Md. Code Regs. 10.21.25.03 – Definitions.

A. In this chapter, terms have the meanings stated in COMAR 10.21.17, COMAR 10.63.01.02, and this regulation.
B. Terms Defined.
1. (1) “Ability-to-pay schedule” means the schedule adopted, according to the provisions of Health-General Article, Title 16, Subtitle 2, Annotated Code of Maryland, by the Secretary to evaluate and establish the extent of a consumer's ability to pay for services rendered.
2. (2) “Administration” means the Behavioral Health Administration.
3. (2-1) “Assertive Community Treatment Program (ACT)” means an evidence-based practice program approved by the Administration under its regulations.
4. (3) “Core service agency (CSA)” has the meaning stated in COMAR 10.63.01.02.
5. (3-1) “Day habilitation” has the meaning stated in COMAR 10.09.46.
6. (3-2) “Emergency department” means an organized hospital-based facility that provides unscheduled episodic services, 24 hours per day, 7 days per week, to individuals who present for immediate medical attention.
7. (4) Emergency Service.
  1. (a) “Emergency service” means a service that is provided to an individual who presents a danger to the life or safety of the individual or another.
  2. (b) “Emergency service” does not include a residential or mobile crisis service.
8. (5) “Enhanced support” means short-term, in-home services, in addition to other services to an individual, provided by a program to support the individual to remain in the community:
  1. (a) For mobile treatment services:
    1. (i) Under COMAR 10.21.19 if approved; and
    2. (ii) Under COMAR 10.63.03.04 if licensed;
  2. (b) For adult psychiatric rehabilitation services:
    1. (i) Under COMAR 10.21.21 if approved; and
    2. (ii) Under COMAR 10.63.03.09 if licensed; or
  3. (c) For outpatient mental health services;
    1. (i) Under COMAR 10.21.20 if approved; and
    2. (ii) Under COMAR 10.63.03.05 if licensed.
9. (5-1) “Evidence-based practice (EBP)” is an Administration-approved practice that applies to certain clinical or rehabilitative interventions provided by public mental health service providers.
10. (5-2) “Family psychoeducation” is an evidence-based practice approved by the Administration under its regulations.
11. (6) “Fee” means the dollar amount, established by the Secretary, that a provider may charge an individual who receives services under this chapter for a unit of service, before the application of an ability-to-pay determination.
12. (7) “Individual practitioner” means:
  1. (a) A marriage and family therapist who is licensed and legally authorized to practice clinical marriage and family therapy in the state in which the service is rendered;
  2. (b) A nurse psychotherapist who is:
    1. (i) Licensed and legally authorized to practice as a nurse psychotherapist in the state in which the service is rendered; and
    2. (ii) Certified by the Maryland Board of Nursing or an equivalent board of nursing in another state as a nurse psychotherapist, and demonstrates, by training and experience, the competency to provide the mental health services;
  3. (c) A certified registered nurse practitioner psychiatric mental health (CRNP-PMH) who is:
    1. (i) Licensed and legally authorized to practice as a certified registered nurse practitioner — psychiatric in the state in which the service is rendered to perform independently the services set forth in COMAR 10.27.07; and
    2. (ii) Certified by the Maryland Board of Nursing or an equivalent board of nursing in another state as a certified registered nurse practitioner with a specialty in psychiatry pursuant to COMAR 10.27.07 and demonstrates, by training and experience, the competency to provide the mental health services;
  4. (d) An occupational therapist who:
    1. (i) Is licensed and legally authorized to practice as an occupational therapist in the state in which the service is rendered, and
    2. (ii) Demonstrates, by training and experience, the competency to provide mental health services;
  5. (e) A physician who:
    1. (i) Is licensed and legally authorized to practice as a physician in the state in which the service is rendered, and
    2. (ii) Demonstrates, by training and experience, the competency to provide mental health services;
  6. (f) A professional counselor who is licensed and legally authorized to practice as a clinical professional counselor in the state in which the service is rendered;
  7. (g) A psychologist who:
