The purpose of In-Home Family Services is to: Promote the safety and well-being of children and their families; Preserve family unity where children's safety can be supported; Maintain permanency for children; and Empower families to achieve or sustain independence and self-sufficiency. The goals of In-Home Family Services include: Enhancing the parents' ability to create a safe, stable, and nurturing home environment that promotes healthy child development; Preventing out-of-home placement of children when safety can be promoted to a sufficient proportion; and Providing, referring to, and coordinating services needed to achieve or maintain family safety, stability, independence, and unity. The Department provides a continuum of service programs designed to achieve the purposes and goals of In-Home Family Services and meet the needs of individual families. The programs include: Services to Families with Children—Central Intake (SFC-I) or Family Support Services (FSS), as described in Regulation .04 of this chapter; Services to Families with Children—Continuing (SFC-C), as described in Regulation .05 of this chapter; Intensive Family Services (IFS), as described in Regulation .06 of this chapter; Families Now, as described in Regulation .07 of this chapter; Continuing Protective Services, as described in Regulation .08 of this chapter; and Consolidated Family Services, as described in Regulation .09 of this chapter. In each program specified in §C of this regulation, services shall be: Child safety based; Family focused; Dedicated to work with families as partners; Built on respect of the family; Designed to build on family strengths and unity within the context of the family's culture and community; Dedicated to prevent, reduce, or eliminate behaviors, institutional practices, and community conditions that may place a child, family, or community at risk of maltreatment; Primarily provided in the home or community; Flexible and based on the changing needs of families and children at various times in their lives; Timely; and Designed to achieve measurable outcomes. The local department may terminate services with the family at any time during the course of the intervention when: The goals have been met and the safety issues have been resolved; There has been a referral to another unit or agency for service; or The family declines or fails to accept service, safety is not an issue, and other intervention is not warranted. In this chapter, the following terms have the meanings indicated. Terms Defined. “Abuse” has the meaning stated in Family Law Article, §5-701, Annotated Code of Maryland, and COMAR 07.02.11.03B. “Acceptance date” means the day the local department determines that the family is in need of a specific service. “Adjudication hearing” has the meaning stated in Courts and Judicial Proceedings Article, §3-801(b), Annotated Code of Maryland. “Applicant” means an individual who applies for service under the program. “Child” has the meaning stated in COMAR 07.02.11.03B. “Child In Need of Assistance (CINA)” has the meaning stated in Courts and Judicial Proceedings Article, §3-801(e), Annotated Code of Maryland. “Client Information System (CIS)” means the automated electronic system that maintains data related to services provided by the local department. “Custody and guardianship” means court-assigned physical custody, authority, and responsibility for a child for the purpose of providing for the child's physical, social, and emotional needs. “Department” means the Department of Human Services. “Family” means: One or more parents and children related by blood, marriage, or adoption, and residing in the same household; or A parent substitute, such as a related or unrelated caregiver or legal guardian, who has responsibility for the 24-hour care and supervision of a child. “Family Support Services—Central Intake” means the centralized services that provide services to families with minor children living in Baltimore City who request those services. “Family Support Services (FSS)” means supportive services provided to families with minor children living within the Family Investment Centers catchment areas in Baltimore City. “Flex funds” means those discretionary funds available to a local department in each of the In-Home Family Services programs to purchase goods and services to support a family's service plan when no other resource is available. “Foster care” has the meaning stated in COMAR 07.02.11.03B. “Imminent risk of out-of-home placement” means that individual who, without specific and timely intervention, will need to be placed in a setting outside of the primary living situation. “Income eligibility requirement” means that a family's monthly gross income does not exceed 80 percent of the State's median income, adjusted for family size, according to Schedule A under COMAR 07.02.04.11. “Indicated” has the meaning stated in Family Law Article, §5-701, Annotated Code of Maryland, and COMAR 07.02.07. “Intensive Family Services (IFS)” means a highly intensive short-term program for children who are at risk of being removed from their homes, which is provided by a team consisting of a social worker and a case associate. “Local department” means the local department of social services in a county or Baltimore City, or the Montgomery County Department of Health and Human Services. “Maltreatment” means any type of child abuse or child neglect as defined in COMAR 07.02.07.02. “Mental injury” has the meaning stated in Family Law Article, §5-701, Annotated Code of Maryland, and COMAR 07.02.07. “Neglect” has the meaning stated in Family Law Article, §5-701, Annotated Code of Maryland, and COMAR 07.02.07. “Out-of-home placement” means the removal of a child from the child's primary home by a representative of the local department for placement in foster care or kinship care. “Order of protective supervision” means an order by a court exercising juvenile jurisdiction: Directing the local department to assure that a remedial program is carried out; and Authorizing supervision of the child in the child's own home. “Preplacement prevention service” means those services offered to a family in order to reduce or eliminate the need to place a child in foster care. “Record” means the original or a copy of any documentary material, including referral information, formal and informal assessments, recommendations, and closing material, while a family is receiving a particular service within a local department. “Ruled out” has the meaning stated in Family Law Article, §5-701, Annotated Code of Maryland, and COMAR 07.02.07. “Return home” has the meaning stated in COMAR 07.02.11.03B. “Reunification” has the meaning stated in COMAR 07.02.11.03B. “Services to Families with Children—Continuing (SFC-C)” means a means test-based program where a family has been assessed by SFC-I and is in need of more extensive service to work toward the efforts of safety, stability, and health of the family. “Services to Families with Children—Central Intake (SFC-I)” means a short-term assessment service for families that are identified as in crisis and at risk of their home dissolving. “SSA” means the Social Services Administration of the Department of Human Services. “Supportive services” means purchased, provided, or referred assistance to clients that are being served by In-Home Family Services. “Unsubstantiated” has the meaning stated in Family Law Article, §5-701, Annotated Code of Maryland, and COMAR 07.02.07. “Voluntary placement” means the temporary placement of a child outside of the primary home by the parent or primary caretaker, in which child and family shall meet the criteria for voluntary placement in COMAR 07.02.11.06. “Voluntary Placement Agreement (VPA)” means a bonding written agreement between the local department and the parent or guardian. In order to achieve family unity within a safe environment for all family members, each In-Home Family Services program can provide, coordinate, or refer families to services including but not limited to: Family, couple, and individual counseling or therapy for assistance in resolving family or parent-child relationship problems; Substance abuse counseling and referral to substance abuse treatment; Medical evaluations and treatment of a household member; Child development and parenting skills training; Family planning counseling; Health care services or information, such as Early and Periodic Screening, Diagnosis and Treatment (EPSDT); Support in acquiring proper registration, testing, and appropriate educational services; Employment counseling; Vocational training; Skills building assistance surrounding child care, normal childhood development, age appropriate disciplinary practices, parenting skills, and conflict resolution; Assistance and support to enhance the likelihood of positive family responsibility and self-sufficiency; Formal education or educational degree equivalent programs; Housekeeping and home management skills training; Housing information and assistance; Emergency financial assistance through flex funds or other available monetary resources; Budgeting assistance and management training; Parent-aide or in-home aide services; Day care assistance; Respite care; Transportation assistance; Assistance with and connection to both formal and informal support systems and resources; Skills training in advocating for support and services for self and family; Court involvement; Other services identified for the promotion of family safety and self-sufficiency; and When applicable, referrals to other service units, such as Child Protective Services, Family Services, and out-of-home voluntary and involuntary placements. Description. Services to Families with Children—Central Intake or Family Support Services is a voluntary assessment and service provision program for families requesting assistance by preventing further breakdown in family functioning which, if not addressed, might require either Child Protective Services intervention, out-of-home placement, or dissolving of the family unit. Services include: Use of an approved family assessment designed to identify both the needs, risks, and safety issues of all household members; A mutually agreed upon combination of assistance to help resolve the identified problems; Any of the services identified in Regulation .03 of this chapter; and Referrals for services to outside vendors in conjunction with Regulation 03 of this chapter. A family is eligible for SFC-I or FSS: Without regard to income; Who is experiencing a situational crisis brought on by: Catastrophe such as fire, flood, or storm; Loss of income; Lack of shelter; Domestic violence; Physical or mental illness; Death of or desertion by a significant other, including incarceration; Breakdown in relationship between adult caregivers, which if not addressed could lead to out-of-home placement of the children; Breakdown in the parent-child relationship; or Substance abuse or emotional disturbance of a child or adult household member; and Who is not currently involved with Child Protective Services or LDSS because of alleged or indicated child abuse or neglect. A family who is experiencing barriers in obtaining benefits under the Family Investment Administration's services shall focus on: Employment, education, training, family responsibility, and self-sufficiency; Obtaining preventive health care for children; Regularly sending school age children to school; and Any or all of the services listed in Regulation .03 of this chapter. Application Procedures. A referral for service can be initiated by: The customer/applicant; Another agency; Another local department or program with a screening and assignment policy in place; or A Family Investment Administration (FIA) supervisor or worker. Within 5 working days of receipt of the referral from the Family Investment Administration, the family shall be assigned a worker. Within 7 calendar days of receipt of the referral from the customer/applicant, another agency, local department, or program, a determination shall be made to: Accept and initiate service for the family; Contact the family or referring source to discuss: The immediacy of the need for service; Any delay in implementation of service due to restraints of the Department, such as staff shortage or excessive referrals; and Alternative or intermediate service resources available within the community until such time that the local department can offer service to the family; or Decline the offer for services and notify the referring source. Within 7 calendar days of the acceptance date, a meeting between the caseworker and family shall take place during which: The applicant shall complete and sign an application form; The worker and the primary caretaker for the child shall complete and sign a preliminary service agreement; and The worker and applicant/customer shall initiate the safety assessment or take appropriate action to ensure safety, if warranted. If the customer is unavailable during this time, there shall be clearly recorded documentation with an explanation and new meeting date within the next 7 calendar days. If there are a minimum of three attempted contacts through a combination of on-site visits and certified letters, the local department shall document the attempts and close the case with no further action. Provision of Services. Within 7 working days of case acceptance, the worker shall complete the safety assessment for every child. Within the 30 calendar days of service, the worker shall complete a family assessment for all household members, including a sanctioned Maryland Risk Assessment. Within the 30 calendar days of service, the caseworker may provide, coordinate, or refer families for any of the services identified in Regulation .03 of this chapter. If continued services are necessary beyond 30 days, and in order to stabilize the family and fulfill the goals of the service agreement, the caseworker shall make the appropriate transfer of service through a locally identified protocol. At any point within the 30 calendar days, services may be terminated and referred to another unit within the local department, including Child Protective Services or other In-Home Family Service. Duration of Services to Families—Central Intake. Services may continue for up to 30 calendar days from the acceptance date. In order to avoid the transfer to another local department unit and before the 30th calendar day, a worker may formally request up to an additional 15 calendar days through the local department's director or director's designee to finalize the service goals and make referrals to external resources. Case Disposition. The worker, on or before the 30th calendar day, shall take one of the following actions: Close the case when no other services are required; Provide assistance, refer to outside resources, and close; Formally request an extension; Refer to continuing SFC-C, after it is determined that: More extensive services are warranted; The family wants the service; and The family meets the income eligibility requirement specified in COMAR 07.02.04.03; or Refer to another local department program by following the appropriate protocol. The worker shall refer back to the Family Investment Administration once barriers have been eliminated or a determination has been made that services are ineffective in removing barriers. Case Closing. Services shall be discontinued and the case closed before the time limits specified in §F of this regulation when: The family declines to accept this voluntary service and there are no safety issues regarding the children in the home; At least three documented attempts have been made to contact the family, which includes regular or certified mail, and there has been no response; Service objectives in the written service agreement have been achieved; The family is not actively progressing toward meeting the objectives of the service agreement; The family cannot be located; The family moves to another jurisdiction; The family circumstances have changed and there are safety issues and risk factors concerning the children in the home and an appropriate referral has been made to assure safety and reduce risk; or The family has met the service objectives mutually agreed upon, further services are needed to stabilize the family, and the appropriate referral is made. Before closure, the worker shall offer the family the opportunity to discuss: The reason for closing; The family's progress; The need to continue providing services; Any referrals made or to be made to other programs or resources; and Other resources and options available to the family if another crisis should occur in the future. Description. Services to Families—Continuing is a voluntary, means based, service program for families who have had an initial assessment and it has been determined that additional assistance is needed to prevent further breakdown in family functioning and stability. Services include those identified in Regulation .03 of this chapter. Eligibility for Services to Families with Children— Continuing. To qualify for SFC-C: A family shall: Have had an initial assessment and been determined to be in need of additional support, information, and services; Agree that services are needed and are voluntarily willing to accept and work actively to meet mutually agreed upon goals; Meet the income eligibility requirement specified in COMAR 07.02.04.03; and Have been experiencing one or more of the conditions or circumstances in Regulation .04B(2) of this chapter; and There are no child maltreatment or child safety issues involved. When existing barriers to independent living have been identified by the Family Investment Administration for case management services, they may be rectified through Family Services. Application Procedures. A family may be referred by local department staff after being assessed to be in need of a more long-term supportive service. A family may be referred by another local department, after agreeing that services are warranted and available for the family. Referral Process. A review of the record will be completed to determine the appropriateness of the family for this particular service within 7 calendar days of the date in which the family was referred. Within 10 calendar days of the referral for service, a supervisor or the assigned worker shall have: Reviewed the record; Made contact with the primary caretaker of the family; and Identified a date to see all family members, or clearly documented why the meeting could not be accomplished and a new meeting date established within the next 7 calendar days, if the customer is unavailable during this time. At the first meeting between the worker and applicant, the worker shall: Review what was accomplished with the previous service, to include corresponding plans for family members; Discuss the need for additional service; Identify preliminary goals, tasks, and a time frame for completion not to exceed 3 months; Complete and sign a preliminary service agreement; and Complete a safety assessment for each child. Scope of Services. The caseworker shall develop and implement a comprehensive service plan to include all other involved agencies or services. Depending upon the family's needs, goals, and progress, there shall be a minimum of three face-to-face contacts per month. Any of the services listed in Regulation .02 of this chapter may be provided. Every 3 months, there shall be a formal reevaluation of service needs with the family including: An updated assessment of risk for all household members; An updated safety assessment for every child in the household; and An alteration of the service and safety plans, as needed. A redetermination of income eligibility shall be completed every 6 months. Services provided shall be: Child safety focused; Support based; Mutually agreed upon; Goal oriented; Developed to build on family and community strengths; Culturally sensitive; and Provided directly or purchased with flex funds. Duration and Reconsideration of SFC-C. SFC-C may be: Provided for up to 6 months after acceptance; Extended for 6 months with written authorization of the local department director or the director's designee; and Extended for a third 6-month increment of service with written authorization from the local department director, the SSA program manager, or their designee. Case Closure. On or before 180th day, the worker shall take the following action: Close when no other services are needed; Provide assistance as appropriate; Refer to outside resources; Refer to another services program by following the appropriate referral procedures for that program; or Request an extension for service of not more than another 6 months in order to accomplish the identified goals made with the family. Services shall be discontinued and the case closed before the time limits specified in §F of this regulation when: Service objectives have been achieved and no safety issues are present; The family no longer wants this voluntary service; The family is not actively progressing toward meeting the objectives of the service agreement; The family cannot be located; The family moves to another jurisdiction; The family is no longer eligible; or A change in the family's circumstances requires referral to another service program. When the plan is to close the case, the worker shall offer the family an interview to discuss: The reason for the closing; The family's progress; Continuing or further needs or concerns; Referrals made or to be made to other programs or resources; and Other resources and options available to the family if, in the future, the family has a need. Description. IFS is a short-term, highly intensive, non-entitlement in-home service for families whose children: Are at imminent or high risk of out-of-home placement; or Have been emergently placed outside of the home within 7 days of service, with the intent of reunification when service is initiated. IFS uses a social worker, or social worker and parent aide team approach that is most effective when a caseload of six families is maintained per worker or team to provide assistance after a mutually agreed upon service agreement has been developed between the family and the local department team. Eligibility for Services. Families are served without regard to income. Families are eligible for services when they: Are facing crises or problems that will affect the well-being of their children and the stability of the family without assistance; Have children: In the home that may or may not have been determined to be at significant risk of maltreatment; or In voluntary out-of-home placements needing assistance returning home; Are likely to benefit from a short-term, highly intensive in-home service to avert an out-of-home placement; Are likely to benefit by achieving reunification before the adjudication hearing; Are actively willing to accept assistance to reduce the identified risk or safety factors, or have at least one caretaker who is willing to actively work toward mutually agreed upon goals in an effort to reduce the identified risk factors; Have been assessed by a previous unit or agency to be eligible for the service, with an appropriate safety plan in place for all children determined to be at risk of maltreatment; and Have not been served for the same presenting problems within the past 18 months by the local department or a vendor associated with the local department. Application Procedures. Families are eligible for IFS only after an initial assessment has been completed and the eligibility criteria are met. Within 24 hours of the referral for service: The case shall be reviewed by a locally sanctioned, formal review system to determine eligibility and appropriateness of the family for IFS, another In-Home Family Service Program, or service either within the local department or another outside agency resource; and A screener shall assign or transfer the referral for service. Within 24 hours of a family's assignment to a worker or team, and not longer than 48 hours from the initial referral: One or more members of the team shall: Review the referral information, including the previous service provision and plan; Visit the family's home; Interview the family members; Reevaluate all children for risk and safety within their environment; Identify with the family the length of service being provided; Mutually assess the most immediate service needs; and Initiate a preliminary written and signed service agreement; or If the family is not available at the time of the home visit, a team member shall fully document the attempt to make the home visit or the reason why this effort was not made. At the first meeting, the family shall sign a preliminary service agreement to acknowledge acceptance of service and a willingness to actively participate in working towards safety, stability, and health. Within 7 working days of case assignment, the team and the family members shall negotiate and execute a short term, individualized service plan/agreement to include obtainable goals, tasks, and expected dates of accomplishment within the 90 day service duration. Scope of Services. IFS is most effective when the team maintains a small caseload of a maximum of 6 families. Depending upon the family's individual needs and progress in the treatment process, there shall be up to 20 hours per week of face-to-face contact with a family. Any of the services listed in Regulation .02 of this chapter may be provided. Services provided directly by the IFS team shall be: Safety focused; Support based; Accessible 24 hours a day, 7 days a week by either direct service staff or a local departmentally sanctioned after-hours caseworker; Available to all family members; Designed to include the family as team members in planning, developing, implementing, and monitoring the service agreement; Intensive; Goal-oriented; Developed to build on family and community strengths; Culturally sensitive; and Provided directly through a vendor-supported provider or purchased with flex funds. Duration of Services. IFS may be provided for up to 90 calendar days from the date of the family's acceptance for service. Services may be extended a maximum of 90 additional days only upon: Written request by the team, which shall include the: Reason for the extension; Specific goals and tasks to be identified for both the team and the family members; and Estimated length of time needed to address each additional goal; Formal review of the request by an endorsed panel within the local department or the director or director's designee; and Written approval of the extension and length of time approved for continued service from the director of the local department or director's designee. Case Closure. Services shall be discontinued and the case closed before the time limits specified in §F of this regulation when: The safety of the children is assured; The service objectives have been achieved; The family no longer wants this voluntary service; The family cannot be located; The family moves to another jurisdiction; or A change in the family's circumstances requires a referral to another service program such as Continuing Protective Service or Out-of-Home Placement. When the plan is to close the case, the worker shall offer the family a face-to-face contact to discuss: The reason for the closing; A review of the family's progress; Continuing or further needs or concerns; Referrals made or to be made to other programs or resources; and Other resources and options available to the family if, in the future, the family has a need. Families Now is a voluntary non-entitlement program to families whose children are at risk of removal from their primary home, or have recently been removed from the home and the plan is rapid reunification. Families Now Levels I, II, III, and IV are developed as separate service provision units with varying degrees of intensity and time allotments. General Scope of Services. Services provided in any of the Families Now support programs include those listed in Regulation .03 of this chapter. Services shall meet the standards listed in Regulation .06E(4) of this chapter. Services may be continued beyond the maximum times specified only upon written authorization of the director of the local department or director's designee. Application Procedures. Families are referred to Families Now by another unit within the local department or another agency that has been providing service. Within 24 hours of the referral to Families Now, at least one member of the unit shall review the referral and collateral information to determine the appropriateness of the program. An initial, face-to-face contact with the family shall be made within the following time frames: 24 hours from the receipt of the referral in Level I; or 5 working days from receipt of the referral in Levels II, III, and IV. If both the caregivers and the children are not available for face-to-face contact, written documentation of all efforts within the required time frame shall be maintained in the record. Each child shall be assessed individually for safety during the initial visit. During the initial contact, the family shall be actively involved in the assessment of both strengths and needs, and shall begin negotiation of the initial service agreement. By the end of the second face-to-face contact, the local department and the family shall have negotiated and executed a short-term, individualized service plan/agreement to cover a period of not more than 3 months. The agreement shall be: Reviewed, amended, modified, or updated if necessary; Signed by the worker, associate, family, and supervisor every 30 days until service termination; and Completed and maintained according to specific program regulations. Families Now—Levels I, II, and III. Level I is the most intensive service level in the Families Now Program. It is most effective when a small caseload of a maximum of six families is maintained and is designed to assist families in which a child is at imminent risk of out-of-home placement or has been placed out-of-home within the past 7 days, with the intent to reunify at the time service begins. This is offered to families who would benefit from: A short-term, intensive, interactive service for up to a maximum of 90 days; and Up to 20 hours per week of face-to-face contact with the local department staff. Level II is designed to: Serve families whose children are at imminent or high risk of out-of-home placement or have been placed out-of-home within the past 7 days; Offer a moderate intensity of service of 1 to 2 visits per week; and Provide service to a family for up to a maximum of 6 months. Level III is designed to serve families: Whose children are at high risk of out-of-home placement or have been placed out-of-home within the past 7 days; Who would benefit from long-term intervention of not more than 1 year; Who can sustain a moderate intensity of 3 to 4 visits per month; Where there is some resistance to service on the part of one or more household members; Who may be involved with the court as a result of abuse or neglect issues; and Who may have been served in a short-term, intensive voluntary program with limited success. Families Now—Level IV/Out-of-Home. Families Now—Level IV/Out-of-Home is designed to serve parents and children while the children are in out-of-home placement in order to expedite reunification or an alternate permanency plan. Families are eligible for service if: Their children have been in out-of-home placement for less than 6 months; The primary permanency plan at the time of the referral to Families Now is reunification; Reunification is expected to occur within 6 months of the referral; None of the circumstances detailed in COMAR 07.02.11.16 exists which would indicate a permanency plan other than reunification; There are indications that intensive family preservation services would reduce the child's length of stay in out-of-home placement; and There is information to believe that there is willingness on the part of the family to actively work towards reunification. Services may be provided for up to 9 months from the date that the case is accepted for service. All services provided in Families Now—Level IV are regulated under COMAR 07.02.11.03B(46). Redetermination. All families in the Families Now program shall be formally reassessed at the end of each 90 days of service. The review requirements of COMAR 07.02.11.18 apply to families and children served in Level IV. When it is jointly determined between the social worker and supervisor that an extension for service is warranted, a formal, written request shall be made to the director or director's designee at least 14 days before the determined closure date. Each request shall contain: A review of why the family is receiving the present service including issues of safety for all children in the home; A review of service provided and justification why all goals were not met; and A new service plan identifying goals, the services to be provided, and the estimated length of time needed in order to complete the service. Written authorization by the director or director's designee shall be provided in order for the family to receive service beyond the mandated time frames designated in Regulation .05D of this chapter. The maximum time limit for any Families Now service is 1 calendar year within a 3-year period. If further service beyond a maximum of 1 calendar year is determined to be essential, a referral to another unit within the Department shall be made. Case Closure. Services shall be discontinued and the case closed before the time limits specified in this regulation when: Safety of the children is assured; Service objectives have been achieved; The family no longer wants the service; The family is not actively progressing toward meeting the objectives of the service agreement; Agency related court involvement has been terminated; The family cannot be located; The family has moved to another jurisdiction, and the local department refers them for service or closes the case with no further follow-up; or A change in the family's circumstances requires referral to another service program such as Continuing Protective Services or Out-of-Home Placement. When the plan is to close the case, the worker shall offer the family an interview to discuss: The reason for the closing; A review of any safety planning made for the child; A review of the family's progress; Continuing or any other further needs or concerns; Referrals made or to be made to other programs or resources; and Other resources and options available to the family if, in the future, the family has a need. Continuing Protective Services is a non-entitlement specialized, time limited, goal-oriented service designed to develop positive, nurturing parent-child relationships for families when children remain at home, when there has been a determination that risk for further maltreatment is significant. This population has either previously been served in another In-Home Family Services program, a similar program outside of the local department, or a program ordered by the court. The purpose of Continuing Protective Services is to: Provide protection to children, while providing services to their families; Reduce the degree of risk of maltreatment, while children remain safely in their homes; Develop a safety plan for children with other family or household members, when parents or other caretakers are unwilling or unable to change; and Remove children from the home, when it is determined that safety will not or cannot be provided, and the child is at imminent risk of harm or has incurred further harm by a family or household member. Eligibility. Families are served without regard to income. The court may order services. Families are eligible when other in-home family services have been offered and the family declines the service, and the local department determines that services are necessary to reduce risk factors associated with the care of the child. Families may be referred by another in-home family service after support has either been offered or provided and the children residing in the home remain at risk of maltreatment. Families may be referred directly from Child Protective Services-Investigations when risk factors remain, in order to assure safety of the children. Families may be served when children are determined to be at risk of maltreatment, families are resistant to service, and court intervention is not appropriate. Families shall be served when the court has intervened and determined that services are essential. Application Procedures. Referrals can be made directly by Child Protective Services Investigations, any other In-Home Family Service, another local department, or the court. At the time of transfer, the following information shall be available to the supervisor and assigned worker: Documentation showing the initial reason for intervention by the local department; A copy of any assessment of the family, to include past services provided; A recently completed risk assessment and corresponding safety plan detailing the action taken to stabilize the family and protect the children; Documentation to indicate the need for Continuing Protective Services; and Documentation of face-to-face contact with the family within 7 calendar days of the closing and transfer from the previous service. Initial Contact Contact shall be made with a family member within 5 working days or 9 calendar days of the transfer to Continuing Protective Services. When possible, a joint transfer visit shall be made with the family by the investigating caseworker and continuing caseworker. At the first visit, a service plan/agreement shall also be initiated with the family. Provision and Scope of Services. For the first 30 days, there shall be contact with the family at least once a week. After the first 30 days, the local department shall have at least 2 contacts per month with each family member. During each contact, all children shall be seen individually and separately from the caregiver. The continuing caseworker shall review, clarify, and make appropriate modifications to the safety plan with the family during this time. At the end of each contact, the worker shall document the ongoing assessment for the safety of each child. Within 45 calendar days from the acceptance date, the worker and the family shall have completed and signed a service plan/agreement to cover a period not longer than 6 months. Any of the services listed in Regulation .03 of this chapter may be provided either directly, through a referral to another agency, or contractually through flex funds. Services shall meet the standards listed in Regulation .04A(2) of this chapter. The local department may petition the court at any time during the course of service when the safety of the children cannot be assured or the caretaker is not actively working toward a resolution of the problem, or both. If the court is involved with the family at the time service is initiated, periodic status reports and an agency court appearance is warranted. The local department may remove a child from the home at any time when reasonable efforts had been made to assure child safety. Duration of Services. Continuing Protective Services are to be provided until: Any concerns for safety have been satisfied and the risk of maltreatment minimized; The child is removed from the home by either a court order or voluntarily, and the child is safe from harm; The family refuses services, the degree of risk is minimal, and the court has declined to accept involvement with the local department or sanctioned service; or The child becomes 18 years old. At the end of every 3 months of service, the supervisor and caseworker shall formally review the safety, progress, and service plan for the family and make appropriate changes. Service shall be provided to the family for up to 12 calendar months. Extension. If the family is determined to need service beyond 12 months, an administrative review shall be requested for an extension at least 30 days before the predetermined closure date. A written request shall be made by the caseworker to the director or director's designee and include the reason for need, a plan of action, and an estimated time for closure. The case shall remain open only upon written approval by the director or the director's designee. The written approval shall provide the conditions and time frame for the extended service time to the family. A copy of the extension request shall be maintained in the record. Case Closing. At any point, Continuing Protective Services may be terminated when: Risk of maltreatment has been reduced and safety has been assured; The family is functioning marginally, but the risks to the child are insufficient to justify court action and the family refuses to utilize services; or There is sufficient reason to remove the child from the home and to place the child in an environment that can assure safety. If, during the course of service, the family relocates outside of the jurisdiction of the LDSS, and it is determined that continued intervention is necessary, the local department where the family has relocated shall be notified immediately both by telephone and written communication to request service. When the plan is to close the case, the caseworker shall meet with the family to discuss the following: The reason for closing; The safety plan that has been established for the child; The family's progress and any further concerns; and The resources and options available to the family within their community. Consolidated Family Services is the blending of Families Now, Intensive Family Services, and Continuing Protective Services to achieve a seamless continuum of services in an effort to better service families whose children are at risk of out-of-home placement. Eligibility. Families are served without regard to income. The court may order services. Families may be referred by another service after support has either been offered or provided and the children residing in the home remain at risk of maltreatment. Families may be served when children are determined to be at risk of maltreatment, families are resistant to service, and court intervention is not appropriate. Families shall be served when the court has intervened and determined that services are essential. Application Procedures. Referrals can be made directly by: Child Protective Services Investigations; Any other In Home Family Service; Another department of social services; or The court. At the time of transfer, the following information shall be available to the supervisor and assigned worker: Documentation showing the initial reason for intervention by the local department; A copy of any assessment of the family, to include past services provided; A recently completed risk assessment and corresponding safety plan, detailing the action taken to stabilize the family and protect the children; Documentation to indicate the need for services; and Documentation of face-to-face contact with the family within 7 calendar days of the closing and transfer from the previous service. Initial Contact. Contact shall be made with family members within 5 working days or 9 calendar days of the transfer to Consolidated Family Services. When possible, a joint transfer visit shall be made with the family by the investigating caseworker and continuing caseworker. At the first visit, a service plan/agreement shall also be initiated with the family. Provision and Scope of Services. For the first 30 days, there shall be contact with the family at least once per week. After the first 30 days, the local department shall have at least two contacts a month with each family member. During each contact all children shall be seen individually and separately from the caregiver. The continuing caseworker shall review, clarify, and make appropriate modifications to the safety plan with the family during this time. At the end of each contact, the worker shall document the ongoing assessment for the safety of each child. Within 45 calendar days from the acceptance date, the worker and the family shall have completed and signed a service plan/agreement to cover a period not longer than 3 months. Any of the services listed in Regulation .03 of this chapter may be provided either directly, through a referral to another agency, or contractually through flex funds. Services shall meet the standards listed in Regulation .04A(2) of this chapter. The local department may petition the court at any time during the course of service when the safety of the children cannot be assured or the caretaker is not actively working toward a resolution of the problem, or both. If the court is involved with the family at the time service is initiated, periodic status reports and agency court appearances are warranted. The local department may remove a child from the home at any time when reasonable efforts have been made to assure the child's safety. Duration of Services. Services are to be provided until: Concerns for safety have been satisfied and the risk of maltreatment minimized; The child is removed from the home by either court order or voluntarily, and the child is safe from harm; The family refuses services, the degree of risk is minimal, and the court has declined to accept involvement with the local department or sanctioned service; or The child becomes 18 years old. At the end of every 3 months of service, the supervisor and caseworker shall formally review the safety, progress, and service plan for the family and make appropriate changes. Service shall be provided to the family for up to 6 calendar months. Extension. If the family is determined to need service for longer than 6 months, an administrative review shall be requested for an extension at least 30 days before the predetermined closure date. A written request shall be made by the caseworker to the director or director's designee to include the reason for need, a plan of action, and an estimated time for closure. The case shall remain open only upon written approval by the director or director's designee. The written approval shall provide the conditions and time frame for the extended service time to the family. A copy of the extension request shall be maintained in the record. Case Closing. At any point, services may be terminated when: The risk of maltreatment has been reduced and safety has been assured; The family is functioning marginally, but the risks to the child are insufficient to justify court action and the family refuses to utilize services; or There is sufficient reason to remove the child from the home and be placed in an environment that can assure safety. If, during the course of service, the family relocates outside of the jurisdiction of the local department, and it is determined that continued intervention is necessary, that local department where the family has relocated shall be notified immediately both by telephone and written communication to request service. When the plan is to close the case, the caseworker shall meet with the family to discuss the following: The reason for closing; The safety plan that has been established for the child; The family's progress and any further concerns; and The resources and options available to the family within their community. To access flex funds on behalf of a family, the worker shall: Determine that the goods or services to be purchased cannot be obtained without cost to the local department; and Document in the case record how the: Goods or services to be purchased support the service plan; Family meets the eligibility criteria and is active in the family service program to which the expenditure is being charged; Family will benefit from the specified purchase; and Specified purchase will directly contribute to: The child's health and welfare; Preventing the child's out-of-home placement; or Reunifying the child who has been placed out-of-home. Families shall be encouraged to contribute toward the cost of purchased items to the extent possible. Approval of Expenditures. The supervisor and the local department director or director's designee may approve all expenditures of flex funds after reviewing the documentation and verifying the appropriateness of the expenditure. Flex fund expenditures exceeding $1,000 per item require the local department director's or director's designee's signature. All purchases require the local department to comply with COMAR 21.05.07. Documentation of the appropriateness of the expenditure shall include written verification of: Delivery of the item by the vendor; and Receipt of the item by the family. Flex funds may be used to purchase goods and services including, but not limited to: Parenting education; Psychiatric or psychological evaluation, testing, and treatment; Drug or alcohol rehabilitation services; Vocational training and employment counseling; Clinical consultation for staff; Therapeutic family recreation; Assistance in developing a support network for the family; Assistance in locating and obtaining housing; Reimbursement for reasonable transportation costs for family visits, treatment, or employment; Special educational services such as tutoring, G.E.D. classes, tuition, and standardized test preparation fees; Personal care supplies, such as clothing and personal hygiene items; Day care services; Security deposits and rental assistance on housing; Deposits or emergency grants to avoid utility terminations; Medical services or equipment not covered by medical assistance or other resources; Learning aids such as flash cards, books, games, and computers; Respite care; Automobile operating or maintenance costs to enable employment, treatment, or family visitation; Essential household items such as sheets, blankets, furniture such as beds, tables, and chairs, and appliances such as a stove or refrigerator; Essential household supplies such as brooms, mops, and cleaning supplies; Employment tools and equipment, uniforms, and footwear; and Other items determined to be essential in maintaining the safety and welfare of the family. Items such as beds or clothing purchased with flex funds for a child who is temporarily residing outside of the primary home are considered the child's possessions. When multiple purchases of similar items whose individual cost exceeds $250 per unit are expected to exceed $5,000 in aggregate cost during the fiscal year, the local department shall solicit competitive bids and enter into written contracts with selected vendors. The maximum annual expenditure of flex funds per family may not exceed 80 percent of the average cost of foster care placement for each at-risk child in the family. The local department shall submit reports of expenditures of flex funds to SSA within 20 days of the close of each quarter of the fiscal year. Decisions of the local department with respect to In-Home Family Services Programs may be appealed as specified in the fair hearing provisions of COMAR 07.02.02. The local department shall give written and oral notification of the right to and the methods of requesting and obtaining a fair hearing to each applicant for and to each recipient of In-Home Family Services: At the time of application; and Whenever the local department notifies the applicant or recipient of any pending action that may deny, suspend, reduce, or terminate the service. A fair hearing need not be held on any decision which has been, or may only be, determined by a court. Courts and Judicial Proceedings Article, §§3-801—3-820; Family Law Article, §§5-524, 5-525, 5-704, 5-709—5-713; Annotated Code of MarylandAgency Note: Federal Regulatory Reference: 42 U.S.C. §620 et seq.; 45 CFR 1355—1357 Effective date: May 4, 1979 (6:9 Md. R. 726) Regulations .06E and .07 amended effective October 6, 1986 (13:20 Md. R. 2207) Regulations .01—.09 repealed and new Regulations .01—.07 adopted effective January 8, 1990 (16:26 Md. R. 2787) Regulations .01—.07 repealed and new Regulations .01—.11 adopted effective September 2, 2002 (29:17 Md. R. 1377) Regulation .10C amended effective May 1, 2023 (50:8 Md. R. 337) Effective date: July 20, 1981 (8:14 Md. R. 1220) Regulation .01 amended effective November 11, 1991 (18:22 Md. R. 2394) Regulation .01 recodified to Regulation .01-1, new Regulation .01 adopted, and Regulation .02 amended as an emergency provision effective October 1, 1993 (20:20 Md. R. 1547); adopted permanently effective October 1, 1994 (21:19 Md. R. 1630) Regulations .02, .03E, .04D, E amended effective October 6, 1986 (13:20 Md. R. 2208) Regulation .07C amended effective May 29, 1989 (16:10 Md. R. 1105) Regulation .08 amended effective May 29, 1989 (16:10 Md. R. 1105); November 11, 1991 (18:22 Md. R. 2394) Regulations .09—.11 adopted effective November 11, 1991 (18:22 Md. R. 2394) Regulation .09A amended effective January 30, 1995 (22:2 Md. R. 76) Chapter repealed effective April 5, 1999 (26:7 Md. R. 540) Effective date: October 1, 1975 (2:22 Md. R. 1370) Regulation .03B amended effective October 26, 1981 (8:21 Md. R. 1705) Chapter repealed effective February 8, 1988 (15:3 Md. R. 303) This chapter defines the eligibility criteria for all social services provided by the Department of Human Services through the Social Services Administration or by other public and private agencies who provide social services through purchase of service agreements with the Administration. This chapter also describes the requirements of eligibility determination and redetermination. “Administration” means the Social Services Administration of the Department of Human Services. “TCA” means temporary cash assistance to eligible children and caretaker relative under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). “Application” means a form signed and dated by a client requesting services from the Department or from a purchase of service vendor funded by the Department. “Documentation” means provision of documents such as pay stubs and benefit awards which verify the amount of monthly or annual gross income. “Elderly Persons” means those persons who have reached age 65, and their spouses, regardless of age. “Emancipated Minor” means a child who is freed from the custody of the parent and from the obligation to render services to the parent. “Family” means the basic family unit consisting of one or more adults and children, if any, related by blood, marriage, or adoption, and residing in the same household. If related adults, other than spouses, reside together, each is considered a separate family. Children living with non-legally responsible relatives, emancipated minors, and children living under the care of unrelated persons are considered separate families. This definition is used for the determination of eligibility based on income and family size. “Fee Scale” means a graduated fee for services related to the individual or family income which does not exceed the cost of the service to be charged the eligible individual. The fee charged for more than one service to a family or individual or more than one individual in a family receiving service is designed to remain reasonably related to income. “Local department” means the local department of social services or the Montgomery County Department of Health and Human Services. Monthly Gross Income. “Monthly Gross Income” means the sum of monthly income received by an individual from sources such as money wages or salary, net income from non-farm self-employment, net income from farm self-employment, dividends, interest, Social Security, pensions or annuities, income from estates, or trusts, net rental income or royalties. Unemployment Compensation, Public Assistance payments, Worker's Compensation, Alimony, Child Support, or Veteran's pensions. These sources are identified by the U.S. Census Bureau in computing average income. The following are excluded from monthly gross income: Earned income of a child; Earned income tax credit; In-kind earnings (food, clothing, room, utilities, and similar items in exchange for labor); National and Community Service Trust Act (NCSTA) organization payments made to participants in AmeriCorps USA, AmeriCorps Vista, AmeriCorps NCCC, The Senior Corps, The Youth Corps, and The Learn and Serve; Grants, loans, or scholarships for education; TCA approved training allowances; Foster care payments; Adoption subsidy payments; Subsidized guardianship payments; Food stamp value; Uniform relocation assistance; Reimbursement for any out-of-pocket expenses incurred while performing volunteer work such as transportation, mileage, or parking expenses; Emergency Assistance to Families with Children grants (EAFC); Third party payments; Needs-based payments made to participants in Workforce Investment Act programs to cover transportation, clothes or uniforms, child care, or other training related expenses; Income or assets distributed to certain Indian tribes as required by Pub. L. No. 94-114, §5; Vietnam Veterans' allowances for children with spina bifida; Supplemental Security Income (SSI); Energy grants and allowances received through the Maryland Department of Human Services Maryland Energy Assistance Program or Electric Universal Service Program; Gifts; Lump sum inheritances or insurance payments; or Capital gains. “Purchase of Service Vendor” means a public or private agency which provides social services under a contractual agreement with the Department. “SSI (Supplemental Security Income)” means monthly cash payments made by the Social Security Administration to an aged, blind, or disabled individual who meets the requirements for this aid under Title XVI of the Social Security Act. The following individuals or families are eligible for services appropriate to them: Recipients of TCA; Recipients of SSI or TEMHA (Temporary Emergency Housing and Medical Assistance) or Public Assistance to Adults (PAA); and Individuals other than those described in §A or B of this regulation if the family's monthly gross income does not exceed 80 percent of the State's median income for a family of four, adjusted for family size, according to Schedule A, or the income requirements in the specific program chapters; the unborn child shall be included in family size in the determination of eligibility related to income for any service needed as a result of the pregnancy. Each individual wishing to do so shall be assured the opportunity to apply for services without delay. The application may be filed by the applicant himself or his authorized representative, or, where the applicant is incompetent or incapacitated, someone acting responsibly for him including agency staff. Any person who fraudulently obtains, attempts to obtain, or aids another person in fraudulently obtaining services to which he is not entitled, may be subject to prosecution. The local department shall inform the applicants for and recipients of a social services program about the eligibility requirements and their rights and obligations under the program. Applicants for services based on income eligibility requirements shall sign an application form prescribed by the agency. The applicant shall: Declare under the penalty of welfare fraud that true, correct, and complete information is provided; Acknowledge that the possibility of selection as part of a State review of eligibility may require documentation of income; Acknowledge the right to withdraw the application at any time; and Acknowledge that the information of the application and any State review will be strictly confidential. Applicants for adoption, foster home approval, day care registration, single parent services, family planning services, voluntary foster care, and voluntary protective services for adults or children shall sign a statement prescribed by the Social Services Administration. The applicant's statement shall: Declare under the penalty of perjury that true, correct, and complete information is provided; and Acknowledge the right to withdraw the application at any time. A recipient of involuntary foster care or involuntary protective services for adults or children shall be requested to sign a statement prescribed by the Social Services Administration. If he refuses, the service is to be provided with the notation in the case record that he did not wish to sign the statement and the date that the case came to the attention of the local department of social services. For family planning services, the case record shall contain the written request of the client acknowledging the voluntary nature of the service. For protective services to adults or to children, the case record shall describe the circumstance of actual or potential abuse, neglect, or exploitation of a child or adult. For information and referral, a signed application by the client is not required. A signed application is not necessary for services for which eligibility is determined on a group basis. Participation by an individual in this service is considered a request for services. Individual Basis. A determination of eligibility shall be made on each application within 30 days of the date on which it was signed. For each individual determined to be eligible, Departmental records shall include sufficient information for the conclusion that the established criteria of eligibility have been met. In the case of income eligibility, written documentation of a person's income may be required, if income statements made by the applicant seem incomplete, inconsistent, or unclear. Written notice shall be given to an applicant or client within 10 working days when a decision is made on an application for services, or during receipt of services, which denies, reduces, suspends, or terminates services. The notice shall state the decision and the basis for it, cite the regulation supporting it, and shall explain the applicant's right to and the method to request a fair hearing. Determination of eligibility may be made by a local department of social services or by a purchase of service vendor. Group Basis. The recipients of Home Delivered Meals Service and Multi-Purpose Senior Center Services are considered eligible as a group and an individual determination of client eligibility is not required. Unless it is denied, a requested service shall be provided within 15 days of eligibility decision except in the following circumstances: Services as described within the service chapters of COMAR are provided to the extent that allocated funds are available. The local department of social services shall establish criteria subject to the approval of, and in the format required by, the Social Services Administration, for placing applicants on a waiting list when sufficient funds are not available to render the service requested. If the insufficiency of funds for a service is Statewide, the criteria shall be established by the Social Services Administration, by regulation when appropriate. Redetermination of eligibility shall be made by the local department or service vendor: When required on the basis of information the agency has obtained about anticipated changes in the individual's situation. Promptly, not to exceed 30 days, after information is obtained by the local department of social services or a purchase of service vendor about changes which have occurred in the individual's circumstances that may make him ineligible. Periodically, but not less frequently than every 6 months. The need for service shall be redetermined at least every 6 months. For individuals whose monthly gross income at the time of determination is derived exclusively from pensions or Social Security benefits, or SSI benefits or a combination thereof, redetermination may be made of their income eligibility at 12-month intervals. Recipients of services for which eligibility is determined on a group basis are not subject to the redetermination requirements. Appeals for an administrative hearing and the conduct of the hearing are according to the administrative hearing regulations in COMAR 07.01.04. SCHEDULE AIncome by Family Size(For the period July 1, 2014-June 30, 2015) Family Size/Percent Median Income 40% 50% 60% 80% 115% 1 person - (52%) $55,355 $22,142 $27,678 33,213 $44,284 $63,658 2 persons - (68%) 72,387 28,955 36,194 43,432 57,910 83,245 3 persons - (84%) 89,420 35,768 44,710 53,652 71,536 102,833 4 persons - (100%) 106,452 42,581 53,226 63,871 85,162 122,420 5 persons - (116%) 123,484 49,394 61,742 74,091 98,787 142,007 6 persons - (132%) 140,517 56,207 70,258 84,310 112,413 161,594 7 persons - (135%) 143,710 57,484 71,855 86,226 114,968 165,267 8 persons - (138%) 146,904 58,762 73,452 88,142 117,523 168,939 9 persons - (141%) 150,097 60,039 75,049 90,058 120,078 172,612 10 persons - (144%) 153,291 61,316 76,645 91,975 122,633 176,285 *For each additional family member above 10 persons, add $3,194 to the median income for a family of 10. Human Services Article §§4-205 and 4-207, Annotated Code of MarylandFederal Statutory Reference: 42 U.S.C. §§621 AND 9902 Effective date: October 1, 1975 Regulation .01 amended effective April 8, 1985 (12:7 Md. R. 699) Regulation .01H amended effective June 27, 1980 (7:13 Md. R. 1271) Regulation .02 amended effective April 8, 1985 (12:7 Md. R. 699) Regulations .02E, F, H, J; .03A, B; .04A, D, E, F, G, H; .05A, C, E; .09C amended effective May 3, 1976 (3:17 Md. R. 912) as emergency; adopted permanently at 3:17 Md. R. 912 Regulation .02F amended effective December 12, 1980 (7:25 Md. R. 2333) Regulation .02H amended effective June 2, 1978 (5:11 Md. R. 886) and June 1, 1979 (6:11 Md. R. 977) Regulation .03C amended effective April 8, 1985 (12:7 Md. R. 699) Regulation .04A amended effective June 30, 1978 (5:13 Md. R. 1041); July 1, 1980 (7:13 Md. R. 1272) Regulation .04B amended effective July 1, 1980 (7:13 Md. R. 1272); June 12, 1981 (8:12 Md. R. 1060); March 1, 1983 (10:3 Md. R. 208) Regulation .04E adopted effective June 2, 1978 (5:11 Md. R. 886) Regulations .04, .05, and .06 repealed effective June 3, 1985 (12:11 Md. R. 1046) Regulation .06 amended effective September 14, 1981 (8:18 Md. R. 1477) Regulations .07, .08, and .09 amended effective June 2, 1978 (5:11 Md. R. 886) Regulation .07B amended effective October 6, 1986 (13:20 Md. R. 2208) Regulation .07D amended effective April 8, 1985 (12:7 Md. R. 699) Regulation .08A amended effective October 6, 1986 (13:20 Md. R. 2208) Regulation .08B amended effective April 8, 1985 (12:7 Md. R. 699) Regulation .08C amended effective May 15, 1981 (8:10 Md. R. 875) Regulation .10 amended effective January 5, 1977 (4:1 Md. R. 15); October 6, 1986 (13:20 Md. R. 2208) Regulation .11 amended by emergency provision effective July 1, 1976 (3:19 Md. R. 1050) Regulation .11 amended effective April 13, 1977 (4:8 Md. R. 633); August 31, 1977 (4:18 Md. R. 1394); November 3, 1978 (5:22 Md. R. 1672); September 7, 1979 (6:18 Md. R. 1457); July 1, 1980 (7:13 Md. R. 1272); August 17, 1981 (8:16 Md. R. 1362); March 1, 1983 (10:3 Md. R. 208); January 30, 1984 (11:2 Md. R. 111); January 14, 1985 (12:1 Md. R. 15); April 8, 1985 (12:7 Md. R. 699); October 20, 1985 (12:21 Md. R. 2029); September 8, 1986 (13:18 Md. R. 2018); October 5, 1987 (14:20 Md. R. 2140); July 1, 1988 (15:11 Md. R. 1330); August 21, 1989 (16:16 Md. R. 1749); November 12, 1990 (17:22 Md. R. 2654); October 28, 1991 (18:21 Md. R. 2307); March 15, 1993 (20:5 Md. R. 513); January 17, 1994 (21:1 Md. R. 29); December 19, 1994 (21:25 Md. R. 2104); December 4, 1995 (22:24 Md. R. 1893); December 16, 1996 (23:25 Md. R. 1784); September 8, 1997 (24:18 Md. R. 1295) Regulation .11 repealed and new Regulation .11 adopted effective November 2, 1998 (25:22 Md. R. 1651) Regulation .11 repealed and new Regulation .11 adopted effective December 13, 1999 (26:25 Md. R. 1897) Regulation .11 repealed and new Regulation .11 adopted effective November 13, 2000 (27:22 Md. R. 2059) Chapter revised effective December 24, 2001 (28:25 Md. R. 2189) Regulation .08 repealed and new Regulation .08 adopted effective November 25, 2002 (29:23 Md. R. 1810); October 13, 2003 (30:20 Md. R. 1447); December 9, 2004 (31:24 Md. R. 1725); October 10, 2005 (32:20 Md. R. 1655); October 9, 2006 (33:20 Md. R. 1614); May 19, 2008 (35:10 Md. R. 972); November 30, 2009 (36:24 Md. R. 1856); November 15, 2010 (37:23 Md. R. 1609); October 17, 2011 (38:21 Md. R. 1276); December 24, 2012 (39:25 Md. R. 1610); December 12, 2013 (40:24 Md. R. 2016); August 3, 2015 (42:15 Md. R. 1015) Effective date: May 6, 1985 (12:9 Md. R. 809) Regulation .01 amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .02 amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .03 amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .04 amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .05C amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .06A, C amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .07D amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .09A amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .11A amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .12 amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .14C amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .15 amended effective March 7, 1988 (15:5 Md. R. 616) The purpose of Child Protective Services is to stop and prevent child abuse and neglect through the: Investigation of child abuse and neglect; Comprehensive assessment of safety, risk and service needs; and Provision of services or service referrals for abused or neglected children and their families. These regulations establish the appropriate protocols for local departments of social services to: Accept reports of suspected child abuse or neglect; Promptly determine whether to investigate a report or to initiate a comprehensive family assessment; Complete a timely investigation or family assessment appropriate to the circumstances; After an investigation, make a finding consistent with the law; After conducting a family assessment, complete and distribute a written assessment addressing safety and risk; and Create and maintain accurate reports and records that can serve as tools in providing services and in future involvement with the family. In this chapter, the following terms have the meanings indicated. Terms Defined. “Accidental means” means an action in which injury is unintended and could not be reasonably expected. “Administration” means the Social Services Administration of the Department of Human Services. “Alleged maltreatment” means child abuse or neglect reported to a local department. “Alleged maltreator” means an individual named in a report as having abused or neglected a child. “Alleged victim” means a child named in a report as having been abused or neglected. “Alternative response” means a component of Child Protective Services that provides for comprehensive assessment of: Risk of harm to a child; Risk of subsequent child abuse or neglect; Family strengths and needs; and The provision of necessary services or referrals for service. “Authority figure” means a person who, because of the person’s position or occupation, exercises authority over a child. Caregiver. “Caregiver” means an individual who has permanent or temporary care, custody, or responsibility for supervision of a child. “Caregiver” includes but is not limited to a stepparent, foster parent, guardian, custodian, employee, or volunteer in a facility or program caring for a child, a person who has responsibility for supervision of the child, or any individual engaged in sex trafficking a child or otherwise controlling a child who is involved in sex trafficking. “Centralized confidential database” means the Department’s internal computerized data system that contains information regarding child abuse and neglect investigations and assessments and protects that information from disclosure. “Child” means an individual younger than 18 years old. “Child abuse” means: The physical or mental injury of a child under circumstances that indicate that the child’s health or welfare is harmed or at substantial risk of being harmed by: A parent; A household or family member; A caregiver; or An authority figure; Sexual abuse, whether physical injuries are sustained or not; or Labor trafficking. “Child advocacy center” means a child-focused facility or program that evaluates, diagnoses, or treats alleged victims. “Child in need of assistance (CINA)” has the meaning stated in Courts and Judicial Proceedings Article, §3-801(f), Annotated Code of Maryland. “Child neglect” means one or more of the following by a parent or caregiver: A failure to provide proper care and attention to a child, including leaving a child unattended, under circumstances that indicate that the child's health or welfare was harmed or placed at substantial risk of harm; or Mental injury of a child caused by the failure to provide proper care and attention to a child. “Child Protective Services (CPS)” means the unit in a local department responsible for responding to reports of suspected child abuse or neglect. “Client Information System (CIS)” means the Department's automated database that maintains data related to local department programs and services. “CPS response” means an investigation or assessment conducted pursuant to Family Law Article, §5-706, Annotated Code of Maryland. “Custodian” means an agency or individual, other than a child's parent or legal guardian, to whom a court has given legal custody. “Department” means the Department of Human Services. “Educator or human service worker” means any professional employee of a: Correctional institute; Public, parochial, or private educational facility; Health care facility; Juvenile services facility; Social service agency or institution; Licensed facility including but not limited to: Caseworkers; Counselors; Probation or parole officers; Social workers; and Teachers. Failure to Provide Proper Care and Attention. “Failure to provide proper care and attention” means the omission of proper care or attention or the provision of improper care or attention. “Failure to provide proper care and attention” includes leaving a child unattended. “Family member” means a relative by blood, adoption, or marriage. “Final determination” means a finding of the local department after all timely appeals. “Finding” means a disposition at the end of an investigation that child abuse or neglect is indicated, unsubstantiated, or ruled out and the identification of an individual responsible for unsubstantiated or indicated child abuse or neglect. “Grooming a child for sexual activity” means forming an emotional connection with a child with the intent of making the child more receptive to sexual conduct. “Health care practitioner” has the meaning stated in Health Occupations Article, §1-301, Annotated Code of Maryland. “Household member” means an individual who lives in, or is regularly present in the home of a child at the time of the alleged child abuse or neglect. “Identifying information” means the name of: The alleged victim; A household or family member of the alleged victim; A parent or legal guardian of the alleged victim; and The alleged maltreator. “Indicated” means a finding that there is credible evidence, which has not been satisfactorily refuted, that child abuse or neglect occurred. “Labor Trafficking” means knowingly: Taking, placing, harboring, persuading, inducing, or enticing a child by force, fraud, or coercion to provide services or labor; or Receiving a benefit or thing of value from the provision of services or labor by a child that was induced by force, fraud, or coercion. “Law enforcement agency” means a police department, bureau, or agency including but not limited to: A federal, State, county, or municipal police department or agency; A Sheriff's office; A State's Attorney's office; and The Attorney General's office. “Law enforcement officer” means any member of a law enforcement agency who is authorized to make arrests as part of the officer's official duties. “Local department” means a department of social services, including the Montgomery County Department of Health and Human Services, with authority to investigate, assess, or assist in investigating or assessing a report of suspected child abuse or neglect. “Maltreatment” means child abuse or neglect. “Maltreator” means an individual whom a local department has found responsible for indicated or unsubstantiated child abuse or neglect. “Mandated reporter” means a health practitioner, educator, human service worker, or law enforcement officer required to notify a local department or law enforcement of suspected child abuse or neglect pursuant to Family Law Article, §5-706, Annotated Code of Maryland. “Mental injury” means an observable, identifiable, and substantial impairment of a child’s mental or psychological ability to function caused by an intentional act or series of acts, regardless of whether there was an intent to harm the child. “Multidisciplinary case consultation team” means a group of professionals, including a local department, convened to consult regarding an investigation, assessment, or provision of services after a report of child abuse or neglect. “Office of Child Care” means the unit of the Maryland State Department of Education responsible for regulating facilities and homes providing care for children. Out-of-Home Care. “Out-of-home care” means care provided to a child in a setting other than the home of the child's parent or guardian. “Out-of-home care” includes but is not limited to care and supervision provided in day care, foster care, residential or 24-hour care, respite care, preschool, school, camp, or recreational programs. “Out-of-home placement” has the meaning stated in COMAR 07.02.11.03B(34). “Preponderance of the evidence” means that it is more likely than not that an act or omission occurred. Providing Proper Care and Attention. “Providing proper care and attention” means providing care appropriate to the child's needs and development. “Providing proper care and attention” includes but is not limited to: Providing appropriate food, clothing, shelter, medical care, nurturing, activity, guardianship, and supervision; and Caring and planning for the child's welfare. “Receiving a report” means obtaining sufficient information about suspected child abuse or neglect to make a decision as to what CPS or other response is appropriate. “Record” means the original or a copy of documentary material, in any form, concerning a report or CPS response to an allegation of child abuse or neglect. “Regularly present in a household” means visiting or staying in a home with sufficient frequency to become a significant part of the child's or family's life. “Report” means an allegation of child abuse or neglect made or received by any state, county, or municipal corporation, with sufficient information to screen the report for an appropriate CPS or other response. “Responsible for child abuse or neglect” means having an unexpunged finding of unsubstantiated or indicated child abuse or neglect. “Ruled out” means a finding that child abuse or neglect did not occur. “Screen out” means reviewing a report of suspected child abuse or neglect and determining that the local department will not accept the report for a CPS response. “Screen the report” means reviewing a report of suspected child abuse or neglect and determining whether the report meets the criteria for a CPS response or referral to other programs or services. “Sex trafficking” means the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a child for the purpose of a commercial sex act. “Sexual abuse” means any act that involves: Sexual molestation or exploitation of a child by: A parent; A household or family member; A caregiver; or An authority figure; or Sex trafficking of a child by any individual. Sexual Molestation or Exploitation. “Sexual molestation or exploitation” means sexual contact or conduct with a child. “Sexual molestation or exploitation” includes but is not limited to: Engaging in exposure or voyeurism; Making sexual advances; Kissing or fondling; Grooming for sexual activity; Committing a sexual crime in any degree including rape, sodomy, or sex trafficking; or Allowing, encouraging, or engaging in obscene or pornographic display, photographing, filming, or depiction of a child in a manner prohibited by law. “Substantial risk of harm” means a real threat to a child’s health or welfare during alleged child abuse or neglect. “Suspected child abuse” means child abuse to which a reporter believes a child has been subjected. “Suspected child neglect” means child neglect to which a reporter believes a child has been subjected. “Unsubstantiated” means a finding that there is insufficient evidence to support a finding of indicated or ruled out. “Victim” means a child who has been abused or neglected. “Voluntary placement” means a placement documented in a voluntary placement agreement pursuant to Family Law Article, §5-501(m), Annotated Code of Maryland. Without regard to economic circumstances, the following individuals are eligible for a CPS response: An alleged victim; An alleged maltreator; and Household and family members of the alleged victim. Alternative Response. Reports that are eligible for an alternative response include: A report of child neglect involving a disabled infant with a life-threatening condition from whom medically indicated treatment, as defined by 42 U.S.C.§5106g, has been withheld; and A report of child abuse or neglect that appears to pose a low risk of harm to a child. Investigation. A report that is not assigned for an alternative response shall be assigned for an investigation. Reports that are not eligible for an alternative response and must be investigated are: Reports of sexual abuse; Reports of Labor Trafficking; Reports of child abuse or neglect occurring in an out-of-home placement; Reports resulting in death, mental injury, or a serious physical injury; and Reports in which the alleged maltreator has: Been identified as responsible for child abuse or neglect in the previous 3 years; Had a report assigned for an alternative response within the previous 12 months; or Had two reports assigned for an alternative response within the previous 24 months. Reassignment. With a CPS supervisor’s approval, a report assigned for an alternative response may be reassigned at any time for an immediate investigation if: The case satisfies a criterion in §C of this regulation or fails to satisfy the criteria in §B of this regulation; A family is unable or has refused to participate in the alternative response assessment; or Other factors or circumstances indicate the family is inappropriate for an alternative response. With a CPS supervisor’s approval, a report assigned for an investigation may be reassigned for an alternative response at any time if: The case satisfies a criterion in §B of this regulation and does not satisfy the criteria in §C of this regulation; and Accepted services would address all issues of risk of child abuse or neglect and child safety. As required by COMAR 07.02.04.04E, if a parent, guardian, or custodian is unwilling to sign a statement acknowledging receipt of written information about CPS responses on the form prescribed by the Administration, the local department shall document the refusal and sign the form. Individuals who are not mandated reporters and have reason to believe that a child has been abused or neglected shall immediately notify a local law enforcement agency or a local department by any available means. A mandated reporter shall report suspected child abuse or neglect that occurred in Maryland: By oral report immediately after the contact or event that revealed the suspected child abuse or neglect to the local department or law enforcement agency in the jurisdiction where the suspected child abuse or neglect occurred; and By written report within 48 hours of the contact or event that revealed the suspected child abuse or neglect to the local department and the State’s Attorney’s Office in the jurisdiction where the suspected child abuse or neglect occurred. A mandated reporter shall report suspected child abuse or neglect that occurred outside of Maryland to any local department in accordance with Family Law Article, §5-705.1, Annotated Code of Maryland. Upon request, a local department shall provide a mandated reporter with a supply of forms created by the Administration that the mandated reporter may use in making a written report. An employee of a local department shall immediately forward any report of suspected child abuse or neglect received in the course of employment, however communicated, to CPS to screen the report. A reporter shall include in a report of suspected child abuse or neglect as much of the following information that is available: The names and home addresses of the alleged victim, the alleged victim’s parents, and any other individual responsible for the alleged victim’s care; The present location of the alleged victim; The alleged victim’s age; The names and ages of other children in the alleged victim’s home or in the care of the alleged maltreator; The specific nature and extent of injury, sexual conduct, or failure to provide proper care and attention; Previous child abuse or neglect of the alleged victim or by the alleged maltreator; Other information that might be of assistance to the local department in determining: The cause of injury or of a failure to provide proper care and attention; The identity of individuals responsible for the alleged child abuse or neglect; and The safety of the alleged victim and risk of future maltreatment; and In the case of suspected child abuse or neglect involving a mental injury: A description of the substantial impairment of the child's mental or psychological ability to function; An explanation of why the reporter believes the mental injury is attributable to maltreatment; Any observations or knowledge about the intent or recklessness of the alleged maltreator in causing a mental injury. The failure or inability of a reporter to provide the information in §F of this regulation will not be grounds for screening out the report unless the information provided is insufficient to allow the local department to locate or identify the alleged victim. An individual is not required to report suspected child abuse or neglect in violation of: The attorney-client privilege under Courts and Judicial Proceedings Article, §9-108, Annotated Code of Maryland including communications: In confidence by a client to the client's attorney, relating to the representation of the client, or That would violate a constitutional right to assistance of counsel; or The privilege in Courts and Judicial Proceedings Article, §9-111, Annotated Code of Maryland, pertaining to communications to a minister of the gospel, clergyman, priest, or rabbi of an established religion received in a professional capacity under circumstances where the professional is bound to maintain the confidentiality of that communication under canon law, religious doctrine, or practice. A local department shall accept reports of suspected child abuse or neglect from any source including local department staff. A local department shall establish a process for ensuring that a report of suspected child abuse or neglect is immediately directed to CPS for an appropriate response. On-Call Staff. A local department shall have trained staff on-call 24 hours a day, 7 days a week, to receive and take appropriate action on reports of suspected child abuse and child neglect. A local department shall ensure that the public has a means of making reports outside of normal office hours. If a local department receives a report of suspected child abuse or neglect alleged to have occurred in Maryland, it shall: Promptly acknowledge receipt of the report in writing to each reporter stating that the local department will take appropriate action; and Immediately notify the local law enforcement agency orally or in writing of any report accepted for a CPS response; and By the end of the next business day following the day of the report, notify law enforcement in writing of the report if the initial notification was communicated orally. If a local department where the alleged maltreatment occurred accepts a report for alternative response and the alleged victim resides in another Maryland jurisdiction, the local department shall immediately forward the report to the local department in the jurisdiction where the child resides to complete the alternative response. Child Abuse or Neglect Alleged to Have Occurred Outside of the State. Promptly after receiving a report of suspected child abuse or neglect pursuant to Regulation .04C of this chapter: The local department shall forward the report to the appropriate agency in the state where the suspected abuse or neglect occurred; and If the child resides in Maryland, notify the local department in the jurisdiction where the child resides. If a reported incident of suspected child abuse or neglect does not meet the definition of child abuse or neglect in Regulation .02B of this chapter, the local department may: Decline to initiate a CPS response; Make referrals to other services or agencies; and Maintain a record of non-identifying information including: A summary of the allegation; and The reason for not accepting the report for a CPS response. If a report of suspected child abuse or neglect arises from the failure of a voluntary placement involving a child with disabilities and diagnostic evidence, family history, and current circumstances do not support a reasonable fear for the safety of the child or family members, a local department shall initiate an appropriate CPS response. If the local department receives a report of suspected child abuse or neglect based on information that the reporter knew to be false at the time of the report, the local department shall, upon completion of the CPS response, refer the reporter to the local State's Attorney's office for possible prosecution under Criminal Law Article, §9-503, Annotated Code of Maryland. Failure to Report. If, during a CPS response, the local department has substantial grounds to believe that a mandated reporter knowingly failed to report suspected child abuse or neglect as required by Family Law Article, §5-704, Annotated Code of Maryland, the local department shall: If the person is employed as a health practitioner, notify the appropriate licensing board in accordance with the provisions of the Health Occupations Article; If the person is employed as a law enforcement officer, notify the law enforcement agency with which the person is employed; or If the person is employed as an educator or human service worker, notify the county board of education or the appropriate agency, institution, or licensed facility with which the person is employed. For purposes of this section, a mandated reporter may be found to have knowingly failed to report if the mandated reporter: Had reason to believe child abuse or neglect occurred and did not make a report; and Had no basis to conclude that another individual had made the mandated report. The local department shall attempt to obtain from a reporting source the information set forth in Regulation .04F of this chapter. The local department shall enter identifying information into the centralized confidential database and, as appropriate, add to or correct information already entered. The local department shall use the centralized confidential database, CIS, other appropriate databases, and available case records to obtain information concerning the alleged maltreator, alleged victim, the alleged victim’s caregiver, household or family members of the alleged victim, and other individuals as appropriate. If a local department determines that, due to the identity of the alleged maltreator as a local department employee, immediate family member of an employee, or other individual with substantial ties to the local department, the local department’s objectivity in providing a CPS response might reasonably be questioned or that extra security measures are warranted to protect the individual’s privacy, the local department shall: Take appropriate steps to restrict access to the report and CPS response; and When appropriate because of possible bias or appearance of bias: Request that another local department conduct the CPS response and recommend a finding or service plan; and If necessary, contact the Administration to request its intervention. Report of Child Fatality. If a report of suspected child abuse or neglect involves a child fatality: The local department shall contact the Administration immediately to: Provide information concerning the incident; and Discuss the local department's plan for completing the investigation and responding to any inquiries made pursuant to Human Services Article, §1-203, Annotated Code of Maryland; and The Administration shall promptly notify the State Fatality Review Team. Report Concerning Child Care. If a report of suspected child abuse or neglect concerns a child care center or family day care home, the local department shall: Promptly notify the Office of Child Care's regional manager; and If the report is accepted for a CPS response, respond in accordance with procedures agreed upon by the local department and the Office of Child Care. Report Concerning Out-of-Home Placement. If a report of suspected child abuse or neglect concerns a child in an out-of-home placement, the local department shall: Notify the Administration; In the case of an out-of-home placement licensed by a child placement agency, notify the child placement agency; In the case of an out-of-home placement licensed by a local department: Notify: The caseworker for the alleged victim; The caseworker for the out-of-home placement; and If the alleged maltreator is a child in the out-of-home placement, the worker for the alleged maltreator; and Coordinate the CPS response with the caseworker for the out-of-home placement and the alleged victim; and Exchange information with the Administration, caseworkers, and a child placement agency regarding: Actions taken regarding the out-of-home placement or children in the out-of-home placement; Information having a bearing on the safety of children in the out-of-home placement; and The disposition of the child abuse or neglect investigation. If a report of suspected child abuse or neglect concerns an adult who is believed to have been abused or neglected as a child, the local department shall: Determine if the alleged maltreator: Is currently the parent of a child; Has permanent or temporary care, custody, or responsibility for supervision of a child; Is a household or family member of a child; or Is an authority figure to a child. Assess whether children are at risk of child abuse or neglect by the alleged maltreator; and After assessing the extent of the child abuse or neglect, how recently the child abuse or neglect occurred, the risk to other children, and the identity of the alleged maltreator, determine whether to conduct a CPS response. If appropriate, the local department shall request information from a provider of health care, including mental health care or substance abuse treatment, regarding a child or adult being assessed or served in connection with a reported incident of suspected child abuse or neglect. CPS Responses Across Jurisdictional Lines in Maryland. Investigations. Except as provided in §J(1)(d) of this regulation, if the alleged child abuse or neglect occurred in a jurisdiction other than where the alleged victim or maltreator lives, the local department where the alleged child abuse or neglect occurred is responsible for the investigation. The local department responsible for the investigation shall: Coordinate activity of involved law enforcement agencies and local departments; Immediately notify the local department in the jurisdiction where the alleged victim or maltreator resides; Forward the results of interviews conducted in other jurisdictions to the State's Attorney's office and the local law enforcement agency; and Make the finding. The local department where the alleged victim or alleged maltreator lives shall: See an alleged victim living in that jurisdiction within the mandated time frame under Regulations .08 and .15 of this chapter and conduct any requested interview of the alleged victim or family; Assess the service needs of an alleged victim and family living in that jurisdiction, including the alleged victim’s need for protection from further child abuse or neglect; Initiate any court action necessary to protect the alleged victim or other children in the care of the alleged maltreator who are at risk of child abuse or neglect; When requested, interview the alleged maltreator; Forward the results of interviews, including recordings