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Maryland Register
Issue Date: March 22, 2024 Volume 51 • Issue 6 • Pages 261 —320
Judiciary Regulations Special Documents General Notices
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| Pursuant to State Government Article, §7-206, Annotated Code of Maryland, this issue contains all previously unpublished documents required to be published, and filed on or before March 4, 2024 5 p.m.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 March 4, 2024. Gail S. Klakring Acting Administrator, Division of State Documents Office of the Secretary of State |
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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. 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.
Wes Moore, Governor; Susan C. Lee, Secretary of State; Gail S. Klakring, Administrator; Mary D. MacDonald, Senior Editor,
Maryland Register and COMAR; Elizabeth
Ramsey, Editor, COMAR Online, and Subscription Manager;
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 ..................................................................... 264
COMAR Research Aids
Table of Pending Proposals ........................................................... 265
Index of COMAR Titles Affected in
This Issue
COMAR
Title Number and Name Page
08 Department of Natural Resources ..................................... 269
10 Maryland Department of Health ........................................ 272
13B Maryland Higher Education Commission ......................... 271
14 Independent Agencies ....................................................... 308
21 State Procurement Regulations ......................................... 270
26 Department of the Environment ........................................ 309
34 Department of Planning ..................................................... 311
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.
DISCIPLINARY PROCEEDINGS .................................. 268
08 DEPARTMENT OF NATURAL RESOURCES
Blue Crabs ................................................................................
Blue Crabs ................................................................................
Shellfish Aquaculture and Leasing
21 STATE PROCUREMENT REGULATIONS
Veteran-Owned Small Business Enterprises
13B MARYLAND HIGHER EDUCATION COMMISSION
Cybersecurity Public Service Scholarship Program
Proposed Action on Regulations
10 MARYLAND DEPARTMENT OF HEALTH
INTERAGENCY
COMMISSION ON SCHOOL
CONSTRUCTION
Administration of the Public School Construction
Program
REGULATION
OF WATER SUPPLY, SEWAGE DISPOSAL,
SOLID WASTE, AND RECYCLABLE MATERIALS
Quality of Drinking Water in Maryland
HISTORICAL
AND CULTURAL PROGRAMS
Maryland Historical Trust African American Heritage
Preservation Program
SUSQUEHANNA RIVER BASIN COMMISSION
Projects Approved for
Consumptive Uses of Water
Projects Approved for Minor
Modifications
WATER AND SCIENCE ADMINISTRATION
Water Quality Certification 23-WQC-0038
Proposed Additions to Handgun Roster and Notice of
Right
to Object or Petition
STATE
COLLECTION AGENCY LICENSING BOARD
Public Meeting .........................................................................
MARYLAND
INSTITUTE FOR EMERGENCY MEDICAL
SERVICES SYSTEMS
MARYLAND
DEPARTMENT OF HEALTH/PHARMACY
AND THERAPEUTICS (P&T) COMMITTEE
Public Meeting .........................................................................
DIVISION
OF LABOR AND INDUSTRY/MARYLAND
OCCUPATIONAL SAFETY AND HEALTH (MOSH)
ADVISORY BOARD
Public Meeting .........................................................................
MARYLAND
STATE LOTTERY AND GAMING CONTROL
COMMISSION
Public Meeting .........................................................................
MARYLAND
HEALTH CARE COMMISSION
BOARD
OF WATERWORKS AND WASTE SYSTEMS
OPERATORS
GOVERNOR’S
WORKFORCE DEVELOPMENT BOARD
Solicitation of Public
Feedback
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.maryland.gov, 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
DECEMBER 2024†
|
Issue |
Emergency and Proposed Regulations 5
p.m.* |
Notices,
etc. 10:30
a.m. |
Final Regulations 10:30
a.m. |
|
2024 |
|||
|
April 5 |
March 18 |
March 25 |
March 27 |
|
April 19 |
April 1 |
April 8 |
April 10 |
|
May 3 |
April 15 |
April 22 |
April 24 |
|
May 17 |
April 29 |
May 6 |
May 8 |
|
May 31 |
May 13 |
May 20 |
May 22 |
|
June 14 |
May 24** |
June 3 |
June 5 |
|
June 28 |
June 10 |
June 17 |
June 18** |
|
July 12 |
June 24 |
July 1 |
July 3 |
|
July 26 |
July 8 |
July 15 |
July 17 |
|
August 9 |
July 22 |
July 29 |
July 31 |
|
August 23 |
August 5 |
August 12 |
August 14 |
|
September 6 |
August 19 |
August 26 |
August 28 |
|
September 20 |
August 30** |
September 9 |
September 11 |
|
October 4 |
September 16 |
September 23 |
September 25 |
|
October 18 |
September 30 |
October 7 |
October 9 |
|
November 1 |
October 11** |
October 21 |
October 23 |
|
November 15 |
October 28 |
November 4 |
November 6 |
|
December
2*** |
November 8** |
November 18 |
November 20 |
|
December 13 |
November 25 |
December 2 |
December 4 |
|
December 27 |
December 9 |
December 16 |
December 18 |
† Please
note that this table is provided for planning purposes and that the Division of
State Documents (DSD) cannot guarantee submissions will be published in an
agency’s desired issue. Although DSD strives to publish according to the
schedule above, there may be times when workload pressures prevent adherence to
it.
* Also note that proposal deadlines are for
submissions to DSD for publication
in the Maryland Register and do not take into account the 15-day AELR review
period. The due date for documents containing 8 to 18 pages is 48 hours before
the date listed; the 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 and corrections pertaining to proposed regulations are listed, followed by “(err)” or “(corr),” respectively. 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.
05 DEPARTMENT OF HOUSING
AND COMMUNITY DEVELOPMENT
05.03.09.01—.11 •
50:7 Md. R. 304 (4-7-23)
05.20.05.01—.09 • 51:3 Md. R. 156 (2-9-24)
08 DEPARTMENT OF NATURAL
RESOURCES
08.02.15.04,.05,.07
• 50:20 Md. R. 904 (10-6-23)
08.02.26.01—.06 •
51:1 Md. R. 30 (1-12-24)
09 MARYLAND DEPARTMENT OF LABOR
09.08.01.18 • 50:25 Md. R. 1093 (12-15-23)
09.08.07.02 • 50:25 Md. R. 1093 (12-15-23)
09.10.02.43,.53 • 50:24 Md. R. 1046 (12-1-23)
09.11.09.02 • 50:26 Md. R. 1135 (12-29-23)
09.13.05.03 • 50:26 Md. R. 1136 (12-29-23)
09.14.02.01,.02,.06-1,.06-2 • 50:25 Md. R. 1094
(12-15-23)
09.14.07.03,.05 • 50:25 Md. R. 1094 (12-15-23)
09.16.01.08 • 50:25 Md. R. 1095 (12-15-23)
09.17.03.03 • 50:25 Md. R. 1096 (12-15-23)
09.18.01.03 • 50:25 Md. R. 1097 (12-15-23)
09.21.04.03 • 50:26 Md. R. 1136 (12-29-23)
09.22.01.12 • 50:25 Md. R. 1099 (12-15-23)
09.23.04.03 •
50:26 Md. R. 1137 (12-29-23)
09.24.01.09 •
50:26 Md. R. 1138 (12-29-23)
09.28.03.03 •
50:26 Md. R. 1139 (12-29-23)
09.33.02.01—.09 •
50:25 Md. R. 1100 (12-15-23)
09.34.01.01,.02,.04,.05
• 51:1 Md. R. 33 (1-12-24)
09.34.01.13 •
51:1 Md. R. 34 (1-12-24)
09.34.02.01 •
51:1 Md. R. 33 (1-12-24)
09.34.03.01,.02 •
51:1 Md. R. 35 (1-12-24)
09.34.04.01—.03 •
51:1 Md. R. 33 (1-12-24)
09.36.07.02 •
50:17 Md. R. 772 (8-25-23)
09.36.08.02 •
50:25 Md. R. 1101 (12-15-23)
10 MARYLAND DEPARTMENT OF HEALTH
Subtitles 01—08 (1st volume)
10.07.14.01—.65 •
51:6 Md. R. 272 (3-22-24)
Subtitle 09 (2nd volume)
10.09.02.05,.07 •
50:24 Md. R. 1048 (12-1-23) (ibr)
10.09.06.09 •
51:1 Md. R. 36 (1-12-24)
10.09.10.07,.08 •
51:2 Md. R. 78 (1-26-24)
10.09.11.11 •
51:2 Md. R. 79 (1-26-24)
10.09.16.01—.12 •
51:3 Md. R. 159 (2-9-24)
10.09.21.02—.06 •
51:2 Md. R. 82 (1-26-24)
10.09.24.02,.07,.12
• 51:2 Md. R. 79 (1-26-24)
10.09.24.03 •
50:18 Md. R. 814 (9-8-23)
10.09.33.09 •
51:3 Md. R. 161 (2-9-24)
10.09.36.01,.04 •
51:4 Md. R. 203 (2-23-24)
10.09.36.03-2 •
50:18 Md. R. 814 (9-8-23)
10.09.39.02,.06 • 50:24 Md. R. 1049 (12-1-23)
10.09.43.10,.13 • 51:2 Md. R. 79 (1-26-24)
10.09.44.01,.15,.21,.23 • 51:3 Md. R. 162 (2-9-24)
10.09.46.12 • 51:4 Md. R. 204 (2-23-24)
10.09.48.08 • 51:4 Md. R. 205 (2-23-24)
10.09.53.04,.05 • 51:4 Md. R. 206 (2-23-24)
10.09.56.02,.04,.10,.14—.17,.19,.21,.22 • 51:4 Md. R.
207 (2-23-24)
10.09.64.01—.09 • 51:3 Md. R. 164 (2-9-24)
10.09.69.02,.11,.12 • 51:4 Md. R. 209 (2-23-24)
10.09.80.01,.05,.08 • 51:1 Md. R. 37 (1-12-24)
10.09.89.14 • 51:4 Md. R. 210 (2-23-24)
10.09.92.04,.05 • 51:1 Md. R. 38 (1-12-24)
Subtitles 10—22 (3rd volume)
10.11.08.01—.06 • 51:1 Md. R. 39 (1-12-24)
10.15.04.01,.02,.04—.26 • 51:5 Md. R. 234 (3-8-24)
10.15.06.02,.03,.05,.10,.11 • 51:2 Md. R. 82 (1-26-24) (ibr)
10.18.05.01—.03 • 51:3 Md. R. 166 (2-9-24)
10.18.06.05,.08,.10 • 51:3 Md. R. 166 (2-9-24)
10.19.03.01—.20 •
51:4 Md. R. 211 (2-23-24)
10.21.31.01—.06 •
51:3 Md. R. 167 (2-9-24)
Subtitles 23—36 (4th volume)
10.25.07.02,.04,.05,.09
• 51:1 Md. R. 41 (1-12-24)
10.25.18.01—.04,.06,.07,.09—.11
• 51:1 Md. R. 43 (1-12-24)
10.27.01.05 • 50:20 Md. R. 907 (10-6-23)
10.32.01.10 • 51:2 Md. R. 83 (1-26-24)
10.34.42.01—.03 •
51:2 Md. R. 84 (1-26-24)
10.35.01.20
• 51:5 Md. R. 247 (3-8-24)
Subtitles 37—52 (5th volume)
10.41.01.01—.04 •
50:16 Md. R. 738 (8-11-23)
10.41.02.01,.02,.04
• 50:16 Md. R. 738 (8-11-23)
10.41.03.02,.03,.05,.06
• 50:16 Md. R. 738 (8-11-23)
10.41.04.01,.02,.06,.08
• 50:16 Md. R. 738 (8-11-23)
10.41.05.01—.07 •
50:16 Md. R. 738 (8-11-23)
10.41.08.01-1,.02,.06,.08,.11,.12,.14
• 50:16 Md. R. 738 (8-11-23)
10.41.09.02 •
50:16 Md. R. 738 (8-11-23)
10.41.11.01—.10 •
50:16 Md. R. 738 (8-11-23)
10.41.13.02,.04 •
50:16 Md. R. 738 (8-11-23)
10.44.01.01—.39 • 50:20 Md. R. 911 (10-6-23)
10.44.19.05—.12 •
50:24 Md. R. 1051 (12-1-23)
10.44.20.02 •
50:20 Md. R. 918 (10-6-23)
10.44.22.02,.04—.06,.08—.15 • 50:20 Md. R. 918 (10-6-23)
10.46.09.01—.04 •
51:2 Md. R. 85 (1-26-24)
Subtitles 53—68 (6th volume)
10.53.08.05 •
50:17 Md. R. 773 (8-25-23)
10.53.09.01—.04 •
50:17 Md. R. 773 (8-25-23)
10.60.01.03,.05 •
50:18 Md. R. 816 (9-8-23)
10.60.02.08,.09 • 50:25 Md. R. 1102 (12-15-23)
10.60.03.01—.05 •
50:25 Md. R. 1102 (12-15-23)
10.63.02.02 •
51:3 Md. R. 168 (2-9-24)
10.63.03.20,.21 •
51:3 Md. R. 168 (2-9-24)
10.63.07.02,.03,.05,.11
• 51:3 Md. R. 173 (2-9-24)
10.65.02.06,.09 •
51:2 Md. R. 86 (1-26-24)
10.65.03.02—.09 •
51:2 Md. R. 86 (1-26-24)
10.65.04.01—.06 •
51:2 Md. R. 86 (1-26-24)
10.65.05.01—.04 •
51:2 Md. R. 86 (1-26-24)
10.65.06.01,.02 •
51:2 Md. R. 86 (1-26-24)
10.65.09.01—.06 •
51:2 Md. R. 86 (1-26-24)
10.67.01.01 •
51:3 Md. R. 164 (2-9-24)
10.67.02.01 •
51:3 Md. R. 174 (2-9-24)
10.67.04.03-1,.03-2,.15,.19,.19-4
• 51:3 Md. R. 174 (2-9-24)
10.67.04.20 •
50:24 Md. R. 1049 (12-1-23)
10.67.05.02 •
51:3 Md. R. 174 (2-9-24)
10.67.06.26 •
51:3 Md. R. 164 (2-9-24)
10.67.06.26-1,.26-3,.27,.30
• 51:3 Md. R. 174 (2-9-24)
10.67.06.28 •
50:24 Md. R. 1049 (12-1-23)
10.67.08.03 • 51:3 Md. R. 174 (2-9-24)
11 DEPARTMENT OF
TRANSPORTATION
Subtitles 11—23 (MVA)
11.11.13.04 •
51:3 Md. R. 177 (2-9-24)
11.12.01.14 •
50:15 Md. R. 698 (7-28-23)
11.13.10.04,.10,.14,.20 • 51:3 Md. R. 177 (2-9-24)
11.20.01.01,.03—.12,.14—.33 • 51:3 Md. R. 178
(2-9-24)
12 DEPARTMENT OF PUBLIC
SAFETY AND CORRECTIONAL SERVICES
12.11.10.06 •
51:2 Md. R. 95 (1-26-24)
13A STATE BOARD OF EDUCATION
13A.08.01.17 •
50:20 Md. R. 924 (10-6-23)
13A.15.05.06 •
51:1 Md. R. 50 (1-12-24)
13A.15.09.01 •
51:1 Md. R. 50 (1-12-24)
13A.15.10.06 •
51:1 Md. R. 50 (1-12-24)
13A.16.08.03 •
51:2 Md. R. 95 (1-26-24)
13A.16.09.01,.04
• 51:1 Md. R. 50 (1-12-24)
13A.16.10.02 •
51:2 Md. R. 95 (1-26-24)
13A.16.10.05 •
51:1 Md. R. 50 (1-12-24)
13A.17.10.02 •
51:2 Md. R. 95 (1-26-24)
13A.18.09.01,.04
• 51:1 Md. R. 50 (1-12-24)
13A.18.10.05 •
51:1 Md. R. 50 (1-12-24)
13B MARYLAND HIGHER
EDUCATION COMMISSION
13B.08.20.02—.13
• 50:4 Md. R. 158 (2-24-23)
14 INDEPENDENT AGENCIES
14.26.02.01—.12 •
50:26 Md. R. 1140 (12-29-23)
14.26.03.01—.13 •
50:26 Md. R. 1142 (12-29-23)
14.26.04.01—.13 •
51:3 Md. R. 183 (2-9-24)
14.26.06.01—.11 •
51:3 Md. R. 183 (2-9-24)
14.30.01.01 •
51:2 Md. R. 97 (1-26-24)
14.30.02.01—.05 •
51:2 Md. R. 97 (1-26-24)
14.30.03.01,.02 •
51:2 Md. R. 97 (1-26-24)
14.30.04.01—.12 •
51:2 Md. R. 97 (1-26-24)
14.30.05.01—.17 •
51:2 Md. R. 97 (1-26-24)
14.30.06.01,.02 •
51:2 Md. R. 97 (1-26-24)
14.30.07.01—.04 •
51:2 Md. R. 97 (1-26-24)
14.30.08.01—.26 •
51:2 Md. R. 97 (1-26-24)
14.30.09.01—.03 •
51:2 Md. R. 97 (1-26-24)
14.30.10.01—.24 •
51:2 Md. R. 97 (1-26-24)
14.30.11.01—.27 •
51:2 Md. R. 97 (1-26-24)
14.30.12.01—.05 •
51:2 Md. R. 97 (1-26-24)
14.30.13.01 •
51:2 Md. R. 97 (1-26-24)
14.30.14.01—.05 •
51:2 Md. R. 97 (1-26-24)
14.30.15.01,.02 •
51:2 Md. R. 97 (1-26-24)
14.31.04.01—.10 •
51:5 Md. R. 248 (3-8-24)
14.32.01.01—.06 •
51:2 Md. R. 109 (1-26-24)
14.32.02.01—.22 •
51:2 Md. R. 109 (1-26-24)
14.32.03.01—.07 •
51:2 Md. R. 109 (1-26-24)
14.32.04.01—.06 •
51:2 Md. R. 109 (1-26-24)
14.32.05.01—.05 •
51:2 Md. R. 109 (1-26-24)
14.32.06.01—.03 •
51:2 Md. R. 109 (1-26-24)
14.32.07.01 •
51:2 Md. R. 109 (1-26-24)
14.32.08.01 •
51:2 Md. R. 109 (1-26-24)
14.34.01.01—.03 •
51:2 Md. R. 110 (1-26-24)
14.34.02.01 •
51:2 Md. R. 110 (1-26-24)
14.34.03.01 •
51:2 Md. R. 110 (1-26-24)
14.34.04.01—.17 •
51:2 Md. R. 110 (1-26-24)
14.34.05.01—.12 •
51:2 Md. R. 110 (1-26-24)
14.34.06.01—.04 •
51:2 Md. R. 110 (1-26-24)
14.38.01.03 •
50:23 Md. R. 1011 (11-17-23)
14.39.02.01—.32 • 51:6 Md. R. 308 (3-22-24) (ibr)
15 MARYLAND DEPARTMENT OF
AGRICULTURE
15.01.05.10 •
51:2 Md. R. 110 (1-26-24)
15.14.09.03 • 50:25 Md. R. 1103 (12-15-23)
15.14.12.02 •
51:2 Md. R. 111 (1-26-24)
18 DEPARTMENT OF
ASSESSMENTS AND TAXATION
18.01.02.03 •
51:3 Md. R. 184 (2-9-24)
18.06.03.01 •
51:3 Md. R. 184 (2-9-24)
21 STATE PROCUREMENT
REGULATIONS
21.03.05.03 •
51:2 Md. R. 112 (1-26-24)
21.05.07.01,.04,.05
• 51:2 Md. R. 112 (1-26-24)
21.05.08.05 •
51:2 Md. R. 112 (1-26-24)
21.05.09.05 •
51:2 Md. R. 112 (1-26-24)
21.11.01.06 •
51:2 Md. R. 112 (1-26-24)
21.11.15.04 •
51:2 Md. R. 112 (1-26-24)
21.13.01.03,.15 •
51:2 Md. R. 112 (1-26-24)
26 DEPARTMENT OF THE
ENVIRONMENT
Subtitles 01—07 (Part 1)
26.04.01.01,.01-1,.20,.31 • 51:6 Md. R. 309 (3-22-24)
(ibr)
Subtitles 08—12 (Part 2)
26.11.40.02,.03 •
50:24 Md. R. 1059 (12-1-23)
Subtitles 19—28 (Part 4)
26.28.01.01—.03 •
50:25 Md. R. 1104 (12-15-23) (ibr)
26.28.02.01—.05 •
50:25 Md. R. 1104 (12-15-23)
26.28.03.01,.02 •
50:25 Md. R. 1104 (12-15-23)
26.28.04.01—.03 • 50:25 Md. R. 1104 (12-15-23)
30 MARYLAND INSTITUTE FOR
EMERGENCY MEDICAL SERVICES SYSTEMS (MIEMSS)
30.01.01.02 •
50:24 Md. R. 1061 (12-1-23)
30.02.02.04,.06—.09 • 50:24 Md. R. 1061 (12-1-23)
30.09.01.02 • 51:2 Md. R. 117 (1-26-24)
30.09.14.04 •
51:2 Md. R. 117 (1-26-24)
31 MARYLAND INSURANCE
ADMINISTRATION
31.10.30.03—.05 •
51:3 Md. R. 185 (2-9-24)
33 STATE BOARD OF
ELECTIONS
33.07.07.01 •
50:26 Md. R. 1147 (12-29-23)
33.07.09.01—.04 •
50:26 Md. R. 1147 (12-29-23)
33.11.01.04 •
50:26 Md. R. 1148 (12-29-23)
33.11.03.02,.08 •
50:26 Md. R. 1147 (12-29-23)
33.11.03.06 •
50:23 Md. R. 1029 (11-17-23)
33.11.04.03 •
50:23 Md. R. 1029 (11-17-23)
33.11.05.04 •
50:26 Md. R. 1148 (12-29-23)
33.16.03.01 •
50:26 Md. R. 1147 (12-29-23)
33.16.06.04 •
50:23 Md. R. 1029 (11-17-23)
33.17.06.10 • 50:26 Md. R. 1147
(12-29-23)
34 DEPARTMENT OF PLANNING
34.04.09.06,.08,.09 • 51:6 Md. R. 311 (3-22-24)
35 DEPARTMENT OF VETERANS
AFFAIRS
35.01.01.02 • 50:25 Md. R. 1115
(12-15-23)
35.03.01.03,.05,.09,.10 • 50:25 Md. R. 1115 (12-15-23)
51:1 Md. R. 58 (1-12-24) (err)
36 MARYLAND STATE LOTTERY
AND GAMING CONTROL AGENCY
36.03.01.02 • 50:26 Md. R. 1149
(12-29-23)
36.03.02.06,.12—.14,.16,.17 •
50:26 Md. R. 1149 (12-29-23)
36.03.03.01,.05—.07,.10 • 50:26
Md. R. 1149 (12-29-23)
36.03.06.03 • 50:26 Md. R. 1149
(12-29-23)
36.03.08.02,.04 • 50:26 Md. R.
1149 (12-29-23)
36.03.10.16,.20,.21,.34 • 50:26
Md. R. 1149 (12-29-23)
36.03.11.05 • 50:26 Md. R. 1149
(12-29-23)
36.04.01.11 • 50:26 Md. R. 1149
(12-29-23)
36.04.02.01,.02 • 50:26 Md. R.
1149 (12-29-23)
36.07.02.12,.18 • 50:26 Md. R.
1149 (12-29-23)
36.10.01.02 • 50:26 Md. R. 1149
(12-29-23)
36.10.02.10,.14 • 50:26 Md. R.
1149 (12-29-23)
36.10.03.02,.04 • 50:26 Md. R.
1149 (12-29-23)
36.10.04.02—.06 • 50:26 Md. R.
1149 (12-29-23)
36.10.05.01,.02 • 50:26 Md. R.
1149 (12-29-23)
36.10.06.02—.07,.09,.11 • 50:26
Md. R. 1149 (12-29-23)
36.10.10.03 • 50:26 Md. R. 1149
(12-29-23)
36.10.13.20,34,.40,.41 • 50:26
Md. R. 1149 (12-29-23)
36.10.14.03,.06 • 50:26 Md. R.
1149 (12-29-23)
36.10.15.03,.04 • 50:26 Md. R.
1149 (12-29-23)
36.11.02.20 • 50:26 Md. R. 1149 (12-29-23)
This is to certify that by an Order of this Court dated March 6, 2024, JOSEPH W. KING, JR. (CPF# 8812150352), as of March 6, 2024, Joseph W. King, Jr. has resigned, effective immediately and her name has been stricken from the register of attorneys in this Court. Notice of this action is given in accordance with Maryland Rule 19-735(e).
* * * * * * * * * *
This is to certify that by an Opinion & Order of this Court dated February 27, 2024, VERNON CHARLES DONNELLY (CPF# 8205010085), as of February 27, 2024, Vernon Charles Donnelly has been disbarred, effective immediately and his name has been stricken from the register of attorneys in this Court. Notice of this action is given in accordance with Maryland Rule 19-761(b).
[24-06-20]
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
Authority: Natural Resources Article, §§4-215 and 4-803, Annotated Code of Maryland
Notice of Final Action
[23-285-F]
On March 4, 2024, the Secretary of Natural Resources adopted amendments to Regulations .01, .10, and .12―.14 under COMAR 08.02.03 Blue Crabs. This action, which was proposed for adoption in 51:1 Md. R. 17—20 (January 12, 2024), has been adopted as proposed.
Effective Date: April 1, 2024.
JOSH KURTZ
Secretary of Natural Resources
Subtitle 02 FISHERIES SERVICE
Authority: Natural Resources Article, §§4-215 and 4-803, Annotated Code of Maryland
Notice of Final Action
[23-271-F]
On March 12, 2024, the Secretary of Natural Resources adopted amendments to Regulation .07 under COMAR 08.02.03 Blue Crabs. This action, which was proposed for adoption in 51:1 Md. R. 20—27 (January 12, 2024), has been adopted with the nonsubstantive changes shown below.
Effective Date: April 1, 2024.
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:
As originally proposed, Regulation .07 inadvertently labeled Janes Island Light Fl. 4§ as existing at 38° 57.803 N, 75° 55.109. This is the wrong coordinate. The change corrects the coordinate to 37°57.803 N, 75° 55.109 W. Additionally, stylistic changes have been made to ensure uniformity. Lastly, this action moves the crab pot line at Rock Hall Harbor to the historical line. The original proposal had moved that line slightly, but based on public comment the Department is reinstituting the line as historically interpreted. This change is less restrictive for crab potters and was reasonably foreseeable at the time of publication.
.07 Crab Pots.
A.—E. (proposed text unchanged)
F. Upper Chesapeake Bay — North of the William Preston Lane Jr.
Memorial Bridge (Chesapeake Bay Bridge).
(1) (proposed text
unchanged)
(2) Eastern Shore.
(a)—(f) (proposed
text unchanged)
(g) Rock Hall
Harbor/Swan Creek/Tavern Creek. All the waters upstream of a line beginning at
a point at or near Swan Point defined by Lat. 39° 8.778' N, Long. 76° 16.523' [[WW]] W then running approximately [[141°]] 140° True to a point [[inside the eastern side of Huntingfield Creek defined by Lat. 39°
7.089' N, Long. 76° 14.777' W]] at a known sunken island defined by
Lat. 39° 7.240' N, Long. 76° 14.870' W then running approximately 170° True to
a point at or near the northern tip of Huntingfield Point defined by Lat. 39°
7.118' N, Long. 76° 14.842' W .
(h) (proposed
text unchanged)
G.—I. (proposed
text unchanged)
J. Crab pots may
not be set in waters that are less than 4 feet deep at mean low tide except as
provided below:
(1) In Pocomoke
Sound, all the waters shoreward of the Maryland-Virginia state line, starting
with the junction with a line running from Bullbegger Point westward to the
northeasternmost point of land on Fair Island defined by Lat. 37° 57.837'
N, Long. 75° 38.914' W, then following the State line in a westerly
direction to State line marker "A" defined by Lat. 37° 54.732'
N, Long. 75° 48.065' W, thence northwesterly to Ware Point defined by
Lat. 37° 56.348' N, Long. 75° 49.264' W.
