Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 21 - MENTAL HYGIENE REGULATIONS › Chapter 10.21.17 - Community Mental Health Programs-Definitions and Administrative Requirements › Section 10.21.17.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In COMAR
				  10.21.16 and subsequent community mental health program chapters, the following
				  terms have the meanings indicated.
B. Terms Defined.
(1) "Ability to pay" means the individual's
				  ability to pay for mental health services, as determined according to the
				  provisions of COMAR 10.04.02.
(2)
				  "Administration" means the Mental Hygiene Administration.
(3) "Administrative services organization
				  (ASO)" means the entity with which the Administration may contract to provide
				  the services described in COMAR 10.09.70 for the public mental health
				  system.
(4) "Advance directive for
				  mental health services" means a plan made by an individual pursuant to
				  Health-General Article, §5-602.1, Annotated Code of Maryland.
(5) "Aftercare plan" means the plan developed
				  by inpatient facility staff according to the requirements of Health-General
				  Article, §10-809, Annotated Code of Maryland and COMAR 10.21.05.
(6) "Case coordination" means the process by
				  which mental health and related support services to an individual are
				  coordinated and monitored.
(7)
				  "Case resolution conference (CRC)" means an informal proceeding before an
				  evidentiary hearing to determine if there are grounds for settlement of a
				  contested case.
(8) "Community
				  support specialist" means the case manager as defined in COMAR
				  10.09.45.
(9) "Contact note" means
				  an entry that is made in an individual's medical record by a program staff
				  member and that describes face-to-face, written, or telephone contact with or
				  regarding the individual.
(10)
				  "Core service agency (CSA)" means the county or multicounty authority,
				  designated under Health-General Article, Title 10, Subtitle 12, Annotated Code
				  of Maryland, to carry out the duties set forth therein.
(11) "Credentialing" means the collection,
				  verification, and assessment of information regarding four critical parameters:
(a) Current licensure;
(b) Relevant training;
(c) Current competence; and
(d) The ability to perform clinical
				  responsibilities.
(12)
				  "Crisis intervention" means the therapeutic response that provides immediate
				  care or referral for an individual with urgent mental health need.
(13) "Day treatment program" means a program
				  approved under COMAR 10.21.02 and is also referred to as partial
				  hospitalization or psychiatric day treatment.
(14) "Deemed status" means the Secretary's
				  granting of approval under this subtitle to a program, based on the program's
				  accreditation under the relevant behavioral healthcare standards of the Joint
				  Commission on Accreditation of Healthcare Organizations (JCAHO) or
				  Rehabilitation Accreditation Commission (CARF).
(15) "Department" means the Department of
				  Health and Mental Hygiene.
(16)
				  "Designated emergency facility" means a health care facility identified under
				  Health-General Article, §10-620, Annotated Code of Maryland, to perform
				  the duties under Health-General Article, §10-624, Annotated Code of
				  Maryland.
(17) "Director" means the
				  Director of the Mental Hygiene Administration.
(18) "Discharge plan" means a brief
				  description of the recommendations for continued treatment.
(19) "Discharge summary" means a detailed
				  review of services provided to an individual, including, at a minimum, the
				  items outlined in Regulation .11C of this chapter.
(20) "Enhanced support" means short-term,
				  in-home services, in addition to other services to an individual, by a program
				  that is approved by the Administration to provide this service, to support the
				  individual to remain in the community.
(21) "Enrolled" means the program's formal
				  acceptance and admission of an individual into the program.
(22) "Facility" has the meaning indicated in
				  Health-General Article, §10-102(e), Annotated Code of Maryland, and may
				  also be referred to as a site.
(23)
				  "Governing body" means the organizational structure that is responsible for all
				  program operations, including:
(a)
				  Establishing policy;
(b)
				  Maintaining quality care; and
(c)
				  Providing management and planning for the program.
(24) "Grievance" means an oral or written
				  complaint filed by or on behalf of an individual regarding the denial of
				  services based on eligibility or medical necessity criteria.