of interviews, to the local department where the child abuse or neglect is alleged to have occurred; Forward any recommended finding to the local department where the child abuse or neglect is alleged to have occurred; and Provide services if appropriate to the alleged victim, and the alleged victim’s family and household; and If a local department receives a request from another local department pursuant to §D of this regulation, the local department to which a report has been referred is responsible for the investigation in accordance with §J(1)(a)—(c) of this regulation and forwarding a recommended finding to the referring local department. Alternative Response. If the local department where the child abuse or neglect is alleged to have occurred determines that an alternative response is appropriate, the local department in the jurisdiction where the child resides shall conduct the alternative response. The local department conducting an alternative response is responsible for completing the assessment under Regulation .14 of this chapter. If the local department conducting the alternative response assessment becomes aware of a mandatory disqualifying factor, that local department shall immediately contact the local department where the child abuse or neglect is alleged to have occurred to discuss the new information. CPS Responses Across State Lines. If a local department receives a report of alleged child abuse or neglect that occurred in another State, the local department shall: Directly contact the agency responsible for the investigation or assessments of such reports in the state and jurisdiction where the maltreatment is alleged to have occurred; and Request that the reporter also contact the appropriate agency in the other jurisdiction. If the alleged victim resides or is in Maryland, the local department shall: Interview the child to assess the child’s safety; and Offer services to the child and the child's family. The local department shall cooperate to the extent requested with the agency investigating or assessing the report in a timely manner. During an investigation, the local department shall: Assess the immediate safety and risk of maltreatment of the alleged victim and of the children who are household or family members of the alleged victim or in the care or custody of the alleged maltreator; Determine if the alleged child abuse or neglect or any other child abuse or neglect is indicated, unsubstantiated, or ruled out; Determine what services, if any, are appropriate and make referrals as necessary; Initiate shelter care, CINA proceeding, or voluntary placement as appropriate; and If possible, determine the identity of a maltreator. If necessary, the local department shall obtain information from the reporting source, parents, other relatives, community members, and other appropriate community resources including schools, hospitals, clinics, or law enforcement agencies. If the local department is denied entry to a child care center or family day care home to conduct an on-site investigation, the local department shall contact the Office of Child Care’s regional manager in an attempt to gain entry under COMAR 13A.15.07 and 13A.16.07. Initial Interviews. Before an initial interview with an adult, the local department representative shall present identification. Before an initial interview with a child, the local department representative shall provide identification in a manner appropriate to the child's developmental level. During an initial interview with the alleged maltreator, the local department representative shall advise the alleged maltreator of: The nature of the alleged child abuse or neglect; and The local department's investigation process. Danger to a Child. If the local department considers an alleged victim to be in danger of immediate harm or injury, the local department shall: Make the least disruptive and least traumatic arrangements necessary for the child's protection and care including but not limited to: Agreeing that the alleged victim may stay with a relative; or Encouraging the family to seek a protective order to limit the alleged maltreator's access to the alleged victim; and If in the best interest of the safety and protection of the alleged victim, remove the child from the home with or without the consent of the parent, guardian, or custodian and: Obtain court authorization for shelter care, if possible, before removal or as soon afterward as possible under Courts and Judicial Proceedings Article, §3-815, Annotated Code of Maryland; and Notify the child's parents, guardians, or custodian of scheduled hearings. If the local department is denied access to an alleged victim and has reason to believe the child is in serious immediate danger, the local department shall request the assistance of a law enforcement officer, who may use reasonable force to gain access to and ensure the protection and safety of the child. If the local department is denied access to a child for purposes of conducting an interview or making an assessment necessary to determine if the child is in serious danger, the local department may seek a court order directing that the child be made available for an interview or assessment. Physical Examination of a Child. If a local department takes an alleged victim into custody without parental consent or before court approval, the local department shall have the child examined to: Relieve any urgent illness or life-threatening health condition; and Determine the nature or extent of any child abuse or neglect. The local department shall attempt to obtain the consent of the parent, guardian, or custodian of the child for an examination. A licensed physician or an individual under the control or supervision of a licensed physician may examine and provide emergency treatment for a child without parental consent if the local department or law enforcement officer states a belief that a child has been abused or neglected. If an alleged victim is examined or treated under this regulation: The local department shall: Attempt to obtain information regarding health care insurance coverage available to the child, including medical assistance; and If necessary, secure medical assistance for an eligible child examined or treated under the emergency conditions. The Maryland Department of Health shall pay all reasonable physician or health care institution charges not covered by other resources; and The child's parent, guardian, or custodian shall repay the Maryland Department of Health for examinations or treatment. The local department or, if warranted, law enforcement shall notify the State's Attorney's office of any preliminary findings in a child abuse investigation within ten days of receipt of the report of suspected child abuse. Physical and Sexual Abuse. Within 24 hours of receiving a report of suspected child abuse, the local department or, by joint agreement with the appropriate law enforcement agency, a law enforcement officer, shall: Initiate an on-site investigation; Except in the case of a child fatality, see the alleged victim and determine if the health, safety, and well-being of the alleged victim requires removing the child; Attempt to see any other children who are in the care of the alleged maltreator and determine if the health, safety, and well-being of the children require that they be removed; Attempt to have an on-site interview with the alleged victim's caregiver; Document all visits or attempted visits; and If appropriate, obtain information relating to possible resources for the child. Neglect — Other Than Mental Injury. Within 5 days of receiving a report of alleged child neglect, the local department shall follow the procedures under §A of this regulation. Abuse and Neglect — Mental Injury. Within 5 days of receiving a report of alleged child abuse or neglect involving mental injury, a local department shall follow the procedures under §A of this regulation. Finding of Mental Injury. If during an investigation of child abuse or neglect, CPS finds evidence that a child’s emotional or psychological welfare may have been harmed, CPS shall consider whether the child has sustained a mental injury. Behavior that may be relevant to a finding of mental injury includes but is not limited to: Implied or overt threats of death or serious injury made to a child or in a child’s presence; Implied or overt threats made in a child’s presence to intentionally harm an animal; Constant denigration of a child; Extensive emotional or physical isolation or confinement of a child; Extreme antagonistic behavior by one or both parents toward the other parent; or Unnecessary and unwarranted medical diagnosis or treatment of a child. Professional Assessments — Mental Injury. If a worker suspects mental injury, the worker shall promptly obtain an assessment by any two of the following: A licensed physician, as defined in Health Occupations Article, §14-101, Annotated Code of Maryland; A licensed psychologist, as defined in Health Occupations Article, §18-101, Annotated Code of Maryland; and A licensed social worker, as defined in Health Occupations Article, §19-101, Annotated Code of Maryland, including a licensed social worker employed by any local department. If a professional assessor concludes that the child has sustained a mental injury, the local department shall request a written assessment that includes: A description of an observable, identifiable, and substantial impairment of the child’s mental or psychological ability to function; and An explanation of the act, series of acts, or omission that is believed to have caused the mental injury regardless of whether there was an intent to harm the child. In conducting the investigation and making a finding, the local department shall consider professional assessments in addition to other information gathered during the investigation. Mental Injury — Categorized. Mental injury caused by an act to a child is child abuse; and Mental injury caused by an omission or other failure to provide proper care or attention to a child is child neglect. A local department shall complete and document an investigation using assessment tools and forms required by the Administration. A local department or, in a joint investigation, a law enforcement agency shall: To the extent possible, complete an investigation within 10 days of receiving a report; or If additional time is required, complete the investigation within 60 days of receiving a report. An investigation is complete when the local department has completed the requirements of Regulation .07A and B of this chapter and a supervisor has approved the finding. Except as provided in §C of this regulation, when a local department completes an investigation with a finding of indicated or unsubstantiated child abuse or neglect, the local department shall identify a maltreator. If a local department completes an investigation with a finding of ruled out child abuse or neglect, the local department may not identify a maltreator. A local department may not identify a maltreator in a case of indicated or unsubstantiated child abuse or neglect if the evidence is insufficient to identify: A parent, caregiver, authority figure, or household or family member of the alleged victim responsible for child physical abuse or child abuse with mental injury; A parent, caregiver, authority figure, or household or family member of the alleged victim, or sex trafficker responsible for child sexual abuse; or A parent or caregiver of the alleged victim responsible for child neglect or child neglect with mental injury. If a child, other than the parent of a victim, is the alleged maltreator, the local department may consider the following factors in determining whether to identify the child as responsible for indicated or unsubstantiated child abuse or neglect: The age and developmental level of the alleged victim; The age and developmental level of the alleged maltreator; The appropriateness of the alleged act of abuse or neglect for the age and developmental level of each child; The psychological condition of each child; The alleged maltreator’s use of coercion, cruelty, violence, or lack of regard for the safety or welfare of the alleged victim; The likelihood of the alleged maltreator committing further child abuse or neglect; and The availability and likely success of services to minimize the risk of future maltreatment. More than one individual may be identified as responsible for child abuse or neglect if more than one: Parent, caregiver, authority figure, or household or family member of the alleged victim, or sex trafficker was more likely than not responsible for the abuse of a child; or Parent or caregiver of the alleged victim was more likely than not responsible for the neglect of a child. The standard of proof required for a determination that an individual is responsible for child abuse or neglect is a preponderance of the evidence and not beyond a reasonable doubt as required for a criminal conviction. Indicated Child Abuse. Physical Abuse with No Mental Injury. Except as provided in §A(3) of this regulation, a local department may make a finding of indicated child physical abuse if there is credible evidence, which has not been satisfactorily refuted, that the following five elements were present during the alleged child abuse: A physical injury; A child victim; A parent, caregiver, authority figure, or household or family member of the alleged victim responsible for the alleged abuse; Circumstances including the nature, extent, and location of the injury indicating that the alleged victim’s health or welfare was harmed or was at substantial risk of harm; and Labor Trafficking. Sexual Abuse. A local department may make a finding of indicated child sexual abuse if there is credible evidence, which has not been satisfactorily refuted, that the following three elements were present during the alleged child sexual abuse: An act that involves sexual molestation, sexual exploitation, or sex trafficking; A child victim; and A parent, caregiver, authority figure, or household or family member of the alleged victim responsible for the alleged child sexual abuse, or sex trafficking of a child by any individual. Physical injury is not required for a finding of indicated sexual abuse. Abuse — Mental Injury. A local department may make a finding of indicated child abuse with mental injury if there is credible evidence not satisfactorily refuted that the following five elements were present during the alleged child abuse with mental injury: A mental injury characterized by an observable, identifiable, substantial impairment to the child's mental or psychological ability to function, which may be shown by the need for specific psychiatric, psychological, or social work intervention; A child victim; A parent, caregiver, authority figure, or household or family member of the alleged victim responsible for the alleged child abuse with mental injury; Mental injury caused by an intentional act or series of acts, regardless of whether there was an intent to harm the child; and Circumstances including the nature and extent of the mental injury indicating that the alleged victim’s health or welfare was harmed or was at substantial risk of harm. Unsubstantiated Child Abuse. A local department may make a finding of unsubstantiated child abuse if there is insufficient evidence to support a finding of indicated or ruled out. A local department may base its finding of unsubstantiated child abuse on insufficient evidence: Supporting one or more elements of indicated child abuse; or Refuting one or more elements of indicated child abuse. A local department may find insufficient evidence supporting a finding of indicated child abuse for reasons including but not limited to: The lack of a credible account by the alleged victim or witness; The failure of the alleged maltreator to completely and credibly refute the allegations; A lack of access to the alleged victim or alleged maltreator despite reasonable efforts to obtain access; or An inability to obtain relevant facts regarding the alleged child abuse despite reasonable efforts. Ruled Out Child Abuse. A local department shall make a finding that child abuse is ruled out if the local department finds that child abuse did not occur. The local department may base a finding of ruled out on: A lack of credible evidence supporting one or more elements of indicated child abuse; or A credible refutation of one or more of the elements of indicated child abuse; or A finding that the alleged maltreator was not responsible for the injury for reasons including but not limited to: The injury was caused by accidental means and was not caused by a reckless disregard for the child’s health or welfare; or The injury was a result of the child's medical condition. If the alleged maltreator was a child and not the parent of the alleged victim, the local department may consider the factors in Regulation .10D of this chapter to determine the appropriate finding. Indicated Child Neglect. Neglect with No Mental Injury. Except as provided in §A(2) of this regulation, the local department may make a finding of indicated child neglect when there is credible evidence, which has not been satisfactorily refuted, that the following four elements were present during the alleged neglect: A failure to provide proper care and attention; A child victim; A parent or caregiver of the alleged victim responsible for the alleged neglect; and Circumstances including the nature, extent, or cause of the alleged neglect indicating that the alleged victim’s health or welfare was harmed or was at substantial risk of harm. Neglect — Mental Injury. The local department may make a finding of indicated child neglect with mental injury if there is credible evidence, which has not been satisfactorily refuted, that the following four elements were present during the alleged neglect with mental injury: A mental injury caused by a failure to provide proper care and attention regardless of whether there was an intent to harm the child and characterized by an observable, identifiable, substantial impairment to the child's mental or psychological ability to function, which may be shown by the need for specific psychiatric, psychological, or social work intervention; A victim who was a child; A parent or caregiver of the alleged victim responsible for the alleged child neglect with mental injury; and Circumstances including the nature and extent of the failure to provide proper care and attention indicating that the child's health or welfare was harmed or was at substantial risk of harm. Unsubstantiated Child Neglect. A local department may make a finding of unsubstantiated child neglect if there is insufficient evidence to support a finding of indicated or ruled out. A local department may base its finding of unsubstantiated child neglect on insufficient evidence: Supporting one or more elements of indicated child neglect; or Refuting one or more elements of indicated child neglect. A local department may find insufficient evidence supporting a finding of indicated child neglect for reasons including but not limited to: The lack of a credible account by the alleged victim or witness; The failure of the alleged maltreator to completely and credibly refute the allegations; A lack of access to the alleged victim or alleged maltreator despite reasonable efforts to obtain access; or An inability to obtain relevant facts regarding the alleged child neglect despite reasonable efforts. Ruled Out Child Neglect. A local department shall make a finding that child neglect is ruled out if the local department finds that child neglect did not occur. The local department may base a finding of ruled out on: A lack of credible evidence supporting one or more elements of indicated child neglect; or The credible refutation of one or more of the elements of indicated child neglect. If the alleged maltreator was a child and not the parent of the alleged victim, the local department may consider the factors in Regulation .10D of this chapter to determine the appropriate finding. Before a local department closes its record of investigation, the local department shall: Ensure that the record is complete; No later than 30 days after completing the investigation: In a case of ruled out child abuse or neglect, notify the alleged maltreator of the finding; In a case of indicated or unsubstantiated child abuse or neglect in which a maltreator has been identified, send notice of the finding and of the right to appeal under COMAR 07.02.26 to the maltreator; and In a case of indicated or unsubstantiated child abuse or neglect in which no individual has been identified as a maltreator, send notice of the finding and of the right to appeal under COMAR 07.02.26 to the alleged maltreator; and Within 5 business days of completing an investigation: Complete a written report of its disposition and any necessary services; and Provide a final report to the State’s Attorney’s Office by any agreed means, including a report of a physical examination or treatment, if performed, of the alleged victim. During the alternative response assessment, the local department shall gather appropriate information to: Evaluate the alleged victim’s home environment; Decide on the safety of the alleged victim and of other children in the household or in the care or custody of the alleged maltreator; and Determine what services, including a voluntary placement, are appropriate. Initial Interviews — Alternative Response. Before an initial interview with an adult, the local department representative shall present identification. Before an initial interview with a child, the local department representative shall provide identification in a manner appropriate to the child’s developmental level. During an initial interview with the alleged maltreator, the local department representative shall provide information concerning: The nature of the alleged child abuse or neglect; and The local department’s alternative response process. If during the course of an alternative response assessment the department takes a child into custody without parental consent or before court approval, the local department shall have the child examined as outlined in Regulation .07F of this chapter. If a law enforcement agency made the report of child abuse or neglect, the local department shall advise the appropriate law enforcement agency that the report has been assigned for an alternative response. Within 24 hours of receiving a report of suspected child abuse assigned for an alternative response, the local department shall: Initiate an on-site assessment with the alleged victim’s parent or primary caregiver; Initiate an on-site assessment with the alleged victim and attempt to see the other children in the care or custody of the alleged maltreator; Determine if the health, safety, or well-being of any children are at risk; Document all visits or attempted visits; and Obtain information relating to possible appropriate resources for the family. Within 5 days of receiving a report of suspected child neglect assigned for an alternative response, the local department shall follow the procedures under §A of this regulation. The local department shall complete its alternative response assessment using assessment tools and forms required by the Administration. An assessment is complete when the local department: Determines the names, ages, and condition of the children in the household or in the care or custody of the alleged maltreator; Assesses the safety of the children in the household or in the care or custody of the alleged maltreator; Evaluates the risk of future child abuse or neglect; and Determines necessary services. The local department shall: Complete an alternative response assessment within 60 days after receipt of the report; and Within 10 days of completing the alternative response assessment, provide a written report to the adult family members who participated in the alternative response identifying accomplishments achieved and services necessary to address: The safety of the alleged victim or other children in the household; and The risk of subsequent child abuse or neglect; and Consistent with the assessment and safety or service plans: Provide appropriate services in the best interests of the children; Link the family or alleged victim for additional services; and As necessary for the safety of the alleged victim or other children in the household, establish a plan to monitor adherence to a safety plan and the delivery and completion of appropriate services. If a local department determines that, as a result of its CPS response, ongoing services are appropriate, it shall immediately refer the case to local department staff providing those services or to service providers outside of the local department. If the local department provides continuing child welfare services through purchase or referral, the local department shall share information regarding the CPS response with the provider as appropriate to the case and in accordance with confidentiality provisions of Regulation .21 of this chapter. If the local department determines that a child is a CINA or would benefit from a voluntary placement, the local department shall file a petition with the court in accordance with Courts and Judicial Proceedings Article, §§3-809 and 3-811, Annotated Code of Maryland. Regardless of whether the local department initiates a CINA proceeding, the local department shall continue, as appropriate, to assess the child's safety and provide services. If an investigation results in a finding of indicated and a child under the age of three is a member of the maltreator’s or victim’s household or is in the care or custody of the maltreator, the department shall make a referral to the lead public agency responsible for providing early intervention services to infants and toddlers with disabilities in the State. Until expunged in accordance with Regulation .19 of this chapter, the local department shall maintain: Every report of suspected child abuse or neglect; and A case record of a CPS Response. The case record shall include: Materials obtained in the CPS response, including but not limited to: The written report of suspected child abuse or neglect; Recordings of interviews conducted by the local department, child advocacy center or, in a joint investigation, by law enforcement during the CPS response; and Medical records, law enforcement reports and photographs, correspondence, consents, court orders, court reports, and all other documents obtained during the CPS response; Documentation of the local department's CPS response including: Notes of contacts and interviews, including handwritten notes; The names, addresses, and telephone numbers if available, of the parents, guardians, identified relatives, and other significant individuals related to the CPS response; A written narrative of the CPS response; Safety and risk assessments and other documentation of the safety of the alleged victim and of the other children in the household and the risk of future maltreatment; The need for ongoing services and linkage to services; and In an investigation: A closing letter to the victim’s parents or guardians documenting the reason for and the outcome of the investigation; and A notice of a finding and the right to appeal to the alleged maltreator; and In an alternative response, a written report provided to the family members; If a local department provides child welfare services other than child protective services after completion of a CPS response, the local department's files related to the child welfare services shall be kept with but not as a part of the CPS response record. General Rules for Expungement. Investigations. A local department shall not expunge records related to an investigation resulting in an indicated finding. A local department shall expunge records related to an investigation resulting in an unsubstantiated finding within 5 years of receiving the report. A local department shall expunge records related to an investigation resulting in a ruled out finding within 2 years of receiving the report. A local department shall expunge records related to a screened out report of child abuse or neglect within 2 years of receiving the report. Alternative Response. The local department shall expunge all records related to an alternative response within 3 years of receiving the report. Exceptions to the General Rules for Expungement. Prior Reports — Extended Expungement Dates. If the local department accepts for a CPS response a report concerning an individual who was the alleged maltreator in a previous investigation or a participant in a previous alternative response, the local department shall not expunge the record related to the previous CPS response before the expungement of the record relating to the subsequent CPS response. If a record in a previous CPS response has an expungement date later than the expungement date for a subsequent CPS response, the general rules for expungement apply. Investigation Response Record — Good Cause for Expungement. Upon written request by an alleged maltreator, the local department shall determine if good cause exists to immediately expunge a record related to an investigation that resulted in a ruled out finding prior to the prescribed expungement date. The director of the local department will determine whether good cause exists based on an evaluation of whether the investigative record would serve any purpose in a future CPS response. The local department’s determination as to whether good cause exists is final and not subject to further review. Upon written request by an alleged maltreator, the local department may retain a record of an investigation past the expungement date. The local department shall not expunge any record related to an investigation until there has been a final determination. Expungement of records in accordance with this regulation will include shredding or deleting all documents including the report of suspected child abuse or neglect and all assessments and investigative findings stored in any manner. Upon accepting a report of suspected child abuse or neglect, the local department shall enter identifying information into a centralized confidential database and, as appropriate, add to or correct information already entered. The local department shall expunge identifying information from the centralized confidential database when it expunges the record related to that report. The local department may only permanently identify an individual as responsible for alleged child abuse or neglect in the centralized confidential database if the individual was found responsible for indicated child abuse or neglect in a final determination. Except as otherwise provided in Family Law Article, Title 5, Subtitle 7, and Human Services Article, §§1-201—1-203, Annotated Code of Maryland, and §§B—D of this regulation: Records and reports, including the information in the records or reports, concerning child abuse or neglect and the information contained in them are confidential; and The unauthorized disclosure of records and reports concerning child abuse or neglect and the information contained in them is a criminal offense subject to the penalty set out in Human Services Article, §1-202(e), Annotated Code of Maryland. A local department shall disclose a record or report, or information in a record or report, concerning a CPS response: To a court: Ruling on a request for shelter care, foster care, or a protective order; Ruling in a CINA case or on a petition for guardianship with a right to consent to adoption of the child; or Ordering disclosure; Under an order of an administrative law judge if: A record or report concerns a case pending before the Office of Administrative Hearings; and Provision is made to comply with other State or federal confidentiality laws; To the State Council on Child Abuse and Neglect, the State Citizens’ Review Board of Children, or their designees, or a child fatality review team, as necessary to carry out their official functions; On written request, to the Baltimore City Health Department’s Office of Youth Violence Prevention if the record or report: Is relevant to the provision of the treatment or care of an alleged victim; Concerns a child convicted of a crime or adjudicated delinquent for an act that caused a fatality or near fatality; or Concerns a child victim of a crime of violence, as defined in Criminal Law Article, §14-101, Annotated Code of Maryland, residing in Baltimore City, and is requested for the purpose of developing appropriate programs and policies aimed at reducing violence against children in Baltimore City; To the Division of Parole and Probation in the Department of Public Safety and Correctional Services if, as a result of a report of suspected child abuse or neglect, the local department has reason to believe that an individual who lives with or is in the regular presence of a child is registered under Criminal Procedure Article, Title 11, Subtitle 7, Annotated Code of Maryland, as a result of committing a sexual crime against a child; To a health care practitioner, or agency, institution, or program treating or caring for an alleged victim if the information or record is relevant to the treatment or care limited to the following: Information regarding the alleged victim’s condition and well-being; Information regarding the alleged victim’s medical and mental health and developmental needs; The name of health care practitioners identified in the record who have treated or cared for the alleged victim; and Other information that the local department determines may be useful including: The status of immunizations; Current medications; or The names of any individuals whose legal access to the alleged victim has been restricted; and Upon request, to the State Medical Director for Children Receiving Child Welfare Services and all personnel under the direct supervision of State Medical Director as necessary to execute the duties of the position. In response to a written request pursuant to Human Services Article, §1-203, Annotated Code of Maryland, concerning an alleged victim who has suffered a fatality or near fatality: The Secretary of the Department or the director of a local department, or their designees, shall consult with the State’s Attorney in the jurisdiction where the fatality or near fatality occurred to determine whether release of information pursuant to §C(3) of this regulation would jeopardize or prejudice a criminal investigation or prosecution; If the State’s Attorney concludes that: Release of information pursuant to §C(3) of this regulation will jeopardize or prejudice a criminal investigation or prosecution, the State’s Attorney shall promptly advise the Department or local department and, within 10 days of the conclusion of the investigation or prosecution, advise the Department or local department that information may be released; or Release of information pursuant to §C(3) of this regulation will not jeopardize or prejudice a criminal investigation prosecution, the State’s Attorney shall promptly advise the Department or local department; Within 30 days of receiving notice pursuant to §C(2)(b) of this regulation or being advised that an ongoing investigation or prosecution has concluded, the Secretary of the Department and the director of the local department, or their designees, shall release the following information if it reasonably relates to the actions or omissions of the Department or local department: The name of a child who suffered a fatality; The dates of CPS responses involving the alleged victim including the date of the report of the fatality or near fatality; The final determination in a current or prior investigation involving the alleged victim; The number and type of services or service referrals provided to the alleged maltreator, the alleged victim, or household or family members of the alleged victim; CINA adjudications of the alleged victim, the alleged victim’s siblings, children in the alleged victim’s household or family, and children in the care of the alleged maltreator; The status of any CPS response involving the alleged victim that was open at the time of the fatality or near fatality; A summary of the facts, including the date of the fatality or near fatality; The cause of a fatality as reported by the medical examiner; and Other information concerning the circumstances of the fatality or near fatality as determined by the Secretary of the Department or the director of the local department to be consistent with the public interest, which includes consideration of the welfare of the alleged victim, the alleged victim’s family or household members, and the alleged maltreator; and The following information may not be disclosed: The name of an alleged victim who sustained a near fatality; The names of an alleged victim’s sibling, parent, household or family member, an individual legally responsible for the alleged victim, and the alleged maltreator; A medical report other than a medical examiner’s report regarding the cause of a fatality; and A file related to the alleged victim. If it furthers a purpose of the specific exception to confidentiality, a local department may disclose, at its discretion, a record or report, or information in a record or report, concerning a CPS response to: Local or state departments of social services, law enforcement, and members of multidisciplinary case consultation teams, investigating a report of suspected child abuse or neglect or providing services to an alleged victim or an alleged victim’s family; Local or state officials administering child protective services, juvenile services, child care, foster care, or adoption, including related licensing, approval, and compliance with regulations, as necessary to carry out their official functions; A licensed practitioner, agency, institution, or program providing treatment or care to an alleged victim; An individual identified as responsible for alleged child abuse or neglect if the individual is responsible for the alleged victim’s welfare; An alleged victim’s parent or caregiver; The appropriate public school superintendent or principal, or equivalent employee of a nonpublic school holding a State certificate of approval or registration with the Maryland State Department of Education, or a nonpublic school under the jurisdiction of the superintendent of schools for the Archdiocese of Baltimore, the Archdiocese of Washington, or the Catholic Diocese of Wilmington, for the purpose of carrying out appropriate personnel or administrative actions following a report of suspected child abuse involving a student committed by: An employee in that school or school system; An independent contractor who supervises or works directly with students in that school or school system; or An employee of an independent contractor, including a bus driver or bus assistant, who supervises or works directly with students in that school or school system; The president of a Maryland public institution of higher education, as defined in Education Article, Title 10, Subtitle 1, Annotated Code of Maryland, or the Chancellor of the University System of Maryland to carry out appropriate personnel or administrative actions following a report of child abuse committed by: An employee of the institution who has on-campus contact with children; or A contractor, employee of a contractor or volunteer who has on-campus contact with children at the institution; and The Office of Child Care: For disclosure to an operator of a child care center that is required to be licensed or to hold a letter of compliance under Family Law Article, Title 5, Subtitle 5, Part VII, Annotated Code of Maryland, or to a family day care provider who is required to be registered under Family Law Article, Title 5, Subtitle 5, Part V, Annotated Code of Maryland, for the purpose of: Determining the suitability of an individual for employment in a child care center or family day care home; or Carrying out appropriate personnel actions following a report of suspected child abuse or neglect when the alleged maltreator is an employee of a child care center or family day care home and, the alleged victim was under the care of the child care center or family day care provider at the time of the alleged maltreatment; or For use in any administrative or judicial enforcement proceedings. A qualified addictions specialist as defined in Family Law Article, Title 5, Subtitle 12, Annotated Code of Maryland; The Juvenile Justice Monitoring Unit of the Office of the Attorney General; or A licensed practitioner of a hospital or birthing center for the purpose of making discharge decisions concerning a child when, based on the practitioner's observation or knowledge of the behavior of the child's parents or immediate family members, the practitioner has reason to believe that the child will be in danger after discharge limited to: A statement as to whether either parent of the child under the practitioner’s care has been found responsible for indicated child abuse or neglect; and A statement as to whether either parent of the child under the practitioner’s care has an open CPS response. With any record or report disclosed to a person other than a mandated reporter pursuant to §D of this regulation, the local department shall provide written notice that redisclosure is subject to the requirements and penalties of Human Services Article, §1-202, Annotated Code of Maryland. Disclosure by Consent. Waiver. A local department may disclose a record or report, or information in a record or report, concerning a CPS response if all individuals with a privacy interest in the records or information have waived their confidentiality interest in accordance with COMAR 07.01.07.05. A parent, guardian, or custodian may waive a child's right to confidentiality for purposes of §F(1)(a) of this regulation only if the parent, guardian or custodian is not alleged to have abused or neglected the child. Employment Background Checks—Indicated Finding. If an individual requires a background check for the purposes of working or volunteering with children, a local department may notify a designated person whether the individual has been identified in a final determination as responsible for indicated child abuse or neglect if the local department receives on a form developed by the Administration: A notarized request from the individual needing the background check stating that the individual will be or is working or volunteering with children; A request signed by the individual needing the background check with a verification of that individual’s identity by the person designated to receive the results of the background check stating that the individual will be or is working or volunteering with children; or Other reliable verification of the individual’s identity from a source approved by the Administration and a statement by the individual needing the background clearance that the individual will be or is working or volunteering with children. With the request under §F(2)(a) of this regulation or by a subsequent request meeting the requirements of §F(2)(a) of this regulation, after a local department has notified a designated party that an individual has been found responsible for indicated child abuse or neglect, the individual may authorize the local department to release to the designated person a brief written summary of the facts resulting in the indicated. In responding to a request pursuant to §F(2)(a) and (b) of this regulation, the local department may not: Identify an individual other than the requestor who was involved in the indicated maltreatment; Disclose information about an individual who has not been identified as responsible for indicated child abuse or neglect in a centralized confidential database; Disclose information about a finding that is not the subject of a final determination. When a local department receives a request pursuant to §F(2)(a) concerning an individual with a finding of indicated child abuse or neglect who has not been offered an opportunity to request a contested case hearing, the local department shall: Provide the individual with appeal rights pursuant to Family Law Article, §5-706.1, Annotated Code of Maryland; and Wait for a final determination before responding to the request for information. Alternative Response Records. The local department may not use or disclose records and reports, including information in those records and reports, related to an alternative response to respond to a request made pursuant to §F(2)(a) and (b)of this regulation. Disclosures in a Child’s Best Interest. Except as provided in §B of this regulation, when making the decision to disclose records or reports, or information in those records and reports in accordance with this regulation, the local department: Shall consider whether disclosure is in the best interests of children identified in the record; and May withhold information if disclosure is contrary to a child's best interest. Identification of Reporting Source. In making a disclosure under this regulation, a local department shall protect the identity of the reporter and of an individual whose life or safety is likely to be endangered by disclosure. The local department shall not disclose the identity of the individual who reported suspected child abuse or neglect unless: The reporter is a mandated reporter who has given written permission to the local department to make the disclosure; or In a court proceeding: The court has unequivocally ordered the local department to disclose the identity of the reporter; The local department has advised the court if it believes that the disclosure of the identity of the reporter is not necessary for a determination of an issue before the court; and The local department has requested that disclosure of the identification of the reporter be confined to the parties and not further disclosed. The Department may publicize or distribute demographic and statistical data for research purposes if the data does not identify particular individuals or cases. Purpose and Composition of Standing Multidisciplinary Case Consultation Teams. A local department shall have at least one standing multidisciplinary case consultation team that meets on a regular basis to make policy recommendations and provide case direction and services for cases including by not limited to: Complex cases; Cases with multiple referrals from mandated reporters; Cases that are likely to result in multiple indicated findings; Open cases in which there has been a fatality or near fatality; and Other cases brought to the team by team members. A local department shall solicit representatives of the following to serve on a standing multidisciplinary case consultation team: The State's Attorney's office; Law enforcement; Medical, including mental health, professions; Education; Private social services; Domestic violence or sexual assault services; Licensing staff of appropriate agencies; Parole and probation; The Department of Juvenile Services; Substance abuse treatment providers; and Other agencies deemed appropriate by team members. Purpose and Composition of Other Multidisciplinary Case Consultation Teams. The local department may convene a multidisciplinary case consultation team on an ad hoc basis to assist in a CPS response or provision of services in a particular case with representatives from the appropriate entities specified in §A(2) of this regulation. Reports Concerning Child Care Centers or Family Day Care Homes. If a report concerns alleged child abuse or neglect in a child care center or family day care home, the local department shall assist the Office of Child Care's regional manager in convening a multidisciplinary case consultation team to assist the agencies in fulfilling their responsibilities under the written agreement developed pursuant to Regulation .23A of this chapter and Family Law Article, §5-706(f), Annotated Code of Maryland. The multidisciplinary case consultation team shall be chaired by the Office of Child Care’s regional manager and include representatives from the: Local department and law enforcement agency investigating the report; State's Attorney's office; and Appropriate medical, including mental health, professions. In cases other than those specified in §B(2) of this regulation, involving reports of child abuse and neglect in out-of-home care, the local department shall consider whether to convene a multidisciplinary case consultation team soliciting participation from: The State's Attorney's office; The appropriate law enforcement agency; and The licensing, approving, or administering agency. To facilitate the investigation and prosecution of cases of alleged child abuse or neglect, the local department shall enter into a collaborative written agreement pursuant to Family Law Article, §5-706(f), Annotated Code of Maryland, with: Appropriate law enforcement agencies; The State's Attorney's office; The Office of Child Care’s regional manager; The local health officer; and The local child advocacy center. Joint Investigation of Child Sexual Abuse Allegations. To facilitate the investigation of alleged child sexual abuse, the local department shall enter into a collaborative written agreement pursuant to Family Law Article, §5-706(g), Annotated Code of Maryland, with the appropriate law enforcement agencies, child advocacy center, and the State’s Attorney’s office to establish joint investigation procedures. Joint investigation procedures shall include: Using appropriate techniques for expediting investigation of sexual abuse complaints; Establishing an ongoing training program for personnel involved in the investigation or prosecution of sexual abuse cases; and Developing and using investigative techniques designed to minimize: The potential for physical harm to the child; Trauma to the child during the investigation and prosecution of the case; and The potential for influencing the child's statement. An agreement signed pursuant to this regulation must include a provision requiring law enforcement agencies to make available to the local department any and all recordings of interviews with a victim, witness, or alleged maltreator conducted in the course of a joint investigation. When a local department makes a finding of indicated or unsubstantiated child abuse or neglect, the local department shall offer a right to a hearing under Family Law Article, §5-706.1, Annotated Code of Maryland, and COMAR 07.02.26 to an individual whom a local department has found responsible for the child abuse or neglect or, if no maltreator has been identified, to the alleged maltreator. Criminal Law Article, §§3-601, 3-602, and 3-602.1; Family Law Article, Title 5, Subtitle 7; Human Services Article, §§1-202 and 4-207; Annotated Code of MarylandChs. 398 and 399, Acts of 2011 (Agency Note: 42 U.S.C. 5106a(b)(2); 45 CFR §1340.20) Effective date: February 1, 1973 Regulation .03B amended effective January 5, 1977 (4:1 Md. R. 15) Chapter revised effective August 17, 1977 (4:17 Md. R. 1293) Regulations .01 and .05B amended effective November 2, 1979 (6:22 Md. R. 1776) Regulation .07B adopted effective May 2, 1980 (7:9 Md. R. 843) Regulation .11 adopted effective November 2, 1979 (6:22 Md. R. 1776) Chapter revised effective March 6, 1981 (8:5 Md. R. 471) Regulations .02B and .08 amended effective December 20, 1982 (9:25 Md. R. 2477) Regulation .02A, C amended effective December 17, 1984 (11:25 Md. R. 2129) Regulation .02E-1 adopted effective March 11, 1985 (12:5 Md. R. 481) Regulation .05B amended effective December 17, 1984 (11:25 Md. R. 2129) Regulation .09I repealed effective December 17, 1984 (11:25 Md. R. 2129) Regulation .10-1 adopted effective December 17, 1984 (11:25 Md. R. 2129) Regulation .11 amended effective March 11, 1985 (12:5 Md. R. 481) Chapter revised effective February 6, 1989 (16:2 Md. R. 157) Regulations .02, .03, .07, .08, and .14 amended and .07-1 and .19 adopted as an emergency provision effective October 1, 1993 (20:20 Md. R. 1547) Regulations .01—.18 repealed and new Regulations .01—.24 adopted effective October 1, 1994 (21:19 Md. R. 1630) Regulation .02B amended effective November 6, 1995 (22:22 Md. R. 1656) Regulation .05G adopted effective July 1, 1996 (23:13 Md. R. 940) Regulation .07 amended effective August 14, 1995 (22:16 Md. R. 1219) Regulation .22 amended effective August 14, 1995 (22:16 Md. R. 1219) Regulation .23A amended effective November 18, 1996 (23:23 Md. R. 1554) Chapter, Protective Services for Neglected and Abused Children, repealed and new chapter, Child Protective Services—Investigation of Child Abuse and Neglect, adopted effective March 18, 2002 (29:5 Md. R. 500) Regulation .02B amended effective November 19, 2007 (34:23 Md. R. 2025); October 5, 2009 (36:20 Md. R. 1527); September 30, 2013 (40:19 Md. R. 1543) Regulation .03 amended effective October 5, 2009 (36:20 Md. R. 1527) Regulation .04A, B amended effective February 20, 2012 (39:3 Md. R. 258) Regulation .05 amended effective April 11, 2005 (32:7 Md. R. 676); November 19, 2007 (34:23 Md. R. 2025) Regulation .05D amended effective February 20, 2012 (39:3 Md. R. 258) Regulation .06 amended effective November 19, 2007 (34:23 Md. R. 2025); February 20, 2012 (39:3 Md. R. 258) Regulation .07A amended effective November 19, 2007 (34:23 Md. R. 2025) Regulation .07C amended effective February 20, 2012 (39:3 Md. R. 258) Regulation .09A amended effective February 20, 2012 (39:3 Md. R. 258) Regulation .12A,C amended effective November 19, 2007 (34:23 Md. R. 2025) Regulation .14A, B amended effective February 20, 2012 (39:3 Md. R. 258) Regulation .15B,C amended effective November 19, 2007 (34:23 Md. R. 2025) Regulation .17 amended effective November 19, 2007 (34:23 Md. R. 2025) Regulation .18 amended effective November 19, 2007 (34:23 Md. R. 2025) Regulation .19 amended effective June 19, 2006 (33:12 Md. R. 997); November 19, 2007 (34:23 Md. R. 2025); December 27, 2010 (37:26 Md. R. 1786) Regulation .19C amended effective September 22, 2008 (35:19 Md. R. 1716); February 20, 2012 (39:3 Md. R. 258) Regulation .20B amended effective February 20, 2012 (39:3 Md. R. 258) Regulation .21A amended effective February 20, 2012 (39:3 Md. R. 258) Regulations .01—.23 repealed and new Regulations .01—.24 adopted effective June 19, 2017 (44:12 Md. R. 586) Regulation .02B amended effective September 7, 2020 (47:18 Md. R. 824); October 13, 2025 (52:19 Md. 1000) Regulation .03C amended effective October 13, 2025 (52:19 Md. R. 1000) Regulation .06H, J amended effective September 7, 2020 (47:18 Md. R. 824) Regulation .08C amended effective September 7, 2020 (47:18 Md. R. 824) Regulation .09C amended effective September 7, 2020 (47:18 Md. R. 824) Regulation .10C, E amended effective September 7, 2020 (47:18 Md. R. 824) Regulation .11 amended effective September 7, 2020 (47:18 Md. R. 824) Regulation .11A amended effective October 13, 2025 (52:19 Md. R. 1000) Regulation .12A amended effective September 7, 2020 (47:18 Md. R. 824) Regulation .13B amended effective September 7, 2020 (47:18 Md. R. 824) Regulation .14 amended effective September 7, 2020 (47:18 Md. R. 824) Regulation .17B amended effective September 7, 2020 (47:18 Md. R. 824) Regulation .21 amended effective September 7, 2020 (47:18 Md. R. 824) Regulation .23A, B amended effective September 7, 2020 (47:18 Md. R. 824) The purpose of the Substance-Exposed Newborns Program is to address the needs of infants born with and identified as being affected by prenatal exposure to controlled substances or by a fetal alcohol spectrum disorder (FASD) by: Requiring health care practitioners who deliver or care for substance-exposed newborns to make a report to a local department of social services; Assessing the safety of, and risk to, substance-exposed newborns; Developing a plan of safe care for substance-exposed newborns if necessary; and Referring the family for appropriate services. The goals of the Substance-Exposed Newborns Program are to: Provide for the safe discharge of substance-exposed newborns from the hospital; Assist the mother, and other family members, in obtaining treatment related to alcohol or drug use or any other appropriate services or resources that may be needed to address child safety; and Generate accurate reports to assist in the evaluation of this program. In this chapter, the following terms have the meanings indicated. Terms Defined. “Controlled drug” means a controlled dangerous substance included in Schedule I, Schedule II, Schedule III, Schedule IV, or Schedule V under Criminal Law Article, Title 5, Subtitle 4, Annotated Code of Maryland. “FASD” means fetal alcohol spectrum disorder, which is an umbrella term for the wide range of effects from prenatal alcohol exposure, including a broad array of physical defects and cognitive, behavioral, emotional, and adaptive functioning deficits. “Health care practitioner” has the meaning stated in Health Occupations Article, §1-301, Annotated Code of Maryland. “Local department” means the local department of social services in the county where the mother of the substance-exposed newborn resides. “Newborn” means a child younger than 30 days old who is born or who receives care in the State. “Substance-exposed newborn” means a newborn: Who has a positive toxicology screen for a controlled drug as evidenced by an appropriate test after birth; Who displays the effects of controlled drug use or symptoms of withdrawal resulting from prenatal controlled drug exposure as determined by medical personnel; Who displays the effects of FASD; or Whose mother had a positive toxicology screen for a controlled drug at the time of delivery. Except as provided in §C of this regulation, a health care practitioner involved in the delivery or care of a substance-exposed newborn shall: Make an oral report to the local department as soon as possible; and Make a written report to the local department not later than 48 hours after the contact, examination, attention, treatment, or testing that prompted the report. To the extent known, a report made pursuant to this section shall include the following information: The name, date of birth, and intended home address of the newborn; The names and home addresses of the newborn’s parents; The nature and extent of the effects of the prenatal alcohol or controlled drug exposure on the newborn; The newborn’s medical condition and any current or ongoing health care needs, including an extended hospital stay prior to discharge, specific medical procedures, medication, specialized equipment, or ongoing monitoring; Whether and when the newborn’s mother had prenatal care; The nature and extent of the mother’s current drug use; The extent to which the mother is responsive to the newborn’s needs and is involved with providing care; The extent of any limitation of the mother’s cognitive skills; The nature and extent of any history of mental illness; and Any additional information regarding: The nature and extent of the impact of the prenatal alcohol or controlled drug exposure on the mother’s ability to provide proper care and attention; and The nature and extent of the risk of harm to the newborn. A health care practitioner is not required to make a report under this section if the health care practitioner: Has knowledge that the head of an institution, a designee of the head, or another individual at that institution has made a report regarding the substance-exposed newborn; Has verified that, at the time of delivery, the mother was using a controlled drug as currently prescribed for the mother by a licensed health care practitioner; or Has verified that, at the time of delivery, the presence of the controlled drug was consistent with a prescribed medical or drug treatment administered to the mother or the newborn. The provisions of §C of this regulation do not relieve the health care practitioner of the obligation as a mandated reporter to make a report to the local department if the health care practitioner has reason to believe that the substance-exposed newborn has been abused or neglected. Within 48 hours after receiving a report of a substance-exposed newborn, the local department shall: See the newborn in person; Consult with a health care practitioner with knowledge of the newborn’s condition and the effects of any prenatal alcohol or controlled drug exposure; and Attempt to interview the newborn’s mother and any other individual responsible for care of the newborn. Promptly after receiving a report, the local department shall assess the safety of, and risk of harm to, the newborn to determine whether any further intervention is necessary. The assessment may include but is not limited to consideration of the following: Prior child protective services involvement; The mother’s prior delivery of a substance-exposed newborn; The nature and extent of mother’s alcohol and controlled drug use and treatment history; The mother’s level of cooperation and willingness to address concerns; The extent and availability of the newborn’s family or other individuals to assist with caregiving and the provision of other support; Evidence of preparations for the newborn’s birth; Availability of stable housing with no apparent safety or health hazards; and The nature and extent of drug use in the home. If, after the assessment, intervention is necessary, the local department shall: Develop a plan of safe care for the newborn; Refer the family for appropriate services including alcohol or controlled drug treatment; and As necessary, develop a plan to monitor the safety of the newborn and the family’s participation in appropriate services. Reports made under this chapter do not create a presumption that a child has been or will be abused or neglected. Family Law Article, §5-704.2, Annotated Code of Maryland(Federal Authority: U.S.C. 42 §5106b) Effective date: December 23, 2013 (40:25 Md. R. 2067) This chapter establishes the requirements, rights, and responsibilities of kinship caregivers and local departments. The primary purposes of these regulations are to: Prioritize and support the placement of children in care with relatives, kin, or other individuals who have a close relationship to a child in care or the child in care’s family; Establish standards to license and compensate kinship caregivers for children in care; Establish a standard that local departments place children in care with kinship caregivers who will provide the children in care with safe, nurturing, and trauma-informed environments where their connections with family are supported and maintained; Reduce placement disruptions through well-supported kinship care; and Provide a structured framework for kinship caregivers to collaborate in parenting the child in care, offer mentorship to the child in care's parents or guardians, and actively participate in the reunification and permanency planning process. In this chapter, the following terms have the meanings indicated. Terms Defined. “Abuse” means: Child abuse as defined in Family Law Article, §5-701, Annotated Code of Maryland; or Sexual abuse of a child as defined in Family Law Article, §5-701, Annotated Code of Maryland, whether or not a child sustains physical injuries. “Administration” means the Social Services Administration of the Department of Human Services. “Adoption” means the legal proceeding by which an individual becomes the child of an adoptive family and has all the legal rights and privileges to which a child born to that family would be entitled. “Case plan” has the meaning stated in COMAR 07.02.11 “Child” means an individual under age 18. “Child in care” means a child or young adult for whom the local department has responsibility for placement, care, custody, or guardianship. “Child in care’s family” means the child in care’s birth family, adoptive family, or legal guardians. “CPS” means the child protective services unit that responds to reports of suspected child abuse or neglect pursuant to Family Law Article §5-701 et. seq. “Day” means a calendar day unless otherwise specified. “Department” means the Department of Human Services. “Family” means the basic family unit consisting of one or more adults and children related by blood, marriage, adoption, legal guardianship, or domestic partnership as that term is defined in Health General Article, §6-101, Annotated Code of Maryland. “Household” means the location where the applicant or licensed kinship caregiver resides. “Household member” means an individual who lives in or is regularly present in a household. “Kin” means an individual who is related to the child through blood or marriage, adoption, tribal law or custom, or cultural custom or practice; or an individual who is unrelated to the child, but has a strong familial or significant bond with the child, or is a person identified by the child’s parent. “Kinship care” means continuous 24-hour care and supportive services provided for a child in care placed in the home of a kinship caregiver. “Kinship caregiver” means an individual who is at least 18 years old and with whom a child in care may be placed for temporary or long–term care; and Is related to a child in care through blood or marriage, adoption, tribal law or custom, or cultural custom or practice; and If not related as in (a) of this subsection, has a strong familial or other significant bond to such child, or is a person identified by the child’s parent. “Kinship resource home” means the residence of an individual or individuals who are licensed as a kinship caregiver. “Licensed” means approved by a local department as a kinship caregiver and a resource for custody and guardianship or adoption of a child in care. “Local department” means a department of social services in a county, Baltimore City, or the Montgomery County Department of Health and Human Services. “Local director” means the director of a local department. “Monthly care stipend” means financial support that a local department provides a kinship caregiver to assist them with caring for a child in care placed in the home. “Neglect” means child neglect as defined in Family Law Article, §5-701, Annotated Code of Maryland. “Out-of-home care” means out-of-home placement and the monitoring of and services provided to a child in aftercare following a child’s out-of-home placement. “Out-of-home placement” means a living arrangement for a child in care, including foster care, kinship care, group care, or residential treatment care. “Parent” means the legal mother or father of a child or young adult whose rights have not been terminated or a legal guardian other than a local department. “Permanency plan” means a plan specifying where and with whom a child in care will live and the proposed legal relationship between the child in care and the temporary or permanent caregivers. “Regularly present in the household” means visiting or staying in a home with sufficient frequency to make an individual a significant part of the household. “Secondhand smoke” means a complex mixture of gasses and particles that includes: Sidestream smoke, that is, smoke from a burning cigarette, cigar, or pipe; and Exhaled mainstream smoke. “Worker” means a local department staff person assigned to work with and support a kinship caregiver or a child in care. “Young adult” means an individual 18 years old or older but not yet 21. Background Clearance. Before or at the time of placing a child in care with a kinship caregiver, the local department shall: Review the following for any kinship caregiver or adult household member: Child protective services records; State and national sex offender registries; and Maryland Judiciary Case Search; Require the kinship caregiver and all household members 18 years old or older to apply within 5 business days for a State and federal fingerprint-based criminal background clearance at location(s) provided by the local department and at no cost to the caregiver or other adults in the home; Ask if any adult in the home has lived out of state in the last 5 years. If yes, the local department shall request documentation from the other state’s state-maintained child abuse and neglect registry; and As soon as they become available, review the results of: Child protective services clearances; State and federal fingerprint-based criminal background clearance; and Out-of-state CPS clearances from any state that a kinship caregiver or household member 18 years old or older has lived within the prior 5 years to determine whether that individual has been found responsible for child abuse or neglect. Disqualifiers. The local department may not license any home in which an adult in the household: Has a felony conviction for: Child abuse or neglect; Spousal abuse; A crime against a child or children, including child pornography; A crime of violence as enumerated in Criminal Law Article, § 14-101, Annotated Code of Maryland, including rape, sexual assault, or homicide, but not including other physical assault or battery; or Human trafficking; or Has had a felony conviction in the prior 5 years for: Physical assault; Battery; or A drug-related offense. Assessment. Before or at the time of placing a child in care with a kinship caregiver, the local department shall conduct a visit at the home of the kinship caregiver to assess the kinship caregiver and their home using the Kinship Caregiver and Home Assessment approved by the Administration to: Assess the caregiver’s willingness and ability to work with the local department and the child’s family, and to provide for the child in care’s physical, medical, mental health, and educational needs; Provide an individualized assessment and objective facts to determine whether the kinship caregiver can meet the physical and mental health needs of the child in care, with consideration of the need for additional support, or reasonable accommodations, or a reasonable modification of policies, practices, or procedures, and including the nature, duration, and severity of a risk to the child, and the likelihood that potential injury to the child will occur. The assessment may not be based on stereotypes or generalizations. Assess the health and safety of the home to include the condition of the home, fire safety, window covering safety, water safety, storage of firearms, and other items potentially dangerous to children; Ensure the kinship caregiver provides a safe sleeping arrangement for the child in care, which may include a bunk bed, trundle bed, or another arrangement the local department deems appropriate, taking into account the age and abilities of the child in car; and. Identify any endangering health or safety concerns and discuss the concerns with the kinship caregiver to: Create a plan with the kinship caregiver on how the local department will assist and support the kinship caregiver in addressing the health and safety concerns, including, as appropriate, identifying and providing auxiliary aids or services or making reasonable modifications to policies, practices, or procedures without jeopardizing the safety of the child in care; Conduct a follow-up inspection as necessary to determine whether the kinship caregiver has addressed the health and safety concerns or if providing auxiliary aids, services, modifications to policies, practices or procedures, or additional support is needed; and Evaluate whether the child in care can remain safely in the home while the kinship caregiver is addressing the concerns. Emergency Placement. If, due to emergency circumstances or time constraints, the local department cannot complete the Kinship Caregiver and Home Assessment before or at the time of placement, a worker shall: Ensure there are no conditions that would render the child in care unsafe until the local department can complete the assessment; and Schedule and conduct a home visit within 5 calendar days from the day of placement, to complete the Kinship Caregiver and Home Assessment. Medical and Mental Health Conditions. If, after an individualized assessment, the local department has established with objective evidence that a kinship caregiver, family member of the caregiver, or household member has a medical or mental health condition that poses a significant risk to the health or safety of the child in care that cannot be improved by a reasonable accommodation or reasonable modification to policies, practices, or procedures, the local department shall request that the kinship caregiver, family member of the caregiver, or household member: Have a medical or mental health examination of a general or specific nature as directed by the local department; and Provide documentation from the examining healthcare provider stating that the medical or mental health condition is not likely to prevent the child in care from receiving care and attention in the home and is not communicable, or harmful to the child in care, or Identify auxiliary aids or services that improve safety concerns. Monthly Care Stipend. As soon as a worker has identified a kinship caregiver with whom to place a child in care, the worker shall take all steps necessary to ensure that the kinship caregiver receives a monthly care stipend starting on the date of placement and for the duration of the placement. Licensing. When a local department has determined that the kinship caregiver, any adult household member, and the kinship resource home have met the requirements of this chapter, the kinship caregiver shall be deemed fully licensed to provide care for any child in care who is identified as kin and may be an adoptive resource, or eligible for custody and guardianship of the child in care, without the need for additional licensing; An individual shall be at least 18 years old to be licensed as a kinship caregiver; An individual licensed under this chapter as a licensed kinship caregiver is dually licensed for both foster care and adoption; and The local department will provide the kinship caregiver with a written license. Kinship Caregivers Who Provide Child Care. If a kinship caregiver provides informal child care for children not living in the home, the local department shall assess the impact that this may have on the kinship caregiver’s ability to provide for the physical, medical, mental health and educational needs of the child in care. The local department shall inform kinship caregivers licensed by the Maryland Office of Child Care of the need to notify the Maryland Office of Child Care of their intent to be licensed kinship caregivers. Plans for Child Care and Alternative Supervision. If a kinship caregiver requires child care services for a child in care while the kinship caregiver is employed or in school: The kinship caregiver shall discuss the child care plan with the local department and obtain local department approval for the plan; and The child care provider shall be certified by the Maryland State Department of Education Office of Child Care or approved by another agency that provides child care services consistent with the licensing standards of the Maryland Department of Education Office of Child Care, unless the local department approves a plan for informal child care. Nothing in this section precludes a kinship caregiver from arranging appropriate child care on an occasional basis for a child in care. Education. Homeschooling. Kinship caregivers: May not homeschool children in care without court approval; Shall utilize a homeschool program approved by Maryland State Department of Education; and Shall provide homeschool progress reports at a frequency established by the local department or the court. Private or Parochial Schooling. A kinship caregiver shall get approval from the local department or the child in care’s parents or guardians before enrolling a child in care in a private or parochial school unless otherwise ordered by the court. If a local department, the court, or the child in care’s parents or guardians approve a child in care’s enrollment in a private or parochial school, the local department: May not pay any costs for tuition, books, or any other costs associated with a child in care enrolled in an accredited private or parochial school; and May not supplement the monthly care stipend to pay these costs. Enrollment. When a child who comes into care is already enrolled in an accredited private or parochial school, the kinship caregiver shall enroll the child in a public school unless the kinship caregiver, with the permission of the local department, the court, or the child’s parents or guardians, assumes financial responsibility for the child’s continued enrollment in the private or parochial school or the parents or guardians continue to financially provide for the education. The local department may decline to license a kinship caregiver if: The kinship caregiver, an adult household member or the kinship resource home cannot or will not meet the requirements of this chapter; The local department determines that the kinship caregiver knowingly reported false information having a substantial bearing on the licensing of the home; The local department has previously denied or revoked the kinship caregiver’s license, unless the local department is satisfied that the kinship caregiver has corrected the condition that was the basis for the denial or revocation; The kinship caregiver prevents the local department from completing its licensing responsibilities; The kinship caregiver or adult household member has been convicted of a crime identified in Regulation .03B of this chapter; An evaluation of criminal convictions other than those identified in Regulation .03B of this chapter indicates behavior harmful to children, taking into consideration all relevant factors, including the relationship of the crime to the capacity to care for children; Based on facts substantiated by objective evidence and taking into account the age and abilities of the child in care, the local department concludes a kinship caregiver cannot provide for the child in care’s physical, medical, mental health and educational needs because of: A kinship caregiver or adult household member’s history of child abuse and neglect findings; Substance or alcohol misuse; Physical or mental health conditions; or A condition or combination of conditions that cannot be improved and prevent the kinship caregiver from providing for the child in care’s physical, emotional, medical, or educational needs. Before issuing any denial, the local department shall provide a secondary review process in accordance with policy established by the Administration. This process shall include: Assessing the licensing materials to ensure compliance with the licensing requirements stipulated in this chapter and addressing any identified areas of concern; and Evaluating the proposed grounds for the proposed denial to determine whether the evidence substantiates the local department’s decision, with particular emphasis on determining that the safety of the child in care would be compromised. A local department shall review each kinship caregiver and home: Annually; or If there are significant changes in the lives of the kinship caregiver or household, discuss the significant change and determine if a review is necessary. Significant changes may include: Illness or death of a household member; Marital problems or significant conflict in the household; A move to a new residence; Suspected abuse or neglect in the home; and Changes in family composition due to individuals leaving or joining the household, marriage, separation, divorce, or another occurrence. In an annual review, the local department shall: Conduct at least one home visit to determine continuing compliance with this chapter; Review child protective services records, criminal background records, state and national sex offender registries, and the results of a search in the Maryland Judiciary Case Search for the kinship caregiver and all household members 18 years old or older; and Meet with the kinship caregiver to discuss the prior year and concerns and needs of the kinship caregiver. In any review under this regulation, the local department shall: Conduct a kinship caregiver assessment of any new kinship caregiver who has not previously had an assessment as required by this regulation; Require that a new kinship caregiver or household member 18 or older apply within 5 business days for a State and federal fingerprint-based criminal background clearance and consent to a child abuse and neglect clearance; When applicable, require that: Any new kinship caregiver has a medical examination if requested by the local department for a reason set forth in Regulation .03E of this chapter: Any new kinship caregiver sign the required forms and a Resource Parent and Kinship Caregiver Agreement; Identify any circumstances or conditions that may affect continued placement of the child in care with the kinship caregiver and any other matters having a bearing on the child in care’s physical, emotional, medical, or educational needs; and Identify resources and develop a plan to address and resolve any outstanding health or safety concerns by an agreed-upon date. A worker shall notify the kinship caregiver in writing within 30 days of completing the review of the kinship caregiver’s license status. A kinship caregiver license can be revoked or suspended for any violation of a regulation in this chapter. If the kinship caregiver moves to a new residence, the local department shall assess the home by completing a new Kinship Caregiver and Home Assessment. A local department shall: Provide individualized case-by-case safety assessments consistent with facts and objective evidence; and apply legitimate requirements necessary to meet the physical, emotional, medical, or educational needs of the child in care that are not based on stereotypes or generalizations; and provide a reasonable modification of policies, practices, or procedures, or auxiliary aids or services to ensure an equal opportunity to be licensed as a kinship caregiver; Help kinship caregivers understand their rights and responsibilities; Consistent with Regulation .08A of this chapter, provide the kinship caregivers with all information that is available about the child in care and the reason the local department took the child into care; Advise the kinship caregiver about medical requirements regarding children in care; Provide the kinship caregiver with a health passport for each child in care placed in the home and determine the kinship caregiver’s role in health care and educational decision-making; Maintain regular contact with the kinship caregiver and the child in care; Provide appropriate supportive services that will enable the kinship caregiver to meet the unique needs of the child in care; Respond as soon as possible or provide appropriate crisis response contacts for crisis situations that may arise from the child's placement in the kinship resource home; Upon placement, initiate a monthly care stipend for the kinship caregiver, explain the initial clothing allowance and how to obtain payment or reimbursement for allowable expenditures made to meet the needs of the child in care, including child care; Inform the kinship caregiver of any requirements in the service plan that would directly affect a child in care; Inform the kinship caregiver of the child in care’s permanency plan, including family finding efforts, keep them updated as to the progress of that plan, and give the kinship caregiver the ability to provide input as to the plan; Obtain the agreement of the kinship caregiver for any visitation plan that involves the use of the kinship caregiver’s home or requires the kinship caregiver to transport the child in care, with attempts made to balance the kinship caregiver’s right to privacy with the right of the parents or guardians to visit the child; and Assist the kinship caregiver in preparation for the separation of the child from out-of-home care. An individualized assessment consistent with facts and objective evidence and an equal opportunity to be licensed as a kinship caregiver. Information About a Child in Care. Before a local department places a child in care and upon learning new information, the worker shall provide the kinship caregiver with all known information about the child’s medical, mental health, behavioral, educational, social, and emotional background, including the reason the child in care entered care and any change in the case plan. Information about the child's family that may be privileged or confidential may not be disclosed. Monthly Care Stipend. Upon placement, the kinship caregiver has a right to a timely monthly care stipend, an initial clothing allowance if this is the child in care’s first placement, and timely reimbursement for allowable expenditures made to meet the child in care’s needs, including child care. Notice of Court Hearings and Meetings. Except for meetings covered by attorney-client privilege, or meetings when confidential information about the parents or legal guardians is discussed, the worker shall advise the kinship caregiver of: The date and time of, and when applicable, right to participate in, family team decision meetings and educational or mental health team meetings regarding a child in care placed in the kinship resource home; Unless waived for good cause, at least 10 days before scheduled court proceedings, the date and time of any scheduled court hearing; The right to be heard at court hearings; Recommendations the local department will make in court regarding the child in care’s permanency plan, placement, or visitation; and Decisions made by the local department and court regarding a child in care placed in the kinship resource home. Advance Notice of Removal. Except as waived by court order or when the local department determines that a child in care is at imminent risk of harm, the local department shall give the kinship caregiver reasonable written notice of plans to remove the child from the kinship resource home. Responsibilities to a Child in Care. A kinship caregiver shall: Participate in the child in care’s physical health, mental health, and dental health care, including documenting every healthcare visit in the child in care’s health passport and advising the child in care’s worker; Participate in the child in care's educational process; Provide supervision and guidance appropriate to the child in care’s age and developmental level; Provide daily essentials that are required for the health, comfort, and personal care of a child in care; Help the child in care cope with any anxiety of being away from the child in care’s family or guardians and promote the child in care's self-esteem and positive self-image; Respect the child in care and the child in care's family and kin; Whenever possible engage and partner with the child in care’s family and kin; Be sensitive to and respect the child in care's individual needs, tastes, and values, and support the child in care's religious beliefs, cultural customs, sexual orientation, gender identity and expression; Involve the child in care in family activities; Establish clear expectations for and limits on behavior; Provide or arrange transportation to appointments, extracurricular activities, employment, social, and cultural events; Support the child in care in understanding their permanency plan and any move from the kinship resource home; Provide an environment free from exposure to secondhand smoke for children in care; and Protect confidential information regarding a child in care and their family. Responsibilities to a Child in Care's Family. A kinship caregiver shall: Assist the local department in maintaining and improving the child in care's relationship with the child in care’s family and support this relationship by helping with family visits, which may include visits in the kinship resource home; Maintain an attitude of respect and understanding towards the child in care’s parents or legal guardians; Provide regular updates and information about the child in care's life; and Serve as a role model for the child in care’s parents or legal guardians. Responsibilities to the Local Department. A kinship caregiver shall: Work as a team member in assessing a child in care's strengths and needs, and implementing the child in care's case plan; Update the local department on the child in care's development and adjustment; Attend case reviews and meetings as requested by the local department; Immediately notify the local department of changes within the kinship caregiver’s family, such as: Employment and child care arrangements; Composition of the household; Address, telephone number, and email address; Health status; and Stressful conditions that may affect the child in care. Provide at least 30 days notice when requesting a child in care be moved except in circumstances that immediately affect the child in care or resource family’s health or safety; Report any suspected incidence of child physical or sexual abuse or neglect to the local department as soon as the incident becomes known to the kinship caregiver; Notify the local department if a child in care runs away or otherwise cannot be located; and Notify the local department of any criminal charges, investigations, or findings related to any crime committed by a household member, as identified in Regulation .03B of this chapter. The local department shall provide kinship caregivers with developmentally appropriate and trauma-responsive resources to manage the behaviors of children in care, including behavior management methods, and connect the kinship caregiver with community programs to address concerning behaviors. Kinship caregivers shall establish clear expectations for behavior and understand and manage challenging behaviors in a trauma-responsive manner, rewarding good behavior. Only a kinship caregiver or other adult caregiver approved by the local department and known to the children in care may discipline children in care. Kinship caregivers may only physically restrain a child in care to protect the child in care from self-injury or from injuring others. Prohibited punishments include: Using corporal punishment that includes spanking, shaking, physical hitting, or any other type of physical punishment, no matter how inflicted; Requiring physical exercises such as running laps or performing pushups; Forcing a child in care to assume or hold an uncomfortable position, such as squatting or bending, or to repeat physical movements; Confining a child in care in a locked room; Using mechanical or chemical restraints; Making remarks that belittle or ridicule a child in care or a child in care's family; Denying essential program services, such as not taking a child in care to a planned appointment for educational, psychiatric, or psychological services; Withholding visitation or communication with the child in care’s family; Withholding meals, clothing, or bedding, or disrupting a child in care’s sleep; and Threatening to have a child in care removed from the home. Initial Notification. If the local department receives a report of suspected abuse or neglect and initiates an investigation, the local department shall; Notify the kinship caregiver that a report of abuse or neglect has been made. Notify the parents or guardians of any child in care living in the kinship resource home and the child in care’s attorney. Investigation. The CPS unit of a local department shall respond to the report of abuse or neglect as required by COMAR 07.02.07. An allegation of abuse or neglect in a kinship resource home does not require the automatic removal of children in care placed in the kinship resource home. The local department shall assess and determine whether it is in the best interests of any children in care placed in the kinship resource home to remain in the kinship resource home pending completion of the investigation. A local department staff member shall visit the kinship resource home at least weekly as long as any children in care remain in the home until the local department decides whether to continue the child in care’s placement with the kinship caregiver. A local department shall not place additional children in care in the home for care or respite care pending the outcome of the investigation and a decision by the local director or designee as to whether the child in care’s placement with the kinship caregiver will continue. The worker and kinship caregiver may take any necessary actions to ensure the safety of the alleged victim pending completion of the investigation, but shall not create a safety plan for children in care. Continued Licensure of a Kinship Resource Home. Within 5 business days of completing the investigation, the local department shall determine whether the kinship caregiver, household members, and kinship resource home still meet the standards for a license and make a recommendation to the local director regarding continued licensure of the kinship caregiver. Within 5 business days after receiving the recommendation of the staff, the local director shall render a written decision as to the continued licensure of the kinship caregiver and whether any children in care removed from the kinship resource home may be returned. The local department shall provide the written decision to the parents or guardians of any children in care living in the kinship resource home, the attorneys for those children in care, and the kinship caregiver. A copy of the local director's decision shall be forwarded to the Administration and uploaded into the electronic system of record of the kinship caregiver and any children in care placed in the home when the alleged abuse or neglect occurred. Grounds. A local department may close a kinship resource home and revoke a kinship caregiver license for any of the following reasons: The child in care for whom the kinship caregiver was caring no longer lives in the home and is not expected to return within 6 months; The kinship caregiver has asked the local department to remove the child in care; On-going conditions or combination of conditions that cannot be improved and prevent the kinship caregiver from providing for the physical, medical, mental health, and educational needs of the child in care; and Misconduct in the kinship resource home, indicated abuse or neglect of a child in care, or other conditions that cannot be improved and pose an immediate threat to a child in care’s health or safety. Notice of Closure and Revocation. The local department shall provide written notice of the decision to close the home and revoke the kinship caregiver’s license, including the action the local department will take, the grounds for the action, and a description of the kinship caregiver’s appeal rights. Removal of Children in Care upon Revocation. Upon deciding to revoke the license of a kinship caregiver, the local department shall immediately remove children in care placed in the home. Relicensure After Closure and Revocation. Once revoked, a local department may not restore a kinship caregiver’s license unless: The local department determines that the kinship caregiver's license was not revoked due to noncompliance with any regulation in this chapter and the kinship caregiver undergoes the relicensing process. There has been an appeal hearing decision favorable to the kinship caregiver; or The local director has given written approval for the relicensing. Appeal Rights. A kinship caregiver aggrieved by a local department's decision to deny, suspend, or revoke a license may appeal under COMAR 07.01.04. Exclusive Jurisdiction of Courts. A kinship caregiver may not use these procedures to appeal a court’s decision or a decision that only a court can make. Expedited Appeal. A kinship caregiver who intends to adopt a child the local department has placed in the kinship caregiver’s home may appeal a local department’s decision to remove the child by advising the local department within 30 days of the removal. The local department shall notify the Office of Administrative Hearings of the appeal; and The Office of Administrative Hearings shall hold a hearing and issue a decision within 45 days of receiving the request. Additional Hearing Rights Under COMAR 07.02.26. If a local department removes a child in care from a kinship resource home because of a child protective services finding, the local department shall advise the kinship caregiver of the rights of the alleged maltreater to request a hearing under COMAR 07.02.26 to challenge that finding. Effective date: March 20, 2000 (27:5 Md. R. 581) Chapter repealed effective April 16, 2012 (39:7 Md. R. 490) New Regulations .01 — .13 adopted effective December 12, 2024 (51:24 Md. R. 1081) The purpose of Youth