Chapter 01. Requirements
Regulation .01 Scope.LinkCopy Citation
This chapter sets forth the requirements for certification of drug and alcohol treatment programs.
Regulation .02 Definitions.LinkCopy Citation
A.
In this subtitle, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Addiction Severity Index” means a standardized method for the assessment of adults regarding addictions severity and patient need.
(2)
“Administration” means the Alcohol and Drug Abuse Administration within the Maryland Department of Health.
(3)
“Administrator” means the program director of an alcohol or drug abuse facility or a health care facility.
(4)
“Admission” means the documented acceptance of an applicant into a program.
(5)
“Adolescent” means an individual 12 — 17 years old.
(6)
“Alcohol abuse” means a disease that is characterized by a pattern of pathological use of alcohol with repeated attempts to control its use, and with significant negative consequences in at least one of the following areas of life: medical, legal, financial, or psychosocial.
(7)
“Alcohol dependence” means a disease characterized by:
(a)
Alcohol abuse; and
(b)
Physical symptoms of withdrawal or tolerance.
(8)
“American Society of Addiction Medicine Patient Placement Criteria” means an instrument designed to indicate patient placement guidelines for admission, continued stay, and discharge.
(9)
“Assessment” means the process of ascertaining the treatment needs of the patient regarding addiction and other social issues.
(10)
“Caseload” means the number of patients for whom a drug and alcohol counselor has the responsibility for providing clinical services and case management.
(11)
“Case management” means the process of coordinating and monitoring the services provided to a patient both within the program and in conjunction with other providers.
(12)
“Certification” means the approval issued to a program by the Administration to provide services under this subtitle.
(13)
“Child” means an individual younger than 12 years old.
(14)
“Clinical director” means the individual who is responsible for the therapeutic and rehabilitative aspects and direction of a program.
(15)
“Clinical staff” means the individuals employed by or associated with a program who provide treatment, care, or rehabilitation to program patients or patients' families.
(16)
“Clinical supervisor” means the individual responsible for providing supervision to alcohol and drug clinical staff as clinically appropriate.
(17)
“Continuous quality review” means objective and systematic monitoring and evaluation of the quality and appropriateness of patient care, the purpose of which is the improvement of that care, prevention of problems, and resolution of problems.
(18)
“Controlled dangerous substance” means any drug, substance, or immediate precursor in Schedules I — V under Criminal Law Article, Title 5, Subtitle 4, Annotated Code of Maryland.
(19)
Correctional Facility.
(a)
“Correctional facility” means an institution overseen by the State or one of the 24 subdivisions where individuals are incarcerated.
(b)
“Correctional facility” includes a jail, detention center, prison, or correctional halfway house.
(20)
“Credentialing” means a process of review to determine the professional level at which an employee may practice.
(21)
“Crisis intervention training” means training of staff to respond adequately to emergency situations, including:
(a)
Medical emergencies;
(b)
Emotional and psychological crises; and
(c)
Emergencies arising from environmental circumstances such as fires, floods, terrorism, and other disasters.
(22)
Critical Incident.
(a)
“Critical incident” means a life, safety, or health threat involving the staff or patients participating in a program.
(b)
“Critical incident” includes, but is not limited to, death or physical or sexual assault.
(23)
“Critical incident report” means the documentation of a critical incident.
(24)
“Department” means the Maryland Department of Health.
(25)
“Detoxification” means the process of withdrawing addictive psychoactive substances from the body in a safe and effective manner.
(26)
“Director” means the Director of the Administration.
(27)
“Discharge plan” means a written description of specific goals and objectives to assist the patient upon leaving treatment.
(28)
Dispense.
(a)
“Dispense” means to deliver a controlled dangerous substance or other drug to the ultimate user by a practitioner pursuant to a lawful order of the practitioner.
(b)
“Dispense” includes prescribing, administering, packaging, labeling or compounding necessary to prepare the substance for delivery.
(29)
“Documentation” means written or recorded information that is dated.
(30)
“Drug” means:
(a)
A controlled dangerous substance that is regulated under the Maryland Controlled Dangerous Substances Act;
(b)
A prescription medication; or
(c)
A chemical substance when used for unintended and harmful purposes.
(31)
“Drug abuse” means a disease which is characterized by a pattern of pathological use of a drug with repeated attempts to control its use, and with significant negative consequences in at least one of the following areas of life: medical, legal, financial, or psychosocial.
