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<regulation prefix="Regulation" num=".02" citation="COMAR 10.21.17.02" title_num="10" subtitle_num="21" chapter_num="17" heading="Definitions.">
  <paragraph num="A.">
    <text>In COMAR 10.21.16 and subsequent community mental health program chapters, the following terms have the meanings indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Terms Defined.</text>
    <paragraph num="(1)">
      <text>“Ability to pay” means the individual's ability to pay for mental health services, as determined according to the provisions of COMAR 10.04.02.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“Administration” means the Mental Hygiene Administration.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>“Administrative services organization (ASO)” means the entity with which the Administration may contract to provide the services described in COMAR 10.09.70 for the public mental health system.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“Advance directive for mental health services” means a plan made by an individual pursuant to Health-General Article, §5-602.1, Annotated Code of Maryland.</text>
    </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 and COMAR 10.21.05.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Case coordination” means the process by which mental health and related support services to an individual are coordinated and monitored.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>“Case resolution conference (CRC)” means an informal proceeding before an evidentiary hearing to determine if there are grounds for settlement of a contested case.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Community support specialist” means the case manager as defined in COMAR 10.09.45.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Contact note” means an entry that is made in an individual's medical record by a program staff member and that describes face-to-face, written, or telephone contact with or regarding the individual.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Core service agency (CSA)” means the county or multicounty authority, designated under Health-General Article, Title 10, Subtitle 12, Annotated Code of Maryland, to carry out the duties set forth therein.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“Credentialing” means the collection, verification, and assessment of information regarding four critical parameters:</text>
      <paragraph num="(a)">
        <text>Current licensure;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Relevant training;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Current competence; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The ability to perform clinical responsibilities.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(12)">
      <text>“Crisis intervention” means the therapeutic response that provides immediate care or referral for an individual with urgent mental health need.</text>
    </paragraph>
    <paragraph num="(13)">
      <text>“Day treatment program” means a program approved under COMAR 10.21.02 and is also referred to as partial hospitalization or psychiatric day treatment.</text>
    </paragraph>
    <paragraph num="(14)">
      <text>“Deemed status” means the Secretary's granting of approval under this subtitle to a program, based on the program's accreditation under the relevant behavioral healthcare standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or Rehabilitation Accreditation Commission (CARF).</text>
    </paragraph>
    <paragraph num="(15)">
      <text>“Department” means the Maryland Department of Health.</text>
    </paragraph>
    <paragraph num="(16)">
      <text>“Designated emergency facility” means a health care facility identified under Health-General Article, §10-620, Annotated Code of Maryland, to perform the duties under Health-General Article, §10-624, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(17)">
      <text>“Director” means the Director of the Mental Hygiene Administration.</text>
    </paragraph>
    <paragraph num="(18)">
      <text>“Discharge plan” means a brief description of the recommendations for continued treatment.</text>
    </paragraph>
    <paragraph num="(19)">
      <text>“Discharge summary” means a detailed review of services provided to an individual, including, at a minimum, the items outlined in Regulation .11C of this chapter.</text>
    </paragraph>
    <paragraph num="(20)">
      <text>“Enhanced support” means short-term, in-home services, in addition to other services to an individual, by a program that is approved by the Administration to provide this service, to support the individual to remain in the community.</text>
    </paragraph>
    <paragraph num="(21)">
      <text>“Enrolled” means the program's formal acceptance and admission of an individual into the program.</text>
    </paragraph>
    <paragraph num="(22)">
      <text>“Facility” has the meaning indicated in Health-General Article, §10-102(e), Annotated Code of Maryland, and may also be referred to as a site.</text>
    </paragraph>
    <paragraph num="(23)">
      <text>“Governing body” means the organizational structure that is responsible for all program operations, including:</text>
      <paragraph num="(a)">
        <text>Establishing policy;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Maintaining quality care; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Providing management and planning for the program.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(24)">
      <text>“Grievance” means an oral or written complaint filed by or on behalf of an individual regarding the denial of services based on eligibility or medical necessity criteria.</text>
    </paragraph>
    <paragraph num="(25)">
      <text>“Group home” means a private group home as defined in Health-General Article, §10-514, Annotated Code of Maryland, and licensed under COMAR 10.21.04.</text>
    </paragraph>
    <paragraph num="(26)">
      <text>“Guardian” means a guardian as defined in Estates and Trusts Article, §13-101, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(27)">