Transitional Services is to prepare and assist youth to make the transition to successful adulthood. Services are designed to promote self-sufficiency and responsible living. In this chapter, the following terms have the meanings indicated. Terms Defined. “Administration” means the Social Services Administration. “Agency” means an organization licensed to provide transitional services to youth. “Benchmark” means specific strategies and actions that focus on preparing youth for independence. “Case manager” means the individual or agent of a local department or provider agency responsible for: Assisting in implementing the permanency plan; and Ensuring the provision of needed services to the youth. “Case plan” means a written description of the youth's needs and services to be provided to meet those needs as outlined in COMAR 07.02.11. “Department” means the Department of Human Services. “Flexible funds” means transitional youth funds available to local departments for the purchase of goods and services necessary to support the objectives of the case plan when no other resource is available. “Foster care” means continuous 24-hour care and supportive services provided for a minor child placed by a child placement agency in an approved family home. “Independent living aftercare” means services provided to a former foster care youth who was in out-of-home placement on their 18th birthday but has not attained the age of 21 or who after attaining 16 years of age, left foster care for kinship guardianship or adoption. “Local department” means the local department of social services in a county or Baltimore City and the Montgomery County Department of Health and Human Services. “Local department independent living coordinator” means the staff person within a local department responsible for coordination of independent living activities for youth within that jurisdiction. “Mentor” means an adult approved by the State or local government who has volunteered to act as a role model and provide positive guidance and support to youth in out-of-home placement. “Permanency plan” means a plan specifying: Where the youth shall live; With whom the youth shall live; and The proposed legal relationship between the youth and the permanent caretaker or caretakers. “Provider agency” means a licensed child placement agency. “Room and board” means a shared or independent living arrangement that includes food and shelter. “Semi-independent living” means a subsidized living arrangement for youth 16 to 21 years old receiving youth transitional services. “Semi-independent living arrangement” means an apartment, boarder arrangement, or other living arrangement approved by the local department, except that a local department may not approve an arrangement for housing in a transient or emergency-type facility, such as a rescue mission, nonresidential hotel, motel, adult shelter, or tourist home. “Service agreement” means a written plan that specifies: The youth transitional service goals for the youth; Tasks required to meet the needs of the youth; Those individuals responsible for completion of the tasks; The time frame for completion of the tasks; and Consent of all parties to the service agreement. “State Independent Living Coordinator” means the individual who administers the Statewide services. “Strengths and needs assessment” means a written assessment identifying the youth's: Strengths; Weaknesses; Living skills; Employability; and Education level. “Successful adulthood” means when a youth exits the foster care system with the transitional skills to become self-sufficient as age and developmentally appropriate for the individual youth. “Youth advisory board” means a group of foster youth who provide input in the planning, design, and implementation of youth transitional activities and services. “Youth Transitional Services" means providing services and supervision to prepare youth for self-sufficiency after discharge from out-of-home placement. To be eligible for youth transitional services, a youth shall be age 14 to 21 years old, committed to a local department or in out-of-home placement pursuant to a voluntary placement agreement. Youth 14 to 21 years old are eligible for age appropriate youth transitional services, regardless of the type of placement or permanency plan. Youth transitional services shall be made available to all eligible youth and shall include the following components: Assessment services; Service agreement; Case plan; Transition plan; Case management services; and Semi-independent living services. The local department shall promote youth participation in youth transitional services in order to encourage youth to accept responsibility for: Preparing for adulthood; and Making the transition from adolescence to successful adulthood. Youth who participate in youth transitional services shall have a strengths and needs assessment that identifies the youth's: Strengths and weaknesses; Independent living skills; Education level; Employability; Emotional and support systems; Documented disability or special needs; Financial resources; Housing needs; and Life goals, including such topics as: Occupation; Housing; Family life; and Health care decisions. The assessment shall be used as a tool for the youth and the caseworker to develop specific tasks: To move the youth towards the goal of self-sufficiency; and Which may be included in the youth's service agreement. A safety assessment shall be conducted in accordance with the safety assessment established by the Department. The caseworker shall consult with youth beginning at the age of 14 to establish appropriate benchmarks. Individual benchmarks shall be established in the following areas: Education; Employment; Health and mental health; Housing; Financial literacy and resources; and Family and friends support. Benchmarks shall be reviewed at least every 180 days. Youth who participate in youth transitional services shall have a case plan as described in COMAR 07.02.11. In addition to the components required by COMAR 07.02.11, the case plan shall include: The youth's strength and needs assessment; A description of the youth's current living arrangements; Educational placement; Health care status; Documentation of special needs; A personal budget; Benchmarks; A signed service agreement; and A discussion of progress made by the youth towards the goal or goals identified in the youth transitional services agreement. Youth who participate in youth transitional services shall have a service agreement as described in COMAR 07.02.11. The service agreement shall establish: Youth transitional services goals; Tasks required to meet the service goals; Individuals responsible for completion of tasks; and Time frames for completion of tasks. For the semi-independent living arrangement, the service agreement shall also include the following: A plan for financing a semi-independent living arrangement, which specifies: The local department's contribution as delineated in Regulation .15 of this chapter; The youth's contribution as set forth in Regulation .15 of this chapter; The date by which it is anticipated the youth's income may increase to enable the youth to become financially self-sufficient; A statement that the youth's subsidy shall be decreased when the youth's income increases; A statement that the local department shall stop subsidy payments if the youth fails to comply with the service agreement; and A statement explaining the youth's responsibility to inform the local department within 72 hours of any: Changes in the youth's situation, including termination, transfer, or resignation of employment; Termination, resignation, or failure to participate in education or training programs; Housing relocation; or Arrest. As appropriate, youth 18 to 21 years old receiving independent living aftercare services shall have a service agreement which supports the following areas, as appropriate: A plan for making the transition to self-sufficiency, including: Goals; Tasks to be completed; and Individuals responsible for completion of tasks; Education, including post-secondary education; Employment and vocational training; Personal and emotional support; and The youth's efforts to achieve self-sufficiency and recognize and accept personal responsibility in preparing for and making the transition to adulthood. Youth Transition Plan. The caseworker shall prepare a youth for the development of a transition plan 120 days prior to the youth’s 14th birthday. Once a youth in out-of-home placement reaches the age of 14, the caseworker shall work with the youth to develop an individualized transition plan. For youth 14 years and older, the transition plan shall be updated at least every 180 days. Except as applicable in §D(5) of this regulation, the transition plan shall be finalized 90 days prior to the youth’s 18th birthday. For youth 18 to 21 years old, a transition plan shall be updated at least every 180 days, and shall be finalized 90 days prior to the youth attaining the age of 21 or exiting care. The youth transition plan shall be: Personalized at the direction of the youth; and Detailed with regard to choices and options in: Housing; Health insurance; Education; Opportunities for mentors and support services; Employment; and Health, including: mental health, sexual health and family planning; and directives concerning decision making if the youth becomes unable to make healthcare decisions. The youth transition plan shall be documented in the case plan and incorporated in the permanency hearings. Youth 14 to 21 years old committed to a local department or placed in out-of-home placement pursuant to a voluntary placement agreement shall receive youth transitional services, regardless of the type of placement or permanency plan. Services to youth shall be appropriate to the youth's level of education and functioning as determined by the strengths and needs assessment and any documented disability. Youth transitional services for a youth in out-of-home placement include: Identification of the need for vocational, educational, or specialized training to the youth in obtaining independence; Instruction in basic living skills, such as: Decision making and time management; Educational and vocational planning; Home emergency and safety; Housing acquisition and management; Personal hygiene; Physical and mental health care; Substance abuse prevention; Preventive health activities (including smoking avoidance and pregnancy prevention); Understanding legal issues; Selecting positive leisure activities; Money management and consumer awareness; Nutrition and meal planning; Parenting; Effective social interactions; Using transportation; and Activities of daily living; Assistance in seeking and maintaining employment, including techniques for: Job searching; Interviewing; Selecting appropriate attire for the workplace; and Practicing work place etiquette including: Relationships with coworkers; Appropriate language; Employer/employee relationships; and Attendance and punctuality; and Assistance in: Identifying and accessing community resources; and Developing a support network. To ensure that youth participating in youth transitional services are provided personal and emotional support as they make the transition to successful adulthood, referrals shall be made to appropriate mentoring partners to foster positive mentoring relationships between youth and dedicated adults. The caseworker shall provide services to youth that are committed to the local department or in out-of-home placement pursuant to a voluntary placement agreement that address the youth's physical, mental health, and emotional needs as delineated in COMAR 07.02.11. The caseworker shall also provide services, which may include: Making referrals to educational or vocational training programs appropriate to a youth's skills; Supporting and monitoring a youth's compliance with the service agreement; and Maintaining monthly visits or contacts with the youth to support progress toward achievement of the youth's identified goals. The caseworker shall conduct a written review every 180 days to determine the appropriateness of: The youth's living arrangements; Any service agreement; and The youth transitional services provided. The caseworker shall assist the youth to apply for medical assistance before exit from out-of-home placement. The purpose of the semi-independent living arrangement is to provide youth an opportunity to learn and practice independent living skills and activities for a specified time period as indicated in the service agreement while receiving services from the local department and provider agency. A youth 16 to 21 years old may be eligible to participate in a semi-independent living arrangement if the youth: Is continually enrolled in and regularly attending school or vocational training or is working at least 80 hours per month; Agrees to the requirements of the service agreement; Needs help in transitioning to self-sufficiency; and Is capable of contributing to the cost of the semi-independent living arrangement through: Earned income from employment; or Unearned income such as scholarships, stipends, grants, work-study arrangements, Social Security (supplemental security income or survivor's benefits), or any combination. Youth who are interested in residing in a semi-independent living arrangement shall: Meet the eligibility requirements; and Apply to the local department. Youth not meeting the requirements of §B(1) and (3) of this regulation may be eligible for participation in a semi-independent living arrangement if the youth has a documented disability in living skills and the youth's case plan documents how the youth's disability can be accommodated in a semi-independent living arrangement. Youth may live in approved placements as outlined in Regulation .02B(19) of this chapter. Independent living aftercare services are available on a voluntary basis to youth 18 to 21 years old who were in out-of-home placement on their 18th birthday or after attaining the age of 16 exited to kinship guardianship or adoption. Independent living aftercare goals are designed to complement the efforts of former foster care recipients between 18 to 21 years old to achieve self-sufficiency by providing: Financial assistance to purchase goods and services; Temporary assistance with room, board and utilities; Counseling; Employment assistance; Education; Medical assistance; and Other appropriate services to assist with self-sufficiency. Youth are eligible to participate in independent living aftercare services if they: Are 18 to 21 years of age; and Have exited from out-of-home placement after attaining the age of at least 18; or After attaining the age of 16 exited to kinship guardianship or adoption. Participate in the development of a service agreement and sign and comply with its terms; and Need continued help in making the transition to self-sufficiency. Youth who apply for independent living aftercare services shall: Meet eligibility requirements; Receive services from the local department in the jurisdiction in which they reside; and Be subject to an intake screening process by the local department to determine appropriateness of aftercare services. Youth age 18 to 21 years old receiving independent living aftercare services may be provided assistance with room and board that may include: Shared housing; or Independent housing. All Maryland foster youth who were in foster care at 18 years old are eligible to continue to receive medical assistance up to 26 years old in the foster care category. Services may be provided for up to 180 days. Services may be extended with authorization from the local director or the local director's designee. Youth may reapply for services up to 21 years old. The Administration shall conduct training consistent with the goals of the John H. Chaffee Foster Care Independence Act regarding the issues confronting adolescents preparing for independence. Training shall include: Instructions in basic living skills as defined in Regulation .09C(2) of this chapter; Substance abuse; Sexuality; Gang involvement; Violence; Peer pressure; Grief and loss; Education; Employment; Health and mental health; Housing; Financial literacy and resources; and Family and friends support. Training regarding the issues confronting adolescents preparing for independence shall be offered to: Local department staff; Provider agency staff; Group home staff; and Foster and adoptive parents. All purchases shall be made as outlined in COMAR 21.05.01.01. Semi-independent living arrangement payments. The local department may provide funding for youth participating in semi-independent living or enhanced aftercare. The local department may pay a semi-independent living arrangement payment for the youth's participation in youth transitional services to assist youth in obtaining: Food; Transportation; Clothing; Recreation; Education; Housing; and Other approved needs. The maximum semi-independent living arrangement payment may not exceed 100 percent of the regular foster care maintenance rate as delineated in COMAR 07.02.11. The local department shall pay the youth directly, except when the local department determines the youth: Is not in compliance with the service agreement; or Has demonstrated an inability to manage money. When a youth is not paid directly, the youth shall have a representative payee. Flexible Funds. If available, flexible funds may be utilized to pay expenses related to the youth becoming self-sufficient. The local department may approve expenses if the youth's case record documents: A need for the service or item as established in the service agreement; and The service or item is not available without cost elsewhere. The local department may terminate funding as a result of: Youth’s failure to comply with service agreement; Marriage; or Military duty. The local department shall terminate funding if the youth: Reaches 21 years old; Dies; or Voluntarily terminates services. The local department shall notify the youth in writing 30 days before taking action to deny, suspend, reduce, or terminate funding. The notification shall include: The date the funding will be affected; The reason for the action; and Notification of the youth's right to appeal the decision in accordance with COMAR 07.01.04. Upon termination of the funding, the local department shall: Arrange for the youth's placement in another approved foster care setting if the youth is still in out-of-home care or enhanced aftercare; and Continue to provide youth transitional services when the following circumstances exists: The youth is under the jurisdiction of the juvenile court and is committed to a local department for placement or continues under the care of the local department pursuant to a voluntary placement agreement; and The youth 18 to 21 years old is: Completing secondary education or a program leading to an equivalent credential; Enrolled in an institution that provides post-secondary or vocational education; Participating in a program or activity designed to promote or remove barriers to employment; Employed for at least 80 hours per month; or Incapable of doing any of the above described activities due to medical condition, which incapability is supported by regularly updated information in the case plan of the child. Local departments shall establish a youth advisory board to ensure that foster youth are provided the opportunity to participate directly in the design and implementation of transitional services and make recommendations for improvements to the services. The Administration shall establish a State advisory board consisting of representatives from the local department youth advisory boards to directly participate at the statewide level in the design and implementation of transitional services and make recommendations for statewide improvements in the services. The youth advisory board shall: Empower youth to have a positive effect in their communities; Encourage youth to develop leadership skills; Provide an opportunity for youth to network with other youth; Develop a speaker's bureau to represent the board; Enhance partnerships between youth and adults; Assist in planning for and participate in the annual teen conference; and Review State and federal legislation that may affect youth transitional services. Each local department shall appoint one board member and one alternate to serve on the State youth advisory board. The local department shall terminate youth transitional services if the youth is 18 to 21 years old and: The out-of-home placement case is closed; or The youth is not participating in youth transitional services. Before a youth 18—21 years old leaves out-of-home placement, the caseworker shall: Conduct an exit conference with the youth; Schedule a family meeting; Review the transition plan with the youth; Obtain contact information for the youth; Provide the youth, free of charge, with a: Certified birth certificate; Social security card; Health insurance card; and Health passport; and Assist the youth with obtaining either a Maryland identification card or a Maryland driver’s license. Foster care services may not continue after a youth is 21 years old. If appropriate, the local department shall refer the 21-year-old to: The Department's Office of Adult Services; or Other agencies for continuing support to maintain independence. A local department administering youth transitional services shall track: The number of youth receiving transitional and aftercare services; The characteristics of the youth receiving transitional and aftercare services; The type and quantity of services being provided to youth; and The outcomes for participating youth. Outcome measures used to assess the operation and effectiveness of the youth transitional services shall include: Educational attainment; Employment; Avoidance of dependency; Homelessness; Non-marital child birth; Incarceration; and High risk behaviors. National Youth in Transition Database. The purpose is to: Develop a data collection system to track the youth transitional services provided to youth; and Develop outcomes that measure success in preparing youth for their transition from out-of-home placement to independence. The Administration shall collect data on youth in two intervals. The baseline data shall be collected on all youth in out-of-home placement within 20 days of the youth’s 17th birthday to track the needs of the youth. Follow-up data shall be collected when the youth attains 19 years old and 21 years old. Data shall be collected in the following areas: Strength and needs assessment; Academic support; Post-secondary educational support; Career preparation; Employment programs or vocational training; Housing education and home management training; Budget and finance management; Health education and risk prevention; Family support and healthy marriage education; Mentoring; Supervised independent living; Room and board financial assistance; and Education financial assistance. Outcomes shall measure: Financial self-sufficiency; Experience with homelessness; Educational attainment; Positive adult connections; High-risk behavior; and Access to health insurance. The confidentiality of information regarding youth shall be strictly safeguarded according to the confidentiality requirements in COMAR 07.01.07 and the access of records requirements in COMAR 07.01.02. The provider agencies and foster parents shall protect the confidentiality of information regarding the foster youth and their natural parents or guardians or caretakers. The provisions of COMAR 07.01.04 apply to this chapter. Courts and Judicial Proceedings Article, §3-801 et seq.; Family Law Article, §§1-101, 5-501—5-503, 5-524—5-525, 5-527—5-528, and 5-531—5-532; Annotated Code of MarylandAgency Note: Federal Reference: Fostering Connection Act of 2008, PL110-35 Effective date: October 31, 1973 Regulation .04C, G amended effective January 5, 1977 (4:1 Md. R. 15) Chapter revised effective May 18, 1979 (6:10 Md. R. 840) Chapter revised effective September 12, 1983 (10:18 Md. R. 1606) Chapter, Service to Single Parents, repealed effective April 5, 1999 (26:7 Md. R. 542) Regulations .01—.19, Independent Living Preparation Program, adopted effective March 4, 2002 (29:4 Md. R. 416) Regulation .13B, C amended effective October 6, 2008 (35:20 Md. R. 1773) Chapter revised effective April 2, 2012 (39:6 Md. R. 407) Regulation .01 amended effective April 24, 2017 (44:8 Md. R. 401) Regulation .02B amended effective May 12, 2014 (41:9 Md. R. 519); April 24, 2017 (44:8 Md. R. 401) Regulation .03 amended effective May 12, 2014 (41:9 Md. R. 519) Regulation .04B amended effective April 24, 2017 (44:8 Md. R. 401) Regulation .08D amended effective May 22, 2017 (44:10 Md. R. 469) Regulation .09D amended effective April 24, 2017 (44:8 Md. R. 401) Regulation .12 amended effective May 12, 2014 (41:9 Md. R. 519) Regulation .13 repealed effective May 12, 2014 (41:9 Md. R. 519) Regulation .18B amended effective May 22, 2017 (44:10 Md. R. 469) The purpose of the Out-of-Home Placement Program of the Social Services Administration is to: Provide short-term 24-hour a day care and supportive services for a child who is in the custody or guardianship of a local department of social services or who is voluntarily placed outside the family home because the child: Has been abused, abandoned, neglected, is dependent, or has a developmental disability or mental disorder; Is in serious immediate danger; or The child's parents, legal guardian, or custodian are unable or unwilling to give proper care and attention to the child and the child's needs; Provide time-limited family reunification services to a child placed in an out-of-home placement, and to the parents or legal guardian of the child, in order to facilitate the child's safe and timely reunification; and Concurrently develop and implement a plan in the best interests of the child to facilitate a planned, permanent living arrangement for the child who cannot be reunified. The goals of out-of-home placement include: Increasing the percentage of children who are reunified with family, whose caretaker is awarded guardianship, or who are legally adopted; Improving outcomes for children by reducing the: Entry rate of children into out-of-home placement; Median length of time children stay in out-of-home placement; Rate at which children re-enter out-of-home placement; and Number of physical placement changes within 24 months of entering out-of-home placement and the duration of the episode; and Improving outcomes for children by: Increasing the number of reunifications achieved within 12 months of entry into an out-of-home placement; and Decreasing the number of children in out-of-home placement over 24 months. In this chapter, the following terms have the meanings indicated. Terms Defined. “Abandonment” means to leave a child without any provision for support and without any person who has accepted long-term responsibility to maintain care and have custody and control of the child when: The whereabouts of the parents or guardian are unknown; and The local department has made reasonable efforts to locate the parent or guardian over a period of at least 6 months and has been unsuccessful. “Abuse” means: The physical or mental injury of a child under circumstances that indicate that the child's health or welfare is harmed or at substantial risk of being harmed by: A parent or other individual who has permanent or temporary care or custody or responsibility for supervision of a child; or Any household or family member; or Sexual abuse of a child, whether physical injuries are sustained or not. “Administration” means the Social Services Administration. “Adoption” means the legal proceeding: By which an individual becomes the child of an adoptive family; and Which confers on the adopted child all the legal rights and privileges to which a child born to that family would be entitled. “Aftercare services” means a service to the child and caregiver when the child is emerging from out-of-home placement and is no longer in a paid out-of-home placement. “Age or Developmentally Appropriate Activities” means extracurricular, enrichment and social activities that are generally accepted as suitable for children of the same chronological age or level of maturity and that promote cognitive, emotional, physical, and behavioral growth. “Agency error” means failure by the local department to act: Upon information provided within prescribed time limits; or Correctly on information provided. Another Planned Permanent Living Arrangement-APPLA. “Another planned permanent living arrangement (APPLA)” means a permanency plan that addresses the individualized needs of the child, including the child's educational plan, emotional stability, physical placement, and socialization needs. “Another planned permanent living arrangement (APPLA)” includes goals that promote the continuity of relations with individuals who will fill a lasting and significant role in the child's life. “Board rate” means the reimbursement to the out-of-home placement provider for the child's maintenance expenses. “Case plan” means the document described in Regulation .13 of this chapter that includes: The reason the child entered care; The reasonable efforts that were made to prevent placement or reasons why prevention efforts were not appropriate; The identification of the concurrent permanency plans and projected timeframes for achievement of each plan; Whether the placement is the least restrictive and whether safety issues are addressed; The local department's efforts to achieve permanency for the child; The extent to which the court's orders have been carried out; The services offered to the parents or legal guardian; The services delivered to the parents or legal guardian; The extent to which the parents or legal guardian have participated in the development of a service agreement; and The extent to which the parents or legal guardian have complied with the service agreement. “Child” means an individual younger than 18 years old, or between 18 and 21 years old if the court retains jurisdiction over the child and the individual meets the eligibility requirements of Regulation .04B of this chapter. “Child in need of assistance (CINA)” means a child who requires court intervention because: The child has been abused, neglected, has a developmental disability, or has a mental disorder; and The child's parents, guardian, or custodian are unable or unwilling to give proper care and attention to the child and the child's needs. “Children with disabilities voluntary placement” is the placement of a child into out-of-home placement upon the request of the parents or legal guardian without relinquishment of legal custody when the child's disability necessitates care or treatment in an out-of-home placement. “Client error” means failure by the provider to correctly, promptly, or adequately report information to the local department. “Close proximity” means a location physically close enough to facilitate family visiting, consistent with the best interest and special needs of the child. “Concurrent permanency planning” means the process of taking concrete steps to implement both primary and secondary permanency plans, for example, by providing time-limited family reunification services while also exploring relatives as resources. “Cost of care” means all the costs associated with the care of the child in foster care, including the board rate, clothing allowance, and any supplemental expenditures made to meet the child's special needs. “Court” means the circuit court for a county sitting as a juvenile court. “Critical incident” means the abuse or neglect of a child or other serious incident involving a child that occurred in-home or in an out-of-home placement. “Dependent child” means a child who has been deprived of adequate support or care by reason of the death, continued absence from home, or physical, mental, or emotional incapacity or disability of the child's parent, guardian, or other custodian. “Episode” means the interval between the date a child enters an out-of-home placement and the date the out-of-home placement is closed due to the: Rescission of commitment by the court; Child reaching age 21; Finalization of the adoption of the child; or Voluntary placement agreement termination. Foster Care. “Foster care” means continuous 24-hour care and supportive services provided for a minor child placed by a child placement agency in an approved family home. “Foster care” includes: Services to the child's parents or legal guardian, siblings, and relatives in order to achieve a safe, permanent placement for the child; Services to the foster parents and supervision of the child in the foster care placement to assure that the placement promotes the child's physical, emotional, and intellectual growth and well-being; and Aftercare services to the child and the child's caregiver to prevent placement disruption or reentry into out-of-home placement. “Gatekeeper” means the person or system designated as the point of entry for the public treatment foster care program, and who authorizes initial and ongoing treatment eligibility. Group Care. “Group care” means continuous 24-hour care and supportive services provided for a minor child placed in a licensed group facility. “Group care” includes: Services to the child's parents or legal guardian, siblings, and relatives in order to achieve a safe, permanent placement for the child; Supervision of a child in an appropriate group care setting to assure that the placement promotes the child's physical, emotional and intellectual growth and well-being; Post-placement services to the child and the child's caregiver to prevent placement disruption or reentry into out-of-home placement. “Guardianship to agency” means guardianship with the right to consent to adoption or long-term care short of adoption as defined in Family Law Article, §5-301(e), Annotated Code of Maryland, and: Is conferred by the court on the executive head of a child placement agency; and Terminates the rights, duties, and obligations of the birth parents. “Health care services” means the provision of medical services by a qualified licensed health care professional, which includes somatic or physical health, mental health, and dental health services. “Intermediate care” means a payment rate above the regular care rate paid to a foster home for a child requiring extra care and supervision because of special physical, emotional, or behavioral needs. “Kinship care” means continuous 24-hour care and supportive services provided for a minor child placed by a child placement agency in the home of a relative related by blood or marriage within the fifth degree of consanguinity or affinity under Estates and Trusts Article, §1-203, Annotated Code of Maryland. “Least restrictive setting” means the most family-like setting consistent with the best interest and special needs of the child. “Legal guardian” means a person to whom guardianship of a child has been given by order of court, including a court other than the juvenile court. “Local department” means a local department of social services in a county or Baltimore City, and the Montgomery County Department of Health and Human Services. “Medical care” means physical, mental health, or dental treatment provided by a qualified, licensed health care professional. “Mental injury” means the observable, identifiable, and substantial impairment of a child's mental or psychological ability to function resulting from abuse or neglect. “Neglect” means the leaving of a child unattended or other failure to give proper care and attention to a child by any parent or other individual who has permanent or temporary care or custody or responsibility for supervision of the child under circumstances that indicate that: The child's health or welfare is harmed or placed at substantial risk of harm; or There is mental injury, or a substantial risk of mental injury, to the child. “Out-of-home placement” means placement of a child into foster care, kinship care, group care, or residential treatment care. Overpayment. “Overpayment” means the amount of payment received by a foster care provider to which the provider was not entitled because payment was made for a child no longer under the care of, or in the home of, the provider. “Overpayment” includes payment resulting from: Agency error; Client error; Fraud; or Suspected fraud as defined in this regulation. Parent or Parents. “Parent” means: The birth or adoptive mothers or fathers of the child; and Includes by reference both the individual mothers and fathers as applicable. “Parents” means the birth or adoptive mothers and fathers of the child. “Payment irregularity” means an incorrect payment, that may be caused by an overpayment or fraud, which is not consistent with the amount allowable to a private agency provider or a foster care parent approved by the local department. “Permanency plan” means a plan specifying where and with whom the child shall live, and the proposed legal relationship between the child and the permanent caretaker or caretakers. “Progress report” means a provider agency's written update of a child's treatment plan for a specific time period. “Public treatment foster care program” is a treatment foster care program operated by a local department that has been approved by the Administration. “Public treatment foster parent” means a caretaker who is: Approved and trained by a local department public treatment foster care program to perform treatment parenting duties; and Responsible for implementing, monitoring, and assessing the progress of a child's individual treatment within the home setting. “Reasonable and prudent parent standard” means the standard characterized by careful and sensible parental decisions that maintain a child’s health, safety, and best interests while at the same time encouraging the child’s emotional and developmental growth, that an out-of-home placement provider shall use when determining whether to allow a child in foster care under the responsibility of the State, to participate in extracurricular, enrichment, and social activities. “Recoupment” means a process used by local departments to recover overpaid amounts by withholding from foster care payments an amount determined appropriate, as provided in Regulation .35 of this chapter. “Recovery” means a process used by local departments to recover overpaid amounts from former foster care providers. “Regular care” means the rate paid for all children in foster care who require routine care and supervision. “Relative” means an individual who is at least 18 years old and related to the child by blood, marriage or adoption within five degrees of consanguinity or affinity. “Residential treatment” means continuous 24-hour care and supportive services for a minor child placed in a facility that provides formal programs of basic care, social work, and health care services. “Respite care” means short-term care for a child to temporarily relieve the foster family or treatment foster family or caregiver from the responsibility of providing 24-hour care for a child. “Restricted foster home” means a family foster home approved to serve only a specific child. “Return home” has the same meaning as reunification in §B(50) of this regulation. “Reunification” means reuniting the child with the child's parents or legal guardian. “Semi-independent living” means a program for youth 16 through 20 years old who are: Participating in Youth Transitional Services as described in COMAR 07.02.10; Living in a subsidized living arrangement; and Supervised by a local department in an apartment or house. “Serious emotional or behavioral condition” means a limitation of an individual's capacity which adversely affects the individual's ability to perform in the following areas: Daily living skills; Community living skills; Interpersonal relationships; and Appropriate educational activities. “Service plan” means the written plan of activities required of the parent or caregiver and the agency to achieve permanency for the child. “Shelter care order” means the court's authorization to a local department to place a child into an out-of-home placement on an emergency basis. “Sibling” means a child that shares at least one parent with another child through blood relation or adoption. “State” means the State of Maryland. “Substitute care” means care provided by the foster parent or the employed staff of a group care facility. Supportive Services. “Supportive services” means services provided to facilitate achievement of the child's permanency plan. “Supportive services” includes: Casework services to the child's parent, legal guardian, relative or pre-adoptive caregiver; and Supervision of the child's out-of-home placement to ensure the child's safety and well-being. “Suspected fraud” means an individual obtaining or attempting to obtain, or aiding another person in obtaining or attempting to obtain, money to which neither is entitled by willfully: Retaining a check for services to a child or for a period that was already paid in full; or Making a false statement or representation to the local department. Termination of Parental Rights means the legal process of obtaining guardianship and ending the rights and responsibilities of the parents. Time-Limited Family Reunification Services. “Time-limited family reunification services” means the services and activities that must be made available to the parents or legal guardian to facilitate the reunification of the child during the first 15 months of out-of-home placement. “Time-limited family reunification services” include the following services mandated by 42 U.S.C. §629a: Individual, group, and family counseling; Inpatient, residential, or outpatient substance abuse treatment services; Mental health services; Assistance to address domestic violence; Services designed to provide temporary child care, including respite care, to families in crisis; and Transportation to or from any of the services listed in §B(59)(b)(i)—(v) of this regulation. “Time-limited voluntary placement” means the placement of a child for a maximum period of 180 days by the parent or legal guardian who requires short-term temporary care for their child and agrees to give the custody of the child to the local department. “Treatment” means the coordinated provision of services to a child based on a thorough assessment of medical, emotional, behavioral, or psychological conditions designed to produce a planned outcome in the child's behavior, attitude, or general condition. “Treatment aftercare” is a planned set of services provided to a child who is transitioning from the treatment foster care program to a traditional out-of-home placement or to a permanent placement. “Treatment foster care” means a program designed and implemented by a child placement agency to provide intensive casework and treatment in a family setting to children with special physical, emotional, or behavioral needs as described in COMAR 07.05.05. “Treatment plan” means a written description of the objectives, goals, and services to address the needs of a child, including the child's projected length of stay in the program. “Treatment team meetings” means meetings to review the implementation of a child's treatment plan and the progress, regress, and effectiveness of the treatment regime. “Voluntary placement” means the placement of a child into foster care voluntarily by the parent or legal guardian who is unable to care for the child, and is either time-limited or for children with disabilities as defined in Regulation .06 of this chapter. “Voluntary placement agreement” means a binding written agreement voluntarily entered into between a local department and the parent or legal guardian of a minor child that specifies, at a minimum, the legal status of the child and the rights and obligations of the parent or legal guardian, the child, and the local department while the child is in placement. “Youth” means a child between the ages of 14 years old and 21 years old. A local department shall initiate out-of-home placement for a child who: Is placed voluntarily in the custody or in the care of the local department, under a written agreement in accordance with Regulation .06 of this chapter; Is abused, abandoned, or neglected, has a developmental disability or a mental disorder, or is in imminent danger, or in serious immediate danger, so long as a court has: Determined that continued residence in the child's home is contrary to the child's welfare, and Committed the child to the custody or guardianship of the local department. A child in out-of-home placement is eligible to remain in out-of-home placement until the end of the month in which the child becomes 18 years old, except that a child 18 to 21 years old may remain in out-of-home placement up to the 21st birthday so long as the child is: Completing secondary education or a program leading to an equivalent credential; Enrolled in an institution that provides post-secondary or vocational education; Participating in a program or activity designed to promote or remove barriers to employment; Employed for at least 80 hours per month; or Incapable of doing any of the activities in §B(1)—(4) of this regulation due to a medical condition, which incapability is supported by regularly updated information in the case plan of the child. A child is not eligible for out-of-home placement if the child: Is married; Is in the military; or Fails to comply with §B of this regulation. A child may not be committed to the custody or guardianship of a local department and placed in an out-of-home placement solely because the child's parent or guardian lacks shelter or because the parent has a disability. The local department shall make appropriate referrals to emergency shelter services and other services for the homeless family with a child who lacks shelter. A child is considered to enter out-of-home placement and the placement episode begins when the local department: Removes the child from the home of the parents, legal guardian, or caregiver; Acquires legal responsibility for the care and placement of the child through a: Court order, including a shelter care order; or Written voluntary placement agreement pursuant to Regulation .06 of this chapter; and Places the child in an out-of-home placement. A child is considered to leave out-of-home placement and the placement episode ends when the: Child is no longer in an out-of-home placement as defined in Regulation .03B of this chapter; Local department no longer has legal custody or guardianship; Local department terminates aftercare services; or Child who was in placement under a written voluntary placement agreement is returned to the care of the parents or legal guardian. A local department with responsibility for a child's case shall: Ensure that all information relating to the child and the child's family is used in planning for the child; Ensure that reasonable efforts were made to prevent placement and achieve a permanency plan for the child; Immediately initiate a search for relatives and the absent parent, if applicable; Within 30 days after removal of a child from the custody of the child’s parent or legal guardian, subject to exceptions due to family or domestic violence, notify any found adult relatives and parents with legal custody of siblings of the child that the child has been removed from the parent’s custody; and Include in the notice: Options to participate in the care and placement of the child; Options that may be missed by failure to respond to the notice; Requirements to become a resource family home; and Services and supports available for the child if placed in the home. Provide the parents or legal guardian with services reasonably designed to facilitate reunification, unless contrary to the child's best interest; Develop a case plan that identifies the concurrent permanency plans in accordance with Regulation .13 of this chapter. Whenever possible: Develop concurrent permanency plans and service agreements with the parents or legal guardian: Include a visitation plan as part of the service agreement; Provide the parents or legal guardian with a copy of the completed concurrent permanency plans and service agreements; and Arrange to discuss with the parents or legal guardian any intended changes in the concurrent permanency plans and service agreements; Implement a visitation plan which: Offers the parents or legal guardian weekly visits when one of the concurrent permanency plans is reunification; Offers siblings visitation with the child living in an out-of-home placement unless the court has ordered no visitation; Does not force a child to participate in visitation but refers the child to a therapist for assistance in resolving the visitation issues; and Offers transportation assistance as appropriate to the parents or legal guardian; Notify the parents or legal guardian of court hearings and periodic reviews, unless they have been notified by the court or the Citizens Review Board for Children (CRBC); Notify the parents or legal guardian of any change in the child's placement, unless doing so would not be in the best interest of the child for a reason specified in the case record; Notify the parents or legal guardian of any change affecting visitation, unless doing so is not feasible for a reason specified in the case record; Notify the parents or legal guardian before petitioning the court for commitment or termination of parental rights; Advise the parents or legal guardian of the availability of free or sliding fee legal services for any court proceeding; Provide aftercare services for up to 6 months following reunification to facilitate a safe and stable permanent placement, if appropriate; Provide the parents or legal guardian with a written and verbal explanation of their rights regarding out-of-home placement; Provide services to the child's family and monitor the safety of any children remaining in the family home; Ensure that, at a minimum, the caseworker: Has monthly face-to-face contact with the parent, legal guardian, and any children remaining in the family home; Maintains contact with the child and out-of-home placement provider as described in Regulation .17 of this chapter; and Has monthly contact with the out-of-home placement provider; Notify the appropriate court if the department has information indicating that a child’s interest as a victim is not protected in a court case; Ensure that the child has opportunities for age or developmentally appropriate activities; and Ensure that the out-of-home placement provider is applying the reasonable and prudent parent standard in making decisions regarding the child’s engagement in age or developmentally appropriate activity opportunities. Time-Limited Voluntary Placement. If a parent or legal guardian is temporarily unable to care for a child because the parent or legal guardian is, or soon will be, hospitalized, incarcerated, or otherwise unable to parent the child, the local department may acquire responsibility for temporary care of the child by accepting a voluntary placement of the child by the parent or legal guardian, under a binding written agreement between the local department and the parent or legal guardian. A child may not remain in out-of-home placement under a time-limited voluntary written agreement for more than 180 calendar days. The local department may accept a time-limited voluntary placement only when all of the following conditions are met: Reasonable efforts have been made to prevent the need to place the child; The local department believes that the parent or legal guardian will meet all responsibilities as set forth in Regulation .07 of this chapter; Both parents, the parent with sole legal custody, the sole caretaker parent of the child, or the legal guardian signs a binding written agreement; The parents or legal guardian who are parties to the voluntary agreement sign a document that gives the local department the authority to consent to medical care, as set forth in Regulation .08 of this chapter; The parents who are parties to the voluntary agreement pay child support in accordance with Regulation .29 of this chapter; and The placement is made in support of a plan of service to the parents or legal guardian designed to lead to reunification within 180 calendar days. The local department shall: Give written and oral notice to the parents or legal guardian that the time-limited voluntary placement agreement can be revoked at any time by a written revocation signed by the same individual or individuals who signed the voluntary agreement; and Inform the parents or legal guardian that the local department shall petition the court for custody if it is determined that the child's best interest requires out-of-home placement for longer than 180 calendar days. Upon receipt of a written revocation, the local department shall: Promptly return the child to the parents or legal guardian; or Immediately petition the court for emergency shelter care for the child. The local department shall petition the court for custody: As soon as the local department determines that the child will require out-of-home placement for longer than 180 calendar days; or Whenever the local department determines that it is in the child's best interest. The child who continues to require out-of-home placement at the end of 180 calendar days of placement pursuant to a time-limited voluntary placement written agreement may remain in out-of-home placement only if a juvenile court has committed the child to the custody or guardianship of a local department. This regulation does not apply to children whose parents have signed a voluntary consent for adoption. Children with Disabilities Voluntary Placement. The following may request a Voluntary Placement Agreement: A parent; A legal guardian; or The Court. A Voluntary Placement Agreement may not be initiated by a third party. The local department shall make reasonable efforts to prevent placement in accordance with Md. Code Ann., Family Law Article, §5-525(e), Annotated Code of Maryland. The local department shall conduct an assessment. In order for the local department to sign a voluntary placement agreement, the following conditions must be met: The child has a documented developmental disability or mental illness; A treatment provider such as a medical doctor, psychiatrist, or psychologist has provided a written recommendation which details the need for out-of-home placement; The child requires an out-of-home placement in order to obtain treatment directly related to the documented disability; The parent is unable to provide treatment or care; The goal is reunification with the family at conclusion of treatment; Local Care Team (LCT) meeting has been held to determine whether any alternative or interim services for the child and family may be provided by any State agency; An appropriate placement and placement date has been determined as follows: The placement must be in the least restrictive setting; and A psychiatric hospital is not considered a placement; The Administration must approve the voluntary placement by signing the Children with Disabilities Placement Checklist; The parent and the Child Support Enforcement Agency must finalize a binding child support agreement detailing the amount and manner for child support payments; Both parents, a parent with sole legal custody, or a legal guardian has signed a voluntary placement agreement which gives the local department the responsibility for placement and care decisions related to the child; and The local department shall make reasonable efforts to prevent placement. A voluntary placement cannot be made if the parent refuses to pay child support or enter into a written agreement. A voluntary placement agreement cannot be signed prior to a placement date. A child may remain in a Children with Disabilities Voluntary Placement beyond 180 calendar days or after the child’s 18th birthday if: A treatment provider such as a medical doctor, psychiatrist, or psychologist has submitted written documentation supporting the need to continue the voluntary placement due to the child's developmental disability or mental illness; and Before the 180th calendar day in placement or prior to a child’s 18th birthday, a juvenile court determines that continuation of the voluntary placement agreement is in the child's best interest. A local department may not seek legal custody as long as: The child has a developmental disability or a mental illness; The placement is needed to obtain treatment or care related to the child's disability; and There is no allegation of child abuse or neglect as defined in Courts and Judicial Proceedings Article, §3-801(b),(s) and,(x), Annotated Code of Maryland. All cases under a children with disabilities voluntary placement agreement shall meet all service and case plan requirements for the out-of-home placement program as set forth in this chapter. A children with disabilities voluntary placement agreement may be terminated prior to a voluntary placement hearing and the child returned to the parent or parents or legal guardian within 15 calendar days of notice if the local department receives a written revocation from the parent or legal guardian that signed the voluntary placement agreement. The local department may rescind the voluntary placement agreement prior to a voluntary placement hearing provided that: The parent or legal guardian who signed the agreement provides the local department with a written revocation of the agreement: or The parent or legal guardian who signed the agreement moves out-of-State: or The parent or legal guardian who signed the agreement fails to fulfill the terms of the agreement including the parent refusing to pay child support in accordance with a child support order: and The local department provides to the parent or legal guardian 15 calendar days written notice which includes details of the reasons for rescission and an explanation of appeal rights and the local department has discussed available placement plans and options with the parent or legal guardian. A children with disabilities voluntary placement agreement may be terminated after a voluntary placement hearing has been held and the local department: Has received a written revocation from the parent or legal guardian that signed the voluntary agreement; The local department has discussed available placement plans and options with the parent or parents or legal guardian; and Has requested that the juvenile proceedings be terminated by sending copies of both the request for revocation and an attached revocation notice to the juvenile court, all counsel, the parent [,and] or legal guardian informing them that the child is no longer in a voluntary placement, that the local department has closed its out-of-home placement case and is requesting that the juvenile court close its case. The local department shall file a petition to request an emergency voluntary placement review hearing, regardless of whether a previous court hearing has occurred, if the local department: Is not in agreement with the parent or legal guardian's written request for revocation; and Has determined that the best interest of the child requires continued out-of-home placement for treatment and care. Each local department shall designate a person to administer requests for voluntary placement agreements who shall be: An existing staff member of the local department; and Provided with annual training by the Administration on policies and procedures regarding the voluntary placement of children with developmental disabilities or mental illnesses. Nothing in the preceding sections shall preclude the local departments from taking appropriate action pertaining to child abuse and neglect as defined in Family Law Article, §5-701, Annotated Code of Maryland. Enhanced After Care. The purpose of Enhanced After Care is to provide former Maryland foster youth an opportunity to re-enter foster care through a voluntary placement agreement so that they can continue learning and practicing independent living skills. The goal of Enhanced After Care is to ensure that the participants recognize and accept personal responsibility for making the transition into adulthood. To be eligible for Enhanced After Care, a youth shall be a former Maryland foster care youth: Whose commitment to the local department was rescinded after the age of 18 years; and Who was not discharged from foster care due to adoption, reunification, guardianship, marriage, or military duty; and Who enters into an Enhanced After Care Voluntary Placement Agreement with the local department in the jurisdiction from which the youth exited foster care or where they are receiving services. To continue to be eligible for Enhanced After Care, within 30 days of signing an Enhanced After Care Voluntary Placement Agreement, a youth shall be: Completing secondary education or a program leading to an equivalent; Enrolled in an institution which provides post secondary or vocational training; Participating in a program or activity designed to promote or remove barriers to unemployment; Employed at least 80 hours per month; or Incapable of doing any of the above described activities due to a medical condition. Youth who exit out-of-home placement after their 18th birthday shall apply for Enhanced After Care services prior to the age of 20 years and 6 months. Youth receiving Enhanced After Care may receive all services available to youth under the Out-of-Home Placement Program as set forth in this chapter. A youth may remain in an Enhanced After Care Voluntary Placement beyond 180 calendar days if before the 180th calendar day in placement, a juvenile court determines that continuation of the voluntary placement agreement is in the youth’s best interest. The local department shall file a petition with the juvenile court to request an extension of the voluntary placement or to request an emergency voluntary placement review hearing if the local department determines termination of the voluntary placement agreements if appropriate. The local department shall terminate services for the following: Youth’s failure to comply with the service agreement or the voluntary placement agreement; Youth turns 21; Youth marries; Youth enters military duty; Youth dies; or Youth voluntarily terminates the voluntary placement agreement. All cases under an Enhanced After Care Voluntary Placement Agreement shall meet all service and case plan requirements for the out-of-home placement program as set forth in this chapter. When there is a conflict between the rights of the parents or legal guardian and those of the child, the child's best interest shall take precedence. After a court has terminated parental rights, the parents no longer have rights as enumerated in this regulation. Consistent with the best interest of the child, the parents or legal guardian of a child in out-of-home placement may: Upon request, obtain for the child an out-of-home placement consistent with their religious affiliation, if this placement is available and suitable; Meet the child's caregivers, unless doing so would pose a danger to the child or the caregivers; Contact the child's caseworker for information about the child or to discuss the child's case; Request a family team conference to discuss local department decisions regarding the child's placement; Petition the court to return custody of a child committed to the custody of the local department; Be represented by legal counsel in all court proceedings; Receive aftercare services; and Participate in decisions about major changes in the life of the child, unless those changes are of matters protected by the child's privacy rights or contrary to the child's best interest. The local department shall encourage the parents or legal guardian to: Participate with the local department in preparing the child's concurrent permanency plans; Participate in the development of a service agreement; Meet regularly, according to a mutually agreed-upon schedule, with the local department representative to discuss progress toward achievement of the permanency goal; and Visit or contact the child regularly as planned with the local department or as ordered by a court, unless the contact has been determined by a court to be contrary to the best interest of the child; Attend all court, administrative, and citizen review hearings regarding the child. The local department shall request the parents or legal guardian when appropriate to: Provide the local department with all medical (including mental health, immunization, and dental) records, educational, legal, financial, and other relevant information about the child, including the birth certificate, the child's Social Security number, and any custody decree affecting the child; Inform the local department and the court of any changes in address, employment, living arrangements, or other matters that would affect the plans for the child; Pay child support in accordance with Regulation .29 of this chapter; Identify and provide information on the whereabouts of the child's other parent and all known relatives; Maintain any existing health care coverage on behalf of the child or obtain health insurance when available; Be responsible for all medical copayments to the health care provider when private health coverage is available on behalf of the child; and Sign all consents required by federal and State law to permit the release of all medical and mental health information and records to enable the local department to provide services to the child and the child's family. Services to Birth Parent. The local department shall make services available to the birth parent requesting services, irrespective of the age of the birth parent, to help the birth parent assess parental roles and responsibilities. These services include, but are not limited to: Counseling; Referral to job training; and Financial assistance information. When an expectant birth parent who is considering placing a child with the local department for adoption requests services, the local department shall provide counseling and other appropriate services before the child is born and during any termination of the parental rights process. The local department shall help the birth parent gain access to the services necessary to accomplish the mutually agreed upon goals. While the child is in care, the local department shall assist the birth parent with resolving the problems that brought about the request for adoption planning. The local department shall inform the birth parent of the: Parent's right to visit the child during the period before guardianship is granted; Parent's right to withdraw consent as set forth in Family Law Article, §5-321(c)(1), Annotated Code of Maryland; Search rights of birth parents and adoptees as set forth in Family Law Article, Title 5, Subtitles 4B and 4C, Annotated Code of Maryland; and Parent's right to file a disclosure veto as set forth in Family Law Article, §5-3A-05(a), Annotated Code of Maryland. When the birth parent decides to place the child for adoption, the local department shall prepare a written placement agreement, which shall: Set forth the placement plan; and Include any special conditions, such as the preferred religion or race of the adoptive family, which the agency and birth parent mutually agree upon. 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. 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. At the time a child is taken into care, the local department shall: Ask the parents or legal guardian to sign a document authorizing the local department to consent to: An initial health care screening; A comprehensive health assessment that meets the requirements of the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program; and All routine and immediate medical care; and 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. 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. The local department shall: 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 Promptly notify the parents or legal guardian of any treatment given without prior notice unless the notification violates the privacy rights of the child. The local department shall document in the child's case record the actions taken by the local department to: Obtain medical consent; Involve the parents or legal guardian in decisions regarding the child's medical care; and Notify the parents or legal guardian of any medical care planned or given to their child. Children in the custody or care of a local department shall be enrolled in Maryland's Medical Assistance Program. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. The local department shall request: A substance abuse screening if the child's behavior or physical health indicates the likelihood of substance abuse; and A full-scale assessment of the child to address the child's treatment needs if the screening results indicate substance abuse. 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. The health passport shall include the following information: The identity of the medical facilities where the child usually receives care; The health care visit report on the child's condition at placement as documented by the child's physician; The child's immunization record, allergies/adverse reactions, chronic health problems, and present medications; Developmental status for a child younger than 4 years old, or for a child with a disability; Consents to health care and release of records; and Receipts for health care and release of records. 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. 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. The local department shall use the child's private insurance and Medical Assistance card to obtain public mental health services for the child. The health passport shall be returned to the local department at the time the child leaves the placement. 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: The child is 18 to 21 years old and exits out-of-home placement; or 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. In the case of serious, immediate danger to the child, the local department shall: Remove the child; and Immediately request authorization from the court or intake officer for shelter care until the next court date when a shelter care hearing is held. Before the shelter care hearing, the local department shall attempt to locate the parents, guardian, custodian, or relatives and provide reasonable notice, oral or written, stating the time, place, and purpose of the shelter care hearing. At the shelter care hearing, the local department shall: Describe the efforts that have been made but have been unsuccessful in preventing or eliminating the need for the removal of the child from the home; Describe the reasons why efforts to prevent placement could not be made before removal from the home; Describe the reasons why a child with a documented developmental disability or mental illness is not appropriate for a children with disabilities voluntary placement. Describe the child's need for out-of-home placement; and Make a recommendation of shelter care. If the court orders shelter care, the local department shall place the child in the least restrictive setting consistent with the child's needs. Before or during the shelter care period, the local department shall meet with the parents or legal guardian, and may hold a family team meeting that includes the parents, legal guardian, and relatives to: Identify all maternal and paternal relatives; Determine if continued out-of-home placement is necessary for the child who has been placed in shelter care; and Determine whether the child can be properly cared for at home or in the home of a family member, and if so, develop an appropriate plan for care of the child. When the local department has any reason to believe that a child is to continue in out-of-home placement beyond the length of the shelter care order, the local department shall promptly file a petition with the court to request custody of the child. A local department shall inform a relative with whom the local department places a child of the relative's right to apply to be licensed as a foster home for that child in accordance with COMAR 07.02.25. Before accepting a time-limited or children with disabilities voluntary placement or seeking shelter care, the local department shall document in the case record reasonable efforts that have been made but have been unsuccessful in preventing or eliminating the need for removal of the child from the home, unless an emergency situation causes removal to be reasonable under the circumstances to provide for the safety of the child. Placement prevention services are those services designed to alleviate the conditions which may make out-of-home placement necessary and may include, but are not limited to: In-home aide services; Day care; Crisis counseling; Family preservation; Assistance in gaining access to emergency financial assistance; Respite care; Self-help groups; Referral for medical care and medical insurance; Special education services; Mental health, drug or alcohol abuse counseling and treatment; Referral to parenting classes; Assistance in locating housing; and Domestic violence counseling. The local department shall make appropriate referrals to emergency shelter services and any other appropriate and available services for families with children lacking shelter, in accordance with Regulation .04D of this chapter. The local department shall document in the child's case record: Any placement prevention services that were provided; The effectiveness of the provided services; The reasons that placement was necessary; and Specific services that would have been appropriate had they been available. If the local department determines that the child's welfare requires removal, the department shall document in the case record the circumstances that support the judgment that prevention services would not be appropriate. In a petition to the court to request custody of a child, the local department shall note the placement prevention services that the child and the child's family have received, or shall state the reasons why placement prevention services were not appropriate and therefore were not provided. For a children with disabilities voluntary placement, efforts to prevent placement may include a request by the local department for an emergency voluntary placement hearing before placement based upon concerns related to the child's treatment and care needs. Whenever the court orders an out-of-home placement, the local department's attorney shall ask the court to incorporate into its order a reasonable efforts finding, as described in Regulation .30 of this chapter. When the local department petitions the court to make a determination of CINA for a child with a documented developmental disability or mental illness: The local department shall detail the reasons why a child with a developmental disability or mental illness is not appropriate for a children with disabilities voluntary placement as an effort to prevent placement; The local department shall, upon order of the court that has held in abeyance a finding on whether the child is a CINA: Assess or reassess the family and child's eligibility for placement in accordance with a children with disability voluntary placement agreement; and Report back to the court in writing within 30 days unless the court extends the time period. The local department shall offer to place the child according to a children with disabilities voluntary placement agreement when so ordered by the court following a hearing to determine that the child and family are eligible for a voluntary placement. In order of preference, a child shall be placed with a relative caregiver, in a foster home, or in a group care setting. A foster home used by the local department shall meet the standards for foster homes established under COMAR 07.02.25 and, except as outlined in Regulation .28 of this chapter, shall be located within the State. A child shall be placed in the least restrictive setting appropriate to the child's needs and: In the local jurisdiction where the child's parent or legal guardian resides; or In another jurisdiction in the State if there is a compelling reason that it is in the best interests of the child because: The child has strong ties to: Family; A placement resource; or Other community resources in another jurisdiction in the State; Necessary specialized services are not available to the child in the local jurisdiction but are available in another jurisdiction in the State; or There are no placements available in the jurisdiction to meet the individualized placement needs of the child. When it is necessary to place a child in another jurisdiction according to this regulation, the local department shall consider: The availability of resources to provide necessary services to the child; The accessibility to family treatment, if appropriate; and The effect on the local school system in the jurisdiction under consideration. The local department shall place a child in a foster care or preadoptive home, except when the child requires extra care and supervision which cannot be provided in a foster care or pre-adoptive home. A child shall be placed with other siblings in an out-of-home placement if it is in the best interests of the siblings to be placed together and placement of the siblings together does not conflict with a specific health or safety regulation. If placement of the siblings together conflicts with a specific health or safety regulation, the local department may place the siblings together if the local department has made a written finding describing how placement of the siblings together serves the best interests of the siblings. If the siblings are not placed together, the caseworker shall document in the record the reasons the siblings are placed apart, and include whether such a joint placement would be contrary to the safety or well-being of any of the siblings. Any residential child care facility used by the local department shall meet the requirements for licensure for the facilities established in COMAR 14.31.05. The local department shall notify the court, and all parties, whenever moving a child from one placement to another. If the child is moved from a court-ordered placement, the local department shall notify the court, all parties, and counsel before the move, or, if not possible, immediately after the move. The local department shall, at the time of placement, make every effort to arrange a relative placement or foster home capable of meeting the child's needs on a long-term basis when the local department has reason to believe that the permanency plan for the child will be adoption or APPLA as defined in Regulation .03 of this chapter. The local department shall make every effort to minimize the number of placements a child has during an episode of out-of-home care. The local department shall ensure that, within 5 school days of being placed in out-of-home placement, a child of school age is attending school, unless this is unattainable for reasons outside the control of the local department. School Stability. With respect to a child who is in the custody of, committed to, or otherwise placed by the local department of social services in out-of-home placement, the local department shall determine whether it is in the child’s best interests to continue the child’s education at the school the child last attended prior to the most recent change in placement. In determining the best interests of the child under §B(1) of this regulation, the local department of social services shall, in consultation with the local education agency, consider the following factors, not in order of priority: The child's age; The school which the child's siblings attend; The child's experiences at the school the child last attended; The child's academic needs; The child's emotional needs; Any other special needs of the child; Continuity of instruction; Length of expected stay at current placement; Likely location of the child's current and future permanent placement; Time remaining in the school year; Distance and time of commute and the impact it may have on the child’s education; and The safety of the child. The local department of social services shall make efforts to seek input from the child’s attorney, parent, parent surrogate, legal guardian and other persons who are able to contribute relevant information to the best interests determination made under this section, unless doing so will create undue delay in placement. The best interests determination made under this section shall be made as soon as possible after the child’s entrance into out-of-home placement or the child’s change in out-of-home placement, but no later than 5 business days thereafter. A child shall continue to be enrolled in and maintain attendance in the school of origin until the local department of social services completes the best interests determination in accordance with this section, and transportation to the school of origin during that time period shall be provided by the local department. The local department of social services shall immediately provide written notice of the best interests determination made under §B(2) of this regulation to both the local educational agency foster care liaison in the local educational agency serving the school of origin and the local educational agency foster care liaison of the local educational agency serving the local zoned school. The local department of social services shall provide written notice of the best interests determination made under §B(2) of this regulation to the child’s school, parent, parent surrogate, legal guardian, and child’s attorney within 5 business days after the best interests determination has been made. The local department shall provide notice to a receiving school regarding the enrollment or imminent enrollment of a child who is in State-supervised care and shall provide to the receiving school: Name, address, and telephone number of the parent, legal guardian, parent surrogate, and the foster parent; and Name, address, and telephone number of the child's caseworker and the caseworker's supervisor. The local department, parent, legal guardian, parent surrogate, foster parent, court-appointed attorney, or court-appointed special advocate acting on behalf of the child in State-supervised care may provide notice to a receiving school regarding the enrollment or imminent enrollment of the child. The local department shall also inform the receiving school of the name of the sending school if that information is available. The local department, if requested, may choose to aid the enrollment process by hand delivering required documents compiled by the sending school to the receiving school which includes a copy of the child's: Completed student withdrawal or transfer record; Academic records and immunization records; and Most recent individualized education plan or most recent educational assessment. When the local department believes that the child may have special educational needs, the local department shall notify the school and request an evaluation of those needs if no prior evaluation has been completed. When the local department believes that a child younger than 5 years old is developmentally disabled, the local department shall request an assessment from the Maryland State Department of Education, Maryland Infant and Toddler’s Program/Preschool Services Branch if no prior assessment has been completed. The local department shall request that the juvenile court notify school officials that a child has been found CINA, so that the local department will be eligible to be notified if the child is habitually truant. A child who is committed or voluntarily placed shall be educated in accordance with State Board of Education regulations, except the child may not be educated under a home instruction program. Tuition Waiver. The Maryland tuition waiver provides a waiver of tuition for a Maryland public institution of higher education and is applicable to certain individuals in, or formerly in, out-of-home care. An individual qualifies for the tuition waiver if the individual was placed by the Department of Human Services in an out-of-home placement and resided in an out-of-home placement: On the individual’s 18th birthday or at the time of graduation from high school or successful completion of a General Equivalency Development Examination (GED); or For at least 1 year on or after the individual’s 13th birthday and the individual was placed into guardianship, adopted, or reunited with at least one of the individual’s parents. Younger siblings of individuals described in §K(1)(b) of this regulation and concurrently placed into the same guardianship or adopted by the same adoptive family from an out-home-placement also qualify for this waiver. An individual who qualifies for this waiver shall be exempted from paying any tuition at a Maryland public institution of higher education, regardless of the individual’s receipt of scholarships or grants, if the individual: Is enrolled as a candidate for an associate's degree, a bachelor's degree, or a vocational certificate at a Maryland public institution of higher education on or before age 25; and Has filed for federal and State financial aid by June 30 of each year. The waiver is applied to the cost of tuition, registration fees, and all fees that are required as a condition of enrollment. Scholarships and grants that the individual receives may not be used to pay these costs. Tuition and registration fees are determined by the individual public institution of higher education. Tuition does not include the cost of room, board, books, or transportation. The tuition waiver is available to the qualified individual for up to 10 years after first enrolling as a candidate for either an associate or bachelor’s degree in a Maryland public institution of higher education, or until a bachelor’s degree is awarded, whichever is earlier. The qualified individual shall inform the financial aid office at the Maryland public institution of higher education of the individual’s potential eligibility for the tuition waiver. The qualified individual is responsible for adherence to all financial aid policies of the Maryland Higher Education Commission and the Maryland public institution of higher education at which the individual is enrolled. The tuition waiver may not be applied retroactively. Federal Education Training Vouchers Program. An individual who was placed by the Department of Human Services in an out-of-home placement may request assistance in obtaining funds for post-secondary education or training at an institution of higher education, through the federal Chafee Education and Training Vouchers (ETV) program. To obtain funds from the ETV program, the individual: Shall have completed high school or received a GED certificate; Shall have exhausted all other forms of financial aid/assistance before requesting funds; Shall have filed for federal and State financial assistance by June 30 of each year for the upcoming school year; and May not be in default on any educational loan or owe a refund of an educational grant. An individual is eligible for the ETV program if the individual: Is eligible for Chafee Independent Living Services according to federal guidelines; Aged out of out-of-home placement; or Lived in out-of-home placement at 14 years old or older and was adopted or entered guardianship at 16 years old or older. The ETV program is available to eligible individuals who are pursuing post-secondary education or training in an institution of higher education up to the age of 26 as long as they are enrolled before their 21st birthday and making satisfactory progress toward completion of such program, but an individual may not participate in the ETV program for more than 5 years. The ETV funds may be applied toward: Tuition and school fees; Room and board; Off campus housing; Books; Rental or purchase of required equipment, materials, and supplies; Childcare; Tutoring costs related to attendance in the educational program; and Transportation that is necessary for the student to attend school. Applications to the ETV program shall be forwarded to the Administration for review and approval by the education specialist. Within 60 days after removal, the local department, together with the child's parent or legal guardian, shall develop a written case plan for each child in out-of-home placement. The case plan shall include concurrent permanency plans, except as provided in §B of this regulation, and shall: Describe the circumstances that make placement necessary; State with whom the child was living before placement and their relationship to the child; and Describe the efforts that were made but were unsuccessful in preventing or eliminating the need for removal from the child's home including the consideration of both in-State and out-of-State placement options, or why such efforts were not possible. The local department shall: Identify and develop a concurrent permanency plan, as appropriate; Consider the following factors in determining that the concurrent permanency plan is in the best interests of the child: Child's ability to be safe and healthy in the home of the child's parent or legal guardian; Child's attachment and emotional ties to the child's siblings, parents, or legal guardian; Child's emotional attachment to the child's current caregiver and the caregiver's family; Length of time the child has resided with the current caregiver; Potential emotional, developmental, and educational harm to the child if moved from the child's current placement; and Potential harm to the child by remaining in State custody for an excessive period of time; Prioritize permanency plan options using the following order of preference: Reunification with the parent or legal guardian; Placement with a relative for adoption, or custody and guardianship; Adoption by a non-relative; Guardianship by a non-relative; or Another Planned Permanent Living Arrangement (APPLA); Project the year and month when the concurrent permanency plans shall be achieved; Describe the specific service and behavioral objectives that shall be achieved before the return of the child to the parents or legal guardian if one of the concurrent permanency plans is reunification; Identify the services to be provided to the parents, legal guardian, and the child in order to achieve the permanency goals; Describe how the local department plans to carry out any voluntary placement agreement; Include consideration of the least restrictive setting appropriate to the child's safety and care needs and when determining a permanency plan consider the following in descending order of priority: The local jurisdiction where the child's parent or legal guardian resides; or Placement in another jurisdiction in the State, based on a compelling reason that it is in the best interest of the child because: The child has strong ties to family, a placement resource, or other community resources in another jurisdiction in the State; Necessary specialized services are not available to the child in the local jurisdiction but are available in another jurisdiction in the State; or There are no placements available in the jurisdiction to meet the individualized special placement needs of the child; Include the following considerations when it is necessary to place a child in another jurisdiction according to this regulation: The availability of resources to provide necessary services to the child; The accessibility to family treatment, if appropriate; and The effect on the local school system in the jurisdiction of consideration; Describe the type of home or institution in which the child has been, or is to be, placed, and discuss the safety and appropriateness of the placement with documentation describing how the placement is: The least restrictive setting available; and In close proximity to the parents' or legal guardian's home, consistent with the best interest and special needs of the child; Discuss how the local department plans to carry out specific court orders, if any, pertaining to the child; Include a plan for ensuring that the child receives safe and appropriate care; Include a plan for working to ensure that services are provided to the child, parents or legal guardian, and resource parents to improve the conditions in the parents' or legal guardian's home and to facilitate the child’s return to his or her own safe home or other safe and appropriate permanent placement; Include a plan for working to ensure that services are provided to the child and foster parents to address the needs of the child while in foster care; Discuss the appropriateness of the services that have been provided to the child under the plan; For a child 14 years old or older, include a written description of the life skills training which will help the child prepare for independent living; To the extent available and accessible, include the most recent health and education records of the child, including: The names and addresses of the child's health and educational providers; The child's grade-level performance; The child's school record; Assurances that the child's placement in out-of-home placement takes into account the appropriateness of the current educational setting and the proximity to the school in which the child is enrolled at the time of placement; Assurances that the child who is 5 years old or older: Is enrolled, or in the process of enrolling, in a full-time elementary or secondary school program; Has completed secondary school; Is participating in, or scheduled to participate in, an independent study program administered by a local school district; or If a child is incapable of attending school on a full-time basis due to a medical condition, the incapacity must be documented and regularly updated in the case plan; A record of the child's immunizations; The child's known medical problems; The child's medications; and Any other relevant health and education information required by Regulations .08 and .12 of this chapter; and Deliver and document reunification services offered and time-limited reunification funds utilized. The case plan shall be reassessed within 120 days of the initial plan, and every 180 days after that. The local department shall amend the case plan, as necessary, in light of the child's situation and of any court orders which affect the child. Within 60 days following placement and whenever the plan is amended, or upon request, the local department shall give a copy of the permanency plan and service agreement to the: Child's parents or legal guardian; and Child or the child's attorney. The local department shall maintain a copy of the case plan and service agreement in the case record. To the extent that funds and other resources are available, a range of services that will facilitate or maintain successful reunification of the child shall be: Provided by the local department; Made available by the local department through referral to another appropriate agency; or Upon written approval by the director or the director's designee, purchased by the local department. The types of services which may be purchased, provided, or accessed through referral to another agency may include but are not limited to: Transportation costs for family visits or other reasons; Rent deposits; Household items; Vocational counseling or training; Mental health services; In-home aide service; Day care, including temporary day care or respite; Individual, group, and family counseling; Assistance to locate housing; Crisis intervention services; Parenting classes; Special education services; and Inpatient, residential, or outpatient substance abuse treatment services. As appropriate to each case, the local department shall develop a written service agreement: With the child's parents or legal guardian, within 60 days of removal if the plan is to return the child to the parents or legal guardian; With the parents or legal guardian within 30 days before the planned reunification; and For the child 16 years old and older, with the child, the parents or legal guardian, and, where appropriate, the foster parents or representative payee. When the permanency plan is reunification, the caseworker shall inform the parents or legal guardian, verbally and in writing, that: Their cooperation in developing the service agreement and in fulfilling the terms of the agreement is imperative; A concurrent permanency plan will be implemented in accordance with