EXPLANATION: CAPITALS INDICATE MATTER ADDE D TO EXISTING LAW .
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*hb0121*
HOUSE BILL 121
J1, J3 3lr0450
(PRE–FILED) CF SB 8
By: Delegate Charkoudian Delegates Charkoudian, Pena –Melnyk, Cullison,
Alston, Bagnall, Bhandari, Guzzone, Hill, S. Johnson, Kaiser, Kerr, Kipke,
R. Lewis, Lopez, Martinez, Taveras, White, and Woods
Requested: September 26, 2022
Introduced and read first time: January 11, 2023
Assigned to: Health and Government Operations
Committee Report: Favorable with amendments
House action: Adopted
Read second time: March 7, 2023
CHAPTER ______
AN ACT concerning 1
Mental Health – Treatment Plans for Individuals in Facilities – Requirements 2
and Residence Grievance System 3
FOR the purpose of requiring that a plan of treatment for an individual with a mental 4
disorder admitted to a certain health care facility include a certain discharge goal 5
and an estimate of the probable length of inpatient stay the individual requires 6
before transfer to a certain setting; requiring certain facility staff to review and 7
reassess a plan of treatment within certain time periods; establishing certain rights 8
and requirements relating to the participation of certain family members and other 9
individuals in the development, review, and reassessment of a plan of treatment; 10
establishing an appeals process for individuals admitted to a State facility relating 11
to the review and reassessment of a plan of treatment; requiring the Maryland 12
Department of Health to adopt certain regulations relating to the appeals process; 13
requiring a certain State health care facility to take certain actions if the facility is 14
unable to address certain needs under a plan of treatment; requiring the Department 15
to report certain information related to the Resident Grievance System to the 16
General Assembly on or before a certain date each year; and generally relating to 17
treatment plans for individuals with mental disorders admitted to mental health 18
care facilities. 19
BY repealing and reenacting, with amendments, 20
Article – Health – General 21 2 HOUSE BILL 121
Section 10–706 1
Annotated Code of Maryland 2
(2019 Replacement Volume and 2022 Supplement) 3
BY adding to 4
Article – Health – General 5
Section 10–908 to be under the new part “Part II. Resident Grievance System 6
Report” 7
Annotated Code of Maryland 8
(2019 Replacement Volume and 2022 Supplement) 9
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 10
That the Laws of Maryland read as follows: 11
Article – Health – General 12
10–706. 13
(a) (1) Except as provided by paragraph (2) of this subsection, promptly after 14
admission of an individual, a facility shall make and periodically update a written plan of 15
treatment for the individual in the facility, in accordance with the provisions of this 16
subtitle. 17
(2) Promptly after admission of an individual to a psychosocial center, the 18
center shall make and periodically update a written plan of rehabilitation for the individual 19
