Capitol Building Maryland Register

Issue Date:  August 27, 2021

Volume 48 •  Issue 18  • Pages 681—788

IN THIS ISSUE

Governor

Judiciary

Regulations

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Pursuant to State Government Article, §7-206, Annotated Code of Maryland, this issue contains all previously unpublished documents required to be published, and filed on or before August 9, 2021 5 p.m.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 August 9, 2021.
 
Gail S. Klakring
Acting 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; Gail S. Klakring, Administrator; Mary D. MacDonald, Senior 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 .....................................................................  685

 

COMAR Research Aids

Table of Pending Proposals ...........................................................  686

 

Index of COMAR Titles Affected in This Issue

COMAR Title Number and Name                                                  Page

07        Department of Human Services ........................................  696

08        Department of Natural Resources .............................  692, 697

09        Maryland Department of Labor .........................................  690

10        Maryland Department of Health ........................................  699

11        Department of Transportation ............................................  706

14        Independent Agencies ...............................................  692, 709

20        Public Service Commission ...............................................  693

27        Critical Area Commission for the Chesapeake and Atlantic Coastal Bays 694

30        Maryland Institute for Emergency Medical Services
Systems (MIEMSS) .......................................................  710

31        Maryland Insurance Administration ..................................  716

36        Maryland State Lottery and Gaming Control
               Agency ............................................................  690, 695, 718

 

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 Governor

PROCLAMATION

Renewal of Declaration of State of Emergency and
   Existence of Catastrophic Health Emergency —
   COVID-19 ..........................................................................  688

 

The Judiciary

COURT OF APPEALS OF MARYLAND

DISCIPLINARY PROCEEDINGS ................................  689

 

Emergency Action on Regulations

09  MARYLAND DEPARTMENT OF LABOR

DIVISION OF LABOR AND INDUSTRY

Emergency Temporary Standards .........................................  690

36  MARYLAND STATE LOTTERY AND GAMING
   CONTROL AGENCY

GENERAL PROVISIONS

General  690

Administrative Procedures .  690

SPORTS WAGERING PROVISIONS

General  690

All Applicants and Licensees—Applications and
   Investigations ......................................................................  690

All Applicants and Licensees—Qualification
   Requirements . 690

Specific Requirements for Sports Wagering Facility
   Licensees .  690

Specific Requirements for Mobile Sports Wagering
   Licenses .  690

Specific Requirements for Other Licenses Required for
   Sports Wagering .  690

License Denial Procedures .  690

Enforcement  690

Unannounced Inspections .  690

Enforcement of Voluntary Exclusion Program ..  690

Mandatory Exclusion ............................................................  690

Collection of Taxes, Fees, and Penalties .  690

Sports Wagering Licensee Minimum Internal Control
   Standards .  690

Sports Wagering Requirements and Limitations .  690

Sports Wagering Licensee Facility Standards .  690

Wagering Using Online, Web-Based, or Mobile
   Applications .  690

Sports Wagering Equipment  690

Sports Wagering Technical Standards .  690

 

Final Action on Regulations

08  DEPARTMENT OF NATURAL RESOURCES

WILDLIFE

Use of Wildlife Areas .  692

14  INDEPENDENT AGENCIES

PRESCRIPTION DRUG AFFORDABILITY BOARD

General Provisions .  692

Prescription Drug Affordability Fund ...................................  692

COMMISSION ON CRIMINAL SENTENCING POLICY

General Regulations .  692

MARYLAND ENVIRONMENTAL SERVICE

Human Resources System ..  693

Procurement  693

20  PUBLIC SERVICE COMMISSION

APPLICATIONS CONCERNING THE CONSTRUCTION
   OR MODIFICATION OF GENERATING STATIONS,
   QUALIFIED GENERATOR LEAD LINES, AND
   OVERHEAD TRANSMISSION LINES

General  693

Administrative Provisions .  693

Details of Filing Requirements — Generating
   Stations ...............................................................................  694

27  CRITICAL AREA COMMISSION FOR THE
   CHESAPEAKE AND ATLANTIC COASTAL BAYS

CRITERIA FOR LOCAL CRITICAL AREA PROGRAM
   DEVELOPMENT

General Provisions ................................................................  694

Agriculture..............................................................................  694

Habitat Protection Areas in the Critical Area ........................  694

DEVELOPMENT IN THE CRITICAL AREA RESULTING
   FROM STATE AND LOCAL AGENCY PROGRAMS

General Provisions .  694

General Approval of State and Local Agency Programs
   Which Result in Development of Local Significance
   on Private Lands or Lands Owned by Local
   Jurisdictions .  694

State Agency Actions Resulting in Development on
   State-Owned Lands ............................................................  694

PROJECT APPLICATIONS

Notification of Project Applications ......................................  694

CRITERIA FOR LOCAL CRITICAL AREA PROGRAM
   DEVELOPMENT

Renewable Energy Generating Systems .  694

DEVELOPMENT IN THE CRITICAL AREA RESULTING
   FROM STATE AND LOCAL AGENCY PROGRAMS

Commission Review, Decision Process, and Time
   Frames .  694

PROJECT APPLICATIONS

Notification of Project Applications .  694

36  MARYLAND STATE LOTTERY AND GAMING
   CONTROL AGENCY

GAMING PROVISIONS

Investigation and Licensing .  695

Video Lottery Facility Minimum Internal Control
   Standards .  695

VIDEO LOTTERY TERMINALS

Video Lottery Technical Standards .  695

TABLE GAMES

Table Game Equipment  695

Table Game Procedures .........................................................  695

 

Proposed Action on Regulations

07  DEPARTMENT OF HUMAN SERVICES

OFFICE OF SECRETARY

Legal Services .......................................................................  696

08  DEPARTMENT OF NATURAL RESOURCES

BOATING―SPEED LIMITS AND OPERATION OF
   VESSELS

Magothy River .......................................................................  697

South River  697

White Hall Bay .  698

Deep Creek Lake .  698

10  MARYLAND DEPARTMENT OF HEALTH

FOOD

Food Service Facilities .  699

BOARD OF ACUPUNCTURE

General Regulations .  700

Continuing Education .  700

BOARD OF EXAMINERS IN OPTOMETRY

Therapeutic Pharmaceutical Agents .  703

MARYLAND HEALTHCHOICE PROGRAM

Maryland Medicaid Managed Care Program: Non-Capitated
   Covered Services .  705

11  DEPARTMENT OF TRANSPORTATION

MOTOR VEHICLE ADMINISTRATION—VEHICLE
   EQUIPMENT

Safety Glass Replacement Standards .  706

14  INDEPENDENT AGENCIES

MARYLAND AUTOMOBILE INSURANCE FUND

Board of Trustees .  709

Binding Rules .  709

Producer Discipline Hearing Rules .  709

30  MARYLAND INSTITUTE FOR EMERGENCY
   MEDICAL SERVICES SYSTEMS (MIEMSS)

GENERAL

Documents Incorporated by Reference .  710

DESIGNATION OF TRAUMA AND SPECIALTY
   REFERRAL CENTERS

Comprehensive Stroke Center Standards .  710

Designated Thrombectomy-Capable Primary Stroke Center
   Standards ............................................................................  714

31  MARYLAND INSURANCE ADMINISTRATION

PROPERTY AND CASUALTY INSURANCE

Notices of Cancellation, Nonrenewal, Premium Increase,
   and Reduction in Coverage .  716

36  MARYLAND STATE LOTTERY AND GAMING
   CONTROL AGENCY

GENERAL PROVISIONS

General  718

Administrative Procedures .  718

SPORTS WAGERING PROVISIONS

General  718

All Applicants and Licensees—Applications and
   Investigations .  718

All Applicants and Licensees—Qualification
   Requirements .  718

Specific Requirements for Sports Wagering Facility
   Licensees .  718

Specific Requirements for Mobile Sports Wagering
   Licenses .  718

Specific Requirements for Other Licenses Required for
   Sports Wagering .  718

License Denial Procedures .  718

Enforcement  718

Unannounced Inspections .  718

Enforcement of Voluntary Exclusion Program ..  718

Mandatory Exclusion ............................................................  718

Collection of Taxes, Fees, and Penalties ...............................  718

Sports Wagering Licensee Minimum Internal Control
   Standards .  718

Sports Wagering Requirements and Limitations .  718

Sports Wagering Licensee Facility Standards .  718

Wagering Using Online, Web-Based, or Mobile
   Applications ........................................................................  718

Sports Wagering Equipment .................................................  718

Sports Wagering Technical Standards ..................................  718

 

Special Documents

DEPARTMENT OF THE ENVIRONMENT

WATER AND SCIENCE ADMINISTRATION

Water Quality Certification 21-WQC-0305 .  782

Water Quality Certification 21-WQC-0320 .....................  782

Water Quality Certification 21-WQC-0322 .  783

DEPARTMENT OF HUMAN SERVICES

STATEMENT OF NEED (SON)

For Psychiatric Respite (PR) and Diagnostic Evaluation
   Treatment Program (DETP) Residential Child Care
   (RCC) Services ..............................................................  783

DEPARTMENT OF NATURAL RESOURCES

FISHING AND BOATING SERVICES — PUBLIC
   NOTICE

Commercial Striped Bass Common Pool Hook and Line
   Fishery Modifications — Effective 8/10/2021 .  784

 

General Notices

DEPARTMENT OF AGING

Public Meeting .  786

CHESAPEAKE BAY TRUST

Public Meeting ......................................................................  786

BOARD OF DIETETIC PRACTICE

Public Meeting ......................................................................  786

EMERGENCY MEDICAL SERVICES ADVISORY
   COUNCIL

Public Meeting .  786

EMERGENCY MEDICAL SERVICES BOARD

Public Meeting ......................................................................  786

COMMISSIONER OF FINANCIAL REGULATION

Public Meeting .  786

MARYLAND DEPARTMENT OF HEALTH

Public Meeting .  786

DEPARTMENT OF INFORMATION TECHNOLOGY

Public Meeting .  786

DIVISION OF LABOR AND INDUSTRY/MARYLAND
   OCCUPATIONAL SAFETY AND HEALTH (MOSH)
   ADVISORY BOARD

Public Hearing .  786

MARYLAND STATE LOTTERY AND GAMING
   CONTROL COMMISSION

Public Meeting .  787

MARYLAND HEALTH CARE COMMISSION

Public Meeting ......................................................................  787

STATE ADVISORY COUNCIL ON QUALITY CARE AT
   THE END OF LIFE

Public Meeting .  787

STATE TREASURER’S OFFICE

Public Meeting .  787

Public Meeting .  787

Public Meeting .  787

BOARD OF WATERWORKS AND WASTE SYSTEMS
   OPERATORS

Public Meeting ......................................................................  787

BOARD OF WELL DRILLERS

Public Meeting .  787

WORKERS’ COMPENSATION COMMISSION

Public Meeting ......................................................................  787

 

 

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 JANUARY 2022

 

Issue
Date

Emergency

and Proposed

Regulations

5 p.m.*

Notices, etc.

10:30 a.m.

Final

Regulations

10:30 a.m.

2021

September 10

August 23

August 30

September 1

September 24

September 3**

September 13

September 15

October 8

September 20

September 27

September 29

October 22

October 4

October 8**

October 13

November 5

October 18

October 25

October 27

November 19

November 1

November 8

November 10

December 3

November 15

November 22

November 24

December 17

November 29

December 6

December 8

2022

January 3***

December 13

December 20

December 22

January 14

December 27

January 3

January 5

January 28

January 10

January 14**

January 19

 

*   Deadlines are for submissions to DSD for publication in the Maryland Register and do not take into account the 15-day AELR review period. Due date for documents containing 8 to 18 pages is 48 hours before the date listed; due date for documents exceeding 18 pages is 1 week before the date listed.

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

** Note closing date changes.

***    Note issue date changes.

The regular closing date for Proposals and Emergencies is Monday.

 


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.

 

01 EXECUTIVE DEPARTMENT

 

01.02.08.13—.17 • 48:15 Md. R. 595 (7-16-21)

 

03 COMPTROLLER OF THE TREASURY

 

03.02.04.01 • 48:1 Md. R. 13 (1-4-21)

 

07 DEPARTMENT OF HUMAN SERVICES

 

07.01.13.07 • 48:18 Md. R. 696 (8-27-21)

07.02.11.08 • 48:17 Md. R. 670 (8-13-21)

 

08 DEPARTMENT OF NATURAL RESOURCES

 

08.02.13.03,.05 • 48:15 Md. R. 596 (7-16-21)

08.18.13.04 • 48:18 Md. R. 697 (8-27-21)

08.18.25.02 • 48:18 Md. R. 697 (8-27-21)

08.18.29.03 • 48:18 Md. R. 698 (8-27-21)

08.18.33.03 • 48:18 Md. R. 698 (8-27-21)

 

09 MARYLAND DEPARTMENT OF LABOR

 

09.03.06.04 • 48:15 Md. R. 602 (7-16-21)

09.09.01.01—.04 • 48:17 Md. R. 671 (8-13-21)

09.09.02.01—.03 • 48:17 Md. R. 671 (8-13-21)

09.09.03.02 • 48:17 Md. R. 671 (8-13-21)

09.10.01.17 • 48:12 Md. R. 476 (6-4-21)

09.10.03.08 • 48:7 Md. R. 261 (3-26-21)

09.37.02.05 • 48:16 Md. R. 632 (7-30-21)

 

10 MARYLAND DEPARTMENT OF HEALTH

 

     Subtitles 01—08 (1st volume)

 

10 • 48:4 Md. R. 190 (2-12-21) (err)

 

     Subtitle 09 (2nd volume)

 

10.09.05.01,.03—.07 • 48:15 Md. R. 603 (7-16-21) (ibr)

10.09.50.07 • 48:17 Md. R. 672 (8-13-21)

10.09.92.08 • 48:3 Md. R. 104 (1-29-21)

                      48:4 Md. R. 190 (2-12-21) (err)

 

Subtitles 10—22 (3rd volume)

 

10.15.03.27 • 48:18 Md. R. 699 (8-27-21)

 

     Subtitles 23—36 (4th volume)

 

10.24.11.01 • 48:15 Md. R. 605 (7-16-21) (ibr)

10.25.06.01—.18 • 48:15 Md. R. 606 (7-16-21)

10.26.02.02—.05,.08 • 48:18 Md. R. 700 (8-27-21)

10.26.06.01—.03 • 48:18 Md. R. 700 (8-27-21)

10.28.12.01,.03—.07 • 48:18 Md. R. 703 (8-27-21)

 

     Subtitles 53—68 (6th volume)

 

10.62.01.01 • 48:12 Md. R. 476 (6-4-21)

10.62.03.01 • 48:12 Md. R. 476 (6-4-21)

10.62.04.04,.05 • 48:12 Md. R. 476 (6-4-21)

10.62.08.02,.05,.10 • 48:12 Md. R. 476 (6-4-21)

10.62.10.02 • 48:12 Md. R. 476 (6-4-21)

10.62.15.08 • 48:12 Md. R. 476 (6-4-21)

10.62.16.06 • 48:12 Md. R. 476 (6-4-21)

10.62.18.01,.04—.10 • 48:12 Md. R. 476 (6-4-21)

10.62.19.02,.04,.09 • 48:12 Md. R. 476 (6-4-21)

10.62.21.02 • 48:12 Md. R. 476 (6-4-21)

10.62.22.02,.03,.06,.07 • 48:12 Md. R. 476 (6-4-21)

10.62.25.02,.05,.10 • 48:12 Md. R. 476 (6-4-21)

10.62.27.02,.08—.10 • 48:12 Md. R. 476 (6-4-21)

10.62.28.02,.03 • 48:12 Md. R. 476 (6-4-21)

10.62.30.04,.08,.09 • 48:12 Md. R. 476 (6-4-21)

10.62.35.01 • 48:12 Md. R. 476 (6-4-21)

10.62.36.01 • 48:12 Md. R. 476 (6-4-21)

10.64.02.01—.03 • 47:23 Md. R. 1002 (11-6-20)

10.67.04.03,.03-1,.03-2,.19,
     .19-3—.19-5
• 48:15 Md. R. 610 (7-16-21)

10.67.05.05-1 • 48:15 Md. R. 610 (7-16-21)

10.67.08.02 • 48:18 Md. R. 705 (8-27-21)

 

11 DEPARTMENT OF TRANSPORTATION

 

     Subtitles 01—10

 

11.02.09.01—.03 • 48:11 Md. R. 429 (5-21-21)

 

     Subtitles 11—23 (MVA)

 

11.13.12.01—.09 • 48:18 Md. R. 706 (8-27-21) (ibr)

11.16.05.01—.04 • 48:15 Md. R. 613 (7-16-21)

 

12 DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONAL SERVICES

 

12.02.29.01—.04 • 48:14 Md. R. 540 (7-2-21)

12.08.01.17,.18,.23 • 48:14 Md. R. 540 (7-2-21)

 

13B MARYLAND HIGHER EDUCATION COMMISSION

 

13B.03.01.01,.03,.04,.13,.14 • 48:11 Md. R. 431 (5-21-21) (ibr)

13B.08.11.04,.07 • 48:15 Md. R. 614 (7-16-21)

 

14 INDEPENDENT AGENCIES

 

14.07.01.01—.18 • 48:18 Md. R. 709 (8-27-21)

14.07.02.01—.08 • 48:18 Md. R. 709 (8-27-21)

14.07.03.01—.06 • 48:18 Md. R. 709 (8-27-21)

14.09.01.01—.04,.08,.09 • 48:16 Md. R. 633 (7-30-21)

14.09.02.01—.04,.06—.08 • 48:16 Md. R. 633 (7-30-21)

14.09.03.02—.05, .07—.09,.11—.16 • 48:16 Md. R. 633 (7-30-21)

14.09.04.01—.03 • 48:16 Md. R. 633 (7-30-21)

14.09.05.01,.03,.07 • 48:16 Md. R. 633 (7-30-21)

14.09.06.04 • 48:16 Md. R. 633 (7-30-21)

14.09.07.02,.07 • 48:16 Md. R. 633 (7-30-21)

14.09.09.02,.04 • 48:16 Md. R. 633 (7-30-21)

14.09.10.02 • 48:16 Md. R. 633 (7-30-21)

14.09.11.02—.04 • 48:16 Md. R. 633 (7-30-21)

14.09.12.02,.03,.07,.08 • 48:16 Md. R. 633 (7-30-21)

14.09.13.01,.02,.08,.12 • 48:16 Md. R. 633 (7-30-21)

14.09.14.01-1,.03 • 48:16 Md. R. 633 (7-30-21)

14.09.15.01 • 48:16 Md. R. 633 (7-30-21)

14.09.16.03,.07—.09,.11,.13,.15,.17 • 48:16 Md. R. 633 (7-30-21)

14.09.17.03 • 48:16 Md. R. 633 (7-30-21)

 

15 MARYLAND DEPARTMENT OF AGRICULTURE

 

15.01.05.10 • 48:16 Md. R. 644 (7-30-21)

 

26 DEPARTMENT OF THE ENVIRONMENT

 

     Subtitles 13 — 18 (Part 3)

 

26.13.01.02,.03,.03-1,.04,.05 • 48:14 Md. R. 547 (7-2-21)

26.13.02.01,.02,.04,.04-3,.04-4,.05,.06,.10,.15,.17,.19-1—.19-8,
     .23
• 48:14 Md. R. 547 (7-2-21)

26.13.03.01,.04,.06,.07—.07-5 • 48:14 Md. R. 547 (7-2-21)

26.13.04.01,.02 • 48:14 Md. R. 547 (7-2-21)

26.13.05..01,.02,.02-2,.05,.11—.14 • 48:14 Md. R. 547 (7-2-21)

26.13.06.01,.02,.19—.22,.25 • 48:14 Md. R. 547 (7-2-21)

26.13.07.02-4,.02-5,.02-8,.13-2 • 48:14 Md. R. 547 (7-2-21)

26.13.09.01—.03 • 48:14 Md. R. 547 (7-2-21)

26.13.10.03,.04,.18,.21—.24 • 48:14 Md. R. 547 (7-2-21)

 

30 MARYLAND INSTITUTE FOR EMERGENCY MEDICAL SERVICES SYSTEMS (MIEMSS)

 

30.01.02.01 • 48:18 Md. R. 710 (8-27-21) (ibr)

30.08.11.15 • 48:12 Md. R. 483 (6-4-21)

30.08.17.01—.19 • 48:18 Md. R. 710 (8-27-21)

30.08.19.01—.15 • 48:18 Md. R. 714 (8-27-21)

 

31 MARYLAND INSURANCE ADMINISTRATION

 

31.03.13.02,.04 • 48:11 Md. R. 432 (5-21-21)

31.04.14.01—.03 • 48:13 Md. R. 520 (6-18-21)

31.05.08.24,.28 • 48:8 Md. R. 322 (4-9-21)

31.08.03.04—.06,.10 • 48:18 Md. R. 716 (8-27-21)

 

33 STATE BOARD OF ELECTIONS

 

33.05.01.02 • 48:17 Md. R. 673 (8-13-21)

33.11.01.01 • 48:17 Md. R. 673 (8-13-21)

33.11.02.03 • 48:17 Md. R. 674 (8-13-21)

33.11.02.05 • 48:17 Md. R. 673 (8-13-21)

33.11.03.06 • 48:17 Md. R. 674 (8-13-21)

33.11.05.07 • 48:17 Md. R. 674 (8-13-21)

33.17.04.03,.06 • 48:17 Md. R. 674 (8-13-21)

 

36 MARYLAND STATE LOTTERY AND GAMING CONTROL AGENCY

 

36.01.01.01,.05 • 48:18 Md. R. 718 (8-27-21)

36.01.02.04—.06 • 48:18 Md. R. 718 (8-27-21)

36.10.01.01—.02 • 48:18 Md. R. 718 (8-27-21)

36.10.02.01—.14 • 48:18 Md. R. 718 (8-27-21)

36.10.03.01—.06 • 48:18 Md. R. 718 (8-27-21)

36.10.04.01—.11 • 48:18 Md. R. 718 (8-27-21)

36.10.05.01—.05 • 48:18 Md. R. 718 (8-27-21)

36.10.06.01—.11 • 48:18 Md. R. 718 (8-27-21)

36.10.07.01—.06 • 48:18 Md. R. 718 (8-27-21)

36.10.08.01—.11 • 48:18 Md. R. 718 (8-27-21)

36.10.09.01—.03 • 48:18 Md. R. 718 (8-27-21)

36.10.10.01—.03 • 48:18 Md. R. 718 (8-27-21)

36.10.11.01—.09 • 48:18 Md. R. 718 (8-27-21)

36.10.12.01—.04 • 48:18 Md. R. 718 (8-27-21)

36.10.13.01—.44 • 48:18 Md. R. 718 (8-27-21)

36.10.14.01—.07 • 48:18 Md. R. 718 (8-27-21)

36.10.15.01—.04 • 48:18 Md. R. 718 (8-27-21)

36.10.16.01—.06 • 48:18 Md. R. 718 (8-27-21)

36.10.17.01—.03 • 48:18 Md. R. 718 (8-27-21)

36.10.18.01—.06 • 48:18 Md. R. 718 (8-27-21)

 

The Governor

PROCLAMATION

Renewal of Declaration of State of Emergency and Existence of Catastrophic Health Emergency — COVID-19

 

WHEREAS, on March 5, 2020, in an effort to control and prevent the spread of COVID‑19, a state of emergency and catastrophic health emergency was proclaimed within the entire State of Maryland, pursuant to the Maryland Constitution and Laws of Maryland, including but not limited to Title 14 of the Public Safety Article;

 

WHEREAS, COVID-19 is a highly infectious respiratory disease that spreads easily from person to person and may result in serious illness or death;

 

WHEREAS, COVID-19 is a public health catastrophe and has been confirmed in all Maryland counties;

 

WHEREAS, since the declaration of a state of emergency and the existence of a catastrophic health emergency on March 5, 2020, there have been more than 472,000 laboratory confirmed positive COVID-19 cases and more than 9,600 related deaths in Maryland;

 

WHEREAS, the proclamation declaring the emergencies was renewed on March 17, 2020, April 10, 2020, May 6, 2020, June 3, 2020, July 1, 2020, July 30, 2020, August 10, 2020, September 8, 2020, October 6, 2020, October 29, 2020, November 25, 2020, December 23, 2020, January 21, 2021, February 19, 2021, March 18, 2021, April 16, 2021, May 12, 2021, June 12, 2021, and July12, 2021;

 

WHEREAS, on June 15, 2021, Executive Order 21-06-15-01, Terminating Various Emergency Orders, was issued to provide a safe and controlled end of various Emergency Orders; and

 

WHEREAS, the emergency conditions, state of emergency, and catastrophic health emergency continue to exist;

 

NOW, THEREFORE, I, LAWRENCE J. HOGAN, JR., governor of the state of Maryland, by virtue of the authority vested in me by the Maryland Constitution and the laws of Maryland, including but not limited to Title 14 of the Public Safety Article, and in an effort to control and prevent the spread of COVID‑19 within the state, hereby declare that a state of emergency and catastrophic health emergency continues to exist within the entire state of Maryland, renew the March 5, 2020, Proclamation for a period of 4 days, until 11:59 p.m. on august 15, 2021, and further provide and order, effective immediately:

 

Health care providers who act in good faith under this catastrophic health emergency proclamation, including orders issued under the proclamation by the Governor and by other State officials acting at the direction of or under delegated authority from the Governor, have the immunity provided by § 14-3A-06 of the Public Safety Article of the Maryland Code.

