Md. Code Regs. 07.02.11.08

Current through Register Vol. 51, No. 11, May 31, 2024

Section 07.02.11.08 - Medical Care

A. The local department shall encourage the parents or legal guardian to participate to the extent of the parents' or legal guardian's capability and availability in plans for the medical care of any child committed to or in voluntary placement with the local department.

B. When the local department holds guardianship with the right to consent to adoption, the local department has the authority to give whatever consent is needed for medical care.

C. At the time a child is taken into care, the local department shall:

(1) Ask the parents or legal guardian to sign a document authorizing the local department to consent to:

(a) An initial health care screening;

(b) A comprehensive health assessment that meets the requirements of the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program; and

(c) All routine and immediate medical care; and

(2) Seek medical guardianship from the court if the parents or legal guardian do not give consent, and, if the child is in need of immediate medical care, obtain treatment while consent is sought.

D. A local department caseworker or a law enforcement officer may take a child who may have been abused or neglected to a medical facility for examination and treatment without parental or legal guardian consent or court order, in accordance with Family Law Article, § 5-712, Annotated Code of Maryland, and COMAR 07.02.07.07F.

E. The local department shall:

(1) Give notice to the child's parents or legal guardian before, and encourage participation in and attendance at, any planned evaluative, diagnostic, or inpatient medical care; and

(2) Promptly notify the parents or legal guardian of any treatment given without prior notice unless the notification violates the privacy rights of the child.

F. The local department shall document in the child's case record the actions taken by the local department to:

(1) Obtain medical consent;

(2) Involve the parents or legal guardian in decisions regarding the child's medical care; and

(3) Notify the parents or legal guardian of any medical care planned or given to their child.

G. Children in the custody or care of a local department shall be enrolled in Maryland's Medical Assistance Program.

H. If the child in an out-of-home placement has private health care coverage, the private coverage shall be the primary source of coverage and Medical Assistance shall be the secondary source of coverage.

I. Initial health care screenings and comprehensive health examinations of children in the custody or care of a local department shall be provided by a primary care physician who is certified by the Maryland Healthy Kids Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program.

J. The local department shall secure an initial health care screening for a child in out-of-home placement before placement or within 24 hours of placement, but not later than 5 working days following placement, except that a child who may have been abused shall receive immediate medical attention.

K. Within 10 working days of a child entering initial placement, the local department shall refer the child for a comprehensive health assessment. The local department shall make reasonable efforts to ensure that the comprehensive health assessment is completed within a time frame that allows for the inclusion of its findings and resulting individualized treatment plan in a written comprehensive assessment report. The local department shall ensure that reasonable efforts are made to secure the written assessment report within 60 calendar days of initial placement.

L. If the child's primary health care provider does not do the initial health assessment, the local department shall make the results of the comprehensive health assessment available to the child's primary health care provider or providers.

M. The primary care physician may make the professional decision to complete the initial and comprehensive health assessments at the same time, and shall forward all assessment results and any indicated follow-up to the local department.

N. Whenever health care needs are identified for a child in out-of-home placement, the local department shall ensure that appropriate follow-up appointments are made for evaluation, diagnosis, and treatment to meet the child's health care needs.

O. The local department shall ensure that all children in out-of-home placement follow the EPSDT schedule of preventive health care that includes screening components based on age from infancy through adolescence.

P. The local department shall make reasonable efforts to schedule an initial oral health evaluation by a dentist within 90 calendar days of initial placement if the child is 1 year old or older upon entry, or within 90 calendar days after the child's first birthday if the child is younger than 1 year old when placed. The local department shall schedule subsequent dental care for children 1 year old and older, which shall include check-ups every 6 months and necessary dental treatment to be provided by the managed care organization or fee-for-service provider.

Q. All children in out-of-home placement shall have a vision exam once a year in addition to any vision screening performed as part of the EPSDT exam.

R. The local department shall encourage adolescents 10 years old and older to openly discuss any questions and concerns with health care providers related to sexuality and reproductive health care.

S. The local department shall request:

(1) A substance abuse screening if the child's behavior or physical health indicates the likelihood of substance abuse; and

(2) A full-scale assessment of the child to address the child's treatment needs if the screening results indicate substance abuse.

T. The local department shall develop and use a health passport for each child in out-of-home placement, which shall be kept current and accompany the child through the out-of-home placement system.

U. The health passport shall include the following information:

(1) The identity of the medical facilities where the child usually receives care;

(2) The health care visit report on the child's condition at placement as documented by the child's physician;

(3) The child's immunization record, allergies/adverse reactions, chronic health problems, and present medications;

(4) Developmental status for a child younger than 4 years old, or for a child with a disability;

(5) Consents to health care and release of records; and

(6) Receipts for health care and release of records.

V. At the time of a child's placement, the local department shall provide the child's out-of-home placement provider with the health passport, which has been completed to the extent possible.

W. The local department shall ensure that the child's case record contains the child's medical history and the most recent copies of the child's health care documents. When the documents are known to exist but have not been provided, the case record shall document efforts made to obtain them.

X. The local department shall use the child's private insurance and Medical Assistance card to obtain public mental health services for the child.

Y. The health passport shall be returned to the local department at the time the child leaves the placement.

Z. The local department shall provide the child who has exited out-of-home placement with a copy of the child's personal health records at no cost when:

(1) The child is 18 to 21 years old and exits out-of-home placement; or

(2) The child, who is younger than 18 years old at the time of exiting out-of-home placement, becomes 18 years old and requests the child's personal health records.

Md. Code Regs. 07.02.11.08

Regulation .08B amended effective July 1, 1985 (12:13 Md. R. 1278)
Regulations .08 adopted as an emergency provision effective February 1, 1989 (16:4 Md. R. 487); emergency status extended at 16:12 Md. R. 1331, 16:21 Md. R. 2254, and 17:8 Md. R. 967; emergency status expired June 30, 1990
Regulations .08 adopted as an emergency provision effective July 17, 1990 (17:16 Md. R. 1984); adopted permanently effective December 24, 1990 (17:25 Md. R. 2904)
Regulation .08I, Z amended effective February 6, 2012 (39:2 Md. R. 140); amended effective 48:23 Md. R. 979, eff. 11/15/2021