(2) In Tangier
Sound, all the waters shoreward of a line drawn from the southern tip of Deal
Island at Lower Thorofare defined by Lat. 38° 7.619' N, Long. 75° 56.993'
W then running approximately 223° to Lower Thorofare entrance Red Nun
"2" defined by Lat. 38° 7.363' N, Long. 75° 57.315' W
then running approximately 338° to a point offshore of Twiggs Point defined by
Lat. 38° 8.099' N, Long. 75° 57.677' W then running approximately
356° to a point at Haines Point Light Fl. 4 § defined by Lat. 38° 10.324'
N, Long. 75° 57.871' W then running approximately 105° true to the
northernmost tip of Deal Island defined by Lat. 38° 10.119' N, Long. 75°
56.874' W.
(3) In Tangier
Sound, all the waters shoreward of a line drawn from Flatcap Point defined by
Lat. 38° 1.981' N, Long. 75° 52.290' W then running approximately
208° true to Janes Island Light Fl. 4 § defined by Lat. [[38°]] 37° 57.803' N, 75° 55.109' W
then running approximately 56° true to James Island Point defined by Lat. 37°
58.474' N, Long. 75° 53.875' W.
(4) All the waters
of Tangier Sound, Pungers Cove and Sound Gut west of a line drawn from Muscle
Hole Point defined by Lat. 38° 7.617' N, Long. 76° 0.817' W then
running approximately 354° true to Sound Point defined by Lat. 38° 4.724'
N, Long. 76° 0.403' W on South Marsh Island.
K. (proposed text unchanged)
JOSH KURTZ
Secretary of Natural Resources
Subtitle 02 FISHERIES SERVICE
Notice of Final Action
[23-292-F]
On March 4, 2024, the Secretary of Natural Resources adopted amendments to:
(1) Regulation .04 under COMAR 08.02.04 Oysters; and
(2) Regulation .04 under COMAR 08.02.23 Shellfish Aquaculture and Leasing.
This action, which was proposed for adoption in 51:1 Md. R. 27—29 (January 12, 2024), has been adopted as proposed.
Effective Date: April 1, 2024.
JOSH KURTZ
Secretary of Natural Resources
Subtitle 02 FISHERIES SERVICE
Authority: Natural Resources Article, §4-2A-03, Annotated Code of Maryland
Notice of Final Action
[23-267-F]
On March 4, 2024, the Secretary of Natural Resources adopted amendments to Regulation .07 under COMAR 08.02.05 Fish. This action, which was proposed for adoption in 51:1 Md. R. 29—30 (January 12, 2024), has been adopted as proposed.
Effective Date: April 1, 2024.
JOSH KURTZ
Secretary of Natural Resources
Title 21
STATE PROCUREMENT REGULATIONS
Subtitle 11 SOCIOECONOMIC POLICIES
21.11.14 Veteran-Owned Small Business Enterprises
Authority: State Finance and Procurement Article, §§14-601—14-605; Chs. 343 and 344, Acts of 2015; Chs. 708 and 709, Acts of 2017; Ch. 740, Acts of 2018; Ch. 79, Acts of 2021
Notice of Final Action
[23-314-F]
On March 12, 2024, the Governor's Office of Small, Minority & Women Business Affairs adopted amendments to Regulations .02—.04, .06, .07, and .09, the repeal of existing Regulation .12, and new Regulation .12 under COMAR 21.11.14 Veteran-Owned Small Business Enterprises. This action, which was proposed for adoption in 51:2 Md. R. 115—117 (January 26, 2024), has been adopted as proposed.
Effective Date: April 1, 2024.
DAVON GARDNER
Director of Policy and Legislative Affairs
Title 13B
MARYLAND HIGHER EDUCATION COMMISSION
13B.08.20 Cybersecurity Public Service Scholarship Program
Authority: Education Article, §§11-105(u), 18-204(c), [18-3503, and 18-3506] and
Title 18, Subtitle 35, Annotated Code of Maryland
Notice of Withdrawal
[22-328-W]
Pursuant to State Government Article, §10-116(b), Annotated Code
of Maryland, notice is given that the proposal to amend Regulations .02—.13
under COMAR 13B.08.20 Cybersecurity Public Service Scholarship Program, which was published in 50:4 Md. R. 158—160
(February 24, 2023), has been withdrawn by operation of law.
GAIL S. KLAKRING
Administrator
Division of State Documents
Proposed Action on Regulations
Title 10
MARYLAND DEPARTMENT OF HEALTH
10.07.14 Assisted Living Programs
Authority: Health-General Article, Title 19, Subtitle 18, Annotated Code of Maryland
Notice of Proposed Action
[23-324-P]
The Secretary of Health proposes to repeal existing Regulations .01—.64
and adopt new Regulations .01—.65 under COMAR 10.07.14 Assisted
Living Programs.
Statement of Purpose
The purpose of this action is to set minimum, reasonable standards for licensure of assisted living programs in Maryland. This chapter is intended to maximize independence and promote the principles of individuality, personal dignity, freedom of choice, and fairness for all individuals residing in assisted living programs while establishing reasonable standards to promote individuals’ health and safety.
Estimate of Economic Impact
I. Summary of Economic Impact. The proposed actions require an assisted living provider to hire an awake overnight employee if the provider has an Alzheimer’s Special Care Unit and if they do not currently employ an awake overnight employee.
II. Types of Economic Impact.
|
Impacted Entity |
Revenue
(R+/R-) 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: |
|
|
|
Assisted living providers |
(-) |
$1,638,000 |
|
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. Assuming 50 percent of the providers need to hire one awake overnight employee, at the new minimum wage of $15, the approximate cost would be $1,638,000.
Economic Impact on Small Businesses
The proposed action has a meaningful economic impact on small
businesses. An analysis of this economic impact follows:
The regulated industries under this chapter are small businesses and will be impacted by the increased costs resulting from the proposed actions.
Impact on Individuals with Disabilities
The proposed action has an impact on individuals with disabilities as follows:
Overall, the proposed action will strengthen the rights of the residents, family council, and resident’s council through many changes. Some include additional training requirements for employees of the assisted living program and changes to the staffing requirements for Alzheimer’s Special Care Units. There are also increased protections for individuals who reside in unlicensed sites. An assisted living program that is operating without a license is subject to immediate prosecution, rather than waiting 30 days.
Opportunity for Public Comment
Comments may be sent to Jourdan Green, Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston St., Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov. Comments will be accepted through April 22, 2024. A public hearing has not been scheduled.
The purpose of this chapter is to set minimum, reasonable
standards for licensure of assisted living programs in Maryland. This chapter
is intended to maximize independence and promote the principles of
individuality, personal dignity, freedom of choice, and fairness for all
individuals residing in assisted living programs while establishing reasonable
standards to promote individuals’ health and safety.
A. In this chapter, the following terms have the meanings
indicated.
B. Terms Defined.
(1) Abuse of a Resident.
(a) “Abuse of a resident” means physical, sexual, mental, or
verbal abuse, or the improper use of a physical or chemical restraint or
involuntary seclusion as those terms are defined in this regulation.
(b) “Abuse of a resident” does not include:
(i) The performance of an accepted medical procedure ordered by
a health care practitioner practicing within the scope of their license;
(ii) Compliance with a valid advance directive; or
(iii) Honoring a resident’s known wishes regarding medical care.
(2) Activities of Daily Living.
(a) “Activities of daily living” means normal daily activities.
(b) “Activities of daily living” includes:
(i) Eating or being fed;
(ii) Grooming, bathing, and oral hygiene, including brushing
teeth, shaving, and combing hair;
(iii) Mobility, transfer, ambulation, and access to the
outdoors, when appropriate;
(iv) Toileting; and
(v) Dressing in clean, weather-appropriate clothing.
(3) Administration of Medication.
(a) “Administration of medication” means the act of preparing
and giving a medication to a resident.
(b) “Administration of medication” includes:
(i) Identifying the time to administer the medication;
(ii) Opening the medication container;
(iii) Removing the medication from the container;
(iv) Giving the medication to the resident.
(c) “Administration of medication” does not include residents
who have the cognitive ability to recognize their medications but only require
assistance such as:
(i) A reminder to take the medication;
(ii) Physical assistance with opening a medication container; or
(iii) Assistance with removing medication from the container.
(4) “Adult medical day care” has the meaning stated in
Health-General Article, §§14-201 and 14-301, Annotated Code of Maryland.
(5) “Advance directive” means:
(a) A written or electronic document, voluntarily executed by
the declarant consistent with the requirements of Health-General Article, Title
5, Subtitle 6, Annotated Code of Maryland; or
(b) A witnessed oral statement, made by the declarant consistent
with the provisions of the Health-General Article, Title 5, Subtitle 6,
Annotated Code of Maryland.
(6) “Alzheimer’s Special Care Unit” means a secured or separated
special unit specifically designed for individuals with any type of dementia,
including a probable or confirmed diagnosis of Alzheimer’s disease and related
dementias.
(7) “Assessment” means a process of evaluating an individual’s
health, functional and psychosocial history, and condition using the Resident
Assessment Tool.
(8) “Assist rail” means a hand rail or other similar,
substantially constructed device that is installed to enable residents to move
safely from one point or position to another.
(9) “Assisted living manager” means the individual who is:
(a) Designated by an assisted living program to oversee the
overall and day-to-day operation of the assisted living program; and
(b) Responsible for the duties set forth in Regulation .15 of
this chapter.
(10) Assisted Living Program.
(a) “Assisted living program” means a residential or
facility-based program for two or more residents that provides housing and
supportive services, supervision, personalized assistance, health-related
services, or a combination of these services to meet the needs of individuals
who are unable to perform, or who need assistance in performing, the activities
of daily living or instrumental activities of daily living, in a way that
promotes optimum dignity and independence for the individuals.
(b) “Assisted living program” does not include:
(i) A nursing home, as defined under Health-General Article,
§19-301, Annotated Code of Maryland;
(ii) A State facility, as defined under Health-General Article,
§10-101, Annotated Code of Maryland;
(iii) A program licensed or approved by the Department under
Health-General Article, Title 7 or Title 10, Annotated Code of Maryland;
(iv) A hospice care program licensed by the Department under
Health-General Article, Title 19, Annotated Code of Maryland;
(v) Services provided by family members;
(vi) Services provided by a licensed residential service agency
or licensed home health agency in an individual’s own home; or
(vii) A Certified Adult Residential Environment Program that is
certified by the Department of Human Services under Human Services Article,
§§6-508—6-513, Annotated Code of Maryland.
(11) “Authorized prescriber” means an individual who is
authorized to prescribe medications under Health Occupations Article, Annotated
Code of Maryland.
(12) “Background check” means a check of court and other records
by a private agency.
(13) “Bank” means a bank, trust company, savings bank, savings
and loan association, or financial institution that is:
(a) Authorized to do business in this State; and
(b) Insured by the Federal Deposit Insurance Corporation.
(14) “Certified medication technician” means an individual who
is certified as a medication technician by the Maryland Board of Nursing under
COMAR 10.39.04.02.
(15) “Chemical restraint” means controlling behavior by use of a
drug that is not otherwise required to treat medical symptoms.
(16) Cognitive Impairment.
(a) “Cognitive impairment” means the loss of those thought
processes that orchestrate relatively simple ideas, movements, or actions into
goal-directed behavior.
(b) “Cognitive impairment” includes lack of judgment, planning,
organization, self-control, and the persistence needed to manage normal demands
of the individual’s environment.
(17) “Common ownership community” means:
(a) A condominium organized under Real Property Article, Title
11, Annotated Code of Maryland;
(b) A homeowners association organized under Real Property
Article, Title 11B, Annotated Code of Maryland; or
(c) A cooperative housing corporation organized under
Corporations and Associations Article, Title 5, Subtitle 6B, Annotated Code of
Maryland.
(18) “Common-use telephone” means a telephone that is:
(a) Within the facility;
(b) Accessible to residents;
(c) Located so that residents can have private conversations;
and
(d) Available to residents to make free local calls.
(19) “Consultant” means an individual or organization, under
contract with a licensee, that may:
(a) Have partial or full responsibility and control over one or
more areas of operations of the assisted living provider; and
(b) Provide expertise related to:
(i) One or more licensure requirements; or
(ii) Standards of care.
(20) “Contact precautions” means the use of a private room and
appropriate personal protective equipment, such as gowns, gloves, or masks to
prevent the transmission of certain organisms between an infected individual
and others.
(21) “Controlled dangerous substance (CDS)” means a medication
or substance listed in Schedule I through Schedule V as defined in Criminal Law
Article, §5-101, Annotated Code of Maryland.
(22) “Criminal history records check” means a check of criminal
history information, as defined in Criminal Procedure Article, §10-201,
Annotated Code of Maryland, by the Department of Public Safety and Correctional
Services.
(23) “Delegating nurse” means a nurse who:
(a) Is licensed to practice registered nursing in this State as
defined in Health Occupations Article, Title 8, Annotated Code of Maryland; and
(b) Has successfully completed the Board of Nursing’s approved
training program for registered nurses, delegating nurses, and case managers in
assisted living.
(24) “Delegation of nursing tasks” means the formal process
approved by the Maryland Board of Nursing which permits a professional nurse to
assign nursing tasks to an unlicensed individual, a certified nursing
assistant, or a medication technician, in accordance with COMAR 10.27.11.03,
through:
(a) A nursing assessment of the patient’s nursing care needs
prior to delegation of tasks;
(b) Instructing the unlicensed individual, certified nursing
assistance, or medication technician or verifying their competency;
(c) Supervising of the delegated task in accordance with COMAR
10.27.11.04;
(d) Retaining accountability and responsibility for the
delegated task;
(e) Evaluating the performance of the delegated task; and
(f) Assuring accurate documentation of outcomes on the nursing
record.
(25) “Department” means the Maryland Department of Health.
(26) “Discharge” means releasing a resident from an assisted
living program, after which the releasing program no longer is responsible for
the resident’s care.
(27) “Emergency admission” means the temporary admittance of an
individual in an assisted living program when the individual’s health and
safety would be jeopardized by not permitting immediate admittance.
(28) “Emergency Medical Services form” means a form issued by
the Maryland Institute for Emergency Medical Services Systems for the purpose
of documenting emergency medical services and do not resuscitate orders as
defined in Health-General Article, §5-601(k), Annotated Code of Maryland,
including a Maryland Medical Orders for Life-Sustaining Treatment (MOLST) form.
(29) Facilitating Access.
(a) “Facilitating access” means:
(i) Making appropriate referrals for care and treatment;
(ii) Arranging for the appointment and involvement of
appropriate health care decision makers, when necessary; and
(iii) Facilitating contact between the resident, the resident
representative, the health care or social service professional, and needed
services.
(b) “Facilitating access” does not mean guaranteeing payment for
services that are not:
(i) Covered by the resident agreement; or
(ii) Paid for by the resident or the resident agent.
(30) “Facility” means the physical plant in which an assisted
living program is operated.
(31) “Family” means a group of two or more individuals related
by legal status or affection who consider themselves a family.
(32) “Family council” means a group of individuals who work
together to protect the rights of and improve the quality of life for residents
of an assisted living program.
(33) “Financial exploitation” means the misappropriation of a
resident’s assets or income, including:
(a) Spending the resident’s assets or income against the will of
or without the consent of the resident or the resident agent;
(b) Spending the resident’s assets or income for the use and
benefit of a person other than the resident, if the resident or resident agent
has not consented to the expenditure; or
(c) The resident agent’s misappropriation of the resident funds.
(34) “Frequent” means occurring or appearing quite often or at
close intervals, but not continuously.
(35) “Health care practitioner” means a physician, a certified
nurse practitioner, or a physician assistant who provides health care services
and is licensed under Health Occupations Article, Annotated Code of Maryland.
(36) “Health condition” means the status of a resident’s
physical, mental, and psychosocial well-being.
(37) “Home health services” means those services provided as
defined in Health-General Article, §§19-401—19-410 or §§19-4A-01—19-4A-10,
Annotated Code of Maryland.
(38) “Household member” means an individual living in an
assisted living program who is not a resident or staff member.
(39) “Incident” means:
(a) The death of a resident from other than natural causes;
(b) The disappearance or elopement of a resident;
(c) An assault on a resident resulting in injury;
(d) An injury to a resident which may require treatment by a
health care practitioner, or an event such as a fall which could subsequently
require treatment;
(e) Abuse, neglect, or financial exploitation of a resident;
(f) An error or omission in medication or treatment which may
result in harm to the resident; or
(g) An emergency situation or natural disaster.
(40) “Informal dispute resolution (IDR)” means an informal
process that provides an assisted living program the opportunity to dispute one
or more deficiencies cited in a written statement of deficiencies issued by the
Department or the Department’s designee related to a recent survey.
(41) “Instrumental activities of daily living” means home
management skills, such as shopping for food and personal items, preparing
meals, or handling money.
(42) “Intensive” means highly concentrated.
(43) “Intermittent nursing care” means nursing care which is
provided episodically, irregularly, or for a limited time period.
(44) Involuntary Seclusion.
(a) “Involuntary seclusion” means the separation of a resident
from others or from the resident’s room against the resident’s will or the will
of the resident representative.
(b) “Involuntary seclusion” does not mean separating a resident
from other residents on a temporary and monitored basis.
(45) “Lavatory” means a basin used to maintain personal
cleanliness that has hot and cold running water and sanitary drainage.
(46) “Law enforcement agency” means the Maryland State Police or
a police agency of a county or municipal corporation.
(47) “License” means a document issued by the Secretary to
operate an assisted living program in Maryland.
(48) “Licensed pharmacist” means an individual who is authorized
to practice pharmacy under Health Occupations Article, Title 12, Annotated Code
of Maryland.
(49) “Licensed physician” means an individual who is authorized
to practice medicine under Health Occupation Article, Title 14, Annotated Code
of Maryland.
(50) “Licensee” means the person to whom a license is issued.
(51) “Management firm” means an organization, under contract
with an applicant for a license or a current licensee, that is intended to have
or has full responsibility and control over the day-to-day operations of the
assisted living program.
(52) “Medical Orders for Life-Sustaining Treatment (MOLST) form”
means the form required to be developed pursuant to Health-General Article,
§5-608.1, Annotated Code of Maryland.
(53) “Medical record” has the meaning stated in Health-General
Article, §4-301, Annotated Code of Maryland.
(54) Mental Abuse.
(a) “Mental abuse” means an intentional course of conduct
resulting in or intended to produce emotional harm.
(b) “Mental abuse” does not include the performance of an
accepted clinical or medical procedure.
(55) “Minimal” means the least amount required to produce the
desired result.
(56) “Neglect” means depriving a resident of adequate food,
clothing, shelter, supervision, essential medical treatment, or essential
rehabilitative therapy.
(57) Nursing Overview.
(a) “Nursing overview” means a process by which a registered
nurse assures that the health and psychosocial needs of the resident are met.
(b) “Nursing overview” includes:
(i) Observation;
(ii) Assessment;
(iii) Staff education; and
(iv) The development, implementation, and evaluation of a
resident’s service plan.
(58) “Occasional” means occurring from time to time, on an
infrequent or irregular basis, with no particular pattern.
(59) “Office of Health Care Quality (OHCQ)” means the Office of
Health Care Quality of the Maryland Department of Health.
(60) “Ongoing” means continuing over an extended period of time.
(61) “Person” means an individual, receiver, trustee, guardian,
personal representative, fiduciary, or representative of any kind and any
partnership, firm, association, corporation, or other entity.
(62) “Personal representative” means an individual appointed by
the court with the duties and authority to settle and distribute the estate of
the decedent.
(63) “Physical abuse” means the sustaining of any physical
injury or pain to a resident as a result of cruel or inhumane treatment, or as
a result of a malicious act by any individual.
(64) Physical Restraint.
(a) “Physical restraint” means the use of a device or physical
action to prevent, suppress, or control head, body, or limb movement, that
cannot be readily and easily removed by the resident.
(b) “Physical restraint” does not mean a protective device as
defined in this regulation.
(65) “Plan of correction” means a written response from the
assisted living program that addresses how each deficiency cited as a result of
a survey by the Department or the Department’s designee will be corrected.
(66) “Protective device” means any device or equipment, except
bedside rails:
(a) That:
(i) Shields a resident from self-injury;
(ii) Prevents a resident from aggravating an existing physical
problem; or
(iii) Prevents a resident from precipitating a potential
physical problem;
(b) That may limit, but does not eliminate, the movement of the
resident’s head, body, or limbs; and
(c) That is prescribed by a health care practitioner.
(67) “Quality assurance” means a system for maintaining
professionally acceptable standards of care by:
(a) Identifying opportunities to improve;
(b) Studying problems, if any, and their root causes; and
(c) Implementing and monitoring interventions to ensure the
intended improvement is achieved and sustained.
(68) “Relief personnel” means qualified individuals who have
been hired to substitute for certain staff members:
(a) In emergency situations; or
(b) When the assisted living manager or other staff is absent
from the assisted living program for extended hours.
(69) “Resident” means an individual 18 years old or older who
requires assisted living services.
(70) “Resident agent” means a person who manages, uses, or
controls the funds or assets that legally may be used to pay an applicant’s or
resident’s share of the costs or other charges for assisted living services.
(71) “Resident agreement” means a document signed by both the
resident or the resident agent and the assisted living manager, or designee,
stating the terms that the parties agree to, including, at a minimum, the
provisions set forth in Regulations .26 and .27 of this chapter.
(72) “Resident Assessment Tool” means Maryland’s Assisted Living
Resident Assessment and Level of Care Scoring Tool that is:
(a) Developed by the OHCQ with input from assisted living
program staff; and
(b) Used by assisted living programs to assess the current
health, physical, and psychosocial status of prospective and current residents.
(73) Resident Representative.
(a) “Resident representative” means a person referenced in
Regulation .35 of this chapter.
(b) “Resident representative” does not include an assisted
living program owner or employee that has been designated as a representative
payee for a resident.
(74) Restraint.
(a) “Restraint” means any chemical restraint or physical
restraint as defined in §B(15) and (64) of this regulation.
(b) “Restraint” does not include a protective device.
(75) “Sanction” means a disciplinary penalty imposed for a
violation of statutes or regulations relating to the operation of an assisted
living program, including, but not limited to, those penalties referenced in
Regulations .58, .59, .61, .63, and .64 of this
chapter.
(76) “Secretary” means the Secretary of Health or the Secretary’s
designee.
(77) “Self-administration of medication” means a resident having
the cognitive and physical ability to take medication as prescribed by an
authorized prescriber:
(a) At the correct time;
(b) By the correct route; and
(c) In the correct dosage.
(78) “Service plan” means a written plan developed by an
assisted living program in conjunction with the resident and the resident
representative, if appropriate, which identifies, among other things, services
that the assisted living program will provide to the resident based upon the
resident’s needs as determined by the Resident Assessment Tool.
(79) “Sexual abuse” means a crime listed in Criminal Law
Article, Title 3, Subtitle 3, Annotated Code of Maryland.
(80) “Short-term residential care” means a stay, either
continuous or intermittent, in an assisted living program of not more than 30
consecutive days from the date of initial admission, which cannot exceed 180
days per year.
(81) Significant Change of Condition.
(a) “Significant change of condition” means a shift in a
resident’s health, functional, cognitive, behavioral, or psychosocial
conditions that either causes an improvement or deterioration in a resident’s
condition as described in the Resident Assessment Tool.
(b) “Significant change of condition” does not include any
ordinary, day-to-day fluctuations in health status, function, or behavior, or
an acute short-term illness, such as a cold, unless these fluctuations continue
to recur.
(82) “Staff” means supervisors, assistants, aides, or other
employees, including independent contractors retained by an assisted living
program, to provide the care and services required by this chapter.
(83) “Standard precautions” means a set of infection control
practices used to prevent transmission of diseases that can be acquired by
contact with blood, body fluids, non-intact skin (including rashes), and mucous
membranes.
(84) “Substantial” means considerable in importance, degree,
amount, frequency, or extent.
(85) “Treatment” means medical or psychological management to
cure, slow the progression of, maintain, or improve a disease or condition.
(86) “Unclaimed deceased resident” means a resident of an
assisted living program:
(a) Who has not prearranged and prepaid for the disposal of the resident’s
body; or
(b) For whom no individual has claimed the body and assumed
funeral or burial responsibility.
(87) “Verbal abuse” means the use of any oral or gestured
language that includes disparaging or derogatory terms, which is directed to a
resident, or within a resident’s hearing distance, regardless of the resident’s
age, ability to comprehend, or disability.
.03
Incorporation by Reference.
In this chapter, the following documents are incorporated by
reference:
A. Centers for Disease Control and Prevention (CDC) Guidelines
for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care
Facilities, which is incorporated by reference in COMAR 10.07.02.02;
B. The Life Safety Code, NFPA 101, which is incorporated by
reference in COMAR 29.06.01.06; and
C. The State Fire Prevention Code, which is incorporated by
reference in COMAR 29.06.01.
A. A person may not operate an assisted living program in this
State without obtaining a license from the Secretary and complying with the
requirements of this chapter.
B. Providing housing under a landlord-tenant arrangement does
not, in and of itself, exclude a person from the licensure requirements of this
chapter.
C. Separate licenses are required for assisted living programs
that are maintained on the same or separate premises, even though the programs
are operated by the same person.
D. The Secretary shall issue a license for a specified number of
beds and a specified level of care.
E. An assisted living program may not provide services beyond
its licensed authority by:
(1) Providing care to more residents than the total number of
licensed beds; or
(2) Providing care beyond the specified level of care without
first obtaining written approval of a resident-specific waiver request from the
Department.
F. The number of residents, as stated in §E of this regulation,
includes:
(1) Residents in the facility;
(2) Individuals admitted to the assisted living program for
short-term residential care;
(3) Family members who are cared for by assisted living program
staff; and
(4) Individuals who are transitioning to the assisted living
program.
G. An assisted living program shall conspicuously post its
license in a common-use area at the facility.
H. A person who falsifies or alters an assisted living program
license shall be subject to referral for a criminal prosecution and imposition
of civil fines, as specified in Regulations .57—.65 of this chapter.
A. An assisted living program may provide:
(1) The level of care for which the assisted living program has
been approved; and
(2) Any lower level of care.
B. At the time of initial licensure, an applicant shall:
(1) Request approval to provide services at one of the three
levels of care set forth in §G of this regulation; and
(2) Demonstrate that the assisted living program has the
capacity to provide the level of care requested either directly or through the
coordination of community services.
C. If, at any time, an assisted living program wants to provide
a higher level of care than that for which it is licensed, the assisted living
program shall request authority from the Department to change its licensed
level of care.
D. The Department shall determine if an applicant or the
assisted living program has the capacity to provide and ensure the requested
level of care.
E. The Department may approve or deny the request.
F. If an applicant or an assisted living program is aggrieved by
the Department’s decision, the applicant or the assisted living program may
appeal by filing a request for a hearing consistent with Regulation .65 of this
chapter.
G. Levels of Care.
(1) The applicant or assisted living program shall:
(a) Request one of the levels of care listed below; and
(b) Have sufficient staff and the abilities necessary to provide
the level of care selected.
(2) Level 1: Low Level of Care.
(a) Health and Wellness. Staff shall have the ability to:
(i) Recognize the causes and risks associated with a resident’s
current health condition once these factors are identified by a health care
practitioner; and
(ii) Provide occasional assistance in accessing and coordinating
health services and interventions.
(b) Functional Condition. Staff shall have the ability to
provide occasional supervision, assistance, support, setup, or reminders with
two or more activities of daily living.
