Capitol Building

Maryland Register


Issue Date: December 23, 2016

Volume 43 • Issue 26 • Pages 1431-1528

IN THIS ISSUE

Judiciary

Regulatory Review and Evaluation

Regulations

Errata

Special Documents

General Notices

 

Pursuant to State Government Article, §7-206, Annotated Code of Maryland, this issue contains all previously unpublished documents required to be published, and filed on or before December 5, 2016 5 p.m.
 
Pursuant to State Government Article, §7-206, Annotated Code of Maryland, I hereby certify that this issue contains all documents required to be codified as of December 5, 2016.
 
Brian Morris
Administrator, Division of State Documents
Office of the Secretary of State

Seal

Information About the Maryland Register and COMAR

MARYLAND REGISTER

   The Maryland Register is an official State publication published every other week throughout the year. A cumulative index is published quarterly.

   The Maryland Register is the temporary supplement to the Code of Maryland Regulations. Any change to the text of regulations published  in COMAR, whether by adoption, amendment, repeal, or emergency action, must first be published in the Register.

   The following information is also published regularly in the Register:

   • Governor’s Executive Orders

   • Attorney General’s Opinions in full text

   • Open Meetings Compliance Board Opinions in full text

   • State Ethics Commission Opinions in full text

   • Court Rules

   • District Court Administrative Memoranda

   • Courts of Appeal Hearing Calendars

   • Agency Hearing and Meeting Notices

   • Synopses of Bills Introduced and Enacted by the General Assembly

   • Other documents considered to be in the public interest

CITATION TO THE MARYLAND REGISTER

   The Maryland Register is cited by volume, issue, page number, and date. Example:

• 19:8 Md. R. 815—817 (April 17, 1992) refers to Volume 19, Issue 8, pages 815—817 of the Maryland Register issued on April 17, 1992.

CODE OF MARYLAND REGULATIONS (COMAR)

   COMAR is the official compilation of all regulations issued by agencies of the State of Maryland. The Maryland Register is COMAR’s temporary supplement, printing all changes to regulations as soon as they occur. At least once annually, the changes to regulations printed in the Maryland Register are incorporated into COMAR by means of permanent supplements.

CITATION TO COMAR REGULATIONS

   COMAR regulations are cited by title number, subtitle number, chapter number, and regulation number. Example: COMAR 10.08.01.03 refers to Title 10, Subtitle 08, Chapter 01, Regulation 03.

DOCUMENTS INCORPORATED BY REFERENCE

   Incorporation by reference is a legal device by which a document is made part of COMAR simply by referring to it. While the text of an incorporated document does not appear in COMAR, the provisions of the incorporated document are as fully enforceable as any other COMAR regulation. Each regulation that proposes to incorporate a document is identified in the Maryland Register by an Editor’s Note. The Cumulative Table of COMAR Regulations Adopted, Amended or Repealed, found online, also identifies each regulation incorporating a document. Documents incorporated by reference are available for inspection in various depository libraries located throughout the State and at the Division of State Documents. These depositories are listed in the first issue of the Maryland Register published each year. For further information, call 410-974-2486.

HOW TO RESEARCH REGULATIONS

An Administrative History at the end of every COMAR chapter gives information about past changes to regulations. To determine if there have been any subsequent changes, check the ‘‘Cumulative Table of COMAR Regulations Adopted, Amended, or Repealed’’ which is found online at http://www.dsd.state.md.us/PDF/CumulativeTable.pdf. This table lists the regulations in numerical order, by their COMAR number, followed by the citation to the Maryland Register in which the change occurred. The Maryland Register serves as a temporary supplement to COMAR, and the two publications must always be used together. A Research Guide for Maryland Regulations is available. For further information, call 410-260-3876.

SUBSCRIPTION INFORMATION

   For subscription forms for the Maryland Register and COMAR, see the back pages of the Maryland Register. Single issues of the Maryland Register are $15.00 per issue.

CITIZEN PARTICIPATION IN
THE REGULATION-MAKING PROCESS

   Maryland citizens and other interested persons may participate in the process by which administrative regulations are adopted, amended, or repealed, and may also initiate the process by which the validity and applicability of regulations is determined. Listed below are some of the ways in which citizens may participate (references are to State Government Article (SG),

Annotated Code of Maryland):

   • By submitting data or views on proposed regulations either orally or in writing, to the proposing agency (see ‘‘Opportunity for Public Comment’’ at the beginning of all regulations appearing in the Proposed Action on Regulations section of the Maryland Register). (See SG, §10-112)

   • By petitioning an agency to adopt, amend, or repeal regulations. The agency must respond to the petition. (See SG §10-123)

   • By petitioning an agency to issue a declaratory ruling with respect to how any regulation, order, or statute enforced by the agency applies. (SG, Title 10, Subtitle 3)

   • By petitioning the circuit court for a declaratory judgment

on the validity of a regulation when it appears that the regulation interferes with or impairs the legal rights or privileges of the petitioner. (SG, §10-125)

   • By inspecting a certified copy of any document filed with the Division of State Documents for publication in the Maryland Register. (See SG, §7-213)

 

Maryland Register (ISSN 0360-2834). Postmaster: Send address changes and other mail to: Maryland Register, State House, Annapolis, Maryland 21401. Tel. 410-260-3876; Fax 410-280-5647. Published biweekly, with cumulative indexes published quarterly, by the State of Maryland, Division of State Documents, State House, Annapolis, Maryland 21401. The subscription rate for the Maryland Register is $225 per year (first class mail). All subscriptions post-paid to points in the U.S. periodicals postage paid at Annapolis, Maryland and additional mailing offices.

Lawrence J. Hogan, Jr., Governor; John C. Wobensmith, Secretary of State; Brian Morris, Administrator; Gail S. Klakring, Senior Editor; Mary D. MacDonald, Editor, Maryland Register and COMAR; Elizabeth Ramsey, Editor, COMAR Online, and Subscription Manager; Tami Cathell, Help Desk, COMAR and Maryland Register Online.

Front cover: State House, Annapolis, MD, built 1772—79.

Illustrations by Carolyn Anderson, Dept. of General Services

 

     Note: All products purchased are for individual use only. Resale or other compensated transfer of the information in printed or electronic form is a prohibited commercial purpose (see State Government Article, §7-206.2, Annotated Code of Maryland). By purchasing a product, the buyer agrees that the purchase is for individual use only and will not sell or give the product to another individual or entity.

 


Closing Dates for the Maryland Register

Schedule of Closing Dates and Issue Dates for the
Maryland Register ....................................................................  1436

 

COMAR Research Aids

Table of Pending Proposals .........................................................  1437

 

Index of COMAR Titles Affected in This Issue

COMAR Title Number and Name                                                  Page

03        Comptroller of the Treasury .............................................  1443

07        Department of Human Resources ....................................  1452

08        Department of Natural Resources ..........................  1443, 1453

09        Department of Labor, Licensing, and
               Regulation ...........................................................  1443, 1453

10        Department of Health and Mental Hygiene ............  1445, 1454

12        Department of Public Safety and Correctional
               Services
...............................................................  1447, 1500

13A     State Board of Education ........................................  1447, 1502

13B     Maryland Higher Education Commission ........................  1505

15        Department of Agriculture ...............................................  1448

18        Department of Assessments and Taxation .......................  1449

21        State Procurement Regulations .........................................  1449

31        Maryland Insurance Administration .......................  1451, 1508

35        Maryland Department of Veterans Affairs .......................  1515

36        Maryland State Lottery and Gaming Control
               Agency ..........................................................................  1434

 

PERSONS WITH DISABILITIES

Individuals with disabilities who desire assistance in using the publications and services of the Division of State Documents are encouraged to call (410) 974-2486, or (800) 633-9657, or FAX to (410) 974-2546, or through Maryland Relay.

 

The Judiciary

COURT OF APPEALS OF MARYLAND

DISCIPLINARY PROCEEDINGS .  1440

 

Regulatory Review and Evaluation

DEPARTMENT OF TRANSPORTATION

Notice of Opportunity for Comment .....................................  1441

INDEPENDENT AGENCIES

Subtitle 27 MARYLAND ENVIRONMENTAL SERVICE

Notice of Opportunity for Public Inspection and
   Comment  1442

Final Action on Regulations

03  COMPTROLLER OF THE TREASURY

ONLINE FANTASY COMPETITIONS

General Provisions .  1443

08  DEPARTMENT OF NATURAL RESOURCES

WILDLIFE

General Wildlife Hunting Regulations .  1443

Hunting Privilege Suspension and Restitution .  1443

09  DEPARTMENT OF LABOR, LICENSING, AND
   REGULATION

REAL ESTATE COMMISSION

Fees .  1443

DIVISION OF LABOR AND INDUSTRY

Employee Injury and Illness Records and Reports .  1444

Maryland Occupational Safety and Health Act —
   Incorporation by Reference of Federal Standards .  1444

Maryland Occupational Safety and Health Standard for
   Confined Spaces ....................................................................  1444

BOARD OF PLUMBING

State Plumbing Code .  1444

10  DEPARTMENT OF HEALTH AND MENTAL HYGIENE

FOOD

Shellfish Sanitation .  1445

MENTAL HYGIENE REGULATIONS

Involuntary Admission to Inpatient Mental Health
   Facilities .  1445

Fee Schedule — Mental Health Services — Community-
   Based Programs and Individual Practitioners .  1445

DEVELOPMENTAL DISABILITIES

Fee Payment System for Licensed Residential and Day
   Programs .  1445

BOARD OF PHYSICIANS

General Licensure Regulations .  1446

Delegation of Duties by a Licensed Physician ― Physician
   Assistant  1446

Licensure of Polysomnographic Technologists .  1446

Licensure of Athletic Trainers .  1446

Licensure of Radiation Therapists, Radiographers,
   Nuclear Medicine Technologists, and Radiologist
   Assistants .  1446

Licensing of Respiratory Care Practitioners 1446

BOARD OF CHIROPRACTIC EXAMINERS

General Regulations  . 1446

Advertising .  1446

Licensure by Credentials for Chiropractors ..............................  1446

Chiropractic Externship Program ..............................................  1446

Fees ..........................................................................................  1446

Chiropractic Assistants .............................................................  1446

Licensure and Registration Examination — Special Needs
    Applicants   1446

Monetary Penalties .  1446

Continuing Education Requirements .........................................  1446

Licensure Examination ..............................................................  1446

Procedures for Clinical Demonstrations in Public
   Places .....................................................................................  1446

Code of Ethics ..........................................................................  1446

Record Keeping ........................................................................  1446

Sanctioning Guidelines .............................................................  1446

BOARD OF MASSAGE THERAPY EXAMINERS

General Regulations ..................................................................  1446

Rules of Procedure for Board Hearings ....................................  1446

Code of Ethics ..........................................................................  1446

Advertising ...............................................................................  1446

Continuing Education Requirements .  1446

Record Keeping ........................................................................  1446

Fees ..........................................................................................  1446

Licensure and Registration Examination — Special Needs
   Applicants ..............................................................................  1446

Sanctioning Guidelines .............................................................  1446

BOARD OF DENTAL EXAMINERS

Fees ..........................................................................................  1447

12  DEPARTMENT OF PUBLIC SAFETY AND
   CORRECTIONAL SERVICES

COMMISSION ON CORRECTIONAL STANDARDS

Minimum Standards for Adult Detention Centers ....................  1447

Minimum Standards for Adult Correctional
   Institutions .............................................................................  1447

Minimum Standards for Adult Community Correctional
   Facilities .................................................................................  1447

13A STATE BOARD OF EDUCATION

SPECIFIC SUBJECTS

Program of Instruction in Career Development for College
   and Career Readiness .............................................................  1447

SPECIAL INSTRUCTIONAL PROGRAMS

Provision of a Free Appropriate Public Education ....................  1447

Programs of Adult Education ...................................................  1448

Approved Paid Work-Based Learning Programs .....................  1448

Hearing Aid Loan Bank ............................................................  1448

15  DEPARTMENT OF AGRICULTURE

SOIL AND WATER CONSERVATION

Agricultural Operation Nutrient Management Plan
   Requirements .........................................................................  1448

18  DEPARTMENT OF ASSESSMENTS AND TAXATION

BUSINESS ORGANIZATIONS

Prohibited Filings .....................................................................  1449

21  STATE PROCUREMENT REGULATIONS

GENERAL PROVISIONS

Terminology .............................................................................  1449

STATE PROCUREMENT ORGANIZATION

Board of Public Works .  1449

Department of Budget and Management ...................................  1449

SPECIFICATIONS

General Policies ........................................................................  1449

PROCUREMENT METHODS AND PROJECT DELIVERY
   METHODS

General Provisions .  1449

Sole Source Procurement ..........................................................  1449

Mandatory Written Solicitation Requirements ..........................  1449

Procurement of Human, Social, Cultural, and Educational
   Services .  1449

CONTRACT FORMATION AND AWARD

Bid and Contract Security/Bonds ..............................................  1449

Invoicing, Payment, and Interest on Late Payments ..................  1449

CONTRACT TERMS AND CONDITIONS

Contract Provisions — All Contracts (except as provided
   under COMAR 21.05.07, 21.07.02, and 21.07.03)   1449

Mandatory Construction Contract Clauses ...............................  1449

SOCIOECONOMIC POLICIES

Minority Business Enterprise Policies ......................................  1449

Vending Facilities on Property Controlled by Department of
   General Services ....................................................................  1449

Veteran-Owned Small Business Enterprises ............................  1449

PROCUREMENT OF ARCHITECTURAL SERVICES AND
   ENGINEERING SERVICES

Department of General Services; A/E Services Exceeding
   $200,000 ................................................................................  1449

Department of General Services A/E Services $200,000 or
   Less .......................................................................................  1449

General Regulations ..................................................................  1449

STATE PROCUREMENT ORGANIZATION

Department of Budget and Management ...................................  1449

CONTRACT FORMATION AND AWARD

Bid and Contract Security/Bonds ..............................................  1449

36  MARYLAND STATE LOTTERY AND GAMING
   CONTROL AGENCY

GAMING PROVISIONS

Video Lottery Facility Minimum Internal Control
   Standards .  1450

INSTANT BINGO MACHINES IN ANNE ARUNDEL AND
   CALVERT COUNTIES

General  1450

 

Withdrawal of Regulations

31  MARYLAND INSURANCE ADMINISTRATION

UNFAIR TRADE PRACTICES

Solicitation of Annuity and Deposit Fund Contracts ................  1451

Annuity Disclosure ...................................................................  1451

 

Proposed Action on Regulations

07  DEPARTMENT OF HUMAN RESOURCES

SOCIAL SERVICES ADMINISTRATION

Youth Transitional Services ......................................................  1452

08  DEPARTMENT OF NATURAL RESOURCES

FISHERIES SERVICE

Yellow Perch .  1453

09  DEPARTMENT OF LABOR, LICENSING, AND
   REGULATION

DIVISION OF LABOR AND INDUSTRY

Maryland Apprenticeship and Training ....................................  1453

10  DEPARTMENT OF HEALTH AND MENTAL HYGIENE

DIVISION OF REIMBURSEMENTS

Charges for Services Provided Through the Department of
   Health and Mental Hygiene .  1454

MEDICAL CARE PROGRAMS

Physicians’ Services .  1454

Freestanding Clinics .................................................................  1454

Medical Laboratories ................................................................  1454

Podiatry Services ......................................................................  1454

Healthy Start Program ..............................................................  1454

Telehealth Services ...................................................................  1454

EPSDT School Health-Related Services or Health-Related
   Early Intervention Services ....................................................  1454

Maryland Medicaid Managed Care Program: Benefits .............  1454

Free-Standing Independent Diagnostic Testing
   Facilities .................................................................................  1454

Portable X-ray Providers ..........................................................  1454

MATERNAL AND CHILD HEALTH

Children’s Medical Services Program ......................................  1454

CHILD ABUSE AND NEGLECT MEDICAL
   REIMBURSEMENT PROGRAM

Services .  1454

FREESTANDING AMBULATORY CARE FACILITIES

General Requirements ...............................................................  1457

Freestanding Major Medical Equipment Facilities ....................  1458

DISEASES

Communicable Diseases and Related Conditions of Public
   Health Importance ..................................................................  1458

HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION
   AND ACQUIRED IMMUNODEFICIENCY SYNDROME
   (AIDS)

Disease Control  1458

HOSPITALS

Acute General Hospitals and Special Hospitals .  1460

MEDICAL CARE PROGRAMS

Nurse Practitioner Services .......................................................  1462

Advanced Practice Nurse Services ...........................................  1462

Nurse Midwife Services ...........................................................  1462

Nurse Anesthetist Services .  1462

Hospital Services ......................................................................  1464

Acute Hospitals ........................................................................  1464

Chronic Hospitals .....................................................................  1464

Special Pediatric Hospitals ........................................................  1464

Special Psychiatric Hospitals ....................................................  1464

Freestanding Clinics .................................................................  1487

Urgent Care Centers .................................................................  1487

Medical Assistance Eligibility ...................................................  1488

Maryland Medicaid Managed Care Program:
   Definitions .............................................................................  1489

Maryland Medicaid Managed Care Program:
   Benefits ..................................................................................  1489

Maryland Medicaid Managed Care Program: School-Based
   Health Centers .......................................................................  1489

School-Based Health Centers (SBHC) .....................................  1489

BOARD OF MORTICIANS AND FUNERAL DIRECTORS

Requirements for Apprenticeship .............................................  1492

Family Security Trust Fund ......................................................  1494

SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR
   WOMEN, INFANTS, AND CHILDREN (WIC)

Retail Food and Pharmacy Vendors .........................................  1495

12  DEPARTMENT OF PUBLIC SAFETY AND
   CORRECTIONAL SERVICES

POLICE TRAINING AND STANDARDS COMMISSION

General Regulations ..................................................................  1500

13A STATE BOARD OF EDUCATION

SPECIFIC SUBJECTS

Program in Cosmetology ..........................................................  1502

Program for Barbers .  1503

SUPPORTING PROGRAMS

Student Transportation ..............................................................  1503

CERTIFICATION

Administrators and Supervisors ...............................................  1505

13B MARYLAND HIGHER EDUCATION COMMISSION

GENERAL EDUCATION AND TRANSFER

Public Institutions of Higher Education ....................................  1505

31  MARYLAND INSURANCE ADMINISTRATION

INSURANCE PRODUCERS AND OTHER INSURANCE
   PROFESSIONALS

Surplus Lines ............................................................................  1508

LONG-TERM CARE

Long-Term Care Insurance .......................................................  1509

Long-Term Care Insurance—Premium Rates and
   Reserves .  1509

35  MARYLAND DEPARTMENT OF VETERANS AFFAIRS

VETERANS CEMETERIES

Burial in State Veterans’ Cemeteries .........................................  1515

 

Errata

COMAR 10.43 .  1516

COMAR 10.65 .............................................................................  1516

 

Special Documents

DEPARTMENT OF THE ENVIRONMENT

FINAL CALENDAR YEAR 2017 STANDARD PERMIT
   APPLICATION TURNAROUND TIMES .........................  1517

INFORMATIONAL PUBLIC MEETING
   ANNOUNCEMENT

Maryland’s Draft 2016 Integrated Report of Surface Water
   Quality ...............................................................................  1520

SUSQUEHANNA RIVER BASIN COMMISSION

Projects Approved for Consumptive Uses of Water .............  1520

Projects Rescinded for Consumptive Uses of Water ............  1521

WATER MANAGEMENT ADMINISTRATION

Notice of Tentative Determination to Issue a General
   Permit for Discharges from State and Federal Small
   Municipal Separate Storm Sewer Systems — General
   Discharge Permit No. 13-SF-5501, General NPDES No.
   MDR055501 .  1522

Notice of Tentative Determination and Public Hearing —
   General Permit for Discharges from Small Municipal
   Separate Storm Sewer Systems — General Discharge
    Permit No. 13-IM-5500, General NPDES No.
    MDR055500 ....................................................................  1522

DEPARTMENT OF TRANSPORTATION

OFFICE OF MINORITY BUSINESS ENTERPRISE
   (OMBE)

Announcement of Calendar Year 2017 Limitation on the
   Personal Net Worth of a Socially and Economically
   Disadvantaged Individual as it relates to Certification of a
   Minority Business Enterprise (MBE) ................................  1523

 

General Notices

ATHLETIC COMMISSION

Public Meeting .  1524

ADVISORY COUNCIL ON CEMETERY OPERATIONS

Public Meeting ..........................................................................  1524

COMPTROLLER OF THE TREASURY/ADMINISTRATION
   AND FINANCE

Reduction of Bond Authorization Announcement ....................  1524

BOARD OF DIETETIC PRACTICE

Public Meeting ..........................................................................  1524

DEPARTMENT OF THE ENVIRONMENT

Public Meeting ..........................................................................  1524

DEPARTMENT OF HEALTH AND MENTAL
   HYGIENE/OFFICE OF HEALTH SERVICES

Public Notice for Community First Choice Daily Rate
   Initiative — Comment Analysis and Public Notice
   Restatement ............................................................................  1524

Public Notice for Opioid Treatment Program Reimbursement
   Rebundling Initiative—Comment Analysis and Public
   Notice Restatement  1525

Public Notice Waiver for Children with Autism Spectrum
   Disorder Amendment ............................................................  1526

Public Notice for January 1, 2017, Fee Schedule . 1526

MARYLAND INSURANCE ADMINISTRATION

Public Hearing ..........................................................................  1527

MARYLAND HEALTH CARE COMMISSION

Public Meeting .  1527

MINORITY BUSINESS ENTERPRISE ADVISORY
   COMMITTEE

Public Meeting ..........................................................................  1527

Public Meeting ..........................................................................  1527

Public Meeting ..........................................................................  1527

Public Meeting ..........................................................................  1527

Public Meeting ..........................................................................  1527

Public Meeting ..........................................................................  1527

DEPARTMENT OF NATURAL RESOURCES/FISHING AND
   BOATING SERVICES

Public Notice — Commercial Striped Bass Common Pool
   Gill Net Season Modification ................................................  1527

RACING COMMISSION

Public Meeting .  1527

RURAL HEALTHCARE DELIVERY WORKGROUP

Public Meeting .  1527

DEPARTMENT OF VETERANS AFFAIRS/MARYLAND
   VETERANS COMMISSION

Public Meeting .  1528

MARYLAND COLLEGE COLLABORATION FOR
   STUDENT VETERANS COMMISSION

Public Meeting .  1528

BOARD OF WELL DRILLERS

Cancellation of Public Meeting .  1528

DIVISION OF WORKFORCE DEVELOPMENT AND
   ADULT LEARNING/MARYLAND APPRENTICESHIP
   AND TRAINING COUNCIL

Public Meeting .  1528

 

COMAR Online

        The Code of Maryland Regulations is available at www.dsd.state.md.us as a free service of the Office of the Secretary of State, Division of State Documents. The full text of regulations is available and searchable. Note, however, that the printed COMAR continues to be the only official and enforceable version of COMAR.

        The Maryland Register is also available at www.dsd.state.md.us.

        For additional information, visit www.dsd.state.md.us, Division of State Documents, or call us at (410) 974-2486 or 1 (800) 633-9657.

 

Availability of Monthly List of
Maryland Documents

        The Maryland Department of Legislative Services receives copies of all publications issued by State officers and agencies. The Department prepares and distributes, for a fee, a list of these publications under the title ‘‘Maryland Documents’’. This list is published monthly, and contains bibliographic information concerning regular and special reports, bulletins, serials, periodicals, catalogues, and a variety of other State publications. ‘‘Maryland Documents’’ also includes local publications.

        Anyone wishing to receive ‘‘Maryland Documents’’ should write to: Legislative Sales, Maryland Department of Legislative Services, 90 State Circle, Annapolis, MD 21401.

 

CLOSING DATES AND ISSUE DATES through JULY 21, 2017

Issue
Date

Emergency

and Proposed

Regulations

5 p.m.*

Final

Regulations

10:30 a.m.

Notices, etc.

10:30 a.m.

January 6**

December 19

December 28

December 23

January 20**

December 30

January 11

January 9

February 3**

January 13

January 25

January 23

February 17

January 30

February 8

February 6

March 3**

February 13

February 22

February 17

March 17

February 27

March 8

March 6

March 31

March 13

March 22

March 20

April 14

March 27

April 5

April 3

April 28

April 10

April 19

April 17

May 12

April 24

May 3

May 1

May 26

May 8

May 17

May 15

June 9**

May 22

May 31

May 26

June 23

June 5

June 14

June 12

July 7

June 19

June 28

June 26

July 21

July 3

July 12

July 10

 

*   Due date for documents containing 8 to 18 pages — 48 hours before date shown; due date for documents exceeding 18 pages — 1 week before date shown

NOTE:  ALL DOCUMENTS MUST BE SUBMITTED IN TIMES NEW ROMAN, 9-POINT, SINGLE-SPACED FORMAT. THE REVISED PAGE COUNT REFLECTS THIS FORMATTING.

** Note closing date changes

***   Note issue date and closing date changes

The regular closing date for Proposals and Emergencies is Monday.

 

 


RegCodificationSystem

Cumulative Table of COMAR Regulations
Adopted, Amended, or Repealed

   This table, previously printed in the Maryland Register lists the regulations, by COMAR title, that have been adopted, amended, or repealed in the Maryland Register since the regulations were originally published or last supplemented in the Code of Maryland Regulations (COMAR). The table is no longer printed here but may be found on the Division of State Documents website at www.dsd.state.md.us.

