reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.09 - Patients' Rights to Visitors › Section 10.21.09.05 - Procedures Pertaining to Visitors

Current through Register Vol. 51, No. 14, July 12, 2024
A. Staff may not provide child care services
				  for visitors.
B. Visitors who leave
				  children unattended and without adequate supervision shall be asked to correct
				  the situation or shall be expected to terminate the visit
				  immediately.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.09 - Patients' Rights to Visitors › Section 10.21.09.06 - Visitor Behavior

Current through Register Vol. 51, No. 14, July 12, 2024
A. Specific
				  visitor behaviors that are prohibited include, but are not limited to:
(1) Verbal or physical abuse or both of staff
				  or patients;
(2) Drinking of
				  alcoholic beverages;
(3) Use of
				  drugs;
(4) Distribution of
				  alcoholic beverages or drugs;
(5)
				  Intoxication when on the premises;
(6) Disregard for patient or staff
				  safety;
(7) Assaultive behavior;
				  or
(8) Acting in a disorderly
				  manner.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.09 - Patients' Rights to Visitors › Section 10.21.09.07 - Procedures for Removal of Visitors

Current through Register Vol. 51, No. 14, July 12, 2024
A. Professional staff shall request any
				  visitor who jeopardizes the care or treatment of patients or the safety of
				  patients, staff, or other visitors to leave the facility immediately and
				  explain at the time of the request the reason or reasons for making the
				  request.
B. Whenever a visitor
				  refuses to leave, the visitor shall be informed that the facility police or law
				  enforcement agencies shall be called immediately to escort the visitor off
				  facility premises.
C. If the
				  visitor continues to resist, formal arrest procedures may be
				  initiated.
D. Specific notice to
				  this effect shall be posted conspicuously at all times.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.09 - Patients' Rights to Visitors › Section 10.21.09.08 - Documentation

Current through Register Vol. 51, No. 14, July 12, 2024
A. Incidents.
(1) Any visitor behavior that leads to
				  removal of the visitor from the premises shall be documented.
(2) Any incident that requires police
				  intervention shall be reported and documented in accordance with facility
				  procedures.
(3) Whenever a visitor
				  is removed from the facility as a result of their disorderly manner, the
				  treatment team shall review the incident and determine what restrictions, if
				  any, shall be placed on the individual's future visiting privileges.
(4) If restrictions are placed on an
				  individual's future visiting privileges, the restrictions shall be subject to
				  the requirements identified in Regulation .08B of this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.09 - Patients' Rights to Visitors › Section 10.21.09.09 - Patient's Refusal to Receive Visitors

Current through Register Vol. 51, No. 14, July 12, 2024
A. Whenever a patient refuses visitors, the
				  refusal shall be noted in the patient's records and may be reviewed by the
				  treatment team.
B. The patient's
				  refusal shall be honored.
C. With
				  the consent of the patient, visitors shall be informed in a timely manner of
				  the patient's refusal.
D. When a
				  patient refuses to receive a visitor and refuses to permit the facility to
				  inform the visitor of the patient's refusal, the facility's communications with
				  the visitor shall be consistent with these wishes.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.09 - Patients' Rights to Visitors › Section 10.21.09.10 - Procedures Pertaining to Complaints

Current through Register Vol. 51, No. 14, July 12, 2024
Complaints about the individual application of this chapter
					 may be addressed through any patient grievance mechanism.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.10 - Psychiatric Residential Treatment Facility (PRTF) Demonstration Waiver Providers › Section 10.21.10.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter sets forth the requirements for a provider of
					 psychiatric residential treatment facilities (PRTF) Medicaid demonstration
					 waiver services as set forth in COMAR 10.09.79. These services are:
A. Caregiver peer-to-peer support;
B. Crisis and stabilization
				  services;
C. Expressive and
				  experiential behavioral services;
D. Family and youth training;
E. Respite services (in-home and
				  out-of-home); and
F. Youth
				  peer-to-peer support.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.10 - Psychiatric Residential Treatment Facility (PRTF) Demonstration Waiver Providers › Section 10.21.10.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
In this chapter, terms have the meanings stated in COMAR
					 10.09.79.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.10 - Psychiatric Residential Treatment Facility (PRTF) Demonstration Waiver Providers › Section 10.21.10.03 - Approval