(c) Medication and Treatment. Staff shall have the ability to
assist a resident with taking medication or to coordinate access to necessary
medication and treatment.
(d) Behavioral Condition. Staff shall have the ability to
monitor and provide uncomplicated intervention to manage occasional behaviors
that are likely to disrupt or harm the resident or others.
(e) Psychological or Psychiatric Condition. Staff shall have the
ability to monitor and manage occasional psychological or psychiatric episodes
or fluctuations that require uncomplicated intervention or support.
(f) Social and Recreational Interests. Staff shall have the
ability to provide occasional assistance in accessing social and recreational
services.
(3) Level 2: Moderate Level of Care.
(a) Health and Wellness. Staff shall have the ability to:
(i) Recognize and accurately describe and define a resident’s
health condition and identify likely causes and risks associated with the
resident’s condition; and
(ii) Provide or ensure access to necessary health services and
interventions.
(b) Functional Condition. Staff shall have the ability to
provide or ensure:
(i) Substantial support with two or more activities of daily
living; or
(ii) Minimal support with any number of activities of daily
living.
(c) Medication and Treatment. Staff shall have the ability to:
(i) Provide or ensure assistance with taking medication; or
(ii) Administer necessary medication and treatment, including
monitoring the effects of the medication and treatment.
(d) Behavioral Condition. Staff shall have the ability to
monitor and provide or ensure intervention to manage frequent behaviors which
are likely to disrupt or harm the resident or others.
(e) Psychological or Psychiatric Condition. Staff shall have the
ability to monitor and manage frequent psychological or psychiatric episodes
that may require limited skilled interpretation, or prompt intervention or
support.
(f) Social and Recreational Interests. Staff shall have the
ability to provide or ensure ongoing assistance in accessing social and
recreational services.
(4) Level 3: High Level of Care.
(a) Health and Wellness. Staff shall have the ability to:
(i) Recognize and accurately describe and define a resident’s
health condition and identify likely causes and risks associated with the
residents’ condition; and
(ii) Provide or ensure ongoing access to and coordination of
comprehensive health services and interventions, including nursing overview.
(b) Functional Condition. Staff shall have the ability to
provide or ensure comprehensive support as frequently as needed to compensate
for any number of activities of daily living deficits.
(c) Medication and Treatment. Staff shall have the ability to:
(i) Provide or ensure assistance with taking medication; and
(ii) Administer necessary medication and treatment, including
monitoring or arranging for monitoring of the effects of complex medication and
treatment regimens.
(d) Behavioral Condition. Staff shall have the ability to
monitor and provide or ensure ongoing therapeutic intervention or intensive
supervision to manage chronic behaviors which are likely to disrupt or harm the
resident or others.
(e) Psychological or Psychiatric Condition. Staff shall have the
ability to monitor and manage a variety of psychological or psychiatric
episodes involving active symptoms, condition changes, or significant risks
that may require skilled interpretation or immediate interventions.
(f) Social and Recreational Interests. Staff shall have the
ability to provide or ensure ongoing access to comprehensive social and
recreational services.
A. Restricted Nomenclature. An assisted living program licensed
under this chapter may not use in its title or advertising the words “hospital”,
“sanitarium”, “nursing”, “convalescent”, “rehabilitative”, “sub-acute”, or “hospice”.
B. Advertising an Assisted Living Program.
(1) Prohibited Terms. A person operating an assisted living
program may not use the term “assisted living” in its advertising without being
licensed as an assisted living program by the Department.
(2) Misleading or False Advertising.
(a) A person may not advertise, represent, or imply to the
public that an assisted living program is authorized to provide a service that
the program is not licensed, certified, or otherwise authorized by the
Department to provide when the license, certificate, or authorization is
required under this chapter.
(b) A person may not advertise an assisted living program in a
misleading or fraudulent manner.
(c) The Department may report misleading or false advertising to
the Office of the Attorney General, Division of Consumer Protection.
C. Drop-In or Day Services.
(1) An assisted living program may not provide day, partial, or
hourly adult day care services without appropriate adult medical day care
licensure.
(2) An individual who has applied for admission or who has been
admitted to the assisted living program may, for a reasonable period of time
not to exceed 30 calendar days, transition to the program in increments of
partial days before becoming a resident.
(3) All regulations of this chapter apply to services and care
provided during this transition period.
(4) The individual transitioning to the assisted living program
is counted as a resident.
D. Dual Licensure. An assisted living program dually licensed as
an adult medical day care program or any other licensed program shall meet all
requirements for both programs.
E. A person who falsifies or alters an assisted living license
shall be subject to referral for criminal prosecution and imposition of civil
fines.
A. Application for License.
(1) To obtain and maintain a license, an applicant shall meet
all of the requirements of:
(a) This chapter;
(b) Other applicable federal, State, and local laws and
regulations; and
(c) Health-General Article, §19-311, Annotated Code of Maryland,
if the program provides services to 17 or more residents.
(2) An applicant shall
submit:
(a) An application on a
written or electronic form developed by the Department;
(b) The completed
Uniform Disclosure Form on a form developed by the Department; and
(c) All other
reasonable documents as required by the Department.
(3) At a minimum, the applicant shall provide:
(a) Verification that the applicant or corporate representative
is 21 years old or older;
(b) Documentation of any prior denial, suspension, or revocation
of a license or certification to provide care to third parties;
(c) Identification of any individual or corporate owner of 25
percent or more interest in the assisted living program;
(d) Documentation of any conviction and current criminal
background check or criminal history records check of the owner, the applicant,
the assisted living manager, the alternate assisted living manager, other
staff, and any household member;
(e) Ownership information as specified on an addendum to the
application;
(f) Verification that the facility is owned, leased, or
otherwise under the control of the applicant;
(g) The level of care to be provided by the assisted living
program, its location, and the name of the proposed assisted living manager;
(h) Documentation of zoning approval, if zoning approval is required
by the local jurisdiction in which the assisted living program will be located;
and
(i) Where applicable, approvals from the local health
department, local or State fire authority, and local area agency on aging.
B. Additional Requirements for Initial Licensure. The Secretary
shall require an applicant for initial licensure to submit:
(1) Information concerning any license or certification held by
the applicant under Health Occupations Article or Health-General Article,
Annotated Code of Maryland, including the prior or current operation by the
applicant of a health care facility or similar health care program;
(2) Information demonstrating financial or administrative
ability to operate an assisted living program in compliance with this chapter,
which shall include a business plan and 1-year operating budget;
(3) Policies and procedures to be implemented as designated in
the application for licensure; and
(4) Other reasonably relevant information, if required by law or
local jurisdiction, such as:
(a) Verification of Workers’ Compensation insurance;
(b) Facility plan review documentation;
(c) Food service permit; and
(d) Rental license.
C. License Suspension or Revocation.
(1) The owner, assisted living manager, alternate assisted
living manager, or board member of an assisted living program that has had its
license suspended or revoked by the Department may not own, operate, lease, or
manage another assisted living program for 10 years from the date the license
was suspended or revoked without good cause shown.
(2) After 10 years, the applicant shall submit evidence to the
Department that the applicant is capable of owning, managing, or operating an
assisted living program.
D. Sanctions and Uncorrected Deficiencies.
(2) The Department may
not approve a license application for an assisted living program if the owner,
assisted living manager, or alternate assisted living manager operates, leases,
or manages a licensed assisted living program that has uncorrected deficiencies.
(3) In making a determination about a pending assisted living
program license application, the Department may consider any sanctions or
uncorrected deficiencies that were imposed before or after the application
submission which present a risk to the health or safety of residents for a
currently licensed assisted living program that is operated, leased, or managed
by an owner, assisted living manager, or alternate assisted living manager in
the pending license application.
E. Violations and Criminal Convictions.
(1) The Department reserves the right to deny licensure to an
applicant based on the owner’s, assisted living manager’s, or alternate
assisted living manager’s prior:
(a) History of violations of assisted living regulations;
(b) Criminal history that the Department determines may be
potentially harmful to residents;
(c) Convictions as described in 42 U.S.C. §1320a–7(a) or
Criminal Law Article, §14-101, Annotated Code of Maryland; and
(d) History of final actions of a Health Occupations Board.
(2) In making a determination about a license application, the
Department shall consider the following factors related to a criminal
conviction:
(a) The age at which the crime was committed;
(b) The circumstances surrounding the crime;
(c) The length of time that has passed since the crime; and
(d) Subsequent work history.
(3) In making a determination about a license application, the
Department shall consider the following factors related to a violation of
assisted living regulations:
(a) The circumstances surrounding the violation;
(b) The length of time since the violation occurred;
(c) The scope of the violation;
(d) The severity of the violation; and
(e) The implementation of a plan of correction.
(4) The Department shall consider other evidence that
demonstrates whether the applicant poses a threat to the health or safety of
residents in an assisted living program.
F. Determination of License Application.
(1) Based on information provided to the Department by the
applicant and the Department’s own investigation, the Secretary shall:
(a) Approve the application unconditionally;
(b) Approve the application conditionally, which may include,
among other conditions, requiring the applicant to use the services of a
management firm approved by the Secretary; or
(c) Deny the application.
(2) The Secretary may not require use of a management firm for a
period in excess of 24 months.
(3) A person may not:
(a) Operate an assisted living program until a provisional
license or license has been issued; or
(b) Operate multiple sites until each site has been inspected
and approved by the Department.
(4) A person aggrieved by a decision of the Secretary under this
section to deny a license application may appeal the Secretary’s action by
filing a request for a hearing consistent with Regulation .65 of this chapter.
G. Provisional Licenses for Less than 2 Years. The Department
may issue a provisional license if:
(1) An assisted living program is not in full compliance with
this chapter;
(2) The Department determines that the noncompliance does not
constitute a safety or health hazard; and
(3) The applicant or assisted living program has submitted a
plan of correction acceptable to the Department which satisfactorily addresses
the correction of each deficiency within a time frame acceptable to the
Department.
H. License Application
Administratively Closed.
(1) An application is not complete until the Department has
received the completed license application and all required documents.
(2) After 180 calendar days from the date of initial receipt,
the Department may deem an incomplete license application inactive and administratively
close the application.
(3) An applicant whose application is administratively closed
may reapply for a license by submitting a new application.
.08
Changes in an Assisted Living Program that Affect the Operating License.
A. General Information
Related to Licensure.
(1) A licensee shall
immediately notify the Department of any change in the information the licensee
had submitted with the most recent application.
(2) A license is valid
only in the name of the licensee to whom it is issued, and is not subject to
sale, assignment, or other transfer.
(3) A license is valid
only for the premises for which it was originally issued.
(4) A licensee shall
forward to the Department a copy of any report or citation of a violation of
any applicable building codes, sanitary codes, fire safety codes, or other
regulations affecting the health, safety, or welfare of residents within 7
calendar days of receipt of the report or citation. An assisted living program’s
failure to notify the Department may result in the imposition of a sanction.
B. Increase in Licensed
Beds.
(1) An assisted living
program may not provide assisted living services to more residents than the
number of beds approved in writing by the Department.
(2) To request an
increase in the number of beds, a licensed assisted living program shall:
(a) Submit the request
for an increase in licensed beds on the form developed by and in the manner
established by the Department; and
(b) Attach the required
documents, including, at a minimum, proof of compliance with all local
requirements for fire safety, use and occupancy, and zoning permits.
(3) If approved, the
Department shall issue a new license to the assisted living program that
includes the approved number of beds.
(4) Upon receipt of a
new license, all use of the previously issued assisted living program license
shall cease.
C. Increase in Level of
Care.
(1) An assisted living
program may not provide a higher level of care for residents than is approved
by the Department unless a specific resident has a waiver to receive a higher
level of care.
(2) To request an
increase in the level of care, an assisted living program shall:
(a) Submit the request
for an increase in the level of care on the form developed by and in the manner
established by the Department; and
(b) Attach supporting
documentation, including any changes in staffing, training, or policies and
procedures.
(3) If approved, the
Department shall issue a new license to the assisted living program that
includes the approved level of care.
(4) Upon receipt of a
new license, all use of the previously issued assisted living program license
shall cease.
D. Name Change.
(1) An assisted living
program shall have a revised license from the Department to change its name or
the name under which the program is doing business.
(2) To request a name
change, an assisted living program shall:
(a) Submit the request
for a name change on the form developed by and in the manner established by the
Department; and
(b) Attach the required
attachments, including a letter of good standing from the Maryland State
Department of Assessments and Taxation (SDAT) Business Express.
(3) Upon processing,
the Department shall issue a new license to the assisted living program that
includes the new name of the licensee.
(4) Upon receipt of a
new license, all use of the previously issued assisted living program license
shall cease.
E. Change of Location.
(1) Prior to operating
an assisted living program at a new location, the applicant shall have an
assisted living program license issued by the Department.
(2) To request an
assisted living program license for a new location, an applicant shall:
(a) Submit an
application for an assisted living program license on the form developed by and
in the manner established by the Department; and
(b) Submit all required
attachments.
(3) An assisted living
program shall notify the Department in writing of a relocation:
(a) Within 60 calendar
days in advance of the effective date if licensed for 49 or fewer beds; or
(b) Within 75 calendar
days in advance of the effective date if licensed for 50 or more beds.
(4) An assisted living
program shall notify residents and resident representatives in writing of a
relocation:
(a) Within 60 calendar
days in advance of the effective date if licensed for 49 or fewer beds; or
(b) Within 75 calendar
days in advance of the effective date if licensed for 50 or more beds.
(5) If approved, the
Department shall issue a license to the assisted living program at the new
location.
(6) Upon receipt of a
new license, all use of the previously issued assisted living program license
shall cease.
F. Change of Ownership —
Sale, Transfer, or Lease of a Facility.
(1) If a sale,
transfer, or lease of a facility causes a change in the person or persons who
control or operate the assisted living program, the assisted living program
shall be considered a new program and the new owner shall apply for a license
and conform to all regulations applicable at the time of transfer of
operations.
(2) The transfer of any
stock which results in a change of the person or persons who control the
program or the transfer of any stock in excess of 25 percent of the outstanding
stock, constitutes a sale.
(3) For the purposes of
Life Safety Code enforcement, the program is considered an existing facility if
it has been in continuous use as an assisted living program.
(4) An assisted living
program shall notify the Department in writing of a change of ownership, sale,
transfer, or lease of a facility:
(a) Within 60 calendar
days in advance of the effective date if licensed for 49 or fewer beds; or
(b) Within 75 calendar
days in advance of the effective date if licensed for 50 or more beds.
(5) An assisted living
program shall notify residents and resident representatives in writing of a
change of ownership, sale, transfer, or lease of a facility:
(a) Within 60 calendar
days in advance of the effective date if licensed for 49 or fewer beds; or
(b) Within 75 calendar
days in advance of the effective date if licensed for 50 or more beds.
(6) If a change of
ownership of the assisted living program is occurring, the new owner shall:
(a) Submit an
application for an assisted living program license on the form developed by and
in the manner established by the Department; and
(b) Submit all required
attachments.
(7) If approved, the
Department shall issue a license to the assisted living program.
(8) Upon receipt of a
new license, all use of the previously issued assisted living licensee shall
immediately cease.
(9) A licensee named in
the original license shall remain responsible for the operation of the assisted
living program until a new license is issued to the new owner, and the current
licensee shall remain responsible for correction of all outstanding
deficiencies or impending sanctions until a new license is issued to the new
owner.
G. Voluntary Closure.
(1) An assisted living
program shall notify the Department of any intention to voluntarily close:
(a) Within 60 calendar
days in advance of the closure if licensed for 49 or fewer beds; or
(b) Within 75 calendar
days in advance of the closure if licensed for 50 or more beds.
(2) The assisted living
program shall include the following information in the notice to the
Department:
(a) The method for
informing residents and resident representatives of its intent to close, change
ownership, change location, or sell its assisted living program; and
(b) The actions the
assisted living program will take to assist residents in securing comparable
housing and assistance, if necessary.
(3) An assisted living
program shall notify residents and resident representatives of a voluntary
closure, in writing:
(a) Within 60 calendar
days in advance of the closure if licensed for 49 or fewer beds; or
(b) Within 75 calendar
days in advance of the closure if licensed for 50 or more beds.
(4) The assisted living
program shall provide at least weekly updates to the OHCQ, including:
(a) Number of residents
remaining in the facility;
(b) Number of residents
with plans for relocation; and
(c) Number of residents
with no plans for relocation.
(5) In addition to the
notice to the Department required by §B of this regulation, after a program
closes, the assisted living program shall:
(a) Notify the
Department of the date of closure and the place of relocation of each resident;
and
(b) Cease all use of
the previously issued assisted living program license.
H. Voiding of License.
(1) Maryland State
Department of Assessments and Taxation (SDAT).
(a) A licensed assisted
living program shall remain in good standing with (SDAT).
(b) If the assisted
living program fails to return to good standing 60 calendar days after receipt
of notification of noncompliance from SDAT or another government agency, the
Department may void the assisted living program’s license.
(2) Ceases the
Provision of Services.
(a) A license is void
if the assisted living program ceases to provide services to residents for a
period of 180 consecutive days.
(b) The owner shall
immediately cease all use of the previously issued assisted living program
license when the license is voided.
I. Surrender of
License.
(1) Unless the
Department agrees to accept the surrender of a license, an assisted living
program may not surrender a license to operate an assisted living program nor
may the license lapse by operation of law while the licensee is under
investigation or while charges are pending against the licensee.
(2) The Department may
set conditions on its agreement with the licensee under investigation or
against which charges are pending to accept surrender of the license.
.09
Licensure Standards Waiver.
A. The Department may grant an assisted living program a waiver
from the licensure requirements of this chapter with or without conditions.
B. The Department may not, however, grant a waiver from the
requirements of Regulation .23A of this chapter. If, however, two individuals
having a long-term or otherwise significant relationship wish to be admitted to
a program in order to reside in the program together, and one of the
individuals requires care as defined in Regulation .23A of this chapter, the
Department may grant a waiver consistent with the process established in
Regulation .24 of this chapter.
C. Application for Licensure Standards Waiver.
(1) An assisted living program shall submit a request for a
waiver under this regulation on a form developed and in the manner established
by the Department.
(2) The requestor shall provide in writing the:
(a) Regulation from which a waiver is sought;
(b) Reason the assisted living program is unable to comply with
the regulation;
(c) Reason that compliance with the regulation will impose a
substantial hardship; and
(d) Reason that a waiver will not adversely affect residents.
D. Evaluation of Application for Licensure Standards Waiver. In
evaluating a waiver request submitted under this regulation, the Department
shall review the statements in the application, and may:
(1) Inspect the assisted living program;
(2) Confer with the assisted living manager or designee; or
(3) Discuss the request with residents or their representatives
to determine whether they believe a waiver is in the residents’ best interest.
E. Grant or Denial of Licensure Standards Waiver.
(1) The Department may grant a waiver request if it determines
that:
(a) Compliance with the regulation from which the waiver is
sought cannot be accomplished without substantial hardship; and
(b) A waiver will not adversely affect residents.
(2) If the Department determines that the conditions of §E(1) of
this regulation are not met, the Department shall deny the request for a
waiver. The denial of a waiver may not be appealed.
F. Written Decision.
(1) The Department shall issue and mail to the applicant a final
written decision on a waiver request submitted under §A of this regulation
within 45 calendar days from receipt of the request and all appropriate
supporting information.
(2) If the Department grants the waiver, the written decision
shall include the waiver’s duration and any conditions imposed by the
Department.
G. If an assisted living program violates any condition of the
waiver, or if it appears to the Secretary that the health or safety of
residents residing in the assisted living program will be adversely affected by
the continuation of the waiver, a waiver may be revoked. The revocation of a
waiver may not be appealed.
.10
Uniform Disclosure Statement.
B. If an individual requests a copy of an assisted living
program’s Uniform Disclosure Statement, the assisted living program shall
provide a copy of the Uniform Disclosure Statement on a form provided by the
Department without cost to the individual making the request.
C. An assisted living program shall provide a copy of the
current Uniform Disclosure Statement to individuals as part of the program’s
marketing materials.
.11 Investigation by Department.
A. Assisted Living Program to Be Open for Inspection.
(1) An assisted living program operated by a licensee, and any
premises proposed to be operated as an assisted living program, shall be open
at all times to announced or unannounced inspections by the Department and by
any agency designated by the Department.
(2) Any part of the facility, and any surrounding accessory
buildings which may be entered by staff or residents, are considered part of
the facility and are subject to inspection.
(3) An assisted living program and any premises proposed to be
operated as an assisted living program may not deny access to the Department or
any agency designated by the Department.
(4) At all times, the staff on duty at an assisted living
program shall know how to contact the assisted living manager, alternate
assisted living manager, delegating nurse, and alternate delegating nurse.
B. Records and Reports.
(1) Inspection.
(a) An assisted living program shall maintain records and
reports.
(b) The records and reports may be paper or electronic
documents.
(c) The records and reports shall be open to inspection by the
Department or its designee.
(d) Except for the records permitted to be stored off-site, an
assisted living program shall immediately, upon request, provide copies of
records and reports, including medical records of residents, to the Department
or its designee.
(2) Maintenance.
(a) The assisted living program shall maintain files on-site
pertaining to:
(i) Current residents;
(ii) Residents who have been discharged within the last 6
months;
(iii) Staff; and
(iv) Quality assurance activities.
(b) The files listed in §B(2)(a) of this regulation shall be
maintained on-site at the licensed assisted living program where residents
receive assisted living services.
(c) All other records may be stored off-site but shall be
available for inspection within 24 hours of a request from the Department or
the Department’s designee.
C. Posting of Documents. An assisted living program shall post
the following documents in a conspicuous place that is visible to residents,
potential residents, and other interested parties:
(1) All of the following:
(a) The notice of compliance or the statement of deficiencies
and the plan of correction for the most recent annual licensure survey; and
(b) The notice of compliance or the statement of deficiencies
and the plan of correction for all surveys conducted since the last annual
licensure survey; or
(2) A notice describing where in the facility the items listed
in §C(1) of this regulation may be found.
D. Notice of Deficiencies.
(1) If a survey identifies noncompliance with a requirement, the
Secretary shall issue a notice:
(a) Citing each deficiency;
(b) Requiring the assisted living program to submit an
acceptable plan of correction within 10 calendar days of receipt of the
statement of deficiencies;
(c) Notifying the assisted living program of sanctions or that
failure to correct the violation may result in sanctions; and
(d) Offering the assisted living program the opportunity for
informal dispute resolution (IDR).
(2) The plan of correction referred to in §D(1)(b) of this
regulation shall include:
(a) How the assisted living program will correct each
deficiency;
(b) The date by which each deficient practice will be corrected;
(c) How the assisted living program will prevent the deficient
practice from recurring; and
(d) Who will be responsible for ensuring the deficiency will not
reoccur.
(3) Failure to return an acceptable plan of correction within
the allotted time frame may result in a sanction.
(4) A request for an IDR does not change the assisted living
program’s requirement to submit a plan of correction for all deficiencies
within 10 calendar days after receipt of the notice of deficiency.
E. Informal Dispute Resolution (IDR).
(1) An assisted living program may request an IDR to dispute one
or more deficiencies in a statement of deficiencies.
(2) The assisted living program shall submit the request for an
IDR to the Department within 10 calendar days of receiving the statement of
deficiencies.
(3) The written request for an IDR shall fully describe the
disagreement with the statement of deficiencies and be accompanied by all
evidence for the Department’s consideration.
(4) At the discretion of the Department, the IDR may be held in person,
by telephone, by video conference, or in writing.
(5) IDRs are informal in nature and are not attended by legal
counsel representing the assisted living program or the Department.
(6) The IDR process may not delay the effective date of any
enforcement action.
(7) In the event an assisted living program requests an IDR of a
deficiency written by a designee of the Department, the Department shall
request the designee to participate in the IDR process.
(8) There is no appeal of the Department’s decision in an IDR.
A. The Department shall be responsible for monitoring and
inspecting assisted living programs to determine compliance with the
requirements of this chapter.
B. Consistent with an interagency agreement, the Department may
delegate certain aspects of its monitoring, inspection, or waiver
responsibilities to the Department of Aging or a local health department.
C. The Department or its designee may conduct announced or
unannounced surveys.
D. An assisted living program shall be surveyed on-site, at
least annually. The Department may extend the time between surveys to up to 18
months if the assisted living program has:
(1) No outstanding plan of correction;
(2) No complaints or facility-reported incidents pending
investigation;
(3) No settlement agreement in effect;
(4) No outstanding civil money penalty; and
(5) No sanctions in effect.
E. The Department, or those agencies delegated responsibility
under this regulation, may inspect an assisted living program more frequently
than annually if it is considered necessary to determine compliance with this
chapter.
.13 Administration.
A. Quality Assurance.
(1) The assisted living program manager or their designee shall
develop and implement a quality assurance plan.
(2) Quality Assurance Plan.
(a) The quality assurance plan shall include an annual facility
risk assessment for tuberculosis, in accordance with the CDC Guidelines for
Preventing the Transmission of Mycobacterium tuberculosis in Health-Care
Settings, 2005.
(b) The assisted living manager and the delegating nurse shall
meet at least every 6 months to review the:
(i) Change in status of the assisted living program’s residents;
(ii) Service plan requirements; and
(iii) Written recommendations, findings, and outcomes of
pharmacy reviews, as required by Regulation .31I of this chapter.
(c) The assisted living manager shall document the proceedings
of the meeting referred to in §A(2)(b) of this regulation.
B. Family Council.
(1) If assisted living program residents have a family council,
the assisted living program shall make reasonable attempts to support and
cooperate with the family council.
(2) The family council for an assisted living program may
include the following members:
(a) Members of a current resident’s family;
(b) An individual appointed by a current resident who has the
capacity to appoint an individual;
(c) A resident representative; or
(d) An individual appointed by a resident representative.
(3) The assisted living program shall provide the family council
the right to privacy for meetings and, if possible, the space to meet
privately.
(4) Staff members may attend a meeting only if requested by the
family council.
(5) The assisted living program shall consider the family
council’s recommendations and grievances and attempt to accommodate those
recommendations and grievances that affect residents’ quality of life.
(6) The assisted living program shall respond in writing within
30 calendar days to the family council when it has received written requests or
grievances from the council.
C. Resident Council.
(1) If an assisted living program has a resident council, the
assisted living program shall make reasonable attempts to support and cooperate
with the resident council.
(2) A resident council includes current residents of the
assisted living program.
(3) The assisted living program
shall provide the resident council the right to privacy for meetings and, if
possible, the space to meet privately.
(4) Staff members may attend a meeting only if requested by the
resident council.
(5) The assisted living program shall consider the council’s
recommendations and grievances and attempt to accommodate those recommendations
and grievances that affect the residents’ quality of life.
(6) The assisted living program shall respond in writing within
30 calendar days to the resident council when it has received written requests
or grievances from the council.
A. Following an analysis of the number of residents that the
assisted living program intends to serve and the individual needs of each
resident, the assisted living program shall develop a staffing plan that
identifies the type and number of staff needed to provide the services required
by this chapter.
B. The assisted living program shall employ or contract with
sufficient numbers of staff to comply with the:
(1) Requirements of this chapter;
(2) Standards of care for the specific conditions of the
residents the assisted living program serves; and
(3) All other applicable laws and regulations.
C. Resident Care Needs.
(1) The resident’s care needs shall determine the:
(a) Need, amount, and frequency of nursing overview by the
registered nurse;
(b) Need for on-site nursing services; and
(c) Need for awake overnight staff.
(2) The Department may approve a waiver of the requirement for
awake overnight staff when the assisted living program has demonstrated to the
Department its use of an effective electronic monitoring system.
(3) The Department may not approve a waiver for awake overnight
staff on an Alzheimer’s Special Care Unit.
(4) The assisted living program shall comply with applicable
requirements of COMAR 10.27.09.
D. On-Site Staff.
(1) The staffing plan shall include on-site staff sufficient in
number and qualifications to meet the 24-hour scheduled and unscheduled needs
of the residents.