State and federal laws; and A court which is considering whether to terminate parental rights will consider the extent to which all parties have fulfilled their obligations under a service agreement. If the parents or legal guardian refuse to meet with the caseworker to develop an agreement, or cannot reach an agreement concerning reunification efforts, the caseworker shall notify: The parents and the parents' attorney, or the legal guardian and the legal guardian's attorney, and the child's attorney in writing that the permanency plan of reunification shall be changed; and All parties of the new permanency plan within 30 days after the first notice is sent. The service agreement shall state what must be done, when, and by whom to: Overcome problems so that the child may safely return home; or Assist the child 14 years or older in preparing for the transition from out-of-home placement to independent living. At a minimum, all service agreements shall include: A statement of the goals and intent of the agreement; A statement of the circumstances which made out-of-home placement necessary; A statement or list of the problems or barriers that shall be overcome to achieve the goals of the agreement; A list of the services and supports that the caseworker and the local department shall provide to assist the parents or legal guardian and the child, as appropriate to the case plan, as well as the time frames in which these services will be provided; A list of the responsibilities and tasks that the parents or legal guardian and child shall undertake and accomplish, as appropriate to the case plan, and the time frames in which each task shall be completed; A visitation plan that: Supports the continuity of the relationship among the child, parents or legal guardian, and siblings, Describes the place and frequency of visits, Identifies the participants in the visits, and Protects the child's safety; A description of the place and frequency of meetings between the caseworker and the parents or legal guardian, foster parents, or other provider and the child; A statement that the overall progress of the child, and the progress of the parent or legal guardian, and the youth, when applicable, toward completing the tasks will be reviewed during scheduled meetings between the caseworker and the parents or legal guardian, foster parents, or other provider and child; A statement that the terms of the agreement may be modified by consent of the parties to the agreement; The length of time that the agreement is to be in effect, not to exceed the date of the next periodic review as described in Regulation .19 of this chapter; A statement of the possible actions to be taken by the local department if the terms of the agreement are not met; The signatures of all parties to the agreement and, in situations where the parties are unavailable or unwilling to sign, the caseworker's signature noting the reason why the parties to the service agreement did not sign; and The date or dates the agreement is signed. The local department shall give a copy of the agreement to all parties, and, upon request, to the attorneys for the parties and shall file a copy in the case record. At least once a month, the local department caseworker shall discuss with the parties their progress towards fulfilling the terms of the service agreement. The service agreement may be renegotiated at any time that the parties agree that a change is needed. Any lack of progress by the parents, legal guardian, or youth in fulfilling the terms of the service agreement shall be discussed with the parties and documented in the case record. A youth who fails to comply with the terms of the service agreement may lose his semi-independent living subsidy and any other privilege that is a part of the independent living plan. Any notification to the youth regarding the youth's lack of progress or termination shall be sent to the youth and the youth's attorney. In addition to engaging in the analysis set for in §C of this regulation and giving primary consideration to the health and safety of the child, the local department shall give serious consideration to implementing the permanency plan other than reunification if any of the following circumstances exists: The parent or guardian has subjected the child to any of the following aggravated circumstances: The parent or guardian has engaged in or facilitated: Chronic or severe physical abuse of the child, a sibling of the child, or another child in the household; Chronic or life threatening neglect of the child, a sibling of the child, or another child in the household; Sexual abuse of the child, a sibling of the child, or another child in the household; Torture of the child, a sibling of the child, or another child in the household; The parent or guardian knowingly failed to take appropriate steps to protect the child after a person in the household inflicted sexual abuse, severe physical abuse, life threatening neglect, or torture on the child or another child in the household; or The child, a sibling of the child, or another child in the household has suffered severe physical abuse or death resulting from abuse by the parent or guardian or another adult in the household and all persons who could have inflicted the abuse or caused the death remain in the household; The parent or guardian has been convicted, in any state or court of the United States, of: A crime of violence, as defined in Criminal Law Article, §14-101, Annotated Code of Maryland, against: The child; Another parent or guardian of the child; Another child of the parent or guardian; or Aiding or abetting, conspiring, or soliciting to commit a crime described above in §A(2)(a) of this regulation; The local department believes the child to be abandoned as defined in Regulation .03B of this chapter; The parent has involuntarily lost parental rights of a sibling of the child; The child was born addicted to or dependent on cocaine, heroin, methamphetamine, or a derivative of them, or with a significant presence of cocaine, heroin, methamphetamine, or a derivative of them in the child's blood, as evidenced by toxicology or other appropriate tests, and the local department has offered the mother admission into a drug treatment program within 90 days after the birth of the child, and the mother: Does not accept admission to the program or its equivalent within 45 days of the offer; or Fails to participate fully in the program or its equivalent; The child has been adjudicated to be a child in need of assistance, neglected, abused, or dependent in a prior juvenile proceeding and the local department has documented one of the following continuous or serious acts or conditions of the parent or legal guardian: A disability which renders the parent or legal guardian consistently unable to care for the immediate and ongoing psychological and physical needs of the child for long periods of time, even with appropriate and available supports and services to avoid discriminating on the basis of disability; Acts of abuse or neglect, as determined by child protective services of the local department, toward any child in the family; Repeated or continuous failure to provide for the child's physical, mental, or emotional health and development, even though the parent or legal guardian is physically and financially able; or The child has been continuously out of the custody of the parents or legal guardian, and in out-of-home placement with the local department for at least a year, and the local department has documented that: The conditions which led to the child's placement still persist, or similar conditions of a potentially harmful nature still exist; There is little likelihood that the conditions which led to the child's placement will be remedied at an early date to make it possible for the child to be returned to the family in the immediate future; Continuation of the parent-child relationship diminishes the child's prospects for early integration into a stable and permanent family; and The parents or legal guardian have failed to implement a plan for resumption of care which would provide adequately for the child's physical, mental, or emotional health and development, or to maintain regular interest or contact with the child. The local department may request a waiver of reunification efforts, for one or both parents, or the legal guardian, from the court at the CINA adjudication hearing or whenever it is determined that the circumstances described in §A(1)—(4) of this regulation apply to a child adjudicated a CINA. At each reconsideration in determining whether to continue a plan of reunification, the local department shall evaluate the parents' or legal guardian's: Progress toward remedying the conditions that led to the child's placement; Ability to provide appropriate care and supervision of other children in their care and custody; Cooperation with the local department in planning for, and meeting, the needs of the child; Attempts to maintain a relationship with the child through visits, phone calls, letters, and other means; and Likelihood of resuming care and custody of the child within 15 months of the child's placement. The local department shall pursue termination of parental rights for a child who has been in out-of-home placement for 15 of the most recent 22 months unless: The case record documents that inadequate services were provided by the local department to the parents or legal guardian; The child is placed permanently with a relative; or A compelling reason exists. When the local department is required to pursue termination of parental rights as required in §D of this regulation or the permanency plan is changed to adoption, except as noted in §I of this regulation, the local department shall: Ask the parents or legal guardian if they will consent to adoption; and Refer the case to the local department's attorney within 30 days of the date the plan is changed. When the case is referred to the attorney, the attorney shall, within 30 days, petition the court for guardianship with the right to consent to adoption. Adoption Services to Child. Criteria. Adoption services shall be available to any child: Whose birth parent voluntarily relinquishes the child for adoption; Whose birth parent is considering relinquishing the child for adoption because of an inability to sustain adequate parental responsibilities; For whom the decision to pursue permanency planning through adoption is considered by the local department to be in the best interest of the child; or For whom there has been a referral from another service program for local department adoption planning. Decision. When an application for adoption services on behalf of a child is received, the local department and the birth parents shall make a decision regarding the appropriate case plan after the local department ascertains the facts and determines the need for the service. Before guardianship is awarded, children accepted for adoption services may be placed in preadoptive resource family homes, or other residential child care facilities approved by or under the supervision of the local department. Preadoptive Foster Care Placement. Eligibility for preadoptive foster care is set forth in Regulation .04 of this chapter. For a Native American child receiving permanency planning services, the local department shall: Comply with the federal Indian Child Welfare Act of 1978, 25 U.S.C. §1901 et seq.; and Notify the Administration's adoption or out-of-home placement program staff when the local department decides on adoption as the permanency plan. Responsibility in Preadoptive Foster Care. The child in preadoptive foster care shall receive services as set forth in this chapter and the local department shall retain ultimate responsibility for: Providing the child with appropriate physical care, emotional security, and intellectual stimulation; and Observing and recording the child's developmental progress. The local department shall assist the child and the foster family in understanding the child's history in order to facilitate the child's separation from the child's birth family and attachment to an adoptive family. Significant social, biographical, medical, developmental, and educational information shall be immediately documented in the child's record for use in assessing the child's special needs and selecting the most appropriate adoptive family for the child. For a child in preadoptive foster care who is separated from siblings, the local department shall ensure the provision of sibling visitation as appropriate in the best interests of the siblings as set forth in Family Law Article, §5-525.2, Annotated Code of Maryland. Upon receipt of a report of a suspected child abuse or neglect related fatality or a fatality in an open service case, the local department shall comply with the Department's protocol for child fatalities, available from the Administration. For a child who is eligible for early intervention and special education services and whose parents are unknown, unavailable, or deceased, the local department shall request surrogate parents to secure the provision of those services. Court-Ordered Termination of Parental Rights. Parental rights may only be terminated by court order. Only the executive head of a child placement agency or the attorney for the child may file a petition to grant guardianship to the agency. When a court determines that a child is an abandoned infant, the petition to grant guardianship to the agency must be filed within 60 days of the court’s determination that the child is an abandoned infant. The petition to grant guardianship to the agency must be filed within 60 days of the court’s determination that reasonable efforts to reunify the child and parent are not required according to §§A(1)—(4) of this regulation. When the local department decides that adoption is the appropriate permanency plan for the child: The local department shall refer the case to the local department’s attorney within 30 days of making that decision, with or without the consent of the parents; and The attorney shall file the termination of parental rights petition within 30 days of receipt of the referral. Court-Ordered Plan of Adoption by a Nonrelative. When the court determines that the permanency plan be changed to adoption by a nonrelative, the local department shall file a petition for guardianship: Within 30 days if the local department supports the plan; or Within 60 days if the local department does not support the plan. A termination of parental rights hearing shall be scheduled in place of the next 6-month review hearing. Notice to Birth Parent of Petition for Guardianship. When a local department decides to petition the court for guardianship, the local department shall advise both birth parents, regardless of marital status, of that decision and that unless waived, they shall receive the types of notices described in this section, whether or not they are consenting to the court action. The local department shall notify a birth parent who is consenting to the termination of parental rights that the birth parent has the right to revoke the consent at any time within 30 days after the consent is filed. The local department shall notify the following of the filing of the petition: The birth parent, unless the birth parent waived, in writing, the right to be notified of that action as a part of the consent; and The attorney who represented the birth parent in a prior juvenile proceeding in which the child was adjudicated to be a child in need of assistance, a neglected child, or an abused child. The local department shall notify a birth parent of the right, unless waived in writing, to be notified of the child's status when: Placement for adoption has not been made within 9 months of the date of the decree of guardianship; Placement for adoption has been made within 9 months of the date of the decree of guardianship, but before an adoption decree was issued, the adoption placement discontinued and the local department has not made a new placement for adoption within 120 days of the removal from the adoptive home; or Decree of adoption has not been issued by the court within 2 years of placement for adoption. In the case of a missing birth parent, the local department shall: Make reasonable efforts to locate the birth parent to explain the plan for the child and to attempt to obtain the birth parent's consent; and Document those efforts in the case record. Within the 6 months preceding the filing of the petition, the local department shall make reasonable efforts to locate a missing birth parent, which shall include an inquiry of the following: The State Motor Vehicle Administration; Maryland local departments of social services; The State Department of Public Safety and Correctional Services; The State Division of Parole and Probation; The detention center for the local jurisdiction in which the petition is filed; The records of the juvenile court for the jurisdiction in which the petition is filed; A particular social services agency, if the local department is aware that the parent has received benefits from that social services agency within 9 months preceding the filing of the petition; A detention facility, if the local department is aware that the parent has been confined to that facility within 9 months preceding the filing of the petition; Each of the following individuals that the local department is able to locate and contact: The other parent of the child, Known members of the parent's immediate family, and The parent's current or last known employer; The Federal Parent Locator Service; and Certified letters to last known address of missing parent. Efforts to locate a missing parent shall be by personal contact, a search of the computer files of the agencies listed and the Federal Parent Locator Service, or by written inquiry by regular mail. If there is no response to a written inquiry within 30 days after it is mailed, the failure to respond is to be considered a negative response. When the local department completes its inquiry of the agencies and individuals listed in §A(6) of this regulation and does not locate the missing parent, the local department staff shall: Refer the case to counsel for filing of a petition for termination of parental rights; and Verify by affidavit or testimony that these inquiries have been made and that they were made within the 6 months preceding the filing of the petition. The local department shall comply with the order of the court requiring publication of the show cause order in at least one or more newspapers of general circulation published in the county in which the petition is filed. The petition must show notice of filing that the Department has on its website for guardianship and mutual consent adoption. Local Department Responsibilities After Award of Guardianship. Once the local department has been awarded guardianship, the local department shall make every effort to locate an adoptive family for the child, as stated in COMAR 07.02.12, through: The Maryland Adoption Resource Exchange; Local department and central office recruitment efforts; and Registration with regional and national exchanges. When any of the conditions set forth in §A(4) of this regulation occur, the local department shall file a written report with the circuit court and forward a copy to Administration, which shall: State the reasons for the delay in placement; and Include a summary of the efforts to locate an adoptive home for the child and a report of the child's placement status. The local department shall notify birth parent at their last known address: In all cases when guardianship was awarded on or after July 1, 1982; and When the birth parent did not waive the right to notice of the child's status as set forth in §A(4) of this regulation. Once the legal rights of the birth parent of a child in out-of-home placement have been terminated by the court, the child's caseworker shall notify the appropriate office of child support enforcement that termination of parental rights has been achieved, unless an arrangement exists by which the court makes the notification. The local department caseworker shall have regular visits with the child in out-of-home placement, as required in this regulation. However, the visits shall be more frequent than as indicated in this regulation when, in the caseworker's professional judgment, it is appropriate to do so. For a child placed in a resource family home, group care a residential treatment facility, or a semi-independent living arrangement, the following apply: The caseworker shall have a face-to-face visit with the child within 5 working days of placement, and subsequently at least once a month; The majority of the monthly visits shall occur in the placement where the child lives; and The caseworker shall have a face-to-face visit with the out-of-home placement provider at least once every 3 months to obtain information about the child's progress, care needs, medical status, and educational needs. A child placed out-of-State in a foster home or a kinship home shall: Be visited monthly by the local department when geographically or fiscally feasible; or Be visited monthly by the receiving state when placed in accordance with an approved Interstate Compact For the Placement of Children, and the receiving state shall provide Maryland with quarterly visitation reports. For a child placed in an out-of-State group home or residential treatment facility, the following apply: The caseworker shall visit the child at the facility monthly if geographically or fiscally feasible; or If it is not geographically or fiscally feasible for monthly visits, the caseworker shall visit the child in the placement quarterly. Each visit with the child shall: Be of sufficient duration and privacy to allow the child the opportunity to express any concerns regarding the placement, services, or needs; Include a discussion, appropriate to the age and cognitive ability of the child, of the major focus areas related to the child, which includes the child's: Safety; Physical and mental health; Progress and concerns; Relationships or visits with parents, siblings, and other relatives; and Overall well-being. Every contact with the child shall be documented in the child's record, including: The date and location of the visit; If other than a visit, the nature of the contact; The name of the person making the contact; The agency that made the visit, if other than the local department; A summary of any significant results of the contact; A discussion of major content areas as described in §F of this regulation; A discussion of monthly meetings between the caregiver or group care staff; Assessments of the quality of care being provided and the child's adjustment to the placement; and The child's safety evaluation using the approved safety assessment tool. Every visit with the child shall be documented as immediately as possible in the case record but not later than 5 business days after the visit occurs. When the local department is informed that a out-of-home placement child is missing, abducted, or has not returned home at a prearranged time, the local department caseworker shall: Notify the: Local law enforcement and obtain a complaint number; Parents or legal guardian and their attorney unless guardianship is granted to the local department; CINA attorney for the child; and The local department's attorney; Compile information on the child's last known whereabouts and activities; Contact and speak with any person who may have relevant information, including: Relatives; Friends; School personnel; Persons at the child's place of employment, if applicable; Persons in the child's neighborhood of origin; Persons in the out-of-home placement neighborhood; Consult with the local law enforcement regarding the procedure to be followed to return the child and whether the local department or local law enforcement will pick up the child; Develop a plan for the child's placement upon return; Document the child's runaway or missing status with a begin and end date in the child's whereabouts section on the case plan; Document weekly search efforts to locate the child on the contact sheets in the case record; Keep the parents, legal guardian, placement provider, and attorneys updated weekly on the status of the search for the child; Maintain weekly contact with local law enforcement regarding the search status for the child; and If the caseworker has information that the runaway or abducted child has been located in another state, the caseworker shall contact the Compact Administrator for the Interstate Compact on Juveniles at the Department of Juvenile Services for assistance in returning the child. Hold of Child's Placement. The caseworker shall contact the current placement provider to determine if the provider is willing to hold the child's placement. If the placement provider is willing to hold the placement: Payment of the board rate may be made for up to 30 days; No difficulty of care stipend payment may be made for the period the child is on runaway or missing from the placement; and If the child fails to return within 30 days, the provider cannot be paid beyond the 30-day time limit. If the placement provider will not hold the child's placement or the 30-day time period has expired, the caseworker shall: Contact the financial unit to stop the foster care payment for the child; and Conduct a new placement search for the child. When the child is located: The local department with jurisdiction over the child is responsible for: Ensuring that the child has transportation to the local department; Assisting local law enforcement or other responsible party with transportation of the child to a placement if found within the local department's jurisdiction; and Retrieving the child if found in another jurisdiction or state; The parents or legal guardian, placement provider, and attorneys shall be notified that the child has been found; The local department shall call local law enforcement in the placement jurisdiction to escort the child to the placement if the child refuses placement; The caseworker shall interview the child regarding the reasons for running away, if applicable, and record the discussion on the contact sheet; and The local department shall obtain a physical examination of the child, and appropriate follow-up medical care for the child. General. A periodic review of a child's status shall be held not less frequently than once every 6 months by the juvenile court, and, if not reviewed by the court, may be reviewed according to §A(2) of this regulation. The review shall be conducted by the court, an administrative panel, or the Citizens' Review Board for Children (CRBC), as described in COMAR 07.01.06. At least one local board of the CRBC exists in every county and Baltimore City, and reviews the cases of children in out-of-home placement in accordance with its local plan as approved by the CRBC State Board and the Secretary of Human Services. Each local department shall provide the local board with information the board requires to perform its duties. The periodic review shall determine the: Continuing necessity for and appropriateness of the placement; Extent of compliance with the permanency plan; and Extent of progress which has been made toward alleviating or mitigating the causes necessitating out-of-home placement. The periodic reviews shall project a likely date by which the permanency plan for the child will be achieved. The local department shall, in preparation for the periodic review held by: The court: Give 10 days notice of the review, whenever possible, to the parents or legal guardian, child, foster parent or the foster parent's attorney, pre-adoptive parent, or relative caregiver; and Document the notice in the child's case record; The CRBC, encourage the parents, legal guardian, foster parents, pre-adoptive parents, relative caregivers, the child's attorney, the child if appropriate, and any other interested individual to attend the review; or An administrative panel: Invite the participation of the parents, legal guardian, foster parents, pre-adoptive parents, relative caregivers, the child's attorney, and the child if appropriate; and Document the notice given in the child's case record. At the permanency planning hearing, the local department shall detail: The efforts to finalize the permanency plan in effect for the child; The services to facilitate the achievement of a permanency plan for the child; The reasons the child's placement is stable and the least restrictive setting available and accessible for the child since the most recent hearing; The services to help maintain the child in the child's existing placement, including all services and benefits available in accordance with State law, regulations, court orders, or stipulated agreements accepted by the court regarding the provision of services to children in out-of-home placements; The efforts to meet the needs of the child, including the child's health, education, safety, and preparation for independence; The assignment of a caseworker that is responsible for the case at all times, and that the caseworker has received within 30 days of assignment all pertinent files and information about the case; and The consideration of both in-State and out-of-State options to finalize the permanency plans. An administrative review shall be conducted by a panel of three or more adults, who may be employees or volunteers of the local department, at least one of whom is not responsible for case management or service delivery to the child, parents, or legal guardian. The written documentation of the periodic review shall be placed in the child's case record. The periodic reviews shall continue until the child exits an out-of-home placement. The court determines the permanency plan for a child based upon the recommendations of the local department and the other parties at the permanency planning hearing consistent with the hierarchy of permanency plans described in Regulation .13 of this chapter. At least 10 days before the permanency planning hearing, the local department shall: Perform the tasks listed in Regulation .19D and E of this chapter; Prepare a written report setting forth the local department's recommendations; and Provide the report to the court, the child's attorney, and the child's parents or legal guardian. Permanency planning hearings shall be scheduled in the following manner: Within 30 days of a court order waiving reunification services; Not later than 11 months after the original placement; and Every 6 months thereafter, or every 12 months when the court has made a determination that the child will be placed with a specific caregiver on a permanent basis. Children with Disabilities Voluntary Placements. A local department may not seek legal custody of a child under a voluntary placement agreement if: The child has a developmental disability or a mental illness; and The purpose of the voluntary placement agreement is to obtain treatment or care related to the child's disability that the parent is unable to provide. If a child needs to remain in out-of-home placement over 180 calendar days, the local department that placed a child pursuant to a children with disabilities voluntary placement agreement shall file a petition to request a voluntary placement hearing in a timely manner so as to obtain, before the 180th calendar day in voluntary placement or prior to the child's 18th birthday, a judicial determination that continuation of the voluntary placement is in the best interest of the child. At the voluntary placement hearing, the local department shall be prepared to address: Whether continuation of the placement is in the child's best interests; Whether reasonable efforts have been made to reunify the child with the family or place the child in a timely manner in accordance with the child's permanency plan; What supports and services will be needed for the child to remain in the family home if the voluntary placement is terminated; Whether the voluntary placement agreement should be amended to better address the needs of the child; and Whether there are outstanding issues concerning the care, safety, protection, and mental and physical development of the child for which the court may find it is necessary to order the local department to file a CINA petition. Enhanced After Care. If the local department and youth agree that the voluntary placement shall continue after 180 calendar days from the signing of the voluntary placement agreement, the local department shall file a petition with the juvenile court before the 180th day, requesting a review of the voluntary placement. Before the 180th calendar day, the local department shall obtain a finding from the court that continuation of the placement is in the best interests of the youth. The local department shall establish and maintain a case record for every child in out-of-home placement containing all of the documents required by this chapter. The record shall also include the following: All of the forms that are required by the State and federal government for statistical accounting; A signed, file-dated copy of any petitions filed with the court; The voluntary placement agreement or the court order for shelter, custody, or guardianship; Any other court order; All service agreements; A dated and summarized record of each agency contact, or attempted contact, with the child, parents, foster parents, and any other individual with whom the agency has contact regarding or on behalf of the child; A statement of consent for medical treatment signed by the child's parent or legal guardian, or a statement of the parent's or legal guardian's refusal to sign consent, and any court order giving medical guardianship to the local department; A copy of any correspondence or reports written or received in regard to the child, including letters of notification to the child's parents or legal guardian regarding responsibilities, requirements, and case reviews. When the child has been in out-of-home placement for 2 months or longer, the local department shall ensure that the child's case record contains, at a minimum: A written case plan that, at a minimum, contains all of the information required by Regulation .13A of this chapter; A copy of the child's birth certificate; and The child's Social Security card or a photocopy of the child's card or a copy of the federal Form SS-5 sent to apply for a Social Security number for the child. Initial Action. The public or private child placement agency employee who receives a report, or makes a personal observation, of suspected abuse or neglect in an out-of-home foster care placement shall immediately: Notify the following unit and staff of the local department in the jurisdiction in which the incident occurred: Child welfare screening unit; The out-of-home placement caseworker or supervisor for each child in placement; and If applicable, the foster home caseworker or supervisor; and Assess the level of safety for each child, and, if the child is not safe, remove the child and arrange for the child's protection and care. Within 5 working days, the local department shall provide notice of the report of suspected child abuse or neglect, and of the action taken in response to the report, to the: Administration; Child's parents or legal guardian, unless: The child sustained an injury in which case notification must be made within 24 hours of the report; or Notification to the parents or legal guardian is contrary to the child's best interest; Child's attorney; Caseworkers for other children living in the out-of-home foster care placement; Parties permitted by State law to receive notification upon request; and Department's Office of Licensing and Monitoring if the child resides in a: Private agency foster home; Group home, including a shelter; or Residential treatment program. Investigation. The local department's child welfare screening unit shall respond to the complaint of abuse or neglect as required by Family Law Article, Title 5, Subtitle 7, Annotated Code of Maryland, and COMAR 07.02.07, except that the investigator may not be the caseworker for any child in the out-of-home foster care placement. Additional children may not be placed in the home pending the outcome of the investigation and the decision by the local department director or designee as to the continued use of the home. The local department shall complete a preliminary reassessment of the home within 2 working days of the complaint to determine whether the home still meets the standards for a foster home pursuant to COMAR 07.02.25 or 07.05.02. If foster children remain in the home, the appropriate local department staff shall visit the foster home weekly until the local department director or designee renders a written decision as to the continued use of the home. The investigator, the caseworkers for the children in the out-of-home placement, and the foster home worker shall remain in close communication throughout the investigation. Review of a Critical Incident in a Foster Home. Not later than 2 working days after the incident is reported, the local department shall, according to the Administration's Critical Incident Protocol, conduct a case conference which shall include the: Child protective services caseworker; Out-of-home placement caseworker and supervisor; and Foster home and private agency caseworker, if applicable. After considering the information provided, the case staffing team shall produce recommendations regarding continued use of the foster home for the local department director or designee. Within 5 working days of receiving the recommendations, the local department director or designee shall render a written decision. A copy of the local department director or designee's decision shall be placed in the foster home record and the child's record. Notification of Foster Home Disposition. Within 5 working days of the staffing review, the local department shall mail a copy of the local department director or designee's written decision to the: Foster parent; Administration; Private child placement agency, if applicable; Child's attorney; and Parties permitted by State law to receive notification upon request. Notification of Investigation Disposition. Upon receipt of the disposition report for the investigation, the local department shall: Notify the: Foster parent; Child's parents, unless notification is contrary to the child's best interest; Child's attorney; and Parties permitted by State law to receive notification upon request; and Place a copy of the letters of notification in the child's record. The decision by the local department to return a foster child to the care of the parents or legal guardian shall be made with the parent or legal guardian's participation after an assessment of their ability to safely care for the child and a thorough evaluation of the parent's or legal guardian's living situation and capacity to safely resume parental responsibilities. The local department shall inform the court when it returns a child who has been committed to a local department to the parents or legal guardian and shall report the pertinent changes in the family or child's situation which support the return. The local department before the return of a child to the parents or the legal guardian, shall notify the court and request a hearing if the court has committed the child to the local department upon a finding of child abuse. The local department shall assist the parents or legal guardian with necessary preparations for the child's return home and shall assist the parent in: Getting those services that may be needed to aid the family such as: Child care; Temporary Cash Assistance (TCA); Emergency Assistance to Families with Children (EAFC); Medical Assistance; or The Maryland Children's Health Choice Program (MCHCP); Locating the appropriate school placement; and Locating a medical care provider for the child. The local department shall provide aftercare services to the parents in accordance with Regulation .25 of this chapter. The local department shall provide aftercare services to the child and the aftercare placement family: For an initial period of up to 3 months, which may be extended an additional 3 months for a total of 6 months; and Beyond the 6 months based upon a compelling reason for extending the services: At 1 month intervals with the written approval of the local director; or For a specified time period as ordered by the court. While providing aftercare services, the local department shall evaluate whether the family can provide adequate care to the child: Without supportive help from the local department; With less intensive services; or With the support of specified community services that are not provided by the local department, but which the local department may assist the family in accessing. The local department shall evaluate every 3 months whether the: Family can keep the child safe, and provide for the child's well being so that custody may be returned to the parents or legal guardian; Child should be returned to out-of-home placement; or Parental rights should be terminated. If the local department determines that the family is providing adequate care for the child, the local department shall make a final report to the court concerning the family's progress and shall request rescission of the commitment. During the aftercare services period, the local department shall visit the child in the aftercare placement a minimum of once every 2 weeks and at least one caretaker must be present. The local department shall include in the case record for an aftercare placement a: Case plan with a service agreement that is updated at least every 60 days during the aftercare placement, which includes a signed service agreement with the aftercare caretakers; Service plan specific to the needs of the child and family; and Safety assessment completed at the time of the aftercare placement. Independent living aftercare services shall be made available to youth 18 to 21 years old as set forth in COMAR 07.02.10. The local department shall give priority to the child's relatives over nonrelatives when determining permanency plans and placement. The decision by the local department to place a child with relatives shall be made: With the participation of the relatives; After completing a home study to include: A physical description of the relative's living situation and family history; Services needed by the child; and Relative's ability and capacity to safely assume parental responsibilities; and When feasible, in conjunction with a visit or visits by the child in the relative's home. The local department shall assist the relatives in obtaining adoption, guardianship, or custody of the child. The projected permanency plan of adoption, guardianship, or custody and guardianship shall have an expected achievement date of 24 months after the placement in care for foster children living with their relatives. The local department shall assist the relatives with necessary preparations for the child's placement and shall assist the relatives with: Getting those services that may be needed to sustain their family, such as: Child care; Temporary Cash Assistance (TCA); Emergency Assistance to Families with Children (EAFC); Medical Assistance; or The Maryland Children's Health Choice Program (MCHCP); Locating appropriate school placement; and Locating an appropriate medical care provider for the child. The local department shall provide aftercare services to the child and relatives in accordance with Regulation .25 of this chapter. Before custody and guardianship is granted to a relative or nonrelative of a child not committed to the local department, the local department shall: Determine if departmental funds are available to support and maintain the child; Assess all factors necessary to determine the best interests of the child; and Pursuant to an order from the court, prepare a report on the suitability of the individual to be the guardian of the child that includes a: Home study for custody and guardianship; Child protective services history, if any; Criminal background check; and Review of the proposed guardian's physical and mental health history. The local department shall submit the report described in §A of this regulation to the court within 120 days after the date that the court issued the order to the local department to produce the report. If the report is not submitted to the court within 120 days, the local department shall be prepared to: Attend a court hearing on the failure to submit the report; Justify to the court why the report is delayed; and Bear the cost of another agency completing the report if so ordered by the court. For children committed to the local department, the local department shall initiate without a court order the custody and guardianship proceedings and perform the tasks listed in §A of this regulation. An order granting custody and guardianship to an individual under this regulation terminates the local department's legal obligations and responsibilities to the child. Interstate Compact. All placements of children for out-of-home placement or as a preliminary to possible adoption in Maryland from another state shall comply with the requirements of the Interstate Compact for the Placement of Children (Compact), Family Law Article, Title 5, Subtitle 6, Annotated Code of Maryland. The placement of Maryland children into states which are members of the Compact shall also comply with the Compact requirements. To place a child out of State, the Compact requires that before the two states involved sign a contract or an agreement, the plan shall be approved by the: Other state based on its interstate placement requirements; and Social Services Administration. A foster child may be placed in a foster home or adoptive home located out of Maryland or by purchase of care from an agency or institution located in another state only under one of the following conditions: The foster family which has the child moved to another state and, after assessment of all pertinent factors, the local department decides that maintenance of the relationship between the foster family and the child would be in the child's best interest. Pertinent factors are: The child's relationship to the foster family over a long period of time; A lack of active family connections in the State; and Imminence of discharge from care. The adoptive family which has the child moves to another state before finalization of the adoption. A local department has a plan approved by the Social Services Administration to use foster or adoptive homes in bordering states. This plan assures that the local department can provide responsible supervision of the placement and that the child's educational and other needs will be adequately met. The facility of any agency or institution in another state, licensed or approved for child care under the laws of that state, can meet the special needs of the child which cannot be met by facilities within this State. A private agency within the State, from which a local department purchases care, uses an out-of-State specialized treatment resource which cannot be provided by a facility within the State, and the local department concurs. Under this plan, the local department shall ensure that the requirements for an interstate placement are met. When a foster child is to be placed out-of-State with a noncustodial parent, relative, or guardian, the local department shall ensure that the requirements for an interstate placement are met. All of the child's resources, including parental support, the child's own benefits, insurance, cash assets, trust accounts, and, for the child who is preparing for independent living, the child's earnings, are considered, as established in the service agreement, in determining the amount available for reimbursement of the cost of care. In calculating the cost of care, the local department shall include the board rate, clothing allowance, any medical care payments made on behalf of the child, and any supplemental purchases made to meet the child's special needs. The local department shall: Initiate child support for every child in out-of-home placement; and Pursue support enforcement activity for both absent parents, unless the: Legal rights of the parents or legal guardian have been officially terminated; and Parents, parent, or legal guardian have been officially notified of the termination. In this regulation, “parent” means the legal father or mother or natural father or mother whose rights and obligations have not been terminated. Legal action for support need not be taken against the father or mother when parental rights have been terminated. The local department caseworkers shall: Inform the parents that they are responsible for the financial support of their children whether the child is in care by court order or by voluntary agreement; and Initiate a support action by furnishing information regarding the child's parents to the local child support enforcement (CSE) unit, which will undertake child support enforcement action for all out-of-home placement cases. After the CSE unit secures a court order of support, the CSE worker shall: Send a copy of the court order to the out-of-home placement caseworker and to the IV-E eligibility case reviewer; Retain copies of the document in both the child's and the parents' or legal guardian's (if appropriate) case records; and Notify the out-of-home placement worker of any changes. Whenever a child's plan is reassessed, the out-of-home placement worker shall request information on whether support has been paid according to the terms of the order, which shall be: Documented in the records; and Considered in making recommendations to the court and reviewing panels. When there is a change in the parents' or legal guardian's address or employment, or any other change which would affect the collection of child support, or when an out-of-home placement case is closed, the out-of-home placement worker shall forward this information to the Child Support Administration. The resource from the child's own earnings is determined in a manner consistent with a plan for the child to eventually assume responsibility for the child's support as provided for in the service agreement. Other Resources for the Child. Other resources available for the child may be in the form of cash assets, trust accounts, insurance (including survivor's disability insurance), or some type of benefit or supplemental security income for the disabled child. While in out-of-home placement, if the child is 18 years old or older and is the beneficiary of insurance or survivor's benefits, the child shall choose whether to: Receive benefits and pay the local department; or Designate the local department as the payee. The local department shall seek a representative payee for an incompetent child 18 years old or older. The child's resources shall be applied directly to the cost of care, with any excess applied first to meeting the special needs of the child, and the net excess saved in a savings account for future needs. Any potential benefits from other resources shall be pursued and made available if possible to the local department as payee. If excess funds saved for the child have not been spent before the child is discharged from out-of-home placement, the funds shall be: Returned to the child upon discharge if the child is 18 years old or older; or If the child is younger than 18 years old, transferred to the parent or legal guardian with whom the child will reside. (Agency Note: Federal Regulatory Reference — 45 CFR 1355 and 1356) Under the Social Security Act, Title IV, Part E, the federal government provides funds to states for maintaining certain children in out-of-home placement or in adoptive families. Definitions. In this regulation, the following terms have the meanings indicated. Terms Defined. “Aid to Families with Dependent Children (AFDC)” means the Income Maintenance program provided under Title IV-A of the Social Security Act, which requires that to be eligible for Title IV-E, the child must meet the AFDC criteria in the IV-A State Plan in effect July 16, 1996. AFDC Standard of Need. “AFDC standard of need” means the cost of a family's basic living needs that the State recognizes as essential for all families, and any special recurring or nonrecurring needs recognized by the State as essential for some persons. “AFDC standard of need” means the AFDC standard of need in effect on July 16, 1996, which is the standard used for Title IV-E eligibility. “Constructive removal” means when the State agency has obtained legal responsibility for a child who is residing with a related or nonrelated interim caretaker and the child is allowed to remain with the interim caretaker, so that the child was not physically removed from the interim caretaker, but was constructively removed from the care and custody of the parent or other specified relative with whom they had physically resided within 6 months before court proceedings or execution of a voluntary placement agreement. “Date child is considered to have entered foster care” means the earlier of: A judicial finding of abuse or neglect; or 60 days from the date the child is removed from the home. “Detention” means the temporary care of a child who, pending court disposition, requires secure custody for the protection of the child or the community, in physically restricting facilities. “Deprivation” means a child is deprived of the care and support of one or both parents as a result of: Death; Physical or mental incapacity; Continued involuntary absence (for example, due to incarceration); Voluntary absence (for example, due to divorce or separation) from the home where the child resides; or Unemployment/underemployment of the primary wage earner. “Federal financial participation (FFP)” means the matching rate paid by the federal government for specified program activities, as provided in 45 CFR §1356.60. “Financial need” means a child's /family's income and resources in the removal home must be within the AFDC standard of need that was in effect on July 16, 1996. “Initial court order” means the very first court order that authorizes the child's removal from the home and includes a judicial finding of contrary to the welfare of the child. “Out-of-home placement” means placement of a child into foster care, kinship care, group care, or residential treatment care. “Physical removal” means that the agency has physically removed the child from the home of a parent or other specified relative. “Redetermination” is a case review completed every 12 months, at which time factors subject to change, are reconsidered and documented. “Removal home” means the home of the parent or other specified relative from whom the child was legally removed. Specified Relative. “Specified relative” means any relation by blood, marriage or adoption who is within the fifth degree of kinship to the dependent child. “Specified relative” includes great-great-great grandparents and first cousins once removed (children of first cousins). Federal financial participation under Title IV-E is available for the child who meets the criteria for both initial IV-E eligibility and IV-E reimbursability, as set forth in §§D—N of this regulation. Initial IV-E eligibility shall be determined when the child enters care. The local department shall make all payments to out-of-home placement providers from State funds until IV-E eligibility has been determined. Initial Eligibility. A child is initially eligible for IV-E funding only if all of the following requirements are met: The child meets the AFDC eligibility criteria in effect in the IV-A State Plan as of July 16, 1996, if: The child was living in the home of a relative specified in §B(2)(n) of this regulation and one of the following is true: The child would have received AFDC in that home in the month of the voluntary placement agreement or initiation of court proceedings, if an application had been made; or The child was not living with an AFDC specified relative, but did live with such a relative in the preceding 6 months, and met the deprivation and financial need requirements as described in §B(2)(f) and (h) of this regulation in the eligibility month; and The child lived with a specified relative from whom custody was removed at some time within the 6-month period before the month of the voluntary placement agreement or initiation of court proceedings; and The child would have been AFDC eligible in that month, if the child had still been living in the home; and The child was the legal responsibility of a local department as a result of: Physical or constructive removal from the home, with a judicial determination that: Continuation of the child in the child's home would be contrary to the child's welfare; Reasonable but unsuccessful efforts were made before placement to prevent or eliminate the need to remove the child, or that reasonable efforts could not be made because of the emergent nature of the situation; and Reasonable efforts are now being made to reunify the child with the child's family; or A valid time limited or children with disabilities voluntary out-of-home placement agreement which was not a voluntary relinquishment for adoption. If the initial court order does not contain the required finding that continuation in the home is contrary to the child's welfare, the child is ineligible for Title IV-E for the duration of that out-of-home placement episode. If the initial court order does not contain the required finding that reasonable efforts were made to prevent placement: The child may still meet the legal status for initial eligibility if a judicial finding of reasonable efforts to prevent placement is made within 60 days of the date the child is removed from the home; The child's IV-E eligibility will begin the first day of the month in which the judicial finding of reasonable efforts to prevent removal is made; and If the determination concerning reasonable efforts to prevent removal is not made, the child is not eligible under IV-E for the duration of the stay in foster care. A child who is initially eligible for IV-E funding shall continue to be eligible as long as the child remains in out-of-home placement. The child becomes ineligible: At the end of the month in which the child becomes 18 years old, except that a child 18 to 21 years old who remains in out-of-home placement is eligible up to the 21st birthday so long as the child is: Completing secondary education or a program leading to an equivalent credential; Enrolled in an institution that provides post-secondary or vocational education; Participating in a program or activity designed to promote or remove barriers to employment; Employed for at least 80 hours per month; or Incapable of doing any of the activities in §§I.(1)(a)—(d) of this regulation due to a medical condition, which incapability is supported by regularly updated information in the case plan of the child; or When the child comes into care as the result of a time limited or children with disabilities voluntary placement agreement and the local department fails to acquire court-ordered custody with a judicial finding of best interests of the child to remain in placement within 180 calendar days of placement rendering the child ineligible on the 181st calendar day. If the child’s parents have consented to termination of parental rights before placement or the court has terminated parental rights before placement, the child may never be determined to be eligible for Title IV-E Foster Care or subsidize adoption payments. Reimbursability. A child shall be eligible for IV-E in order for the child’s care to be reimbursabile. A child may lose and regain reimbursability depending on changes in the circumstances of the placement. The loss of reimbursability may not deprive a child of future reimbursability except in the circumstances described in §F of this regulation. The child's care is reimbursable for any given month when all of the following conditions are met for that month: There is a “reasonable efforts” finding specific to the child; The child is in a IV-E reimbursable placement as defined in §N of this regulation; and The local department has placement and care responsibility for the child. Judicial Determination. A judicial determination of reasonable efforts to finalize the permanency plan shall be obtained not later than 12 months from the date the child is considered to have entered foster care and at least once every 12 months thereafter while the child is in foster care. If a judicial determination regarding reasonable efforts to finalize a permanency plan is not made within the prescribed time frame, the child becomes ineligible for Title IV-E payments at the end of the month in which the judicial determination was required to have been made and remains ineligible until such a determination is made. The child becomes eligible for IV-E payments again the first day of the month the judicial determination regarding reasonable efforts to finalize a permanency plan is made. Only the following are reimbursable placements: A fully licensed or approved resource family home meeting the standards as prescribed in COMAR 07.02.25; A private, nonmedical group home or residential child care facility licensed by the State; A public nonmedical group home or child care facility which accommodates not more than 25 children; or A supervised independent living setting in which the child who is 18 years old is living independently. A Title IV-E redetermination shall be completed every 12 months. Board Rates and Clothing Allowance. Board rates and monthly clothing allowances are set forth in Schedules A and B of Regulation .39 of this chapter. The board rate is effective for the full month in which the child reaches the lower age specified for each group. The board rate is based on the cost of maintenance expenses for the child. The monthly clothing allowance covers the purchase and upkeep of clothing. The emergency care rate is for the care of the child who was placed in out-of-home placement on an emergency basis. This rate may not be paid for more than 2 months. The regular care rate, as defined in Regulation .03B of this chapter, is for the care of the child who requires usual and ordinary supervision in a foster family or pre-adoptive home. A relative may be eligible to receive foster care rates for the care of a committed child if the relative's home meets the approval requirements for a foster home, as described in COMAR 07.02.25. The intermediate care rate set forth in Regulation .39, Schedule A of this chapter is for the care of the child who requires intermediate care as defined in Regulation .03B of this chapter. Foster parents who receive intermediate care rates shall: Provide care for a child who requires intermediate care; Have the desire to make a major investment of time, and the ability to give affection and attention without positive response from the child; Be required to supervise or provide prescribed physical care, such as the preparation of special medication; Have the ability to accept and cope with difficult child behaviors; Participate in social service, medical, or psychiatric treatment plans for the child; Participate in training arranged by the local department and the cost of this training may not be borne by the foster parents. The local department shall include in the child's and the foster family's case records a written justification for including the child in the intermediate payment category. The justification shall include a written certification or evaluation by a physician, psychologist, or licensed social worker stating that the child requires a high degree of supervision and care. Treatment Foster Care. The treatment foster care rate is paid only to foster parents who are providing treatment foster care through one of the State's public treatment foster care programs in accordance with Regulation .33 of this chapter. Treatment foster care payments shall be made monthly. The payment shall consist of the board rate according to Schedule A of Regulation .39 of this chapter, and a supplemental treatment difficulty of care stipend. The Administration shall set the amount of the treatment foster care stipend by service intensity level for local departments that operate a public treatment foster care program. The payment for respite care services for the public treatment foster care program shall be according to Schedule A of Regulation .39 of this chapter, unless the respite placement is a purchase of care placement, which will be paid at the negotiated per diem rate. Supportive Services. Supportive services may be purchased in order to maintain the child in the community. Supportive services may be purchased from: A foster family who by virtue of special training or experience is able to provide supportive services; or Another provider appropriate to the special needs of the child. Supportive services purchased according to §I(2)(a) and (b) shall be approved in writing by the director of the local department or the director's designee who is other than the caseworker. This written approval shall confirm that: The child requires the identified supportive service because of a health problem, or an emotional or behavioral problem; and The service provider is capable, by virtue of special training or experience, of providing the needed service. The services may not be purchased or authorized until the Executive Director of the Social Services Administration or the Director's designee has allocated the amount of funds that are available to purchase them. Retainer Fee. Foster parents who are approved as emergency foster homes may be paid a separate retainer fee, contingent on availability of funds, in accordance with State guidelines. When a child in group care makes a planned visit to a foster family for a weekend or other period, the local department shall pay the foster family the per diem rate in Schedule A of Regulation .39 of this chapter for each overnight stay of the child's visit. The local department shall pay transportation costs from and to the group care placement. A special clothing grant may be made as needed according to the child's age as specified in Schedule B of Regulation .39 of this chapter. The monthly clothing allowance may not be paid for the same month that the initial clothing allowance is paid. The initial clothing allowance is not available to the child in group care when the clothing allowance is in the negotiated rate paid to the provider. Medical Care. Medical care for foster children is provided under the Medical Care Programs of the State. Provision is not made for payment for medical care from out-of-home placement funds, except that: Payment may be made for essential medical needs for a child when the service or equipment is not available through the Medical Assistance and Health Choice Programs, or other established health care programs; If a child is covered under the child's parents' medical insurance, the scope of the coverage shall be ascertained and used first; For costs not available through the Medical Assistance and Health Care Programs of the State, reimbursement shall be made to foster parents for out-of-pocket medical expenses incurred for foster children as set forth in §N(2) of this regulation. Procedures for Reimbursement. Foster parents shall retain all nonreimbursed bills. Bills for nonprescription drugs shall be accompanied by a physician's statement concerning the child's need for the drugs. Local departments are authorized to pay from their administrative funds the following items: Eyeglasses beyond the one pair per year covered by the Maryland Medical Assistance Program and for cost of eyeglass repair as needed; Nonprescription drugs if accompanied by a physician's statement as to the child's need for them; Any payment or copayment required for each prescription filled on behalf of a foster child enrolled in the Maryland Medical Assistance Program; Any other medical service that the child requires, if accompanied by a physician's statement as to the child's need for the service, or a court order. Transportation for or on behalf of the foster child, whether reimbursed to a foster parent or paid to a vendor, may be allowed under the following special circumstances: To carry out a special plan for the child; To provide regular transportation required over a period of time; To provide essential transportation when the distance or the means of transportation or the time of day entails unusual cost. The amount reimbursed may include: Public transportation costs for the child or for the adult to accompany him when necessary, or both, provided, however, that the costs may not be met when the adult is an employee of another agency; Incidental expenses such as meals; Cab fare when necessary because of emergency need or lack of less expensive means of transportation; Mileage reimbursement at the same rate paid to State employees, when a foster parent furnishes transportation in a personally owned car. Funeral Expenses. The local department may pay funeral expenses not exceeding $650 for a child who dies while in out-of-home placement. Any resources of the foster child including insurance benefits or the child's estate, or of an individual who was legally responsible for the child's support, are to be used to pay for burial expenses. The cost of funeral expenses shall be charged to State funds. Special direct burial expenses, such as the cost of a burial lot, vault when required, grave digging, and burial clothing, which are met by family or friends are exempt from this requirement. Purchased Foster Care. The purchased family foster care rate is for the care of a child who requires extra supervision and attention in a home equipped to give this special care. This type of purchase may be used to prevent placement of a child in a group care facility, or to enable his discharge from a group care facility. Rates for the purchase of care from licensed child placement agencies are provided for purchased family care supervised through the licensed child placement agencies. Licensed child placement agencies are reimbursed as follows: Foster care purchased from agencies, which includes room and board, is paid according to the negotiated rate issued by State Department of Education and the terms of the contract with the Department. Purchase of Supportive Services. Provision is made to purchase supportive services, as needed, in order to maintain the children in the community. These special supportive services may be purchased from two sources which are the foster family who by virtue of special training or experience is able to provide them, or through another resource appropriate to the special needs of the child. The supportive services to be provided shall be approved in writing by the director of the licensed child placement agency or the director's designee who is other than the caseworker. This written approval shall confirm that the child requires the identified supportive service because of a health (physical or mental) condition, or an emotional or behavioral problem, and that the service provider is capable, by virtue of special training or experience, of providing the needed service. Supportive services may not be purchased or authorized until the Executive Director of the Social Services Administration or the Director's designee has allocated the amount of funds that are available to purchase them. Private Child Placement Agency Treatment Foster Care Rate. This rate, paid according to the negotiated rate issued by the State Department of Education and the terms of the contract with the Department, provides for the care of a child who requires treatment foster care as defined in Regulation .03B of this chapter. In recognition of the severe nature of the problems of children cared for in treatment foster homes, a supplemental difficulty of care stipend is paid to these foster parents. The Department shall set the amount of the stipend to be included in the contract with the private provider agency. Initial Clothing Allowance. The initial one-time only clothing allowance as set forth in Schedule B of Regulation .39 of this chapter may be made on behalf of any child entering foster care to meet basic clothing needs. Group Care in an Institution or Group Home. The Administration shall negotiate rates for: Basic care which includes room, meals, and clothing; Social work service to a child dealing with the child's placement and needs, including identified special services in addition to the facility's routine supervision and services; Health-related services including psychological, psychiatric, medical, and dental services not provided under the Medical Assistance Program and Health Choice Program; and Approved education program or school, for the period of actual attendance, needed as part of an individual treatment plan not paid for by the Maryland State Department of Education and not generally available. Supplemental Services. If funds are available, the local department may purchase supplemental services for a child on an individual need. Supplemental services are services: Not included in the negotiated rates listed in §D(1) of this regulation and not available from other resources but needed to complete the treatment plan for a child; and Approved by the local director or the director's designee as a need based on written documentation in the child's case record. Supplemental services include, but are not limited to: Speech therapy; Transportation related to special education; or One-to-one staffing. Cooperative Relationships—Purchase of Care. In any purchase of care plan, the local department and the agencies or facilities involved are required to jointly develop and carry out a responsible plan for services appropriate to the needs of the child, his natural family, or other significant persons in the child's life. The plan shall be implemented by regular interagency contacts. The group facility shall send a written report on the status of the child to the local department at a minimum of every 180 days. The local department worker shall remain involved with the child and the child's family during and after purchase of care to assure continuity of care and treatment, coordination of interagency effort, and to minimize the duration of purchase of care when possible. The goals of the PTFC program, in addition to the goals of out-of-home placement as stated in Regulation .02 of this chapter, are to provide, in a family setting, intensive services to a child with a serious emotional, behavioral, medical, or psychological condition. PTFC Child Eligibility Requirements. To be eligible for PTFC, the child shall: Qualify for foster care under Regulation .04 of this chapter; Have one or more conditions as detailed in §B(2) of this regulation; and Need a high level of treatment in a family setting. Eligible conditions for PTFC include: A serious medical condition including, but not limited to: HIV positive and symptomatic; AIDS; Multiple handicaps; A symptomatic drug-exposed newborn requiring treatment care; A serious emotional or behavioral condition as defined in Regulation .03B of this chapter, or psychological condition indicated in a psychiatric diagnosis by appropriate qualified professionals, or the same conditions resulting from continuous substance abuse; A developmental disability as defined in COMAR 10.22.01.01B; or A medically fragile child condition as outlined in COMAR 14.31.05.03B. Siblings who do not require treatment foster care may be eligible to be placed as a nontreatment foster child in the same treatment home with a sibling who requires treatment foster care with written approval from the Administration. The PTFC caseworker is responsible for: Providing supervision, training, and consultation to treatment and biological parents; Arranging and ensuring that a child receives necessary services; and Acting as the leader of a child's treatment team. Each local department PTFC program shall establish a gatekeeper for the PTFC program from existing staff who shall: Act as the single point of entry for placement of children in the PTFC program; Perform periodic assessment of continued treatment foster care eligibility for each child in the PTFC program; and Perform program monitoring functions for the PTFC program. Staffing Requirements. The caseload ratio may not be greater than one PTFC caseworker to eight children. The PTFC program may decrease the case load ratios of the PTFC caseworker set forth in §E(1) of this regulation if it is determined that one or more of the following circumstances apply: The children's needs require the PTFC caseworker to provide more intensive supervision and training for the PTFC parents; Traveling distances between placements of children requires 2 hours of travel or more and impedes the PTFC caseworker's ability to maintain frequent and direct contact with the PTFC child; The PTFC caseworker provides case management services and performs duties in addition to services to the child such as recruitment and training of PTFC parents; or Other factors necessitate the reduction of the caseload to ensure adequate provision of services. The local department PTFC program shall have a written policy for planned discharge of a child from the PTFC which shall be incorporated as part of the child's treatment plan. Before discharge from the PTFC program, the local department shall develop a treatment aftercare plan as part of the child's case record, and which include: The name, address, telephone number, and relationship of the individual to whom the child is being discharged; A summary of the services provided during care; A summary of the growth and achievements of the child during care; Any identified needs of the child that remain unmet; and Recommendations for treatment aftercare services needed upon discharge from the PTFC. Referral Responsibilities. The local department caseworker shall make a written determination that a child is eligible for treatment foster care, and forward the determination to the PTFC gatekeeper along with: A referral for purchase of care, and all supporting documentation; A current case plan drafted within 180 calendar days before the date of referral; Relevant medical records current within 1 year before the date of referral; and Psychological or psychiatric evaluations performed within 1 year before the date of referral to the gatekeeper if eligibility is based on a serious emotional, behavioral, or psychological condition. The gatekeeper shall respond in writing to the referring local department caseworker within 14 working days, accepting or denying admission of a child and giving the reason for a denied admission. The PTFC child, the child's attorney, and parent or legal guardian has the right to appeal the eligibility review decision. The length of stay in a PTFC program is subject to review and assessment for continued PTFC eligibility by the gatekeeper at least once a year. The PTFC caseworker shall: Develop a treatment plan within 30 calendar days of a child's acceptance into the program; Convene a treatment team to evaluate the child's treatment plan at intervals not to exceed 3 months that shall include: The treatment foster care caseworker; Parents or legal guardian, if appropriate; Local department of social services caseworker, if applicable; PTFC parents; and Any therapist, psychologist, psychiatrist, physician, or professional involved in providing treatment services; Visit face-to-face with the PTFC parents a minimum of twice a month; Visit face-to-face with the child a minimum of twice a month; Provide services to the family of a PTFC child as required in the permanency and treatment plans; Meet with the child and the child's family according to the child's treatment plan, legal status, and permanency plan; Attend hearings; If the child has a separate local department caseworker: Provide information to the local department caseworker on changes affecting services to the child which could result in revisions to the treatment plan, such as changes in placement, placement location, or visitation plans; Provide the local department caseworker with a written progress report every 3 months, which includes the current treatment plan and notes from the most recent treatment team meeting discussing progress on the treatment plan; Provide all medical and psychological information necessary for the care of the child to the PTFC parents; Provide PTFC parents access to crisis respite care and planned monthly respite care for their treatment foster children; and Maintain a written pre-service curriculum for the PTFC program and make available to PTFC parents in-service training opportunities. Treatment Home Capacity Requirements. Not more than two out-of-home placement children may be placed in one eligible treatment home without the prior written approval from the Administration. Requests to place a third out-of-home placement child, including a sibling, in the home must be made by the local department treatment program in writing to the Administration. The local department PTFC program shall establish a written treatment plan for every treatment child in its program, which includes: Role of the PTFC foster parent; Role of the PTFC caseworker; Specific tasks to be carried out by PTFC parents during placement; Identification of treatment team members who will assist in the provision of planned care; and Long-term goals of treatment, including: Criteria for discharge; Projected length of stay in the program; Projected post-treatment; and Treatment aftercare services. The PTFC parent approved by the PTFC program shall: Meet all of the requirements of a local department foster parent as prescribed by COMAR 07.02.25; Meet all of the service and responsibility requirements of COMAR 07.02.21.10A and D; Complete 8 hours of PTFC parent pre-service training in addition to the foster parent pre-service training requirements of COMAR 07.02.25; and Complete 20 hours of in-service training annually. Amount Paid to the Provider. The amount paid to the provider for care of the child is the amount determined by the standards established in Regulation .39 of this chapter, less any amount the child, who is planning for independent living, pays directly to the foster home from the child's own earnings as established in the service agreement. Except for the child's own earnings, all resources shall be paid directly to the local department as reimbursement against the cost of the child's care. The amount that the local department pays to the foster parent or payee is not affected by any resource except the child's own earnings. The provider payee is: The foster parent in whose home the child has been placed; The agency or institution from which care is being purchased for the child; A vendor from whom purchase of certain goods or services has been authorized for the child according to established standards; The child in a semi-independent living arrangement, or the child's payee. Period Covered and Method of Payment to the Provider. The period covered for regular payments shall be the calendar month or that part of the calendar month for which the local department has custody of the child, or has care and placement responsibilities for the child through a voluntary placement agreement, and the child is in the provider's care. Temporary absence of the child from the foster home or group facility, such as for hospitalization or runaway status, with the intent for the child to return to the home or facility does not require recalculation of the amount of monthly board allowance unless the absence exceeds 30 days, in which case additional payment is not made. When the child returns, payment shall be resumed beginning with the date of return. The amount of payment is calculated on a monthly basis and shall be paid by check or electronic transfer. In calculating the amount for a partial month's care, the following shall apply: Board. The amount for board shall be the per diem board rate times the number of days of care, counting the day the child goes into care, but not counting the day the child leaves care. For a child who has moved during the month from one foster home to another, each foster home shall be paid the per diem rate for the days that the child was in each foster home, as set forth above. Clothing and Other Items for Foster Family Care. For a child who is entering care, the full monthly amount for clothing may be allowed so long as the child is in the home for any part of the month, except that if an amount is allowed for initial clothing, then no other allowance for clothing may be made for that month. Payment for Board and Clothing for Group Care. The monthly clothing allowance for group care is combined with board and negotiated by the administration as a single rate. Payment is for actual monthly costs not to exceed this rate. The amount of board and clothing allowance for care for a partial month is the actual per diem cost for board and clothing times the number of days of care but not counting the day the child leaves care. The per diem cost is the actual monthly cost for board and clothing times 12 divided by 365. The initial clothing allowance is not available to group care, except for a child who is in a State institution. Local Department Which Pays. Payment shall be made by the local department which has responsibility for the child's placement through the court order or voluntary agreement. When a child is placed in another local department's jurisdiction through intercounty placement, the local department which has legal responsibility for the child shall make the payment to the foster home. Within 30 days of the knowledge of payment irregularity, the local department shall commence overpayment procedures. Overpayment Procedures. To correct an overpayment, the local department shall: Determine the correct payment amount and take action to correct the continuing payment; Calculate the total amount of the overpayment; and Notify the provider in writing of the suspected overpayment amount within 10 days after determining that an overpayment exists. The local department may not recoup an overpayment from a provider until the local department has notified the provider in writing that an overpayment has been identified. The local department may propose to reduce, suspend, or terminate payment to correct the overpayment. The provider may request a fair hearing to challenge the proposed action. If the local department's decision following a fair hearing is upheld, the proposed reduction, suspension, or termination of the overpayment includes any overpayment made pending the decision. Termination of payment does not relieve the provider of the obligation to reimburse the local department for any overpayment. To obtain reimbursement, the local department shall: Request repayment of the overpayment; and If appropriate, initiate collection efforts in conformity with the procedure required to refer the debt to the Central Collection Unit, Department of Budget and Management. If payment to the provider is subsequently reinstated, the local department shall recoup the amount of the overpayment as prescribed in §I of this regulation. If a person repays the local department, the local department shall accept and credit the payment. Fair Hearing. Before the local department takes action to recover or recoup an overpayment, the local department shall advise the provider of the: Right to a fair hearing; and Procedure and time limit for requesting a fair hearing according to Regulation .38 of this chapter and COMAR 07.01.04. The provider may request a fair hearing to challenge the: Decision of the local department that an overpayment occurred; Amount or cause of the overpayment; or Proposed method to repay the overpayment. Within 30 days following a fair hearing, the Office of Administrative Hearings shall notify the individual in writing of the: Agency decision; and Reasons for the decision. Suspected Fraud Procedures. If the local department determines that a case is one of suspected fraud as defined in Regulation .03B of this chapter, the local department shall refer the case to the: The Department's Office of the Inspector General (OIG); or State's attorney's office (SAO). Before the local department refers a case to the (OIG) or SAO, the referral document shall be approved by a supervisor or the director's designee. After making the referral, the local department: Shall inform the OIG or the SAO of any new facts or changed circumstances in the case; Shall provide access to relevant information in its possession to the assigned investigators; and May not notify a provider of the referral to the OIG or the SAO but may answer “yes” or “no” when the provider asks whether a referral was made. Recoupment Procedures. Recoupment. Except as noted in §I(1)(b) of this regulation, the local department shall take action to recoup an overpayment and determine with the provider: The total amount to be recouped; and An amount to be recouped through a monthly deduction from the continuing payment for as many months as are necessary until the overpayment is repaid. In the case of foster care providers, the amount recouped may not reduce the personal needs allowance by more than 50 percent of the monthly foster care payment rate. Procedures for Dual Jurisdictions. When a provider moves from one local department jurisdiction to another, the: Forwarding local department shall notify the receiving local department of the recoupment process; and Receiving local department shall continue the recoupment process, if appropriate, and credit all money recouped to the program funding source according to the Department's instructions. A local department may establish a supplement to the State standard to be used to meet special needs, provided that the: Supplement is met by local funds and is included in the fiscal agreement between the Department of Human Services and the local government; Supplement is applied uniformly to homes located within the local department's jurisdiction and to specific homes located in the jurisdictions of other local departments, when the local department which makes a supplemental payment places a child in a home located in the jurisdiction of another local department; Supplemented items are not included in the State standard. The plan to supplement shall be approved as local policy by the Social Services Administration before being put into effect. The plan shall specify the: Amount budgeted for the supplement; Reasons for needing it; and Plan for assuring that the amounts in excess of the State maximum are paid from local funds. Insurance. The Department shall, under certain conditions, provide liability insurance premiums from State funds, for foster parents who care for children under the direct supervision of the local departments or under the direct supervision of licensed private child placement agencies. The insurance shall cover: Bodily injury and property damage that a foster child causes to an individual or the property of a person other than a foster parent; and Actions brought against the foster parents by the child's parents or legal guardians for any accident to the foster child. Excluded from coverage are claims for: Alienation of affections; Accidents involving vehicles which are licensed or intended for road use; and Payment to the foster parents for injury or damage caused by the foster child to the foster parent which is otherwise covered by insurance. Reimbursement. The Secretary of Human Services shall reimburse a foster parent for costs of bodily injury or property damage that the child causes to the foster parent. Excluded for reimbursement to the foster parent are claims in which: The actions of the foster parent contributed substantially to the bodily injury or property damage sustained; or If available, the foster parent's insurance covers the bodily injury or property damage sustained. The maximum amount of reimbursement is $5,000. Payments in excess of $2,000 require approval by the State Board of Public Works. At the time of placement, the local department shall give to each parent or legal guardian of a child in out-of-home placement written and verbal notification of the right and methods of requesting and obtaining a fair hearing. The local department shall notify the parents or legal guardian of its intent to take any action which will deny, reduce, suspend, or terminate visits with the child, reunification services, or aftercare services, and of the right and methods of requesting and obtaining a fair hearing on that intended action. A fair hearing need not be held on any decision which has been, or may only be, determined by a court. In all other respects, the provisions of COMAR 07.01.04 apply to fair hearings on out-of-home placement services. Schedule A Family Foster Care Rates Type of Care Monthly Board Per Diem Monthly Clothing Allowance Total Regular Care: Regular Care Infant through Age 11 $775 $27.45 $60 $835 Age 12 and older 775 27.94 75 850 Intermediate Care Infant through Age 11 890 31.23 60 950 Age 12 and older 890 31.72 75 965 Respite 30 Treatment Foster Care (Specialized Care): Infant through Age 11 775 27.45 60 835 Age 12 and older 775 27.94 75 850 Respite 50 Emergency Care: Per Diem 30 Retainer Fee for Emergency Foster Home Shelter Care 100 Schedule B Initial Clothing Maximum Allowances (Initial one-time only clothing allowances are made on an “as needed” basis not to exceed the maximums in this schedule.) Age Group Maximum Infant through age 5 $60 Age 6 through age 11 75 Age 12 and older 100 Courts and Judicial Proceedings Article, §§3-801, 3-802, 3-815, 3-816.1, 3-817, 3-819.1, 3-819.2, 3-820, and 3-823;Education Article, §§7-101(b) and 15-106.1; Family Law Article, §§5-501, 5-504, 5-524—5-534, 5-701, and 5-709;Human Services Article, §9-101 et seq.; Annotated Code of Maryland(Agency Note: Federal Regulatory Reference: 42 U.S.C. §§620 et seq., 670 et seq.; 45 CFR §205.10;45 CFR §303.72; 45 CFR 1355—1357) Effective date: February 1, 1973 Regulation .05, .06 amended effective January 8, 1975 (2:1 Md. R. 14) Regulation .05D, .09 effective January 1, 1976 (3:13 Md. R. 718) as emergency; amended effective October 27, 1976 (3:22 Md. R. 1249) Regulation .05F amended effective June 8, 1977 (4:12 Md. R. 946) Regulation .07B amended effective January 5, 1977 (4:1 Md. R. 15) Regulation .09 effective July 1, 1976 (3:18 Md. R. 980) as emergency; amended effective March 2, 1977 (4:25 Md. R. 372) Regulation .09, schedules B-2 and B-3 amended effective May 11, 1977 (4:10 Md. R. 764) Chapter revised effective February 10, 1978 (5:3 Md. R. 136) (Previous Regulations .01, .02, .03, .04, .05, .06, .07, .07D, and .08 renumbered as Regulations .04, .06, .07, .09, .10, .11, .13, .14, and .15 respectively. New Regulations .01, .02, .03, .05, .08, .12, .16, .17, and .18 adopted) Regulation .01C adopted as an emergency provision effective October 1, 1982 (9:18 Md. R. 1795) adopted permanently effective December 20, 1982 (9:25 Md. R. 2477) Regulations .01 and .02 amended effective July 4, 1983 (10:13 Md. R. 1179) Regulation .07B amended as an emergency provision effective October 1, 1981 (8:21 Md. R. 1703); emergency status extended at 8:24 Md. R. 1934, 8:25 Md. R. 1992, 9:2 Md. R. 110, and 9:6 Md. R. 611; adopted permanently effective March 1, 1982 (9:4 Md. R. 328) Regulation .08B amended effective July 1, 1985 (12:13 Md. R. 1278) Regulation .09-1 adopted effective April 22, 1985 (12:8 Md. R. 800) Regulation .10B amended effective May 19, 1978 (5:10 Md. R. 777); March 23, 1979 (6:6 Md. R. 510); January 2, 1983 (9:26 Md. R. 2571) Regulation .10C amended effective March 23, 1979 (6:6 Md. R. 510); October 5, 1979 (6:20 Md. R. 1628) Regulation .10G amended effective July 27, 1979 (6:15 Md. R. 1270) Regulation .10A—D amended effective July 1, 1985 (12:13 Md. R. 1278) Regulation .11C amended effective July 1, 1985 (12:13 Md. R. 1278) Regulation .13F amended effective July 1, 1985 (12:13 Md. R. 1278) Regulation .18-1 adopted effective October 6, 1986 (13:20 Md. R. 2208) Regulation .19 amended effective November 18, 1977 (4:24 Md. R. 1805); May 19, 1978 (5:10 Md. R. 777); June 2, 1978 (5:11 Md. R. 883); August 25, 1978 (5:17 Md. R. 1326); March 23, 1979 (6:6 Md. R. 510); July 27, 1979 (6:15 Md. R. 1270); October 5, 1979 (6:20 Md. R. 1628); September 5, 1980 (7:18 Md. R. 1739); May 24, 1982 (9:10 Md. R. 1018); January 2, 1983 (9:26 Md. R. 2571); February 13, 1984 (11:3 Md. R. 198); July 1, 1985 (12:13 Md. R. 1278); January 13, 1986 (13:1 Md. R. 15); December 15, 1986 (13:25 Md. R. 2657); May 30, 1988 (15:11 Md. R. 1330); February 6, 1989 (16:2 Md. R. 158) Regulations .01—.19 repealed and new Regulations .01—.34 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 .01—.19 repealed and new Regulations .01—.34 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 .03B amended effective October 19, 1998 (25:21 Md. R. 1572) Regulation .13A amended effective November 7, 1994 (21:22 Md. R. 1874) Regulation .30-1 adopted effective October 19, 1998 (25:21 Md. R. 1572) Regulation .32 amended effective August 24, 1998 (25:17 Md. R. 1359) Regulation .34 amended effective February 3, 1992 (19:2 Md. R. 152) Chapter revised effective February 7, 2000 (27:2 Md. R. 143) Regulation .03B amended effective August 7, 2000 (27:15 Md. R. 1400) Regulation .13A amended as an emergency provision effective April 1, 2000 (27:8 Md. R. 794); emergency status expired September 30, 2000 Regulation .13A amended effective August 7, 2000 (27:15 Md. R. 1400) Regulation .21A amended effective August 7, 2000 (27:15 Md. R. 1400) Regulation .21A amended as an emergency provision effective April 1, 2000 (27:8 Md. R. 794); emergency status expired September 30, 2000 Regulation .32A amended effective August 7, 2000 (27:15 Md. R. 1400) Chapter revised effective November 30, 2009 (36:24 Md. R. 1856) Regulation .02C amended effective February 6, 2012 (39:2 Md. R. 140) Regulation .03B amended effective February 6, 2012 (39:2 Md. R. 140); May 12, 2014 (41:9 Md. R. 519); August 17, 2015 (42:16 Md. R. 1054); May 22, 2017 (44:10 Md. R. 470) Regulation .04 amended effective August 17, 2015 (42:16 Md. R. 1054) Regulation .04B amended effective February 6, 2012 (39:2 Md. R. 140) Regulation .05C amended effective February 6, 2012 (39:2 Md. R. 140); August 17, 2015 (42:16 Md. R. 1054); May 22, 2017 (44:10 Md. R. 470) Regulation .06 amended effective May 12, 2014 (41:9 Md. R. 519) Regulation .06B amended effective February 6, 2012 (39:2 Md. R. 140) Regulation .07F adopted effective February 6, 2012 (39:2 Md. R. 140) Regulation .08I, Z amended effective February 6, 2012 (39:2 Md. R. 140) Regulation .08K, P amended effective November 15, 2021 (48:23 Md. R. 979) Regulation .11H amended effective February 6, 2012 (39:2 Md. R. 140) Regulation .12 amended effective August 19, 2013 (40:16 Md. R. 1341); September 7, 2020 (47:18 Md. R. 824) Regulation .12B amended effective August 17, 2015 (42:16 Md. R. 1054) Regulation .12J, K amended effective February 6, 2012 (39:2 Md. R. 140) Regulation .12K amended effective November 11, 2013 (40:22 Md. R. 1876) Regulation .13 amended effective February 6, 2012 (39:2 Md. R. 140) Regulation .15 amended effective February 6, 2012 (39:2 Md. R. 140) Regulation .16 amended effective February 6, 2012 (39:2 Md. R. 140) Regulation .16A, B amended effective May 22, 2017 (44:10 Md. R. 470) Regulation .16-1 adopted effective February 6, 2012 (39:2 Md. R. 140) Regulation .17 amended effective February 6, 2012 (39:2 Md. R. 140) Regulation .21 amended effective May 12, 2014 (41:9 Md. R. 519) Regulation .25G amended effective February 6, 2012 (39:2 Md. R. 140) Regulation .29M amended effective February 6, 2012 (39:2 Md. R. 140) Regulation .30 amended effective February 6, 2012 (39:2 Md. R. 140) Regulation .39A amended effective February 6, 2012 (39:2 Md. R. 140) Adoption services are provided to: Effect a permanent plan, through adoption, at the earliest possible time, for a child in out-of-home placement who cannot or should not be reunited with the child’s birth parent; Protect a child from unnecessary separation from the birth parent; Provide, in the shortest time possible, an adoptive family who will ensure a child’s safety and well-being; Permit adoption of a child only by individuals who are qualified for the responsibility; and Protect, as appropriate, the confidentiality of the adoption process and share nonidentifying medical information to permit an adopted child and adoptive family to grow and develop undisturbed. In this chapter, the following terms have the meanings indicated. Terms Defined. “Administration” means the Social Services Administration of the Department of Human Services. “Adoptee” means an individual: Whose adoption decree was issued by a Maryland court; or Who was placed for adoption by a: Maryland licensed child placement agency; or Local department. “Adoption” means a legal proceeding: By which an individual becomes the child of an adoptive family; and Which confers on the adopted child all the legal rights and privileges to which a child born to the adoptive family is entitled. “Adoption assistance” means funds or services provided by a local department to the adoptive family on behalf of an adopted child, which may include: Monetary payment; Medical care; Medical assistance; or Special services. “Adoption placement” means the placement of a legally free child with an approved adoptive family or individual who has signed an Adoption Placement Agreement. “Adoptive family” means an adoptive parent or legal guardian who is eligible to receive adoption assistance on behalf of a child. “Aid to Dependent Families (AFDC)” means the federal standard for aid as described in COMAR 07.02.11.30. “Birth father” means the biological father of a child. “Birth mother” means the biological mother of a child. “Birth parent” means the biological mother or father of a child, and may include both jointly or individually as is applicable. “Birth sibling” means an individual who shares at least one birth parent with an adoptee. “Dissolution” means the parental rights of the adoptive parent have been terminated. “Dual approval” means: The approval of a prospective family as a resource for both foster care and adoption; or The approval of a prospective family as a resource for both foster care and day care. “Guardianship” means guardianship with the right to consent to adoption or long-term care short of adoption as conferred by a court on the executive head of a child placement agency, and terminates the rights, duties and obligations of the birth parent. “Independent adoption” means an adoption pursuant to Family Law Article, Title 5, Subtitle 3B, Annotated Code of Maryland. “Indian child” means a Native American child as defined in the federal Indian Child Welfare Act of 1978. “Intercountry adoption” means the adoption by a Maryland resident of a child from a country other than the United States. “Intermediate care rate” means a payment rate above the regular rate paid to a resource family home for a child requiring extra care and supervision because of special physical, emotional or behavioral needs, as defined in COMAR 07.02.11. “IV-E” means Title IV, Part E of the Social Security Act. “Local department” means the department of social services in a county or in Baltimore City, and the Montgomery County Department of Health and Human Services. “Mediation” means the consensual process whereby the parties are assisted by one or more impartial mediators to voluntarily arrive at a plan or agreement to expedite permanency or to decide the nature and extent of future contact between the birth parent, adoptee, and adoptive family. “Medically fragile child” means a child who: Depends at least part of each day on mechanical ventilation; Requires prolonged intravenous administration of nutritional substances or drugs; Depends on other device-based respiratory or nutritional support, including tracheostomy tube care, suctioning, oxygen support, or tube feeding on a daily basis; or Depends on other medical devices that compensate for vital body functions and requires daily or near daily nursing care, including a child who requires: Renal dialysis as a consequence of chronic kidney failure; or Other mechanical devices such as catheters or colostomy bags as well as substantial nursing care in connection with the disabilities. “Minor parent” means a parent who is younger than 18 years old. “Nonidentifying information” means information including medical and birth family history information that does not disclose or permit disclosure of the identity or location of the birth parent or adoptee. Nonrecurring Adoption Expenses. “Nonrecurring adoption expenses” means expenses incurred by the adoptive parent of a special needs child involved in a public agency, private agency, independent, or intercountry adoption, or through a child placement agency licensed in another state if the family is not applying for or receiving adoption assistance from that state. Nonrecurring adoption expenses include: Reasonable and necessary adoption fees; Court costs; Attorney’s fees; The adoption home study costs, including health and psychological examinations; Supervision of the placement before adoption; Transportation; and The reasonable costs of lodging and food for the child and adoptive parent incurred during preplacement visits. “Open adoption” means an adoption in which it is the expressed intent of all parties to the adoption that the child maintains contact, including the possibility of visitation, with the birth parent or other birth relatives. Out-of-Home Placement. “Out-of-Home Placement” means placement of a child into foster care, kinship care, group care, or residential treatment care. “Out-of-Home Placement” includes an adoptive placement. “Parent” means the legal mother or father of a child or the biological mother or father whose rights have not been terminated, or a legal guardian other than a local department. “Permanency plan” has the meaning stated in COMAR 07.02.11. “Post adoption assistance” means a monthly adoption assistance authorized after finalization of an adoption based on a condition that was present but not known or discovered at the time of the adoption. “Post placement services” means services provided after adoptive placement to a child and the child’s adoptive family after placement but before entry of a final decree of adoption. “Private agency” means an organization licensed by the Administration for the placement of children in homes or with individuals. “Public agency” means a local department of social services. “Regular care rate” means the rate paid for a child in foster care who requires regular care and supervision. “Special needs factor” means a condition specific to a child that prevents the child’s placement without the provision of adoption assistance or medical benefits, including: A child 6 to 17 years old; Physical or mental disease or disability; Emotional disturbance; Membership in a sibling group; Recognized high risk of physical or mental disability or disease; or Race or ethnicity if combined with any of these factors. “Termination of parental rights” means the legal process of ending the rights and responsibilities of the parent. “Treatment foster care” means a program designed and implemented by a local department or child placement agency to provide intensive casework and treatment in a family setting to children with special physical, emotional, or behavioral needs as described in COMAR 07.02.11. The decision to select a particular family for a child shall be based on the child’s best interests and shall include consideration of: The needs of the child; The ability of a prospective adoptive family to meet the child’s overall physical, mental, emotional, and psychological needs, as well as any identified special needs; and The capacity of the prospective adoptive family to address the child’s needs based on the child’s cultural, ethnic, and racial background. The local department may not delay or deny the placement of a child for adoption on the basis of race, color, or national origin of the prospective adoptive family or the child involved. Selection of an Adoptive Home for a Child. In an adoptive placement of an Indian child, the local department shall give preference to placement as set forth in the federal Indian Child Welfare Act of 1978. When a child is in need of an adoption placement, the local department shall take the following steps to recruit adoptive families who can meet the child’s individual needs: Use the following documented information in the child’s agency record about the child to identify potential adoptive families: Identifying information; History; Current behavioral issues; and An accurate description of the child’s personality, recreational interests, and ties to birth relatives. Within 15 working days of a change in the permanency plan by the court to adoption, determine whether there is an appropriate adoptive family, approved by the local department, who is committed to adopt the child when the termination of parental rights petition is granted using the criteria set forth in §E(2)(a) of this regulation; Consistent with the best interests of the child, consider the following adoptive placement options in order of priority: Adoption by a relative; Adoption by the current foster parent with whom a child has resided continually for at least 12 months or for a sufficient length of time to establish positive relationships and family ties; or Adoption by another adoptive family; If no appropriate local department approved family resource is identified within 15 working days of the change in the permanency plan, provide a strengths-based narrative, as described in §E(3) of this regulation, to the AdoptUSKids to identify prospective adoptive families; and Continue to engage in recruitment efforts until a permanent placement is achieved for the child unless there is a change in the child’s permanency plan. The AdoptUSKids narrative shall be a strengths-based narrative that: Is respectful of the child’s confidentiality concerns regarding the child’s: Identifying information; History; Current behavioral issues; and Provides an accurate description of the child’s: Personality; Recreational interests; and Ties to birth relatives. Documentation in the case record of efforts to locate a family for a child shall include: Photolisting; Dates and descriptions of events attended by the child that provide an opportunity for the child to meet potential adoptive parents; and Written descriptions of the child used to promote the adoption. Child Specific Recruitment Efforts. Some children may need child-specific recruitment efforts to recruit an adoptive family because of: Unique emotional needs that require families with parenting experience; Membership in a sibling group, and it would be in the children’s best interests to be placed together; Physical, mental, or medical conditions indicating that the child will need a family with the capacity and the ability to make use of community resources and to advocate on behalf of a child with special needs; or Race or ethnicity, although the child’s membership in a minority race or ethnic group alone does not qualify for child specific recruitment. Aggressive Recruitment and Placement of Siblings. Aggressive recruitment efforts shall be made to locate an appropriate family willing to adopt a sibling group for whom the Department has determined that placement together is in the siblings’ best interest. If aggressive recruitment efforts fail to locate an appropriate family willing to adopt the siblings, preference for the separate placement of the siblings shall be given to families who are willing to assist the children in maintaining contact with each other. When difficulty in locating an appropriate adoptive family for a child is anticipated, the child shall be listed with, AdoptUsKids and other adoption exchanges before the 15th working day mandatory deadline in order to extend the parameters of the search as early as possible. Open Adoption. Open adoption may permit contact between an adopted child and the child’s birth relatives, including: Birth parents; Grandparents: or Siblings. A local department may explore an open adoption when: Older children in out-of-home care have formed significant emotional attachments to their birth parent or other birth relatives; or It is otherwise appropriate and in the child’s best interests to maintain contact with the child’s birth parent or birth relatives. Open adoption arrangements may be flexible to address the desires of the parties and the needs of the child and may include: Face-to-face contacts; Communication using electronic mail and social networking sites; and The exchange of cards, letters, or phone calls, either directly or through a third party. If mediation is used to facilitate an open adoption or adoption finalization, the local department shall: Provide information to all parties regarding the mediation process; and Make any necessary referrals so that mediation may occur. Adoption Placement Plan. If the resource family that provided out-of-home services to the child has been selected as the adoptive family of the child, the family shall sign an Intent to Adopt Placement Agreement. When a non-related resource family with whom the child has not previously lived is selected as the adoptive family, the child and family shall: Have pre-placement visits prior to the day of placement; and The family shall sign an Intent to Adopt Placement Agreement. Postplacement Services. Goals of Postplacement Service. The local department shall: Sustain permanence for children placed with adoptive families prior to finalization of the adoption; Help resolve any adjustment problems that may occur during postplacement; and Promote the integration of the family and child as a single-family unit. Duration. The child must live with the adoptive family for at least 6 months or shorter period allowed by the juvenile court on recommendation of the local department as set forth in Family Law Article, §5-349, Annotated Code of Maryland; Postplacement services may be extended by mutual agreement of the family and local department based on the needs of the child and the family. Requirements for Service. The agency caseworker shall: Clarify with the family the mutual rights and responsibilities in regard to the placement at the beginning of the placement as set forth in COMAR 07.02.25.07, .08, and .17; Provide postplacement services to all children and families before an adoption is finalized to strengthen and support the family functioning and integration. Content of Services. The agency shall: Provide evaluative, supportive, and educational services geared to adoptive family development with emphasis on the unique nature of adoption; Place special emphasis on the integrity and continuity of the child’s heritage and genetic histories as to the continuing growth and development of the child as an individual, and to the development of the family as an integrated unit; and Maintain ultimate responsibility for other services set forth in COMAR 07.02.11.16G(4)(a) until the adoption is finalized by the Court. Frequency of Contact and Length of Service. The agency caseworker shall: Visit the adoptive family as often as indicated but at least monthly in accordance with requirements in COMAR 07.02.11.17 and .05 and Family Law Article, §5-349, Annotated Code of Maryland; Use observations during the visits in determining the frequency of visits and the family’s readiness for finalization of the adoption; and Include the child in these visits according to the child’s age and capability. Removal of a Child from Adoptive Home. The local department may remove a child before a final decree of adoption is issued if, in the opinion of the local department, conditions in the adoptive home impair the child’s security in the family and jeopardize the physical safety or emotional development of the child; Decision to Finalize Adoption. The caseworker shall assess the readiness of the family to finalize the adoption based on the following indications: The family’s indication that they are ready to adopt. The worker’s recommendation that the adoption is in the child’s best interest and that the family is ready to adopt; The child’s indicated readiness in the following ways: A child over 10 years of age consents; or A child under 10 years of age does not object. Once the family and the caseworker have determined that it is time to finalize the adoption, the caseworker shall: Prepare the necessary documents to support the family’s finalization of the adoption; and Acquire the local department director’s consent to the adoption. Termination of Postplacement Services. Postplacement Services are terminated when the adoption decree is finalized by the Court. Post adoption services may be provided to support the adoptive placement after adoption finalization in accordance with available staff resources. Upon request of the adoptive family, the local department may make the following services available: Short-term adoption related counseling; Information and referral services; and Provision of any additionally acquired medical, social, psychological, and genetic history of the minor adoptee to the adoptive family. The agency shall provide services to the birth parent of an adopted individual until the adoptee is 21 years old: Providing a birth parent the opportunity to update agency records with the appropriate birth family history; Providing a birth parent the opportunity to release the agency from the confidentiality requirements relating to identifying information requested by the adult adoptee at some later date; Accepting from a birth parent medical information critical to the adoptee’s growth and development, and making full effort to communicate this to the adoptive family or the adult adoptee, as appropriate; Accepting from an adoptee or the adoptive family medical information which may be critical to the birth family, and making efforts to communicate this to the birth family; and Providing information and referral, when appropriate, regarding services available through the Mutual Consent Voluntary Adoption Registry and search, contact, and reunion services as set forth in COMAR 07.02.13. The local department shall provide information to the adoptive family regarding the following: Counseling in support of the placement and to prevent dissolution of the adoption; Post Adoption Permanency Program services as described in §F of this regulation; Referral services; and The Maryland Tuition Waiver and the Maryland Education and Training Voucher program as set forth in COMAR 07.02.11. Release of Nonidentifying Information. Upon request of an adoptee, or the adoptive or birth parent, a local department shall release all non-identifying medical and birth family history information contained in the closed adoption file to the requestor. When a local department has no medical information, local department staff shall inform the requestor of the: Lack of the requested information; and Right to petition the court to appoint a special intermediary to gather the needed medical information if the adoptee or a blood relative of the adoptee or birth parent has an urgent need for the medical information. When an adoptee or birth parent petitions the court for medical information, a local department shall attempt to locate the adoptee or the birth parent in order to obtain the needed medical information after the court: Makes a judicial determination that there is an urgent need for the medical information; and Appoints the local department as the intermediary. When a local department has been appointed intermediary and the adoptee or birth parent has been located, the local department: Shall advise the individual of the need for the medical information without revealing any identifying information about the adoptee or birth parent: May not encourage or discourage contact between the adoptee and the individual’s birth parent; and Shall file a confidential report with the court addressing the efforts to contact the adoptee and the birth parent and the results when efforts to locate the adoptee or birth parent are completed. A local department shall: Provide all the available information on the location of the birth parent to anyone who has been court ordered to act as intermediary; and Place a copy of the court order appointing the intermediary in the records of the individuals involved. Post Adoption Permanency Program Services. The purpose of the Post Adoption Permanency Program services is to provide post adoption assistance in the form of services to children adopted through a public agency or a licensed private agency and their adoptive families. A local department shall notify families of the availability of post adoption support services during the adoption orientation process. Upon the request of an adoptive parent for available post adoption support services, the local department of social services shall: Obtain a copy of the adoption decree from the adoptive family requesting support services; Conduct a clinical assessment of the needs of the child and the adoptive family; and Determine whether the adopted child is at risk of coming into of out-of-home placement, or foster care placement and in need of post adoption support services not available from other resources. Upon determining that an adopted child and adoptive family are in need of post adoption support services the local department shall: Develop with the family a proposed post adoption support services plan that: Identifies treatment goals; Suggests treatment modalities; and Recommends services; Select appropriate vendors from those providers approved by the local department; and Submit the plan to the Administration for review and funding plan approval. Upon submission of the proposed support services plan, the Executive Director or designee shall determine whether to approve the service plan and the funding necessary to implement the plan. The Administration shall notify the local department of the status of the proposed service plan within 15 days of receipt of the service plan request. Funds available for the provision of post adoption support services shall be: Limited to the maximum amount established by the Maryland General Assembly; and Provided during a fixed year until allocated funds are expended. The local department shall provide the post adoption support services to the adopted child or the adoptive family upon approval and release of funds by the Administration. Services may include: Short-term adoption-related counseling; Medical treatment; Mental health services; Crisis intervention services; and Information and referral services. Adoption assistance is medical benefits, and in appropriate cases a monthly payment, provided to adoptive families on behalf of eligible children to help the family defray the costs of meeting a child’s special needs. The Administration shall offer adoption assistance to the parent of an eligible child that meets the eligibility criteria for an applicable child or a nonapplicable child. An eligible child shall be under the guardianship of a local department or a licensed private placement agency, or have been adopted in a consensual adoption pursuant to Family Law Article, §5-338, Annotated Code of Maryland. IV-E Child Eligibility Criteria. A child who is not a citizen or resident of the United States and who was either adopted outside the United States or brought to the United States for the purpose of being adopted may not be considered an applicable child, unless: The adoption dissolves or the adoptive parent dies; and The child is subsequently adopted from out-of-home placement. The Administration shall determine that a child is an applicable child, has special needs, and meets certain placement or medical criteria prior to an adoption in order for a child to receive IV-E adoption assistance. A child is an applicable child if: The child is: 6 years old or older in fiscal year 2015; 4 years old or older in fiscal year 2016; or In federal fiscal year 2017, when a child of any age will meet the criterion; The child has been in foster care under the responsibility of the Title IV-E agency for at least 60 consecutive months; or The child is the sibling of a child that meets either the age or time in foster care requirements in §D(3)(a) and (b) of this regulation, and the siblings are placed in the same adoptive placement. Special needs for an applicable child exist when the child cannot or should not be returned to the home of the parent and: The child meets all medical or disability requirements for SSI, or one of the special needs factors exist; and Reasonable but unsuccessful efforts have been made to place the child without assistance, unless the child is being adopted by their foster parent and has significant emotional ties with that person. An applicable child meets placement or medical criteria if: The child is in the care of a public agency or a licensed child placement agency or tribe pursuant to: An involuntary removal in accordance with a judicial determination that it is contrary to the child’s welfare to remain in the home; A voluntary placement agreement; or A voluntary relinquishment; The child meets all medical and disability eligibility requirements of SSI; The child was residing in a foster family home or childcare institution with their minor parent, and the minor parent was removed from the home pursuant to either: An involuntary removal in accordance with a judicial determination that it was contrary to the child’s welfare to remain in the home; or A voluntary placement agreement or a voluntary relinquishment; or The child was eligible for adoption assistance in a prior adoption and is now being subsequently adopted because the adoptive parents have died or their parental rights have been terminated. Nonapplicable Child Eligibility Criteria. A nonapplicable child is a child that does not meet the applicable child criteria as detailed in §D of this regulation. A nonapplicable child will be eligible for IV-E adoption assistance if the child is a special needs child and the child meets certain placement or medical criteria prior to the adoption. Special needs for a nonapplicable child exist when: The child cannot or should not be returned to the home of the parent; One of the special needs factors exists; and Reasonable but unsuccessful efforts have been made to place the child without adoption assistance, unless the child is being adopted by their foster parent who provided foster care services and has significant emotional ties with that person. A nonapplicable child meets the placement or medical criteria prior to the adoption if: The child is Aid to Families with Dependent Children eligible at the time of removal pursuant to: An involuntary removal in accordance with a judicial determination it is contrary to the child’s welfare to remain in the home; or A voluntary placement agreement wherein the child received IV-E foster care payments in that placement; The child is eligible for SSI; The child’s minor parent was in foster care and received foster care maintenance payments that covered the minor parent and the child; or The child was eligible for adoption assistance in a prior adoption and is now being subsequently adopted because the adoptive parents have died or their parental rights have been terminated. Payments. The adoption assistance payment shall be determined through negotiation and agreement between the local department and the adoptive parent. The adoption assistance payment may be combined with the parent’s financial resources to assist with meeting the child’s identifiable, quantifiable current and future needs. The amount and duration of the payment: Shall be based on the needs of the child and the circumstances of the family; and May not exceed the foster care payment received by the foster parents for the child. The amount of the adoption assistance payment for a medically fragile child adopted by his or her treatment foster parents may not exceed the foster care payment received by the treatment foster parents up to a maximum of $2,000. The local department may determine a $0 payment is appropriate in certain circumstances, including: Adoption assistance is not needed by the parent at the time the adoption is finalized to defray the cost of meeting the child’s special needs; or The child is at risk of developing a physical or mental disease or disability, but is not currently symptomatic. Allowances, paid to the resource parents in addition to the foster care payment, such as those for transportation, day care, or camp, or differential amounts paid to resource parents in certain counties, may not be included in the negotiated adoption assistance rate. Negotiation. The local department shall negotiate the amount of the adoption assistance based upon the: Needs of the child; The circumstances of the family; and The family’s ability to incorporate the child into their household. As a part of the negotiation process, the local department shall assess the child’s needs based on: Documentation in the record; Documentation provided by the adoptive family; and Any additional relevant information. The negotiation process shall include a discussion of: The child’s needs and the family’s circumstances; and The assistance the local department may provide to help the family assume primary financial responsibility for the child. The local department and the adoptive parent shall explore the availability of other resources such as SSI and other Social Security benefits, adoption tax credits, educational or vocational training assistance, and community supports that may be available to meet the child’s needs on an ongoing basis after the adoption is finalized. Concurrent Receipt of Benefits. The local department shall advise the family that, if the nonapplicable child receives SSI and adoption assistance at the same time, the SSI benefits will be reduced on a dollar-for-dollar basis in the amount of the IV-E adoption assistance. If a child receives other Social Security benefits, such as survivor’s benefits, retirement benefits, or old age benefits, the amount of these benefits may be considered when negotiating the amount of the adoption assistance. The adoptive family shall report their receipt of adoption assistance to the Social Security Administration. The family shall report their receipt of benefits to the Administration while the adoption assistance agreement is in effect. Adoption assistance payments shall become effective on the date the adoption is finalized. If the local department makes an overpayment through error or some other means, the local department may recover the over payment. Adoption Assistance Agreement. An adoption assistance agreement shall be: In writing; Binding on all parties; On a form approved and distributed by the Administration; and Signed by the director of the local department or designee and the adoptive parent prior to the finalization of the adoption. If the Maryland adoptive parent and the child move to another state: The adoption assistance agreement shall remain in effect; The adoptive parent shall be referred by the local department to the appropriate federal Title XIX and Title XX agencies in the adoptive parent’s state of residence; and The local department shall provide the state of residence with documentation regarding the child’s eligibility for Medicaid and Title XX services as provided by the state of residence. Medical Benefits. A child who has an adoption assistance agreement in effect is eligible for Medicaid benefits under the state Medicaid plan in his or her state of residence. Children who have an adoption assistance agreement that provides for a $0 monthly payment shall be eligible for Medicaid. Interstate Adoption. If the State public child welfare agency has responsibility for placement and care of a child prior to finalization of the adoption, that State shall be responsible for entering into the adoption assistance agreement with the family, provided the child is an eligible child. If the State public child welfare agency does not have responsibility for placement and care of a child, the adoption assistance agreement should be applied for and made in the adoptive parents’ State of residence. In that event, the public child welfare agency in the adoptive parents’ State of residence is responsible for determining whether the child meets the definition of special needs, entering into the adoption assistance agreement and paying the subsidy, consistent with the way public benefits are paid in other programs. An adoption assistance payment shall not exceed the foster care payment received by the foster parents for the child. In order to protect the interests of the child, the local department shall follow the procedures established by the Interstate Compact on Adoption Medical Assistance to facilitate the interstate coordination of benefits. The adoptive parent shall be referred by the local department to the appropriate federal Title XIX and Title XX agencies in their state of residence or tribal service area. The local department shall provide the state of residence or tribal service area with documentation regarding the child’s eligibility for Medicaid and Title XX services as provided by the state of residence, or tribal service area. Death of Adoptive Parents or Dissolution of the Adoption. If a child is receiving IV-E adoption assistance and the adoptive parents die or the parental rights of the adoptive parents are terminated, the adoption assistance may be paid on behalf of the child: In a subsequent adoption; and If the child continues to meet the special needs factor criteria; and The Adoption Assistance Agreement is signed by the Director or designee and the subsequent adoptive parent prior to the finalization of the adoption. Annual Redetermination. A local department shall review a child’s continued eligibility for adoption assistance on an annual basis. The adoptive parent shall notify the local department of circumstances that would make them ineligible for adoption assistance payments or for adoption assistance payments in a different amount. A local department shall send a redetermination packet to the adoptive family at least 90 days prior to the annual renewal due date. At least 60 days prior to the annual renewal due date, an adoptive family shall submit documentation to the local department to enable the department to confirm the child’s continued eligibility for adoption assistance at the current adoption assistance rate. Education, vocational training, and disability documentation for a child younger than 18 years old includes: Proof of routine medical care provided to the child within 6 months prior to the renewal date for the child who is not required to attend school due to age; Proof of enrollment and attendance for the child who is of the age where school attendance is compulsory in the form of: A current report card; Documentation of current participation in a home and hospital educational program approved by the educational agency in the child’s place of residence; or Documentation that the child is currently incapable of attending school on a full-time basis due to a documented medical condition of the child; or Proof of current enrollment in the program and proof of routine medical care provided to the child within 6 months prior to the renewal date for the child who is enrolled in a home school program approved by the educational agency in the child’s place of residence. Education, vocational training, and disability documentation for a child 18 years old or older includes: Documentation of a current mental or physical disability that warrants the continuation of adoption assistance; or If the child began receiving adoption assistance after reaching 16 years of age, documentation of: Enrollment in school; Participation in a program or activity that promotes or reduces barriers to employment; Employment for at least 80 hours per month; or A medical condition due to which the child is incapable of any of these activities. If an adoptive family’s failure to return the required information for renewal to the local department leads the Department to conclude that one of the bases for terminating the adoption assistance as stated in §M of this regulation exists, the local department may terminate the adoption assistance. The family must be given a letter of intended action that contains a statement regarding the right to appeal the determination. Renegotiation of Adoption Assistance. The amount of the adoption assistance may be renegotiated at the request of the adoptive parent or the local department at any time while the adoption assistance agreement is in effect. To assist in the renegotiation process, the local department shall request information from the adoptive family regarding any changes in circumstances that would justify an adjustment in the amount of adoption assistance, such as the child’s entry into out-of-home placement, and such information may include: School reports; Psychological evaluations; Medical reports; Costs and descriptions of services needed for the child, including documentation that services are not covered by the current adoption assistance amount or by medical assistance or community resources; and The amount of the adjustment requested. The renegotiated adoption assistance amount may not exceed the foster care payment the foster parent received when the child was in foster care. Changes in the adoption assistance amount shall be agreed to by the adoptive parent and approved by the Administration. If a child receives other Social Security benefits, such as survivor’s benefits, retirement benefits, or old age benefits, the IV-E monthly adoption assistance payment may not be reduced to reflect receipt of this resource unless the adoptive parent agrees to the reduction. Termination of IV-E Adoption Assistance. IV-E adoption assistance for an adoptive child shall be terminated when the adoptive child is 18 years old unless: The adoptive child who the local department has determined to have a mental or physical disability that warrants the continuation of assistance may continue to receive IV-E adoption assistance until age 21; or The adoptive child who was 16 years old or older when the adoption assistance payments began may continue to receive IV-E adoption assistance until age 21 provided that subsequent to the child’s 18th birthday the child is: The child is completing secondary education or a program leading to an equivalent credential; The child is enrolled in an institution which provides post-secondary or vocational education;; The child is participating in a program or activity designed to promote, or remove barriers to, employment; The child is employed for at least 80 hours per month; or The child is incapable of doing any of the above described activities due to a medical condition. IV-E adoption assistance shall be terminated when: The adoptive parents or the adoptive child dies; The adoptive parent is no longer legally responsible for the child; or The adoptive parent is no longer providing any financial support to the child. At least 30 days before the planned termination, the local department shall send the adoptive parent a notice that includes: The intent to terminate the adoption assistance; The specific regulations providing grounds for termination; and A statement describing the adoptive family’s right to appeal. State-funded adoption assistance is medical benefits, and in appropriate cases a monthly payment, to adoptive families on behalf of eligible adoptive children with special needs that is intended to help defray the cost of raising such children. An eligible child: Is not eligible for a IV-E monthly adoption assistance; Is in the guardianship of a public or private agency or is going to be adopted in a consensual adoption pursuant to Family Law Article, §5-338, Annotated Code of Maryland; and Has a special needs factor as set forth in Regulation .02B(35) of this chapter. A child is not eligible for adoption assistance if being adopted by a biological parent whose rights were previously terminated. Payments. The adoption assistance payment shall be determined through negotiation and agreement between the local department and the adoptive parent. The adoption assistance payment may be combined with the parent’s financial resources to assist with meeting the child’s identifiable, quantifiable current and future needs. The amount and duration of the payment: Shall be based on the needs of the child and the circumstances of the family; and May not exceed the foster care payment received by the foster parents for the child. The amount of the adoption assistance payment for a medically fragile child adopted by his or her treatment foster parents may not exceed the foster care payment received by the treatment foster parents up to a maximum of $2,000. Additional allowances, such as those for transportation, day care, camp, or other differential amounts paid to resource parents in certain counties, that may be paid to a resource parent in addition to the board rate may not be included in the adoption assistance rate. Negotiation. A local department shall negotiate the amount of the adoption assistance based upon the needs of the child and the circumstances of the family and the family’s ability to incorporate the child into their household. As part of the negotiation process, a local department shall assess a child’s needs based on documentation in the record or provided by the adoptive family and any additional relevant information. The negotiation process shall include a discussion of the child’s needs, the family’s circumstances, and the assistance a department may provide to help a family assume primary financial responsibility for a child. The local department and the adoptive parent shall explore the availability of other resources, such as SSI and other Social Security benefits, adoption tax credits, tuition waivers, educational or vocational training assistance, and community supports that may be available to meet the child’s needs on an ongoing basis after the finalization of the adoption. Concurrent Receipt of Benefits or Other Income. If a child receives SSI and State-funded adoption assistance, the SSI shall be reduced dollar for dollar in the amount of the adoption assistance. If a child receives other Social Security benefits, such as disability, survivor’s benefits or retirement benefits, or other income, the monthly adoption assistance payment may be reduced to reflect the receipt of the additional resources. The family shall report their receipt of benefits to the Local Department while the Adoption Assistance Agreement is in effect. Adoption assistance payments shall become effective on the date the adoption is finalized. If the local department makes an overpayment through error or some other means the local department may recover the over payment. Adoption Assistance Agreement. An adoption assistance agreement shall be in writing, and binding on all parties. An adoption assistance agreement shall be on a form approved and distributed by the Administration. An adoption assistance agreement shall be signed by the director of a local department, or designee, and the adoptive parent prior to the finalization of the adoption. Medical Benefits. A child who is eligible for State-funded adoption assistance is eligible for Medicaid under Maryland’s Medicaid State plan. A child with an adoption assistance agreement that provides for a $0 monthly payment shall be eligible for Medicaid under Maryland’s Medicaid State plan. A State-funded adoption assistance recipient who moves to another state may be eligible for Medicaid in the new state of residence if the state offers reciprocity for children from Maryland who have a State-funded adoption assistance agreement. Interstate Adoption. If the State public child welfare agency has responsibility for placement and care of a child prior to finalization of the adoption, that state shall be responsible for entering into the adoption assistance agreement with the family, provided the child is an eligible child. If the State public child welfare agency does not have responsibility for placement and care of a child, the adoption assistance agreement should be applied for and made in the adoptive parents’ state of residence. In that event, the public child welfare agency in the adoptive parents’ state of residence is responsible for determining whether the child meets the definition of special needs, entering into the adoption assistance agreement and paying the subsidy, consistent with the way public benefits are paid in other programs. An adoption assistance payment shall not exceed the foster care payment received by the foster parents for the child. The adoption assistance agreement shall remain in effect if the Maryland adoptive parent and the child move to another state. In order to protect the interests of the child, the local department shall follow the procedures established by the Interstate Compact on Adoption Medical Assistance to facilitate the interstate coordination of benefits. The adoptive parent shall be referred by the local department to the appropriate federal Title XIX and Title XX agencies in their state of residence or tribal service area. The local department shall provide the state of residence or tribal service area with documentation regarding the child’s eligibility for Medicaid and Title XX services as provided by the state of residence, or tribal service area. Death of Parents and Dissolution of the Adoption. Adoption assistance may not be denied to a child whose adoption has dissolved or whose adoptive parents have died if the child: Received adoption assistance during the child’s prior adoption; and Continues to meet the special needs eligibility criteria set forth in §B of this regulation. The adoption assistance may be paid on behalf of the child to a subsequent caretaker if: The caretaker assumes legal custody and/or guardianship of the child; and The local department has determined that the caretaker is able to provide appropriate care for the child. Adoption assistance may not be paid on behalf of an adoptive child to a biological parent who has been awarded legal custody and/or guardianship of the child. Annual Redetermination. The local department shall confirm annually the child’s continued eligibility for adoption assistance. At least 90 days prior to the renewal due date, the local department shall send the adoptive family a written request for the required information necessary for redetermination. At least 60 days prior to the annual renewal due date, the adoptive family shall submit documentation to enable the local department to determine that: The family is still legally and financially responsible for the care of the child at the time of the redetermination; The child continues to meet the special needs criteria; and The current amount of the adoption assistance payment is appropriate. The family shall submit the following documents: If the child is younger than 18 years old and not required to attend school due to age, proof of routine medical care provided to the child within 6 months prior to the renewal date; If the child is younger than 18 years old and of the age where school attendance is compulsory: A current report card; Documentation of current participation in a home and hospital educational program approved by the educational agency in the child’s place of residence; or Documentation that the child is currently incapable of attending school on a full-time basis due to a documented medical condition of the child; If the child is enrolled in a home school program approved by the educational agency in the child’s place of residence, proof of current enrollment in the program and proof of routine medical care provided to the child within 6 months prior to the renewal date; or If the child is 18 years old or older: Documentation that the child has a mental or physical disability warranting the continuation of assistance; or Completing secondary education or a program leading to an equivalent credential; or Enrolled in an institution which provides post-secondary or vocational education; or Participating in a program or activity designed to promote, or remove barriers to employment; or Employed at least 80 hours per month; or Incapable of doing any of the above described activities due to a medical condition. Suspension. A local department shall suspend the adoption assistance because of the following: the adoptive family’s failure to return the required information for renewal to the department; a child who was adopted re-enters out-of-home care. At least 30 days in advance of the planned suspension of the adoption assistance payments, a local department shall send the adoptive parent a: Notice that includes the intent to suspend the adoption assistance; Statement of the specific regulations cited as grounds for suspension; and Statement describing the adoptive family’s right to appeal the decision to the local department. If the payment is suspended due to family’s failure to return the required information for renewal to the local department,, the payment shall be reinstated on the date the adoptive family provides the required documentation, and a separate intended action letter must be sent to the family. Renegotiation of Adoption Assistance. The amount of the adoption assistance may be renegotiated at the request of the adoptive parent or the local department at any time while the adoption assistance agreement is in effect. To assist in the renegotiation process, the local department shall request information from the adoptive family regarding any changes in circumstances that would justify an adjustment in the amount of adoption assistance, such information may include: School reports; Psychological evaluations; Medical reports; Costs and descriptions of services needed for the child, including documentation that services are not covered by the current adoption assistance amount or by medical assistance or community resources; and The amount of the adjustment requested. The renegotiated adoption assistance amount may not exceed the foster care payment the adoptive parent received when the child was in out-of-home care. Changes in the adoption assistance amount shall be approved by the Administration. If a child receives Social Security benefits, such as survivor’s benefits, retirement benefits, or old age benefits, the State-funded monthly adoption assistance payment may be reduced to reflect receipt of this resource. Termination of Adoption Assistance. State-funded adoption assistance may be terminated upon the occurrence of any of the following conditions: A child re-enters out-of-home placement; A legally responsible adoptive parent no longer provides the child’s primary financial support; An adoptive parent’s rights have been terminated; An adoptive parent dies and there is no suitable subsequent caregiver; or The child’s 18th birthday if the child does not meet the conditions of §J(2) of this regulation. The adoptive child may continue to receive adoption assistance until their 21st birthday provided that subsequent to the child’s 18th birthday the child has a mental or physical disability warranting the continuation of the assistance; or the child is: Completing secondary education or a program leading to an equivalent credential; Enrolled in an institution which provides post-secondary or vocational education; or Participating in a program or activity designed to promote, or remove barriers to, employment; or Employed for at least 80 hours per month; or Incapable of doing any of the above described activities due to a medical condition. At least 30 days before the planned termination, a local department shall send the adoptive parent a notice that includes: The intent to terminate the adoption assistance; A statement of the specific regulations cited as grounds for termination; and A statement describing the adoptive family’s right to appeal. Post adoption assistance payment is a State Medicaid benefits and/or a State-funded monthly payment to adoptive families on behalf of adoptive children who have a condition that would have made them eligible for adoption assistance had the condition been known prior to finalization of their adoption. A child may be eligible for post adoption assistance if: The child was in the guardianship of a Maryland public or Maryland private agency at the time of the adoption; and The child has a documented condition that existed at the time of finalization of the adoption but had not been “discovered or diagnosed,” and if the condition had been known at the time of the finalization of the adoption it would have made the child eligible for adoption assistance. Payments. A post adoption assistance payment shall be determined through negotiation and agreement between a local department and the adoptive parent. The post adoption assistance payment may combine with the parent’s financial resources to assist with meeting the child’s identifiable, quantifiable current and future needs. The amount of a post adoption assistance payment may not exceed the foster care payment the parent would have received for the child if the child were in foster care at the time the adoption was finalized. The local department may determine a $0 payment is appropriate for an eligible child who otherwise qualifies for the adoption assistance, if the Administration determines that: Post adoption assistance is not needed by the parent to defray the cost of meeting the special needs of the child at the time the post adoption agreement is entered into; or The child had a physical or mental disease or disability at the time of finalization, but is not currently symptomatic. Negotiation. A local department shall negotiate the amount of the post adoption assistance based upon the needs of the child and the circumstances of the family, and the family’s ability to incorporate the child into their household. As part of the negotiation process, a local department shall assess the child’s needs based on documentation in the record or provided by the adoptive family and any additional relevant information. The negotiation process shall include a discussion of the child’s needs, the family’s circumstances, and the assistance the local department may provide to help the family provide for the special needs of the child. The local department and the family shall explore the availability of other resources to meet the child’s needs on an ongoing basis, such as SSI and other Social Security benefits, adoption tax credits, tuition waivers, and community supports that may be available. Concurrent Receipt of Benefits or Other Income. The family shall notify the Administration if the child receives other benefits while the adoption assistance agreement is in effect. If a child is eligible for SSI and State-funded post adoption assistance, the SSI shall be reduced dollar for dollar in the amount of the post adoption assistance. If the SSI Program does not reduce the SSI grant, the local department of social services shall reduce the amount of the post adoption assistance grant dollar for dollar in the amount of the SSI payment. If a child receives Social Security benefits, such as survivor’s benefits or retirement benefits, or other income, the monthly post adoption assistance may be reduced to reflect this resource. Post adoption assistance payments begin at the time the adoption assistance agreement is signed by the parties. Post Adoption Assistance Agreement. A post adoption assistance agreement shall be in writing, binding on all parties, and between a local department and the family and the relevant agencies. The post adoption assistance agreement shall be on a form approved and distributed by the Administration. The adoption assistance agreement shall be signed by the director of the local department, or designee, and the family prior to payment. Medical Benefits. A child who is eligible for State-funded post adoption assistance is eligible for Medicaid under Maryland’s Medicaid State plan. A State-funded post adoption assistance recipient who moves to another state may be eligible for Medicaid in the new state of residence if the state offers reciprocity for children from Maryland who have a State-funded post adoption assistance agreement. A child with an adoption assistance agreement that provides for a $0 monthly payment shall be eligible for Medicaid benefits under the Maryland Medicaid State plan. Interstate Adoption. If the state public child welfare agency has responsibility for placement and care of a child prior to finalization of the adoption, that state shall be responsible for entering into the post adoption assistance agreement with the family, provided the child is an eligible child. If the State public child welfare agency did not have responsibility for placement and care of a child prior to finalization of the adoption, the post adoption assistance agreement should be applied for and made in the adoptive parents’ state of residence. The post adoption payment shall not exceed the applicable board rate in Maryland or the applicable board rate in the state of residence while the child was in foster care, whichever was higher. If the Maryland family and the child move to another state, the post adoption assistance agreement shall remain in effect. In order to protect the interests of the child, a local department shall follow the procedures established by the Interstate Compact on Adoption and Medical Assistance to facilitate the interstate coordination of benefits. The adoptive parents shall be referred by a local department to the appropriate federal Title XIX and Title XX agencies in their state of residence. The local department shall provide the state of residence with documentation regarding the child’s eligibility for Maryland Medicaid and Title XX services. Death of Parents and Dissolution of an Adoption. Post adoption assistance may not be denied to a child whose adoption has dissolved or whose adoptive parents have died if the child: Received an adoption assistance during the child’s prior adoption; and Continues to meet the special needs eligibility criteria set forth in §B of this regulation. If an adoption dissolves or the parents die, post adoption assistance may be paid on behalf of a child to a subsequent caretaker if: The child continues to meet the special needs criteria; The caretaker assumes guardianship of the child; and A local department determines that the caretaker is able to provide appropriate care for the child. Annual Redetermination. A local department shall confirm a child’s continued eligibility for post adoption assistance annually. At least 90 days prior to the renewal due date, a local department shall send a written request for the required information necessary for redetermination. At least 60 days prior to the annual renewal due date, an adoptive family shall submit documentation to enable the local department to determine that: The family is still legally and financially responsible for the care of the child at the time of the redetermination; The child continues to meet the special needs criteria; and The current amount of the post adoption assistance payment is appropriate. The family shall submit the following documents: If the child is younger than 18 years old and not required to attend school due to age, proof of routine medical care provided to the child within 6 months prior to the renewal date; If the child is younger than 18 years old and of the age where school attendance is compulsory: A current report card; Documentation of current participation in a home and hospital educational program approved by the educational agency in the child’s place of residence; or Documentation that the child is currently incapable of attending school on a full-time basis due to a documented medical condition of the child; If the child is enrolled in a home school program approved by the educational agency in the child’s place of residence, proof of current enrollment in the program and proof of routine medical care provided to the child within 6 months prior to the renewal date; or If the child is 18 years old or older: Documentation that the child has a mental or physical disability warranting the continuation of the assistance; or Completing secondary education or a program leading to an equivalent credential; or Enrolled in an institution which provides post-secondary or vocational education; or Participating in a program or activity designed to promote, or remove barriers to employment; or Employed at least 80 hours per month; or Incapable of doing any of the above described activities due to a medical condition. Suspension. A local department shall suspend the post adoption assistance because of the following: The adoptive family’s failure to return the required information for renewal to the department; A child who was adopted re-enters foster care. At least 30 days before the planned suspension, the local department shall send the adoptive parent a notice that includes: The intent to suspend the adoption assistance; The specific regulations providing grounds for suspension; and A statement describing the adoptive family’s right to appeal. If the payment is suspended due to family’s failure to return the required information for renewal to the local department, the payment shall be reinstated on the date the adoptive family provides the required documentation. Renegotiation of Post Adoption Assistance. The amount of the post adoption assistance may be renegotiated at the request of the adoptive parent or the local department at any time while the post adoption assistance agreement is in effect. To assist in the renegotiation process, the local department shall request information from the adoptive family regarding any changes in circumstances that would justify an adjustment in the amount of post adoption assistance, such information may include: School reports; Psychological evaluations; Medical reports; Costs and descriptions of services needed for the child, including documentation that services are not covered by the current post adoption assistance amount or by medical assistance or community resources; and The amount of the adjustment requested. The renegotiated post adoption assistance amount may not exceed the foster care payment the adoptive parent received when the child was in out-of-home care. Changes in the adoption assistance amount shall be approved by the Administration. If a child receives Social Security benefits, such as survivor’s benefits, retirement benefits, or old age benefits, the State-funded monthly post adoption assistance payment may be reduced to reflect receipt of this resource. Termination of Post Adoption Assistance. State-funded post adoption assistance may be terminated upon the occurrence of any of the following conditions: A child re-enters out-of-home placement; A legally responsible adoptive parent no longer provides significant financial support to the child; An adoptive parent’s rights have been terminated; The adoptive parent dies and there is no suitable subsequent caregiver; The child’s 18th birthday if the child does not meet the conditions of §J(2) of this regulation. The adoptive child may continue to receive post adoption assistance until their 21st birthday provided that subsequent to the child’s 18th birthday the child has a mental or physical disability warranting the continuation of the assistance; or the child is: Completing secondary education or a program leading to an equivalent credential; Enrolled in an institution which provides post-secondary or vocational education; Participating in a program or activity designed to promote, or remove barriers to, employment; Employed at least 80 hours per month; or Incapable of doing any of the above described activities due to a medical condition. At least 30 days before the planned termination, the local department shall send the adoptive parent a notice that includes: The intent to terminate the adoption assistance; A statement of the specific regulation cited as ground for termination; and A statement describing the adoptive family’s right to appeal. In a domestic adoption, an adoptive parent of a child who meets the special needs criteria as delineated in Regulation .05(D)(4) or .05(E)(3) of this chapter may be eligible for reimbursement for certain nonrecurring expenses directly related to the legal process of adoption. In an intercountry adoption, an adoptive parent of a child who meets the definition of a child with special needs may be eligible for reimbursement of certain nonrecurring expenses directly related to the legal process of adoption provided if the child is: 5 years old or younger in federal fiscal year 2015; 3 years old or younger in federal fiscal year 2016; or 1 years old or younger in federal fiscal year 2017 As of October 1, 2017, children in an intercountry adoption will not be eligible for this subsidy. In Maryland public agency adoptions, the local department shall determine that the child meets the definition of special needs prior to the adoption in order for the child to receive nonrecurring expense reimbursement adoption assistance. In an independent or intercountry adoption, at least 60 days prior to finalization of the adoption, the family shall supply an official copy and official English translations of the following documentation necessary to enable the Administration to determine if the child meets the definition of a child with special needs: A court order terminating the parental rights of the birth mother and birth father, or in the case of an orphaned child, a death certificate for the child’s birth mother and birth father; Current psychological or medical reports or evaluations, or testing results that document the existence of one of the special needs factors; and Documentation that reasonable, but unsuccessful efforts have been made to place the child in an adoptive home without providing adoption assistance, including: A notarized affidavit signed by the prospective adoptive parent stating that they will not adopt the child without the adoption assistance; and Photolisting, registration on one or more adoption registries, or other attempts on behalf of the child to identify other prospective adoptive parents in addition to those applying for the adoption assistance. A lump sum maximum payment up to $2,000 may be paid on behalf of the adoptive parents for documented expenses related to the legal process of adopting a child, including: Homestudy fees; Medical information required to complete the homestudy; Legal fees; Post placement supervision; or Travel to meet the child. A local department shall maintain documentation of reimbursement of nonrecurring expenses in an adoptive family’s adoption case record. Nonrecurring Expenses Adoption Assistance Agreement. An agreement for the payment of nonrecurring expenses shall be: In writing; Binding on all parties; Between the local department and the prospective adoptive parent; On a form approved by the Administration; and Approval by the Administration. Each applicant for adoption assistance or family who is receiving adoption assistance has the right to appeal the denial, reduction, suspension, or termination of adoption assistance. The local department shall: Notify the applicant or family of the right to appeal the local department’s decision in writing; and Provide information as to the procedure to be followed in making an appeal. Education Article, §15-106.1; Family Law Article, Title 5, Subtitle 3, Subtitle 3A, Subtitle 3B, Subtitle 4, Subtitle 4A,§§5-101, 5-501, 5-524, 5-525, 5-525.1, 5-525.2, and 5-530; Human Services Article, §4-207; Annotated Code of Maryland;Ch. 444, Acts of 2007; 25 U.S.C. §§1901—1963, 42 U.S.C. §670 et seq.; 45 CFR 1355, 1356.4, and 1356.41 Effective date: December 10, 1975 (2:28 Md R. 1667) Regulation .02B amended, D and E adopted effective December 19, 1983 (10:25 Md. R. 2266) Regulation .02C amended effective December 2, 1977 (4:25 Md. R. 1911) Regulation .03E amended effective November 30, 1979 (6:24 Md. R. 1918); repealed effective December 19, 1983 (10:25 Md. R. 2266) Regulation .03-1 adopted effective December 19, 1983 (10:25 Md. R. 2266) Regulation .04B amended effective January 5, 1977 (4:1 Md. R. 15) Regulation .05E adopted effective April 22, 1985 (12:8 Md. R. 800) Regulations .06 and .07C amended effective December 2, 1977 (4:25 Md. R. 1911) Regulation .06A amended effective November 5, 1984 (11:22 Md. R. 1897) Regulation .06D amended effective November 30, 1979 (6:24 Md. R. 1919); August 11, 1986 (13:16 Md. R. 1826) Regulation .10 adopted effective October 6, 1986 (13:20 Md. R. 2208) Annotation: The procedures for the termination of parental rights, as found in COMAR 07.02.12.03-1, do not impair the due process rights of a parent. Attorney General Opinion No. 83-038 (August 29, 1983) Regulations .01—.10 repealed and new Regulations .01—.20 adopted effective February 20, 1989 (16:3 Md. R. 340) Regulation .02B amended and Regulation .21 adopted as an emergency provision effective September 20, 1990 (17:20 Md. R. 2418); adopted permanently effective January 21, 1991 (18:1 Md. R. 27) Regulation .04A, C amended effective December 14, 1998 (25:25 Md. R. 1831) Regulation .05A amended effective July 4, 1994 (21:13 Md. R. 1155) Regulation .10F amended effective March 19, 1990 (17:5 Md. R. 636) Regulation .12A amended effective March 19, 1990 (17:5 Md. R. 636) Regulation .12B amended effective May 6, 1996 (23:9 Md. R. 669) Regulation .15 amended effective March 19, 1990 (17:5 Md. R. 636); July 4, 1994 (21:13 Md. R. 1155) Regulation .20C amended effective March 19, 1990 (17:5 Md. R. 636) Regulation .20E adopted effective July 4, 1994 (21:13 Md. R. 1155) Chapter revised effective April 3, 2000 (27:6 Md. R. 639) Regulation .01F amended effective August 5, 2002 (29:15 Md. R. 1141) Regulation .02B amended effective August 5, 2002 (29:15 Md. R. 1141) Regulation .05A amended effective August 5, 2002 (29:15 Md. R. 1141) Regulation .15 amended effective March 28, 2005 (32:6 Md. R. 935) Regulation .15A, C amended effective August 5, 2002 (29:15 Md. R. 1141) Regulation .15-1A, C, E amended effective August 5, 2002 (29:15 Md. R. 1141) Regulation .15-1C, G amended effective March 28, 2005 (32:6 Md. R. 935) Regulation .18A amended effective August 5, 2002 (29:15 Md. R. 1141) Regulation .18C amended effective March 28, 2005 (32:6 Md. R. 935) Regulation .21B—D amended and F adopted effective August 5, 2002 (29:15 Md. R. 1141) Regulation .21F, G amended effective March 22, 2010 (37:6 Md. R. 476) Regulation .21G adopted effective June 29, 2009 (36:13 Md. R. 898) Regulation .22 repealed effective August 5, 2002 (29:15 Md. R. 1141) Regulations .01—.21 repealed and new Regulations .01—.09 adopted effective April 16, 2012 (39:7 Md. R. 490) Regulations .01—.09 repealed and new Regulations .01—.09 adopted effective November 7, 2016 (43:22 Md. R. 1218) The purpose of this chapter is to: Allow adult adoptees and eligible birth family members to: Exchange identifying information between all eligible consenting persons who register and are matched through the Maryland Mutual Consent Voluntary Adoption Registry; Search for and exchange identifying and nonidentifying information between adult adoptees and their birth parents who consent to the services of the Search, Contact, and Reunion Services Program; and Maintain confidentiality and anonymity if other birth family members search for the adult adoptees and eligible birth family members, and they do not desire contact; Allow adult adoptees and birth parents to file disclosure vetoes to protect their confidentiality; Allow a local department to contact a sibling of a minor in out-of-home placement in order to develop a placement resource or facilitate a family connection, if the sibling was adopted through a local department; and Allow a director of a local department or designee to contact relatives of a minor in out-of-home placement who was adopted through a local department for the purposes of developing a placement resource or to facilitate a family connection if the local department has determined that reunification with the minor’s adoptive parent is not in the minor’s best interest. In this chapter, the following terms have the meanings indicated. Terms Defined. “Administration” means the Social Services Administration. “Adult adoptee” means an adult adopted individual: Whose adoption decree was issued by a Maryland court; Who is 21 years old or older; and Who does not have a biological sibling younger than 21 years old who has the same adoptive parents. “Child placement agency” means a: Local department of social services; or Private agency that: Engages or engaged in the placement of children in homes or with individuals; and Is or was licensed by the Social Services Administration under Family Law Article, §5-507, Annotated Code of Maryland. “Confidential intermediary” means an individual or child placement agency qualified by the Director of the Social Services Administration for the purpose of providing contact, search, and reunion services. “Consent form” means a signed, notarized form: Issued by the Social Services Administration; Completed by the registrant for the Search, Contact, and Reunion Services Program or the Maryland Mutual Consent Voluntary Adoption Registry; Verifying the registrant as an adult adoptee or a birth parent, and giving information about the birth and adoption of the adoptee; and Providing the following information: The name of the child placement agency that placed the child for adoption if known; and The persons or agencies to whom identifying information may be released. “Director” means the Executive Director of the Social Services Administration. “Disclosure veto” means a signed, notarized document completed by a birth parent or an adopted individual 21 years old or older or a sibling prohibiting the disclosure of any identifying information concerning that parent, adoptee, or sibling that is contained in agency, birth, or court records for adoptions finalized on or after January 1, 2000. “Fee” means the amount of payment established by the Director that may be charged for services related to the Registry or the Search, Contact, and Reunion Services Program. “Local department” means the department of social services in a county or Baltimore City or the Montgomery County Department of Health and Human Services. “Match” means the positive comparison of information contained in Registry affidavits indicating familial relationship between registrants and confirmation of the relationship by the child placement agency, local department, vital statistics, or court records. “Member of the adoptive family” means an adoptive parent, grandparent, brother, or sister of an adopted individual whether the familial relationship is based on blood or marriage. “Notarized” means an individual commissioned by a state as a notary public has verified the identity of the signatory of a document, witnessed the signature, taken the signatory's oath, affirmation, or acknowledgment if called for by the document, completed any notarial certificate on the document, signed, dated, affixed the notary public's seal of office and commission expiration date to the document, and recorded the notarization in the notary public's register of official acts. “Out-of-home placement” means placement of a child into foster care, kinship care, group care, or residential treatment care. “Registrant” means an individual accepted for registration with: The Maryland Mutual Consent Voluntary Registry; or The Maryland Search, Contact and Reunion Services Program. “Registration form” means a form issued by the Social Services Administration, completed and signed by the individual who is registering, providing information known to the registrant about the adoptee and the birth parent. “Registry” means the Maryland Mutual Consent Voluntary Adoption Registry where birth parents, adoptees, and birth siblings may register to have identifying information released to each other. “Relative” means a parent, grandparent, brother, or sister of an adopted individual whether the familial relationship is based on blood or marriage. In the case of a minor in out-of-home placement who was adopted through a local department, “Relative” means an individual at least 21 years old who is related to the minor by blood or marriage within five degrees or consanguinity or affinity under the civil law rule. “Search, contact, and reunion services” means the program that provides services to adult adoptees and their birth parents and siblings and to minors in out-of-home placement through the use of a confidential intermediary to: Identify, search for, and locate adopted individuals, birth parents, siblings, and relatives and members of the adoptive family as specified in Regulation .08B of this chapter; Assess the mutual desire for communication or disclosure of information among the adoptees, birth parents, siblings, and relatives and members of the adoptive family as specified in Regulation .08 of this chapter and permit the communication of the information to the appropriate parties; Provide counseling, or referral to counseling, for adoptees, birth parents, siblings, relatives, and members of the adoptive family; or If a sibling of a minor in out-of-home placement was adopted through a local department, contact the sibling to develop a placement resource or facilitate a family connection. “Secretary” means the Secretary of the Department of Human Services. “Service agreement” means a written agreement made between the confidential intermediary and the registrant. “Sibling” means a brother or sister of the whole or half blood who: Is 21 years old or older; and Has been adopted. “Waiver” means the reduction of a fee based on the individual's written request and verification of family income if family income is less than the national poverty level. Registry Registration Requirements. Registration shall be accepted from: An adoptee, 21 years old or older; and An adoptee's birth mother, birth father, and birth siblings who are 21 years old or older. Completion of the registration process. The registrant shall: Complete a consent form containing a statement of the individual's consent to be identified to other registrants matched as birth family members; Complete a registration form giving: The individual's current name; Any previous name or names; Current address and telephone numbers; Any information known about the individual being sought including name or names, birth name, adoptive name, date and place of birth, and names of adoptive parents; The name and address of the agency that placed the child for adoption; and The name and address of the court that issued the adoption or guardianship decree; and Pay the fees prescribed by the Director according to the registration fee schedule for the Mutual Consent Registry and Search, Contact, and Reunion Services Programs. Fees. The fee shall accompany the consent form. A fee is not required from any registrant whose income is at or below the national poverty level. The registrant may provide notification to the Administration of changes in information occurring after the affidavit and registration form are filed. A registrant may withdraw from the registry at any time by submitting a notarized affidavit to the Administration that contains the registrant's name and a request to be removed from the registry files. Matches. Upon receipt of a registration form, consent form, and fees the registry shall search its files for potential matching family members. Before identifying information is released to either registrant, verification that a familial relationship exists shall be obtained from a source that is independent of registry files. To prevent errors in identifying family members, relationship of the family members shall be verified by a third party before identifying information may be released to the registrants. The third party may be, but is not limited to: The agency that placed the child for adoption; The Bureau of Vital Statistics; or A court of competent jurisdiction. A match is made if: An adoptee and the adoptee's birth mother and birth father register; Two or more of the birth siblings register; or An adoptee and only one birth parent of the adoptee register if any of the following conditions exist: An adoptee and the birth mother register and there is no known birth father; The Administration has been notified or received information that the nonregistering birth parent is deceased; The birth mother of the adoptee declares that the identity of the birth father is unknown; The adoption agency submits from a court of competent jurisdiction in the state of the adoptee's birth or adoption a copy of a judgment that declares that the identity of the natural father is unknown; The father named in a birth or adoption record has declared the parent-child relationship does not exist; At the time of the adoption, notice of the filing of the petition for adoption or guardianship was not given to the nonregistering natural parent of the adoptee and the parent did not participate in the judicial proceedings that terminated the parent-child relationship; Notice of the filing of the petition for adoption or guardianship was not given to the nonregistering birth parent; or 1 year has elapsed since the registering parent filed the affidavit and the nonregistering birth parent has not filed a notarized affidavit stating the nonregistering parent's refusal to permit the match. Access to Records. The administration may inquire into the records of a child placement agency, local department of social services, or court that issued the adoption or guardianship decree. The court that issued the adoption decree shall order that the Administration have access to the court record on receipt of a petition from the Administration that states review of the record is needed in order to make a match or to provide matching information. Confidentiality and Record Retention. The registry shall retain information and documents collected until the date specified by the registrant or 99 years after the registration, whichever occurs first. If necessary, registry documents and information shall be destroyed in accordance with the State procedure for disposal of confidential information. Information in the registry may not be disclosed except as otherwise provided in these regulations or pursuant to a court order. Information on the registry may be used for search, contact, and reunion services if the adoptee or birth parent registers for that Program. Program Registration Requirements. Program registration is open to: An adoptee, 21 years old or older, who does not live with a birth sibling younger than 21 years old; The birth parents of an adult adoptee whose parental rights were not terminated under Family Law Article, Subtitle 3, Annotated Code of Maryland; A sibling of an adopted individual who is 21 years old or older and who has been adopted; or A director of a local department acting on behalf of a minor in out-of-home placement. Completion of Registration Process. The registrant shall provide: A completed consent form containing a statement of the registrant's consent to be identified to the birth parents, adoptee, sibling, or relative; A completed registration form as described in Regulation .03A(2)(b) of this chapter; A photo identification of the registrant; and Payment of a registration fee as prescribed in the registration fee schedule for the mutual consent registry and Search, Contact, and Reunion Services Program that is available from the Director or the Director's designee. If a registrant is a director of a local department acting on behalf of a minor in out-of-home placement and the purpose is solely to facilitate a family connection, the consent form required by §A(2)(a) of this regulation: Shall be signed by the parent, guardian, or attorney of the child in out-of-home placement if the child is younger than 16 years old, unless the local department has a court order granting the local department the right to release the information; or May be signed by the child, if the child is 16 years old or older. A fee is not required from: A registrant whose gross income is at or below the federal poverty level; or A director of a local department who applies for search, contact, and reunion services on behalf of a minor in out-of-home placement. The Director or the Director's designee shall maintain the list of confidential intermediaries. A child placement agency may apply to the Director or the Director's designee to be a confidential intermediary. The director of a child placement agency shall appoint an employee as the representative member to make the application on behalf of the agency. Qualifications established by the Director shall be met by each member or former member of the staff of a child placement agency that provides search, contact, and reunion services and shall include: Possession of a bachelor's degree from an accredited college or university or a State employee grandfathered into a social work classification by the Department of Budget and Management, Office of Personnel Services and Benefits; 2 years of experience providing casework or adoption services; Documentation of the completion of a criminal background record check or of the request for a criminal background check; Attendance at 8 hours of training, approved by the Director, in providing search, contact, and reunion services; Supervision by a licensed clinical or graduate social worker while providing search, contact, and reunion services; Completion of refresher confidential intermediary training as required by the Director; and Any other qualification that the Director establishes for confidential intermediaries. The Director may establish a reasonable fee for an application under this section. The overall amount of the fees collected may not exceed the cost of processing the application. The Director shall refer the registrant for the Search, Contact, and Reunion Services Program to the child placement agency that handled the adoption if the agency is known and is a confidential intermediary. If the child placement agency is unknown, the Director shall make reasonable efforts to determine the identity of the child placement agency that placed the child for adoption. The Director shall have access to any birth record or public record as defined in State Government Article, §10-611, Annotated Code of Maryland, including a court record and the original birth records that relate to the new birth certificate of an adopted individual to determine the identity of the child placement agency that placed the child for adoption. The Director may charge an individual who applies for the Search, Contact, and Reunion Services Program a reasonable fee for a search conducted to determine the child placement agency that placed the child for adoption if the identity of the agency is unknown. The overall amount of fees collected for the search for the child placement agency may not exceed the cost of providing the search. A fee is not required from a registrant whose gross income is at or below the federal poverty level. If the Director cannot determine the name of the child placement agency or if there was not an agency involved with the adoption, the Director shall provide search services or the list of confidential intermediaries to the registrant. A registrant who applies for search, contact, and reunion services shall execute a service agreement with a confidential intermediary concerning the provision of search, contact, and reunion services and the fee to be paid for those services. The service agreement shall state the services to be provided by the confidential intermediary and shall last for 90 days beginning the day after the service agreement is signed by both parties. If the search is unsuccessful after the first 90-day period, the service agreement may be extended for an additional 90 days. No additional fees may be charged by the confidential intermediary if an additional 90 days is used to continue the search, contact, and reunion service. A report shall be made to the Director that the service agreement has been extended along with a report of progress made at the end of the first 90-day period and the steps to be taken during the second 90-day period. Fees. The confidential intermediary may charge the individual a reasonable fee for search, contact, and reunion services. Fees are nonrefundable. The fee to be charged by the confidential intermediary shall be included in the service agreement. Fees shall be waived by the confidential intermediary if the client requests the waiver in writing and provides verification of income that coincides with the schedule in the confidential intermediary fee schedule for the search, contact, and reunion services. The overall amount of fees collected may not exceed the cost of providing the services or the amounts prescribed in the confidential intermediary fee schedule for search, contact, and reunion services available from the Director, whichever is less. Fees for services are charged to the registrant one time. If additional services are requested by the registrant within 1 year of the signing of a first service agreement, all previous payments are applied to the total service costs for that year. For example, if the registrant signs a service agreement requesting nonidentifying heritage information and 30 days later requests contact and reunion services with both parents, the confidential intermediary may only charge the registrant the difference between the first fees paid and the cost of the additional service. The confidential intermediary shall promptly: Provide the registrant with a copy of the signed service agreement; File the executed service agreement with the Director; and Determine the identity of the adoptee or birth parent, and search for and contact either the adoptee or the birth parent sought by the applicant. The Director may authorize a confidential intermediary to obtain the following documents: The original birth certificate of the adoptee; The new birth certificate of the adoptee and any records that relate to it; The final adoption decree of the adoptee; and Any information that is contained in a public record as defined in State Government Article, §10-611, Annotated Code of Maryland, including a court record. The confidential intermediary shall submit a statement to the custodian of the record to be inspected, signed by the Director or the Adoption Program Manager of the Department of Human Services and notarized, authorizing the confidential intermediary to obtain the information. The confidential intermediary shall submit to the Director a report of the findings within 90 days of the execution of a service agreement. Results. If an individual contacted by the confidential intermediary consents to the disclosure of specified information: The confidential intermediary shall obtain a consent form from the individual that specifies the nature of the information to be disclosed; The information shall be disclosed to the registrant who applied for search, contact, and reunion services; The confidential intermediary shall: Disclose the information authorized by the consent form; and Facilitate contact and reunion between the parties; and The confidential intermediary may facilitate a reunion between the adoptee and birth family members if the birth mother or the birth father do not wish contact but agree by notarized affidavit that their birth relatives may be contacted by the confidential intermediary. If the individual contacted by the confidential intermediary does not consent to the disclosure of information: The confidential intermediary may not disclose any identifying information concerning the individual contacted; The confidential intermediary shall refrain from further and subsequent inquiry with the individual contacted; The confidential intermediary shall report the refusal to the registrant who applied for search, contact, and reunion services; and The confidential intermediary shall provide all nonidentifying heritage and health information contained in the agency record and obtained from contact with the birth family or adoptee. If the individual sought by the confidential intermediary is not found within the period specified in the service agreement, the confidential intermediary shall file a report with the Director indicating all efforts to locate the individual including the following: Network clearances accessed by the confidential intermediary; Results of contacts with other agencies to determine the individual's identity or whereabouts; and All other efforts to locate the individual. If the individual sought by a confidential intermediary is deceased, the confidential intermediary shall indicate in the report whether any relatives or members of the adoptive family were contacted and whether those individuals consent to disclosure of information and: The confidential intermediary may not