDEPENDENCE ; 
 
 (III) PROMOTE OPPORTUNITIES FOR COMMUNITY LIVING AND 
INCLUSION; AND 
 
 (IV) ARE NOT AVAILABLE UND ER A ANOTHER WAIVER SERVICE 
OR SERVICES PROVIDED UNDER THE STATE PLAN ESTABLISHE D IN SUBTITLE 3 OF 
THIS TITLE. 
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 (2) “INDIVIDUAL–DIRECTED FAMILY AND FAMILY–DIRECTED GOODS 
AND SERVICES ” INCLUDES ANY OTHER ALL GOODS OR SERVICES AU THORIZED 
UNDER BY REGULATIONS ADOPT ED OR GUIDANCE ISSUED BY T HE FEDERAL 
CENTERS FOR MEDICARE AND MEDICAID SERVICES UNDER § 1915(C) OF THE 
SOCIAL SECURITY ACT. 
 
 [(l)] (M) (1) “Individual support services” means an array of services that are 
designed to increase or maintain an individual’s ability to live alone or in a family setting. 
 
 (2) “Individual support services” include: 
 
 (i) In–home assistance with meals and personal care; 
 
 (ii) Counseling; 
 
 (iii) Physical, occupational, or other therapies; 
 
 (iv) Architectural modification; and 
 
 (v) Any other services that the Administration considers 
appropriate to meet the individual’s needs. 
 
 (3) “Individual support services” does not include full day or residential 
services. 
 
 [(m)] (N) “Intellectual disability” means a developmental disability that is 
evidenced by significantly subaverage intellectual functioning and impairment in the 
adaptive behavior of an individual. 
 
 [(n)] (O) “Knowingly” has the meaning stated in § 2–601 of this article. 
 
 [(o)] (P) “Live independently” means: 
 
 (1) For adults: 
 
 (i) Managing personal care, such as clothing and medication; 
 
 (ii) Managing a household, such as menu planning, food preparation 
and shopping, essential care of the premises, and budgeting; and 
 
 (iii) Using community resources, such as commercial establishments, 
transportation, and services of public agencies; or 
 
 (2) For minors, functioning in normal settings without the need for 
supervision or assistance other than supervision or assistance that is age appropriate.   LAWRENCE J. HOGAN, JR., Governor Ch. 737 
 
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 [(p)] (Q) “Meaningful day services” means employment supports or home– and 
community–based supports, other than residential services, that assist an individual in 
developing and maintaining skills, interests, and personalized connections that may create 
opportunities for paid employment, increased independence, or meaningful relationships 
with other individuals in the community. 
 
 (R) “PERSON–CENTERED PLAN OF SERVICE ” MEANS THAT A PLAN FO R 
SERVICES AND SUPPORTS : 
 
 (1) REFLECTS WHAT IS IMPO RTANT TO THE INDIVID UAL AND FOR THE 
INDIVIDUAL’S HEALTH AND WELFARE; AND 
 
 (2) IS DEVELOPED WITH INP UT FROM THE INDIVIDU AL OR THE 
INDIVIDUAL’S REPRESENTATIVE , IF APPLICABLE. 
 
 (1) IS DEVELOPED WITH A F OCUS ON THE INDIVIDU AL HAVING 
CONTROL OVER THE SER VICES AND SUPPORTS ; 
 
 (2) ENSURES THAT THE INDI VIDUAL IS THE PRIMARY CONTRIBUTOR 
TO THE PLAN AND MAY RECEIVE SUPPORT FROM OTHER PERSONS SELECT ED BY THE 
INDIVIDUAL IN DEVELO PING THE PLAN; 
 
 (3) IDENTIFIES AND ADDRES SES, TO THE EXTENT PRACTI CABLE: 
 
 (I) THE INDIVIDUAL ’S PREFERENCES AND IN	TERESTS 
RELATED TO ACHIEVIN G THE INDIVIDUAL ’S DESIRED LIFESTYLE ; AND 
 
 (II) THE SUPPORTS REQUIRED TO ACHIEVE THE INDIV IDUAL’S 
DESIRED LIFESTYLE AN D PROVIDED IN A MANN ER THAT ENABLES THE INDIVIDUAL 
TO HAVE CONTROL OVER THE INDIVIDUAL ’S DAILY LIFE AND MAI NTAINS THE 
INDIVIDUAL’S HEALTH AND WELFARE ; AND 
 
