1. A. The goals of the PTFC program, in addition to the goals of out-of-home placement as stated in Regulation .02 of this chapter, are to provide, in a family setting, intensive services to a child with a serious emotional, behavioral, medical, or psychological condition.

2. B. PTFC Child Eligibility Requirements.

   1. (1) To be eligible for PTFC, the child shall:

      1. (a) Qualify for foster care under Regulation .04 of this chapter;
      2. (b) Have one or more conditions as detailed in §B(2) of this regulation; and
      3. (c) Need a high level of treatment in a family setting.

   2. (2) Eligible conditions for PTFC include:

      1. (a) A serious medical condition including, but not limited to:

         1. (i) HIV positive and symptomatic;
         2. (ii) AIDS;
         3. (iii) Multiple handicaps;
         4. (iv) A symptomatic drug-exposed newborn requiring treatment care;
      2. (b) A serious emotional or behavioral condition as defined in Regulation .03B of this chapter, or psychological condition indicated in a psychiatric diagnosis by appropriate qualified professionals, or the same conditions resulting from continuous substance abuse;
      3. (c) A developmental disability as defined in COMAR 10.22.01.01B; or
      4. (d) A medically fragile child condition as outlined in COMAR 14.31.05.03B.
   3. (3) Siblings who do not require treatment foster care may be eligible to be placed as a nontreatment foster child in the same treatment home with a sibling who requires treatment foster care with written approval from the Administration.

3. C. The PTFC caseworker is responsible for:

   1. (1) Providing supervision, training, and consultation to treatment and biological parents;
   2. (2) Arranging and ensuring that a child receives necessary services; and
   3. (3) Acting as the leader of a child's treatment team.

4. D. Each local department PTFC program shall establish a gatekeeper for the PTFC program from existing staff who shall:

   1. (1) Act as the single point of entry for placement of children in the PTFC program;
   2. (2) Perform periodic assessment of continued treatment foster care eligibility for each child in the PTFC program; and
   3. (3) Perform program monitoring functions for the PTFC program.

5. E. Staffing Requirements.

   1. (1) The caseload ratio may not be greater than one PTFC caseworker to eight children.

   2. (2) The PTFC program may decrease the case load ratios of the PTFC caseworker set forth in §E(1) of this regulation if it is determined that one or more of the following circumstances apply:

      1. (a) The children's needs require the PTFC caseworker to provide more intensive supervision and training for the PTFC parents;
      2. (b) Traveling distances between placements of children requires 2 hours of travel or more and impedes the PTFC caseworker's ability to maintain frequent and direct contact with the PTFC child;
      3. (c) The PTFC caseworker provides case management services and performs duties in addition to services to the child such as recruitment and training of PTFC parents; or
      4. (d) Other factors necessitate the reduction of the caseload to ensure adequate provision of services.
6. F. The local department PTFC program shall have a written policy for planned discharge of a child from the PTFC which shall be incorporated as part of the child's treatment plan.

7. G. Before discharge from the PTFC program, the local department shall develop a treatment aftercare plan as part of the child's case record, and which include:

   1. (1) The name, address, telephone number, and relationship of the individual to whom the child is being discharged;
   2. (2) A summary of the services provided during care;
   3. (3) A summary of the growth and achievements of the child during care;
   4. (4) Any identified needs of the child that remain unmet; and
   5. (5) Recommendations for treatment aftercare services needed upon discharge from the PTFC.

8. H. Referral Responsibilities.

   1. (1) The local department caseworker shall make a written determination that a child is eligible for treatment foster care, and forward the determination to the PTFC gatekeeper along with:

      1. (a) A referral for purchase of care, and all supporting documentation;
      2. (b) A current case plan drafted within 180 calendar days before the date of referral;
      3. (c) Relevant medical records current within 1 year before the date of referral; and
      4. (d) Psychological or psychiatric evaluations performed within 1 year before the date of referral to the gatekeeper if eligibility is based on a serious emotional, behavioral, or psychological condition.
   2. (2) The gatekeeper shall respond in writing to the referring local department caseworker within 14 working days, accepting or denying admission of a child and giving the reason for a denied admission.
9. I. The PTFC child, the child's attorney, and parent or legal guardian has the right to appeal the eligibility review decision.
10. J. The length of stay in a PTFC program is subject to review and assessment for continued PTFC eligibility by the gatekeeper at least once a year.

