WES MOORE, Governor Ch. 263
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Chapter 263
(House Bill 121)
AN ACT concerning
Mental Health – Treatment Plans for Individuals in Facilities – Requirements
and Resident Grievance System
FOR the purpose of requiring that a plan of treatment for an individual with a mental
disorder admitted to a certain health care facility include a certain discharge goal
and an estimate of the probable length of inpatient stay the individual requires
before transfer to a certain setting; requiring certain facility staff to review and
reassess a plan of treatment within certain time periods; establishing certain rights
and requirements relating to the participation of certain family members and other
individuals in the development, review, and reassessment of a plan of treatment;
establishing an appeals process for individuals admitted to a State facility relating
to the review and reassessment of a plan of treatment; requiring the Maryland
Department of Health to adopt certain regulations relating to the appeals process;
requiring a certain State health care facility to take certain actions if the facility is
unable to address certain needs under a plan of treatment; requiring the Department
to report certain information related to the Resident Grievance System to the
General Assembly on or before a certain date each year; and generally relating to
treatment plans for individuals with mental disorders admitted to mental health
care facilities.
BY repealing and reenacting, with amendments,
Article – Health – General
Section 10–706
Annotated Code of Maryland
(2019 Replacement Volume and 2022 Supplement)
BY adding to
Article – Health – General
Section 10–908 to be under the new part “Part II. Resident Grievance System Report”
Annotated Code of Maryland
(2019 Replacement Volume and 2022 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Health – General
10–706.
(a) (1) Except as provided by paragraph (2) of this subsection, promptly after
admission of an individual, a facility shall make and periodically update a written plan of Ch. 263 2023 LAWS OF MARYLAND
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treatment for the individual in the facility, in accordance with the provisions of this
subtitle.
(2) Promptly after admission of an individual to a psychosocial center, the
center shall make and periodically update a written plan of rehabilitation for the individual
in the facility, in accordance with the provisions of this subtitle.
(b) The Director shall adopt rules and regulations under this section that include:
(1) [A] SUBJECT TO SUBSECTION (D) OF THIS SECTION , A description
of the nature and content of plans of treatment; and
(2) [Appropriate] SUBJECT TO SUBSECTION (E) OF THIS SECTION ,
APPROPRIATE time periods for the development, implementation, and review of each plan.
(c) An individual shall:
(1) Participate, in a manner appropriate to the individual’s condition, in
the development and periodic updating of the plan of treatment; and
(2) Be told, in appropriate terms and language, of:
(i) The content and objectives of the plan of treatment;
(ii) The nature and significant possible adverse effects of
recommended treatments;
(iii) The name, title, and role of personnel directly responsible for
carrying out the treatment for the individual; and
(iv) When appropriate, other available alternative treatments,
services, or providers of mental health services.
(D) A PLAN OF TREATMENT SHALL INCLUD E:
(1) A LONG–RANGE DISCHARGE GOAL ; AND
(2) AN ESTIMATE OF THE PR OBABLE LENGTH OF INP ATIENT STAY
THE INDIVIDUAL REQUI RES BEFORE TRANSFER TO A LESS RESTRICTIV E OR
INTENSIVE TREATMENT SETTING.
(E) FACILITY STAFF WHO WO RK DIRECTLY WITH AND PROVIDE TRE ATMENT
TO AN INDIVIDUAL SHA LL REVIEW AND REASSE SS THE PLAN OF TREAT MENT FOR
THE INDIVIDUAL TO DE TERMINE THE INDIVIDU AL’S PROGRESS AND ANY N EED FOR
ADJUSTMENTS TO THE P LAN NOT LESS THAN : WES MOORE, Governor Ch. 263
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(1) ONCE EVERY 15 DAYS FOR THE FIRST 2 MONTHS A FTER
ADMISSION OF THE IND IVIDUAL TO THE FACIL ITY; AND
(2) ONCE EVERY 60 DAYS FOR THE REMAIND ER OF THE INPATIENT
STAY OF THE INDIVIDU AL IN THE FACILITY.