 (4) ALIGNS SERVICES AND S UPPORTS TO ENSURE TH AT THE 
INDIVIDUAL HAS ACCES S TO THE FULL BENEFI TS OF COMMUNITY LIVI NG IN A 
MANNER THAT EMPHASIZ ES THE INDIVIDUAL ’S QUALITY OF LIFE, WELL–BEING, AND 
INFORMED CHOICE .  
 
 [(q)] (S) “Provider” means an individual who is licensed or certified under 
Subtitle 9 of this title and provides services to: 
 
 (1) A recipient; or 
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 (2) An individual with a developmental disability who receives funding for 
services from a source other than the Administration. 
 
 [(r)] (T) “Recipient” means an individual who receives services funded by the 
Administration under this title. 
 
 [(s)] (U) “Release” means a permanent, temporary, absolute, or conditional 
release of an individual from a State residential center. 
 
 [(t)] (V) “Residential services” means individualized support and services that 
assist an individual in developing and maintaining skills in living in the community. 
 
 (W) (1) “SELF–DIRECTED SERVICES ” MEANS WAIVER PROGRAM 
SERVICES: 
 
 (I) FOR WHICH PARTICIPANT S OR THEIR REPRESENT ATIVES 
HAVE DECISION–MAKING AUTHORITY OVE R AND TAKE DIRECT RE SPONSIBILITY FOR 
MANAGEMENT OF THE SE RVICES WITH THE ASSI STANCE OF AVAILABLE SUPPORTS 
CHOSEN BY THE PARTIC IPANT OR THE PARTICI PANT’S REPRESENTATIVE ; AND 
 
 (II) THAT ARE PROVIDED IN A MANNER THAT FURTHERS: 
 
 1. FURTHERS THE RIGHT OF INDIVID UALS WITH 
DISABILITIES, REGARDLESS OF THE PH YSICAL OR INTELLECTUAL CAPACIT Y OF THE 
INDIVIDUALS, AND THEIR REPRESENTA TIVES, AS APPLICABLE , TO MAKE CHOICES 
ABOUT AND DI RECT ALL ASPECTS OF THEIR LIVES, INCLUDING THROUGH CONTROL 
OVER RECEIPT OF, AND FUNDING FOR , SUPPORT SERVICES BY CHOOSING AND 
CONTROLLING THE DELI VERY OF WAIVER SERVI CES, WHO PROVIDES THE SER VICES, 
AND HOW SERVICES ARE PROVIDED; AND 
 
 2. RECOGNIZES THAT ALL INDIVIDUALS HAVE THE 
CAPACITY TO MAKE CHO ICES AND MAY BE SUPP ORTED IN MAKING CHOI CES. 
 
 (2) “SELF–DIRECTED SERVICES ” INCLUDES SERVICES TH AT: 
 
 (I) PROVIDE AN INDIVIDUAL WITH: 
 
 1. THE DECISION–MAKING EMPLOYER AUTH ORITY TO 
RECRUIT, HIRE, TRAIN, AND SUPERVISE, AND DISMISS THE INDIVIDUALS 
EMPLOYEES AND VENDOR S WHO FURNISH THE INDI VIDUAL’S SERVICES; AND 
 
 2. THE BUDGET AUTHORITY OVER HOW FUNDS IN A 
BUDGET ARE SPENT WITHIN THE TOTAL APP ROVED ANNUAL BUDGET ; 
   LAWRENCE J. HOGAN, JR., Governor Ch. 737 
 
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 (II) MAXIMIZE THE OPPORTUN ITIES OF AN INDIVIDUAL TO LIVE 
AS INDEPENDENTLY AS POSSIBLE IN THE MOST INCLUSIVE COMMUNITY –BASED 
SETTING OF THE INDIV IDUAL’S CHOICE; 
 
 (III) EMPOWER AN INDIVIDUAL TO EXERCISE CHOICE A ND 
CONTROL OVER NEEDED LONG–TERM SERVICES AND SU PPORTS; AND 
 
 (IV) HELP TO MAIN TAIN AND IMPROVE THE INDIVIDUAL ’S 
HEALTH AND QUALITY O F LIFE IN THE INDIVIDUAL’S COMMUNITY . 
 
