Maryland Department of Health 10.63.01, 10.63.03, 10.63.04 and 10.63.06 Licensure and Exemption Requirements (COMMUNITY-BASED BEHAVIORAL HEALTH PROGRAMS AND SERVICES)

PROPOSAL

Maryland Register

Issue Date: November 14, 2016

Volume 43 • Issue 23 • Pages 1289—1290

Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Subtitle 63 COMMUNITY-BASED BEHAVIORAL HEALTH PROGRAMS AND SERVICES

Notice of Proposed Action

[16-287-P]

The Secretary of Health and Mental Hygiene proposes to amend:

(1) Regulations .02, .04, and .05 under COMAR 10.63.01 Requirements for All Licensed Programs;

(2) Regulations .14, .18, and .19 under COMAR 10.63.03 Descriptions and Criteria for Programs and Services Required to Have an Accreditation-Based License;

(3) Regulation .03 under COMAR 10.63.04 Additional Requirements for Accreditation-Based Licenses for Specific Residential Community-Based Behavioral Health Services; and

(4) Regulation .10 under COMAR 10.63.06 Application and Licensure Process.

Statement of Purpose

The purpose of this action is to update the behavioral health program licensure requirements and to add the program exemption requirements.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

The proposed action has no economic impact.

Economic Impact on Small Businesses

The proposed action has minimal or no economic impact on small businesses.

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to dhmh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through December 14, 2016. A public hearing has not been scheduled.

10.63.01 Requirements for All Licensed Programs

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

.02 Definitions.

A. In this [chapter] subtitle, the following terms have the meanings indicated.

B. Terms Defined.

(1)—(21) (text unchanged)

(22) “Demonstration project” means an experimental project that, if deemed successful, will be considered for future adoption.

[(22)] (23)—[(26)] (27) (text unchanged)

[(27)] (28) “Exempt provider” means a provider that, under Health-General Article, [§§8-403 and 10-901(c)] §7.5-401, Annotated Code of Maryland, is not required to be licensed by the Secretary to provide services in Maryland.

[(28)] (29)—[(39)] (40) (text unchanged)

(41) “Office of Health Care Quality (OHCQ)” means the Office of Health Care Quality of the Department of Health and Mental Hygiene.

[(40)] (42)—[(42)] (44) (text unchanged)

(45) “Pilot project” means an experimental project that, if deemed successful, will be adopted as a permanent policy or program.

[(43)] (46)—[(57)] (60) (text unchanged)

.04 Exempt Providers.

A. In accordance with Health-General Article, [§§8-403 and 10-901] §7.5-401, Annotated Code of Maryland, the following providers are exempt from the requirements of, and are not required to be licensed under, this subtitle:

(1)—(6) (text unchanged)

[(7) Organizations that hold meetings or provide support services but do not provide any type of treatment;]

[(8)] (7)—[(10)] (9) (text unchanged)

B. Notwithstanding the provisions of §A of this regulation, a provider shall have a valid and current license under this subtitle in order to provide the following services:

(1) (text unchanged)

(2) Substance-related disorder [residential services] programs as described in COMAR [10.63.05.04] 10.63.03.11—.14.

C. The Department may exempt a program from the requirements of this subtitle:

(1) If the program:

(a) Is a pilot project;

(b) Is a federal or State demonstration project; or

(c) Does not fall within any of the program descriptions set out in:

(i) COMAR 10.63.03;

(ii) COMAR 10.63.04; or

(iii) COMAR 10.63.05; and

(2) If the program demonstrates to the satisfaction of the Department that it is subject to:

(a) Contractual provisions;

(b) Conditions of grant award; or

(c) Other requirements that are comparable to the regulations in this subtitle.

.05 Requirements for Licensed Community-Based Behavioral Health Program.

A.—D. (text unchanged)

E. Agreement to Cooperate.

(1) (text unchanged)

(2) The agreement to cooperate shall provide for coordination and cooperation between the parties in carrying out behavioral health activities in the jurisdiction, including but not limited to facilitating:

(a) (text unchanged)

(b) The transition of services if [the]:

(i) The program closes; or

(ii) A program discontinues a service.

(3) (text unchanged)

F.—G. (text unchanged)

10.63.03 Descriptions and Criteria for Programs and Services Required to Have an Accreditation-Based License

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

.14 Residential-Intensive Level 3.7 Program.

A. (text unchanged)

B. [A] If the program's license specifically authorizes the service, a residential-intensive [intensity] level 3.7 program may provide [the following services if the program’s license specifically authorizes the services:

(1) A withdrawal management service as described in Regulation .18 of this chapter; and

(2) An] an opioid treatment service as described in Regulation .19 of this chapter.

C. A residential-intensive level 3.7 program shall employ a physician, nurse practitioner, or physician assistant who:

(1) Assesses each patient in person within 24 hours of admission or earlier, if medically necessary;

(2) Assesses each patient thereafter, as medically necessary; and

(3) Is available to provide on-site monitoring of care and further evaluation on a daily basis.

.18 Withdrawal Management Service.

A withdrawal management service is one that:

A.—C. (text unchanged)

D. Motivates the individual to participate in appropriate treatment programs for alcohol or other drug dependence; [and]

E. Provides additional referrals as necessary; and

F. At Level I-WM, Level 2-WM, and Level 3.7-WM, employs a physician, nurse practitioner, or physician assistant who:

(1) Obtains a comprehensive medical history and physical examination of the patient at admission; and

(2) Medically monitors each patient.

.19 Opioid Treatment Service.

An opioid treatment service is one that:

A.—I. (text unchanged)

J. [Administratively] Nonvoluntarily tapers or transfers a patient only if the:

[(a)] (1)—[(b)] (2) (text unchanged)

[(c)] (3) Patient misses 3 consecutive medication days, and the program physician, after reevaluation, has determined that [administrative] nonvoluntary taper is warranted; or

[(d)] (4) (text unchanged)

K.—L. (text unchanged)

10.63.04 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

.03 Group Homes for Adults with Mental Illness.

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

[A.] (1) (text unchanged)

[B.] (2) Provide a home-like, supportive residential environment:

[(1)] (a) (text unchanged)

[(2)] (b) In a large group home for more than [9] 8, but not more than 16 individuals with a mental health disorder; and

[C.] (3) (text unchanged)

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.

10.63.06 Application and Licensure Process

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

.10 Discontinuation of Program Operations.

A.—F. (text unchanged)

G. If a program licensed to provide community-based behavioral health services intends to discontinue a service, the program director shall provide immediate notification to the:

(1) CSA;

(2) LAA;

(3) LBHA; or

(4) OHCQ.

VAN T. MITCHELL
Secretary of Health and Mental Hygiene