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Department
				  shall grant approval to providers to be eligible to receive State and federal
				  funds for PRTF waiver services if the provider meets the requirements set forth
				  in this chapter.
B. Application. To
				  provide PRTF waiver services, a provider applicant shall:
(1) Submit an application to the
				  Department;
(2) Submit the
				  application on the form approved by the Department, with all questions answered
				  and all required documents attached; and
(3) Attest that the provider applicant is in
				  compliance with the general provider requirements and specific PRTF waiver
				  service requirements set forth in this chapter and in COMAR 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.10 - Psychiatric Residential Treatment Facility (PRTF) Demonstration Waiver Providers › Section 10.21.10.04 - Denial, Emergency Suspension of Approval, and Disciplinary Action

Current through Register Vol. 51, No. 14, July 12, 2024
A. Denial of
				  Approval.
(1) If the Department proposes to
				  deny approval to an applicant under the provisions of this chapter, the
				  Department shall give written notice of the proposed denial to the:
(a) Provider applicant;
(b) Care management entity; and
(c) Administrative service organization
				  (ASO).
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.10 - Psychiatric Residential Treatment Facility (PRTF) Demonstration Waiver Providers › Section 10.21.10.05 - General Conditions for PRTF Waiver Services Provider Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. A provider of
				  PRTF waiver services shall:
(1) Provide the
				  documentation required by the Department for initial approval and provider
				  recertification, or as requested by the Department;
(2) Be approved by the Department as meeting
				  the requirements of this chapter and COMAR 10.09.79, and being able to provide
				  the services set forth in COMAR 10.09.79;
(3) Have a provider agreement in effect, to
				  include adherence to quality assurance, auditing, and monitoring policies and
				  procedures;
(4) Receive training
				  and certification as required and approved by MHA and determined to be
				  appropriate for the level and scope of services provided;
(5) Meet all the conditions for participation
				  in COMAR 10.09.36 except as otherwise specified in this chapter;
(6) Maintain general liability insurance, and
				  provide proof of this insurance at the time of initial application to be a
				  provider of PRTF waiver services, at recertification, and upon request by the
				  Department;
(7) Make available to
				  the Department and federal funding agents all records, including but not
				  limited to personnel files for each individual employed, and financial,
				  treatment, and service records for inspection and copying; and
(8) Comply with the following prohibitions
				  against utilization of staff:
(a) Unless
				  waived by the Department in accordance with §D of this regulation,
				  prohibit from working with the participant or the participant's family any
				  staff, volunteers, students, or any individual who is:
(i) Convicted of, received probation before
				  judgment, or entered a plea of nolo contendere to a felony or a crime of moral
				  turpitude or theft; or
(ii) Has an
				  indicated finding of child abuse or neglect;
(b) Before permitting staff, volunteers,
				  students, or any individual from working with the participant, or the
				  participant's family:
(i) Ensure that, at its
				  own expense, all staff, volunteers, students, and any individual have
				  background checks as set forth in §§B and C of this
				  regulation;
(ii) Review the results
				  of the background checks; and
(iii)
				  Maintain the background checks in the individual's personnel file;
				  and
(c) Maintain written
				  documentation in the individual's personnel file that the director and all
				  direct service provider staff including, but not limited to, volunteers,
				  interns, and students, meet the criteria set forth in this
				  regulation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.10 - Psychiatric Residential Treatment Facility (PRTF) Demonstration Waiver Providers › Section 10.21.10.06 - Specific Conditions for PRTF Waiver Services Providers - Respite Services

Current through Register Vol. 51, No. 14, July 12, 2024
To be eligible to provide PRTF waiver services as a
					 provider of in-home or out-of-home respite services under COMAR
					 10.09.79.06B, a
					 provider shall:
A. Meet the
				  requirements of COMAR 10.21.27;
B.
				  Ensure that respite care specialists are:
(1)
				  21 years old or older and have a high school diploma; or
(2) Between 18 and 20 years old and in
				  possession of at least an associate or bachelor's degree from an accredited
				  school in a human services field;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.10 - Psychiatric Residential Treatment Facility (PRTF) Demonstration Waiver Providers › Section 10.21.10.07 - Specific Conditions for PRTF Waiver Service Providers - Caregiver Peer-to-Peer Support and Youth Peer-to-Peer Support