 [(u)] (X) “Services” means residential, day, or other services that provide for 
evaluation, diagnosis, treatment, care, supervision, assistance, or attention to individuals 
with developmental disability and that promote habilitation of these individuals. 
 
 [(v)] (Y) “Services coordination” means a service that consists of the following 3 
major functions that are designed to assist an individual in obtaining the needed services 
and programs that the individual desires in order to gain as much control over the 
individual’s own life as possible: 
 
 (1) Planning services; 
 
 (2) Coordinating services; and 
 
 (3) Monitoring service delivery to the individual. 
 
 [(w)] (Z) “State residential center” means a licensed facility operated by the 
State that provides residential and habilitation services to individuals with an intellectual 
disability who are at least 18 years old and meet the criteria set forth in § 7–502 of this 
title. 
 
 (AA) “SUPPORT BROKER ” MEANS A PERSON WHO ADVOCATES ON BEHALF OF 
AND AS DIRECTED BY WORKS AT THE DIRECTI ON OF AND FOR THE BE NEFIT OF AN 
INDIVIDUAL WHO USES SELF–DIRECTED SERVICES , INCLUDING BY ASSISTI NG THE 
INDIVIDUAL OR THE INDIVIDUAL ’S FAMILY OR OTHER REPRESENTATIVE ANOTHER 
INDIVIDUAL CHOSEN BY THE INDIVIDUAL WITH: 
 
 (1) MAKING INFORMED DECIS IONS IN ARRANGING FO R, DIRECTING, 
AND MANAGING SERVICE S THE INDIVIDUAL REC EIVES, INCLUDING DECISIONS 
RELATED TO PERSONNEL REQUIREMENTS AND RES OURCES NEED ED TO MEET THE 
REQUIREMENTS ; 
 
 (2) ACCESSING AND MANAGIN G IDENTIFIED SUPPORT S AND 
SERVICES BEST SUITED FOR THE INDIVIDUAL ; AND 
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 (3) PERFORMING OTHER TASK S AS ASSIGNED BY THE INDIVIDUAL 
AND AS AUTHORIZED BY REGULATIONS ADOPTED OR GUIDANCE ISSUED B Y THE 
FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES UNDER § 1915(C) OF 
THE SOCIAL SECURITY ACT. 
 
 [(x)] (BB) “Support services” means supports that assist an individual to maintain 
or improve the individual’s functional abilities, enhance interactions, or engage in 
meaningful relationships in the home or community. 
 
 [(y)] (CC) “Treatment” means any education, training, professional care or 
attention, or other program that is given to an individual with developmental disability. 
 
 [(z)] (DD) “Vocational services” means a service that provides job training and 
placement, supported employment and training in acceptable work behaviors, and 
vocationally–related social and other skills. 
 
 [(aa)] (EE) “Waiver program” means each Medicaid Home	– and  
Community–Based Services Waiver funding program submitted by the Department and 
approved by the federal Centers for Medicare and Medicaid Services in accordance with § 
1915(c) of the Social Security Act that is overseen and administered by the Administration. 
 
 [(bb)] (FF) “Waiver program services” means services funded by the 
Administration in accordance with a waiver program, including: 
 
 (1) Meaningful day services; 
 
 (2) Residential services; and 
 
 (3) Support services. 
 
7–408. 
 
 (A) THE ADMINISTRATION , IN CONSULTATION WITH STAKEHOLDERS , 
SHALL ESTABLISH AND PROVIDE TRAINING MAT ERIALS TO COORDINATO RS OF 
COMMUNITY SERVICES SPECIFICALLY ON THE SELF–DIRECTED SERVICES MODEL OF 
RECEIVING SERVICES , INCLUDING TRAINING MATERIALS O N SELF–DIRECTED 
SERVICES, PROCEDURES , POLICIES, AND RESOURCES . 
 