(25) "Group home" means a private group home
				  as defined in Health-General Article, §10-514, Annotated Code of Maryland,
				  and licensed under COMAR 10.21.04.
(26) "Guardian" means a guardian as defined
				  in Estates and Trusts Article, §
											13-101, Annotated
				  Code of Maryland.
(27) "HIPAA"
				  means part of the federal act outlined in
				  42 U.S.C. §
												1320D et seq., as amended, and the
				  implementing regulations at 45 CFR Parts 160 and 164, as amended.
(28) "Health officer" means the individual
				  nominated by a county and appointed by the Secretary under the provision of
				  Health-General Article, Title 3, Subtitle 3, Annotated Code of
				  Maryland.
(29) "Health promotion
				  and training" means activities to increase an individual's awareness of
				  physical and mental health status and of the resources required to help promote
				  good physical and mental health.
(30) "Independent living skills training"
				  means activities to promote, maintain, or restore an individual's ability to
				  perform essential activities of daily life.
(31) "Individual" means:
(a) An adult;
(b) A person authorized to consent to health
				  care for an adult;
(c) A
				  minor;
(d) A minor who is 16 years
				  old or older, if the medical care concerns treatment to which the minor has the
				  right to consent, and if the minor has consented to treatment;
(e) A parent;
(f) A guardian;
(g) The attorney of the minor;
(h) The custodian of the minor; or
(i) A representative of the minor designated
				  by a court who can legally consent to treatment consistent with the authority
				  granted.
(32)
				  "Individual rehabilitation plan (IRP)" means the plan prepared according to the
				  requirements outlined in the chapter or chapters under this subtitle that
				  delineate the requirements for the specific rehabilitation program.
(33) Individual Treatment and Rehabilitation
				  Plan (ITRP).
(a) "ITRP" means the plan
				  prepared according to the requirements outlined in the chapter or chapters
				  under this subtitle that delineate the requirements for the specific
				  program.
(b) "ITRP" may substitute
				  for a separate ITP and IRP.
(34) "Individual Treatment Plan (ITP)" means
				  the plan prepared according to the requirements outlined in the chapters under
				  this subtitle that delineate the requirements for the specific
				  program.
(35) "Inpatient facility"
				  means an inpatient institution that provides evaluation, treatment, and 24-hour
				  residential care for individuals who have mental disorders.
(36) "Lead CSA" means, for programs that
				  provide services in multiple jurisdictions, the CSA identified by the
				  Administration in collaboration with the appropriate CSAs to represent all
				  involved jurisdictions.
(37)
				  "Managed intervention plan (MIP)":
(a) Means
				  the plan that is developed, when appropriate, that details the strategies to be
				  implemented in times of crisis to provide for a revised plan of services and
				  supports to maintain the individual in a residential rehabilitation program
				  residence, to prevent the unplanned discontinuation of services, or to prevent
				  an inpatient admission; and
(b) May
				  be incorporated into the individual rehabilitation plan (IRP) or individual
				  treatment and rehabilitation plan (ITRP).
(38) "Maryland Medical Records Act" means the
				  act outlined in Health-General Article, §4-301, Annotated Code of
				  Maryland.
(39) "Medical Assistance
				  Program" means the Medical Assistance Program as defined in COMAR
				  10.09.36.01A.
(40) "Medicare" means the
				  insurance program administered by the federal government under Title XVIII of
				  the Social Security Act, 42
				  U.S.C. §
												1395 et seq., as
				  amended.
(41) Medication
				  Monitoring.
(a) "Medication monitoring"
				  means:
(i) Providing face-to-face assistance
				  to an individual to achieve compliance with treatment with all prescribed
				  psychiatric or somatic medications; and
(ii) As needed, reviewing the individual's
				  existing medication regimen with the appropriate physician.
(b) "Medication monitoring" does
				  not mean:
(i) Prescribing
				  medication;
(ii) Measuring or
				  pouring medicine;
(iii) Preparation
				  of a syringe for injection; or
(iv)
				  Administration of medication.