 

GIVEN Under My Hand and the Great Seal of the State of Maryland in the City of Annapolis, this 11th day of August, 2021.

LAWRENCE J. HOGAN, JR.
Governor

 

ATTEST:

JOHN C. WOBENSMITH
Secretary of State

[21-18-32]

 

 

The Judiciary

COURT OF APPEALS OF MARYLAND

DISCIPLINARY PROCEEDINGS

     This is to certify that by an Order of this Court dated August 10, 2021,TIMOTHY GUY SMITH (CPF# 8712010585), 2480 Route 97, #7, Glenwood, Maryland 21797, 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).

*   *   *   *   *   *   *   *   *   *

     This is to certify that by an Opinion and Order of this Court dated August 11, 2021, EDWARD EMAD MOAWAD (CPF# 150720003), 5425 Wisconsin Avenue, Suite 600, Chevy Chase, Maryland 20815, has been disbarred, 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).

[21-18-28]

 

 

Emergency Action on Regulations

Symbol Key

   Roman type indicates text existing before emergency status was granted.

   Italic type indicates new text.

   [Single brackets] indicate deleted text.

 

Emergency Regulations

Under State Government Article, §10-111(b), Annotated Code of Maryland, an agency may petition the Joint Committee on Administrative, Executive, and Legislative Review (AELR), asking that the usual procedures for adopting regulations be set aside because emergency conditions exist. If the Committee approves the request, the regulations are given emergency status. Emergency status means that the regulations become effective immediately, or at a later time specified by the Committee. After the Committee has granted emergency status, the regulations are published in the next available issue of the Maryland Register. The approval of emergency status may be subject to one or more conditions, including a time limit. During the time the emergency status is in effect, the agency may adopt the regulations through the usual promulgation process. If the agency chooses not to adopt the regulations, the emergency status expires when the time limit on the emergency regulations ends. When emergency status expires, the text of the regulations reverts to its original language.

 

Title 09
MARYLAND DEPARTMENT OF LABOR

Subtitle 12 DIVISION OF LABOR AND INDUSTRY

09.12.29 Emergency Temporary Standards

Authority: Labor and Employment Article, §§2-106(b)(5), 5-309(a)(1), 5-312, and 5-314, Annotated Code of Maryland; Ch. 736, §2, Acts of 2021

Notice of Emergency Action

[21-121-E]

The Joint Committee on Administrative, Executive, and Legislative Review has granted emergency status to new Regulations .01 and .02 under a new chapter, COMAR 09.12.29 Emergency Temporary Standards.

Emergency status began: August 16, 2021.

Emergency status expires: January 30, 2022.

Comparison to Federal Standards

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

Economic Impact on Small Businesses

The emergency action has minimal or no economic impact on small businesses.

.01 Purpose.

This chapter establishes Emergency Temporary Standards for employers in Maryland.

.02 Incorporation by Reference of Federal Standard.

A. In this chapter, the following documents are incorporated by reference.

B. Documents Incorporated — COVID Emergency Temporary Standard. All amendments and revisions to 29 CFR §1910, Subpart U, that appeared in the Federal Register on June 21, 2021 (86 FR 32620-32628), as amended, are adopted by reference with the following substitutions:

(1) Where “Assistant Secretary” appears, substitute “Assistant Commissioner of MOSH”;

(2) Where “OSH Act” appears, substitute “Maryland Occupational Safety and Health Act”; and

(3) Where “OSHA” appears, substitute “MOSH” for “OSHA”, except for references to “OSHA injury” and “illness records”.

MATTHEW S. HELMINIAK
Commissioner of Labor and Industry

 

Title 36
MARYLAND STATE LOTTERY AND GAMING CONTROL AGENCY

Notice of Emergency Action

[21-108-E]

The Joint Committee on Administrative, Executive, and Legislative Review has granted emergency status to:

 (1) Amendments to Regulations .01 and .05 under COMAR 36.01.01General;

(2) Amendments to Regulations .04—.06 under COMAR 36.01.02 Administrative Procedures; and

(3) Under a new subtitle, Subtitle 10 Sports Wagering Provisions:

     (a) New Regulations .01 and .02 under a new chapter, COMAR 36.10.01 General;

     (b) New Regulations .01—.14 under a new chapter, COMAR 36.10.02 All Applicants and Licensees — Applications and Investigations;

     (c) New Regulations .01—.06 under a new chapter, COMAR 36.10.03 All Applicants and Licensees — Qualification Requirements;

     (d) New Regulations .01—.11 under a new chapter, COMAR 36.10.04 Specific Requirements for Sports Wagering Facility Licensees;

     (e) New Regulations .01—.05 under a new chapter, COMAR 36.10.05 Specific Requirements for Mobile Sports Wagering Licenses;

     (f) New Regulations .01—.11 under a new chapter, COMAR 36.10.06 Specific Requirements for Other Licenses Required for Sports Wagering;

     (g) New Regulations .01—.06 under a new chapter, COMAR 36.10.07 License Denial Procedures;

     (h) New Regulations .01—.11 under a new chapter, COMAR 36.10.08 Enforcement;

     (i) New Regulations .01—.03 under a new chapter, COMAR 36.10.09 Unannounced Inspections;

     (j) New Regulations .01—.03 under a new chapter, COMAR 36.10.10 Enforcement of Voluntary Exclusion Program;

     (k) New Regulations .01—.09 under a new chapter, COMAR 36.10.11 Mandatory Exclusion;

     (l) New Regulations .01—.04 under a new chapter, COMAR 36.10.12 Collection of Taxes, Fees, and Penalties;

     (m) New Regulations .01—.44 under a new chapter, COMAR 36.10.13 Sports Wagering Licensee Minimum Internal Control Standards;

     (n) New Regulations .01—.07 under a new chapter, COMAR 36.10.14 Sports Wagering Requirements and Limitations;

     (o) New Regulations .01—.04 under a new chapter, COMAR 36.10.15 Sports Wagering Licensee Facility Standards;

     (p) New Regulations .01—.06 under a new chapter, COMAR 36.10.16 Wagering Using Online, Web-based, or Mobile Applications;

     (q) New Regulations .01—.03 under a new chapter, COMAR 36.10.17 Sports Wagering Equipment; and

     (r) New Regulations .01—.06 under a new chapter, COMAR 36.10.18 Sports Wagering Technical Standards.

Emergency status began: August 5, 2021.

Emergency status expires: January 25, 2022.

 

     Editor’s Note:  The text of this document will not be printed here because it appears as a Notice of Proposed Action on pages 718—781 of this issue, referenced as [21-108-P]. 

JOHN MARTIN
Director

 

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 08
DEPARTMENT OF NATURAL RESOURCES

Subtitle 03 WILDLIFE

08.03.02 Use of Wildlife Areas

Authority: Natural Resources Article, §§10-205 and 10-808, Annotated Code of Maryland

Notice of Final Action

[21-084-F]

On August 17, 2021, the Secretary of Natural Resources adopted amendments to Regulation .28 under COMAR 08.03.02 Use of Wildlife Areas. This action, which was proposed for adoption in 48:14 Md. R. 539 (July 2, 2021), has been adopted as proposed.

Effective Date: September 6, 2021.

JEANNIE HADDAWAY-RICCIO
Secretary of Natural Resources

 

Title 14
INDEPENDENT AGENCIES

Subtitle 01 PRESCRIPTION DRUG AFFORDABILITY BOARD

14.01.01 General Provisions

Authority: Health-General Article, §21-2C-03(f), Annotated Code of Maryland

Notice of Final Action

[21-082-F]

On August 17, 2021, the Prescription Drug Affordability Board adopted new Regulation .01 under a new chapter, COMAR 14.01.01 General Provisions, under a new subtitle, Subtitle 01 Prescription Drug Affordability Board. The Board voted unanimously to adopt the regulations, after careful consideration of the comments submitted. This action, which was proposed for adoption in 48:14 Md. R. 543—544 (July 2, 2021), has been adopted as proposed.

Effective Date: September 6, 2021.

ANDREW YORK
Executive Director

 

Subtitle 01 PRESCRIPTION DRUG AFFORDABILITY BOARD

14.01.02 Prescription Drug Affordability Fund

Authority: Health-General Article, §21-2C-11, Annotated Code of Maryland

Notice of Final Action

[21-083-F]

On August 17, 2021, the Prescription Drug Affordability Board adopted new Regulations .01—.05 under a new chapter, COMAR 14.01.02 Prescription Drug Affordability Fund, under a new subtitle, Subtitle 01 Prescription Drug Affordability Board. The Board voted unanimously to adopt the regulations, after careful consideration of the comments submitted. This action, which was proposed for adoption in 48:14 Md. R. 544—545 (July 2, 2021), has been adopted as proposed.

Effective Date: September 6, 2021.

ANDREW YORK
Executive Director

 

Subtitle 22 COMMISSION ON CRIMINAL SENTENCING POLICY

14.22.01 General Regulations

Authority: Criminal Procedure Article, §6-211, Annotated Code of Maryland

Notice of Final Action

[21-079-F]

On August 17, 2021, the Maryland State Commission on Criminal Sentencing Policy adopted amendments to Regulation .09 under COMAR 14.22.01 General Regulations. This action, which was proposed for adoption in 48:14 Md. R. 545—546 (July 2, 2021), has been adopted as proposed.

Effective Date: October 1, 2021.

DAVID SOULE
Executive Director

 

Subtitle 27 MARYLAND ENVIRONMENTAL SERVICE

14.27.02 Human Resources System

Authority: Natural Resources Article, §§3-103.1 and 3-127, Annotated Code of Maryland

Notice of Final Action

[21-080-F]

On August 16, 2021, the Maryland Environmental Service adopted amendments to Regulations .01, .02, and .25 under COMAR 27.14.02 Human Resources System. This action, which was proposed for adoption in 48:14 Md. R. 546 (July 2, 2021), has been adopted as proposed.

Effective Date: September 6, 2021.

CHARLES C. GLASS, Ph.D.
Executive Director

 

Subtitle 27 MARYLAND ENVIRONMENTAL SERVICE

14.27.03 Procurement

Authority: Natural Resources Article, §3-127, Annotated Code of Maryland

Notice of Final Action

[21-081-F]

On August 16, 2021, the Maryland Environmental Service adopted amendments to Regulations .03 and .04 under COMAR 14.27.03 Procurement. This action, which was proposed for adoption in 48:14 Md. R. 546—547 (July 2, 2021), has been adopted as proposed.

Effective Date: September 6, 2021.

CHARLES C. GLASS, Ph.D.
Executive Director

 

Title 20
PUBLIC SERVICE COMMISSION

Subtitle 79 APPLICATIONS CONCERNING THE CONSTRUCTION OR MODIFICATION OF GENERATING STATIONS, QUALIFIED GENERATOR LEAD LINES, AND OVERHEAD TRANSMISSION LINES

20.79.01 General

Authority: Public Utilities Article, §§2-113, 2-121, and 7-205—7-208, Annotated Code of Maryland

Notice of Final Action

[21-074-F]

On August 10, 2021, the Maryland Public Service Commission adopted amendments to Regulation .02, new Regulations .05, .10, and .11, amendments to and the recodification of existing Regulation .05 to be Regulation .06, the repeal of existing Regulation .09, and the recodification of existing Regulations .06—.08 to be Regulations .07—.09 under COMAR 20.79.01 General. This action, which was proposed for adoption in 48:13 Md. R. 511—514 (June 18, 2021), has been adopted as proposed.

Effective Date: September 6, 2021.

ANDREW S. JOHNSTON
Executive Secretary

 

Subtitle 79 APPLICATIONS CONCERNING THE CONSTRUCTION OR MODIFICATION OF GENERATING STATIONS, QUALIFIED GENERATOR LEAD LINES, AND OVERHEAD TRANSMISSION LINES

20.79.02 Administrative Provisions

Authority: Public Utilities Article, §§2-113, 2-121, and 7-205—7-208, Annotated Code of Maryland

Notice of Final Action

[21-075-F]

On August 10, 2021, the Maryland Public Service Commission adopted amendments to Regulations .01 and .02 under COMAR 20.79.02 Administrative Provisions. This action, which was proposed for adoption in 48:13 Md. R. 515—516 (June 18, 2021), has been adopted as proposed.

Effective Date: September 6, 2021.

ANDREW S. JOHNSTON
Executive Secretary

 

Subtitle 79 APPLICATIONS CONCERNING THE CONSTRUCTION OR MODIFICATION OF GENERATING STATIONS, QUALIFIED GENERATOR LEAD LINES, AND OVERHEAD TRANSMISSION LINES

20.79.03 Details of Filing Requirements — Generating Stations

Authority: Public Utilities Article, §§2-113, 2-121, and 7-205—7-208, Annotated Code of Maryland

Notice of Final Action

[21-076-F]

On August 10, 2021, the Maryland Public Service Commission adopted amendments to Regulations .01 and .02, new Regulations .03 and .04, and the recodification of existing Regulations .03—.05 to be Regulations .05—.07 under COMAR 20.79.03 Details of Filing Requirements — Generating Stations. This action, which was proposed for adoption in 48:13 Md. R. 516—519 (June 18, 2021), has been adopted as proposed.

Effective Date: September 6, 2021.

ANDREW S. JOHNSTON
Executive Secretary

 

Title 27
CRITICAL AREA COMMISSION FOR THE CHESAPEAKE AND ATLANTIC COASTAL BAYS

Notice of Final Action

[21-056-F]

On August 4, 2021, the Critical Area Commission for the Chesapeake and Atlantic Coastal Bays adopted:

(1) Amendments to Regulation .01 under COMAR 27.01.01 General Provisions;

(2) The repeal of existing Regulations .01 and .03, amendments to Regulation .02, and new Regulation .03 under COMAR 27.01.06 Agriculture;

(3) Amendments to Regulation .01-6 under COMAR 27.01.09 Habitat Protection Areas in the Critical Area;

(4) Amendments to Regulation .01 under COMAR 27.02.01 General Provisions;

(5) Amendments to Regulation .01 under COMAR 27.02.03 General Approval of State and Local Agency Programs Which Result in Development of Local Significance on Private Lands or Lands Owned by Local Jurisdictions;

(6) The repeal of existing Regulation .07, new Regulation .07, and amendments to Regulation .09 under COMAR 27.02.05 State Agency Actions Resulting in Development on State-Owned Lands; and

(7) Amendments to Regulation .01 under COMAR 27.03.01 Notification of Project Applications.

This action, which was proposed for adoption in 48:9 Md. R. 371—375 (April 23, 2021), has been adopted as proposed.

Effective Date: September 6, 2021.

CHARLES C. DEEGAN
Chairman

 

Notice of Final Action

[21-072-F]

On August 4, 2021, the Critical Area Commission for the Chesapeake and Atlantic Coastal Bays adopted:

(1)  New Regulation .02-1 and amendments to Regulation .03 under COMAR 27.01.14 Renewable Energy Generating Stations;

(2) New Regulation .02 and the recodification of existing Regulation .02 to be Regulation .02-1 under COMAR 27.02.07 Commission Review, Decision Process, and Time Frames; and

(3) Amendments to Regulation .04 under COMAR 27.03.01 Notification of Project Applications.

This action, which was proposed for adoption in 48:13 Md. R. 519—520 (June 18, 2021), has been adopted with the nonsubstantive changes shown below.

Effective Date: September 6, 2021.

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 27.03.01.04G: The phrase "to a local jurisdiction" is being deleted. This change is  nonsubstantive as it eliminates unnecessary words and does not affect the application of the regulation.

 

Subtitle 03 PROJECT APPLICATIONS

27.03.01 Notification of Project Applications

Authority: Natural Resources Article, §§8-1808(c) and 8-1811, Annotated Code of Maryland

.04 Categories of Applications of Which the Commission Wishes to Receive Notification.

A.—F. (text unchanged)

G. Major and Minor Solar Energy Generating Systems.  The local approving authority shall submit a copy of any application [[to a local jurisdiction]] for a major or a minor solar energy generating system that would occur wholly or partially in a limited development area and resource conservation area in accordance with COMAR 27.01.14 and COMAR 27.02.07, and a copy of the final approved application for a major solar energy generating system.

CHARLES C. DEEGAN
Chairman

 

Title 36
MARYLAND STATE LOTTERY AND GAMING CONTROL AGENCY

Notice of Final Action

[21-085-F]

On August 17, 2021, the Maryland State Lottery and Gaming Control Agency adopted amendments to:

(1) Regulation .17 under COMAR 36.03.02 Investigation and Licensing;

(2) Regulations .20, .28, and .38 under COMAR 36.03.10 Video Lottery Facility Minimum Internal Control Standards;

(3) Regulations .27 and .30 under COMAR 36.04.01 Video Lottery Technical Standards;

(4) Regulations .15 and .16 under COMAR 36.05.02 Table Game Equipment; and

(5) Regulation .01 under COMAR 36.05.03 Table Game Procedures.

This action, which was proposed for adoption in 48:14 Md. R. 577—579 (July 2, 2021), has been adopted as proposed.

Effective Date: September 6, 2021.

GORDON MEDENICA
Director

 

 

Proposed Action on Regulations

 


Title 07
DEPARTMENT OF HUMAN SERVICES

Subtitle 01 OFFICE OF SECRETARY

07.01.13 Legal Services

Authority: Courts and Judicial Proceedings Article, §3-813; Family Law Article, §5-323(a)(2); Annotated Code of Maryland

Notice of Proposed Action

[21-113-P]

The Secretary of Human Services proposes to amend Regulation .07 under COMAR 07.01.13 Legal Services.

Statement of Purpose

The purpose of this action is to remove an outdated process. The Judicare Committee no longer reviews invoices of the Court-appointed attorneys on behalf of the Department, and has not done so for more than 10 years.

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 Lauren C. Graziano, Director of Government Affairs, Department of Human Services, 311 W. Saratoga Street, Baltimore, MD 21201, or call 410-767-6886, or email to laurenc.graziano@maryland.gov. Comments will be accepted through September 27, 2021. A public hearing has not been scheduled.

.07 Adult Guardianships or Protective Services.

A. Court-Appointed Attorney Payment Procedures.

(1) (text unchanged)

(2) The Director shall[:

(a) Review] review the attorney's submission to ensure that all required information and documentation have been submitted[; and].

[(b) Forward request for payment to the Judicare Committee for review, investigation, and recommendation of a reasonable fee if the request is over $500.

B. Judicare Committee.

(1) The Judicare Committee shall review the request received from the Director and shall:

(a) Determine whether the services rendered were reasonable and necessary according to accepted standards of practice in the Maryland Legal Services Program;

(b) Determine the amount of a reasonable fee; and

(c) Send its recommendation to the Director.

(2) In making its recommendation of a reasonable fee, the Judicare Committee may consider the following:

(a) The amount of reasonable and necessary time spent by the attorney on the case;

(b) The attorney's customary fee for cases of the type submitted and the prevailing fees of other attorneys for those cases in the geographic area of the attorney's practice;

(c) The complexity of the case and degree of skill required of the attorney;

(d) The indigence of the person;

(e) The fact that the State is not a private litigant but is a bulk purchaser of counsel services for private litigation; and

(f) The ethical obligation of attorneys to provide services at reduced cost or at no cost to indigent persons.]

[C.] B. (text unchanged)

LAUREN C. GRAZIANO
Director of Government Affairs

 

Title 08
DEPARTMENT OF NATURAL RESOURCES

Subtitle 18 BOATING — SPEED LIMITS AND OPERATION OF VESSELS

08.18.13 Magothy River

Authority: Natural Resources Article, §8-704, Annotated Code of Maryland

Notice of Proposed Action

[21-112-P]

The Secretary of Natural Resources proposes to amend Regulation .04 under COMAR 08.18.13 Magothy River.

Statement of Purpose

The purpose of this action is to expand the current demarcation line for the speed zone on Cool Springs Cove and Forked Creek. The proposed action relocates the demarcation line for the 6 knot speed limit that is in place at all times during the year approximately 400 feet north (downstream) of the current line. This will help account for large wakes being experienced by local residents and the marina due to newer styles of watercraft being used in this area over the last several years. The proposed action also reorganizes the section so that the regulation complies with formatting rules. This action will increase safety for all waterway users, community marinas, and privately owned waterfront properties within the waterway area.

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 Magothy River Regulations, Regulatory Staff, Department of Natural Resources Fishing and Boating Services, 580 Taylor Avenue, E-4, Annapolis, MD 21401, or call 410-260-8417, or email to boatingregspubliccomment.dnr@maryland.gov. Comments will be accepted through September 27, 2021. A public hearing has not been scheduled.

.04 Magothy River South Shore.

A. (text unchanged)

B. Cool Spring Cove — Forked Creek[, encompasses the area beginning at a point at or near Lat. 39° 3.828' N., Long. 76° 29.428' W., then running 90° (True) to a point, at or near Lat. 39° 3.828' N., Long. 76° 29.118' W., and running to the head of the cove and creek. This area has a 6-knot speed limit all year].

(1) Area. All of the waters upstream of a line beginning at a point defined by Lat. 39º3.892' N, Long. 76º29.472' W; then running 90° True to a point defined by Lat. 39º3.890' N, Long. 76º29.058' W.

(2) The speed limit for the area described in §B(1) of this regulation is 6 knots at all times.

C.―H. (text unchanged)

JEANNIE HADDAWAY-RICCIO
Secretary of Natural Resources

Subtitle 18 BOATING — SPEED LIMITS AND OPERATION OF VESSELS

08.18.25 South River

Authority: Natural Resources Article, §8-704, Annotated Code of Maryland

Notice of Proposed Action

[21-111-P]

The Secretary of Natural Resources proposes to amend Regulation .02 under COMAR 08.18.25 South River.

Statement of Purpose

The purpose of this action is to change the speed limit in the area near the Riva Bridge to be consistent with the speed limit in the Route 2 bridge area. The proposed action changes the speed limit for the Riva Bridge area from 6 knots on Saturdays, Sundays, and holidays during the boating season to 6 knots at all times. The proposed action also reorganizes the section so that the regulation complies with formatting rules.

As noted by Natural Resources Police (NRP), the area leading under the bridge is a confusing point to waterway users. NRP has received many complaints from the boating public because of high wake caused by other boats. Creating a full-time 6 knot speed zone, as opposed to the part-time speed zone that exists now, will reduce potential injuries and property damage.

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 South River Regulations, Regulatory Staff, Department of Natural Resources Fishing and Boating Services, 580 Taylor Avenue, E-4, Annapolis, MD 21401, or call 410-260-8417, or email to bostingregspubliccomment.dnr@maryland.gov. Comments will be accepted through September 27, 2021. A public hearing has not been scheduled.

.02 South River Proper.

