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
Universal Citation: MD Code Reg 10.21.17.02
Current through Register Vol. 51, No. 19, September 20, 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.
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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