11. K. The PTFC caseworker shall:

    1. (1) Develop a treatment plan within 30 calendar days of a child's acceptance into the program;

    2. (2) Convene a treatment team to evaluate the child's treatment plan at intervals not to exceed 3 months that shall include:

       1. (a) The treatment foster care caseworker;
       2. (b) Parents or legal guardian, if appropriate;
       3. (c) Local department of social services caseworker, if applicable;
       4. (d) PTFC parents; and
       5. (e) Any therapist, psychologist, psychiatrist, physician, or professional involved in providing treatment services;
    3. (3) Visit face-to-face with the PTFC parents a minimum of twice a month;
    4. (4) Visit face-to-face with the child a minimum of twice a month;
    5. (5) Provide services to the family of a PTFC child as required in the permanency and treatment plans;
    6. (6) Meet with the child and the child's family according to the child's treatment plan, legal status, and permanency plan;
    7. (7) Attend hearings;

    8. (8) If the child has a separate local department caseworker:

       1. (a) Provide information to the local department caseworker on changes affecting services to the child which could result in revisions to the treatment plan, such as changes in placement, placement location, or visitation plans;
       2. (b) Provide the local department caseworker with a written progress report every 3 months, which includes the current treatment plan and notes from the most recent treatment team meeting discussing progress on the treatment plan;
    9. (9) Provide all medical and psychological information necessary for the care of the child to the PTFC parents;
    10. (10) Provide PTFC parents access to crisis respite care and planned monthly respite care for their treatment foster children; and
    11. (11) Maintain a written pre-service curriculum for the PTFC program and make available to PTFC parents in-service training opportunities.

12. L. Treatment Home Capacity Requirements.

    1. (1) Not more than two out-of-home placement children may be placed in one eligible treatment home without the prior written approval from the Administration.
    2. (2) Requests to place a third out-of-home placement child, including a sibling, in the home must be made by the local department treatment program in writing to the Administration.

13. M. The local department PTFC program shall establish a written treatment plan for every treatment child in its program, which includes:

    1. (1) Role of the PTFC foster parent;
    2. (2) Role of the PTFC caseworker;
    3. (3) Specific tasks to be carried out by PTFC parents during placement;
    4. (4) Identification of treatment team members who will assist in the provision of planned care; and

    5. (5) Long-term goals of treatment, including:

       1. (a) Criteria for discharge;
       2. (b) Projected length of stay in the program;
       3. (c) Projected post-treatment; and
       4. (d) Treatment aftercare services.

14. N. The PTFC parent approved by the PTFC program shall:

    1. (1) Meet all of the requirements of a local department foster parent as prescribed by COMAR 07.02.25;
    2. (2) Meet all of the service and responsibility requirements of COMAR 07.02.21.10A and D;
    3. (3) Complete 8 hours of PTFC parent pre-service training in addition to the foster parent pre-service training requirements of COMAR 07.02.25; and
    4. (4) Complete 20 hours of in-service training annually.