(2) When a resident is in the facility, a staff member shall be
present.
(3) When a resident is expected to return to the assisted living
program, a staff member shall be present.
(4) A staffing schedule shall:
(a) Be maintained on-site;
(b) Include the date, shift hours, and identifying name of all
staff members scheduled to work; and
(c) Be kept on file for 18 months.
E. Awake Overnight Staff.
(1) An assisted living program shall provide awake overnight
staff when a resident’s assessment using the Resident Assessment Tool indicates
that awake overnight staff is required according to instructions on that tool.
(2) If a health care practitioner or assessing registered nurse,
in the health care practitioner’s or registered nurse’s clinical judgment, does
not believe that a resident requires awake overnight staff, the health care
practitioner or assessing registered nurse shall document the reasons in the
area provided in the Resident Assessment Tool.
(3) The assisted living program shall retain this documentation
in the resident’s record.
(4) Awake overnight staff are required on an approved Alzheimer’s
Special Care Unit.
F. Electronic Monitoring Systems.
(1) Upon the written recommendation of the resident’s health
care practitioner, the assisted living program may apply to the Department for
a waiver in accordance with Regulation .09 of this chapter to use an electronic
monitoring system instead of awake overnight staff.
(2) If an electronic monitoring system is approved by the
Department for the assisted living program to use, the licensee shall document
the approval of the electronic monitoring system in the area provided on the
Resident Assessment Tool.
(3) When a resident is assessed or reassessed using the Resident
Assessment Tool, the health care practitioner shall review and document the:
(a) Need for awake overnight staff if the resident’s previous
assessment or review of an assessment indicated awake overnight staff was not
necessary at the time; and
(b) Continued appropriateness of a waiver to use an approved
electronic monitoring system instead of awake overnight staff.
(4) The assisted living program shall comply with applicable
requirements of COMAR 10.27.09.
(5) The Department may not approve a waiver for awake overnight
staff on an Alzheimer’s Special Care Unit.
G. On-Site Nursing Requirements.
(1) An assisted living program shall provide on-site nursing
when a delegating nurse or health care practitioner, based upon the needs of a
resident, issues a nursing or clinical order for that service.
(2) If an assisted living manager determines that a nursing or
clinical order should not or cannot be implemented, the assisted living
manager, delegating nurse, and resident’s health care practitioner shall
discuss any alternatives that could safely address the resident’s needs.
(3) The assisted living manager shall document in the resident’s
record this discussion and all individuals who participated in the discussion.
(4) If there are alternatives that could safely address the
resident’s needs, the assisted living manager shall notify the resident and, if
appropriate, the resident’s legal representative, the delegating nurse, and
resident’s health care practitioner of the change to the order.
(5) The assisted living manager shall document in the resident’s
record this change and the date of notification.
(6) If an assisted living manager fails to implement a nursing
or clinical order without identifying and providing alternatives to the care or
service order, the delegating nurse shall notify the resident’s health care
practitioner, the OHCQ, and the resident or, if appropriate, the legal
representative of the resident.
(7) Failure to implement a nursing or clinical order, without
demonstrating why the order should not be followed or without identifying
alternatives to care, may result in sanctions against the assisted living
program and referral of a licensed or certified staff to the appropriate health
occupations licensing board.
H. On-site nursing personnel shall work in partnership with the
delegating nurse and assisted living program staff to ensure:
(1) Adequate assessment of residents;
(2) Planning of medical services; and
(3) Oversight of nursing activities.
A. Qualifications.
(1) An individual shall be licensed as required by Health
Occupations Article, §9-3A-01, Annotated Code of Maryland, before the
individual may practice as an assisted living manager in Maryland.
(2) The assisted living manager shall at a minimum:
(a) Be 21 years old or older;
(b) Possess a high school diploma, a high school equivalency
diploma, or other appropriate education and have experience to conduct the
responsibilities specified in §C of this regulation;
(c) For level 3 licensed programs, have:
(i) A 4-year, college-level degree;
(ii) 2 years experience in a health care related field and 1
year of experience as an assisted living program manager or alternate assisted
living manager; or
(iii) 2 years experience in a health care related field and
successful completion of an 80-hour assisted living manager training course
approved by the Department;
(e) Be immune to measles, mumps, rubella, and varicella as
evidenced by history of disease or vaccination;
(f) Have no criminal convictions or other criminal history that
indicates behavior that is potentially harmful to residents, documented through
either a criminal history records check or a criminal background check,
completed within 1 month before employment;
(g) Have sufficient skills, training, and experience to serve
the residents in a manner that is consistent with the philosophy of assisted
living;
(h) Have verifiable knowledge in:
(i) The health and psychosocial needs of the population being
served;
(ii) The resident assessment process;
(iii) Use of service plans;
(iv) Cuing, coaching, and monitoring residents who
self-administer medications, with or without assistance;
(v) Providing assistance with ambulation, personal hygiene,
dressing, toileting, and feeding; and
(vi) Resident rights;
(i) Receive initial and annual training
in:
(i) Fire and life
safety;
(ii) Infection control,
including standard precautions;
(iii) Emergency
disaster plans; and
(iv) Basic food safety;
and
(j) Receive initial
certification and recertification every 2 years for:
(i) Basic first aid
taught by a first aid instructor certified by a national organization; and
(ii) Basic
cardiopulmonary resuscitation (CPR), including a hands-on component, taught by
a CPR instructor certified by a nationally recognized organization.
(3) An assisted living manager who has completed the training
and passed the examination set forth in Regulation .16 of this chapter shall be
presumed to have met the knowledge requirements of §A(1)(g) and (h) of this
regulation.
B. The Department may determine that an individual is not
sufficiently qualified to serve as an assisted living manager if that
individual’s managerial or administrative experience, or education, is not
sufficient to perform the responsibilities set forth in §C of this regulation
for the residents the assisted living program intends to serve.
C. Duties. The assisted living manager shall:
(1) Be on-site or available on call; and
(2) Have overall responsibility for:
(a) The management of the assisted living program, including
recruiting, hiring, training, and supervising all staff, and ensuring that
either a criminal history records check or a criminal background check is
conducted consistent with the requirements of Health-General Article, Title 19,
Subtitle 19, Annotated Code of Maryland;
(b) The development and implementation of a staffing plan, which
includes an orientation and ongoing training program for all staff, with
specific training in the management, assessment, and programming for the
resident with cognitive impairment as required by Health-General Article,
§19-319.1, Annotated Code of Maryland;
(c) The development and implementation of all policies,
programs, and services as required by this chapter;
(d) Requiring all employees to perform hand hygiene with either
soap and water or an alcohol-based hand sanitizer before and after each direct
resident contact for which hand hygiene is indicated by acceptable practice;
(e) Providing or ensuring, through the coordination of community
services, that each resident has access to appropriate medical and psychosocial
services, as established in the resident service plan developed under
Regulation .28 of this chapter;
(f) Ensuring that there is appropriate coordination of all
components of a resident’s service plan, including necessary transportation and
delivery of needed supplies;
(g) Ensuring that there is appropriate oversight and monitoring
of the implementation of each resident’s service plan;
(h) Ensuring that all record keeping conforms to the
requirements of this chapter and other applicable laws;
(i) Ensuring that all requirements of this chapter and other
applicable laws are met;
(j) Implementing a nursing or clinical order of the delegating
nurse or documenting in the resident’s record why the order should not be
implemented;
(k) Notifying the Department:
(i) When the manager terminates the program’s contract with or
employment of a delegating nurse; and
(ii) Of the reason why the contract or employment was
terminated;
(l) Notifying the resident and, if applicable, the resident
representative or interested family member of any:
(i) Significant change in condition of the resident;
(ii) Adverse event that may result in a change in condition;
(iii) Outcome of the resident’s care that results in an
unanticipated consequence; and
(iv) Corrective action, if any;
(m) Ensuring that the annual influenza vaccine has been advised
in accordance with current CDC recommendations and documented surveillance of
non-immune staff when indicators of local influenza activity are elevated; and
(n) Ensuring that the COVID-19 vaccine has been advised in
accordance with current CDC recommendations and documented surveillance of
non-immune staff when indicators of local COVID-19 activity are elevated.
.16 80-Hour Assisted Living Manager Training
Course.
A. In addition to the requirements in Regulation .15 of this
chapter, by January 1, 2006, an assisted living manager shall complete an
80-hour manager training course that is approved by the Department.
B. The completed manager’s training course shall:
(1) Consist of 80 hours of course work and include an
examination;
(2) Consist of training programs that include direct
participation between faculty and participants; and
(3) Include not more than 25 hours of training through Internet
courses, correspondence courses, tapes, or other training methods that do not
require direct interaction between faculty and participants.
C. An assisted living manager employed in a program shall
complete 20 hours of Department-approved continuing education every 2 years.
D. A program that fails to employ an assisted manager who meets
the requirements of this regulation may be subject to:
(1) Sanctions under Regulation .57 of this chapter; and
(2) A civil money penalty not to exceed $10,000.
E. The training requirements of §A of this regulation do not
apply to an individual who:
(1) Is employed by a program and has enrolled in a
Department-approved manager training course that the individual expects to
complete within 6 months;
(2) Is temporarily serving as an assisted living manager under Health
Occupations Article, §9-3A-01, Annotated Code of Maryland, due to an assisted
living manager leaving employment and before the hiring of a permanent manager;
(3) Has been employed as an assisted living manager in this
State for 1 year before January 1, 2006; or
(4) Is licensed as a nursing home administrator in this State.
F. The Department may require an individual who is exempt under
the provisions of §E of this regulation to complete a manager training course
and examination if:
(1) The Department finds that the assisted living manager
repeatedly has violated State law or regulations on assisted living; and
(2) Those violations have caused or have the potential to cause
physical or emotional harm to a resident.
.17
80-hour Assisted Living Manager Basic Training Course.
A. The 80-hour assisted living manager basic training course
shall include the following content:
(1) Philosophy of assisted living, 2 hours, including:
(a) Philosophy and background of assisted living and aging in
place;
(b) Objectives and principles of assisted living resident
programs;
(c) Comparison of assisted living to other residential programs;
(d) Basic concepts of choice, independence, privacy,
individuality, and dignity; and
(e) Normalization of the environment;
(2) Aging process and its impact, 4 hours, including:
(a) Physical characteristics of the assisted living residents;
(b) Psychosocial characteristics of the assisted living
residents;
(c) Basic needs of the elderly and disabled; and
(d) Activities of daily living;
(3) Assessment and level of care waiver, 6 hours, including:
(a) Purpose and process;
(b) Guidelines for conducting assessments;
(c) Level of care assessments; and
(d) Collaboration with the delegating nurse;
(4) Service planning, 6 hours, including:
(a) Required services;
(b) Enhanced scope of services;
(c) Development of individualized service plans;
(d) Scheduling of appropriate activities;
(e) Structure of activities;
(f) Care notes; and
(g) Collaboration with the delegating nurse;
(5) Clinical management, 20 hours, including:
(a) Role of the delegating nurse;
(b) Appropriate nurse delegation;
(c) Concept of self-administration of medications;
(d) Concept of medication management;
(e) Assistance with self-administration of medications;
(f) Administration of medications;
(g) Coordination of services and care providers;
(h) Collaboration with the delegating nurse;
(i) Preventing medication errors;
(j) Patient safety;
(k) Medication monitoring;
(l) Pharmacy consultation;
(m) Medication storage;
(n) Infection prevention and control to include:
(i) Standard and contact precautions;
(ii) Bloodborne pathogens;
(iii) Standard hand hygiene practices;
(iv) Safe injection practices;
(v) Use of personal protective equipment; and
(vi) Cleaning and disinfection of equipment and the environment;
(o) Appropriate staffing patterns;
(p) Pressure sores;
(q) Effective pain management;
(r) Basic first aid taught by a first aid instructor certified
by a national organization;
(s) Basic cardiopulmonary resuscitation (CPR), including a
hands-on component, taught by a CPR instructor certified by a nationally
recognized organization; and
(t) Substance abuse;
(6) Admission and discharge criteria, 4 hours, including:
(a) Overview of criteria for admission and discharge;
(b) Resident contracts;
(c) Resident rights;
(d) Financial management of resident’s funds; and
(e) Working with families of residents;
(7) Nutrition and food safety, 8 hours, including:
(a) Menu and meal planning;
(b) Basic nutritional needs;
(c) Safe food handling;
(d) Preventing food-borne illnesses;
(e) Therapeutic diets; and
(f) Dehydration;
(8) Dementia, mental health, and behavior management, 12 hours,
including:
(a) An overview consisting of:
(i) Description of normal aging and conditions causing cognitive
impairment;
(ii) Description of normal aging and conditions causing mental
illness;
(iii) Risk factors for cognitive impairment;
(iv) Risk factors for mental illness;
(v) Health conditions that affect cognitive impairment;
(vi) Health conditions that affect mental illness;
(vii) Early identification and intervention for cognitive
impairment;
(viii) Early identification and intervention for mental illness;
and
(ix) Procedures for reporting cognitive, behavioral, and mood
changes;
(b) Effective communication consisting of:
(i) Effect of cognitive impairment on expressive and receptive
communication;
(ii) Effect of mental illness on expressive and receptive
communication;
(iii) Effective communication techniques, including verbal,
nonverbal, tone and volume of voice, and word choice; and
(iv) Environmental stimuli and influences on communication,
including setting, noise, and visual cues;
(c) Behavioral intervention consisting of:
(i) Identifying and interpreting behavioral symptoms;
(ii) Problem solving for appropriate intervention;
(iii) Risk factors and safety precautions to protect other residents
and the individual;
(iv) De-escalation techniques; and
(v) Collaboration with the delegating nurse;
(d) Making activities meaningful consisting of:
(i) Understanding the therapeutic role of activities;
(ii) Creating opportunities for activities, including
productive, leisure, and self-care; and
(iii) Structuring the day;
(e) Staff and family interaction consisting of:
(i) Building a partnership for goal-directed care;
(ii) Understanding family needs; and
(iii) Effective communication between family and staff; and
(f) Managing staff stress consisting of:
(i) Understanding the impact of stress on job performance, staff
relations, and overall facility environment;
(ii) Identification of stress triggers;
(iii) Self-care skills;
(iv) De-escalating techniques; and
(v) Devising support systems and action plans;
(9) End of life care, 4 hours, including:
(a) Advance directives;
(b) Hospice care;
(c) Maryland Medical Orders for Life-Sustaining Treatment
(MOLST) order form;
(d) Power of attorney;
(e) Appointment of a health care agent;
(f) Living will;
(g) Pain management;
(h) Providing comfort and dignity; and
(i) Supporting the family;
(10) Management and operation, 4 hours, including:
(a) Role of the assisted living manager;
(b) Overview of accounting, accounts payable, and accounts
receivable;
(c) The revenue cycle and budgeting;
(d) The basics of financial statements;
(e) Hiring and training of staff;
(f) Developing personnel policies and procedures;
(g) Census development; and
(h) Marketing;
(11) Emergency planning, 4 hours, including:
(a) Fire, disaster, and emergency preparedness;
(b) Occupational Safety and Health Administration (OSHA)
requirements;
(c) Maintaining the building, grounds, and equipment;
(d) Elopements;
(e) Transfers to the hospital;
(f) Evacuations;
(g) Power outages;
(h) Severe weather;
(i) Fire;
(j) Emergency response systems; and
(k) Security systems;
(12) Quality assurance, 4 hours, including:
(a) Incident report processes; and
(b) Quality improvement processes; and
(13) Survey process, 2 hours, including:
(a) State statutes and regulations;
(b) What to expect during a survey; and
(c) Documentation.
B. A person seeking to offer the assisted living manager
training course shall request and obtain approval by the Department by:
(1) Submitting the proposed curriculum and training materials to
the Department; and
(2) Being available for an in-person or telephone interview by
the Department.
.18 Alternate Assisted Living Manager.
An alternate assisted living manager shall:
A. Be available to assume the responsibilities described in
Regulation .15C(2)(a)—(l) of this chapter when the assisted living manager is
not available;
B. Be 21 years old or older;
C. Have 2 years of experience in a health-related field; and
D. Meet the qualifications of Regulation .19B(1)—(7) of this
chapter.
.19
Other Staff — Qualifications.
A. Age Requirements of Other Staff.
(1) Direct resident care staff shall be:
(a) 18 years old or older; or
(b) 16 or 17 years old who are enrolled in a certified nursing
assistant training program and are supervised until certified.
(2) Other staff not performing direct resident care may be younger
than 18 years old.
B. Qualifications of Other Staff. The qualifications of other
staff include:
(1) Evidence that the staff is:
(a) Free from tuberculosis in a communicable form in accordance
with Guidelines for Preventing the Transmission of Mycobacterium tuberculosis
in Health-Care Facilities;
(b) Immune to measles, mumps, rubella, and varicella as
evidenced by history of disease or vaccination; and
(c) Free from any impairment which would hinder the performance
of assigned responsibilities;
(2) Having no criminal convictions or criminal history that
indicates behavior that is potentially harmful to residents, as evidenced
through a criminal background check completed within 30 calendar days before
employment;
(3) Having sufficient skills, education, training, and
experience to serve the residents in a manner that is consistent with the
philosophy of assisted living;
(4) Participating in and completing an orientation program and
ongoing training to ensure that the residents receive services that are
consistent with their needs and generally accepted standards of care for the
specific conditions of those residents to whom staff will provide services;
(5) Receiving initial and annual
training in:
(a) Fire and life
safety, including the use of fire extinguishers;
(b) Infection control,
including standard precautions, contact precautions, and hand hygiene;
(c) Basic food safety;
and
(d) Emergency disaster
plans;
(6) Completing basic
first aid training taught by a first aid instructor certified by a national
organization and recertification every 2 years;
(7) Having training or experience in:
(a) The health and psychosocial needs of the population being
served as appropriate to their job responsibilities;
(b) The resident assessment process;
(c) The use of service plans; and
(d) Resident’s rights; and
(8) Holding appropriate licensure or certification as required
by law.
C. With the exception of certified nursing assistants (CNAs) and
geriatric nursing assistants (GNAs), if job duties involve the provision of
personal care services as described in Regulation .30E of this chapter, an
employee:
(1) Shall demonstrate competence to the delegating nurse before
performing these services; and
(2) May work for 10 calendar days before demonstrating to the
delegating nurse that they have the competency to provide these services, if
the employee performing the tasks is accompanied by:
(a) A certified nursing assistant;
(b) A geriatric nursing assistant; or
(c) An individual who has been approved by the delegating nurse.
E. Relief personnel
shall be available at all times in the event that the regularly scheduled staff
members are unavailable. Relief personnel shall meet the requirements of §B of
this regulation.
F. Proof of training shall include:
(1) Date of class;
(2) Course content;
(3) Documentation of successful completion of the training
content;
(4) Written, electronic, or video proof of attendee
participation; and
(5) Signature, qualifications, and contact information of each
trainer.
G. Training with No Direct Interaction. When the training method
does not involve direct interaction between faculty and participant, the
assisted living program shall make available to the participant a trained
individual to answer questions and respond to issues during the training.
H. Training in Cognitive Impairment,
Mental Illness, and Behavioral Health.
(1) When job duties
involve the provision of personal care services as described in Regulation .30E
of this chapter, employees shall receive a minimum of 6 hours of initial
training on cognitive impairment, mental illness, and behavioral health within
the first 120 calendar days of employment.
(2) The training shall be designed to meet the specific needs of
the assisted living program’s population as determined by the assisted living
manager, including the following, as appropriate:
(a) An overview of the following:
(i) A description of normal aging and conditions causing
cognitive impairment;
(ii) A description of normal aging and conditions causing mental
illness;
(iii) Risk factors for cognitive impairment;
(iv) Risk factors for mental illness;
(v) Health conditions that affect cognitive impairment;
(vi) Health conditions that affect mental illness;
(vii) Early identification of and intervention for cognitive
impairment;
(viii) Early identification of and intervention for mental
illness; and
(ix) Procedures for reporting cognitive, behavioral, and mood
changes;
(b) Effective communication, including:
(i) The effect of cognitive impairment on expressive and
receptive communication;
(ii) The effect of mental illness on expressive and receptive
communication;
(iii) Effective verbal, nonverbal, tone and volume of voice, and
word choice techniques; and
(iv) Environmental stimuli and influences on communication;
(c) Behavioral intervention, including:
(i) Identifying and interpreting behavioral symptoms;
(ii) Problem solving for appropriate intervention;
(iii) Risk factors and safety precautions to protect the
individual and other residents; and
(iv) De-escalation techniques;
(d) Making activities meaningful, including:
(i) Understanding the therapeutic role of activities;
(ii) Creating opportunities for productive, leisure, and
self-care activities; and
(iii) Structuring the day;
(e) Staff and family interaction, including:
(i) Building a partnership for goal-directed care;
(ii) Understanding the needs of families; and
(iii) Effective communication between family and staff;
(f) End of life care, including:
(i) Pain management;
(ii) Providing comfort and dignity; and
(iii) Supporting the family; and
(g) Managing staff stress, including:
(i) Understanding the impact of stress on job performance, staff
relations, and overall facility environment;
(ii) Identification of stress triggers;
(iii) Self-care skills;
(iv) De-escalation techniques; and
(v) Devising support systems and action plans.
(3) When job duties do not involve the provision of personal
care services as described in Regulation .30E of this chapter, employees shall
receive a minimum of 2 hours of training on cognitive impairment, mental
illness, and behavioral health within the first 120 calendar days of
employment. The training shall include:
(a) An overview of the following:
(i) A description of
normal aging and conditions causing cognitive impairment;
(ii) A description of
normal aging and conditions causing mental illness;
(iii) Risk factors for
cognitive impairment;
(iv) Risk factors for
mental illness;
(v) Health conditions
that affect cognitive impairment;
(vi) Health conditions
that affect mental illness;
(vii) Early
identification and intervention for cognitive impairment;
(viii) Early
identification and intervention for mental illness; and
(ix) Procedures for
reporting cognitive, behavioral, and mood changes;
(b) Effective
communication, including:
(i) The effect of
cognitive impairment on expressive and receptive communication;
(ii) The effect of
mental illness on expressive and receptive communication;
(iii) Effective verbal,
nonverbal, tone and volume of voice, and word choice techniques; and
(iv) Environmental
stimuli and influences on communication; and
(c) Behavioral
intervention including risk factors and safety precautions to protect the
individual and other residents.
(a) 2 hours for
employees whose job duties involve the provision of personal care services as
described in Regulation .30E of this chapter; and
(b) 1 hour for
employees whose job duties do not involve the provision of personal care
services as described in Regulation .30E of this chapter.
I. Training may be provided through various means, including:
(1) Classroom instruction;
(2) In-service training;
(3) Internet courses;
(4) Correspondence courses;
(5) Prerecorded training; or
(6) Other training methods approved by the Department.
J. When the training method does not involve direct interaction
between faculty and participant, the assisted living program shall make
available to the participant during the training a trained individual to answer
questions and respond to issues raised by the training.
The assisted living
program shall maintain the following information for each staff member:
A. Full name, age, and
gender;
B. Address and
telephone number;
C. Educational
background;
D. Employment history;
E. Notes on references;
F. Performance
evaluations;
G. Attendance records;
H. Individual to be
notified in case of emergency;
I. Documentation that a
criminal history records check was conducted in accordance with Health-General
Article, §19-1901, Annotated Code of Maryland;
J.
Documentation that the staff is:
(1) Free from tuberculosis in a communicable form in
accordance with Guidelines for Preventing the Transmission of Mycobacterium tuberculosis
in Health-Care Facilities; and
(2) Immune to measles, mumps, rubella, and varicella as
evidenced by history of disease or vaccination;
K. Evidence that the
annual influenza vaccine has been advised in accordance with current CDC
recommendations and documented surveillance of non-immune staff when indicators
of local influenza activity are elevated;
L. Evidence that the
COVID-19 vaccine has been advised in accordance with current CDC
recommendations and documented surveillance of non-immune staff when indicators
of local COVID-19 activity are elevated;
M. Documentation of
appropriate licensure or certification as required by law; and
N. Documentation of all
required training and courses.
A. The assisted living program shall have a current and signed
agreement with a registered nurse for services of a delegating nurse and
delegation of nursing tasks. If the delegating nurse is an employee of the
assisted living program, the employee’s job description may satisfy this
requirement.
B. The program shall maintain documentation that the delegating
nurse has completed the mandatory training course developed by the Board of
Nursing.
C. Duties. The delegating nurse shall:
(1) Be on-site to observe each resident at least every 45 calendar days;
(2) Be available on call at all times as required under this
chapter or have a qualified alternate delegating nurse available on call; and
(3) Have the overall responsibility for:
(a) Managing the clinical oversight of resident care in the
assisted living program;
(b) Issuing nursing or clinical orders, based upon the needs of
residents;
(c) Reviewing the assisted living manager’s assessment of
residents;
(d) Appropriate delegation of nursing tasks; and
(e) Notifying the Department:
(i) If the delegating nurse’s contract or employment with the
assisted living program is terminated; and
(ii) Of the reason why the contract or employment was
terminated.
D. If the delegating nurse is not available to perform any
duties, there shall be a qualified alternate delegating nurse available to
perform those duties.
E. When an assisted living manager fails to implement nursing or
clinical orders without identifying alternatives to the care or service order,
the delegating nurse shall notify the resident’s health care practitioner, the
Department, and the resident, or, if applicable, the resident representative.
.22
Preadmission Requirements.
A. Before Move In.
(1) Before admission the assisted living manager or designee in
corroboration with the delegating nurse shall determine whether:
(a) The resident may be admitted under the assisted living
program’s licensure category;
(b) Requires a level of care that the Department has approved
for the assisted living program; and
(c) The resident’s needs can be met by the program.
(2) Within 30 days before admission, the assisted living manager
or designee shall determine admission eligibilities described in §A(1) of this
regulation based on completion of a resident assessment using the Resident
Assessment Tool as described in §B of this regulation. The Department may
modify the level of care determination made by the assisted living program at
any time. The Resident Assessment Tool:
(a) Determines the resident’s required level of care;
(b) Forms the basis for development of the resident’s service plan;
and
(c) Determines whether the resident needs awake overnight
monitoring.
B. Resident Assessment Tool.
(1) Within 30 days prior to admission, the prospective resident’s
health status shall be documented on the Resident Assessment Tool.
(2) Information on the Resident Assessment Tool shall be based
on an examination conducted by a primary physician, certified nurse
practitioner, certified registered nurse midwife, registered nurse, or
physician assistant that is based on the resident’s current health status.
(3) If the potential resident is admitted on an emergency basis
by a local department of social services, the required assessment using the
Resident Assessment Tool shall be completed as soon as possible but no later
than 14 calendar days after the emergency admission.
(4) Information on the assessment shall include at a minimum:
(a) Recent medical history, including any acute medical
conditions or hospitalizations;
(b) Significant medical conditions affecting functioning,
including the individual’s ability for self-care, cognition, physical
condition, and behavioral and psychosocial status;
(c) Other active and significant chronic or acute medical
diagnoses;
(d) Known allergies to foods and medications;
(e) Medical confirmation that the individual is free from
communicable tuberculosis, and other active reportable airborne communicable
diseases;
(f) Current scheduled and as needed (PRN) medications;
(g) Current and other needed treatments and services for medical
conditions and related problems;
(h) Current nutritional status, risk factors for malnutrition
and dehydration, and, if available, height and weight;
(i) Diets ordered by a health care practitioner;
(j) Medically necessary limitations or precautions; and
(k) Monitoring or tests that need to be performed or followed up
after admission.
C. Reassessment Documented on the Resident Assessment Tool.
(1) The Resident Assessment Tool shall be reviewed at least
every 6 months and the review shall be documented by the delegating nurse and
assisted living manager.