      <text>“HIPAA” means part of the federal act outlined in 42 U.S.C. §1320D et seq., as amended, and the implementing regulations at 45 CFR Parts 160 and 164, as amended.</text>
    </paragraph>
    <paragraph num="(28)">
      <text>“Health officer” means the individual nominated by a county and appointed by the Secretary under the provision of Health-General Article, Title 3, Subtitle 3, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(29)">
      <text>“Health promotion and training” means activities to increase an individual's awareness of physical and mental health status and of the resources required to help promote good physical and mental health.</text>
    </paragraph>
    <paragraph num="(30)">
      <text>“Independent living skills training” means activities to promote, maintain, or restore an individual's ability to perform essential activities of daily life.</text>
    </paragraph>
    <paragraph num="(31)">
      <text>“Individual” means:</text>
      <paragraph num="(a)">
        <text>An adult;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A person authorized to consent to health care for an adult;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A minor;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A minor who is 16 years old or older, if the medical care concerns treatment to which the minor has the right to consent, and if the minor has consented to treatment;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>A parent;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>A guardian;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>The attorney of the minor;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>The custodian of the minor; or</text>
      </paragraph>
      <paragraph num="(i)">
        <text>A representative of the minor designated by a court who can legally consent to treatment consistent with the authority granted.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(32)">
      <text>“Individual rehabilitation plan (IRP)” means the plan prepared according to the requirements outlined in the chapter or chapters under this subtitle that delineate the requirements for the specific rehabilitation program.</text>
    </paragraph>
    <paragraph num="(33)">
      <text>Individual Treatment and Rehabilitation Plan (ITRP).</text>
      <paragraph num="(a)">
        <text>“ITRP” means the plan prepared according to the requirements outlined in the chapter or chapters under this subtitle that delineate the requirements for the specific program.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“ITRP” may substitute for a separate ITP and IRP.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(34)">
      <text>“Individual Treatment Plan (ITP)” means the plan prepared according to the requirements outlined in the chapters under this subtitle that delineate the requirements for the specific program.</text>
    </paragraph>
    <paragraph num="(35)">
      <text>“Inpatient facility” means an inpatient institution that provides evaluation, treatment, and 24-hour residential care for individuals who have mental disorders.</text>
    </paragraph>
    <paragraph num="(36)">
      <text>“Lead CSA” means, for programs that provide services in multiple jurisdictions, the CSA identified by the Administration in collaboration with the appropriate CSAs to represent all involved jurisdictions.</text>
    </paragraph>
    <paragraph num="(37)">
      <text>“Managed intervention plan (MIP)”:</text>
      <paragraph num="(a)">
        <text>Means the plan that is developed, when appropriate, that details the strategies to be implemented in times of crisis to provide for a revised plan of services and supports to maintain the individual in a residential rehabilitation program residence, to prevent the unplanned discontinuation of services, or to prevent an inpatient admission; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>May be incorporated into the individual rehabilitation plan (IRP) or individual treatment and rehabilitation plan (ITRP).</text>
      </paragraph>
    </paragraph>
    <paragraph num="(38)">
      <text>“Maryland Medical Records Act” means the act outlined in Health-General Article, §4-301, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(39)">
      <text>“Medical Assistance Program” means the Medical Assistance Program as defined in COMAR 10.09.36.01.</text>
    </paragraph>
    <paragraph num="(40)">
      <text>“Medicare” means the insurance program administered by the federal government under Title XVIII of the Social Security Act, 42 U.S.C. §1395 et seq., as amended.</text>
    </paragraph>
    <paragraph num="(41)">
      <text>Medication Monitoring.</text>
      <paragraph num="(a)">
        <text>“Medication monitoring” means:</text>
        <paragraph num="(i)">
          <text>Providing face-to-face assistance to an individual to achieve compliance with treatment with all prescribed psychiatric or somatic medications; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>As needed, reviewing the individual's existing medication regimen with the appropriate physician.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>“Medication monitoring” does not mean:</text>
        <paragraph num="(i)">
          <text>Prescribing medication;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Measuring or pouring medicine;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Preparation of a syringe for injection; or</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Administration of medication.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(42)">
      <text>“Mental health professional” means an individual who is licensed, certified, or otherwise legally authorized to provide the mental health service:</text>
      <paragraph num="(a)">
        <text>Under Health Occupations Article, Annotated Code of Maryland; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>In the state where the service is rendered.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(43)">
      <text>“Mental health program (program)” means a community-based program that is approved by the Department under this subtitle to be eligible to receive State or federal funds, or both.</text>