    1. (i) Is licensed and legally authorized to practice as a psychologist in the state in which the service is rendered, and
    2. (ii) Demonstrates, by training and experience, the competency to provide mental health services; or
  8. (h) A social worker who is licensed and legally authorized to practice as a clinical social worker in the state in which the service is rendered.
13. (7-1) “Intensive outpatient services” means services that are delivered to an individual by a multidisciplinary team for a minimum of 3 hours of therapeutic activities, including at least two group therapies.
14. (7-2) “Level I” means a level of service provided to an individual who is enrolled in the Traumatic Brain Injury Waiver Program, based on the requirements for intensity of services and staffing outlined in:
  1. (a) For individuals receiving residential habilitation services, COMAR 10.09.46.07D(2);
  2. (b) For individuals receiving day habilitation services, COMAR 10.09.46.08F(2); and
  3. (c) For individuals receiving supported employment services, COMAR 10.09.46.09C(2).
15. (7-3) “Level II” means a level of service provided to an individual who is enrolled in the Traumatic Brain Injury Waiver Program, based on the requirements for intensity of services and staffing outlined in:
  1. (a) For individuals receiving residential habilitation services, COMAR 10.09.46.07D(3);
  2. (b) For individuals receiving day habilitation services, COMAR 10.09.46.08F(3); and
  3. (c) For individuals receiving supported employment services, COMAR 10.09.46.09C(3).
16. (7-4) “Level III” means a level of service provided to an individual who is enrolled in the Traumatic Brain Injury Waiver Program, based on the requirements for intensity of services and staffing outlined in:
  1. (a) For individuals receiving residential habilitation services, COMAR 10.09.46.07D(4);
  2. (b) For individuals receiving day habilitation services, COMAR 10.09.46.08F(4); and
  3. (c) For individuals receiving supported employment services, COMAR 10.09.46.09C(4).
17. (7-5) “Local behavioral health authority (LBHA)” has the meaning stated in COMAR 10.63.01.02.
18. (8) Mental Health Program.
  1. (a) “Mental health program” means a program that provides a plan of mental health treatment or mental health rehabilitation, consisting of various therapeutic modalities, that is:
    1. (i) Approved by the Department under this subtitle or COMAR 10.09 to be eligible to receive State or federal funds; and
    2. (ii) Provided in the community.
  2. (b) “Mental health program” includes:
    1. (i) Non-hospital-based partial hospitalization (psychiatric day treatment) services under COMAR 10.21.02 if approved, and COMAR 10.63.03.08 if licensed;
    2. (ii) Therapeutic nursery programs under COMAR 10.21.18;
    3. (iii) Mobile treatment services under COMAR 10.21.19 if approved, and COMAR 10.63.03.04 if licensed;
    4. (iv) Outpatient mental health clinic (OMHC) services under COMAR 10.21.20 if approved, and COMAR 10.63.03.05 if licensed;
    5. (v) Psychiatric rehabilitation programs for adults under COMAR 10.21.21 if approved, and COMAR 10.63.03.09 if licensed, including supported living services;
    6. (vi) Residential rehabilitation programs under COMAR 10.21.22 if approved, and COMAR 10.63.04.05 if licensed;
    7. (vii) Home health services under COMAR 10.09.04;
    8. (viii) Supported employment programs under COMAR 10.21.28 if approved, and COMAR 10.63.03.16 if licensed;
    9. (ix) Respite care programs under COMAR 10.21.27 if approved, and COMAR 10.63.03.15 if licensed;
    10. (x) Residential crisis services programs under COMAR 10.21.26 if approved, and COMAR 10.63.04.04 if licensed; and
    11. (xi) Therapeutic and psychiatric rehabilitation services for minors under COMAR 10.21.29 if approved, and COMAR 10.63.03.10 if licensed.
19. (9) Mobile Treatment.
  1. (a) “Mobile treatment” means a program approved under COMAR 10.21.19, or licensed under COMAR 10.63.03.04.
  2. (b) “Mobile treatment” does not include transporting an individual to a program site to receive services.
20. (10) Off-Site.
  1. (a) “Off-site” means a location, other than a site defined in §B(11) of this regulation, to which mental health program staff travels to provide services to an individual.
  2. (b) “Off-site” includes, with respect to psychiatric rehabilitation program services, those services delivered to an individual:
    1. (i) In the individual's home, including a residential rehabilitation program residence;
    2. (ii) At a job site; or
