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<chapter num="03" heading="Interagency Discharge Planning for Hospitalized Children and Adolescents" title_num="14" subtitle_num="31">
  <regulation prefix="Regulation" num=".01" heading="Scope.">
    <text>The following regulations govern procedures for the development of interagency plans for the provision of services to hospitalized children.</text>
  </regulation>
  <regulation prefix="Regulation" num=".02" heading="Definitions.">
    <paragraph num="A.">
      <text>In this chapter, the following terms have the meanings indicated.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Terms Defined.</text>
      <paragraph num="(1)">
        <text>“Case service coordinator” means a State employee, assigned to the Office for Children, who is responsible for tracking the status of hospitalized children and coordinating interagency efforts to secure the timely and appropriate placement of these children.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>“Departments” means the Maryland Departments of Health, Human Services, Education, and Juvenile Services.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>“Discharge plan” means the written plan, developed by the hospital treatment team and qualified professionals from the Departments providing services to the child, which describes the services, treatment, and training appropriate for the child outside the hospital setting.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>“Hospitalized child” means both State-hospitalized children and privately hospitalized children.</text>
      </paragraph>
      <paragraph num="(5)">
        <text>“Lead agency” means the Department designated by the multi-agency review team to implement the hospitalized child's discharge plan.</text>
      </paragraph>
      <paragraph num="(6)">
        <text>“Multi-agency review team” means a committee of senior officials from the Departments and the Office for Children.</text>
      </paragraph>
      <paragraph num="(7)">
        <text>“Private psychiatric hospital” means Brooklane Hospital, Gundry Glass Hospital, Sheppard and Enoch Pratt Hospital, and Taylor Manor Hospital.</text>
      </paragraph>
      <paragraph num="(8)">
        <text>“Privately hospitalized child” means an individual under 18 years old, committed by juvenile court order to State custody and who is admitted to a private psychiatric hospital.</text>
      </paragraph>
      <paragraph num="(9)">
        <text>“State-hospitalized child” means an individual 18 years old admitted to the Mental Hygiene Administration's inpatient hospital-level care.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Procedures for Identification and Tracking of Hospitalized Children.">
    <paragraph num="A.">
      <text>Each State hospital and each private psychiatric hospital, when possible, shall complete an inpatient tracking form for each hospitalized child and report to a designated Department as follows:</text>
      <paragraph num="(1)">
        <text>Within 24 hours after the first business day following the admission of a hospitalized child, the hospital staff shall complete and transmit the inpatient tracking form to the designated Department; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The hospital staff shall update the inpatient tracking forms every 2 weeks and transmit the forms to the designated Department.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>The case service coordinator shall maintain the tracking forms and any data reports generated from the forms. The case service coordinator shall forward data reports generated from the forms to all Departments.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Procedures for Development of Interagency Plans.">
    <paragraph num="A.">
      <text>Within 10 working days after a child is hospitalized, the lead agency shall provide case management services to each hospitalized child, in the manner considered appropriate by the lead agency, to assist in securing and maintaining appropriate discharge services and placement.</text>
    </paragraph>
    <paragraph num="B.">
      <text>The hospital treatment team and lead agency shall jointly develop for each hospitalized child a discharge plan that includes recommendations for the services needed to maintain the child outside the inpatient setting and provide appropriate treatment.</text>
    </paragraph>
    <paragraph num="C.">
      <text>The recommendations in the discharge plan may include the following:</text>
      <paragraph num="(1)">
        <text>Therapy;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Education;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Residential arrangement;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Medications and medical needs;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Physical needs;</text>
      </paragraph>
      <paragraph num="(6)">
        <text>Social and recreational needs;</text>
      </paragraph>
      <paragraph num="(7)">
        <text>Family involvement in therapy; and</text>
      </paragraph>
      <paragraph num="(8)">
        <text>Family visitation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>The case manager from the lead agency shall attend the discharge planning meeting with the hospital treatment team, or be available by telephone to discuss the discharge plan. The lead agency shall be responsible for implementing the discharge plan.</text>
    </paragraph>
    <paragraph num="E.">
      <text>The multi-agency review team shall meet every 2 weeks to review the discharge plan and the tracking forms of each hospitalized child who is ready for discharge or whose tracking forms indicate possible difficulty in obtaining timely and appropriate discharge to assist in resolving problems that might require interagency action or planning.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".05" heading="Transitional Services.">
    <paragraph num="A.">
      <text>Transitional services include:</text>
      <paragraph num="(1)">
        <text>Therapeutic;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Educational;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Interim residential;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Social; and</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Recreational.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>The lead agency shall provide transitional services when the treating physician, in consultation with the hospital treatment team and the lead agency, determines that:</text>
      <paragraph num="(1)">
        <text>The hospitalized child is ready for discharge and remains in the hospital; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Transitional services are necessary to prevent specific clinical deterioration of the hospitalized child.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>The lead agency, in consultation with the treating physician and the hospital treatment team, other departments, the child, and the child's parents if the parents are available, shall determine the specific transitional services provided to the child.</text>
    </paragraph>
    <paragraph num="D.">
      <text>The lead agency may provide transitional services if:</text>
      <paragraph num="(1)">
        <text>The lead agency determines that transitional services are necessary to assist with a hospitalized child's adjustment to an aftercare placement; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Resources are available.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="Authority">Article 41, §§6-101 and 6-104; Article 83C, §§2-102, 2-104, and 2-113; Article 88A, §3; Education Article, §§8-301—8-303 and 8-401—8-417; Health-General Article, §§2-102, 2-104, 2-105, 4-305, 4-307, 7-401, 7-1007, 10-204, 10-207, 10-712, 10-1203, and 15-102.1; Annotated Code of Maryland</annotation>
    <annotation type="History" subtype="Administrative History">Effective date: July 31, 1995 (22:15 Md. R. 1117)</annotation>
    <annotation type="History" subtype="Administrative History">COMAR 01.04.03 revised and recodified to COMAR 14.31.03 as an emergency provision effective June 30, 2005 (32:15 Md. R. 1314); recodified permanently effective November 28, 2005 (32:23 Md. R. 1828)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02 amended as an emergency provision effective June 30, 2005 (32:15 Md. R. 1314); amended permanently effective November 24, 2005 (32:23 Md. R. 1828)</annotation>
  </annotations>
</chapter>