in the facility, in accordance with the provisions of this subtitle. 20
(b) The Director shall adopt rules and regulations under this section that include: 21
(1) [A] SUBJECT TO SUBSECTION (D) OF THIS SECTION , A description 22
of the nature and content of plans of treatment; and 23
(2) [Appropriate] SUBJECT TO SUBSECTION (E) OF THIS SECTION, 24
APPROPRIATE time periods for the development, implementation, and review of each plan. 25
(c) An individual shall: 26
(1) Participate, in a manner appropriate to the individual’s condition, in 27
the development and periodic updating of the plan of treatment; and 28
(2) Be told, in appropriate terms and language, of: 29
(i) The content and objectives of the plan of treatment; 30
(ii) The nature and significant possible adverse effects of 31
recommended treatments; 32
HOUSE BILL 121 3
(iii) The name, title, and role of personnel directly responsible for 1
carrying out the treatment for the individual; and 2
(iv) When appropriate, other available alternative treatments, 3
services, or providers of mental health services. 4
(D) A PLAN OF TREATMENT SH ALL INCLUDE: 5
(1) A LONG–RANGE DISCHARGE GOAL ; AND 6
(2) AN ESTIMATE OF THE PR OBABLE LENGTH OF INP ATIENT STAY 7
THE INDIVIDUAL REQUI RES BEFORE TRANSFER TO A LESS RESTRICTIV E OR 8
INTENSIVE TREATMENT SETTING. 9
(E) FACILITY STAFF WHO WO RK DIRECTLY WITH AND PROVIDE TREATMENT 10
TO AN INDIVIDUAL SHALL REVIE W AND REASSESS THE P LAN OF TREATMENT FOR 11
THE INDIVIDUAL TO DE TERMINE THE INDIVIDU AL’S PROGRESS AND ANY N EED FOR 12
ADJUSTMENTS TO THE P LAN NOT LESS THAN : 13
(1) ONCE EVERY 15 DAYS FOR THE FIRST 2 MONTHS AFTER 14
ADMISSION OF THE IND IVIDUAL TO THE FACILITY; AND 15
(2) ONCE EVERY 60 DAYS FOR THE REMAIND ER OF THE INPATIENT 16
STAY OF THE INDIVIDU AL IN THE FACILITY. 17
(F) (1) ON THE ADMISSION OF A N INDIVIDUAL TO A FA CILITY AND AT 18
EACH REVIEW AND REAS SESSMENT OF THE INDI VIDUAL’S PLAN OF TREATMENT , THE 19
FACILITY SHALL ASK: 20
(I) ASK THE INDIVIDUAL WHETH ER THE INDIVIDUAL 21
CONSENTS TO THE INCLUSION OF FAMILY MEMBERS OR AN Y OTHER INDIVIDUALS IN 22
BEING INFORMED OF AN D GIVEN THE OPPORTUN ITY TO PARTICIPATE I N MEETINGS 23
WITH THE TREATMENT T EAM REGARDING THE DEVELOPMENT , REVIEW, AND 24
REASSESSMENT OF THE PLAN OF TREATMENT OF THE INDIVIDUAL ; AND 25
(II) IF CONSENT IS GIVEN U NDER ITEM (I) OF THIS PARAGRAPH , 26
AT LEAST EVERY 7 DAYS AFTER CONSENT I S GIVEN, RECONFIRM THE CONSEN T AND 27
PROVIDE THE INDIVIDU AL AT A CLINICAL VISIT WITH AN OPP ORTUNITY TO CONSENT 28
TO ADDITIONAL INDIVI DUALS BEING INFORMED OF AND GIVEN THE OPP ORTUNITY 29
TO PARTICIPATE IN ME ETINGS WITH THE TREA TMENT TEAM . 30
(2) IF AN INDIVIDUAL AGRE ES TO HAVE FAMILY ME MBERS OR OTHER 31
INDIVIDUALS PARTICIP ATE IN THE DEVELOPMENT , REVIEW, AND REASSESSMENT OF 32
THE INDIVIDUAL ’S PLAN OF TREATMENT , THE FACILITY SHALL : 33
4 HOUSE BILL 121
(I) INCLUDE THE FAMILY ME MBERS AND OTHER INDI VIDUALS 1
AUTHORIZED BY THE IN DIVIDUAL IN: 2
1. EACH STAGE OF THE DEV ELOPMENT OF THE PLAN OF 3
TREATMENT ; 4
2. ANY REVIEW AND REASSE SSMENT OF THE PLAN O F 5
TREATMENT ; AND 6