Table of Pending Proposals

   The table below lists proposed changes to COMAR regulations. The proposed changes are listed by their COMAR number, followed by a citation to that issue of the Maryland Register in which the proposal appeared. Errata pertaining to proposed regulations are listed, followed by “(err)”. Regulations referencing a document incorporated by reference are followed by “(ibr)”. None of the proposals listed in this table have been adopted. A list of adopted proposals appears in the Cumulative Table of COMAR Regulations Adopted, Amended, or Repealed.

 


02 OFFICE OF THE ATTORNEY GENERAL

 

02.06.03.01—.10 • 42:13 Md. R. 798 (6-26-15)

 

07 DEPARTMENT OF HUMAN RESOURCES

 

07.02.10.01,.02,.04,.09 • 43:26 Md. R. 1452 (12-23-16)

07.02.10.08,.18 • 43:24 Md. R. 1352 (11-28-16)

07.02.11.03,.05,.16 • 43:24 Md. R. 1353 (11-28-16)

07.02.14.01—.14 • 43:2 Md. R. 143 (1-22-16)

07.02.15.01—.11 • 43:17 Md. R. 964 (8-19-16)

07.02.17.03,.04,.06—.08 • 43:17 Md. R. 968 (8-19-16)

07.02.18.02,.04,.06—.14 • 43:17 Md. R. 969 (8-19-16)

07.02.19.01—.08,.10,.12—.14,.16 • 43:17 Md. R. 971 (8-19-16)

 

08 DEPARTMENT OF NATURAL RESOURCES

 

08.02.01.05 • 43:23 Md. R. 1282 (11-14-16)

08.02.01.09 • 43:25 Md. R. 1388 (12-9-16)

08.02.01.13 • 43:16 Md. R. 903 (8-5-16)

08.02.05.22 • 43:23 Md. R. 1283 (11-14-16)

08.02.10.01 • 43:23 Md. R. 1283 (11-14-16)

08.02.11.01,.04 • 43:25 Md. R. 1389 (12-9-16)

08.02.21.03 • 43:26 Md. R. 1453 (12-23-16)

08.03.01.01 • 43:16 Md. R. 904 (8-5-16)

08.04.16.01—.03 • 43:2 Md. R. 162 (1-22-16)

 

09 DEPARTMENT OF LABOR, LICENSING, AND REGULATION

 

09.12.43.02,.05 • 43:26 Md. R. 1452 (12-23-16)

09.35.02.02,.03 • 43:21 Md. R. 1170 (10-14-16)

09.38.01.01 • 43:18 Md. R. 1022 (9-2-16)

 

10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE

 

     Subtitles 01—08 (1st volume)

 

10.02.01.04 • 43:26 Md. R. 1454 (12-23-16)

10.03.01.08 • 43:23 Md. R. 1284 (11-14-16)

10.05.01.08 • 43:26 Md. R. 1457 (12-23-16)

10.05.03.04 • 43:26 Md. R. 1458 (12-23-16)

10.06.01.01,.02,.17,.18 • 43:26 Md. R. 1458 (12-23-16)

10.06.02.02,.04,.13 • 43:25 Md. R. 1392 (12-9-16)

10.07.01.01,.31 • 43:26 Md. R. 1460 (12-23-16)

 

     Subtitle 09 (2nd volume)

 

10.09.01.01—.10 • 43:26 Md. R. 1462 (12-23-16)

10.09.02.07 • 43:26 Md. R. 1454 (12-23-16) (ibr)

10.09.06.01—.18 • 43:26 Md. R. 1464 (12-23-16)

10.09.08.04 • 43:26 Md. R. 1487 (12-23-16)

10.09.08.07,.10 • 43:26 Md. R. 1454 (12-23-16)

10.09.09.07 • 43:26 Md. R. 1454 (12-23-16)

10.09.14.07 • 43:25 Md. R. 1393 (12-9-16)

10.09.15.07 • 43:26 Md. R. 1454 (12-23-16)

10.09.17.06 • 43:25 Md. R. 1393 (12-9-16)

10.09.20.09—.11,.14 • 43:23 Md. R. 1284 (11-14-16)

10.09.21.01—.11 • 43:26 Md. R. 1462 (12-23-16)

10.09.23.01-1,.07 • 43:25 Md. R. 1393 (12-9-16) (ibr)

10.09.23.03 • 43:24 Md. R. 1354 (11-28-16)

10.09.24.08-2 • 43:26 Md. R. 1488 (12-23-16)

10.09.38.06 • 43:26 Md. R. 1454 (12-23-16)

10.09.39.01—.10 • 43:26 Md. R. 1462 (12-23-16)

10.09.49.11 • 43:26 Md. R. 1454 (12-23-16)

10.09.50.07 • 43:26 Md. R. 1454 (12-23-16)

10.09.51.07 • 43:25 Md. R. 1393 (12-9-16)

10.09.54.13—.19,.22 • 43:23 Md. R. 1285 (11-14-16)

10.09.60.01—.08 • 43:24 Md. R. 1355 (11-28-16)

10.09.62.01 • 43:26 Md. R. 1489 (12-23-16)

10.09.65.19 • 43:25 Md. R. 1394 (12-9-16)

10.09.65.19-3 • 43:24 Md. R. 1354 (11-28-16)

10.09.67.01,.07,.12 • 43:24 Md. R. 1354 (11-28-16)

10.09.67.20 • 43:26 Md. R. 1454 (12-23-16)

10.09.67.28 • 43:26 Md. R. 1489 (12-23-16)

10.09.68.01—.03 • 43:26 Md. R. 1489 (12-23-16)

10.09.70.02 • 43:25 Md. R. 1398 (12-9-16)

10.09.76.01—.11 • 43:26 Md. R. 1489 (12-23-16)

10.09.77.04,.06 • 43:26 Md. R. 1487 (12-23-16)

10.09.80.01,.05,.06,.08 • 43:25 Md. R. 1402 (12-9-16)

10.09.84.14—.20,.23,.24 • 43:23 Md. R. 1286 (11-14-16)

10.09.87.07 • 43:26 Md. R. 1454 (12-23-16)

10.09.88.07 • 43:26 Md. R. 1454 (12-23-16)

10.09.92.01—.14 • 43:26 Md. R. 1464 (12-23-16)

10.09.93.01—.16 • 43:26 Md. R. 1464 (12-23-16)

10.09.94.01—.13 • 43:26 Md. R. 1464 (12-23-16)

10.09.95.01—.13 • 43:26 Md. R. 1464 (12-23-16)

 

     Subtitles 10 — 22 (3rd Volume)

 

10.11.03.14 • 43:26 Md. R. 1454 (12-23-16)

10.14.01.01,.02,.02-1,.07 • 43:25 Md. R. 1404 (12-9-16) (ibr)

10.14.06.02—.06 • 43:25 Md. R. 1406 (12-9-16)

10.15.05.01,.01-1,.13,.14,.20-1,.21,.24—
   .26-2
• 43:25 Md. R. 1407 (12-9-16) (ibr)

10.15.06.01-.07,.10,.12—.20 • 43:25 Md. R. 1407 (12-9-16)

10.15.08.02,.03 • 43:25 Md. R. 1407 (12-9-16)

10.16.07.03,.14 • 43:25 Md. R. 1415 (12-9-16)

10.18.04.01—.03 • 43:26 Md. R. 1458 (12-23-16)

10.21.25.03-2,.05—.13 • 43:19 Md. R. 1077 (9-16-16)

10.22.10.05 • 43:23 Md. R. 1287 (11-14-16)

 

     Subtitles 23 — 36 (4th Volume)

 

10.24.15.01 • 43:25 Md. R. 1417 (12-9-16) (ibr)

10.24.19.01 • 43:18 Md. R. 1027 (9-2-16) (ibr)

10.27.01.04—.18 • 43:24 Md. R. 1357 (11-28-16)

10.27.21.02—.05,.07 • 43:25 Md. R. 1418 (12-9-16)

10.29.09.02—.06,.11,.14 • 43:26 Md. R. 1492 (12-23-16)

10.29.15.02—.05,.07,.08 • 43:26 Md. R. 1494 (12-23-16)

10.33.01.14 • 43:25 Md. R. 1419 (12-9-16)

 

     Subtitles 37—65 (5th Volume)

 

10.37.10.03 • 43:20 Md. R. 1115 (9-30-16)

10.37.10.07-2 • 43:22 Md. R. 1244 (10-28-16)

10.38.12.01—.04 • 43:23 Md. R. 1287 (11-14-16)

10.39.01.03—.09 • 43:24 Md. R. 1357 (11-28-16)

10.39.04.04 • 43:24 Md. R. 1357 (11-28-16)

10.41.03.08 • 43:25 Md. R. 1420 (12-9-16)

10.41.08.02 • 43:25 Md. R. 1420 (12-9-16)

10.41.11.02 • 43:25 Md. R. 1420 (12-9-16)

10.48.01.07 • 43:26 Md. R. 1454 (12-23-16)

10.53.02.01—.10 • 43:24 Md. R. 1357 (11-28-16)

10.54.03.03,.04,.07—.11,.13—.16,.18,
     .19
• 43:26 Md. R. 1495 (12-23-16)

10.62.01.01 • 43:22 Md. R. 1245 (10-28-16)

10.62.08.03,.05—.07 • 43:22 Md. R. 1245 (10-28-16)

10.62.09.03 • 43:22 Md. R. 1245 (10-28-16)

10.62.12.02 • 43:22 Md. R. 1245 (10-28-16)

10.62.15.04—.07 • 43:22 Md. R. 1245 (10-28-16)

10.62.19.02,.04—.06 • 43:22 Md. R. 1245 (10-28-16)

10.62.20.03 • 43:22 Md. R. 1245 (10-28-16)

10.62.22.02 • 43:22 Md. R. 1245 (10-28-16)

10.62.25.03,.05—.07 • 43:22 Md. R. 1245 (10-28-16)

10.62.26.03 • 43:22 Md. R. 1245 (10-28-16)

10.62.28.02 • 43:22 Md. R. 1245 (10-28-16)

10.63.01.02,.04,.05 • 43:23 Md. R. 1289 (11-14-16)

10.63.03.14,.18,.19 • 43:23 Md. R. 1289 (11-14-16)

10.63.04.03 • 43:23 Md. R. 1289 (11-14-16)

10.63.06.10 • 43:23 Md. R. 1289 (11-14-16)

 

11 DEPARTMENT OF TRANSPORTATION

 

     Subtitles 01—10

 

11.01.18.01,.02 • 43:22 Md. R. 1251 (10-28-16)

 

12 DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONAL SERVICES

 

12.04.01.01,.16 • 43:26 Md. R. 1500 (12-23-16)

 

13A STATE BOARD OF EDUCATION

 

13A.02.08.01—.03 • 43:22 Md. R. 1252 (10-28-16)

13A.03.07.01—.05 • 43:22 Md. R. 1252 (10-28-16)

13A.04.03.01—.11 • 43:22 Md. R. 1253 (10-28-16)

13A.04.19.01—.09 • 43:26 Md. R. 1502 (12-23-16)

13A.04.20.02,.04,.05,.07 • 43:26 Md. R. 1503 (12-23-16)

13A.06.07.01,.08—.10 • 43:26 Md. R. 1503 (12-23-16)

13A.07.11.01—.05 • 43:10 Md. R. 595 (5-13-16) (ibr)

13A.12.04.04 • 43:26 Md. R. 1505 (12-23-16)

 

13B MARYLAND HIGHER EDUCATION COMMISSION

 

13B.01.01.03,.15 • 43:25 Md. R. 1421 (12-9-16)

13B.02.02.08 • 43:25 Md. R. 1422 (12-9-16)

13B.05.01.05 • 43:25 Md. R. 1423 (12-9-16)

13B.05.01.06 • 43:25 Md. R. 1424 (12-9-16)

13B.06.01.02,.02-1,.04—.10 • 43:26 Md. R. 1505 (12-23-16)

13B.07.02.07 • 43:23 Md. R. 1290 (11-14-16)

13B.08.09.01—.11 • 42:22 Md. R. 1398 (10-30-15)

13B.08.13.01—.10 • 43:8 Md. R. 506 (4-15-16)

13B.08.14.01—.15 • 43:6 Md. R. 421 (3-18-16)

13B.08.15.01—.16 • 43:9 Md. R. 546 (4-29-16)

 

14 INDEPENDENT AGENCIES

 

14.06.03.05,.06 • 42:26 Md. R. 1638 (12-28-15)

14.35.01.01,.02 • 43:18 Md. R. 1039 (9-2-16)

14.35.07 • 43:19 Md. R. 1092 (9-16-16) (err)

14.35.07.01—.21 • 43:18 Md. R. 1039 (9-2-16)

14.36.04.01,.03—.08 • 43:4 Md. R. 342 (2-19-16)

 

15 DEPARTMENT OF AGRICULTURE

 

15.05.01.02 • 43:19 Md. R. 1088 (9-16-16)

15.06.04.06 • 43:21 Md. R. 1171 (10-14-16)

 

19A STATE ETHICS COMMISSION

 

19A.01.01.02,.04 • 43:20 Md. R. 1140 (9-30-16)

19A.01.02.02,.04 • 43:20 Md. R. 1140 (9-30-16)

19A.01.03.02,.04 • 43:20 Md. R. 1140 (9-30-16)

19A.04.Appendices A and B • 43:20 Md. R. 1140 (9-30-16)

19A.04.01.03 • 43:20 Md. R. 1140 (9-30-16)

19A.04.02.04,.05 • 43:20 Md. R. 1140 (9-30-16)

19A.04.03.01 • 43:20 Md. R. 1140 (9-30-16)

19A.05.Appendices A and B • 43:20 Md. R. 1140 (9-30-16)

19A.05.02.04,.06 • 43:20 Md. R. 1140 (9-30-16)

19A.06.01.03 • 43:20 Md. R. 1140 (9-30-16)

19A.06.02.04,.05 • 43:20 Md. R. 1140 (9-30-16)

19A.06.02.04,.05 • 43:20 Md. R. 1140 (9-30-16)

19A.06.03.05,.07 • 43:20 Md. R. 1140 (9-30-16)

19A.07.01.04,.06—.08 • 43:20 Md. R. 1140 (9-30-16)

 

20 PUBLIC SERVICE COMMISSION

 

20.31.01.02 • 43:23 Md. R. 1291 (11-14-16)

20.31.03.01 • 43:23 Md. R. 1291 (11-14-16)

 

26 DEPARTMENT OF THE ENVIRONMENT

 

     Subtitles 01—07 (Part 1)

 

26.04.02.09 • 43:25 Md. R. 1424 (12-9-16)

 

     Subtitles 08—12 (Part 2)

 

26.08.07.04 • 43:24 Md. R. 1361 (11-28-16)

 

     Subtitles 19—27 (Part 4)

 

26.19.01.01—.61 • 43:23 Md. R. 1293 (11-14-16) (ibr)

 

29 DEPARTMENT OF STATE POLICE

 

29.01.02.01,.02,.11,.16 • 43:10 Md. R. 609 (5-13-16)

29.05.02.01—.08 • 43:12 Md. R. 693 (6-10-16)

 

30 MARYLAND INSTITUTE FOR EMERGENCY MEDICAL SERVICES SYSTEMS (MIEMSS)

 

30.08.15.03 • 43:23 Md. R. 1316 (11-14-16)

 

31 MARYLAND INSURANCE ADMINISTRATION

 

31.03.06.10 • 43:26 Md. R. 1508 (12-23-16)

31.14.01.13,.24,.36 • 43:26 Md. R. 1509 (12-23-16)

31.14.02.03—.06,.06-1 • 43:26 Md. R. 1509 (12-23-16)

31.04.15.03 • 43:25 Md. R. 1425 (12-9-16)

31.05.11.02 • 43:25 Md. R. 1425 (12-9-16)

31.05.12.01 • 43:25 Md. R. 1425 (12-9-16)

31.08.01.02 • 43:24 Md. R. 1362 (11-28-16)

31.08.02.02 • 43:24 Md. R. 1362 (11-28-16)

31.08.03 • 43:24 Md. R. 1362 (11-28-16)

31.08.08.07 • 43:24 Md. R. 1362 (11-28-16)

31.08.09.06—.08,.13,.14 • 43:24 Md. R. 1362 (11-28-16)

31.08.10.02 • 43:24 Md. R. 1362 (11-28-16)

31.08.13.03,.04,.06 • 43:20 Md. R. 1146 (9-30-16)

31.10.11.14 • 43:24 Md. R. 1365 (11-28-16)

31.13.01.22 • 43:23 Md. R. 1318 (11-14-16)

31.14.03.06 • 43:24 Md. R. 1365 (11-28-16)

31.15 • 43:2 Md. R. 128 (1-22-16) (err)

31.16.08.06 • 43:24 Md. R. 1366 (11-28-16)

 

33 STATE BOARD OF ELECTIONS

 

33.01.01.01 • 43:4 Md. R. 345 (2-19-16)

33.05.04.05 • 43:4 Md. R. 346 (2-19-16)

33.13.07.06 • 43:24 Md. R. 1367 (11-28-16)

33.13.08.06,.07 • 43:24 Md. R. 1367 (11-28-16)

33.13.10.02—.04 • 43:24 Md. R. 1367 (11-28-16)

33.13.13.08 • 43:24 Md. R. 1367 (11-28-16)

33.14.02.03 • 43:24 Md. R. 1369 (11-28-16)

33.16.01.01 • 43:4 Md. R. 346 (2-19-16)

33.16.02.05 • 43:4 Md. R. 346 (2-19-16)

33.16.03.01,.02 • 43:4 Md. R. 346 (2-19-16)

33.16.04.01 • 43:4 Md. R. 346 (2-19-16)

33.16.05.03,.04 • 43:4 Md. R. 346 (2-19-16)

33.16.06.01 • 43:4 Md. R. 346 (2-19-16)

33.20.06.01 • 43:24 Md. R. 1369 (11-28-16)

 

35 DEPARTMENT OF VETERANS’ AFFAIRS

 

35.03.01.05 • 43:26 Md. R. 1515 (12-23-16)

 


The Judiciary

 


 

COURT OF APPEALS OF MARYLAND

DISCIPLINARY PROCEEDINGS

This is to certify that by an Order of the Court of Appeals dated December 6, 2016, RICHARD WELLS MOORE, JR., 2300 York Road, Suite 213,      Timonium, Maryland 21093, has been disbarred by consent, effective immediately, from the further practice of law in this State, and his name as an attorney at law has been stricken from the register of attorneys in this Court (Maryland Rule 19-761).

[16-26-31]

 

Regulatory Review and Evaluation

Regulations promulgated under the Administrative Procedure Act will undergo a review by the promulgating agency in accordance with the Regulatory Review and Evaluation Act (State Government Article, §§10-130 — 10-139; COMAR 01.01.2003.20). This review will be documented in an evaluation report which will be submitted to the General Assembly’s Joint Committee on Administrative, Executive, and Legislative Review.  The evaluation reports have been spread over an 8-year period (see COMAR 01.01.2003.20 for the schedule).  Notice that an evaluation report is available for public inspection and comment will be published in this section of the Maryland Register.


 

Title 11
DEPARTMENT OF TRANSPORTATION

Notice of Opportunity for Comment

In accordance with the Regulatory Review and Evaluation Act, State Government Article, §§10-130—10-139, Annotated Code of Maryland, the Motor Vehicle Administration (MVA) is currently reviewing and evaluating the following chapters:

 

11.15.01 Gratis Registration Plates

11.15.02 Transporter Registration Plates

11.15.03 Recreational Vehicles
11.15.04 Class B Vehicle Requirements

11.15.05 Unorthodox Vehicles

11.15.06 Historic Motor Vehicles

11.15.07 Special Registration Number—Personalized Plates

11.15.08 Special Mobile Equipment

11.15.09 Temporary Registration

11.15.10 Amateur Radio Operator Registration Plates

11.15.11 Registration Transfer

11.15.12 Titling and Multiyear Registration for Fleet Vehicles

11.15.13 Issuance of a Nonresident Permit

11.15.14 Certificates of Title

11.15.15 Issuance of Chesapeake Bay Commemorative Plates

11.15.16 Issuance, Renewal, Display, and Expiration of Registrations

11.15.18 Vehicle Registration Issuance by State Agencies or Political Subdivisions Acting as Agent for Motor Vehicle Administration

11.15.19 Special Registration Numbers and Plates for Members of Certain Nonprofit Organizations

11.15.20 Dump Service Registration

11.15.21 Effect of Parking and Traffic Control Device Violations on Vehicle Registrations

11.15.22 Apportioned Registration of Fleet Vehicles

11.15.23 Special Registration Plates for Recipients of Combat-Related Armed Forces Medals and Honorably Discharged Veterans

11.15.24 Proportional Registration of Rental Vehicles

11.15.25 Certificate of Origin

11.15.26 Refund of Excise Tax

11.15.27 Four or More Axle Dump Service Vehicles

11.15.28 Vehicle Registration Suspension and Nonrenewal for Failure to Pay Toll

11.15.29 Rejection of Registration Plates

11.15.30 Issuance of Special Agricultural Registration Plates

11.15.31 Electronic Transmission of Titling and Registration Information

11.15.32 Low Speed Vehicles

11.15.33 Vehicle Trade-in Allowance

11.15.34 Salvage Vehicle Calculation

11.15.35 Mopeds, Motor Scooters, and Off-Highway Recreational Vehicles

11.16.01 Transportation of Hazardous Materials

11.16.02 Authorized Emergency and Service Vehicles

11.16.03 Personal Residential Permits for Reserved Parking Spaces for Permanently Disabled Persons

11.16.04 Revocation of Disabled Registration Plates and Parking Placards

11.17.01 Reexamination of Drivers

11.17.02 Expiration and Renewal of Driver's License

11.17.03 Physical and Mental Condition

11.17.04 Epilepsy - Restoration of License following Ineligibility

11.17.05 Use of Bioptic Telescopic Lenses

11.17.06 Identification Cards

11.17.08 Reinstatement of Revoked Driver's License or Privileges

11.17.09 Proof of Age, Name, Identity, Residence, and Lawful Status

11.17.11 Unauthorized Additions to Driver's License, Permit, or Photo Identification Card

11.17.12 Social Security Number

11.17.13 Point System: Definition of Moving Violation and of Points

11.17.14 Driver Knowledge and Skills Tests

11.17.15 Under 21 Alcohol Restriction

11.17.16 Corrected Driver's License

11.17.17 Provisional Driver's License

11.17.18 Disposition and Records of Traffic Citations: Citation Accountability

11.17.19 Issuance of Temporary Driver License Valid in Maryland Only

11.17.20 Emergency Vehicle—Requirements for certain License Exemptions

11.17.21 Proof of Age, Name, Identity, and Residency for Federally Noncompliant Driver Licenses and Identification Cards

11.18.01 Insurance Requirements

11.18.02 Self-Insurers

11.18.03 Adjustment of Uninsured Motorist Penalty Fee for Lapse of Insurance

11.18.04 Reporting Requirements for lapse or Termination of Required Security

11.19.01 Definitions Applicable to Type I and Type II School Vehicles

11.19.02 Type I School Vehicles—Construction Standards

11.19.03 Type II School Vehicles—Construction Standards

11.19.04 School Vehicles Inspection

11.19.05 School Vehicle Drivers

11.19.06 Use of Nonschool Vehicles by Schools or Licensed Child Care Centers

11.19.07 Testing of Equipment on School Vehicles

11.19.08 Certified School Vehicle Inspection Facilities for Vehicles 12 Years Old or Older

 

The purpose of this review and evaluation is to determine whether existing regulations continue to accomplish the purposes for which they were adopted, clarify ambiguous or unclear language, and repeal obsolete or duplicative provisions. Pursuant to its work plan, MVA will evaluate the need to retain, amend, or repeal the regulations based on whether the regulations:

 

·    Continue to be necessary for public interest;

·    Continue to be supported by statutory authority and judicial opinions;

·    Are obsolete or otherwise appropriate for amendment or repeal;

·    Continue to be effective in accomplishing the intended purposes of the regulations

 

MDOT would like to provide interested parties with an opportunity to participate in the review and evaluation process by submitting comments on the regulations. The comments may address any concerns about the regulations. If the comments include suggested changes to the regulations, please be as specific as possible and provide language for the suggested changes. Comments must be received by January 23, 2017.

Comments should be directed to Tracey C. Sheffield, Regulations Coordinator, Motor Vehicle Administration, 6601 Ritchie Highway, N.E., Room 200, Glen Burnie, Maryland 21062 or by email to tsheffield@mdot.state.md.us.

[16-26-30]

 

Title 14
INDEPENDENT AGENCIES

Subtitle 27 MARYLAND ENVIRONMENTAL SERVICE

Notice of Opportunity for Public Inspection and Comment

In accordance with the Regulatory Review and Evaluation Act, State Government Article, §§10-130—10-138, Annotated Code of Maryland, the Maryland Environmental Service is currently reviewing and evaluating the following chapters under COMAR 14.27

 

COMAR 14.27.02 Human Resources

COMAR 14.27.03 Procurement

COMAR 14.27.04 Public Information Act Requests

 

Opportunity for Public Comment

The Maryland Environmental Service would like to provide interested parties with an opportunity to participate in the review and evaluation process and is requesting written public comments submitted by mail to Pamela Fuller, Paralegal, Maryland Environmental Service, 259 Najoles Road, Millersville, MD 21118, by fax at (410) 729-8220, or by email to pfull@menv.com. Comments must be received not later than February 28, 2017. 

[16-26-14]

 

 


Final Action on Regulations

 

Symbol Key

   Roman type indicates text already existing at the time of the proposed action.

   Italic type indicates new text added at the time of proposed action.

   Single underline, italic indicates new text added at the time of final action.

