Friday, September 19, 2014

8 Regulations for SUD Treatment & 30 for Mental Health Treatment! What Happened to Behavioral Health Integration?

Currently, the Department of Health and Mental Hygiene (DHMH) is figuring out how to integrate the Mental Hygiene Administration (MHA) and the Alcohol and Drug Abuse Administration (ADAA). Part of this process is to integrate the two different sets of regulations, which provide a framework for determining what services are delivered, who is able to deliver them, and how the services are delivered. 

Currently, there are eight regulations for the delivery of substance abuse treatment services compared to thirty for the delivery of mental health treatment services (see attached). If Substance Use Disorder (SUD) is now recognized as the neurologically-based mental health disorder that science has proven it to be, then individuals struggling with SUD should get the same protections and receive the same quality of care that Maryland currently affords to individuals struggling with all other mental health disorders. Unfortunately, this is currently not the case.

Marylanders have been waiting for true integration, and hence –comparable and equitable regulations, for years. Now that DHMH is reviewing and changing these regulations, consumers of SUD services and their families must make it clear to DHMH, that delivering anything less than exactly what consumers of mental health services already have, will not be acceptable. It is time for SUD patients to receive their fair share of protections and standards.


We need regulations that ensure the following:

  • Hearing impaired or deaf clients must receive appropriate accommodations, specifically services in sign language;
  • All programs, providing all levels of treatment, must have a community advisory committee “to assure community and consumer participation in the establishment of policies and procedures”;
  • Regulations for “group homes” must not exclude SUD;
  • Community-based service providers, family members, and others must be able to participate and be involved in aftercare planning, and treatment providers must be required to distribute an aftercare plan to them;
  • Treatment providers must make it a high priority to obtain consent to involve the patient’s family members whenever possible;
  • Providers must provide discharge or release notification to “the individual’s next-of-kin”;
  • Regional Institutes for Children and Adolescents (RICAs), must not exclude SUD, or a comparable program must be established for kids with SUD;
  • Therapeutic group homes for children under 18, must not exclude SUD, or a comparable program must be established for kids with SUD;
  • Educational services must be provided for kids with SUD until age 21;
  • Treatment providers must adopt a patient “Bill of Rights”, and ensure that it is readily available;
  • Inpatient facilities must allow visitation equal to one hour / day for each day of the week a patient spends in treatment;
  • Medicaid demonstration waivers must be available to pay for SUD services including: caregiver peer-to-peer support; crisis and stabilization; expressive and experiential behavioral services; family and youth training; youth peer-to-peer support; etc.
  • “family support organizations” must be able to provide waiver services, including: caregiver peer-to-peer support, youth peer-to-peer support, or family and youth training at residential SUD treatment facilities;
  • Family support organizations must be able to receive training and certification from DHMH to provide waiver services;
  • Expressive and experiential behavioral services must be available to SUD residential facilities, including: art, dance, equine therapy, horticulture, music, and drama;
  • Care aides providing crisis services must have a bachelor’s degree;
  • A “resident grievance system”, which includes four distinct stages for escalation, must include opportunities for: consultation with a legal assistance provider, outside mediation, written response from the facility Director, time parameters for responses, Central Review Committee Oversight under DHMH, and must be readily available at all SUD treatment facilities;
  • Regulations for “emergency petition” for assessing an individual with a mental health disorder who is a harm to self or others, must not exclude SUD;
  • Treatment and recovery programs must collaborate with county Core Service Agencies;
  • Consistent regulations for resolving conflicts between programs and individuals served by the program must be established and enforced;
  • Program directors must be “culturally sensitive” and ensure that written material designed for patients, is at a “suitable reading comprehension level”,
  • A patient must have the right to appeal their discharge from services prior to being discharged;
  • Notice of discharge must be provided to the patient within a specified number of days prior to discontinuation of services, “except in the case of imminent danger”;
  • Treatment providers must link SUD patients to services to resolve housing, employment, education, social, and legal issues;
  • Regulations must be established regarding supported housing services to ensure that houses are clean, managers have contacts for the individual’s next-of-kin, and there is an emergency evacuation procedure. Individuals residing in supportive housing must have access to food, an adequate supply of hygiene products (soap, towels, toilet tissue), access to a phone, a clean mattress and pillow, and other basic necessities.;
  • Regulations for respite care must not exclude SUD;
  • SUD clients must have access to vocational programs;
  • SUD clients must have access to telemental health services;


Current Regulations for Substance Use Disorder under ADAA and for All Other Mental Health Disorders under MHA


Subtitle 47 ALCOHOL AND DRUG ABUSE ADMINISTRATION
10.47.01 Requirements
10.47.02 Specific Program Requirements
10.47.03 Specific Program Requirements for Correctional Levels of Care
10.47.04 Certification Requirements
10.47.05 Education Programs
10.47.06 Substance Abuse Treatment Outcomes Partnerships (S.T.O.P.) Fund
10.47.07 Prescription Drug Monitoring Program
10.47.08 Overdose Response Program


Subtitle 21 MENTAL HYGIENE REGULATIONS

10.21.01 Involuntary Admission to Inpatient Mental Health Facilities
10.21.02 Psychiatric Day Treatment Services
10.21.03 Requirements for Individual Treatment Plans
10.21.04 Community Mental Health Programs—Group Homes for Adults with Mental Illness
10.21.05 Aftercare Plans
10.21.06 Admission to Regional Institutes for Children and Adolescents
10.21.07 Therapeutic Group Homes
10.21.08 Services for Mentally Ill Hearing Impaired Patients in Facilities
10.21.09 Patients' Rights to Visitors
10.21.10 Psychiatric Residential Treatment Facility (PRTF) Demonstration Waiver Providers
10.21.11 Purchase of Residential Therapeutic Care for Children
10.21.12 Use of Quiet Room and Use of Restraint
10.21.13 Use of Quiet Room and Use of Seclusion
10.21.14 Resident Grievance System
10.21.15 Petition for Emergency Evaluation—Payment for Services
10.21.16 Community Mental Health Programs—Application, Approval, and Disciplinary Processes
10.21.17 Community Mental Health Programs—Definitions and Administrative Requirements
10.21.18 Community Mental Health Programs—Therapeutic Nursery Programs
10.21.19 Community Mental Health Programs—Mobile Treatment Services
10.21.20 Community Mental Health Programs—Outpatient Mental Health Centers
10.21.21 Community Mental Health Programs—Psychiatric Rehabilitation Programs for Adults
10.21.22 Community Mental Health Programs—Residential Rehabilitation Programs
10.21.23 Community-Based Fund
10.21.24 Interagency Discharge Planning for Hospitalized Children and Adolescents
10.21.25 Fee Schedule—Mental Health Services—Community-Based Programs and Individual Practitioners
10.21.26 Community Mental Health Programs—Residential Crisis Services
10.21.27 Community Mental Health Programs—Respite Care Services
10.21.28 Community Mental Health Programs—Mental Health Vocational Programs (MHVP)
10.21.29 Community Mental Health Programs—Psychiatric Rehabilitation Services for Minors
10.21.30 Telemental Health Services

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