3. ANY MEETING OF FACILI TY STAFF THAT HAS A 7
PURPOSE OF DEVELOPIN G, REVIEWING, OR REASSESSING THE P LAN OF 8
TREATMENT ; AND PROVIDE A SCHEDULE OF ROUTINE TREATMENT TE AM MEETINGS 9
WHERE THE PLAN O F TREATMENT IS DISCU SSED; 10
(II) PROVIDE NOTICE TO THE FAMILY MEMBERS AND O THER 11
INDIVIDUALS OF A TRE ATMENT TEAM MEETING : 12
1. AT LEAST 7 DAYS IN ADVANCE OF T HE MEETING; OR 13
2. IF THE TREATMENT TEAM MEETING IS BEING HEL D 14
DUE TO AN EMERGENCY , AS SOON AS THE MEETING IS SCHEDULED ESTABLISH A 15
PROCESS FOR THE AUTH ORIZED INDIVIDUALS T O PARTICIPATE IN TRE ATMENT 16
TEAM MEETINGS ; 17
(III) IF THE TREATMENT TEAM MEETING IS BEING HEL D 18
OUTSIDE THE REGULAR SCHEDULE, INFORM THE AUTHORIZE D INDIVIDUALS AS 19
SOON AS THE MEETING IS SCHED ULED; AND 20
(IV) IF THE TREATMENT TEAM MEETING IS BEING HEL D DUE TO 21
AN EMERGENCY , INFORM THE AUTHORIZE D INDIVIDUALS OF THE OUTCOME OF THE 22
MEETING AS SOON AS P RACTICABLE. 23
(3) THE INDIVIDUAL MAY WI THDRAW THE CONSENT G IVEN UNDER 24
PARAGRAPH (1) OF THIS SUBSECTION A T ANY TIME ORALLY OR IN WRITING. 25
(4) A TREATING PROVIDER MA Y WITHHOLD INFORMATI ON ON AN 26
INDIVIDUAL PLAN OF T REATMENT FROM A FAMI LY MEMBER OR OTHER A UTHORIZED 27
INDIVIDUAL IF: 28
(I) IN THE TREATING PROVI DER’S CLINICAL JUDGMENT, THE 29
CONSENT GIVEN UNDER PARAGRAPH (1) OF THIS SUBSECTION W AS PROVIDED 30
THROUGH COERCIVE MEA NS; 31
HOUSE BILL 121 5
(II) THE TREATING PROVIDER BELIEVES IT IS IN TH E BEST 1
CLINICAL INTEREST OF THE INDIVIDUAL ; OR 2
(III) THE INDIVIDUAL REQUES TS THAT A SPECIFIC P IECE OF THE 3
PLAN OF TREATMENT BE WITHHELD. 4
(G) (1) IF AN INDIVIDUAL ADMI TTED TO A FACILITY O R ANY FAMILY 5
MEMBER OR OTHER INDI VIDUAL AUTHORIZED BY THE INDIVIDUAL TO PA RTICIPATE 6
IN THE REVIEW AND RE ASSESSMENT OF THE PL AN OF TREATMENT FOR THE 7
INDIVIDUAL UNDER SUBSECTION (F) OF THIS SECTION BELI EVES THAT THE PLAN O F 8
TREATMENT IS NOT MEE TING THE NEEDS OF TH E INDIVIDUAL, THE INDIVIDUAL , 9
FAMILY MEMBER , OR OTHER AUTHORIZED INDIVIDUAL HAS THE R IGHT TO REQUEST 10
THAT THE FACILITY RE VIEW AND REASSESS TH E PLAN OF TREATME NT. 11
(2) ON RECEIPT OF A REQUE ST UNDER PARAGRAPH (1) OF THIS 12
SUBSECTION, THE FACILITY STAFF W HO WORK DIRECTLY WIT H AND PROVIDE 13
TREATMENT TO THE IND IVIDUAL SHALL CONDUCT: 14
(I) CONDUCT A REVIEW AND REASSES SMENT OF THE PLAN OF 15
TREATMENT THAT INCLUDES A WRITTEN EXPLANATION OF HOW ALL ISSUES RAISED 16
IN THE REQUEST WERE CONSIDERED IN THE RE VIEW AND REASSESSMENT OF THE 17
PLAN OF TREATMENT ; 18
(II) COMMUNICATE THE RESUL TS OF THE REVIEW AND 19
REASSESSMENT OF THE PLAN OF TREATMENT TO THE PATIENT AND INDI VIDUAL 20
WHO REQUESTED THE REVIEW AND REASSESSMENT , INCLUDING AN EXPLANA TION 21
OF HOW ALL ISSUES RA ISED IN THE REQUEST WERE CONSIDERED ; AND 22
(III) INCLUDE THE REQUEST F OR THE REVIEW AND 23
REASSESSMENT OF THE PLAN OF TREATMENT AN D THE OUTCOME OF THE REVIEW 24
AND ASSESSMENT , INCLUDING THE EXPLAN ATION OF THE OUTCOME , IN THE 25
MEDICAL RECORDS OF T HE INDIVIDUAL. 26
(3) IF THE FACILITY DOES NOT MAKE ANY CHANGES TO THE PLAN OF 27