Current through Register Vol. 51, No. 14, July 12, 2024
A. A family support organization may provide
				  PRTF waiver services of caregiver peer-to-peer support, youth peer-to-peer
				  support, or family and youth training. To be eligible to provide PRTF waiver
				  services as a family support organization, the organization shall:
(1) Be a private, nonprofit entity designated
				  under § 501(c)(3) of the Internal Revenue Service Code, and submit copies
				  of the certificate of incorporation and Internal Revenue Service
				  designation;
(2) Have a board of
				  directors comprised of more than 50 percent caregivers with a primary daily
				  responsibility for raising a child or youth up to 26 years old with emotional,
				  behavioral, or mental health challenges;
(3) Submit a list of board members with
				  identification of those who are caregivers meeting the criteria in §A(2)
				  of this regulation;
(4) Establish
				  hiring practices that give preference to:
(a)
				  Current or previous caregivers of a child or youth with emotional, behavioral,
				  or mental health challenges;
(b)
				  Youth who are 18 through 26 years old, who have or had emotional or behavioral
				  health challenges, or both; or
(c)
				  Both §A(4)(a) and (b) of this regulation;
(5) Submit a copy of the organization's
				  personnel policy that sets forth the preferred employment criteria stated in
				  §A(4) of this regulation;
(6)
				  Employ a staff that is comprised of at least 75 percent individuals who are:
(a) Current or previous caregivers of a child
				  or youth with emotional, behavioral, or mental health challenges; or
(b) Youth who are 18 through 26 years old
				  with emotional, behavioral, or mental health challenges;
(7) Submit a list of staff and positions held
				  with identification of those who fit the experienced caregiver and youth
				  criteria stated in §A(6) of this regulation; and
(8) Submit a certificate of eligibility that
				  includes:
(a) Attestation of compliance with
				  §A(1)-(6) of this regulation; and
(b) The organization's mission statement that
				  establishes the purpose of the organization as providing support and education
				  to youth with emotional, behavioral, or mental health challenges and their
				  caregivers.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.10 - Psychiatric Residential Treatment Facility (PRTF) Demonstration Waiver Providers › Section 10.21.10.08 - Specific Conditions for PRTF Waiver Service Providers - Family and Youth Training

Current through Register Vol. 51, No. 14, July 12, 2024
A. Family
				  and Youth Training Providers. To provide services set forth COMAR
				  10.09.79.06B, a
				  provider shall be:
(1) An approved waiver
				  provider agency, including but not limited to, a family support organization;
				  or
(2) An approved individual
				  waiver service provider.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.10 - Psychiatric Residential Treatment Facility (PRTF) Demonstration Waiver Providers › Section 10.21.10.09 - Specific Conditions for PRTF Waiver Service Providers - Expressive and Experiential Behavioral Services

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Expressive and experiential behavioral services are:
(1) Art behavioral services;
(2) Dance/movement behavioral
				  services;
(3) Equine-assisted
				  behavioral services;
(4)
				  Horticultural behavioral services;
(5) Music behavioral services; and
(6) Psychodrama/drama behavioral
				  services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.10 - Psychiatric Residential Treatment Facility (PRTF) Demonstration Waiver Providers › Section 10.21.10.10 - Specific Conditions for PRTF Waiver Service Providers - Crisis and Stabilization Services

Current through Register Vol. 51, No. 14, July 12, 2024
To provide the services set forth COMAR
					 10.09.79.06B, a
					 provider shall:
A. Be an
				  agency;
B. Have a current formal
				  written agreement with a local core service agency to serve as a crisis
				  response system;
C. Have capacity
				  to provide or arrange for services 24 hours a day, 7 days per week, including:
(1) Face-to-face clinical care;
(2) Psychiatric consultation; and
(3) Person-to-person phone
				  coverage;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.11 - Purchase of Residential Therapeutic Care for Children › Section 10.21.11.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter outlines the requirements that a provider of
					 residential therapeutic services to emotionally or behaviorally disordered
					 children shall meet to be eligible to accept children placed by the Mental
					 Hygiene Administration.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.11 - Purchase of Residential Therapeutic Care for Children › Section 10.21.11.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meaning indicated.
B. Terms Defined.
(1) "Direct supervision" means that a
				  provider staff member maintains continuous visual contact with the
				  child.
(2) "Family of origin" means
				  the child's parent, guardian, or primary caretaker.
(3) "Least restrictive setting" means the
				  treatment program or facility in which needed services are delivered in the
				  environment that least limits the child being served.
(4) "Oversight" means that a provider staff
				  member approves and is aware of the child's activities.
(5) "Primary caretaker" means the adult
				  individual who carries responsibility for the welfare of a child where the
				  child resides.
(6) "Secure setting"
				  means a treatment program or facility that is locked to prevent a child from
				  leaving without staff permission.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.11 - Purchase of Residential Therapeutic Care for Children › Section 10.21.11.03 - Provider Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A provider of residential therapeutic services may not be
					 eligible to accept children placed by the Mental Hygiene Administration unless
					 the provider:
A. Is licensed by the
				  Department of:
(1) Human Resources, under the
				  provisions of COMAR 07.02.23 or 07.02.13;
(2) Juvenile Services, under the provisions
				  of COMAR 16.06.01; or
(3) Health
				  and Mental Hygiene, under the provisions of COMAR 10.21.07;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.12 - Use of Quiet Room and Use of Restraint › Section 10.21.12.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
These regulations govern the use of quiet rooms and
					 restraint in all facilities as defined in Health-General Article,
					 §§10-101(e) and 10-701, Annotated Code of Maryland. These regulations
					 are supplemental to any other applicable law and regulation. In the event of
					 conflict between these regulations and any other regulations or laws, the more
					 stringent apply.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.12 - Use of Quiet Room and Use of Restraint › Section 10.21.12.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated.
B. Terms Defined.
(1) Category I Restraint.
(a) "Category I restraint" means a device
				  identified by the facility which limits a patient's mobility to the extent that
				  the patient would not be able to independently reposition himself or herself or
				  would otherwise be rendered helpless in an emergency.
(b) "Category I restraint" includes, but is
				  not limited to, four-point restraints and safety suits.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.12 - Use of Quiet Room and Use of Restraint › Section 10.21.12.03 - Use of Restraint