   Single underline, roman indicates existing text added at the time of final action.

   [[Double brackets]] indicate text deleted at the time of final action.

 

 


Title 03
COMPTROLLER OF THE TREASURY

Subtitle 11 ONLINE FANTASY COMPETITIONS

03.11.01 General Provisions

Authority: Criminal Law Article, §12-114, Annotated Code of Maryland

Notice of Final Action

[16-215-F]

On December 7, 2016, the Comptroller of the Treasury adopted new Regulations .01—.14 under a new chapter, COMAR 03.11.01 Fantasy Sports Competition Regulations, under a new subtitle, Subtitle 11 Online Fantasy Competitions. This action, which was proposed for adoption in 43:17 Md. R. 960—963 (August 19, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

PETER FRANCHOT
Comptroller

 

Title 08
DEPARTMENT OF NATURAL RESOURCES

Subtitle 03 WILDLIFE

08.03.10 General Wildlife Hunting Regulations

Authority: Natural Resources Article, §10-205, Annotated Code of Maryland

Notice of Final Action

[16-265-F]

On December 13, 2016, the Secretary of Natural Resources adopted the repeal of Regulation .11 under COMAR 08.03.10 General Wildlife Hunting Regulations. This action, which was proposed for adoption in 43:22 Md. R. 1225 (October 28, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

MARK J. BELTON
Secretary of Natural Resources

 

Subtitle 03 WILDLIFE

08.03.16 Hunting Privilege Suspension and Restitution

Authority: Natural Resources Article, §§10-1101.1, 10-1107, and 10-1108, Annotated Code of Maryland

Notice of Final Action

[16-266-F-I]

On December 13, 2016, the Secretary of Natural Resources adopted new Regulations .01—.05 under COMAR 08.03.16 Hunting Privilege Suspension and Restitution. This action, which was proposed for adoption in 43:22 Md. R. 1225—1227 (October 28, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

MARK J. BELTON
Secretary of Natural Resources

 

Title 09
DEPARTMENT OF LABOR, LICENSING, AND REGULATION

Subtitle 11 REAL ESTATE COMMISSION

09.11.09 Fees

Authority: Business Occupations and Professions Article, §17-213; Business Regulation Article, §2-106.4; Annotated Code of Maryland

Notice of Final Action

[16-151-F]

On October 19, 2016, the Real Estate Commission adopted amendments to Regulation .02 under COMAR 09.11.09 Fees. This action, which was proposed for adoption in 43:13 Md. R. 721—722 (June 24, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

KATHIE CONNELLY
Executive Director
Real Estate Commission

 

Subtitle 12 DIVISION OF LABOR AND INDUSTRY

09.12.21 Employee Injury and Illness Records and Reports

Authority: Labor and Employment Article, §§2-106(b)(4), 5-312, and 5-702—5-704, Annotated Code of Maryland

Notice of Final Action

[16-269-F]

On December 12, 2016, the Commissioner of Labor and Industry adopted amendments to Regulation .02 under COMAR 09.12.21 Employee Injury and Illness Records and Reports. This action, which was proposed for adoption in 43:22 Md. R. 1227—1228 (October 28, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

THOMAS J. MEIGHEN
Commissioner of Labor and Industry

 

Subtitle 12 DIVISION OF LABOR AND INDUSTRY

09.12.31 Maryland Occupational Safety and Health Act — Incorporation by Reference of Federal Standards

Authority: Labor and Employment Article §§2-106(b)(4) and 5-312(b), Annotated Code of Maryland

Notice of Final Action

[16-051-F]

On December 12, 2016, the Commissioner of Labor and Industry adopted, through incorporation by reference under COMAR 09.12.31 Maryland Occupational Safety and Health Act — Incorporation by Reference of Federal Standards, amendments relating to Confined Spaces in Construction, 29 CFR Part 1926, published in 80 FR 25366 — 25526 (May 4, 2015).

This action, which was proposed for adoption in 43:2 Md. R. 176 (January 22, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

THOMAS J. MEIGHEN
Commissioner of Labor and Industry

 

Subtitle 12 DIVISION OF LABOR AND INDUSTRY

09.12.35 Maryland Occupational Safety and Health Standard for Confined Spaces

Authority: Labor and Employment Article, §§2-106(b)(4) and 5-312, Annotated Code of Maryland

Notice of Final Action

[16-279-F]

On December 12, 2016, the Commissioner of Labor and Industry adopted the repeal of Regulations .01—.05 under COMAR 09.12.35 Maryland Occupational Safety and Health Standard for Confined Spaces. This action, which was proposed for adoption in 43:22 Md. R. 1228 (October 28, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

THOMAS J. MEIGHEN
Commissioner of Labor and Industry

 

Subtitle 20 BOARD OF PLUMBING

09.20.01 State Plumbing Code

Authority: Business Occupations and Professions Article, §§12-205 and
12-207, Annotated Code of Maryland

Notice of Final Action

[16-196-F-I]

On October 20, 2016, the State Board of Plumbing adopted amendments to Regulations .01 — .04 and new Regulation .05 under COMAR 09.20.01 State Plumbing Code. This action, which was proposed for adoption in 43:16 Md. R. 904—909 (August 5, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

MICHAEL J. KASTNER, JR.
Chair
Board of Plumbing

 

Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Subtitle 15 FOOD

10.15.07 Shellfish Sanitation

Authority: Health-General Article, §§18-102, 21-211, 21-234, 21-304,
21-321, and 21-346—21-350, Annotated Code of Maryland

Notice of Final Action

[16-274-F-I]

On December 14, 2016, the Secretary of Health and Mental Hygiene adopted amendments to Regulation .01 under COMAR 10.15.07 Shellfish Sanitation. This action, which was proposed for adoption in 43:22 Md. R. 1229 (October 28, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

VAN T. MITCHELL
Secretary of Health and Mental Hygiene

 

Subtitle 21 MENTAL HYGIENE REGULATIONS

10.21.01 Involuntary Admission to Inpatient Mental Health Facilities

Authority: Health-General Article, §§7.5-204—7.5-205, 10-616, 10-619, and 10-806(d)(3), Annotated Code of Maryland

Notice of Final Action

[16-237-F]

On December 7, 2016, the Secretary of Health and Mental Hygiene adopted amendments to Regulations .02 and .04 under COMAR 10.21.01 Involuntary Admission to Inpatient Mental Health Facilities.

Also at this time, the Secretary is withdrawing the proposed amendments to Regulations .08 and .09 under COMAR 10.21.01 Involuntary Admission to Inpatient Mental Health Facilities, which were printed in the same Notice of Proposed Action.

This action, which was proposed for adoption in 43:19 Md. R. 1076—1077 (September 16, 2016), has otherwise been adopted as proposed.

Effective Date: January 2, 2017.

VAN T. MITCHELL
Secretary of Health and Mental Hygiene

 

Subtitle 21 MENTAL HYGIENE REGULATIONS

10.21.25 Fee Schedule — Mental Health Services — Community-Based Programs and Individual Practitioners

Authority: Health-General Article, §§10-901, 15-103, and 15-105; Title 16, Subtitles 1 and 2; Annotated Code of Maryland

Notice of Final Action

[16-280-F]

On December 14, 2016, the Secretary of Health and Mental Hygiene adopted amendments to Regulations .03 and .08 under COMAR 10.21.25 Fee Schedule — Mental Health Services — Community-Based Programs and Individual Practitioners. This action, which was proposed for adoption in 43:22 Md. R. 1229—1230 (October 28, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

VAN T. MITCHELL
Secretary of Health and Mental Hygiene

 

Subtitle 22 DEVELOPMENTAL DISABILITIES

10.22.17 Fee Payment System for Licensed Residential and Day Programs

Authority: Health-General Article, §§2-104(b), 7-306.1, 7-307, 15-105,
15-107, and 16-201, Annotated Code of Maryland

Notice of Final Action

[16-270-F]

On December 14, 2016, the Secretary of Health and Mental Hygiene adopted amendments to Regulations .06—.08 under COMAR 10.22.17 Fee Payment System for Licensed Residential and Day Programs. This action, which was proposed for adoption in 43:22 Md. R. 1230—1239 (October 28, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

VAN T. MITCHELL
Secretary of Health and Mental Hygiene

 

Subtitle 32 BOARD OF PHYSICIANS

Notice of Final Action

[16-275-F]

On December 14, 2016, the Secretary of Health and Mental Hygiene adopted amendments to:

(1) Regulations .08, .10, and .11 under COMAR 10.32.01 General Licensure Regulations;

(2) Regulation .09 under COMAR 10.32.03 Delegation of Duties by a Licensed Physician ― Physician Assistant;

(3) Regulations .07 and .08 under COMAR 10.32.06 Licensure of Polysomnographic Technologists;

(4) Regulation .07 under COMAR 10.32.08 Licensure of Athletic Trainers;

(5) Regulation .13 under COMAR 10.32.10 Licensure of Radiation Therapists, Radiographers, Nuclear Medicine Technologists, and Radiologist Assistants; and

(6) Regulations .09 and .11 under COMAR 10.32.11 Licensing of Respiratory Care Practitioners.

This action, which was proposed for adoption in 43:22 Md. R. 1239—1244 (October 28, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

VAN T. MITCHELL
Secretary of Health and Mental Hygiene

 

Notice of Final Action

[16-250-F]

On December 9, 2016, the Secretary of Health and Mental Hygiene adopted:

(1) Amendments to the subtitle name under COMAR 10.43 Board of Chiropractic Examiners;

(2) Amendments to the chapter name under COMAR 10.43.01 General Regulations;

(3) Amendments to the chapter name and Regulations .01—.03 under COMAR 10.43.03 Advertising;

(4) Amendments to Regulation .01 under COMAR 10.43.04 Licensure by Credentials for Chiropractors;

(5) Amendments to Regulations .02 and .03 under COMAR 10.43.05 Chiropractic Externship Program;

(6) Amendments to the chapter name and the recodification of existing Regulations .04—.05 to be Regulations .03—.04 under COMAR 10.43.06 Fees;

(7) Amendments to Regulations .01 and .09 under COMAR 10.43.07 Chiropractic Assistants;

(8) Amendments to the chapter name under COMAR 10.43.08 Licensure and Registration Examination—Special Needs Applicants;

(9) The recodification of existing COMAR 10.43.10 to be COMAR 10.43.09, amendments to the chapter name, and amendments to Regulation .02 under COMAR 10.43.09 Monetary Penalties;

(10) The recodification of existing COMAR 10.43.11 to be COMAR 10.43.10, amendments to the chapter name, and amendments to Regulation .02 under COMAR 10.43.10 Continuing Education Requirements;

(11) The recodification of existing COMAR 10.43.12 to be COMAR 10.43.11, amendments to the chapter name, and amendments to Regulation .02 under COMAR 10.43.11 Licensure Examination;

(12) The recodification of existing COMAR 10.43.13 to be COMAR 10.43.12 and amendments to the chapter name under COMAR 10.43.12 Procedures for Clinical Demonstrations in Public Places;

(13) The recodification of existing COMAR 10.43.14 to be COMAR 10.43.13 and amendments to the chapter name under COMAR 10.43.13 Code of Ethics;

(14) The recodification of existing COMAR 10.43.15 to be COMAR 10.43.14, amendments to the chapter name, and amendments to Regulation .02 under COMAR 10.43.14 Record Keeping;

(15) The recodification of existing COMAR 10.43.16 to be COMAR 10.43.15, amendments to the chapter name, and amendments to Regulation .02 under COMAR 10.43.15 Sanctioning Guidelines;

(16) New Subtitle 65 under COMAR 10.65 Board of Massage Therapy Examiners;

(17) The recodification of existing COMAR 10.43.17 to be COMAR 10.65.01, amendments to the chapter name, new Regulations .01 and .02, the recodification of existing Regulations .01, .05, and .07 to be Regulations .03, .07, and .09, amendments to and the recodification of existing Regulations .02—.04, .06 and .08—.10 to be Regulations .04—.06, .08, and .10—.12, and the recodification of existing Regulations .11 and .12 to be Regulations .13 and .14 under a new chapter, COMAR 10.65.01 General Regulations;

(18) New Regulations .01—.09 under a new chapter, COMAR 10.65.02 Rules of Procedure for Board Hearings;

(19) The recodification of existing COMAR 10.43.18 to be COMAR 10.65.03, amendments to the chapter name, and amendments to Regulations .03 and .09 under a new chapter, COMAR 10.65.03 Code of Ethics;

(20) The recodification of existing COMAR 10.43.19 to be COMAR 10.65.04, amendments to the chapter name, and amendments to Regulations .01—.03 and .06 under a new chapter, COMAR 10.65.04 Advertising;

(21) The recodification of existing COMAR 10.43.20 to be COMAR 10.65.05 and amendments to the chapter name under a new chapter, COMAR 10.65.05 Continuing Education Requirements;

(22) The recodification of existing COMAR 10.43.21 to be COMAR 10.65.06 and amendments to the chapter name under a new chapter, COMAR 10.65.06 Record Keeping;

(23) New Regulations .01 and .03—.04 and the recodification of existing Regulation .03 under COMAR 10.43.06 to be Regulation .02 under a new chapter, COMAR 10.65.07 Fees;

(24) New Regulations .01 and .02 under a new chapter, COMAR 10.65.08 Licensure and Registration Examination—Special Needs Applicants; and

(25) New Regulations .01—.06 under a new chapter, COMAR 10.65.09 Sanctioning Guidelines.

This action, which was proposed for adoption in 43:20 Md. R. 1117—1128 (September 30, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

VAN T. MITCHELL
Secretary of Health and Mental Hygiene

 

Subtitle 44 BOARD OF DENTAL EXAMINERS

10.44.20 Fees

Authority: Health Occupations Article, §4-505, Annotated Code of Maryland

Notice of Final Action

[16-272-F]

On December 14, 2016, the Secretary of Health and Mental Hygiene adopted amendments to Regulation .02 under COMAR 10.44.20 Fees. This action, which was proposed for adoption in 43:22 Md. R. 1245 (October 28, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

VAN T. MITCHELL
Secretary of Health and Mental Hygiene

 

Title 12
DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONAL SERVICES

Subtitle 14 COMMISSION ON CORRECTIONAL STANDARDS

Notice of Final Action

[16-252-F]

On November 21, 2016, the Secretary of Public Safety and Correctional Services, in cooperation with the Commission on Correctional Standards, adopted amendments to:

(1) Regulations .02, .03, .06, and .09 under COMAR 12.14.03 Minimum Standards for Adult Detention Centers;

(2) Regulations .01, .02, .05, and .08 under COMAR 12.14.04 Minimum Standards for Adult Correctional Institutions; and

(3) Regulations .01, .02, .05, and .08 under COMAR 12.14.05 Minimum Standards for Adult Community Correctional Facilities.

This action, which was proposed for adoption in 43:20 Md. R. 1136—1138 (September 30, 2016), has been adopted as proposed.

Effective Date: April 1, 2017.

STEPHEN T. MOYER
Secretary of Public Safety and Correctional Services

 

Title 13A
STATE BOARD OF EDUCATION

Subtitle 04 SPECIFIC SUBJECTS

13A.04.10 Program of Instruction in Career Development for College and Career Readiness

Authority: Education Article, §2-205, Annotated Code of Maryland

Notice of Final Action

[16-236-F]

On December 5, 2016, the Maryland State Board of Education adopted amendments to Regulations .01 and .02 under COMAR 13A.04.10 Program of Instruction in Career Development for College and Career Readiness. This action, which was proposed for adoption in 43:19 Md. R. 1085—1086 (September 16, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

KAREN B. SALMON, Ph.D.
State Superintendent of Schools

 

Subtitle 05 SPECIAL INSTRUCTIONAL PROGRAMS

13A.05.01 Provision of a Free Appropriate Public Education

Authority: Education Article, §§2-205, 7-305, 8-301—8-307, 8-3A-01—
8-3A-08,
and 8-401—8-416; Human Services Article, §§8-401—8-409; Labor and Employment Article, §§11-801 and 11-901 et seq.; State Government Article §9-1607.1; Annotated Code of Maryland
Federal Statutory Reference: 20 U.S.C. §§1411—1416; Federal Regulatory References: 34 CFR 300, 301, and 99

Notice of Final Action

[16-259-F]

On December 5, 2016, the Maryland State Board of Education adopted amendments to Regulations .03 and .05—.08 under COMAR 13A.05.01 Provision of a Free Appropriate Public Education. This action, which was proposed for adoption in 43:20 Md. R. 1138—1139 (September 30, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

KAREN B. SALMON, Ph.D.
State Superintendent of Schools

 

Subtitle 05 SPECIAL INSTRUCTIONAL PROGRAMS

13A.05.03 Programs of Adult Education

Authority: Education Article, §2-205, Annotated Code of Maryland

Notice of Final Action

[16-235-F]

On December 5, 2016, the Maryland State Board of Education adopted the repeal of Regulations .01—.03 under COMAR 13A.05.03 Programs of Adult Education. This action, which was proposed for adoption in 43:19 Md. R. 1086 (September 16, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

KAREN B. SALMON, Ph.D.
State Superintendent of Schools

 

Subtitle 05 SPECIAL INSTRUCTIONAL PROGRAMS

13A.05.08 Approved Paid Work-Based Learning Programs

Authority: Education Article, §2-205, Annotated Code of Maryland

Notice of Final Action

[16-234-F]

On December 5, 2016, the Maryland State Board of Education adopted the repeal of Regulations .01—.06 under COMAR 13A.05.08 Approved Paid Work-Based Learning Programs. This action, which was proposed for adoption in 43:19 Md. R. 1086—1087 (September 16, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

KAREN B. SALMON, Ph.D.
State Superintendent of Schools

 

Subtitle 05 SPECIAL INSTRUCTIONAL PROGRAMS

13A.05.12 Hearing Aid Loan Bank

Authority: Education Article, §§2-205 and 8-605, Annotated Code of Maryland

Notice of Final Action

[16-233-F]

On December 5, 2016, the Maryland State Board of Education adopted new Regulations .01—.03 under new chapter, COMAR 13A.05.12 Hearing Aid Loan Bank. This action, which was proposed for adoption in 43:19 Md. R. 1087—1088 (September 16, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

KAREN B. SALMON, Ph.D.
State Superintendent of Schools

 

Title 15
DEPARTMENT OF AGRICULTURE

Subtitle 20 SOIL AND WATER CONSERVATION

15.20.07 Agricultural Operation Nutrient Management Plan Requirements

Authority: Agriculture Article, §§ 8-801—8-806, Annotated Code of Maryland

Notice of Final Action

[16-268-F-I]

On December 13, 2016, the Secretary of Agriculture adopted amendments to Regulation .02 under COMAR 15.20.07 Agricultural Operation Nutrient Management Plan Requirements.  This action, which was proposed for adoption in 43:22 Md. R. 1254 (October 28, 2016), has been adopted with the nonsubstantive changes shown below.

Effective Date: January 2, 2017.

Attorney General's Certification

In accordance with State Government Article, §10-113, Annotated Code of Maryland, the Attorney General certifies that the following changes do not differ substantively from the proposed text. The nature of the changes and the basis for this conclusion are as follows:

The following changes correct a spelling error and provide two cross-references to clarify an exception to the winter prohibition against the application of nutrients to agricultural land and nutrient management standards governing emergency applications of organic fertilizer.

E. Prohibition against Winter Application

     1. Except as provided in subsections E.2, E.3 and E.4, after July 1, 2016, a person may not make a winter application of a nutrient source to agricultural land.

     2. a. The prohibition against making a winter application after July 1, 2016 does not apply to a nutrient source that originates from:

         (i) A dairy or livestock operation with less than 50 animal units; or

         (ii) A municipal wastewater treatment plant with a design flow capacity of less than 0.5 million gallons per day.

              b. This exception to the general prohibition referenced in subsection E.1 expires after the winter application that ends on February 28, 2020.

     3. The prohibition against making a winter application does not apply to potash, liming materials, or manure deposited directly by livestock. A person may make a winter application of certain nutrients for greenhouse production and for certain vegetable crops, small fruit crops, small grain crops, and cool season grass sod production listed in the Maryland Nutrient Management Manual Section I-B.

     4. Applications required in emergency situations due to an imminent overflow of a storage facility from on farm generated organic fertilizer shall be managed as provided in III D.2 in consultation with the Maryland Department of Agriculture. Operators in such situations shall contact the MDA regional nutrient management representative for guidance. Operators will be required to enter into an agreement of intent with the Soil Conservation District or private entity that is a certified Technical Service Provider approved by NRCS.

JOSEPH BARTENFELDER
Secretary of Agriculture

Title 18
DEPARTMENT OF ASSESSMENTS AND TAXATION

Subtitle 04 BUSINESS ORGANIZATIONS

18.04.11 Prohibited Filings

Authority: Corporations and Associations Article, §1-201.1(c), Annotated Code of Maryland

Notice of Final Action

[16-273-F]

On December 14, 2016, the Director of the Department of Assessments and Taxation adopted new Regulation .01 under a new chapter, COMAR 18.04.11 Prohibited Filings. This action, which was proposed for adoption in 43:22 Md. R. 1255 (October 28, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

SEAN P. POWELL
Director of Assessments and Taxation

 

Title 21
STATE PROCUREMENT REGULATIONS

Notice of Final Action

[16-261-F]

On December 7, 2016, the Board of Public Works adopted:

(1) Amendments to Regulation .01 under COMAR 21.01.02 Terminology;

(2) Amendments to Regulation .04 under COMAR 21.02.01 Board of Public Works;

(3) Amendments to Regulations .02 and .03 under COMAR 21.02.03 Department of Budget and Management;

(4) Amendments to Regulation .03 under COMAR 21.04.01 General Policies;

(5) Amendments to Regulation .01 under COMAR 21.05.01 General Provisions;

(6) Amendments to Regulation .04 under COMAR 21.05.05 Sole Source Procurement;

(7) Amendments to Regulations .04, .07, and .08 under COMAR 21.05.08 Mandatory Written Solicitation Requirements;

(8) New Regulations .01—.07 under a new chapter, COMAR 21.05.12 Procurement of Human, Social, Cultural, and Educational Services.

(9) Amendments to Regulations .09 and .10 under COMAR 21.06.07 Bid and Contract Security/Bonds;

(10) New Regulations .01—.06 under a new chapter, COMAR 21.06.09 Invoicing, Payment, and Interest on Late Payments;

(11) Amendments to Regulations .08, .18, .20, .25, and .26 under COMAR 21.07.01 Mandatory Contract Provisions—All Contracts (except as provided under COMAR 21.05.07, 21.07.02, and 21.07.03);

(12) Amendments to Regulation .04 under COMAR 21.07.02 Mandatory Construction Contract Clauses;

(13) Amendments to Regulation .09 under COMAR 21.11.03 Minority Business Enterprise Policies;

(14) Amendments to Regulations .01 and .02 under COMAR 21.11.09 Vending Facilities on Property Controlled by Department of General Services;

(15) Amendments to Regulations .02 and .04 under COMAR 21.11.13 Veteran-Owned Small Business Enterprises;

(16) Amendments to Regulations .10 and .10-1 under COMAR 21.12.04 Department of General Services; A/E Services Exceeding $200,000;

(17) Amendments to Regulation .01 under COMAR 21.12.05 Department of General Services; A/E Services $200,000 or Less; and

(18) The repeal of existing Regulations .01—.07 under COMAR 21.14.01 General Regulations.

This action, which was proposed for adoption in 43:21 Md. R. 1172—1180 (October 14, 2016), has been adopted with the nonsubstantive changes shown below.

Effective Date: January 2, 2017.

Attorney General's Certification

In accordance with State Government Article, §10-113, Annotated Code of Maryland, the Attorney General certifies that the following changes do not differ substantively from the proposed text. The nature of the changes and the basis for this conclusion are as follows:

COMAR 21.02.03.02 and 21.06.07.10: Minor typographical errors and corrections to comply with statutes.

 

Subtitle 02 STATE PROCUREMENT ORGANIZATION

21.02.03 Department of Budget and Management

Authority: State Finance and Procurement Article, §§3-405, 3-502, 12-101, 12-107, 13-103, 13-104, 13-107.1, and 13-111, Annotated Code of Maryland

.02 Review and Approval of Solicitations and Contracts for Services.

A. — B. (proposed text unchanged)

C. Policies and Procedures—Service Contracts [[and Information Technology Contracts]].

(1) — (8) (proposed text unchanged)

D. (proposed text unchanged)

 

Subtitle 06 CONTRACT FORMATION AND AWARD

21.06.07 Bid and Contract Security/Bonds

Authority: State Finance and Procurement Article, §§12-101, 13-207—13-209, 13-216, and 17-102—17-109, Annotated Code of Maryland

.10 Performance and Payment Bonds.

A. Performance Bonds

(1) General. A performance bond is required for all construction contracts in excess of $100,000 in the amount equal to at least 100 percent of the contract price. A performance bond may be required for a [[contact]] contract for services, supplies, maintenance, or construction-related services expected to exceed [[$50,000]] $100,000, as determined by the procurement officer. The performance bond shall be delivered by the contractor to the State not later than the time the contract is executed. If a contractor fails to deliver the required performance bond, the contractor’s bid shall be rejected, its bid security shall be enforced, and award of the contract may be made to the next lowest responsive and responsible bidder.