A.―C. (text unchanged)

D. Riva Bridge Area.

(1) Area. [This encompasses the area] All of the waters upstream of a line beginning at a point at or near Lat. 38°57.229' N[.], Long. 76°34.330' W[.,]; then running 30° [(]True[)] to a point, at or near Lat. 38°57.451' N[.], Long. 76°34.166' W[.,]; and downstream of a line beginning at a point, at or near Lat. 38°57.211' N[.], Long. 76°34.545' W[.,]; then running 20° [(]True[)] to Addison Point, at or near Lat. 38°57.495' N[.], Long. 76°34.412' W.

(2) [Except as otherwise restricted, the] The speed limit for [this] the area described in §D(1) of this regulation is 6 knots [on Saturdays, Sundays, and Holidays during the boating season] at all times.

E.―G. (text unchanged)

JEANNIE HADDAWAY-RICCIO
Secretary of Natural Resources

 

Subtitle 18 BOATING — SPEED LIMITS AND OPERATION OF VESSELS

08.18.29 White Hall Bay

Authority: Natural Resources Article, §8-704, Annotated Code of Maryland

Notice of Proposed Action

[21-110-P]

The Secretary of Natural Resources proposes to amend Regulation .03 under COMAR 08.18.29 Whitehall Bay.

Statement of Purpose

The purpose of this action is to expand the speed zone in Mill Creek. The Department received a request to remove both the Mill Creek proper (Northern Branch) and Martin Cove speed zone demarcation lines and establish a new demarcation line in the main stem of Mill Creek. Over the past decade there has been increasing congestion in this area due to both boaters and other waterway users. Some of these waterway users have created excessive wakes that have caused damage to personal property. The new line will begin just prior to the intersection of the waterways, approximately 235 yards down the main stem of Mill Creek waterway. The proposed action removes the descriptions for both Martin Cove and Mill Creek proper (Northern Branch) and establishes a new speed zone demarcation line for the combined and extended area. The proposed action establishes a 6 knot speed limit on Saturdays, Sundays, and holidays all year for the entire area, which is the current rule for the Mill Creek proper and Martins Cove waterways. The Department expects that by extending the 6 knot speed limit to the new line, both safety and property concerns will be addressed.

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 Mill Creek Regulations, Regulatory Staff, Department of Natural Resources Fishing and Boating Services, 580 Taylor Avenue, E-4, Annapolis, MD 21401, or call 410-260-8417, or email to boatingregspubliccomment.dnr@maryland.gov. Comments will be accepted through September 27, 2021. A public hearing has not been scheduled.

.03 Mill Creek.

A. (text unchanged)

[B. Martins Cove encompasses the area beginning at a point, at or near Lat. 39° 0.162' N., Long. 76° 27.457' W., then running 172° (True) to a point, at or near Lat. 39° 0.035'N., Long. 76° 27.435' W., and running to the head of the cove. This area has a 6-knot speed limit Saturdays, Sundays, and State holidays, all year.

C. Mill Creek proper encompasses the area beginning at a point, at or near Lat. 39° 0.162'N., Long. 76° 27.457' W., then running 97° (True) to a point, at or near Lat. 39° 0.150'N., Long. 76° 27.335' W., and running to the head of the creek. This area has a 6-knot speed limit Saturdays, Sundays, and State holidays, all year.]

B. Martins Cove and Mill Creek Proper.

(1) Area. All of waters upstream of a line beginning at a point, at or near Lat. 39º0.035' N, Long. 76º27.435' W; then running 97° True to a point, at or near Lat. 39º0.025' N, Long. 76º27.298' W.

(2) The speed limit for the area described in §B(1) of this regulation is 6 knots on every:

(a) Saturday;

(b) Sunday; and

(c) State or federal holiday.

[D.] C.[E.] D. (text unchanged)

JEANNIE HADDAWAY-RICCIO
Secretary of Natural Resources

 

Subtitle 18 BOATING — SPEED LIMITS AND OPERATION OF VESSELS

08.18.33 Deep Creek Lake

Authority: Natural Resources Article, §8-704, Annotated Code of Maryland

Notice of Proposed Action

[21-109-P]

The Secretary of Natural Resources proposes to amend Regulation .03 under COMAR 08.18.33 Deep Creek Lake.

Statement of Purpose

The purpose of this action is to update and clarify existing boating laws and coordinates of certain boundaries.

There is an inlet between Beckman’s Peninsula and Harvey’s Peninsula that is very narrow, so waterway users are restricted from towing in that area. The coordinates for the restricted area were incorrect. The proposed action describes the correct area. The action also reorganizes the text to make it clear and to follow style guidelines.

The proposed action modifies the speed limit in the portion of Deep Creek Lake known as North Glade Cove. The Cove is narrow with many obstacles and is heavily used by recreational vessels, both powered and non-powered. The proposed action defines the area with coordinates. The defined area is designated as a minimum wake zone. Minimum wake zone is defined in the Code of Maryland Regulations (COMAR 08.18.01.03) and means that a person may not operate or give permission to operate a vessel in excess of the slowest possible boat speed necessary to maintain steerage under prevailing wind and sea conditions not to exceed 3 knots (3.5 statute miles per hour or 5.6 kilometers per hour). This action will increase the safety of the boating community and decrease damage to the surrounding shoreline and dock structures.

These changes will ensure safer boating on Maryland’s waterways.

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 Deep Creek Lake Regulations, Regulatory Staff, Department of Natural Resources Fishing and Boating Services, 580 Taylor Avenue, E-4, Annapolis, Maryland 21401, or call 410-260-8417, or email to boatingregspubliccomment.dnr@maryland.gov. Comments will be accepted through September 27, 2021. A public hearing has not been scheduled.

.03 Speed Limits and Restrictions.

A. Restricted [Skiing] Area—[North Glade Cove.] Inlet Between Beckman’s Peninsula and Harvey’s Peninsula. [From 12 noon until sunset on each Saturday, Sunday, and each holiday officially recognized by the State or federal government, or both, an individual may not operate a vessel towing an individual on a ski, aquaplane, or similar device in that area of Deep Creek Lake described as that portion of North Glade Cove lying eastward of a line beginning at a point, at or near Lat. 39° 30.238' N., Long. 79° 16.157' W., then running 159° (True) to a point, at or near Lat. 39° 30.099' N., Long. 79° 16.090' W.]

(1) Area. All of the waters enclosed by a line beginning at a point defined by Lat. 39°29.860' N, Long. 79°17.190' W; then running 80° True to a point defined by Lat. 39°29.880' N, Long. 79°16.970' W; then running 0° True to a point defined by Lat. 39°30.070' N, Long. 79°16.970' W; then running 283° True to a point defined by Lat. 39°30.109' N, Long. 79°17.167' W; then running 184° True to the point of beginning.

(2) An individual may not operate a vessel towing an individual on a ski, aquaplane, or similar device in the area described in §A(1) of this regulation from 12 noon until sunset on any:

(a) Saturday;

(b) Sunday; or

(c) State or federal holiday.

B. Speed Limit. The following areas are designated minimum wake zones:

(1)—(6) (text unchanged)

(7) Those portions of Pawn Run Cove which lie northwest of a line beginning at a point, at or near Lat. 39°28.012' N., Long. 79°18.711' W., then running 263° (True) to a point, at or near Lat. 39°28.000' N., Long. 79°18.842' W., then running 147° (True) to a point, at or near Lat. 39°27.890' N., Long. 79°18.749' W.; and

(8) [From 11 a.m. to 4 p.m., each Saturday and Sunday, and each holiday from Memorial Day holiday weekend through Labor Day, that area of] All of the waters of North Glade Cove [which connects to Beckman’s Cove,] lying [north] east of a line beginning at a point[, at or near Lat. 39° 29.871' N., Long. 79° 16.920' W., then running 260° (True) to a point, at or near Lat. 39° 29.831' N., Long. 79° 17.215' W., and south of a line beginning at a point at or near Lat. 39° 30.074' N., Long. 79° 16.971' W., then running 283° (True) to a point, at or near Lat. 39° 30.109' N., Long. 79° 17.167' W.] defined by Lat. 39°30.250' N, Long. 79°16.020' W; then running 200° True to a point defined by Lat. 39°30.099' N, Long. 79°16.090' W.

JEANNIE HADDAWAY-RICCIO
Secretary of Natural Resources

 

Title 10
MARYLAND DEPARTMENT OF HEALTH

Subtitle 15 FOOD

10.15.03 Food Service Facilities

Authority: Health-General Article, §§18-102, 21-202, 21-301, and 21-330.1, Annotated Code of Maryland

Notice of Proposed Action

[21-117-P]

The Secretary of Health proposes to amend Regulation .27 under COMAR 10.15.03 Food Service Facilities.

Statement of Purpose

The purpose of this action is to align Regulation .27 Farmer’s Market, Bake Sales, and Cottage Food Business, with Ch. 405 (H.B. 1017), Acts of 2020, which established that cottage food businesses may request a unique identification number from the Department to be used in lieu of a business address on a cottage food product label.

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 Jason Caplan, Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through September 27, 2021. A public hearing has not been scheduled.

.27 Farmer’s Market, Bake Sales, and Cottage Food Business.

A. The approving authority shall accept as being from an approved source the homemade foods specified in §B of this regulation when the foods are:

(1) (text unchanged)

(2) Offered or sold only in the State:

(a) Subject to the requirements of [§C(5) and (6)] §C(6) and (7) of this regulation, at a retail food store; or

(b) (text unchanged)

B. (text unchanged)

C. Cottage Food Business.

(1) The approving authority shall allow the owner of a cottage food business to sell only cottage food products processed and packaged in Maryland that are:

(a)—(b) (text unchanged)

(c) Prepackaged with a label that contains the following information:

(i) The name and address of the cottage food business or the name, phone number, and identification number assigned to the cottage food business by the Department;

(ii)—(viii) (text unchanged)

(2) A cottage food business may request a unique identification number from the Department which can be used in lieu of the address of the cottage food business on the product label required under §C(1) of this regulation.

[(2)] (3)—[(5)] (6) (text unchanged)

[(6)] (7) The owner of a cottage food business may not sell or offer for sale a cottage food product to a retail food store until notified by the Department, in writing, that the requirements stated in [§C(5)] §C(6) of this regulation are satisfactorily met.

D. (text unchanged)

DENNIS R. SCHRADER
Secretary of Health

 

Subtitle 26 BOARD OF ACUPUNCTURE

Notice of Proposed Action

[21-107-P]

The Secretary of Health proposes to:

(1) Amend Regulations .02—.05 and adopt new Regulation .08 under COMAR 10.26.02 General Regulations; and

(2) Adopt new Regulations .01—.03 under a new chapter, COMAR 10.26.06 Continuing Education.

This action was considered by the Board of Acupuncture at public meetings held on November 12, 2019, March 10, 2020, November 10, 2020, and March 9, 2021, notice of which was given by publication on the Board’s website at https://health.maryland.gov/bacc/Pages/index.aspx pursuant to General Provisions Article, §3–302(c), Annotated Code of Maryland.

Statement of Purpose

The purpose of this action is to:

(1) Update the definition of “practice acupuncture” as a result of Ch. 543, Acts of 2019;

(2) Add language that an applicant shall have graduated from a master’s level program or its equivalent in acupuncture, as a result of Ch. 543, Acts of 2019;

(3) Remove obsolete language and make clarifying changes;

(4) Define and establish qualifications and procedures for acupoint injection therapy; and

(5) Establish a new chapter for continuing education requirements.

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 Jason Caplan, Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through September 27, 2021. A public hearing has not been scheduled.

 

10.26.02 General Regulations

Authority: Agriculture Article, §§2-301(g) and 2-304; Health Occupations Article, §§1-211, 1A-205, 1A-301, 1A-302, 1A-306, 1A-307, and 1A-316; Annotated Code of Maryland

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1) (text unchanged)

(2) “Acupoint injection therapy” means a form of acupuncture that utilizes therapeutic and natural injectable fluids in place of traditional needles.

[(2)] (3) “Acupuncture” means a form of health care[,] based on [a theory] East Asian medical theories of energetic physiology[,] that [describes] describe the interrelationship of the body organs [or] and functions of a human or animal [with an associated point or combination of points].

[(3)] (4)—[(7)] (8) (text unchanged)

[(8)] (9) “Practice acupuncture” means the use of [oriental] East Asian medical therapies for the purpose of normalizing energetic physiological functions including pain control, and for the promotion, maintenance, and restoration of health including, but not limited to:

(a) Stimulation of [points of] a human or animal body by the insertion of [acupuncture] needles;

(b) The application of moxibustion; [and]

(c) [Manual, mechanical, thermal, or electrical] The following therapies, practices, and remedies only when performed in accordance with the principles of [oriental acupuncture] East Asian medical theories[.] such as:

(i) Manual therapies;

(ii) Mechanical therapies;

(iii) Thermal therapies;

(iv) Acupoint injection therapy in accordance with Regulation .08 of this chapter;

(v) Hot and cold therapy;

(vi) Therapeutic exercise and stretching;

(vii) Electric stimulation;

(viii) Light and cold laser;

(ix) Herbal remedies;

(x) Mindfulness practices; and

(xi) Nutritional and lifestyle counseling; and

(d) The utilization of the findings or results of clinical data to engage in the practice of acupuncture as defined in Health Occupations, §1A-101 et seq., Annotated Code of Maryland, which may include traditional or modern diagnostic methods such as:

(i) Lab testing; and

(ii) Diagnostic imaging.

[(9)] (10)—[(10)] (11) (text unchanged)

.03 Application for License.

A.—C. (text unchanged)

D. The applicant shall provide documentary evidence of having met one of the following standards for education, training, or demonstrated experience:

(1) Graduation from [a course of training of at least 1,800 hours in acupuncture, including 300 clinical hours,] at least a master’s level program or its equivalent in acupuncture that is:

(a)—(b) (text unchanged)

(c) Found by the Board to be equivalent to a course approved [by the ACAOM] or accredited by the authority listed under §D(1)(a) or (b) of this regulation; or

(2) (text unchanged)

E. An applicant shall demonstrate proof of proficiency in the written and oral communication of the English language by providing documentary evidence that the applicant has:

(1) [The applicant has completed] Completed at least 60 classroom credits from an English-speaking undergraduate school or English-speaking professional school; [or]

(2) [The applicant has achieved] Achieved a passing score on the TOEFL within the 2 years preceding license application[.]; or

(3) Passed the NCCAOM written and practical examination components in English.

[F. Proof of proficiency in the English language does not apply to an individual who was in possession of a valid Maryland acupuncture license by March 1, 1996, or had applied by that date and subsequently met all requirements for licensure.]

.04 Approval of Applicant for Licensure.

A.—D. (text unchanged)

[E. For each individual registered with the State Board of Physician Quality Assurance to perform acupuncture as of July 1, 1994, the Board shall consider the individual licensed until December 31, 1995.]

.05 Term, Renewal, Reinstatement, and Inactive Status.

A.—E. (text unchanged)

[F. Continuing Education.

(1) A licensee applying for renewal shall complete 30 hours of relevant continuing education during the 2-year period preceding the expiration of the license which include the following:

(a) At least 20 hours in formally organized programs which are relevant to the practice of acupuncture and Oriental medicine and are approved by the Board or sponsored by, but not limited to, the following organizations and their member organizations:

(i) American Academy of Medical Acupuncture;

(ii) American Association of Acupuncture and Oriental Medicine (AAAOM);

(iii) Council of Colleges of Acupuncture and Oriental Medicine (CCAOM);

(iv) Colleges and universities accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM);

(v) National Commission for the Certification of Acupuncture and Oriental Medicine (NCCAOM);

(vi) Society for Acupuncture Research; or

(vii) The National Acupuncture Detoxification Association;

(b) Not more than 10 hours of formally organized training programs in Western science and medical practices, medical ethics, medical research, or cardiopulmonary resuscitation which are relevant to the practice of acupuncture and are sponsored by, but not limited to, organizations listed in §F(1)(a) of this regulation and the following organizations:

(i) World Health Organization (WHO);

(ii) National Institutes of Health (NIH);

(iii) American Medical Association (AMA);

(iv) American Nurses Association (ANA);

(v) American Psychiatric Association (APA);

(vi) Red Cross;

(vii) Local colleges; or

(viii) Local hospitals;

(c) Not more than 10 hours of training in approved programs which will assist a licensee to carry out the licensee’s professional responsibilities, including, but not limited to:

(i) Management courses for a school administrator;

(ii) Foreign language training for translators of relevant texts;

(iii) Educational methodology for teachers of acupuncture;

(d) Not more than 10 hours teaching acupuncture and related Oriental medical therapies in an accredited school or in a program approved for acupuncture continuing education;

(e) Not more than 7 hours of pro bono work as outlined in §F(3) of this regulation; or

(f) Not more than 7 hours in published writing or articles in acupuncture and Oriental medicine that are:

(i) Peer-reviewed research or peer-reviewed clinically relevant articles in acupuncture and Oriental medicine; and

(ii) Limited to 4 hours per article.

(2) Pro Bono Work.

(a) Pro bono work shall earn 1 credit hour for each 3 hours of pro bono activity up to a maximum of 7 credit hours per renewal cycle.

(b) Pro bono work shall be for the provision of acupuncture services provided through an organization offering humanitarian services such as, but not limited to:

(i) Domestic or international victims in an emergency situation or disaster area;

(ii) Low income or underserved areas or populations;

(iii) Special needs populations; or

(iv) United States military personnel.

(c) Upon completion of the pro bono work, the licensee shall obtain from the facility written documentation of completion of pro bono hours including:

(i) The name of the facility;

(ii) The address where the pro bono work was provided;

(iii) The type of work that was done;

(iv) The number of hours of actual work provided for which the licensee desires credit hours; and

(v) A statement guaranteeing that the work provided no financial benefit to licensee.

(3) Licensees shall maintain the documentation of their continuing education credits for 4 years from the date of their acupuncture renewal.

(4) If requested by the Board, a licensee shall provide proof of continuing education attendance by providing documentation of:

(a) Name of the program;

(b) Date of the program;

(c) Number of continuing education hours earned; and

(d) Name of the sponsoring organization.]

.08 Acupoint Injection Therapy.

A. Registration. To obtain the required registration from the Board as qualified to practice acupoint injection therapy, an applicant shall:

(1) Possess a current acupuncture license in good standing;

(2) Successfully complete a Board-approved specialty training program in acupoint injection therapy that consists of a minimum of 20 hours of theory and clinical training, which include each of the following topics:

(a) Uses and contraindications for injectable substances;

(b) Proper storage and disposal of injection syringes and injection compounds;

(c) Safety and emergency procedures;

(d) Administration and practical injection skills, including injection technique;

(e) Universal precautions including management of:

(i) Blood borne pathogens; and

(ii) Biohazardous waste; and

(f) Clinical training;

(3) Possess a current certification in basic life support or cardiopulmonary resuscitation (CPR) approved by the American Heart Association or American Red Cross; and

(4) Complete and submit an application provided by the Board.

B. Practice. To practice acupoint injection therapy, the licensed acupuncturist:

(1) Shall:

(a) Possess a registration for acupoint injection therapy from the Board;

(b) Explain acupoint injection therapy to the patient in advance of treatment;

(c) Obtain written informed consent specific to acupoint injection therapy that shall be included in the patient’s medical record;

(d) Only perform subcutaneous or intramuscular injection in accordance with the principles of acupuncture and East Asian medical theories;

(e) Have an adverse event or emergency plan in place for allergic reactions to injected substances;

(f) Maintain professional liability coverage for this procedure;

(g) Only use prepackaged acupoint injectable therapeutic substances that are:

(i) Acquired from an appropriately licensed entity in compliance with federal and state law;

(ii) Sterile from the appropriately licensed entity; and

(iii) Stored in accordance to manufacturer’s specifications;

(2) May use the following acupoint injectable therapeutic substances without further approval:

(a) Water;

(b) Saline;

(c) Dextrose;

(d) Glucose;

(e) Procaine; or

(f) Lidocaine;

(3) May use acupoint injectable therapeutic substances from the following categories only with Board approval:

(a) Vitamins;

(b) Amino acids;

(c) Proteins;

(d) Sugars; or

(e) Homeopathic substances; and

(4) May not:

(a) Administer compounds for which the licensed acupuncturist has not been appropriately trained in accordance with this regulation;

(b) Give an injectable substance to a patient for self-injection; or

(c) Administer intravenous injections.

C. The Board shall maintain a list of all:

(1) Licensed acupuncturists registered by the Board as qualified to practice acupoint injection therapy;

(2) Board-approved acupoint injection therapy training programs; and

(3) Formularies of Board-approved acupoint injectable therapeutic substances from the categories listed in §B(3) of this regulation.

D. On or after the effective date of this regulation, unless the person is registered by the Board as qualified to practice acupoint injection therapy, an individual may not:

(1) Represent to the public that the individual is an acupoint injection therapy registered acupuncturist; or

(2) Practice acupoint injection therapy.

E. Violation of this regulation constitutes unprofessional conduct and may result in disciplinary action as set forth in Health Occupations Article, §4-315, Annotated Code of Maryland.

 

10.26.06 Continuing Education

Authority: Health Occupations Article, §§1A-205 and 1A-306, Annotated Code of Maryland

.01 Scope.

This regulation governs all acupuncturists licensed to practice in the State of Maryland.

.02 Definitions.

A. In this chapter, the following term has the meaning indicated.

B. Term Defined. “Board” means the State Board of Acupuncture.

.03 Licensure Renewal.

A. A licensee applying for renewal shall complete 30 hours of relevant continuing education during the 2-year period preceding the expiration of the license which include the following:

(1) At least 20 hours in formally organized programs approved by the Board which are relevant to the practice of acupuncture and East Asian medicine;

(2) Not more than 10 hours of formally organized training programs in Western science and medical practices, medical ethics, medical research, or cardiopulmonary resuscitation which are relevant to the practice of acupuncture and East Asian medicine;

(3) Not more than 10 hours of training in approved programs which will assist a licensee to carry out the licensee’s professional responsibilities, including, but not limited to:

(a) Management courses for a school administrator;

(b) Foreign language training for translators of relevant texts; or

(c) Educational methodology for teachers of acupuncture;

(4) Not more than 10 hours teaching acupuncture and related East Asian medical therapies in an accredited school or in a program approved for acupuncture continuing education;

(5) Not more than 7 hours of pro bono work as outlined in §B of this regulation;

(6) Not more than 7 hours in published writing or articles in acupuncture and East Asian medicine that are:

(a) Peer-reviewed research or peer-reviewed clinically relevant articles in acupuncture and East Asian medicine; and

(b) Limited to 4 hours per article;

(7) Not more than 20 hours for passage of the NCCAOM exam within the 2-year period preceding the expiration of the license; or

(8) Not more than 10 hours serving on a professional board involving:

(a) Acupuncture; or

(b) East Asian medicine.

B. Pro Bono Work.

(1) Pro bono work shall:

(a) Earn 1 credit hour for each 3 hours of pro bono activity up to a maximum of 7 credit hours per renewal cycle; and

(b) Be for the provision of acupuncture services provided through an organization offering humanitarian services such as, but not limited to:

(i) Domestic or international victims in an emergency situation or disaster area;

(ii) Low-income or underserved areas or populations;

(iii) Special needs populations; or

(iv) United States military personnel.

(2) Upon completion of the pro bono work, the licensee shall obtain from the facility written documentation of completion of pro bono hours including:

(a) The name of the facility;

(b) The address where the pro bono work was provided;

(c) The type of work that was done;

(d) The number of hours of actual work provided for which the licensee desires credit hours; and

(e) A statement guaranteeing that the work provided no financial benefit to the licensee.

C. Licensees shall maintain the documentation of their continuing education credits for 4 years from the date of their acupuncture renewal.

D. If requested by the Board, a licensee shall provide proof of continuing education attendance by providing documentation of the:

(1) Name of the program;

(2) Date of the program;

(3) Number of continuing education hours earned; and

(4) Name of the sponsoring organization.