(32)
“Drug dependence” means a disease characterized by:
(a)
Drug abuse; and
(b)
Physical symptoms of withdrawal or tolerance.
(33)
“Family” means an individual's immediate relatives or significant others.
(34)
“Family counseling” means a distinct discipline that utilizes accepted family system theories and intervention techniques.
(35)
“Governing body” means the organizational structure that is responsible for establishing policy, maintaining quality care, and providing management and planning for the program.
(36)
“Individualized treatment plan” means a written plan of action that is developed and modified to address a patient's specific service needs.
(37)
“Intermediate care facility” means a facility that provides a planned regimen of 24-hour professionally directed evaluation, observation, medical monitoring, and addiction treatment in an inpatient setting.
(38)
“Maintenance” means medically supervised continuation of the administration of methadone, LAAM, or other drugs approved by the Administration.
(39)
“Medical director” means a physician who oversees the medical practice of a program.
(40)
“Methadone” means a synthetic opioid.
(41)
“Nurse” means an individual who is licensed by the State Board of Nursing to practice registered nursing or licensed practical nursing as defined in Health Occupations Article, §8-101, Annotated Code of Maryland.
(42)
“Nurse practitioner” means a registered nurse who is certified as a nurse practitioner as defined in Health Occupations Article, §8-508, Annotated Code of Maryland.
(43)
“Office of Health Care Quality” means the office under the Department that oversees certification and inspection of programs for the Administration.
(44)
“Patient” means an individual who is admitted into a program.
(45)
“Physician” means any person authorized by law to practice medicine in this State under Health Occupations Article, §14-101, Annotated Code of Maryland.
(46)
“Physician assistant” means an individual licensed to act as an assistant to a licensed physician in Maryland, as defined in Health Occupations Article, §15-101, Annotated Code of Maryland.
(47)
“Possess” means the exercise of actual or constructive dominion or control over a controlled dangerous substance.
(48)
“Prevention program” means the Early Intervention Level 0.5 level of treatment as described in COMAR 10.47.02.03.
(49)
“Privileging” means the process of review to determine the duties a volunteer or employee may perform.
(50)
“Problem Oriented Screening Instrument for Teenagers” means a standardized method of screening to determine whether or not an adolescent may have alcohol or other drug abuse or dependence or both and will need further evaluation.
(51)
Program.
(a)
“Program” means any organization or individual that provides treatment, care, or rehabilitation for individuals who show the effects of drug abuse or alcohol abuse, and represents or advertises itself as an alcohol or other drug abuse treatment program.
(b)
“Program” includes a:
(i)
Program or facility that is owned or operated by the State or any of its political subdivisions; and
(ii)
Detoxification facility as defined in Health-General Article, §8-101(g), Annotated Code of Maryland.
(52)
“Progress note” means an objective documentation of the patient's progress in relation to specific treatment goals and objectives.
(53)
“Screening” means the utilization of a valid tool or instrument approved by the Administration to determine whether or not an individual may have alcohol or other drug abuse or dependence or both and will need further evaluation.
(54)
“Secretary” means the Secretary of Health.
(55)
“Self-help group” means a voluntary fellowship or group that supports patients in recovery from alcohol and other drug abuse or dependence.
(56)
“Therapeutic agent” means an intervention that is used to effect positive change.
(57)
“Treatment plan goal” means an intended resolution of a patient's clinical condition or problem that is completed within a specific amount of time and will contribute to the completion of treatment in a program.
(58)
“Treatment plan objective” means a behaviorally measurable symptom or social, legal, or family change that results in a stepwise achievement of a treatment goal.
(59)
“Utilization review” means a systematic assessment of the appropriateness of patient admissions, continuation in treatment, and referral to specific treatment services within a program.
(60)
“Variance” means an alternate method of meeting the intent of a regulation under this subtitle.
(61)
“Waiting list” means a list of individuals who are appropriate for services from a program but for whom a treatment slot is not available for 4 or more weeks for outpatient programs, or 2 or more weeks for residential programs.
(62)
“Waiver” means the exemption from compliance with a regulation under this subtitle.
Regulation .03 Governance.LinkCopy Citation
A.