disclose the identity of the deceased to the individual who applied for search, contact, and reunion services; The confidential intermediary shall report that the individual sought is deceased to the registrant for the services; If the deceased individual is a biological parent, the confidential intermediary may, with the consent of the registrant, attempt to contact a relative who is 21 years old or older to assess the willingness of the relative to communicate or exchange information; If the deceased individual is an adoptee, the confidential intermediary may, with the consent of the registrant, attempt to contact a member of the adoptive family who is 21 years old or older to assess the willingness of the member of the adoptive family to communicate or exchange information; If the registrant consents to contacting a relative or member of the adoptive family, the registrant shall execute another written agreement with the confidential intermediary concerning the provision of search, contact, and reunion services; The confidential intermediary may charge the individual a reasonable fee for the additional search, contact, and reunion services as described above; The overall amount of fees collected may not exceed the costs of providing the services; and The confidential intermediary shall promptly: File the executed agreement with the Director; and Attempt to contact the relative or member of the adoptive family sought by the registrant. The following individuals may file a disclosure veto prohibiting the disclosure of any information concerning the individual contained in agency, birth, or court records: A biological parent of an adoptee; An adopted individual 21 years old or older; or A sibling as defined in Regulation .02B of this chapter. A disclosure veto shall be filed with the Director. The Director immediately shall forward a copy of a disclosure veto to the Secretary of the Maryland Department of Health. An individual authorized to file a disclosure veto may cancel or refile a disclosure veto at any time. Family Law Article, §§5-101, 5-356—5-360, 5-3A-39—5-3A-43, 5-3B-28—5-3B-30, 5-4B-01—5-4B-12, 5-4C-01—5-4C-07, Annotated Code of Maryland42 U.S.C. §671; 45 CFR §1355.21; Ch. 326, Acts of 2011 Effective date: May 28, 1975 (2:12 Md. R. 866) Regulation .03A amended and E repealed effective January 16, 1984 (11:1 Md. R. 39) Regulation .04D repealed effective January 16, 1984 (11:1 Md. R. 39) Regulation .06G repealed effective January 16, 1984 (11:1 Md. R. 39) Regulation .07B amended effective August 8, 1980 (7:16 Md. R. 1592); January 16, 1984 (11:1 Md. R. 39) Regulation .08B amended effective November 4, 1977 (4:23 Md. R. 1729); July 29, 1985 (12:15 Md. R. 1509) Regulations .13 and .17 repealed effective January 16, 1984 (11:1 Md. R. 39) Regulation .14B amended effective October 29, 1975 (2:24 Md. R. 1480) Regulations .18 and .19 amended effective October 19, 1979 (6:21 Md. R. 1706) Chapter revised effective March 6, 1989 (16:4 Md. R. 494) Regulation .07F amended as an emergency provision effective December 17, 1992 (20:1 Md. R. 23) Regulation .08H amended effective September 9, 1996 (23:18 Md. R. 1315) Regulation .08L amended effective January 26, 1998 (25:2 Md. R. 75) Regulations .01—.27, License for Child Placement Agencies, repealed effective January 8, 2001 (27:26 Md. R. 2357) Regulations .01—.09, Post-Adoption Reunion Services, adopted effective June 24, 2002 (29:12 Md. R. 926) Regulation .01 amended effective January 9, 2012 (38:27 Md. R. 1763) Regulation .01D adopted effective August 17, 2015 (42:16 Md. R. 1054) Regulation .02B amended effective November 19, 2007 (34:23 Md. R. 2026); January 9, 2012 (38:27 Md. R. 1763); August 17, 2015 (42:16 Md. R. 1054) Regulation .04 amended effective November 19, 2007 (34:23 Md. R. 2026) Regulation .04A amended effective August 17, 2015 (42:16 Md. R. 1054) Regulation .04A, B amended effective January 9, 2012 (38:27 Md. R. 1763) Regulation .04E amended effective October 3, 2011 (38:20 Md. R. 1201) Regulation .08B amended effective November 19, 2007 (34:23 Md. R. 2026) Regulation .09A amended effective November 19, 2007 (34:23 Md. R. 2026) The purpose of the In-Home Aide Services Program (IHAS) is to complement other social services programs by providing specific services to individuals of all ages in the community in order to: Prevent or reduce the length of institutional placement; Prevent or reduce the length of out-of-home placement of children; Prevent or remedy abuse, neglect, self-neglect, or exploitation; or Promote self-sufficiency. In this chapter, the following terms have the meanings indicated. Terms Defined. “Abuse” means the sustaining of any physical injury of an IHAS client receiving service as a result of: Cruel or inhumane treatment; or A malicious act by a person. “Administration” means the Social Services Administration of the Department of Human Services. “Case manager” means an individual designated by the local department or other social service agency to: Assess the individual's need for services; Develop a plan to meet these needs; Assist the individual to obtain necessary services; and Monitor the services provided, and the individual's continued need for services. “Client” means an eligible individual receiving In-Home Aide Services. “Exploitation” means any action which involves the misuse of an IHAS client's funds, property, or person. “Functional disability” means difficulty in performing activities of daily living because of: A physical, cognitive, or psychiatric condition; or Environmental factors. “Institutionalization” means placement in a hospital, psychiatric hospital, or nursing home. “Local department” means the Department of Social Services in one of the 23 counties or Baltimore City or the Montgomery County Department of Health and Human Services, where the applicant resides or will reside. “Neglect” means the willful deprivation of an IHAS client of adequate food, clothing, essential medical treatment, or habilitative therapy, shelter, or supervision. “Self-neglect” means the inability of an IHAS client to perform activities of daily living or to provide the IHAS client with the services: That are necessary for the client's physical and mental health; and The absence of which impairs or threatens the client's well-being. An individual is eligible for IHAS if the individual: Is receiving case management in a social service program from the local department, or from a social service agency through an arrangement with the administration, and requires the service as a part of a treatment plan to: Prevent or reduce the length of institutional placement; Prevent or reduce the length of out-of-home placement of children; Prevent or remedy abuse, neglect, self-neglect, or exploitation; or Promote self-sufficiency; Is unable to obtain the necessary paraprofessional services from another resource; Is willing to accept IHAS; and Agrees to pay any fee required in a fee schedule published by the administration. Waiver of Fees. The director of a local department or the designee may waive a fee for service for applicants or clients who require services as part of a treatment plan to prevent or remedy abuse, neglect, self-neglect, or exploitation. The local department shall document in the case record every 90 days the continued need for the waiver. Application. Local departments shall accept and process requests for In-Home Aide Service by, or on behalf of, any individual or family. The local department shall assign requests for IHAS that do not come from a case manager in the local department or other social services agency to a case manager in the local department. If the case manager in a local department or other social service agency decides that IHAS services are needed, the case manager shall make a request for services to an IHAS supervisor on behalf of an eligible individual. The request shall include: An assessment of the individual's functional capacity, if required; A medical evaluation by the individual's physician, if required; A ranking scale scored according to Regulation .10F of this chapter; A copy of the service plan which the IHAS is required to complete; Income documentation; Documentation of eligibility; and An application for IHAS signed by the individual or individual's representative. A functional assessment, medical evaluation, or personal care plan is required if necessary to determine the amount and type of the IHAS to be delivered. The IHAS supervisor shall review the request for completeness, and inform the case manager of additional information required to determine the applicant's need for IHAS. If the request is complete, and the IHAS supervisor decides that the applicant is eligible, the IHAS supervisor shall insert the applicant's name in the appropriate order on the waiting list for IHAS. The IHAS supervisor shall notify the case manager of the applicant's ranking and of the availability of service within 2 working days of the receipt of the completed request. When the service is to begin, the IHAS supervisor, with the case manager, shall develop a written plan for aide services for the individual that includes: The goals to be met; Tasks to be performed; Amount and the length of service to be provided including a personal care plan prepared by a registered nurse or physician if personal care is required; The specific results expected from the provision of aide services; and The date service is expected to begin. If the IHAS supervisor agrees with the case manager that an applicant requires immediate service in order to prevent abuse, neglect, self-neglect, exploitation, institutional placement, or foster care for children, and there is a resource available, the IHAS supervisor shall request the case manager to forward a complete written request within 5 working days. If the local department is notified by another local department that a client who is in danger of immediate institutionalization, child foster care, or death, without IHAS, has moved to the area of the local department, the local department shall begin IHAS immediately if funds or staff are available. The local department shall forward a copy of the case record within 3 working days of the notification of the move. If funds or staff are available, the local department may provide the services by: Assigning a local department staff member; Purchasing the services from a private for-profit or nonprofit agency that has contracted with the Administration to provide the service; or Purchasing the services from a self-employed individual. The local department shall, if funds or staff are available, make available during weekends and evenings as well as during normal working hours, the following services: Meal planning and preparation; Personal care services which include: Help with dressing, bathing, feeding, grooming, and assistance with the bedpan or urinal; Assistance in and out of bed, with ambulation, and transfers from bed to wheel chair; Cleaning the eligible individual's bedroom, bath, kitchen, and personal laundry; Providing transportation to health and shopping facilities as well as other community resources required by the service plan. The local department shall have available, during weekends and evenings as well as during normal working hours, the following therapeutic aide services: Teaching meal planning and meal preparation; and Providing therapeutic aide services that include emotional support, introducing the client to neighborhood resources, and reinforcing appropriate self-care and caretaking behaviors, and teaching budgeting and home management. Provision of Additional Services. The local department may make arrangements for the provision of additional types of in-home aide services including heavy chore services to the eligible individual. If the case manager documents in the case record that intensive aide service, that is, more than 20 hours of aide service per week, is necessary to prevent imminent nursing home placement, or abuse, neglect, or self-neglect, and funds or staff are or become available, the local department shall provide the number of hours and days of care, including evening and weekend care, necessary to prevent nursing home placement, or abuse, neglect, or self-neglect, subject to the limitations in Regulation .07B of this chapter. A family with children shall receive intensive aide service, that is more than 20 hours of aide service per week, if funds or staff are or become available, and if the: Need for the additional amount of service is documented in the case record as necessary to prevent foster care, or to reduce the length of foster care placement; and Case manager assesses the family as potentially capable of providing adequate and safe care of the child without the use of aide service within the time specified in the service plan for effecting reunification or preventing out-of-home placement. The local department shall establish procedures to ensure the delivery of the aide service as required by the plan for aide service. Status Reports. Regardless of the method by which service is delivered, the local department shall require the service provider to complete a report to the IHAS supervisor on the client's current situation as often as necessary, and not less than monthly, to record any change in the client's situation. The report is required if the client prevents the aide from performing the tasks agreed to in the plan for aide services or the aide: Identifies a change in the client's functional capacity; Identifies a physical deterioration or improvement; Receives a request for services which are not part of the plan for aide services; Has a poor relationship with the client, or a household member; Identifies abuse, neglect, self-neglect, or exploitation of the client; Identifies a change in the client's environment; Receives a request from the client to terminate service; Notes termination or initiation of services from another source; or Identifies a threat to the aide's well-being because of environmental hazards, contagious disease, or because the client, or a member of the household threatens physical harm or is verbally abusive to the aide. The IHAS supervisor shall keep the report in the case record in the local department, and shall forward a copy of the report to the case manager. If the aide suspects that the client or a dependent in the client's care is in physical danger, the aide shall report the circumstances immediately to the IHAS supervisor, the case manager, or the local department's after-hours emergency service. Significant Change in Client's Status. If there is a change in the client's status which the IHAS supervisor determines may affect the case management plan or the plan for aide service, the supervisor shall inform the case manager within 2 working days. The IHAS supervisor shall send a current report on the client's situation to the case manager with a request that the client be reassessed, and a medical reevaluation and revised personal care plan be prepared if indicated. The IHAS supervisor, with the case manager, shall develop a new or revised plan for aide services within 5 working days of receipt of the reassessment and personal care plan. The local department may suspend services up to 4 weeks: While the client is absent from the home; or If the client requests termination. The IHAS supervisor shall: Notify the case manager when the client is not at home; and Notify the case manager if the client has requested termination, and include a copy of the aide's status report. Emergency Suspension. If the IHAS supervisor determines that there is an immediate threat to the aide's health, safety, or welfare from environmental hazards, or from a client, a member of the client's household, or someone regularly present during times of service, the local department may immediately suspend services on an emergency basis. If services are suspended on an emergency basis, the notice provisions of Regulation .09B of this chapter do not apply. The local department shall send by certified mail written notice of the suspension to the client stating: The regulatory basis for the suspension; That the client is entitled to a hearing within 7 calendar days of a request for a hearing; That the Secretary's designee shall issue a decision concerning the emergency suspension within 7 calendar days of the hearing; That if the emergency suspension order is upheld, aide services shall be suspended until it is determined that the health, safety, or welfare of the aide is no longer threatened; and That the suspension may lead to termination. The local department may provide aide services up to the maximum of 20 hours per week for each eligible individual except for individuals identified in Regulation .06D(2) and (3) of this chapter. For a client requiring intensive service as identified in Regulation .06D(2) of this chapter, the IHAS supervisor shall determine the total cost for 6 months of IHAS. The local department may not provide IHAS to a client if the total public cost for 6 months of IHAS exceeds 67 percent of the average Statewide cost of nursing home care for 6 months as determined by the Administration. The local department may only provide intensive services to individuals identified in Regulation .06D(2) or (3) if the case manager assesses the family as potentially capable of providing adequate and safe care of the child without the use of aide service within the time specified in the service plan for effecting reunification or preventing out-of-home placement. The local department shall redetermine the client's income and whether the client is required to pay a fee at least every 6 months. The local department shall reconsider the client's need for In-Home Aide Services, including any required change in the personal care plan, and complete a current ranking scale, at least every 6 months or sooner if the client's situation has changed significantly. The local department shall terminate services under any of the following circumstances: Objectives of service have been reached and the IHAS supervisor and case manager agree that service is no longer needed; The family, client, or case manager is able to secure the necessary service from an alternative source; The case manager evaluates the client as no longer in need of IHAS; The client is deceased; The client moves to the jurisdiction of another local department; The client is hospitalized, placed in a long-term care facility, or is receiving community-based waiver program services; The client is no longer eligible; The limit in Regulation .07A of this chapter has been reached; The case manager, with the IHAS supervisor, determines that the service has not been effective in achieving the specific changes in the client's condition or family's situation which were expected to result from providing services; If an individual on the waiting list has a ranking score of seven or above, the local department shall: Terminate the client with the lowest score below seven; or If there is more than one client with the lowest score, terminate the client whose service began first; If the resources of the local department are insufficient to serve the existing clients, the local department shall terminate the client with the lowest ranking score below seven on the IHAS Ranking Scale, and continue terminating until the remaining clients can be served with the resources available; The service is suspended for 4 weeks; The client requests termination; The client declines IHAS service; or The client has prevented the IHAS aide from performing tasks agreed upon in the care plan for aide service. If a local department terminates service under §C(5) of this regulation, and if the client or individual in the client's care is in danger of immediate institutionalization, child foster care, or death without IHAS, the local department shall notify the new local department immediately in order that IHAS may begin at the earliest possible moment. If the client's new address is near enough, the local department may continue IHAS until the new department begins IHAS. Except when the services are suspended on an emergency basis, the local department shall send notice to the client at least 15 days before taking action which will deny, reduce, suspend, or terminate services. The notice shall state the decision and the basis for it, cite the regulations supporting it, and explain the applicant's right to, and the method to request, a fair hearing. The local department shall give written notification of the right to and the procedures for requesting and obtaining a fair hearing, to each applicant or client of IHAS at the time of application, and if the local department notifies the applicant or client of an action which might deny, delay, suspend, reduce, or terminate service. The procedures are set forth in COMAR 07.01.04. Emergency Action Hearing Requests. All emergency action hearing requests shall be filed with the local department within 30 days of the certified mailing of the notice of the local department's action, and shall state the name and address of the client, and the effective date of the action appealed. The local department shall notify the Office of Administrative Hearings immediately upon receipt of an emergency action hearing request. Oral notification shall be followed by written notification within 24 hours. A hearing shall be conducted within 7 days of the filing date of the hearing request. A decision by the administrative law judge shall be rendered within 7 days after the conclusion of the hearing. Discrimination. The local department may not discriminate in the delivery of service, as required by the nondiscrimination procedures as set forth in COMAR 07.01.03. Local departments shall use the ranking scale shown in §F of this regulation, for applicants who are eligible for aide services. Local departments shall keep a waiting list if they are unable to serve eligible applicants immediately upon request for services. If a local department has more than one office, it may maintain a separate waiting list for each office. Subject to Regulation .08C(10) of this chapter, if there is a waiting list, local departments shall provide aide services to applicants with the highest point total first. Applicants with equal scores shall be served according to the date of application, and those with earlier application dates shall be served first. Individuals on the waiting list shall be served as resources become available. If a rescoring is required by Regulation .08B of this chapter, the local department shall score the client based on the case manager's assessment of the client's condition if IHAS were removed. IHAS Ranking Scale. IHAS is necessary in order to prevent eviction, or correct environmental conditions which are unsafe or detrimental to the applicant's or the client's health. — 1 Applicant's or client's income is equal to or below the amount for the appropriate family size in a fee schedule published by the administration. — 1 The wage earner would lose job income or job if aide service is not provided. — 1 The applicant or client has suffered a personal or financial loss within the last 6 months which affects the individual's emotional or social functioning. — 1 A community resource is not available and willing to assist the applicant or client with the problem which is causing the need for aide service, or the applicant or the client is socially and psychologically isolated. — 1 The applicant or client is not currently receiving in-home aide service from any other agency, or aide service is being discontinued. — 1 An applicant can be discharged from institutional or child foster care only if aide service is provided — 3 The applicant or client or an individual cared for by the applicant or client is in danger of immediate institutionalization or child foster care if aide services are not provided. — 3 The request for service is related to care of children between: 10—17 years old — 1 6—9 years old — 2 5 years old and under — 3 The client, or individual cared for by the client, is in danger of abuse or neglect by the client or other individual: Mild — 1 Moderate — 2 Severe — 3 High risk for death — 4 The applicant or client has a physical, psychiatric, or cognitive disability, and needs assistance in order to perform activities of daily living: Mild — 1 Moderate — 2 Severe — 3 Eligible for institutionalization — 4 Human Services Article, §§6-501—6-505; Family Law Article, §§5-524, 5-710, and 14-207; Annotated Code of Maryland(Agency Note: Federal Regulatory Reference—45 CFR 1357) Effective date: August 31, 1977 (4:18 Md. R. 1394) Regulation .10 amended effective November 3, 1978 (5:22 Md. R. 1672); September 7, 1979 (6:18 Md. R. 1457); July 1, 1980 (7:13 Md. R. 1272); August 17, 1981 (8:16 Md. R. 1362) Regulations .01—.10, Homemaker Service, repealed effective July 1, 1985 (12:13 Md. R. 1278) Regulations .01—.11, In-Home Aide Services, adopted effective July 1, 1985 (12:13 Md. R. 1278) Regulation .11 amended effective July 27, 1987 (14:15 Md. R. 1658); July 25, 1988 (15:15 Md. R. 1807); July 10, 1989 (16:13 Md. R. 1419) Recodified from COMAR 07.02.14 to 07.06.12, December, 1992 Regulations .01—.11 repealed and new Regulations .01—.10 adopted effective October 15, 2001 (28:20 Md. R. 1780) Regulation .01C amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .02B amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .03 amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .05D, E amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .06 amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .07B amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .08 amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .09 amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .10E, F amended effective July 28, 2008 (35:15 Md. R. 1347) Chapter recodified from COMAR 07.06.12 to COMAR 07.02.14 effective June, 2009 The purpose of the Social Services to Adults (SSTA) Program is to engage clients and their formal and informal resources while in the process of decreasing risk to the client and achieving successful client goals through identification, linkage and enhancement of client supports and resources. This includes: Achieving or maintaining the client’s safe living environment in the community with formal and informal supports; Achieving or maintaining self-sufficiency; Preventing or avoiding abuse, neglect, self-neglect, or exploitation; Preventing or reducing unnecessary or inappropriate institutionalization; Achieving or maintaining economic self-support; and Securing necessary and appropriate institutional care services. The program seeks to build, sustain, and augment, rather than to replace, the adult's formal or informal resources. SSTA targets service delivery resources to those clients most in need. In this chapter, the following terms have the meanings indicated. Terms Defined. “Abuse” means the sustaining of any physical injury by a vulnerable adult as a result of cruel or inhumane treatment or as a result of a malicious act by any person. “Administration” means the Social Services Administration of the Department of Human Services. “Adult” means a person who is 18 years old or older who does not have a minor child living with and dependent on the person. “Adult Foster Care” means a program that provides a family setting in the community for an aged adult or an adult with disabilities who requires: Protective oversight; Assistance with the activities of daily living; and Room and board. “Adult's representative” means a person authorized by the adult to act on the adult's behalf, or the adult's court-appointed guardian. “Aged adult” means an adult who is 65 years old or older and that adult's spouse. “Case management” means services provided to an adult which include: A comprehensive assessment of the adult's strengths, needs, risk level, and resources; Development of a comprehensive service plan designed to address the adult's risk level and need; Referral to and linkage with appropriate resources both within the local department and in the broader community; Provision of direct services to the adult, if called for in the service plan; Advocacy with and on behalf of the adult to obtain, access, and secure available resources and to develop additional resources when necessary; and Monitoring and evaluation of the effectiveness and efficiency of formal and informal resources used in meeting the adult's needs and ongoing assessment of whether a need for continuing services exists. “Certified Adult Residential Environment (CARE) Home” means a certified adult residential protective living environment home that provides case management services to adults with disabilities 18 years old or older, who cannot live alone primarily due to mental or physical health impairments and need assistance with activities of daily living. “Client” means an adult who is eligible for and is receiving services from the SSTA program. “Crisis intervention” means case management on an intensive basis with the goal of restabilizing the adult's life situation. “Exploitation” means any action which involves the misuse of a vulnerable adult's funds, property, or person. “Formal Resources” means professionals and/or agencies that provide services or treatment to the client. “Home Delivered Meal Service” means the preparation and delivery of meals to the homes of eligible persons to prevent institutionalization, malnutrition, and feelings of isolation. This may include personnel, equipment, supplies, and food costs. “Informal Resources” includes but is not limited to family members, neighbors, volunteers, faith-based groups and other community members who are involved with the client as a support. “Information and referral” means the brief process which includes: Receipt of an inquiry about or request for information or service; Provision of information; or Identification of and referral to an appropriate available resource, including providing instructions regarding the application and eligibility requirements of the resource. “In-Home Aide Services” means services provided to an adult with a functional disability in need of assistance with activities of daily living. “Liquid assets” means any real or personal property, possession, or valuable the adult owns individually or jointly, which can be converted to cash for support and maintenance. “Local department” means the Department of Social Services or its designee in one of the 24 Maryland jurisdictions including Baltimore City and the Baltimore and Montgomery counties Departments of Health and Human Services. Neglect. “Neglect” means the willful deprivation of a vulnerable adult of adequate food, clothing, essential medical treatment or habilitative therapy, shelter, or supervision. “Neglect” does not include the providing of nonmedical remedial care and treatment for the healing of injury or disease, with the consent of the vulnerable adult, recognized by State law instead of medical treatment that the vulnerable adult receives voluntarily. “Non-aged adult” means an adult who is 18 years old, but not yet 65 years old or older. “Program” means the Social Services to Adults program. “Self-neglect” means the inability of a vulnerable adult to perform activities of daily living or to provide the vulnerable adult with the services: That are necessary for the vulnerable adult's physical and mental health; and The absence of which impairs or threatens the vulnerable adult's well-being. “Service plan” means the written plan developed with the adult or the adult's representative which describes the goal of service, the specific services to be provided, and the method for providing the services, and which includes at least the following: Lists of the adult's service needs as perceived by the adult or the adult's representatives as well as by the SSTA worker; An assessment of the adult's strengths, needs, risk level and resources as these affect service needs; A plan for meeting the adult's needs, including consideration of the roles to be played by: The adult; The adult's family; The adult's friends; Community resources; and Local department resources; Specification of the tasks to be carried out by: The adult; The adult's family or friends; Local department staff, including the SSTA worker; and Other agencies and resources; Specification of the service plan period during which the plan will be in effect; Specification of the expected frequency of contact between the SSTA worker and the adult; The schedule for redetermination of eligibility and reassessment of services; and At the time of reassessment, an evaluation of the appropriateness, the effectiveness, and the efficiency of service that have been received by the adult. “Vulnerable adult” means an adult who lacks the physical or mental capacity to provide for the adult's daily needs. An adult is eligible for SSTA if the adult: Is a resident of Maryland. Temporary absence from the State may not interrupt continuity of residence. Is in need of the services. Need is: Established if the local department determines that the program’s services will help the adult to achieve the program’s purposes; Determined by the local department staff based on information provided by the adult and other appropriate sources which may include, but need not be limited to: The adult’s family or friends; Medical or mental health providers familiar with the adult; or Resources to whom the adult is referred for assessment or evaluation purposes. Has income that does not exceed 80 percent of the State Median Income based on individual family size as described in COMAR 07.02.04.08 and has liquid assets as described within this regulation. The following criteria apply: Eligibility criteria for information and referral services or crisis intervention services is provided without regard to income; and Eligibility for on-going case management services may exceed 80 percent of the State Median Income should the adult be assessed as requiring In-Home Aide Services or Adult Foster Care, except as provided in §C of this regulation, if the adult is eligible for placement in a CARE Home. Has liquid assets that do not exceed: $19,999 for one individual; and $3,000 more for each additional family member. Liquid assets include, but are not limited to: Checking accounts; Savings accounts; Certificates of deposit; Stocks; Bonds; Life insurance cash value in excess of $3,500 per person; Real estate or property that is not the client's primary residence; Individual retirement accounts which can be drawn on without penalty; Trust fund accounts; Annuity accounts; Income from lottery prize winnings; and Mutual fund accounts. Agrees to receive the service and agrees to pay any fee assessed for services at the time of the initial application or during the reconsideration period. An adult is not eligible for SSTA if the adult, or the adult’s representative, does not agree to receive the services and/or participate fully in identifying and engaging needed resources. An adult is not eligible for SSTA while receiving case management from the CARE program or any other case management service program. The adult or the adult's representative shall make a referral for service to the local department in writing, by telephone, or in person. The local department based upon availability if staff, shall send a representative to take the application and establish the eligibility of an adult wishing to apply when the adult or the adult's representative is unable to come to the local department. The Department’s representative shall complete an initial assessment of the client’s risk, needs, resources, and eligibility within 10 days of receipt of referral. If the local department finds that it is faced with limited staff resources or experiences a delay in the completion of an application to establish eligibility, the client’s name shall be placed on a Client Waitlist without an assessment. After the adult is placed on the Client Waitlist without an assessment, the local department shall notify the adult or the adult’s representative in writing of the action. The written notice shall include the following: An explanation that, due to a lack of funding or staff, an assessment of the client’s eligibility for the program cannot be conducted by the Department at this time, and that the adult’s name will be placed on a Client Waitlist without an assessment; Information that explains that the adult will be contacted by the Department when staff is available to meet with them and discuss their eligibility and application for services; Information that directs the adult or the adult’s representative to contact the agency should the adult’s circumstances, need, risk level, or contact information changes so that their referral information can be updated; Information that specifies the regulation supporting the reason for any necessary intended agency action; and Information informing the adult that the local department shall contact the adult at least annually to ensure continued accuracy of the referral information, and that services are still needed. The adult or the adult's representative shall complete and sign an application, on a form provided by the Administration. When the request is for information and referral only, a signed application is not required. A request for information and referral service may be made in writing, by telephone, or in person by the adult or the adult's representative. The date of application is the date on which the local department receives the signed application. The local department shall collect the application and determine client’s eligibility and the type of service for which the applicant is appropriate. After determining eligibility and program appropriateness, the local department shall notify the adult or the adult’s representative in writing of the decision. If the decision is to: Accept the application for service the notice shall include the facts that: The adult is eligible for service and which service will be provided; Type and amount of service to be provided; and The right to, and the method for, obtaining a fair hearing; Place the client on a waitlist, the notice shall include the facts that: The adult is eligible for service, however, due to a lack of funding or staff, services are not available at this time and the client will be placed on a waitlist for services; Information directing the client or the client’s representative to contact the local department should the client’s need, risk level, or circumstances change; and The specific regulation supporting the reason; or Deny the application for service, and the notice shall include the: Reason for the denial; Specific regulation supporting the reason; and Right to and the method for, obtaining a fair hearing. Service Appropriateness. Information and Referral service is appropriate for an adult with generally adequate coping skills and who: Has a question about the existence or availability of a resource in the community; Requires a service not provided by the department but with minimum assistance can use another system providing the needed service; and Has a problem and is able to make independent decisions but refuses other services from the department. Crisis Intervention service is appropriate for an adult whose normal coping patterns have failed and who: Is experiencing a situational change; Needs guidance in taking on a new role or achieving other adjustment; and Has at least minimal capacity for independent functioning. Case Management service is appropriate for an adult who: Seeks to achieve or maintain economic self-support; Seeks to achieve or maintain self-sufficiency; Seeks assistance navigating needed service systems; Is at risk of abuse, neglect, exploitation, or self-neglect; Requires service from the local department or other resource in order to be discharged from an institution; Is discharged or released from a nursing institution has sufficient capacity for independent living and decision-making but requires service from the local department or other agency in order to secure appropriate resources to live in the community; Is experiencing a crisis, examples of which include but are not limited to adults in the following circumstances: Previously a recipient of community service, but no longer eligible; Recently unemployed; Homeless; or Recent loss of a spouse; Seeks to engage and enhance involvement with formal and informal resources; Seeks to achieve successful personal outcomes; or Requires In-Home Aide Services, Adult Foster Care, or who is eligible and waiting for placement in a CARE home. Information and Referral. When only information and referral is needed, the local department, no later than 5 working days following the request for service, shall: Clarify the type of information or referral which is requested, if needed; and Provide information, about availability of programs, appropriate to the request, or make a referral to an available resource, including direction regarding the application and eligibility requirement of the available resource. When providing Information and Referral Services, the SSTA worker shall have contact with the adult or the adult’s representative as needed in order to: Assist the client in identifying, engaging and/or enhancing the client’s access and involvement with available formal or informal resources; and Identify and inform the local department administration staff of unmet needs or barriers to service delivery. The local department may not deliver information and referral service for more than 30 days after the date of application. Crisis Intervention. When crisis intervention is appropriate the local department shall: Begin a full assessment of the adult’s eligibility, needs, strengths, and resources by no later than the first work day following the date of application; and Establish a service plan by no later than 14 calendar days following the date of application. During crisis intervention services, the SSTA worker shall have face-to-face contact with the adult on at least a weekly basis in order to: Provide counseling and other services which the worker has agreed to provide as part of the service plan; Assist the client in accessing to available resources as required by the service plan; Monitor the effectiveness of any service to which the adult is referred or which is serving the adult; Monitor progress in achieving the goals of the service plan; Revise the service plan as needed; and Identify and inform the local department administrative staff of unmet needs or barriers to service delivery. The local department may not deliver crisis intervention service for more than 60 days after the date of application. Continuing SSTA Case Management Services. When case management is appropriate, the local department shall: Begin a full assessment of the adult’s eligibility, risk level, needs, strengths, and resources by no later than 7 calendar days following the date of application. In the event that there is an indication that the adult may be institutionalized if service is not provided, the assessment shall begin no later than the first working day following the date of application. Conduct an analysis of the case no more than 90 days after acceptance of the case at Intake. This analysis is to determine whether the case will be open in Continuing Social Services to Adults, closed or assigned to the waitlist. This analysis should focus on the client’s level of risk, level of dependency on the local department, and the resources needed to support the client’s goals as stated in the Service Plan. Conduct a case analysis at the time of case reconsideration to determine whether case will be closed or whether staff resources will be committed to the case up to an additional 6 months. Conduct a case analysis at any time there is a significant change in the client’s circumstances and/or risk. Establish an individual service plan by no later than 90 calendar days following the date of application. During case management service, the case manager shall have contact with the adult monthly through face-to-face contact no less frequently than once every 3 months in order to: Provide services which the worker has agreed to provide as part of the service plan; Assist the client in identifying, obtaining and/or enhancing access and involvement with available resources as required by the service plan; Monitor the effectiveness of any service to which the client is referred or which is serving the client; Monitor progress in achieving the goals of the service plan; Revise the service plan as needed but not less than every 6 months; and Identify and inform the local department administration staff of unmet needs or barriers to service delivery. Adult Protective Services. While providing the service of this program, the SSTA case manager shall be alert for indicators of abuse, neglect, exploitation, or self-neglect and, therefore, requires Adult Protective Services. If the SSTA case manager determines that indicators of abuse, neglect, or exploitation exist, the worker shall make a referral to Adult Protective Services immediately. If the SSTA case manager determines that indicators of self-neglect exist, the worker shall make a referral to Adult Protective Services if: The adult or the adult's representative does not agree to and cooperate with a SSTA service plan which would result in a substantial abatement of the risk due to self-neglect; or Guardianship of the Person of the adult is necessary to mitigate the risk due to self-neglect. When the SSTA case manager refers a SSTA client to Adult Protective Services, the case manager shall continue services to the client until Continuing Adult Protective Services has begun. In-Home Aide Services. When the service plan indicates that an adult needs service from the In-Home Aide Services program, the case manager shall complete a written referral to the In-Home Aide Services program. The referral shall include at least the following: A clear list of the specific aide services requested; An explanation of why aide service is needed and what other resources have been explored to meet the adult's need for aide service; and A statement of the specific objectives to be achieved by the aide service. When the SSTA case manager reassesses the client’s service plan which includes use of In-Home Aide Services, the worker shall: Request from the In-Home Aide Services program staff a Progress Report outlining their evaluation of the effect and effectiveness of the aide service on the client's overall circumstances; and Notify the In-Home Aide Services program of any changes to the contents of the referral. When the case manager determines that the adult requires immediate service from the In-Home Aide Services program in order to prevent abuse, neglect, self-neglect, exploitation, or institutional placement, the worker shall make an immediate verbal request to the In-Home Aide Services supervisor. The SSTA worker shall forward a written referral to the In-Home Aide Services supervisor within 5 working days of the verbal request for services. When the case manager is notified that service to an adult from the In-Home Aide Services program will be or has been terminated, the worker shall begin a reassessment of the adult's service needs immediately, unless the termination is the result of a service plan previously developed by the worker with the adult or the adult's representative. The local department shall make a redetermination of eligibility: When required on the basis of information the agency has obtained about change or anticipated changes in the adult's situation; Promptly, not to exceed 30 days, after information is obtained by the local department about changes in the adult's circumstances which may make the adult ineligible; or Periodically, but not less frequently than every 6 months. The local department shall make a reassessment of service needs: Whenever required because of a significant change in the adult's circumstances which may affect the type or amount of service the adult needs; or Periodically, but not less frequently than every 6 months. A reassessment shall include, at least: A review of the most current service plan to determine progress towards goals; An assessment of the effectiveness and efficiency of the formal and informal resources which have provided support to the adult during the most recent service plan period and any previous period, if appropriate; A reassessment of the adult's strengths, needs, level of risk, dependency on the local department, and resources; and Development of an individualized service plan for the next service period, if the decision is that services are to continue; and Conduct a case analysis to determine whether the case will be closed or whether staff resources will be committed to the case for up to an additional 6 months, by focusing on the client’s level of risk, level of dependency on the local department and needed resources to support achievement of the client’s goals as stated in the client’s service plan. Whenever the local department does a redetermination of eligibility, the local department shall also: Complete a reassessment; and Notify the client or the client’s representative in writing of their eligibility status for services. The local department shall terminate the provision of SSTA when: The adult is no longer eligible; An eligible adult moves to the jurisdiction of another local department and a referral for service to that department is made; The adult is in need of Continuing Adult Protective Services and referral to that program is made and service has begun; Specific, measurable, time-limited goals and objectives have been reached; The case manager determines the adult no longer needs the service, or level of service currently provided; The case manager determines the service has not been effective in achieving the specific goals, objectives, and changes in the client's condition which were expected to result from the service, and that continued service is not expected to be effective; The adult requests termination; The adult has died; The adult has entered a long-term care facility; The adult, the adult's family or other informal supporters have failed to perform the tasks specified in the service plan agreement; An adult on the waiting list declines to receive SSTA; An adult exhibits uncooperative behavior, abuse, or misuse of the service; or The adult or the adult's representative refuses to accept specific time-limited goals, objectives, and recommendations of the service plan. Whenever SSTA case management is terminated because the adult, or the adult's representative, does not agree to receive the service, the case manager shall assess and document whether a reason exists to report the case for an Adult Protective Services investigation. Client Waitlist without an Assessment. The local department shall establish and enforce a procedure for governing a written waiting list for customers requesting services, if due to a lack of staff the local department is unable to assess the client’s need and eligibility for services at the time of referral. Client Waitlist with an Assessment. The local department shall establish and enforce a procedure governing a written waiting list for adults, assessed and determined eligible for services, if the local department is unable to provide SSTA based on available resources or staffing or both. SSTA case management services staff shall be provided to applicants in accordance with the local department criteria. Eligible adults shall be ranked in accordance with the local department’s established criteria which shall take into account the adult’s vulnerability, level of risk, needs and available resources. The local department shall update the client’s ranking on the waitlist as necessary, based on reported changes in the customer’s status but not less frequently than every 6 months. Appeal of the Local Department Decision. The local department shall give written notification of the right to and the procedures for, requesting and obtaining a fair hearing to each applicant or recipient of public assistance at the time of application, and whenever the local department notifies the applicant or recipient of any action which might deny, delay, suspend, reduce, or terminate assistance. The procedures are set in COMAR 07.01.04. Discrimination. The local department may not discriminate in the delivery of services as required by the nondiscrimination regulations in COMAR 07.01.03. Human Services Article, §§4-205(a), 4-207, 5-205(a), and 5-207, Annotated Code of Maryland Effective date: November 4, 1977 (4:23 Md. R. 1729) Regulation .11 amended effective November 3, 1978 (5:22 Md. R. 1672); September 7, 1979 (6:18 Md. R. 1457); July 1, 1980 (7:13 Md. R. 1272); August 17, 1981 (8:16 Md. R. 1362) Regulations .01—.11 under Community Home Care Services repealed effective July 29, 1985 (12:15 Md. R. 1510) Regulations .01—.12 adopted effective July 29, 1985 (12:15 Md. R. 1510) Regulation .03A amended effective November 26, 1990 (17:23 Md. R. 2732) Regulation .12 amended effective October 6, 1986 (13:20 Md. R. 2209); July 12, 1987 (14:14 Md. R. 1570); July 1, 1988 (15:11 Md. R. 1330); July 1, 1989 (16:12 Md. R. 1333) Regulation .12 repealed effective November 26, 1990 (17:23 Md. R. 2732) Recodified from COMAR 07.02.15 to 07.06.13, December, 1992 Chapter revised effective October 29, 2001 (28:21 Md. R. 1854) Regulation .02B amended effective December 1, 2008 (35:24 Md. R. 2075) Regulation .03 amended effective December 1, 2008 (35:24 Md. R. 2075) Regulation .05 amended effective December 1, 2008 (35:24 Md. R. 2075) Regulation .06 amended effective December 1, 2008 (35:24 Md. R. 2075) Regulation .07 amended effective December 1, 2008 (35:24 Md. R. 2075) Regulation .08C amended effective December 1, 2008 (35:24 Md. R. 2075) Regulation .09 amended effective December 1, 2008 (35:24 Md. R. 2075) Regulation .11D amended effective December 1, 2008 (35:24 Md. R. 2075) Chapter recodified from COMAR 07.06.13 to COMAR 07.02.15, effective June, 2009 Regulation .01 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .02B amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .03 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .03A amended effective August 20, 2012 (39:16 Md. R. 1079) Regulation .03C amended effective April 18, 2011 (38:8 Md. R. 505) Regulation .04A—C amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .05 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .06 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .07 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .08 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .09 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .10 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .11 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .12 repealed effective April 18, 2011 (38:8 Md. R. 505) Adult Protective Services is a social services program to assist vulnerable adults who are unable to provide for their basic living needs or access necessary professional services, or protect their own interests and are subject to abuse, neglect, exploitation, or self-neglect. Service provision is normally limited to 6 months in which time risk is reduced. Adult Protective Services makes every effort to stabilize the vulnerable adult in the adult's own home within the community through community support services that reduce risk factors. In this chapter, the following terms have the meanings indicated. Terms Defined. “Abuse” means the sustaining of any physical injury by a vulnerable adult as a result of cruel or inhumane treatment or as a result of a malicious act by a person. “Adult” means a person 18 years old or older. “Assisted living manager” means an individual who is designated by the licensee to oversee the day-to-day operation of the assisted living program. Assisted Living Program. “Assisted living program” means a residential or facility-based program that provides assistance in performing the activities of daily living or instrumental activities of daily living, in a way that promotes optimum dignity and independence of the individuals, such as providing: Housing and supportive services; Supervision; Personalized assistance; Health-related services; or A combination of these services. “Assisted living program” does not include: A nursing home, as defined under Health-General Article, §19-301, Annotated Code of Maryland; A State facility, as defined under Health-General Article, §10-101, Annotated Code of Maryland; A program licensed or approved by the Maryland Department of Health under Health-General Article, Title 7 or Title 10, Annotated Code of Maryland; or A hospice care program licensed by the Maryland Department of Health under Health-General Article, Title 19, Annotated Code of Maryland. “Director” means the director of the local department of social services. “Disabled person” means an adult who has been judged by a court for purposes of adult public guardianship of the person to be unable to provide for his daily needs sufficiently to protect his health or safety due to: A mental disability; Disease; Habitual drunkenness; or Addiction to drugs. “Emergency” means that an adult is living in conditions which present a substantial risk of death or immediate and serious physical harm to himself or others. “Exploitation” means any action which involves the misuse of a vulnerable adult's funds, property, or person. “Guardian of the person” means an individual, agency, or corporation appointed by a court to undertake certain actions in the interest of a disabled person. The guardian is authorized by the court to make responsible decisions for the disabled person about the disabled person's health care, shelter, or daily needs for food or clothing and to receive and spend money from the disabled person's assets to meet those needs. “Guardian of the property” means a person or agency appointed by the court to manage the property of a disabled person or a minor. “Law enforcement agency” means a State, county, or municipal police department, bureau, or agency. “Licensee” means the person, association, partnership, or corporation to whom the license is issued. “Local department” means the department of social services or the Montgomery County Department of Health and Human Services, in the jurisdiction where the: Vulnerable adult lives; or Abuse, neglect, or exploitation is alleged to have taken place. “Local State's Attorney” means the State's Attorney for the jurisdiction where the: Vulnerable adult lives; or Abuse, neglect, or exploitation is alleged to have taken place. Neglect. “Neglect” means the willful deprivation of a vulnerable adult of adequate food, clothing, essential medical treatment or habilitative therapy, shelter, or supervision. “Neglect” does not include the providing of nonmedical remedial care and treatment for the healing of injury or disease if the nonmedical care and treatment is recognized by State law and is done with the informed consent of the vulnerable adult. “Office of Health Care Quality” means the State office authorized to license and regulate quality of care in hospitals and health-related facilities in Maryland, as provided under COMAR 10.07.14. “Police officer” means a State or local officer who is authorized to make arrests as part of the officer's official duty. “Resident” means an individual 18 years old or older who requires assisted living services. “Review board” means the Adult Public Guardianship Review Board. “Self-neglect” means the inability of a vulnerable adult to perform activities of daily living or to provide the vulnerable adult with the services: That are necessary for the vulnerable adult's physical and mental health; and The absence of which impairs or threatens the vulnerable adult's well-being. “Vulnerable adult” means an adult who lacks the physical or mental capacity to provide for the adult's daily needs. A vulnerable adult is eligible for an investigation of reports by himself or others when abuse, neglect, self-neglect, or exploitation is occurring, except in instances of abuse of a patient occurring in a: Mental health facility under Health-General Article, Title 10, Annotated Code of Maryland; Facility for mentally retarded individuals under Health-General Article, Title 7, Annotated Code of Maryland; or A nursing home or hospital under Health-General Article, Title 19, Annotated Code of Maryland. A vulnerable adult determined to be in need of and accepting services or who is under court order to receive service is eligible. There is no fee for Adult Protective Services, however, eligibility fees for ancillary services offered are governed by the regulations for that specific program. A health practitioner, police officer, or human service worker who contacts, examines, attends or treats an alleged vulnerable adult and who has reason to believe that the adult has been subject to abuse, neglect, self-neglect, or exploitation shall notify the local department of social services. An individual who has reason to believe that an alleged vulnerable adult has been subjected to abuse, neglect, self-neglect, or exploitation may file a report with the local department of social services. The local department shall request that the report contain as much of the following information as is known to the person making the report: The name, age, and home address of the alleged vulnerable adult; The name and home address of the individual responsible for the care of the alleged vulnerable adult; The whereabouts of the alleged vulnerable adult; The nature of the alleged vulnerable adult's incapacity; The nature and extent of the abuse, neglect, self-neglect, or exploitation of the alleged vulnerable adult, including evidence or information available to the reporter concerning previous injury possibly resulting from abuse, neglect, self-neglect, or exploitation; and Any other information that would help to determine the: Cause of the suspected abuse, neglect, self-neglect, or exploitation, and Identity of any individual responsible for the abuse, neglect, self-neglect, or exploitation. The local department shall notify the individual making the report that the investigation has begun as a result of the report. Confidentiality regulations shall determine the amount and kind of information disclosed. To protect the welfare of the alleged vulnerable adult the local department shall begin a thorough investigation: Within 5 working days after the receipt of the report of suspected abuse, neglect, self-neglect, or exploitation; or Within 24 hours after the receipt of the report of suspected abuse, neglect, self-neglect, or exploitation if the report indicates that an emergency exists. To protect the welfare of the alleged vulnerable adult the local department shall complete an investigation: Within 30 days of the receipt of the report; and Within 10 days of the receipt of the report, if the report indicates that an emergency exists as described in §A(2) of this regulation. A vulnerable adult is eligible for investigation of a report of suspected self-neglect, neglect, or exploitation when the vulnerable adult is a patient or resident in a facility identified in Regulation .03 of this chapter. The local department, when appropriate, may forward to the State Office of Aging or Office of Heath Care Quality a referral to investigate allegations received of suspected self-neglect, neglect, and exploitation within facilities identified in Regulation .03 of this chapter regarding a vulnerable adult's living environment and suspected maltreatment by facility staff. Report of a Resident in an Assisted Living Program. If emergency flex funds or local department staff are available, the local department may assist the resident with relocation to another assisted living program, upon notification by the Office of Health Care Quality, or the assisted living manager or alternative manager of the emergency removal of a resident or the emergency suspension or revocation of a facility's license. Upon completion of an investigation, the local department may send a report of the outcome of a completed investigation to the Office of Health Care Quality, the local law enforcement agency, and the State's Attorney's Office, if appropriate, or if there appears to be evidence of criminal intent to harm or exploit a vulnerable adult. The investigation shall include: A face-to-face interview with the vulnerable adult; and Information gathered from the adult and collateral contacts. The investigation shall be directed to: A determination of whether the individual is a vulnerable adult; and Whether there has been abuse, neglect, self-neglect, or exploitation. If there is a finding of abuse, neglect, or exploitation of a vulnerable adult, the investigation shall include information regarding: The nature, cause, and extent of the abuse, neglect, and exploitation; and The identity of the individual or individuals responsible for the abuse, neglect, and exploitation. The information collected shall include: Facts about whether the adult is unable to provide for his daily needs sufficiently to protect his health, welfare, or safety; Psycho-social factors affecting functioning of the adult; Medical factors affecting functioning of the adult; and Environmental factors affecting the adult, including housing, availability of transportation, and income. The local department shall secure the cooperation of the vulnerable adult to the extent possible. The local department shall inform the referring party when the investigation begins and the name of the assigned caseworker. Except in accordance with a court order, local departments may not share information on a case unless it furthers the investigation or service provision or is required in reports to law enforcement officials. The local department shall: Report to the appropriate local law enforcement agency any incident of abuse, neglect, or exploitation of an alleged vulnerable adult when the possibility of a crime being committed against the alleged vulnerable adult is indicated by information provided in the initial report to the local department or by information obtained in the course of investigation; and Send to the local State's Attorney and the appropriate law enforcement agency any incident of abuse, neglect, or exploitation of an alleged vulnerable adult which was or should have been reported to the appropriate law enforcement agency as described in §A(1) of this regulation. Each local department shall meet with the appropriate law enforcement agencies and State's Attorney's office to develop written agreements on procedures for joint investigation responsibilities and information sharing. A representative of the local department may contact the appropriate law enforcement agency if in the course of investigation the representative believes that an emergency exists. The representative may ask the police officer to accompany the representative and if the police officer agrees that an emergency exists, ensure that the individual is transported to an appropriate health care facility. As appropriate, a local or State Office on Aging or local geriatric evaluation service may assist in the investigation. The local department shall develop, record, and initiate an appropriate plan for service for each client. The service plan shall include the following: An assessment of the situation which describes the: Client's level of risk which means the nature and imminence of risk to the client without intervention; Client's ability to act on his own behalf which means a statement of the client's strengths and weaknesses in planning and effecting strategies to ameliorate risk; Current strengths and supports to the client; and Person or persons contributing to the client's risk by action or inaction; A plan for intervention which directly addresses the strategies to reduce identified risk; Specific measurable objectives with an estimated time for achievement, keeping the timelines consistent with the 6-month timeframe. Services provided by the local department include: Counseling; Coordinating and facilitating the client's use of community resources including health services. The following services are available through the local department of social services directly or by purchase and may be provided when they are a part of the service plan: Home care and chore services as provided for in the In-Home Aide Services regulations under COMAR 07.06.12; Adult day care provided by contractual arrangement with the Maryland Department of Health and subject to that Department's regulations, limitations, and eligibility schedules; Transportation provided through the In-Home Aide Services program, or any transportation available from community resources or governmental agencies in the local subdivision; Emergency arrangement of food or shelter as available from resources such as: Federal, State, or local programs, or Private providers; Provision of any recommendation, reports, or petitions concerning the adult in need of protective services to the court; Legal assistance including assistance to arrange for purchase of counsel with the vulnerable adult's own resources when the adult is not eligible for legal services from any other source. If, after the investigation under this chapter, the director determines that the adult requires protective services, with the adult's consent the director shall provide the services. If the Department believes that the client is disabled and the client is unable or unwilling to accept services necessary for the client's health, safety, or well-being and there is not a less restrictive form of intervention available, the director shall petition the court for: An emergency order for protective services under the Estates and Trusts Article, Title 13, Subtitle 7, Annotated Code of Maryland, and Regulation .12 of this chapter; The appointment of a guardian of the person under the Estates and Trusts Article, Title 13, Subtitle 7, Annotated Code of Maryland, and Regulation .11 of this chapter; or The appointment of a guardian of the property under the Estates and Trusts Article, Title 13, Subtitle 2, Annotated Code of Maryland. The local department shall file a petition for guardianship in the appropriate court when: A vulnerable adult who is a client of the Adult Protective Services program is in need of services but lacks sufficient understanding to make and communicate responsible decisions about his person because of mental disability, disease, habitual drunkenness, or addiction to drugs. The petition requires two statements from either two licensed physicians or one licensed physician and one licensed psychologist or licensed certified social worker-clinical, attesting to the nature, severity, and probable duration of any disability or condition. A less restrictive form of intervention is not available which is consistent with the vulnerable adult's welfare, safety, or condition. There is no known individual or agency already empowered to act as surrogate decision maker. There is no interested individual or agency who can or will serve as guardian. The local department shall make a thorough effort to locate such an individual or agency. The director shall submit with any petition filed under this regulation the findings of the investigation including: An evaluation of the medical, psychiatric, and social factors that affect the individual's condition; and A description of recommended services. The director shall request specific powers limited to those necessary to provide for the care and safety of the adult. The local department shall make a thorough effort to locate an individual or agency who can or will serve as guardian. For adults younger than 65 years old, the director of the local department of social services, upon appointment as the court-appointed guardian of the person, may delegate responsibilities of guardianship to the director's designee, staff person or persons whose names and positions have been registered with the court prior to the guardianship proceedings. The local department may not request appointment of the director as guardian of property. The local department shall ensure that an attorney is appointed by the court to represent the alleged disabled adult if the adult is not otherwise represented. Office on Aging. When the local department of social services determines that an adult 65 years old or older is the subject of a proposed petition for guardianship, the local department shall notify the Secretary of the Department of Aging or the Secretary's designee and arrange a conference between the staff of the two agencies to give notice of the need to file for guardianship, the authority to be requested for the guardianship, a basic plan for services, and who shall file the guardianship petition. If the two agencies cannot agree, the director of the local department of social services shall: Consult with the Executive Director of the Social Services Administration or the Executive Director's designee; Initiate any action they agree is necessary to protect the interests of the adult; and Provide notice of the Executive Director's action to the State Program Manager for Adult Public Guardianship of the Department of Aging (including a copy of any petition and notice of any hearing dates). Petition. When a local department of social services determines that the conditions set forth in Regulation .11A exist except for statements by two authorized licensed health professionals and, in addition, determines that an emergency exists, the local department shall file a petition for services to address the emergency. Whenever a local department is informed that a law enforcement officer has transported an adult to a health care facility because, from personal observation, the officer believes it is possible that the adult will suffer immediate and serious physical injury or death, the director shall within 24 hours of notification file a petition. The petition shall include a statement of the facts demonstrating that an emergency exists and that the local department has attempted without success to obtain the person's consent to services. A court order authorizing emergency services is in effect for a maximum of 144 hours. However, in accord with Estates and Trusts Article, §13-709(c)(5), Annotated Code of Maryland, the court may extend the terms of the emergency order until appointment of a guardian of the individual pursuant to Estates and Trusts Article, §13-705, Annotated Code of Maryland. When protective services are given on the basis of an emergency order, the temporary guardian shall file a report with the court of the services given. The local department of social services shall in each case of emergency services determine whether a continuing guardianship is required. When an emergency petition is filed on a person 65 years old or older, the local department shall advise the Secretary of Aging or the Secretary's designee or the director of the local office on aging or the director's designee of the filing so that the Secretary or the director or their assigned designees have an opportunity to attend the hearing on the petition and to develop a service plan. This notice may be given by telephone. The local department of social services shall: Review the service plan and the effectiveness of the service given; Decide whether to continue the service at least every 6 months; and Decide whether to extend voluntary service beyond the initial 6 months. Extension of service is permissible with supervisory approval and specific documentation of the need to extend the service and if the criteria for termination are not met, as listed in §B of this regulation. The local department of social services shall terminate services for any recipient of Adult Protective Services when: The goals and objectives outlined in the service plan have been attained and the adult is not at risk; The adult's service needs are not protective in nature and can be met by another local department program or a community service; The adult decides to terminate and the local department determines that there is neither sufficient risk nor evidence of incapacity to warrant court action; The adult refuses voluntary services and the court dismisses a petition to provide services or to appoint a guardian of the person; The court revokes a guardianship and the adult refuses voluntary services; or The court appoints as guardian another agency or individual and that guardian does not wish the local department to continue services. Services provided without a court order may be terminated if a recipient has moved from the local department of social services jurisdiction or is placed in a Maryland Department of Health facility for a period exceeding 30 days. Local Department. The local department may request termination of its status as guardian when the circumstances or capacity of the adult changes so that the local department determines that guardianship is no longer necessary. The local department may not justify termination of guardianship solely because a disabled adult has been placed in a licensed and regulated facility which assures the adult's needs are met (including a nursing home or State mental hospital) until the placement has continued for at least 6 months. Written Notice. The local department of social services shall send a written notice of its intent to deny, reduce, suspend, or terminate services at least 10 working days before the action is taken. The notice shall include: The action to be taken; The reason for the action; The specific regulation supporting this action; and The right to and method for an appeal for a fair hearing. Appeals for a fair hearing and the conduct of the hearing are according to the fair hearing regulations in COMAR 07.01.04. The local department shall give written and oral notification of the right to and methods of requesting and obtaining a fair hearing to each applicant for, and to each recipient of, adult protective services at application and whenever the local department notifies the applicant or recipient of any pending action that may deny, suspend, reduce, or terminate this service. There are one or more boards serving each subdivision for the purpose of reviewing at least semi-annually the guardianship cases which are held by any public agency. The boards are advisory to the court and make recommendations to the court to continue, modify, or terminate a guardianship. The local department shall cooperate with the Adult Public Guardianship Review Board in the review of guardianships and provide administrative support staff, office space and any reports required by the Board. Within 6 months following receipt of guardianship, the local department shall make a report to the Board, and shall make reports at 6-month intervals as long as the local department retains guardianship. The reports shall be made in a timely fashion to meet scheduled reviews of the Board. Reports to Adult Public Guardianship Review Boards shall include the: Present place of residence and health status of the ward; Guardian's plan for preserving and maintaining the future well-being of the ward; Need for continuation or cessation of the guardianship or for any plans in altering the powers of the guardian; and Most recent dates of contact with the ward by the director or the director's designee. An individual in the United States may not be excluded from participating in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance on the grounds of race, color, sex, national origin, or religious and political beliefs. An individual acting on behalf of a vulnerable adult, who believes the vulnerable adult has been discriminated against may file a written complaint that sets forth the events and circumstances of the alleged discrimination. Complaints may be filed with: The Secretary of Human Services; The Office of Employment and Program Equity; or The Office of Civil Rights, Department of Health and Human Services, Region III, Philadelphia, Pennsylvania. The Department shall investigate promptly and notify the complainant of its findings within 60 days. Suspected fraud is to be referred by the local department to the State's Attorney for a decision with regard to any necessary legal action, if the facts indicate that an individual has knowingly obtained, attempted to obtain, or aided in the obtainment of, services to which he is not entitled or which are greater than those to which he is justly entitled, by means of a willfully false statement or misrepresentation, by the willful failure to disclose to the local department a change in household or financial condition, or by impersonation or other fraudulent device. Family Law Article, §§14-101—14-404, Annotated Code of Maryland Effective date: August 8, 1980 (7:16 Md. R. 1593) Regulations .10E and .11 amended effective October 6, 1986 (13:20 Md. R. 2209) Chapter revised effective October 31, 1988 (15:22 Md. R. 2555) Regulation .10B amended effective August 19, 1991 (18:16 Md. R. 1811) Regulation .15A amended effective February 18, 1991 (18:3 Md. R. 302) Recodified from COMAR 07.02.16 to 07.06.14, December, 1992 Regulation .11 amended as an emergency provision effective October 1, 1997 (24:19 Md. R. 1334); amended permanently effective December 1, 1997 (24:24 Md. R. 1669) Regulation .12B amended effective January 17, 1994 (21:1 Md. R. 29) Chapter revised effective December 10, 2001 (28:24 Md. R. 2127) Regulation .01 amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .02B amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .05 amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .07A amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .09B amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .11 amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .12A, E amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .13D, E amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .15A amended effective July 28, 2008 (35:15 Md. R. 1347) Regulation .16B amended effective July 28, 2008 (35:15 Md. R. 1347) Chapter recodified from COMAR 07.06.14 to COMAR 07.02.16, effective June, 2009 These regulations establish standards for adult foster care and procedures for enforcement of those standards. They apply to all adult foster care programs offered by local departments of social services. Adult Foster Care Programs are optional to the local departments. In this chapter, the following terms have the meanings indicated. Terms Defined. “Adult Foster Care” means a program that provides a family setting in the community for an aged adult or an adult with disabilities who requires: Protective oversight; Assistance with the activities of daily living; and Room and board. “Local department” means the department of social services in a county or Baltimore City or the Montgomery County Department of Health and Human Services. “Protective oversight” means a service of the Adult Foster Care provider which includes the following: Daily awareness of a foster adult's functioning and whereabouts; Crisis intervention; Supervision of medication, nutrition, and money management; Coordination of medical care services delivered in and out of the foster home; and 24-hour responsibility for the foster adult's welfare while in the foster home. The foster adult shall: Be 18 years old or older; Be an individual with a disability; Be able to benefit from the service; Have a need for the support and interaction of family living; and Provide a medical and behavioral health history to allow proper care and supervision. The local department may establish financial eligibility based on the foster adult's income or age or other factors if required by the terms of any source of funding for the local department's program. Application Process. The local department shall: Accept applications from the adult, a relative, or a guardian or other representative; Determine the eligibility of applicants; Assess the applicant's needs and capacities; Decide with the applicant whether the service is appropriate; Refer the applicant to a suitable resource if the decision is that foster care is not appropriate; and Develop a service plan for each eligible applicant. The Service Plan. The service plan shall specify: A suitable placement approval as meeting all requirements of these regulations; Any necessary assistance with making the placement; Any supportive services needed during the placement; and The way in which the provider will be paid. Local Department Continuing Responsibility. The local department shall: Maintain continuing contact with the foster adult and caregiver; Encourage relatives of the foster adult to participate in the planning and placement; Intervene if a crisis arises; Review the foster adult's case at least every 6 months and modify the service plan as necessary; Maintain a file of eligible applicants needing placement; and Maintain a file of available approved adult foster homes. The adult foster care provider shall: Have adequate income and financial stability to provide a reasonable standard of living for the foster family; Have the skills, knowledge, and ability to provide adequate care for foster adults; Cooperate with the local department in the enforcement of these regulations and any other program requirements; Communicate as needed with the local department, relatives, and community resources concerning the foster adult's condition; Have the maturity, patience, and warmth to respond to the foster adult's emotional needs; Be 21 years old or older; Provide for required supervision and care when the caregiver is absent from the home; and Provide three satisfactory non-relative character references. The local department shall: Review applications from those desiring to be considered as adult foster care providers. Review and approve or disapprove all applications within 90 days, after the local department has received all required documentation. If it is determined that there will be a delay in the approval or disapproval of the application, the local department shall advise the applicant, in writing, within 5 working days of the reason for the delay. Conduct a home study if a foster adult is already in the home when an application to be a provider is made. Due consideration is given to the importance of maintaining the home for the adult involved. If the home cannot be approved, the local department shall notify both the foster adult and the caregiver and offer them assistance to meet the standards or inform them of the possible alternatives and of the consequences of continuing in an unapproved home. Conduct an annual review of the foster care home and advise the caregiver in writing of continued approval or disapproval. Offer consultation and supportive services to caregivers. The local department shall require: A written approval from the local health department of the water supply (well) and waste disposal. A home using a municipal water and sewer system may be exempt from this requirement. Documentation that the home meets the requirement, if any, of the local fire marshal. A clean, well maintained and structurally sound home. The local department may consult with a local building inspector if there is question about possible structural defects. Sleeping and living quarters for foster adults which have: Appropriate modified access for foster adults whose special physical needs require it (in most cases, foster adults require a first floor and, preferably, a ground level room); Adequate opportunity for privacy in sleeping and living quarters for each foster adult; Grab rails and other special equipment in accordance with individual needs; Storage for clothing and personal possessions, and, if possible, some of the foster adult's own furniture; Adequate protection and supervision; Accessibility to family living spaces, which the foster adults are expected to share as a part of the family's life style; and Adequate household supplies. A limit of four foster adults at a time. The local department shall assess the needs of each foster adult as well as the capacities of the provider and the home before making a placement. That the foster home meet requirements and be approved by the local department before taking an adult in the home. Upon discovery of a violation of these regulations, the local department shall give the home written notice of the nature of the violation and shall set a time period, not to exceed 90 days, within which the violation is to be corrected. At the end of the period, if the home has failed to correct the violation, the local department shall send to all the foster adults in the home a notice that contains: A written description of the violation; An offer to aid in relocation to an approved home or other living arrangement; A warning that in 60 days the local department will notify the Social Security Administration of the violation and that the Social Security Administration may reduce the amount of the SSI benefits of any foster adult still in the home. If, after the expiration of the 60-day period for relocation of the adults, the violation remains uncorrected, the local department shall notify the Social Security Administration of the violation and of the date the relocation period ended. The local department may not assist in the placement of a foster adult in any home not in full compliance with the standards for Adult Foster Homes approval. Appeals for a fair hearing and the conduct of the hearing are according to the fair hearing regulations in COMAR 07.01.04. The local department shall give written and oral notification of the right and methods of requesting and obtaining a fair hearing to each applicant for, and to each recipient of, adult foster care services at application and whenever the local department notifies the applicant or recipient of any pending action that may deny, suspend, reduce, or terminate this service. Human Services Article, §§4-205 and 4-207, Annotated Code of Maryland(Agency Note: Federal Regulatory Reference, 45 CFR Part 229) Effective date: August 8, 1980 (7:16 Md. R. 1594) Recodified from COMAR 07.02.17 to 07.06.16 Regulation .02 repealed and new Regulation .02 adopted effective October 15, 2001 (28:20 Md. R. 1780) Regulation .03 amended effective October 15, 2001 (28:20 Md. R. 1780) Regulation .05 amended effective October 15, 2001 (28:20 Md. R. 1780) Chapter recodified from COMAR 07.06.16 to COMAR 07.02.17, effective June, 2009 Regulation .03A amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .04 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .06 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .07E amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .08B amended effective April 10, 2017 (44:7 Md. R. 353) The purpose of the Respite Care Program is to provide short-term, periodic and temporary care for individuals with developmental or functional disabilities in or out of their homes by qualified care workers in order to relieve the family or informal caregiver. This temporary care of the adult or child with a developmental or functional disability provides a period of rest and renewal for the family while contributing to maintaining the individual in the community, enabling the individual to live in a family or family-like environment, or assisting the individual in achieving a greater level of independence. Respite care is provided at planned intervals, in a time of crisis, or on an as-needed basis. This is not an entitlement program. In this chapter, the following terms have the meaning indicated. Terms Defined. “Administration” means the Social Services Administration of the Department of Human Services. “Applicant” means an individual with a developmental or functional disability, a family member, a caregiver, or an authorized representative of the individual with the disability, who is applying for respite services. “Consumer” means an individual with a developmental or functional disability, who receives respite care services. “Developmental disability” means a severe, chronic disability which: Is attributable to a mental or physical impairment or a combination of physical and mental impairments, including a head injury; Is manifested before an individual is 22 years old; Is likely to continue indefinitely; Results in a substantial functional limitation in three or more of the following areas of major life activity: Self-care; Receptive and expressive language; Learning; Mobility; Self-direction; Capacity of independent living; and Economic self-sufficiency; and Reflects an individual's need for a combination and sequence of special interdisciplinary or generic care, treatment, or other services which are lifelong or of extended duration and are individually planned and coordinated. “Family” means one or more adults, with or without children, related by blood, marriage, adoption, or legal guardianship, and domestic partners residing in the same household with an individual with a developmental or functional disability. “Foster Home” means a certified Department of Human Services foster home. “Functional disability” means a severe, chronic disability which: Is attributable to a mental or physical impairment or combination of mental and physical impairments; Is likely to continue indefinitely; Results in substantial functional limitations in three or more of the following areas of major life activity: Self-care; Receptive and expressive language; Learning; Mobility; Self-direction; Capacity for independent living; and Economic self-sufficiency; and Reflects an individual's need for a combination and sequence of special interdisciplinary or generic care, treatment, or other services which are lifelong or of extended duration and are individually planned and coordinated. “Informal caregiver" means the individual who routinely cares for the individual with a developmental or functional disability and is not compensated for the care. The informal caregiver may live in a residence other than that of the individual with the disability. “Level I care” means supervisory and personal care, and may include any or all of the following: Household and personal assistance services, which include light housekeeping services, chore services, assistance with meals and special diets, food preparation, dressing, shopping, escort service, writing letters, and reading to consumers; and Personal care services in accordance with the service plan. “Level II care” means skilled care delivered by a licensed health care provider or a certified skilled professional. “Licensed Health Care Provider” means is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities. “Local department” means the department of social services in a county or Baltimore City or the Montgomery County Department of Health and Human Services. “Provider” means a public or private nonprofit agency or local department, which provides respite care services under a contractual agreement with, or direct grant from, the Administration or a local department. “Qualified care worker” means a person who, by training, experience, or authorization is qualified to deliver the care needed and who has been designated as such by a respite services provider or the family caregiver. “Respite care” means short-term periodic and temporary care of individuals with developmental or functional disabilities in order to temporarily relieve the family or informal caregiver. “Respite care facility” means a designated program, location, private home or center, outside of the consumer's residence, where respite care is provided. “Service statement” means a written document which records pertinent information the provider considers essential for providing respite care services, including: Eligibility; Amount and level of respite care services; Any fee required; Records referring the applicant to other sources for services identified as needed, but not available from the provider; and Assessment of the family's respite care needs. “Subsidy” means funds available from the Administration to assist in the payment of respite care service fees, if the total income of a consumer, or the family of a consumer who is younger than 18 years old is less than 150 percent of the State's median income adjusted to family size. “Total income” means the sum of income received by the consumer, or the family of a consumer, if the consumer is under 18, and is eligible for respite care services minus medical expenses. Eligibility for Respite Care Services. Except as provided in §B of this regulation, the following individuals are eligible for respite care services: A family residing in Maryland with an individual with a developmental or functional disability; An individual in Maryland with a developmental or