This chapter establishes the financial mechanism for a Community-Based Fund created when wards are closed at Maryland State inpatient psychiatric facilities. It sets out the process for calculating savings from downsizing, depositing those savings into the Fund, and disbursing funds to support community-based mental health services for individuals discharged from closed wards. Facility operators and core service agencies must follow prescribed planning, calculation, and reporting procedures to ensure savings are redirected to community care rather than supplanting existing resources.
View official sourceCode of Maryland Regulations Chapter 23 Community-Based Fund Administrative History Effective date: October 23, 1995 (22:21 Md. R. 1616) Regulation .02B amended effective February 9, 1998 (25:3 Md. R. 145) Regulation .03C amended effective February 9, 1998 (25:3 Md. R. 145) Authority Health-General Article, §10-208, Annotated Code of Maryland .01 Scope. This chapter establishes the process for deposits to and disbursements from a community-based fund that is established when a ward is closed at a State inpatient facility. .02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Administration” means the Mental Hygiene Administration. (2) “Admission” means that an individual is: (a) Taken into observation status on the basis of certification for involuntary admission under Health-General Article, §§10-614 — 10-617, Annotated Code of Maryland, and COMAR 10.21.01.07 ; or (b) Voluntarily admitted under the provisions of Health-General Article, §10-609 or 10-610, Annotated Code of Maryland. (3) “Average annual itemized expenses” means the amount budgeted for institutional services and administrative overhead costs that are appropriated for the facility in the fiscal year in which downsizing occurs. (4) “Core service agency (CSA)” means the county or multicounty authority, designated under Health-General Article, Title 10, Subtitle 12, Annotated Code of Maryland, and approved by the Department, that is responsible for planning, managing, and monitoring publicly funded mental health services. (5) “Department” means the Maryland Department of Health. (6) “Director” means the Director of the Maryland Department of Health. (7) “Downsizing” means the process by which the Administration analyzes the projected capacity of a State inpatient facility and implements procedures to close a ward or wards. (8) “Fund” means the Mental Hygiene Community-Based Services Fund established according to the requirements of Health-General Article, §10-208, Annotated Code of Maryland. (9) “Secretary” means the Secretary of Health. (10) “State inpatient facility” means a facility listed in Health-General Article, §10-406(a), Annotated Code of Maryland. .03 Planning. A. The Administration shall identify annually the number and size of wards, if any, marked for closure at each State inpatient facility. B. The Administration may use State general funds that are appropriated in advance to assist in downsizing. C. In planning for the provision of appropriate treatment and support services in the community, if the jurisdictions to which individuals discharged from the closing wards are: (1) Served by a core service agency (CSA) or agencies, the Administration shall collaborate with the appropriate CSA; or (2) Not served by a CSA, the Administration, in collaboration with the local health officer, shall carry out the necessary planning. Cross References 10.21.23.04B(2) .04 Deposits to the Fund. A. When the Administration determines to close a ward or wards of a facility, the Administration shall assure that savings resulting from the downsizing are used as provided under Regulation .05 of this chapter . B. In depositing to the Fund, the Administration shall follow the following process: (1) Calculate the net daily cost of maintaining an individual in the facility by: (a) Subtracting from the facility's total general fund appropriation: (i) Average annual itemized expenses for costs that are required to continue to provide care, treatment, and support services; (ii) Cost for new admissions to the facility under Health-General Article, Title 10, Subtitle 6, Annotated Code of Maryland; and (iii) Cost for court-ordered evaluations and commitments to the facility under Health-General Article, Title 12, Annotated Code of Maryland; and (b) Dividing the net result under §B(1)(a) of this regulation by the average patient population of the facility, to arrive at the net facility cost per individual per day; (2) According to the planning process under Regulation .03C of this chapter , determine the community cost per individual per day of providing appropriate treatment and mental health support services; (3) Subtract from the facility cost per individual per day yielded under §B(1) of this regulation the community cost per individual per day yielded under §B(2) of this regulation to yield the savings per individual per day; (4) Multiply the savings per individual per day under §B(3) of this regulation by the capacity of the ward or wards closed to arrive at the total savings per day; and (5) For the fiscal year that the ward is closed, deposit to the Fund the prorated amount, based on the total savings per day under §B(4) of this regulation , multiplied by the number of days that the ward is vacated. Cross References 10.21.23.06B(2)(a) .05 Disbursements from the Fund. A. The Administration shall ensure that the first priority for disbursements from the Fund is for the care and treatment of individuals discharged from the closed ward or wards. B. The Administration may not use the Fund to supplant State general fund resources for existing community services. C. Disbursements from the Fund, in excess of the amount required to annualize the cost of care and treatment of individuals discharged from the closed ward or wards, are subject to the State appropriations process. D. The Director shall ensure that the Fund is used to provide needed services in the community, including but not limited to: (1) Case management; (2) Crisis services; (3) Outpatient mental health clinic; (4) Psychiatric day treatment; (5) Group home placement; (6) Mobile treatment services; (7) Psychiatric rehabilitation; (8) Residential rehabilitation; (9) Supported employment; (10) Supported living; (11) Therapeutic group homes; and (12) Consumer-operated programs. E. Portions of the Fund that are unspent at the end of a fiscal year, and earned interest, shall remain in the Fund to be used for the purposes specified in this regulation. Cross References 10.21.23.04A 10.21.23.06B(3) .06 Reporting. A. On or before January 1 of each year, the Secretary shall prepare a report on the Fund to be submitted to the General Assembly and the Department of Fiscal Services. B. The Secretary shall include in the report: (1) The number and capacity of State inpatient facility wards closed during the prior fiscal year; (2) An accounting of: (a) The amount deposited to the Fund according to the methodology outlined under Regulation .04 of this chapter , and (b) All other amounts reallocated from facilities to community programs; (3) An accounting of disbursements from the Fund in accordance with Regulation .05 of this chapter ; and (4) The number and capacity of State inpatient facility wards planned for closure during the current fiscal year.