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