Current through Register Vol. 51, No. 14, July 12, 2024
A. Staff
				  authorized under the provisions of Regulation .05A of this chapter shall use a
				  restraint only to:
(1) Prevent and reduce
				  serious, destructive, and damaging actions by a patient to the patient or to
				  another;
(2) Prevent serious
				  disruption of the therapeutic environment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.12 - Use of Quiet Room and Use of Restraint › Section 10.21.12.04 - Protective Device Use

Current through Register Vol. 51, No. 14, July 12, 2024
A. When the
				  definition of a restraint or a protective device is in dispute, in each case
				  under discussion, the clinical director or the clinical director's physician
				  designee shall clarify and document in the patient's medical record the
				  device's correct purpose.
B. The
				  patient's treatment team shall document in the treatment plan the team's
				  rationale for use of a protective device.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.12 - Use of Quiet Room and Use of Restraint › Section 10.21.12.05 - Procedures in the Use of Restraint

Current through Register Vol. 51, No. 14, July 12, 2024
A. A physician who is responsible either for
				  the care of the patient or for assessment of the appropriateness of a restraint
				  or, when the appropriate physician is not readily available to assess the
				  patient, a registered nurse shall conduct a clinical evaluation of the patient
				  to determine:
(1) Whether an emergency
				  situation is present; or
(2) The
				  degree to which the patient presents a serious disruption to the therapeutic
				  environment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.12 - Use of Quiet Room and Use of Restraint › Section 10.21.12.06 - Placement of Patient in Restraint

Current through Register Vol. 51, No. 14, July 12, 2024
A. When possible, staff shall advise a
				  patient, in a nonthreatening manner, that continuation of a specific behavior
				  may result in the use of restraint.
B. When a physician or registered nurse
				  determines that the use of a restraint is appropriate, staff involved shall
				  make a reasonable effort to verbally persuade the patient to be cooperative
				  with the restraint.
C. Staff shall
				  apply a restraint only in accordance with the facility's policy and procedure
				  manual.
D. To the extent consistent
				  with the patient's safety and the safety of others:
(1) Staff shall place the patient in the
				  restraint in as dignified a manner as the situation permits, using the least
				  amount of physical force necessary; and
(2) As necessary, additional staff shall
				  participate in the placement of a patient in seclusion.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.12 - Use of Quiet Room and Use of Restraint › Section 10.21.12.07 - Limitations and Placement of Children in Restraint

Current through Register Vol. 51, No. 14, July 12, 2024
In addition to the requirements outlined in this chapter,
					 when:
A. Restraining a child, staff
				  may not use four-point restraints; and
B. Applying or repositioning a restraint,
				  staff shall avoid the application of force on long bone joints.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.12 - Use of Quiet Room and Use of Restraint › Section 10.21.12.08 - Clinical Interventions During Restraint