The program shall:
(1)
Have a governing body legally responsible for overseeing the management and operation of the program and for ensuring compliance with applicable laws and regulations by:
(a)
Approving the program's:
(i)
Mission;
(ii)
Goals;
(iii)
Policies and procedures;
(iv)
Budget; and
(v)
Program service plan;
(b)
Adopting written bylaws;
(c)
Overseeing the operation of the program, according to the stated purposes of the program;
(d)
Ensuring proper management of the program by developing a job description for the administrator, and hiring, supervising, and providing for periodic performance evaluation of the administrator; and
(e)
Ensuring sound fiscal operation;
(2)
Implement fiscal policies and procedure which include:
(a)
The maintenance of fiscal records according to generally accepted accounting principles in Article 19, §28A, Annotated Code of Maryland, and COMAR 10.02.01 and 10.04.04;
(b)
Appropriate fire, casualty, liability, unemployment, and workers' compensation insurance;
(c)
In the event of fiscal instability, immediately notifying the Office of Health Care Quality;
(d)
Maintaining and posting a list of services and associated charges; and
(e)
Maintaining an annual program budget reflecting anticipated expenditures and sources of income;
(3)
Implement personnel policies and procedures that include:
(a)
Personnel policies and procedures that promote the objectives of the program;
(b)
Personnel policies that include:
(i)
The qualifications required for each position;
(ii)
An employee assistance policy and procedure;
(iii)
A policy to prevent discrimination prohibited by Article 49B, Annotated Code of Maryland, and federal law;
(iv)
A policy designed to prevent sexual harassment of staff and patients and appropriately manage complaints of sexual harassment;
(v)
A staff grievance procedure;
(vi)
A mechanism for assuring annual employee tuberculosis testing;
(vii)
Before employment, applying for national and State criminal history records checks;
(viii)
As part of the employment or volunteer application process, requiring the applicant to complete and sign a sworn statement or written affirmation disclosing the existence of a criminal conviction, probation before judgment disposition, not criminally responsible disposition, or pending charges without a final disposition;
(ix)
Requiring the employee to comply with §A(3)(b)(viii) of this regulation annually; and
(x)
Providing information to the employee so the employee may determine whether he or she needs testing or vaccination or both for hepatitis;
(c)
Maintaining a personnel file, in accordance with State and federal confidentiality requirements, for each employee, contractual staff, intern, or volunteer, that includes the individual’s:
(i)
Written application or resume including, name, home address, current telephone number, educational and training background, and employment history;
(ii)
Emergency contact information;
(iii)
Copies of required credentials;
(iv)
Current job title and description;
(v)
Current wage and salary information;
(vi)
Annual performance evaluation;
(vii)
Contracts, if applicable;
(viii)
Results of a criminal background check;
(ix)
Results of tuberculosis tests; and
(x)
Documentation of attendance at continuing education courses or other training; and
(d)
Not permitting any individual with a documented history of physical, mental, or sexual abuse or neglect of adolescents or children to work with children and adolescents;
(4)
Manage the program by:
(a)
Implementing a policy and procedure manual that contains:
(i)
An all hazards emergency protocol plan, approved by the Administration and updated at the time of recertification, that includes the name of the contact person for access to medical and clinical records, the written agreement or agreements with another facility to provide services in case of an emergency, notification procedures for the State Methadone Authority, program staff, and patients, a policy regarding patient access to emergency mental health services necessitated by a hazardous event, and a policy assuring that correctional levels of care comply with the institution’s all hazards emergency plan;
(ii)
The program's mission and goals;
(iii)
A description of the organizational structure of the program;
(iv)
Identification of the duties of the administrator and, if applicable, the medical director or clinical director;
(v)
Admission, transition, discharge, and termination procedures;
(vi)
Procedures governing patient rights and grievances;
(vii)
If applicable, a procedure for storing, handling, prescribing, dispensing, administering, and disposing of medications;
(viii)
Procedures for assisting program enrollees with access to entitlements, insurance benefits, and reimbursements for which the individual is eligible, if the program provides case management services; and
(ix)
Procedures for staff orientation, supervision, training, and education that include, but are not limited to, ethics and State and federal laws regarding confidentiality including, but not limited to, Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland, 42 CFR Part 2, The Health Insurance Portability Assurance and Accountability Act (HIPAA), and 45 CFR Parts 160 and 164; and