(2) (proposed text unchanged)

B. — C. (proposed text unchanged)

SHEILA McDONALD
Executive Secretary

 

Title 36
MARYLAND STATE LOTTERY AND GAMING CONTROL AGENCY

Subtitle 03 GAMING PROVISIONS

36.03.10 Video Lottery Facility Minimum Internal Control Standards

Authority: State Government Article, §§9-1A-02 and 9-1A-04, Annotated Code of Maryland

Notice of Final Action

[16-278-F]

On December 14, 2016, the Maryland State Lottery and Gaming Control Agency adopted amendments to Regulation .11 under COMAR 36.03.10 Video Lottery Facility Minimum Internal Control Standards. This action, which was proposed for adoption in 43:22 Md. R. 1255 (October 28, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

GORDON MEDENICA
Director

 

Subtitle 07 INSTANT BINGO MACHINES IN ANNE ARUNDEL AND CALVERT COUNTIES

36.07.01 General

Authority: Criminal Law Article, §§12-301.1 and 12-308; State Government Article, §9-110; Annotated Code of Maryland

Notice of Final Action

[16-263-F]

On November 29, 2016, the Maryland State Lottery and Gaming Control Agency adopted amendments to Regulation .03 under COMAR 36.07.01 General. This action, which was proposed for adoption in 43:21 Md. R. 1180—1181 (October 14, 2016), has been adopted as proposed.

Effective Date: January 2, 2017.

GORDON MEDENICA
Director

 

 

 


Withdrawal of Regulations


 

Title 31
MARYLAND INSURANCE ADMINISTRATION

Subtitle 15 UNFAIR TRADE PRACTICES

Notice of Withdrawal

[16-012-W]

The Insurance Commissioner withdraws proposed amendments to Regulations .01—.07 under COMAR 31.15.04 Solicitation of Annuity and Deposit Fund Contracts, and proposed new Regulations .01—.09 under a new chapter, COMAR 31.15.15 Annuity Disclosure, as published in 43:1 Md. R. 76—83 (January 8, 2016)

ALFRED W. REDMER, Jr.
Insurance Commissioner

 

 


Proposed Action on Regulations

 



Title 07
DEPARTMENT OF HUMAN RESOURCES

Subtitle 02 SOCIAL SERVICES ADMINISTRATION

07.02.10 Youth Transitional Services

Authority: Courts and Judicial Proceedings Article, §3-801 et seq.; Family Law Article, §§1-101, 5-501—5-503, 5-524—5-525, 5-527—5-528, and 5-531—5-532; Annotated Code of Maryland
Agency Note: Federal Reference: Fostering Connection Act of 2008,
PL110-35

Notice of Proposed Action

[16-351-P]

The Secretary of Human Resources proposes to amend Regulations .01, .02, .04, and .09 under COMAR 07.02.10 Youth Transitional Services.

Statement of Purpose

The purpose of this action is to define “successful adulthood” to conform to the provisions of the federal “Preventing Sex Trafficking and Strengthening Families Act” (PL 113-183).

Comparison to Federal Standards

There is a corresponding federal standard to this proposed action, but the proposed action is not more restrictive or stringent.

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 Tristan Fernandez, Government Affairs Administrator, Department of Human Resources, 311 W. Saratoga St. Baltimore, MD 21201, or call 410-767-8966, or email to Tristan Fernandez, or fax to 410-333-0637. Comments will be accepted through January 23, 2017. A public hearing has not been scheduled.

.01 Purpose.

The purpose of Youth Transitional Services is to prepare and assist youth to make the transition to [independent living] successful adulthood. Services are designed to promote self-sufficiency and responsible living.

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)—(20) (text unchanged)

(21) “Successful adulthood means when a youth exits the foster care system with the transitional skills to become self-sufficient as age and developmentally appropriate for the individual youth.

[(21)] (22) [(22)] (23) (text unchanged)

.04 Program Requirements.

A. (text unchanged)

B. The local department shall promote youth participation in youth transitional services in order to encourage youth to accept responsibility for:

(1) (text unchanged)

(2) Making the transition from adolescence to successful adulthood.

.09 Transitional Youth Services.

A.—C. (text unchanged)

D. To [assure] ensure that youth participating in youth transitional services are provided personal and emotional support as they make the transition to successful adulthood, referrals shall be made to appropriate mentoring partners to foster positive mentoring relationships between youth and dedicated adults.

GREGORY S. JAMES
Acting Secretary of Human Resources

Title 08
DEPARTMENT OF NATURAL RESOURCES

Subtitle 02 FISHERIES SERVICE

08.02.21 Yellow Perch

Authority: Natural Resources Article, §§4-215 and 4-215.2, Annotated Code of Maryland

Notice of Proposed Action

[16-344-P]

The Secretary of Natural Resources proposes to amend Regulation .03 under COMAR 08.02.21 Yellow Perch.

Statement of Purpose

The purpose of this action is to change the size limits for commercial hook and line to be consistent with other commercial harvest methods. Currently, the commercial yellow perch hook and line fishery operates under the same size and daily creel limits as the recreational hook and line yellow perch fishery (9-inch minimum size limit and a 10-fish daily creel limit). The action removes the current size limit for commercial hook and line and makes the 8 ½-inch minimum size limit and 11-inch maximum size limit currently in place for other commercial gear types apply to all commercial harvest. The 10-fish-per-day limit for hook and line is not changed. This change was requested by commercial fishermen. The change does not have a biological effect on the population and it standardizes all size limits among the commercial fishery.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. The action may have an economic impact on individuals who harvest yellow perch commercially using hook and line.

 

 

Revenue (R+/R-)

 

II. Types of Economic Impact.

Expenditure (E+/E-)

Magnitude

 


A. On issuing agency:

NONE

B. On other State agencies:

NONE

C. On local governments:

NONE

 

 

Benefit (+)
Cost (-)

Magnitude

 


D. On regulated industries or trade groups:

Size limit

(+)

Indeterminable

E. On other industries or trade groups:

NONE

F. Direct and indirect effects on public:

NONE

III. Assumptions. (Identified by Impact Letter and Number from Section II.)

D. This action may have an impact on harvesters who use hook and line to catch yellow perch. The impact is indeterminable, but likely minimal. There are approximately 60 harvesters that declare that they will harvest yellow perch, about half of those actually harvest and less than 5 report harvesting with hook and line. No one reported harvest with hook and line in 2015 or 2016. This change may allow those harvesters to be more competitive in the yellow perch market and have some flexibility with their businesses, but the extent is unknown.

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 Yellow Perch Regulations, Regulatory Staff, Department of Natural Resources Fishing and Boating Services, 580 Taylor Avenue, B-2, Annapolis, MD 21401, or call 410-260-8300, or email to fisheriespubliccomment.dnr@maryland.gov, or fax to 410-260-8310. Comments will be accepted through January 23, 2017. A public hearing has not been scheduled.

.03 Commercial.

A. (text unchanged)

B. Size.

[(1) The minimum size for yellow perch harvested by hook and line is 9 inches total length.]

[(2)] (1) The minimum size for yellow perch [harvested by means other than hook and line] is 8-1/2 inches total length.

[(3)] (2) The maximum size for yellow perch [harvested by means other than hook and line] is 11 inches total length.

C.—K. (text unchanged)

MARK J. BELTON
Secretary of Natural Resources

 

Title 09
DEPARTMENT OF LABOR, LICENSING, AND REGULATION

Subtitle 12 DIVISION OF LABOR AND INDUSTRY

09.12.43 Maryland Apprenticeship and Training

Authority: Labor and Employment Article, §11-405, Annotated Code of Maryland

Notice of Proposed Action

[16-340-P]

The Maryland Apprenticeship and Training Council proposes to amend Regulations .02 and .05 under COMAR 09.12.43 Maryland Apprenticeship and Training. This action was considered by the Council at a public meeting held on March 8, 2016, notice of which was published in 43:4 Md. R. 352 (February 19, 2016).

Statement of Purpose

The purpose of this action is to amend the regulations to allow for competency-based apprenticeship programs. This regulatory change is necessary in order to come into conformity with United States Department of Labor federal standards of apprenticeship.

Comparison to Federal Standards

There is a corresponding federal standard to this proposed action, but the proposed action is not more restrictive or stringent.

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 Christopher MacLarion, Director, Apprenticeship and Training, Dept. of Labor, Licensing and Regulation, 1100 N. Eutaw Street, Room 209, Baltimore, MD 21201, or call 410-767-3969, or email to christopher.maclarion@maryland.gov, or fax to 410-333-5162. Comments will be accepted through January 23, 2017. A public hearing has not been scheduled.

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1) — (4) (text unchanged)

(5) “Competency” means the attainment of manual, mechanical, or technical skills and knowledge as specified by an occupational standard and demonstrated by an appropriate written and hands-on proficiency measurement.

(6) Competency-Based Approach.

(a) “Competency-based approach” means a method to measure skill acquisition through the individual apprentice’s successful demonstration of acquired skills and knowledge, as verified by the program sponsor.

(b) “Competency-based approach” includes requiring an apprentice to complete an on-the-job learning component of registered apprenticeship with the program standards addressing:

(i) How on-the-job learning will be integrated into the program;

(ii) Describing competencies; and

(iii) Identifying an appropriate means of testing and evaluation for such competencies.

[(5)] (7)[(7)] (9) (text unchanged)

(10) “Hybrid approach” means a method to measure an individual apprentice’s skill acquisition through a combination of a specified minimum number of hours of on-the-job learning and the successful demonstration of competency as described in a work process schedule.

[(8)] (11)[(17)] (20) (text unchanged)

(21) “Time-based approach” means a method that measures skill acquisition through the individual apprentice’s completion of at least 2,000 hours of on-the-job learning as described in a work process schedule.

.05 Standards of an Apprenticeship Program.

A. — C. (text unchanged)

D. An apprenticeship program shall include the following provisions:

(1) The employment and training of the apprentice in a skilled [trade] occupation;

(2) A term of apprenticeship, [of not less than 2,000 hours, consistent with the training requirements established by industry practice;] which for an individual apprentice:

(a) May be measured through either a time-based approach, a competency-based approach, or a hybrid approach; and

(b) Is determined by the program sponsor, subject to approval by the Division, with the advice of the Council, depending on which approach is appropriate for the apprenticeable occupation for which the program standards are registered;

(3) A work processes outline which:

(a) (text unchanged)

(b) Is an organized syllabus of operations and manual manipulative practices which shall be arranged in a logical manner and assigned sufficient time frames for these practices to equip an apprentice [or trainee] with a comprehensive basic skill development background to qualify for journeyperson or another stated training objective;

(4) — (22) (text unchanged)

E. — L. (text unchanged)

JAMES E. RZEPKOWSKI
Assistant Secretary for Workforce
Development and Adult Learning

 

Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Notice of Proposed Action

[16-359-P-I]

The Secretary of Health and Mental Hygiene proposes to amend:

(1) Regulation .04 under COMAR 10.02.01 Charges for Services Provided Through the Department of Health and Mental Hygiene;

(2) Regulation .07 under COMAR 10.09.02 Physicians’ Services;

(3) Regulations .07 and .10 under COMAR 10.09.08 Freestanding Clinics;

(4) Regulation .07 under COMAR 10.09.09 Medical Laboratories;

(5) Regulation .07 under COMAR 10.09.15 Podiatry Services;

(6) Regulation .06 under COMAR 10.09.38 Healthy Start Program;

(7) Regulation .11 under COMAR 10.09.49 Telehealth Services;

(8) Regulation .07 under COMAR 10.09.50 EPSDT School Health-Related Services or Health-Related Early Intervention Services;

(9) Regulation .20 under COMAR 10.09.67 Maryland Medicaid Managed Care Program: Benefits;

(10) Regulation .07 under COMAR 10.09.87 Free-Standing Independent Diagnostic Testing Facilities;

(11) Regulation .07 under COMAR 10.09.88 Portable X-ray Providers;

(12) Regulation .14 under COMAR 10.11.03 Children’s Medical Services Program; and

(13) Regulation .07 under COMAR 10.48.01 Services.

Statement of Purpose

The purpose of this action is to replace in its entirety the Medical Assistance Provider Fee Manual and incorporate by reference the Professional Services Provider Manual and Fee Schedule. This proposal also updates references to this document in other chapters.

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 A. Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 W. 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 January 23, 2017. A public hearing has not been scheduled.

 

 Editor’s Note on Incorporation by Reference

     Pursuant to State Government Article, §7-207, Annotated Code of Maryland, the Maryland Medical Assistance Program, Professional Services Provider Manual and Fee Schedule, Effective October 2016, has been declared a document generally available to the public and appropriate for incorporation by reference. For this reason, it will not be printed in the Maryland Register or the Code of Maryland Regulations (COMAR). Copies of this document are filed in special public depositories located throughout the State. A list of these depositories was published in 43:1 Md. R. 10 (January 8, 2016), and is available online at www.dsd.state.md.us. The document may also be inspected at the office of the Division of State Documents, 16 Francis Street, Annapolis, Maryland 21401.

 

Subtitle 02 DIVISION OF REIMBURSEMENTS

10.02.01 Charges for Services Provided Through the Department of Health and Mental Hygiene

Authority: Health-General Article, §§16-201—16-407, Annotated Code of Maryland

.04 Setting of Charges for Local Health Departments.

A. (text unchanged)

B. CPT-Based Charge.

(1) (text unchanged)

(2) Approved Method for Determining CPT-Based Charges.

(a) (text unchanged)

(b) For any health service performed by a local health department for which a rate is not assigned in the applicable Medicare Physicians Fee Schedule, the CPT-based charge shall be equivalent to 150 percent of the Maryland Medical Assistance participating provider fee allowance for the corresponding CPT code in the [current Maryland Medical Assistance Program, Physicians’ Services Provider Fee Manual] Professional Services Provider Manual and Fee Schedule, as published by the Department and incorporated by reference in COMAR [10.09.02.07] 10.09.02.07D.

(c) For any health service performed by a local health department for which a rate is not assigned on the applicable Medicare Physicians Fee Schedule or in the [current Maryland Medical Assistance Program, Physicians’ Services Provider Fee Manual] Professional Services Provider Manual and Fee Schedule, the CPT-based charge shall be equivalent to the average hourly rate of the employees providing the service to the recipients of services,, calculated based upon current fiscal year salaries and fringe benefits, multiplied by the projected time of service with recipient of services, plus 20 percent for indirect costs.

C.—D. (text unchanged)

 

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.02 Physicians’ Services

Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

.07 Payment Procedures.

A.—C. (text unchanged)

D. The Maryland Medical Assistance [Program Physicians’ Services Provider Fee Manual, Revision January 2014, is] Program’s procedures for payment are contained in the [Medical Assistance Provider Fee Manual, dated October 1986] Professional Services Provider Manual and Fee Schedule (Effective October 2016). All the provisions of this document, unless specifically excepted, are incorporated by reference.

E.—Q. (text unchanged)

 

10.09.08 Freestanding Clinics

Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

.07 Freestanding Clinic Reimbursement Methodology.

A. Reimbursement for Family Planning Clinics. The Department shall pay the family planning clinic the lesser of the provider’s customary charge or the provider’s acquisition cost, but no more than the maximum reimbursement allowed for similar procedures or services required in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D. If the service is free to individuals not covered by Medicaid:

(1) The provider:

(a) (text unchanged)

(b) Shall be reimbursed in accordance with [the Provider Fee Manual] COMAR 10.09.02.07D; and

(2) (text unchanged)

B. Reimbursement for Abortion Clinics. For dates of service on or after April 1, 2015, the Department shall pay the abortion clinic the lesser of the provider’s customary charge, but no more than the maximum reimbursement allowed for similar procedures or services required in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D. If the service is free to individuals not covered by Medicaid:

(1) The provider:

(a) (text unchanged)

(b) Shall be reimbursed in accordance with [the Provider Fee Manual] COMAR 10.09.02.07D; and

(2) (text unchanged)

C. (text unchanged)

D. The Department shall pay all other freestanding clinics at the lesser of the provider’s customary charge, or the provider’s acquisition cost, but no more than the maximum reimbursement allowed for similar procedures or services required in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D. If the service is free to individuals not covered by Medicaid:

(1) The provider:

(a) (text unchanged)

(b) Shall be reimbursed in accordance with [the Provider Fee Manual] COMAR 10.09.02.07D; and

(2) (text unchanged)

.10 Payment Procedures.

A.—B. (text unchanged)

C. The provider shall bill the Program the provider’s customary charge to the general public for similar services. If the service is free to individuals not covered by Medicaid:

(1) The provider:

(a) (text unchanged)

(b) Shall be reimbursed in accordance with [the Provider Fee Manual] COMAR 10.09.02.07D; and

(2) (text unchanged)

D.—I. (text unchanged)

 

10.09.09 Medical Laboratories

Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

.07 Payment Procedures.

A.—C. (text unchanged)

D. [The fee schedule is contained in the Medical Assistance Provider Fee Manual, dated October 1, 1986, which is used in conjunction with “Physician’s Current Procedural Terminology”, and the Health Care Financing Administration’s Common Procedure Code System (HCPCS). All the provisions of these documents, unless specifically noted, are incorporated by reference in this section, with the Medical Laboratories 2011 Provider Manual and Fee Schedule.] Providers are reimbursed according to COMAR 10.09.02.07D.

E.—P. (text unchanged)

 

10.09.15 Podiatry Services

Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

.07 Payment Procedures.

A.—C. (text unchanged)

D. The Program shall pay for medically necessary covered services at the lower of the provider’s amount billed to the Program or the maximum reimbursement rates set forth [on the physicians’ fee schedule according to COMAR 10.09.02.07] in COMAR 10.09.02.07D.

E.—J. (text unchanged)

 

10.09.38 Healthy Start Program

Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

.06 Payment Procedures.

A.—B. (text unchanged)

C. Payments shall be made:

(1)—(3) (text unchanged)

(4) For high-risk nutrition counseling as follows:

(a)—(c) (text unchanged)

(d) To all other eligible providers, according to [the current fee-for-service schedule specified in the Program Physicians’ Provider Fee Manual which is contained in the Medical Assistance Provider Fee Manual, dated October 1986, all the provisions of which, unless specifically excepted, are incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D.

 

10.09.49 Telehealth Services

Authority: Health-General Article, §§2-104(b) and 15-105.2(b), Annotated Code of Maryland; Ch. 280, Acts of 2013

.11 Reimbursement.

A.—B. (text unchanged)

C. Originating Site Transmission Fee.

(1) The telehealth transmission fee is set:

(a) In [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D; or

(b) (text unchanged)

(2) (text unchanged)

D. Distant Site Professional Fee.

(1) The distant site professional fee shall be:

(a) For somatic services provided via telehealth, as set forth in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D; or

(b) For behavioral health services provided via telehealth, as set forth in [the Departmental fee schedule for Public Mental Health System Reimbursement, which is incorporated by reference in] COMAR 10.09.59.09.

(2) (text unchanged)

 

10.09.50 EPSDT School Health-Related Services or Health-Related Early Intervention Services

Authority: Health-General Article, §§2-104(b), 15-103, and 15-124, Annotated Code of Maryland

.07 Payment Procedures.

A.—D. (text unchanged)

E. Reimbursement for health-related services and health-related early intervention services is contained in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, Revision January 2014, contained in the Medical Assistance Provider Fee Manual, dated October 1986, the provisions of which, unless specifically excepted, are incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D. The State portion of reimbursement is provided by the Maryland State Department of Education.

 

10.09.67 Maryland Medicaid Managed Care Program: Benefits

Authority: Health-General Article, Title 15, Subtitle 1, Annotated Code of Maryland

.20 Benefits — EPSDT Services.

A. (text unchanged)

B. The health care services described in §A(3) of this regulation shall include, at a minimum, all services described in this chapter, and the following:

(1)—(2) (text unchanged)

(3) Audiology services, as listed in the Maryland Medical Assistance Audiology Procedure Code and Fee Schedule[: contained in the Medical Assistance Provider Fee Manual, all the provisions of which, unless specifically excepted are incorporated by reference in], according to COMAR 10.09.51.04A(4);

(4)—(6) (text unchanged)

C. (text unchanged)

10.09.87 Free-Standing Independent Diagnostic Testing Facilities

Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

.07 Payment Procedures.

A.—C. (text unchanged)

D. The Department’s fee-schedule is contained in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D.

E.—I. (text unchanged)

 

10.09.88 Portable X-ray Providers

Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

.07 Payment Procedures.

A.—C. (text unchanged)

D. The Department’s fee-schedule is contained in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D.

E.—I. (text unchanged)

 

Subtitle 11 MATERNAL AND CHILD HEALTH

10.11.03 Children’s Medical Services Program

Authority: Health-General Article, §15-125, Annotated Code of Maryland

.14 Billing Procedures for Physician Office Services.

A. (text unchanged)

B. The CMS Program shall:

(1) Use the fee schedule contained in the Maryland Medical Assistance [Provider Fee Manual] Program’s Professional Services Provider Manual and Fee Schedule, which is incorporated by reference in COMAR [10.09.02.07 and 10.09.09.07] 10.09.02.07D;

(2) (text unchanged)

(3) Reimburse the provider for:

(a) (text unchanged)

(b) Injectable drugs at rates promulgated by the [Medical Assistance fee schedule for physician services] Professional Services Provider Manual and Fee Schedule referenced in §B(1) of this regulation.

C. (text unchanged)

 

Subtitle 48 CHILD ABUSE AND NEGLECT MEDICAL REIMBURSEMENT PROGRAM

10.48.01 Services

Authority: Family Law Article, §§5-701—5-910, Annotated Code of Maryland

.07 Payment Procedures.

A.—C. (text unchanged)

D. The fee schedule for covered services except hospital services shall be the same as is contained in the [July 1, 1982, Medical Assistance Provider Fee Manual, as amended, the provisions of] Maryland Medical Assistance Program’s Professional Services Provider Manual and Fee Schedule which [are] is incorporated by reference [under] in COMAR [10.09.02, 10.09.03, and 10.09.09] 10.09.02.07D.

E.—L. (text unchanged)

VAN T. MITCHELL
Secretary of Health and Mental Hygiene

 

Subtitle 05 FREESTANDING AMBULATORY CARE FACILITIES

10.05.01 General Requirements

Authority: Health-General Article, §19-3B-03, Annotated Code of Maryland

Notice of Proposed Action

[16-353-P]

The Secretary of Health and Mental Hygiene proposes to amend Regulation .08 under COMAR 10.05.01 General Requirements.

Statement of Purpose

The purpose of this action is to remove the outdated term “supervising physician” and replace it with “qualified health care practitioner”. The change in this proposal was identified as a result of a comprehensive and extensive review of COMAR 10.05.01 conducted by the Office of Health Care Quality (OHCQ) which included inviting comments from stakeholders, OHCQ surveyors, and other departments; posting a notification on OHCQ’s website; and sending out email notifications to approximately 300 stakeholders.

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 A. Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 W. 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 January 23, 2017. A public hearing has not been scheduled.

.08 Quality Assurance Program.

A.—B. (text unchanged)

C. Peer Review. The administrator shall ensure that the facility establishes a peer review process that includes:

(1) (text unchanged)

(2) Procedures, approved by a [supervising physician,] qualified health care practitioner to identify and minimize risks to the patient; and

(3) (text unchanged)

D.—G. (text unchanged)

VAN T. MITCHELL
Secretary of Health and Mental Hygiene

 

Subtitle 05 FREESTANDING AMBULATORY CARE FACILITIES

10.05.03 Freestanding Major Medical Equipment Facilities

Authority: Health-General Article, §19-3B-07, Annotated Code of Maryland

Notice of Proposed Action

[16-336-P]

The Secretary of Health and Mental Hygiene proposes to amend Regulation .04 under COMAR 10.05.03 Freestanding Major Medical Equipment Facilities.

Statement of Purpose

The purpose of this action is to remove the requirement for the Office of Health Care Quality to notify the licensee 5 days before conducting an on-site inspection thus allowing the Department to conduct on-site random sample survey reviews.

This was the only change identified as a result of a comprehensive and extensive review of COMAR 10.05.03 conducted by the Office of Health Care Quality (OHCQ) which included inviting comments from stakeholders, OHCQ surveyors, and other departments; posting a notification on OHCQ’s website; and sending out email notifications to approximately 300 stakeholders.

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 A. Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 W. 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 January 23, 2017. A public hearing has not been scheduled.

.04 Inspections by the Secretary.

A. The Secretary may verify compliance with licensing requirements through on-site random sample record reviews. [Unless there is an immediate threat to the health and safety of patients or employees, the Secretary shall notify the licensee 5 days before conducting an on-site inspection.]

B. (text unchanged)

VAN T. MITCHELL
Secretary of Health and Mental Hygiene

 

Notice of Proposed Action

[16-346-P]

The Secretary of Health and Mental Hygiene proposes to:

(1) Amend Regulations .01, .02, .17, and .18 under COMAR 10.06.01 Communicable Diseases and Related Conditions of Public Health Importance; and

(2) Repeal in their entirety Regulations .01—.03 under COMAR 10.18.04 Disease Control.

Statement of Purpose

The purpose of this action is to:

(1) Repeal the chapter on HIV/AIDS control in Subtitle 18 (COMAR 10.18.04);

(2) Add HIV/AIDS control content to COMAR 10.06.01.17 which currently addresses syphilis control;

(3) Update wording to use “individual” rather than “person” when referring to a human being and not an entity that could be a human being or a corporation and to use the phrase “sexually transmitted infection” rather than “sexually transmitted disease”;

(4) Update the time frame in which a physician shall report to the health officer an individual receiving treatment for or under medical observation for syphilis in an infectious stage from “immediately” to “within 1 working day” to maintain consistency with the information in the table found in COMAR 10.06.01.03;

(5) Add email addresses to the list of information that a physician shall endeavor to ascertain about those whom a patient with syphilis or HIV has potentially had infectious contact with;

(6) Remove language detailing isolation of the reported person as an action to be taken to protect the public health against a person not examined by a physician for infection with HIV/AIDS or syphilis within one week after notification of their exposure to the disease; and

(7) Remove “by a licensed physician” from the text stating that that a reported individual shall be examined to ascertain whether they have been infected with syphilis and HIV/AIDS.