Current through Register Vol. 51, No. 14, July 12, 2024
A. Regardless of the physical setting in
				  which the patient is placed, at a minimum, one staff member shall be assigned
				  continuously while the patient is in a category I restraint.
B. While the patient is restrained, in order
				  to provide appropriate clinical care, at a minimum, staff clinically trained to
				  do so shall:
(1) Keep the patient in full view
				  at all times;
(2) Protect the
				  patient from harm by others;
(3)
				  Closely observe the patient at least every 15 minutes, and document each
				  observation by the observer;
(4)
				  Unless contraindicated by circumstances as assessed and documented by a
				  physician or registered nurse, at least hourly, make and document personal
				  contact with the patient for the purpose of:
(a) Determining if the patient has any
				  special needs which need attention;
(b) Checking circulation of the extremities
				  restrained;
(c) Adjusting the
				  restraint; and
(d) Realigning the
				  body or massaging the extremities restrained, or both;
(5) Unless contraindicated by circumstances
				  as assessed and documented by a physician or registered nurse, offer or provide
				  the following:
(a) Full range of motion, every
				  2 hours;
(b) Toilet facilities, at
				  least every 2 hours;
(c) Bathing
				  and oral hygiene, at least once during a 24-hour period;
(d) Meals, at the regularly scheduled hours
				  and under the supervision of nursing personnel; and
(e) Fluids, at least every 2 hours;
				  and
(6) As clinically
				  indicated, record temperature, pulse, blood pressure, and
				  respirations.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.12 - Use of Quiet Room and Use of Restraint › Section 10.21.12.09 - Limitations on Restraint and Continuous Restraint

Current through Register Vol. 51, No. 14, July 12, 2024
A. Staff may not initiate "standing" or "as
				  needed" orders for restraint.
B. A
				  physician may write an order for restraint for a period of up to, but not more
				  than, 24 hours.
C. If a patient in
				  restraint requires continuous restraint for over a 24-hour period, a physician
				  shall:
(1) Conduct a face-to-face evaluation
				  of the patient to determine whether continuous restraint is
				  appropriate;
(2) Document the
				  evaluation in the patient's medical record; and
(3) If the patient is restrained under the
				  provisions of §§D and E of this regulation, carry out the
				  requirements of §C(1) and (2) of this regulation every 24 hours throughout
				  the period that the patient continues in restraint.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.12 - Use of Quiet Room and Use of Restraint › Section 10.21.12.10 - Documentation

Current through Register Vol. 51, No. 14, July 12, 2024
A. Restraint
				  Orders. A physician shall:
(1) To initiate
				  the use of restraint:
(a) Enter an order in
				  the patient's medical record; or
(b) Authorize an order to be written by a
				  registered nurse on the physician's order sheet in the patient's medical
				  record:
(i) Indicating that physician's verbal
				  order for restraint; or
(ii)
				  Directing the release of the patient and the rationale for that
				  release;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.12 - Use of Quiet Room and Use of Restraint › Section 10.21.12.11 - Use of Quiet Room

Current through Register Vol. 51, No. 14, July 12, 2024
A. Patient
				  Request.
(1) A patient may request the use of
				  a quiet room and, unless clinically contraindicated, may be granted use of a
				  quiet room.
(2) Unless staff
				  terminates use of the quiet room for clinical reasons, the patient may
				  terminate self-initiated use of the quiet room at any time.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.12 - Use of Quiet Room and Use of Restraint › Section 10.21.12.12 - Quality Assurance

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  clinical director or the clinical director's designee shall review daily all
				  uses of restraint and investigate unusual or possibly unwarranted patterns of
				  use.
B. The physician involved in
				  the restraint may not function in the capacity outlined in §A of this
				  regulation.
C. A facility shall
				  identify a committee to review periodically, but not less than quarterly, the
				  use of restraint to assure that the standards maintained by the facility are,
				  at a minimum, consistent with this chapter.
D. Staff who implement orders for restraint:
(1) Shall have documented annual training in
				  the proper use of restraint including training for special populations which
				  include, but are not limited to, children and the elderly; and
(2) May not implement orders for restraint
				  until trained by the facility to do so unless, in an emergency situation, the
				  safety of the patient or others is threatened.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.12 - Use of Quiet Room and Use of Restraint › Section 10.21.12.13 - Procedures Pertaining to Complaints

Current through Register Vol. 51, No. 14, July 12, 2024
Complaints about the individual application of this chapter
					 may be addressed through any patient grievance mechanism.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.12 - Use of Quiet Room and Use of Restraint › Section 10.21.12.14 - Variance with Standards