(b)
Implementing a program service plan, approved by the Administration, that is based on the levels of treatment to be provided as defined in COMAR 10.47.02.03 — .11 and describes how the program shall comply with the regulatory requirements, is updated annually, and includes:
(i)
A description of medical staff, if required by the level of treatment;
(ii)
A description of the program's scope that includes target populations and other program characteristics;
(iii)
Staff positions, their job descriptions, and educational and clinical training requirements, including an organizational chart detailing lines of authority and responsibility;
(iv)
A list of services to be delivered, including the types of medication and controlled dangerous substances to be prescribed, the types of group sessions, including education, the types of individual sessions and a complete family services plan;
(v)
Names of clinical supervisors and the number of alcohol and drug counselors supervised;
(vi)
Types of services that are available by referral; and
(vii)
Planning protocol for transfer or discharge of patients;
(5)
Implement a continuous quality review process that includes:
(a)
Designated teams responsible for implementation;
(b)
An ongoing procedure for utilization review;
(c)
A plan to identify problems and initiate actions to correct deviations from the program’s established standards, which includes:
(i)
Data collection;
(ii)
Current information regarding efficient and effective service delivery;
(iii)
Indicators relevant to the needs of the population served; and
(iv)
Ongoing internal review of the program, including monitoring for effectiveness of changes incorporated; and
(d)
An opportunity for all staff to participate on the teams described in §E of this regulation; and
(6)
Report critical incidents to the Administration within 5 business days of the incident;
(7)
Limit an individual’s role on the governing body to being a nonvoting member if the individual has an immediate family member who:
(a)
Is employed by the program;
(b)
Consults on behalf of the program;
(c)
Owns the program; or
(d)
Sits on an advisory committee for the program; and
(8)
Refuse to allow an individual to serve on the program’s governing body if the individual receives any monetary benefit from the program.
B.
The program may not allow:
(1)
An immediate family member of an employee of an organization to serve as a voting member of the governing body, board of directors, or advisory committee; or
(2)
An individual who is compensated for providing goods or services to the program to serve on the governing body, board of directors, or advisory committee.
Regulation .04 Clinical Requirements.LinkCopy Citation
A.
Admission. The program:
(1)
Shall upon request for admission:
(a)
Establish an interview date that falls within 10 working days of the individual's initial contact;
(b)
Refer or recommend another program to the individual; or
(c)
Place the individual on a waiting list;
(2)
Shall have a detailed description of patient placement criteria for admission to the program, including:
(a)
Eligibility criteria, using guidelines such as the American Society of Addiction Medicine Patient Placement Criteria or other guidelines approved by the Administration; and
(b)
Procedures for admission;
(3)
Shall include in its admission procedures:
(a)
An intake process;
(b)
An emergency intake process, including a procedure to refer individuals who are not suitable for its program to a more suitable program;
(c)
A procedure for developing and maintaining a waiting list; and
(d)
A fee schedule; and
(4)
May not admit a patient unless the individual meets the admission criteria of the American Society of Addiction Medicine Patient Placement Criteria or other guidelines approved by the Administration.
B.
Assessment.
(1)
A program shall prepare a comprehensive assessment for each patient, unless the patient is being readmitted to the same program or admitted to a different program within 30 days of the patient's last discharge, or has received an assessment by a licensed or certified clinician or program within 30 days, in which case the program may update the prior assessment.
(2)
The comprehensive assessment shall assess the following areas:
(a)
Physical health;
(b)
Employment or financial support;
(c)
Drug and alcohol;
(d)
Treatment history;
(e)
Legal;
(f)
Family and social;
(g)
Educational; and
(h)
Mental health.
(3)
Programs shall use the Addiction Severity Index as the standardized assessment instrument for adults, or an equivalent assessment instrument chosen by the Administration.
(4)
Programs shall use the Problem Oriented Screening Instrument for Teenagers as the standardized screening instrument for adolescents, or an equivalent screening instrument chosen by the Administration.
(5)
The initial physical health assessment shall meet the requirements of the appropriate level of treatment.
C.
Treatment Plans.
