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    PROPOSAL
    Maryland Register
    Issue Date:  March 3, 2017
    Volume 44 • Issue 5 • Pages 297—302
     
    Title 10
    DEPARTMENT OF HEALTH AND MENTAL HYGIENE
    Subtitle 07 HOSPITALS
    10.07.04 [Related Institutions —] Residential Treatment Centers for Emotionally Disturbed Children and Adolescents
    Authority: Health-General Article, §§19-301, 19-305, 19-308, 19-309 and 19-360, Annotated Code of Maryland
    Notice of Proposed Action
    [17-094-P]
    The Secretary of Health and Mental Hygiene proposes to repeal the Preface and existing Regulations .04, .05, and .07, adopt new Regulations .01, .05, .06, and .16—.22, recodify and amend existing Regulations .01—.03 to be Regulations .02—.04, respectively, recodify existing Regulation .06 to be Regulation .07, and amend Regulations .08—.10 and .12—.15 under COMAR 10.07.04 Residential Treatment Centers for Emotionally Disturbed Children and Adolescents.
    Statement of Purpose
    The purpose of this action is to:
    (1) Update the regulations to align with current practices and the Joint Commission’s requirements;
    (2) Add terms used in the profession;
    (3) Require that the quantity of food served in the center meets minimum daily requirements; and
    (4) Require specific actions and procedures for restraints and seclusion, complaint investigations, reports, civil money penalties, hearings, notifications, and resident rights.
    Comparison to Federal Standards
    There is no corresponding federal standard to this proposed action.
    Estimate of Economic Impact
    The proposed action has no economic impact.
    Economic Impact on Small Businesses
    The proposed action has minimal or no economic impact on small businesses.
    Impact on Individuals with Disabilities
    The proposed action has no impact on individuals with disabilities.
    Opportunity for Public Comment
    Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to dhmh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through April 3, 2017. A public hearing has not been scheduled.
    .01 Scope.
    A. The treatment and care of emotionally disturbed children and adolescents are of great concern to various State agencies including the Department of Health and Mental Hygiene, Department of Human Resources, Maryland State Department of Education and Department of Juvenile Justice.
    B. The Department of Health and Mental Hygiene, Department of Human Resources, Maryland State Department of Education, and Department of Juvenile Services, by statute, are responsible to ascertain that applicants for licenses conform to the regulations promulgated under the legal authority vested in the respective departments.
    [.01] .02 Definitions.
    A. In this chapter, the following terms have the meanings indicated.
    B. Terms Defined.
    (1) “Accredited residential treatment center” means a residential treatment center that is accredited by the Joint Commission.
    (2) “Adverse event” means an unexpected occurrence that:
    (a) Is related to a resident’s medical or behavioral treatment; and
    (b) Is not related to the natural course of the resident’s illness or underlying disease condition.
    [A.] (3) 'Center' means a [related institution as defined in Health-General Article, Title 19, Subtitle 3, 'Hospitals and Related Institutions' Annotated Code of Maryland and shall include a residential treatment center for emotionally disturbed children or adolescents with overnight accommodations for two or more non-related individuals who are referred for admission on the recommendation of a physician] residential treatment center.
    (4) “Change in condition” means a significant change in a resident’s physical, mental, or psychological status including:
    (a) Life-threatening conditions;
    (b) Clinical complications, including significant somatic symptoms that require the assessment or treatment by qualified medical personnel;
    (c) The need to discontinue a medication or treatment because of:
    (i) An adverse consequence; or
    (ii) The need to begin a new form of treatment;
    (d) Evaluation at or admission to a hospital;
    (e) Injuries that require the assessment of or treatment by qualified medical personnel;
    (f) The use of restraint or seclusion; and
    (g) Suicide attempts.
    [B.] (5) 'Department' means the [Departments] Department of Health and Mental Hygiene[, except in those circumstances where inapplicable].
    [C.] (6) (text unchanged)
    (7) 'Governing body' means the organizational structure that is responsible for all center operations, including:
    (a) Establishing policy;
    (b) Maintaining quality care; and
    (c) Providing management and planning for the center.
