Sec. 10.21.17.02. Definitions

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 10.67.08 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 Maryland Department of Health.

(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 10.09.36.01.

(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 10.67.06.

(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 Maryland Department of Health Administration.

(b) "Public mental health system" includes the specialty mental health system described in COMAR 10.67.08.

(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 Health 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.