(1)
A program shall develop a written treatment plan, with the participation of the patient, based on the comprehensive assessment and patient placement criteria, that shall set forth:
(a)
The patient's individualized needs, including:
(i)
Socialization;
(ii)
Alcohol and drug abuse or dependence;
(iii)
Psychological;
(iv)
Vocational;
(v)
Educational;
(vi)
Physical health;
(vii)
Legal; and
(viii)
Family; and
(b)
Individualized interventions, including:
(i)
Long-range and short-range treatment plan goals and objectives;
(ii)
Strategy for implementation of treatment plan goals and objectives;
(iii)
Target dates for completion of treatment plan goals and objectives;
(iv)
A schedule of clinical services including individual, group, and, if appropriate, family counseling;
(v)
Criteria for successful completion of treatment;
(vi)
Referrals to ancillary services, if needed; and
(vii)
Referrals to self-help groups, if recommended.
(2)
If the alcohol and other drug counselor is unable to develop a treatment plan within the required time, the clinical director or the clinical supervisor shall:
(a)
Determine the reason for a delay in development of a treatment plan;
(b)
Document the reason in the patient's record; and
(c)
Direct an appropriate clinical staff person to develop a treatment plan within 7 working days of the clinical director's or clinical supervisor's documentation of the delay.
(3)
The length of stay in the program shall be based on the patient's level of illness severity and response to treatment.
D.
Infectious Disease Education. Within the first 30 days of treatment, a program shall ensure and document in the patient record that human immunodeficiency virus, hepatitis, sexually transmitted diseases, and tuberculosis education was completed, including:
(1)
Risk assessment;
(2)
Risk reduction; and
(3)
If appropriate, referral for counseling and testing.
E.
Family Involvement and Utilization of Self-Help Groups.
(1)
A program may provide education and support services to a patient's family directly or through referrals to appropriate community agencies.
(2)
A program shall:
(a)
Develop procedures for obtaining an assessment of the treatment needs of the patient's family;
(b)
Provide access or referral to family counseling;
(c)
Describe how family members are involved in the patient's recovery process; and
(d)
Develop procedures to encourage ongoing active participation by the patient and the patient's family in self-help groups and support activities.
F.
Referrals. Referral documentation shall include the:
(1)
Reason for referral;
(2)
Name of the individual;
(3)
Referring program;
(4)
Receiving program; and
(5)
Final disposition of referral.
G.
Discharge.
(1)
A program shall complete a written discharge summary.
(2)
The discharge summary shall include:
(a)
The reason for admission;
(b)
The reason for discharge;
(c)
The individual's address;
(d)
A summary of services delivered, including frequency and duration of services, and progress made;
(e)
If appropriate, the diagnosis and prognosis at the time of discharge;
(f)
Current medications, if applicable;
(g)
Continuing service recommendations and summary of transition process; and
(h)
The extent of the individual's involvement in the discharge plan.
(3)
The discharge summary shall be completed within 30 days of the patient's discharge from the program.
(4)
In the event of a patient's transfer from the program to another program, the discharging program shall complete a written transfer summary.
(5)
The transfer summary shall include:
(a)
The reason for admission;
(b)
The reason for discharge;
(c)
The individual's address;
(d)
The diagnosis and prognosis at the time of discharge; and
(e)
Current medications, if applicable.
(6)
The transfer summary shall be completed at the time of the patient's discharge from the program.
H.
Child and Adolescent Services.
(1)
A parent or guardian of a child or adolescent, with the child or adolescent's consent, may apply on behalf of the child or adolescent for admission to a certified program.
(2)
A program exclusively for children and adolescents shall:
(a)
Maintain written treatment protocols providing for the needs of adolescents and children, emphasizing the use of family interventions;
(b)
Provide for the educational needs of adolescents in compliance with local, State, and federal laws and regulations;
(c)
Comply with criminal background requirements for all staff; and
(d)
Meet any other requirements requested by the Administration.
(3)
A program that admits children and adolescents:
(a)
May not admit a child or adolescent into treatment unless the treatment plan indicates that the program is appropriate for the child or adolescent;
(b)
Shall provide separate social, residential, dietary, and recreational activities for the child or adolescent, if appropriate;
(c)
Shall obtain informed consent from the child or adolescent, or the parents or guardians for the child or adolescent, to be admitted to the program;
(d)
Shall comply with criminal background requirements for all staff; and
(e)
Shall meet any other requirements requested by the Administration.
(4)
A program that does not admit children and adolescents shall:
(a)
Identify in its program service plan the elements of the program that make treatment, care, and rehabilitation for children or adolescents contraindicated; and
(b)
Meet any other requirements requested by the Administration.
