# COMAR Title 10 — Maryland Department of Health

## Subtitle 63 — Community-Based Behavioral Health Programs and Services

### Chapter 04 — Additional Requirements for Accreditation-Based Licenses for Specific Residential Community-Based Behavioral Health Services

**Authority:** Health-General Article, §§7.5-204, 8-402, 8-404, and 10-901, Annotated Code of Maryland

**Administrative History:** Effective date: July 1, 2016 (43:10 Md. R. 585)

**Administrative History:** Regulation .03 amended effective February 27, 2017 (44:4 Md. R. 255)

#### Regulation .01 Scope.

*COMAR 10.63.04.01*

This chapter sets forth descriptions of, criteria for, and licensing requirements for, three specific programs that provide residential community-based behavioral health services. These programs shall comply with COMAR 10.63.01—.02, 10.63.04, and 10.63.06. Residential Rehabilitation Programs shall also comply with COMAR 10.63.03.09.

#### Regulation .02 Covered Programs.

*COMAR 10.63.04.02*

This chapter applies to the following programs:

A. Group Homes for Adults with Mental Illness;

B. Residential Crisis Services (RCS) program; and

C. Residential Rehabilitation Program (RRP).

#### Regulation .03 Group Homes for Adults with Mental Illness.

*COMAR 10.63.04.03*

A. In order to be licensed under this subtitle, a group home for adults with mental illness shall:

  (1) Meet the definition in Health-General Article, §10-514 (b), (d), and (e), Annotated Code of Maryland;

  (2) Provide a home-like, supportive residential environment:

    (a) In a small group home, which provides services for more than 3, but not more than 8 individuals with a mental health disorder; or

    (b) In a large group home for more than 8, but not more than 16 individuals with a mental health disorder; and

  (3) Meet the site requirements set out in Regulation .07 of this chapter verified through an annual site inspection conducted by the CSA or LBHA.

B. A group home for adults with mental illness may not provide services for individuals with a primary diagnosis of developmental disability, as defined in Health-General Article, §7-101, Annotated Code of Maryland.

#### Regulation .04 Residential Crisis Services (RCS).

*COMAR 10.63.04.04*

In order to be licensed under this subtitle, a residential crisis services program:

A. Shall provide short-term mental health treatment and support services in a structured environment for individuals who require 24-hour supervision due to a psychiatric crisis;

B. Shall be designed to:

  (1) Prevent psychiatric inpatient admission;

  (2) Shorten the length of inpatient stay;

  (3) Effectively use general hospital emergency departments; and

  (4) Provide an alternative to psychiatric inpatient admission;

C. Shall have staff who are on-site 24 hours per day, 7 days per week, whenever an individual is on-site receiving services;

D. For adults, shall meet the site requirements set out in Regulation .07 of this chapter verified through an annual site inspection conducted by the CSA or LBHA; and

E. For individuals younger than 21 years old, may offer services in an appropriately licensed therapeutic program, as appropriate.

#### Regulation .05 Residential Rehabilitation Program (RRP).

*COMAR 10.63.04.05*

In order to be licensed under this subtitle, a residential rehabilitation program (RRP) shall:

A. Serve individuals with a mental disorder;

B. Be operated by a licensed PRP-A;

C. Lease or own the RRP sites;

D. Be approved by BHA for RRP funding;

E. Provide a home-like, supportive residential environment;

F. Provide services for no more than 3 individuals per RRP site, unless also licensed as a group home as provided in Regulation .03 of this chapter;

G. Promote the individual’s ability to engage and participate in appropriate community activities;

H. Enable the individual to develop the daily living skills needed for independent functioning;

I. Have:

  (1) On-site staffing, as needed to meet the needs of the individuals served; and

  (2) Staff that are available on call, 24 hours per day, 7 days per week;

J. Meet the site requirements as set out in Regulation .07 of this chapter, verified through an annual site inspection conducted by the CSA or LBHA, as appropriate;

K. Have a written policy regarding the development of and process for implementation of a managed intervention plan (MIP) for an individual receiving residential services who may be at risk of an unplanned discharge, which:

  (1) Is developed in collaboration with the individual, treatment team members, and CSA or LBHA, as appropriate; and

  (2) Includes a description of additional individualized services and supports that may be needed, and identification of temporary residential alternatives, if any; and

L. If an MIP is executed, develop a transition plan that:

  (1) Is created in collaboration with the individual, treatment team members, CSA or LBHA, as appropriate, and ASO; and

  (2) Includes the elements outlined in §K(2) of this regulation.

#### Regulation .06 Application Requirements for a Residence to be Operated by a Program.

*COMAR 10.63.04.06*

A program seeking a license under this subtitle for a residential site shall submit to the CSA or LBHA a completed application that:

A. Is on the form required by the Administration with all required documents attached; and

B. Includes documentation that the residence:

  (1) Is owned or leased by the applicant; or

  (2) Will be owned or leased by the applicant; and

  (3) Is located in a building that will have continuous fire, liability, and hazard insurance coverage.

#### Regulation .07 Residential Site Requirements.

*COMAR 10.63.04.07*

A program licensed to provide community-based behavioral health residential services under this chapter shall ensure that:

A. All areas of a residence, including storage areas:

  (1) Are safe;

  (2) Clean; and

  (3) Free of hazards and clutter;

B. A residence has:

  (1) No housing code or zoning violations;

  (2) Working smoke alarms or smoke detectors that meet local fire codes for residential dwellings;

  (3) Hot and cold running water:

  (4) Adequate light, heat, and ventilation; and

  (5) Sufficient, appropriate, and functional furnishings, equipment, supplies, and utensils comparable to those found in the residences of nondisabled individuals;

C. Each resident:

  (1) Has the resources to purchase or has access to food;

  (2) Has the resources to acquire an adequate supply of soap, towels, and toilet tissue;

  (3) Who self-administers medication, has access to a secure storage area for the resident’s medications;

  (4) Has access to a secure storage area for funds and valuables;

  (5) Has access to transportation;

  (6) Has access to a telephone in the residence; and

  (7) To the extent possible, may use personal possessions and preferences in furnishing and decorating the resident’s space.

D. The following emergency procedures are followed:

  (1) Posted near the telephone are telephone numbers for the:

    (a) Fire department, police, ambulance, and poison control center; and

    (b) Program’s on-call staff; and

  (2) An emergency evacuation procedure that is explained to and practiced by residents within 10 days after entering residence and, at a minimum, every 3 months after that;

E. Each bedroom has:

  (1) A minimum of 70 square feet for a single bedroom and a minimum of 120 square feet for a double bedroom;

  (2) An interior door, except for an efficiency apartment;

  (3) Closet space in or convenient to each bedroom for each individual using the bedroom;

  (4) Coverings for each window, for privacy;

  (5) A bed with a clean mattress and pillow for each resident using the bedroom;

  (6) At least two sets of bed linens per resident; and

  (7) Not more than two residents using the bedroom;

F. Each toilet and bathing area has:

  (1) A minimum of one full bathroom for every four residents; and

  (2) At least one toilet, one basin, and one tub or shower connected to hot and cold water;

  (3) Easy access and conveniently located, not more than one floor level from living, dining, and sleeping rooms; and

  (4) Privacy for the individual using it; and

G. The program has a written relocation plan for each site that:

  (1) Specifies where residents may live temporarily if the CSA or LBHA determines that conditions in the approved residence pose an imminent risk to the health, safety, or welfare of a resident;

  (2) Is approved by the CSA or LBHA, as appropriate; and

  (3) Is updated annually.