    3. (iii) At another community location appropriate to the individual's needs.
  3. (c) “Off-site” does not include:
    1. (i) A juvenile detention center; or
    2. (ii) Any facility or group home that is licensed to provide rehabilitative or therapeutic services, or living skills.
21. (11) “On-site” means a mental health program facility or other site to which a program has access and at which the program regularly delivers services to individuals who come to the site for the services.
22. (11-1) Other Mental Health Professional.
  1. (a) “Other mental health professional” means an individual who is licensed, certified, or otherwise legally authorized to independently provide the mental health service.
  2. (b) “Other mental health professional” includes a:
    1. (i) Licensed certified social worker — clinical;
    2. (ii) Nurse psychotherapist;
    3. (iii) Licensed clinical professional counselor;
    4. (iv) Licensed clinical marriage and family therapist; or
    5. (v) Certified registered nurse practitioner — psychiatric mental health (CRNP-PMH).
23. (12) “Outpatient mental health clinic (OMHC)” means a program approved under COMAR 10.21.20 or licensed under COMAR 10.63.03.05.
24. (13) “Partial hospitalization program” means a program approved under COMAR 10.21.02 or licensed under COMAR 10.63.03.08.
25. (14) “Program” means a mental health program as defined in §B(8) of this regulation.
26. (15) “Provider” means:
  1. (a) A community-based mental health program as defined in §B(8) of this chapter; or
  2. (b) An individual practitioner as defined in §B(7) of this chapter.
27. (16) “Psychiatric rehabilitation program for adults (PRP)” means a program approved under COMAR 10.21.21 or licensed under COMAR 10.63.03.09.
28. (16-1) “Residential crisis services (RCS)” means a program approved under COMAR 10.21.26 or licensed under COMAR 10.63.04.04.
29. (16-2) “Residential habilitation” has the meaning stated in COMAR 10.09.46.
30. (17) “Residential rehabilitation program (RRP)” means a program approved under COMAR 10.21.22 or licensed under COMAR 10.63.04.05.
31. (17-1) “Respite care” means services that are approved under COMAR 10.21.27 or licensed under COMAR 10.63.03.15
32. (18) “Secretary” means the Secretary of Health
33. (19) “Serious emotional disturbance” means a condition that is:
  1. (a) Manifest in an individual younger than 18 years old;
  2. (b) Diagnosed according to a current diagnostic and statistical manual of the American Psychiatric Association that is recognized by the Secretary, excluding the following, unless it coexists with a diagnosable psychiatric disorder:
    1. (i) Developmental disorder;
    2. (ii) Substance abuse; and
    3. (iii) Disorder classified under the “V” code; and
  3. (c) Characterized by a functional impairment that substantially interferes with or limits the child's role or functioning in the family, school, or community activities, including the following:
    1. (i) Inability to achieve or maintain one or more developmentally appropriate social, behavioral communicative, or adaptive skills; or
    2. (ii) Episodic, recurrent, and continuous functional impairments.
34. (20) “Serious and persistent mental disorder” means a disorder that is:
  1. (a) Manifest in an individual 18 years old or older;
  2. (b) Diagnosed, according to a current diagnostic and statistical manual of the American Psychiatric Association that is recognized by the Secretary, as:
    1. (i) Schizophrenic disorder;
    2. (ii) Major affective disorder;
    3. (iii) Other psychotic disorder; or
    4. (iv) Borderline or schizotypal personality disorders, with the exclusion of an abnormality that is manifested only by repeated criminal or otherwise antisocial conduct; and
  3. (c) Characterized by impaired role functioning, on a continuing or intermittent basis, for at least 2 years, including at least three of the following:
    1. (i) Inability to maintain independent employment;
    2. (ii) Social behavior that results in intervention by the mental health system;
    3. (iii) Inability, due to cognitive disorganization, to procure financial assistance to support living in the community;
    4. (iv) Severe inability to establish or maintain a personal social support system;
    5. (v) Need for assistance with basic living skills.
35. (21) “Therapeutic and psychiatric rehabilitation services for minors” means a program approved under COMAR 10.21.29 or licensed under COMAR 10.63.03.10.

