<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.21.17.04" title_num="10" subtitle_num="21" chapter_num="17" heading="Consent for Services, Orientation, and Advance Directive for Mental Health Services.">
  <paragraph num="A.">
    <text>Consent for Services.</text>
    <paragraph num="(1)">
      <text>Before initiating services to an individual, a program shall:</text>
      <paragraph num="(a)">
        <text>Obtain consent from the individual to:</text>
        <paragraph num="(i)">
          <text>Render services to the individual; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Involve, as appropriate, the appropriate CSA, the individual's family members, and others designated by the individual in the individual's service process;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Review with the individual:</text>
        <paragraph num="(i)">
          <text>That the program may disclose, without consent, certain protected health information, and obtain an acknowledgment from the individual of having received notice that such disclosure may occur;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>That the program may disclose, without consent, protected health information to other medical assistance programs and providers; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>The requirements of the Health Insurance Portability and Accountability Act and the Maryland Medical Records Act, as to scope and limits of the confidentiality provisions; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>If the individual is a minor who cannot consent to services, obtain the appropriate consents and make the required disclosures.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>If the individual agrees to consent to services but is unable or unwilling to give written consent, a program shall:</text>
      <paragraph num="(a)">
        <text>Document the reasons why the individual cannot give written consent;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Verify the individual's verbal consent to services; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Periodically attempt to obtain written consent and document such efforts.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Orientation.</text>
    <paragraph num="(1)">
      <text>On or before the date that an individual receives services, the program director shall ensure that an individual who has been admitted to the program receives information, verbally and in writing, including, but not limited to:</text>
      <paragraph num="(a)">
        <text>A description of the services available;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Individual rights and responsibilities;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Program hours and on-call procedures;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The program's procedures for discharge;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>The program's procedures for confidentiality;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Crisis intervention services; and</text>
      </paragraph>
      <paragraph num="(g)">
        <text>The complaint and grievance processes.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The individual's program coordinator shall document in the individual's medical record the individual's receipt of the information contained in §B(1) of this regulation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Advance Directive for Mental Health Services. For individuals who are 16 years old or older, the program director shall:</text>
    <paragraph num="(1)">
      <text>Ensure that an individual who has been admitted to the program receives information, verbally and in writing, regarding making an advance directive for mental health services;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Document whether an individual has a current advance directive for mental health services;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>If an individual has a mental health advance directive, include a copy of the document in the individual's medical record; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>If an individual requests assistance with making an advance directive for mental health services, assign staff to assist the individual.</text>
    </paragraph>
  </paragraph>
</regulation>