(5)
Programs that provide services to adults and permit the adult's children or adolescents to be present at the program shall verify that the children and adolescents:
(a)
Receive proper supervision;
(b)
Are appropriately enrolled in education services; and
(c)
Have access to appropriate health care.
I.
Medication Control and Staff Requirements.
(1)
A program shall develop and implement a written policy and procedure governing the use of controlled dangerous substances and other drugs used by the program. The policies shall include:
(a)
A list of controlled dangerous substances and other drugs administered, dispensed, or stored at the program;
(b)
Procedures to account for and secure the drugs from time of order until dispensing;
(c)
Computer security and accountability, if applicable;
(d)
Other policy and procedures required by the Administration; and
(e)
Procedures for all Level III programs to hold securely all take-home opioid therapy medication for patients who are on opioid maintenance therapy.
(2)
A program shall dispense medications to the patient according to the instructions, supervision, and directions of the licensed physician.
(3)
If staff observes an adverse reaction to medication, the program immediately shall contact a licensed physician or emergency medical service to ensure the patient receives treatment.
(4)
Medication Errors.
(a)
For a medication error regarding administration, dispensing, documentation, inventory, or storage, an appropriate clinical staff person shall complete a report at the time of the incident.
(b)
The report shall be filed and brought to the immediate attention of the:
(i)
Administrator; and
(ii)
Medical director, if a medical director is employed by the program.
(5)
Programs shall report the diversion of any controlled substance to the Administration as soon as the diversion is discovered.
Regulation .05 Environmental Requirements.LinkCopy Citation
A.
Life Safety Requirements. A program shall:
(1)
Have a facility free from fire hazards and have:
(a)
Adequate smoke detectors;
(b)
Working and updated fire extinguishers;
(c)
A written fire evacuation plan; and
(d)
A current fire inspection certification;
(2)
Comply with applicable federal, State, and local sanitation, building, fire codes, and zoning requirements;
(3)
Maintain documentation of legally required periodic evacuation drills, if applicable; and
(4)
Within the first 30 days of employment, provide staff training in emergency evacuation procedures.
B.
Special Accommodations. A program shall have protocols, which may include referral agreements with other programs, that provide for admission and treatment of individuals with:
(1)
Limited English proficiency or hearing and speaking disabilities; and
(2)
Physical and mental disabilities.
C.
Residential Treatment Programs. A program shall have:
(1)
Nurses' stations, if appropriate;
(2)
A dining room;
(3)
Bathrooms;
(4)
Telephones;
(5)
A living room;
(6)
Space for privacy for visits;
(7)
Space for leisure time activities;
(8)
Offices for both administrative and counseling personnel; and
(9)
Sleeping quarters that:
(a)
Do not allow for more than six patients to share the sleeping quarters, except for therapeutic communities that use dormitory style sleeping areas;
(b)
Provide adolescents and adults with separate sleeping quarters;
(c)
Provide privacy for patients;
(d)
Provide beds that:
(i)
Are at least 3 feet apart;
(ii)
Are located more than 18 inches away from radiators and registers;
(iii)
Are at least 36 inches wide, and not rollaway-type beds, cots, or folding beds;
(iv)
Have mattresses that are clean, in good repair, and the same size as the bed frame; and
(v)
Have at least two sets of sheets;
(e)
Have at least two dresser drawers and an enclosed space for hanging clothes; and
(f)
Have a mirror and window coverings in good repair;
(10)
A method for safely storing a patient's valuables; and
(11)
A written plan for providing temporary shelter for patients if a facility becomes uninhabitable.
D.
Dietary Services. If meals are provided, a program shall:
(1)
Comply with applicable local, State, and federal laws;
(2)
Have a written plan describing the organization and delivery of dietary services; and
(3)
Require a dietitian licensed under the Health Occupations Article, §5-101, Annotated Code of Maryland, to develop and implement the dietary service plan.
E.
Infection Control — Universal Precautions. A program shall observe universal precautions as required under COMAR 10.07.02.21-1.
Regulation .06 Staff Requirements.LinkCopy Citation
A.
Administrator.
(1)
A program shall have an administrator.