    (8) “Joint Commission” means the voluntary national healthcare accreditation service recognized for:
    (a) Medicare certification purposes by Public Law 89-97; and
    (b) Maryland State licensure purposes by Health-General Article, §19-2302, Annotated Code of Maryland.
    [D.] (9) (text unchanged)
    (10) “Person” means an individual, receiver, trustee, guardian, personal representative, fiduciary, or representative of any kind and any partnership, firm, association, corporation, or other entity.
    [E.] (11) 'Resident' means any child or adolescent domiciled in a center for the purpose of receiving the services offered [above] by a residential treatment center.
    (12) “Residential treatment center” means a psychiatric institution that provides campus-based intensive and extensive evaluation and treatment of children and adolescents with severe and chronic emotional disturbances who require a self-contained therapeutic, educational, and recreational program in a residential setting.
    [F.] (13) “Secretary' means the Secretary of Health and Mental Hygiene [except in those circumstances where otherwise qualified].
    [.02] .03 License Requirements.
    A. License Required. A person[, group of persons, or association] may not establish, conduct, maintain, or operate in the State a center without first obtaining a license from the Secretary.
    B. (text unchanged)
    C. License Not Required Under [These Regulations] This Chapter. The following facilities are not deemed to be within the purview of these licensing requirements and are not required to obtain a license under these provisions:
    (1) Any institution for well children, including day nurseries, child care centers, foster boarding homes, and institutions for intellectually disabled children; and
    (2) (text unchanged)
    D.—F. (text unchanged)
    [.03] .04 Licensing Procedure.
    A. Application. Applicants shall conform to the following:
    (1) An applicant desiring to open or to continue the operation of an existing center shall file with the Secretary, on a written or electronic form provided by the Secretary[, a notarized application]:
    (a) [Setting forth the] The name of the applicant desiring the license; and
    [(b) Stating that the applicant is not less than 21 years old and of reputable and responsible character;]
    [(c)] (b) [Indicating the] The location of the center, the name of the person in charge, and any additional documents and information that the Secretary may require.
    (2) (text unchanged)
    (3) All licenses shall expire [1 year] 3 years from the date of issuance unless revoked.
    (4)—(5) (text unchanged)
    (6) License renewal shall be based on accreditation by the Joint Commission.
    (7) The center shall be required to submit evidence of current accreditation that shall include:
    (a) A copy of the current accreditation letter issued to the center;
    (b) A copy of the standards determined not to be in compliance, or with recommendations for improvement issued to the center; and
    (c) The evidence of the action taken to correct noncompliance which was submitted to the accreditation organization.
    B.—F. (text unchanged)
    .05 Denial or Revocation of License.
    A. The Secretary shall deny a license to a person who has been convicted of a felony that relates to Medicaid or to a nursing home.
    B. The Secretary shall revoke the license of any licensee convicted of a felony that relates to Medicaid or to a nursing home.
    C. The Secretary may deny or revoke a license if the center does not meet the requirements of:
    (1) Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland; and
    (2) Any regulation adopted under Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland, including this chapter.
    D. A center subject to denial or revocation of license under this chapter, may request a hearing as set forth in accordance with Regulation .20 of this chapter.
    .06 Inspection.
    Open to Inspection. A center licensed under this chapter and any premises proposed to be operated by an applicant for a license shall be open at all reasonable times to inspection by:
    A. The Secretary or designee;
    B. The Department of Human Resources;
    C. The Maryland State Department of Education;
    D. The Department of Juvenile Services; or
    E. Any other agency authorized by the Secretary.
    .08 Physical Plant.
    A. Construction. [Any] A new building designated as a residential treatment center and any existing building proposed for conversion for this use shall meet the following:
    [(1) Be a completely detached structure, no part of which is used for any other purpose, of fire resistive construction, or, if non-fire resistive, with an approved sprinkler system;]
    [(2)] (1) (text unchanged)
    [(3)] (2) [It] The center shall comply with all other applicable governing laws or ordinances; and
    (3) The center shall be constructed to comply with the requirements of the Americans with Disabilities Act.
