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<chapter num="05" heading="Aftercare Plans" title_num="10" subtitle_num="21">
  <regulation prefix="Regulation" num=".01" heading="Scope.">
    <text>This chapter applies to aftercare plans, which are:</text>
    <paragraph num="A.">
      <text>Provided to an individual who has been accepted under the provisions of Health-General Article, Title 10, Subtitle 6, Health-General Article, Title 12, Subtitle 1, or Courts and Judicial Proceedings Article, Title 3, Subtitle 8, Annotated Code of Maryland, in one of the following:</text>
      <paragraph num="(1)">
        <text>Mental Hygiene Administration facility under Health-General Article, §10-406, Annotated Code of Maryland;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Private psychiatric inpatient facility;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Residential treatment center for children and adolescents; or</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Psychiatric unit in an acute care general hospital; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Designed to:</text>
      <paragraph num="(1)">
        <text>Enhance the opportunity for the individual to live in the community; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Assist in the prevention of homelessness.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".02" heading="Definitions.">
    <paragraph num="A.">
      <text>In this chapter, the following terms have the meanings indicated.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Terms Defined.</text>
      <paragraph num="(1)">
        <text>“Accepted” means:</text>
        <paragraph num="(a)">
          <text>Taken into confinement on the basis of an application and certificate for involuntary admission, according to the provisions of Health-General Article, §§10-614 — 10-616, Annotated Code of Maryland; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Admitted, as defined in §B(4) of this regulation.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>“Administration” means the Mental Hygiene Administration.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>“Administrative services organization (ASO)” means the organization under contract with the Administration to provide administrative services for the public mental health system.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>“Admitted” means:</text>
        <paragraph num="(a)">
          <text>Admitted voluntarily, according to the provisions of Health-General Article, §10-609 or 10-610, Annotated Code of Maryland;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Admitted involuntarily, by an administrative law judge, according to the provisions of Health-General Article, §10-632, Annotated Code of Maryland; or</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Committed by a court according to the provisions of:</text>
          <paragraph num="(i)">
            <text>Health-General Article, Title 12, Subtitle 1, Annotated Code of Maryland; or</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>Courts and Judicial Proceedings Article, Title 3, Subtitle 8, Annotated Code of Maryland.</text>
          </paragraph>
        </paragraph>
      </paragraph>
      <paragraph num="(5)">
        <text>“Aftercare plan” means the plan developed by inpatient facility staff according to the requirements of Health-General Article, §10-809, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(6)">
        <text>“Chief executive officer (CEO)” means the individual responsible for the overall management of a facility.</text>
      </paragraph>
      <paragraph num="(7)">
        <text>“Discharge” means authorization by a physician for a voluntarily or involuntarily admitted individual to leave an inpatient facility.</text>
      </paragraph>
      <paragraph num="(8)">
        <text>“Proper consent” means consent given by the individual, or, if the individual is a child or adolescent, by the individual's parent or guardian, to release relevant information.</text>
      </paragraph>
      <paragraph num="(9)">
        <text>“Release” means the authorization for an individual who is confined in an inpatient facility on the basis of an application and certificate for involuntary admission to leave the inpatient facility:</text>
        <paragraph num="(a)">
          <text>Given by a physician during the observation status period; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Ordered by an administrative law judge at an involuntary admissions hearing.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Content and Nature of Aftercare Plans.">
    <paragraph num="A.">
      <text>Staff designated by the CEO to assist individuals in aftercare planning shall, as soon as possible after acceptance, in collaboration with the individual:</text>
      <paragraph num="(1)">
        <text>Initiate the aftercare planning process;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>With proper consent, involve in the aftercare planning process:</text>
        <paragraph num="(a)">
          <text>Community-based service providers;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Family members;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Others who have a personal interest in the individual; and</text>
        </paragraph>
        <paragraph num="(d)">
          <text>Third-party payors, including Medical Assistance, the Administration's ASO, or private insurance carriers, if involved, for authorization of outpatient services;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(3)">
        <text>Assist in applying for benefits to which the individual may be entitled and document the outcome of the benefits application process in the individual's record.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Before discharge or release, designated staff shall:</text>
      <paragraph num="(1)">
        <text>Provide notification of the discharge or release:</text>
        <paragraph num="(a)">
          <text>With proper consent, to:</text>
          <paragraph num="(i)">
            <text>The individual's next-of-kin;</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>As appropriate, the core service agency (CSA);</text>
          </paragraph>
          <paragraph num="(iii)">
            <text>Community-based treatment and support services providers rendering services before the individual's inpatient admission; and</text>
          </paragraph>
          <paragraph num="(iv)">
            <text>Third-party payors, including Medical Assistance, the Administration's ASO, or private insurance carriers, if involved, for authorization of outpatient services; and</text>
          </paragraph>
        </paragraph>
        <paragraph num="(b)">
          <text>If the individual is a minor, to the parent or guardian; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>Assist the individual to participate in the aftercare plan by:</text>
        <paragraph num="(a)">
          <text>Explaining to the individual the benefits of:</text>
          <paragraph num="(i)">
            <text>The aftercare plan;</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>Community-based treatment and support services; and</text>
          </paragraph>
          <paragraph num="(iii)">
