Maryland Administrative Code

.08 Documentation. A. Incidents. (1) Any visitor behavior that leads to removal of the visitor from the premises shall be documented. (2) Any incident that requires police intervention shall be reported and documented in accordance with facility procedures. (3) Whenever a visitor…

.09 Patient's Refusal to Receive Visitors. A. Whenever a patient refuses visitors, the refusal shall be noted in the patient's records and may be reviewed by the treatment team. B. The patient's refusal shall be honored. C. With the consent of the patient, visitors shall be infor…

.10 Procedures Pertaining to Complaints. Complaints about the individual application of this chapter may be addressed through any patient grievance mechanism.

.01 Scope. This chapter sets forth the requirements for a provider of psychiatric residential treatment facilities (PRTF) Medicaid demonstration waiver services as set forth in COMAR 10.09.79. These services are: A. Caregiver peer-to-peer support; B. Crisis and stabilization serv…

.02 Definitions. In this chapter, terms have the meanings stated in COMAR 10.09.79.

.03 Approval. A. The Department shall grant approval to providers to be eligible to receive State and federal funds for PRTF waiver services if the provider meets the requirements set forth in this chapter. B. Application. To provide PRTF waiver services, a provider applicant sha…

.04 Denial, Emergency Suspension of Approval, and Disciplinary Action. A. Denial of Approval. (1) If the Department proposes to deny approval to an applicant under the provisions of this chapter, the Department shall give written notice of the proposed denial to the: (a) Provider…

.05 General Conditions for PRTF Waiver Services Provider Participation. A. A provider of PRTF waiver services shall: (1) Provide the documentation required by the Department for initial approval and provider recertification, or as requested by the Department; (2) Be approved by t…

.06 Specific Conditions for PRTF Waiver Services Providers — Respite Services. To be eligible to provide PRTF waiver services as a provider of in-home or out-of-home respite services under COMAR 10.09.79.06B, a provider shall: A. Meet the requirements of COMAR 10.21.27; B. Ensure…

.07 Specific Conditions for PRTF Waiver Service Providers — Caregiver Peer-to-Peer Support and Youth Peer-to-Peer Support. A. A family support organization may provide PRTF waiver services of caregiver peer-to-peer support, youth peer-to-peer support, or family and youth training…

.08 Specific Conditions for PRTF Waiver Service Providers — Family and Youth Training. A. Family and Youth Training Providers. To provide services set forth COMAR 10.09.79.06B, a provider shall be: (1) An approved waiver provider agency, including but not limited to, a family sup…

.09 Specific Conditions for PRTF Waiver Service Providers — Expressive and Experiential Behavioral Services. A. Expressive and experiential behavioral services are: (1) Art behavioral services; (2) Dance/movement behavioral services; (3) Equine-assisted behavioral services; (4) H…

.10 Specific Conditions for PRTF Waiver Service Providers — Crisis and Stabilization Services. To provide the services set forth COMAR 10.09.79.06B, a provider shall: A. Be an agency; B. Have a current formal written agreement with a local core service agency to serve as a crisis…

.01 Scope. This chapter outlines the requirements that a provider of residential therapeutic services to emotionally or behaviorally disordered children shall meet to be eligible to accept children placed by the Mental Hygiene Administration.

.02 Definitions. A. In this chapter, the following terms have the meaning indicated. B. Terms Defined. (1) “Direct supervision” means that a provider staff member maintains continuous visual contact with the child. (2) “Family of origin” means the child's parent, guardian, or pri…

.03 Provider Requirements. A provider of residential therapeutic services may not be eligible to accept children placed by the Maryland Department of Health unless the provider: A. Is licensed by the Department of: (1) Human Services, under the provisions of COMAR 07.02.23 or 07.…

.01 Scope. These regulations govern the use of quiet rooms and restraint in all facilities as defined in Health-General Article, §§10-101(g) and 10-701, Annotated Code of Maryland. These regulations are supplemental to any other applicable law and regulation. In the event of conf…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) Category I Restraint. (a) “Category I restraint” means a device identified by the facility which limits a patient's mobility to the extent that the patient would not be abl…

.03 Use of Restraint. A. Staff authorized under the provisions of Regulation .05B of this chapter may use a restraint: (1) Only during an emergency in which the behavior of the patient places the patient or others in serious threat of violence or injury; (2) If ordered by a physi…

.04 Protective Device Use. A. When the definition of a restraint or a protective device is in dispute, in each case under discussion, the clinical director or the clinical director's physician designee shall clarify and document in the patient's medical record the device's correc…

.05 Procedures in the Use of Restraint. A. A facility shall: (1) Have a written policy specifying the method used to ensure that a patient whose primary language or method of communication is nonverbal is able to effectively communicate distress during a physical restraint or hol…

.06 Placement of Patient in Restraint. A. When possible, staff shall advise a patient, in a nonthreatening manner, that continuation of a specific behavior may result in the use of restraint. B. When a physician or registered nurse determines that the use of a restraint is approp…

.07 Limitations and Placement of Children in Restraint. In addition to the requirements outlined in this chapter, when: A. Restraining a child, staff may not use four-point restraints; and B. Applying or repositioning a restraint, staff shall avoid the application of force on lon…