    </paragraph>
    <paragraph num="(44)">
      <text>“Mental health vocational program (MHVP)” means a program approved under COMAR 10.21.28.</text>
    </paragraph>
    <paragraph num="(45)">
      <text>“Minor” means an individual who is younger than 18 years old.</text>
    </paragraph>
    <paragraph num="(46)">
      <text>“Mobile treatment services (MTS) program” means a program approved under COMAR 10.21.19.</text>
    </paragraph>
    <paragraph num="(47)">
      <text>“Nurse” means an individual who is licensed and legally authorized to practice as a nurse:</text>
      <paragraph num="(a)">
        <text>Under Health Occupations Article, Annotated Code of Maryland; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>In the state where the service is rendered.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(48)">
      <text>“Occupational therapist” means an individual who is licensed and legally authorized to practice as an occupational therapist:</text>
      <paragraph num="(a)">
        <text>Under Health Occupations Article, Annotated Code of Maryland; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>In the state where the service is rendered.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(49)">
      <text>“On-call” means the availability of designated program staff 24 hours per day, 7 days per week.</text>
    </paragraph>
    <paragraph num="(50)">
      <text>“Outpatient mental health center (OMHC)” means a program approved under COMAR 10.21.20.</text>
    </paragraph>
    <paragraph num="(51)">
      <text>“Physician” means an individual who is licensed and legally authorized to practice medicine:</text>
      <paragraph num="(a)">
        <text>Under Health Occupations Article, Annotated Code of Maryland; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>In the state where the service is rendered.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(52)">
      <text>“Primary care provider (PCP)” means a practitioner who is the primary coordinator of care for the individual, whose responsibility it is to provide accessible, continuous, comprehensive, and coordinated health care services and includes PCPs covering the full range of benefits required by the Maryland Medicaid Managed Care Program, as specified in COMAR 10.09.67.</text>
    </paragraph>
    <paragraph num="(53)">
      <text>“Primary caretaker” means the minor's custodial parent or parents or the adult with whom the minor currently resides.</text>
    </paragraph>
    <paragraph num="(54)">
      <text>“Privileging” means the process by which a program determines that staff members are qualified to perform assigned duties.</text>
    </paragraph>
    <paragraph num="(55)">
      <text>“Professional counselor” means an individual who is certified or licensed and legally authorized to practice as a professional counselor:</text>
      <paragraph num="(a)">
        <text>Under Health Occupations Article, Annotated Code of Maryland; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>In the state where the service is rendered.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(56)">
      <text>“Program director” means the individual who is responsible for the daily operations of a program, as outlined in the chapter under this subtitle that delineates the requirements for a specific program.</text>
    </paragraph>
    <paragraph num="(57)">
      <text>“Program improvement plan (PIP)” means a written statement from a program that documents the program's methods and time frames for correcting deficiencies cited by the Department's designated approval unit.</text>
    </paragraph>
    <paragraph num="(58)">
      <text>“Progress summary note” means an entry by an individual's program coordinator in the individual's medical record that summarizes the individual's progress toward goals delineated in the individual's ITP, IRP, or ITRP.</text>
    </paragraph>
    <paragraph num="(59)">
      <text>“Provisional diagnosis” means the diagnosis given as a result of an initial assessment of the symptoms at the first encounter with an individual that lasts only until the correct nature of the illness has been clarified by further clinical examination.</text>
    </paragraph>
    <paragraph num="(60)">
      <text>“Psychiatric rehabilitation program (PRP)” means a program approved under COMAR 10.21.21 for adults, and COMAR 10.21.29 for minors, or both.</text>
    </paragraph>
    <paragraph num="(61)">
      <text>“Psychiatrist” means a physician who:</text>
      <paragraph num="(a)">
        <text>Is certified in psychiatry by the American Board of Psychiatry and Neurology; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Has completed the minimum educational and training requirements to be qualified to take the Board of Psychiatry and Neurology examination for certification in psychiatry.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(62)">
      <text>“Psychologist” means an individual who is licensed and legally authorized to practice as a psychologist:</text>
      <paragraph num="(a)">
        <text>Under Health Occupations Article, Annotated Code of Maryland; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>In the state where the service is rendered.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(63)">
      <text>“Psychologist Associate” means an individual approved by the Board of Examiners of Psychologists for exemption to perform psychological services pursuant to Health Occupations Article, §18-301(b)(3), Annotated Code of Maryland, and COMAR 10.36.07.</text>
    </paragraph>
    <paragraph num="(64)">
      <text>Public Mental Health System (PMHS).</text>
      <paragraph num="(a)">
        <text>“Public mental health system” means the system for the delivery of mental health treatment and supports to individuals who meet medical necessity criteria and financial eligibility as established by the Maryland Department of Health Administration.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Public mental health system” includes the specialty mental health system described in COMAR 10.09.70.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(65)">