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 January 23, 2017. A public hearing has not been scheduled.

 

Subtitle 06 DISEASES

10.06.01 Communicable Diseases and Related Conditions of Public Health Importance

Authority: Health-General Article, §§2-104(b), 18-102, 18-103, 18-105,
18-201, 18.201.1, 18-202, 18-205, 18-208, 18-214.1, 18-307, 18-337, and
2
4-101—24-110, Annotated Code of Maryland

.01 Scope.

A. This chapter does not apply to human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) surveillance, reporting, record maintenance, or confidentiality, which [is] are covered by COMAR [10.18] 10.18.02 and 10.18.03.

B. This chapter applies to human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) control.

[B.] C. This chapter provides regulations for [cooperative] coordinated control efforts for communicable [disease] diseases and related [condition control] conditions by the Department, local health officers, medical laboratory directors, physicians, veterinarians, and other Maryland governmental agencies, as guided by policy statements such as:

(1)—(2) (text unchanged)

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1) (text unchanged)

(2) “Case” means an individual who has laboratory or clinical evidence of being infected by an infectious agent.

[(2)] (3) (text unchanged)

[(3) “Case” or “case of a disease” means an individual who has laboratory or clinical evidence of being infected by an infectious agent. A case may or may not have symptoms of the infection.]

(4)—(25) (text unchanged)

(26) “Sexually transmitted [disease or] infection” means an infection which may be spread by sexual intercourse [or other forms of sexual contact with an infected individual, including a disease or condition classified as a venereal disease], including oral, anal, or vaginal sexual contact with an infected individual.

(27)—(29) (text unchanged)

.17 [Sexually Transmitted Disease —] Syphilis and HIV.

A. Control of a Case.

(1) [A] For an individual who appears to have or who has syphilis in a stage which is or may become communicable, or HIV, a physician [in attendance upon an individual who appears to have, or who has, syphilis in a stage which is or may become communicable,] shall instruct the individual in the use of any measure[,] and render any treatment which may be necessary to prevent the spread of the disease.

(2) An individual under medical observation for diagnosis [or under treatment for] of syphilis or HIV shall remain under medical supervision until the:

(a) (text unchanged)

(b) Syphilis or HIV, if present, has been reported to the health officer; [and]

(c) [Person] Individual with syphilis has had the treatment that is necessary for the protection of the public health[.]; and

(d) Individual with HIV has entered into HIV medical care.

(3) A physician [in attendance] shall report to the health officer [immediately] within 1 working day and in writing the name and address of an individual who is:

(a) (text unchanged)

(b) Under medical observation for diagnosis or treatment of syphilis in an infectious or potentially infectious stage, who fails to return for observation or treatment within 1 week of the date of a missed appointment, and is not known to the attending physician to be under medical observation or treatment elsewhere for this [disease] infection.

(4) A health officer shall:

(a) Investigate [a person] an individual reported to the health officer under the provisions of [§A(3)(b)] §A(3) of this regulation or Health-General Article, §18-201.1, Annotated Code of Maryland, who is within the health officer’s territorial jurisdiction;

(b) Take such measures [, which may include isolation at home or in a hospital or other institution,] as may be deemed necessary for the protection of the public health; and

(c) Forward to the Secretary immediately a report of [a person] an individual reported under the provisions of [§A(3)(b)] §A of this regulation or Health-General Article, §18-201.1, Annotated Code of Maryland, who is outside the health officer’s territorial jurisdiction for referral to the health officer of the proper jurisdiction.

B. Control of Contacts.

(1) A physician in attendance upon a patient having syphilis [shall] or HIV:

(a) [Endeavor] Shall endeavor to bring an individual with whom the patient has had potentially infectious contact to examination and [epidemiologic treatment], as appropriate, prophylaxis by:

(i) Requesting the health officer to conduct a contact investigation of any case of syphilis[,] or HIV; or

(ii) Interviewing the patient in order to ascertain the names, descriptions, addresses, [and] telephone numbers, and email addresses of those with whom the patient has had potentially infectious contact; [and]

(b) [Report] Shall report immediately to the health officer [any untreated] an individual identified as having had potentially infectious contact with [an individual] a patient having syphilis reported under the provisions of §A(3) of this regulation; and

(c) May report to the health officer an individual identified as having had potentially infectious contact with a patient having HIV reported under Health-General Article, §18-201.1, Annotated Code of Maryland, if a patient that has been informed of the patient’s HIV positive status refuses to notify the patient’s sexual and needle-sharing partners.

(2) A health officer shall:

(a) Investigate and notify immediately an individual reported under the provisions of §B(1)(b) of this regulation, who is within the health officer’s jurisdiction, [to submit to] of the individual’s exposure and advise the individual to undergo a medical examination to ascertain whether the individual is infected with syphilis or HIV; and

(b) Forward immediately to the Secretary all reports of [persons] individuals who are outside the health officer’s territorial jurisdiction for referral to the health officer of the proper jurisdiction[; and.

(c) Take action to protect the public health against a person who is not examined by a licensed physician for infection with this disease within 1 week after notification. This action may include isolation of the reported person at home or in a hospital or other institution].

(3) A reported individual shall:

(a) Within 1 week of notification, be examined [by a licensed physician] to ascertain whether the individual has been infected with syphilis or HIV; and

(b) (text unchanged)

C.—D. (text unchanged)

.18 Other Sexually Transmitted [Diseases] Infections.

A. (text unchanged)

B. Control of Contacts.

(1) (text unchanged)

(2) A physician in attendance upon [a person] an individual who is a sexual contact of a case of a sexually transmitted [disease] infection shall perform a medical examination and render indicated treatment.

C. (text unchanged)

VAN T. MITCHELL
Secretary of Health and Mental Hygiene

 

Subtitle 07 HOSPITALS

10.07.01 Acute General Hospitals and Special Hospitals

Authority: Health-General Article, §§19-308 and 19-308.6; Public Safety Article, §14-110.1; Annotated Code of Maryland

Notice of Proposed Action

[16-334-P]

The Secretary of Health and Mental Hygiene proposes to amend Regulation .01 and adopt new Regulation .31 under COMAR 10.07.01 Acute General Hospitals and Special Hospitals.

Statement of Purpose

The purpose of this action is to establish minimum regulatory standards that reflect a consensus on quality practices for palliative care programs within Maryland’s hospitals. The standards are primarily based on recommendations generated from a report developed by the Maryland Health Care Commission in collaboration with the Office of Health Care Quality. This regulatory action is required by Health-General Article, §19–308.9, Annotated Code of Maryland.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. Through research and a pilot study, the Maryland Health Care Commission (MHCC) drafted a report providing cost estimates of implementing a palliative care program. The Office of Health Care Quality (OHCQ) utilized the 2015 MHCC report to determine the estimated cost for a large and a small hospital to implement a palliative care program. The report stated that 31 hospitals had such a program. OHCQ subtracted the number of hospitals the MHCC report identified as having a program from the total number of hospitals with 50 or more beds and determined that there were 10 hospitals remaining that would need to establish a palliative care program. These 10 hospitals were further broken down by the number of beds that are likely to need palliative care services. OHCQ estimates that a hospital with 60 or fewer beds would be able to meet the requirement by implementing a part-time palliative care program, while a hospital with 60 or more beds might require a full-time program. OHCQ estimates the costs to implement a palliative care program include utilizing the following staff: a physician, a nurse practitioner, and a social worker.

 

 

Revenue (R+/R-)

 

II. Types of Economic Impact.

Expenditure (E+/E-)

Magnitude

 


A. On issuing agency:

NONE

B. On other State agencies:

NONE

C. On local governments:

NONE

 

 

Benefit (+)
Cost (-)

Magnitude

 


D. On regulated industries or trade groups:

Affected hospitals

(-)

$2,100,000

E. On other industries or trade groups:

Physician, nurse practitioners, and social workers

(+)

$2,100,000

F. Direct and indirect effects on public:

NONE

III. Assumptions. (Identified by Impact Letter and Number from Section II.)

D. and E. The estimated implementation cost to hospitals has been determined by adding the following:

6 small hospitals × $150,000 cost for part-time palliative care program = $900,000

4 large hospitals × $300,000 cost for full-time palliative care program = $1,200,000

Estimated implementation cost:

Cost to small hospitals ($900,000) + Cost to large hospitals ($1,200,000) = $2,100,000

Trade group and industries will benefit as the implementation of 10 additional palliative care programs will provide additional employment opportunities.

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 January 23, 2017. A public hearing has not been scheduled.

.01 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)—(6) (text unchanged)

(7) “Authorized decision maker” means the health care agent, guardian of the person, or surrogate decision maker who is making health care decisions on behalf of a patient in accordance with the Health Care Decisions Act, Health-General Article, §§5-601—5-618, Annotated Code of Maryland.

[(6-1)] (8)[(18)] (21) (text unchanged)

(22) “Medical Orders for Life Sustaining Treatment (MOLST) form” means the form required to be developed pursuant to Health-General Article, §5-608.1, Annotated Code of Maryland.

[(19)] (23)[(21)] (25) ( text unchanged)

(26) “Palliative care” means specialized medical care for individuals with serious illnesses or conditions that:

(a) Is focused on providing patients with relief from the symptoms, pain, and stress of a serious illness or condition, whatever the diagnosis;

(b) Has the goal of improving quality of life for the patient, the patient’s family, and other caregivers;

(c) Is provided at any age and at any stage in a serious illness or condition; and

(d) Can be provided along with curative treatment.

(27) “Palliative care program” means an interdisciplinary team that provides palliative care services.

[(22)] (28)[(29)] (37) (text unchanged)

.31 Hospital Palliative Care Programs.

A. Acute general hospitals and special hospitals-chronic care with 50 or more beds shall establish an active hospitalwide palliative care program that provides consultation services to patients suffering from pain and symptoms due to serious illnesses or conditions.

B. The hospital shall:

(1) Promote the palliative care program;

(2) Provide information and referrals to patients and families when appropriate regarding the availability of palliative care services; and

(3) Inform patients of the patient’s right to request a palliative care consultation.

C. Staffing.

(1) The hospital shall designate a qualified interdisciplinary care team with training in palliative care to staff the palliative care program.

(2) The hospital shall ensure that:

(a) A qualified health care professional coordinates the activities of the palliative care program with the palliative care patient’s interdisciplinary care team;

(b) Staff is appropriately trained, credentialed, or certified in the staff’s area of expertise;

(c) Staff receives continuing training and education; and

(d) Written policies and procedures for the hospital palliative care program are established, implemented, maintained, and updated periodically.

D. Palliative Care Education and Training. The hospital shall provide and document training to medical and other clinical staff as determined by the hospital regarding:

(1) Services provided by the palliative care program;

(2) Domains of palliative care; and

(3) Legal requirements for:

(a) Health care decisions; and

(b) MOLST as referenced in COMAR 10.01.21.

E. Interdisciplinary Plan of Care.

(1) The hospital shall incorporate the recommendations of the palliative care program into the palliative care patient’s interdisciplinary care plan.

(2) The hospital shall review the interdisciplinary plan of care and revise it as necessary to meet the needs of the palliative care patient.

(3) The palliative care program shall conduct care conferences as appropriate to review the plan of care with:

(a) The palliative care patient;

(b) The palliative care patient’s family;

(c) The health care professionals; and

(d) Other interdisciplinary team members.

(4) Contents. The hospital shall ensure that the palliative care patient’s plan of care includes at a minimum:

(a) Initial assessments conducted by the interdisciplinary palliative care team;

(b) Psychological needs assessment;

(c) Treatment goals;

(d) Choice of treatment options;

(e) Preferred care setting;

(f) Preferred site of death and after-death arrangements, as appropriate;

(g) Grief and bereavement plan, as appropriate;

(h) Assessment of cultural needs;

(i) Assessment of legal needs; and

(j) Assessment of discharge needs.

(5) Collaboration. The hospital shall document and provide palliative care services in collaboration with:

(a) The attending physician; and

(b) Any other health care provider managing the patient’s care.

(6) Continuity of Care. The hospital shall coordinate services to ensure continuity of care for the palliative care patient. The hospital shall:

(a) Transfer the pertinent parts of the medical record, medical orders, and plan of care with the palliative care patient upon transfer to post-acute care;

(b) Ensure that MOLST forms are completed in accordance with COMAR 10.01.21;

(c) Convert a palliative care patient’s treatment goals into medical orders, as appropriate; and

(d) Have reporting mechanisms to keep all staff informed and updated about care changes and treatment goals.

F. Palliative Care Services.

(1) The hospital or palliative care program shall counsel the palliative care patient or the patient’s authorized decision maker regarding:

(a) Health options;

(b) Pain management options;

(c) Prognosis;

(d) Risks and benefits of treatment;

(e) Availability of grief and bereavement services, as appropriate;

(f) Psychological services;

(g) Availability of spiritual care counseling through the hospital or outpatient providers; and

(h) Hospice services, as appropriate.

(2) Referrals.

(a) As appropriate and upon request by the patient or authorized decision maker, the hospital may make timely referrals.

(b) The hospital shall document any referrals made to:

(i) Inpatient or outpatient bereavement providers;

(ii) Psychological services for the palliative care patient and the patient’s family;

(iii) Inpatient or outpatient spiritual care services; and

(iv) Hospice.

(3) Pain and Symptom Management. The hospital shall:

(a) Conduct and document pain and symptom assessments using available standardized scales to appropriately manage a palliative care patient’s symptoms;

(b) Provide adequate and appropriate dosage of analgesics and sedatives to meet the needs of the palliative care patient; and

(c) Educate the patient and the patient’s family about the use of opioids during end-of-life care.

(4) Other Services. The hospital shall provide culturally and linguistically appropriate education and support about how to safely care for the patient at home or in an alternate residential setting as appropriate.

(5) Imminent Death. The palliative care program shall document and counsel the patient, the authorized decision maker, the patient’s family, and the interdisciplinary care team about the active dying phase and imminent death as appropriate.

(6) MOLST. The hospital shall comply with the procedures and requirements of the Medical Orders for Life-Sustaining Treatment Form, which is incorporated by reference at COMAR 10.07.21.

(7) Interpreter Services. The hospital shall ensure interpreter services are available and accessible to the palliative care program.

G. Advance Directives.

(1) The hospital shall recognize the authority of:

(a) An advance directive established in compliance with Health-General Article, §5-602, Annotated Code of Maryland; and

(b) An authorized decision maker.

(2) The hospital shall ensure that any provided advance directive and authorized decision maker designation are in the patient’s medical record, including the electronic medical record.

(3) The hospital shall promote advance care planning and the completion of advance directives through community outreach activities.

H. Ethics Committee. The hospital shall allow staff, patients, and the patient’s family in the palliative care program access to an ethics committee to address ethical conflicts at the end of life.

I. Quality Improvement. The palliative care program shall take part in the hospital’s quality improvement and performance improvement activities to the extent required by State and federal statute.

J. Departmental Oversight. The Department shall have access to all data maintained through the hospital’s palliative care program to determine the hospital’s compliance with State and federal regulations.

VAN T. MITCHELL
Secretary of Health and Mental Hygiene

 

Subtitle 09 MEDICAL CARE PROGRAMS

Notice of Proposed Action

[16-337-P]

The Secretary of Health and Mental Hygiene proposes to:

(1) Repeal in their entirety existing Regulations .01—10 under existing COMAR 10.09.01 Nurse Practitioner Services and adopt new Regulations .01—.08 under a new chapter, COMAR 10.09.01 Advanced Practice Nurse Services;

(2) Repeal in their entirety existing Regulations .01—.11 under COMAR 10.09.21 Nurse Midwife Services; and

(3) Repeal in their entirety existing Regulations .01—.10 under COMAR 10.09.39 Nurse Anesthetist Services.

Statement of Purpose

The purpose of this action is to adopt new streamlined regulations pertaining to advanced practice nurses under one chapter.

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 January 23, 2017. A public hearing has not been scheduled.

 

10.09.01 Advanced Practice Nurse Services

Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland

.01 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) “Advanced practice nurse” means a:

(a) Certified nurse practitioner;

(b) Certified nurse midwife; or

(c) Certified registered nurse anesthetist.

(2) “American College of Nurse-Midwives (ACNM)” means the private professional organization which:

(a) Sets the standards nationwide for the education and practice of nurse midwives; and

(b) Certifies, by examination, those who have completed the approved educational program.

(3) “Board” means the Maryland State Board of Nursing.

(4) “Certified nurse midwife (CNM)” means a registered nurse who is:

(a) Certified by the Board to practice nurse midwifery; and

(b) Certified by the American College of Nurse-Midwives.

(5) “Certified nurse practitioner” means:

(a) A registered nurse who, by reason of certification under COMAR 10.27.07, may practice in Maryland as a nurse practitioner under the terms of that chapter; or

(b) If out-of-State, a registered nurse who qualifies as a nurse practitioner in the state in which services are provided.

(6) “Certified registered nurse anesthetist (CRNA)” means a registered nurse who is certified to practice nurse anesthesia by the Board.

(7) “Department” means the Department of Health and Mental Hygiene, as defined in COMAR 10.09.36.01.

(8) “Newborn” means an infant who is not more than 48 hours old.

(9) “Nurse midwifery” means the health care management of newborns and women throughout their reproductive life cycle.

(10) “Participant” means an individual who is certified as eligible for, and is receiving Medical Assistance benefits.

(11) “Physician” means an individual who meets the licensure requirements and conditions of participation of COMAR 10.09.02.

(12) “Program” means the Maryland Medical Assistance Program.

(13) “Provider” means an advanced practice nurse who, through appropriate agreement with the Department, has been identified as a Program provider by the issuance of a provider number.

.02 License and Certification Requirements.

A. The provider shall meet all license requirements as set forth in COMAR 10.09.36.02.

B. A certified nurse practitioner applying for provider status shall:

(1) Hold a current license to practice registered nursing in Maryland and be certified as a nurse practitioner by the Board; or

(2) Meet the nurse practitioner regulatory requirements of the state in which the services are provided.

C. A certified nurse midwife applying for provider status shall:

(1) Hold a current license to practice registered nursing in Maryland, be certified as a nurse midwife by the American College of Nurse-Midwives, and be in compliance with requirements to practice nurse midwifery established by the Board; or

(2) Meet the nurse midwife regulatory requirements of the state in which the services are provided.

D. A certified registered nurse anesthetist applying for provider status shall:

(1) Hold a current license to practice registered nursing in Maryland and meet the requirements of the Board as set forth in COMAR 10.27.06; or

(2) Meet the nurse anesthetist regulatory requirements of the state in which the services are provided.

.03 Conditions for Participation.

A. A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03.

B. An advanced practice nurse may not knowingly employ or contract with a person, partnership, or corporation which the Program has disqualified from providing or supplying services to Program participants.

.04 Covered Services.

A. Subject to §B of this regulation, the Program covers medically necessary services rendered to participants as follows:

(1) For nurse practitioners:

(a) Medically necessary services within the provider’s scope of practice as described in COMAR 10.27.07; or

(b) If out-of-State, nurse practitioners’ services authorized in the state in which the services are provided;

(2) For nurse midwives:

(a) Medically necessary services within the provider’s scope of practice as described in COMAR 10.27.05; or

(b) If out-of-State, nurse midwives’ services authorized in the state in which the services are provided;

(3) For nurse anesthetists:

(a) Medically necessary services within the provider’s scope of practice as described in COMAR 10.27.06; or

(b) If out-of-State, nurse anesthetists’ services authorized in the state in which the services are provided;

(4) Laboratory services when the advanced practice nurse is not required to register their office as a medical laboratory pursuant to Health-General Article, Title 17, Subtitle 2, Annotated Code of Maryland; and

(5) Drugs and supplies within the nurse’s scope of practice.

B. The services in §A of this regulation shall be:

(1) Clearly related to the participant’s medical needs; and

(2) Described in the participant’s medical record in sufficient detail to support the invoice submitted for those services.

.05 Limitations.

The Program does not cover the following under this chapter:

A. Services not medically necessary;

B. Services prohibited by the Maryland Nurse Practice Act or by the Board;

C. Advanced practice nursing services included as part of the cost of:

(1) An inpatient facility;

(2) A hospital outpatient department; or

(3) A freestanding clinic;

D. Visits by or to the provider solely for the purpose of the following:

(1) Prescription, drug, or food supplement pick-up;

(2) Recording of an electrocardiogram;

(3) Ascertaining the patient’s weight;

(4) Interpretation of laboratory tests or panels; or

(5) Prescribing or administering medication;

E. Drugs and supplies which are acquired by the provider at no cost;

F. Injections and visits solely for the administration of injections, unless medical necessity and the patient’s inability to take oral medications are documented in the patient’s medical record;

G. More than one visit per day unless adequately documented as an emergency situation;

H. Services paid under the free-standing dialysis program as described in COMAR 10.09.22;

I. Immunizations required for travel outside the continental United States;

J. Prescriptions and injections for central nervous system stimulants and anorectic agents when used for weight control;

K. Acupuncture;

L. Hypnosis;

M. Travel expenses;

N. Investigational or experimental drugs and procedures;

O. Services denied by Medicare as not medically justified;

P. Specimen collection, except by venipuncture and capillary or arterial puncture, as a separate service;

Q. Those laboratory or X-ray services performed by another facility, which shall be billed to the Program directly by the facility; and

R. For certified nurse midwives, a separate visit charge on date of delivery.

.06 Payment Procedures.

A. The provider shall submit the request for payment in the format designated by the Department.

B. The Department reserves the right to return to the provider, before payment, all requests for payment not properly completed.

C. The provider shall charge the Program the provider’s:

(1) Customary charge to the general public for similar services; and

(2) Acquisition cost for injectable drugs or dispensed medical supplies.

D. The provider shall be paid the lesser of:

(1) The provider’s customary charge to the general public unless the service is free to individuals not covered by Medicaid; or

(2) The Medicaid rates as described in COMAR 10.09.02.07.

E. If a service is free to individuals not covered by Medicaid:

(1) The provider:

(a) May charge the Program; and

(b) Shall be reimbursed in accordance with §D of this regulation; and

(2) The provider’s reimbursement is not limited to the provider’s customary charge.

F. Payments on Medicare claims are authorized, if:

(1) Services are covered by the Program;

(2) The provider accepts Medicare assignments;

(3) Medicare makes direct payment to the provider;

(4) Medicare has determined that services were medically justified; and

(5) Initial billing is made directly to Medicare according to Medicare guidelines.

G. The Department shall make supplemental payments on Medicare claims subject to the following provisions:

(1) Deductible insurance shall be paid in full; and

(2) Coinsurance shall be paid at the lesser of:

(a) 100 percent of the coinsurance amount; or

(b) The balance remaining after the Medicare payment is subtracted from the Medicaid rate.

H. The provider may not bill the Program for:

(1) Completion of forms and reports;

(2) Broken or missed appointments; or

(3) Professional services rendered by mail or telephone.

I. The Program may not make direct payment to recipients.

J. Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.

K. The Program shall reimburse for all medical laboratory services according to the fees established under COMAR 10.09.09.

L. An advanced practice nurse who is employed by or under contract to any physician, clinic, or hospital may not bill for any service for which reimbursement is sought by the physician, clinic, or hospital.

M. The Program may not reimburse nurse midwives for prenatal or postpartum care once the patient has been referred to a physician for completion of prenatal or postpartum care.

.07 Recovery and Reimbursement.

Recovery and reimbursement are as set forth in COMAR 10.09.36.07.

.08 Causes for Suspension or Removal and Imposition of Sanctions.

Causes for suspension or removal and imposition of sanctions are as set forth in COMAR 10.09.36.08.

VAN T. MITCHELL
Secretary of Health and Mental Hygiene

 

Subtitle 09 MEDICAL CARE PROGRAMS

Notice of Proposed Action

[16-332-P]

The Secretary of Health and Mental Hygiene proposes to:

(1) Repeal Regulations .01—.18 under COMAR 10.09.06 Hospital Services;

(2) Adopt new Regulations .01—.14 under a new chapter, COMAR 10.09.92 Acute Hospitals;

(3) Adopt new Regulations .01—.16 under a new chapter, COMAR 10.09.93 Chronic Hospitals;

(4) Adopt new Regulations .01—.13 under a new chapter, COMAR 10.09.94 Special Pediatric Hospitals; and

(5) Adopt new Regulations .01—.13 under a new chapter, COMAR 10.09.95 Special Psychiatric Hospitals.

Statement of Purpose

The purpose of this action is to replace in its entirety the Hospital Services chapter and create separate chapters for Acute, Chronic, Special Pediatric and Special Psychiatric Hospitals, respectively.

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 January 23, 2017. A public hearing has not been scheduled.

 

10.09.92 Acute Hospitals

Authority: Health-General Article, §§2-104(b), 15-102.8, 15-103, and 15-105, Annotated Code of Maryland

.01 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) “Acute hospital” means an institution that provides active, short-term medical diagnosis, treatment, and care.

(2) “Acute level of care” means care in which a patient is treated:

(a) For a brief but severe episode of illness, for conditions that are the result of disease or trauma; and

(b) During recovery from surgery.

(3) “Acute rehabilitation hospital” means an institution devoted to therapy that is designed to facilitate the process of recovery from illness or injury for patients with various neurological, muscular-skeletal, orthopedic, and other medical conditions following stabilization of acute medical issues.

(4) “Administrative day” means a day of medical services delivered to a participant who no longer requires an acute level of care.