(2)
Qualifications. The administrator shall:
(a)
Possess a working knowledge of all applicable State and federal laws;
(b)
Possess a working knowledge of program management skills;
(c)
Be employed as an administrator before October 1, 2002; or
(d)
Have at a minimum:
(i)
A bachelor's degree from an accredited educational institution; and
(ii)
At least 5 years of documented experience in human services, 2 years of which include providing administrative or clinical supervision.
(3)
Duties. The administrator shall ensure that the program complies with all applicable State and federal laws.
B.
Clinical Director.
(1)
A program may have a clinical director.
(2)
The clinical director functions under the administrative supervision of the administrator.
(3)
Qualifications. The clinical director shall have at a minimum:
(a)
A master's degree in counseling or a related discipline regulated under the Health Occupations Article, Annotated Code of Maryland, and certification or licensure as an alcohol and drug counselor by the Board of Professional Counselors and Therapists; or
(b)
Approval to supervise by the Board of Professional Counselors and Therapists.
C.
Clinical Supervisor.
(1)
A program shall have a clinical supervisor.
(2)
Qualifications. The clinical supervisor shall:
(a)
Be employed as a clinical supervisor before October 1, 2002; or
(b)
Have at a minimum:
(i)
A master's degree in counseling or a related discipline regulated under the Health Occupations Article, Annotated Code of Maryland, and certification or licensure as an alcohol and drug counselor by the Board of Professional Counselors and Therapists; or
(ii)
Approval to supervise by the Board of Professional Counselors and Therapists.
(3)
Duties. A clinical supervisor may carry a caseload at the discretion of the administrator.
D.
Clinical Staff.
(1)
Qualifications. All staff employed as alcohol and drug counselors shall, at a minimum be:
(a)
Licensed or certified as an alcohol and drug counselors by the Board of Professional Counselors and Therapists;
(b)
Approved by the Board of Professional Counselors and Therapists; or
(c)
Licensed, certified, or permitted under the Health Occupations Article, Annotated Code of Maryland to provide substance abuse treatment.
(2)
Credentials. The administrator shall ensure that program staff, including students, interns, and volunteers, are credentialed and appropriately privileged.
(3)
Policies and Procedures. All clinical staff, including the administrator, clinical director, and clinical supervisor, shall review the program's policies and procedures and shall sign a statement saying that they reviewed and understood the policies and procedures.
Regulation .07 Patient Rights and Grievance Procedures.LinkCopy Citation
A.
Patient Rights.
(1)
A program shall:
(a)
Treat each patient with consideration, respect, and full recognition of the patient's human dignity and individuality;
(b)
Provide treatment, care, and services that are adequate, appropriate, and in compliance with relevant State, local, and federal laws and regulations;
(c)
Prevent physical or mental abuse by the program staff;
(d)
Provide an atmosphere free from discrimination;
(e)
Not allow use of any physical restraints;
(f)
Ensure privacy and confidentiality; and
(g)
Allow the patient the right to refuse participation in any experimental research unless the research complies with 45 CFR Part 46.
(2)
A program shall post in a conspicuous area and provide to each patient a statement of patients' rights.
B.
Grievance Procedures. A program shall:
(1)
Have a grievance procedure approved by the Administration;
(2)
Provide the patient upon admission a description of grievance policy and procedure that includes the:
(a)
Patient's right to grieve program decisions including but not limited to:
(i)
Discharge; and
(ii)
Change in status;
(b)
Steps of the grievance process; and
(c)
Levels to which the grievance may be taken;
(3)
Take no retaliation against a patient who presents a grievance; and
(4)
Inform each patient if revisions are made to the grievance policy and the nature and extent of the revisions.
C.
Nondiscrimination. A program may not discriminate in the provision of services on the basis of race, creed, color, age, gender, sexual orientation, national origin, marital status, disabilities, and any other classification prohibited under State or federal law including:
(1)
Americans with Disabilities Act, 28 CFR 35; and
(2)
Fair Housing Act, 42 U.S.C. §3604.
Regulation .08 Records.LinkCopy Citation
A.
Program Records.
(1)
A program shall either manually or electronically maintain a record for each patient that includes, but is not limited to:
(a)
A patient identifier, which may be a name, number, or an identifying code;
(b)
Intake information, including the patient's name, date of admission, summary of medical examinations, allergies to medication, and laboratory reports;
(c)
Assessments, individualized treatment plans, progress notes, and consent to disclose information if needed;
(d)
Documentation of each program contact with the patient;
(e)
Critical incident reports documented on the day of the incident; and
(f)
A discharge summary.
