Md. Code Regs. 10.21.29.05

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

Section 10.21.29.05 - Eligibility, Screening, and Initiation of Service

A. Eligibility.

(1) A minor is eligible for PRP services if, as a result of a serious emotional disturbance, the:

(a) Minor:

(i) Has been referred for PRP services by a licensed mental health professional who is providing inpatient, residential treatment center, or outpatient mental health services to the minor;

(ii) Is currently in, and remains in active mental health treatment; and

(iii) Has the appropriate consent to participate in PRP services; and

(b) Administration's administrative services organization:

(i) Determines that the services are medically necessary; and

(ii) Authorizes the services according to the provisions of COMAR 10.21.17.03A.

(2) PRP services for minors shall be prioritized for minors who have a serious emotional disturbance and who meet the following eligibility criteria:

(a) Have severe functional impairments in at least one or more life domains;

(b) Based on the clinical evaluation and ongoing treatment plan, are, with PRP services, expected to have reduced symptoms of their mental illness or their functional behavioral impairment as a result of their mental illness;

(c) Have an impairment as a result of their mental illness that results in:

(i) A clear, current threat to the minor's ability to be maintained in the minor's customary setting;

(ii) An emerging or pending risk to the safety of the minor or others; or

(iii) Other evidences of significant psychological or social impairment such as inappropriate social behavior causing serious problems with peer or family relationships;

(d) Due to dysfunction, is at risk for requiring a higher level of care, or is returning from a higher level of care;

(e) There is clinical evidence that:

(i) The current intensity of outpatient treatment will not be sufficient to reduce the minor's symptoms and functional behavioral impairment resulting from the mental illness and restore the minor to an appropriate functional level, or prevent clinical deterioration, or avert the need to initiate a more intensive level of care due to the current risk to the individual or others; or

(ii) For minors transitioning from an inpatient, day hospital, or residential treatment setting to a community setting, PRP services will be necessary to prevent clinical deterioration and support successful transition back to the community, or avert the need to initiate or continue a more intensive level of care;

(f) The minor's disorder can be expected to improve through medically necessary rehabilitation or there is clinical evidence that this intensity of psychiatric rehabilitation is needed to maintain the minor's level of functioning; and

(g) The minor is judged to be in enough behavioral control to be safe in the psychiatric rehabilitation program and benefit from the psychiatric rehabilitation provided.

(3) In addition to those minors outlined in §A(1) and (2) of this regulation, a PRP for minors may provide services to other minors who either contract privately for services or for whom another agency contracts for services.

(4) If a PRP for minors provides services to a minor outlined in §A(3) of this regulation, the PRP may not seek reimbursement by the PMHS for providing services to that minor.

B. Screening.

(1) Within 5 working days of receipt by the program of a complete referral for PRP services, staff assigned by the program director, in collaboration with the minor and the minor's parent or guardian, if appropriate, shall schedule an appointment to conduct a face-to-face screening assessment to:

(a) Assess the minor's:

(i) Rehabilitation services needs;

(ii) Willingness to participate in PRP services; and

(b) Determine the program's ability to address the needs identified in §B(1)(a) of this regulation.

(2) If, following the screening assessment under §B(1) of this regulation, the program director determines that the program's services are not appropriate for a minor who has been referred, the program director shall, in writing, promptly:

(a) Inform the minor and the parent or guardian, if appropriate, of the determination and the reason; and

(b) Provide the minor, and the parent or guardian, if appropriate, with recommendations for alternative services.

(3) Within 5 working days of the screening assessment conducted under §B(1) of this regulation, unless the program director has notified the minor of the determination under §B(2) of this regulation, the program director shall notify the minor and the parent or guardian, if appropriate, whether the program:

(a) Accepts the minor and identifies a date that the program can initiate services to the minor;

(b) Will accept the minor, following an updated review of the minor's eligibility status, when program capacity permits, and inform the minor of the:

(i) Minor's placement on a waiting list, if any; and

(ii) Estimated date services may be initiated; or

(c) Will accept the minor following the minor's discharge or release from an inpatient facility, RTC, or detention center.

(4) If the minor is placed on a waiting list under §B(3)(b) of this regulation, the program director shall discuss with the minor and, if appropriate, the minor's parent or guardian:

(a) The option of remaining on the program's waiting list until the date established under §B(3)(b) of this regulation; and

(b) Alternative services that are available.

C. Initiation of Services. Before the initiation of services, PRP staff assigned by the program director shall:

(1) Document:

(a) That a parent or guardian has applied for entitlements for which the minor may be eligible;

(b) If the application has been made, the outcome of the minor's application; and

(c) If the application has not been made, that staff have assisted the minor's parent or guardian to apply for entitlements; and

(2) Discuss with the minor and, if appropriate, the minor's parent or guardian, and provide written documentation to the minor and, if appropriate, the minor's parent or guardian, of the charges for services and, if applicable, the process for determining ability to pay.

Md. Code Regs. 10.21.29.05

Regulation .05A amended effective February 12, 2007 (34:3 Md. R. 299)