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Excluding the prohibition described in §B of this regulation, staff may
				  not vary from the standards identified in this chapter unless the variation is
				  for an extreme crisis.
B. There may
				  not be any variance with standards established in this regulation and in
				  Regulations .03 and .04, .06B-G and I-J, .07, .09A, .11, .12A and D-F, .13, and
				  .14 of this chapter.
C. Staff shall
				  document, on the facility's variance report, a variance with standards
				  permitted under this chapter.
D.
				  The CEO shall rule on and document each variance permitted in §A of this
				  regulation to determine whether the variance was:
(1) An extreme crisis;
(2) A deviation from the facility's
				  procedure; or
(3) A problem in the
				  facility's policy which is correctable by administrative action.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.13 - Use of Quiet Room and Use of Seclusion › Section 10.21.13.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
These regulations govern the use of quiet rooms and
					 seclusion in all facilities as defined in Health-General Article,
					 §§10-101(e) and 10-701, Annotated Code of Maryland. These regulations
					 are supplemental to any other applicable law and regulation. In the event of
					 conflict between these regulations and any other regulations or laws, the more
					 stringent apply.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.13 - Use of Quiet Room and Use of Seclusion › Section 10.21.13.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated.
B. Terms Defined.
(1) "Chief executive officer (CEO)" means the
				  individual responsible for the overall management of a facility.
(2) "Clinical director" means the
				  psychiatrist in charge of the clinical care of all psychiatric patients in that
				  facility.
(3) "Emergency situation"
				  means any situation in which a patient's behavior poses a serious and imminent
				  danger to the physical safety of self or others.
(4) "Facility" means any public or private
				  hospital, clinic, or other institution that provides or purports to provide
				  treatment or other services for a mental disorder, except an acute general
				  hospital that does not have a separately identified inpatient psychiatric
				  service.
(5) "Patient" means an
				  individual receiving services for a mental disorder in a facility and includes
				  any student receiving care and treatment in that facility.
(6) "Physician" means an individual who is
				  authorized to practice medicine under Health Occupations Article, Title 14,
				  Annotated Code of Maryland.
(7)
				  "Quiet room" means an unlocked room that patients are not physically prevented
				  from leaving, which is designated for patients' voluntary use to allow them
				  time out of the company of other patients.
(8) "Registered nurse" means an individual
				  who is licensed to practice registered nursing under Health Occupations
				  Article, Title 8, Annotated Code of Maryland.
(9) "Seclusion" means the involuntary
				  confinement of a patient under the direction of a physician or registered nurse
				  alone in a room which a patient is physically prevented from leaving.
(10) "Serious disruption to a therapeutic
				  environment" means imminent danger of damage to the physical environment, or
				  behavior of such a grave or protracted nature that it significantly interferes
				  with the emotional well-being of other patients or with their
				  treatment.
(11) "Treatment team"
				  means the patient's treatment team as defined in COMAR
				  10.21.03.02C.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.13 - Use of Quiet Room and Use of Seclusion › Section 10.21.13.03 - Use of Seclusion

Current through Register Vol. 51, No. 14, July 12, 2024
A. Staff
				  authorized under the provisions of Regulation .04A of this chapter shall use
				  seclusion only to:
(1) Prevent and reduce
				  serious, destructive, and damaging actions by a patient to the patient or to
				  another; or
(2) Prevent serious
				  disruption of the therapeutic environment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.13 - Use of Quiet Room and Use of Seclusion › Section 10.21.13.04 - Procedures in the Use of Seclusion

Current through Register Vol. 51, No. 14, July 12, 2024
A. A physician who is responsible either for
				  the care of the patient or for assessment of the appropriateness of seclusion
				  or, when the appropriate physician is not readily available to assess the
				  patient, a registered nurse shall conduct a clinical evaluation of the patient
				  to determine:
(1) Whether an emergency
				  situation is present; or
(2) The
				  degree to which the patient presents a serious disruption to the therapeutic
				  environment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.13 - Use of Quiet Room and Use of Seclusion › Section 10.21.13.05 - Placement of a Patient in a Seclusion Room

Current through Register Vol. 51, No. 14, July 12, 2024
A. When possible, staff shall advise a
				  patient, in a nonthreatening manner, that continuation of a specific behavior
				  may result in the use of seclusion.
B. When a physician or registered nurse
				  determines that the use of seclusion is appropriate, staff involved shall make
				  a reasonable effort to verbally persuade the patient to enter the seclusion
				  room.
C. To the extent consistent
				  with the patient's safety and the safety of others:
(1) Staff shall place the patient in the
				  seclusion room in as dignified a manner as the situation permits, using the
				  least amount of physical force necessary; and
(2) As necessary, additional staff shall
				  participate in the placement of a patient in seclusion.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.13 - Use of Quiet Room and Use of Seclusion › Section 10.21.13.06 - Clinical Interventions During Seclusion