TREATMENT FOR THE IN DIVIDUAL, THE FACILITY SHALL : 28
(I) PROVIDE A DETAILED WR ITTEN EXPLANATION FO R THE 29
DECISION TO THE INDIV IDUAL AND ANY FAMILY MEMBER AND INDIVIDUA L 30
AUTHORIZED BY THE IN DIVIDUAL TO PARTICIP ATE IN THE REVIEW AN D 31
REASSESSMENT OF THE PLAN OF TREATMENT ; AND 32
(II) INCLUDE THE EXPLANATI ON IN THE MEDICAL RE CORDS OF 33
THE INDIVIDUAL IF A STATE FACILITY DOES NOT MA KE ANY CHANGES TO TH E PLAN 34
OF TREATMENT FOR THE INDIVIDUAL, THE STATE FACILITY SHALL PROVIDE 35 6 HOUSE BILL 121
REFERRAL INFORMATION FOR THE RESIDENT GRIEVANCE SYSTEM ESTABLISHED 1
UNDER COMAR 10.21.14. 2
(H) (1) AN INDIVIDUAL ADMITTE D TO A STATE FACILITY M AY REQUEST 3
AN ADMINISTRATIVE HE ARING FOR A RECONSID ERATION OF THE REVIE W AND 4
REASSESSMENT COMPLET ED UNDER SUBSECTION (G) OF THIS SECTION BY F ILING A 5
REQUEST FOR HEARING WITH THE CHIEF EXECU TIVE OFFICER OF THE STATE 6
FACILITY OR THE CHIE F EXECUTIVE OFFICER ’S DESIGNEE WITHIN 7 DAYS AFTER 7
RECEIPT OF THE WRITT EN EXPLANATION OF TH E REVIEW AND REASSES SMENT. 8
(2) WITHIN 72 HOURS AFTER RECEIPT OF A REQUEST FOR A 9
HEARING, THE CHIEF EXECUTIVE OFFICER OF THE STATE FACILITY OR THE CHIEF 10
EXECUTIVE OFFICER ’S DESIGNEE SH ALL FORWARD THE REQU EST TO THE OFFICE 11
OF ADMINISTRATIVE HEARINGS. 12
(3) SUBJECT TO PARAGRAPH (5) OF THIS SUBSECTION , THE OFFICE 13
OF ADMINISTRATIVE HEARINGS SHALL CONDUC T A HEARING AND ISSU E A DECISION 14
WITHIN 15 CALENDAR DAYS AFTER THE RECEIPT OF THE REQUEST FORWARDED 15
UNDER PARAGRAPH (2) OF THIS SUBSECTION . 16
(4) THE INDIVIDUAL ADMITT ED TO A STATE FACILITY IS ENT ITLED TO 17
BE REPRESENTED BY CO UNSEL AT THE ADMINIS TRATIVE HEARING . 18
(5) THE ADMINISTRATIVE HE ARING MAY BE POSTPON ED BY 19
AGREEMENT OF THE PAR TIES OR FOR GOOD CAUS E SHOWN. 20
(6) THE ADMINISTRATIVE LA W JUDGE SHALL CONDUC T A DE NOVO 21
HEARING TO DETERMINE WHETHER THE PLAN OF TREATMENT IS MEETING THE 22
NEEDS OF THE INDIVID UAL. 23
(7) AT THE HEARING , THE INDIVIDUAL REPRE SENTING THE STATE 24
FACILITY: 25
(I) MAY INTRODUCE THE WRI TTEN EXPLANATION REL ATING 26
TO THE PLAN OF TREAT MENT AS EVIDENCE ; AND 27
(II) SHALL PROVE , BY CLEAR AND CONVINC ING EVIDENCE , 28
THAT THE PLAN OF TRE ATMENT IS MEETING TH E NEEDS OF THE INDIV IDUAL. 29
(8) (I) THE ADMINISTRATIVE LA W JUDGE SHALL STATE ON THE 30
RECORD THE FINDINGS OF FACT AND CONCLUSI ONS OF LAW. 31
(II) THE ADMINISTRATIVE LA W JUDGE SHALL DETERM INE 32
THAT: 33 HOUSE BILL 121 7
1. BY CLEAR AND CONVINCI NG EVIDENCE, THE PLAN OF 1
TREATMENT IS MEETING THE NEEDS OF THE IND IVIDUAL; OR 2
2. THE PLAN O F TREATMENT IS NOT M EETING THE 3
NEEDS OF THE INDIVID UAL. 4
(III) IF THE ADMINISTRATIVE LAW JUDGE DETERMINES THAT 5
THE PLAN OF TREATMEN T IS NOT MEETING THE NEEDS OF THE INDIVID UAL, THE 6
ADMINISTRATIVE LAW J UDGE SHALL ORDER THE STATE FACILITY TO MAK E 7
ARRANGEM ENTS FOR THE INDIVID UAL TO RECEIVE NECES SARY TREATMENT , WHICH 8
MAY INCLUDE TREATMEN T FROM ANOTHER FACIL ITY OR ANOTHER HEALT H CARE 9
PROVIDER OUTSIDE THE STATE FACILITY. 10
(9) THE DETERMINATION OF THE ADMINISTRATIVE L AW JUDGE IS A 11