    B. Heating. [Centers] A center shall be equipped with a central heating system capable of maintaining a minimum temperature of [75°F] 68°F throughout the residential section of the building when the temperature falls to 0°F or below. Alternate modern types of heating systems may be accepted if approved by the fire authorities. Space heaters and portable heaters are not acceptable.
    C. Lighting.
    (1) Lighting shall be adequate for the activities conducted in the various areas.
    (2) Bedrooms and dormitories shall be lighted by outside windows and shall also have artificial light adequate for reading and other uses.
    (3) All entrances, hallways, stairways, inclines, ramps, cellars, attics, storerooms, kitchens, laundries, and service units shall have sufficient artificial lighting to prevent accidents and promote efficiency of service.
    [(2) A minimum lighting level of 20 foot candles is required for the safe lighting of stairways.]
    D. Bathrooms. [Centers] A center shall [be provided with] provide the following minimum bathroom facilities:
    (1) One [lavatory and one water closet] hand sink and one toilet for each six residents of the same sex on each floor[.];
    (2) One [bathroom] bathtub or shower for each 12 beds on each floor[.];
    (3) The number of beds for which the center is licensed shall be used in determining the number of bathroom fixtures required even if some of the beds are not occupied[.];
    (4) There shall be one complete bathroom on each floor used by the residents, regardless of the number of beds[.];
    (5) All bath and toilet rooms shall be easily accessible, conveniently located and well lighted with a night light burning all night[. They shall be ventilated to the atmosphere mechanically.] and have mechanical exhaust ventilation;
    (6) A lavatory or toilet facility may not [open]:
    (a) Open directly into a kitchen, pantry or food preparation room[. It may not be]; or
    (b) Be located so that a resident [must] is required to pass through another resident's room to enter it[.]; and
    (7) Bathrooms shall be constructed using anti-ligature fixtures and designed for the safety of the residents.
    E. (text unchanged)
    F. Water Supply.
    (1) (text unchanged)
    (2) Adequacy. The supply shall be adequate in quantity and delivered under sufficient pressure to satisfactorily serve fixtures in the [home] center.
    (3) Temperature. The hot water heating equipment shall be of sufficient capacity to supply an adequate amount of water not in excess of 125°F for [domestic use, and at 180°F for kitchen and laundry use] bathing and showering. The center shall install mixing valves or other anti-scalding devices.
    (4) Hot water for kitchen and laundry use shall be at least 160°F.
    G. Seclusion and Restraint.
    (1) Seclusion and restraint rooms shall be constructed and maintained free of hazards to ensure the safety of the residents.
    (2) The rooms shall allow for the unobstructed view of the resident.
    (3) The rooms shall be equipped with adequate lighting for the staff to view the resident.
    (4) Locking mechanisms on doors shall allow for prompt access in the event of an emergency.
    (5) The rooms shall be adequate in size for staff to safely restrain residents or provide emergency care and treatment.
    .09 Fire Regulations.
    [A. Fire Prevention Code. Centers] A center shall be free from fire hazards and shall comply with all applicable local fire and building codes and the [State Fire Prevention Code which requires adherence to the National Fire Protection Association (NFPA) Standard No. 101, 'Building and Exits Code.'] safety requirements of the National Fire Protection Association, NFPA 101 'Life Safety Code', which is incorporated by reference at COMAR 29.06.01.06.
    [Agency note: This regulation provides general minimal requirements and does not encompass detailed specifications for all categories of construction. The licensee shall be required to meet additional standards as directed by fire authorities in order to achieve full compliance with the State Fire Prevention Code.
    B. Sprinkler Requirements.
    (1) Centers licensed for four or more residents shall be provided with, or exempted from the need for approved sprinkler systems as follows:
    (a) Buildings of non-fire resistive construction of more than one story above ground shall be provided with an approved sprinkler system.
    (b) One story structures of non-fire resistive construction of 1 hour or higher rating are exempt from the sprinkler requirement unless specifically required by fire authorities.
    (c) Fire resistive structures, regardless of number of stories, are not required to be equipped with a full sprinkler protection except in areas designated as hazardous by fire authorities.