(5) “Administrative services organization (ASO)” means an organization with which the Department contracts to assist in the management and operation of the Maryland Public Behavioral Health System.

(6) “Admission” means the formal acceptance by a hospital of a participant who is to be provided with room, board, and medically necessary services in an area of the hospital where patients stay at least overnight.

(7) “Ancillary services” means diagnostic and therapeutic services, including but not limited to radiology, laboratory tests, pharmacy, and physical therapy services, provided exclusive of room and board.

(8) “Concurrent review” means a periodic reauthorization of continued medical eligibility for the level of services provided in an acute hospital which allows for close monitoring of the participant’s progress, treatment goals, and objectives during an inpatient hospitalization.

(9) “Date of service” means:

(a) For inpatient hospitalizations, the date of admission into an acute hospital up to, but not including, the date of discharge;

(b) For outpatient services, the date services are rendered in the outpatient department of the hospital;

(c) For emergency services, the date or dates the services are rendered in the emergency department of an acute hospital; or

(d) For observation services, the date or dates the services are rendered in an acute hospital.

(10) “Department” means the Maryland Department of Health and Mental Hygiene, which is the single State agency designated to administer the Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.

(11) “Designee” means any entity designated to act on behalf of the Department.

(12) “Diagnosis-related group” means a participant classification system adopted by the U.S. Department of Health and Human Services, in which each hospital discharge case is assigned a category based on the primary diagnosis, secondary diagnoses (if any), procedures performed, age, sex, and discharge status of the participant.

(13) “Electronic signature” means a secure electronic identification of an individual who authorizes an electronic record or transaction.

(14) “Emergency department” means the area in a hospital that is designed, staffed, and equipped to provide prompt treatment to individuals requiring immediate medical care for acute illness, trauma, and other medical conditions.

(15) “Emergency services” means any health care service provided to evaluate and treat any medical condition where immediate, unscheduled medical care is required.

(16) “Emergent condition” means a disease, illness, or injury characterized by sudden onset and symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent layperson, who possesses an average knowledge of health and medicine, to result in:

(a) Placing the participant’s health or, with respect to a pregnant woman, the health of the woman or unborn child in serious jeopardy;

(b) Serious impairment of bodily functions; or

(c) Serious dysfunction of any bodily organ or part.

(17) “Freestanding medical facility” means a facility:

(a) In which medical and health services are provided;

(b) That is physically separate from a hospital or hospital grounds; and

(c) That is an administrative part of a hospital or related institution.

(18) “Health Services Cost Review Commission (HSCRC)” means the independent organization within the Department of Health and Mental Hygiene which is responsible for reviewing and approving rates for hospitals pursuant to Health-General Article, Title 19, Subtitle 2, Annotated Code of Maryland.

(19) “Maryland Medical Assistance Program” means the program of comprehensive medical and other health-related care for indigent and medically indigent individuals.

(20) “Medically necessary” means that the service or benefit is:

(a) Directly related to diagnostic, preventative, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;

(b) Consistent with standards of good medical practice;

(c) The most cost-efficient service that can be provided without sacrificing effectiveness or access to care; and

(d) Not primarily for the convenience of the participant, family, or provider.

(21) “Medicare” means the medical insurance program administered by the federal government under Title XVIII of the Social Security Act, 42 U.S.C. §1395 et seq.

(22) “Nonqualified alien” means a foreign-born resident who:

(a) Is not a naturalized U.S. citizen; and

(b) Is eligible for federal Medical Assistance coverage of only emergency medical services, as specified under COMAR 10.09.24.05-2A.

(23) “Observation services” means the medically necessary services used to assess the participant’s outpatient condition to determine the need for possible admission to an inpatient acute care setting.

(24) “Organ” means a part of an organism that is typically self-contained and has a specific vital function, such as a heart or liver.

(25) “Out-of-State hospital” means any hospital outside of Maryland, except for hospitals located in the District of Columbia.

(26) “Outpatient services” means nonemergency services provided to the participant on the hospital campus that do not require hospital admission.

(27) “Participant” means an individual who is enrolled with the Department to receive Medical Assistance services.

(28) “Patient” means an individual awaiting or undergoing health care or treatment.

(29) “Preauthorization” means the approval required from the Department or its designee before a service can be rendered by the provider and reimbursed.

(30) “Preoperative day” means an inpatient day in an acute hospital before:

(a) Surgery for a participant who is being admitted for surgery; or

(b) A surgical procedure when the participant was admitted for a nonsurgical procedure but the need for surgery arose during that stay.

(31) “Program” means the Maryland Medical Assistance Program.

(32) “Prospective payment system” means a predetermined amount of reimbursement per day for inpatient hospital services.

(33) “Provider” means an acute hospital which, through agreement with the Department, has been identified as a Program provider by the issuance of a provider number.

(34) “Retrospective review” means the process of determining medical necessity of an inpatient admission after the participant has been discharged from the hospital.

(35) “Specialty behavioral health” means services as defined in COMAR 10.09.70.02D and F.

.02 License Requirements.

A. In order to participate in the Program, a provider shall:

(1) Be licensed as a hospital by the Department pursuant to Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland; and

(2) Obtain other licenses, as set forth in COMAR 10.07.01.

B. The provider shall ensure that Clinical Laboratory Improvement Amendments (CLIA) certification exists for all clinical laboratory services performed, and:

(1) If located in Maryland, comply with requirements of:

(a) Health-General Article, Title 17, Subtitles 2 and 3, Annotated Code of Maryland; and

(b) COMAR 10.10.01; or

(2) If located out-of-State, comply with:

(a) All applicable standards established by the state or locality in which the service is provided; and

(b) The requirements of COMAR 10.09.09.02.

.03 Conditions for Participation.

A. A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03.

B. To participate in the Program as an acute hospital services provider, the provider shall:

(1) Meet the requirements of Title XIX of the Social Security Act for participation as a hospital, as issued by the Department of Health and Human Services;

(2) Directly provide or make available through contractual arrangements or transfer agreements, medically necessary covered services;

(3) Accept payment by the Program as payment in full for the covered service;

(4) Make available to the Department or its designee the participant’s medical record for review and certification of medical necessity for admission and continuation of stay;

(5) Maintain documentation of each contact with the participant as part of the complete medical record, which, at a minimum, includes:

(a) Date of service;

(b) The participant’s chief medical complaint or reason for visit;

(c) A description of the services provided, including:

(i) Progress notes;

(ii) Imaging studies;

(iii) Laboratory results;

(iv) Medication administration records; and

(v) Discharge summary; and

(d) A signature, electronic or handwritten, along with the printed or typed name of the individual providing care, with the appropriate title; and

(6) If the hospital provider is the only hospital within the county, participate with each participating HealthChoice Managed Care Organization in the county.

C. If an out-of-State or District of Columbia hospital, the hospital shall:

(1) Unless a waiver has been granted by the Secretary of Health and Human Services, have in effect a utilization review plan applicable to all participants who receive Medical Assistance under Title XVII of the Social Security Act which meets the requirements of §1861(k) of the Social Security Act; and

(2) Comply with applicable regulations of this chapter and COMAR 10.09.36.

.04 Covered Services.

A. The Program covers the services listed in §B of this regulation according to the conditions and requirements indicated.

B. The Program covers the following hospital services:

(1) Medically necessary emergency services as defined in COMAR 10.09.36.01, including triage, related ancillary services, and when necessary, observation stays of a participant who presents to a hospital emergency department;

(2) Medically necessary services performed in an outpatient department of a hospital;

(3) Medically necessary services performed at a freestanding medical facility;

(4) Medically necessary inpatient hospital services meeting the following criteria:

(a) Inpatient days, including preoperative days, determined to be medically necessary by the Department or its designee;

(b) Admissions from an emergency department resulting in a medically necessary inpatient stay; and

(c) Elective admissions that the Department or its designee determines to be medically necessary;

(5) Inpatient stays determined to be medically necessary due to an emergent condition by the Department or its designee for a nonqualified alien;

(6) Administrative days determined to be necessary by the Department or its designee; and

(7) Medically necessary services performed in an acute rehabilitation hospital when the participant meets the following criteria at the time of admission:

(a) Requires active and ongoing therapeutic intervention of multiple therapy disciplines, one of which shall be physical or occupational therapy;

(b) Requires and can reasonably be expected to actively participate in, and benefit from, the therapy, which generally consists of:

(i) At least 3 hours of therapy a day, at least 5 days a week; or

(ii) In well-documented cases, at least 15 hours of intensive rehabilitation therapy within a 7 day consecutive period;

(c) Is sufficiently stable to be able to actively participate in the therapy program; and

(d) Requires supervision by a licensed physician, who has specialized training and experience in inpatient rehabilitation, which includes:

(i) Conducting face-to-face visits with the patient at least 3 days a week to assess the patient both medically and functionally; and

(ii) Modifying the course of treatment as needed to maximize the participant’s capacity to benefit from the rehabilitation process.

.05 Limitations.

The Program does not cover:

A. Hospital services, procedures, drugs, or hospital admissions that are investigational or experimental;

B. Hospital services denied by Medicare as not medically necessary;

C. Inpatient admissions or outpatient visits solely for the administration of injections, unless medical necessity and the participant’s inability to take appropriate oral medications is documented in the participant’s medical record;

D. Elective inpatient admissions without preauthorization;

E. Elective inpatient admissions from the emergency department for dialysis services that are the result of problems occurring with placement in a freestanding dialysis facility;

F. Outpatient visits for one or more of the following:

(1) Prescription drug or food supplement pick up;

(2) Collection of specimens for laboratory procedures;

(3) Recording of an electrocardiogram;

(4) Ascertaining the participant’s weight; and

(5) Administration of vaccines;

G. Interpretation of laboratory tests or panels;

H. Autopsies;

I. Weight control medications;

J. Care provided to a well newborn beyond the:

(1) Length of the mother’s stay for a normal obstetrical or uncomplicated caesarean section delivery; or

(2) First 4 days of the newborn’s life when the mother remains in the hospital due to other circumstances;

K. Telephones, televisions, or personal comfort items or services;

L. Duplicate care or services;

M. Elective admissions to hospitals outside of Maryland, except the District of Columbia, unless the Department or its designee determines that comparable services are not available in Maryland;

N. Inpatient and outpatient diagnostic and laboratory services not ordered by the attending physician or other practitioner;

O. Inpatient days provided in excess of the days approved by the Department or its designee;

P. Hospital laboratory tests which are coverable under COMAR 10.09.09, unless the specimen is obtained in the hospital for a participant receiving inpatient, outpatient, emergency department, or observation services; and

Q. Hospital services provided outside of the United States.

.06 Utilization Review.

A. Elective Inpatient Preauthorization Reviews.

(1) The hospital shall only request preauthorization for inpatient stays when such services:

(a) Cannot be provided on an outpatient basis; or

(b) Can only be provided in a facility that is licensed as an acute hospital.

(2) The hospital shall obtain preauthorization for elective inpatient admissions from the Department or its designee, before the participant is admitted, by providing the following information including, but not limited to:

(a) Participant’s medical history and physical;

(b) Doctor’s progress notes; and

(c) Sufficient clinical information or documentation that supports the medical necessity of the acute inpatient admission.

B. Concurrent Reviews.

(1) As long as the participant remains hospitalized, the Department or its designee shall perform concurrent reviews based on the participant’s diagnosis and medical condition.

(2) For emergency inpatient admissions that exceed more than 24 hours, the concurrent review process shall be initiated by the hospital within the first 48 hours of the admission, or by the next business day.

(3) For elective inpatient admissions, the hospital shall initiate the concurrent review process before the termination of days previously certified by the Department or its designee.

(4) The hospital shall forward sufficient clinical documentation to the Department or its designee that supports the need for continuing acute care. Documentation submitted shall include, but is not limited to:

(a) Current medical health status;

(b) Treatment received to date; and

(c) A proposed treatment plan for the continued stay.

C. Retrospective Reviews.

(1) The hospital shall request that the Department or its designee perform a retrospective review of an inpatient admission after the participant is discharged, to determine the medical necessity of the admission and stay.

(2) The hospital shall provide the following to the Department or its designee when requesting a retrospective review following discharge from an acute hospital. Documentation submitted shall include, but is not limited to:

(a) The participant’s complete medical record;

(b) The principal, secondary, and tertiary diagnoses; and

(c) All surgical procedure codes.

D. Reviews for Nonqualified Aliens. The Department or its designee reviews the admission and discharge summary of an emergency inpatient admission for a nonqualified alien to determine whether the inpatient hospital stay meets the emergent condition criteria as defined in COMAR 10.09.24.05-2A.

E. Reviews for Behavioral Health. The hospital shall contact the behavioral health ASO to request an authorization for all inpatient admissions that are described in COMAR 10.09.70.02D and F.

.07 Payment Procedures.

A. Reimbursement Principles for Acute Hospitals Located in Maryland.

(1) The Department will make no direct reimbursement to any State-operated hospital. The Department will claim federal fund recoveries from the U.S. Department of Health and Human Services for services to participants in State-operated hospitals.

(2) Acute hospitals located in Maryland that participate in the Program, shall charge the rates approved by the HSCRC and be reimbursed 94 percent pursuant to COMAR 10.37.10, except for administrative days.

(3) If the Program discontinues using rates which have been approved by HSCRC, the Program shall reimburse providers:

(a) According to Medicare standards and principles for retrospective cost reimbursement described in 42 CFR §413; or

(b) On the basis of charges if less than reasonable cost.

(4) The Department may not reimburse for the services of a hospital’s salaried or contractual physicians as a separate line item. Charges for these services should be included in the room and board rate or the appropriate ancillary service only, when HSCRC has included these salaries in the hospital’s costs.

(5) The Program shall reimburse room and board charges from the day of admission up to, but not including, the date of discharge from the hospital.

(6) The provider shall submit a request for payment according to procedures established by the Department.

(7) The Program reserves the right to return to the provider any invoice that is not properly completed.

(8) Payments on Medicare claims are authorized if:

(a) The provider accepts Medicare assignment;

(b) Medicare makes a direct payment to the provider;

(c) Medicare determined that services are medically necessary;

(d) The services are covered by the Program; and

(e) Initial billing is made directly to Medicare according to Medicare guidelines.

(9) The Department shall make a supplemental payment on Medicare claims as follows:

(a) Deductible and co-insurance shall be paid in accordance with the limits of this regulation; and

(b) Hospitals shall be paid subject to the HSCRC discounts, except in the case of a participant receiving hospital services in an out-of-State facility, in which case the deductible and co-insurance shall be paid in full.

(10) The provider shall not bill the Department or participant for:

(a) Completion of forms and reports;

(b) Broken or missed appointments;

(c) Services rendered by mail, telephone, or otherwise not in person, with the exception of telehealth services in accordance with COMAR 10.09.49; and

(d) Providing a copy of a participant’s medical record, when requested by another licensed provider on behalf of the participant.

(11) Billing time limitations are set forth in COMAR 10.09.36.06.

(12) Freestanding medical facilities are reimbursed by the Department at the rate set for the freestanding facility by HSCRC.

B. Reimbursement Principles for Out-of-State Hospitals.

(1) For hospitals outside of Maryland, excluding the District of Columbia, claims reflecting dates of service on or after October 1, 2009, shall be reimbursed at a rate that is 100 percent of the amount reimbursable by the host state’s Title XIX agency or the amount of the hospital’s actual charges in total, whichever is less.

(2) Out-of-State providers are responsible for reimbursing the Department or its designee for overpayments, in accordance with COMAR 10.09.36.07.

C. Reimbursement Principles for Administrative Days.

(1) The hospital shall be paid for administrative days that are requested at the time of retrospective review and that are authorized by the Department or its designee after review of the:

(a) Clinical documentation;

(b) Discharge plan indicating that the hospital was seeking placement for the participant on the administrative days requested; and

(c) Documentation that was submitted to the Department on the authorized form that shows placement activity occurred on each day claimed as an administrative day.

(2) To be paid for administrative days, for participants who are not ventilator dependent, the reimbursement amount shall be an estimated Statewide average of the Program nursing home payment rate as determined by the Department.

(3) A hospital is not eligible for administrative day reimbursement if the days have already been billed as acute days.

D. Reimbursement Principles for Freestanding Acute Rehabilitation Hospitals. For freestanding acute rehabilitation hospitals not approved by the Program for reimbursement according to HSCRC rates, the Department shall reimburse these hospitals using a prospective payment system.

.08 District of Columbia Hospital Reimbursement.

A. Inpatient Services Rate Calculation.

(1) A hospital in the District of Columbia shall:

(a) Bill its usual and customary charges; and

(b) Be reimbursed for covered services the lesser of its percentage of charges as calculated in §A(2) of this regulation or its charges.

(2) The percentage of charges in §A(1) of this regulation is the product of the following:

(a) The cost-to-charges percentage using only those costs of the hospital reported in the hospital’s most recent cost report as determined by the Program or its designee;

(b) The lesser of 100 percent or the cost-to-charge projection percentage which is:

(i) The hospital’s cost-to-charge ratio in its most recent cost report trended by its cost-to-charge ratio in the 2 prior years’ cost reports or, if 3 years of data are not available, the hospital’s cost-to-charge ratio in its most recent cost report divided by its cost-to-charge ratio in the prior year’s cost report; and

(ii) Applied from the midpoint of the report period used to develop the cost-to-charges percentage in §A(2)(a) of this regulation, to the midpoint of the prospective payment period;

(c) The percentage of the hospital’s costs which are efficiently and economically incurred as adjusted to reflect labor market differences between District of Columbia hospitals and Maryland hospitals; and

(d) The uncompensated care factor which is equal to:

(i) For pediatric hospitals with average lengths of stay less than 18 days, one plus two and a half times the quotient of the hospital’s uncompensated care divided by gross revenue; or

(ii) For all other hospitals, one plus the quotient of the hospital’s uncompensated care divided by gross revenue.

(3) Effective for dates of service starting July 1, 2012, and forward, the rate calculated for FY 2012 in accordance with §A(2) of this regulation shall be increased by 9 percent.

(4) A hospital in the District of Columbia shall be reimbursed for administrative days in accordance with Regulation .07C of this chapter.

(5) Efficiently and economically incurred District of Columbia hospitals’ costs are those costs which are:

(a) Less than or equal to the adjusted costs for the same all-participant, refined-diagnosis-related groups in Maryland hospitals;

(b) For hospitals with average lengths of stay of 18 days or more:

(i) Less than or equal to the adjusted cost for the same diagnosis-related groups in Maryland hospitals; and

(ii) Categorized into the following two age groups: younger than 18 years old, and 18 years old or older;

(c) Exclusive of:

(i) Maryland case charges greater than $500,000; and

(ii) District of Columbia hospital case charges greater than $500,000 times the ratio of the average charge of the District of Columbia hospital case divided by the average charge of the Maryland hospital case; and

(d) Derived from hospital costs as specified in this subsection.

(6) Maryland hospital costs are the hospitals’ charges reduced by the hospital-specific ratio of operating costs to gross charges as determined by the Program or designee.

(7) There may not be a year-end cost settlement.

B. Outpatient Services.

(1) A hospital located in the District of Columbia shall:

(a) Bill its usual and customary charges; and

(b) Be reimbursed for covered services the lesser of its percentage of charges as calculated in §B(2) of this regulation or its charges.

(2) The percentage of charges in §B(1) of this regulation is the product of:

(a) The cost-to-charges percentage using only those costs of the hospital reported in the hospital’s most recent cost report as determined by the Program or its designee; and

(b) The lesser of 100 percent or the cost-to-charge projection percentage which is:

(i) The hospital’s cost-to-charge ratio in its most recent cost report trended by its cost-to-charge ratio in the 2 prior years’ cost reports or, if 3 years of data are not available, the hospital’s cost-to-charge ratio in its most recent cost report divided by its cost-to-charge ratio in the prior year’s cost report; and

(ii) Applied from the midpoint of the report period used to develop the cost-to-charges percentage in §B(2)(a) of this regulation, to the midpoint of the prospective payment period.

(3) Effective for dates of service starting July 1, 2012, and forward, the rates calculated for FY 2012 in accordance with §B(2) of this regulation shall be increased by 9 percent.

(4) The analysis shall be performed by the Program or its designee.

(5) There may not be a year-end cost settlement.

(6) Outpatient reimbursement rates are implemented in conjunction with, and are applicable to, the same dates of service as inpatient rates.

C. Submitting Cost Reports.

(1) The provider shall submit to the Department or its designee, in the form prescribed, financial and statistical data within 5 months after the end of the provider’s fiscal year unless the Department grants the provider an extension or the provider discontinues participation in the Program.

(2) When reports are not received within 5 months and an extension has not been granted:

(a) For hospitals reimbursed in accordance with this regulation, the Program shall reduce the inpatient percentage of payment for that hospital by 5 percentage points, starting the calendar month after the calendar month in which the report is due, which will remain in effect until the report has been submitted, and there will be no refund; or

(b) For hospitals reimbursed according to Medicare standards and principles for retrospective cost reimbursement as described in 42 CFR §413, the Department shall:

(i) Withhold from the provider a maximum of 5 percent of the current monthly interim payment starting the calendar month after the calendar month in which the report is due and any subsequent calendar months until the report has been submitted; and

(ii) Refund withholdings at cost settlement.

(3) If a provider discontinues participation in the Program, financial and statistical data shall be submitted to the Department within 45 days after the effective date of termination.

(4) The Program shall grant an extension for submission of cost reports:

(a) Upon written request by the provider, setting forth the specific reasons for the request, if the Department determines, taking into consideration the totality of the circumstances, that the request is reasonable; or

(b) Concurrent with any extension granted to the hospital by Medicare, but not to exceed 60 days from the due date of cost reports.

(5) In addition to a reduction in payment percentage or withholding a percentage of interim payment pursuant to §C(2) of this regulation, when a report is not submitted by the last day of the 6th month after the end of the provider’s fiscal year and the provider has not received an extension, the Department may impose one or more sanctions as provided for in Regulation .12 of this chapter.

(6) When a report is not submitted by the last day of the 6th month after the end of the provider’s fiscal year or a report is submitted but the provider cannot furnish proper documentation to verify costs, the Department shall, if applicable, make final cost settlement for that fiscal year at a certain percentage of the last final per diem rates for which the Department has verified costs for that facility, provided that the rates established will not exceed the maximum per diem rates in effect when the facility’s costs were last settled.

(7) For purposes of §C(1)—(6) of this regulation, reports are considered received when the submitted reports are completed according to instructions issued by the Department or its designee.

(8) When a report is received after imposing a reduction as specified in §C(2)(a) of this regulation, the rate of reimbursement calculated using the latest cost report information shall be implemented starting with the 1st day of the 4th full calendar month after the month in which the report was received by the Program.

.09 Submitting Cost Reports for Freestanding Acute Rehabilitation Hospitals.

A. The provider shall submit to the Department or its designee, in the form prescribed, financial and statistical data within 5 months after the end of the provider’s fiscal year unless the Department grants the provider an extension or the provider discontinues participation in the Program.

B. For hospitals who do not submit reports within 5 months, for whom an extension has not been granted, and who are reimbursed according to Medicare standards and principles for retrospective cost reimbursement as described in 42 CFR §413, the Department shall:

(1) Withhold from the provider a maximum of 5 percent of the current monthly interim payment starting the calendar month after the calendar month in which the report is due and any subsequent calendar months until the report has been submitted; and

(2) Refund withholdings at cost settlement.

C. If a provider discontinues participation, financial and statistical data shall be submitted to the Department within 45 days after the effective date of termination.

D. The Program shall grant an extension for submission of cost reports:

(1) Upon written request by the provider, setting forth the specific reasons for the request, if the Department determines, taking into consideration the totality of the circumstances, that the request is reasonable; or

(2) Concurrent with any extension granted to the hospital by Medicare, but not to exceed 60 days from the due date of cost reports.

E. In addition to a reduction in payment percentage or withholding a percentage of interim payment pursuant to §B of this regulation, when a report is not submitted by the last day of the 6th month after the end of the provider’s fiscal year and the provider has not received an extension, the Department may impose one or more sanctions as provided for in Regulation .12 of this chapter.

F. When a report is not submitted by the last day of the 6th month after the end of the provider’s fiscal year or a report is submitted but the provider cannot furnish proper documentation to verify costs, the Department shall, if applicable, make final cost settlement for that fiscal year at a certain percentage of the last final per diem rates for which the Department has verified costs for that facility, provided that the rates established will not exceed the maximum per diem rates in effect when the facility’s costs were last settled.

G. For purposes of §§A—F of this regulation, reports are considered received when the submitted reports are completed according to instructions issued by the Department or its designee.

.10 Cost Settlement for Freestanding Acute Rehabilitation Hospitals.

A. Retrospective Cost Reimbursement for Freestanding Acute Rehabilitation Hospitals.

(1) An acute rehabilitation hospital not approved by the Program for reimbursement according to HSCRC rates shall be reimbursed according to Medicare standards and principles for retrospective cost reimbursement described in 42 CFR §413, or on the basis of charges if less than reasonable cost.

(2) In calculating retrospective cost reimbursement rates, the Department or its designee will deduct from the designated costs or group of costs those restricted contributions which are designated by the donor for paying certain provider operating costs, or groups of costs, or costs of specific groups of participants.

(3) When the cost, or group or groups of costs designated, cover services rendered to all participants, including Medical Assistance participants, operating costs applicable to all participants shall be reduced by the amount of the restricted grants, gifts, or income from endowments, thus resulting in a reduction of allowable costs.

(4) Final settlement for services in the provider’s fiscal year shall be determined based on Medicare retrospective cost principles found in 42 CFR §413, adjusted for Medicaid allowable costs. Allowable costs specific to the Program shall be limited to a base year cost per discharge increased by the applicable federal rate of increase times the number of Program discharges for that fiscal year.

