Md. Code Regs. 10.21.19.06

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

Section 10.21.19.06 - Treatment and Support Services Provided

A. Medication Services.

(1) Evaluation and Prescription. When prescribing medication for an individual, the MTS psychiatrist shall:

(a) Conduct a face-to-face evaluation of the individual;

(b) Through a medical history, evidence of a recent physical examination, records review, laboratory testing, or other appropriate measures, assure that there are no contraindications to the prescription of specific medications;

(c) Document in the individual's medical record the rationale for prescribing the medication;

(d) Explain to the individual or the individual's legal guardian both the benefits and the side effects of prescribed psychiatric medications before and, when appropriate, during treatment and document the explanation in the individual's medical record; and

(e) Order and monitor tests at medically recommended intervals and document the results in the individual's medical record.

(2) Administration.

(a) An individual licensed under Health Occupations Article, Annotated Code of Maryland, to administer medication may do so.

(b) A licensed practical nurse or a registered nurse may delegate the administration of medication only according to the provisions of COMAR 10.27.11.

(3) Monitoring. When required by the individual's ITP, a member of the treatment team credentialed and privileged to do so shall provide the following services:

(a) Supporting the individual's self-administration of prescribed medication;

(b) To the extent possible, monitoring compliance with instructions appearing on the label;

(c) Reading the label to ensure that each container of medication is clearly labeled with the individual's name, the contents, directions for use, and expiration date;

(d) Ensuring that each individual has secure, appropriate, and accessible space in which to store medications;

(e) Observing and documenting any apparent reactions to medication and, either verbally or in writing and in a timely fashion, communicating to the prescribing authority any problems that possibly may be related to the medication; and

(f) Reinforcing education on the role and effects of medication in symptom management.

(4) Education Regarding Medication. As required by an individual's ITP, a nurse, a physician, or other privileged and credentialed staff shall educate the individual and, with the individual's consent, the individual's family or significant others, by:

(a) Verifying the individual's understanding of the directions for administration of medication; and

(b) Providing information regarding:

(i) The role, effects, and importance of medication in symptom management,

(ii) Expected benefits and expected side effects of prescribed medication, and

(iii) Nutritional and dietary expectations and risks related to the individual's medication regimen.

B. Independent Living Skills Assessment and Training. The MTS staff shall:

(1) In collaboration with the individual, assess the individual's level of functioning in the areas of:

(a) Community living skills, including but not limited to:

(i) Mobility training, and

(ii) Money management;

(b) Activities of daily living, including:

(i) Meal planning and preparation,

(ii) Personal hygiene, and

(iii) Grooming; and

(c) Interpersonal and socialization skills, including:

(i) Communication, and

(ii) Leisure and social activities; and

(2) Based on the assessment conducted under §B(1) of this regulation, provide rehabilitation activities to assist with and facilitate the individual's acquisition and improvement of independent living skills.

C. Health Promotion and Training.

(1) To supplement and support the somatic health care provided by an individual's primary health care provider, the MTS psychiatrist or registered nurse shall carry out health promotion activities, including but not limited to:

(a) Monitoring of a chronic medical condition that is managed by a primary health care provider, including:

(i) Teaching on illness prevention and wellness maintenance, and

(ii) Reinforcement of instructions given by the primary health care provider;

(b) Evaluating an acute problem to determine the most appropriate health care provider and referring the individual to the provider; and

(c) Assisting an individual to understand and carry out health-care-related behaviors, including activities related to diagnostic testing preparation and prescribed treatment for acute and short-term illness.

(2) When indicated in the individual's ITP, MTS staff shall provide basic health teaching in the following areas:

(a) Nutrition;

(b) Exercise;

(c) Dental care;

(d) Substance abuse prevention; and

(e) Prevention of injury and illness at home and in the community.

(3) MTS staff credentialed and privileged to do so shall provide training in communicable disease prevention, including prevention of sexually transmitted diseases and bloodborne pathogens, including HIV/AIDS.

D. Interactive Therapies. MTS staff shall provide, as required in the individual's ITP, therapies, including individual, group, and family therapy focused on:

(1) Assessment and definition of problems;

(2) Planning and goal setting;

(3) Development of effective problem-solving techniques;

(4) Evaluation of progress; and

(5) Other issues raised by the individual.

E. Crisis Intervention Service. The MTS treatment team shall provide to an individual who is receiving MTS a crisis intervention service that is:

(1) Designed to be implemented in the event of a crisis in the home or other setting in which the individual is involved;

(2) Explained in terms understandable to the individual; and

(3) Available, on an on-call basis, 24 hours per day, 7 days per week.

F. Support, Linkage, and Advocacy. The MTS treatment team shall assure appropriate coordination with community and family resources that are considered essential to meeting the individual's identified needs, including but not limited to intervention and advocacy with:

(1) MTS staff and other community mental health and rehabilitation service providers;

(2) Mental health clinic and psychiatric rehabilitation programs;

(3) Social service agencies;

(4) Courts and detention centers;

(5) Providers of needed medical and dental services;

(6) Immediate and extended family members;

(7) For school age children, the educational system; and

(8) Recreational activities.

Md. Code Regs. 10.21.19.06