    (2) Compliance. Centers opened on or after the effective date of these regulations, shall meet the requirements of §B(1), of this regulation, before a license can be issued. Centers in existence before April 17, 1967, shall meet these requirements as follows:
    (a) Centers with four to nine beds shall comply not later than August 1, 1970;
    (b) Centers with 10 to 14 beds shall comply not later than August 1, 1969;
    (c) Centers with 15 or more beds shall comply not later than August 1, 1968.]
    .10 General Requirements.
    A. Cleanliness and Maintenance. The following shall be observed:
    (1) (text unchanged)
    (2) All walls, floors, ceilings, windows, and fixtures shall be kept clean. Interior walls and floors shall [be of a character which permits frequent cleansing] be easily cleanable.
    (3) (text unchanged)
    [(4) The center shall be kept free of unnecessary accumulations of personal possessions, boxes, trunks, suitcases, papers, unused furniture, bed clothing, linens, bric-a-brac, and other extraneous materials.]
    [(5)] (4)[(6)] (5) (text unchanged)
    [(7)] (6) Bathtubs and [lavatories] hand sinks may not be used for laundering or storing soiled linens.
    [(8)] (7) (text unchanged)
    [B. Social Services. All social services shall comply with the requirements of the Department of Human Resources and the Department of Health and Mental Hygiene.]
    B. The center shall provide adequate furnishings and equipment to meet the needs of the residents, including but not limited to:
    (1) Beds and mattresses in good repair;
    (2) A storage area for each resident within their room;
    (3) A desk and chair for each resident room; and
    (4) Adequate furnishings in dayrooms and lounge areas to allow for recreational and relaxation purposes.
    .12 Management Requirements.
    A. (text unchanged)
    B. Responsible Person. The licensee or administrator appointed by the licensee and all persons in supervisory or other responsible positions shall be 21 years old or older. The [administrator may not leave the premises day or night without delegating responsibility to a competent employee 21 years old or older.] licensee shall ensure 24-hour coverage by an administrator or designee.
    [C. Character. The licensee and administrator shall be of good moral character, in good physical and mental health, and should have a genuine interest in the welfare of residents.]
    [D.] C. Qualifications of Administrator.
    (1) The administrator of the center shall be a psychiatrist, psychologist, social worker, [graduate] registered nurse, or any other person trained in the behavioral sciences or in administration.
    (2) The administrator shall be capable by experience and training of directing and supervising persons working in the center.
    [The administrator shall have an understanding of children and their needs and the principles of good child care today. He shall supervise and integrate the work so that children benefit from their living experience, and he shall be alert to changes which will better meet the needs of children.]
    [E.] D. Financial Responsibility. The licensee shall [give] provide to the Secretary assurance of financial responsibility to meet the minimum needs for services offered, safety, maintenance, food, and comfort of the residents of the center.
    [F.] E. Compliance with Regulations.
    (1) The licensee shall charge the administrator to be familiar with [these regulations] this chapter.
    (2) The licensee or administrator shall also familiarize employees with those standards related to their work.
    (3) The center’s governing body shall be responsible for the center’s compliance with all applicable federal and State regulations.
    [G.] F. Availability of Information. The licensee or administrator shall make available to the Secretary such information as may be requested to [insure] ensure that the institution is meeting requirements of [these regulations] this chapter.
    .13 Health Services.
    A. Supervision of Treatment Program. Treatment at any center shall be under the direction of a qualified psychiatrist[, not necessarily certified by the Secretary,] who is responsible for the adequacy, quality, and appropriateness of the treatment program for each resident. There shall be sufficient professional personnel to [insure] ensure the implementation of the treatment program for each resident.
    B. Medical Supervision. [All residents] A resident shall be under the medical care of a physician licensed in the State. Each resident shall have a complete physical examination [on or immediately before admission] done within 30 days before admission, and updated within 72 hours after admission, and at appropriate, regularly scheduled intervals thereafter.
    C. Principal Physician. [Centers] The center shall arrange for a physician to serve as principal physician and a qualified relief to cover periods when [his] their services are not available. [He] The medical director or assigned on call physician shall respond at times of emergency and be available as needed to advise the administrator and nursing staff on medical questions.