DENNIS R. SCHRADER
Secretary of Health

 

Subtitle 28 BOARD OF EXAMINERS IN OPTOMETRY

10.28.12 Therapeutic Pharmaceutical Agents

Authority: Health Occupations Article, §§11-101, 11-205, 11-302—11-309, 11-401.1, 11-404, and 11-404.1, Annotated Code of Maryland

Notice of Proposed Action

[21-118-P]

The Secretary of Health proposes to amend Regulations .01, .03, and .04, repeal existing Regulations .05 and .06, and amend and recodify existing Regulation .07 to be Regulation .05 under COMAR 10.28.12 Therapeutic Pharmaceutical Agents. This action was considered by the Board of Examiners in Optometry at a public meeting held on July 29, 2020, notice of which was given by publication on the Board’s website at https://health.maryland.gov/optometry/Pages/index.aspx pursuant to General Provisions Article, §3–302(c), Annotated Code of Maryland.

Statement of Purpose

The purpose of this action is to:

(1) Add clarifying language to the definitions;

(2) Establish evaluation standards for therapeutically certified optometrists utilizing therapeutic pharmaceutical agents (TPAs);

(3) Remove obsolete language; and

(4) Repeal existing Regulations .05 and .06.

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 Jason Caplan, Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through September 27, 2021. A public hearing has not been scheduled.

.01 Definitions.

A. (text unchanged)

B. Terms Defined.

(1) (text unchanged)

(2) “Adverse reaction” means the unintended or unexpected effect of treatment on a patient caused by or resulting from:

(a) An adverse drug reaction; [or]

(b) The removal of a superficial foreign body from the eye[.]; or

(c) The ordering of a laboratory test.

(3) (text unchanged)

[(4) “Comanagement plan” means the formal, written individualized treatment plan signed and agreed to by an ophthalmologist and an optometrist with TPA certification for the treatment and management of primary open angle glaucoma.]

[(5)] (4) “Diagnostic pharmaceutical agent (DPA)” means a medication [which directly or indirectly affects] that:

(a) Directly or indirectly affects the pupil of the eye as defined in COMAR 10.28.11; [or]

(b) Directly or indirectly affects the sensitivity of the cornea as defined in COMAR 10.28.11[.]; or

(c) Stains the ocular surface.

[(6)] (5) “Ophthalmologist” means a physician[:

(a) Who] who practices in the specialty of ophthalmology and who is licensed by the Maryland Board of Physicians[;

(b) Licensed in an adjoining state who practices the specialty of ophthalmology and meets the following requirements:

(i) The physician’s participation in the comanagement plan has been requested by a Maryland TPA-certified optometrist and a justification for the request has been submitted to the Board, and

(ii) The Board concludes that the physician’s participation is permitted by State law and no other means of meeting patient care needs is reasonably available].

[(7)] (6) “Primary open angle glaucoma” means glaucomatous changes characterized by:

(a)—(b) (text unchanged)

(c) One or more of the following:

(i) The appearance of optic disc damage or optic nerve fiber layer damage as evidenced by the size or shape of the optic disc cup, thinning or notching of the optic disc rim, progressive changes in the appearance of the optic disc cup, optic disc hemorrhage, or nerve fiber layer defects, seen clinically or via imaging;

(ii) The presence of abnormalities in the visual field including arcuate defect, nasal step, paracentral scotoma, or general depression, in the absence of other causes or explanations for a visual field defect[,]; or

(iii) Intraocular pressure [repeatably above 21mm Hg (by Goldmann applanation or its equivalent) at some course during observation which] that is thought to pose a threat to the health of the optic nerve.

[(8) “Quality assurance program” means the process which includes peer review, record review, self-assessment, and data collection.]

[(9)] (7)—[(13)] (11) (text unchanged)

.03 Requirements for Renewal of Certification.

A.—E. (text unchanged)

F. TPA Self-Assessment. At the time of license renewal, the therapeutically certified optometrist shall complete a self-assessment checklist provided by the Board to evaluate the following aspects of the optometrist’s practice utilizing TPAs, including but not limited to:

(1) Legibility and completeness of TPA records;

(2) Documentation of patient visits, services rendered, and communications;

(3) Documentation of subjective complaints, objective findings, clinical assessments relating to the findings of the diagnosis, and the plan;

(4) A written office plan for handling emergencies;

(5) A system for patients to reach the optometrist, or to access care, in the event of an ocular emergency;

(6) A systematic discarding of expired medications;

(7) Documentation of current CPR certification;

(8) An infection control policy;

(9) Patient confidentiality;

(10) A patient tracking system that enables identification and follow-up to ensure treatment of patients who:

(a) Are being followed or referred out for emergency sight or life-threatening conditions; or

(b) Fail to keep appointments;

(11) Procedures for appropriate termination of the doctor-patient relationship when necessary;

(12) Satisfactory explanation of the treatment plan so that the patient knows and understands the nature of the patient’s problem or problems and the goals of the treatment regimen; and

(13) Advice to patients regarding the importance of progress examinations and follow-up care.

.04 Standards of Quality for Therapeutically Certified Optometrists and Optometric Care.

A. The therapeutically certified optometrist shall provide clinical therapeutic eye care consistent with published, [nationally] universally accepted practice or clinical guidelines and standards of care.

B. The therapeutically certified optometrist shall adhere to the additional guidelines and standards of care given in [§§C—U] §§C—T of this regulation.

C. (text unchanged)

[D. The therapeutically certified optometrist shall file and label all TPA records in a manner which makes them readily retrievable and available for review.]

[E.] D. The therapeutically certified optometrist shall document the following data, if applicable, for each TPA patient visit or communication:

(1)—(3) (text unchanged)

(4) Medication/treatment provided; and

[(5) Fee charged; and]

[(6)] (5) (text unchanged)

[F.] E. The therapeutically certified optometrist shall document the following data as part of the patient’s permanent file:

(1)—(2) (text unchanged)

(3) Name of the doctor to whom the patient is referred, appointment date, and [time of any referrals for consultation or treatment] documentation that the patient or guardian preferred to schedule the referral appointment on their own;

(4)—(6) (text unchanged)

[G.] F.—[K.] J. (text unchanged)

[L.] K. The therapeutically certified optometrist shall maintain a written tracking system to identify patients who are being followed or referred for [disease-risk] emergency sight or life-threatening conditions and who fail to keep appointments.

[M.] L. The therapeutically certified optometrist shall [contact] document that a [disease-risk] patient who fails to keep an appointment for an emergency sight or life-threatening condition was contacted by [a telephone call and a mailed notice, if needed.]:

(1) Telephone;

(2) Electronic mail or other electronic means;

(3) Text message; or

(4) Mail.

[N.] M.[O.] N. (text unchanged)

[P.] O. The therapeutically certified optometrist shall remove superficial foreign bodies from the eye in accordance with the applicable standards of care established under Health Occupations Article, Title 11, Annotated Code of Maryland. [A therapeutically certified optometrist may remove superficial foreign bodies from the human eye only if the foreign body:

(1) May be removed with a cotton-tipped applicator or blunt spatula; and

(2) Has not penetrated beyond the Bowman’s membrane of the cornea and is not within 2.5 millimeters of the visual axis.]

[Q.] P. (text unchanged)

[R.] Q. The therapeutically certified optometrist shall report to the Board, on the form provided by the Board, within 10 working days of the occurrence, an adverse reaction [resulting from administration of a therapeutic pharmaceutical agent or from the removal of a superficial foreign body from the eye]. The therapeutically certified optometrist shall include in the report, at a minimum, the following:

(1)—(4) (text unchanged)

[S.] R. Glaucoma [Comanagement] Management.

(1) (text unchanged)

(2) A therapeutically certified optometrist may administer and prescribe topical [therapeutical] pharmaceutical agents for glaucoma only[:] as authorized by law.

[(a) For patients with primary open angle glaucoma;

(b) After the optometrist refers the patient to an ophthalmologist; and

(c) After the ophthalmologist and optometrist jointly and promptly develop a written individualized comanagement treatment plan that is signed by the ophthalmologist and optometrist.

(3) The treatment plan may be modified only upon the mutual consultation and consent of the optometrist and ophthalmologist, and the optometrist shall note the modification in the patient’s record.

(4) The therapeutically certified optometrist shall refer the patient to an ophthalmologist at least once a year.

(5) The therapeutically certified optometrist shall make available to the ophthalmologist the results of the tests or procedures including visual fields tests, optic nerve photos, or nerve fiber layer photos performed by the optometrist, and the ophthalmologist shall make available to the optometrist the results of tests or procedures performed by the ophthalmologist.

T. The therapeutically certified optometrist and the ophthalmologist shall ensure that the glaucoma comanagement plan includes at least the following:

(1) The tests, examinations, and procedures performed that led to the diagnosis;

(2) An initial schedule of the tests and examinations necessary to treat the patient;

(3) The estimated number of times the patient may need to be seen by the optometrist and the ophthalmologist;

(4) The optometrist’s name, address, and license number;

(5) The ophthalmologist’s name, address, and license number;

(6) A medication plan;

(7) A target intraocular pressure (IOP) which, if exceeded, requires reassessment of the comanagement plan and appropriate therapeutic intervention to reduce the intra-ocular pressure to an acceptable level; and

(8) Criteria for surgical intervention.]

[U.] S. In developing a [comanagement] glaucoma treatment plan that ensures the maximum effectiveness for the patient, the therapeutically certified optometrist [and the ophthalmologist] shall consider the following:

(1) (text unchanged)

(2) Status of the optic nerve structure, function, and its relationship to [IOP] intraocular pressure;

(3) Identification of a target intraocular pressure at or below the target level in which further optic nerve damage is unlikely to occur;

(4) Maintenance of [IOP] intraocular pressure at or below the target level by initiating appropriate therapeutic intervention;

(5) Monitoring of the optic nerve and resetting the target [IOP] intraocular pressure if deterioration occurs;

(6) (text unchanged)

(7) Education of the patient in the management of primary open angle glaucoma disease; [and]

(8) Reference to accepted clinical guidelines for glaucoma follow-up management[.]; and

(9) Criteria for surgical intervention.

T. Laboratory Tests. Laboratory tests shall be ordered by a therapeutically certified optometrist only as provided by law.

[.07] .05 Monitoring of Complaint Investigation.

A. The Board shall review complaints against optometrists relating to ocular therapeutics, [comanagement] management of primary open angle glaucoma, removal of superficial foreign bodies, and other aspects of practice by a therapeutically certified optometrist.

B. (text unchanged)

[C. The Board shall submit a report summarizing the Board’s investigation of complaints concerning TPAs, the results of the investigations, and actions taken by the Board to the Secretary annually, at the end of the Board’s fiscal year. The Board shall ensure that the reports protect the confidentiality of the optometrists and the complainants.]

DENNIS R. SCHRADER
Secretary of Health

 

Subtitle 67 MARYLAND HEALTHCHOICE PROGRAM

10.67.08 Maryland Medicaid Managed Care Program: Non-Capitated Covered Services

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

Notice of Proposed Action

[21-119-P]

The Secretary of Health proposes to amend Regulation .02 under COMAR 10.67.08 Maryland Medicaid Managed Care Program: Non-Capitated Covered Services.

Statement of Purpose

The purpose of this action is to update the list of behavioral health diagnosis codes to reflect the addition of new International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes, and to update the current buprenorphine and evaluation and management procedure codes included in the behavioral health carve out.

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 Jason Caplan, Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-225), or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through September 27, 2021. A public hearing has not been scheduled.

.02 Behavioral Health Non-Capitated Covered Services.

A. An MCO is not responsible for reimbursing for the following substance use disorder services, regardless of diagnosis:

(1) Services delivered by a community-based provider as described in COMAR 10.09.80 with the following procedure codes:

H0001—

J0574

(text unchanged)

Q9991

Injection, Buprenorphine extended-release, less than or equal to 100 mg

Q9992

Injection, Buprenorphine extended-release, greater than 100 mg

(2) (text unchanged)

B.—J. (text unchanged)

K. An MCO is not responsible for reimbursing for services billed by a physician related to prescribing buprenorphine or Vivitrol when the following conditions are met:

(1)—(4) (text unchanged)

(5) The procedure code listed on the claims is one of the following:

[99201]

[Evaluation and Management, Minimal, new patient]

99202

J0574

(text unchanged)

Q9991

Injection, Buprenorphine extended-release, less than or equal to 100 mg

Q9992

Injection, Buprenorphine extended-release, greater than 100 mg

80305—

80307

(text unchanged)

L. Table of substance use disorder diagnoses:

(1) (text unchanged)

(2) For dates of service on or after October 1, 2015:

F1010

(text unchanged)

F1011

Alcohol abuse, in remission

F10120—F10129

(text unchanged)

F10130

Alcohol abuse with withdrawal, uncomplicated

F10131

Alcohol abuse with withdrawal delirium

F10132

Alcohol abuse with withdrawal with perceptual disturbance

F10139

Alcohol abuse with withdrawal, unspecified

F1014

(text unchanged)

F10150

Alcohol abuse with [alcohol-induce] alcohol-induced psychotic disorder with delusions

F10151

Alcohol abuse with [alcohol-induce] alcohol-induced psychotic disorder with hallucinations

F10159—F1024

(text unchanged)

F10250

Alcohol dependence with [alcohol-induce] alcohol-induced psychotic disorder with delusions

F10251

Alcohol dependence with [alcohol-induce] alcohol-induced psychotic disorder with hallucinations

F10259

Alcohol dependence with [alcohol-induce] alcohol-induced psychotic disorder, unspecified

F10280—F10929

(text unchanged)

F10930

Alcohol use, unspecified with withdrawal, uncomplicated

F10931

Alcohol use, unspecified with withdrawal delirium

F10932

Alcohol use, unspecified with withdrawal with perceptual disturbance

F10939

Alcohol use, unspecified with withdrawal, unspecified

F1094

(text unchanged)

F10950

Alcohol use, unspecified with [alcohol-induce] alcohol-induced psychotic disorder with delusions

F10951

Alcohol use, unspecified with [alcohol-induce] alcohol-induced psychotic disorder with hallucinations

F10959—F1110

(text unchanged)

F1111

Opioid abuse, in remission

F11120— F11129

(text unchanged)

F1113

Opioid abuse with withdrawal

F1114 — F1210

(text unchanged)

F1211

Cannabis abuse, in remission

F12120 — F12129

(text unchanged)

F1213

Cannabis abuse with withdrawal

F12150 — F1310

(text unchanged)

F1311

Sedative, hypnotic or anxiolytic abuse, in remission

F13120 — F13129

(text unchanged)

F13130

Sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated

F13131

Sedative, hypnotic or anxiolytic abuse with withdrawal delirium

F13132

Sedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance

F13139

Sedative, hypnotic or anxiolytic abuse with withdrawal, unspecified

F1314 — F13151

(text unchanged)

F13159

Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or [anxiolyti-induced] anxiolytic-induced psychotic disorder, unspecified

F13180—F14129

(text unchanged)

F1413

Cocaine abuse, unspecified with withdrawal

F1414—F14929

(text unchanged)

F1493

Cocaine use, unspecified with withdrawal

F1494—F15129

(text unchanged)

F1513

Other stimulant abuse with withdrawal

F1514—F19129

(text unchanged)

F19130

Other psychoactive substance abuse with withdrawal, uncomplicated

 

F19131

Other psychoactive substance abuse with withdrawal delirium

F19132

Other psychoactive substance abuse with withdrawal with perceptual disturbances

F19139

Other psychoactive substance abuse with withdrawal, unspecified

F1914—R785

(text unchanged)

M. Table of mental health diagnoses:

(1) (text unchanged)

(2) For dates of service on or after October 1, 2015:

F200—

F509

(text unchanged)

F53

Mental and behavioral disorders associated with the puerperium, not elsewhere classified

F530

Postpartum depression

F531—

Z046

(text unchanged)

N. (text unchanged)

O. Table of poisoning diagnoses, for dates of service on or after July 1, 2016:

T360X2A — T403X2A

(text unchanged)

T40412A

Poisoning by fentanyl or fentanyl analogs, self-harm, initial encounter

T40422A

Poisoning by tramadol, self-harm, initial encounter

[T404X2A] T40492A

[Poisoning by other synthetic narcotics, intentional self-harm] Poisoning by other synthetic narcotics, self-harm, initial encounter

T405X2A

Poisoning by cocaine, intentional self-harm, initial encounter

T40602A

Poisoning by unspecified narcotics, intentional self-harm, initial encounter

T40692A — T50992A

(text unchanged)

DENNIS R. SCHRADER
Secretary of Health

 

Title 11
DEPARTMENT OF TRANSPORTATION

Subtitle 13 MOTOR VEHICLE ADMINISTRATION—VEHICLE EQUIPMENT

11.13.12 Safety Glass Replacement Standards

Authority: Transportation Article, §§12-104(b) and 22-406, Annotated Code of Maryland

Notice of Proposed Action

[21-106-P-I]

The Administrator of the Motor Vehicle Administration proposes to adopt new Regulations .01—.09 under a new chapter, COMAR 11.13.12 Safety Glass Replacement Standards.

Statement of Purpose

The purpose of this action is to adopt new regulations to establish standards and requirements for aftermarket safety glass replacement in order to conform to Ch. 461 (H.B. 519), Acts of 2021.

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 Tracey Sheffield, Regulations Coordinator, MDOT MVA, 6601 Ritchie Highway, N.E., Room 200, Glen Burnie, MD 21062, or call 410-768-7545, or email to tsheffield@mdot.maryland.gov, or fax to 410-768-7506. Comments will be accepted through September 27, 2021. 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 American National Standard for Safety Glazing Materials for Glazing Motor Vehicles and Motor Vehicle Equipment Operating on Land Highways (ANSI/SAE Z26.1) 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 48:1 Md. R. 7 (January 4, 2021), 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.

.01 Scope.

This chapter implements the automotive glass replacement safety standard addressing procedures, education, and product performance for motor vehicles falling within the guidelines of the Federal Motor Vehicle Safety Standard (FMVSS) 208 and 212.

.02 Definitions.

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

B. Terms Defined.

(1) “Advanced Driver Assistance Systems (ADAS)” means an automated system that enhances vehicle safety and assists in reducing driver error.

(2) “Adhesive bonding system” means an engineered system using chemical products, used together as a technique or process, to bond substrates.

(3) “Anti-pinch mechanism” means a feature that reverses the window or panel direction of travel when resistance is encountered.

(4) “Equivalent retention system” means a system that meets or exceeds the vehicle manufacturer’s performance strength specifications or has been certified by the retention system manufacturer or private labeler as appropriate for the specific application.

(5) “Final exam” means a comprehensive exam that evaluates the individual’s knowledge and skills, including but not limited to retention-system-specific replacement procedures, a variety of automotive safety issues, minimum drive-away time, environmental conditions as they affect retention system performance, federal safety requirements, and the basics of safe and effective automotive glass replacement.

(6) “Full cut” means removing an existing bead of urethane to a height of approximately 1 to 2 mm wherever the residual bead is structurally sound and the substrate condition is not defective.

(7) “Initialize”, “initialization”, or “re-initialization” means a procedure that re-establishes proper operation of the intended function.

(8) “Minimum drive-away strength” means the minimum properties as defined and specified by the retention systems manufacturer or private labeler to meet the requirements of FMVSS 208 and 212 as it pertains to glass retention systems.

(9) “Minimum drive-away time” means the time necessary for a given adhesive system to attain minimum drive-away strength after an adhesive bonded glass part is set in place.

(10) “Polyurethane adhesive” means a thermoplastic polymer adhesive produced by the condensation reaction of polyisocyanate and a hydroxyl containing material.

(11) “Private labeler” means any individual or corporation or the entity engaged in sale or distribution of a product labeled as its own, but manufactured by any different entity.

(12) “Recalibration” means the process by which a vehicle’s Advanced Driver Assistance System is returned to the vehicle manufacturer’s specifications.

(13) “Retention system” means any original equipment or equivalent method of glazing attachment.

(14) “Those engaged in automotive glass replacement” refers to any individual, business, or organization that replaces automotive glass, including but not limited to individual technicians, automotive glass replacement businesses, automotive body shops, and dealerships.

.03 Incorporation by Reference.

A. In this chapter, the following documents are incorporated by reference.

B. Documents Incorporated.

(1) American National Standard for Safety Glazing Materials for Glazing Motor Vehicles and Motor Vehicle Equipment Operating on Land Highways (ANSI/SAE Z26.1);

(2) 49 CFR §571.205 — Standard No. 205, Glazing Materials (FMVSS 205); and

(3) 49 CFR §571.205 — Standard No. 111; Rear Visibility.

.04 Vehicle Assessment Before Replacement.

A. Those engaged in automotive glass replacement may not undertake or complete any installation unless first a thorough assessment of the vehicle has been made.

B. If, after the assessment made under §A of this regulation, it has been determined that any discovered conditions on the vehicle could compromise the vehicle’s retention system, the technician may not undertake or complete the installation. The owner or operator then shall be so notified verbally and in writing.

C. If, after the assessment made under §A of this regulation, it has been determined that the vehicle has an ADAS which could require recalibration after any automotive glass replacement, and the technician chooses not to follow Regulation .08I of this chapter, the technician may not undertake or complete the installation. The owner/operator then shall be so notified verbally and in writing. Documentation of customer notification shall be kept as a record in accordance with the provisions of Regulation .08G of this chapter.

D. The following vehicles are exempt from this chapter:

(1) Registered as a Class L historic vehicle;

(2) Registered as a Class N street rod vehicle; and

(3) Registered as a Class K farm area/island vehicle.

.05 Selection of Glass and Retention Systems.

Those engaged in automotive glass replacement shall:

A. Use glass products meeting the requirements of ANSI Z26.1 as required by Federal Motor Vehicle Safety Standard 205;

B. Use either an original equipment manufacturer (OEM) approved retention system or equivalent retention system as certified in writing by the equivalent retention system manufacturer directly or through a private labeler;

C. Obtain and follow written comprehensive and current application instructions from the retention systems manufacturer or private labeler, including at least:

(1) The proper use of the retention system;

(2) Storage specifications;

(3) Minimum drive-away time charts containing temperature and humidity variables, if applicable; and

(4) Any special procedures required for adverse weather conditions;

D. Use only retention systems that have lot numbers and expiration dates printed on appropriate products; and

E. Use glass products compatible with the ADAS which may be affected/impacted by the glass replacement.

.06 Installation Standards — Adhesive Bonded.

A. Those engaged in automotive glass replacement shall follow the adhesive manufacturer’s application instructions, as provided by the manufacturer directly or through the private labeler. All in-shop or mobile installations shall be performed under environmental and other conditions that are compatible with the application instructions required in Regulation .05 of this chapter.

B. Products shall be stored and controlled according to manufacturers’ requirements as provided directly or through a private labeler.

C. No automotive glass replacement shall be undertaken using an adhesive glass retention bonding system that would not achieve minimum drive-away strength by the time the vehicle may be reasonably expected to be operated.

D. The vehicle owner/operator shall be notified prior to and after the installation process of the minimum drive-away time under the circumstances of the replacement.

E. Adhesive shall be applied so that the finished bead cross-section profile and dimensions meet or exceed the original equipment configuration or recommendation of the adhesive system manufacturer.

F. If the OEM installation was polyurethane, then the glass shall be replaced with polyurethane or an equivalent adhesive bonding system. If the OEM installation was butyl, polysulfide, or other non-polyurethane, and the vehicle is licensed for highway use, adhesive bonded stationary glass installations shall be performed using polyurethane or an equivalent retention system unless in conflict with current OEM specifications.

G. All adhesive system component lot numbers shall be traceable to each job.

H. All glass parts shall be traceable to the installation by a DOT number and part number.

I. No product that has exceeded the manufacturer or private labeler’s stated expiration date, open shelf life, or active shelf life shall be used.

J. All supplemental mechanical glass retention devices shall be replaced to original equipment specifications.

K. When inappropriate replacement materials or methods are detected, those engaged in an automotive glass replacement shall report their findings to the vehicle owner or operator.

L. When those engaged in automotive glass replacement correct inappropriate glass installations, they shall remove any inappropriate materials that would compromise the retention system. They shall fully correct any adverse glass installation related conditions caused by the use of inappropriate materials or methods, and they shall use appropriate methods pursuant to Regulation .05 of this chapter.