 (B) AS PART OF THE PROCES S OF DEVELOPING A PE RSON–CENTERED PLAN 
OF SERVICE FOR A REC IPIENT, A COORDINATOR OF COM MUNITY SERVICES SHAL L 
EDUCATE THE RECIPIEN T ON THE AVAILABILITY OF SELF–DIRECTED SERVICES ALL 
MODELS OF SERVICE AV AILABLE TO THE RECIP IENT, INCLUDING SELF –DIRECTED 
SERVICES, TRADITIONAL SERVICES , AND PROVIDER –MANAGED SERVICES , TO 
ASSIST THE RECIPIENT AND THE RECIPIENT ’S FAMILY OR REPRESEN TATIVE IN   LAWRENCE J. HOGAN, JR., Governor Ch. 737 
 
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MAKING AN INFORMED C HOICE ON WHICH SERVI CES THE RECIPIENT WOULD LIKE 
TO RECEIVE: 
 
 (1) WHEN THE INDIVIDUAL B EGINS RECEIVING SERV ICES FROM A 
COORDINATOR OF COMMU NITY SERVICES; AND 
 
 (2) AT LEAST ONCE EACH YE AR THAT THE INDIVIDU AL IS RECEIVING 
SERVICES FROM A COOR DINATOR OF COMMUNITY SERVICES. 
 
 (C) A COORDINATOR OF COMMUNIT Y SERVICES SHALL REP ORT TO THE 
ADMINISTRATION , IN THE FORM AND MANN ER REQUIRED BY THE ADMINISTRATION , 
THAT THE COORDINATOR OFFERED PROVIDED INFORMATION ON SELF–DIRECTED 
SERVICES, TRADITIONAL SERVICES , AND PROVIDER –MANAGED SERVICES TO AN 
INDIVIDUAL IN ACCORD ANCE WITH THIS SECTI ON. 
 
7–409. 
 
 (A) THE ADMINISTRATION SHALL PROVIDE TO A RECIPIE NT WHO RECEIVES 
SELF–DIRECTED SERVICES : 
 
 (1) INDIVIDUAL–DIRECTED FAMILY AND FAMILY–DIRECTED GOODS 
AND SERVICES IN AN A MOUNT BASED ON THE R ECIPIENT’S NEEDS AND INCLUDED IN 
THE RECIPIENT’S PERSON–CENTERED PLAN OF SER VICE AS CALCULATED ON: 
 
 (I) ON AN ANNUAL BASIS ; AND 
 
 (II) WITHIN THE LIMITS OF THE APPROVED ANNUAL BUDGET 
GENERATED BY THE DEPARTMENT ’S LONG TERM SERVICES AND SUPPORTS 
SOFTWARE SYSTEM OR ITS REPLACEMENT SYST EM;  
 
 (2) ACCESS TO THE RECIPIE NT’S PLAN OF SERVICE AN D BUDGETS 
FOR THE PLAN OF SERV ICE THROUGH THE DEPARTMENT ’S LONG TERM SERVICES 
AND SUPPORTS SOFTWARE SYS TEM OR ITS REPLACEMENT S YSTEM; 
 
 (3) UP TO 40 30 HOURS OF SUPPORT BRO KER SERVICES EACH 
MONTH, AS NEEDED BY THE REC IPIENT AND WITHIN THE RECIP IENT’S TOTAL 
APPROVED ANNUAL BUDG ET; 
 
 (4) AN OPTION FOR A FAMIL Y MEMBER OR LEGAL GU ARDIAN OF THE 
RECIPIENT TO PROVIDE SERVICES FOR THE REC IPIENT, IF: 
 
 (I) THE RECIPIENT OR AN INDI VIDUAL AUTHORIZED TO MAKE 
CARE DECISIONS ON BE HALF OF THE RECIPIEN T CHOOSES THE FAMILY MEMBER TO 
PROVIDE THE SERVICES ; AND  Ch. 737 	2022 LAWS OF MARYLAND  
 
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 (II) THE RECIPIENT ALSO HI RES A SUPPORT BROKER ; 
 