(F) (1) ON THE ADMISSION OF A N INDIVIDUAL TO A FA CILITY AND AT
EACH REVIEW AND REAS SESSMENT OF THE INDIVIDUAL’S PLAN OF TREATMENT , THE
FACILITY SHALL ASK:
(I) ASK THE INDIVIDUAL WHETH ER THE INDIVIDUAL
CONSENTS TO THE INCLUSION OF FAMILY MEMBERS OR AN Y OTHER INDIVIDUALS IN
BEING INFORMED OF AN D GIVEN THE OPPORTUN ITY TO PARTICIPATE I N MEETINGS
WITH THE TREATMENT TEAM REG ARDING THE DEVELOPMENT , REVIEW, AND
REASSESSMENT OF THE PLAN OF TREATMENT OF THE INDIVIDUAL ; AND
(II) IF CONSENT IS GIVEN U NDER ITEM (I) OF THIS PARAGRAPH ,
AT LEAST EVERY 7 DAYS AFTER CONSENT I S GIVEN, RECONFIRM THE CONSEN T AND
PROVIDE THE INDIVIDU AL AT A CLINICAL VISIT WITH AN OPPORTUNI TY TO CONSENT
TO ADDITIONAL INDIVI DUALS BEING INFORMED OF AND GIVEN THE OPP ORTUNITY
TO PARTICIPATE IN ME ETINGS WITH THE TREA TMENT TEAM .
(2) IF AN INDIVIDUAL AGRE ES TO HAVE FAMILY ME MBERS OR OTH ER
INDIVIDUALS PARTICIP ATE IN THE DEVELOPME NT, REVIEW, AND REASSESSMENT OF
THE INDIVIDUAL ’S PLAN OF TREATMENT , THE FACILITY SHALL :
(I) INCLUDE THE FAMILY ME MBERS AND OTHER INDI VIDUALS
AUTHORIZED BY THE IN DIVIDUAL IN:
1. EACH STAGE OF THE DEV ELOPMENT OF THE PLAN OF
TREATMENT ;
2. ANY REVIEW AND REASSE SSMENT OF THE PLAN O F
TREATMENT ; AND
3. ANY MEETING OF FACILI TY STAFF THAT HAS A
PURPOSE OF DEVELOPIN G, REVIEWING, OR REASSESSING THE P LAN OF
TREATMENT ; AND PROVIDE A SCHEDULE OF ROUTINE TREATMENT TEAM MEETI NGS
WHERE THE PLAN OF TR EATMENT IS DISCUSSED ;
(II) PROVIDE NOTICE TO THE FAMILY MEMBERS AND O THER
INDIVIDUALS OF A TRE ATMENT TEAM MEETING :
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1. AT LEAST 7 DAYS IN ADVANCE OF T HE MEETING; OR
2. IF THE TREATMENT TEAM MEETING IS BEING HELD
DUE TO AN EMERGENCY , AS SOON AS THE MEETI NG IS SCHEDULED ESTABLISH A
PROCESS FOR THE AUTH ORIZED INDIVIDUALS T O PARTICIPATE IN TRE ATMENT
TEAM MEETINGS ;
(III) IF THE TREATMENT TEAM MEETING IS BEING HEL D
OUTSIDE THE REGULAR SCHEDULE, INFORM THE AUTHORIZED INDIVI DUALS AS
SOON AS THE MEETING IS SCHEDULED; AND
(IV) IF THE TREATMENT TEAM MEETING IS BEING HEL D DUE TO
AN EMERGENCY , INFORM THE AUTHORIZE D INDIVIDUALS OF THE OUTCOME OF THE
MEETING AS SOON AS P RACTICABLE.
(3) THE INDIVIDUAL MAY WITHDRAW THE CONSENT GIVEN UNDER
PARAGRAPH (1) OF THIS SUBSECTION A T ANY TIME ORALLY OR IN WRITING.
(4) A TREATING PROVIDER MA Y WITHHOLD INFORMATI ON ON AN
INDIVIDUAL PLAN OF T REATMENT FROM A FAMI LY MEMBER OR OTHER A UTHORIZED
INDIVIDUAL IF:
(I) IN THE TREATING PROVIDER ’S CLINICAL JUDGMENT , THE
CONSENT GIVEN UNDER PARAGRAPH (1) OF THIS SUBSECTION W AS PROVIDED
THROUGH COERCIVE MEA NS;
(II) THE TREATING PROVIDER BELIEVES IT IS IN TH E BEST
CLINICAL INTEREST OF THE INDIVIDUAL ; OR
(III) THE INDIVIDUA L REQUESTS THAT A SP ECIFIC PIECE OF THE
PLAN OF TREATMENT BE WITHHELD.