      <text>“Quality management (QM)” means the process by which a program maintains and improves the quality of services.</text>
    </paragraph>
    <paragraph num="(66)">
      <text>“Referral” means a contact made with a program by an individual, or on behalf of an individual, for mental health services.</text>
    </paragraph>
    <paragraph num="(67)">
      <text>“Rehabilitation coordinator” means the program staff person who is responsible for coordinating and providing rehabilitation services to an individual.</text>
    </paragraph>
    <paragraph num="(68)">
      <text>“Residence” means a housing unit leased or owned by an approved residential rehabilitation program (RRP).</text>
    </paragraph>
    <paragraph num="(69)">
      <text>“Residential checklist” means the form issued by the Department for the purpose of recording information gathered during the inspection of rehabilitation residences.</text>
    </paragraph>
    <paragraph num="(70)">
      <text>“Residential crisis services (RCS)” means services provided by a program approved under COMAR 10.21.26.</text>
    </paragraph>
    <paragraph num="(71)">
      <text>“Residential rehabilitation program (RRP)” means a program that is approved under COMAR 10.21.22.</text>
    </paragraph>
    <paragraph num="(72)">
      <text>“Residential specialist” means the individual designated by the Department or the CSA to inspect, monitor, and determine the approval status of a residence.</text>
    </paragraph>
    <paragraph num="(73)">
      <text>“Respite care services” means services provided by a program approved under COMAR 10.21.27.</text>
    </paragraph>
    <paragraph num="(74)">
      <text>“Secretary” means the Secretary of Health or the Secretary's designee.</text>
    </paragraph>
    <paragraph num="(75)">
      <text>“Serious emotional disturbance” means a condition that is:</text>
      <paragraph num="(a)">
        <text>Manifest in an individual younger than 18 years old;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Diagnosed according to a current diagnostic classification system that is recognized by the Secretary, excluding the following, unless they co-exist with a diagnosable psychiatric disorder:</text>
        <paragraph num="(i)">
          <text>Developmental disorders;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Substance abuse; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Disorder classified under the “V” code; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Characterized by a functional impairment that substantially interferes with or limits the minor's functioning in the family, school, or community.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(76)">
      <text>“Serious mental illness” means a mental disorder that is:</text>
      <paragraph num="(a)">
        <text>Manifest in an individual 18 years old or older;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Diagnosed, according to a current diagnostic classification system that is recognized by the Secretary as:</text>
        <paragraph num="(i)">
          <text>Schizophrenic disorder;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Major affective disorder;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Other psychotic disorder; or</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Borderline or schizotypal personality disorder, with the exclusion of an abnormality that is manifested only by repeated criminal or otherwise antisocial conduct; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Characterized by impaired functioning on a continuing or intermittent basis, for at least 2 years, and includes at least three of the following:</text>
        <paragraph num="(i)">
          <text>Inability to maintain independent employment;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Social behavior that results in interventions by the mental health system;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Inability, due to cognitive disorganization, to procure financial assistance to support living in the community;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Severe inability to establish or maintain a personal support system; or</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Need for assistance with basic living skills.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(77)">
      <text>“Social skills training” means activities to diminish tendencies toward isolation and withdrawal by assisting individuals to acquire, maintain, or develop communication and other interpersonal skills.</text>
    </paragraph>
    <paragraph num="(78)">
      <text>“Social worker” means an individual who is licensed and legally authorized to practice as a social worker:</text>
      <paragraph num="(a)">
        <text>Under Health Occupations Article, Annotated Code of Maryland; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>In the state where the service is rendered.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(79)">
      <text>“Supported housing” means activities to enable an individual to maintain housing of the individual's choice.</text>
    </paragraph>
    <paragraph num="(80)">
      <text>“Therapeutic group home (TGH)” means a program that is licensed under COMAR 10.21.04, 10.21.07, and COMAR 14.31.05, 14.31.06, and 14.31.07.</text>
    </paragraph>
    <paragraph num="(81)">
      <text>“Therapeutic milieu” means an environment that is clinically structured to provide mental health treatment in a place other than the individual's residence.</text>
    </paragraph>
    <paragraph num="(82)">
      <text>“Therapeutic nursery program (TNP)” means a program approved under COMAR 10.21.18.</text>
    </paragraph>
    <paragraph num="(83)">
      <text>“Treatment coordinator” means the licensed mental health professional who is responsible for coordinating and providing mental health services to an individual.</text>
    </paragraph>
    <paragraph num="(84)">
      <text>“Working day” means any day except Saturday, Sunday, or a holiday on which State offices are closed.</text>
    </paragraph>
  </paragraph>
</regulation>