Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.25 - Fee Schedule - Mental Health Services - Community-Based Programs and Individual Practitioners › Section 10.21.25.03 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  terms have the meanings stated in COMAR 10.21.17, COMAR
				  10.63.01.02, and this
				  regulation.
B. Terms Defined.
(1) "Ability-to-pay schedule" means the
				  schedule adopted, according to the provisions of Health-General Article, Title
				  16, Subtitle 2, Annotated Code of Maryland, by the Secretary to evaluate and
				  establish the extent of a consumer's ability to pay for services
				  rendered.
(2) "Administration"
				  means the Behavioral Health Administration.
(2-1) "Assertive Community Treatment Program
				  (ACT)" means an evidence-based practice program approved by the Administration
				  under its regulations.
(3) "Core
				  service agency (CSA)" has the meaning stated in COMAR 10.63.01.02.
(3-1) "Day habilitation" has the meaning
				  stated in COMAR 10.09.46.
(3-2)
				  "Emergency department" means an organized hospital-based facility that provides
				  unscheduled episodic services, 24 hours per day, 7 days per week, to
				  individuals who present for immediate medical attention.
(4) Emergency Service.
(a) "Emergency service" means a service that
				  is provided to an individual who presents a danger to the life or safety of the
				  individual or another.
(b)
				  "Emergency service" does not include a residential or mobile crisis
				  service.
(5) "Enhanced
				  support" means short-term, in-home services, in addition to other services to
				  an individual, provided by a program to support the individual to remain in the
				  community:
(a) For mobile treatment services:
(i) Under COMAR 10.21.19 if approved;
				  and
(ii) Under COMAR
				  10.63.03.04 if licensed;
(b) For adult psychiatric
				  rehabilitation services:
(i) Under COMAR
				  10.21.21 if approved; and
(ii)
				  Under COMAR
				  10.63.03.09 if licensed,
				  or
(c) For outpatient
				  mental health services;
(i) Under COMAR
				  10.21.20 if approved; and
(ii)
				  Under COMAR
				  10.63.03.05 if licensed.
(5-1)
				  "Evidence-based practice (EBP)" is an Administration-approved practice that
				  applies to certain clinical or rehabilitative interventions provided by public
				  mental health service providers.
(5-2) "Family psychoeducation" is an
				  evidence-based practice approved by the Administration under its
				  regulations.
(6) "Fee" means the
				  dollar amount, established by the Secretary, that a provider may charge an
				  individual who receives services under this chapter for a unit of service,
				  before the application of an ability-to-pay determination.
(7) "Individual practitioner" means:
(a) A marriage and family therapist who is
				  licensed and legally authorized to practice clinical marriage and family
				  therapy in the state in which the service is rendered;
(b) A nurse psychotherapist who is:
(i) Licensed and legally authorized to
				  practice as a nurse psychotherapist in the state in which the service is
				  rendered; and
(ii) Certified by the
				  Maryland Board of Nursing or an equivalent board of nursing in another state as
				  a nurse psychotherapist, and demonstrates, by training and experience, the
				  competency to provide the mental health services;
(c) A certified registered nurse practitioner
				  - psychiatric mental health (CRNP-PMH) who is:
(i) Licensed and legally authorized to
				  practice as a certified registered nurse practitioner-psychiatric in the state
				  in which the service is rendered to perform independently the services set
				  forth in COMAR 10.27.07; and
(ii)
				  Certified by the Maryland Board of Nursing or an equivalent board of nursing in
				  another state as a certified registered nurse practitioner with a specialty in
				  psychiatry pursuant to COMAR 10.27.07 and demonstrates, by training and
				  experience, the competency to provide the mental health services;
(d) An occupational therapist who:
(i) Is licensed and legally authorized to
				  practice as an occupational therapist in the state in which the service is
				  rendered, and
(ii) Demonstrates, by
				  training and experience, the competency to provide mental health
				  services;
(e) A
				  physician who:
(i) Is licensed and legally
				  authorized to practice as a physician in the state in which the service is
				  rendered, and
(ii) Demonstrates, by
				  training and experience, the competency to provide mental health
				  services;
(f) A
				  professional counselor who is licensed and legally authorized to practice as a
				  clinical professional counselor in the state in which the service is
				  rendered;
(g) A psychologist who:
(i) Is licensed and legally authorized to
				  practice as a psychologist in the state in which the service is rendered,
				  and
(ii) Demonstrates, by training
				  and experience, the competency to provide mental health services; or
(h) A social worker who is
				  licensed and legally authorized to practice as a clinical social worker in the
				  state in which the service is rendered.
