COMAR 10.21.05

Chapter 05 Aftercare Plans

This chapter establishes requirements for aftercare planning upon discharge or release from inpatient psychiatric facilities, including state Mental Hygiene Administration facilities, private psychiatric inpatient facilities, residential treatment centers for children and adolescents, and psychiatric units in acute care general hospitals. Designated facility staff must initiate aftercare planning as soon as possible after acceptance, collaborate with the individual and community providers, and prepare a written aftercare plan covering diagnoses, medications, continuing treatment, and referrals. The plan must be distributed to community treatment programs, family members providing housing, and third-party payors within 48 hours or by the first appointment, whichever is sooner.

Code of Maryland Regulations

Chapter 05 Aftercare Plans

Administrative History

Effective date: December 14, 1998 (25:25 Md. R. 1831)

Authority

Health-General Article, §§10-709 and 10-809, Annotated Code of Maryland

.01 Scope.

This chapter applies to aftercare plans, which are:

A.
 Provided to an individual who has been accepted under the provisions of Health-General Article, Title 10, Subtitle 6, Health-General Article, Title 12, Subtitle 1, or 
Courts and Judicial Proceedings Article, Title 3, Subtitle 8, Annotated Code of Maryland
, in one of the following:

(1)
 Mental Hygiene Administration facility under Health-General Article, §10-406, Annotated Code of Maryland;

(2)
 Private psychiatric inpatient facility;

(3)
 Residential treatment center for children and adolescents; or

(4)
 Psychiatric unit in an acute care general hospital; and

B.
 Designed to:

(1)
 Enhance the opportunity for the individual to live in the community; and

(2)
 Assist in the prevention of homelessness.

.02 Definitions.

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

B.
 Terms Defined.

(1)
 “Accepted” means:

(a)
 Taken into confinement on the basis of an application and certificate for involuntary admission, according to the provisions of Health-General Article, §§10-614 — 10-616, Annotated Code of Maryland; or

(b)
 Admitted, as defined in 
§B(4) of this regulation
.

(2)
 “Administration” means the Mental Hygiene Administration.

(3)
 “Administrative services organization (ASO)” means the organization under contract with the Administration to provide administrative services for the public mental health system.

(4)
 “Admitted” means:

(a)
 Admitted voluntarily, according to the provisions of Health-General Article, §10-609 or 10-610, Annotated Code of Maryland;

(b)
 Admitted involuntarily, by an administrative law judge, according to the provisions of Health-General Article, §10-632, Annotated Code of Maryland; or

(c)
 Committed by a court according to the provisions of:

(i)
 Health-General Article, Title 12, Subtitle 1, Annotated Code of Maryland; or

(ii)
 
Courts and Judicial Proceedings Article, Title 3, Subtitle 8, Annotated Code of Maryland
.

(5)
 “Aftercare plan” means the plan developed by inpatient facility staff according to the requirements of Health-General Article, §10-809, Annotated Code of Maryland.

(6)
 “Chief executive officer (CEO)” means the individual responsible for the overall management of a facility.

(7)
 “Discharge” means authorization by a physician for a voluntarily or involuntarily admitted individual to leave an inpatient facility.

(8)
 “Proper consent” means consent given by the individual, or, if the individual is a child or adolescent, by the individual's parent or guardian, to release relevant information.

(9)
 “Release” means the authorization for an individual who is confined in an inpatient facility on the basis of an application and certificate for involuntary admission to leave the inpatient facility:

(a)
 Given by a physician during the observation status period; or

(b)
 Ordered by an administrative law judge at an involuntary admissions hearing.

.03 Content and Nature of Aftercare Plans.

A.
 Staff designated by the CEO to assist individuals in aftercare planning shall, as soon as possible after acceptance, in collaboration with the individual:

(1)
 Initiate the aftercare planning process;

(2)
 With proper consent, involve in the aftercare planning process:

(a)
 Community-based service providers;

(b)
 Family members;

(c)
 Others who have a personal interest in the individual; and

(d)
 Third-party payors, including Medical Assistance, the Administration's ASO, or private insurance carriers, if involved, for authorization of outpatient services;

(3)
 Assist in applying for benefits to which the individual may be entitled and document the outcome of the benefits application process in the individual's record.