(42) "Mental health professional" means an
				  individual who is licensed, certified, or otherwise legally authorized to
				  provide the mental health service:
(a) Under
				  Health Occupations Article, Annotated Code of Maryland; or
(b) In the state where the service is
				  rendered.
(43) "Mental
				  health program (program)" means a community-based program that is approved by
				  the Department under this subtitle to be eligible to receive State or federal
				  funds, or both.
(44) "Mental health
				  vocational program (MHVP)" means a program approved under COMAR
				  10.21.28.
(45) "Minor" means an
				  individual who is younger than 18 years old.
(46) "Mobile treatment services (MTS)
				  program" means a program approved under COMAR 10.21.19.
(47) "Nurse" means an individual who is
				  licensed and legally authorized to practice as a nurse:
(a) Under Health Occupations Article,
				  Annotated Code of Maryland; or
(b)
				  In the state where the service is rendered.
(48) "Occupational therapist" means an
				  individual who is licensed and legally authorized to practice as an
				  occupational therapist:
(a) Under Health
				  Occupations Article, Annotated Code of Maryland; or
(b) In the state where the service is
				  rendered.
(49) "On-call"
				  means the availability of designated program staff 24 hours per day, 7 days per
				  week.
(50) "Outpatient mental
				  health center (OMHC)" means a program approved under COMAR 10.21.20.
(51) "Physician" means an individual who is
				  licensed and legally authorized to practice medicine:
(a) Under Health Occupations Article,
				  Annotated Code of Maryland; or
(b)
				  In the state where the service is rendered.
(52) "Primary care provider (PCP)" means a
				  practitioner who is the primary coordinator of care for the individual, whose
				  responsibility it is to provide accessible, continuous, comprehensive, and
				  coordinated health care services and includes PCPs covering the full range of
				  benefits required by the Maryland Medicaid Managed Care Program, as specified
				  in COMAR 10.09.67.
(53) "Primary
				  caretaker" means the minor's custodial parent or parents or the adult with whom
				  the minor currently resides.
(54)
				  "Privileging" means the process by which a program determines that staff
				  members are qualified to perform assigned duties.
(55) "Professional counselor" means an
				  individual who is certified or licensed and legally authorized to practice as a
				  professional counselor:
(a) Under Health
				  Occupations Article, Annotated Code of Maryland; or
(b) In the state where the service is
				  rendered.
(56) "Program
				  director" means the individual who is responsible for the daily operations of a
				  program, as outlined in the chapter under this subtitle that delineates the
				  requirements for a specific program.
(57) "Program improvement plan (PIP)" means a
				  written statement from a program that documents the program's methods and time
				  frames for correcting deficiencies cited by the Department's designated
				  approval unit.
(58) "Progress
				  summary note" means an entry by an individual's program coordinator in the
				  individual's medical record that summarizes the individual's progress toward
				  goals delineated in the individual's ITP, IRP, or ITRP.
(59) "Provisional diagnosis" means the
				  diagnosis given as a result of an initial assessment of the symptoms at the
				  first encounter with an individual that lasts only until the correct nature of
				  the illness has been clarified by further clinical examination.
(60) "Psychiatric rehabilitation program
				  (PRP)" means a program approved under COMAR 10.21.21 for adults, and COMAR
				  10.21.29 for minors, or both.
(61)
				  "Psychiatrist" means a physician who:
(a) Is
				  certified in psychiatry by the American Board of Psychiatry and Neurology;
				  or
(b) Has completed the minimum
				  educational and training requirements to be qualified to take the Board of
				  Psychiatry and Neurology examination for certification in psychiatry.
(62) "Psychologist" means an
				  individual who is licensed and legally authorized to practice as a
				  psychologist:
(a) Under Health Occupations
				  Article, Annotated Code of Maryland; or
(b) In the state where the service is
				  rendered.
