<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".08" citation="COMAR 10.21.19.08" title_num="10" subtitle_num="21" chapter_num="19" heading="Required Staff.">
  <text>A provider of MTS shall ensure that the MTS staff includes, at a minimum:</text>
  <paragraph num="A.">
    <text>A program director who:</text>
    <paragraph num="(1)">
      <text>Is a mental health professional;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Is available to provide MTS administration and supervision:</text>
      <paragraph num="(a)">
        <text>If fewer than 40 individuals are receiving services, for an amount of time calculated on the basis of 1/2 hour per week for each individual who is receiving services; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>If 40 or more individuals are receiving services, 20 hours per week;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Is responsible for operational oversight for, at a minimum:</text>
      <paragraph num="(a)">
        <text>Fulfilling the administrative requirements under COMAR 10.21.17 and the day-to-day clinical responsibilities for MTS;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Recruiting, hiring, training, and supervising staff;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Developing and implementing the budget;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Keeping the governing body informed of, at a minimum, the program's approval status and performance;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Ensuring that MTS are available to the individual, if needed, 24 hours per day, 7 days per week, and establishing on-call responsibilities;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Ensuring continuity of care during the time that an individual is receiving MTS by evaluating caseloads and coordinating staff schedules; and</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Ensuring that transition services are provided; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>May carry out any of the clinical and training duties of a mental health professional or other MTS staff;</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>A psychiatrist who:</text>
    <paragraph num="(1)">
      <text>Is involved, for an amount of time calculated on the basis of at least 1/4 hour per week for each individual who is receiving services, in:</text>
      <paragraph num="(a)">
        <text>Consultation with MTS staff; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Evaluating and providing MTS;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Ensures that MTS are provided in accordance with accepted standards of medical practice;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Following a screening evaluation of an individual completed under Regulation .04B of this chapter, has an initial face-to-face contact with the individual, as required under Regulation .05A of this chapter, to:</text>
      <paragraph num="(a)">
        <text>Formulate and document the psychiatric diagnosis or affirm a psychiatric diagnosis that has been entered in the individual's MTS medical record;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Assess medical needs;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Confirm the medical necessity of MTS;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>When appropriate, order MTS for the individual; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Authorize the initial ITP;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Is responsible for, at a minimum, the following:</text>
      <paragraph num="(a)">
        <text>Evaluating the individual, face-to-face, at least every 3 months;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>As required under the provisions of Regulation .05C of this chapter, participating in the development, required periodic review, and signing of an individual's ITP;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Prescribing medication and providing other medication services outlined in Regulation .06A of this chapter;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Providing the appropriate treatment indicated in the individual's ITP; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Supervising psychiatric residents, if any, who provide MTS, including, if duties are delegated, providing, at least monthly, a review of the status of the individuals whom the resident is treating;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>May delegate the following duties to a third-year or fourth-year resident of an accredited program in psychiatry:</text>
      <paragraph num="(a)">
        <text>Except for the initial 3-month evaluation, the periodic evaluations required under §B(4)(a) of this regulation;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Participation in the development, required periodic review, and signing of an individual's ITP, required under §B(4)(b) of this regulation;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>If the resident is a licensed physician, prescribing medication and providing other medication services, as provided under §B(4)(c) of this regulation; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>As provided in §B(4)(d) of this regulation, providing the appropriate treatment indicated in the individual's ITP; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>May not delegate:</text>
      <paragraph num="(a)">
        <text>The initial psychiatric evaluation;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Formulation and documentation of the psychiatric diagnosis or affirmation of a psychiatric diagnosis that has been entered in the individual's MTS medical record; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Ordering of MTS for an individual;</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>A registered nurse who:</text>
    <paragraph num="(1)">
      <text>Is licensed under the provisions of Health Occupations Article, Title 8, Annotated Code of Maryland;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Participates in MTS for an amount of time calculated on the basis of at least 1 hour per week for each individual who is receiving services; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>As permitted under Health Occupations Article, Annotated Code of Maryland, performs assigned duties that the nurse is credentialed and privileged to perform, including but not limited to:</text>
      <paragraph num="(a)">
        <text>Medication administration and other medication services outlined in Regulation .06A of this chapter; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Health promotion and training, as outlined in Regulation .06C of this chapter;</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>At least one social worker who:</text>
    <paragraph num="(1)">
      <text>Is licensed under the provisions of Health Occupations Article, Title 19, Annotated Code of Maryland; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>As permitted under Health Occupations Article, Annotated Code of Maryland, performs assigned duties the social worker is credentialed and privileged to perform, including but not limited to:</text>
      <paragraph num="(a)">
        <text>Interactive therapies, as outlined in Regulation .06D of this chapter;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Support, linkage, and advocacy, as outlined in Regulation .06F of this chapter; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Discharge and transition services as outlined in Regulation .07 of this chapter; and</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>At least one mental health professional who:</text>
    <paragraph num="(1)">
      <text>May include the staff identified in §§C and D of this regulation; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>As permitted under Health Occupations Article, Annotated Code of Maryland, performs assigned duties that the mental health professional is credentialed and privileged to perform, including but not limited to:</text>
      <paragraph num="(a)">
        <text>Conducting the screening evaluation required under Regulation .04B of this chapter and participating in the initial psychiatric evaluation required under Regulation .05A of this chapter;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>According to the provisions of Regulation .05C of this chapter, reviewing and signing an individual's ITP;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The duties outlined in Regulations .06 and .07 of this chapter that the mental health professional is licensed or credentialed and privileged to perform;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>When credentialed and privileged by the program to do so, functioning as the treatment coordinator for individuals who are receiving MTS;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Supervising direct service providers; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Assuring that, before the provision of MTS and, as needed, on an in-service basis, appropriate training is provided to direct service providers.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>