Sec. 10.21.01.07. Observation Status

A. Upon a properly executed application executed in accordance with Regulation .03 of this chapter and certificates for IVA and all required attachments in accordance with Regulation .04 of this chapter, an inpatient facility that accepts individuals who are referred for IVA may take an individual into confinement on observation status.

B. GES Evaluation. If an individual is an emergency evaluee, and the individual is 65 years old or older, on the first working day after the individual is taken into confinement on observation status, staff at a State inpatient facility or Veterans' Administration hospital shall:

(1) Notify the GES team in the county where the individual resides; and

(2) Document whether the GES grants clearance for the involuntary admission of the individual.

C. Examination.

(1) A psychiatrist shall examine an individual if the individual remains confined on observation status in an inpatient facility within 24 hours of the initial confinement.

(2) If a physician who examines an individual confined on observation status determines that the individual does not meet the requirements for IVA outlined in Health-General Article, §10-617, Annotated Code of Maryland, and Regulation .04C(4)(c) of this chapter, the physician shall:

(a) If the individual meets the requirements for voluntary admission, offer the individual an application for voluntary admission; or

(b) Immediately release the individual, following:

(i) Notification to the parent or guardian that the individual is being released, if the individual is a minor or is a disabled adult who is under guardianship of the parent or guardian under the provisions of Estates and Trusts Article, §13-708, Annotated Code of Maryland; and

(ii) Preparation of a written aftercare plan in accordance with Health-General Article, §10-809, Annotated Code of Maryland.

D. Medical Records.

(1) An inpatient facility shall maintain the medical records for individuals who are confined on observation status separate from the inpatient medical records of the facility.

(2) The inpatient facility may not disclose an individual's observation status medical record in any way that would indicate that the individual had been present in the inpatient facility, except:

(a) For the sole purposes of:

(i) Providing notice of admission status and rights and notice of hearing to the individual's parent, guardian, or next of kin, in accordance with Regulations .05 and .06 of this chapter;

(ii) Calling witnesses to testify at the individual's IVA hearing; and

(iii) Fulfilling the provisions of Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland; or

(b) Upon the authorization of the individual.

(3) Staff at the inpatient facility where an individual is confined may use prior observation status medical records, as necessary, to provide for the proper care or treatment of the individual.

E. Rights. An individual who is confined on observation status in an inpatient facility shall be entitled to the rights granted in accordance with Health-General Article, Title 10, Subtitle 7, and Title 4, Subtitle 3, Annotated Code of Maryland.

F. An individual taken into an inpatient facility in accordance with §A of this regulation shall remain confined on observation status until the individual is:

(1) Voluntarily admitted to the inpatient facility in accordance with the provisions of Health-General Article, §10-609 or 10-610, Annotated Code of Maryland, and if the individual is:

(a) A minor, a parent or guardian who is not a representative of a State agency signs an application for voluntary admission of a minor, in accordance with Health-General Article, §10-610, Annotated Code of Maryland;

(b) A minor who is confined in a State inpatient facility, a parent or guardian has not previously executed an application for voluntary admission of a minor during the minor individual's current confinement in the State inpatient facility; and

(c) Not a disabled adult who is under guardianship of the person under the provisions of Estates and Trusts Article, §13-708, Annotated Code of Maryland;

(2) Released by a physician of the inpatient facility before the scheduled IVA hearing pursuant to §C(2)(b) of this regulation;

(3) Admitted to the inpatient facility by an ALJ following an IVA hearing in accordance with Health-General Article, §10-632, Annotated Code of Maryland, and Regulation .09G of this chapter; or

(4) Released from the inpatient facility by an ALJ following an IVA hearing in accordance with Health-General Article, §10-632, Annotated Code of Maryland, and Regulation .09G of this chapter.

G. Discharge of an Individual on Observation Status and Referral for Direct IVA at Another Inpatient Facility. An inpatient facility may refer for IVA to another inpatient facility an individual who is confined on observation status only if the receiving inpatient facility agrees to have the hearing held within 10 days of the individual's initial confinement in the discharging inpatient facility on the basis of application and certificates for IVA.

H. Payment or Reimbursement for Care or Treatment. Payment or reimbursement for care or treatment of an individual who is confined on observation status in, or who is involuntarily admitted to, an inpatient facility shall be in accordance with the provisions of Health-General Article, Title 16, Subtitle 2, Annotated Code of Maryland.