FINAL DECISION FOR T HE PURPO SE OF JUDICIAL REVIE W OF A FINAL DECISIO N 12
UNDER THE ADMINISTRATIVE PROCEDURE ACT. 13
(I) (1) WITHIN 14 CALENDAR DAYS AFTER THE ADMINISTRATIVE L AW 14
JUDGE ISSUES A DECIS ION UNDER SUBSECTION (H) OF THIS SECTION , THE 15
INDIVIDUAL OR THE STATE FACILITY MAY AP PEAL THE DECISION TO THE CIRCUIT 16
COURT ON THE RECORD FROM THE HEARING CON DUCTED BY THE OFFICE OF 17
ADMINISTRATIVE HEARINGS. 18
(2) THE SCOPE OF REVIEW S HALL BE AS A CONTEST ED CASE UNDER 19
THE ADMINISTRATIVE PROCEDURE ACT. 20
(3) (I) REVIEW SHALL BE ON TH E RECORD MA DE BEFORE THE 21
OFFICE OF ADMINISTRATIVE HEARINGS, UNLESS EITHER PARTY TO THE APPEAL 22
REQUESTS TRANSCRIPTI ON OF THE TAPE. 23
(II) A REQUEST FOR TRANSCRI PTION OF THE TAPE SH ALL BE 24
MADE AT THE TIME THE APPEAL IS FILED. 25
(III) 1. THE OFFICE OF ADMINISTRATIVE HEARINGS SHALL 26
PREPARE THE TRANSCRI PTION BEFORE THE APP EAL HEARING. 27
2. THE PARTY REQUESTING THE TRANSCRIPTION SH ALL 28
BEAR THE COST OF TRA NSCRIPTION. 29
(4) THE CIRCUIT COURT SHA LL HEAR AND ISSUE A DECISION ON AN 30
APPEAL WITHIN 30 CALENDAR DAYS AFTER THE DATE THE APPEAL WAS FILED AN 31
INDIVIDUAL ADMITTED TO A STATE FACILITY OR ANO THER INDIVIDUAL 32
AUTHORIZED BY THE AD MITTED INDIVIDUAL MA Y REQUEST A RECONSID ERATION OF 33 8 HOUSE BILL 121
THE REVIEW AND REASS ESSMENT COMPLETED UN DER SUBSECTION (G) OF THIS 1
SECTION BY FILING A GRIEVANCE WITH THE RESIDENT GRIEVANCE SYSTEM UNDER 2
COMAR 12.21.14. 3
(I) (1) AN INDIVIDUAL ADMITTE D TO A STATE FACILITY OR ANO THER 4
INDIVIDUAL AUTHORIZE D BY THE ADMITTED IN DIVIDUAL MAY APPEAL THE 5
RECONSIDERATION OF T HE REVIEW AND REASSE SSMENT COMPLETED UND ER 6
SUBSECTION (H) OF THIS SECTION BY F ILING A REQUEST WITH THE DEPARTMENT ’S 7
HEALTHCARE SYSTEM’S CHIEF MEDICAL OFFICER. 8
(2) THE DEPARTMENT SHALL ADOP T REGULATIONS TO EST ABLISH A 9
PROCESS FOR THE APPE AL OF THE RECONSIDER ATION OF THE REVIEW AND 10
REASSESSMENT UND ER PARAGRAPH (1) OF THIS SUBSECTION . 11
(J) IF A AN INDIVIDUAL IS ADM ITTED TO A STATE FACILITY AND TH E STATE 12
FACILITY IS UNABLE T O PROVIDE THE TREATM ENT NECESSARY TO ADD RESS THE 13
REHABILITATION NEEDS OF AN INDIVIDUAL UND ER A PLAN OF TREATME NT FOR THE 14
INDIVIDUAL, THE STATE FACILITY SHALL: 15
(1) MAKE ARRANGEMENTS FOR THE INDIVIDUAL TO RE CEIVE 16
NECESSARY TREATMENT FROM ANOTHER FACILIT Y OR OTHER HEALTH CA RE 17
PROVIDER OUTSIDE THE STATE FACILITY; AND 18
(2) ENSURE THAT TREATMENT FOR THE INDIVIDUAL I S 19
COORDINATED BETWEEN THE STATE FACILITY AND THE OTH ER FACILITY OR 20
HEALTH CARE PROVIDER . 21
PART II. RESIDENT GRIEVANCE SYSTEM REPORT. 22
10–908. 23
ON OR BEFORE JANUARY 1 EACH YEAR , BEGINNING IN 2024, THE 24
DEPARTMENT SH ALL REPORT TO THE GENERAL ASSEMBLY, IN ACCORDANCE WITH 25
§ 2–1257 OF THE STATE GOVERNMENT ARTICLE, ON: 26
(1) THE RESIDENT GRIEVANCE SYSTEM ESTABLISHED UN DER 27
COMAR 12.21.14; AND 28
(2) THE GRIEVANCES THAT W ERE RECEIVED BY THE RESIDENT 29
GRIEVANCE SYSTEM RELAT ED TO STATE FACILITIES DURI NG THE IMMEDIATELY 30
PRECEDING FISCAL YEA R. 31
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 32
October 1, 2023. 33