Sec. 14.31.06.17. Admission, Individual Plan of Care, Behavior Intervention Plan, and Discharge

A. General Requirements.

(1) The licensee shall have and follow written policies regarding:

(a) Admission;

(b) Individual plan of care;

(c) Behavior intervention plan;

(d) Behavior support services; and

(e) Discharge.

(2) The licensee shall form a team comprised of at least the following individuals to participate in the:

(a) Admission process:

(i) A representative designated by the placing agency;

(ii) Program staff responsible for the care and supervision of the child;

(iii) Unless clearly inappropriate, the child; and

(iv) If appropriate, the child’s parent or legal guardian; and

(b) Development of the individual plan of care and the discharge plan:

(i) A representative designated by the placing agency;

(ii) A human service professional from the program considering the admission;

(iii) Program staff responsible for the care and supervision of the child;

(iv) The child’s parent or legal guardian, if consistent with the child’s permanency plan; and

(v) Unless clearly inappropriate, the child.

(3) Each team shall:

(a) Document those present and participating; and

(b) Indicate in the individual case record the reason, if known, why an invited individual did not attend.

B. Admission.

(1) The licensee shall include in its admission policy a:

(a) Statement of nondiscrimination consistent with Title VII of the Civil Rights Act and State Government Article, Title 20, Annotated Code of Maryland;

(b) Provision for an assessment to determine the child’s needs and the licensee’s ability to meet them; and

(c) Method for notifying, when appropriate, a child’s parent or legal guardian if the child is self-admitted.

(2) The licensee may not admit a child referred by an out-of-State placing agency without documentation that the agency has initiated actions to abide by any applicable interstate compact.

(3) The licensee may not admit into care:

(a) More children than the number specified in its license;

(b) Children outside of the age range specified in the license; or

(c) Children not of the gender specified in the license.

(4) In order to admit a child whose characteristics and needs do not fit the profile approved by the licensing agency, the licensee shall document that it has:

(a) Obtained oral permission from the licensing agency before the child's admission; and

(b) Requested written documentation of the licensing agency’s permission within 5 days of the child’s placement, which describes:

(i) The reasons for the placement; and

(ii) How the program will ensure adequate and appropriate care for the child.

(5) Except for emergency placements, the licensee shall admit a child only upon receipt of at least:

(a) A social history or predisposition report, to include any history of abuse or neglect;

(b) A health history that is not older than 6 months, including, if applicable, a list of currently prescribed medications;

(c) A mental health screening report that:

(i) Includes screening for the child's risk of suicide; and

(ii) Was completed in less than 72 hours before the child's placement;

(d) An educational history;

(e) Medical insurance documentation;

(f) If required by federal or State law, any psychological, psychiatric, or developmental assessment that is not older than 12 months;

(g) Emergency telephone numbers to contact the child’s parent or legal guardian;

(h) If applicable, a document that specifies a guardian or custodian of the child other than the biological parent;

(i) The child's permanency plan;

(j) Authorizations necessary for providing care, including:

(i) Medical, dental, and behavioral health authorizations for routine and emergency care;

(ii) Any applicable court order or master's recommendation; and

(iii) Applicable non-court order for shelter care.

(6) For emergency placements, the licensee and the placing agency shall ensure that the licensee receives the documents specified in §§A, B, and C of this regulation within 24 hours of the child's placement.

(7) If it has the discretion to refuse to admit a child referred by the placing agency, the licensee shall process each referral promptly and submit to the placing agency its decision on the referral within 10 days after receipt.

(8) The licensee shall:

(a) Examine each child upon admission;

(b) Document in the child's individual case record any illness, fever, rash, bruise, or injury; and

(c) Take appropriate action as necessary.

(9) Within 3 days after admission, the licensee shall include in a child’s individual case record:

(a) A preliminary, individualized assessment of the child’s needs performed by a human service professional;

(b) A safe environment plan; and

(c) Any document listed in §B(4) of this regulation not received before the child’s placement.