(63)
				  "Psychologist Associate" means an individual approved by the Board of Examiners
				  of Psychologists for exemption to perform psychological services pursuant to
				  Health Occupations Article, §
											18-301(b)(3),
				  Annotated Code of Maryland, and COMAR 10.36.07.
(64) Public Mental Health System (PMHS).
(a) "Public mental health system" means the
				  system for the delivery of mental health treatment and supports to individuals
				  who meet medical necessity criteria and financial eligibility as established by
				  the Department of Health and Mental Hygiene, Mental Hygiene
				  Administration.
(b) "Public mental
				  health system" includes the specialty mental health system described in COMAR
				  10.09.70.
(65) "Quality
				  management (QM)" means the process by which a program maintains and improves
				  the quality of services.
(66)
				  "Referral" means a contact made with a program by an individual, or on behalf
				  of an individual, for mental health services.
(67) "Rehabilitation coordinator" means the
				  program staff person who is responsible for coordinating and providing
				  rehabilitation services to an individual.
(68) "Residence" means a housing unit leased
				  or owned by an approved residential rehabilitation program (RRP).
(69) "Residential checklist" means the form
				  issued by the Department for the purpose of recording information gathered
				  during the inspection of rehabilitation residences.
(70) "Residential crisis services (RCS)"
				  means services provided by a program approved under COMAR 10.21.26.
(71) "Residential rehabilitation program
				  (RRP)" means a program that is approved under COMAR 10.21.22.
(72) "Residential specialist" means the
				  individual designated by the Department or the CSA to inspect, monitor, and
				  determine the approval status of a residence.
(73) "Respite care services" means services
				  provided by a program approved under COMAR 10.21.27.
(74) "Secretary" means the Secretary of the
				  Department of Health and Mental Hygiene or the Secretary's designee.
(75) "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 classification system that is recognized by the Secretary, excluding
				  the following, unless they co-exist with a diagnosable psychiatric disorder:
(i) Developmental disorders;
(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
				  minor's functioning in the family, school, or community.
(76) "Serious mental illness" means a mental
				  disorder that is:
(a) Manifest in an
				  individual 18 years old or older;
(b) Diagnosed, according to a current
				  diagnostic classification system that is recognized by the Secretary as:
(i) Schizophrenic disorder;
(ii) Major affective disorder;
(iii) Other psychotic disorder; or
(iv) Borderline or schizotypal personality
				  disorder, with the exclusion of an abnormality that is manifested only by
				  repeated criminal or otherwise antisocial conduct; and
(c) Characterized by impaired functioning on
				  a continuing or intermittent basis, for at least 2 years, and includes at least
				  three of the following:
(i) Inability to
				  maintain independent employment;
(ii) Social behavior that results in
				  interventions 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 support system; or
(v) Need for assistance with basic living
				  skills.
(77)
				  "Social skills training" means activities to diminish tendencies toward
				  isolation and withdrawal by assisting individuals to acquire, maintain, or
				  develop communication and other interpersonal skills.
(78) "Social worker" means an individual who
				  is licensed and legally authorized to practice as a social worker:
(a) Under Health Occupations Article,
				  Annotated Code of Maryland; or
(b)
				  In the state where the service is rendered.
(79) "Supported housing" means activities to
				  enable an individual to maintain housing of the individual's choice.
(80) "Therapeutic group home (TGH)" means a
				  program that is licensed under COMAR 10.21.04, 10.21.07, and COMAR 14.31.05,
				  14.31.06, and 14.31.07.
(81)
				  "Therapeutic milieu" means an environment that is clinically structured to
				  provide mental health treatment in a place other than the individual's
				  residence.
(82) "Therapeutic
				  nursery program (TNP)" means a program approved under COMAR 10.21.18.
(83) "Treatment coordinator" means the
				  licensed mental health professional who is responsible for coordinating and
				  providing mental health services to an individual.
(84) "Working day" means any day except
				  Saturday, Sunday, or a holiday on which State offices are closed.