(5) Base Year. For purposes of determining limits on the increase of cost, in accordance with Medicare regulations, the base year shall be:

(a) For an existing provider, the first year of entering into the Program or the first year separate rates for the unit or units of service or services are approved; or

(b) For a new provider, the 12-month period immediately before the provider was initially subject to target rate increases.

(6) Initial Interim Rates. In order to establish an initial interim rate, the provider shall submit to the Department or its designee, before the beginning of the first billing period, the following:

(a) A detailed cost build-up, consistent with Medicare principles and cost finding, that supports the requested rate;

(b) A current, projected, and prior year’s charge rate schedule;

(c) Finalized prior year’s Medicare cost reports and the most current submission;

(d) A detailed revenue schedule; and

(e) Audited financial statements.

(7) The provider shall supply the Department or its designee the assurances necessary to establish that its customary charges to participants liable for payment on a charge basis exceed the allowable cost for these services.

(8) Initial Interim Rates for Newly Established Services or Providers.

(a) The provider shall submit to the Department or its designee, a detailed cost build-up, consistent with Medicare principles and cost finding that supports the requested rate that follows.

(b) The Department will compare the rate with a compatible facility and determine a reasonable rate that does not exceed the projected charges.

(9) Revision of Interim Rates.

(a) The provider may request an interim rate revision if the actual and projected costs exceed the interim rate by 10 percent.

(b) The provider shall furnish the Department or its designee with appropriate documentation showing the reason for the increase and other necessary comparisons.

(c) The Department will lower the provider’s interim rate to closely approximate the final allowable reasonable cost based on the results of the prior year’s review.

(d) The provider may request no more than one interim rate revision during the provider’s fiscal year.

(10) Cost Settlement. The provider shall submit to the Department or its designee:

(a) A Medicaid cost report based on actual data using the cost reporting forms used by Medicare for retrospective cost reimbursement;

(b) A copy of its Maryland Medical Assistance log;

(c) Cost reports that are sufficient in detail to support a separate cost finding for designated Maryland Medical Assistance unique cost centers; and

(d) A finalized Medicare cost report for the cost reporting year.

(11) Final Program costs shall be Maryland Medical Assistance specific.

(12) Tentative cost settlements may not be performed on a routine basis. However, the Program reserves the right to calculate tentative settlements in limited cases, when appropriate, as determined by the Department.

(13) The Department will base final settlement on the results of the finalized Medicare cost reports.

B. The Department or its designee shall notify each provider participating in the Program of the results of the final settlement under §A(10)—(13) of this regulation.

C. Within 60 days after the provider receives the notification described in §B of this regulation, the Department shall pay the amount due to the provider regardless of whether the provider files an appeal.

D. The provider may request review of the settlement under §A(10)—(13) of this regulation by filing written notice with the Program’s Appeal Board within 30 days after receipt of the notification of the results of the settlement from the Department or its designee.

E. The Appeal Board shall be composed of the following:

(1) A representative of the hospital industry who is:

(a) Knowledgeable in Medicare and Medicaid reimbursement principles; and

(b) Appointed by the Secretary of the Department;

(2) An individual who:

(a) Is employed by the State;

(b) Is knowledgeable in Medicare and Medicaid reimbursement principles;

(c) Did not participate in the verification of costs; and

(d) Is appointed by the Secretary of the Department; and

(3) A third member selected by the first two members of the Appeal Board.

F. When the Appeal Board reviews an appeal from a provider in which an Appeal Board member is employed or in which the member has a financial or personal interest, the Secretary of the Department shall designate an alternate for the member.

G. If the provider elects not to appeal to the Appeal Board:

(1) The provider shall pay the amount due within 60 days after the notification described in §B of this regulation;

(2) The provider may request a longer payment schedule within 60 days after the provider receives notification of the amount due the Program, the Department may establish, after consultation with the provider, a longer payment schedule; and

(3) The Department shall establish a longer payment schedule if, in the Department’s judgment based on sufficient documentation submitted by the provider, failure to grant a longer payment schedule would:

(a) Result in financial hardship to the provider; or

(b) Have an adverse effect on the quality of participant care furnished by the facility.

H. If the provider elects to appeal to the Appeal Board, the following provisions apply:

(1) Within 30 days after a provider’s filing of an appeal of the Department or its designee’s determination that the provider owes money to the Program, the Department or its designee shall:

(a) Recalculate the amount due to the Program based on the verification, exclusive of the amount in controversy which is subject to the appeal; and

(b) Notify the provider of that amount;

(2) In order to enable the Department or its designee to perform this recalculation, the provider shall indicate the specific adjustment and the specific amount being appealed;

(3) Subject to the provisions of §H(4) of this regulation, payment for the amount due the Program, if any, after the recalculation, shall be made within 60 days after the provider receives notification of the recalculation; and

(4) If a provider requests a longer payment schedule within 60 days after the provider receives notification of the recalculation, the Department may establish, after consultation with the provider, a longer payment schedule in accordance with §G(3) of this regulation.

I. Appeal Board Findings.

(1) After the Department receives the findings of the Appeal Board, the Department shall:

(a) Determine the amount that is due either to the Program or to the provider; and

(b) Notify the provider of that amount.

(2) The portion of the amount in controversy that is paid is subject to an award of interest that is:

(a) Calculated from the date the appeal was filed through the date of payment; and

(b) Based on the 6-month Treasury Bill rate in effect on the date the appeal was filed.

(3) Interest paid to a provider under §I(2) of this regulation is not subject to any offset or other reduction against otherwise allowable costs.

(4) If the provider accepted the determination made under §I(1) of this regulation, within 60 days after the provider receives the notification under §I(1) of this regulation, the Program shall pay the amount the Department determined is due the provider, if any.

(5) Subject to §I(6) of this regulation, within 60 days after the provider receives the notification, the provider shall pay the amount due the Program, if any.

(6) If a provider requests a longer payment schedule within 30 days after the provider receives notification of the amount due the Program, the Department may establish, after consultation with the provider, a longer payment schedule in accordance with §G(3) of this regulation.

J. After expiration of the 60-day payment period, or longer payment schedule established by the Department as described in §§G—I of this regulation, and in addition to the sanctions provided in Regulation .12 of this chapter, the Department may recover the unpaid balance by withholding the amount due from the interim payment which would otherwise be payable to the provider.

K. The Department or a provider aggrieved by a reimbursement decision of the Appeal Board may appeal the decision of the Appeal Board as the final decision for judicial review under the Administrative Procedure Act, State Government Article, §10-222, Annotated Code of Maryland.

L. If the provider or the Department appeals the final decision of the Appeal Board, the provider or the Department shall place any money due from the provider or from the Program in an interest-bearing escrow account. The money due shall include the interest, based on the rate in §I(2)(b) of this regulation, calculated from the date of the administrative appeal through the date of opening the escrow account. The money shall remain in escrow until a final decision has been rendered. Upon a final determination of the dispute, the appropriate person administering the escrow account shall distribute the money in that account, including any interest accrued, in conformity with the final determination.

M. The provider may file an appeal of the results of the settlement with the Medicare Appeal Board as a substitute for the Department’s Appeal Board, and the decision rendered by the Medicare Appeal Board will be accepted by the Department as binding.

.11 Recovery and Reimbursement.

A. General policies governing recovery and reimbursement procedures applicable to all providers are set forth in COMAR 10.09.36.07.

B. If refund of a payment as specified in §A of this regulation is not made, the Department shall reduce its current payment to the provider by the amount of the duplicate payment, overpayment, or third-party payment.

.12 Cause for Suspension or Removal and Imposition of Sanctions.

Causes for suspension or removal and imposition of sanctions shall be as set forth in COMAR 10.09.36.08.

.13 Appeal Procedures.

A provider filing an appeal from an administrative decision made in connection with these regulations shall do so according to COMAR 10.09.36.09.

.14 Interpretive Regulation.

General policies governing the interpretive regulations applicable to all providers are set forth in COMAR 10.09.36.10.

 

10.09.93 Chronic Hospitals

Authority: Health-General Article, §§2-104(b), 15-102.8, 15-103, and 15-105, Annotated Code of Maryland

.01 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) “Acute hospital” means an institution that provides active, short-term medical diagnosis, treatment, and care.

(2) “Administrative day” means a day of medical services delivered to a participant who no longer requires the level of care that the provider is licensed to deliver.

(3) “Admission” means the formal acceptance by a hospital of a participant who is to be provided with room, board, and medically necessary services in an area of the hospital where individuals stay at least overnight.

(4) “Ancillary services” means diagnostic and therapeutic services including but not limited to radiology, laboratory tests, pharmacy, and physical therapy services, provided exclusive of room and board.

(5) “Appropriate facility” means:

(a) A facility located within a 25-mile radius of the participant’s residence; or

(b) If acceptable to the participant, a more distant facility, which is licensed and certified to render the participant’s required level of care, except when the only facility or facilities that provide the level of care and specialized services required by the participant exceed that distance.

(6) “Brain injury” means an injury or insult to the brain that occurs after birth and is not related to congenital or degenerative disease, which results in cognitive, physical, behavioral, or emotional disability that is documented in the medical record.

(7) “Brain injury community integration program” means a program located on the campus of a licensed chronic hospital and approved by the Department to treat individuals with primary diagnoses of brain injury resulting in functional limitations and disability, who need services designed to transition to home or a community-based program of services and supports.

(8) Chronic Hospital.

(a) “Chronic hospital” means an institution licensed by the Department of Health and Mental Hygiene in accordance with COMAR 10.07.01.03B, which provides services to patients with complex medical needs who do not require hospitalization in an acute hospital, but whose treatment needs exceed the capabilities of a nursing facility.

(b) “Chronic hospital” does not mean a long-term care hospital, as defined at 42 CFR §412.23(e).

(9) “Concurrent review” means a periodic reauthorization of continued medical eligibility for the level of services provided by a chronic hospital which allows for close monitoring of the participant’s progress, treatment goals, and objectives, performed during an inpatient hospitalization.

(10) “Date of service” means:

(a) For inpatient hospitalizations, the date of admission into a chronic hospital up to, but not including, the date of discharge; or

(b) For outpatient services, the date services are rendered in the outpatient department of the hospital.

(11) “Department” means the Maryland Department of Health and Mental Hygiene, which is the single State agency designated to administer the Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.

(12) “Designee” means any entity designated to act on behalf of the Department.

(13) “Electronic signature” means a secure electronic identification of an individual who authorizes an electronic record or transaction.

(14) “Health Services Cost Review Commission (HSCRC)” means the independent organization within the Department of Health and Mental Hygiene which is responsible for reviewing and approving rates for hospitals pursuant to Health-General Article, Title 19, Subtitle 2, Annotated Code of Maryland.

(15) “Interdisciplinary team” means a physician-led multidisciplinary clinical team consisting of, at a minimum:

(a) The participant or an individual of the participant’s choice;

(b) A physician;

(c) A registered nurse;

(d) A social worker;

(e) The participant’s case manager; and

(g) Any other clinical professional indicated by an individual’s specific needs, including but not limited to:

(i) A psychologist;

(ii) A behavioral analyst;

(iii) A dietitian or nutritionist; and

(iv) Licensed therapists in other disciplines.

(16) “Level of care” means an assessment that an individual needs the level of services provided in a special psychiatric hospital.

(17) “Medical Assistance Program” means the program of comprehensive medical and other health-related care for indigent and medically indigent persons.

(18) “Medically necessary” means that the service or benefit is:

(a) Directly related to diagnostic, preventative, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;

(b) Consistent with standards of good medical practice;

(c) The most cost-efficient service that can be provided without sacrificing effectiveness or access to care; and

(d) Not primarily for the convenience of the participant, family, or provider.

(19) “Medicare” means the medical insurance program administered by the federal government under Title XVIII of the Social Security Act, 42 U.S.C. §1395 et seq.

(20) “Neuro-behavioral” means the discipline within medical rehabilitation that focuses on behavioral impairments seen in association with brain injury resulting from trauma, hypoxia, or ischemia.

(21) “Out-of-State hospital” means any hospital outside of Maryland, except for hospitals located in the District of Columbia.

(22) “Outpatient services” means services provided to the participant on the hospital campus that do not require hospital admission.

(23) “Participant” means an individual who is enrolled with the Department to receive Medical Assistance services.

(24) “Program” means the Maryland Medical Assistance Program.

(25) “Provider” means a chronic hospital which, through agreement with the Department, has been identified as a Program provider by the issuance of a provider number.

.02 License Requirements.

A. In order to participate in the Program, a provider shall:

(1) Be licensed by the Department pursuant to Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland, as a hospital; and

(2) Obtain any other licenses required by COMAR 10.07.01.

B. The provider shall ensure that Clinical Laboratory Improvement Amendments (CLIA) certification exists for all clinical laboratory services performed, and:

(1) If located in Maryland, comply with requirements of:

(a) Health-General Article, Title 17, Subtitles 2 and 3, Annotated Code of Maryland; and

(b) COMAR 10.10.01; or

(2) If located out-of-State, comply with other applicable standards established by the state or locality in which the service is provided and with the requirements of COMAR 10.09.09.02.

C. The provider shall obtain accreditation by the Commission on Accreditation of Rehabilitation Facilities if it provides neuro-behavioral rehabilitation or brain injury services.

.03 Conditions for Participation ― General.

A. A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03.

B. To participate in the Program as a chronic hospital services provider, the provider shall:

(1) Meet the requirements of Title XIX of the Social Security Act for participation as a hospital, as issued by the U.S. Department of Health and Human Services;

(2) 24 hours per day, 7 days per week, meet the following staffing requirements:

(a) On-call or on-site physician services;

(b) On-site registered nurses;

(c) On-site respiratory therapist services; and

(d) On-site advanced cardiac life support services;

(3) Directly provide or make available through contractual arrangements or transfer agreements, medically necessary covered services;

(4) Accept payment by the Program as payment in full for the covered service;

(5) Make available to the Department or its designee the participant’s medical record for review and certification of medical necessity for admission and continuation of stay; and

(6) Maintain documentation of each contact with the participant as part of the complete medical record, which, at a minimum, includes:

(a) Date of service;

(b) The participant’s chief medical complaint or reason for admission;

(c) A description of the services provided, including:

(i) Progress notes;

(ii) Imaging studies;

(iii) Laboratory results;

(iv) Medication administration records; and

(v) Discharge summary; and

(d) A signature, electronic or handwritten, along with the printed or typed name of the individual providing care, with the appropriate title.

.04 Specific Conditions for Provider Participation — Brain Injury Community Integration Program.

A. To participate in the Program as a provider operating a brain injury community integration program, the provider shall be:

(1) Accredited by the Commission on Accreditation of Rehabilitation Facilities; and

(2) Approved by the Department to provide the Program.

B. Staff Requirements. In addition to the requirements in Regulation .03 of this chapter, a brain injury community integration program shall meet staffing requirements, as approved by the Program, necessary to provide the neuro-behavioral management programming set forth in Regulation .05D of this chapter.

C. At least annually, in a form specified by the Program, a provider operating a brain injury community integration program shall report on the individuals admitted to and participating in the program, including:

(1) Length of stay;

(2) Discharge setting; and

(3) Any other data specified by the Program.

.05 Covered Services.

A. Chronic hospitals shall provide the following services:

(1) Complex respiratory care services;

(2) Complex wound care services;

(3) Services for participants with multiple co-morbidities, including but not limited to services necessary to care for:

(a) Ventilator-assisted individuals who have been ventilator dependent for less than 6 months and who need further medical stabilization or are candidates for weaning from ventilator assistance;

(b) Tracheostomy participants who require suctioning more frequently than every 2 hours or are candidates for decannulation;

(c) More than two extensive stage IV decubiti which require daily intensive treatment that is not available in a nursing facility; or

(d) Extensive post-operative or post-traumatic care with multiple drains or extensive dressing change or therapies beyond the capabilities of a nursing facility;

(4) For participants admitted for intensive rehabilitation services, at least two sessions, 5 days per week, of physical therapy, occupational therapy, or speech therapy focused on language pathology; and

(5) Ancillary services.

B. Treatment Plan.

(1) Within 24 hours of a participant’s admission, a physician shall perform a documented face-to-face evaluation of the participant and begin developing an individualized treatment plan designed to meet the participant’s assessed needs.

(2) By the 7th day of a participant’s admission, an interdisciplinary team shall establish a written, individualized treatment plan for the participant, which shall include, at a minimum:

(a) Diagnoses;

(b) Treatment goals;

(c) Frequency of interventions for each type of service ordered;

(d) Duration of treatment of each type of service ordered; and

(e) Prognosis.

(3) The physician-led interdisciplinary team shall update the individualized treatment plan weekly until discharge.

C. The Program covers outpatient hospital services provided by a chronic hospital when the services are:

(1) Medically necessary; and

(2) Provided to individuals who are eligible for Medical Assistance and who are not current inpatients at the chronic hospital, except when payment for certain outpatient services provided to a participant on the date of inpatient admission or within 3 calendar days before the date of an inpatient admission are bundled, in accordance with 42 CFR §412.2(c)(5).

D. The program covers the following brain injury community integration program services:

(1) Neuro-behavioral management programming, which includes, but is not limited to:

(a) Assessment of maladaptive behaviors using valid and reliable behavioral measurement tools;

(b) Pharmacologic intervention provided to manage maladaptive behaviors related to brain injury;

(c) Neuro-behavioral programming created, implemented, overseen, and revised as needed;

(d) Incorporation of neuro-behavioral programming into therapy and care for participants in the community integration program; and

(e) Referral to a neuro-psychiatrist, as needed, if a neuro-psychiatrist is not a member of the facility staff;

(2) Cognitive skills adaptation and compensation programming, including:

(a) Specific programming dedicated to cognitive skills adaptation and compensation; and

(b) Incorporation of cognitive compensatory strategies into community integration program participant’s interdisciplinary team treatment;

(3) Community re-entry programming, including specific programming dedicated to social or pragmatic skills, leisure skills, and life skills; and

(4) According to the participant’s needs:

(a) The services of a psychiatrist or psychiatric nurse;

(b) Services and supports related to substance use disorders and other addictions;

(c) Speech therapy, which includes but is not limited to:

(i) Cognitive skills;

(ii) Communication skills;

(iii) Swallowing ability; and

(iv) Linguistic programming that assists the patient to connect the meaning of words to their context;

(d) Occupational therapy, which includes but is not limited to:

(i) Instrumental activities of daily living; and

(ii) Community re-entry activities;

(e) Physical therapy, which includes but is not limited to:

(i) Ambulation; and

(ii) Motor planning and coordination;

(f) Dietary services, which includes but is not limited to nutritional needs assessment and monitoring; and

(g) Case management, which includes but is not limited to:

(i) Treatment planning; and

(ii) Discharge planning.

E. The Program covers administrative days approved by the Department or its designee according to the conditions set forth in Regulation .08C of this chapter.

.06 Limitations.

The Program does not cover:

A. Services for individuals who are not eligible for Medicaid;

B. Services for individuals who are not medically eligible for chronic hospital services;

C. Services identified by the Department or its designee as not medically necessary;

D. Hospital services, procedures, drugs, or hospital admissions that are investigational or experimental;

E. Duplicated care or services;

F. Interpretation of laboratory tests or panels;

G. Inpatient and outpatient diagnostic and laboratory services not ordered by the attending physician or other practitioner involved in the participant’s care; or

H. Telephones, televisions, or personal comfort items or services.

.07 Medical Eligibility.

A. General Requirements.

(1) An admission to a chronic hospital is medically necessary for a participant whose:

(a) Medical condition is not stabilized subsequent to a course of treatment at an acute hospital, or whose deteriorating medical condition resulted in a readmission to an acute hospital from a nursing facility or community setting; and

(b) Service and care needs require active and continuing medical treatment at an intensity and frequency not provided in a nursing facility, as defined in COMAR 10.09.10.01B, such as:

(i) 24-hour availability of a physician, physician assistant, or nurse practitioner, and associated nursing staff; and

(ii) Active and continuing medical treatment by a physician at least three times per week as documented in the medical record, physician orders, and physician progress notes.

(2) An admission to a chronic hospital is medically necessary for a participant who needs intensive rehabilitation services other than those provided in a special rehabilitation hospital.

(3) A participant who may not be able to fully participate in a chronic hospital rehabilitation program may be admitted for a brief trial period of inpatient care after review by the Department or its designee and approval by the Program. If no progress on rehabilitative goals occurs, the participant shall be discharged to a lower level of care.

B. Medical Criteria for Brain Injury Community Integration Programs. In order to be preauthorized by the Program for services in a brain injury community integration program, a participant:

(1) Shall have a primary diagnosis of brain injury;

(2) Shall be at low risk of potential medical instability;

(3) May not require acute inpatient physical rehabilitation services;

(4) Shall require an intensive neuro-behavioral or neuro-cognitive rehabilitation program at a chronic level of care as described in §A of this regulation in order to:

(a) Address pervasive and persisting maladaptive behaviors, or behavioral health risk factors, that preclude a safe discharge to the community or to a less restrictive setting; and

(b) Relearn basic living and adaptive skills;

(5) Shall have potential for achievement of specific functional outcomes with the potential of improving functional ability so that discharge to a less restrictive setting is a reasonable goal;

(6) Shall need rehabilitative programming, which may include:

(a) Recreation therapy;

(b) Speech language pathology;

(c) Occupational therapy;

(d) Physical therapy; and

(e) Neuro-psychology;

(7) Shall require at least two contacts daily within the rehabilitative programming that address the neuro-behavioral or neuro-cognitive needs of the participant;

(8) Shall require active and continued clinical treatment by a physician who is experienced in neuro-rehabilitation and in psychopharmacology for a minimum of three contacts per week;

(9) Shall require a structured and integrated environment of care that provides on-going behavioral programming designed to reduce maladaptive behaviors that are reinforced by clinical support and administrative staff;

(10) Shall make progress toward the achievement of specified functional outcomes; and

(11) Shall have the ability to participate in the required number of therapy sessions.

.08 Utilization Review.

A. Admission and Prior Approval.

(1) For participants and individuals who have applied for Medical Assistance, the provider shall request a determination from the Department or its designee at the time of admission, or at the time of application for Medical Assistance, that the individual meets the medical eligibility criteria set forth in Regulation .07A of this chapter.

(2) For a participant to be preauthorized for services in a brain injury community integration program, the provider shall request a determination from the Department or its designee that the participant meets the criteria set forth in Regulation .07B of this chapter.

(3) If the provider obtains the determination set forth in §A(1) or (2) of this regulation after admission, the eligibility determination shall be effective on the date that the determination was requested.

B. Concurrent Review.

(1) On a monthly basis, the provider shall notify the Department or its designee of all persons who have:

(a) Received an initial determination of medical eligibility for chronic hospital services;

(b) Been determined to continue to meet medical eligibility criteria for chronic hospital services;

(c) Been discharged; or

(d) Been determined to no longer be medically eligible.

(2) Concurrent review shall be conducted as long as the participant remains hospitalized, based on the participant’s diagnosis and condition, to ensure the medical necessity of the participant’s inpatient stay, at the following intervals:

(a) After an initially authorized 30-day stay, or at the end of the expected length of stay identified at admission, whichever comes first; and

(b) Every 14 days following the initial concurrent review, including clinical updates, on a form determined by the Department or its designee.

(3) The Department or its designee may conduct on-site reviews.

C. Administrative Days.

(1) To be paid for administrative days, the provider shall document, in a form designated by the Department, information which satisfies the conditions listed below:

(a) The participant who was initially eligible has been determined to no longer require chronic hospital services, and the provider has:

(i) Received a determination from the Department or its designee that the participant requires the level of service provided by a nursing facility but an appropriate facility is not available;

(ii) Established a plan for discharge during the period of administrative days, is actively pursuing placement at an appropriate level of care for the participant, and has documented this activity in the participant’s record; and

(iii) Submitted documentation to the Department or its designee that placement activity was conducted no fewer than 3 days per week during the period for which payment is requested for administrative days; or

(b) The participant is no longer medically eligible to receive chronic hospital services but cannot be moved, and the following conditions are met:

(i) The medical reason the participant cannot be moved is documented by the attending physician in the participant’s medical record;

(ii) The attending physician reevaluates the medical cause of the participant’s inability to be moved at least once every 7 days; and

(iii) The provider documents the active treatments used to resolve the medical cause of the participant’s inability to be moved;

(2) To receive reimbursement for administrative days, the provider shall document that it has met the conditions of §C(1) of this regulation, at least every 14 days.

(3) Documentation shall be submitted to the Department or its designee no later than 3 business days following the end of the 14-day period.

.09 Payment Procedures.

A. Reimbursement of Maryland Chronic Hospitals.

(1) In-State chronic hospitals shall be reimbursed according to:

(a) Rates approved by the HSCRC pursuant to COMAR 10.37.03; or

(b) The administrative day rate as follows:

(i) For a participant who is not ventilator-dependent, payment for approved administrative days shall be the estimated Statewide average Medicaid nursing facility payment rate as determined by the Department; and

(ii) For a participant who is ventilator-dependent, payment for approved administrative days shall be the estimated average Medicaid nursing facility payment rate for ventilator-dependent residents as determined by the Department.

(2) State-operated chronic hospitals shall be reimbursed according to Regulation .10 of this chapter. The Department shall make no direct reimbursement to any State-operated chronic hospital.