M. When sealing air or water leaks within a polyurethane retention system, only compatible polyurethane adhesive shall be used. No silicone or butyl may be used.

N. Only the full cut method should be used for polyurethane retention systems.

.07 Installation Standards — Rubber Gasket.

A. If the OEM utilizes the combination of a rubber gasket and polyurethane as a retention system, an equivalent adhesive bonding system shall be used in the installation. In cases when the OEM did not include polyurethane or an equivalent adhesive system, such systems shall be used if later production models included the addition of adhesive systems without body style modification.

B. If the OEM gasket installation did not include adhesive and the vehicle is licensed for highway use and is less than 10,000 pounds gross vehicle weight, the installation shall include polyurethane or an equivalent adhesive bonding system. The following vehicles are exempt:

(1) Registered as a Class L historic vehicle;

(2) Registered as a Class N street rod vehicle; and

(3) Registered as a Class K farm area/island vehicle.

C. When sealing air or water leaks within a rubber gasket or polyurethane adhesive system, only compatible polyurethane shall be used. No silicone or butyl may be used.

.08 Additional Requirements.

A. All mechanically fastened automotive glass parts shall be replaced according to original equipment specifications.

B. Glass parts, including custom cut parts, shall be marked in compliance with the certification requirements specified in FMVSS 205 and the marking requirements of ANSI Z26.1, incorporated by reference in Regulation .03 of this chapter, for those vehicles licensed for highway use.

C. Those engaged in automotive mirror replacement shall install external and internal replacement mirrors that meet or exceed original equipment specifications and the requirements of 49 CFR §571.111 — Standard No. 111; Rear Visibility.

D. Whenever OEM retention systems are modified on later production models without body style modification, the most current retention system shall be used in the replacement unless otherwise specified by the OEM.

E. Notification of Defective Product.

(1) A failure or defect in any product used or intended for use in the automotive glass replacement process that could jeopardize customer safety shall be reported promptly to the manufacturer or supplier of the product.

(2) Any product installed by those engaged in automotive glass replacements that is discovered to be defective or capable of jeopardizing customer safety shall be immediately reported to the customer with an offer to remedy the situation.

F. Those engaged in automotive glass replacement may not introduce any chemical agents, such as cleaners, solvents, lubricants, or release agents, or utilize any installation practice that will adversely affect the glass retention system.

G. Those engaged in automotive glass replacement shall create and retain records of each auto glass replacement for a period of at least 3 years from the date the work was completed sufficient to demonstrate compliance with this standard. Records, either electronic or hard copy, shall be legible, easily identifiable, and readily available. The 3-year period may be temporarily shortened for specific, clear, and substantial reasons, but shall be adhered to when such reasons no longer exist.

H. Those engaged in the repair, removal, or replacement of motorized windows and/or panels in automobiles that are equipped with anti-pinch mechanisms shall reset, initialize, and/or confirm their proper operation before the vehicle is released to its owner/operator. If the reset operation cannot be completed for any reason, the vehicle owner/operator shall be informed verbally and in writing of the failure to reset the system. In addition, the owner/operator shall be instructed to seek out a facility equipped to reset the system. The replacement glass installer is not responsible for the selection of any reset facility. Documentation of customer notification shall be kept as record pursuant to §G of this regulation.

I. If the vehicle has an ADAS, it may require recalibration after any automotive glass replacement. Only trained personnel who elect to provide recalibration services may complete the recalibration, and only if they obtain and use proper equipment and provide the outcome of the recalibration to the owner/operator. If these conditions cannot be met, or if the automotive glass installer does not provide recalibration services, the owner/operator shall be advised prior to and at the completion of the installation that:

(1) The vehicle has an ADAS;

(2) After automotive glass replacement, the vehicle may require the recalibration of the ADAS;

(3) The replacement glass installer will not recalibrate the ADAS;

(4) There are locations where recalibration may be obtained; and

(5) The replacement glass installer is not responsible for the selection of any recalibration location.

.09 Education.

A. Technicians installing replacement automotive glass shall be fully qualified for the tasks they are required to perform. Such qualifications shall include, at a minimum, completion of a comprehensive training program, at least 3 hours every 3 years, with a final exam and an ongoing education component. The program shall include, among other things:

(1) Automotive glass replacement safety issues;

(2) An understanding of OEM installation standards and procedures;

(3) Relevant technical specifications;

(4) Adhesive system manufacturer specific comprehensive retention system training; and

(5) The opportunity to apply and demonstrate the skills technicians learn.

B. Training with respect to the content and requirements of the current version of ANSI Z26.1 shall be required for all personnel directly involved in the automotive glass replacement process and may include, for example, scheduling, purchasing, installing, customer service, quality control, and management. Records of this training detailing content, date, participants, and acknowledgment of the participant’s successful completion of the training and receipt of a printed copy of the current standard shall be maintained.

CHRISTINE NIZER
Administrator
Motor Vehicle Administration

 

Title 14
INDEPENDENT AGENCIES

Subtitle 07 MARYLAND AUTOMOBILE INSURANCE FUND

Notice of Proposed Action

[21-116-P]

The Maryland Automobile Insurance Fund proposes to repeal:

(1) Regulations .01—.18 under COMAR 14.07.01 Board of Trustees;

(2) Regulations .01—.08 under COMAR 14.07.02 Binding Rules; and

(3) Regulations .01—.06 under COMAR 14.07.03 Producer Discipline Hearing Rules.

Statement of Purpose

The purpose of this action is to repeal COMAR 14.07.01 Board of Trustees; COMAR 14.07.02 Binding Rules; and COMAR 14.07.03 Producer Discipline Hearing Rules. Pursuant to Ch. 509, Acts of 2017, which amended Insurance Article, §20-201, Annotated Code of Maryland, the Board of Trustees processes and procedures, binding rules, and producer discipline hearing rules are no longer subject to State Government Article, Title 10, Subtitle 1, Annotated Code of Maryland; therefore, regulations are no longer required. Instead, the Board of Trustees processes and procedures, binding rules, and producer discipline hearing rules are governed by by-laws, policies, and procedures adopted by the Board of Trustees pursuant to Insurance Article, §§20-202, 20-509, 20-513, and 20-514, Annotated Code of Maryland.

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 Sandra Dodson, Government Relations, Maryland Automobile Insurance Fund, 1215 E. Fort Ave., Suite 300, Baltimore, MD 21230, or call 667-210-5182, or email to sdodson@marylandauto.net. Comments will be accepted through September 27, 2021. A public hearing has not been scheduled.

ALFRED W. REDMER, JR.
Executive Director

 

Title 30
MARYLAND INSTITUTE FOR EMERGENCY MEDICAL SERVICES SYSTEMS (MIEMSS)

Subtitle 01 GENERAL

30.01.02 Documents Incorporated by Reference

Authority: Education Article, §13-516, Annotated Code of Maryland

Notice of Proposed Action

[21-120-P-I]

The State Emergency Medical Services Board proposes to amend Regulation .01 under COMAR 30.01.02 Documents Incorporated by Reference. This action was considered and approved by the State Emergency Medical Services Board at its regular meeting on July 13, 2021, notice of which was given by publication on the Maryland Institute for Emergency Medical Service Systems website, www.mimess.org, beginning July 7, 2021, under General Provisions Article, §3-302, Annotated Code of Maryland.

Statement of Purpose

The purpose of this action is to incorporate by reference the current Maryland Medical Protocols for Emergency Medical Services.

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 E. Fremont Magee, Assistant Attorney General, Maryland Institute for Emergency Medical Services Systems, 653 West Pratt Street, Baltimore, MD 21201, or call 410-706-8531, or email to fmagee@miemss.org, or fax to 410-706-2138. Comments will be accepted through September 27, 2021. 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 Protocols for Emergency Medical Services (MIEMSS) (Effective July 1, 2021) 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 48:1 Md. R. 7 (January 4, 2021), 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.

.01 Incorporation by Reference.

A. (text unchanged)

B. Documents Incorporated.

(1) “Maryland Medical Protocols for Emergency Medical Services (MIEMSS [August 20, 2020] July 1, 2021 Edition)”. This document can be obtained through the Maryland Institute for Emergency Medical Services Systems at 653 W. Pratt Street, Baltimore, Maryland 21201 (410-706-4449).

(2)—(4) (text unchanged)

THEODORE R. DELBRIDGE, M.D.
Executive Director

 

Subtitle 08 DESIGNATION OF TRAUMA AND SPECIALTY REFERRAL CENTERS

30.08.17 Comprehensive Stroke Center Standards

Authority: Education Article, §13-509, Annotated Code of Maryland

Notice of Proposed Action

[21-115-P]

The Maryland Emergency Medical Services Board proposes to repeal Regulations .01, .03—.05, .07, .10, .12, .13, and .17—.19, amend and recodify existing Regulations .02, .06, .08, .09, .11, and .14—.16 to be Regulations .01, .05, .07, .09, .10, and .12—.14, respectively, and adopt new Regulations .02—.04, .06, .11, and .15—.18 under COMAR 30.08.17 Comprehensive Stroke Center Standards. This action was considered by the Maryland Emergency Medical Services Board at an open meeting held on February 9, 2021.

Statement of Purpose

The purpose of this action is to update the current standards for comprehensive stroke centers with the most current recommendations/guidelines for care of the complex stroke patient population.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. Designation as a comprehensive stroke center is voluntary. Currently designated comprehensive stroke centers have made a substantial commitment to stroke care and participated in the development of the regulations. These standards reflect the current standard of practice for treatment of complex stroke patients.

 

 

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:

 Costs associated with meeting standards

(-)

Unknown

E. On other industries or trade groups:

NONE

F. Direct and indirect effects on public:

Benefit to stroke patients

(+)

Unknown

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

D. Designation is voluntary. Designated comprehensive stroke centers have already incorporated many of the requirements into their current practices so their expenses will vary.

F. The most complex stroke patients will be transported to a facility equipped to manage their cases.

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 Anna Aycock, Chief, Health Facilities and Special Programs, MIEMSS, 653 West Pratt St, Baltimore, MD 21201, or call 410-706-3930, or email to aaycock@miemss.org. Comments will be accepted through September 27, 2021. A public hearing has not been scheduled.

[.02] .01 Designated Comprehensive Stroke Center.

[A] In addition to meeting the requirements of COMAR 30.08.11.01, a designated comprehensive stroke center hospital shall:

[A. Be licensed as an acute care hospital by the hospital licensing authority in the jurisdiction in which it is located;

B. Be accredited by the Joint Commission;]

[C.] A.—[D.] B. (text unchanged)

[E. If located in Maryland, be a base station approved under COMAR 30.03.06;

F. Have a comprehensive stroke center director;]

[G.] C. (text unchanged)

[H. Provide care to acute stroke patients through qualified clinical staff who meet the requirements in Regulation .12 of this chapter;]

[I.] D. Annually care for at least 20 Subarachnoid Hemorrhage by aneurysm patients per year;

[J.] E. Annually perform [at least 10 craniotomies for aneurysm clipping (grade 1A)] a combined total of 15 endovascular coiling and surgical clippings per year for aneurysm;

[K. Have sufficient patient volume to maintain competency;]

F. Annually administer fibrinolytics to 25 eligible patients per year or 50 eligible patients over 2 years:

(1) IV fibrinolytic ordered and monitored via telemedicine at another hospital is acceptable; and

(2) IV fibrinolytic administered at an outside hospital and transferred to CSC site is acceptable;

G. Satisfy the MIEMSS requirements for designation as a comprehensive stroke center by MIEMSS; and

[L. Meet the requirements of Regulations .02 through .18 of this chapter; and]

[M.] H. [Satisfy] Meet the [requirement] requirements for [an on-site] a site review [under] in COMAR 30.08.02.06, [by means of] which may be satisfied by completing either:

(1) An on-site review by MIEMSS [under COMAR 30.08.02.06]; or

[(2) Both of the following:

(a) Certification by the Joint Commission as a Comprehensive Stroke Center; and

(b) Meeting the requirements of Regulation .19 of this chapter.]

(2) A site survey as part of The Joint Commission Disease Specific Care Certification Program for certification as a comprehensive stroke center if the hospital:

(a) Authorized The Joint Commission to provide MIEMSS with survey findings, certification reports, and other information related to The Joint Commission’s certification of the hospital as a comprehensive stroke center;

(b) Allows MIEMSS to participate in the accreditation site survey; and

(c) Provides MIEMSS any additional information required to determine it has satisfied the requirements for designation under this chapter.

.02 Organization.

The designated comprehensive stroke center shall meet the requirements of COMAR 30.08.11.02.

.03 Emergency Department.

The designated comprehensive stroke center shall meet the requirements of COMAR 30.08.11.03.

.04 Neuroscience Intensive Care Unit.

The designated comprehensive stroke center shall maintain a dedicated neuroscience intensive care unit that meets the requirements of this regulation and:

A. Has designated beds for the care of acute stroke patients;

B. Has 24/7 on-site practitioners with neurovascular training, including, for example, APNs, PAs, neuro-intensivists, fellows, or residents;

C. Provides care to acute stroke patients through qualified clinical staff who meet the requirements in Regulations .12—.15 of this chapter;

D. Follows standardized processes derived from evidence-based practice clinical practice guidelines to facilitate clinical care;

E. Incorporates individualized plans of care that are based on the patient’s assessed needs and reflect coordination of care with other programs, as determined by patient comorbidities;

F. Has a process to assess the abilities and resources of family members to be involved in post-acute care; and

G. Maintains written documentation delineating the function of the neuroscience intensive care unit, including:

(1) Admission criteria;

(2) Discharge criteria;

(3) Acute stroke care protocols;

(4) Interdisciplinary rounding;

(5) Rehabilitation assessment and services in the hospital; and

(6) Outcome data.

[.06] .05 Stroke Unit.

[The hospital] In addition to meeting the requirements of COMAR 30.08.11.07, the designated comprehensive stroke center shall:

[A. Maintain a designated stroke unit which has designated beds for the care of the stroke patients beyond the acute phase which are:

(1) Part of a separate unit; or

(2) Part of an existing unit;

B. Maintain written documentation delineating the function of the stroke unit, including:

(1) Admission criteria;

(2) Discharge criteria;

(3) Acute stroke care protocols;

(4) Discharge instructions, including but not limited to:

(a) Signs and symptoms of acute stroke;

(b) Effects and prognosis of acute stroke;

(c) Potential complications of acute stroke;

(d) Needs and rationales for treatment;

(e) Patient compliance instructions for risk reduction and secondary prevention programs; and

(f) Post-stroke support services;

(5) Rehabilitation assessment/services in the hospital;

(6) Post-acute rehabilitation services post-discharge; and

(7) Outcomes data to include a minimum of 90-day follow-up assessment;]

[C.] A.—[D.] B. (text unchanged)

[E.] C. Have priority bed availability for stroke patients with appropriately trained registered nurses in sufficient numbers based on patient acuity; and

[F.] D. Have a written plan for triaging patients from the neuroscience intensive care unit and/or the dedicated this unit to make beds available for other stroke patients when necessary or for provision of alternate critical care beds for stroke patients with appropriately trained registered nurse staff[; and.

G. Provide appropriate physician supervision for nurse practitioners and physician assistants when those personnel assist in providing acute stroke care].

.06 Stroke Team.

A. In addition to meeting the requirement of COMAR 30.08.11.05, the hospital shall:

(1) Establish one or more acute stroke teams which shall respond to the emergency department with coordinated services for the effective delivery of emergency and acute stroke treatment;

(2) Use the National Institutes of Health Stroke Scale (NIHSS) for the initial assessment of patients with acute stroke, with clinicians performing an NIHSS having documented training in the completion of the NIHSS; and

(3) Perform ongoing neurological assessment on patients with acute stroke.

B. The acute stroke team shall include at a minimum:

(1) A physician, with special competence in caring for the acute stroke patient, who is Board-certified or Board-eligible in:

(a) Neurology;

(b) Critical care medicine; or

(c) Emergency medicine; and

(2) At least one additional health care provider, with experience in caring for the acute stroke patient, who may be:

(a) An emergency physician;

(b) A neurology resident or fellow;

(c) An internist;

(d) A registered nurse;

(e) A physician assistant; or

(f) A nurse practitioner.

C. If a physician otherwise satisfies §B(1) of this regulation but is not Board-certified or Board-eligible in neurology, a Board-certified or Board-eligible neurologist shall be available within 15 minutes for consultation under the terms of a written agreement by:

(1) Telephone; or

(2) Audio/visual communication.

[.08] .07 Operating Room.

[The] In addition to meeting the requirements of COMAR 30.08.11.04, the hospital shall have:

[A. An operating room with neurosurgical services promptly available 24 hours a day, with appropriately trained support staff and equipment;]

[B.] A. An attending board certified/board eligible neurosurgeon on call with a [30-minute] 45-minute arrival time to the hospital; [and]

[C. An on-call neurosurgical backup plan with documented contingency plans in case the capability of the neurosurgeon, hospital, or system to care for the stroke patients is overwhelmed.]

B. Written procedures demonstrating the ability to care for two complex neurosurgical stroke patients at one time using appropriate clinical staff; and

C. Written documentation demonstrating on-call and back-up on-call schedules for physicians and staff for 24/7 coverage.

[.09] .08 Endovascular Interventional Services.

The hospital shall have:

A. Interventional services promptly available 24 hours a day with appropriately trained support staff and equipment[;], including:

[B. Interventional services shall include:]

(1)—(4) text unchanged

(5) Stenting/angioplasty of intracranial [vessel] vessels;

[C.] B. A [board certified/board eligible] neurointerventionalist [or] who may be a board-certified/board-eligible neuroradiologist, neurologist, or neurosurgeon [with interventional stroke treatment experience] on call with a [30] 45-minute arrival time to the hospital; [and]

[D.] C. [A documented contingency plan for accessing] An on-call schedule for primary and back-up neurointerventionalists or neuroradiologists [if the capability of the neurointerventionalist[, neuroradiologist, hospital, or system to care for stroke patients is overwhelmed.];

D. A written protocol to accept the inter-facility transfer of acute ischemic stroke patients requiring endovascular therapy that includes communication and feedback to the sending facility; and

E. A written protocol to accept the inter-facility transfer of acute stroke patients requiring a higher level of care.

.09 Neuroimaging Services.

In addition to meeting the requirements of COMAR 30.08.11.09, a designated comprehensive stroke center shall have the following diagnostic capability available when indicated:

A. Carotid duplex ultrasound;

B. Transcranial ultrasonography; and

C. Transesophageal or transthorasic echocardiogram.

[.11] .10 Laboratory/Diagnostic Services.

The hospital shall meet the requirements of COMAR 30.08.11.08. [perform and interpret laboratory and diagnostic services within 45 minutes of a written, oral, or electronic order, 24 hours a day. These services include but are not limited to:

A. A complete blood count;

B. Blood chemistries;

C. Electrocardiograms;

D. Chest radiographs; and

E. Coagulation panel (platelet count, PT/INR, aPTT).]

.11 Qualifications of Stroke Center Director and Clinicians.

A. Director.

(1) The stroke center medical director shall be a physician with competence in caring for the acute stroke patient and be Board-certified or Board-eligible in:

(a) Neurology;

(b) Neurosurgery; or

(c) Vascular neurology.

(2) The stroke center medical director’s qualifications shall include:

(a) Completion of a stroke fellowship or vascular neurosurgery fellowship and obtained vascular neurology certification by the American Board of Psychiatry and Neurology;

(b) Active participation in the Stroke Quality Improvement Council (QIC);

(c) 12 hours of category 1 CME credits related to stroke care annually;

(d) Participation in at least one regional, national, or international stroke conference annually;

(e) Participation in stroke patient morbidity and mortality reviews; and

(f) Participation in stroke research and publication efforts.

B. Neurologists, Neurosurgeons, NeurInterventionalists, NeuroRadiologisst, NeuroIntensivists, and Vascular Surgeons. Qualifications for neurologists, neurosurgeons, neurointerventionalists, neuroradiologists, vascular surgeons and neurointensivists shall include:

(1) Board certification or Board eligibility in their specialty as approved by the American Board of Medical Specialties;

(2) Completion of:

(a) A fellowship;

(b) Demonstrated experience equivalent to completion of a stroke specialty fellowship appropriate to their area of expertise; or

(c) Both of these;

(3) 8 or more hours of category 1 or 2 CME credits per year related to stroke care;

(4) Participation in stroke patient morbidity and mortality reviews; and

(5) Participation in stroke research and publication efforts.

C. Emergency Physicians. The qualifications of emergency physicians who care for stroke patients shall include:

(1) Board certification or Board eligibility in emergency medicine as approved by the American Board of Medical Specialties;

(2) Participation in stroke patient morbidity and mortality reviews;

(3) 4 or more hours of category 1 or 2 CME credits per year related to stroke care; and

(4) Participation in stroke research and publication efforts.

D. Nurse Practitioners. Nurse Practitioners who care for stroke patients shall:

(1) Hold a current license with the Maryland State Board of Nursing to practice as a registered nurse and a nurse practitioner;

(2) Have an agreement with the Maryland State Board of Nursing which states that the nurse practitioner has a scope of practice that includes patients with acute neurological disease;

(3) Maintain certification as a nurse practitioner from the American Nurses Credentialing Center or other certification organization as deemed appropriate by the Maryland State Board of Nursing; and

(4) Be credentialed through the hospital’s credentialing process.

E. Physician Assistants. Physician assistants who care for stroke patients shall:

(1) Have graduated from a physician assistant educational program accredited by the Accreditation Review Commission on Education for the Physician Assistant or its successor;

(2) Maintain current certification by the National Commission on Certification of Physician Assistants;

(3) Maintain an approved delegation agreement on file with the Maryland Board of Physicians; and

(4) Be credentialed through the hospital credentialing process.

[.14] .12 Qualifications of Nurses, Nurse Practitioners, and Physician Assistants in the Neuroscience Intensive Care Unit.

A. Clinical nurses, nurse practitioners, and physician assistants providing care to stroke patients in the neuroscience intensive care unit shall be trained in assessment of neurological function and management and treatment of all aspects of neurocritical care, including:

(1)—(4) (text unchanged)

(5) Care of patients post mechanical thrombectomy;

[(5)] (6)—[(7)] (8) (text unchanged)

B. (text unchanged)

[.15] .13 Qualifications of Nurses, Nurse Practitioners, and Physician Assistants in the Emergency Department.

A. Emergency department nurses, nurse practitioners, and physician assistants who triage patients in the emergency department or care for acute stroke patients shall be trained in:

(1)—(2) (text unchanged)

(3) Use of clinically appropriate [fibrinolytics] fibrinolytic in acute ischemic stroke and the indication for endovascular therapy in acute ischemic stroke;

(4) Mechanical thrombectomy protocols;

[(4)] (5)[(7)] (8) (text unchanged)

B. (text unchanged).

[.16] .14 Continuing Medical Education Requirements for Nurses, Nurse Practitioners, and Physician Assistants in the Stroke Unit.

Continuing education requirements for nurses, nurse practitioners and physician assistants who care for the acute stroke patients in the stroke unit shall include [at least] a minimum of 5 hours of stroke-specific education annually.

.15 Prevention/Public Education.

The designated comprehensive stroke center shall meet the requirements of COMAR 30.08.11.12.

.16 Policies, Protocols, Guidelines, and Agreements.

In addition to meeting the requirements of COMAR 30.08.11.13, the hospital shall:

A. Have written policies ensuring that:

(1) Transfer of patients from another facility is appropriate and patients are received in a timely manner; and

(2) All stroke patients receive care commensurate with the hospital’s designation as a comprehensive stroke center;

B. Have written care protocols for advanced treatment of complex stroke patients, including, but not limited to, acute ischemic stroke patients, acute intra-arterial therapeutic interventions, management of intracranial hemorrhage, and management of subarachnoid hemorrhage;

C. Have written procedures demonstrating the ability of neurosurgery and interventional radiology to care for two complex stroke patients at one time with appropriate clinicians;

D. Maintain up-to-date written care protocols for the treatment of acute stroke in:

(1) The neuroscience intensive care unit;

(2) The stroke unit;

(3) The emergency department; and

(4) All other locations where stroke care is provided;

E. Have established mechanisms to serve and act as a resource center for other facilities in their region or state, which shall include:

(1) Providing expertise in managing particular cases through the use of telemedicine or other alternative means;

(2) Offering guidance for triage of patients;

(3) Providing advanced diagnostic, surgical or interventional procedures and treatment to patients initially treated at a non-primary stroke center or a primary stroke center; and

(4) Acting as an educational resource for other hospitals and health care professionals; and

F. Have written policies and or protocols delineating the scope of practice and the roles and responsibilities of nurse practitioners and physician assistants providing care to the acute stroke patient in the neuroscience intensive care unit, the emergency department, and the stroke unit.