(2) A new Resident Assessment Tool shall be completed:
(a) At least annually;
(b) Within 48 hours, but not later than required by the resident’s
condition, after a significant change in a resident’s condition; and
(c) Within 48 hours of a delegating nurse’s determination that a
new Resident Assessment Tool needs to be completed.
(3) If the previous Resident Assessment Tool did not indicate
the need for awake overnight staff, each reassessment or review of the
assessment shall include documentation as to whether awake overnight staff is
required due to a change in the resident’s condition.
D. Functional Assessment. Within 30 calendar days before
admission, the assisted living manager, or designee, shall collect on the
Resident Assessment Tool the following information regarding the current
condition of each resident:
(1) Level of functioning in activities of daily living;
(2) Level of support and intervention needed, including any
special equipment and supplies required to compensate for the individual’s
deficits in activities of daily living;
(3) Current physical or psychological symptoms requiring
monitoring, support, or other intervention by the assisted living program;
(4) Capacity for making personal and health care related
decisions;
(5) Presence of disruptive behaviors, or behaviors which present
a risk to the health and safety of the resident or others; and
(6) Social factors, including:
(a) Significant problems with family circumstances and personal
relationships;
(b) Spiritual status and needs; and
(c) Ability to participate in structured and group activities,
and the resident’s current involvement in these activities.
E. Resident Requirements for Awake Overnight Staff.
(1) Before admission, the assisted living manager shall ensure
that the resident is assessed using the Resident Assessment Tool.
(2) When the resident scores in any of the areas identified as “Triggers
for Awake Overnight Staff” in the Resident Assessment Tool, the assisted living
program shall provide awake overnight staff or document why awake overnight
staff is not necessary in accordance with Regulation .14E of this chapter.
F. Short-Term Residential Care Requirements.
(1) For persons admitted for short-term residential care, the
following are required:
(a) Current physical condition and medical status as specified
in §B(4) of this regulation;
(b) Functional assessment as specified in §D of this regulation;
and
(c) A resident agreement, in accordance with Regulations .26 and
.27 of this chapter.
(2) If the person is admitted for a subsequent short-term
admission, the following are required:
(a) Current physical condition and medical status as specified
in §B(4) of this regulation;
(b) Functional assessment as specified in §D of this regulation;
and
(c) A new resident agreement or an addendum to the prior
resident agreement.
G. A resident admitted as an emergency placement by a local
department of social services is exempt from all physical examination and
assessment requirements of this regulation if the resident is in temporary
emergency shelter and services status, not to exceed 14 calendar days, with
notification to the Department of the placement within 48 hours.
A. An assisted living program may not provide services to
individuals who at the time of initial admission, as established by the initial
assessment, would require:
(1) More than intermittent nursing care;
(2) Treatment of stage three or stage four skin ulcers;
(3) Ventilator services;
(4) Skilled monitoring, testing, and frequent adjustment of
medications and treatments where there is the presence of a fluctuating acute
condition; or
(5) Monitoring of a chronic medical condition that is not
controllable through readily available medications and treatments.
B. An individual may not be admitted to an assisted living
program who is:
(1) Dangerous to the individual or others when the assisted
living program would be unable to eliminate the danger through the use of
appropriate treatment modalities; or
(2) At high risk for health or safety complications which cannot
be adequately managed.
C. The provisions of §§A and B of this regulation do not apply
to a resident being admitted to an assisted living program when the resident is
under the care of a general hospice care program licensed by the Department
which ensures delivery of one or more of the services described under §§A and B
of this regulation through the hospice program’s plan of care.
.24 Resident-Specific Level of Care Waiver.
A. An assisted living program may request a resident-specific
waiver to continue to provide services to a resident if:
(1) The resident’s level of care exceeds the level of care for
which the assisted living program has authority to provide; or
(2) The resident would require care that falls into one of the
categories set forth in Regulation .23.
B. An assisted living program may not continue providing
services to a resident whose needs exceed the level of care for which the
licensee has authority to provide, without approval of the Department.
C. Temporary Change in Level of Care.
(1) A level of care waiver is not required for a resident whose
level of care is expected to increase for a period not to exceed 30 calendar
days.
(2) The assisted living program shall submit a waiver
application as soon as program personnel determine that the increased level of
care or the condition requiring the waiver is likely to exceed 30 calendar
days.
D. When requesting a resident-specific waiver, the assisted
living program shall demonstrate that:
(1) The assisted living program has the capability of meeting
the needs of the resident; and
(2) The needs of other residents will not be jeopardized.
E. Approval of Waiver Request.
(1) The Department may grant a resident-specific level of care
waiver, with or without conditions, if the Department determines that the:
(a) Resident’s needs can be met;
(b) Needs of other residents will not be jeopardized; and
(c) Provider complies with the requirements of Regulation .47A
of this chapter.
(2) Terms of a Resident-Specific Waiver.
(a) An approved resident-specific waiver applies only to the
resident for whom the waiver was granted.
(b) The waiver no longer applies if the resident’s level of
care, as determined through an assessment, declines or improves to the point
that the resident requires a higher or lower level of care than authorized by
the waiver.
(c) When the Department grants a waiver to continue to provide
services to a resident whose needs fall within one of the categories in
Regulation .23, the assisted living program shall, at a minimum, comply with
certain federal Medicare requirements for home health agencies referenced in 42
CFR §§484.1, 484.2, 484.40—484.80, 484.100—484.115, 484.200—484.265, and
484.300—484.375.
F. Denial of a Resident-Specific Waiver Request.
(1) The Department shall deny the request for a
resident-specific waiver if the Department determines that the:
(a) Assisted living program is not
capable of meeting the needs of the resident; or
(b) Needs of other residents will be jeopardized if the waiver
request is granted.
(2) The Department may not grant resident-specific waivers:
(a) That total more than 50 percent of the assisted living
program’s bed capacity for residents whose needs exceed the level of care for
which the assisted living program has authority to provide as specified in
Regulation .04D of this chapter; or
(b) For the continuation of services to a resident whose needs
fall within one of the categories set forth in .23B of this regulation, for up
to 20 percent of capacity, or 20 beds, whichever is less, unless a waiver is
granted by the Department.
(3) The decision of the Department may not be appealed.
(4) The Department’s denial of a resident-specific level of care
waiver request:
(a) Does not prohibit the resident from being admitted to
another program that is capable of meeting the resident’s needs and is licensed
to provide that level of care; and
(b) Does not provide any exception to the admission restrictions
set forth in .23A of this regulation.
(5) If the Department initially denies a resident-specific level
of care waiver request and determines that a resident’s health or safety may
significantly deteriorate because of the provider’s inability to provide or
ensure access to care that will meet the needs of the resident, the:
(a) Denial is not subject to informal dispute resolution; and
(b) Department may direct the relocation of the resident to a
safe environment.
G. The Department’s Decision.
(1) The Department shall communicate the decision to grant or
deny a resident-specific waiver to the assisted living manager in writing,
including all appropriate supporting documentation, within 7 calendar days from
receipt of the waiver request.
(2) Dispute of a Resident-Specific Waiver.
(a) If the resident or the resident representative disagrees
with the Department’s denial of a waiver request, the resident or, as
applicable, the resident representative may dispute the Department’s decision
by:
(i) Submitting a written request to the Department within 7
calendar days after receipt of the Department’s denial; and
(ii) Including in the written request the reasons why the
Department’s denial may be incorrect.
(b) The Department shall consider the request and notify the
resident or the resident representative within 7 calendar days of receipt of
the request whether or not the Department’s decision to deny a level of care
waiver is sustained.
(c) The Department’s decision from the dispute is not:
(i) A contested case as defined in State Government Article,
§10-202(d), Annotated Code of Maryland; or
(ii) Subject to further appeal.
(d) In making a decision to sustain or change the decision to
deny a waiver request, the Department shall consider, among other factors,
whether the:
(i) Granting of waivers has resulted in one or more residents
having experienced a decline in their physical, functional, or psychosocial
well-being; and
(ii) Decline in the residents’ condition might have been
prevented had the waivers not been granted.
(e) If the Department sustains the decision to deny the waiver
request, the Department shall notify the assisted living program of what action
is required, including, but not limited to:
(i) Revocation of some or all of the resident-specific waivers
which have been granted; or
(ii) A change in licensure category.
(f) Decision to Sustain the Denial of Waiver Request.
(i) Upon notification of the decision to sustain the denial of
waiver, the assisted living program shall submit a response with an appropriate
plan of action for approval by the Department.
(ii) If the Department does not approve the assisted living
program’s plan of action, the Department shall notify the assisted living
program that one or more resident-specific waivers are revoked or that a change
in licensure status is required.
(iii) The determination to sustain the denial of waiver request
may not be appealed.
(iv) Failure of the assisted living program to comply with the
Department’s decision is grounds for the imposition of sanctions.
H. The Department shall, during a survey or other inspection, or
when a resident-specific level of care waiver request is made, review the
number of resident-specific waivers an assisted living program holds to ensure
that the assisted living program continues to be able to provide appropriate
care to all of its residents and to ensure that the current licensure category
is appropriate. The Department shall notify the assisted living program if, at
any time, the Department determines that:
(1) The assisted living program is not providing appropriate
care to its residents because of the number of resident-specific waivers it
holds; or
(2) The number of resident-specific waivers an assisted living
program holds necessitates a change in licensure category.
.25
Payment of Funds Before Admission.
If an assisted living program requires payment of funds before
admission, the funds shall be fully refundable unless the assisted living
program discloses, in writing, what portion is not refundable.
.26 Resident Agreement — General Requirements and
Nonfinancial Content.
A. Except as otherwise provided under §E of this regulation, for
a person admitted for other than short-term residential care, the resident or
the resident agent and the assisted living manager or their designee shall
sign, before or at the time of admission, a resident agreement that:
(1) Is a clear and complete reflection of commitments agreed to
by the parties, and the actual practices that will occur in the assisted living
program;
(2) Is accurate, precise, easily understood, legible, readable,
and written in plain English;
(3) Conforms to all relevant State and local laws and
requirements in effect when the agreement is executed; and
(4) Recommends review of the agreement by an attorney or other
representative chosen by the resident.
B. For a person admitted for short-term residential care, the
resident or the resident agent and the assisted living manager or their
designee shall sign, before or at the time of admission, a resident agreement
as set forth in this regulation excluding the provisions of §D(9)(c) and 8(d)
and (e) of this regulation.
C. The assisted living program shall:
(1) Give a copy of the signed resident agreement to the resident
and the resident agent;
(2) Maintain a copy of the resident agreement on-site; and
(3) Make the resident agreement available for review by the
Department or its designee.
D. The resident agreement shall include, at a minimum, the
following provisions:
(1) A statement of the level of care for which the assisted
living program is licensed;
(2) The level of care needed by the resident, as determined by
the initial assessment required by Regulation .05 of this chapter;
(3) Unless the assisted living program is part of a continuing
care retirement community and the agreement is signed by a continuing care
subscriber as defined in COMAR 32.02.01.01B, a statement indicating that if a
resident’s level of care, after admission, exceeds the level of care for which
the assisted living program is permitted to provide and a waiver for the
continued stay of the resident has not been granted, the assisted living
program shall discharge the resident from the program;
(4) If the assisted living program is part of a continuing care
retirement community and a separate, concurrent resident agreement is signed by
a continuing care subscriber as defined in COMAR 32.02.01.01B, a statement
indicating that if the resident’s level of care, after admission to assisted
living, exceeds the level of care for which the assisted living program is
permitted to provide and a waiver for the continued stay of the resident has
not been granted:
(a) The assisted living program may not provide any services to
the resident beyond that which it is licensed to provide;
(b) If the assisted living program offers either comprehensive
care services, or priority access to comprehensive care services, and a
comprehensive care bed is available for occupancy, the resident shall be given
the option to transfer to comprehensive care; and
(c) The resident may be discharged from the continuing care
retirement community only for just cause as set forth in COMAR 32.02.01.31B;
(5) A listing of services provided by the assisted living
program and a listing of personal care and health care services the assisted
living program does not provide;
(6) An explanation of the assisted living program’s complaint or
grievance procedure;
(7) A policy on resident self-administration of medications;
(8) A policy on the administration of medications to a resident
by a spouse or domestic partner who is also a resident of the assisted living
program;
(9) Occupancy provisions, including:
(a) Policies regarding bed and room assignment, including the
specific room and bed assigned to the resident at the time of admission;
(b) Policies for temporary or permanent changes to the resident’s
accommodations, including:
(i) Relocating the resident within the facility;
(ii) Making a change in roommate assignment; or
(iii) Increasing or decreasing the number of individuals
occupying a room;
(c) Procedures for
transferring the resident to another facility;
(d) The availability of locks for storage;
(e) The availability of locks, if any, for the resident’s room;
(f) Security procedures which the assisted living program shall
implement to protect the resident and the resident’s property;
(g) The staff’s right, if any, to enter a resident’s room;
(h) The resident’s rights and obligations concerning use of the
facility, including common areas;
(i) If non-residents live on the premises, the assisted living
program shall disclose what parts of the licensed space they are permitted in
and during what hours;
(j) Provisions for continuous service in the event of an
emergency;
(k) An acknowledgment that the resident or the resident
representative has reviewed all assisted living program rules, requirements,
restrictions, or special conditions that the assisted living program will
impose on the resident; and
(l) The assisted living program’s bed hold policy in case of
unavoidable or optional absences such as hospitalizations, recuperative stays
in other settings, or vacation, including:
(i) The conditions under which the assisted living program will
hold a bed;
(ii) Relevant time frames;
(iii) Payment terms;
(iv) The circumstances under which the program will no longer
hold the bed; and
(v) The period of time during which the resident is permitted to
return and resume residence in the facility;
(10) Admission and discharge
policies and procedures, including:
(a) Any additional admission requirement imposed by the assisted
living program;
(b) Those actions, circumstances, or conditions which may result
in the resident’s discharge from the assisted living program;
(c) The procedures which the assisted living program shall
follow to verify that the receiving program or facility has the required
license to operate that type of program or facility;
(d) The procedures which the assisted living program shall
follow when discharging a resident without the resident’s consent, except in
the case of a health emergency or substantial risk to other residents,
including:
(i) The termination of the resident agreement on discharge; and
(ii) At least 30 calendar days written notice to the resident or
resident representative before the effective date of the discharge;
(e) Procedures that the assisted living program shall follow
when discharging, without 30 calendar days notice, a hospitalized resident
whose medical needs have advanced beyond the level of care for which the
assisted living program is licensed to provide. The procedures shall include at
a minimum:
(i) A statement that a transfer to the hospital is not grounds
for discharge; and
(ii) A requirement that the delegating nurse shall perform and
document a nursing assessment of the resident’s condition at the hospital to
determine if the resident can safely return to the facility;
(f) Procedures that the resident shall follow when terminating
the resident agreement;
(g) A statement that the resident or
resident representative shall give at least 30 calendar days notice to the
assisted living program before the effective date of termination except in the
case of a health emergency;
(h) Procedures the assisted living program shall follow when a
multiple person unit is vacated by one resident due to discharge or death, including
provisions:
(i) For termination of the agreement; and
(ii) Appropriate refunds;
(11) Obligations of the licensee, the resident, or the resident
representative as to:
(a) Arranging for or overseeing medical care; and
(b) The monitoring of the health status of the resident;
(12) Adult medical day care policies and availability; and
(13) Any arrangements the resident has made, or wishes to
make, with regard to burial, including, but not limited to:
(a) Financial;
(b) Religion preferred funeral director, if any; and
(c) The name, address, and relationship of any person who has
agreed to claim the body of the resident or who has agreed to assume funeral or
burial responsibility.
E. If the services provided in an assisted living program that
is part of a continuing care retirement community are covered under a
continuing care agreement that complies with Human Services Article, Title 10,
Subtitle 4, and Health-General Article, §19-1806, Annotated Code of Maryland:
(1) The Department may not require a separate resident agreement
for the assisted living program; and
(2) The requirements set forth in this regulation and Regulation
.27 of this chapter do not apply.
F. The assisted living program may not include a provision in
the agreement which is inconsistent with any of the requirements of this
chapter.
.27 Resident Agreement —
Financial Content.
A. The resident agreement shall include financial provisions,
which include at a minimum:
(1) Obligations of the assisted living program and the resident,
or the resident agent, as to:
(a) Handling the finances of the resident;
(b) The purchase or rental of essential or desired equipment and
supplies;
(c) Arranging and contracting for services not covered by the
resident agreement;
(d) Ascertaining the cost of and purchasing durable medical
equipment; and
(e) Disposition of resident property upon discharge or death of
the resident; and
(2) Rate structure and payment provisions covering:
(a) All rates to be charged to the resident, including, but not
limited to:
(i) Service packages;
(ii) Fee for service rates; and
(iii) Any other non-service-related charges;
(b) Notification of the rate structure applicable for other
levels of care provided by the assisted living program and the criteria to be
used for imposing additional charges for the provision of additional services,
if the resident’s service and care needs change;
(c) Payment arrangements and fees, if known, for third-party
services not covered by the resident agreement, but arranged for by either the
resident, the resident agent, or the assisted living program;
(d) Identification of the persons responsible for payment of all
fees and charges and a clear indication of whether the person’s responsibility
is or is not limited to the extent of the resident’s funds;
(e) A provision which provides at least 45 calendar days notice
of any rate increase, except if necessitated by a change in the resident’s
medical condition;
(f) Fair and reasonable billing, payment, and credit policies;
(g) The procedures the assisted living program will follow in
the event the resident or resident agent can no longer pay for services
provided for in the resident agreement or for services or care needed by the
resident, including 30 calendar days notice of the resident’s discharge to the:
(i) Ombudsman within the Department of Aging or local area
agency on aging; and
(ii) Local Department of Human Services or Adult Protective
Services; and
(h) Terms governing the refund of any prepaid fees or charges,
in the event of a resident’s discharge from the assisted living program or
termination of the resident agreement.
B. When the resident’s needs significantly change and the level
of service provided needs to be increased or decreased, the resident agreement
shall be amended by the parties to reflect the changes in services being
provided and any applicable increase or decrease in charges.
C. Charges that incur after the
death of the resident may not include services provided to the resident after
their death, but may include administrative charges.
A. Service Plan Development.
(1) The assisted living manager, or designee, shall ensure that
all services are provided in a manner that respects and enhances the dignity,
privacy, and independence of each resident.
(2) A service plan for each resident shall be developed in a
manner that enhances the principles of dignity, privacy, resident choice,
resident capabilities, individuality, and independence without compromising the
health or reasonable safety of other residents.
(3) The resident shall be invited to participate in the
development of the initial service plan and any subsequent service plans.
(4) At the resident’s request, a resident representative, family
member, or other individual shall be invited to participate in all service plan
meetings.
(5) When the resident lacks the capacity to participate, the
resident representative, as applicable to their authority, shall be invited to
participate in all service plan meetings.
(6) The assisted living program shall accommodate the schedules
of participants in a service plan meeting when possible.
B. Assessment of Condition.
(1) The resident’s service plan shall be based on an assessments
of the resident’s health, function, behavioral, and psychosocial status using
the Resident Assessment Tool and the nursing assessment.
(2) A full assessment of the resident shall be completed:
(a) Within 48 hours but not later than required by nursing
practice and the patient’s condition after:
(i) A significant change of condition; and
(ii) Each nonroutine hospitalization; and
(b) At least annually.
(3) When the delegating nurse determines in the nurse’s clinical
judgment that the resident does not require a full assessment within 48 hours,
the delegating nurse shall:
(a) Document the determination and the reasons for the
determination in the resident’s record; and
(b) Ensure that a full assessment of the resident is conducted
within 7 calendar days.
(4) A review of the assessment shall be conducted every 6 months
for residents who do not have a change in condition. Further evaluation by a
health care practitioner is required and changes shall be made to the resident’s
service plan, if there is a score change in any of the following areas:
(a) Cognitive and behavioral status;
(b) Ability to self-administer medications; and
(c) Behaviors and communication.
(5) If the resident’s previous assessment did not indicate the
need for awake overnight staff, each full assessment or review of the full
assessment shall include documentation as to whether awake overnight staff is
required due to a change in the resident’s condition.
C. Special Care Needs. The service plan shall reflect increased
monitoring, intervention, and oversight, as clinically appropriate for special
care needs, including:
(1) Fall risk or frequent falls;
(2) Pressure ulcer risk, prevention, and treatment;
(3) Diabetes management;
(4) Oxygen therapy;
(5) Enteral feedings;
(6) Foley catheter care;
(7) Ostomy care;
(8) Therapeutic medication levels;
(9) Mental illness; and
(10) Behaviors that are likely to disrupt or harm the resident
or others.
D. The assisted living manager, or designee, shall ensure that:
(1) A written service plan or other documentation sufficiently
recorded in the resident’s record is developed by staff, which at a minimum
addresses:
(a) The services to be provided to the resident, which are based
on the assessment of the resident;
(b) When and how often the services are to be provided; and
(c) How and by whom the services are to be provided;
(2) The service plan is developed within 30 calendar days of
admission to the assisted living program; and
(3) The service plan is reviewed by staff at least every 6
months, and updated, if needed, unless a resident’s condition or preferences
significantly change, in which case the assisted living manager or designee
shall review and update the service plan sooner to respond to these changes.
A. The assisted living manager shall ensure that an individual
record or log is maintained at the assisted living program for each resident in
a manner that ensures security and confidentiality, and which includes at a
minimum:
(1) Resident Assessment Tools;
(2) Nursing assessments;
(3) Medical orders;
(4) Service plans;
(5) Care notes;
(6) Emergency data sheet;
(7) Applicable advance directive and mental health advance
directive;
(8) Maryland Medical Orders for Life-Sustaining Treatment form;
(9) Monthly weights or, in accordance with the health care
practitioner’s orders for weights, more or less frequently;
(10) Pharmacy reviews, if appropriate;
(11) Rehabilitation plans, if appropriate; and
(12) Any other records related to the care and services provided
to the resident.
B. Readmission of a Resident.
(1) A resident shall be reassessed by the delegating nurse
within 48 hours of readmission to the program if the following occurs:
(a) Hospitalizations or a 15-day or longer stay in any skilled
facility; or
(b) There is a significant change in the resident’s mental or
physical status upon return to the program after an absence from the program.
(2) When the delegating nurse determines in the nurse’s clinical
judgment that the resident does not require a full assessment within 48 hours,
the delegating nurse shall:
(a) Document the determination and the reasons for the
determination in the resident’s record; and
(b) Ensure that a full assessment of the resident is conducted
within 7 calendar days.
C. The assisted living manager shall develop policies and
procedures to ensure that all information relating to a resident’s condition or
preferences, including any significant change as defined in Regulation .02B of
this chapter, is documented in the resident’s record and communicated in a
timely manner to:
(1) The resident;
(2) The resident representative, as appropriate; and
(3) Health care practitioners and staff who are involved in the
development and implementation of the resident’s service plan, as appropriate.
D. Resident Care Notes.
(1) Appropriate staff shall write care notes for each resident:
(a) On admission;
(b) At least weekly;
(c) With any significant changes in the resident’s condition,
including when incidents occur and any follow-up action is taken;
(d) When the resident is transferred from the facility to
another health care facility;
(e) On return from medical appointments;
(f) When seen in the facility by any health care practitioner or
health care provider;
(g) On return from nonroutine leaves of absence; and
(h) When the resident is discharged permanently from the
facility, including the location and manner of discharge.
(2) Staff shall write care notes that are individualized,
legible, dated, timed, and signed by the writer.
E. The assisted living program shall maintain a resident’s
record for 5 years after the resident is discharged.
F. If an assisted living program ceases operation, the assisted
living program shall make arrangements to retain records as required by §E of
this regulation.
G. If the assisted living program changes ownership, the prior
owner shall provide all written and electronic records of current residents to
the new owner in a usable format prior to the issuance of the new license.
H. An assisted living program shall:
(1) Maintain the privacy and confidentiality of a resident’s
medical records and medical information;
(2) Release medical records or medical information about a
resident only with the consent of the resident or resident representative, or
as permitted by Health-General Article, Title 4, Subtitle 3, Annotated Code of
Maryland; and
(3) Maintain and dispose of a resident’s medical records in
accordance with Health-General Article, Title 4, Subtitle 3, Annotated Code of
Maryland.
A. Meals.
(1) The assisted living manager shall ensure that:
(a) A resident is provided three meals in a common dining area
and additional snacks during each 24-hour period, 7 days a week;
(b) Meals and snacks are well-balanced, varied, palatable,
properly prepared, and of sufficient quality and quantity to meet the daily
nutritional needs of each resident with specific attention given to the
preferences and needs of each resident;
(c) All food is prepared in accordance with all State and local
sanitation and safe food handling requirements;
(d) Food preparation areas are maintained in accordance with all
State and local sanitation and safe food handling requirements; and
(e) At a minimum, residents have access to snacks or food
supplements between breakfast and lunch, between lunch and dinner, and during
the evening hours.
(2) The assisted living program shall ensure that menus are
nutritionally adequate by having a dietitian or nutritionist review the 4-week
menu:
(a) Prior to initial licensure;
(b) If substantive changes beyond accepted food substitutions
have been made; and
(c) At least every 3 years.
(3) Menus.
(a) Menus shall be written at least 1 week in advance with
portion sizes tailored to each resident.
(b) The assisted living program shall post a weekly menu in a
conspicuous place that is visible to residents and other interested parties.
(c) Menus shall be maintained on file, as served, for 6 months.
(4) Special Diets.
(a) The assisted living program staff shall:
(i) Prepare or arrange for the provision of special diets as
ordered by the resident’s health care practitioner or as needed by the resident’s
condition; and
(ii) Document special diets in the resident’s record.
(b) If the diet is beyond the capability of the assisted living
program, the resident or the resident’s health care practitioner shall make
other arrangements for the resident’s care, or the assisted living program
shall discharge the resident.
B. Monitoring. The assisted living manager shall ensure that
each resident is monitored on a daily basis to ensure that the resident’s
service plan is being properly implemented.
C. Adaptive Equipment and Assistive Devices.
(1) The assisted living manager or their designee shall ensure
that all adaptive equipment and assistive devices are in proper working order.
(2) The assisted living manager or designee shall facilitate the
repair or replacement of adaptive equipment and assistive devices, as needed.
(3) Assisted living staff shall assist the resident, as needed,
to utilize the adaptive equipment and assistive devices.
D. Nursing Services. The assisted living manager, in
consultation with the delegating nurse, shall ensure that all nursing services
are provided consistent with the Nurse Practice Act, Health Occupations
Article, Title 8, Annotated Code of Maryland.
E. Personal Care Services. The assisted living manager shall
provide or ensure the provision of all necessary personal care services,
including, but not limited to, the range of assistance needed by a resident to
complete the activities of daily living as defined in Regulation .02B of this
chapter.
F. Housekeeping Services. The assisted living manager shall
ensure that:
(1) Housekeeping services are provided; and
(2) All areas of the facility are maintained in a clean and
orderly condition.
G. Health Care and Social Services. The assisted living manager
is responsible for facilitating access to any appropriate health care and
social services for the resident as determined in the resident’s assessment,
including, but not limited to:
(1) Social work services;
(2) Rehabilitative services, including occupational, physical,
speech, and audiology therapies;
(3) Home health services;
(4) Hospice services;
(5) Skilled nursing services;
(6) Health care practitioner services;
(7) Oral health care;
(8) Dietary consultation and services;
(9) Counseling;
(10) Psychiatric services;
(11) Psychological services; and
(12) Other specialty health services.
H. Social and Recreational Activities.
(1) In accordance with the resident’s service plan, the assisted
living program staff shall encourage resident participation in social and
recreational activities, including:
(a) Providing or arranging for transportation to these
activities in accordance with the resident’s service plan; and
(b) Assisting a resident with communication, interpersonal, and
social skills, including managing difficult behaviors in accordance with the
resident’s service plan.
(2) The assisted living manager shall provide or arrange
appropriate opportunities for socialization, social interaction, and leisure
activities that reflect the resident’s preferences and promote the physical and
mental well-being of each resident.