Authority: Courts and Judicial Proceedings Article, §§3-801, 3-802, 3-815, 3-816.1, 3-817, 3-819.1, 3-819.2, 3-820, and 3-823;
Education Article, §§7-101(b) and 15-106.1; Family Law Article, §§5-501, 5-504, 5-524—5-534, 5-701, and 5-709;
Human Services Article, §9-101 et seq.; Annotated Code of Maryland
(Agency Note: Federal Regulatory Reference: 42 U.S.C. §§620 et seq., 670 et seq.; 45 CFR §205.10;
45 CFR §303.72; 45 CFR 1355—1357)

Effective date: February 1, 1973

Regulation .05, .06 amended effective January 8, 1975 (2:1 Md. R. 14)

Regulation .05D, .09 effective January 1, 1976 (3:13 Md. R. 718) as emergency; amended effective October 27, 1976 (3:22 Md. R. 1249)

Regulation .05F amended effective June 8, 1977 (4:12 Md. R. 946)

Regulation .07B amended effective January 5, 1977 (4:1 Md. R. 15)

Regulation .09 effective July 1, 1976 (3:18 Md. R. 980) as emergency; amended effective March 2, 1977 (4:25 Md. R. 372)

Regulation .09, schedules B-2 and B-3 amended effective May 11, 1977 (4:10 Md. R. 764)

Chapter revised effective February 10, 1978 (5:3 Md. R. 136) (Previous Regulations .01, .02, .03, .04, .05, .06, .07, .07D, and .08 renumbered as Regulations .04, .06, .07, .09, .10, .11, .13, .14, and .15 respectively. New Regulations .01, .02, .03, .05, .08, .12, .16, .17, and .18 adopted)

Regulation .01C adopted as an emergency provision effective October 1, 1982 (9:18 Md. R. 1795) adopted permanently effective December 20, 1982 (9:25 Md. R. 2477)

Regulations .01 and .02 amended effective July 4, 1983 (10:13 Md. R. 1179)

Regulation .07B amended as an emergency provision effective October 1, 1981 (8:21 Md. R. 1703); emergency status extended at 8:24 Md. R. 1934, 8:25 Md. R. 1992, 9:2 Md. R. 110, and 9:6 Md. R. 611; adopted permanently effective March 1, 1982 (9:4 Md. R. 328)

Regulation .08B amended effective July 1, 1985 (12:13 Md. R. 1278)

Regulation .09-1 adopted effective April 22, 1985 (12:8 Md. R. 800)

Regulation .10B amended effective May 19, 1978 (5:10 Md. R. 777); March 23, 1979 (6:6 Md. R. 510); January 2, 1983 (9:26 Md. R. 2571)

Regulation .10C amended effective March 23, 1979 (6:6 Md. R. 510); October 5, 1979 (6:20 Md. R. 1628)

Regulation .10G amended effective July 27, 1979 (6:15 Md. R. 1270)

Regulation .10A—D amended effective July 1, 1985 (12:13 Md. R. 1278)

Regulation .11C amended effective July 1, 1985 (12:13 Md. R. 1278)

Regulation .13F amended effective July 1, 1985 (12:13 Md. R. 1278)

Regulation .18-1 adopted effective October 6, 1986 (13:20 Md. R. 2208)

Regulation .19 amended effective November 18, 1977 (4:24 Md. R. 1805); May 19, 1978 (5:10 Md. R. 777); June 2, 1978 (5:11 Md. R. 883); August 25, 1978 (5:17 Md. R. 1326); March 23, 1979 (6:6 Md. R. 510); July 27, 1979 (6:15 Md. R. 1270); October 5, 1979 (6:20 Md. R. 1628); September 5, 1980 (7:18 Md. R. 1739); May 24, 1982 (9:10 Md. R. 1018); January 2, 1983 (9:26 Md. R. 2571); February 13, 1984 (11:3 Md. R. 198); July 1, 1985 (12:13 Md. R. 1278); January 13, 1986 (13:1 Md. R. 15); December 15, 1986 (13:25 Md. R. 2657); May 30, 1988 (15:11 Md. R. 1330); February 6, 1989 (16:2 Md. R. 158)

Regulations .01—.19 repealed and new Regulations .01—.34 adopted as an emergency provision effective February 1, 1989 (16:4 Md. R. 487); emergency status extended at 16:12 Md. R. 1331, 16:21 Md. R. 2254, and 17:8 Md. R. 967; emergency status expired June 30, 1990