(G) (1) IF AN INDIVIDUAL ADMI TTED TO A FACILITY O R ANY FAMILY
MEMBER OR OTHER INDI VIDUAL AUTHORIZED BY THE INDIVIDUAL TO PA RTICIPATE
IN THE REVIEW AND RE ASSESSMENT OF THE PL AN OF TRE ATMENT FOR THE
INDIVIDUAL UNDER SUB SECTION (F) OF THIS SECTION BELI EVES THAT THE PLAN O F
TREATMENT IS NOT MEE TING THE NEEDS OF TH E INDIVIDUAL, THE INDIVIDUAL ,
FAMILY MEMBER , OR OTHER AUTHORIZED INDIVIDUAL HAS THE R IGHT TO REQUEST
THAT THE FACILITY RE VIEW AND REASSESS THE PLAN OF TREATMENT .
(2) ON RECEIPT OF A REQUE ST UNDER PARAGRAPH (1) OF THIS
SUBSECTION, THE FACILITY STAFF W HO WORK DIRECTLY WIT H AND PROVIDE
TREATMENT TO THE IND IVIDUAL SHALL CONDUCT: WES MOORE, Governor Ch. 263
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(I) CONDUCT A REVIEW AND REASSES SMENT OF THE PLAN OF
TREATMENT THAT INCLUDES A WRIT TEN EXPLANATION OF H OW ALL ISSUES RAISED
IN THE REQUEST WERE CONSIDERED IN THE RE VIEW AND REASSESSMENT OF THE
PLAN OF TREATMENT ;
(II) COMMUNICATE THE RESUL TS OF THE REVIEW AND
REASSESSMENT OF THE PLAN OF TREATMENT TO THE PATIENT AND INDIVIDU AL
WHO REQUESTED THE RE VIEW AND REASSESSMEN T, INCLUDING AN EXPLANA TION
OF HOW ALL ISSUES RA ISED IN THE REQUEST WERE CONSIDERED ; AND
(III) INCLUDE THE REQUEST F OR THE REVIEW AND
REASSESSMENT OF THE PLAN OF TREATMEN T AND THE OUTCOME OF THE REVIEW
AND ASSESSMENT , INCLUDING THE EXPLAN ATION OF THE OUTCOME , IN THE
MEDICAL RECORDS OF T HE INDIVIDUAL.
(3) IF THE FACILITY DOES NOT MAKE ANY CHANGES TO THE PLAN OF
TREATMENT FOR THE IN DIVIDUAL, THE FACILITY SHALL:
(I) PROVIDE A DETAILED WR ITTEN EXPLANATION FO R THE
DECISION TO THE INDI VIDUAL AND ANY FAMIL Y MEMBER AND INDIVID UAL
AUTHORIZED BY THE IN DIVIDUAL TO PARTICIP ATE IN THE REVIEW AN D
REASSESSMENT OF THE PLAN OF TREATMENT ; AND
(II) INCLUDE THE EXPLANATION IN THE M EDICAL RECORDS OF
THE INDIVIDUAL IF A STATE FACILITY DOES N OT MAKE ANY CHANGES TO THE PLAN
OF TREATMENT FOR THE INDIVIDUAL, THE STATE FACILITY SHALL PROVIDE
REFERRAL INFORMATION FOR THE RESIDENT GRIEVANCE SYSTEM ESTABLISHED
UNDER COMAR 10.21.14.
(H) (1) AN INDIVIDUAL ADMITTE D TO A STATE FACILITY MAY RE QUEST
AN ADMINISTRATIVE HE ARING FOR A RECONSID ERATION OF THE REVIE W AND
REASSESSMENT COMPLET ED UNDER SUBSECTION (G) OF THIS SECTION BY F ILING A
REQUEST FOR HEARING WITH THE CHIEF EXECUTIVE OFFICER OF THE STATE
FACILITY OR THE CHIE F EXECUTIVE OFFICER ’S DESIGNEE WITHIN 7 DAYS AFTER
RECEIPT OF THE WRITT EN EXPLANATION OF TH E REVIEW AND REASSES SMENT.