    D. Restrictions on Medication. Medication may not be given without the written order of a physician, nurse practitioner, or physician assistant except in an emergency when medication or treatment may be given on the verbal or telephone order of the [physician] prescriber. These orders shall be entered on the doctor's order sheet and shall be confirmed [in writing] by the [physician] prescriber at [his] the next visit.
    E. [Drug] Medication Handling. The center shall comply with all applicable Federal, State, and local laws and ordinances, standards, and codes regulating the purchasing, handling, storage, administration, and recording of [drugs shall be compiled with] medications, including controlled substances.
    .14 [Additional Staff] Staffing Requirements.
    [The following staffing requirements shall be met by the institution:]
    A. The administrator shall employ sufficient and [satisfactory] qualified personnel to [insure] ensure adequate treatment and care of the residents and the maintenance, cleaning, and housekeeping.
    [B. Staff directly responsible for children are fitted for this by an understanding for children, by health, maturity, strength, and by willingness and ability to learn how best to help children.]
    [C.] B. The staff shall be sufficient in number so that the individual needs of residents are met [in the group and the general operation of the institution is carried on without having to depend upon other residents to carry the basic maintenance].
    [D.] C. (text unchanged)
    [E. Work schedules shall be so arranged that one or more competent, trained individuals is present at all hours to render assistance in emergencies.
    F. A written application shall be on file for each employee. The application shall contain the age, birth-date, social security number, home address, and educational background and past employment of the employee. The job classification of the employee shall be noted on the application. The registration or license number of all professional personnel shall be recorded on the application.
    G. The administrator shall have on file for each staff member at the center, a report of a pre-employment medical examination. The report shall include the physician's statement that the individual is physically able to perform the duties for which he is employed and is free from tuberculosis.
    Agency note: An annual medical examination thereafter is recommended.
    H. Each staff member shall have an examination for tuberculosis annually. This examination may be either a chest x-ray or an intra-dermal tuberculin test (Mantoux test). For all positive reactors to the intra-dermal tuberculin test, a chest x-ray shall be made promptly and thereafter annually. The report on each examination shall be filed promptly with the local health officer by the administrator of the center.]
    D. Clinical staff shall, at a minimum, have current training in:
    (1) CPR;
    (2) The Heimlich maneuver; and
    (3) First aid.
    E. The center shall ensure that one or more competent trained individuals are present 24 hours a day with the required skills to address medical and behavioral emergencies.
    F. The center shall maintain personnel records on each employee, including:
    (1) The initial application;
    (2) Current professional license and certification;
    (3) Criminal background checks; and
    (4) Performance appraisals and annual competency evaluations.
    G. Each staff member shall have a pre-employment examination for tuberculosis and additional testing when known TB exposure occurs.
    [I.] H. There shall be personnel policies which define staff jobs, qualifications, [salaries,] hours, vacation, sick leave, and retirement.
    .15 Accommodations.
    A. Usable Living Space Needed.
    (1) Each center shall provide at least 35 square feet of usable floor space per resident, in addition to bedroom space, in order to meet minimal requirements for dining, living, and recreational facilities.
    (2) A minimum of 80 square feet is required for single occupancy bedrooms, and 60 square feet per bed for multiple occupancy bedrooms.
    (3) Usable space excludes service areas, entrance ways, door swing areas, closets, dormers, and other breaks in floor areas.
    [B. The usable floor area for rooms having sloping walls shall be calculated for bed occupancy only for that area having a ceiling height of 8 feet and 50 percent of the area having a ceiling height between 4 feet and 7 feet 6 inches, provided at least 50 percent of the total area has a ceiling height of 8 feet.]
    [C.] B. (text unchanged)
    [D.] C. Areas Devoted to Educational Programs. Provision of space for classrooms and other educational activities shall be made in accordance with the needs of the center as approved by the Department of Education [(See Regulation .02E(3), of this chapter)].
    .16 Restraints and Seclusion.
    The use of restraints and seclusion shall be in compliance with 42 CFR §§483.352—483.376 Condition of Participation for the Use of Seclusion and Restraint in Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services For Individuals Under Age 21.