(1) The assisted living manager or designee shall facilitate
access to spiritual and religious activities consistent with the preferences
and beliefs of the resident.
(2) The assisted living manager or designee shall provide or
arrange for transportation to spiritual and religious activities in accordance
with the resident’s service plan.
.31 Medication Management and Administration.
A. All unlicensed staff who will administer medications to
residents shall have first completed the medication administration course that
is taught by a registered nurse who is approved by the Maryland Board of
Nursing to teach the certified medication technician course.
B. The assisted living manager shall document completion of the
medication technician training and certification as a medication technician by
the Maryland Board of Nursing per COMAR 10.39.04 in the personnel file or other
readily available record of each unlicensed staff member who administers
medications.
C. All medications shall be administered consistent with
applicable requirements of COMAR 10.27.11.
D. Self-Administration of Medication.
(1) An assisted living manager shall ensure that the resident’s
initial assessment process identifies whether a resident:
(a) Is capable of self-administration of medication;
(b) Is capable of self-administration of medication, but
requires a reminder to take medications or physical assistance with opening and
removing medications from the container, or both; or
(c) Requires that medications be administered by the assisted
living program staff or by a spouse or domestic partner of the resident in
accordance with §E of this regulation.
(2) For a resident who is capable of self-administration or,
although capable, requires a reminder or physical assistance, as stated in
§D(1)(b) of this regulation, the assisted living manager shall ensure that the
resident is reassessed by the delegating nurse quarterly for the ability to
safely self-administer medications with or without assistance.
E. Administration of Medication by a Spouse or Domestic Partner.
While residing in the same assisted living program as their spouse or domestic
partner, a resident may administer medications to their spouse or domestic
partner providing the following documentation is maintained in the resident’s
record:
(1) An initial assessment by their health care practitioner
documenting the resident’s competency and ability to safely administer
medications to their spouse or domestic partner;
(2) Quarterly assessments by the delegating nurse documenting
the resident’s continued ability to safely administer medications to their
spouse or domestic partner; and
(3) Current signed medical orders.
F. Medication Regimen Review Upon Admission.
(1) The assisted living manager shall consult within 14 calendar
days of a resident’s admission with the individuals set forth in §F(2) of this
regulation to review a new resident’s medication regime.
(2) The medication review may be conducted by a:
(a) Health care practitioner;
(b) Registered nurse, who may be the delegating nurse; or
(c) Licensed pharmacist.
G. The purpose of the medication regimen review required by §F
of this regulation is to review with the assisted living manager or designee:
(1) A resident’s current medication profile, including all
prescription and nonprescription over-the-counter medications and tube
feedings;
(2) The potential that current medications have to act as a
chemical restraint;
(3) The potential for any side effects;
(4) The potential for adverse drug interactions; and
(5) Any medication errors that have occurred since admission.
H. The assisted living manager, or designee, shall ensure that
the medication regimen review required by §F of this regulation is documented
in the resident’s records, including any recommendations given by the reviewer.
I. Pharmacy Review.
(1) The assisted living manager shall arrange for a licensed
pharmacist to conduct an on-site review of health care practitioner
prescriptions, health care practitioner orders, and resident records at least
every 6 months for any resident receiving nine or more medications, including
over-the-counter and PRN (as needed) medications.
(2) The pharmacist’s review shall include, but is not limited
to, whether:
(a) The assisted living program is in compliance with Board of
Pharmacy’s requirements for packaging of medications;
(b) Each resident’s medications are properly stored and maintained;
(c) Each resident receives the medications that have been
specifically prescribed for that resident in the manner that has been ordered;
(d) The desired effectiveness of each medication is achieved
based on available information, and, if not, that the appropriate authorized
prescriber is so informed;
(e) Any undesired side effects, potential and actual adverse
drug reactions, and medication errors are identified and reported to the
appropriate authorized prescriber;
(f) The resident has a medical condition as documented in the
resident’s records that is not currently being treated by medication;
(g) There is medication use without current indication in the
resident’s records of a medical condition that warrants the use of the
medication;
(h) There is medication overuse that is causing side effects as
documented in the resident records;
(i) Current medication selections result in inappropriate
medication dosage;
(j) The resident may be experiencing drug interactions;
(k) The resident is receiving medication, either prescribed or
over-the-counter medications, as well as herbal remedies that could result in
drug-drug, drug-food, or drug-laboratory test interactions;
(l) Administration times of medication need to be modified to
address drug interactions or meal times, or both;
(m) Periodic diagnostic monitoring required by certain
medications have been performed; and
(n) More cost-effective medications are available to treat
current medical conditions.
(3) The pharmacist shall document the pharmacy review as
required under this section in each resident’s chart and this documentation
shall be reviewed every 6 months as part of the assisted living program’s
quality assurance activities as required in Regulation .13 of this chapter.
J. The person conducting the on-site review under §F or G of
this regulation shall recommend changes, as appropriate, to the appropriate
authorized prescriber and the assisted living manager or designee.
K. If a resident requires that staff administer medications as
defined in Regulation .02B(3) of this chapter, and the administration of
medications has been delegated to an unlicensed staff person pursuant to COMAR
10.27.11, the assisted living manager shall comply with COMAR 10.27.11 by
arranging for an on-site review by the delegating registered nurse at least
every 45 calendar days. The delegating nurse shall make appropriate
recommendations to the appropriate authorized prescriber, and the assisted living
manager or designee.
L. Safe Storage of Medication. The assisted living manager, or
designee, shall ensure that:
(1) Medications are stored in the original dispensed container;
(2) Medications are stored in a secure location, at the proper
temperature; and
(3) The following documentation is maintained for all
prescription and over-the-counter medications prescribed to residents:
(a) Name of the resident;
(b) Name of the medication;
(c) Reason for the medication;
(d) Dose;
(e) Frequency;
(f) Route;
(g) Authorized prescriber’s name;
(h) Date of issuance;
(i) Expiration date;
(j) Refill limits; and
(k) Directions for use.
M. Medications and treatments shall be administered consistent
with current signed medical orders and using professional standards of
practice.
N. Only sealed, unopened medication packages or individual unit
dose blisters may be returned to the inventory of the pharmacy.
O. Required Documentation.
(1) A staff member shall record the documentation required under
§L of this regulation for all residents for whom medications are administered,
or who receive assistance in taking their medications, as defined by Regulation
.02B(3)(b) of this chapter, at the time that the resident takes or receives
medications.
(2) A staff member shall record the documentation required under
§L of this regulation for residents who self-administer:
(a) Upon admission; or
(b) When changes in the resident’s medication regimen are
ordered by a health care practitioner.
P. Accounting for Narcotic and Controlled Substances.
(1) A qualified staff member and a witness shall count and
record Schedule II through V controlled substances before the close of every
shift.
(2) The daily record shall account for all controlled substances
documented as administered on the medication administration record.
(3) All Schedule II through V controlled substances shall be
maintained under a double lock system.
(4) As required, the assisted living program shall obtain a
Controlled Dangerous Substances registration certificate from the Department’s
Office of Controlled Substances Administration.
(5) The assisted living manager shall develop written policies
and procedures to guard against theft and diversion of controlled substances,
that include:
(a) Proper storage;
(b) Accountability;
(c) Access;
(d) Destruction; and
(e) Reporting procedures.
(6) Controlled substances may not be returned to the pharmacy.
(7) Controlled substances in need of disposal shall be destroyed
on-site at the assisted living program and their destruction shall be:
(a) Conducted by two members of the staff, one of whom shall be
a licensed practitioner, pharmacist, or nurse; and
(b) Recorded on a form supplied by the Division of Drug Control,
a copy of which shall be forwarded to the Division within 10 calendar days of
destruction.
.32
Alzheimer’s Special Care Unit.
A. Initial Approval of an Alzheimer’s Special Care Unit. An
assisted living program requesting the initial approval to operate an Alzheimer’s
Special Care Unit shall submit to the Department a written description of the
Alzheimer’s Special Care Unit using a disclosure form developed by the
Department. The description shall explain how:
(1) The form of care and treatment provided by the Alzheimer’s Special
Care Unit is specifically designed for the specialized care of individuals
diagnosed with Alzheimer’s disease or a related dementia; and
(2) The care in the Alzheimer’s Special Care Unit differs from
the care and treatment provided in the nonspecial care unit.
B. Approval of an Alzheimer’s Special Care Unit.
(1) An assisted living program shall have written approval from
the Department prior to operating an Alzheimer’s Special Care Unit.
(2) The Department will either approve or not approve the
operation of the Alzheimer’s Special Care Unit.
C. Substantive Changes to the Alzheimer’s Special Care Unit.
(1) The written description of the Alzheimer’s Special Care Unit
shall accurately reflect the current operation of the unit.
(2) If any substantive changes are made to Alzheimer’s Special Care
Unit, the revised written description shall be submitted to the Department for
review and approval.
(3) The Department shall inform the provider of the decision of
the review within 30 calendar days from the Department’s receipt of the revised
written description.
D. An assisted living program with an Alzheimer’s Special Care Unit
shall disclose the written description of the unit to:
(1) Any person on request;
(2) The resident, as appropriate; and
(3) The family or resident representative before admission of
the resident to the Alzheimer’s Special Care Unit.
E. The description of the Alzheimer’s Special Care Unit shall
include:
(1) A statement of philosophy or mission;
(2) How the services of the unit are different from services
provided in the rest of the assisted living program;
(3) Staff training and staff job titles,
including:
(a) A description of a
minimum of 6 hours of advanced cognitive impairment training for any staff who
is licensed, certified, or registered under Health Occupations Article,
Annotated Code of Maryland, or any staff whose job duties include providing
personal care on the Alzheimer’s Special Care Unit, including:
(i) 2 hours related to
effective communication;
(ii) 2 hours related to
behavioral interventions; and
(iii) 2 hours related
to making activities meaningful; and
(b) The number of hours
of dementia-specific training provided annually for all staff by job
classification and a summary of training content;
(4) Admission procedures, including screening criteria;
(5) Assessment and service planning protocol, including criteria
to be used that would trigger a reassessment of the resident’s status before
the customary 6-month review;
(6) Staffing patterns, including:
(a) The ratio of direct care staff to resident for a 24-hour
cycle;
(b) A description of how the staffing pattern differs from that
of the rest of the assisted living program; and
(c) Use of awake overnight staff on the unit;
(7) A description of the physical environment and any unique
design features appropriate to support the functioning of cognitively impaired
individuals;
(8) A description of activities, including frequency and type,
how the activities meet the needs of residents with dementia, and how the
activities differ from activities for residents in other parts of the assisted
living program;
(9) The assisted living program’s fee or fee structure for
services provided by the Alzheimer’s Special Care Unit;
(10) Discharge criteria and procedures;
(11) Any services, training, or other procedures that are over
and above those that are provided in the existing assisted living program; and
(12) Any other information that the Department may require.
F. The Department shall restrict admission or close the
operation of an Alzheimer’s Special Care Unit if the Department determines that
the assisted living program has not demonstrated compliance with this
regulation or the health or safety of residents is at risk.
A. Staff of the assisted living program shall complete an
incident report within 24 hours of having knowledge that an incident, as
defined in Regulation .02B(39) of this chapter, occurred.
B. The assisted living program shall make incident reports
available on the premises to the Department and any government agency
designated by the Department.
C. All incident reports shall include:
(1) Time, date, and place;
(2) Individuals present;
(3) Complete description of the incident;
(4) Response of the staff at the time; and
(5) Notification to the:
(a) Resident or, if appropriate, the resident representative;
(b) Resident’s health care practitioner, if appropriate;
(c) Delegating nurse;
(d) Licensing or law enforcement authorities, when appropriate;
and
(e) Follow-up activities, including investigation of the
occurrence and steps to prevent its reoccurrence.
D. The assisted living program shall
notify the OHCQ within 24 hours of a resident death resulting from:
(1) Abuse;
(2) Neglect;
(3) Wandering;
(4) Elopement;
(5) A medication error;
(6) Burns; or
(7) Any injury incurred at the assisted living program.
A. Relocation within the Facility.
(1) The assisted living program may not relocate a resident
within the facility except in accordance with the terms and conditions of the
resident agreement.
(2) An assisted living program shall notify a resident and the
resident representative at least 5 calendar days before a nonemergency
relocation within the facility and obtain the consent of the resident or
resident representative.
(3) An assisted living program shall document in the resident’s
record how the requirements of this regulation have been met.
B. Discharge.
(1) Discharge of a resident or transfer to another facility or
address without the consent of the resident or the resident representative
shall be in accordance with the resident agreement.
(2) An assisted living program shall notify a resident or the
resident representative within 30 calendar days before a non-emergency
discharge.
(3) In the event of an emergency, the program shall notify the
resident or the resident representative as quickly as possible and document the
reason for the emergency and abbreviated notice.
C. The assisted living program shall consider the resident’s
specific care needs and preferences in developing a safe and appropriate
discharge plan.
D. When the resident is discharged to another facility, the
assisted living program shall provide to the receiving facility any information
related to the resident that is necessary to ensure continuity of care and
services, including, at a minimum, the:
(1) Emergency data sheet;
(2) Current medication and treatment orders;
(3) Medication administration records; and
(4) Most current Resident Assessment Tool.
E. When the resident is discharged to home or to a non-facility setting,
the assisted living program shall provide the resident and resident
representative any information related to the resident that is necessary to
ensure continuity of care and services, including, at a minimum, the:
(1) Emergency data sheet;
(2) Current medication and treatment orders;
(3) Medication administration records; and
(4) Most current Resident Assessment Tool.
F. In the event of a health emergency requiring the transfer to
an acute care facility, a copy of an emergency data sheet shall accompany the
resident to an acute care facility. This data sheet shall, at a minimum,
include:
(1) The resident’s full name, date of birth, Social Security
number, if known, and insurance information;
(2) The name, telephone number, and address of the resident
representative;
(3) The name and telephone number of the resident’s health care
practitioner;
(4) The resident’s current documented diagnoses;
(5) Current medications prescribed for the resident;
(6) The resident’s known allergies to food or medications, if
any;
(7) The resident’s dietary restrictions, if any;
(8) Any relevant information concerning the event that
precipitated the emergency; and
(9) Appended copies of:
(a) Advance directives;
(b) Maryland Medical Orders for Life-Sustaining Treatment
(MOLST) form;
(c) Powers of attorney, if any; and
(d) Guardianship orders, if any.
G. Within 30 calendar days of the date of discharge, the
assisted living program shall:
(1) Give each resident or resident agent:
(a) A final statement of account; and
(b) Any refunds due; and
(2) Return any money, property, or valuables held in trust or
custody by the assisted living program.
H. If requested by a resident, a resident representative, a
governmental agency, or, on its own initiative, the Office of the Attorney
General may:
(1) Investigate whether an abuse of a resident’s funds
contributed to the decision to discharge the resident; and
(2) Make appropriate referrals of the matter to other government
agencies.
A. An assisted living program shall
recognize the applicable authority of:
(1) A guardian of the person under Estates and Trusts Article,
§13-705, Annotated Code of Maryland;
(2) A guardian of the property under Estates and Trusts Article,
§13-201, Annotated Code of Maryland;
(3) An advance directive that meets the requirements of
Health-General Article, §5-602, Annotated Code of Maryland;
(4) A surrogate decision maker with authority under
Health-General Article, §5-605, Annotated Code of Maryland;
(5) A power of attorney that meets the
requirements under Estates and Trusts Article, Title 17, Annotated Code of
Maryland;
(6) A representative payee or other similar fiduciary; and
(7) Any other person, if that person was designated by a
resident who was competent at the time of designation, and the resident or
representative has provided the assisted living program with documentation of
the designation.
B. Representative Payee or Other Similar Fiduciary.
(1) An assisted living program staff member who serves as a
representative payee for a resident may not be considered the resident
representative.
(2) An assisted living program shall notify the Department if an
assisted living program staff member is designated as the representative payee
for a resident.
C. An assisted living program shall document in the resident’s
record the name of the person, if any, with the authority identified in §A of
this regulation or include the documentation in the record.
D. An assisted living program may not recognize the authority of
a resident representative if the representative attempts to exceed the
authority:
(1) Stated in the instrument that grants the representative
authority; or
(2) Established by federal or State law.
E. An assisted living program who commits financial exploitation
of a resident shall be in violation of this chapter as well as applicable civil
and criminal laws.
A. Resident Bill of Rights.
(1) An assisted living program shall develop a Resident Bill of
Rights that, at a minimum, includes the following rights:
(a) Be treated with consideration, respect, and full recognition
of the resident’s human dignity and individuality;
(b) Receive treatment, care, and services that are adequate,
appropriate, and in compliance with relevant State, local, and federal laws and
regulations;
(c) Receive services and supports that optimize autonomy,
independence, and personal choice;
(d) Actively participate in planning and developing the resident’s
service plan and medical treatment;
(e) Choose a pharmacy provider, if the provider can comply with
the assisted living programs’ reasonable policies and procedures for patient
safety in medication supply and administration;
(f) Make an informed decision to accept or refuse treatment;
(g) Privacy, including the right to have a staff member knock on
the resident’s door before entering unless the staff member knows that the
resident is asleep or there is an emergency situation;
(h) Be free from mental, verbal, sexual, and physical abuse,
neglect, and financial exploitation;
(i) Be free from involuntary seclusion and physical and chemical
restraint used in violation of this chapter;
(j) Confidentiality;
(k) Manage personal financial affairs to the extent permitted by
law;
(l) Retain and have access to legal counsel in a private
setting;
(m) Attend or not attend religious services as the resident
chooses, and receive visits from members of the clergy;
(n) Possess and use personal clothing and other personal effects
to a reasonable extent, and to have reasonable security for those effects in
accordance with the assisted living program’s security policy;
(o) Determine dress, hairstyle, or other personal effects
according to individual preference, unless the personal hygiene of a resident
is compromised;
(p) Meet or visit privately with any individual the resident
chooses, subject to reasonable restrictions on visiting hours and places:
(i) In accordance with the resident agreement; and
(ii) As posted by the assisted living manager;
(q) Make suggestions or complaints or present grievances on
behalf of the resident, or others, to the assisted living manager, government
agencies, or other persons without threat or fear of retaliation;
(r) Receive a prompt response, through an established complaint
or grievance procedure, to any complaints, suggestions, or grievances the
resident may have;
(s) Have access to the procedures for making complaints to:
(i) The Long-Term Care Ombudsman Program of the Department of
Aging as set forth in COMAR 32.03.02;
(ii) The Adult Protective Services Program of the local
department of human services;
(iii) The OHCQ of the Department; and
(iv) The designated protection and advocacy agency, if
applicable;
(t) Have access to writing instruments, stationery, and postage;
(u) Receive and send correspondence without delay, and without
the correspondence being opened, censored, controlled, or restricted, except on
request of the resident, or written request of the resident representative;
(v) Receive a prompt, reasonable response from an assisted
living manager or staff to a personal request of the resident;
(w) Receive notice before the resident’s roommate is changed
and, to the extent possible, have input into the choice of roommate;
(x) Have reasonable access to the private use of a common use
telephone within the facility; and
(y) Retain personal clothing and possessions as space permits
with the understanding that the assisted living program may limit the number of
personal possessions retained at the facility for the health and safety of
other residents.
(2) An assisted living program shall:
(a) Provide the Resident Bill of Rights to all residents and
resident representatives prior to or upon admission; and
(b) Either:
(i) Post the Resident Bill of Rights in a conspicuous place that
is visible to residents, potential residents, and other interested parties; or
(ii) Post a notice stating where in the facility the Resident
Bill of Rights is located.
B. Confidential Information.
(1) Any case discussion, disclosure of health information,
consultation, examination, or treatment of a resident is:
(a) Confidential;
(b) To be done discreetly; and
(c) Not open to an individual who is not involved directly in
the care of the resident, unless the resident or resident representative
permits the individual to be present.
(2) Except as necessary for the transfer of a resident from the
assisted living program to another facility, or as otherwise required by law,
the personal and medical records of a resident are confidential and may not be
released without the consent of the resident or resident representative to any
individual who is:
(a) Not associated with the assisted living program; or
(b) Associated with the assisted living program, but does not
have a demonstrated need for the information.
(3) The assisted living manager shall share resident information
with the Department as necessary to administer this chapter.
C. Work Duties.
(1) A resident may not be assigned to do any work for the
assisted living program without the resident’s consent and appropriate
compensation, unless the resident declines to be compensated.
(2) The resident’s work duties shall be described in the
resident’s record.
(3) The resident’s declining to be compensated shall be
documented in the resident’s record.
(4) The resident may, at any time, discontinue the work duties
without threat or fear of retaliation.
D. Adult Medical Day Care.
(1) Adult day care attendance or attendance at any other
structured program shall be voluntary.
(2) Adult medical day care availability and policies shall be
disclosed in the assisted living program’s resident agreement.
.37
Abuse, Neglect, and Financial Exploitation.
A. An assisted living program shall develop and implement
policies and procedures prohibiting abuse, neglect, and financial exploitation
of residents.
B. An assisted living program may not knowingly employ an
individual who has any criminal conviction or other criminal history that
indicates behavior that is potentially harmful to residents, documented through
either a criminal history records check or a criminal background check.
C. Reports of Abuse, Neglect, or Financial Exploitation.
(1) An assisted living program or employee of an assisted living
program who has witnessed, or otherwise has reason to believe, that a resident
has been subjected to abuse, neglect, or financial exploitation shall report
the alleged abuse, neglect, or financial exploitation within 24 hours to the:
(a) Appropriate law enforcement agency;
(b) Office of Health Care Quality of the Department;
(c) Ombudsman within the Department of Aging or local area
agency on aging;
(d) Local Department of Human Services or Adult Protective
Services; and
(e) Assisted living manager unless they are believed to be
involved with the abuse, neglect, or financial exploitation.
(2) An assisted living program or an employee may be subject to
a penalty imposed by the Secretary of up to $1,000 for failing to make a report
required by §C(1) of this regulation within 3 days after learning of the
alleged abuse, neglect, or financial exploitation.
(3) A person aggrieved by the action of the Secretary under §C
of this regulation may appeal the Secretary’s action by filing a request for a
hearing in accordance with Regulation .65 of this chapter.
(4) A licensed or certified individual who has knowledge of, but
does not report, suspected abuse, neglect, or financial exploitation may be
referred to their respective health occupation board.
D. Investigations. An assisted living program shall:
(1) Thoroughly investigate all allegations of abuse, neglect, or
financial exploitation and maintain on-site written documentation of the
investigation; and
(2) Take appropriate action to prevent further incidents of
abuse, neglect, or financial exploitation while the investigation is in
progress.
E. Investigation Reports.
(1) The assisted living program or any government agency that
investigates the abuse, neglect, or financial exploitation shall send a report
to the:
(a) Appropriate law enforcement agency;
(b) Office of Health Care Quality of the Department;
(c) Ombudsman within the Department of Aging or local area
agency on aging; and
(d) Local Department of Human Services or Adult Protective
Services.
(2) The entities set forth in §E(1) of this regulation may make
a referral, if appropriate, to:
(a) The State’s attorney’s office; or
(b) The Medicaid Fraud Control Unit of the Criminal Division of
the Office of the Attorney General.
F. Immunity from Civil Liability. An individual who, acting in
good faith, makes a report under this regulation has immunity from liability as
described in Health-General Article, §19-347(g), Annotated Code of Maryland.
G. Notice. The assisted living program shall post signs that set
forth the reporting requirements of §C(1) of this regulation, conspicuously in
the employee and public areas of the facility.
A. The resident has the right to be free of restraints used in
violation of this chapter.
B. A protective device as defined in Regulation .02B of this
chapter is not considered a restraint.
C. Improper Use of Chemicals or
Drugs. Chemicals or drugs may not be used for residents in the following ways:
(1) In excessive dose, including duplicate drug therapy;
(2) For excessive duration, without adequate monitoring;
(3) Without adequate indications for its use; or
(4) In the presence of adverse consequences which indicate the
dose should be reduced or discontinued.
D. Improper Use of Physical Restraints. Residents may not be
physically restrained:
(1) For discipline or convenience; or
(2) If a restraint is not ordered by a health care practitioner
to treat the resident’s symptoms or medical conditions.
E. Restraint Orders.
(1) Any restraint shall be ordered by a health care practitioner
and shall specify:
(a) The purpose of the restraint;
(b) The type of restraint to be used; and
(c) The length of time the restraint shall be used.
(2) A resident may not have an as-needed restraint order.
(3) Orders for the use of a restraint shall be time specific.
(4) A resident may not remain in a restraint for more than 2
hours without a change in position and toileting opportunity.
(5) If an order for the use of a restraint is to be continued,
the order shall be renewed at least every 7 calendar days by a health care
practitioner.
(6) The delegating nurse shall provide training to staff in the
appropriate use of the restraint ordered by the health care practitioner.
F. Bed Rails. Bed rails may be considered a restraint depending
upon the reason for the use of bed rails and how the bed rails are used. This
determination is based upon the resident and the effect that bed rails would
have upon the resident, as documented in the resident’s record.
G. The program shall notify the resident’s family or the
resident representative each time a restraint is used.
.39
Protection of a Resident’s Personal Funds.
A. A resident may:
(1) Manage the resident’s financial affairs; or
(2) Consistent with State law, choose any individual who is
willing and able to handle the resident’s financial affairs.
B. An assisted living program may refuse to handle a resident’s
financial affairs.
C. An assisted living program may not manage a resident’s funds
without an express written request from the:
(1) Resident; or
(2) Resident agent.
D. Management of Personal Funds. On the written authorization of
a resident or resident agent, an assisted living program shall hold, safeguard,
manage, and account for the resident’s personal funds as specified in this
regulation.
E. Safeguards Required.
(1) Each assisted living program shall develop adequate
safeguards to secure the personal funds of a resident that are entrusted to the
assisted living program.
(2) An assisted living program to which $300 or more of a
resident’s personal funds is entrusted shall deposit the money in an
interest-bearing bank account. If an assisted living program is entrusted with
a resident’s personal funds that are less than $300, the assisted living
program may deposit the funds in a bank account.
(3) An assisted living program that manages residents’ personal
funds, regardless of the amount managed, shall maintain on behalf of the
residents:
(a) A bond, with the State as obligee, equal to the average
monthly balance of all the funds held or managed by the assisted living program
for the residents of the facility;
(b) A letter of credit, with the State as obligee, equal to the
average monthly balance of all the funds held or managed by the assisted living
program for the residents of the facility; or
(c) Net assets equal to the average monthly balance of all the
funds held or managed by the assisted living program for the residents of the
facility.
(4) The bond, letter of credit, or list of assets shall be kept
at the assisted living program for inspection by the Department or its
designee.
F. Establishment of Resident Accounts.
(1) When an assisted living program manages a resident’s
financial affairs, the assisted living program shall:
(a) Establish and maintain a system that ensures a full,
complete, and separate accounting, in accordance with generally accepted
accounting principles, of a resident’s personal funds entrusted to the assisted
living program; and
(b) Keep the accounts of its residents separate from the
accounts of the facility.
(2) Bank accounts opened for residents’ personal funds by an
assisted living program shall have minimal or no fees.
(3) Any interest earned on the bank accounts shall accrue to the
resident.
(4) Any fees charged by the bank for the maintenance of the
account shall be paid by the resident.
G. Records of Resident Personal Funds. For all resident funds
entrusted to an assisted living program, the assisted living program shall:
(1) Maintain an individual record for each resident, which
includes the following information for each transaction:
(a) The date of the transaction;
(b) The type of transaction, that is, whether it is a deposit,
withdrawal, or any other transaction; and
(c) The balance of funds after the completion of the
transaction;
(2) Make available for inspection by the resident, or, when
applicable, the resident agent or resident representative, a statement of the
resident’s account; and
(3) Make available at the assisted living program, for audit by
the Department or its designee, records pertaining to each resident’s personal
funds, including the written authorization required by §D of this regulation.