.08 Clinical Interventions During Restraint. A. Regardless of the physical setting in which the patient is placed, at a minimum, one staff member shall be assigned continuously while the patient is in a category I restraint. B. While the patient is restrained, in order to provide…

.09 Limitations on Restraint and Continuous Restraint. A. Staff may not initiate “standing” or “as needed” orders for restraint. B. Each order for restraint, used for the management of an emergency in which the behavior of the patient places the patient or others in serious threa…

.10 Documentation. A. Restraint Orders. A physician shall: (1) To initiate the use of restraint: (a) Enter an order in the patient's medical record; or (b) Authorize an order to be written by a registered nurse on the physician's order sheet in the patient's medical record: (i) I…

.11 Use of Quiet Room. A. Patient Request. (1) A patient may request the use of a quiet room and, unless clinically contraindicated, may be granted use of a quiet room. (2) Unless staff terminates use of the quiet room for clinical reasons, the patient may terminate self-initiate…

.12 Quality Assurance. A. The clinical director or the clinical director's designee shall review daily all uses of restraint and investigate unusual or possibly unwarranted patterns of use. B. The physician involved in the restraint may not function in the capacity outlined in §A…

.13 Procedures Pertaining to Complaints. Complaints about the individual application of this chapter may be addressed through any patient grievance mechanism.

.14 Variance with Standards. A. Excluding the prohibition described in §B of this regulation, staff may not vary from the standards identified in this chapter unless the variation is for an extreme crisis. B. There may not be any variance with standards established in this regula…

.01 Scope. These regulations govern the use of quiet rooms and seclusion in all facilities as defined in Health-General Article, §§10-101(g) and 10-701, Annotated Code of Maryland. These regulations are supplemental to any other applicable law and regulation. In the event of conf…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Chief executive officer (CEO)” means the individual responsible for the overall management of a facility. (2) “Clinical director” means the psychiatrist in charge of the c…

.03 Use of Seclusion. A. Staff authorized under the provisions of Regulation .04C of this chapter may use seclusion: (1) Only during an emergency in which the behavior of the patient places the patient or others in serious threat of violence or injury; and (2) If ordered by a phy…

.04 Procedures in the Use of Seclusion. A. A facility shall have a written policy specifying the method used to ensure that a patient whose primary language or method of communication is nonverbal is able to effectively communicate distress during a seclusion. B. A facility shall…

.05 Placement of a Patient in a Seclusion Room. A. When possible, staff shall advise a patient, in a nonthreatening manner, that continuation of a specific behavior may result in the use of seclusion. B. When a physician or registered nurse determines that the use of seclusion is…

.06 Clinical Interventions During Seclusion. A. While the patient is secluded, in order to provide appropriate clinical care, at a minimum, clinically trained staff shall: (1) Observe the patient at least every 15 minutes, and document each observation by the observer; (2) Unless…

.07 Limitations on Seclusion and Continuous Seclusion. A. Staff may not initiate “standing” or “as needed” orders for seclusion. B. Each order for seclusion, used for the management of an emergency in which the behavior of the patient places the patient or others in serious threa…

.08 Documentation. A. Seclusion Orders. A physician shall: (1) To initiate the use of seclusion: (a) Enter an order in the patient's medical record; or (b) Authorize an order to be written by a registered nurse on the physician's order sheet in the patient's medical record: (i) I…

.09 Use of Quiet Room. A. Patient Request. (1) A patient may request the use of a quiet room and, unless clinically contraindicated, may be granted use of a quiet room. (2) Unless staff terminates use of the quiet room for clinical reasons, the patient may terminate self-initiate…

.10 Quality Assurance. A. The clinical director or the clinical director's designee shall review daily all uses of seclusion and investigate unusual or possibly unwarranted patterns of use. B. The physician involved in the seclusion may not function in the capacity outlined in §A…

.11 Procedures Pertaining to Complaints. Complaints about the individual application of this chapter may be addressed through any patient grievance mechanism. Cross References 10.21.13.12B(8)

.12 Variance with Standards. A. Excluding the prohibition described in §B of this regulation, staff may not vary from the standards identified in this chapter unless the variation is for an extreme crisis. B. There may not be any variance with standards established in: (1) This r…

.01 Scope. These regulations govern the administrative process to be used to ensure that the rights of residents residing in the Behavioral Health Administration facilities are protected. Although the residents and the legal assistance providers ultimately shall decide whether to…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Central Review Committee” means the Maryland Department of Health (MDH) staff or their respective designees in the following positions: (a) The Director of the Behavioral …

.03 General Policies of the Resident Grievance System. A. When invoked, and when the process provides a fair, efficient, and complete remedy for allegations of rights violations, a grievant, when involved, the grievant's LAP, and the facility shall follow the four-stage administr…

.04 Duties of the Rights Advisors and Director of the RGS. A. The rights advisor shall: (1) Investigate all complaints in a professionally appropriate manner; (2) Attempt to resolve grievances fairly and thoroughly; (3) Prepare written reports for each grievance investigated; (4)…

.05 Procedures for Filing a Grievance. A. A facility shall provide for a direct and effective means of communication between the residents and the rights advisor, including but not limited to communication by telephone and in person. B. The following may present a grievance to a …