.17 Quality Management.

A. In addition to the requirements of COMAR 30.08.11.14, the hospital shall incorporate into the hospital’s quality assurance process reports about:

(1) Specific acute stroke treatment benchmarks; and

(2) Stroke treatment quality improvement goals.

B. The hospital shall establish a multidisciplinary institutional quality assurance/performance improvement committee that meets on a regular basis to:

(1) Monitor quality benchmarks;

(2) Review complications; and

(3) Review and modify practice patterns as appropriate.

C. In cases where mechanical endovascular reperfusion therapy is appropriate, the hospital shall achieve door-to-device times (arrival to first pass of thrombectomy device) in 50 percent or more of eligible acute ischemic stroke patients within 120 minutes (for direct arriving patients) and within 60 minutes (for inter-facility transfer patients) treated with endovascular therapy.

D. The hospital shall demonstrate progress towards reducing door-to-device times in 50 percent or more of eligible acute ischemic stroke patients within 90 minutes for direct arriving patients.

.18 Acute Stroke Research.

A hospital shall:

A. Have an acute stroke research program and acute stroke research plan; and

B. Demonstrate participation in clinical research trials in acute stroke care.

THEODORE R. DELBRIDGE, M.D.
Executive Director

 

Subtitle 08 DESIGNATION OF TRAUMA AND SPECIALTY REFERRAL CENTERS

30.08.19 Designated Thrombectomy-Capable Primary Stroke Center Standards

Authority: Education Article, §13-509, Annotated Code of Maryland

Notice of Proposed Action

[21-114-P]

The Maryland Emergency Medical Services Board proposes to adopt new Regulations .01—.15 under a new chapter, COMAR 30.08.19 Designated Thrombectomy-Capable Primary Stroke Center Standards. This action was considered by the Maryland Emergency Medical Services Board at an open meeting held on February 9, 2021.

Statement of Purpose

The purpose of this action is to expand stroke care throughout the State to meet the needs of the stroke patient population experiencing large vessel occlusions.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. These regulations establish standards for a new level of stroke center to care for patients with large vessel occlusions and will expand the availability of stroke care in the State. Designation as a stroke center is voluntary. Current designated centers already have most of the required personnel and equipment in place to meet the new standards.

 

 

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:

(1) Increased patients

(+)

Unknown

(2) Personnel and equipment costs to meet standards

(-)

Variable

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(1). Designation as a stroke center is voluntary. Designation expands the number of stroke patients a hospital can serve.

D(2). Current designated stroke centers already have most of the required personnel and equipment in place to meet the new standards.

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 Anna Aycock, Chief, Health Facilities and Special Programs, MIEMSS, 653 West Pratt St, Baltimore, MD 21201, or call 410-706-3930, or email to aaycock@miemss.org. Comments will be accepted through September 27, 2021. A public hearing has not been scheduled.

.01 Designated Thrombectomy-Capable Primary Stroke Center.

In addition to meeting the requirements of COMAR 30.08.11, a designated thrombectomy-capable primary stroke center hospital shall:

A. Be designated by MIEMSS as a primary stroke center at the time of application for designation as a thrombectomy-capable primary stroke center;

B. Continue to meet the primary stroke center requirements in COMAR 30.08.11 to the extent such requirements are consistent with designation as a thrombectomy-capable primary stroke center;

C. Require each physician who performs mechanical thrombectomy to have performed 15 mechanical thrombectomies over the past 12 months or 30 over the past 24 months, which may include procedures performed at other facilities;

D. Perform mechanical thrombectomy and have provided post-procedure care for a minimum of 15 patients in the past 12 months or at least 30 patients over the past 24 months;

E. Meet the requirements of Regulations .01—.15 of this chapter;

F. Satisfy the MIEMSS requirements for designation as a thrombectomy-capable primary stroke center by MIEMSS; and

G. Meet the requirements for a site review in COMAR 30.08.02.06, which may be satisfied by completing either:

(1) An on-site review by MIEMSS; or

(2) A site survey as part of The Joint Commission Disease Specific Care Certification Program for certification as a thrombectomy-capable primary stroke center if the hospital:

(a) Authorizes The Joint Commission to provide MIEMSS with survey findings, certification reports, and other information related to The Joint Commission’s certification of the hospital as a thrombectomy-capable primary stroke center;

(b) Allows MIEMSS to participate in the accreditation site survey; and

(c) Provides MIEMSS any additional information required to determine that the hospital has satisfied the requirements for designation under this chapter.

.02 Organization.

A hospital designated as a thrombectomy-capable primary stroke center shall meet the requirements of COMAR 30.08.11.02.

.03 Emergency Department.

The emergency department of a hospital designated as a thrombectomy-capable primary stroke center shall meet the requirements of COMAR 30.08.11.03

.04 Operating Room.

The operating room of a hospital designated as a thrombectomy-capable primary stroke center shall meet the requirements of COMAR 30.08.11.04

.05 Stroke Team.

A. In addition to meeting the requirements of COMAR 30.08.11.05, the acute stroke team shall include at a minimum:

(1) A physician, with special competence in caring for an acute stroke patient, who is Board-certified or Board-eligible in:

(a) Neurology;

(b) Critical care medicine;

(c) Emergency medicine; or

(d) Internal medicine; and

(2) At least one additional health care provider, with experience in caring for the acute stroke patient, who may be:

(a) An emergency physician;

(b) An internal medicine physician;

(c) A neurology resident or fellow;

(d) A registered nurse;

(e) A physician’s assistant; or

(f) A nurse practitioner.

B. If a physician otherwise satisfies §A(1) of this regulation but is not Board-certified or Board-eligible in neurology, a Board-certified or Board-eligible neurologist shall be available within 15 minutes for consultation under the terms of a written agreement by:

(1) Telephone; or

(2) Audio/visual communication.

.06 Intensive Care Unit.

A hospital designated as a thrombectomy-capable primary stroke center shall maintain an intensive care unit that:

A. Has designated beds for the care of the acute stroke patient;

B. Has 24/7 on-site practitioners with critical care privileges, including, for example, APNs, PAs, fellows, or residents;

C. Provides care to acute stroke patients through qualified clinical staff who meet the requirements in Regulation .11 of this chapter;

D. Follows standardized processes derived from evidence-based clinical practice guidelines to facilitate clinical care;

E. Incorporates individualized plans of care that are based on the patient’s assessed needs and reflect coordination of care with other programs, as determined by patient comorbidities;

F. Has a process to assess the abilities and resources of family members to be involved in post-acute care; and

G. Maintains written documentation delineating the function of the intensive care unit, including:

(1) Admission criteria;

(2) Discharge criteria;

(3) Acute stroke care protocols;

(4) Interdisciplinary rounding;

(5) Rehabilitation assessment and services in the hospital; and

(6) Outcome data.

.07 Stroke Unit.

The stroke unit of a hospital designated as a thrombectomy-capable primary stroke center shall meet the requirements of COMAR 30.08.11.07.

.08 Laboratory/Diagnostic Services.

A hospital designated as a thrombectomy-capable primary stroke center shall meet the requirements of COMAR 30.08.11.08.

.09 Neuroimaging Services.

In addition to meeting the requirements of COMAR 30.08.11.09, a hospital designated as a thrombectomy-capable primary stroke center shall have the following diagnostic capability available when indicated:

A. Carotid duplex ultrasound;

B. Transcranial ultrasonography; and

C. Transesophageal/transthoracic echocardiogram.

.10 Endovascular Interventional Services.

A hospital designated as a thrombectomy-capable primary stroke center shall have:

A. Interventional services promptly available 24 hours a day with appropriately trained support staff and necessary equipment;

B. Interventional services that include:

(1) Intra-arterial reperfusion therapy; and

(2) Stenting/angioplasty of intracranial vessels;

C. A neurointerventionalist who may be a Board-certified/Board-eligible neuroradiologist, neurologist, or neurosurgeon on-call with a 45-minute arrival time to the hospital;

D. An on-call schedule for a primary and a back-up neurointerventionalist; and

E. A written protocol to accept the inter-facility transfer of acute ischemic stroke patients requiring endovascular therapy that includes communication and feedback to the sending facility.

.11 Qualifications of Stroke Center Director and Clinicians.

In addition to meeting the requirements of COMAR 30.08.11.10, a neurointerventionalist shall have:

A. 4 or more hours of category 1 or 2 CME credits per year related to stroke care; and

B. Performed 15 mechanical thrombectomies over the past 12 months or 30 over the past 24 months.

.12 Qualifications of Emergency Department Clinical Staff.

In addition to meeting the requirements of COMAR 30.08.11.11, the emergency department clinical staff who triage or care for acute stroke patients shall be educated, by the hospital, on mechanical thrombectomy protocols.

.13 Prevention/Public Education.

A hospital designated as a thrombectomy-capable primary stroke center shall meet the requirements of COMAR 30.08.11.12.

.14 Policies, Protocols, Guidelines, and Agreements.

In addition to meeting the requirements of COMAR 30.08.11.13, a hospital designated as a thrombectomy-capable primary stroke center shall:

A. Have written policies ensuring that:

(1) Transfer of patients from another facility is appropriate and patients are received in a timely manner; and

(2) All stroke patients will receive medical care commensurate with the hospital’s designation as a thrombectomy-capable primary stroke center;

B. Have written procedures demonstrating the ability to care for two complex interventional radiology stroke patients at one time, using appropriate clinical staff;

C. Have written documentation demonstrating on-call and back-up on-call schedules for physicians and staff for 24/7 coverage;

D. Have written care protocols for advanced treatment of complex stroke patients, including, but not limited to, acute ischemic stroke patients and acute intra-arterial therapeutic interventions; and

E. Document and review the scope of practice and the roles and responsibilities of nurse practitioners and physician assistants providing care to the acute stroke patient in the intensive care unit, the emergency department, and the stroke unit.

.15 Quality Management.

In addition to meeting the requirements of COMAR 30.08.14, a hospital designated as a thrombectomy-capable primary stroke center shall:

A. Monitor and demonstrate 24-hour post-procedure stroke and death rates of less than or equal to 1 percent for diagnostic neuro-angiography;

B. Monitor documentation of the reasons potentially eligible ischemic stroke patients did not receive mechanical thrombectomy;

C. Monitor and demonstrate tracking and trending of modified Rankin Scores (mRS) at 90 days post-discharge on patients with acute ischemic stroke who received mechanical endovascular reperfusion therapy;

D. In cases where mechanical endovascular reperfusion therapy is appropriate, achieve door-to-device times, arrival to first pass of thrombectomy device, in 50 percent or more of eligible acute ischemic stroke patients within 120 minutes for direct arriving patients and within 60 minutes for inter-facility transfer patients treated with endovascular therapy; and

E. Demonstrate progress towards reducing door-to-device times, arrival to first pass of thrombectomy device in 50 percent or more of eligible acute ischemic stroke patients within 90 minutes for direct arriving patients.

THEODORE R. DELBRIDGE, M.D.
Executive Director

Title 31
MARYLAND INSURANCE ADMINISTRATION

Subtitle 08 PROPERTY AND CASUALTY INSURANCE

31.08.03 Notices of Cancellation, Nonrenewal, Premium Increase, and Reduction in Coverage

Authority: Insurance Article, §§2-109, 11-318, 27-609, 27-613, and 27-614, Annotated Code of Maryland

Notice of Proposed Action

[21-105-P]

     The Insurance Commissioner proposes to amend Regulations .04—.06 and .10 under COMAR 31.08.03 Notices of Cancellation, Nonrenewal, Premium Increase, and Reduction in Coverage.

Statement of Purpose

The purpose of this action is to amend regulations to implement Ch. 103 (S.B. 110), Acts of 2021. Specifically, these regulations update the need for duplicate and triplicate notices, correct existing regulation language regarding mailing method to match the current statutory requirement, and update the outdated fax number on the forms. Finally, these changes implement the language of Insurance Article, §11-318, Annotated Code of Maryland, regarding an increase in premium due to the application of a program that measures the insured’s driving habits during that policy period.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. The proposed change may decrease insurance companies cost because they are no longer required to send forms in duplicate or triplicate. The cost to insureds may increase if they take part in a program that measures their driving habits during the current policy period and their driving habits are poor.

 

 

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:

(+)

Minimal

E. On other industries or trade groups:

NONE

F. Direct and indirect effects on public:

(-)

Minimal

 

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

D. The proposed change may decrease insurance companies cost because they are no longer required to send forms in duplicate or triplicate.

F. The cost to insureds may increase if they take part in a program that measures their driving habits during the current policy period and their driving habits are poor.

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 Lisa Larson, Director of Regulations, Maryland Insurance Administration, 200 St. Paul Place, Suite 2700, Baltimore, MD 21202, or call 410-468-2007, or email to insuranceregreview.mia@maryland.gov, or fax to 410-468-2020. Comments will be accepted through September 27, 2021. A public hearing has not been scheduled.

.04 Procedure and Requirements Regarding Cancellation or Nonrenewal.

A notice of cancellation or nonrenewal sent by an insurer to its insured in accordance with Insurance Article, §27-613, Annotated Code of Maryland, shall be sent [in triplicate] by certified mail and shall, in addition to the statutory information required in the notice of cancellation or nonrenewal, include the following on the first page of the notice in 12-point bold type:

 

IMPORTANT
“Right of Protest”

 

The “Right of Protest” does not apply to cancellation or nonrenewal due to nonpayment of premium.

 

You may protest the action proposed by this notice as provided under Insurance Article, §27-613, Annotated Code of Maryland. For your protest to be duly filed you, the named insured, must sign a copy of this notice and send it to:

 

Insurance Commissioner
Maryland Insurance Administration
200 St. Paul Place
Suite 2700
Baltimore, Maryland 21202
Fax Number [410-468-2334 or] 410-468-2307

 

within thirty (30) days after this notice was mailed to you. If your protest is not filed within the thirty (30) days, it cannot be considered by the Insurance Administration. Instead of mailing or faxing the signed notice, you may file your protest online via the Maryland Insurance Administration’s website (www.insurance.maryland.gov) by uploading a signed copy at the following link:

 

https://enterprise.insurance.maryland.gov/consumer/ConsumerPortalWelcomePage.aspx

 

Your timely filed protest stays the action proposed by this notice. Accordingly, your insurance policy will remain in effect with the same coverages and premium that applied on the mailing date of the notice until a determination is made by the Commissioner. In order to keep your policy in effect, however, you must timely pay any authorized premium due or becoming due before the determination is issued.

The Insurance Commissioner will determine whether your protest has merit. You will then be notified in writing whether the proposed action is disallowed or your protest is dismissed.

 

If the protest is dismissed, you then have the right, within thirty (30) days after the mailing date of the determination, to request a hearing.

 

If you request a hearing, you will be notified in writing of the time and place of the hearing at least ten (10) days before the hearing. The Commissioner shall order the insurer to pay reasonable attorney fees incurred by you for representation at the hearing if the Commissioner finds that: (1) the actual reason for the proposed action is not stated in the notice or the proposed action is not in accordance with §27-501 of the Insurance Article, the insurer’s filed rating plan, its underwriting standards, or the lawful terms and conditions of the policy related to a cancellation or nonrenewal; and (2) the insurer’s conduct in maintaining or defending the proceeding was in bad faith or the insurer acted willfully in the absence of a bona fide dispute.

 

I protest the action proposed by the insurer.

 

My reasons for protesting the action are:

 

_____________________________________________________

 

Signed (Named Insured)_____________________ Date ________

 

Daytime Phone Number__________________________________

.05 Procedure and Requirements Regarding a Reduction in Coverage.

A notice of reduction in coverage sent by an insurer to its insured in accordance with Insurance Article, §27-613, Annotated Code of Maryland, shall be sent [in triplicate] by certificate of mail and shall, in addition to the statutory information required in the notice of reduction in coverage, include the following on the first page of the notice in 12-point bold type:

 

IMPORTANT
“Right of Protest”

 

You may protest the action proposed by this notice as provided under Insurance Article, §27-613, Annotated Code of Maryland. For your protest to be duly filed you, the named insured, must sign a copy of this notice and send it to:

 

Insurance Commissioner
Maryland Insurance Administration
200 St. Paul Place
Suite 2700
Baltimore, Maryland 21202
Fax Number [410-468-2334 or] 410-468-2307

 

within thirty (30) days after this notice was mailed to you. If your protest is not filed within the thirty (30) days, it cannot be considered by the Insurance Administration. Instead of mailing or faxing the signed notice, you may file your protest online via the Maryland Insurance Administration’s website (www.insurance.maryland.gov) by uploading a signed copy at the following link:

 

https://enterprise.insurance.maryland.gov/consumer/ConsumerPortalWelcomePage.aspx

 

Your timely filed protest stays the action proposed by this notice. Accordingly, your insurance policy will remain in effect with the same coverages and premium that applied on the mailing date of the notice until a determination is made by the Commissioner. In order to keep your policy in effect, however, you must timely pay any authorized premium due or becoming due before the determination is issued.

 

The Insurance Commissioner will determine whether your protest has merit. You will then be notified in writing whether the proposed action is disallowed or your protest is dismissed.

 

If the protest is dismissed, you then have the right, within thirty (30) days after the mailing date of the determination, to request a hearing.

 

If you request a hearing, you will be notified in writing of the time and place of the hearing at least ten (10) days before the hearing. The Commissioner shall order the insurer to pay reasonable attorney fees incurred by you for representation at the hearing if the Commissioner finds that: (1) the actual reason for the proposed action is not stated in the notice or the proposed action is not in accordance with §27-501 of the Insurance Article, the insurer’s filed rating plan, its underwriting standards, or the lawful terms and conditions of the policy related to a reduction in coverage; and (2) the insurer’s conduct in maintaining or defending the proceeding was in bad faith or the insurer acted willfully in the absence of a bona fide dispute.

 

I protest the action proposed by the insurer.

 

My reasons for protesting the action are:

_____________________________________________________

 

Signed (Named Insured)___________________ Date__________

 

Daytime Phone Number _________________________________

.06 Procedures and Requirements Regarding an Increase in Premium.

A. Scope.

(1) (text unchanged)

(2) This regulation does not apply to an increase in premium due to:

(a)—(j) (text unchanged)

(k) The removal or reduction of a discount [if] unless the discount is [not] removed or reduced wholly or partly due to:

(i)—(ii) (text unchanged)

(iii) The claims history of the insured; [or]

(iv) A retiering of the insured; or

(v) The application of a program that measures the operation of an insured vehicle during the current policy period as referenced in Insurance Article, §11-318, Annotated Code of Maryland;

(l)—(n) (text unchanged)

B. Notice.

(1) (text unchanged)

(2) The insurer shall send a notice of premium increase to its insured [in duplicate by certificate of] using a first-class mail tracking method.

C. (text unchanged)

.10 Record Retention Requirements.

A. Length of Retention. An insurer that provides a notice of cancellation, nonrenewal, premium increase, or reduction in coverage pursuant to Insurance Article, §27-613 or 27-614, Annotated Code of Maryland, and this chapter, shall retain a copy of the notice and [certificate] its proof of mailing for at least 3 years from the effective date of the notice.

B. Form of Records. An insurer may maintain a copy of a notice and [certificate] the proof of mailing required to be retained by §A of this regulation in paper, photographic, microprocessed, magnetic, mechanical, electronic, digital, or any other medium, if the copy of the notice and [certificate] proof of mailing are maintained in a manner that:

(1)—(4) (text unchanged)

KATHLEEN A. BIRRANE
Insurance Commissioner

 

Title 36
MARYLAND STATE LOTTERY AND GAMING CONTROL AGENCY

Notice of Proposed Action

[21-108-P]

The Maryland State Lottery and Gaming Control Agency proposes to:

(1) Amend Regulations .01 and .05 under COMAR 36.01.01 General;

(2) Amend Regulations .04—.06 under COMAR 36.01.02 Administrative Procedures; and

(3) Adopt under a new subtitle, Subtitle 10 Sports Wagering Provisions:

              (a) New Regulations .01—.02 under a new chapter, COMAR 36.10.01 General;

              (b) New Regulations .01—.14 under a new chapter, COMAR 36.10.02 All Applicants and Licensees — Applications and Investigations;

              (c) New Regulations .01—.06 under a new chapter, COMAR 36.10.03 All Applicants and Licensees — Qualification Requirements;

              (d) New Regulations .01—.11 under a new chapter, COMAR 36.10.04 Specific Requirements for Sports Wagering Facility Licensees;

              (e) New Regulations .01—.05 under a new chapter, COMAR 36.10.05 Specific Requirements for Mobile Sports Wagering Licenses;

              (f) New Regulations .01—.11 under a new chapter, COMAR 36.10.06 Specific Requirements for Other Licenses Required for Sports Wagering;

              (g) New Regulations .01—.06 under a new chapter, COMAR 36.10.07 License Denial Procedures;

              (h) New Regulations .01—.11 under a new chapter, COMAR 36.10.08 Enforcement;

              (i) New Regulations .01—.03 under a new chapter, COMAR 36.10.09 Unannounced Inspections;

              (j) New Regulations .01—.03 under a new chapter, COMAR 36.10.10 Enforcement of Voluntary Exclusion Program;

              (k) New Regulations .01—.09 under a new chapter, COMAR 36.10.11 Mandatory Exclusion;

              (l) New Regulations .01—.04 under a new chapter, COMAR 36.10.12 Collection of Taxes, Fees, and Penalties;

              (m) New Regulations .01—.44 under a new chapter, COMAR 36.10.13 Sports Wagering Licensee Minimum Internal Control Standards;

              (n) New Regulations .01—.07 under a new chapter, COMAR 36.10.14 Sports Wagering Requirements and Limitations;

              (o) New Regulations .01—.04 under a new chapter, COMAR 36.10.15 Sports Wagering Licensee Facility Standards;

              (p) New Regulations .01—.06 under a new chapter, COMAR 36.10.16 Wagering Using Online, Web-Based, or Mobile Applications;

              (q) New Regulations .01—.03 under a new chapter, COMAR 36.10.17 Sports Wagering Equipment; and

              (r) New Regulations .01—.06 under a new chapter, COMAR 36.10.18 Sports Wagering Technical Standards.

     This action was considered at the Maryland Lottery and Gaming Control Commission open meeting held on July 15, 2021, notice of which was given pursuant to General Provisions Article, §3-302(c), Annotated Code of Maryland.