(2) WITHIN 72 HOURS AFTER RECEIPT OF A REQUEST FOR A
HEARING, THE CHIEF EXECUTIVE OFFICER OF THE STATE FACILITY OR THE CHIEF
EXECUTIVE OFFICER ’S DESIGNEE SHALL FOR WARD THE REQUEST TO THE OFFICE
OF ADMINISTRATIVE HEARINGS.
(3) SUBJECT TO PARAGRAPH (5) OF THIS SUBSECTION , THE OFFICE
OF ADMINISTRATIVE HEARINGS SHALL CONDUC T A HEARING AND ISSUE A DECISION Ch. 263 2023 LAWS OF MARYLAND
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WITHIN 15 CALENDAR DAYS AFTER THE RECEIPT OF THE R EQUEST FORWARDED
UNDER PARAGRAPH (2) OF THIS SUBSECTION .
(4) THE INDIVIDUAL ADMITT ED TO A STATE FACILITY IS ENT ITLED TO
BE REPRESENTED BY CO UNSEL AT THE ADMINIS TRATIVE HEARING .
(5) THE ADMINISTRATIVE HE ARING MAY BE POSTPON ED BY
AGREEMENT OF THE PAR TIES OR FOR GOOD CAU SE SHOWN.
(6) THE ADMINISTRATIVE LA W JUDGE SHALL CONDUC T A DE NOVO
HEARING TO DETERMINE WHETHER THE PLAN OF TREATMENT IS MEETING THE
NEEDS OF THE INDIVID UAL.
(7) AT THE HEARING , THE INDIVIDUAL REPRE SENTING THE STATE
FACILITY:
(I) MAY INTRODUCE THE WRI TTEN EXPLANATION REL ATING
TO THE PLAN OF TREAT MENT AS EVIDENCE ; AND
(II) SHALL PROVE , BY CLEAR AND CONVINC ING EVIDENCE ,
THAT THE PLAN OF TRE ATMENT IS MEETING TH E NEEDS OF THE INDIV IDUAL.
(8) (I) THE ADMINISTRATIVE LA W JUDGE SHALL STATE ON THE
RECORD THE FINDINGS OF FACT AND CONCLUSI ONS OF LAW.
(II) THE ADMINISTRATIVE LA W JUDGE SHALL DETERM INE
THAT:
1. BY CLEAR AND CONVINCI NG EVIDENCE, THE PLAN OF
TREATMENT IS MEETING THE NEEDS OF THE IND IVIDUAL; OR
2. THE PLAN OF TREATMENT IS NOT MEETING THE
NEEDS OF THE INDIVID UAL.
(III) IF THE ADMINISTRATIVE LAW JUDGE DETERMINES THAT
THE PLAN OF TREATMEN T IS NOT MEETING THE NEEDS OF THE INDIVID UAL, THE
ADMINISTRATIVE LAW JU DGE SHALL ORDER THE STATE FACILITY TO MAK E
ARRANGEMENTS FOR THE INDIVIDUAL TO RECEIV E NECESSARY TREATMEN T, WHICH
MAY INCLUDE TREATMEN T FROM ANOTHER FACIL ITY OR ANOTHER HEALT H CARE
PROVIDER OUTSIDE THE STATE FACILITY.
WES MOORE, Governor Ch. 263
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(9) THE DETERMINATION OF THE ADMINISTRATIVE LAW J UDGE IS A
FINAL DECISION FOR T HE PURPOSE OF JUDICI AL REVIEW OF A FINAL DECISION
UNDER THE ADMINISTRATIVE PROCEDURE ACT.
(I) (1) WITHIN 14 CALENDAR DAYS AFTER THE ADMINISTRATIVE L AW
JUDGE ISSUES A DECIS ION UNDER SU BSECTION (H) OF THIS SECTION , THE
INDIVIDUAL OR THE STATE FACILITY MAY AP PEAL THE DECISION TO THE CIRCUIT
COURT ON THE RECORD FROM THE HEARING CON DUCTED BY THE OFFICE OF
ADMINISTRATIVE HEARINGS.