Current through Register Vol. 51, No. 14, July 12, 2024
A. While the patient is secluded, in order to
				  provide appropriate clinical care, at a minimum, clinically trained staff
				  shall:
(1) Observe the patient at least every
				  15 minutes, and document each observation by the observer;
(2) Unless contraindicated by circumstances
				  as assessed and documented by a physician or registered nurse, at least hourly,
				  make and document personal contact with the patient for the purpose of
				  determining if the patient has any special needs which need
				  attention;
(3) Unless
				  contraindicated by circumstances as assessed and documented by a physician or
				  registered nurse, offer or provide the following:
(a) Toilet facilities, at least every 2
				  hours;
(b) Bathing and oral
				  hygiene, at least once during a 24-hour period;
(c) Meals, at the regularly scheduled hours
				  and under the supervision of nursing personnel; and
(d) Fluids, at least every 2 hours;
				  and
(4) As clinically
				  indicated, record temperature, pulse, blood pressure, and
				  respirations.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.13 - Use of Quiet Room and Use of Seclusion › Section 10.21.13.07 - Limitations on Seclusion and Continuous Seclusion

Current through Register Vol. 51, No. 14, July 12, 2024
A. Staff may not initiate "standing" or "as
				  needed" orders for seclusion.
B.
				  Excluding requirements outlined in §D of this regulation, each order or
				  subsequent order for seclusion may be written for a period up to, but not more
				  than, 24 hours.
C. If a patient in
				  seclusion requires continuous seclusion for over a 24-hour period, a physician
				  shall:
(1) Conduct a face-to-face evaluation
				  of the patient to determine whether continuous seclusion is
				  appropriate;
(2) Document the
				  evaluation in the patient's medical record; and
(3) If the patient is secluded under the
				  provisions of §D of this regulation, carry out the requirements of
				  §C(1) and (2) of this regulation every 24 hours throughout the period that
				  the patient continues in seclusion.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.13 - Use of Quiet Room and Use of Seclusion › Section 10.21.13.08 - Documentation

Current through Register Vol. 51, No. 14, July 12, 2024
A. Seclusion
				  Orders. A physician shall:
(1) To initiate
				  the use of seclusion:
(a) Enter an order in
				  the patient's medical record; or
(b) Authorize an order to be written by a
				  registered nurse on the physician's order sheet in the patient's medical
				  record:
(i) Indicating that physician's verbal
				  order for seclusion; or
(ii)
				  Directing the release of the patient and the rationale for that
				  release;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.13 - Use of Quiet Room and Use of Seclusion › Section 10.21.13.09 - Use of Quiet Room

Current through Register Vol. 51, No. 14, July 12, 2024
A. Patient
				  Request.
(1) A patient may request the use of
				  a quiet room and, unless clinically contraindicated, may be granted use of a
				  quiet room.
(2) Unless staff
				  terminates use of the quiet room for clinical reasons, the patient may
				  terminate self-initiated use of the quiet room at any time.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.13 - Use of Quiet Room and Use of Seclusion › Section 10.21.13.10 - Quality Assurance

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  clinical director or the clinical director's designee shall review daily all
				  uses of seclusion and investigate unusual or possibly unwarranted patterns of
				  use.
B. The physician involved in
				  the seclusion may not function in the capacity outlined in §A of this
				  regulation.
C. A facility shall
				  identify a committee to review periodically, but not less than quarterly, the
				  use of seclusion to assure that the standards maintained by the facility are,
				  at a minimum, consistent with this chapter.
D. Staff who implement orders for seclusion:
(1) Shall have documented annual training in
				  the proper use of seclusion including training for special populations which
				  include, but are not limited to, children and the elderly; and
(2) May not implement orders for seclusion
				  until trained by the facility to do so unless, in an emergency situation, the
				  safety of the patient or others is threatened.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.13 - Use of Quiet Room and Use of Seclusion › Section 10.21.13.11 - Procedures Pertaining to Complaints

Current through Register Vol. 51, No. 14, July 12, 2024
Complaints about the individual application of this chapter
					 may be addressed through any patient grievance mechanism.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.13 - Use of Quiet Room and Use of Seclusion › Section 10.21.13.12 - Variance with Standards

