Md. Code Regs. 10.09.29.01

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.29.01 - Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Active treatment" means inpatient psychiatric services which involve implementation of a professionally developed and supervised individual plan of care described in 42 CFR § 441.155, that is:

(a) Developed and implemented no later than 14 days after admission; and

(b) Designed to achieve the recipient's discharge from inpatient status at the earliest possible time.

(2) "Acute psychiatric services" mean psychiatric services rendered in response to a severe psychiatric condition requiring intervention in order to bring the patient's symptoms under control.

(3) "Admissions team" means an independent team that certifies the need for services (as specified in 42 CFR §§ 441.152 and 441.153). The certification shall be made by an independent team that:

(a) Includes a physician;

(b) Has competence in diagnosis and treatment of mental illness, preferably in child psychiatry; and

(c) Has knowledge of the individual's situation.

(3-1) "Children's residential treatment center" means a residential treatment center that admits patients 12 years old and younger.

(4) "Department" means the Department of Health and Mental Hygiene, the State agency designated to administer the Maryland Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq.

(5) "Department of Human Resources" means the department of State government encompassing the Family Investment Administration, the Social Services Administration, and the Child Support Enforcement Administration.

(6) "Family Investment Administration" means the administrative unit of the Department of Human Resources and its affiliated local departments responsible for determining a person's eligibility for Medical assistance.

(7) "Individual plan of care" means a written plan developed for each recipient in accordance with 42 CFR §§ 456.180- 456.181, and §§ 456.280 - 456.281, and defined in 42 CFR § 441.155 (individual plan of care). The plan of care shall:

(a) Be based on a diagnostic evaluation that includes examination of the medical, psychological, social, behavioral, and developmental aspects of the recipient's situation and reflects the need for inpatient psychiatric care;

(b) Be developed by a team of professionals in consultation with the recipient and the recipient's parents, legal guardians, or others in whose care the recipient will be released after discharge;

(c) State treatment objectives;

(d) Prescribe an integrated program of therapies, activities, and experiences designed to meet the objectives; and

(e) Include, at an appropriate time, post-discharge plans and coordination of inpatient services with partial discharge plans and related community services to ensure continuity of care with the recipient's family, school, and community upon discharge.

(8) "Local department of social services" means that unit of the Baltimore City or county social services department under the supervision of the Family Investment Administration.

(9) "Medical Assistance Program" means a program of comprehensive medical and other health-related care for indigent and medically indigent persons.

(10) "Medicare" means the medical insurance program administered by the federal government under Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq.

(10-1) "Mental health services" means those services described in COMAR 10.09.59.06 rendered to treat an individual for a diagnosis set forth in COMAR 10.67.08.02M.

(11) "Physician" means an individual who is currently licensed to practice medicine in the state in which his practice is located.

(12) "Preauthorization" means an approval required from the Department or its designee and transmitted to the provider before services can be rendered.

(13) "Program" means the Maryland Medical Assistance Program, which administers comprehensive medical and health-related benefits to indigent and medically indigent persons.

(14) "Provider" means a residential treatment center which, through appropriate agreement with the Department, has been identified as a Program provider by the issuance of an individual account number.

(15) "Recipient" means a person who is certified as eligible for, and is receiving, Medical Assistance benefits.

(16) "Recipient under 21 years old" means a recipient who is either:

(a) Under 21 years old; or

(b) Twenty-one years old and received residential treatment center services immediately before the recipient reached age 21. The recipient continues to be recognized as a recipient under 21 years old until the earlier of the date the recipient either:

(i) No longer requires inpatient psychiatric services; or

(ii) Reaches 22 years old.

(17) "Residential treatment center" means any institution which falls within the jurisdiction of Health-General Article, §19-308, Annotated Code of Maryland, and is licensed as required by COMAR 10.07.04 or other applicable standards established by the state in which the service is provided.

(18) "Secretary" means the Secretary of the Department of Health and Mental Hygiene.

Md. Code Regs. 10.09.29.01

Regulations .01 adopted as an emergency provision effective July 1, 1986 (13:13 Md. R. 1474); adopted permanently effective December 1, 1986 (13:24 Md. R. 2559)
Regulation .01 amended as an emergency provision effective July 1, 1997 (24:16 Md. R. 1150); amended permanently effective December 29, 1997 (24:26 Md. R. 1758)
Regulation .01B amended effective April 5, 2010 (37:7 Md. R. 571); amended effective 49:7 Md. R. 462, eff. 4/4/2022