Authority: Health-General Article, §§10-901, 15-103, and 15-105; Title 16, Subtitles 1 and 2; Annotated Code of Maryland

Effective date:

Regulations .01 — .08 adopted as an emergency provision effective July 1, 1997 (24:18 Md. R. 1293); adopted permanently effective October 20, 1997 (24:21 Md. R. 1449)

Chapter revised as an emergency provision effective July 1, 1998 (25:14 Md. R. 1123)

Chapter revised effective October 1, 1998 (25:18 Md. R. 1435 and 25:19 Md. R. 1506)

Chapter revised as an emergency provision effective March 1, 2000 (27:4 Md. R. 451); revised permanently effective June 26, 2000 (27:12 Md. R. 1139)

Regulation .01D amended as an emergency provision effective July 1, 2002 (29:24 Md. R. 1915); amended permanently effective December 23, 2002 (29:25 Md. R. 1982)

Regulation .02B amended as an emergency provision effective July 1, 2002 (29:24 Md. R. 1915); amended permanently effective December 23, 2002 (29:25 Md. R. 1982)

Regulation .02B amended as an emergency provision effective July 1, 2003 (30:17 Md. R. 1202); amended permanently effective October 27, 2003 (30:21 Md. R. 1529)

Regulation .04A, B amended as an emergency provision effective July 1, 2002 (29:24 Md. R. 1915); amended permanently effective December 23, 2002 (29:25 Md. R. 1982)

Regulation .05A, D amended as an emergency provision effective July 1, 2002 (29:24 Md. R. 1915); amended permanently effective December 23, 2002 (29:25 Md. R. 1982)

Regulation .06A amended as an emergency provision effective July 1, 2002 (29:24 Md. R. 1915); amended permanently effective December 23, 2002 (29:25 Md. R. 1982)

Regulation .09A, B amended as an emergency provision effective July 1, 2002 (29:24 Md. R. 1915); amended permanently effective December 23, 2002 (29:25 Md. R. 1982)

Regulation .10A, D amended as an emergency provision effective July 1, 2002 (29:24 Md. R. 1915); amended permanently effective December 23, 2002 (29:25 Md. R. 1982)

Regulation .11A amended as an emergency provision effective July 1, 2002 (29:24 Md. R. 1915); amended permanently effective December 23, 2002 (29:25 Md. R. 1982)

Regulation .14 adopted as an emergency provision effective July 1, 2003 (30:17 Md. R. 1202); adopted permanently effective October 27, 2003 (30:21 Md. R. 1529)

Chapter revised as an emergency provision effective February 1, 2004 (31:5 Md. R. 446); revised permanently effective June 7, 2004 (31:11 Md. R. 857)

Regulation .08B amended effective December 19, 2005 (32:25 Md. R. 1942)

Regulation .08H adopted effective December 19, 2005 (32:25 Md. R. 1942)

Chapter revised as an emergency provision effective July 1, 2006 (33:15 Md. R. 1274); emergency status extended at 34:4 Md. R. 397; revised permanently effective February 26, 2007 (34:4 Md. R. 400)

Regulations .02, .03, and .05 — .10 amended as an emergency provision effective July 1, 2008 (35:21 Md. R. 1822)

Regulations .02, .03, and .05 — .10 amended as an emergency provision effective December 22, 2008 (36:2 Md. R. 97); amended permanently effective March 23, 2009 (36:6 Md. R. 491)

Regulation .03 amended effective January 2, 2017 (43:26 Md. R. 1445)

Regulation .03B amended effective January 7, 2013 (39:26 Md. R. 1664); February 3, 2014 (41:2 Md. R. 91)

Regulation .03-1 adopted as an emergency provision effective December 22, 2008 (36:2 Md. R. 97); adopted permanently effective March 23, 2009 (36:6 Md. R. 491)

Regulation .03-1 amended effective June 27, 2011 (38:13 Md. R. 755)

Regulation .03-2 adopted as an emergency provision effective December 22, 2008 (36:2 Md. R. 97); emergency status expired June 19, 2009

Regulation .03-2 amended effective January 7, 2013 (39:26 Md. R. 1664); February 3, 2014 (41:2 Md. R. 91)

Regulations .05 — .11 amended as an emergency provision effective July 1, 2007 (34:17 Md. R. 1506); amended permanently effective October 8, 2007 (34:20 Md. R. 1739)

Regulation .05 — .11 amended effective January 7, 2013 (39:26 Md. R. 1664); February 3, 2014 (41:2 Md. R. 91)

Regulation .08 amended effective June 27, 2011 (38:13 Md. R. 755)

Regulation .08C amended effective January 2, 2017 (43:26 Md. R. 1445)

Regulation .09I adopted as an emergency provision effective October 20, 2009 (36:24 Md. R. 1855); adopted permanently effective February 8, 2010 (37:3 Md. R. 176)

Regulation .09I amended effective June 27, 2011 (38:13 Md. R. 755); December 11, 2014 (41:24 Md. R. 1427)

Regulation .09J adopted effective December 11, 2014 (41:24 Md. R. 1427)

Regulation .11 amended effective February 3, 2014 (41:2 Md. R. 91)

Regulation .12 adopted effective February 3, 2014 (41:2 Md. R. 91)

Regulation .13 adopted effective February 3, 2014 (41:2 Md. R. 91)