(7-1) "Intensive outpatient services" means
				  services that are delivered to an individual by a multidisciplinary team for a
				  minimum of 3 hours of therapeutic activities, including at least two group
				  therapies.
(7-2) "Level I" means a
				  level of service provided to an individual who is enrolled in the Traumatic
				  Brain Injury Waiver Program, based on the requirements for intensity of
				  services and staffing outlined in:
(a) For
				  individuals receiving residential habilitation services, COMAR
				  10.09.46.07D(2);
(b) For individuals receiving day
				  habilitation services, COMAR
				  10.09.46.08F(2);
				  and
(c) For individuals receiving
				  supported employment services, COMAR
				  10.09.46.09C(2).
(7-3) "Level II" means a
				  level of service provided to an individual who is enrolled in the Traumatic
				  Brain Injury Waiver Program, based on the requirements for intensity of
				  services and staffing outlined in:
(a) For
				  individuals receiving residential habilitation services, COMAR
				  10.09.46.07D(3);
(b) For individuals receiving day
				  habilitation services, COMAR
				  10.09.46.08F(3);
				  and
(c) For individuals receiving
				  supported employment services, COMAR
				  10.09.46.09C(3).
(7-4) "Level III" means a
				  level of service provided to an individual who is enrolled in the Traumatic
				  Brain Injury Waiver Program, based on the requirements for intensity of
				  services and staffing outlined in:
(a) For
				  individuals receiving residential habilitation services, COMAR
				  10.09.46.07D(4);
(b) For individuals receiving day
				  habilitation services, COMAR
				  10.09.46.08F(4);
				  and
(c) For individuals receiving
				  supported employment services, COMAR
				  10.09.46.09C(4).
(7-5) "Local behavioral health authority
				  (LBHA)" has the meaning stated in COMAR 10.63.01.02.
(8) Mental Health Program.
(a)"Mental health program" means a program
				  that provides a plan of mental health treatment or mental health
				  rehabilitation, consisting of various therapeutic modalities, that is:
(i) Approved by the Department under this
				  subtitle or COMAR 10.09 to be eligible to receive State or federal funds;
				  and
(ii) Provided in the
				  community.
(b) "Mental
				  health program" includes:
(i)
				  Non-hospital-based partial hospitalization (psychiatric day treatment) services
				  under COMAR 10.21.02 if approved, and COMAR
				  10.63.03.08 if licensed;
(ii) Therapeutic nursery programs
				  under COMAR 10.21.18;
(iii) Mobile
				  treatment services under COMAR 10.21.19 if approved, and COMAR
				  10.63.03.04 if licensed;
(iv) Outpatient mental health clinic (OMHC)
				  services under COMAR 10.21.20 if approved, and COMAR
				  10.63.03.05 if licensed;
(v) Psychiatric rehabilitation programs for
				  adults under COMAR 10.21.21 if approved, and COMAR
				  10.63.03.09 if licensed, including
				  supported living services;
(vi)
				  Residential rehabilitation programs under COMAR 10.21.22 if approved, and COMAR
				  10.63.04.05 if licensed;
(vii) (text unchanged)
(viii) Supported employment programs under
				  COMAR 10.21.28 if approved, and COMAR
				  10.63.03.16 if licensed;
(ix) Respite care programs under COMAR
				  10.21.27 if approved, and COMAR
				  10.63.03.15 if licensed;
(x) Residential crisis services programs
				  under COMAR 10.21.26 if approved, and COMAR
				  10.63.04.04 if licensed;
				  and
(xi) Therapeutic and
				  psychiatric rehabilitation services for minors under COMAR 10.21.29 if
				  approved, and COMAR
				  10.63.03.10 if licensed.
(9) Mobile Treatment.
(a) "Mobile treatment" means a program
				  approved under COMAR 10.21.19, or licensed under COMAR 10.63.03.04.
(b) "Mobile treatment" does not include
				  transporting an individual to a program site to receive services.
(10) Off-Site.
(a) "Off-site" means a location, other than a
				  site defined in §B(11) of this regulation, to which mental health program
				  staff travels to provide services to an individual.
