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<regulation prefix="Regulation" num=".06" citation="COMAR 10.21.19.06" title_num="10" subtitle_num="21" chapter_num="19" heading="Treatment and Support Services Provided.">
  <paragraph num="A.">
    <text>Medication Services.</text>
    <paragraph num="(1)">
      <text>Evaluation and Prescription. When prescribing medication for an individual, the MTS psychiatrist shall:</text>
      <paragraph num="(a)">
        <text>Conduct a face-to-face evaluation of the individual;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Through a medical history, evidence of a recent physical examination, records review, laboratory testing, or other appropriate measures, assure that there are no contraindications to the prescription of specific medications;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Document in the individual's medical record the rationale for prescribing the medication;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Explain to the individual or the individual's legal guardian both the benefits and the side effects of prescribed psychiatric medications before and, when appropriate, during treatment and document the explanation in the individual's medical record; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Order and monitor tests at medically recommended intervals and document the results in the individual's medical record.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Administration.</text>
      <paragraph num="(a)">
        <text>An individual licensed under Health Occupations Article, Annotated Code of Maryland, to administer medication may do so.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A licensed practical nurse or a registered nurse may delegate the administration of medication only according to the provisions of COMAR 10.27.11.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Monitoring. When required by the individual's ITP, a member of the treatment team credentialed and privileged to do so shall provide the following services:</text>
      <paragraph num="(a)">
        <text>Supporting the individual's self-administration of prescribed medication;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>To the extent possible, monitoring compliance with instructions appearing on the label;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Reading the label to ensure that each container of medication is clearly labeled with the individual's name, the contents, directions for use, and expiration date;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Ensuring that each individual has secure, appropriate, and accessible space in which to store medications;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Observing and documenting any apparent reactions to medication and, either verbally or in writing and in a timely fashion, communicating to the prescribing authority any problems that possibly may be related to the medication; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Reinforcing education on the role and effects of medication in symptom management.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Education Regarding Medication. As required by an individual's ITP, a nurse, a physician, or other privileged and credentialed staff shall educate the individual and, with the individual's consent, the individual's family or significant others, by:</text>
      <paragraph num="(a)">
        <text>Verifying the individual's understanding of the directions for administration of medication; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Providing information regarding:</text>
        <paragraph num="(i)">
          <text>The role, effects, and importance of medication in symptom management;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Expected benefits and expected side effects of prescribed medication; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Nutritional and dietary expectations and risks related to the individual's medication regimen.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Independent Living Skills Assessment and Training. The MTS staff shall:</text>
    <paragraph num="(1)">
      <text>In collaboration with the individual, assess the individual's level of functioning in the areas of:</text>
      <paragraph num="(a)">
        <text>Community living skills, including but not limited to:</text>
        <paragraph num="(i)">
          <text>Mobility training; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Money management;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Activities of daily living, including:</text>
        <paragraph num="(i)">
          <text>Meal planning and preparation;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Personal hygiene; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Grooming; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Interpersonal and socialization skills, including:</text>
        <paragraph num="(i)">
          <text>Communication; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Leisure and social activities; and</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Based on the assessment conducted under §B(1) of this regulation, provide rehabilitation activities to assist with and facilitate the individual's acquisition and improvement of independent living skills.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Health Promotion and Training.</text>
    <paragraph num="(1)">
      <text>To supplement and support the somatic health care provided by an individual's primary health care provider, the MTS psychiatrist or registered nurse shall carry out health promotion activities, including but not limited to:</text>
      <paragraph num="(a)">
        <text>Monitoring of a chronic medical condition that is managed by a primary health care provider, including:</text>
        <paragraph num="(i)">
          <text>Teaching on illness prevention and wellness maintenance; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Reinforcement of instructions given by the primary health care provider;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Evaluating an acute problem to determine the most appropriate health care provider and referring the individual to the provider; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Assisting an individual to understand and carry out health-care-related behaviors, including activities related to diagnostic testing preparation and prescribed treatment for acute and short-term illness.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>When indicated in the individual's ITP, MTS staff shall provide basic health teaching in the following areas:</text>
      <paragraph num="(a)">
        <text>Nutrition;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Exercise;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Dental care;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Substance abuse prevention; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Prevention of injury and illness at home and in the community.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>MTS staff credentialed and privileged to do so shall provide training in communicable disease prevention, including prevention of sexually transmitted diseases and bloodborne pathogens, including HIV/AIDS.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Interactive Therapies. MTS staff shall provide, as required in the individual's ITP, therapies, including individual, group, and family therapy focused on:</text>
    <paragraph num="(1)">
      <text>Assessment and definition of problems;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Planning and goal setting;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Development of effective problem-solving techniques;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Evaluation of progress; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Other issues raised by the individual.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Crisis Intervention Service. The MTS treatment team shall provide to an individual who is receiving MTS a crisis intervention service that is:</text>
    <paragraph num="(1)">
      <text>Designed to be implemented in the event of a crisis in the home or other setting in which the individual is involved;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Explained in terms understandable to the individual; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Available, on an on-call basis, 24 hours per day, 7 days per week.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Support, Linkage, and Advocacy. The MTS treatment team shall assure appropriate coordination with community and family resources that are considered essential to meeting the individual's identified needs, including but not limited to intervention and advocacy with:</text>
    <paragraph num="(1)">
      <text>MTS staff and other community mental health and rehabilitation service providers;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Mental health clinic and psychiatric rehabilitation programs;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Social service agencies;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Courts and detention centers;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Providers of needed medical and dental services;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Immediate and extended family members;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>For school age children, the educational system; and</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Recreational activities.</text>
    </paragraph>
  </paragraph>
</regulation>