COMAR 10.21.03

Chapter 03 Requirements for Individual Treatment Plans

This regulation establishes requirements for individual treatment plans (ITPs) at inpatient mental health facilities licensed by or under the jurisdiction of the Maryland Department of Health. Facility operators must ensure that a qualified mental health professional treatment team develops, signs, and records a comprehensive ITP within 15 days of admission, with reassessments at least every 15 days for the first two months and every 60 days thereafter. The regulation explicitly excludes institutions for the care of developmentally disabled patients and applies to both voluntary and involuntary admissions.

Code of Maryland Regulations

Chapter 03 Requirements for Individual Treatment Plans

Administrative History

Effective date: June 25, 1975 (2:14 Md. R. 1016)

Annotation: 
COMAR 10.21.03
 cited in Attorney General Opinion No. 82-034 (November 18, 1982)

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Chapter revised effective January 9, 1989 (15:27 Md. R. 3129)

Authority

Health-General Article, §10-705, Annotated Code of Maryland

Preface

The intent of the individualized treatment plan is to assure that the individual rights of patients are preserved and respected; to assure that the specific individual needs of patients are identified and met as efficiently, effectively, and economically as possible; to assure medico-legal responsibility; to assure that the treatment team includes approved and competent personnel representative of the several clinical disciplines; and to serve as a data base for determining and requesting necessary resources.

.01 Scope.

A.
 These regulations shall apply to every individual admitted either voluntarily or involuntarily to any inpatient mental health facility licensed by, or under the jurisdiction of, the Maryland Department of Health. These regulations may not apply to institutions for the care of developmentally disabled patients, or to those patients committed by the courts for evaluation only.

B.
 These regulations are supplemental to any other laws and regulations that may be applicable. In the event of conflict between these regulations or laws and any other regulations or laws, the more stringent shall apply.

.02 Definitions.

A.
 “Active treatment” means the regular participation by a patient in professionally developed and supervised activities, experiences, or therapies based on an individual treatment plan.

B.
 “Department” means the Maryland Department of Health.

C.
 “Mental health professional treatment team” means:

(1)
 One or more duly licensed physicians or psychiatrists, one of whom shall assume responsibility for the development and implementation of an individual treatment plan. If the physician member of the mental health professional treatment team has less than 2 years of post-degree experience in a mental health setting, at least one other member of the team shall have attained the master's degree and have 2 years of post-degree experience in a mental health setting.

(2)
 One or more of the following mental health professionals:

(a)
 A psychologist, licensed in the State, or an individual with a master's degree in psychology or a related field from an accredited college or university in a program acceptable to the Board of Examiners of Psychologists, under the supervision of a licensed psychologist, and with at least 2 years of postdegree experience in a mental health setting;

(b)
 A professional registered nurse licensed in the State with at least one of the following credentials:

(i)
 Two years of psychiatric nursing experience;

(ii)
 A bachelor of science degree and 1 year of psychiatric experience; or

(iii)
 A master's degree and 1 year of psychiatric nursing experience;

(c)
 A social worker, licensed in the State, with a master's degree in social work from an accredited school of social work and 2 years experience, 1 of which shall have been in a mental health setting; or

(d)
 An occupational therapist, licensed in the State, with a bachelor of science degree in occupational therapy from an accredited school of occupational therapy and 2 years experience, 1 of which shall have been in a mental health setting.

(3)
 Other members of the hospital staff who work directly with the patient, including other professionals and paraprofessionals and professionals in service and in training.

D.
 “Patient” means any person voluntarily or involuntarily admitted to one of the mental health facilities under the jurisdiction of, or licensed by, the Maryland Department of Health pursuant to the provisions of Health-General Article, Title 10, Annotated Code of Maryland.

.03 Content and Nature of Individual Treatment Plan.

A.
 The individual treatment plan is a comprehensive and thoughtfully written plan based on an initial diagnostic impression and an overall evaluation of the patient's specific needs and problems. It includes an inventory of the patient's strengths as well as weaknesses, and sets forth short-term measurable goals and behaviorally stated objectives aimed at maximal restoration of the patient's adaptive capacity and return to the community as soon as possible. Based on the above goals objectives, a plan of active treatment shall be prescribed which aims at the arrest, reversal, and amelioration of the patient's illness symptoms. There shall be included a long-range discharge goal as well as an estimate of the probable length of inpatient stay needed before transfer to a less restrictive or intensive treatment milieu.

B.
 The individual treatment plan shall be initially recorded and appropriately updated in the patient's permanent medical record.

C.
 The initial individual treatment plan shall be developed by members of the mental health professional treatment team who are directly involved in the patient's care including at least one member each from Regulation .02C(1) and (2), of this chapter. The initial individual treatment plan shall be signed by the physician responsible for its development. The names of the other members of the mental health professional treatment team involved in the development of the plan shall be noted adjacent to the signature of the physician.

D.
 A comprehensive, thoughtfully written, and properly signed individual treatment plan shall be recorded in the permanent medical record, or on a separate form which will become part of the permanent medical record, no later than 15 days after admission.

E.
 The individual treatment plan shall include or refer to essential written or verbal information which has been gathered, as well as relevant information derived from other parts of the medical record, that will help identify the specific needs and problems of the individual patient. The individual treatment plan shall also include an initial psychiatric diagnosis recorded in the official nomenclature of the American Psychiatric Association, discharge planning data relating to community and financial resources available to the patient, and the legal status of the patient. Information may not be gathered without the consent of the patient or of the patient's parent or legally appointed representative if the patient is a minor or is incompetent.

F.
 The individual treatment plan shall include a notation of any therapeutic task, labor, recreation, or other scheduled activity to be performed by the patient, including the rationale for these in relation to the treatment plan and the projected goals.

G.
 The individual treatment plan shall include, when applicable, a description of the patient's individualized educational plan. Special education plans, in conformance with the regulations of the Department of Education, are mandatory for patients through 20 years old.

H.
 The individual treatment plan shall include, when feasible, patient participation in accordance with Health-General Article, §10-706, Annotated Code of Maryland.

I.
 Care shall be taken to preserve the confidentiality of the patient-mental health professional treatment team member relationship. Information from a patient's record, including the individual treatment plan, may not be disclosed to any person, organization, or agency except in the case of a court order or with the written consent of the patient or of the patient's parent, if the patient is a minor, or legally appointed representative, if the patient is incompetent.

J.
 The individual treatment plan shall be periodically reassessed by members of the mental health professional treatment team who are working directly with the patient, including at least one member each from Regulation .02C(1) and (2), of this chapter, including the physician responsible for the implementation of the plan. This reassessment shall be made no less than once every 15 days for the first 2 months for all newly admitted or readmitted patients, and after that, at least once every 60 days.

K.
 The mental health professional treatment team members who make the reassessment shall place a written entry in the permanent medical record or on a separate form which will become part of the permanent medical record. This entry shall be signed by the physician responsible for the implementation of the plan. The names of the other members of the mental health professional treatment team involved in the reassessment of the plan shall be noted adjacent to the signature of the physician.

L.
 The initial individual treatment plan and all subsequent reassessments shall be easily identifiable as a separate, comprehensively written, and properly signed entry into the permanent medical record or on a separate form which will become part of the permanent medical record.

.04 Severability.

If any section or provision of these regulations is declared unconstitutional or void by any court of competent jurisdiction, or its applicability to any person or circumstances is held invalid, the constitutionality or validity of the remainder of these regulations and their applicability to other persons and circumstances may not be affected, and, to this end, the sections and provisions of these regulations are declared to be severable.