(b) "Off-site" includes, with respect to
				  psychiatric rehabilitation program services, those services delivered to an
				  individual:
(i) In the individual's home,
				  including a residential rehabilitation program residence;
(ii) At a job site; or
(iii) At another community location
				  appropriate to the individual's needs.
(c) "Off-site" does not include:
(i) A juvenile detention center; or
(ii) Any facility or group home that is
				  licensed to provide rehabilitative or therapeutic services, or living
				  skills.
(11)
				  "On-site" means a mental health program facility or other site to which a
				  program has access and at which the program regularly delivers services to
				  individuals who come to the site for the services.
(11-1) Other Mental Health Professional.
(a) "Other mental health professional" means
				  an individual who is licensed, certified, or otherwise legally authorized to
				  independently provide the mental health service.
(b) "Other mental health professional"
				  includes a:
(i) Licensed certified social
				  worker - clinical;
(ii) Nurse
				  psychotherapist;
(iii) Licensed
				  clinical professional counselor;
(iv) Licensed clinical marriage and family
				  therapist; or
(v) Certified
				  registered nurse practitioner - psychiatric mental health (CRNP-PMH).
(12) "Outpatient mental
				  health clinic (OMHC)" means a program approved under COMAR 10.21.20 or licensed
				  under COMAR 10.63.03.05.
(13)
				  "Partial hospitalization program" means a program approved under COMAR 10.21.02
				  or licensed under COMAR 10.63.03.08.
(14) "Program" means a mental health program
				  as defined in §B(8) of this regulation.
(15) "Provider" means:
(a) A community-based mental health program
				  as defined in §B(8) of this chapter; or
(b) An individual practitioner as defined in
				  §B(7) of this chapter.
(16) "Psychiatric rehabilitation program for
				  adults (PRP)" means a program approved under COMAR 10.21.21 or licensed under
				  COMAR 10.63.03.09.
(16-1)
				  "Residential crisis services (RCS)" means a program approved under COMAR
				  10.21.26 or licensed under COMAR 10.63.04.04.
(16-2) "Residential habilitation" has the
				  meaning stated in COMAR 10.09.46.
(17) "Residential rehabilitation program
				  (RRP)" means a program approved under COMAR 10.21.22 or licensed under COMAR
				  10.63.04.05.
(17-1) "Respite care"
				  means services that are approved under COMAR 10.21.27 or licensed under COMAR
				  10.63.03.1.
(18) "Secretary" means
				  the Secretary of Health and Mental Hygiene.
(19) "Serious emotional disturbance" means a
				  condition that is:
(a) Manifest in an
				  individual younger than 18 years old;
(b) Diagnosed according to a current
				  diagnostic and statistical manual of the American Psychiatric Association that
				  is recognized by the Secretary, excluding the following, unless it coexists
				  with a diagnosable psychiatric disorder:
(i)
				  Developmental disorder;
(ii)
				  Substance abuse; and
(iii) Disorder
				  classified under the "V" code; and
(c) Characterized by a functional impairment
				  that substantially interferes with or limits the child's role or functioning in
				  the family, school, or community activities, including the following:
(i) Inability to achieve or maintain one or
				  more developmentally appropriate social, behavioral communicative, or adaptive
				  skills; or
(ii) Episodic,
				  recurrent, and continuous functional impairments.
(20) "Serious and persistent
				  mental disorder" means a disorder that is:
(a)
				  Manifest in an individual 18 years old or older;
(b) Diagnosed, according to a current
				  diagnostic and statistical manual of the American Psychiatric Association that
				  is recognized by the Secretary, as:
(i)
				  Schizophrenic disorder;
(ii) Major
				  affective disorder;
(iii) Other
				  psychotic disorder; or
(iv)
				  Borderline or schizotypal personality disorders, with the exclusion of an
				  abnormality that is manifested only by repeated criminal or otherwise
				  antisocial conduct; and
(c) Characterized by impaired role
				  functioning, on a continuing or intermittent basis, for at least 2 years,
				  including at least three of the following:
(i)
				  Inability to maintain independent employment;
(ii) Social behavior that results in
				  intervention by the mental health system;
(iii) Inability, due to cognitive
				  disorganization, to procure financial assistance to support living in the
				  community;
(iv) Severe inability to
				  establish or maintain a personal social support system;
(v) Need for assistance with basic living
				  skills.
(21)
				  "Therapeutic and psychiatric rehabilitation services for minors" means a
				  program approved under COMAR 10.21.29 or licensed under COMAR 10.63.03.10.