(2) THE SCOPE OF REVIEW S HALL BE AS A CONTEST ED CASE UNDER
THE ADMINISTRATIVE PROCEDURE ACT.
(3) (I) REVIEW SHALL BE ON TH E RECORD MADE BEFORE THE
OFFICE OF ADMINISTRATIVE HEARINGS, UNLESS EITHER PARTY TO THE APPEAL
REQUESTS TRANSCRIPTI ON OF THE TAPE.
(II) A REQUEST FOR TRANSCRI PTION OF THE TAPE SH ALL BE
MADE AT THE TIME THE APPEAL IS FILED.
(III) 1. THE OFFICE OF ADMINISTRATIVE HEARINGS SHALL
PREPARE THE TRANSCRI PTION BEFORE THE APP EAL HEARING.
2. THE PARTY REQUESTING THE TRANSCRIPTION SH ALL
BEAR THE COST OF TRA NSCRIPTION.
(4) THE CIRCUIT COUR T SHALL HEAR AND ISS UE A DECISION ON AN
APPEAL WITHIN 30 CALENDAR DAYS AFTER THE DATE THE APPEAL WAS FILED AN
INDIVIDUAL ADMITTED TO A STATE FACILITY OR ANO THER INDIVIDUAL
AUTHORIZED BY THE AD MITTED INDIVIDUAL MA Y REQUEST A RECONSID ERATION OF
THE REVIEW AN D REASSESSMENT COMPL ETED UNDER SUBSECTIO N (G) OF THIS
SECTION BY FILING A GRIEVANCE WITH THE RESIDENT GRIEVANCE SYSTEM UNDER
COMAR 12.21.14 10.21.14.
(I) (1) AN INDIVIDUAL ADMITTE D TO A STATE FACILITY OR ANO THER
INDIVIDUAL AUTHORIZE D BY THE ADMITTED INDIVIDUAL MAY APPEA L THE
RECONSIDERATION OF T HE REVIEW AND REASSE SSMENT COMPLETED UND ER
SUBSECTION (H) OF THIS SECTION BY F ILING A REQUEST WITH THE DEPARTMENT ’S
HEALTHCARE SYSTEM’S CHIEF MEDICAL OFFICER.
(2) THE DEPARTMENT SHALL ADOP T REGULATIONS TO ES TABLISH A
PROCESS FOR THE APPE AL OF THE RECONSIDER ATION OF THE REVIEW AND
REASSESSMENT UNDER P ARAGRAPH (1) OF THIS SUBSECTION .
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(J) IF A AN INDIVIDUAL IS ADM ITTED TO A STATE FACILITY AND TH E STATE
FACILITY IS UNABLE T O PROVIDE THE TREATM ENT NECESSARY TO ADD RESS THE
REHABILITATION NEEDS OF AN INDIVIDUAL UND ER A PLAN OF TREATME NT FOR THE
INDIVIDUAL, THE STATE FACILITY SHALL:
(1) MAKE ARRANGEMENTS FOR THE INDIVIDUAL TO RE CEIVE
NECESSARY TREATMENT FROM ANOTHER FACILITY OR OTHER HEALTH CARE
PROVIDER OUTSIDE THE STATE FACILITY; AND
(2) ENSURE THAT TREATMENT FOR THE INDIVIDUAL I S
COORDINATED BETWEEN THE STATE FACILITY AND THE OTH ER FACILITY OR
HEALTH CARE PROVIDER .
PART II. RESIDENT GRIEVANCE SYSTEM REPORT.
10–908.
ON OR BEFORE JANUARY 1 EACH YEAR , BEGINNING IN 2024, THE
DEPARTMENT SHALL REPO RT TO THE GENERAL ASSEMBLY, IN ACCORDANCE WITH
§ 2–1257 OF THE STATE GOVERNMENT ARTICLE, ON:
(1) THE RESIDENT GRIEVANCE SYSTEM ESTABLISHED UN DER
COMAR 12.21.14 10.21.14; AND
(2) THE GRIEVANCES THAT W ERE RECEIVED BY THE RESIDENT
GRIEVANCE SYSTEM RELATED TO STATE FACILITIES DURI NG THE IMMEDIATELY
PRECEDING FISCAL YEA R.
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 2023.
Approved by the Governor, May 3, 2023.