Statement of Purpose

The purpose of this action is to:

(1) Under COMAR 36.01.01, amend this existing chapter to add definitions to include Sports Wagering, and clarify that the “gaming activity” that Commission members, staff, and related individuals are not allowed to participate in, is all the gaming activities that the Agency regulates;

(2) Under COMAR 36.10.02, incorporate sports wagering and clarify the existing processes in which the Agency refers contested case hearings to the Office of Administrative Hearings;

(3) Under COMAR 36.10.01, which establishes an all new subtitle 10 – Sports Wagering Provisions, add all definitions for sports wagering;

(4) Under COMAR 36.10.02, outline all the requirements for submitting sports wagering license applications, and background investigations for persons who must be backgrounded, and the applicable costs;

(5) Under COMAR 36.10.03, require that all applicants and licensee in the Sports Wagering Program are to meet the same qualification requirements for the licensees for casinos and casino-related businesses; that all applicants and licensees must prove their qualifications -- financial stability and responsibility, integrity of financial backers and investors, and good character, honesty, and integrity -- by clear and convincing evidence, during the whole time they are licensed;

(6) Under COMAR 36.10.04, outline the requirements for the ‘brick and mortar’ licenses, which are categories called Class A-1, A-2, B-1, and B-2;

(7) Under COMAR 36.10.05, establish the requirements for applicants who want to conduct online sports wagering;

(8) Under COMAR 36.10.06, describe the specific requirements for licensure as:

     • An Online Sports Wagering Operator, which operates online wagering for a mobile Sports Wagering licensee;

     • A Sports Wagering Facility Operator, which operates in-person wagering for a Sports Wagering Facility licensee;

     • A Sports Wagering Contractor, which provides services and goods related to sports wagering to any of the above licensees;

     • A Sports Wagering Employee, who is a Principal Employee, Wagering Employee, or Non-wagering Employee who is employed by any of the above sports wagering licensees; and

     • For registration or certification as a Sports Wagering Vendor, which supplies services and goods that are not related to sports wagering;

(9) Under COMAR 36.10.07, outline the due process to be afforded an applicant who Commission staff recommend the Commission deny a license application if staff finds the applicant is not technologically or operationally ready to securely and legally conduct sports wagering; and for contractors and employees, if staff determines that the applicant did not meet qualifications;

(10) Under COMAR 36.10.08, establish the processes for taking enforcement action against a licensee, including fines, and suspension or revocation of a license;

(11) Under COMAR 36.10.09, describe the manner in which the Commission may inspect premises and records of licensees, and related entities;

(12) Under COMAR 36.10.10, establish how licensees are required to exclude from their sports wagering floors, or from online wagering, individuals who have self-excluded from sports wagering;

(13) Under COMAR 36.10.11, describe how an individual may be placed on our mandatory exclusion list of individuals who are not permitted in sports wagering facilities or to make wagers;

(14) Under COMAR 36.10.12, establish the guidelines for payment, and collection, of taxes, fees, and penalties;

(15) Under COMAR 36.10.13, detail the requirements for accounting, auditing, staffing, promotional play, various kinds of documentation, and reporting of licensee’s sports wagering operations;

(16) Under COMAR 36.10.14, establish requirements about approval of bet types, prohibited wagers, reserve requirements, limits on wagers, funding of wagers, and complaints about wagers;

(17) Under COMAR 36.10.15, outline requirements for Commission approval of facility plans and designs;

(18) Under COMAR 36.10.16, establish requirements about geolocation, age verification, data security, and the limitation on a mobile sports wagering licensee using only 1 individually branded website;

(19) Under COMAR 36.10.17, cover registration, testing, and authorization of kiosks; and

(20) Under COMAR 36.10.18, outline the technical requirements for Mobile and Online Sports Wagering Operator licensees, including for wagering platforms, geolocation systems, security, and bettor accounts.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. In general, the implementation of the proposed action will have a positive economic impact to the State, some sports wagering licensees, and some players, but the extent of the impact is indeterminable. Sports wagering revenue forecasts to the State range from $15 million to $25 million. These proposed regulations will establish the necessary framework for the implementation of Maryland’s Sports Wagering Program.

 

 

Revenue (R+/R-)

 

II. Types of Economic Impact.

Expenditure

(E+/E-)

Magnitude

 


A. On issuing agency:

(E+)

MINOR

B. On other State agencies:

(R+)

MINIMAL

C. On local governments:

NONE

NONE

 

 

Benefit (+)

Cost (-)

Magnitude

 


D. On regulated industries or trade groups:

(+)

MAJOR

E. On other industries or trade groups:

(+)

MINOR

F. Direct and indirect effects on public:

Blueprint for Maryland’s Future Fund (BMFF)

(+)

 MAJOR

 

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

A. There will be additional staff costs to implement and regulate this new Sports Wagering Program. The Agency estimates that there will be a need for not less than thirty-five (35) new positions as the Program rolls out. Staff is needed in the Agency’s Licensing, Compliance, Auditing, and Financial Sections to regulate up to potentially 107 sports wagering licensees.

B. With the implementation of sports wagering, more multinational corporations and foreign businesses may register to do business in the State.

C. Sports wagering may not materially affect gaming revenue, so local impact grants to designated jurisdictions should not be affected.

D. Potential sports wagering licensees may need to hire additional staff to implement the necessary regulatory requirements of operating a sports book. These licensees will need to procure specialized systems for taking, monitoring, and transacting wagers. In addition, licensees will incur other costs for licensing, backgrounding, and providing the necessary business infrastructure. Fantasy Competition Operators will be submitting 15% of their proceeds from competitions to the BMFF. Similarly, sports wagering licensees will be submitting 15% of their proceeds from sports wagering to the BMFF. In addition, fees from sports wagering application fees and license renewal fees collected from potential sports wagering licensees will go to the BMFF.

E. Sports wagering application fees and license renewal fees collected from potential sports wagering licensees will go to the BMFF. In addition, 5% of the fees collected from each Class A–1 and A–2 sports wagering facility license will go to the new Small, Minority–Owned, and Women–Owned Business Sports Wagering Assistance Fund.

F. Maryland residents will have the ability to participate in sports wagering within the state rather than travel to neighboring jurisdictions. In addition, Sports Wagering licensees and Fantasy Competition Operators will be submitting 15% of their proceeds from sports wagering or competitions to the Commission for distribution to the BMFF.

Economic Impact on Small Businesses

The proposed action has a meaningful economic impact on small business. An analysis of this economic impact follows.

Although an exact impact is indeterminable at this time, there may be a positive benefit to small, minority and women-owned businesses entering into the sports wagering program either through minority equity ownership or MBE participation.

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

Comments may be submitted in writing using one of the following methods: Submit using the online form available at www.mdgaming.com/sports-wagering-comments, send an email to sports.wagering@maryland.gov, or mail to James B. Butler, Managing Director, Organizational Compliance, Maryland Lottery and Gaming Control Agency, 1800 Washington Blvd., Suite 330, Baltimore, MD 21230. Comments will be accepted through September 27, 2021. Comments must be received during the 30-day public comment period in order to be considered. Comments sent by mail must be received by September 27, 2021. Comments will not be accepted by telephone or facsimile. All comments will be published on mdgaming.com after the public comment has ended. A public meeting on these regulations will be held on Wednesday, September 22, 2021, at 10 a.m., in the Auditorium at the Montgomery Park Business Center, where the Maryland Lottery and Gaming Control Agency Headquarters is located, 1800 Washington Boulevard, Baltimore, MD 21230. For the most up-to-date information regarding the status of this public meeting, please go to https://www.mdgaming.com/maryland-sports-wagering/sports-wagering-regulations/. If additional information is needed or if you require an accommodation in order to participate in the meeting, please contact James B. Butler, by telephone (410) 230-8781, by email jutler@maryland.gov, or by fax to (410) 230-8727.

 

Subtitle 01 GENERAL PROVISIONS

36.01.01 General

Authority: State Government Article, §§9-101—9-111, 9-116, 9-123,
9-1A-01, 9-1A-02, 9-1A-04, 9-1A-24, 9-1E-04, and 10-205, Annotated Code of Maryland

.01 Definitions.

A. (text unchanged)

B. Terms Defined.

(1) (text unchanged)

(2) Cash.

(a) “Cash” means coins, U.S. currency, money orders, debit cards, and checks.

(b) “Cash” does not include credit.

[(2)] (3)[5] (6) (text unchanged)

[(6)] (7) “Final action on a sanction” means:

(a) If after the Director sends a deficiency notice under COMAR 36.02.02, 36.03.04, 36.06.05, 36.07.02, [or] 36.03.03 or 36.10.08, a licensee fails to submit a timely, acceptable corrective action plan, and the Commission adopts as final the Director’s deficiency notice; [or]

(b) If the Commission holds a hearing on the Director’s recommendation to impose a sanction, the date of the Commission’s written decision[.]; or

(c) If a licensee seeks judicial review of the Commission’s sanction, the most recent date of:

(i) The decision of the Office of Administrative Hearings;

(ii) A final judgement under Maryland Rule 2-601; or

(iii) The entry of a mandate under Maryland Rule 8-606.

[(7)] (8) Gaming Activity.

(a) (text unchanged)

(b) “Gaming activity” [does not include] includes activities [as provided] described in COMAR 36.06 — COMAR [36.09] 36.10.

[(8)] (9)[(14)] (15) (text unchanged)

(16) “Sports wagering” has the meaning stated in State Government Article §9-1E-01, Annotated Code of Maryland, and COMAR 36.10.01.02.

(17) “Sports wagering law” means State Government Article, Title 9, Subtitle 1E, Annotated Code of Maryland.

[(15)] (18)[(22)] (25) (text unchanged)

(26) “Winnings” means the amount won from a sports wager that is not reduced by a loss.

[(23)] (27) (text unchanged)

.05 Limitations on Gaming Activity.

Gaming activity may not be engaged in by, and a prize [or], jackpot, or winnings may not be paid to:

A.—E. (text unchanged)

 

36.01.02 Administrative Procedures

Authority: General Provisions Article, §§4-101—4-601; State Government Article, §§9-108—9-111, 9-1A-04, 9-1E-04, 10-201, 10-226, 10-301—
10-305, 10-501—10-512, and 10-611—10-630; Annotated Code of Maryland

.04 Petition for Declaratory Ruling.

A.—D. (text unchanged)

E. Review By Commission.

(1) The Director’s decision shall be forwarded to the Commission for its review and approval before it may be considered final for a petition for declaratory ruling under:

(a) State Government Article, Title 9, Subtitles 1, 1A, 1B, [and] 1D, and 1E, Annotated Code of Maryland, or regulations promulgated thereunder; and

(b) (text unchanged)

(2) (text unchanged)

F.—G. (text unchanged)

.05 Petition for Promulgation, Amendment, or Repeal of a Regulation.

A.—C. (text unchanged)

D. Disposition.

(1) (text unchanged)

(2) Within 60 days after submission of the petition, the Director shall forward the petition to the Commission with a recommendation to deny the petition or initiate rulemaking proceedings for a petition pertaining to regulations promulgated under:

(a) State Government Article, Title 9, Subtitles 1, 1A, 1B, [and] 1D, and 1E, Annotated Code of Maryland; or

(b) (text unchanged)

(3) (text unchanged)

E. (text unchanged)

.06 Commission Hearings.

A.—N. (text unchanged)

O. Delegation of Hearing Authority.

(1) The Commission may, on a case-by-case basis, delegate [the hearing of a contested case] to the Office of Administrative Hearings[.] the authority to:

(a) Conduct a contested case hearing; and

(b) Issue:

(i) Proposed or final findings of fact;

(ii) Proposed or final conclusions of law;

(iii) Proposed or final findings of fact and conclusions of law; or

(iv) A proposed or final order.

(2) Hearings delegated to the Office of Administrative Hearings.

(a) This section applies to a contested case where the Commission has delegated authority to the Office of Administrative Hearings to conduct a contested case hearing under §O(1) of this regulation.

(b) The administrative law judge who hears a case shall submit to the Commission a decision that contains one of the following, as delegated by the Commission to the Office of Administrative Hearings:

(i) Proposed or final findings of fact;

(ii) Proposed or final conclusions of law;

(iii) Proposed or final findings of fact and conclusions of law; or

(iv) A proposed or final order.

(c) When making a decision, the administrative law judge is bound by any regulation, bulletin, final order, or settled and preexisting policy of the Commission to the same extent that the Commission is or would have been bound if the Commission were hearing the case.

(d) The Office of Administrative Hearings shall send the administrative law judge’s decision directly to the parties and the Commission.

[(2)] (3)[(9)] (10) (text unchanged)

 

Subtitle 10 SPORTS WAGERING PROVISIONS

36.10.01 General

Authority: Business Regulation Article, §§11-101, 11-524, 11-815 — 11-832; Criminal Law Article, §§12-301.1 and 12-308; State Government Article, §§9-110, 9-1A-01, 9-1A-04, 9-1A-05, 9-1A-11, 9-1A-14, 9-1A-24, 9-1E-01, and 9-1E-05, Annotated Code of Maryland; Ch. 603, §6, Acts of 2012, and Ch. 10, §23, Acts of 2018

.01 Scope.

This subtitle applies to the State’s Sports Wagering Program.

.02 Definitions.

A. In addition to the terms defined in State Government Article, §§9-1A-01 and 9-1E-01, Annotated Code of Maryland, and COMAR 36.01, 36.03, and 36.04, which have the same meanings in this subtitle, the following terms have the meanings indicated.

B. Terms Defined.

(1) “ACH” means the Automated Clearing House, which is a network that connects all banking and financial institutions within the United States.

(2) “Affiliate” means a person that directly, or indirectly through one or more intermediaries, owns, controls, is controlled by, or is under common ownership or control with another person.

(3) “Age and identity verification” means a method, system, or device used by a sports wagering licensee to verify the bettor’s age and the bettor’s identity.

(4) “AML” means Anti-Money Laundering.

(5) “Applicant” means a person who, as required under State Government Article, Title 9, Subtitle 1E, submits to the Commission an application for a license or for qualification or renewal of a license.

(6) “Application” means the forms, information, documentation, and assurances submitted by an applicant or licensee to obtain a license or for qualification or renewal of a license.

(7) “Associated equipment” means any equipment or mechanical, electromechanical or electronic contrivance, component or machine used in connection with sports wagering, including computerized systems for controlling and monitoring mobile sports wagering.

(8) “Award” means the act of the SWARC approving the application of an applicant that meets the requirements for licensure under State Government Article Title 9, Subtitle 1E, Annotated Code of Maryland, for a sports wagering license, which authorizes the Commission to issue the sports wagering license that is necessary for the applicant to commence sports wagering operations.

(9) “Awardee” means a qualified applicant to which SWARC has awarded a license.

(10) “Beneficial owner” means a person that holds at least a 5 percent interest in an applicant for or holder of, a license awarded or issued under this subtitle, that is evidenced by:

(a) Record ownership;

(b) Stock or other ownership in an entity in a chain of parent and subsidiary, or affiliate entities, any one of which participates in the capital or profits of a sports wagering applicant or licensee; or

(c) An interest that entitles a person to benefit substantially and is equivalent to ownership by an agreement, relationship, or other arrangement.

(11) “Bettor” means a person who places a sports wager.

(12) “Books and records” means documents pertaining to, prepared by, or generated by a sports wagering licensee, regardless of the medium through which the record is generated or maintained, including all general ledger records, subsidiary records and ledgers, computer-generated data, forms, documents, internal audit reports and work papers, correspondence, and personnel records.

(13) “Cancelled wager” means a wager that has been cancelled by a sports wagering licensee due to an event or circumstance that prevents completion of the wager or causes the wager to be nonredeemable.

(14) “Cheat” or “cheating” means to act alone, facilitate, deceive, or conspire or collude with another person, to improve the chance of winning a wager or to alter the outcome of a wager, by:

(a) Using non-public information in placing, increasing, decreasing, or cancelling a wager;

(b) Altering or misrepresenting the outcome of a sporting event on which a wager has been placed;

(c) Claiming or collecting winnings on a wager that the person did not win or that the person was not otherwise authorized to claim or collect;

(d) Manipulating, altering, or interfering with sports wagering equipment, associated equipment, communication technology, or client software with the intent to affect or alter the outcome of a sporting event;

(e) Interfering with or influencing a participant in a sporting event with the intent to alter an outcome of, or an individual’s performance in, a sporting event;

(f) Any conduct the Commission identifies as a means of conducting organized crime through sports wagering; or

(g) Any other conduct the Commission identifies as an abuse of the operation and administration of sports wagering as cheating in regulations promulgated under State Government Article, Title 9, Subtitles 1A or 1E, Annotated Code of Maryland.

(15) “Client software” means any software or application installed or operating on a bettor’s device for the purpose of interacting with an online wagering system and conducting online sports wagering.

(16) “Communication technology” means the methods and components used by a sports wagering licensee to facilitate the transmission of information related to sports wagering, including a:

(a) Transmitting system;

(b) Receiving system; and

(c) Wire, cable, radio, microwave, optic, or computer data network.

(17) “Controlling entity” means an entity that possesses, directly or indirectly, the power to direct or cause the direction of the management and policies of a person, whether through ownership of voting securities, by contract, by beneficial ownership, or otherwise.

(18) “Data information center” means the physical location owned or leased by a sports wagering facility licensee, mobile sports wagering licensee, or online sports wagering licensee designated as the location where the licensee’s electronic data is stored, processed, or otherwise maintained.

(19) “Day” means a calendar day.

(20) “Dormant account” means a sports wagering bettor account that has not had any login or wagering activity for a period of 3 years.

(21) “Electronic bingo” or “electronic tip jar machine” has the same meaning as “instant bingo machine” stated in COMAR 36.07.01.02.

(22) “Entrant” means a participant in a sporting event upon which a wager may be placed as to the participant’s finishing position or performance in the sporting event.

(23) “Event number” means a set of alpha or numeric characters that correspond to a sporting event or an event ancillary to a sporting event.

(24) “Exchange wager” means a wager in which a bettor wagers with or against another bettor through a sports wagering licensee.

(25) “Excluded individual” means an individual who has been:

(a) Placed on the Commission’s voluntary exclusion list under COMAR 36.01.03 and 36.10.10; or

(b) Placed on the Commission’s mandatory exclusion list under 36.10.11.

(26) “Global risk management” means management, consultation, instruction, or transmission of information relating to sports wagering by a sports wagering licensee who holds a license to conduct sports wagering in another jurisdiction, to a sports wagering licensee in the State, including:

(a) Managing risks associated with sports wagering involving a sporting event for which a wager may be accepted;

(b) Setting or changing of available bets or wagers;

(c) Establishing cutoff times for bets or wagers;

(d) Accepting or rejecting of bets or wagers;

(e) Pooling or laying off of bets or wagers; or

(f) Setting lines, point spreads, odds, or other activity relating to betting or wagering.

(27) “Gross pool” means the total amount of money wagered on the outcome of a particular event.

(28) “Holding company” means a principal or principal entity that directly or indirectly owns:

(a) At least 5 percent of the stock, equity interest, or other voting security of a sports wagering applicant or licensee; or

(b) Through an interest in one or more subsidiaries, a power, right, or security of a sports wagering applicant or licensee.

(29) “House rules” means a sports book licensee’s Commission-approved requirements for its sports wagering operation that are in addition to the Commission’s regulations, and that shall include:

(a) A Method for calculating and paying winning wagers;

(b) A process for handling incorrectly posted events, odds, wagers, or results;

(c) An effect of sporting event schedule changes;

(d) A method of notifying patrons of odds or proposition changes;

(e) A procedure for accepting wagers other than those processes posted by the sports wagering licensee;

(f) A method of notifying bettors that a winning ticket expires 182 days after the wager is won;

(g) If the sports wagering system allows the bettor to place a wager that pays more than the stated maximum amount, the licensee’s policy and methods for:

(i) Limiting the maximum amount a bettor may win on a wager; and

(ii) Precluding a bettor from, or allowing a bettor to, collect, a payout in excess of the purported winnings;

(h) A method of contacting the sports book licensee with questions and complaints;

(i) A method of preventing an excluded individual from participating in a sports wagering activity;

(j) A process for any employee of a sports governing body or member team who is not prohibited from wagering to register with the Commission prior to placing a sports wager;

(k) A method of funding a sports wager; and

(l) Any other item required by the Commission to be addressed in the licensee’s house rules.

(30) “Independent certified testing laboratory” means a person engaged in the testing and verification of sports wagering equipment and the equipment, systems, and software utilized to collect, monitor, interpret, analyze, authorize, issue, redeem, report, and audit data with regard to a sports wagering activity that:

(a) Holds a certificate in good standing for compliance with:

(i) International Organization for Standardization #17025—General Requirements for the Competence of Testing and Calibration Laboratories; and

(ii) International Organization for Standardization #17020—General Criteria for the Operation of Various Types of Bodies Performing Inspections;

(b) Has performed testing and certification of sport wagering equipment, systems, and software on behalf of a state within the United States for a period of 5 or more years; and

(c) Has been approved by the Commission to test and certify equipment, systems, and software on its behalf.

(31) “Indirect interest” means an interest, claim, right, legal share, or other financial stake in a person that is determined by the Commission to exist by virtue of a financial or other interest in another person.

(32) “In-game wager” and “In-play bet” mean a wager placed on the outcome of a sporting event after the event has started.

(33) “Institutional investor” means:

(a) A retirement fund administered by a public agency for the exclusive benefit of federal, State or local public employees;

(b) An investment company registered under §8 of the Investment Company Act of 1940 (15 U.S.C. §80a-8);

(c) A collective investment trust organized by a bank under Part 9 of the rules of the Comptroller of the Currency (12 CFR §9.18);

(d) A closed end investment trust registered with the U.S. Securities and Exchange Commission;

(e) A chartered or licensed life insurance company;

(f) A property and casualty insurance company;

(g) A banking or other chartered or licensed lending institution;

(h) An investment advisor registered under the Investment Advisors Act of 1940 (15 U.S.C. §§80b-1—80b-21); or

(i) Any other person registered in any foreign jurisdiction and regulated in accordance with a statue of any foreign jurisdiction that the Commission determines to be substantially similar to that regulated by the Investment Company Act of 1940 or the Investment Advisors Act of 1940.

(34) “Integrity monitoring” means the observation of sports wagering to identify unusual wagering activity or other suspicious sports wagering activity that may be reported to law enforcement or an organization charged with oversight or monitoring of a sporting event.

(35) “Issue” or “issuance” means the Commission’s final act of authorizing an applicant to legally exercise the authority of, or commence activity under, the scope of the license for which it applied.

(36) “Kiosk” means a Commission-approved device that may be used by a bettor to place a wager and may be used to redeem a winning wager.

(37) “Layoff wager” means a wager placed by a sports wagering operator with another sports wagering operator for the purpose of offsetting bettor wagers.

(38) “Licensee” means an applicant who has been issued a license required under this subtitle.

(39) “Mandatory exclusion list” means a list maintained by the Commission under State Government Article, §§9-1A-24 and 9-1E-11, Annotated Code of Maryland, that identifies an individual who is to be excluded or ejected from:

(a) A sports wagering facility; or

(b) Participating in online sports wagering.

(40) “Maryland State Fair Society” means the holder of a license issued to the holder by the State Racing Commission allowing the holder to have a race that meets specified conditions under Business Regulation Article, §11–524, Annotated Code of Maryland.

(41) “Mobile sports wagering licensee” means a sports wagering licensee who is authorized to conduct and operate online sports wagering.

(42) “Maximum wager limit” means the largest wager that can be wagered on a single sports wager.

(43) “Money line wager” means a wager on a participant winning a sporting event without the use of the point spread.

(44) “Multi-factor authentication” means a procedure that requires more than one method to verify a bettor’s identity through a combination of two or more independent credentials, including:

(a) Information known only to the bettor, such as a password, pattern or answers to challenge questions;

(b) A bettor’s biometric data, such as fingerprints, facial or voice recognition, to the extent this data does not violate privacy laws; and

(c) Using something the bettor has, such as the bettor’s phone.

(45) “Non-wagering employee” means an individual who is:

(a) Employed or is seeking to be employed by an applicant for or holder of a sports wagering license, and whose duties are or will be other than the duties of a wagering employee; or

(b) Not otherwise required by the Commission to be licensed as a wagering employee.

(46) “Online sports wagering” means sports wagering that is conducted through an online gaming system that:

(a) Is accessed on a computer, phone, or other interactive device; and

(b) Is accepted by a mobile sports wagering licensee or an online sports wagering operator.

(47) “Online sports wagering operator” or “online sports wagering operator licensee” means an entity registered with a state to do business within a jurisdiction of the United States that the Commission has issued a license to operate online sports wagering on behalf of a mobile sports wagering licensee.

(48) “Over-under wager” means a wager in which a sports wagering licensee sets a number for a statistic in a sporting event, and a bettor wagers that the actual result in the sporting event will be higher or lower than the number set by the sports wagering licensee.

(49) “Pari–mutuel betting” has the meaning stated in Business Regulation Article, §11-101, Annotated Code of Maryland.

(50) “Parlay wager” means a wager that involves two or more sports wagers combined into one wager.

(51) “Payout” means the total payment due on a winning wager.