 (5) REIMBURSEMENT PAID ON A PER–MILE BASIS FOR 
TRANSPORTAT ION PROVIDED TO THE RECIPIENT BY AN INDI VIDUAL WHO IS NOT 
EMPLOYED BY THE INDI VIDUAL, IF THE TRANSPORTATIO N IS RELATED TO TO THE 
OWNER OF A SPECIALIZ ED, MODIFIED, OR ACCESSIBLE VEHICL E DRIVEN BY AN 
EMPLOYEE OF THE RECI PIENT AND FOR THE PU RPOSE OF THE RECIP IENT 
ENGAGING IN ACTIVITI ES SPECIFIED IN THE RECIPIENT’S PERSON–CENTERED PLAN 
OF SERVICE;  
 
 (6) A BUDGET FOR SELF –DIRECTED SERVICES TH AT PROVIDES 
SUBSTANTIALLY SIMILA R SERVICES AS THOSE PROVIDED TO A RECIPI ENT WHO 
DOES NOT SELF –DIRECT SERVICES , INCLUDING FUNDING FOR MANAGERI AL OR 
DIRECT SUPPORT POSIT IONS THE ABILITY TO USE F UNDS FROM THE RECIPI ENT’S 
APPROVED ANNUAL BUDG ET FOR THE PURPOSE O F FUNDING AT LEAST O NE 
POSITION TO ASSIST T HE RECIPIENT IN MANA GING THE RECIPIENT ’S HOME, STAFF, 
AND OTHER ADMINISTRA TIVE DUTIES AND PAY A DMINISTRATIVE EXPENS ES NEEDED 
TO OPERATE THE RECIP IENT’S PLAN OF SERVICE , INCLUDING INTERNET SERVICE 
AND OFFICE EQUIPMENT ; 
 
 (7) AN OPTION FOR A RECIP IENT WHO HAS A DEMON STRATED NEED 
FOR OVERNIGHT SUPPOR TS PROVIDED THROUGH PER SONAL SUPPORT SERVICES 
CARRIED OUT USING TH E RECIPIENT’S EMPLOYER OR BUDGET AUTHORITY TO 
DIRECT AND CHOOSE TH E EMPLOYEE, VENDOR, OR PROVIDER OF THE OVER NIGHT 
SUPPORTS, INCLUDING WHETHER TO USE FUNDING IN THE R ECIPIENT’S BUDGET 
FOR SELF–DIRECTED SERVICES AL LOCATED FOR PERSONAL SUPPO RT SERVICES 
FOR OVERNIGHT SUPPOR TS; 
 
 (8) THE CHOICE OF A VENDO R TO PROVIDE FISCAL MANAGEMENT 
SERVICES FROM AT LEA ST THREE OPTIONS ; 
 
 (9) THE OPTION TO EMPLOY A REPRESENTATIVE , SUPPORT BROKER , 
OR TEAM OF INDIVIDUA LS TO SUPPORT THE RE CIPIENT IN DIRECTING SERVICES; 
AND 
 
 (10) TRAINING FOR A REPRES ENTATIVE, SUPPORT BROKER , OR TEAM 
OF INDIVIDUALS ON SE LF–DIRECTED SERVICES . 
 
 (B) SUBJECT TO SUBSECTION (A)(3) OF THIS SECTION , THE 
ADMINISTRATION SHALL PROVIDE TO A RECIPIE NT OF SELF–DIRECTED SERVICES 
ANY SUPPORT BROKER S ERVICES THAT ARE : 
   LAWRENCE J. HOGAN, JR., Governor Ch. 737 
 
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 (1) AUTHORIZED UNDER BY REGULATIONS ADOPT ED OR GUIDANCE 
ISSUED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES IN § 1915(C) OF 
THE SOCIAL SECURITY ACT; AND 
 
 (2) SELECTED BY THE RECIP IENT. 
 