H. Fire and Theft Coverage. For all resident funds entrusted to
an assisted living program, the assisted living program shall establish and
maintain adequate fire and theft coverage to protect a resident’s funds that
are on the premises of the assisted living program.
I. Availability of Personal Funds.
(1) A resident or, if applicable, the resident’s legally
authorized representative, has the right to access funds entrusted to the
assisted living program:
(a) During normal business hours, if the funds are held within
the facility; or
(b) Within 3 banking days, if a bank, the State, or a county or
municipal treasurer holds the money.
(2) If an assisted living program transfers or discharges a
resident, the assisted living program shall:
(a) Request and follow the resident’s written instructions for
transferring the resident’s funds;
(b) Return, upon the resident’s or, when applicable, the
resident agent’s demand, the resident’s money that the assisted living program
has in its possession and have the resident or resident agent sign a receipt
for the money; or
(c) Make available to the resident or the resident agent, within
3 banking days, the resident’s money which is held in an account with a bank,
the State, or a county or municipal treasurer.
J. Ownership Change.
(1) If the ownership of an assisted living program changes, the
previous owner, with the approval of each resident, shall give the new owner a
certified written audit of all funds that residents have entrusted to the
assisted living program.
(2) The new owner shall give to the previous owner a signed
receipt acknowledging the receipt of the accounts.
(3) The new owner shall comply with the safeguard requirements
of §E of this regulation.
(4) If the resident wants the new owner to hold, safeguard,
manage, or account for the residents personal funds, then a new written
authorization in compliance with §D of this regulation shall be executed.
K. Resident Liability. A resident is not liable for any act or
omission of the assisted living program concerning the finances of the assisted
living program or the resident.
.40
Misuse of Resident’s Funds.
A. A person may not misappropriate a resident’s assets or
income, including spending the resident’s assets or income against or without
the consent of the resident or, if the resident is unable to consent, the
resident agent.
B. An individual who witnessed, or otherwise has reason to
believe, that there has been an abuse of a resident’s funds shall make a
complaint within 24 hours to the:
(1) Appropriate law enforcement agency;
(2) Office of Health Care Quality of the Department;
(3) Ombudsman within the Department of Aging or local area
agency on aging; and
(4) Local Department of Human Services or Adult Protective
Services.
C. The agency that investigates the abuse of a resident’s funds
shall send a report to any other agency listed under §B of this regulation that
participates in the licensure or subsidizes the care of the resident. Any
agency may make a referral to the State’s Attorney’s Office, or to the Medicaid
Fraud Control Unit of the Criminal Division of the Office of the Attorney
General, if appropriate.
.41 Approval of
Burial Arrangements for Unclaimed Deceased Residents.
A. An assisted living program shall ascertain and document on
admission of the resident, or within 14 calendar days of admission, any
arrangements the resident has made, or wishes to make, with regard to burial,
including, but not limited to:
(1) Financial;
(2) Religious;
(3) Name of preferred funeral director, if any; and
(4) The name, address, and relationship of any person who has
agreed to claim the body of the resident or who has agreed to assume funeral or
burial responsibility.
B. Notification on Death. On the death of an individual who
appears to be an unclaimed deceased resident, the assisted living manager or
designee shall contact any person who, although not having been identified in
advance as being responsible for the burial arrangements, might nevertheless at
the time of death be willing to claim the body and assume responsibility.
.42 General Physical
Plant Requirements.
A. The facility and exterior grounds, shall be kept:
(1) In good repair;
(2) Clean;
(3) Free of any object, material, or condition that may create a
health hazard, accident, or fire;
(4) Free of any object, material, or condition that may create a
public nuisance; and
(5) Free of insects and rodents.
B. Bathtubs, shower stalls, and lavatories may not be used by
the staff for laundering or storing soiled linens.
C. The assisted living program shall provide in the resident’s
room adequate storage space for excess supplies, some personal possessions of
residents, and similar items which is:
(1) Protected from the elements; and
(2) Secure, fixed, and locked in a manner that the resident can
access without assistance or with that level of assistance normally required
and readily available upon request.
D. Residents may possess their own cleaning supplies and
personal hygiene items if the assisted living manager and delegating nurse have
determined that the products would not present a threat to the safety of the
resident or others and this decision is documented in the records. The cleaning
supplies and personal hygiene items shall be kept in the resident’s room and
out of view of other residents when the materials are not in use.
A. Approved Source. A facility shall be served by water from an
approved public water supply. If an approved public water supply is not
available, a private water supply may be accepted if it is approved by the
local jurisdiction in which the program is located or a private certified
vendor to be submitted with an initial licensure application.
B. Adequacy. The water supply shall be adequate in quantity and
delivered under sufficient pressure to satisfactorily serve all fixtures in the
facility.
C. Hot Water Temperature. Hot water accessible to residents
shall be blended externally to the hot water generator, by either individual
point-of-use control valves of the anti-scald or thermostatic mixing valve
type, to a maximum temperature of 120°F and a minimum temperature of 100°F at
the fixture.
The facility shall be served by an approved public sewage
disposal system, if available. If an approved public sewage disposal system is
not available, a private sewage disposal system may be accepted if approved by
the local jurisdiction in which the program is located.
A. The facility shall provide:
(1) Lockable exterior doors and windows; and
(2) An effective automated device or system to alert staff to
individuals entering or leaving the building.
B. A facility need not use an automated alert for an exit door
when the exit is staffed by a receptionist or other staff member who views and
maintains a log of individuals entering and leaving the facility.
A. An assisted living program shall provide assist rails in
stairways used by residents and for all toilets, showers, and bathtubs used by
residents unless, through a waiver request, the Department determines that the
physical abilities of the residents make these devices unnecessary for resident
safety.
B. An assisted living program with a licensed capacity of 17 or
more beds shall also provide assist rails on both sides of corridors used by
residents.
A. The facility shall comply with:
(1) All applicable local fire and building codes; and
(2) The Life Safety Code, NFPA 101, including Chapter 24 of NFPA
101 if the facility is a one or two family dwelling as defined by NFPA 101.
B. Fire Extinguishers. An assisted living program shall:
(1) Ensure that fire extinguishers are:
(a) Located on each floor and adjacent to, or in, special hazard
areas, such as:
(i) Furnace rooms;
(ii) Boiler rooms;
(iii) Kitchens; or
(iv) Laundries;
(b) Of standard and approved types;
(c) Installed and maintained to be conveniently available for
use at all times; and
(d) Serviced annually, as evidenced by documentation maintained
on-site, by an individual or company licensed by the Maryland State Fire
Marshall; and
(2) Initially and at least annually instruct staff in the use of
fire extinguishers.
C. Emergency and Disaster Plan.
(1) The assisted living program shall develop an Assisted Living
Emergency Preparedness Packet in compliance with the requirements of §C(2)—(11) of this regulation, which
shall be readily available to all staff.
(2) The assisted living program shall develop an emergency and
disaster plan that includes procedures that shall be followed before, during,
and after an emergency or disaster, including:
(a) Evacuation, transportation, or sheltering in-place of
residents;
(b) Notification of families and staff regarding the action that
will be taken concerning the safety and well-being of the residents;
(c) Staff coverage, organization, and assignment of
responsibilities for ongoing sheltering in-place or evacuation, including
identification of staff members available to report to work or remain for
extended periods; and
(d) The continuity of services, including:
(i) Operations, planning, financial, and logistical
arrangements;
(ii) Procuring essential goods, equipment, and services to
sustain operations for at least 72 hours;
(iii) Relocation to alternate facilities or other locations; and
(iv) Reasonable efforts to continue care.
(3) The assisted living program shall have a tracking system to
locate and identify residents in the event of displacement, an emergency, or a
disaster that includes at a minimum the:
(a) Resident’s name;
(b) Date and time that the resident was sent to the initial
alternative facility or location;
(c) Name of the initial alternative facility or location where
the resident was sent; and
(d) Contact person and phone number for the facility where the resident
was sent.
(4) When the assisted living program relocates residents, the
assisted living program shall send a brief medical fact sheet with each
resident that includes at a minimum the resident’s:
(a) Name;
(b) Medical condition or diagnosis;
(c) Medications;
(d) Allergies;
(e) Special diets or dietary restrictions; and
(f) Family or legal representative contact information.
(5) The brief medical fact sheet for each resident described in
§C(4) of this regulation shall be:
(a) Updated upon the occurrence of change in any of the required
information;
(b) Reviewed at least monthly; and
(c) Maintained in a central location readily accessible and
available to accompany residents in case of an emergency evacuation.
(6) The assisted living program shall review the emergency and
disaster plan at least annually and update the plan as necessary.
(7) The assisted living program shall:
(a) Identify a facility, facilities, or an alternate location or
locations that have agreed to house the licensee’s residents during an
emergency evacuation; and
(b) Document an agreement with each facility or location.
(8) The assisted living program shall:
(a) Identify a source or sources of transportation that have
agreed to safely transport residents during an emergency evacuation; and
(b) Document an agreement with each transportation source.
(9) Upon request, an assisted living program shall provide a
copy of the facility’s emergency and disaster plan to the local emergency
management organization for the purpose of coordinating local emergency
planning. The assisted living program shall provide the emergency and disaster
plan in a format that is mutually agreeable to the local emergency management
organization.
(10) The assisted living program shall identify an emergency and
disaster planning liaison for the facility and shall provide the liaison’s
contact information to the local emergency management organization.
(11) The assisted living program shall prepare an executive
summary of its evacuation procedures to provide to a resident, family member,
or legal representative upon request. The executive summary shall, at a
minimum:
(a) List means of potential transportation to be used in the
event of evacuation;
(b) List potential alternative facilities or locations to be
used in the event of evacuation;
(c) Describe means of communication with family members and
legal representatives;
(d) Describe the role of the resident, family member, or legal
representative in the event of an emergency situation; and
(e) Notify families that the information provided may change
depending upon the nature or scope of the emergency or disaster.
D. Evacuation Plans. The facility shall:
(1) Conspicuously post individual floor plans with designated
evacuation routes on each floor; and
(2) Ensure that all staff have access to the entire emergency
preparedness plan.
E. Orientation and Drills.
(1) The assisted living program shall:
(a) Orient staff to the emergency and disaster plan and to their
individual responsibilities within 24 hours of the commencement of job duties;
and
(b) Document completion of the orientation in the staff member’s
personnel file through the signature of the employee.
(2) Fire Drills.
(a) The assisted living program shall conduct fire drills at
least quarterly on all shifts.
(b) Documentation and Retention. The assisted living program
shall document and maintain on file for a minimum of 2 years the:
(i) Completion date and time of each drill;
(ii) Names and signatures of staff who participated in the
drill;
(iii) Fire scenario used in the drill;
(iv) Steps taken by staff during the drill;
(v) Successful and non-successful actions taken by staff during
the drill; and
(vi) Opportunities for improvement identified as a result of the
drill.
(3) Semiannual Disaster Drill.
(a) The assisted living program shall conduct a semiannual
emergency and disaster drill on all shifts during which it practices evacuating
residents or sheltering in-place so that each is practiced at least one time a
year.
(b) The drills may be conducted via a table-top exercise if the
program can demonstrate that moving residents will be harmful to the residents.
(c) The assisted living program shall document and keep on file
for a minimum of 2 years the:
(i) Completion date and time of each disaster drill or training
session;
(ii) Names and signature of staff who participated in the drill
or training;
(iii) Type of disaster utilized for the drill or training;
(iv) Type of drill or training undertaken;
(v) Steps taken or discussed by staff during the drill or
training;
(vi) Successful and non-successful actions taken or discussed by
staff during the drill or training; and
(vii) Opportunities for improvement as identified as a result of
the drill.
(4) The assisted living program shall cooperate with the local
emergency management agency in emergency planning, training, and drills and in
the event of an actual emergency.
F. Emergency Electrical Power Generator.
(1) Generator Required. By October 1, 2009, an assisted living
program with 50 or more residents shall have an emergency electrical power
generator on the premises, unless the program meets the requirements of §F(7)
of this regulation.
(2) Generator Specifications. The power source shall be a
generating set and prime mover located on the program’s premises with automatic
transfer. The emergency generator shall:
(a) Be activated immediately when normal electrical service
fails to operate;
(b) Come to full speed and load acceptance within 10 seconds;
and
(c) Have the capability of 48 hours of operation of the systems
listed in §F(5) of this regulation from fuel stored on-site.
(3) Test of Emergency Power System.
(a) The program shall test the emergency power system once each
month.
(b) During testing of the emergency power system, the generator
shall be exercised for a minimum of 30 minutes under normal emergency facility
connected load.
(c) Results of the test shall be recorded in a permanent log
book that is maintained for that purpose.
(d) The assisted living program shall monitor the fuel level of
the emergency generator after each test.
(4) The emergency power system shall provide lighting in the
following areas of the facility:
(a) Areas of egress and protection as required by the State Fire
Prevention Code and Life Safety Code 101 as adopted by the State Fire
Prevention Commission;
(b) Nurses’ station;
(c) Medication distribution station or unit dose storage;
(d) An area for emergency telephone use;
(e) Boiler or mechanical room;
(f) Kitchen;
(g) Emergency generator location and switch gear location;
(h) Elevator, if operable on emergency power;
(i) Areas where life support equipment is used;
(j) If applicable, common areas or areas of refuge; and
(k) If applicable, toilet rooms of common areas or areas of
refuge.
(5) Emergency electrical power shall be provided for the
following:
(a) Nurses’ call system;
(b) At least one telephone in order to make and receive calls;
(c) Fire pump;
(d) Well pump;
(e) Sewerage pump and sump pump;
(f) If required for evacuation purposes, an elevator;
(g) If necessary, heating equipment needed to maintain a minimum
temperature of 70°F (24°C) in all common areas or areas of refuge;
(h) Life support equipment; and
(i) Nonflammable medical gas systems.
(6) Common Areas or Areas of Refuge. If the emergency power
system does not provide heat to all resident rooms and toilet rooms, the
program shall provide common areas or areas of refuge for all residents. The
areas shall meet the following requirements:
(a) The common area or areas of refuge shall maintain a minimum
temperature of 70°F (24°C);
(b) Heated toilet rooms shall be provided adjacent to the common
areas or areas of refuge; and
(c) The program facility shall provide to the Department a
written plan that defines the:
(i) Specified common areas or areas of refuge;
(ii) Paths of egress from the common areas or areas of refuge;
and
(iii) Provision for light, heat, food service, and washing and
toileting of residents.
(7) Applicability of Emergency Power Requirements.
(a) An assisted living program shall be exempt from the
requirements of this section if the program can safely transfer residents
through an enclosed corridor to a building that is equipped with an electrical
power generator that satisfies the requirements of §E of this regulation.
(b) An assisted living program may request a waiver from the
requirements of this section in accordance with the procedures outlined in
COMAR 10.07.14.09 on a year-to-year basis. The program shall demonstrate in the
waiver request financial hardship that would create an undue financial burden
on the facility and will require the facility to cease operation of the
assisted living program.
(c) When the Department grants a waiver to an assisted living
program for the requirements of this section, the assisted living program
shall:
(i) Disclose in writing to current and prospective residents
that the program does not have an emergency generator; and
(ii) Develop a plan to follow in the event of a loss of
electrical power.
.48 Smoking.
A. The assisted living program shall have a written smoking
policy that indicates whether or not the program permits smoking.
B. When smoking is permitted, the assisted living program shall:
(1) Establish smoking policies and procedures which are designed
to minimize the risk of fire;
(2) Provide in the policies and procedures at least the
following:
(a) Prohibit smoking in any hazardous location and in any room
or compartment where flammable liquids, combustible gases, or oxygen are used
or stored;
(b) Designate smoking areas; and
(c) Provide the smoking areas with ash trays of noncombustible
material and safe design;
(3) Provide smoking areas that comply with COMAR 09.12.23, if
the facility is considered an “enclosed work place” as defined in COMAR
09.12.23, including the ventilation requirements set forth in that chapter;
(4) Assess each resident who smokes to determine if assistance
or supervision is needed and document the assessment in the resident’s service
plan; and
(5) At least annually or after a change of condition that may
impact a resident’s ability to smoke, reassess a resident who smokes to
determine if assistance or supervision is needed and document the reassessment
in the resident’s service plan.
A. Multipurpose Space.
(1) The assisted living program shall provide at least 35 square
feet of usable multipurpose floor space per licensed bed. Multipurpose space
includes:
(a) Dining;
(b) Living; and
(c) Indoor recreational space.
(2) Usable floor space in a facility does not include:
(a) Service areas;
(b) Administrative offices;
(c) Entrance ways;
(d) Closets;
(e) Lockers;
(f) Wardrobes;
(g) Spaces where ceiling heights are less than acceptable for
habitable space, as defined by the applicable local building code; or
(h) Corridors.
(3) The assisted living program may not restrict residents from
any area constituting multipurpose space unless a comparable multipurpose space
is available for resident use.
B. Living Room.
(1) The assisted living program shall make at least one living
room available for resident use.
(2) The assisted living program shall ensure that the living
rooms are:
(a) Well lit and ventilated;
(b) Easily accessible; and
(c) Furnished with a sufficient number of reading lamps, tables,
chairs, or sofas based on residents’ needs.
C. Outdoor Space. An assisted living program shall:
(1) Provide or arrange for outside activity space;
(2) Adequately light outside activity space during all times
residents have access to the space; and
(3) Provide the necessary security and supervision of the
outside activity space sufficient to meet the needs of the residents.
D. Public Toilets.
(1) An assisted living program with a licensed capacity of 17 or
more beds shall provide public restrooms that are:
(a) Sufficient in number, and appropriately located, to serve
both residents and visitors; and
(b) Located close enough to activity areas to allow all
residents to participate comfortably in activities and social opportunities.
(2) The public toilet is not calculated in the ratio required by
Regulation .50A of this chapter.
E. Dining Room. An assisted living program shall provide a well
lit, adequately ventilated, and appropriately furnished dining area.
F. Kitchen.
(1) An assisted living program shall have a kitchen that has
adequate:
(a) Storage, refrigerator, and freezer space for perishable and
nonperishable foods;
(b) Food preparation area or areas with cleanable surfaces;
(c) Equipment to deliver foods at safe and palatable
temperatures;
(d) Space and equipment to wash, sanitize, and store utensils;
(e) Space to store and clean garbage cans either within or
outside the kitchen;
(f) Ice-making capabilities;
(g) Equipment for the preparation of food, unless all food
service is catered; and
(h) Equipment for serving and distributing food to residents.
(2) An assisted living program with a licensed capacity of 17 or
more beds shall comply with the food service facility regulations in COMAR
10.15.03.
(3) An assisted living program with fewer than 17 residents is
not required to comply with COMAR 10.15.03 unless required to comply by its
local jurisdiction or the Department determines and directs that a program
shall comply with particular provisions of COMAR 10.15.03 in order to minimize
health risks to its residents.
(4) An assisted living program with fewer than 17 residents:
(a) Shall obtain food from sources that comply with all laws and
regulations relating to food, food processing, food handling, and food
labeling;
(b) Shall protect food from contamination while being stored,
prepared, displayed, served, or transported;
(c) Shall promptly discard the following:
(i) Spoiled food;
(ii) Swelled, rusty, or leaky canned foods; and
(iii) Food exposed to fire, smoke, or water damage;
(d) May not serve to residents home-canned food or food in a
hermetically sealed container as defined in COMAR 10.15.03.02B, which was
prepared in a place other than a licensed food processing establishment;
(e) Shall maintain potentially hazardous food as defined in
COMAR 10.15.03.02B at 45°F or below, or 140°F or above, until served to
residents;
(f) Shall maintain food equipment, appliances, and utensils in a
clean and sanitary manner and in good repair;
(g) Shall maintain food contact surfaces smooth and free of
breaks, open seams, cracks, chips, and pits;
(h) Shall maintain floors, walls, and storage areas in a clean
and sanitary manner and in good repair;
(i) Shall provide refrigeration operated at or below 45°F and
equipped with an indicating thermometer graduated at 2°F intervals; and
(j) Shall provide freezer space operated at 0°F or less and
equipped with an indicating thermometer graduated at 2°F intervals.
.50
Resident’s Room and Furnishings.
A. Resident Room.
(1) More than two residents may not share a resident room.
(2) An assisted living program shall provide at least 80 square
feet of functional space for single occupancy resident rooms and 120 square
feet of functional space for double occupancy resident rooms.
(3) Functional space in a resident room does not include the
floor area of:
(a) Toilet rooms and bathing facilities;
(b) Closets, wardrobes, bureaus, or lockers;
(c) Entrance vestibules; or
(d) The arc of any door, excluding closet doors, that opens into
the room.
(4) A room may not be used as a resident room if:
(a) The only access to the room is through a bathroom or other
resident room; or
(b) In order to move from the room to a living room or dining
room a person must first go outdoors.
(5) For a program with a licensed capacity of 17 or more beds, a
room may not be used as a resident room if in order to move from the room to a
living room or dining room, an individual is required to first pass through a
kitchen.
(6) Resident rooms shall be for the private use of the assigned
resident or residents. A resident’s room shall have a latching door and may
have a lock on the resident room side of the door at the licensee’s option.
(7) If a resident in a double occupancy room requests dividers,
curtains, or screens between the beds to ensure privacy, the assisted living
program shall furnish them.
(8) A resident shall have access to a mirror either in the
resident’s room or in the resident’s private bathroom, unless a health care
practitioner documents in the resident’s record that access to a mirror would
be detrimental to the health of the resident.
(9) A resident’s room shall have window shades or their
equivalent.
(10) The assisted living program shall provide adequate closet
or wardrobe space, conveniently located to allow each resident to keep personal
clothing.
B. Furnishings. Unless a resident brings personal furnishings,
or as otherwise specified in the resident agreement, the assisted living
program shall provide the following to each resident:
(1) A bed, which may not be a rollaway, cot, or folding bed, but
shall:
(a) Be at least 36 inches wide;
(b) Be in good repair;
(c) Meet the resident’s medical needs; and
(d) Include:
(i) A clean mattress sized to fit the bed frame; and
(ii) At least two clean pillows;
(2) A bedside stand with a drawer;
(3) A chair;
(4) At least two dresser drawers in a chest of drawers;
(5) A bedside or over-the-bed lamp; and
(6) A sufficient supply of bath and bed linens.
C. A competent resident may waive the resident’s right to one or
all of the furnishings listed in §B of this regulation by signing a waiver and
having the waiver placed in the resident’s record.
D. The assisted living program shall inform a resident of all of
the furnishings that the assisted living program provides. The resident may
choose, at their cost, to provide a personal bed or other furnishings if they
are not hazardous.
.51 Bathrooms for
Residents.
A. Toilets.
(1) An assisted living program shall provide toilets in a
separate room or compartment with latching hardware for privacy.
(2) Buildings with one to eight occupants shall have a minimum
ratio of one toilet to four occupants.
(3) Buildings with nine or more occupants shall have a minimum
ratio of one toilet to four occupants and a minimum of one toilet for each
floor on which a resident room is located.
B. Hand Sinks.
(1) Buildings with one to eight occupants shall have a minimum
ratio of one hand sink to four occupants.
(2) Buildings with nine or more occupants shall have a minimum
ratio of one hand sink to four occupants and a minimum of one hand sink for
each floor on which a resident room is located.
C. Bathtubs or Showers. An assisted living program shall:
(1) Provide residents with bathtubs or showers that are enclosed
in a separate room or compartment with latching hardware for privacy; and
(2) Have a minimum ratio of one bathtub or shower to eight
occupants.
A. Resident’s Room.
(1) An assisted living program shall ensure that a resident’s
room:
(a) Is lighted by an outside window that:
(i) Contains a glass surface; and
(ii) Has square footage at least equal to 10 percent of the room’s
required floor area;
(b) Has a minimum of 60 watts or the equivalent of artificial
light provided for reading; and
(c) Is provided with additional artificial light as required for
other uses, such as night lights to enable residents to get to the bathroom at
night.
(2) An assisted living program shall provide additional lighting
or watts upon reasonable request by the resident or the resident’s legal
representative.
B. Common Use Areas. An assisted living program shall ensure
that common use areas, such as entrances, hallways, inclines, ramps, cellars,
attics, storerooms, kitchens, and laundries, have sufficient artificial
lighting to prevent accidents and promote efficient service.
C. The assisted living program shall provide sufficient light to
meet the resident’s needs.
.53 Heating,
Ventilation, and Air Conditioning.
A. An assisted living program may not use space heaters unless
approved by the State or local fire authorities.
B. Minimum Temperature. The facility shall have a system that
provides in areas used by residents a minimum temperature of 70°F in cold
weather and a maximum temperature of 80°F in hot weather.
C. Temperature Control.
(1) An assisted living program with a licensed capacity of one
to eight beds shall provide at least one thermostat per building.
(2) An assisted living program with a licensed capacity of nine
or more beds shall provide for each resident’s room:
(a) A thermostat; or
(b) An approved mechanical device for modulating a room’s
temperature, such as adjustable vanes in a hot air vent.
D. An assisted living program shall:
(1) Ensure that all rooms and areas have sufficient ventilation
to prevent excessive heat, steam, condensation, smoke, and other noxious odors;
and
(2) Provide forced mechanical exhaust ventilation or an approved
equivalent for:
(a) All bathing compartments;
(b) Toilet rooms;
(c) Any area used for toileting;
(d) Soiled utility rooms;
(e) Designated smoking rooms; and
(f) Other rooms, as determined by the Department.
.54 Radiators.
A. If steam or hot water plumbing reaches a temperature in
excess of 130°F or directly powered radiating surfaces are located in areas of
the facility that are accessible to residents, the assisted living program
shall position or shield the radiating surfaces in a manner to prevent resident
contact.
B. The assisted living program shall ensure that the radiator
shielding device:
(1) Allows for efficient heat transfer;
(2) Is constructed to minimize vermin harborage;
(3) Is constructed of easily cleanable materials; and
(4) Complies with all State and local fire codes.
.55 Laundry.
A. An assisted living program shall furnish laundry service,
either on-site or off-site.
B. An assisted living program shall ensure that the laundry is:
(1) Adequate to meet the needs of the residents;
(2) Processed and handled in a manner to prevent the spread of
infection; and
(3) Adequately sanitized by the use of sufficient hot water or
appropriate chemical agents, or a combination of both.
C. Unless otherwise agreed by the program and the resident, dry
cleaning services are not considered part of required laundry services in this
chapter.
.56 Telephones.
A. An assisted living program with a licensed capacity of one to
eight beds shall provide:
(1) At least one common-use telephone for residents; and
(2) A posting next to the common-use telephone or in a
conspicuous location that contains the telephone numbers for the local police
department and fire department.
B. An assisted living program with a licensed capacity of nine
to 16 beds shall provide at least one common-use telephone. If there are nine
or more residents that do not have private telephones in their own rooms, the
assisted living program shall provide a second common-use telephone.
C. An assisted living program with a licensed capacity of 17 or
more beds shall provide:
(1) That each resident’s room accommodates the use of the
resident’s own private telephone; and
(2) An adequate number of common-use telephones to accommodate
those residents who do not have private telephones installed in their rooms.
.57 Sanctions.
A. If the Secretary determines that an assisted living program
has violated this chapter, the Secretary, in addition to the sanctions set
forth in this chapter, may impose one or more of the following:
(1) Restrict the number of residents the assisted living program
may admit in accordance with Health-General Article, §19-328, Annotated Code of
Maryland;
(2) Require the assisted living program to reduce the number of
residents in care;
(3) Restrict the levels of care for which the assisted living
program may provide services;
(4) Require the assisted living program, and any of its staff,
to receive remedial instruction in a specific area;
(5) Require the assisted living program to use the services of
and cover the costs of a management firm approved by the Department;
(6) Require the assisted living program to use the services of
and cover the costs of a consultant to provide expertise related to:
(a) One or more licensure requirements;
(b) Standards of care; or
(c) Discharge planning.
