Sec. 10.21.19.08. Required Staff

A provider of MTS shall ensure that the MTS staff includes, at a minimum:

A. A program director who:

(1) Is a mental health professional;

(2) Is available to provide MTS administration and supervision:

(a) If fewer than 40 individuals are receiving services, for an amount of time calculated on the basis of 1/2 hour per week for each individual who is receiving services; or

(b) If 40 or more individuals are receiving services, 20 hours per week;

(3) Is responsible for operational oversight for, at a minimum:

(a) Fulfilling the administrative requirements under COMAR 10.21.17 and the day-to-day clinical responsibilities for MTS;

(b) Recruiting, hiring, training, and supervising staff;

(c) Developing and implementing the budget;

(d) Keeping the governing body informed of, at a minimum, the program's approval status and performance;

(e) Ensuring that MTS are available to the individual, if needed, 24 hours per day, 7 days per week, and establishing on-call responsibilities;

(f) Ensuring continuity of care during the time that an individual is receiving MTS by evaluating caseloads and coordinating staff schedules; and

(g) Ensuring that transition services are provided; and

(4) May carry out any of the clinical and training duties of a mental health professional or other MTS staff;

B. A psychiatrist who:

(1) Is involved, for an amount of time calculated on the basis of at least 1/4 hour per week for each individual who is receiving services, in:

(a) Consultation with MTS staff; and

(b) Evaluating and providing MTS;

(2) Ensures that MTS are provided in accordance with accepted standards of medical practice;

(3) Following a screening evaluation of an individual completed under Regulation .04B of this chapter, has an initial face-to-face contact with the individual, as required under Regulation .05A of this chapter, to:

(a) Formulate and document the psychiatric diagnosis or affirm a psychiatric diagnosis that has been entered in the individual's MTS medical record;

(b) Assess medical needs;

(c) Confirm the medical necessity of MTS;

(d) When appropriate, order MTS for the individual; and

(e) Authorize the initial ITP;

(4) Is responsible for, at a minimum, the following:

(a) Evaluating the individual, face-to-face, at least every 3 months;

(b) As required under the provisions of Regulation .05C of this chapter, participating in the development, required periodic review, and signing of an individual's ITP;

(c) Prescribing medication and providing other medication services outlined in Regulation .06A of this chapter;

(d) Providing the appropriate treatment indicated in the individual's ITP; and

(e) Supervising psychiatric residents, if any, who provide MTS, including, if duties are delegated, providing, at least monthly, a review of the status of the individuals whom the resident is treating;

(5) May delegate the following duties to a third-year or fourth-year resident of an accredited program in psychiatry:

(a) Except for the initial 3-month evaluation, the periodic evaluations required under §B(4)(a) of this regulation;

(b) Participation in the development, required periodic review, and signing of an individual's ITP, required under §B(4)(b) of this regulation;

(c) If the resident is a licensed physician, prescribing medication and providing other medication services, as provided under §B(4)(c) of this regulation; and

(d) As provided in §B(4)(d) of this regulation, providing the appropriate treatment indicated in the individual's ITP; and

(6) May not delegate:

(a) The initial psychiatric evaluation;

(b) Formulation and documentation of the psychiatric diagnosis or affirmation of a psychiatric diagnosis that has been entered in the individual's MTS medical record; or

(c) Ordering of MTS for an individual;

C. A registered nurse who:

(1) Is licensed under the provisions of Health Occupations Article, Title 8, Annotated Code of Maryland;

(2) Participates in MTS for an amount of time calculated on the basis of at least 1 hour per week for each individual who is receiving services; and

(3) As permitted under Health Occupations Article, Annotated Code of Maryland, performs assigned duties that the nurse is credentialed and privileged to perform, including but not limited to:

(a) Medication administration and other medication services outlined in Regulation .06A of this chapter; and

(b) Health promotion and training, as outlined in Regulation .06C of this chapter;

D. At least one social worker who:

(1) Is licensed under the provisions of Health Occupations Article, Title 19, Annotated Code of Maryland; and

(2) As permitted under Health Occupations Article, Annotated Code of Maryland, performs assigned duties the social worker is credentialed and privileged to perform, including but not limited to:

(a) Interactive therapies, as outlined in Regulation .06D of this chapter;

(b) Support, linkage, and advocacy, as outlined in Regulation .06F of this chapter; and

(c) Discharge and transition services as outlined in Regulation .07 of this chapter; and

E. At least one mental health professional who:

(1) May include the staff identified in §§C and D of this regulation; and

(2) As permitted under Health Occupations Article, Annotated Code of Maryland, performs assigned duties that the mental health professional is credentialed and privileged to perform, including but not limited to:

(a) Conducting the screening evaluation required under Regulation .04B of this chapter and participating in the initial psychiatric evaluation required under Regulation .05A of this chapter;

(b) According to the provisions of Regulation .05C of this chapter, reviewing and signing an individual's ITP;

(c) The duties outlined in Regulations .06 and .07 of this chapter that the mental health professional is licensed or credentialed and privileged to perform;

(d) When credentialed and privileged by the program to do so, functioning as the treatment coordinator for individuals who are receiving MTS;

(e) Supervising direct service providers; and

(f) Assuring that, before the provision of MTS and, as needed, on an in-service basis, appropriate training is provided to direct service providers.