<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".08" citation="COMAR 10.21.20.08" title_num="10" subtitle_num="21" chapter_num="20" heading="Treatment Services.">
  <paragraph num="A.">
    <text>An OMHC shall have the capacity to provide the treatment services outlined in §§B — F of this regulation as required by the individual's ITP.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Mental Health Treatment. The program director shall ensure that licensed mental health professionals provide mental health treatment including:</text>
    <paragraph num="(1)">
      <text>Individual therapy;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Family therapy; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Group therapy.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Psychological Evaluation and Testing. The program director shall ensure that, if medically necessary and required by an individual's ITP, the OMHC provides psychological evaluation and testing by a staff psychologist or psychologist consultant, or by referral.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Co-Occurring Substance Abuse Treatment.</text>
    <paragraph num="(1)">
      <text>The program director shall ensure that the program provides substance abuse treatment as a component of its mental health program for individuals with secondary co-occurring disorders or has a written plan to coordinate mental health services with a certified substance abuse program if necessary.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If the assessment conducted under Regulation .06B of this chapter indicates that the individual has a secondary co-occurring substance abuse disorder, the individual's treatment plan and progress notes shall:</text>
      <paragraph num="(a)">
        <text>If the program is providing substance abuse treatment, reflect the course of treatment relative to the disorder; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>If the program is not providing substance abuse treatment, with proper consent and if indicated, include documentation of coordination of care and collaboration with the provider of substance abuse services.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Medication Services.</text>
    <paragraph num="(1)">
      <text>The medical director shall ensure that appropriate staff are trained and updated on the use, effect, interactions, and potential side effects of medication used by individuals served by the program.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Appropriate licensed mental health professionals shall, as clinically indicated, provide the following services:</text>
      <paragraph num="(a)">
        <text>Prescription;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Administration;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Monitoring; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Education regarding medication.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Prescription. Staff identified under §E(2) of this regulation shall:</text>
      <paragraph num="(a)">
        <text>When initially prescribing medication for an individual:</text>
        <paragraph num="(i)">
          <text>Conduct a face-to-face evaluation of the individual;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Assess whether there are contraindications to prescription of specific medications;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Involve the individual in the choice of medication;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Document in the individual's medical record the rationale for prescribing the medication;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Explain the benefits and possible side effects of taking or not taking prescribed psychiatric medications and document the explanation;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>With proper consent and if appropriate, promptly notify anyone responsible for administering or monitoring medication, of the medication regimen; and</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>With proper consent and if clinically indicated, notify the individual's primary care physician of medication prescription, if any; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>If managing medication on an ongoing basis:</text>
        <paragraph num="(i)">
          <text>At a minimum of every 90 days, evaluate the individual face-to-face;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Alter medications and adjust dosage as clinically indicated;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Document the rationale for the current prescription;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Order and monitor tests at medically recommended intervals and document results in the individual's medical record;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Educate the individual and others designated by the individual about prescribed medications, including the name of medication, dosage, frequency, proper storage, expected results, and potential side effects;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>With proper consent and if appropriate, promptly notify anyone responsible for administering or monitoring medication, of any changes in the medication regimen; and</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Notify the individual's primary care physician every 6 months of medication changes, if any.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>On-Call and Crisis Intervention Services.</text>
    <paragraph num="(1)">
      <text>The program director shall ensure that on-call and crisis intervention services are provided by a program's licensed mental health professional to an individual who has been enrolled in the OMHC:</text>
      <paragraph num="(a)">
        <text>Face-to-face during the 40 hours that the OMHC is open; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>By telephone, on an on-call basis, 24 hours per day, 7 days per week, during the hours the OMHC is not open:</text>
        <paragraph num="(i)">
          <text>Through the OMHC; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>By written agreement with another OMHC or mental health crisis service provider.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>If clinically appropriate, a crisis response plan or an advance directive for mental health services shall be developed and documented in the medical record, that:</text>
      <paragraph num="(a)">
        <text>An individual and, if the individual is a minor, the primary caretaker may implement in the event of or to prevent a crisis at home, school, work, or other setting in which the individual is involved; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Is stated in terms that the individual and, if involved, the primary caretaker understand.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>