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Excluding the prohibition described in §B of this regulation, staff may
				  not vary from the standards identified in this chapter unless the variation is
				  for an extreme crisis.
B. There may
				  not be any variance with standards established in this regulation and in
				  Regulations .03 and .04, .05B-E and G, .07A, .09, .10A, D, E(1), and F, .11,
				  and .12 of this chapter.
C. Staff
				  shall document, on the facility's variance report, a variance with standards
				  permitted under this chapter.
D.
				  The CEO shall rule on and document each variance permitted in §A of this
				  regulation to determine whether the variance was:
(1) An extreme crisis;
(2) A deviation from the facility's
				  procedure; or
(3) A problem in the
				  facility's policy which is correctable by administrative action.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.14 - Resident Grievance System › Section 10.21.14.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
These regulations govern the administrative process to be
					 used to ensure that the rights of residents residing in the Behavioral Health
					 Administration facilities are protected. Although the residents and the legal
					 assistance providers ultimately shall decide whether to invoke the Resident
					 Grievance System, it is the intent that the Resident Grievance System provide a
					 fair, efficient, and complete mechanism for receiving, investigating, and
					 resolving resident complaints, including rights issues, in a timely
					 manner.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.14 - Resident Grievance System › Section 10.21.14.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated.
B. Terms Defined.
(1) "Central Review Committee" means the
				  Maryland Department of Health (MDH) staff or their respective designees in the
				  following positions:
(a) The Director of the
				  Behavioral Health Administration;
(b) The clinical director of the Behavioral
				  Health Administration; and
(c) The
				  Director of the Resident Grievance System.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.14 - Resident Grievance System › Section 10.21.14.03 - General Policies of the Resident Grievance System

Current through Register Vol. 51, No. 14, July 12, 2024
A. When invoked, and when the process
				  provides a fair, efficient, and complete remedy for allegations of rights
				  violations, a grievant, when involved, the grievant's LAP, and the facility
				  shall follow the four-stage administrative procedure outlined in this
				  chapter.
B. Through a timely
				  process of systematic and orderly stages as outlined in this chapter, all those
				  involved in the RGS process shall give grievances a fair
				  consideration.
C. To ensure that
				  the rights of residents in the Behavioral Health Administration facilities are
				  fully protected and that allegations of rights violations are investigated and
				  resolved, the Director of the RGS shall provide an accessible internal
				  system.
D. The rights advisor shall
				  investigate grievances:
(1) Promptly,
				  impartially, and with the least disruption to the grievant's treatment plan;
				  and
(2) Without abridging the right
				  of a grievant to have the grievance process transpire within the required time
				  frames or be completed within 65 working days.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.14 - Resident Grievance System › Section 10.21.14.04 - Duties of the Rights Advisors and Director of the RGS

Current through Register Vol. 51, No. 14, July 12, 2024
A. The rights advisor shall:
(1) Investigate all complaints in a
				  professionally appropriate manner;
(2) Attempt to resolve grievances fairly and
				  thoroughly;
(3) Prepare written
				  reports for each grievance investigated;
(4) Maintain the RGS reports;
(5) Attempt to identify residents who may
				  benefit from services offered by the LAP and:
(a) Refer the residents identified to the
				  LAP; and
(b) Advise the LAP of the
				  referrals;
(6)
				  Investigate abuse allegations, even though the State police and the facility
				  also may be conducting an investigation of the same allegations;
(7) Monitor any corrective action used to
				  resolve grievances, and:
(a) Notify the CEO if
				  corrective action has not been taken; and
(b) If corrective action has not been taken
				  by the CEO within a reasonable period of time, notify the RGS
				  Director;
(8) When a
				  rights advisor discusses a grievance with a grievant, inform the rievant that,
				  if the grievant requests, the rights advisor is available to attend and
				  advocate for the grievant before the Behavioral Health Administration
				  committees, boards, and tribunals;
(9) Inform the grievant of the right to
				  appeal a decision during any stage of the grievance process, and if a grievant
				  wishes to appeal:
(a) Upon request, file an
				  appeal on behalf of the grievant;
(b) Advise the grievant that the resident may
				  be represented by a LAP following the completion of stage 2 of the grievance
				  procedure; and
(c) With the
				  grievant's consent, attend and advocate in the best possible manner for the
				  grievant on appeal, except in cases when, as a result of the rights advisor's
				  professional judgment, the grievant's case is determined to be frivolous;
				  and
(10) In cases when,
				  as a result of the rights advisor's professional judgment, the grievant's case
				  is determined to be frivolous, forward the grievance to the Director of the
				  RGS.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.14 - Resident Grievance System › Section 10.21.14.05 - Procedures for Filing a Grievance

Current through Register Vol. 51, No. 14, July 12, 2024
A. A facility shall provide for a direct and
				  effective means of communication between the residents and the rights advisor,
				  including but not limited to communication by telephone and in
				  person.
B. The following may
				  present a grievance to a rights advisor:
(1)
				  A resident;
(2) An employee of a
				  facility;
(3) A resident's family
				  member;
(4) A LAP; or
(5) An interested person.