<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.21.18.04" title_num="10" subtitle_num="21" chapter_num="18" heading="Referral and Admission.">
  <paragraph num="A.">
    <text>Referral. A therapeutic nursery may accept a referral to the therapeutic nursery from:</text>
    <paragraph num="(1)">
      <text>Education, social service, or health care agency staff;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Family members; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Other interested individuals and agencies.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Eligibility. A child is eligible for therapeutic nursery services if the child:</text>
    <paragraph num="(1)">
      <text>Has or is at risk for a mild to severe mental disorder, as defined in the current Diagnostic and Statistical Manual of Mental Disorders, or mild to severe behavioral problems, or both;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Is at risk for emotional or behavioral problems because the child:</text>
      <paragraph num="(a)">
        <text>Is experiencing substantial developmental delay or atypical development which, if left untreated, is likely to impair severely the child's ability to function independently, as measured by diagnostic instruments and procedures that meet usual and customary practice standards, in one or more of the following areas:</text>
        <paragraph num="(i)">
          <text>Cognitive development;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Physical development;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Language and speech development;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Psychosocial development; or</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Self-help skills;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Has experienced psychological trauma, as identified by an evaluation by a mental health professional;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Has a diagnosed physical or mental condition which has a high probability of resulting in developmental delay; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Has been excluded, for developmental or behavioral problems, from more than one preschool or day care program;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Is at risk for emotional or behavioral problems and is a child who is being assessed or has been assessed in a suspected child abuse or neglect investigation pursuant to Family Law Article, §5-701 et seq., Annotated Code of Maryland; or</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Is at risk for emotional or behavioral problems because of significant family history, as identified by an evaluation by a mental health professional.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Admission.</text>
    <paragraph num="(1)">
      <text>A therapeutic nursery program may admit a child:</text>
      <paragraph num="(a)">
        <text>If the child is:</text>
        <paragraph num="(i)">
          <text>For Program A, younger than 3 years old, and the primary caretaker is available to participate in the treatment process; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>For Program B, 3 years old or older, but younger than 5 years old;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Upon the written or tape-recorded consent of the child's parent or guardian; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>For whom a physician orders therapeutic nursery services as medically necessary.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A therapeutic nursery program may not admit a child:</text>
      <paragraph num="(a)">
        <text>Whose primary or sole diagnosis or condition is:</text>
        <paragraph num="(i)">
          <text>Mental retardation;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Visual impairment;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Hearing impairment;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Physical disorder; or</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Technology dependence; or</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Who has cognitive deficits that severely limit the ability to benefit from the treatment modalities provided by the therapeutic nursery.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>