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DHMH : request for informal comment

DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Request for Informal Comment on Regulations for Summer Youth Camps
 
The Department of Health and Mental Hygiene (DHMH) is requesting informal comments from the public on proposed changes to regulations for summer youth camps.  The Maryland Youth Camp Act (Health-General Article, §§14 401—14-411, Annotated Code of Maryland) and Code of Maryland Regulations (COMAR) 10.16.06 establish the regulatory framework for summer youth camps.  The Department is proposing to look at the following questions:
 
  1. Should there be a change in the frequency of inspections for camps, based on their health and safety experience, inspection history, and risk?
  2. Should camps that have affiliations with national accrediting organizations be exempted from certain requirements of the Youth Camp Act and associated regulations? 
  3. Should camps of a certain size be required to have health professionals on staff?
  4. Should there be changes in medication administration rules for certain types of medications?
  5. Should there be new requirements for youth camps in the response to and reporting of certain illnesses and injuries, including concussions? 
  6. Should camps be allowed to use electronic medical records?
  7. Should immunization history requirements be the same for residential as for day camps?
     
 
Background
 
There are more than 700 youth camps that are certified and inspected annually by the Department of Health and Mental Hygiene.  There are a comparable number of camps that are either self-regulated because they are operated by government agencies, or accredited by alternative accrediting organizations such as the American Camping Association or the Boy Scouts of America.
 
The Certification for Youth Camps regulations, COMAR 10.16.06, address health and safety considerations, inspection frequency, criminal background checks for camp personnel, alternative accreditation, medication administration, and other topics related to protecting the health and safety of children at Maryland camps.  The regulations have not been significantly updated since 1992 (except for application fees, which were updated in 2011).  The Department feels that after 20 years it is appropriate to re-examine some of the most important provisions of the regulations.  Specifically, the Department seeks comments on the following: 
 
Frequency of Inspections

COMAR 10.16.06.12 and 10.16.06.09 contain the framework for the Department to inspect youth camps on an annual basis when they apply for a certificate.  Currently, the Department inspects each camp (other than self-regulated camps, or camps that are alternatively accredited) every year.  The Department seeks public input on alternatives to this framework.  Specifically, the Department is considering a change in the regulation that would establish criteria for a camp to self-inspect or self-assess as part of an annual certification process.  This process, which would be phased in over several years, would allow camps that meet the criteria for self-inspection or self-assessment to be inspected every four years by the Department. The other three years, camps would complete a self-assessment form, developed by the Department. 
 
In addition, the Department is considering a change in the application fee schedule for camps that could meet the criteria for self-assessment that averages the current fees for the inspection year (year in which inspection takes place) over all of the years (including years in which there is no inspection).  Thus, if the camp qualified for self-assessment, the camp would pay one-fourth of the current application fee each year, whether the camp was completing a self-assessment or being inspected.
 
The Department also requests comments on the following related issues: 
 
  1. The contents of a form for self-inspection that would be submitted to DHMH in years in which the camp self-inspects.
  2. The Department believes that new camps would need to establish a history of two years after which they could be eligible for self-inspection, based on their track record and experience. The Department seeks comments on this question. 
  3. The Department seeks comments on criteria for camps to go from self-inspection to a required inspection (for example, if there are violations of the regulations or adverse events at the camp, the types of violations or events that would automatically trigger a return to annual inspections and paying the annual application fee). 
  4. The Department believes that a camp with violations will need to be inspected by the Department annually for a minimum of 2 years, after which the camp might re-apply for self-inspection.  The Department seeks comments on this proposal. 
  5. The Department believes that camps with significant changes in operation, location, ownership, personnel, or activities might require more frequent Departmental inspections, and seeks comments on this issue.
  6. The Department also believes that there should be options for random inspections of camps that are self-assessing or self-inspecting, to assure that the reported self-assessments are accurate.  The Department seeks comments on this as well. 

Health Personnel On Site
 
COMAR 10.16.06.23 requires that: (1) a camp health supervisor is available for consultation at all times when campers are present at a camp; and (2) must be on site at all times when campers are present in a day or residential camp where 50 percent or more of the campers have identified medical problems.  The Department seeks public comment on whether the health supervisor should be on site at all times for camps with more than a certain minimum number of campers (for example, a camp with more than 50 campers at any given time). 
 
The Department is also considering a requirement that all camp directors have specific training in health and medication administration, or that at all times there be on site a staff member with specific training in health and medication administration.  The Department seeks public input on this question, specifically on how it may conflict or be consistent with professional scope of practice requirements, as well as requirements in child care or school settings. 
 
Medication Administration

A number of issues have arisen over the past several years regarding administration of medication at summer youth camps (COMAR 10.16.06.33).  These include the use of emergency medications such as epinephrine for allergic reactions and anaphylaxis, medications for seizures, asthma, and diabetes, the application of topical non-prescription sunblock, and other questions.  The Department seeks public comments on revisions to the current regulation, including whether and how to amend the regulations so that they are more consistent with regulations for schools and child care facilities. 
 
Health Log and Health Records on File

COMAR 10.16.06.24 and 10.16.06.27 require the camp to maintain a camper’s personal health record and record of injuries and illnesses.  The Department requests comments on whether and how to permit the camper’s personal health record or log of injuries and illnesses to be maintained electronically. 
 
Reporting of Illnesses and Injuries
COMAR 10.16.06.25 requires a camp to report certain illnesses and conditions to the Department.  The Department requests comments on whether this requirement should specifically be amended, in addition to COMAR 10.16.06.22 (health treatment), to specifically address certain conditions such as concussions, allergic reactions, or other conditions.
 
Immunization History
The health records (COMAR 10.16.06.27) for day camps and 5-day residential camps require only documentation of enrollment in a Maryland school and the date of last tetanus immunization, while other camps (residential camps longer than 5 days) require an immunization record (COMAR 10.16.06.28).  The Department seeks public comments on whether this distinction is appropriate and should be maintained, or instead altered in some fashion. 

The Secretary requests written comments by Wednesday, October 10, 2012, on these questions.  The Secretary has asked the Youth Camps Safety Advisory Council to review comments and to make recommendations on whether the Department should take any additional action.  The Council was established in Health-General Article, §1-404, Annotated Code of Maryland to advise the Department on regulations pertaining to summer youth camps.  In addition to reviewing written comments, the Council will hold a public meeting to solicit additional public input on the questions above on October 10, 2012, at 7178 Columbia Gateway Drive, Columbia, MD 21046.   The Council will then vote on recommendations to forward to the Secretary of Health and Mental Hygiene
.  
Written comments should be submitted by Wednesday, October 10, 2012, at 5:00 PM. 
 
Comments may be submitted by mail to Michele Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 W. Preston St., Room 512, Baltimore, MD 21201, email to dhmh.regs@maryland.gov, or by fax to 410-767-6483.