(52) “Penalty” means an amount not to exceed $5,000 that the Commission may impose for each separate violation of the Sports Wagering Law, the Commission’s regulations, or a directive of the Commission.

(53) “Personally identifiable information” means data or information that may be used, alone or combined with other data or information, to identify, contact, or locate a registered bettor, including:

(a) Name, initials, or personal mark;

(b) Unique biometric or genetic print of an individual’s image;

(c) Social Security number;

(d) Date of birth;

(e) Identification number issued by the government of a state, or the United States;

(f) Passport or identification number issued by a government for the purpose of establishing identity or documenting citizenship-related status;

(g) Financial information, including an account number, taxpayer identification number, security code, access code, or password;

(h) Residential address; or

(i) Data or information determined by the Commission to identify an individual.

(54) “Point of sale system” means the hardware, software and communications that comprise a system capable of accepting sports wagers using terminals operated by a cashier or a kiosk operated by a bettor on the premises of a sports wagering facility that has been approved by the Commission.

(55) “Pool wager” means a wager with a fixed entry cost where the bettor’s winnings depend on the number of other bettors wagering on the sporting event.

(56) Predatory Marketing Practice.

(a) “Predatory marketing practice” means an advertisement or promotion of an activity, product, or service related to sports wagering that is:

(i) False or deceptive;

(ii) Illegal;

(iii) Knowingly directed to an individual who is younger than 21 years old;

(iv) Knowingly directed to an excluded individual; or

(v) Prohibited by law, regulation or court order.

(b) “Predatory marketing practice” includes an advertisement or promotion of an activity, product, or service related to sports wagering that:

(i) Uses or depicts an individual who is, or appears to be, younger than 21 years old;

(ii) By font, color, placement, or any other means, obscures or fails to disclose a material condition or limiting factor associated with the activity, product, or service being marketed; or

(iii) Fails to include or obscures the gambling assistance message required under COMAR 36.10.10.

(57) “Principal” means:

(a) An officer, director, or person who directly or indirectly owns or holds a legal or beneficial interest of at least 5 percent in the securities of an applicant for or holder of a license awarded or issued under this subtitle;

(b) A person who has a controlling interest in, or the ability to elect a majority of the board of directors of an applicant for or holder of a license awarded or issued under this subtitle;

(c) A lender or other licensed financial institution of a sports wagering license applicant for or holder of a license awarded or issued under this subtitle or licensee, or a sports wagering contractor license applicant or licensee other than a bank or lending institution which makes a loan or holds a mortgage or other lien acquired in the ordinary course of business;

(d) An underwriter of an applicant for or holder of a license award or issued under this subtitle; or

(e) A person or deemed by the Commission to be a principal.

(58) Principal Employee.

(a) “Principal employee” means an individual who owns, controls, or manages a licensee that is a sports wagering facility, sports wagering mobile operator, online sports wagering operator, sports wagering facility operator, or sports wagering contractor.

(b) “Principal employee” includes an employee of a Tier 1 sports wagering contractor who performs any function of a Tier 1 sports wagering contractor.

(c) “Principal employee” does not include a wagering employee or non-wagering employee.

(59) “Prohibited sports wager” means any sports wager not approved by the Commission.

(60 “Proposition wager” or “proposition bet” means a wager on an individual action, statistic, occurrence, or non-occurrence which is determined during a sporting event.

(61) “Registered bettor” means a person who has registered with a sports wagering licensee for inclusion in the licensee’s bettor tracking system.

(62) “Restricted area” means that part of a sports wagering facility directly related to the operation of sports wagering where access is specifically designated by the Commission as restricted, including:

(a) Cashier’s cage, including a satellite cashiers’ cage and ancillary offices;

(b) Computer space allocated to sports wagering platforms;

(c) Count room and trolley storage area;

(d) Areas designated for the storage or repair of sports wagering equipment;

(e) Information technology operations centers;

(f) Surveillance monitoring rooms;

(g) Vault and armored car bay locations;

(h) Data information center;

(i) Any area that the sports wagering licensee has designated as restricted in its Commission-approved accounting and internal control systems; and

(j) Any other area the Commission designates a restricted area.

(63) “Risk management” means processes and tools that sports wagering licensees use to manage the risk and liabilities associated with sports wagering.

(64) “Sanction” means an enforcement action that the Commission may take against an applicant or licensee, and may include suspension or revocation of a license, reprimand, or imposition of a condition on a licensee.

(65) “Satellite simulcast betting” has the meaning stated in Business Regulation Article, §11-815, Annotated Code of Maryland.

(66) “Satellite simulcast facility” means the location specified in a permit issued by the State Racing Commission necessary for offering satellite simulcast betting under Business Regulation Article, §§11-815 – 11-832, Annotated Code of Maryland.

(67) “Settled wager” means a wager that has been resolved with a result of either a win, loss, or push to the bettor.

(68) “Sports bettor tracking system” means the hardware, software, communications technology, and other ancillary equipment owned or leased by a sports wagering licensee to collect, monitor, interpret, analyze, authorize, report, and audit data pertaining to:

(a) A sports wagering activity; and

(b) If a bettor has registered with the sports wagering licensee for inclusion in a bettor tracking system, a bettor’s sports wagering activity.

(69) “Sports wagering” means:

(a) The business of accepting a wager on a sporting event; and

(b) Placing a wager with a sports wagering licensee on a sporting event.

(70) “Sports wagering account” means an electronic account that may be established by a bettor for the purpose of sports wagering, including making deposits and withdrawals, placing wagers, and receiving payouts on winning wagers.

(71) “Sports Wagering Application Review Commission” or “SWARC” means the Commission established under State Government Article, §9-1E-15, Annotated Code of Maryland.

(72) “Sports wagering contractor” or “contractor” means, other than an individual, a person who contracts with a sports wagering licensee to provide services as a Tier 1 or Tier 2 sports wagering contractor, that may include:

(a) Management or operation;

(b) Security;

(c) Service, maintenance, update, or repair of sports wagering equipment or associated equipment or software;

(d) Ownership or control of a sports wagering licensee; or

(e) Any other service for which the Commission requires a sports wagering contractor license.

(73) “Sports wagering contractor—Tier 1” or “Tier 1 contractor” means a sports wagering contractor that provides sports wagering equipment or services and:

(a) Does not accept wagers;

(b) Whose services may affect wagering outcomes;

(c) Manufactures self-service kiosks, devices, or machines that have been approved by the Commission for use in a sports wagering facility;

(d) May have contact with, or access to, sports wagering equipment or sports wagering systems;

(e) Supplies parts or software related to sports wagering operations;

(f) Provides security for sports wagering operations; or

(g) May employ a sports wagering employee that is a principal employee.

(74) “Sports wagering contractor—Tier 2” or “Tier 2 contractor” means a sports wagering contractor that supplies equipment or services related to a sports wagering licensee’s sports wagering operations, and:

(a) Whose services may not affect wagering outcomes;

(b) Has no contact with, or access to, sports wagering equipment or sports wagering systems; and

(c) May not employ a sports wagering employee that is a principal employee.

(75) “Sports wagering employee” or “wagering employee” means an individual who:

(a) Is or is seeking to be employed by an applicant for or holder of a sports wagering licensee, whose duties relate, or may relate to the operation of a sports wagering facility or sports wagering, and who performs or supervises or may perform or supervise the performance of:

(i) Operating, servicing, or maintaining sports wagering equipment or associated equipment or software;

(ii) Accounting, maintaining, or auditing a licensee’s sports wagering-related financial records;

(iii) Counting or processing sports wagering revenue, wagers, payouts, or proceeds;

(iv) Conducting security or surveillance in or around a sports wagering facility or the operation center of a mobile sports wagering licensee or online sports wagering operator licensee; or

(v) Operating or maintaining a sports wagering licensee’s information systems;

(b) Is employed by a sports wagering contractor, whose duties directly relate to the repair, service, or distribution of sports wagering equipment or associated equipment or software, or is otherwise required to be present at a wagering facility or in a restricted area of a wagering facility; or

(c) Is otherwise required by the Commission to be licensed as a sports wagering employee.

(76) “Sports wagering equipment” means any mechanical, electronic or other device, mechanism, or equipment, and related supplies used or consumed in the operation of sports wagering, including a self-service kiosk on the premises of a sports wagering facility.

(77) “Sports wagering facility”, “wagering facility”, or “facility” means a place where a bettor may place a wager in person, that:

(a) Is physically located on premises that are owned, leased, or occupied by a sports wagering facility licensee; and

(b) Has been issued a sports wagering facility license by the Commission.

(78) “Sports wagering facility operator” or “sports wagering facility operator licensee” means a person that operates sports wagering on behalf of a sports wagering facility licensee:

(a) On premises that are physically owned, leased, or occupied by the sports wagering facility licensee; and

(b) Has been issued a sports wagering facility operator license by the Commission.

(79) “Sports wagering facility operator license” means an operator license issued by the Commission to a person that operates a sports wagering facility on behalf of a sports wagering facility licensee.

(80) “Sports wagering interactive website” means the interactive wagering application through which a sports wagering licensee makes authorized mobile sports wagering available.

(81) “Sports wagering license” means a license issued by the Commission that authorizes the holder to accept sports wagers.

(82) “Sports wagering licensee” means the holder of a sports wagering license.

(83) “Sports wagering operation” or “sports wagering operations” means the entirety of a sports wagering licensee’s business of conducting sports wagering and related activities, including:

(a) Accepting and redeeming wagers;

(b) Maintaining financial accounting;

(c) Securing a sports wagering platform;

(d) Securing an online sports wagering system;

(e) Conducting surveillance of a sports wagering facility;

(f) Owning, leasing, or occupying a sports wagering facility;

(g) Developing marketing;

(h) Arranging advertising; and

(i) Performing any other related activity.

(84) “Sports wagering platform” means:

(a) Hardware and software used for a website, application, or other platform which is accessible via the internet or mobile, wireless, or similar communications technology that allows bettors to participate in sports wagering; or

(b) Hardware, software, firmware, communications technology, or other equipment that a sports wagering licensee uses to:

(i) Allow a bettor to participate in sports wagering;

(ii) Display the wager outcomes and other similar information necessary to facilitate sports wagering;

(iii) Review bettor accounts and generate financial reports;

(iv) Suspend wagering on sporting events;

(v) Input outcomes for sporting events; and

(vi) Set any configurable parameters.

(85) “Sports wagering ticket” means a printed record issued or an electronic record maintained by a sports wagering platform that evidences a sports wager.

(86) “Sports wagering voucher” means a printed record or digital representation issued by a sports wagering platform that may be used to fund a wager or may be redeemable for cash.

(87) “Straight wager” and “single-game bet” mean a wager on a single sporting event that will be determined by a point spread, money line or total score.

(88) “Teaser bet” means a wager in which the sports wagering licensee adjusts the odds of winning in a bettor’s favor.

(89) “Temporary sports wagering facility” means an area approved by the Commission for use in sports wagering operations during the construction of a facility.

(90) Unredeemed Item.

(a) “Unredeemed item” means a sports wagering voucher, sports wagering ticket, or similar item that

has monetary value and:

(i) Has been won by a bettor participating in sports wagering; or

(ii) Has been inserted into sports wagering equipment.

(b) “Unredeemed item” does not include cash.

(91) “Unusual wagering activity” means a wager or pattern of wagering by a bettor that:

(a) Is abnormal in amount, frequency, pattern, or type; or

(b) May indicate past, current, attempted, or planned cheating.

(92) “Video lottery employee” means an individual who holds a license issued under State Government Article, §9-1A-14, Annotated Code of Maryland, and meets the requirements of COMAR 36.03.02.12.

(93) “Voided wager” means a wager invalidated by a licensee for a specified sporting event.

(94) “Wager” or “wagering” means betting a sum of money or promotional credit on the outcome of a sporting event.

(95) “Wagering day” means a period of time determined by the Commission, not to exceed 24 hours, that marks the beginning and ending times of wagering activities for the purposes of establishing accounting reports and determining daily proceeds.

 

36.10.02 All Applicants and Licensees—Applications and Investigations

Authority: State Government Article, §§9-1A-02, 9-1A-04, 9-1-07, 9-1A-08,
9-1A-20, 9-1A-25, and 9-1E-01 — 9-1E-15, Annotated Code of Maryland

.01 Scope.

All applicants for licenses related to the State’s Sports Wagering Program shall comply with the requirements set forth in State Government Article, Title 9, Subtitle 1E, Annotated Code of Maryland, and the Commission’s regulations, to establish their qualifications, comply with requirements for the issuance of a license, and, if the Commission issues a license, comply with the contents of the license application, and all applicable laws and regulations.

.02 General.

A. This chapter includes application and license requirements for all licenses the Commission is authorized to issue under State Government Article, §9-1E-05, Annotated Code of Maryland, to implement the State’s Sports Wagering Program.

B. Applicants and licensees are subject to any additional requirements in this Subtitle based on the category of license the applicant applies for or the licensee holds.

C. Unless a person holds a valid license issued by the Commission, the person may not offer or conduct sports wagering, or engage in an activity for which a license is required.

.03 Process.

A. Submission Requirements.

(1) If the Commission requires an application to be submitted by a particular date:

(a) The application and nonrefundable application fee shall be delivered to the Commission not later than 5 p.m. on the date specified by the Commission; and

(b) An application submitted after the deadline may not be accepted or considered by the Commission.

(2) An applicant may not submit an application less than 1 year after the Commission has:

(a) Taken final action on a license denial of a previous license application involving the applicant;

(b) Taken final action on a sanction resulting in revocation of a previous license involving the applicant; or

(c) Provided an individual with written notice of termination of a temporary license.

B. Applications.

(1) An application submitted to the Commission shall:

(a) Consist of an original and the number of copies required by the Commission and shall be in an electronic format or other format required by the Commission; and

(b) Be sworn before a notary public as to its truth and validity by the applicant or, if the applicant is not an individual, by the chief executive officer of the applicant.

(2) An applicant shall include the applicable nonrefundable application fee with the license application.

(3) Upon receipt of a timely application and application fee, the Commission staff shall review the application to determine whether it contains all the information required under this chapter.

(4) If the Commission determines that required information has not been submitted, Commission staff shall notify the applicant in writing of the nature of the deficiency.

(5) An applicant notified in accordance with §B(4) of this regulation may submit the documents necessary to complete the application not later than 15 days after the Commission issues the notification.

(6) The Commission may not consider the application of an applicant who is notified in accordance with §B(4) of this regulation and who fails to submit the requested documents in a timely manner.

(7) The Commission shall review and consider a timely, complete application submitted as required in this regulation.

C. Changes in Application.

(1) If information submitted by an applicant as part of a license application changes or becomes inaccurate before the Commission acts on the application, the applicant shall immediately notify the Commission in writing of the change or inaccuracy.

(2) After an application has been filed by an applicant, the applicant may not amend the application except to:

(a) Address a deficiency in accordance with a notice sent under §B(4) of this regulation;

(b) Clarify information contained in the application as required by the Commission or the Commission staff; or

(c) Address a change in the circumstances surrounding the application that was outside the control of the applicant and that affects the ability of the applicant to comply with the law or the regulations of the Commission.

(3) To amend an application under §C(2)(c) of this regulation, an applicant shall submit to the Commission a written request to amend the application, stating:

(a) The change in the circumstances surrounding the application that necessitates the amendment;

 (b) The nature of the amendment; and

(c) The reason why the amendment is necessary to bring the application into compliance with the law or the regulations of the Commission.

(4) The Commission or Commission staff shall grant or deny each request submitted under §C(3) of this regulation and notify the applicant.

(5) A request shall be granted if the applicant establishes by clear and convincing evidence that:

(a) The circumstances requiring the amendment were outside the control of the applicant;

(b) Before the change in the circumstances surrounding the application, the application complied with the applicable provisions of law or regulations of the Commission; and

(c) The amendment is necessary to bring the application into compliance with the applicable provisions of the law or regulations of the Commission.

(6) An applicant may withdraw a license application if:

(a) The applicant submits a written request to the Commission to withdraw the application; and

(b) The written request is submitted before the Commission has:

(i) Denied the application; or

(ii) Terminated a temporary license.

(7) If an applicant withdraws an application, the application fee will not be refunded.

D. Notice of Intended Change in Licensed Sports Wagering Employee’s Employment Status.

(1) Within 14 calendar days of a change in employment status, a licensee shall notify the Commission of the intended change in employment by submitting forms and documents required by the Commission in the manner set forth in §B of this regulation.

(2) The Commission shall conduct a background investigation of the individual to verify that the individual’s license remains in good standing.

(3) If the Commission determines that the individual’s license is not in good standing, the Commission shall notify the individual and, within 15 days after the Commission issues the notification, the licensee shall submit:

(a) Information, documentation, or assurances to establish, by clear and convincing evidence, that the licensee remains qualified to hold a license; and

(b) Any other information, documentation, or assurances required by the Commission.

(4) If the licensee has been separated from employment with a sports wagering facility licensee, sports wagering operator licensee, mobile sports wagering facility licensee, or online sports wagering licensee for more than 6 months and notified the Commission of an intended change in employment status, the licensee shall pay the fee for conducting a criminal history records check specified in Regulation .05B of this chapter.

(5) The Commission may not approve a change in employment status for a sports wagering employee licensee who fails to establish, by clear and convincing evidence, all license qualification criteria.

(6) A sports wagering employee may not effect a change in employment status without prior Commission approval.

E. Burden of Proof. Under all circumstances, the burden of proof shall be on the person that is required to be licensed, maintain the license, or qualified to establish, by clear and convincing evidence, the person is eligible and qualified as required under State Government Article, Title 9, Subtitle 1E, Annotated Code of Maryland, and the Commission’s regulations.

F. Administrative Costs of Background Investigations.

(1) Promptly upon receipt of an invoice from the Commission, an applicant for a license or a licensee who has notified the Commission of an intended change in employment status shall reimburse the Commission for:

(a) The administrative costs associated with performing background investigations of the applicant, the licensee who has notified the Commission of an intended change in employment status, and any individual required to provide information under Regulation .06 of this chapter; and

(b) Any payments made by the Commission to a person approved by the Commission to conduct background investigations.

(2) Failure to reimburse the Commission shall be grounds for disqualification of an applicant or disapproval of a licensee’s change in employment status.

(3) The Commission may require an advance deposit from an applicant or licensee who has notified the Commission of an intended change in employment status for the Commission’s estimate of the administrative costs of conducting the applicant’s or licensee’s background investigation.

(4) If administrative costs of conducting an applicant’s or licensee’s background investigation exceed the estimate provided in §F(3), the applicant or licensee shall pay the additional costs prior to the Commission finalizing the background investigation.

(5) The Commission shall refund to an applicant any unused amount of the advance deposit.

G. Payment and Collection.

(1) An applicant shall pay the administrative costs and fees required under this regulation by:

(a) Wire transfer;

(b) Money order;

(c) Certified check made payable to the “Maryland Lottery and Gaming Control Commission”; or

(d) Any other manner designated by the Commission.

(2) The Commission may address an applicant’s or licensee’s failure to pay a required fee, penalty, or proceeds:

(a) As provided in COMAR 36.10.12; or

(b) By filing a claim against the performance bond that covers the applicant.

H. Continuing Obligations.

(1) At all times, a person who is awarded or issued a license, and a person who is otherwise required to meet Commission qualifications, shall conform to all of the information contained in the license application and documents submitted to SWARC and the Commission.

(2) An applicant or licensee may not discriminate against a person who in good faith informs the Commission of an act or omission that the person believes constitutes a violation of State Government Article, Title 9, Subtitle 1E, Annotated Code of Maryland, or regulations promulgated by the SWARC or the Commission.

(3) If information submitted to the SWARC or the Commission by a person described in §H(1) of this regulation changes during the term of the license or qualification, the person shall immediately submit written notification of the change to the Commission.

(4) An applicant or licensee has an affirmative and continuing obligation to:

(a) Inform the Commission of an act or omission that the applicant or licensee knows or should have known constitutes a violation of State Government Article, Title 9, Subtitle 1E, Annotated Code of Maryland, or the Commission’s regulations;

(b) Provide the Commission with all information relating to qualifications in the form specified by the Commission;

(c) Provide assistance and information required by the Commission;

(d) Cooperate in a Commission inquiry, investigation, or hearing;

(e) On issuance of a request to answer or produce information, evidence, or testimony requested by the Commission, provide it; and

(f) As required under State Government Article, §9-1E-07(b)(3), Annotated Code of Maryland, comply with any Commission request or requirement for information and records necessary for setting reasonable and appropriate minority business enterprise participation goals and procedures for the procurement of goods and service related to sports wagering, including procurement of construction, equipment, and ongoing services.

(5) Failure to comply with the obligations of §H of this regulation shall be grounds for the Commission taking enforcement action under COMAR 36.10.08.

.04 Personal and Background Information.

A. Except as otherwise provided in the Commission’s regulations, the application documents shall include the information required under §B of this regulation, for a person who is:

(1) The applicant;

(2) A director, officer, or key management individual employed by the applicant;

(3) A partner of the applicant;

(4) Any other person who owns, controls, or directs a legal or beneficial interest of 5 percent or more in the applicant;

(5) A principal;

(6) A principal employee;

(7) A principal entity;

(8) A holding company of the applicant; or

(9) An affiliate of the applicant.

B. An individual listed under §A of this regulation shall furnish the individual’s:

(1) Full name and any previous names or aliases;

(2) Date of birth;

(3) Physical description;

(4) Home and business addresses and telephone numbers;

(5) Driver’s license number and state of issuance;

(6) Social Security number;

(7) Photograph in a type and size required by the Commission;

(8) Fingerprints for a criminal records check:

(a) For a State resident, from an electronic fingerprinting service approved by the Commission; or

(b) For an out-of-State resident, one FBI and one State fingerprint card, taken within the previous 45 days before submission to the Commission; and

(9) Any other document or information required by the Commission.

C. A person listed under §A of this regulation that is not an individual shall furnish, with its application documents:

(1) Pursuant to any applicable requirements of the Maryland State Department of Assessment and Taxation, evidence that the person is in good standing to conduct business in the State;

(2) For a corporation, documentation showing the:

(a) State in which the applicant is incorporated; and

(b) Name and address of the applicant’s resident agent for service of process in Maryland; and

(3) For a nonprofit corporation, only the information required under §B of this regulation for an individual who is a director or officer of the applicant.

D. A licensee who has notified the Commission of an intended change in employment status shall provide the information as set forth in §B of this regulation.

E. The Commission may require an applicant to furnish the information listed in §B of this regulation for the applicant’s family and associates.

F. Inadvertent, nonsubstantive errors that might be made in furnishing the information required by this regulation may not be used as a reason by the Commission for disqualifying the applicant.

.05 Information for Background Investigation.

A. An individual or authorized representative of a person that is required to submit an application, or be investigated, shall:

(1) Submit to the Commission a complete legible set of the individual’s fingerprints for:

(a) The Federal Bureau of Investigation; and

(b) The Maryland Criminal Justice Information System;

(2) Complete a background form supplied by the Commission which includes a statement disclosing whether the individual has ever been:

(a) Arrested;

(b) Convicted of, pled nolo contendere to, or received probation before judgment for, a felony or misdemeanor, other than a misdemeanor traffic offense;

(c) Sanctioned by a government agency related to gaming or sports wagering;

(d) Found liable in connection with a civil action related to gaming or sports wagering;

(e) A debtor in a bankruptcy proceeding; or

(f) Denied a bond; and

(3) Complete any acknowledgement forms required by law including an FBI Privacy Act notice.

B. The forms submitted in compliance with this regulation shall be accompanied by the:

(1) Fee authorized under Criminal Procedure Article, §10-221(b)(7), Annotated Code of Maryland, for access to Maryland criminal history records; and

(2) Mandatory processing fee required by the Federal Bureau of Investigation for a national criminal history records check.

C. If an applicant under State Government Article, Title 9, Subtitle 1E, Annotated Code of Maryland, is a citizen of any country other than the United States, the background investigation required under State Government Article, §9-1E-07(f), Annotated Code of Maryland, shall include an international criminal history records check.

.06 Consent for Investigation.

A. An individual