Regulations .01—.19 repealed and new Regulations .01—.34 adopted as an emergency provision effective July 17, 1990 (17:16 Md. R. 1984); adopted permanently effective December 24, 1990 (17:25 Md. R. 2904)

Regulation .03B amended effective October 19, 1998 (25:21 Md. R. 1572)

Regulation .13A amended effective November 7, 1994 (21:22 Md. R. 1874)

Regulation .30-1 adopted effective October 19, 1998 (25:21 Md. R. 1572)

Regulation .32 amended effective August 24, 1998 (25:17 Md. R. 1359)

Regulation .34 amended effective February 3, 1992 (19:2 Md. R. 152)

Chapter revised effective February 7, 2000 (27:2 Md. R. 143)

Regulation .03B amended effective August 7, 2000 (27:15 Md. R. 1400)

Regulation .13A amended as an emergency provision effective April 1, 2000 (27:8 Md. R. 794); emergency status expired September 30, 2000

Regulation .13A amended effective August 7, 2000 (27:15 Md. R. 1400)

Regulation .21A amended effective August 7, 2000 (27:15 Md. R. 1400)

Regulation .21A amended as an emergency provision effective April 1, 2000 (27:8 Md. R. 794); emergency status expired September 30, 2000

Regulation .32A amended effective August 7, 2000 (27:15 Md. R. 1400)

Chapter revised effective November 30, 2009 (36:24 Md. R. 1856)

Regulation .02C amended effective February 6, 2012 (39:2 Md. R. 140)

Regulation .03B amended effective February 6, 2012 (39:2 Md. R. 140); May 12, 2014 (41:9 Md. R. 519); August 17, 2015 (42:16 Md. R. 1054); May 22, 2017 (44:10 Md. R. 470)

Regulation .04 amended effective August 17, 2015 (42:16 Md. R. 1054)

Regulation .04B amended effective February 6, 2012 (39:2 Md. R. 140)

Regulation .05C amended effective February 6, 2012 (39:2 Md. R. 140); August 17, 2015 (42:16 Md. R. 1054); May 22, 2017 (44:10 Md. R. 470)

Regulation .06 amended effective May 12, 2014 (41:9 Md. R. 519)

Regulation .06B amended effective February 6, 2012 (39:2 Md. R. 140)

Regulation .07F adopted effective February 6, 2012 (39:2 Md. R. 140)

Regulation .08I, Z amended effective February 6, 2012 (39:2 Md. R. 140)

Regulation .08K, P amended effective November 15, 2021 (48:23 Md. R. 979)

Regulation .11H amended effective February 6, 2012 (39:2 Md. R. 140)

Regulation .12 amended effective August 19, 2013 (40:16 Md. R. 1341); September 7, 2020 (47:18 Md. R. 824)

Regulation .12B amended effective August 17, 2015 (42:16 Md. R. 1054)

Regulation .12J, K amended effective February 6, 2012 (39:2 Md. R. 140)

Regulation .12K amended effective November 11, 2013 (40:22 Md. R. 1876)

Regulation .13 amended effective February 6, 2012 (39:2 Md. R. 140)

Regulation .15 amended effective February 6, 2012 (39:2 Md. R. 140)

Regulation .16 amended effective February 6, 2012 (39:2 Md. R. 140)

Regulation .16A, B amended effective May 22, 2017 (44:10 Md. R. 470)

Regulation .16-1 adopted effective February 6, 2012 (39:2 Md. R. 140)

Regulation .17 amended effective February 6, 2012 (39:2 Md. R. 140)

Regulation .21 amended effective May 12, 2014 (41:9 Md. R. 519)

Regulation .25G amended effective February 6, 2012 (39:2 Md. R. 140)

Regulation .29M amended effective February 6, 2012 (39:2 Md. R. 140)

Regulation .30 amended effective February 6, 2012 (39:2 Md. R. 140)

Regulation .39A amended effective February 6, 2012 (39:2 Md. R. 140)