C. Individual Plan of Care. The licensee shall require the team convened pursuant to §A(2)(b) of this regulation:

(1) To develop for each child, within 30 days after admission, an individual plan of care that includes:

(a) An evaluation that meets the requirements of the Early and Periodic Screening, Diagnosis and Treatment program;

(b) If appropriate, a behavior intervention plan as defined in §D of this regulation;

(c) Measurable objectives with time frames leading to the achievement of goals;

(d) Implementation dates and strategies;

(e) Individuals responsible for providing the supports, services, implementation, and monitoring of the plan;

(f) Documentation indicating whether or not the child and parent or legal guardian agree with the plan;

(g) Education, including special education and related services to implement the individualized education program of a student as required under the Individuals With Disabilities Education Act;

(h) Family relationship;

(i) Health care;

(j) Life skills development;

(k) Personal, emotional, and social development;

(l) Recreation plan;

(m) Vocational training;

(n) The placing agency’s permanency plan; and

(o) Other areas as appropriate; and

(2) To execute the:

(a) Review and update of every child’s individual plan of care at least every 90 days;

(b) Modification of the individual plan of care as required by the child’s needs, interests, and circumstances; and

(c) Documentation of monthly progress toward achievement of goals and estimated length of stay.

D. Behavior Plan.

(1) The licensee shall have a comprehensive written policy that identifies the process by which a behavior intervention plan is determined to be appropriate.

(2) The licensee shall ensure that a behavior intervention plan is developed for each child for whom it is appropriate that includes:

(a) An assessment of each challenging behavior as identified in the individual plan of care;

(b) A description of the function of current behaviors including their frequency and severity;

(c) The behavioral objectives for the child including:

(i) Criteria for determining achievement of the objectives established;

(ii) A description of the adaptive skills to be learned by a child that serve as alternatives to behaviors that present a danger to self or serious bodily harm to others;

(iii) A description of the adaptive skills to be learned by a child that serve as functional alternatives to the challenging behavior or behaviors to be decreased;

(iv) Identification of the individual or individuals responsible for monitoring the behavior intervention plan;

(v) The data to be collected to assess progress towards meeting the behavior intervention plan’s objectives;

(vi) Documentation for the use of physical restraint, the reason for its use, and the length of time used; and

(vii) For licensees of the Maryland Department of Health, documentation for the use of mechanical restraint, the reason for its use, and the length of time used;

(d) Take into account the medical condition of the child; and

(e) Describe the treatment techniques and when the techniques are to be used.

(3) Before implementation, the licensee shall ensure that each behavior intervention plan that includes the use of restraints includes the written informed consent of:

(a) The child, when appropriate;

(b) The child’s parent or legal guardian, when appropriate; and

(c) The placing agency’s designee.

(4) If the program is licensed to serve children with developmental disabilities, each behavior intervention plan that includes the use of restraints shall be approved by the standing committee established under COMAR 14.31.07.08 before the plan’s implementation.

E. Behavior Support Services.

(1) A licensee who contracts for behavior support services as determined by the behavior intervention plan shall ensure that its contractor:

(a) Meets the requirements of this chapter; and

(b) Is knowledgeable about the licensing agency's service delivery system.

(2) Behavior support services may include:

(a) Behavioral consultation;

(b) Temporary augmentation of staff;

(c) Behavioral training; and

(d) Behavioral respite services.

(3) In addition to the training requirements in COMAR 10.22.02.10-.11 for licensees of the Maryland Department of Health and the training and requirements of this chapter, the licensee shall ensure that staff who provide behavior support services, before being assigned independent duties, receive training in the:

(a) Principles of behavioral change; and

(b) Use of a specific behavior management technique as outlined in the child’s behavior intervention plan.

F. Discharge.

(1) For planned discharges, the licensee shall:

(a) Except for emergency shelter placement, and at least 30 days before a planned discharge, prepare a discharge plan which includes:

(i) The name, address, telephone number, and relationship of the individual with whom the child will be residing upon discharge;

(ii) A statement of unmet identified and continuing needs including but not limited to behavioral and somatic health, education, family and peer relationships, employment, behavior, medications, and recommendation for follow-up treatment; and

(b) Within 30 calendar days after discharge, submit to the placing agency a discharge summary which includes:

(i) A final summary of the child’s performance in the program;

(ii) A summary of the child’s health, dental, optical, and behavioral health records; and

(iii) A summary of services provided to the child, including behavioral and somatic health, education, family and peer relationships, employment, behavior, medications, and recommendation for follow-up treatment.

(2) For unplanned discharges, the licensee shall:

(a) Provide at least 72 hours’ notice to the placing agency unless there is imminent risk of harm to self or others;

(b) At the time of discharge, provide to the placement agency a discharge plan which includes:

(i) Specific details of the reason for discharge; and

(ii) A statement of unmet and continuing needs; and

(c) Within 30 calendar days after discharge, submit to the placing agency a discharge summary which includes:

(i) A final summary of the child’s performance in the program;

(ii) A final summary of the child’s medical, dental, optical, and behavioral health records; and

(iii) A summary of services provided to the child.