functional disability, who does not reside with a family or; An individual in Maryland with a developmental or functional disability living in a foster home. Exception. Except for an individual with a developmental or functional disability living in a foster home, families or informal caregivers who receive no respite support from other public or private agencies or programs shall have priority in receiving DHS respite care services funding. Eligibility for Subsidy. A family or an individual with a developmental or functional disability eligible for respite care services may be eligible for a subsidy if the family's or the individual with the disability's total income is less than or equal to 150 percent of the State's median income adjusted to family size. If the family's or the individual with the developmental or functional disability's annual income equals or exceeds 150 percent of the State's median income, the family or individual with a disability pays the full fee for care. An applicant seeking respite care services shall apply to the provider of the services. If the local department does not provide the services, it shall refer the applicant to the DHS respite care provider in their area or to another appropriate provider. The provider shall inform the applicant about the eligibility requirements, rights, and obligations under the program. The applicant shall complete the application on a form approved by the Administration. The completed application shall include: The date of application; The name of the individual with the developmental or functional disability; The address of the applicant, and phone number, if any, of the nearest phone for emergencies; The name and address of the informal caregiver; The school or day program in current use by the individual with the developmental or functional disability; The living arrangement of the applicant, including information about the household composition; Other current state or county services used by the consumer; The amount and source of total income; Medical or psychological information by a licensed health care provider which enables the respite care provider agency to determine that the applicant is an individual with a developmental or functional disability and the type and level of care needed; The name, address, telephone number, and relationship of the applicant to the individual with the developmental or functional disability; and Authorization for the release of medical and psychological information. Notice to Applicant. Within 30 days after receipt of the application the provider shall notify the applicant in writing that the application is incomplete, has been accepted, or has been denied. If the application is incomplete, the notice shall state: The parts of the application which have not been completed; and That if the application is not completed within 30 days, the provider is required to deny the application. If the application is accepted, the notice shall state: The amount of services to be delivered; The type and level of service to be delivered; The schedule for use of the service; The amount of any fee to be paid; That eligibility and financial status are redetermined if a change occurs that might affect the eligibility or financial status, and at least every 12 months; That the service statement is reviewed and amended if a change occurs, and at least every 12 months; and The right to, and method for, obtaining a fair hearing. If the applicant is denied, the notice shall state the: Reason for denial; Specific regulation supporting the decision; and The right to, and method for, obtaining a fair hearing. The provider shall deny the application if: The medical or psychological information does not indicate that the applicant is an individual with a developmental or functional disability, or is a family member or informal caregiver of a person with a developmental or functional disability; The application remains incomplete 30 days after notice to the applicant under §B(2) of this regulation. Respite care services may be provided for an individual with a developmental or functional disability in a crisis situation before completing the application, at the discretion of the provider. If the total income is less than or equal to 150 percent of the State's median income adjusted to family size, the applicant may be eligible for a subsidy. Income amounts are included in the total income only if they are regular and ongoing. One-time payments such as gifts or income tax refunds are not included. The total income includes items deducted from salaries and wages such as withholding taxes or social security. Medical Expenses. Medical expenses are deducted from total income if the medical expenses are: Related exclusively to the expenses of the individual with the developmental or functional disability, such as prosthetic devices, but not expenses which would apply to other members of the applicant's household, such as cold remedies; Documented as paid by a valid receipt; Not covered by any insurance or other payment coverage; and Calculated for the preceding 12 months. For paid care workers, the hourly pay rate is set and published by the Administration. The pay rate for a day of respite care is 10 times the hourly rate paid. When more than one individual with a developmental or functional disability requires care in the same household, payments and fees are 1/2 the set rate for each additional individual with a disability in the household, in addition to the full rate for the initial individual. The income of the consumer determines the amount of the subsidy the consumer may receive. A sliding fee scale based on family income is established and published by the Administration. Care Record. If an application is accepted, the provider shall develop and maintain a care record for each recipient of the service. The care record includes the: Completed application; Service plan; Records of each redetermination and reconsideration; Records of termination and disposition of the case; and Records of service delivery. Level of Care. The levels of care are: Level I care; and Level II care. Method of Delivery. Respite care services may be delivered either in the residence of the individual with the developmental or functional disability or in a respite care facility. Respite care services, within one State fiscal year, are available as follows: On an hourly basis, up to a total of 24 hours of care provided in periods of less than 10 hours in any 24-hour period; and On a daily basis, up to 14 days of care with 1 day being not fewer than 10, or more than 24 hours in any 24-hour period. An unused day of care may be converted into hours, with 1 day equal to 10 hours. Respite care services may not be used to substitute for routine paid attendant care. Qualified care workers may care for individuals in the household other than the individual with a developmental or functional disability, only if the provider determines that such an arrangement will not compromise the quality of care received by the individual with the disability. The number of individuals cared for may not exceed a total of five and any financial arrangements for household members without a developmental or functional disability may not include respite care subsidy funds. Respite care services may not be provided if: A subsidy is required and all provider funds have been expended or obligated; All care worker time has been committed; and All the consumer’s eligible hours have been exhausted. Respite care services may not be provided by anyone living in the same household as the consumer. A redetermination of eligibility for respite care service and subsidy, and reconsideration of the service statement is required: If a change occurs which affects eligibility or the need for service; and At least every 12 months. The provider shall document in the care record the determination and reconsideration and include: The current living arrangements; A written statement of subsidy status, and the amount and type of services for which the family is eligible; and Any necessary revisions to the service statement. The provider shall terminate services if: The provider and consumer agree that the respite care service does not meet the needs identified in the service statement; Requested by the consumer; The applicant, consumer or informal caregiver has provided fraudulent information, inappropriate information or withheld information impacting the eligibility for service or misused the subsidy; The consumer has moved from the area served by the provider; The consumer cannot be located by the provider at the time of redetermination; or The individual with a developmental or functional disability moves into a supervised or protected living situation under the administration of a public or private agency other than a foster home. If the provider terminates services, the provider shall send a notice to the consumer that includes the: Reason for the termination; Specific regulation supporting the decision; and Right to, and the method for obtaining, a fair hearing. Each applicant for or a consumer of services, or an individual acting on behalf of an applicant or consumer, may appeal the denial, reduction, or termination of a service, or failure to act upon a request for service with reasonable promptness to the Hearings Unit of the Social Services Administration. The requirements and procedures in COMAR 07.01.04 apply. Qualification of care workers is done by the providers using a form approved by the Administration. The minimum requirements for a qualified care worker are: 18 years old or older; Education sufficient to enable the worker to deliver the care needed; Personal characteristics that are needed to deliver care to an individual with a developmental or functional disability; Training or experience necessary to enable the person to deliver the care needed as evidenced by a training certificate or designation by the provider or consumer based on experience; and Good physical and mental health, as documented by a licensed health care provider. The provider shall report to the Administration the methods used to ensure that the care workers are qualified to deliver the care required. Approval of a respite care home is made by the provider, including the determination of the number of individuals with developmental or functional disabilities who may be cared for at one time in the home. The minimum requirements for a location to be approved as a respite care home are: Physical accessibility for the individual with the developmental or functional disability; Hot and cold running water; Functioning smoke detectors; Operable telephones; Inside bathroom facilities that are in good working condition; Sewage disposal and drinking water that meets local codes; Operable and safe heating and cooling systems; Operable refrigerator and stove; Food storage space protected against invasion of rodents, insects, dust, water leakage, and other sources of contamination; Furniture, including a separate bed and any special equipment adequate for the comfort and safety of the individual with the developmental or functional disability; and Satisfactory performance on a health and fire safety checklist established by the Administration. Respite care facilities other than a home shall maintain licensure as appropriate. The providers shall submit reports and accounts as required by the Administration. The provider shall use generally accepted methods of accounting. The provider shall make the accounts and records available to representatives of the Administration and other State or federal staff authorized to inspect the records of the provider at reasonable times, upon written request from the Administration. Human Services Article, Title 7, Subtitle 2, Annotated Code of Maryland Effective date: May 6, 1985 (12:9 Md. R. 809) Regulation .01 amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .02 amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .03 amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .04 amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .05C amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .06A, C amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .07D amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .09A amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .11A amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .12 amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .14C amended effective November 13, 1989 (16:22 Md. R. 2363) Regulation .15 amended effective March 7, 1988 (15:5 Md. R. 616) Recodified from COMAR 07.02.06 to COMAR 07.06.11, December, 1992 Regulations .01—.15 repealed and new Regulations .01—.14 adopted effective December 24, 2001 (28:25 Md. R. 2189) Chapter recodified from COMAR 07.06.11 to COMAR 07.02.18, effective June, 2009 Chapter revised effective April 10, 2017 (44:7 Md. R. 353) The Certified Adult Residential Environment (CARE) Program, also known as Project Home, is a voluntary program that: Develops, certifies, and monitors protective CARE housing for individuals with disabilities; Provides case management services to residents living in CARE housing; and Provides a long-term or permanent housing setting for a stable population of individuals with disabilities using an Adult Foster Family Model of Care and is not a tenant/landlord housing arrangement. In this chapter, the following terms have the meanings indicated. Terms Defined. “Administration” means the Social Services Administration of the Department of Human Services. “Adult Foster Family Model of Care” means a program of care where: An adult with a disability is cared for as a member of the care provider's family; Care is provided in the provider's home; and The provider functions as the resident's family as specified in Regulation .10 of this chapter. “Adult Protective Services (APS)” means the program under COMAR 07.06.14 which protects vulnerable adults who are subject to abuse, neglect, exploitation, or self-neglect. “Behavioral health impairment” means a substance abuse, mental health or addictive disorder or a combination of these disorders. CARE Home. “CARE home” means a certified adult residential environment home that provides a resident with a supportive housing arrangement, help in accessing community resources, and protective oversight. “CARE home” includes a: Private home which is the provider's residence, 24 hours a day, 7 days a week and serves a maximum of four residents; Supervised home which is not the provider's residence but may have live-in staff and serves not more than four residents, if certified prior to January 1, 2007; or Group home which may be the provider's residence, may have live-in staff, and serves five to eight residents, if certified prior to January 1, 2007. “Case manager” means a local department of social services social worker or family services caseworker who provides a range of services that includes: Assessing the resident's needs; Defining goals with the resident; Planning for and linking the resident to needed services and resources; Monitoring the delivery of services; and Advocating for the development and delivery of service to the resident. “Individual with a disability” means an individual who is 18 years old or older and has a physical, medical, or behavioral health impairment which: Prevents the individual from carrying out the necessary tasks of independent living; and Is not so severe or complex as to require specialized professional intervention from the CARE provider. “Institutionalized individual” means an inpatient at a psychiatric hospital, rehabilitation hospital, nursing home, or similar setting. “Licensed Health Care Provider” has the same meaning as Health Occupations Article, §4-301, Annotated Code of Maryland. “Linking” means the process of referring a resident to a specific service as part of a plan to meet the resident's needs and ensuring service delivery. “Local department” means the department of social services in a county or Baltimore City or the Montgomery County Department of Health and Human Services. “Protective oversight” means a service of the CARE provider which includes the following: Daily awareness of the resident's functioning and whereabouts; Requests to appropriate professionals for help in responding to an emergency situation; Supervision of teaching and assisting with activities of daily living for a resident; Provision of supportive services to a resident as defined in the resident's Individualized Service Plan Agreement; and Encouragement of a resident toward independence and appropriate activity to facilitate the resident's ability to plan and make decisions. Provider. “Provider” means the individual whom a local department certifies for operation of a CARE home. A Provider is not considered an employee of the local department. A provider may not accept payment for care of a resident other than that allowed in COMAR 07.03.07 as a reimbursement for the cost of care or any supplement established by federal, State, or local government. A provider functions as a caregiver in an adult foster family model of care. “Provider” does not mean the provider of: Psychiatric treatment; or Specialized professional intervention. “Public Assistance to Adults (PAA)” means the funding to help cover the cost of the CARE placement for eligible individuals as specified under COMAR 07.03.07. “Relative” means a spouse, parent, son, daughter, grandparent, grandchild, stepparent, stepchild, brother, or sister, domestic partner or anyone who is related to an individual by blood, adoption, or marriage. “Resident” means an individual who: Resides in a CARE home; Requires the services of a CARE home; and Is not a relative of the provider. “Resident of Maryland” means an individual who at the time of application is physically present in the State, and has no immediate plans to leave Maryland for residence in another state. “Individualized service plan agreement” means a written plan which describes: A resident's service goals; and The provider's services for the resident and method of providing the services. “Service slot” means the resources, including funding and case management capacity, necessary to provide residential services for an individual with disabilities in a CARE home. “Service team” means the case manager, provider, resident, and representatives of other agencies and disciplines who have a role in providing services to the resident. “Specialized professional intervention” means health, nursing, social, psychological, or psychiatric services provided by an individual licensed in his or her profession by this State or another state. “Supportive housing arrangement” in an adult foster family model of care means a housing arrangement that provides an individual with: Room and board; Assistance with the activities of daily living that are fundamental for self care (such as bathing, dressing, and eating) or instrumental activities of daily living that are not necessary for fundamental functioning (such as preparing meals, grocery shopping, and managing money); Protective oversight; and Assistance with medication administration, which means a client having the ability to take medication at the correct time, in the correct route, and in the correct dosage as prescribed by an authorized prescriber with the support of a provider or provider backup who can offer physical assistance and reminders. An individual is eligible for CARE services if the individual: Is a resident of Maryland; Is an individual with a disability; Is 18 years old or older; Has no appropriate and willing relative who will provide a community placement; Does not require the provider to take responsibility for services beyond the capacity of the CARE program's adult foster care model of housing, including health services, treatment regimens, and interventions that require specialized professional intervention; Needs the CARE services provided in the CARE home; Agrees to pay the cost of placement from personal resources or through public assistance; Is not a relative of the provider; and Does not pose a risk or danger to him or herself and/or others. Fee Consideration. Case management service is available without regard to income for a resident placed by the CARE program. A resident's income may determine whether the resident will be charged for certain supportive services provided or purchased by the local department. The local department shall screen an applicant's completed application for CARE services on forms prescribed by the Administration. A complete application comprises the following information: A completed Project Home application form. A health history and the applicant's most recent health assessments; and Consent forms signed by the applicant for the release of information to the local department by: Appropriate health professionals; and Legitimate sources of financial information. If the applicant has been found not eligible, the local department shall send written notice to the applicant which shall include the reason for the decision. If a service slot is not available for an eligible applicant, the local department shall: Rank the applicant according to §E(1) of this regulation; and Notify the applicant in writing within 30 days of receipt of the complete application that the applicant: Has been placed on a waiting list; and May be eligible for referral to other services through the local department. If an applicant is found eligible and a service slot is available the local department shall assign a case manager to: Complete a comprehensive assessment of the applicant's capacities and needs in a community living situation; Establish the level of care required by the applicant by considering the following characteristics of the applicant: Illnesses and disabilities which may require medical or corrective treatment; Ability to perform physical self-maintenance activities; Ability to perform basic activities of daily life; and Level of cognitive functioning, emotional and behavioral controls, and social competence; Determine the amount of income and other resources available to pay for placement; Determine the availability of an appropriate CARE home; Decide with the applicant whether CARE service is appropriate; Send a written notice to the applicant, within 30 days of the case manager's assignment of the case, of the application decision which shall include: For acceptance: Decision; Reason for the decision; Level of care to be provided; Fact that an appropriate CARE home is or is not available, or that the applicant agreed that the local department shall seek a placement for the applicant in another jurisdiction; and The resident's right to appeal any part of the decision as provided in COMAR 07.01.04, and the method for obtaining a fair hearing; or For denial: Decision; Reason for the decision; Specific regulation supporting the decision; and Applicant's right to appeal the decision as provided in COMAR 07.01.04 and the method for obtaining a fair hearing; and If the local department is unable to place an eligible applicant, refer to §E(1) of this regulation. Priority for Service. Based on the applicant's situation at the time of application, an applicant is ranked on the following descending point system: Applicant is in an abusive situation, or is under public guardianship (15 points); Applicant is at high risk of institutional placement or continued institutional placement without supervised housing (15 points); Relative caregiver is 60 years old or older (15 points); Applicant is dependent on an unreliable or overburdened caregiver for daily needs (10 points); Applicant is homeless or facing homelessness and is unable to use independent housing (10 points); Relative caregiver suffers from a physical or mental disability that is a barrier to caring for the applicant or the caregiver is caring for another disabled family member (10 points); Applicant's income is below the poverty level (10 points); Applicant is lacking family or community supports necessary for coping with daily living (5 points); Applicant is a recipient of Supplemental Security Income (SSI) (5 points); or Applicant's income is below the State median income as specified in COMAR 07.02.04.08 (5 points). Applicants who have equal points under §E(1) of this regulation and are equally appropriate for an available slot shall be offered service in the order in which the local department received the applications for service. Selection of a CARE Home. The case manager shall identify an appropriate CARE home and, with the applicant and the provider, make a placement plan. The selection of an appropriate CARE home shall include consideration of the following: The possibility of a same room assignment for both spouses if both require CARE services; Whether the CARE home can accommodate the needs of the applicant; The location of the CARE home, and whether the CARE home is in: The geographic area requested by the applicant; The community where the applicant has established supports; or A community which can provide access to specialized resources that the applicant wants or needs; and Whether the care available from the provider is: Sufficient to supervise the resident; and The least restrictive setting which meets the resident's needs. If the CARE home is located outside the jurisdiction served by the local department: The local department in the jurisdiction where the home is located shall assign a case manager; and The new case manager shall work cooperatively with the original case manager to serve the applicant until: Placement is made; and The case is transferred to the local department in the jurisdiction where the home is located. Completed Application for Public Assistance to Adults (PAA). The case manager shall: If needed, ensure that an application for PAA is made by, or on behalf of, the applicant; Provide confirmation to the local department PAA worker of the placement plan including date, address of CARE home, and level of care; and Obtain a decision on eligibility for assistance. Development of an Individualized Service Plan Agreement. The case manager, in consultation with the resident and service team, shall develop a service plan which includes the following: The specific goals to be accomplished by the resident; A list of the services needed to meet the goals as determined by the resident, the case manager, provider, and the service team; The specific plan for completing the tasks to meet the service needs of the resident, including identifying the individual, either the service team member or the resident, who will perform the task; A time line for completing tasks; The expected frequency of contact between the case manager and the resident; and The schedule for the local department to: Monitor the delivery of service; Redetermine eligibility for service; and Reassess the resident's needs. Facilitation of Placement. Before placing the applicant in the CARE home, the case manager shall establish a residential agreement with the applicant and provider which shall determine the: Method and amount of payment; Level and type of service to be provided by the CARE home; and Provider's specific house rules. Facilitation of Agency Linkage. The case manager shall: Complete referrals to services specified in the individualized service plan agreement following the resident's placement in the CARE home; and Follow-up on referrals as needed, until the delivery of service begins. Monitoring the Implementation of the Individualized Service Plan Agreement. The case manager, with the resident, shall monitor the service plan through contact with the provider and others providing services, to ensure delivery and coordination of services and activities as specified in the service plan. Reconsideration of the Individualized Service Plan Agreement. Reconsideration of the individualized service plan agreement shall occur: Within 90 days after placement, and at least every 6 months thereafter; or As required in Regulation .06B of this chapter. At the time of reconsideration, the case manager with the resident and service team shall: Reassess the resident's service needs; and Revise the individualized service plan agreement as needed. Advocating on Behalf of the Resident. The case manager: Shall explore all possible community resources to provide needed services to the resident; and May convey unmet needs and barriers to service delivery in writing to the local department's program supervisors or administrators. Coordination of Resident Entitlements. The case manager shall coordinate all applications or reapplication activities necessary to ensure that the resident receives or retains federal and State benefits. Referral to Adult Protective Services (APS). The case manager shall report in writing to the local department's APS any instances of suspected abuse, neglect, self-neglect, or exploitation of a resident. Arrangement of a New CARE Placement. The case manager, with the resident, shall arrange a new CARE placement when the: Resident or the provider requests a change because difficulties in the placement cannot be resolved; Local department finds the CARE home to be in violation of the requirements of this chapter, and revokes or does not recertify the home; or Case manager has determined that the current provider is unable to provide adequately for the resident's needs and safety. Time Requirements of Local Department. The local department shall: Pursue a new placement and provide appropriate transition planning and service for the resident within 30 days of the request or the decision to change the placement; or In case of emergency, attempt to move the resident immediately. Placement in Another Jurisdiction. If the resident moves or intends to move to another local jurisdiction, the case manager shall consult with the local department serving the other local jurisdiction. If the other local department has an appropriate and available placement and a case management capacity to serve the resident, the other local department shall assign a case manager to work cooperatively with the resident's current case manager to arrange placement. If the new placement is arranged, the case shall be transferred to the local department in the jurisdiction where the new home is located. Maintaining Contact With the Resident and Provider. The case manager shall have face-to-face visits individually with the resident and with the resident and provider together. The case manager shall visit the resident: At least every 2 weeks in the following circumstances: During the first 3 months after placement; During the first month following the assignment of a new case manager; and When the resident's case plan does not include contact at least every 2 weeks with other service providers or appropriate friends or relatives; or At least once a month under all other circumstances unless a different schedule is warranted, in which case the case manager shall request a schedule change for approval by the Supervisor after the resident has been in placement for 90 days. Under no circumstances shall the resident be seen less than every 2 months. During each 6-month period, the case manager shall visit the resident and the provider together in the CARE home at least once. The case manager, with the supervisor's documented approval, may alter the required visitation schedule if the resident's situation requires or permits it. Redetermination. The case manager shall redetermine eligibility and level of care: Within 30 days after the local department obtains information about changes in the resident's circumstances which may affect the resident's eligibility; and Annually. Reconsideration. A reconsideration of a resident's case plan shall include: Reassessment of the resident's needs and goals; Evaluation of services provided; and Progress towards meeting the goals set out in the case plan. The case manager shall reconsider a case plan: If there is a significant change in the resident's circumstances which may affect the type or amount of service the resident needs; and Not less frequently than 90 days after placement, and thereafter at least every 6 months. Termination. The local department shall terminate CARE services when at least one of the following situations exists: The resident is no longer eligible; The resident, if competent to make the decision, requests termination or the resident's guardian requests termination; The resident is unwilling to use available services and the service team can propose no further plan which is acceptable to the resident; The resident is no longer residing in a CARE home and the local department has no plan to arrange a CARE placement; The resident's conduct poses a risk to the safety or well-being of self, of the provider, or of other residents in the home; The provider has requested removal of the resident and the local department is unable to provide another appropriate placement; or The resident refuses to reimburse the provider for service. When the local department terminates CARE services, the local department shall: Refer the resident to the local department's Social Services to Adults (SSTA) program if the resident requests case management services; and At least 15 days before termination, provide written notice to the resident which shall include the: Decision to terminate the service; Reason for the decision; Regulation supporting the decision; and Resident's right to appeal the decision and the method of obtaining a fair hearing. Following termination of CARE services, the case manager shall provide for one month: Follow-up services; and Appropriate referrals to other community services including other services within the local department. Immediate Suspension of Services to Resident. If the conduct of the resident poses a threat to the safety or well-being of the provider or the residents in the home, the local department may, without giving 15 days notice, immediately suspend services to the resident for a period not to exceed 30 days. Within 72 hours of the suspension, the local department shall advise the resident in writing of the: Grounds for the action taken; and Resident's right to appeal the suspension. If the CARE Home Certificate is revoked or the case manager determines that the CARE Provider can no longer meet the needs of the resident and the resident refuses another CARE home placement, then the local department may terminate services to the resident. At the end of the suspension period, the local department shall either reinstate or terminate services. If the local department terminates services, it shall provide the resident with a notice of the termination at least 15 days before the effective date of termination. A provider and the CARE home operated by the provider shall meet standards set forth in this regulation, and have a separate certification for each site at which the provider applicant proposes to house CARE residents. The provider or incorporated provider's designee shall: Be 21 years old or older; Document that the provider applicant has sufficient financial resources to establish and operate the CARE home; Document the provider applicant's place of residence; Have three satisfactory nonrelative character references; Have no criminal record or Adult Protective Services or Child Protective Services history that indicates behavior potentially harmful to residents; Have no household member 18 years old or older and not receiving CARE services who has a criminal record or history indicating potentially harmful behavior to residents; Be willing to work with the local department and other appropriate agencies for the well-being of the resident; Exhibit a genuine interest in the welfare of the resident and perform the provider responsibilities appropriate to meet the resident's physical and social needs; Participate in CARE training programs as required by the local department or the Administration; Submit a medical statement, from a licensed medical care provider, indicating that the applicant has the physical and mental capacity to provide care to residents; and Sign a provider agreement stating that the provider shall: Accept as full reimbursement for care for a resident placed by the CARE program, an amount equal to the rates established in COMAR 07.03.07, and any supplement established or administered by federal, State, or local government; Reimburse the resident for any payment the resident made for care not received due to the resident's removal from placement by the case manager for cause due to actions of the provider; and Maintain and make available to the local department, upon request, records pertaining to expenditures on behalf of the resident residing in the CARE home. Providers must have at least one backup provider, or backup/substitute staff, who shall: Be 21 years old or older, or 18 through 20 years old and supervised by a staff member 21 years old or older; Have no criminal record or Adult Protective Services or Child Protective Services history that indicates behavior potentially harmful to residents; Have three satisfactory nonrelative character references; Be willing to work for the well-being of the resident with the local department staff and other agencies involved; Exhibit a genuine interest in the welfare of the resident and be willing to perform provider responsibilities appropriate to meet the resident's physical and social needs; Attend required CARE training as determined by the local department; and Submit a medical statement, from a licensed medical care provider, indicating that the backup provider(s) and/or staff has the physical and mental capacity to provide care to residents. Requirements of a CARE Home. The CARE home shall: Be owned, held, leased, or otherwise controlled by the provider; Pass health and fire safety inspections conducted by local health and fire departments or fire marshals, unless the inspections are not available in the local jurisdiction of the residence; Contain not more than three separate supervised apartment units if an individual home is divided into apartments, unless the supervised apartment units were certified prior to January 1, 2007, in which case the home may be certified as a CARE home with more than three separate supervised apartments; Provide not more than double occupancy per bedroom for residents; Provide a minimum of 70 square feet for single occupancy bedrooms and 60 square feet per bed for double occupancy for residents; Have sleeping areas not used for any other purpose; When a basement is used as a bedroom, it shall be finished, adequately heated and lighted, have a window and fire egress and be enclosed for privacy; Provide grab rails in bathrooms and stairways; Provide a minimum temperature of 68° Fahrenheit in rooms used by residents; Have toilets, lavatories, baths, and showers adequate in number, location, and size to accommodate the needs of residents and other household members; When the condition of the resident requires it, have bathroom facilities on any floor where the resident is permitted; Have an adequate water supply, with well water tested and approved by the local health authorities; Provide an outside fire escape for a resident bedroom located on the third floor or higher; Have a minimum of one operable: Smoke detector per floor; Fire extinguisher rated for use against chemical and electrical fires that is readily accessible on each floor where residents are permitted and near hazardous areas; A carbon monoxide alarm in homes where there is fossil fuel such as natural gas, propane, fuel oil and pellet stoves; and Landline telephone that is accessible to the resident; Post by each landline telephone the emergency telephone numbers for the police and fire department, and any backup support person; Have safe and functioning systems for: Heating and cooling; Hot and cold running water; Sewage; Electricity; Cooking; Refrigeration; Artificial and natural light; and Ventilation; Have clean and adequately furnished bedrooms and separate beds for each resident which include: An individual bed, which may not be a rollaway cot or folding bed, for each resident; Adequate closet and drawer space; Linens for bedroom and bathroom; and An adequate source of light for reading and other use in bedroom and in common areas; Have sufficient dishes, glassware, plates, and flatware to provide each resident with a complete set of eating utensils; Have cleaning supplies, toilet paper, and soap available for use by the residents; Have at least one comfortably furnished living room and a common dining area available for residents' use; and Have a safe place to keep residents' valuables such as a locked box. A person who wishes to operate a CARE home shall apply at the local department and submit a completed application on a form prescribed by the Administration. Processing of Application by the Local Department. Except under circumstances set forth in Regulation .16 of this chapter, the local department shall evaluate the provider applicant and the residence through the following activities: Visit to the residence and an interview with the provider applicant; Review with law enforcement authorities any criminal record of: The provider applicant; Any household member 18 years old or older who will reside in the CARE home but not as a recipient of CARE services; and Any backup provider or providers who will care for residents; Contact, and evaluate the responses of, three references listed on the application regarding the applicant's suitability to be a CARE provider, including references who have: Work experience directly related to the duties or requirements of the CARE provider or contact with the employers of the provider applicant; and Previously been licensed or certified by a State agency or a state agency from a state other than Maryland; Review the qualifications, including age, references, and criminal records of all backup provider or providers who will care for residents; Determine the number of residents that may be cared for in the home; Determine the level of care available from the provider to compute the rate of payment as set forth in COMAR 07.03.07; Obtain and review required health and fire inspection reports; Arrange for CARE training for the provider applicant, and the backup provider or providers, that is provided by the local department or the Administration; and Sign the provider agreement. If an application is incomplete, the local department shall send a written notification to the provider applicant which shall include a: List of missing or incomplete documentation; and Statement that if the completed application is not received by the local department within 30 days from the date of the notice, the local department shall deny the application according to §D of this regulation. Notice of Decision. Within 90 days of the start of the evaluation process as set forth in §B of this regulation, the local department shall notify the provider applicant in writing of the decision regarding the application. If the decision is to certify the provider applicant, the notice shall include the: Decision; Certificate to operate as a CARE home; Expiration date of the certificate; Number of CARE residents permitted in the home; Level of care available from the provider; Statement that the local department may make unannounced inspection visits; and Information of the provider applicant's right to appeal the decision as provided in COMAR 07.01.04 and of the method for obtaining a fair hearing. Temporary Certification. The local department may issue or extend a temporary certificate if the residence does not fully comply with the regulations if the deficiencies: Do not constitute a life, safety, or health hazard; and Can be corrected within 90 days of the temporary certificate date. The notice of the decision to issue a temporary certificate shall include: Decision; Temporary certificate to operate the CARE home for 90 days; Expiration date of the certificate; Deficiencies to be corrected; Statement of notice that certification as a CARE home is available when the deficiencies are corrected; and Information indicated in §C(2)(d)—(g) of this regulation. If the decision is to deny the application, the notice shall include the: Decision; Reason for the decision; Specific regulation supporting the decision; and Information of the applicant's right to appeal the decision and method for obtaining a fair hearing. The local department shall deny the application if the: Residence does not meet the requirements specified in Regulation .07 of this chapter; or Applicant: Prevents the local department from completing its responsibility for determining whether to issue a certification; Fails to complete the application within the time set forth in §B(1) of this regulation; Has not corrected the deficiencies that prevented more than temporary certification as specified in §C(3) of this regulation; Withdraws the application; or Provided false information on the application or during the evaluation process. Local department responsibilities to the provider include: Referral to training offered by the Administration; Consultation and supportive services; Assistance to formulate realistic house rules; Technical advice to meet the standards of the CARE program; and An annual review of the CARE home and provider and subsequent written notice of recertification or disapproval of certification. Level of Care. A CARE home shall provide a level of care based on the provider's ability to: Respond to the resident's need for supervision; Teach activities of daily living; Provide personal care services and encouragement; and Facilitate the resident's decision making and planning. The level of care and services provided to an individual resident shall be: Specified in the residential service agreement; Based on the initial or most recent assessment of the intensity of the services needed by the resident; Determined by the case manager using the assessment form provided by the Administration; and Provided by the care provider according to the service plan developed by the case manager, and based on the applicant's needs described in the applicant's assessment form. Four Levels of Care, as Determined by the Case Manager's Assessment. Level A is minimal supervision, assistance, and personal care, where the provider shall: Perform brief interventions in the applicant's self-care routine; and Carry out general supportive oversight. Level B is moderate supervision, assistance, and personal care, where the provider shall: Perform substantial or frequent interventions in the applicant's self-care routine; and Provide general supervision and oversight of the applicant's activities. Level C is extensive supervision, assistance, and personal care, where the provider: Shall perform substantial or frequent interventions in the applicant's self-care routine; May implement a plan of teaching elements of activities of daily living; and Shall provide supportive supervision and oversight of the applicant's activities. Level D is specialized and intense supervision, assistance, and personal care, where the provider: Shall perform very frequent interventions in the applicant's self-care routine; May implement a plan of teaching elements of activities of daily living; and Shall provide supportive supervision and oversight of the resident's activities. Other Provider Responsibilities. The provider shall: Designate and utilize a backup support approved by the local department to provide care in emergency situations or in the provider's extended absence; Provide the resident with three balanced meals per day or other special diet prescribed by the resident's health care provider; Provide resident with sufficient, weather appropriate, clothing to maintain hygiene; Maintain all of the home's equipment and supplies in a safe and functioning condition; If the provider permits smoking, designate a smoking area; Post the CARE home certification in the area of the residence visible to residents and visitors; Establish a fire escape plan, instruct each resident about the plan upon arrival in the home, and practice the plan with all residents at least every 3 months; Maintain records on each resident that include: Dates of placement and discharge; Payment sources and amount; Individualized service plan agreement; and Emergency data; Provide an area in the home where the resident may have visitors with a reasonable amount of privacy; In collaboration with the case manager and resident, establish a written resident-provider agreement which includes the: Method and amount of payment; Level and type of service to be provided; and Provider's house rules; Except in an emergency, provide at least 30 days notice to the resident and resident's case manager if change in placement is required; Notify the local department or case manager within 24 hours of any: Unusual incident or accident involving a resident or provider such as serious illness, accident, death, significant change in behavior, or move; or Planned or unplanned absence from the home; Notify the local department at least 90 days before relocating the home; and Notify the local department at least 30 days before making any other changes affecting certification. A certificate may not be transferred to another residence or provider. Time Limitation. A certificate is valid for 1 year from the date of issuance. A temporary certificate is valid for 90 days from the date of issuance. Level of Care. A residence certified for: Level D may have applicants at Levels A, B, C, or D; Level C may have only applicants at Level A, B, or C; Level B may have only applicants at Level A or B; or Level A shall have only applicants at Level A. Number of Residents. A provider may not provide care for more than the number of CARE residents stated on the certificate. A CARE home may have not more than: Four CARE residents in a provider's home; Four CARE residents, exclusive of staff, for a supervised apartment, unless the supervised apartment was certified prior to January 1, 2007 in which case it may be a CARE home with more than four residents; or Eight CARE residents, exclusive of staff, for a group home, unless the group home was certified prior to January 1, 2007 in which case it may be a CARE home with more than eight CARE residents. Non-CARE Residents. A provider may not provide care to a non-CARE resident. All residents not a member of the provider's family shall be placed there by the Project Home Program. The local department shall initiate the process to recertify the CARE home: Within 30 days after the local department obtains information about changes in the provider's circumstances or the residence which affect the certification; and At least once a year. Application for Recertification. The local department shall send the provider an application: Within 10 days after obtaining the provider's information about a change; or At least 60 days before the certificate expires. When the local department's recertification visit precedes the expiration date of the certificate, the provider may complete the application at the face-to-face recertification visit. The recertification application notice shall include an application due date to allow the local department to make its decision within the required time limits. Evaluation of Recertification Application. Upon receipt of the application, the local department shall: Visit the residence and interview the provider to discuss any changes in circumstances; Review status of criminal record for: A household member over 18 years old, who resides in the CARE home, but is not a CARE resident; and Backup provider or providers, and staff where appropriate, who care for residents; Contact if possible, all case managers who worked with residents in the home during the current certification year and evaluate their assessment of the home; Request and review reports of health and fire inspections if needed and available; Review the qualification of backup providers or providers, and staff where appropriate; Arrange for any required CARE training for the provider and staff; Determine the number of CARE residents the home may care for and the level of care to be provided; and Advise the provider in writing within 90 days of the beginning of the recertification process of the decision to deny or recertify as set forth in Regulation .08C of this chapter. The local department may place the provider on probationary status: Upon finding that a violation requires immediate action to protect the health, safety, or welfare of a resident in the provider's care; and For not more than 60 days from the date of the department’s knowledge of the violation. Probation Notice. The local department shall notify the provider of the probationary status in writing within 10 days of the local department's knowledge of a violation. The probation notice shall include the: Reason for probationary status; Regulation on which it is based; Provider's right to appeal the decision and the method for requesting a fair hearing; and Statement that probationary status may lead to revocation of certification if the violation is not corrected within the probation period. On or before the date ending the probationary period, the local department shall remove the probationary status, extend the probationary status, or revoke the certificate. During the probationary period, the local department shall obtain the approval of the director or designee of the local department before placing a new applicant in the CARE home. The local department may revoke a certificate if: The provider or the CARE home fails to meet certification requirements as stated in Regulation .07 of this chapter; The provider fails to disclose pertinent information related to certification or provides false information to the local department; Conditions in the home represent a threat to the health, safety, or welfare of a resident; The provider requests that the certificate be revoked; The provider fails to submit required information by the due date on the recertification application to the local department; or The provider fails to abide by the provider agreement or any set of written procedures required by the local department. The local department shall inform the provider in writing of its decision to revoke certification at least 15 days before the proposed action. The notice shall include the: Decision; Reason for revocation; Regulation supporting the decision; and Provider's right to appeal the decision and the method of obtaining a fair hearing. If the provider's certificate expires or is revoked, the local department shall send a written notice, if appropriate, to: All residents of the home; Individuals responsible for residents' placement in the home including: The families or guardians of residents; or Representative payees of SSI beneficiaries; and MDH, Office of Health Care Quality. The written notice from the local department shall include: Notice that the certificate is revoked or expired; A description of the violation; An offer to assist in the resident's relocation to another approved home or other living arrangement; and Notice that the local department shall terminate benefit payment to a PAA recipient if the recipient is not living in a certified home. The delivery of case management services and the certification of CARE homes are subject to the limitation of available funds and staff. For CARE applicants who cannot be served due to insufficient funds or staff, the local department shall: Maintain a waiting list; and Serve eligible applicants in the order in which they are ranked in accordance with Regulation .04E of this chapter. For provider applicants who cannot be studied for certification due to insufficient staff or the absence of need for additional homes, the local department shall: Maintain a waiting list; and Study applicants in the order in which they applied, unless special needs of resident applicants awaiting placement can be met only by later provider applicants with specific services. The local department shall provide written notice of the waiting list status to applicants for service and provider applicants. The resident, a representative acting on behalf of the resident, or the provider may request a fair hearing as provided in COMAR 07.01.04. The local department and provider are subject to the prohibition against discrimination as stated in COMAR 07.01.03. Health-General Article, §§19-1801—19-1806; Human Services Article, §§6-508—6-513; Annotated Code of Maryland(Agency Note: Federal Regulatory Reference: 45 CFR Part 1397) Effective date: February 24, 1986 (13:4 Md. R. 395) Regulations .02, .03, .07, and .08 amended; new Regulation .16 adopted; and existing Regulations .16 and .17 recodified to be .17 and .18 as an emergency provision effective February 24, 1986 (13:6 Md. R. 667); emergency status expired June 30, 1986 Regulations .02I, K; .03C; .07; .08A amended effective July 13, 1986 (13:14 Md. R. 1631) Regulations .16 and .17 recodified to .17 and .18, and new Regulation .16 adopted effective July 13, 1986 (13:14 Md. R. 1631) Chapter 20 “C.A.R.E. Program” revised as Chapter 20 “Certified Adult Residential Environment (C.A.R.E.) Program” effective October 3, 1988 (15:20 Md. R. 2333) Regulation .10A amended effective November 1, 1990 (17:20 Md. R. 2424) Recodified from COMAR 07.02.20 to 07.06.15, December, 1992 Regulations .01—.18, Certified Adult Residential Environment C.A.R.E.(CARE) Program repealed effective June 11, 2001 (28:11 Md. R. 1053) Regulations .01—.17, Certified Adult Residential Environment (CARE) Program adopted effective June 11, 2001 (28:11 Md. R. 1053) Regulation .01 amended effective July 17, 2008 (35:14 Md. R. 1245) Regulation .02B amended effective July 17, 2008 (35:14 Md. R. 1245) Regulation .03A amended effective July 17, 2008 (35:14 Md. R. 1245) Regulation .04 amended effective July 17, 2008 (35:14 Md. R. 1245) Regulation .05 amended effective July 17, 2008 (35:14 Md. R. 1245) Regulation .06C, D amended effective July 17, 2008 (35:14 Md. R. 1245) Regulation .07 amended effective July 17, 2008 (35:14 Md. R. 1245) Regulation .08 amended effective July 17, 2008 (35:14 Md. R. 1245) Regulation .10 amended effective July 17, 2008 (35:14 Md. R. 1245) Regulation .11 amended effective July 17, 2008 (35:14 Md. R. 1245) Regulation .12C amended effective July 17, 2008 (35:14 Md. R. 1245) Regulation .14A amended effective July 17, 2008 (35:14 Md. R. 1245) Regulation .15A amended effective July 17, 2008 (35:14 Md. R. 1245) Regulation .16C amended effective July 17, 2008 (35:14 Md. R. 1245) Chapter recodified from COMAR 07.06.15 to COMAR 07.02.19, effective June, 2009 Regulation .01C amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .02B amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .03A amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .04 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .05A, L amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .06C amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .07 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .08B amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .10B amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .12C amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .13A, B amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .14A amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .16B amended effective April 10, 2017 (44:7 Md. R. 353) This chapter applies to the approved treatment foster care programs operated by child placement agencies licensed by the Social Services Administration, Department of Human Services under COMAR 07.02.13, and treatment foster care programs operated by a local department of social services. The goal of treatment foster care is to provide intensive services to a child with a serious emotional, behavioral, medical, or psychological condition. In this chapter, the following terms have the meanings indicated. Terms Defined. “Administration” means the Social Services Administration. “Case manager” means a provider agent or representative responsible for: Providing supervision, training, and consultation to treatment and biological parents; Arranging and ensuring necessary services to a child; and Acting as the leader of a child's treatment team. “Case plan” means a written description of a child's needs and services to be provided to meet those needs as outlined in COMAR 07.02.13.05D and the relevant federal statutes and regulations. “Clinical supervisor” means a provider agent or representative responsible for providing supervision, training, consultation, and support to the case manager. “Foster family care” means 24-hour substitute care provided for a child in an approved or licensed foster family home. “Local department” means the department of social services in a county or Baltimore City. “Medical passport” means a confidential, abbreviated health record as outlined in COMAR 07.02.11.08. “Permanency plan” means a plan specifying: Where and with whom a child shall live; and The proposed legal relationship between a child and the child's permanent caretaker or caretakers. “Professional staff” means the case manager and clinical supervisor within the treatment foster care program. “Progress report” means a provider agency's written update of a child's treatment plan for a specific time period. “Provider agency” means the unit within the: Local department of social services charged with implementing the treatment foster care program; or Licensed child placement agency responsible for implementing the treatment foster care program. “Record keeping” means a systematic recording of information documenting activities of a child's behavior and progress in targeted areas, as defined by the treatment plan. “Respite care” means short-term care for a child to relieve the treatment family or care giver. “Serious emotional, behavioral condition” means a limitation of an individual's capacity which adversely affects the individual's ability to perform in the following areas: Daily living skills; Community living skills; Interpersonal relationships; and Appropriate educational activities. “Treatment” means the coordinated provision of services and use of procedures designed to produce a planned outcome in an individual's behavior, attitude, or general condition based on a thorough assessment of possible contributing factors. “Treatment accountability” means: Behaviorably measurable time-limited goals and a set of written procedures for achieving them; and A process for assessing results. “Treatment foster care” means a 24-hour substitute care program, operated by a licensed child placement agency or local department of social services, for children with a serious emotional, behavioral, medical, or psychological condition. “Treatment foster parent” means a caretaker who is: Licensed and trained by a child placement agency to perform parenting duties; and Responsible for implementing, monitoring, and assessing the progress of a child's individual treatment within the home setting. “Treatment plan” means a written description of the objectives, goals, and services to address the needs of a child, including the child's projected length of stay in the program. “Universal precautions” means health and safety measures used as a barrier between an individual and another individual's body fluids. The case load ratio may not be greater than one case manager to ten children. The provider agency may decrease the case load ratios of the case manager set forth in §A of this regulation if it is determined that one or more of the following circumstances apply: The children's needs require more intensive supervision and training for the treatment parents; Travel distances between placements of children impede the case manager's ability to maintain frequent and direct contact with clients; The case manager provides case management services and performs the following additional duties: Recruitment and training of treatment foster parents, Casework services to a child's biological family, and Therapeutic service to a child; or Other factors necessitate the reduction of the case load to ensure adequate provision of services. A provider agency shall provide clinical supervision to casework staff. A provider agency shall meet the following staff training requirements in which professional staff shall: Participate in a minimum of 20 hours of preservice training, before assuming casework responsibilities, which includes: An overview of treatment foster care and its history and development, and permanency planning, Orientation to the provider agency's treatment philosophy and skill training in its specific treatment methodologies, The provider agency's discipline policy, including the use of passive physical restraint, The provider agency's policies and procedures, including documentation and evaluation requirements, Identification and reporting of child abuse and neglect, Foster care regulations as set forth in COMAR 07.02.11, Maryland statutes and regulations governing confidentiality of records Procedures for access to records as set forth in COMAR 07.01.02, Crisis intervention, grief and loss issues for foster children, and child development, and Application of universal precautions; Participate in a complete sequence of the provider agency's preservice training for treatment parents; Receive at least 30 hours of training annually that includes written policies and procedures specific to the needs of the children served; and Receive certification of the completion of required training under §§A and B of this regulation for the professional staff's personnel file. A child is eligible for treatment foster care if the local department determines that the child: Qualifies for foster care under COMAR 07.02.11.04; and Has one or more of the following conditions: A serious medical condition including, but not limited to: HIV positive and symptomatic or has AIDS, Multiple handicaps, or A symptomatic drug-exposed newborn; or A serious emotional, behavioral, or psychological condition including: Psychiatric diagnosis by appropriate qualified professionals, or History of an ongoing substance abuse problem; or Developmental disability; or Is in need of a high level of treatment in a family setting. Siblings who do not require treatment foster care may be placed in the same home with a sibling who requires treatment foster care. Discharge Criteria. The provider agency shall have a written policy for planned discharge of a child from the treatment program. The aftercare plan shall: Become a part of the child's case record; and Include the following: The name, address, telephone number, and relationship of the individual to whom the child is being discharged, A summary of the services provided during care, A summary of the growth and achievements of the child during care, and Identified needs of the child which remain unmet and recommendations for services not available from the new placement. Local Department Responsibilities. The local department shall: Determine that a child is eligible for treatment foster care; and Send to each potential provider agency with which the local department seeks to place a child the following: A referral for purchase of care, A current case plan drafted within 180 calendar days before the date of referral, Relevant medical records within 1 year before the date of referral to the provider agency, and The psychological or psychiatric evaluations performed within 1 year before the date of referral to the provider agency if eligibility is based on a serious emotional, behavioral, or psychological condition. A provider agency shall: Have a written admission policy which includes the acceptance criteria; and Respond in writing to the referring agency within 14 working days, accepting or denying admission of a child and giving the reason for a denied admission. The provider agency shall: Within 30 calendar days of a child's acceptance into the program, develop a treatment plan in conjunction with the local department; Convene a team, including but not limited to the local department of social services, treatment parents, and therapist to evaluate each child's treatment plan at intervals not to exceed 3 months; Visit the treatment foster parents at least twice a month; Provide a child access to medical care; Have face-to-face contact with a child at a minimum of twice a month; Provide services to the biological family of a treatment foster care child as required in the permanency and treatment plans; Attend foster care review board hearings and court hearings; Provide advance information to the local department on changes affecting services to a child which could result in revisions to the treatment plan, such as changes in placement, placement location, or visitation plans; Provide the local department every 3 months with a written progress report on the treatment plan; Provide the treatment foster parents all medical and psychological information necessary for the care of a child; Provide treatment foster parents access to both planned and crisis respite care of their treatment foster children; and Maintain a written preservice and in-service training curriculum specific to the population serviced. The local department shall: Within 30 calendar days of the child's acceptance into the provider agency, develop a permanency plan in conjunction with the provider agency; Inform the foster care review board and the court of a child's placement with the provider agency and the name of the child's case manager; Review with a child's case manager the progress report required in §A(9) of this regulation; Meet with a child and the child's biological family every 6 months in consultation with the child's case manager to update the treatment plan; and Attend foster care review board hearings and court hearings. The number of children placed in one eligible treatment home may not exceed two without prior justification and approval in writing from the Administration. Treatment Foster Parent Qualifications. A treatment foster parent shall meet the following criteria: Comply with all foster family approval regulations as specified in COMAR 07.02.13; Be available to a child on a 24-hour basis; Arrange for child care services consistent with COMAR 07.02.13.07B(3) and .17B(7); Possess a high school diploma or equivalent including, but not limited to, life experience; and Have access to public or private transportation to transport a child to all necessary services identified in the individual treatment plan. Treatment Foster Parent Training. Prospective treatment foster parents shall receive at least 24 hours Areas of training include: A history of the importance of foster parents to the child welfare program, from a historical perspective to the present team approach concept; The definition of foster care and its relationship to permanency planning; The rationale for teamwork in permanency planning; An explanation of the needs and rights of children in foster care; An explanation of the needs, rights, and responsibilities of parents of children in care; A delineation of the complementary roles of foster parents and caseworkers; A review of the grieving process; Exploration of an applicant's own feelings about separation; Recommendations for helping foster families work with the feelings and resultant behaviors that are typical of children separated from their biological parents; The development of an accepting attitude with regard to the biological parent-child relationship; A review of issues related to substance abuse; and Health and safety practices related to universal precautions. In-Service Training Requirements. Treatment foster care parents shall attend 20 hours of in-service training annually. Certification of training shall be documented in the treatment parent's case record. Treatment Foster Parent Responsibilities. The foster parent shall: Assist the case manager and other team members in the development of treatment plans for a child or youth in their care; Attend team meetings and training sessions; Keep a systematic record of a child's behavior and progress in targeted areas on at least a weekly, or preferably, a daily basis; Ensure a child access to medical and dental care, including accompanying the child to medical and dental appointments and carrying out treatment prescribed by health care providers; Coordinate recreational and leisure time activity; Monitor a child's school attendance and progress, and attend parental conferences and activities; Provide transportation services; Maintain a medical passport; Attend and provide information at court hearings as specified in the treatment plan; and Assist a child in maintaining contact and visitation with the child's biological family unless otherwise indicated in the child's treatment plan. A written treatment plan includes: Role of the treatment foster parent; Role of the provider case worker; Specific tasks to be carried out by treatment parents during placement; Long-term goals of treatment, including criteria for discharge, projected length of stay in the program, projected post-treatment, and aftercare services; and Identification of treatment team members who will assist in the provision of planned care. The length of stay in a treatment foster care program is subject to review pursuant to COMAR 07.02.11.18. The Administration shall provide liability insurance for treatment foster parents as outlined in COMAR 07.02.25.21. The child placement agency shall provide liability insurance as outlined in COMAR 07.02.13.04N(1) and (2). A treatment foster parent aggrieved by a decision of a provider agency has the right to appeal according to COMAR 07.02.02 and 07.02.13.04R. The agency shall complete and maintain for inspection an annual written evaluation as specified in COMAR 07.02.13.04H(1)—(5). Family Law Article, §§5-501—5-534, Annotated Code of Maryland; Agency Note: Federal Regulatory Reference 45 CFR §§228.13 and 228.42 Effective date: October 9, 1995 (22:20 Md. R. 1541) The purpose of a family support center program is to provide parents and their children with a hospitable and constructive environment to provide or coordinate services which: Improve parenting skills; Develop the family as a functioning unit; and Promote the growth and development of their children. In this chapter, the following terms have the meanings indicated. Terms Defined. “Administration” means the Social Services Administration of the Department of Human Services as staff to the Subcabinet. “Applicant” means a parent who has applied to receive services from one of the family support centers in the network. "Center" means a family support center operated by a provider under a contract with the Intermediary. “Intermediary” means the agency that provides management for the operation of the State's network of community-based family support centers. “Parent” means the mother or father of a child and includes a single youth who is at risk of early or unplanned parenthood. “Provider” means an agency or individual who contracts with the Intermediary to operate a center. “Subcabinet” means the Subcabinet for Children, Youth and Families established under Article 49D, §4.1, Annotated Code of Maryland. “Temporary Cash Assistance (TCA)” means a form of cash assistance provided to assistance units that are technically and financially eligible. Any parent may use the center. A center shall provide directly, by purchase or other arrangement, services to include: Parenting skills, parent education classes, and other activities; Health care counselling; Diagnostic and assessment services to identify developmental problems of the young parent and of the child; Child care as necessary to allow participation in the Program; Peer support activities, including recreational and social activities; Educational services such as GED and post-high school classes; and Pre-employment counselling and skill development, to assist the parent in securing and maintaining employment. The center shall plan and provide services to both parents, their children, grandparents, and other family members, to the extent possible. The center may provide other services when approved by the Intermediary. Before operating a center, the provider shall submit to the Intermediary a program plan which describes the: Services to be provided; Manner in which the services are provided; Staff to carry out the program and training plans for the staff. The provider: Shall employ staff of the type and qualifications as required by the program plan; May use volunteers in the program and train and supervise them as required by the program plan; Shall operate the center during the day, evenings, and weekends as necessary to meet the parents' needs according to the program plan. The program plan shall describe the methods to be used to refer parents to other agencies that provide services not available at the center. The center shall maintain: A record of: Attendance at the center, Expenditures to be reimbursed by the designated State fiscal agent, Services provided; and Other records as required by the Administration. The Intermediary shall send to the Administration: A written monthly report of: Center attendance, including number of TCA customers serviced, Expenditures to be reimbursed by the designated State fiscal agent, Types of services provided; and Copies of reports made by the center to other agencies or organizations, including private foundations and the Maryland Legislature. The provider shall maintain the records and reports of grievance decisions for inspection by the Intermediary and Administration. The provider shall include in the program plan a description of the grievance system in each center available to parents. The grievance system shall include: A written decision to parents by the provider resolving the grievance, and the procedures for appealing to the Intermediary; A written decision to parents by the Intermediary reviewing the decision of the provider, and the procedures for appealing to the Office of Administrative Hearings; and A written communication to the Administration containing the results of the grievance. An applicant for services may appeal to the Office of Administrative Hearings for a fair hearing in the following situations: The applicant's complaint is not resolved by the provider's grievance system; The applicant is denied services; or The applicant disagrees with the manner or form of the provisions of service. The Office of Administrative Hearings fair hearing process shall conform to the procedures in COMAR 07.01.04. Article 88A, §§3 and 5, Annotated Code of Maryland Effective date: April 6, 1987 (14:7 Md. R. 829) Regulation .02A amended effective October 4, 1999 (26:20 Md. R. 1544) Regulation .02B amended effective December 26, 1988 (15:26 Md. R. 2981); October 4, 1999 (26:20 Md. R. 1544) Regulation .05A amended effective October 4, 1999 (26:20 Md. R. 1544) Regulation .06 amended effective October 4, 1999 (26:20 Md. R. 1544) Regulation .07 amended effective October 4, 1999 (26:20 Md. R. 1544) Effective date: March 20, 1989 (16:5 Md. R. 626) Regulation .02B amended effective November 9, 1992 (19:22 Md. R. 1987) Regulation .13-1 adopted effective November 9, 1992 (19:22 Md. R. 1987) Regulation .17 repealed and new Regulation .17 adopted effective November 9, 1992 (19:22 Md. R. 1987) Chapter repealed effective October 5, 1998 (25:20 Md. R. 1528) Effective date: August 21, 1989 (16:16 Md. R. 1749) Regulations .01—.05, Mutual Consent Voluntary Adoption Registry, repealed effective April 3, 2000 (27:6 Md. R. 639) This chapter establishes the licensing requirements, rights, and responsibilities of resource parents and local departments. The primary purposes of these regulations are to: Ensure that local departments place children with resource parents who will provide children in out-of-home care with safe, nurturing, and trauma-informed environments where their connections with family are supported and maintained; and Provide a structured framework for resource parents to collaborate in parenting children in out-of-home care, offer mentorship to the children’s parents or guardians, and actively participate in the reunification and permanency planning process. In this chapter, the following terms have the meanings indicated. “Abuse” means: Child abuse as defined in Family Law Article, §5-701, Annotated Code of Maryland; or Sexual abuse of a child as defined in Family Law Article, §5-701, Annotated Code of Maryland, whether or not a child sustains physical injuries. “Administration” means the Social Services Administration of the Department of Human Services. “Adoption” means the legal proceeding by which an individual becomes the child of an adoptive family and has all the legal rights and privileges to which a child born to that family would be entitled. “Applicant” means an individual applying to a local department to be a resource parent. “Case plan” has the meaning stated in COMAR 07.02.11 “Child” means an individual under age 18. “Child in care” means a child or young adult for whom the local department has responsibility for placement, care, custody, or guardianship. “Child in care’s family” means the child’s birth family, adoptive family, or legal guardian. “CPS” means the child protective services unit that responds to reports of suspected child abuse or neglect pursuant to Family Law Article §5-701 et. seq. “Day” means a calendar day unless otherwise specified. “Department” means the Department of Human Services. “Family” means the basic family unit consisting of one or more adults and children related by blood, marriage, adoption, legal guardianship, or domestic partnership as that term is defined in Health General Article, §6-101, Annotated Code of Maryland. Foster Care. “Foster care” means continuous 24-hour care and supportive services provided for a child a local department places in a resource home. “Foster care” includes: Services to the child's parents or legal guardians, family, and kin to achieve a safe, permanent placement for the child; Services to the resource parents and monitoring of the child in the out-of-home placement; and Post-placement services to the child and the child's caregiver to prevent placement disruption or re-entry into out-of-home placement. “Household” means the home where the applicant or licensed resource parent lives. “Household member” means an individual who lives in or is regularly present in a household. “Kin” means an individual who is related to the child through blood, marriage, adoption, tribal law or custom, or cultural custom or practice; or an individual who is unrelated to the child, but has a strong familial or significant bond with the child, or is a person identified by the child’s parent. “LGBTIQA+2” means individuals who identify as lesbian, gay, bisexual, transgender, intersex, queer/questioning, asexual, two-spirit, or other description that an individual may use to describe their gender, sexuality, and psychological sex characteristics. “Licensed” means approved by a local department as a resource parent and a resource for custody and guardianship or adoption of a child. “Local department” means a department of social services in a county or Baltimore City or the Montgomery County Department of Health and Human Services. “Local director” means the director of a local department. “Monthly care stipend” means financial support that a local department provides to a resource parent to assist the resource parent with caring for a child in care and placed in the resource home. “Neglect” means child neglect as defined in Family Law Article, §5-701, Annotated Code of Maryland “Out-of-home care” means out-of-home placement and the monitoring of and services provided to a child in aftercare following a child’s out-of-home placement. “Out-of-home placement” means a living arrangement for a child in care, including foster care, kinship care, group care, or residential treatment care. “Parent” means the legal mother or father of a child or young adult whose rights have not been terminated or a legal guardian other than a local department. “Permanency plan” means a plan specifying where and with whom a child in care will live and the proposed legal relationship between the child and the temporary or permanent caregiver. “Regularly present in the household” means visiting or staying in a home with sufficient frequency to make an individual a significant part of the household. “Resource home” means the residence of an individual that a local department has licensed as a resource parent. “Resource parent” means an individual whom a local department licenses to provide 24-hour care for a child in care in the resource home. “Secondhand smoke” means a complex mixture of gasses and particles that includes: Sidestream smoke, that is, smoke from a burning cigarette, cigar, or pipe; and Exhaled mainstream smoke. “Sleeping arrangement” means the location where a child in care will sleep and the furniture provided for sleeping. “Worker” means a local department staff member assigned to work with and support a resource parent or a child in care. “Young adult” means an individual 18 years old or older but not yet 21 years old. Applicants. An individual shall apply to become a licensed resource parent at the local department in the jurisdiction where the individual resides. A couple residing together and applying to be licensed resource parents shall each meet the requirements of this chapter. Any applicant, whether applying as a single resource parent or as part of a couple, shall be: A United States citizen or non-citizen lawfully admitted for permanent residence under the Immigration and Nationality Act; and At least 21 years old. If an applicant had a prior license, approval, or certification from another foster care or adoption agency, the local department shall obtain written confirmation from the previous agency that the applicant was in good standing. If an individual moves into a household to become part of a couple licensed to serve as resource parents, the individual shall meet all the requirements of this chapter, including meeting the preservice training requirements. The local department shall have 120 days from the date the local department accepts the application to approve or deny the applicant for licensing. Physical Examination for All Individuals Living in the Household. The applicant and all household members shall: Undergo an initial medical examination by a licensed health care practitioner; and Authorize the release of health information to the local department upon request. For all applicants and household members 18 years old or older, the initial examination shall include an assessment for risk of tuberculosis, and, if indicated, the result of any tuberculosis test shall be provided to the local department. If an applicant or a member of the household has symptoms or a history of physical or mental health concerns, or a condition that may be contagious or injurious to the physical or emotional health of a child in care, the local department may: Require the individual to undergo additional medical or mental health examinations as specified by the local department; Require the individual to provide written documentation from the examining health care practitioner stating that the medical or mental health condition is not likely to prevent a child in care from receiving care and attention in the home and is not communicable, or harmful to a child in care; and Deny, suspend, or revoke a resource parent license if the local department does not receive the written documentation within a reasonable amount of time from the date of the request for documentation. All applicants who intend to accept placement of a child in care under the age of 1 shall provide proof of an up-to-date pertussis vaccination for themselves and for any household member 18 years or older. An individual who joins the household shall comply with the requirements of this section. Background Clearances. An applicant and any household member 18 years old or older shall apply for a State and federal fingerprint-based criminal background clearance and provide sufficient information for a local department to conduct the clearances and searches in §D(2) and (3) of this regulation. Review Clearance Results. For all applicants and household members 18 years or older, the local department shall review the results of: State and federal fingerprint based criminal background clearances; Child protective services clearances; Motor Vehicle Administration driving records; A search of the Maryland Judiciary Case Search; and A search of the Maryland and National Sex Offender registries. Out-of-State CPS Clearance. The local department shall request information from the state-maintained child abuse and neglect registry in any state in which an applicant or household member 18 years old or older has lived within the prior 5 years to determine whether that individual has been found responsible for child abuse or neglect. A local department may not license or continue to license an individual as a resource parent if that individual or any household member 18 years old or older has a felony conviction for: Child abuse or neglect; Spousal abuse; A crime against a child or children, including child pornography; A crime of violence as enumerated in the Criminal Law Article, § 14-101, Annotated Code of Maryland, including rape, sexual assault, or homicide, but not including other physical assault or battery; or Human trafficking. A local department may not license or continue to license an individual as a resource parent if that individual or any household member 18 years old or older has a felony conviction within the prior 5 years, involving: Physical assault; Battery; or Drug-related offense. Review of Charges. A local department shall review charges, investigations, other convictions, or findings related to any other crimes of any applicant or adult household member to determine their possible effect on: The safety of any child in care; The ability of the local department to achieve its goals in providing services to any child in care; and The applicant’s ability to execute the responsibilities of a resource parent. A local department may deny, suspend, or revoke a resource parent license based on this review. Review of CPS History. If the local department receives information that reveals a pending CPS investigation, the local department may not license an applicant until the investigation is completed. The local department may not license or continue to license as a resource parent an individual if they or any household member has been indicated for child abuse or neglect, either in this state or in another state. Only a local director may grant an exception and shall do so in writing. When assessing whether to grant an exception, the local director shall make a decision that is in children’s best interest taking into account the following: The nature and severity of the maltreatment that resulted in the finding; The number of indicated findings; Any factors that might indicate that the maltreatment was a one-time incident including the circumstances surrounding the maltreatment and the number of years that have passed since the maltreatment; and Any evidence that the applicant or household member has changed since the most recent maltreatment. After a local department licenses a resource home, if an individual 18 years old or older joins the household, or if any household member becomes 18, the local department shall review for those individuals the results of the following clearances: State and federal fingerprint based criminal background clearances; In-State, and if applicable, out-of-State, child protective services clearances Motor Vehicle Administration driving records; Maryland Judiciary Case Search; and Maryland and National Sex Offender registries. Child Support Clearance. For applicants only, the local department shall review the result of a child support clearance. If the applicant has a child support arrearage, the local department shall: Provide the applicant with the opportunity to correct the arrearage; and Inform the applicant that they may either pay the arrearage in full or make payment arrangements with the Child Support Administration that are acceptable to the local department. The local department may deny the application if the applicant cannot, within the 120-day application process, make: Full payment; or Enter into a payment agreement. Financial Stability of Resource Parents. A resource parent shall have sufficient income and financial stability to provide reasonable living conditions for their family group without depending on the monthly care stipend. Except when a resource parent is participating in a DHS-sponsored program in which a stipend is provided to allow one or more parents to operate without external income resources, a resource parent shall have income or resources to make timely payments for shelter, food, utilities, clothing, and other household expenses prior to the addition of a child in care. If a resource parent receives government assistance, the local department may not disqualify the resource parent solely on this basis. Transportation. A resource parent shall ensure that the child in care has legal and safe transportation to and from: Medical, mental health, and dental appointments; School; Social events; Employment; Visits or activities with family and friends; and Events scheduled by the local department. Plans for Child Care and Alternative Supervision. If a resource parent requires child care services for a child in care while the resource parent is employed or in school: The resource parent shall discuss the child care plan with the local department and obtain local department approval for the plan; and The child care provider shall be certified by the Maryland State Department of Education Office of Child Care or approved by another agency that provides child care services consistent with the licensing standards of the Maryland Department of Education Office of Child Care, unless the local department approves a plan for informal child care. Nothing in this section precludes a resource parent from arranging appropriate child care on an occasional basis for a child in care. Health and Safety. The worker shall assess the home using a home health and safety survey approved by the Administration to ensure that the home meets health and safety standards; and If a worker has concerns about the health and safety of the home, the worker may request that the local health department or other certified inspector inspect the home, which may include water and lead testing. Fire Safety. The worker shall assess the home for fire safety using a fire safety survey approved by the Administration. The resource home shall have working smoke and carbon monoxide detectors. If a worker has concerns about fire safety, the worker may request that a fire marshal or other certified fire inspector complete an inspection of the home. General Safety Requirements. Firearms and Ammunition. All firearms in the resource home shall be unloaded, stored in a locked storage area, and inaccessible to children. All ammunition shall be stored separately from the firearms in a locked storage area, inaccessible to children. The resource parent shall take all safety precautions to ensure that firearms are not used to injure children in the resource home. The worker shall obtain assurances from the applicant that no loaded firearms will be kept in the resource home unless required because a state, federal, or local law enforcement officer lives in the household and maintains and stores the firearms, in accordance with state, federal, and local law enforcement safety procedures. Potentially dangerous materials. A resource parent shall ensure that prescription and non-prescription medication, dangerous household supplies, tools, and any other potentially dangerous items are inaccessible to children. Window Coverings. A window covering installed before October 1, 2010, may not have unsecured cords, beads, ropes, or strings. Any window covering installed after October 1, 2010, shall be cordless. Sleeping and Living Areas. The resource home shall: Provide the child in care space for privacy, studying, and the storage of clothes, toys, and personal possessions; and Provide a safe sleeping arrangement for the child in care as follows: A sleeping arrangement may include a bunk bed, trundle bed, or another safe permanent arrangement the local department deems appropriate; A child in care under two years old shall sleep in a crib or other secure bed that will ensure the child in care’s safety; Except for a child in care younger than 2 years, children