 (C) (1) THE SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION , THE 
ADMINISTRATION MAY NO T ESTABLISH A LIMIT ON: 
 
 (1) (I) THE DOLLAR AMOUNT OF INDIVIDUAL–DIRECTED FAMILY 
AND FAMILY–DIRECTED GOODS AND SERVICES P ROVIDED TO A RECIPIE NT; OR 
 
 (2) (II) THE NUMBER OF HOURS O	F OVERNIGHT SUPPORTS 
PERSONAL SUPPORT SER VICES PROVIDED TO A RECIPI ENT WHO RECEIVES 
SELF–DIRECTED SERVICES THAT: 
 
 1. ARE NECESSARY FOR THE HEALTH AND SAFETY OF 
THE RECIPIENT; AND 
 
 2. ARE AUTHORIZED BY REG ULATIONS ADOPTED OR 
GUIDANCE ISSUED BY T HE FEDERAL CENTERS FOR MEDICARE AND MEDICAID 
SERVICES UNDER § 1915(C) OF THE SOCIAL SECURITY ACT. 
 
 (2) A RECIPIENT MAY NOT RE CEIVE SERVICES OR SU PPORTS IN 
EXCESS OF THE RECIPI ENT’S ANNUAL APPROVED BU DGET. 
 
 (D) THE STATE MAY NOT REQUIRE A RECIPIENT TO DEMON STRATE 
COMPETENCY BEFORE TH E ADMINISTRATION AUTHOR IZES THE RECIPIENT T O 
RECEIVE SELF–DIRECT SERVICES . 
 
7–410. 
 
 (A) THE ADMINISTRATION SHALL PROVIDE UP TO 40 30 HOURS OF 
SUPPORT BROKER SERVI CES EACH MONTH TO A RECIPIENT OF WAIVER SERVICES, 
AS NEEDED BY THE RECIPIENT AND WITHIN THE RECIPIENT ’S TOTAL APPROVED 
ANNUAL BUDGET . 
 
 (B) SUBJECT TO SUBSECTION (A) OF THIS SECTION, THE ADMINISTRATION 
SHALL PROVIDE TO A R ECIPIENT OF WAIVER S ERVICES ANY SUPPORT BROKER 
SERVICES THAT ARE AU THORIZED UNDER BY REGULATIONS ADO PTED OR GUIDANCE 
ISSUED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES UNDER § 
1915(C) OF THE SOCIAL SECURITY ACT. 
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 SECTION 2. AND BE IT FURTHER ENACTED, That on or before January 1, 2023, 
the Developmental Disabilities Administration shall submit to the Centers for Medicare 
and Medicaid Services an amendment to the Community Pathways Waiver that includes 
the overnight supports requirements established under Section 1 of this Act. 
 
 SECTION 3. AND BE IT FURTHER ENACTED, That on or before January 1 each 
year, beginning in 2023 and ending in 2026, the Developmental Disabilities Administration 
shall report to the General Assembly, in accordance with § 2–1257 of the State Government 
Article, on the progress in implementing the requirements established under Section 1 of 
this Act and the recommendations outlined in the Self–Directed Advocacy Network of 
Maryland’s “Recommendations to Summary Study Workgroup House Bill 318 of 2021”.  
 
 SECTION 4. AND BE IT FURTHER ENACTED, That, to the extent authorized by 
law, the Developmental Disabilities Administration shall leverage federal funding, 
including funding provided by the Centers for Medicare and Medicaid Services, to pay for 
the services established under this Act. 
 
 SECTION 5. AND BE IT FURTHER ENACTED, That the Maryland Department of 
Health shall: 
 
 (1) collect utilization data on recipients of self–directed services and 
determine the fiscal impact of expanding services as required under Section 1 of this Act; 
and 
 
 (2) on or before January 1, 2023, provide a baseline report to the General 
Assembly, in accordance with § 2–1257 of the State Government Article, on the utilization 
and cost of self–directed services. 
 
 SECTION 6. AND BE IT FURTHER ENACTED, That, on or before October 1, 2024, 
the Maryland Department of Health shall report to the General Assembly, in accordance 
with § 2–1257 of the State Government Article, on the findings and recommendations of 
the Maryland Department of Health related to the expansion of self–directed services as 
required under Section 1 of this Act.  
 
 SECTION 5. 7. AND BE IT FURTHER ENACTED, That this Act shall take effect 
October 1, 2022. 
 
Enacted under Article II, § 17(c) of the Maryland Constitution, May 29, 2022.