    .17 Complaint Investigations.
    A. Notwithstanding any other provision of this chapter, residential treatment centers shall be open to inspections by the Department to investigate and resolve any complaint concerning:
    (1) Resident care;
    (2) Safety;
    (3) Medical and nursing supervision;
    (4) Physical environment;
    (5) Sanitation; or
    (6) Dietary matters.
    B. Complaints.
    (1) To expeditiously resolve a complaint that alleges the existence of any non-life-threatening deficiency, the Department may refer the complaint directly to the residential treatment center.
    (2) If appropriate, issues relating to the practice of medicine or the licensure or conduct of a health professional may be referred to the residential treatment center and to the appropriate health occupation licensing board for resolution.
    (3) If the Department determines that the center has not satisfactorily addressed the referred complaint or if the complaint alleges the existence of a potentially serious or life-threatening deficiency, the Department shall conduct an independent investigation.
    (4) When conducting its independent investigation of an accredited residential treatment center, the Department shall use the standards of the Joint Commission and this chapter.
    .18 Reports.
    A. The center shall furnish to the Secretary reports covering the following:
    (1) Deaths, serious injuries, or unusual incidents, including suicide attempts, by no later than the close of business of the next business day following the event; and
    (2) Any occurrences which threaten the welfare, safety, or health of any resident of the center such as fire, infectious disease outbreaks, or poisoning.
    B. The center shall comply with the reporting requirements of the Department of Juvenile Services, the Department of Human Resources, the Maryland State Department of Education, or other placement agencies.
    C. The center shall comply with the reporting requirements of 42 CFR §483.374(b) and (c).
    D. Serious Occurrence Notification.
    (1) Staff shall report any serious occurrence described in 42 CFR §483.374(b) involving a resident to both the State Medicaid agency and the State-designated Protection and Advocacy System by not later than close of business the next business day after a serious occurrence.
    (2) The report shall include:
    (a) The name of the resident involved in the serious occurrence; and
    (b) A description of the occurrence.
    (3) In the case of a minor, the center shall notify the resident’s parent or parents or legal guardian or legal guardians:
    (a) As soon as possible; or
    (b) No later than 24 hours after the serious occurrence.
    (4) Staff shall document in the resident’s record that the serious occurrence was reported to both the State Medicaid agency and the State-designated Protection and Advocacy System, including the name of the individual to whom the incident was reported.
    (5) A copy of the report shall be maintained in the resident’s record, as well as in the incident and accident report logs kept by the center.
    .19 Civil Money Penalties.
    A. Civil Money Penalties. The Secretary may impose a civil money penalty on a person if:
    (1) The person maintains or operates an unlicensed center; or
    (2) A serious or life-threatening patient care deficiency exists and the center fails to correct the deficiency through immediate corrective action.
    B. In determining whether a civil money penalty is to be imposed, the Secretary shall consider the following factors:
    (1) Number, nature, and seriousness of the patient care deficiencies;
    (2) The extent to which the patient care deficiency or deficiencies are part of an ongoing pattern during the preceding 24 months;
    (3) The degree of risk to the health, life, or safety of the residents of the center that is caused by the patient care deficiency or deficiencies;
    (4) The efforts made by, and the ability of the center to correct, the patient care deficiency or deficiencies through implementation of immediate corrective action; and
    (5) The center’s prior history of compliance.
    C. If the Department determines that a person has been operating an unlicensed center, the Department may impose a civil money penalty not to exceed $10,000.
    D. If the Department determines that a serious or life-threatening deficiency or an ongoing pattern of deficiencies exists, the Department shall notify the center of the deficiency or deficiencies and may:
    (1) Impose a per-day civil money penalty not to exceed $10,000 until sustained compliance has been achieved;
    (2) Permit the center the opportunity to correct the deficiencies by a specific date; or
    (3) Impose a per-instance civil money penalty not to exceed $10,000 for each instance of violation.
    E. If the Department permits a center the opportunity to correct the deficiencies by a specific date, and the center fails to comply with this requirement, the Department may impose a per-day civil money penalty for each day of violation until correction of the deficiency or deficiencies has been verified and sustained compliance has been maintained.