(2)
A program shall maintain Medicaid patient records for at least 6 years following discharge, and all other patient records for at least 3 years as required by Health-General Article, §4-403, Annotated Code of Maryland, and shall:
(a)
Maintain, transfer, and destroy all records in a manner consistent with the medical records confidentiality and disclosure requirements of:
(i)
Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland;
(ii)
Health-General Article, §4-403, Annotated Code of Maryland;
(iii)
42 CFR Part 2;
(iv)
The Health Insurance Portability and Accountability Act (HIPAA); and
(v)
45 CFR Parts 160 and 164;
(b)
Locate all records so that they are convenient and available to designated staff; and
(c)
Provide a designated staff member responsible for appropriate records control, including storage, security, and indexing records.
B.
Management Information System. The program shall:
(1)
Participate in the Administration's management information system;
(2)
Comply with reporting requirements as required by the Department; and
(3)
Complete and submit the driving while intoxicated data collection form chosen by the Administration for those arrested for driving while intoxicated or driving under the influence.
C.
Electronic Records.
(1)
Electronic records shall be maintained according to requirements set forth in this regulation.
(2)
A companion hard copy file shall be maintained at the program and shall contain the following:
(a)
Informed consent to treatment signed by the patient;
(b)
Any requests for or releases of information shared with other entities signed by the patient;
(c)
Any treatment plan or treatment plan update signed by the patient; and
(d)
Any program agreements or patient/counselor behavioral contracts signed by the patient.
Regulation .08-1 Outcome Evaluation.LinkCopy Citation
A.
The Administration shall annually evaluate all publicly funded substance abuse treatment programs certified under this subtitle, using federal outcomes measures or other subsequently adopted federal standards, to determine the extent that individuals who have received treatment under these programs have:
(1)
Been successfully retained in the treatment program;
(2)
Been successfully discharged from the treatment program;
(3)
Reduced their substance use;
(4)
Successfully attained, maintained, or increased their employment;
(5)
Demonstrated a decrease in engaging in criminal activity; and
(6)
Successfully established or maintained stable living arrangements.
B.
All publicly funded programs shall fully comply with the Administration’s reporting requirements completing all data fields required within the Administration’s management information system as directed.
Regulation .09 Referral Agreements and Program Cooperation.LinkCopy Citation
A.
A program shall coordinate patient care with other community service providers to ensure that the widest range of appropriate services are available to patients.
B.
Referral Agreements.
(1)
A program shall establish referral agreements with other human service agencies as required by COMAR 10.47.02.
(2)
The program shall make the referral agreements available to the Administration for review.
(3)
A program shall have referral agreements with other programs for individuals with disabilities whom the program may be unable to accommodate.
Chapter annotations
Authority: Health-General Article, §§8-401 — 8-405 and 19-308, Annotated Code of Maryland
History: Effective date: April 8, 1985 (12:7 Md. R. 703)
History: Regulations .26H, .30L, and .31K amended effective June 17, 1985 (12:12 Md. R. 1165)
History: Regulations .01—.33, Certification of Alcoholism and Alcohol Abuse Facilities, repealed and new Regulations .01—.09, Requirements, adopted effective June 10, 2002 (29:11 Md. R. 882)
History: Regulation .02B amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 894); amended permanently effective May 5, 2008 (35:9 Md. R. 898)
History: Regulation .03 amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 894); amended permanently effective May 5, 2008 (35:9 Md. R. 898)
History: Regulation .03 amended effective December 12, 2013 (40:24 Md. R. 2017)
History: Regulation .04 amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 894); amended permanently effective May 5, 2008 (35:9 Md. R. 898)
History: Regulation .05A amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 894); amended permanently effective May 5, 2008 (35:9 Md. R. 898)
History: Regulation .06A, D amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 894); amended permanently effective May 5, 2008 (35:9 Md. R. 898)
History: Regulation .07A amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 894); amended permanently effective May 5, 2008 (35:9 Md. R. 898)
History: Regulation .08 amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 894); amended permanently effective May 5, 2008 (35:9 Md. R. 898)
History: Regulation .08-1 adopted effective December 12, 2013 (40:24 Md. R. 2017)