B.
 Before discharge or release, designated staff shall:

(1)
 Provide notification of the discharge or release:

(a)
 With proper consent, to:

(i)
 The individual's next-of-kin;

(ii)
 As appropriate, the core service agency (CSA);

(iii)
 Community-based treatment and support services providers rendering services before the individual's inpatient admission; and

(iv)
 Third-party payors, including Medical Assistance, the Administration's ASO, or private insurance carriers, if involved, for authorization of outpatient services; and

(b)
 If the individual is a minor, to the parent or guardian; and

(2)
 Assist the individual to participate in the aftercare plan by:

(a)
 Explaining to the individual the benefits of:

(i)
 The aftercare plan;

(ii)
 Community-based treatment and support services; and

(iii)
 The involvement of family or others who have a personal interest in the individual;

(b)
 Encouraging the individual to consent to the aftercare plan; and

(c)
 Arranging appointments for the individual with appropriate community programs.

C.
 In collaboration with community programs and government agencies that have agreed to provide aftercare services to the individual after discharge or release, designated staff shall prepare a written aftercare plan that includes:

(1)
 The individual's:

(a)
 Name;

(b)
 Date of birth; and

(c)
 Address and telephone number upon discharge or release;

(2)
 For a minor or an individual under guardianship, the name, address, and telephone number of the custodial adult or guardian;

(3)
 If the individual will reside in program-arranged housing, the name, address, telephone number, and contact person of the placement agency;

(4)
 The date and type of admission and discharge or release;

(5)
 The scheduled court date, if any;

(6)
 The diagnoses, including existing psychiatric, somatic, and dental diagnoses, and level of functional assessment;

(7)
 The type of treatment initiated;

(8)
 The name, address, and telephone number of the primary care provider;

(9)
 Medication information, including the:

(a)
 Medication prescribed;

(b)
 Dosage schedules;

(c)
 Amount of each medication given to the individual upon discharge or release; and

(d)
 Information necessary to help the individual to obtain the prescribed medication in the community;

(10)
 The most recent laboratory results, including therapeutic drug levels;

(11)
 If applicable, a description of:

(a)
 Allergies, including medication allergies;

(b)
 Nutritional requirements; and

(c)
 Active somatic problems requiring continued attention;

(12)
 Information on the individual's medical insurance coverage, including the:

(a)
 Company;

(b)
 Policy number;

(c)
 Name of the policy holder; and

(d)
 Preauthorization information, if given, for services to be initiated upon discharge or release;

(13)
 Entitlements, if any, and status;

(14)
 The plan for continuing treatment, including but not limited to:

(a)
 Outpatient mental health treatment services;

(b)
 Somatic care;

(c)
 Psychiatric rehabilitation and support services;

(d)
 When appropriate, substance abuse services; and

(e)
 Case management;

(15)
 A list of additional referrals indicated, such as:

(a)
 Public social services;

(b)
 Legal aid;

(c)
 Educational services;

(d)
 Housing services;

(e)
 Vocational services;

(f)
 Peer support services; and

(g)
 Available crisis services; and

(16)
 Any identifying information required by the Administration's ASO.

.04 Distribution of Aftercare Plan.

A.
 Designated staff shall provide the individual with the opportunity to consent or withhold consent for release of all or any portion of the plan to any provider.

B.
 Within 48 hours or by the first appointment, whichever is sooner, designated staff shall provide the aftercare plan, in accordance with the provisions of 
§A of this regulation
, to the:

(1)
 Community treatment and support programs designated in the aftercare plan;

(2)
 Family members or others with a personal interest in the individual, if any, who are identified in the aftercare plan to provide housing; and

(3)
 Third-party payors, if involved, for authorization of outpatient services.

C.
 Designated staff shall document in the individual's medical record who received information from the aftercare plan.

D.
 If the individual does not consent to an aftercare plan, designated staff shall:

(1)
 Place in the individual's record a statement to this effect signed, when possible, by the individual, the individual's guardian, or, for a minor, the parent or guardian; and

(2)
 Provide to the individual, in writing, information on outpatient mental health clinics, crisis and emergency services, and other available community mental health services and resources within the jurisdiction in which the individual resides, and document in the individual's record what information was provided.