    F. If the Department proposes to impose a civil money penalty, the Secretary shall issue an order which shall state the:
    (1) Deficiency or deficiencies on which the order is based;
    (2) Amount of civil money penalties to be imposed; and
    (3) Manner in which the amount of civil money penalties imposed was calculated.
    G. A center subject to a civil money penalty under this regulation may request a hearing as set forth in accordance with Regulation .20 of this chapter.
    .20 Hearings.
    A. A request for a hearing shall be filed with the Office of Administrative Hearings, with a copy to the Office of Health Care Quality of the Department, not later than 30 days after receipt of notice of the Secretary's action. This request shall include a copy of the Secretary's action.
    B. A hearing requested under this chapter shall be conducted in accordance with:
    (1) State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland;
    (2) COMAR 28.02.01; and
    (3) COMAR 10.01.03.
    C. The burden of proof is as provided in COMAR 10.01.03.16.
    D. Unless otherwise stated in this chapter, the Office of Administrative Hearings shall issue a proposed decision within the time frames set forth in COMAR 28.02.01.
    E. The aggrieved person may file exceptions as provided in COMAR 10.01.03.18
    F. A final decision by the Secretary shall be issued in accordance with COMAR 10.01.03.20.
    .21 Notifications.
    A. Within 24 hours of an event or change in condition and in accordance with State and federal confidentiality laws, a center shall attempt to notify a resident and a resident’s representative, family member, legal guardian, or custodian of:
    (1) A change in the resident’s condition;
    (2) An adverse event that affected the resident; and
    (3) If appropriate, the corrective action taken.
    B. The notification may be waived by the individual identified under Regulation .19A of this chapter if the individual sends a written response instructing the center that the individual:
    (1) Waives the required notifications; or
    (2) Requests that the notification be provided only under the circumstances identified in the written response.
    C. All written responses waiving some or all notifications shall be maintained in the resident’s medical record.
    D. The center shall document in the medical records that the required notification were completed. The documentation shall include:
    (1) The nature of the event or change in condition;
    (2) The names of the individuals who received notification;
    (3) The dates and times of the notifications; and
    (4) The name of the staff who made the notifications.
    E. If a center has made reasonable attempts to notify the required individuals and has been unable to make contact, the failure to reach the individuals shall be documented in the medical records.
    F. If the Department determines that the center has failed to provide the required notification, the Department shall require the center as part of its plan of correction to provide notification as soon as possible.
    .22 Resident Rights.
    A. The center shall post the list of resident rights in areas of the center where the residents can read the posting. A resident of a residential treatment center has the right to:
    (1) Be treated with respect;
    (2) Have their cultural spiritual, personal beliefs, values, and preferences respected;
    (3) Personal privacy;
    (4) Practice their religious beliefs;
    (5) Receive information about care and treatment in a manner that he or she understands;
    (6) Be free from neglect, exploitation, and verbal, sexual, physical, and mental abuse;
    (7) Access protection and advocacy services;
    (8) Receive care in a safe setting;
    (9) File a complaint and have it investigated without fear of retribution;
    (10) Have visitors in accordance with the center’s visitation policy;
    (11) Send and receive mail;
    (12) Consult with their attorney, advocate, or social worker in private; and
    (13) Make and receive telephone calls in accordance with the center’s policy.
    B. The resident’s parents or guardians or, if the resident is age 18 or older, the resident shall have the right to:
    (1) Be involved in the treatment planning process;
    (2) Consent to treatment and medication;
    (3) Be informed of changes in the treatment plan and medication regimen;
    (4) Withhold consent for treatment; and
    (5) Have complaints investigated in a timely manner.
    C. A resident’s rights shall only be restricted if the provision of that right poses a threat to the therapeutic needs of the resident or places the resident’s or other residents’ safety and security at risk.
    D. Restrictions on a resident’s rights shall be documented in the treatment plan and reviewed and approved by the treatment team.
    E. Restrictions on a resident’s rights shall be removed as soon as possible when the restriction is not therapeutically indicated.
    VAN T. MITCHELL
    Secretary of Health and Mental Hygiene