            <text>The involvement of family or others who have a personal interest in the individual;</text>
          </paragraph>
        </paragraph>
        <paragraph num="(b)">
          <text>Encouraging the individual to consent to the aftercare plan; and</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Arranging appointments for the individual with appropriate community programs.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>In collaboration with community programs and government agencies that have agreed to provide aftercare services to the individual after discharge or release, designated staff shall prepare a written aftercare plan that includes:</text>
      <paragraph num="(1)">
        <text>The individual's:</text>
        <paragraph num="(a)">
          <text>Name;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Date of birth; and</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Address and telephone number upon discharge or release;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>For a minor or an individual under guardianship, the name, address, and telephone number of the custodial adult or guardian;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>If the individual will reside in program-arranged housing, the name, address, telephone number, and contact person of the placement agency;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>The date and type of admission and discharge or release;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>The scheduled court date, if any;</text>
      </paragraph>
      <paragraph num="(6)">
        <text>The diagnoses, including existing psychiatric, somatic, and dental diagnoses, and level of functional assessment;</text>
      </paragraph>
      <paragraph num="(7)">
        <text>The type of treatment initiated;</text>
      </paragraph>
      <paragraph num="(8)">
        <text>The name, address, and telephone number of the primary care provider;</text>
      </paragraph>
      <paragraph num="(9)">
        <text>Medication information, including the:</text>
        <paragraph num="(a)">
          <text>Medication prescribed;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Dosage schedules;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Amount of each medication given to the individual upon discharge or release; and</text>
        </paragraph>
        <paragraph num="(d)">
          <text>Information necessary to help the individual to obtain the prescribed medication in the community;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(10)">
        <text>The most recent laboratory results, including therapeutic drug levels;</text>
      </paragraph>
      <paragraph num="(11)">
        <text>If applicable, a description of:</text>
        <paragraph num="(a)">
          <text>Allergies, including medication allergies;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Nutritional requirements; and</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Active somatic problems requiring continued attention;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(12)">
        <text>Information on the individual's medical insurance coverage, including the:</text>
        <paragraph num="(a)">
          <text>Company;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Policy number;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Name of the policy holder; and</text>
        </paragraph>
        <paragraph num="(d)">
          <text>Preauthorization information, if given, for services to be initiated upon discharge or release;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(13)">
        <text>Entitlements, if any, and status;</text>
      </paragraph>
      <paragraph num="(14)">
        <text>The plan for continuing treatment, including but not limited to:</text>
        <paragraph num="(a)">
          <text>Outpatient mental health treatment services;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Somatic care;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Psychiatric rehabilitation and support services;</text>
        </paragraph>
        <paragraph num="(d)">
          <text>When appropriate, substance abuse services; and</text>
        </paragraph>
        <paragraph num="(e)">
          <text>Case management;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(15)">
        <text>A list of additional referrals indicated, such as:</text>
        <paragraph num="(a)">
          <text>Public social services;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Legal aid;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Educational services;</text>
        </paragraph>
        <paragraph num="(d)">
          <text>Housing services;</text>
        </paragraph>
        <paragraph num="(e)">
          <text>Vocational services;</text>
        </paragraph>
        <paragraph num="(f)">
          <text>Peer support services; and</text>
        </paragraph>
        <paragraph num="(g)">
          <text>Available crisis services; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(16)">
        <text>Any identifying information required by the Administration's ASO.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Distribution of Aftercare Plan.">
    <paragraph num="A.">
      <text>Designated staff shall provide the individual with the opportunity to consent or withhold consent for release of all or any portion of the plan to any provider.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Within 48 hours or by the first appointment, whichever is sooner, designated staff shall provide the aftercare plan, in accordance with the provisions of §A of this regulation, to the:</text>
      <paragraph num="(1)">
        <text>Community treatment and support programs designated in the aftercare plan;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Family members or others with a personal interest in the individual, if any, who are identified in the aftercare plan to provide housing; and</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Third-party payors, if involved, for authorization of outpatient services.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>Designated staff shall document in the individual's medical record who received information from the aftercare plan.</text>
    </paragraph>
    <paragraph num="D.">
      <text>If the individual does not consent to an aftercare plan, designated staff shall:</text>
      <paragraph num="(1)">
        <text>Place in the individual's record a statement to this effect signed, when possible, by the individual, the individual's guardian, or, for a minor, the parent or guardian; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Provide to the individual, in writing, information on outpatient mental health clinics, crisis and emergency services, and other available community mental health services and resources within the jurisdiction in which the individual resides, and document in the individual's record what information was provided.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="Authority">Health-General Article, §§10-709 and 10-809, Annotated Code of Maryland</annotation>
    <annotation type="History" subtype="Administrative History">Effective date: December 14, 1998 (25:25 Md. R. 1831)</annotation>
  </annotations>
</chapter>