in care of opposite genders may not sleep in the same room unless otherwise approved by the local department; A child in care 2 years old or older may not share a bedroom with an adult unless otherwise approved by the local department; and A child in care may not share a bed with an adult or another child. Pets. A resource parent who has a pet in the home shall: Provide age-appropriate supervision when the child in care is interacting with the pet; and Keep the pet up to date on rabies vaccinations. Swimming Pools, Hot Tubs, Spas, Waterfront Properties, Fish or Duck Ponds, and Similar Bodies of Water. A resource parent shall provide supervision with regard to water safety appropriate for a child in care's age and ability. The resource home worker shall: Discuss requirements for barriers and safety mechanisms to ensure the safety of children in care; and Inspect the pool, hot tub, spa, waterfront property, fish or duck pond, or similar body of water for safety compliance. A resource parent shall ensure that any swimming pool, fish or duck pond, or similar body of water at the resource home: Is maintained in a safe and sanitary condition; and Complies with county zoning, building, or health codes or ordinances. With regard to an in-ground pool, the resource parent shall have the pool area enclosed by a fence at least four feet high with a gate that can be locked or have another safety mechanism to prevent access to the pool from the resource home; With regard to an above-ground swimming pool or hot tub, the resource parent shall have: Retractable or removable ladders that shall be locked when not in use or stored away from the pool; and A pool with sides at least four feet above the ground at all points or fencing around a pool that is at least four feet high at all points; All doors and gates that access a pool, hot tub, or spa shall have locks; If a pool, hot tub, or spa has a deck area with a door, the door shall be locked; All permanent steps to the pool, hot tub, or spa shall have a locked gate; A pool, hot tub, or spa shall not have climbable objects on the exterior; Hot tubs or spas shall be securely covered when not in use; When there is waterfront property, a fish or duck pond, or a similar body of water at or near the resource home, the local department may require that the body of water or the resource home be fenced with a locked gate or have other safety mechanisms in place; A resource parent shall have at least one individual currently trained in cardiopulmonary resuscitation (CPR) present at the resource home's swimming pool and water recreation area when being used by a child in care; Upon consideration of the following, a local director may give a resource parent a written exemption from one or more provisions of this subsection if doing so does not violate zoning, building or safety codes, or related ordinances; The age, special needs, and swimming ability of the child in care placed in the resource home; The proximity and location of the pool, hot tub, spa, or body of water to the resource home; and Any other safety mechanism in place that ensures the safety of the child in care. Restrictions. A local department may not permit a resource parent it licenses to: Provide child care unless registered with the Maryland State Department of Education as a child care provider; Be approved to provide child or adult care by more than one agency unless the local director or designee gives approval in writing; Be licensed as both a child placement and an adult placement resource unless the Administration gives the resource parent written approval for the express purpose of allowing a child in care to transition to the care of the Maryland Developmental Disabilities Administration in the Maryland Department of Health; Be licensed by a private and public child placement agency concurrently; Independently accept a child for care from an individual or agency other than the agency that licensed the resource parent; Provide housing and care except to a child of a relative or friend on a temporary basis, and this child shall be counted as the resource parent's own child in the count of the children in the home; Care for an adult who has special medical or mental health needs unless the local department evaluates the situation and determines that this care does not interfere with the care of the child in care; Except as provided for in § B of this regulation, care for more than six children in the resource home, including those of the resource parent; Care for more than two children under the age of 2, including the resource parent's own children, unless approved by the local department. Exception. The local department may permit a resource parent to care for up to eight children, including the resource parent’s children: When necessary to keep a sibling group together; In the case of an emergency placement of up to 90 days; or In appropriate circumstances, if the local director or designee has given written approval. Resource parent licensed as a child care provider. When a resource parent is licensed to provide child care, the resource parent: May not exceed the child capacity number stated on the certificate of registration issued by the Maryland State Department of Education Office of Child Care; Shall follow the age and child-to-adult ratio requirements outlined by the Maryland State Department of Education Office of Child Care; and Shall provide a signed copy of the dual license agreement between the resource parent, the Maryland State Department of Education Office of Child Care, and the local department. Education. Homeschooling. A resource parent: May not homeschool a child in care without court approval; Shall utilize a homeschool program approved by Maryland State Department of Education; and Shall provide homeschool progress reports at a frequency established by the local department or the court. Private or Parochial Schooling. A resource parent shall get approval from the local department or the child in care’s parents or legal guardians before enrolling a child in care in a private or parochial school, unless otherwise ordered by the court. If a local department or the child in care’s parents or guardians approve a child in care’s enrollment in a private or parochial school, the local department: May not pay any costs for tuition, books, or any other costs associated with a child in care enrolled in an accredited private or parochial school; and May not supplement the monthly care stipend to pay these costs. Enrollment. When a child who enters care is already enrolled in an accredited private or parochial school, the resource parent shall enroll the child in care in a public school unless the resource parent, with the permission of the local department or the child in care’s parents or legal guardians, assumes financial responsibility for the child in care’s continued enrollment in the private or parochial school or the parents or legal guardians continue to financially provide for the education. A local department shall license a resource parent who can meet the complex needs of children in care while supporting reunification or other permanency plans. A resource parent shall have the following characteristics: Knowledge of and ability to provide children in care a positive, nurturing, and trauma-informed environment; Willingness to work cooperatively with the local department in: The best interest of the child in care; Establishing a supportive relationship with the parents or legal guardians and other family members of the child in care; Supporting the permanency plan established by the local department and the courts; Supporting the goals established in the case plan; Being available to local department staff for communication and home visits; and Ensuring that the requirements of this chapter are met. Maturity and personality characteristics that: Help the child in care understand placement in out-of-home care and the child in care's own feelings about the placement; and Help maintain the child in care’s family connections through regular and consistent family contact as required by the local department. The capacity to value, understand, respect, and support individuals from different racial, ethnic, religious, cultural heritage, socio-economic backgrounds, sexual orientation, and gender identity and expression from that of the resource parent; The capacity to understand that it is in the best interest of a child in care, of multiracial parentage to have multiracial experiences; The skills to promote the process of socialization through family life to enhance the child in care's growth and learning; The suitability in age and physical stamina to meet the demands of the care of growing children; The emotional capacity to handle life's stresses and adapt to change and difficult situations; The willingness to support and encourage a child in care's educational progress and take an active role by attending school conferences and similar activities whenever possible; and The ability to provide time free from the interference of other responsibilities and to give a child in care needed care, supervision, and attention. Pre-service Training. Each resource parent applicant shall complete a pre-service training program approved by the Administration. This training shall cover the following: Role and relationships between local department personnel, the resource parent, the child in care's parents or legal guardians, and the child in care; Developmental needs of children in out-of-home care; Attachment, separation, grief, and loss; Trauma-related behaviors and trauma-informed parenting; Confidentiality; Behavior management; Reasonable and prudent parenting; Co-parenting with parents and legal guardians; Supporting a child in care’s relationship with their parents or legal guardian; Maintaining a child in care’s connections; Reunification and permanency plans; Effective communication; Conflict resolution; Cultural and religious differences between the resource parent and the child in care’s family Issues faced by individuals who identify as LGBTQIA+2; Caring for children in care with medical, mental health, and behavioral needs; Recognizing and responding to signs of depression, anxiety, and other mental health conditions; Administration and storage of medications; Recognizing and reporting signs of child abuse and neglect; and Services available for children in care and resource parents. The local department may consider another nationally recognized pre-service training program completed within the prior 3 years as meeting the pre-service training requirement. If a resource parent applicant completes the pre-service training, the training is valid for 3 years from the date of completion. Resource parents who relocate to Maryland and have had an active resource home license in another state within the prior 3 years may be exempt from pre-service training requirements at the discretion of the local department. Continuing Training. Each resource parent shall complete at least 10 hours of training approved by the local department annually, including 2 hours of behavior management training, every 2 years. The training may cover the areas listed in §A of this regulation and any additional topics as needed. CPR & First Aid Training. Prior to a local department licensing a resource parent and at 2-year intervals thereafter, each resource parent shall complete cardiopulmonary resuscitation (CPR) and first aid training. Consideration. The local department shall prioritize initiating a home study on the basis of the applicant's flexibility in the children they can parent and the needs of children in out-of-home care. Local Department Assessment. The home study process shall provide an opportunity for a local department to study and assess an applicant’s potential for resource parenting; and The local department shall use a home study framework approved by the Administration. Self-Assessment. The home study process shall include an opportunity for the applicant to assess their potential for resource parenting. A home study shall provide in-depth information about out-of-home care, reunification, and adoption to an applicant, including: The differences between foster parenting, parenting one's own child, and adoption of a child; The reasons children enter out-of-home care; The needs and challenges of children in need of out-of-home care and adoption, including medical, mental health, behavioral, educational, and social needs; The needs and expectations of parents, or legal guardians and their rights, and responsibilities, including visitation; The importance of family and kinship connections including the priority of placing children with family or kin whenever available; The role and responsibilities of resource parents to the child in care, the child in care’s parents, kin or legal guardians, the local department, and the resource parent's own family; The role and responsibilities of the local department to the resource family, the child in care, and the child in care’s family and kin; The Administration's behavior management, confidentiality, and reasonable and prudent parenting policies; The impact foster care and adoption may have on the applicant’s own family; The impact that separation and placement may have on the child in care, the child in care’s family, and the resource family; The nature and purpose of the permanency plan, the case plan, and the service agreement; The requirements for licensing a resource parent; Understanding that the priorities of a permanency plan may change throughout the life of the case; The option to be considered as an adoptive home for children who have a permanency plan of adoption by a non-relative; The legal, technical, procedural, financial, medical, and educational aspects of foster care; An overview of the Citizens Review Board for Children and other review processes and the resource parents' role in these processes; and The requirement that each resource parent applicant attend and complete the pre-service and continuing training and any additional training required by the Administration. Resource Home Study Process. Initiation of Application. The applicant shall: Sign a resource parent application and, as applicable, the consent to release confidential information forms; Complete resource home application materials; Participate in home study interviews; and Complete other tasks as requested by the local department. Visits. The worker shall conduct at least three visits with the applicant, one of which may be conducted by videoconference. The visits in the applicant’s home shall include: A discussion with all household members; and An inspection of the home. References. The worker shall obtain three personal written references. One of the references shall be by a relative; and Two of the references shall be by non-relatives; The worker shall conduct interviews with each reference: Two of the interviews, shall be in-person or by video conference; and The third interview may be conducted by telephone. The worker shall obtain a written reference from a school staff member or homeschool monitor for each school-aged child in the applicant’s home. Recommendation of Resource Home for Licensing. A local department shall notify an applicant in writing, within 120 days of the date that the local department accepts the application, of its decision to approve or deny licensure. An applicant aggrieved by a decision may file an appeal according to Regulation .20 of this chapter. An individual licensed under this chapter as a resource parent is dually licensed for both foster care and adoption. The local department may deny an application if: The applicant, a household member, or the home in which the child in care will be placed fails to meet the requirements of this chapter; The local department’s evaluation of the application materials reveals that the applicant knowingly reported false information; The local department, another department, or a private child placement agency has previously denied or revoked a license of the applicant as a resource home, kinship home, or adoptive resource unless the local department is satisfied that the condition that was the basis for the denial or revocation has been corrected; The applicant prevents the local department from completing its responsibilities for licensure; An evaluation of criminal records or child abuse or neglect records of the applicant or a household member indicates behavior harmful to a child in care; or Based on substantial, credible evidence, the local department concludes that the applicant cannot provide for the health, safety, or welfare of the children in care because of abuse of alcohol or other controlled dangerous substances, mental health concerns, or any other condition that creates reasonable doubt as to the applicant's ability to provide foster care. A local department shall: Conduct an annual reconsideration of each resource parent and resource home that includes at least one home visit to determine continuing compliance with this chapter. Provide written notice to the resource parent of an upcoming annual reconsideration at least 60 days prior to the reconsideration due date; Conduct a review of the resource home record and interview the worker for each child in care placed in the resource home in preparation for the reconsideration; Conduct an inspection of the resource home and complete a home health and safety survey and fire safety survey; Review and obtain an updated signed copy of the resource parent and kinship caregiver agreement; Obtain written verification of each resource parent’s income, if applicable; Obtain written verification of an updated medical examination every 2 years from the date of licensure for all household members or when there are indications of serious health problems; Obtain proof of updated rabies vaccinations for any pets, if applicable; and Update the CPS, Motor Vehicle Administration, Maryland Judiciary Case Search, and Maryland and National sex offender registry clearances for the resource parent and household members 18 years old or older, and a child support clearance for the resource parent. A new household member who will take on the role of a resource parent shall complete: An application to be a resource parent; All other forms required of a resource parent; Clearances required of a new resource parent; and Preservice training; A worker may discuss the following with the resource parents: Composition of the resource family, The relationship of the resource parents with each other, with their own children, and with the children in care; Satisfactions and difficulties of resource parenting; The family’s social and recreational activities, and household responsibilities; Methods of behavior management; The resource parents’ relationship with the child in care’s parents and family; The results of any clearances, as appropriate; The resource parent’s child care plan; The resource parent’s involvement in meeting the child in care’s education and health care needs; Any preferences for children in care placed in the resource home in the future in terms of number, age, or gender; and The child in care’s permanency plan. The worker shall complete the annual reconsideration and share the status of the license with the resource parent, in writing within 30 days of the reconsideration date. Major Changes. Resource parents shall notify the local department of major changes in their lives that may affect their ability to care for children in care, including: Illness or death of a household member; Marital problems or significant conflict in the household; A move to a new residence; Suspected abuse or neglect in the home; and Changes in the family composition due to individuals leaving or joining the household, marriage, separation, divorce, or another occurrence. The local department shall discuss each major change and determine whether to complete a reconsideration. If the resource parent moves to a new residence, the local department shall assess the home by completing: A fire safety survey; and A home health and safety survey. A local department shall: Provide pre-service and continuing training opportunities; Help resource parents understand their rights and responsibilities; Consistent with regulation .12A of this chapter, provide the resource parents with all known information that is available about the child in care and the reason the child in care entered out-of-home care; Advise the resource parents about medical requirements regarding children in care; Provide resource parents with a health passport for each child in care placed in the resource home; Maintain regular contact with the resource parent and the child in care in the resource home; Provide appropriate supportive services that will enable the resource parents to meet the unique needs of the child in care; Respond as soon as possible or provide appropriate crisis response contacts for crisis situations that may arise from the child in care's placement in the resource home; Upon placement, initiate a monthly care stipend for the resource parents and explain the initial clothing allowance and how to obtain payment or reimbursement for allowable expenditures made to meet the child in care's needs, including child care; Inform the resource parents of any requirements in the service plan that would directly affect a child in care; Inform the resource parents of the child in care's permanency plan, including family finding efforts, and keep the resource parents updated as to the progress of that plan and give the resource parents the ability to provide input as to the plan; Obtain the agreement of resource parents to any visitation plan that involves the use of the resource parents' home or requires the resource parents to transport the child in care, with attempts made to balance the resource parents’ right to privacy with the right of the parents to visit the child in care; and Assist the resource parents in preparation for the separation of the child in care from out-of-home care. Information About a Child in Care. Prior to a local department placing a child in care in a resource home, and upon learning new information, the worker shall provide the resource parent with all known information about the child in care’s medical, mental health, behavioral, educational, social, and emotional background, including the reason the child in care came into care and any change in the case plan. Information about the child in care’s family that may be privileged or confidential may not be disclosed. Monthly Care Stipend. Upon placement, the resource parent has a right to a timely monthly care stipend, an initial clothing allowance if this is the child in care’s first placement, and timely reimbursement for allowable expenditures made to meet the child in care's needs, including child care. Notice of Court Hearings and Meetings. Except for meetings covered by attorney-client privilege, or meetings when confidential information about the parents or legal guardians is discussed, the worker shall advise the resource parent of: The date and time of, and when applicable, right to participate in, family team decision meetings and educational or mental health team meetings regarding a child in care placed in the resource home; Unless waived for good cause, at least 10 days before scheduled court proceedings, the date and time of any scheduled court hearing; The right to be heard at court hearings; Recommendations the local department will make in court regarding the child in care’s permanency plan, placement, or visitation; and Decisions made by the local department and court regarding a child in care placed in the resource home. Advance notice of removal. Except as waived by court order or when the local department determines that a child in care is at imminent risk of harm, the local department shall give the resource parent reasonable written notice of plans to remove the child in care from the resource home. A resource parent has the right to liability insurance coverage for certain damages in accordance with Regulation .19 of this chapter. Responsibilities to a Child in Care. A resource parent shall: Participate in the child in care's physical health, mental health, and dental health care, including documenting every healthcare visit in the child in care’s health passport and advising the child in care’s worker; Participate in the child in care's educational process; Provide supervision and guidance appropriate to the child in care's age and developmental level; Provide daily essentials that are required for the health, comfort, and personal care of a child in care; Help the child in care cope with any anxiety of being away from the child in care’s family or guardians, and promote the child in care’s self-esteem and positive self-image; Respect the child in care and the child in care's family and kin; Whenever possible engage and partner with the child in care’s family and kin; Be sensitive to and respect the child in care's individual needs, tastes, and values, and support the child in care's religious beliefs, cultural customs, sexual orientation, and gender identity and expression; Involve the child in care in family activities; Establish clear expectations for and limits on behavior; Provide or arrange transportation to appointments, extracurricular activities, employment, and social, and cultural events; Support the child in care in understanding their permanency plan and any move from the resource home; Provide an environment free from exposure to secondhand smoke for a child in care; Protect confidential information regarding a child in care and their family; Responsibilities to a Child in Care's Family. A resource parent shall: Assist the local department in maintaining and improving the child in care's relationship with the child in care’s family and support this relationship by helping with family visits, which may include visits in the resource home; Maintain an attitude of respect and understanding towards the child in care’s family; Provide regular updates and information about the child in care's life; and Serve as a role model for the child in care’s family. Responsibilities to the Local Department. A resource parent shall: Participate in required training; Work as a team member in assessing a child in care's strengths and needs, and implementing the child in care’s case plan; Update the local department on the child in care's development and adjustment; Attend case reviews and meetings as requested by the local department; Immediately notify the local department of changes within the resource family, such as: Employment and child care arrangements; Composition of the household; Address, telephone number, and email address; Health status; and Stressful conditions that may affect the child in care. Provide at least 30 days notice when requesting a child in care be moved except in circumstances that immediately affect the child in care or resource family’s health or safety; Report any suspected incident of child physical or sexual abuse or neglect to the local department as soon as the incident becomes known to the resource parent; Notify the local department if a child in care runs away or otherwise cannot be located; and Notify the local department of any criminal charges, investigations, or findings related to any crime committed or alleged to have been committed by a household member. The local department shall provide resource parents with developmentally appropriate and trauma-informed resources to manage the behaviors of children in care, including behavior management methods, and connect the resource parent with community programs to address concerning behaviors. Resource parents shall establish clear expectations for behavior and understand and manage challenging behaviors in a trauma-informed manner, rewarding good behavior. Only a resource parent or other adult caregiver approved by the local department and known to the child in care may discipline a child in care. Resource parents may only physically restrain a child in care to protect the child in care from self-injury or from injuring others. Prohibited punishments include: Using corporal punishment that includes spanking, shaking, physical hitting, or any other type of physical punishment, no matter how inflicted; Requiring physical exercises such as running laps or performing pushups; Forcing a child in care to assume or hold an uncomfortable position such as squatting or bending, or to repeat physical movements; Confining a child in care in a locked room; Using mechanical or chemical restraints; Denying essential program services, such as not taking a child in care to a planned appointment for educational, psychiatric, or psychological services; Withholding visitation or communication with the child in care’s family or kin; Withholding meals, clothing, or bedding, or disrupting a child in care’s sleep; Making remarks that belittle or ridicule a child in care or a child in care's family; and Threatening to have a child in care removed from the resource home. Initial Notification. If the local department receives a report of suspected abuse or neglect and initiates an investigation, the local department shall: Notify the resource parent that a report of abuse or neglect has been made; and Notify the parents or legal guardians of any children in care living in the resource home and the children in care’s attorney. Investigation. The CPS unit of a local department shall respond to the report of abuse or neglect as required by COMAR 07.02.07. An allegation of abuse or neglect in a resource home does not require the automatic removal of children in care placed in the resource home. The local department shall assess and determine whether it is in the best interests of any children in care placed in the resource home to remain in the resource home pending completion of the investigation. A local department staff member shall visit the resource home at least weekly as long as any children in care remain in the home until the local department makes a decision about the continued licensure of the resource home. A local department shall not place additional children in care in the resource home for care or respite care pending the outcome of the investigation and a decision by the local director or designee as to the continued licensure of the resource home. The worker and resource parent may take any necessary actions to ensure the safety of the alleged victim pending completion of the investigation, but shall not create a safety plan for children in care. Continued Licensure of Resource Home. Within 5 business days of completing the investigation, the local department shall determine whether the resource parent, household members, and resource home still meet the standards for a license and make a recommendation to the local director as to the continued licensure of the resource parent. Within 5 business days after receiving the recommendation of the staff, the local director shall render a written decision as to the continued licensure of the resource parent and whether any children in care removed from the resource home may be returned. The local department shall provide the written decision to the parents or guardians of any children in care living in the resource home, the attorneys for those children in care, and the resource parent. A copy of the local director's decision shall be forwarded to the Administration and uploaded into the electronic system of record of the resource parent and any children in care placed in the resource home when the alleged abuse or neglect occurred. A licensed resource parent may choose to suspend acceptance of children in care for up to 1 year and still maintain licensed status. During the period in which the license is on hold, the resource parent is not required to undergo an annual reconsideration. At the point that the resource parent wishes to accept children in care, the local department shall complete a reconsideration. The local department shall close the resource home if the resource parent does not wish to accept children in care at the end of the 1-year period. The local department shall give a resource parent 30 days written notice that includes the intended action to close the resource home and the resource parent's right to appeal the local department’s decision. If former resource parents request that their home be relicensed within 3 years of being closed in good standing, the local department shall conduct a reconsideration as required under Regulation .10 of this chapter and require that: Each resource parent and household members 18 years old or older apply for new state and federal fingerprint-based criminal background clearance and CPS clearances; Each resource parent completes 10 hours of in-service training, including 2 hours of behavioral management training; and Each resource parent completes CPR and first aid training, if it has been more than 2 years since last completed. If former resource parents have been closed for more than 3 years, the resource parents may apply to be relicensed and shall meet all the requirements outlined in this chapter. Closure of a Resource Home. A local department may close a resource home for one or more of the following reasons: The local department has not placed any children in the resource home in the previous 2 years; or The characteristics of the children the resource parent is willing to accept for care in the resource home are not consistent with the characteristics of the children in care or entering care. The local department shall give a resource parent 30 days written notice that includes the intended action to close the home and the resource parent's right to appeal the local department’s decision. Suspension. After receiving a complaint indicating possible violations of the resource home regulations, a local department shall assess to determine compliance with applicable regulations and discuss the possible violations with the resource parent. A local department may suspend a resource parent license for a period not exceeding 60 days for a violation of these regulations. Except in situations that permit an emergency suspension, the local department shall provide 20 days advance notice of a suspension and send the resource parent: Notice that includes the intended action; A statement of the grounds and specific regulations violated; and A statement describing the resource parent's right to appeal the decision of the local department. When a resource parent license is suspended, the local department may not place any new children in care in the resource home. Children in care may remain in the home only if: The suspension was caused by a violation of these regulations that does not threaten the health and safety of the children in care; The local department agrees that the reason for the suspension can be corrected within 60 days from the date of the suspension; or The resource parent files an appeal within 20 days of the local department's notice. If the resource parent does not correct the reason for the suspension, the local department shall remove the children from the home within 60 days of the date of suspension. The local department shall restore the resource parent’s license status or revoke the license by the end of the suspension period. Revocation. The local department may revoke a license for any violation of these regulations. Except in situations that permit an emergency revocation the local department shall provide 20 days advance notice of a revocation. The local department shall send the resource parents; Notice that includes the intended action; A statement of the grounds and specific regulations violated; and A statement describing the resource parent's right to appeal the decision of the local department. If the resource parents do not appeal an intended revocation within 20 days, the local department shall immediately remove the children from the home. Emergency Suspension or Revocation. If the local department finds evidence of gross incompetence or gross misconduct in the resource home or other action or condition that poses an immediate threat to the children’s health and safety, the local department shall, without giving 20 days notice, suspend or revoke the resource parent license. The local department shall send the resource parents; Notice that includes the intended emergency revocation or suspension; A statement of the grounds and specific regulations violated; and A statement about the resource parent’s right to appeal the local department’s If the local department decides to issue a notice of an emergency revocation or suspension, the local department shall immediately remove the children. Once suspended or revoked on an emergency basis, the local department shall not restore the resource parent’s license unless: The resource parent has received a favorable appeal hearing decision; or The local director has given written approval for the reinstatement. The Administration shall provide liability insurance for resource parents who care for children under certain conditions. The insurance shall cover the following: Bodily injury and property damage that a child in care causes to a person or the property of a person other than a resource parent; and Actions against a resource parent by a natural parent for any accident to the child. Reimbursement. Subject to the provisions of this section, the Department shall reimburse a resource parent for costs of bodily injury or property damage that the child in care causes to the resource parent and that insurance does not cover. Before reimbursement under this subsection, the Department shall be satisfied that the actions of the resource parent did not contribute substantially to the bodily injury or property damage sustained. Reimbursement under this subsection shall be made for all costs to a maximum amount of $5,000. All payments in excess of $2,000 require the approval of the Board of Public Works. The Department shall advise the resource parent of this coverage and that it will not cover claims related to: Injury or damage to which the resource parent substantially contributed; Injury or damage covered by the resource parent’s insurance; Claims of alienation of affection; Accidents involving vehicles that are licensed or intended for road use; Claims exceeding $5,000.00; and Injury or damage that was otherwise covered by insurance. Appeal Rights. A resource parent aggrieved by a local department's decision to deny, suspend, or revoke a license may appeal under COMAR 07.01.04. Exclusive Jurisdiction of Courts. A resource parent may not use these procedures to appeal a court’s decision or a decision only a court can make. Expedited Appeal. A resource parent who intends to adopt a child in care whom the local department placed in the resource home may appeal a local department’s decision to remove the child in care by advising the local department within 30 days of the removal. The local department shall notify the Office of Administrative Hearings of the appeal. The Office of Administrative Hearings shall hold a hearing and issue a decision within 45 days of receiving the request. Additional Hearing Rights Under COMAR 07.02.26. If a local department removes a child from a resource home because of a child protective services finding, the local department shall advise the resource parents of the rights of the alleged maltreater to request a hearing under COMAR 07.02.26 to challenge that finding. Human Services Article, §2-209, Annotated Code of Maryland Effective date: July 4, 1994 (21:13 Md. R. 1155) Chapter revised effective December 12, 2002 (29:24 Md. R. 1918) Regulation .02B amended effective June 15, 2009 (36:12 Md. R. 836) Regulation .08A amended effective June 15, 2009 (36:12 Md. R. 836) Chapter revised effective April 16, 2012 (39:7 Md. R. 490) Regulation .04E amended effective September 30, 2013 (40:19 Md. R. 1543) Regulations .01—.24 repealed and new Regulations .01 — .20 adopted effective December 12, 2024 (51:24 Md. R. 1081) Except as set forth in §B of this regulation, an individual found responsible by a local department for indicated or unsubstantiated child abuse or neglect or who was alleged to have abused or neglected a child in a case that resulted in a finding of indicated or unsubstantiated child abuse or neglect with no maltreator identified is entitled to an opportunity to appeal in accordance with this chapter. In those cases in which, before June 1, 1999, a local department made a finding of indicated or unsubstantiated child abuse or neglect and an individual has not been offered an opportunity for a contested case hearing, and the individual has now requested a hearing, that appeal will be conducted in accordance with the procedures in these regulations under the substantive law applicable at the time of the local department’s finding. In this chapter, the following terms have the meanings indicated. Terms Defined. “Administrative law judge (ALJ)” means an administrative law judge of the Office of Administrative Hearings. “Alleged maltreatment” means child abuse or neglect reported to a local department. “Alleged maltreator” means an individual reported to a local department as responsible for child abuse or neglect. “Alleged victim” means a child named in a report as having been abused or neglected. “Appellant” means an individual who has requested an appeal under this chapter. “Centralized confidential database” means the Department’s confidential computerized data system that contains information regarding child abuse and neglect investigations and assessments and protects that information from disclosure. “Child abuse” has the meaning stated in COMAR 07.02.07.02B. “Child in need of assistance (CINA)” has the meaning stated in Courts and Judicial Proceedings Article, §3-801(f), Annotated Code of Maryland. “Child neglect” has the meaning stated in COMAR 07.02.07.02B. “Conference” means a meeting requested by an appellant to discuss a finding of unsubstantiated child abuse or neglect with a local department supervisor. “Contested case hearing” has the meaning stated in State Government Article, §10-202(d), Annotated Code of Maryland. “Department” means the Department of Human Services. “Final determination” means a finding of the local department after all timely appeals. Hearing. “Hearing” means a contested case hearing pursuant to State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland. “Hearing” does not include a record review hearing under appeal procedures in place between 1993 and 1999. “Identify an individual as responsible for child abuse or neglect in a centralized confidential database” means entering a notation that a local department has determined that the individual is responsible for indicated child abuse or neglect under circumstances specified in Family Law Article, §5-714, Annotated Code of Maryland. “Identifying information” means the name of: The alleged victim; A household or family member of the alleged victim; A parent or legal guardian of the alleged victim; and The alleged maltreator. “Indicated” means a finding that there is credible evidence, which has not been satisfactorily refuted, that child abuse or neglect occurred. “Local department” means the department of social services, or the Montgomery County Department of Health and Human Services, that made the finding being appealed in accordance with this chapter. “Maltreator” means an individual whom a local department has found responsible for indicated or unsubstantiated child abuse or neglect. “Office of Administrative Hearings (OAH)” means the unit within the Executive Branch established by State Government Article, §9-1602, Annotated Code of Maryland. “Party” means the appellant or the local department. “Record” means the original or a copy of any documentary material, in any form, concerning a Child Protective Services response to an allegation of child abuse or neglect. “Redacted record” means a copy of the record from which the local department has removed certain information in compliance with State and federal laws governing confidentiality, including but not limited to: Annotated Code of Maryland: Health-General Article, Title 4, Subtitle 3; General Provisions Article, Title 4, Subtitle 3; Human Services Article, §§1-201—1-203; and Courts and Judicial Proceedings Article, §§3-827, 9-108, and 9-121; Code of Maryland Regulations (COMAR): 07.01.07; and 07.02.07;and Code of Federal Regulations (CFR): 34 CFR 99; 42 CFR §2.1 et seq.; and 45 CFR 1340.20. “Report” means an allegation of child abuse or neglect made or received by any state, county, or municipal corporation, with sufficient information to screen the report for an appropriate CPS or other response. “Responsible for child abuse or neglect” means having an unexpunged finding of unsubstantiated or indicated child abuse or neglect. “Ruled out” means a finding that child abuse or neglect did not occur. “Unsubstantiated” means a finding that there is insufficient evidence to support a finding of indicated or ruled out. An appeal of a finding of indicated child abuse or neglect under this chapter shall consist of a hearing. An appeal of a finding of unsubstantiated child abuse or neglect under this chapter shall consist of: A conference with a supervisor at the local department; and A hearing, if requested. This chapter and COMAR 07.01.04 govern the procedures and practice in all hearings conducted under this chapter. In the event of a conflict between this chapter and COMAR 07.01.04, this chapter applies. The time limits set forth in this chapter may be waived for good cause. A local department's finding is affirmed if: An individual does not request, when offered, a conference or a hearing; or An individual fails to attend, when scheduled, a conference or a hearing. Within 30 days after a local department has completed an investigation of child abuse or neglect, the local department shall send a notice of action to: An individual whom a local department has found responsible for indicated or unsubstantiated child abuse or neglect; and An individual alleged to have abused or neglected a child in a case that resulted in a finding of indicated or unsubstantiated child abuse or neglect with no maltreator identified. The notice shall include: The finding; An explanation of how to appeal to OAH in accordance with this chapter, including the obligation to pay a filing fee or request a waiver of the fee; A statement that the local department may identify an individual as responsible for child abuse or neglect in a centralized confidential database if the individual: Is found guilty of any criminal charge arising out of the alleged child abuse or neglect; Is found responsible for indicated child abuse or neglect in a final determination; or Has failed to successfully appeal a finding of indicated child abuse or neglect in accordance with this chapter. A statement of the circumstances under which the finding may be disclosed; Notice of an appellant’s obligation to notify OAH of any criminal or CINA proceedings arising out of the alleged child abuse or neglect; and Notice of an appellant’s obligation to immediately advise the local department and OAH of a change of address. A local department may send a single notice if an individual is found responsible for: Abuse or neglect of more than one child; or More than one incident of abuse or neglect of one child. The local department shall send the notice to the individual at the address noted in the record. Minors. If the individual to whom the local department would send notice under §A of this regulation is younger than 18 years old and not legally emancipated, the local department shall send notice to the individual's: Parent or legal guardian; and If the individual is a foster child: To the attorney, if the child is represented; and To the local department worker assigned to the child’s foster care case. Indicated Child Abuse or Neglect. An individual found responsible for indicated child abuse or neglect or any individual who was alleged to have abused or neglected a child in a case that resulted in a finding of indicated child abuse or neglect with no maltreator identified may appeal the finding by, not later than 60 days after receipt of the local department's notice of action, filing with OAH: The required filing fee or appropriately documented request for a fee waiver; and The contested case hearing request form. Unsubstantiated Child Abuse or Neglect. An individual found responsible in a case of unsubstantiated child abuse or neglect or any individual who was alleged to have abused or neglected a child in a case that resulted in a finding of unsubstantiated child abuse or neglect with no maltreator identified may appeal the finding by forwarding to the local department, not later than 60 days after receipt of the local department's notice of action, a written request for a conference. Failure of an appellant to comply with the requirements in this regulation shall result in dismissal of the appeal. OAH shall notify the local department of a request for a hearing not later than 15 days after receipt. If a local department receives a request for a hearing with a proper fee enclosed or an appropriately documented request for a fee waiver, it shall forward the request to OAH not later than 10 days after receipt. If a local department receives a request for a hearing without the proper fee or appropriately documented request for a fee waiver, it shall return the request to the appellant as soon as possible but not later than 10 days after receipt. If OAH receives a request for a conference, it shall forward the request to the local department not later than 10 days after receipt. An individual is presumed to have received the notice of action 3 business days after the date on the top of the form. OAH will schedule the hearing in the jurisdiction where the appellant resides unless all of the parties consent to another venue. An appellant shall notify OAH of: A pending criminal proceeding arising out of the alleged child abuse or neglect; and The final resolution of a criminal proceeding arising out of the alleged child abuse or neglect. If a criminal proceeding is pending on charges arising out of the alleged child abuse or neglect, OAH shall stay the hearing until final disposition of the criminal proceeding. If, after final disposition of the criminal proceeding, the appellant is: Found guilty of any criminal charges arising out of the alleged child abuse or neglect, including being found guilty and receiving probation before judgment or taking an Alford plea, OAH shall dismiss the appeal; or Found not guilty of any criminal charges arising out of the alleged child abuse or neglect or if the charges were dismissed or put on the stet docket, OAH shall vacate the stay and schedule further proceedings in accordance with this chapter. An appellant and the local department shall notify OAH of any CINA proceeding of which they are aware concerning a child: Who has been allegedly abused or neglected by the appellant; or Who is in the care, custody, or household of the appellant. If a CINA proceeding is pending, OAH shall stay the hearing until the child is found by a court to be a CINA or the CINA proceeding is otherwise concluded. After a CINA proceeding has concluded, OAH shall vacate the stay and schedule further proceedings in accordance with this chapter. Within 10 days of receiving a request for a conference, the local department shall: Schedule a conference to occur at the local department within 30 days of the local department receiving the conference request; and Send notice to the appellant that includes the: Date and time of the conference; and Procedures for the conference. The conference shall be attended by: The appellant; A local department supervisor; and Other local department staff as designated by the local department. Redacted Record. At the conference, the local department: Shall permit the appellant to review the redacted record in the presence of a local department supervisor; and May give the appellant a copy of the redacted record. The supervisor attending the conference shall explain to the appellant: The local department's finding; The basis for the finding; The purpose of the conference, including allowing the appellant to have an opportunity to request: That the record, including the finding, be modified; and That the record be supplemented by information the appellant provides. The appellant's right to appeal the outcome of the conference in accordance with Regulation .09B and C of this chapter; and The possible modification of the finding to indicated or ruled out child abuse or neglect as a result of a requested hearing. Summary. Within 10 days of the conference, the local department shall send to the appellant a written summary of the conference including: Any modifications the local department will make to the record or finding; A description of any information the local department will add to the record; and If the finding has not been changed, a contested case hearing request form and procedures for appealing the finding of the unsubstantiated child abuse or neglect conference in accordance with this chapter. If an appellant fails to appear for a scheduled conference and within 5 business days does not show good cause for failing to appear, the local department shall advise the appellant in writing that: The appeal is terminated; and The appellant may not request a hearing to appeal the local department's finding of unsubstantiated child abuse or neglect but may request a hearing to appeal the local department's decision that the appellant did not show good cause for failing to appear at the scheduled conference. If as a result of the conference the local department does not agree to modify its unsubstantiated finding, the appellant may appeal the finding of unsubstantiated child abuse or neglect in a hearing in accordance with this chapter. An appellant may appeal the finding of unsubstantiated child abuse or neglect by, not later than 60 days after receipt of the local department’s summary of conference, filing with OAH: The contested case hearing request form; The summary of the conference; and The required filing fee or appropriately documented request for a fee waiver. If an appellant does not receive a written summary of the conference within 20 days of the conference, the appellant may appeal the finding by: Requesting a contested case hearing request form from the local department; and Sending to OAH not later than 80 days after the date of the conference: The contested case hearing request form; and The required filing fee or appropriately documented request for a fee waiver. OAH shall dismiss the appeal of an unsubstantiated finding by any individual who does not submit a summary of the conference unless the individual can establish that: The individual had a conference but did not receive a conference summary within 20 days of the conference; or The individual requested a conference in accordance with this chapter, and that: The local department failed to schedule a conference in accordance with this chapter; or The individual had good cause for failing to attend a scheduled conference. Upon written request, a local department shall offer an individual found responsible for an unexpunged finding of indicated or unsubstantiated child abuse or neglect made before June 1, 1999, an opportunity to appeal in accordance with this chapter, if the individual has not: Been found guilty of a criminal charge arising out of the alleged child abuse or neglect; Previously had a hearing at OAH to appeal the finding; or Previously been given notice of the opportunity to request a hearing. Upon written request, a local department may offer an individual found responsible for an unexpunged finding of indicated or unsubstantiated child abuse a hearing if the individual provides documentation of a change of address prior to the local department sending notice of the finding and of appeal rights. Any hearing held in accordance with §A or B of this regulation will be: Conducted under current appeal procedures; and Decided based on the law defining child abuse or neglect at the time the finding was made. The local department shall serve the appellant with the redacted record not later than 14 days before the scheduled hearing. Service is presumed to occur 3 days after mailing. If service of the record does not occur in accordance with this regulation, the appellant may request a reasonable postponement to review the record. The local department is not required to provide a summary of the basis for its action. By written request made at least 10 days before the hearing, the parties have the right to receive, not later than 5 days before the hearing, copies of documents and a list of witnesses to be presented by the other party at the hearing. OAH may prohibit the introduction of information requested pursuant to §C of this regulation if the information was not provided 5 or more days before the hearing. OAH's rules of discovery as set forth in COMAR 28.02.01 do not apply in contested cases conducted under this chapter. A party may not call a child younger than 14 years old to testify or otherwise participate in a hearing under this chapter unless the party seeking to introduce the child’s testimony or involve the child demonstrates that: The child's testimony or involvement is essential to a determination of the appeal; and There is no likelihood that the requested testimony or involvement will emotionally harm the child. The local department bears the burden of proof at the hearing. The local department's record shall be presumed authentic. Representation. The local department's case may be presented by a local department representative or an attorney representing the local department. An appellant’s case may be presented by the appellant or an attorney representing the appellant. An appellant may withdraw a request for a hearing at any time by notifying OAH in writing of the intent to withdraw. If the appellant withdraws the request, OAH shall dismiss the appeal and notify the local department. If the local department notifies OAH in writing that it has modified the finding to ruled out, OAH shall cancel the hearing and notify the appellant. Dismissal or voluntary withdrawal of an appeal or request for a hearing automatically affirms the local department's finding and, in the case of a finding of indicated child abuse or neglect, the local department's right to identify the appellant as an individual found responsible for child abuse or neglect in a centralized confidential database. Not later than 45 days after the hearing, OAH shall issue a decision and order to the: Appellant or, if represented at the hearing by an attorney, the appellant’s attorney; The local department’s appeal representative or attorney; and The Department. The decision and order shall: Summarize the evidence presented; and Contain a determination as to whether the local department established by a preponderance of the evidence that its finding was consistent with the law and supported by credible evidence. If the ALJ upholds a local department's finding of the appellant as responsible for indicated child abuse or neglect, the ALJ shall permit the local department to identify the appellant as responsible for child abuse or neglect in a centralized confidential database. If the ALJ determines that the local department's finding or the identification of the appellant as responsible for unsubstantiated or indicated child abuse or neglect was not consistent with the law or not supported by credible evidence, the ALJ shall order the local department to do one or more of the following: Modify the finding to indicated, unsubstantiated, or ruled out; Expunge all references to the appellant as responsible for child abuse or neglect; or Change the type of maltreatment from: Abuse to neglect; or Neglect to abuse. After OAH issues the decision and order, OAH shall return the contested case record to the Department. The ALJ's decision is subject to appeal by any party pursuant to State Government Article, §10-222, Annotated Code of Maryland. If the ALJ orders the local department to modify or expunge the finding, or expunge reference to the appellant as an individual responsible for child abuse or neglect and neither party appeals, the local department shall take the action within 30 days. OAH may destroy the recording of a contested case one year after the date of the decision unless either party has specifically requested that the recording not be destroyed. Family Law Article, §§5-701, 5-706, 5-706.1, 5-707, and 5-714; Human Services Article, Title 1; Annotated Code of Maryland Effective date: Regulations .01—.16 adopted as an emergency provision effective October 1, 1993 (20:20 Md. R. 1551) (Emergency provisions are temporary and not printed in COMAR) Regulations .01—.16 adopted effective October 1, 1994 (21:19 Md. R. 1633) Regulations .01—.16 amended and .17—.22 adopted as an emergency provision effective June 16, 1998 (25:14 Md. R. 1119); emergency status extended at 26:9 Md. R. 725; emergency status rescinded at 26:16 Md. R. 1233 Regulation .03A amended effective November 6, 1995 (22:22 Md. R. 1656) Regulation .07 amended effective November 6, 1995 (22:22 Md. R. 1656) Regulations .01—.16 repealed and new Regulations .01—.15 adopted as an emergency provision effective July 19, 1999 (26:17 Md. R. 1233); emergency status extended at 26:27 Md. R. 2013 (Emergency provisions are temporary and not printed in COMAR) Regulations .01—.16 repealed and new Regulations .01—.15 adopted effective March 20, 2000 (27:5 Md. R. 582) Regulation .05 amended effective November 19, 2007 (34:23 Md. R. 2026) Regulations .01—.15 repealed and new Regulations .01—.15 adopted effective June 19, 2017 (44:12 Md. R. 586) The purpose of the Maryland Safe Haven Program is to provide the mother of a newborn the opportunity to provide a safe abandonment of her newborn by: Providing immunity from civil liability and criminal prosecution for a mother who leaves an unharmed newborn with a responsible adult person under certain circumstances; Requiring the approval of the responsible adult with whom the newborn is left; Requiring a responsible adult who accepts the newborn to take certain action as soon as reasonably possible; and Providing immunity from civil liability and criminal prosecution for certain persons, hospitals, and other facilities under certain circumstances. The goals of the Maryland Safe Haven Program are to: Provide for safe abandonment of a newborn with a responsible adult under circumstances where the mother of the newborn does not express a plan to return for the newborn; Offer the mother of a newborn an opportunity to leave her unharmed newborn, whose age may be determined with a reasonable degree of medical certainty, with a responsible adult; Provide appropriate medical care for a newborn abandoned to a responsible adult; and Provide for a long-term plan of care of the abandoned newborn. In this chapter, the following terms have the meanings indicated. Terms Defined. Child in Need of Assistance (CINA). “Child in Need of Assistance (CINA)” has the meaning stated in the Courts and Judicial Proceedings Article, §3-801(f), Annotated Code of Maryland. “Child in need of assistance” means a child who requires court intervention because: The child has been abused, has been neglected, has a developmental disability, or has a mental disorder; and The child's parents, guardian, or custodian are unable or unwilling to give proper care and attention to the child and the child's needs. “Department (DHS)” means the Department of Human Services. “Designated facility” means a hospital, State police barracks, or local police department. “Local department (LDSS)” means a local department of social services in a county or Baltimore City or the Montgomery County Department of Health and Human Services. “Newborn” means a child from birth through 10 days old or through 240 hours old, whichever is later. “Order of shelter care (OSC)” means a court order requiring a placement of a child in a physically unrestricting facility, but does not include care in a State mental health facility. “Reasonable degree of medical certainty” means the necessity and sufficiency of evidence needed to establish the age of the abandoned child. “Responsible adult” means an individual 18 years old or older who may reasonably be expected to provide proper care to a newborn left in the individual's care and who is willing and able to immediately take the newborn to a designated facility. “Termination of parental rights (TPR)” means the legal process of obtaining guardianship and ending the rights and responsibilities of the parents. “Unharmed” means there is no evidence of physical injury or failure to give proper care and attention to a newborn. A hospital presented with a newborn by the newborn's mother or other responsible adult and identified as an abandoned newborn shall make an effort to obtain information on a voluntary basis pertaining to the newborn's medical history or risk factors from the individual presenting the newborn. The hospital shall make reasonable, diligent efforts to obtain information from the mother or responsible adult as to why it is believed that the mother of the newborn has no intention of returning for the newborn. The hospital or other designated facility that accepts a newborn shall notify the LDSS within 24 hours after accepting the newborn. The LDSS in the jurisdiction where the hospital is located shall take responsibility of the newborn when medically ready for discharge under an OSC. A CINA petition shall be filed by the LDSS on behalf of the abandoned newborn in the jurisdiction where the hospital is located in conjunction with the request for an OSC. A Child Protective Services investigation shall be initiated if the mother, father, or relative of the newborn comes forth to identify the newborn and requests that the newborn be placed in the individual's care. The child shall remain in the care of the LDSS under an OSC with a CINA finding and commitment to the LDSS pending the outcome of the investigation. The LDSS shall pursue TPR on the newborn consistent with COMAR 07.02.12.04C and 07.02.11.16A relating to involuntary termination of parental rights if the LDSS believes the newborn to be abandoned as defined in COMAR 07.02.11.03.B(1). Human Services Article, §4-207; Courts and Judicial Proceedings Article, §5-641; Annotated Code of Maryland(Agency Note: Federal Statutory Reference—42 U.S.C. §629a) Effective date: November 24, 2003 (30:23 Md. R. 1651) Regulation .02B amended effective August 23, 2010 (37:17 Md. R. 1184) The purpose of the guardianship assistance program is to provide legal stability for a child who is in the custody or guardianship of a local department of social services by allowing relative caregivers to take full legal responsibility for the child. The goals of the guardianship assistance program are to: Encourage relative caregivers to become legal guardians of a child who has been placed in their home by a local department of social services by removing financial barriers; and Provide a permanent, safe, nurturing environment for a child that supports a familial cultural background. In this chapter, the following terms have the meanings indicated. Terms Defined. “Case plan” has the meaning stated in COMAR 07.02.11. “Child” means an individual: Younger than 18 years old; or 18 to 21 years old if the court retains jurisdiction over the child and the child meets the eligibility requirements established in COMAR 07.02.11. “Court” means the circuit court for a county or Baltimore City sitting as a juvenile court. “Guardianship” means that a court has granted physical and legal custody that includes legal authority, and responsibility for a child, to an individual to provide for a child’s needs. “Guardianship assistance agreement” means the written and binding agreement between the local department of social services and the relative caregiver. “Guardianship Assistance Program” means a program whereby the State, under qualifying circumstances, contributes financial assistance and medical assistance to help in the care of a child. “Kinship care” means continuous 24-hour care and supportive services provided for a minor child placed by a child placement agency in the home of a relative related by blood or marriage within the fifth degree of consanguinity or affinity as set forth in the Estates and Trusts Article, §1-203, Annotated Code of Maryland. “Local department” means a local department of social services in a county or Baltimore City, and the Montgomery County Department of Health and Human Services. “Parent” means the birth or adoptive mother or father of the child and includes by reference both mother and father as applicable. “Regular care rate” means the rate paid for all children in foster care who require routine care and supervision. “Relative” means an adult who is at least 18 years old, and who is: Related by blood, marriage or adoption within the fifth degree of consanguinity or affinity as set forth in the Estates and Trusts Article, §1-203, Annotated Code of Maryland; or An individual who makes up the family support system, including: Adults related beyond the fifth degree of consanguinity or affinity; Godparents; Friends of the family; or Other adults who have a strong familial bond with the child. “Relative caregiver” means a relative, or relatives as is applicable, of a child who is in the care, custody, or guardianship of a local department and who has been designated by the local department as a temporary 24-hour caregiver of that child. “Relative guardian” means a relative caregiver whom the court has designated as guardian. “Resource home” means an individual or family approved by a local department as described in COMAR 07.02.25. “Sibling” means a child that shares at least one parent with another child through blood relation, adoption or marriage of a parent. “Voluntary placement” means the placement of a child into foster care voluntarily by the parent or legal guardian who is unable to care for the child, and is either time-limited or for children with disabilities as defined in COMAR 07.02.11. “Youth” means a child 14 to 21 years old who is still in the custody of the State. Both the child and the relative caregiver shall meet the eligibility requirements stated in Regulations .04 and .05 of this chapter, respectively; and The child shall be placed with the relative caregiver for at least the last 6 consecutive months prior to the establishment of a guardianship assistance; and The relative caregiver home shall be approved as a resource home or kinship care home for the last 6 consecutive months in which the child resided with the relative caregiver. The local department shall negotiate and enter into a binding guardianship assistance agreement with the proposed relative caregiver prior to the court decree of custody and guardianship to the relative caregiver. The effective date of the guardianship assistance payment shall be the date the court awards custody and guardianship to the relative caregiver. Guardianship assistance program participation may not be: Transferred to a person who is not a party to the guardianship assistance agreement including the spouse of the relative guardian who has chosen not to be a party to the agreement or the guardianship; or Applied retroactively to a time prior to the execution of the guardianship assistance agreement and guardianship decree of the court. A child committed to a local department or under a voluntary placement agreement with a local department shall be eligible for consideration to participate when: As a result of a judicial determination that continuation in the home would be contrary to the welfare of the child or the child has been removed from the home pursuant to a voluntary placement agreement; The child has resided with the relative caregiver for the last 6 consecutive months; The local department of social services has established that return home and adoption have been ruled out; The child demonstrates a strong attachment to the relative caregiver; The child is under the age of 18 years old, at the time of the court hearing to award custody and guardianship; and The school age child under 18 years old, is a full-time elementary or secondary school student, or is incapable of attending school due to a documented medical condition. A youth shall be consulted and be in agreement with the guardianship arrangement. To be eligible for the guardianship assistance program, the relative caregiver shall: Successfully complete the application requirements as set forth in §B of this regulation; Be an approved resource or formal kinship care home with the child in the placement for the last 6 consecutive months; and Demonstrate a strong commitment to permanently care for the child. The relative caregiver shall: Complete a signed written application; Complete a physical assessment and a mental health history; Meet all the requirements of approval for a resource home or kinship care home as set forth in COMAR 07.02.25. Refusal by the relative caregiver or any adult member of the household to consent to any of the requirements of §B of this regulation shall be grounds for denial of the guardianship assistance request. The spouse of a relative guardian shall be encouraged to participate as a relative guardian for the agreement and the court determined guardianship. To be eligible for the Title IV-E guardianship assistance payment, both the child and the relative caregiver shall meet the eligibility requirements of this regulation. Child Eligibility. To be eligible for the Title IV-E guardianship assistance payment, the child shall be under 18 years old, except as stated in §B(2) or (3) of this regulation, and the child shall: Meet the requirements for eligibility as stated in Regulation .04 this chapter; and Have been eligible for Title IV-E foster care maintenance payments for the last 6 consecutive month period during which the child resided in the home of the relative caregiver. The child or youth who has a documented mental or physical disability, which the local department determines warrants the continuation of assistance shall be eligible until 21 years old. A youth who was at least 16 years old at the time the guardianship assistance agreement became effective shall be eligible until 21 years old as long as the youth is: Completing secondary education or a program leading to an equivalent credential; Enrolled in or attending, subsequent to the youth’s 18th birthday a: Maryland Higher Education Commission institution of higher learning or an equivalent; or Vocational training program; Participating in a program or activity designed to promote, or remove barriers to, employment; Employed for at least 80 hours per month; or Incapable of doing any of the above described activities due to a medical condition. If an eligible youth receiving guardianship assistance payments upon reaching 18 to 21 years old is not eligible under §B(2) or (3) of this regulation, the youth’s guardianship assistance payment may be converted to the State guardianship assistance payment as detailed in Regulation .07 of this chapter. Siblings. All siblings of a Title IV-E eligible child are eligible for guardianship assistance payment if: The sibling is committed to the local department and placed with the same relative caregiver at the same time or after the eligible child is placed; The local department, after monitoring the sibling in the placement for a minimum of 6 months with the relative caregiver, agrees that the placement of the siblings together is appropriate; and The relative caregiver agrees that the placement of the siblings together in the placement is appropriate. The sibling who meets the criteria of §C(1)of this regulation and is placed in the home of the same relative caregiver, as the eligible child shall be included in: The original guardianship assistance agreement for the eligible child or a separate guardianship agreement identifying the child as a sibling of an eligible child, if at the time of execution of the agreement the sibling meets the criteria of §C(1) of this regulation; or An amended or separate guardianship assistance agreement identifying the child as a sibling of an eligible child, if placed with the relative after the time of execution of the original guardianship assistance agreement, which shall be executed prior to the court decree of guardianship of the sibling to the relative caregiver. Relative caregiver eligibility. The relative caregiver shall meet the requirements for eligibility as set forth in Regulation .05 this chapter; and The home of the relative caregiver shall be fully approved as a resource home for 6 consecutive months during which the child resided with the relative caregiver. To be eligible for the State guardianship assistance payment, both the child and the relative caregiver shall meet the eligibility requirements of this regulation. Child Eligibility. Except as stated in §B(2) of this regulation, the child shall be under the age of 18 years old and shall: Meet the requirements for eligibility as set forth in Regulation .04 of this chapter; and Have resided with the relative caregiver in a kinship care placement as set forth in COMAR 07.02.25 for the last 6 consecutive months. A youth that has been determined to be eligible and receiving guardianship assistance payment under §B or C of Regulation .06 of this chapter for the Title IV-E guardianship assistance payment shall be deemed eligible for the State guardianship payment beginning at the age of 18 if: The youth does not qualify for the Title IV-E guardianship assistance payment as set forth in §B(2) or B(3) of Regulation .06 of this chapter; The youth remains the financial responsibility of the relative guardian; and The youth meets the criteria for continued participation as delineated in Regulation .11 of this chapter. Relative Caregiver Eligibility. The relative caregiver shall meet the requirements for eligibility as stated in Regulation .05 of this chapter; or The relative caregiver who is approved as a kinship parent and not a resource home: Shall meet the requirements of Regulation .05B of this chapter; and Shall be an approved kinship care home as delineated in COMAR 07.02.25 for a period of at least 6 consecutive months during which the child resided with the kinship parent. The local department shall ensure: The child is under the age of 18 years old prior to being considered for the Guardianship Assistance Program; and The child and relative caregiver are in agreement with the custody and guardianship recommendation. The local department shall negotiate and enter into a guardianship assistance agreement with the relative caregiver. The agreement shall specify: The amount of and manner in which the monthly assistance shall be paid; The assistance payment shall be paid monthly as a per diem rate and will fluctuate month to month; Any additional services and assistance that the child and relative caregiver will be eligible for under the agreement, if any; The procedure by which the relative caregiver may apply for additional services as needed; For a IV-E eligible child, that the State shall pay the total cost of nonrecurring expenses associated with obtaining legal guardianship of the child, not to exceed $2,000; The manner in which the payment may be adjusted periodically, in consultation with the relative guardian, based on the circumstances of the relative guardian and the needs of the child; That the relative guardian shall report any changes in the child or relative guardian eligibility; The continuation of the agreement up to the age of 21 years old when specific criteria are met; That an annual or periodic reconsideration shall be held to ascertain any changes; The reasons for suspension or discontinuation of payment; The reasons for termination of the agreement; and That the agreement shall remain in effect without regard to the State residency of the relative guardian. The agreement shall be signed prior to the court granting the guardianship decree. The local department shall provide the relative caregiver with a copy of the signed agreement. The effective date of the assistance payment shall be the date the court awards custody and guardianship to the relative caregiver. The local department shall not make custody and guardianship recommendations to the court until: All aspects of the home study have been completed; The relative caregiver is found eligible; and A guardianship assistance agreement has been negotiated and signed by all parties. The local department shall notify birth parents of the intended action to transfer legal guardianship to the relative caregiver. The written notification shall contain information that their parental rights are not being terminated and that parents or any other party in the case may petition the court to review the custody and guardianship order at any time in the future. The notification shall be by certified mail to the last known address. The local department shall ensure that: The guardianship assistance agreement is signed prior to the finalization of the guardianship; The guardianship assistance payment begins after the court awards custody and guardianship to the relative guardian; and The child’s case plan has been changed to reflect the new permanency plan of custody and guardianship and the case record contains the necessary documentation including: Determination that reunification or adoption is not appropriate for the child; If siblings are not placed in the same home, the reason for separation of the siblings and the efforts made by the local department for visitation; Justification that custody and guardianship with the relative caregiver is in the child’s best interest; Details of the child’s eligibility; Documentation that adoption was discussed with the relative caregiver as the more permanent option and the list of reasons not to pursue adoption; Documentation of the efforts made by the local department to discuss the plan of relative guardianship with the child’s parent; and If the child is at least 14 years old, documentation that the child has been consulted regarding the kinship guardianship arrangement. The local department shall maintain a separate case record and medical assistance card for each sibling included in the guardianship assistance agreement. Once the court grants guardianship to the relative caregiver: The legal responsibility of the local department is terminated; and The local department maintains responsibility for the guardianship assistance payment until the assistance is terminated according to Regulation .13 of this chapter. The relative guardian shall agree to: Exercise primary care and supervision of the child or youth until the child or youth reaches 18 years old or up to 21 years old with continued eligibility as set forth in Regulation .11 of this chapter; Inform the local department if the child’s birth parent plans to reside with the relative guardian; Apply to become the payee for social security benefits, supplemental security income or child support on behalf of the child; and Notify the local department of any change in the placement, including: Reunification of the child with a parent; Extenuating circumstances such as: A need for temporary housing; or Participation in rehabilitation due to prior substance abuse issues. The following circumstances shall affect the eligibility status of the relative guardian, or the continued eligibility status of the relative guardian: The relative guardian may not voluntarily return the child to the birth parent’s care and custody; and If the child is no longer living with the relative guardian, the guardianship assistance shall be: Suspended immediately; and Terminated if the child is not returned to the physical custody of the relative guardian within 60 days. Relocation Out-of-State. The relative guardian shall notify the local department in writing of plans to relocate out of the State: 30 days prior to relocation; and Include the relocation address in the notification. Guardianship assistance payments shall continue in the new location with receipt of notice as long as the child and the relative guardian remain eligible. The child’s eligibility for medical assistance: For the IV-E eligible child, shall continue, as the child is categorically eligible regardless of relocation to another state as long as the child is receiving a monthly guardianship assistance payment of at least $1; or For the State eligible child, may continue in the new location if the child is determined to be eligible for medical insurance by state of residence. The local department shall negotiate the monthly assistance amount for each eligible child or sibling. The monthly guardianship assistance payment may not exceed 100 percent of the regular care board rate based on the child’s age as set forth in COMAR 07.02.11, which would have been paid on behalf of the child if the child had remained or was placed in a resource family home. The assistance amount shall be based upon an assessment of the child’s special needs, which may include: Child’s age; Documented medical diagnosis; Documented mental or emotional diagnosis; or A need for childcare. The monthly assistance may be adjusted periodically in consultation with the relative guardian, based on the circumstances of the relative guardian and the needs of the child. Any adjustment must be approved by the Social Services Administration prior to the signing of a new guardianship assistance agreement. Medical Assistance. The child who is eligible for the Title IV-E guardianship assistance is categorically eligible for the federal Medicaid program available in the state of residence if the child is receiving Title IV-E guardianship assistance on an ongoing basis of at least $1 per month. The child who is eligible for the state guardianship assistance: Who resides with the relative guardian in the State shall be eligible for state medical assistance for a period of 1 year, and be evaluated annually thereafter for continued State medical assistance; and Who resides with the relative guardian out-of-State shall apply for medical assistance in the State of residence. For a IV-E eligible child, the local department shall provide a one-time only payment for nonrecurring expenses related to cost associated with obtaining legal guardianship up to a maximum of $2,000. Nonrecurring expenses include: Legal fees for guardianship of an eligible child; or Assistance with legal fees needed for guardianship of an ineligible sibling placed in the same household. Other expenditures made necessary by the transfer of guardianship may also be included in the one-time payment, such as: Transportation; Criminal background check; and Reasonable cost of lodging and food for the child and relative caregiver residing out-of-State. Nonrecurring expense payments may not include expenditures for legal fees unrelated to guardianship of a child. All requests for nonrecurring expenses shall be approved by the Social Services Administration prior to the signing of the guardianship assistance agreement and finalization of the guardianship by the court. Documentation supporting non-recurring expenses shall be submitted by the relative caregiver to the local department 30 days prior to the date of the court hearing for custody and guardianship. The guardianship assistance agreement shall remain in effect without regard to the state of residence of the relative guardian. Consideration of Other Financial Resources Available to Child. The local department shall: Notify the Family Investment Administration in writing of the guardianship assistance; Recommend the closing of the Temporary Cash Assistance case for the child only recipient grant as a result of custody and guardianship being awarded to the relative guardian and the assistance negotiated; and Request confirmation from the Family Investment Administration of the termination of the child only recipient grant. Social Security benefits shall be considered resources for determining and negotiating the assistance payment. Receipt of guardianship assistance may reduce the child's supplemental security income benefits. The local department shall inform the Social Security Administration of the assistance payment. The relative guardian shall apply to become the representative payee for Social Security benefits on behalf of the child and shall disclose the guardianship assistance payment to the Social Security Administration. Child Support. The local department shall consider a child support award as a resource when negotiating the assistance payment. The assistance payment shall be reduced by the child support amount received by the relative guardian on behalf of the child. The relative guardian shall apply to become the payee for child support on behalf of the child upon finalization of the guardianship. The local department shall notify the Child Support Administration of the guardianship assistance payment. The local department shall conduct a reconsideration of the guardianship assistance at least once every year until the guardianship assistance is terminated. The local department shall provide written notice to the relative guardian 60 days prior to the due date of the required annual reconsideration, which shall include: A copy of the current guardianship assistance agreement; A list of information or documentation required to be submitted by the relative guardian for reconsideration of the guardianship assistance including: A signed written statement that the child continues to reside with and be in the care of the relative guardian; Documentation that the child: Is a full-time student, which shall be in the form of a copy of the report card or third party documentation; Is incapable of attending school due to a documented medical condition and therefore not enrolled in school; or Is 18 years old or older and is in compliance with §E of this regulation; and A copy of the child’s immunization record documenting regular health care if the child is not school age or not enrolled in school; Notice that the guardianship assistance may be reduced as a result of the reconsideration; and A request that the relative guardian contact the local department to schedule a consultation for reconsideration of the guardianship assistance. Consultation with the relative guardian shall include discussion of: Continued eligibility and participation of the child in the guardianship assistance program; Continued eligibility and participation of the relative guardian in the guardianship assistance program; and Any additions or modifications to the guardianship assistance agreement including: Payment amounts; Termination time frame; and Requirement that all parties must agree to any change or amendment. Following the reconsideration, the local department shall provide to the relative guardian: 30 days written notice of any planned reduction of the guardianship assistance amount as a result of the reconsideration; and A copy of any proposed amendments to the guardianship assistance agreement as a result of the reconsideration. Continuation of Title IV-E guardianship assistance for youth age 18 to 21 years old. A youth who was at least 16 years old at the time the guardianship assistance agreement became effective shall be eligible for Title IV-E guardianship assistance payments until 21 years old as long as the youth is: Completing secondary education or a program leading to an equivalent credential; Enrolled in or attending, subsequent to the youth’s 18th birthday, a: Maryland Higher Education Commission institution of higher learning or an equivalent; or Vocational training program; Participating in a program or activity designed to promote, or remove barriers to, employment; Employed for at least 80 hours per month; or Incapable of doing any of the above described activities due to a medical condition. A youth with a documented physical or mental disability warranting continuance of assistance shall remain eligible for Title IV-E or State guardianship payments until attaining 21 years old provided the relative guardian provides documentation of the physical or mental disability to the local department 30 days prior to the youth attaining age 18, and provides documentation showing disability at each annual reconsideration. A youth who is not eligible for continued participation according to §E(1) or (2) of this regulation remains eligible for State guardianship assistance payments until age 21, provided the youth is: Completing secondary education or a program leading to an equivalent credential; Enrolled in or attending, subsequent to the youth’s 18th birthday, a: Maryland Higher Education Commission institution of higher learning or an equivalent; or Vocational training program; Participating in a program or activity designed to promote, or remove barriers to, employment; Employed for at least 80 hours per month; or Incapable of doing any of the above described activities due to a medical condition. The local department shall request in writing 60 days prior to the child attaining 18 years old, and at each subsequent annual reconsideration, from the relative guardian documentation of the child’s continued need for guardianship assistance as required in §B and §C(1)—(3) of this regulation. The local department shall suspend the guardianship assistance when the: Child is placed in foster care or another out of home setting with a plan of return home to the relative guardian; Child is returned to the care of the birth parent with a plan of return home to the relative guardian; Relative guardian fails to comply with the guardianship assistance agreement within a specified length of time; Relative guardian notifies the local department that the child temporarily lives outside of the home and the relative guardian is no longer assuming responsibility for the child; or Subsequent to the child’s 18th birthday, the child no longer meets conditions described in Regulation .11E of this chapter for continued assistance. The local department shall provide 30 days written notification to the relative guardian via a letter of intended action prior to any suspension of the assistance. The local department shall terminate the guardianship assistance for the following reasons: The youth reaches 18 years old and does not meet the continued eligibility criteria as set forth in Regulation .11 of this chapter; The relative guardian requests termination of the assistance; The local department determines the relative guardian is not legally responsible for the child; The child is returned to the custody of the birth parent; The child or relative guardian dies; The child attains 21 years old; The child becomes an emancipated minor; The child marries; The child enlists in the military; The local department determines the relative guardian is not providing any financial support for the child; or Assistance has been suspended according to Regulation .12 of this chapter for 60 days. Guardianship assistance shall be terminated upon written request from the relative guardian. Guardianship assistance is not transferable to a relative that is not a party to both the guardianship assistance agreement and the applicable decree of custody and guardianship. The local department shall provide 30 days written notification to the relative guardian prior to termination. The local department, in accordance with COMAR 07.01.04, shall provide the opportunity for a fair hearing if guardianship assistance is: Denied; Suspended; Reduced; or Terminated for reasons other than: The child reaches age 21; The child dies; or All relative guardians who are party to both the assistance agreement and the court decree for custody and guardianship die. Courts and Judicial Proceedings Article, §3-819.2; Family Law Article, §5-525; Annotated Code of Maryland(Agency Note: Federal Statutory Reference—42 U.S.C. §673(d)) Effective date: February 20, 2012 (39:3 Md. R. 258) Regulation .02B amended effective August 17, 2015 (42:16 Md. R. 1054) Regulation .03A amended effective August 17, 2015 (42:16 Md. R. 1054) Regulation .04A amended effective August 17, 2015 (42:16 Md. R. 1054) Regulation .05A, B amended effective August 17, 2015 (42:16 Md. R. 1054) Regulation .06B amended effective August 17, 2015 (42:16 Md. R. 1054) Regulation .07B amended effective August 17, 2015 (42:16 Md. R. 1054) Regulation .08B amended effective August 17, 2015 (42:16 Md. R. 1054) Regulation .10A, C amended effective August 17, 2015 (42:16 Md. R. 1054)