B. Reimbursement of Out-of-State Hospitals.

(1) The Department shall reimburse an out-of-State hospital that provides a level of service equivalent to that provided at a chronic hospital only if:

(a) The proposed admission is first reviewed by the Department or its designee and the out-of-State placement is determined medically necessary according to Regulation .07A of this chapter;

(b) The hospital possesses the same certifications and accreditations as the Program requires for a comparable level of services and specific program in a Maryland chronic hospital; and

(c) The hospital meets one of the following conditions:

(i) The hospital proposes to provide a service or specific treatment that the participant cannot obtain in a Maryland chronic hospital; or

(ii) The hospital is located geographically closer to the established residence of the participant than a Maryland chronic hospital.

(2) The Department shall reimburse an out-of-State hospital at the lesser of:

(a) The average rate established by the HSCRC for an equivalent cost center for a Maryland chronic hospital; or

(b) The rate charged by the out-of-State hospital pursuant to 42 CFR Part 412, Subpart O.

.10 Cost Reporting—State-Operated Chronic Hospitals.

A. The provider shall submit to the Department or its designee, in the form prescribed, financial and statistical data within 5 months after the end of the provider’s fiscal year unless the Department grants the provider an extension or the provider discontinues participation in the Program.

B. For hospitals who do not submit reports within 5 months, for whom an extension has not been granted, and who are reimbursed according to Medicare standards and principles for retrospective cost reimbursement as described in 42 CFR §413, the Department shall:

(1) Withhold from the provider a maximum of 5 percent of the current monthly interim payment starting the calendar month after the calendar month in which the report is due and any subsequent calendar months until the report has been submitted; and

(2) Refund withholdings at cost settlement.

C. If a provider discontinues participation, financial and statistical data shall be submitted to the Department within 45 days after the effective date of termination.

D. The Program shall grant an extension for submission of cost reports:

(1) Upon written request by the provider, setting forth the specific reasons for the request, if the Department determines, taking into consideration the totality of the circumstances, that the request is reasonable; or

(2) Concurrent with any extension granted to the hospital by Medicare, but not to exceed 60 days from the due date of cost reports.

E. In addition to a reduction in payment percentage or withholding a percentage of interim payment pursuant to §B of this regulation, when a report is not submitted by the last day of the 6th month after the end of the provider’s fiscal year and the provider has not received an extension, the Department may impose one or more sanctions as provided for in Regulation .14 of this chapter.

F. When a report is not submitted by the last day of the 6th month after the end of the provider’s fiscal year or a report is submitted but the provider cannot furnish proper documentation to verify costs, the Department shall, if applicable, make final cost settlement for that fiscal year at a certain percentage of the last final per diem rates for which the Department has verified costs for that facility, provided that the rates established will not exceed the maximum per diem rates in effect when the facility’s costs were last settled.

G. For purposes of §§A—F of this regulation, reports are considered received when the submitted reports are completed according to instructions issued by the Department or its designee.

.11 Cost Settlement — State-operated Chronic Hospitals.

A. Final settlement for services in the provider’s fiscal year shall be determined based on Medicare retrospective cost principles found at 42 CFR §413, adjusted for Program allowable costs. Allowable costs specific to the Program shall be limited to a base year cost per discharge increased by the applicable federal rate of increase times the number of Program discharges for that fiscal year.

B. Base Year. For purposes of determining limits on the increase of cost, in accordance with Medicare regulations, the base year for an existing provider shall be the first year of entering into the Program or the first year separate rates for the unit or units of service or services are approved.

C. The provider shall supply the Department or its designee the assurances necessary to establish that its customary charges to participants liable for payment exceed the allowable cost for these services.

D. Revision of Interim Rates. The provider may request an interim rate revision should the actual and projected cost exceed the interim rate by 10 percent. The provider shall furnish the Department or its designee with appropriate schedules showing the reason for the increase and any other information supporting the request. The Department will lower the provider’s interim rate to closely approximate the final allowable reasonable cost based on the results of the prior year’s review. The provider may request not more than two interim rate revisions during the accounting year.

E. Cost Settlement. The provider shall submit to the Department or its designee a Medicaid cost report based on actual data using the cost reporting forms used by Medicare for retrospective cost reimbursement. The provider shall also submit a copy of its Maryland Medical Assistance log. The submitted cost report shall be in sufficient detail to support a separate cost finding for designated Maryland Medical Assistance unique cost centers. Tentative cost settlements may not be performed on a routine basis. However, the Program reserves the right to calculate tentative settlements in limited cases, when appropriate, as determined by the Department. The provider shall furnish the Department or its designee with a finalized Medicare cost report for the cost reporting year. The Department will base final settlement on the results of the finalized Medicare cost reports.

.12 Cost Settlement for State-operated Chronic Hospitals — Payments and Appeals.

A. The Department or its designee shall notify each provider participating in the Program of the results of the final settlement under Regulation .11 of this chapter.

B. Within 60 days after the provider receives the notification described in §A of this regulation, the Department shall pay the amount due to the provider regardless of whether the provider files an appeal.

C. The provider may request review of the settlement under Regulation .11 of this chapter by filing written notice with the Program’s Appeal Board within 30 days after receipt of the notification of the results of the settlement from the Department or its designee.

D. The Appeal Board shall be composed of the following:

(1) A representative of the hospital industry who is:

(a) Knowledgeable in Medicare and Medicaid reimbursement principles; and

(b) Appointed by the Secretary of the Department;

(2) A person who:

(a) Is employed by the State;

(b) Is knowledgeable in Medicare and Medicaid reimbursement principles;

(c) Did not participate in the verification of costs; and

(d) Is appointed by the Secretary of the Department; and

(3) A third member selected by the first two members of the Appeal Board.

E. When the Appeal Board reviews an appeal from a provider in which an Appeal Board member is employed or in which the member has a financial or personal interest, the Secretary of the Department shall designate an alternate for the member.

F. If the provider elects not to appeal to the Appeal Board:

(1) The provider shall pay the amount due within 60 days after the notification described in §A of this regulation;

(2) If the provider requests a longer payment schedule within 60 days after the provider receives notification of the amount due the Program, the Department may establish, after consultation with the provider, a longer payment schedule; and

(3) The Department shall establish a longer payment schedule if, in the Department’s judgment based on sufficient documentation submitted by the provider, failure to grant a longer payment schedule would:

(a) Result in financial hardship to the provider; or

(b) Have an adverse effect on the quality of participant care furnished by the facility.

G. If the provider elects to appeal to the Appeal Board, the following provisions apply:

(1) Within 30 days after a provider appeals a determination by the Department or its designee that the provider owes money to the Program, the Department or its designee shall:

(a) Recalculate the amount due to the Program based on the verification, exclusive of the amount in controversy which is subject to the appeal; and

(b) Notify the provider of that amount;

(2) In order to enable the Department or its designee to perform this recalculation, the provider shall indicate the specific adjustment and the specific amount being appealed;

(3) Subject to the provisions of §G(4) of this regulation, payment for the amount due the Program, if any, after the recalculation, shall be made within 60 days after the provider receives notification of the recalculation; and

(4) If a provider requests a longer payment schedule within 60 days after the provider receives notification of the recalculation, the Department may establish, after consultation with the provider, a longer payment schedule in accordance with §F(3) of this regulation.

H. Appeal Board Findings.

(1) After the Department receives the findings of the Appeal Board, the Department shall:

(a) Determine the amount that is due either to the Program or to the provider; and

(b) Notify the provider of that amount.

(2) The portion of the amount in controversy that is paid is subject to an award of interest that is:

(a) Calculated from the date the appeal was filed through the date of payment; and

(b) Based on the 6-month Treasury Bill rate in effect on the date the appeal was filed.

(3) Interest paid to a provider under §H(2) of this regulation is not subject to any offset or other reduction against otherwise allowable costs.

(4) If the provider accepted the determination made under §H(1) of this regulation, within 60 days after the provider receives the notification under §H(1) of this regulation, the Program shall pay the amount the Department determined is due the provider, if any.

(5) Subject to §H(6) of this regulation, within 60 days after the provider receives the notification, the provider shall pay the amount due the Program, if any.

(6) If a provider requests a longer payment schedule within 30 days after the provider receives notification of the amount due the Program, the Department may establish, after consultation with the provider, a longer payment schedule in accordance with §F(3) of this regulation.

I. After expiration of the 60-day payment period, or longer payment schedule established by the Department as described in §§F—H of this regulation, and in addition to the sanctions provided in Regulation .14 of this chapter, the Department may recover the unpaid balance by withholding the amount due from the interim payment which would otherwise be payable to the provider.

J. The Department or a provider aggrieved by a reimbursement decision of the Appeal Board may appeal the decision of the Appeal Board as the final decision for judicial review under the Administrative Procedure Act, State Government Article, §10-222, Annotated Code of Maryland.

K. If the provider or the Department appeals the final decision of the Appeal Board, the provider or the Department shall place any money due from the provider or from the Program in an interest-bearing escrow account. The money due shall include the interest, based on the rate in §H(2)(b) of this regulation, calculated from the date of the administrative appeal through the date of opening the escrow account. The money shall remain in escrow until a final decision has been rendered. Upon a final determination of the dispute, the appropriate person administering the escrow account shall distribute the money in that account, including any interest accrued, in conformity with the final determination.

L. The provider may file an appeal of the results of the settlement with the Medicare Appeal Board as a substitute for the Department’s Appeal Board, and the decision rendered by the Medicare Appeal Board will be accepted by the Department as binding.

.13 Recovery and Reimbursement.

A. General policies governing recovery and reimbursement procedures applicable to all providers are set forth in COMAR 10.09.36.07.

B. If refund of a payment as specified in §A of this regulation, is not made, the Department shall reduce its current payment to the provider by the amount of the duplicate payment, overpayment, or third-party payment.

.14 Cause for Suspension or Removal and Imposition of Sanctions.

Causes for suspension or removal and imposition of sanctions shall be as set forth in COMAR 10.09.36.08.

.15 Appeal Procedures.

A provider filing an appeal from an administrative decision made in connection with these regulations shall do so according to COMAR 10.09.36.09.

.16 Interpretive Regulation.

General policies governing the interpretive regulations applicable to all providers are set forth in COMAR 10.09.36.10.

 

10.09.94 Special Pediatric Hospitals

Authority: Health-General Article, §§2-104(b), 15-102.8, 15-103, and 15-105, Annotated Code of Maryland

.01 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) “Acute hospital” means an institution that provides active, short-term medical diagnosis, treatment, and care.

(2) “Administrative day” means a day of medical services delivered to a participant who no longer requires the level of care that the provider is licensed to deliver.

(3) “Admission” means the formal acceptance by a hospital of a participant who is to be provided with room, board, and medically necessary services in an area of the hospital where patients stay at least overnight.

(4) “Ancillary services” means diagnostic and therapeutic services including but not limited to radiology, laboratory tests, pharmacy, and physical therapy services, provided exclusive of room and board.

(5) “Appropriate facility” means:

(a) A facility located within a 25-mile radius of the participant’s residence; or

(b) If acceptable to the participant, a more distant facility, which is licensed and certified to render the participant’s required level of care, except when the only facility or facilities that provide the level of care and specialized services required by the participant exceed that distance.

(6) “Concurrent review” means a periodic reauthorization of continued medical eligibility for the level of services provided by a special pediatric hospital, which allows for close monitoring of the participant’s progress, treatment goals, and objectives, performed during an inpatient hospitalization.

(7) “Date of service” means:

(a) For inpatient hospitalizations, the date of admission into a special pediatric hospital up to, but not including, the date of discharge; or

(b) For outpatient services, the date services are rendered in the outpatient department of the hospital.

(8) “Department” means the Maryland Department of Health and Mental Hygiene, which is the single State agency designated to administer the Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.

(9) “Designee” means any entity designated to act on behalf of the Department.

(10) “Diagnosis-related group” means a participant classification system adopted by the U.S. Department of Health and Human Services, in which each hospital discharge case is assigned a category based on the primary diagnosis, secondary diagnoses, if any, procedures performed, and age, sex, and discharge status of the participant.

(11) “Electronic signature” means a secure electronic identification of an individual who authorizes an electronic record or transaction.

(12) “Health Services Cost Review Commission (HSCRC)” means the independent organization within the Department of Health and Mental Hygiene which is responsible for reviewing and approving rates for hospitals pursuant to Health-General Article, Title 19, Subtitle 2, Annotated Code of Maryland.

(13) “Level of care” means an assessment that an individual needs the level of services provided in a special psychiatric hospital.

(14) “Maryland Medical Assistance Program” means the program of comprehensive medical and other health-related care for indigent and medically indigent persons.

(15) “Medically necessary” means that the service or benefit is:

(a) Directly related to diagnostic, preventative, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;

(b) Consistent with standards of good medical practice;

(c) The most cost-efficient service that can be provided without sacrificing effectiveness or access to care; and

(d) Not primarily for the convenience of the participant, family, or provider.

(16) “Medicare” means the medical insurance program administered by the federal government under Title XVIII of the Social Security Act, 42 U.S.C. §1395 et seq.

(17) “Out-of-State hospital” means any hospital outside of Maryland, except for hospitals located in the District of Columbia.

(18) “Outpatient services” means services provided to the participant on the hospital campus that do not require hospital admission.

(19) “Participant” means an individual who is enrolled with the Department to receive Medical Assistance services.

(20) “Plan of treatment” means a written plan developed by a participant’s consulting physician and other appropriate clinicians, which is provided to the Department on request and includes:

(a) Diagnosis;

(b) Treatment goals;

(c) Specific procedures planned for the participant, including surgeries;

(d) Duration of treatment of each type of service ordered;

(e) Expected length of stay; and

(f) Any other appropriate information, including caregiver education and discharge plan.

(21) “Program” means the Maryland Medical Assistance Program.

(22) “Prospective payment system” means a predetermined amount of reimbursement per day for inpatient hospital services.

(23) “Provider” means a special pediatric hospital which, through agreement with the Department, has been identified as a Program provider by the issuance of a provider number.

(24) Special Pediatric Hospital.

(a) “Special pediatric hospital” means a facility licensed by the Office of Health Care Quality as a special hospital that provides nonacute medical, rehabilitation, therapy, and palliative services to children and adolescents younger than 22 years old.

(b) “Special pediatric hospital” includes an out-of-State or District of Columbia hospital identified by the Program as:

(i) A facility that provides nonacute medical, rehabilitation, therapy, and palliative services to children and adolescents younger than 22 years old; and

(ii) A facility that provides nonacute medical, rehabilitation, and therapy services to individuals ages 2 through 22 with co-occurring medical and behavioral conditions.

.02 License Requirements.

A. In order to participate in the Program, a provider shall:

(1) Be licensed by the Department pursuant to Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland, as a hospital; and

(2) Obtain other licenses, as set forth in COMAR 10.07.01.

B. The provider shall ensure that Clinical Laboratory Improvement Amendments (CLIA) certification exists for all clinical laboratory services performed, and:

(1) If located in Maryland, comply with requirements of:

(a) Health-General Article, Title 17, Subtitles 2 and 3, Annotated Code of Maryland; and

(b) COMAR 10.10.01; or

(2) If located out-of-State, comply with other applicable standards established by the state or locality in which the service is provided and with the requirements of COMAR 10.09.09.02.

.03 Conditions for Participation.

A. A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.

B. To participate in the Program as a special pediatric hospital services provider, the provider shall:

(1) Meet the requirements of Title XIX of the Social Security Act for participation as a hospital, as issued by the U.S. Department of Health and Human Services;

(2) Directly provide, or make available through contractual arrangements or transfer agreements, medically necessary covered services;

(3) Accept payment by the Program as payment in full for the covered services;

(4) Make available to the Department or its designee the participant’s medical record for review and certification of medical necessity for admission and continuation of stay; and

(5) Maintain documentation of each contact with the participant as part of the complete medical record, which, at a minimum, includes:

(a) Date of service;

(b) The participant’s chief medical complaint or reason for admission or outpatient visit;

(c) A description of the services provided, including:

(i) Progress notes;

(ii) Imaging studies;

(iii) Laboratory results;

(iv) Medication administration records; and

(v) Discharge summary; and

 (d) A signature, electronic or handwritten, along with the printed or typed name of the individual providing care, with the appropriate title.

C. If an out-of-State or District of Columbia hospital, the hospital shall:

(1) Have in effect a utilization review plan applicable to all participants who receive Medical Assistance under Title XIX of the Social Security Act which meets the requirements of §1861(k) of the Social Security Act unless a waiver has been granted by the Secretary of Health and Human Services; and

(2) Allow HealthChoice managed care organizations to pay no more and no less than the reimbursement rates established in Regulation .07 of this chapter unless the parties mutually agree to an alternative arrangement in a contract either on or after July 1, 2011.

.04 Covered Services.

A. The Program covers the following inpatient services at special pediatric hospitals:

(1) A hospital admission determined to be medically necessary for a participant who is stable enough for transfer to a post-acute setting and requires medical or rehabilitative services that:

(a) Cannot be provided at a lower level of care; and

(b) Meets the medical eligibility criteria under Regulation .06 of this chapter;

(2) Administrative days for the length of time certified by the Department or its designee;

(3) Inpatient admissions for intensive occupational therapy, physical therapy, or speech therapy on a regimen which is less than 3 hours per day, 5 days per week, when these services are provided in a unit that is accredited by the Commission on Accreditation of Rehabilitation Facilities to provide rehabilitation services; and

(4) Ancillary services.

B. The Program covers the following outpatient hospital services:

(1) Medically necessary services for the provision of diagnostic, curative, palliative, or rehabilitative treatment; and

(2) For a participant younger than 21 years old, physical therapy, occupational therapy, speech therapy, and audiology services if:

(a) The therapy provider develops a written plan of treatment in collaboration with the participant’s primary care physician and the participant or the parent or guardian of the participant;

(b) The service is provided according to the plan of treatment; and

(c) The services provider sends an update of the plan of treatment to the participant’s primary care physician every 90 days.

.05 Limitations.

The Program does not cover:

A. Investigational or experimental hospital services, procedures, or drugs;

B. Inpatient admissions or outpatient visits solely for the administration of injections, unless medical necessity and the participant’s inability to take appropriate oral medications is documented in the participant’s medical record;

C. Outpatient visits intended to accomplish one or more of the following:

(1) Prescription drug or food supplement pick-up;

(2) Collection of specimens for laboratory procedures;

(3) Recording of an electrocardiogram; or

(4) Ascertaining the participant’s weight;

D. Interpretation of laboratory tests or panels;

E. Autopsies;

F. Immunizations required for travel outside the continental United States;

G. Leaves of absence beyond the period of the census check of the same day;

H. Day care;

I. Psychological evaluations and treatments except when:

(1) Ordered by a physician, and the medical necessity is documented in the participant’s medical record; or

(2) Performed as mental health service, as part of the plan of treatment;

J. Duplicated care or services;

K. Elective admissions to hospitals outside of Maryland and the District of Columbia unless the Department or its designee determines that comparable services are not available in Maryland, except under certain conditions where child participants are in foster care, or are for other reasons placed outside the State and are covered under certain criteria, as determined by the Department or its designee;

L. Inpatient and outpatient diagnostic services not specifically ordered by the attending physician or other responsible practitioner;

M. Inpatient days or services provided in excess of the days approved by the Department or its designee;

N. Hospital laboratory tests which are coverable under COMAR 10.09.09.04, if the specimen is not obtained in the hospital;

O. Hospital services provided outside of the United States;

P. The completion of forms and reports;

Q. Broken or missed appointments;

R. Professional services rendered by mail or telephone; or

S. Telephones, televisions, or personal comfort items or services.

.06 Utilization Review.

A. The Department or its designee shall conduct utilization review to determine that special pediatric hospital admissions and outpatient services are authorized only when medically necessary.

B. Review Procedure.

(1) For all admissions, the special pediatric hospital shall provide:

(a) The elements of a participant’s medical record specified by the Department or its designee for preadmission review, and request to certify the participant’s admission; and

(b) Sufficient clinical information or documentation to the Department or its designee that supports the need for admission to a special pediatric hospital including, but not limited to:

(i) Current medical health status;

(ii) Treatment received to date;

(iii) Proposed treatment plan for requested admission; and

(iv) Expected length of stay.

(2) Admission for inpatient services may be authorized only when these services cannot be provided:

(a) On an outpatient basis; or

(b) In a facility that is licensed to provide a more appropriate level of care to the participant.

(3) Concurrent review shall be conducted as long as the participant remains hospitalized, based on the participant’s diagnosis and condition, to ensure the medical necessity of the participant’s inpatient stay, at the following intervals:

(a) After an initially authorized 14-day stay, or at the end of the expected length of stay identified at admission, whichever comes first; and

(b) Every 14 days following the initial concurrent review, in a form and including clinical documentation as specified by the Department or its designee.

(4) The Department or its designee may conduct on-site reviews after an initially authorized period of 30 days, and every 30 days thereafter until discharge.

(5) An elective inpatient hospital admission requires preadmission authorization by the Department or its designee.

C. Administrative Days.

(1) To be paid for administrative days, the provider shall document, in a form designated by the Department, information which satisfies the conditions listed below:

(a) The participant has been determined to no longer require special pediatric hospital services, and the provider has:

(i) Received a determination from the Department or its designee that the participant requires the level of service provided in a lower-acuity facility, but an appropriate facility is not available;

(ii) Established a plan for discharge during the period of administrative days, is actively pursuing placement at an appropriate level of care for the participant, and has documented this activity in the participant’s record; and

(iii) Submitted documentation to the Department or its designee that placement activity was conducted no fewer than 3 days per week during the period for which payment is requested for administrative days; or

(b) The participant is no longer medically eligible to receive special pediatric hospital services but cannot be moved, and the following conditions are met:

(i) The medical reason the participant cannot be moved is documented by the attending physician in the participant’s medical record;

(ii) The attending physician reevaluates the medical cause of the participant’s inability to be moved at least once every 7 days; and

(iii) The provider documents the active treatments used to resolve the medical cause of the participant’s inability to be moved;

(2) To receive reimbursement for administrative days, the provider shall document that it has met the conditions of §C(1) of this regulation, at least every 14 days.

(3) Documentation shall be submitted to the Department or its designee no later than 3 business days following the end of the 14-day period.

.07 Payment Procedures.

A. HSCRC Reimbursement Principles.

(1) Except for hospitals reimbursed under the provisions of §B of this regulation and except for administrative days, hospitals located in Maryland that participate in the Program shall charge and be reimbursed according to rates approved by the HSCRC pursuant to COMAR 10.37.03.

(2) If the Program discontinues using rates which have been approved by HSCRC, the Program shall reimburse a provider:

(a) According to Medicare standards and principles for retrospective cost reimbursement described in 42 CFR §413; or

(b) On the basis of charges if less than reasonable cost.

(3) The Department may not reimburse for the services of a hospital’s salaried or contractual physicians as a separate line item.

B. Annual Market Basket Reimbursement Principles.

(1) Except as specified in §B(2)—(5) of this regulation, a special pediatric hospital not approved by the Program for reimbursement according to HSCRC rates shall be reimbursed according to Medicare standards and principles for retrospective cost reimbursement described in 42 CFR §413, or on the basis of charges if less than reasonable cost. In calculating retrospective cost reimbursement rates, the Department or its designee will deduct from the designated costs or group of costs those restricted contributions which are designated by the donor for paying certain provider operating costs, or groups of costs, or costs of specific groups of participants. When the cost, or group or groups of costs designated, cover services rendered to all participants, including Medical Assistance participants, operating costs applicable to all participants shall be reduced by the amount of the restricted grants, gifts, or income from endowments, thus resulting in a reduction of allowable costs.

(2) For days of service on or after July 1, 2006, in special pediatric hospitals with pediatric rehabilitation beds in Maryland not approved by the Program for reimbursement according to HSCRC rates, the Department shall reimburse these hospitals using a prospective payment system consisting of per diem rates based on service categories audited and adjusted in the provider’s fiscal year 2004 cost report. The base per diem rates shall be:

(a) Annually adjusted by the factor indicated in the Centers for Medicare and Medicaid Services Annual Market Basket Update Factor for the Long Term Care Hospital Prospective Payment System; and

(b) Determined by allocating Medicaid inpatient costs into service categories as follows:

(i) Rehabilitation categories — $1,486.58;

(ii) Feeding categories — $2,213.98;

(iii) Severe behavior categories — $2,544.66; and

(iv) Other categories — $1,126.69.

(3) For new services established after July 1, 2006, in special pediatric hospitals with pediatric rehabilitation beds in Maryland not approved by the Program for reimbursement according to HSCRC rates, the Program shall pay at an initial rate that is set as an interim rate at the Medicaid weighted average rate of all existing inpatient per diem rates. After the first full year, actual cost data shall be used to prospectively set the new service rate.

(4) For days of service on or after July 1, 2006, in special pediatric hospitals with pediatric rehabilitation beds in Maryland not approved by the Program for reimbursement according to HSCRC rates, the Department shall reimburse hospital based outpatient services on a prospective basis that shall be adjusted annually by the difference between the:

(a) Medicaid weighted average charge increase; and

(b) Centers for Medicare and Medicaid Services Outpatient Prospective Payment System Market Basket Update Factor.

(5) For outpatient services in §B(4) of this regulation, the revenue shall be maintained at the fiscal year 2011 level beginning July 1, 2011.

C. Out-of-State Hospitals Reimbursement Principles.

(1) An out-of-State hospital, except a hospital located in the District of Columbia, shall be reimbursed the lesser of its charges or the amount reimbursable by the host state’s Title XIX agency. The hospital shall be reimbursed for administrative days in accordance with Regulation .09E of this chapter.

(2) For outpatient services, an out-of-State hospital, except a hospital located in the District of Columbia, shall be reimbursed the lesser of its charges or the amount reimbursable by the host state’s Title XIX agency.

.08 Distr