(7) Mandate staffing patterns which specify number of personnel,
personnel qualifications, or both;
(8) Require the establishment of an escrow account in accordance
with Health-General Article, §19-362, Annotated Code of Maryland;
(9) Direct the assisted living program to correct the violations
in a specific manner or within a specified time frame, or both;
(10) Notify, or require the assisted living program to notify,
the representative or family of any resident who is affected by the
noncompliance;
(11) Increase the frequency of monitoring visits during a
specified period of time; or
(12) Enter into an agreement with the assisted living program
establishing certain conditions for continued operation, including time limits
for compliance.
B. If the Secretary determines that the assisted living program
has violated a condition or requirement of an imposed sanction, the Secretary
may suspend or revoke the license.
C. Appeals.
(1) An assisted living program aggrieved by the imposition of a
sanction under §A(1), (2), or (3) or B of this regulation may appeal the
Secretary’s action by filing a request for a hearing in accordance with
Regulation .65 of this chapter.
(2) An assisted living program aggrieved by the imposition of a
sanction under §A(8) of this regulation may appeal the Secretary’s action in
accordance with Health-General Article, §§19-364 and 19-367, Annotated Code of
Maryland.
(3) This section does not, however, create an appeal for a
decision made under Regulation .23A of this chapter.
A. The Secretary may impose a civil money penalty on a person
if:
(1) The person maintains or operates an unlicensed assisted
living program;
(2) A deficiency or an ongoing pattern of deficiencies exists in
the assisted living program; or
(3) The person falsely advertises a program in violation of
Regulation .06B(2) of this chapter.
B. In determining whether a civil money penalty is to be
imposed, the Secretary shall consider the following factors:
(1) Nature, number, and seriousness of the deficiencies;
(2) The extent to which the deficiency or deficiencies are part
of an ongoing pattern during the preceding 24 months;
(3) The degree of risk to the health, life, or safety of the
residents of the program that is caused by the deficiency or deficiencies;
(4) The efforts made by, and the ability of the program to
correct, the deficiency or deficiencies; and
(5) An assisted living program’s prior history of compliance.
C. If the Department determines that a deficiency or an ongoing
pattern of deficiencies exists, the Department shall notify the program of the
deficiency or deficiencies and may:
(1) Impose a per day civil money penalty until sustained
compliance has been achieved;
(2) Permit the program the opportunity to correct the
deficiencies by a specific date; or
(3) Impose a per instance civil money penalty for each instance
of violation.
D. If the Department permits a program the opportunity to
correct the deficiencies by a specific date, and the program fails to comply
with this requirement, the Department may impose a per day civil money penalty
for each day of violation until correction of the deficiency or deficiencies
has been verified and sustained compliance has been maintained.
E. If the Department proposes to impose a civil money penalty,
the Secretary shall issue an order which shall state the:
(1) Deficiency or deficiencies on which the order is based;
(2) Amount of civil money penalties to be imposed; and
(3) Manner in which the amount of civil money penalties imposed
was calculated.
.59
Amount of Civil Money Penalties.
A. A civil money penalty imposed on a person under this chapter
may not exceed the amounts identified in Health-General §19-1809, Annotated
Code of Maryland.
B. In setting the amount of the civil money penalty under this
chapter, the Secretary shall consider the following factors:
(1) Nature, number, and seriousness of the deficiencies;
(2) The degree of risk to the health, life, or safety of the
residents of the program that is caused by the deficiency or deficiencies;
(3) The efforts made by, and the ability of, the program to
correct the deficiency or deficiencies;
(4) Whether the amount of the civil money penalty will
jeopardize the financial ability of the program to continue operation as a
program; and
(5) Other factors as justice may require.
C. A person aggrieved by the action of the Secretary under this
regulation may appeal the Secretary’s action by filing a request for a hearing
in accordance with Regulation .65 of this chapter.
.60
Civil Money Penalties — Hearings.
A. A hearing on the appeal shall be held consistent with the
State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.
B. The Secretary shall have the burden of proof with respect to
the imposition of the civil money penalties under this chapter.
A. Operating Without a License.
(1) A person may not knowingly and willfully operate, maintain,
or own an assisted living program without a license.
(2) A person who violates §A(1) of this regulation is guilty of
a felony and on conviction is subject to:
(a) For a first offense, a fine not exceeding $10,000,
imprisonment not exceeding 5 years, or both; and
(b) For a subsequent offense, a fine not exceeding $20,000,
imprisonment not exceeding 5 years, or both.
(3) If the Department finds a credible allegation that an
assisted living program is operating without a license, the Department, or the
Office of Health Care Quality, shall investigate whether residents in the
assisted living program have been subjected to neglect, abuse, or financial
exploitation.
(4) On receipt of a credible allegation, or after an
investigation that results in a finding that residents in an unlicensed
assisted living program have been subjected to neglect, abuse, or financial
exploitation, the person operating the unlicensed program shall be subject to
immediate prosecution under §A(2) of this regulation.
(5) If the person operating an unlicensed assisted living
program fails or refuses to cooperate fully in an investigation by the
Department, or the Office of Health Care Quality, conducted under §A(3) of this
regulation, the person operating the unlicensed assisted living program shall
be subject to immediate prosecution under §A(2) of this regulation.
(6) If the Department finds, after an investigation conducted
under §A(3) of this regulation, that there is no reason to believe that
residents in the assisted living program operating without a license have been
subject to financial exploitation, neglect, or abuse:
(a) The Department shall provide written notice to the
unlicensed assisted living program that the program shall come into compliance
with licensure requirements within 30 days after receipt of the written
notification; and
(b) The person operating the program may not be subject to
prosecution under §A(2) of this regulation if the
person:
(i) Has promptly and in good faith submitted a complete
application to the Department for an assisted living program license;
(ii) Is awaiting a decision from the Department regarding the
application; and
(iii) Has not been denied an assisted living program license on
a prior occasion.
(7) In recommending the amount of the criminal penalty under
§A(2) of this regulation, the State shall consider factors including the
nature, number, and seriousness of the violations.
(8) The Department, the Attorney General, a State’s Attorney, or
a local health officer may petition a circuit court for injunctive relief
against the operation of an assisted living program operating without a
license.
(9) A violation of §A(1) of this regulation shall be a
violation of the Consumer Protection Act.
B. Advertisement and Representation of an Assisted Living
Program.
(1) A person may not advertise, represent, or imply to the
public that an assisted living program is authorized to provide a service that
the program is not licensed, certified, or otherwise authorized by the
Department to provide when the license, certificate, or authorization is
required under this subtitle.
(2) A person may not advertise an assisted living program in a
misleading or fraudulent manner.
(3) A person who violates §B(1) of this regulation is subject to
a civil money penalty imposed by the Secretary not exceeding $10,000 for each
offense.
(4) In setting the amount of a civil money penalty on the
program under §B(1) of this regulation, the Secretary shall consider factors
including the nature, number, and seriousness of the violations and the ability
of the assisted living program to pay the penalty.
C. Referral to an Assisted Living Program Operating Without a
License.
(1) A person may not willfully and knowingly refer another
person to an assisted living program that is operating without a license.
(2) A person who violates §C(1) of this regulation is subject to
the following civil penalties:
(a) For a first offense, a civil penalty not exceeding $1,000;
(b) For a second offense, a civil penalty not exceeding $2,000;
or
(c) For a third or subsequent offense, a civil penalty not
exceeding $3,000.
(3) The Secretary shall remit all civil penalties collected
under this regulation to the Office of Health Care Quality for the purposes of
carrying out the provisions of Health-General Article, §19–1813, Annotated Code
of Maryland.
.62 Health Care Quality Account.
A. The Department shall establish a health care quality account
in the Department for assisted living programs.
B. The health care quality account shall be funded by civil
money penalties paid by assisted living programs.
C. The Department shall use funds from the health care quality
account to improve the quality of care in assisted living programs.
D. Expenditure of funds may include, but is not limited to, the
following:
(1) Funding for the establishment and operation of a
demonstration project;
(2) A grant award;
(3) Relocation of residents in crisis situations;
(4) Provision of educational programs to assisted living
programs, the Office of Health Care Quality, other government, professional, or
advocacy agencies, and consumers; and
(5) Any other purpose that will directly improve quality of
care.
E. Suggestions for the use of funds may be submitted to the
Department from:
(1) Members of the public;
(2) Advocacy organizations;
(3) Government agencies;
(4) Professional organizations, including trade associations;
(5) Assisted living programs; and
(6) Assisted living associations.
F. Decision on Expenditure of Funds.
(1) The Department, in its sole discretion, shall decide how to
spend funds from the health care quality account.
(2) The Department’s decision to spend funds or not to spend
funds for a specific project or purpose is not a contested case as defined in
State Government Article, §10-202(d), Annotated Code of Maryland, and therefore
may not be appealed.
A. The Secretary may immediately suspend a license on finding
that the public health, safety, or welfare imperatively requires emergency
action.
B. The Department shall deliver a written notice to the assisted
living program:
(1) Informing the program of the emergency suspension;
(2) Giving the reasons for the action and the regulation or
regulations with which the assisted living program has failed to comply that
forms the basis for the emergency suspension; and
(3) Notifying the assisted living program of its right to
request a hearing and to be represented by counsel.
C. The filing of a hearing request does not stay the emergency
action.
D. When a license is suspended by emergency action:
(1) The assisted living program shall immediately cease the use
of all previously issued assisted living program licenses and return all paper
licenses to the Department;
(2) The assisted living program shall stop providing assisted
living services immediately;
(4) The assisted living
manager or alternate assisted living manager shall immediately notify the
following entities of the emergency action:
(a) Ombudsman within
the Department of Aging or local area agency on aging; and
(b) Local Department of
Human Services or Adult Protective Services.
E. In the event of an emergency suspension, the Department may
assist in the relocation of residents.
F. A person aggrieved by the action of the Secretary under this
regulation may appeal the Secretary’s action by filing a request for a hearing
consistent with Regulation .65 of this chapter.
G. Show Cause Hearing.
(1) In addition to the right to request a hearing consistent
with Regulation .65 of this chapter, a person aggrieved by the action of the
Secretary under this regulation shall be provided with the opportunity for a
hearing to show cause why the Department should lift the summary suspension.
(2) If requested in writing, the show cause hearing shall be
held promptly within a reasonable time after the effective date of the order of
summary suspension. The time limit for filing an appeal with the Office of
Administrative Hearings to obtain an evidentiary hearing shall be followed by
the filing of a request for a show cause hearing.
(3) The show cause hearing shall be a nonevidentiary hearing to
provide the parties with an opportunity for oral argument on the summary
suspension.
(4) The show cause hearing shall be conducted before the
Secretary or a designee of the Secretary, who:
(a) Shall determine procedural issues;
(b) May impose reasonable time limits on each party’s oral
argument; and
(c) Shall make rulings reasonably necessary to facilitate the
effective and efficient operation of the show cause hearing.
(5) At the conclusion of the show cause hearing, the Secretary
or the Secretary’s designee may:
(a) Affirm the order of summary suspension;
(b) Rescind the order of summary suspension;
(c) Enter into a consent order; or
(d) Enter into an interim order warranted by the circumstances
of the case, including one providing for a stay of the summary suspension
subject to certain conditions.
(6) After the show cause hearing, if the Secretary or the
Secretary’s designee decides to continue the summary suspension, the person
aggrieved by the decision may request an evidentiary hearing before the Office
of Administrative Hearings consistent with Regulation .65 of this chapter.
H. Hearing.
(1) The Office of Administrative Hearings shall conduct a
hearing as provided in Regulation .65 of this chapter and issue a proposed
decision within the time frames set forth in COMAR 28.02.01.
(2) An aggrieved person may file exceptions pursuant to COMAR
10.01.03.
(3) The Secretary shall make a final decision pursuant to COMAR
10.01.03.
(4) If the Secretary’s final decision does not uphold the emergency
suspension, the assisted living program may resume operation.
A. The Secretary, for cause shown, may notify the assisted
living program of the Secretary’s decision to revoke the assisted living
program’s license. The revocation shall be stayed if a hearing is requested.
B. The Department shall notify the assisted living program in
writing of the following:
(1) The effective date of the revocation;
(2) The reason for the revocation;
(3) The regulations with which the assisted living program has
failed to comply that form the basis for the revocation;
(4) That the assisted living program is entitled to a hearing,
if requested, and to be represented by counsel;
(5) That the assisted living program shall stop providing
services on the effective date of the revocation if the assisted living program
does not request a hearing;
(6) That the revocation shall be stayed if a hearing is
requested; and
(7) That the assisted living program is required to surrender
its license to the Department if the revocation is upheld.
C. The assisted living manager or their designee shall:
(1) Notify the residents and residents’ representatives of the
revocation;
(2) Make every reasonable effort to assist residents and
resident representatives in making safe and appropriate discharge plans,
including to other licensed assisted living programs; and
(3) Immediately notify the following entities of the revocation:
(a) Ombudsman within the Department of Aging or local area
agency on aging; and
(b) Local Department of Human Services or Adult Protective
Services.
D. The Department may assist in the relocation of residents or
require the assisted living program to use the services of and cover the costs
of a consultant to arrange safe and appropriate discharges for residents.
E. A person aggrieved by the action of the Secretary under this
regulation may appeal the Secretary’s action by filing a request for a hearing
in accordance with Regulation .65 of this chapter.
A. A request for a hearing shall be filed with the Office of
Administrative Hearings, with a copy to the Office of Health Care Quality of
the Department, not later than 30 days after receipt of notice of the Secretary’s
action. The request shall include a copy of the Secretary’s action.
B. A hearing requested under this chapter shall be conducted in
accordance with State Government Article, Title 10, Subtitle 2, Annotated Code
of Maryland, and COMAR 10.01.03 and 28.02.01.
C. The burden of proof is as provided in COMAR 10.01.03.28.
D. Unless otherwise stated in this chapter, the Office of
Administrative Hearings shall issue a proposed decision within the time frames
set forth in COMAR 28.02.01.
E. The aggrieved person may file exceptions as provided in COMAR
10.01.03.18.
F. A final decision by the Secretary shall be issued in
accordance with COMAR 10.01.03.18J.
LAURA HERRERA SCOTT
Secretary of Health
Subtitle 39 INTERAGENCY COMMISSION ON SCHOOL CONSTRUCTION
14.39.02 Administration of the Public School Construction Program
Authority: Education Article, §§4-126, 5-112, and 5-303; State Finance and Procurement Article, §5-7B-07; Annotated Code of Maryland
Notice of Proposed Action
[23-251-P-I]
The Interagency Commission on School Construction proposes to
adopt new Regulation .01, recodify existing Regulations .01—.03, .05,
and .07—.31 to be Regulations .02—.04, .06, and .08—.32,
respectively, and amend and recodify existing Regulations .04 and .06
to be Regulations .05 and .07, respectively, under COMAR
14.39.02 Administration of the Public School Construction Program. This
action was considered by the Interagency Commission on School Construction at
an open meeting held on October 12, 2023, notice of which was given by
publication on the General Assembly website pursuant to the General Provisions
Article, §3-302(c), Annotated Code of Maryland.
Statement of Purpose
The purpose of this action is to incorporate by reference the adopted Gross Area Baselines and amend State Rated Capacity calculation requirements for certain physical education and gymnasium spaces.
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 Victoria Howard, Policy Analyst, Interagency Commission on School Construction, 200 W. Baltimore St., 2nd Floor, Baltimore, MD 21201, or call 410-767-0600, or email to victoria.howard@maryland.gov. Comments will be accepted through April 22, 2024. A public hearing has not been scheduled.
Open Meeting
Final action on the proposal will be considered by Interagency Commission on School Construction during a public meeting to be held on May 9, 2024, at 9 a.m., at https://iac.mdschoolconstruction.org/?page_id=315.
Editor’s Note on Incorporation by Reference
Pursuant to State Government
Article, §7-207, Annotated Code of Maryland, the Interagency Commission on
School Construction Gross Area Baseline Per Student Square Footage Allowances
(September 14, 2023)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
51:1 Md. R. 8 (January 12, 2024) and is available online at
www.dsd.maryland.gov. 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.
The Interagency Commission on School Construction Gross Area
Baseline Per Student Square Footage Allowances (September 14, 2023) is
incorporated by reference.
[.04] .05
State-Rated Capacity.
A.—B. (text unchanged)
C. Secondary Schools.
(1) (text
unchanged)
(2) Classrooms.
(a) (text unchanged)
(b) Secondary-school classrooms include laboratories, career
technology rooms, music rooms, art rooms, consumer science rooms, gymnasiums,
and auxiliary physical education classrooms. One physical education
classroom up to 2,500 square feet which contains specialized equipment that
cannot be stored or relocated may be excluded upon application to and approval
of the IAC or its designee.
(c) A gymnasium [with
a standard interscholastic basketball court] up to 13,000 square feet
counts as two classrooms. A gymnasium exceeding 13,000 square feet
counts as three classrooms.
(3)—(5) (text unchanged)
D.—F. (text unchanged)
[.06] .07 Maximum State Construction Allocation.
A.—D. (text unchanged)
E. Gross Area Baselines.
(1)—(3) (text unchanged)
(4) Gross
Area Baseline Concentration of Poverty Add-On.
School projects with a concentration of poverty level above 55 percent are
eligible for a concentration of poverty square footage add-on, upon submission
of a concentration of poverty square footage usage plan, based upon the
following:
(a) School projects with an eligible enrollment of fewer than
600 students are eligible for a concentration of poverty add-on of up to 1,000
square feet plus the concentration of poverty level percentage points above 55
percent multiplied by 60 square feet, up to a maximum of 1,500 square feet.
(b) School projects with an eligible enrollment between 600 and
900 students are eligible for a concentration of poverty add-on of up to 1,500
square feet plus the concentration of poverty level percentage points above 55
percent multiplied by 60 square feet, up to a maximum of 2,000 square feet.
(c) School projects with an eligible enrollment of more than 900
students are eligible for a concentration of poverty add-on of up to 2,000
square feet plus the concentration of poverty level percentage points above 55
percent multiplied by 60 square feet, up to a maximum of 2,500 square feet.
(5) Gross Area Baseline English Learner Add-On. School projects
with an English learner population above 10 percent are eligible for an English
learner square footage add-on, based upon the following:
(a) School projects with an eligible enrollment of fewer than
600 students are eligible for an English learner add-on of 500 square feet plus
the number of percentage points of the project school populations of English
learners above 10 percent, multiplied by 25 square feet, up to a maximum of
1,500 square feet.
(b) School projects with an eligible enrollment between 600 and
900 students are eligible for an English learner add-on of 1,000 square feet
plus the number of percentage points of
the project school populations of English learners above 10 percent, multiplied
by 25 square feet, up to a maximum of 2,000 square feet.
(c) School projects with an eligible enrollment of more than 900
students are eligible for an English learner add-on of 1,500 square feet plus
the number of percentage points of the
project school populations of English learners above 10 percent, multiplied by
25 square feet, up to a maximum of 2,500 square feet.
(6) Gross Area Baseline Career and Technology Education Add-On.
School projects approved for Career and Technology Education programs are
eligible for a Career and Technology Education square footage add-on based upon
the program size. Program sizes shall be regularly reviewed and updated by the
IAC and published to the IAC website. Square footage allocations for program
sizes are as follows:
(a) Extra small Career and Technology Education programs receive
an add-on of 500 gross square feet.
(b) Small Career and Technology Education programs receive an
add-on of 1,000 gross square feet.
(c) Medium Career and Technology Education programs receive an
add-on of 3,000 gross square feet.
(d) Large Career and Technology Education programs receive an
add-on of 4,000 gross square feet.
(e) Extra large Career and Technology Education programs receive
an add-on of 6,000 gross square feet.
F.—N. (text unchanged)
ALEX DONAHUE
Executive Director
Title 26
DEPARTMENT OF ENVIRONMENT
Subtitle 04 REGULATION OF WATER SUPPLY, SEWAGE DISPOSAL, SOLID WASTE, AND RECYCLABLE MATERIALS
26.04.01 Quality of Drinking Water in Maryland
Authority: Environment Article, Title 9, Subtitles 2 and 4, Annotated Code of Maryland
Notice of Proposed Action
[23-311-P-I]
The Secretary of the Environment proposes to amend Regulations .01,
.01-1, and .20 and adopt new Regulation .31 under COMAR
26.04.01 Quality of Drinking Water in Maryland.
Statement of Purpose
The purpose of this action is to clarify and formalize procedures. Current MDE regulations in COMAR 26.04.01.20B (Tier 1 Public Notices) do not explicitly include outages, flooded wells, or flooded springs as Tier 1 public notices. However, these issues occur in water systems regularly and are a risk to public health. This proposed regulation describes actions that must be taken during an outage or flooded well/spring incident. This proposed action and an upcoming guidance manual (not cited in the regulation) will provide clear instructions for water systems to:
• Issue a boil water advisory (BWA) for an outage or flooded well/spring (when and how);
• Notify MDE that a BWA has been issued;
• Use relevant standards that should be followed for disinfection during an outage, flooded wells and flooded springs;
• Monitor water quality by sampling prior to lifting a BWA;
• Lift a BWA;
• Notify MDE that a BWA has been lifted; and
• Maintain records for outages, a flooded well/spring, and any BWA.
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 Gregory C. Busch, P.E., Program Manager, Water Supply Program, Maryland Department of the Environment, 1800 Washington Blvd., Baltimore, MD 21230, or call 410-537-3901, or email to gregory.busch@maryland.gov. Comments will be accepted through April 22, 2024. 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 following have been declared
documents generally available to the public and appropriate for incorporation
by reference:
(1) American Water
Works Association, AWWA Standard, Disinfecting Water Mains (ANSI/AWWA C651-14),
effective February 1, 2015.
(2) American Water Works Association, AWWA Standard, Disinfection of Wells (ANSI/AWWA C654-13), effective July 1, 2013.
For this reason, they will not
be printed in the Maryland Register or the Code of Maryland Regulations
(COMAR). Copies of these documents are filed in special public depositories
located throughout the State. A list of these depositories was published in 51:1
Md. R. 8 (January 12, 2024), and is available online at www.dsd.maryland.gov.
These documents may also be inspected at the office of the Division of State
Documents, 16 Francis Street, Annapolis, Maryland 21401.
.01 Definitions.
A. (text unchanged)
B. Terms Defined.
(1)—(22) (text unchanged)
(23) “Flooded spring” means when water enters a spring box from
above the ground surface.
(24) “Flooded well” means when water enters a well casing from
above the ground surface.
[(23)] (25)—[(46)] (48) (text unchanged)
(49) “Outage” means a complete loss of pressure in a water main
that causes one or more service connections to lose their supply of drinking
water.
[(47)] (50)—[(76)] (79) (text unchanged)
.01-1 Incorporation by Reference.
A. (text unchanged)
B. Documents Incorporated.
(1) Code of Federal Regulations (CFR) — 40 CFR §§141 and 142 (July 1, 2014):
[(1)] (a)—[(17)] (q) (text unchanged)
(2) American Water Works Association, AWWA Standard,
Disinfecting Water Mains (ANSI/AWWA C651-14), effective February 1, 2015.
(3) American Water Works Association, AWWA Standard,
Disinfection of Wells (ANSI/AWWA C654-13), effective July 1, 2013.
.20 Public Notification of Variances, Exemptions, and Noncompliance with Standards.
A. General Public Notification Requirements.
(1)—(4) (text unchanged)
(5) If a supplier of water experiences an outage under
Regulation .31A(1)(b) of this chapter, the supplier of water may limit the
distribution of the public notice to individuals who are served by the portion
of the distribution system that experienced the outage.
[(5)] (6) (text unchanged)
(1) The violation categories requiring Tier 1 notices are specified in 40 CFR §141.202 and [include] this regulation, including:
(a)—(h) (text unchanged)
(i) Occurrence of an outage under Regulation .31A(1)(b) of this
chapter;
(j) Detection of E. coli in any sample collected under
Regulation .31D of this chapter;
(k) Entry
of water from a flooded spring into a distribution system;
(l) Entry
of water from a flooded well into a distribution system; or
[(i)] (m) (text unchanged)
(2)—(3) (text unchanged)
C.—D. (text unchanged)
E. Public Notice Content.
(1) Each public notice shall meet the requirements [as described] in 40 CFR §141.205, and shall include the following information:
(a) A description of the violation or situation, including, as applicable, the contaminant or contaminants of concern, and the contaminant level or levels;
(b)—(j) (text unchanged)
(2)—(9) (text unchanged)
(10) A supplier of water that experiences an outage under
Regulation .31A(1)(b) of this chapter shall include the following language in
each public notice: “There is a heightened risk of contamination due to a loss
of pressure in the drinking water system. Sensitive populations (persons who
are elderly, immunocompromised, ill, pregnant, nursing, young children, etc.)
and anyone else who desires an increased level of protection should boil water
until further notice.”
.31 Outages, Flooded Wells, and Flooded Springs.
A. Outages.
(1) A supplier of water that experiences an outage shall perform
one of the following:
(a) The requirements in §A(2) of this regulation; or
(b) The requirements in §§B, C(1), D, E, H, and I of this
regulation.
(2) A planned outage occurs when the supplier of water performs
all of the following requirements:
(a) Issues a public notice to individuals who are served by the
portion of the distribution system that will experience the outage before the
outage occurs; and
(b) Follows all procedures listed in §§C(1), D, E, and I of this
regulation.
B. Public Notification Requirements. A supplier of water shall
comply with Regulation .28 of this chapter and shall issue a Tier 1 public
notice as provided in Regulation .20 of this chapter each time one of the
following events occurs:
(1) An outage that does not meet the requirements in §A(2) of
this regulation;
(2) Water from a flooded spring enters a distribution system;
(3) Water
from a flooded well enters a distribution system; or
(4) E. coli is detected
in any sample collected in accordance with §D of this regulation.
C. Repair and Disinfection Procedures.
(1) A supplier of water that experiences an outage shall meet
all of the following requirements:
(a) Perform the procedures that are established in ANSI/AWWA
C651-14 for each affected area of the distribution system;
(b) Document any evidence of contamination in writing;
(c) Disinfect each repair part with a minimum 1 percent free
chlorine solution; and
(d) Instruct each affected customer to flush each plumbing fixture for at least 5 minutes after water service is restored.
(2) A supplier of water that experiences a flooded well shall
perform all of the following requirements:
(a) Disinfect the flooded well in accordance with ANSI/AWWA
C654-13; and
(b) If water from a flooded well enters a distribution system,
the supplier of water shall meet all of the following requirements:
(i) Flush each affected area of the distribution system; and
(ii) After distribution system flushing is completed, instruct each
customer to flush each plumbing fixture for at least 5 minutes.
(3) A supplier of water that experiences water from a flooded
spring entering a distribution system shall meet all of the requirements in
§C(2)(b) of this regulation.
D. Water Quality Sampling for Outages.
(1) A supplier of water that experiences an outage shall sample
each affected area of the distribution system for each of the following:
(a) Total coliform;
(b) E. coli; and
(c) If the supplier of water uses chemical disinfection,
disinfectant residual at the location where each bacteriological sample is
taken.
(2) The supplier of water shall collect the number of samples
specified in §E of this regulation and shall gather these samples from
different, representative locations in each affected area of the distribution
system.
E. Number of Required Samples.
|
Number of Service
Connections Impacted |
Number of Samples |
|
1—50 |
1 |
|
51—100 |
2 |
|
101—500 |
3 |
|
501—1,000 |
4 |
|
Over 1,000 |
Consult with the Approving Authority |
F. Water Quality Sampling for Flooded Wells. A supplier of water
that experiences a flooded well shall perform all of the following
requirements:
(1) Sample the flooded well for total coliform and E. coli in
accordance with ANSI/AWWA C654-13; and
(2) If water from the flooded well enters the distribution
system, meet all of the requirements in §§D and E of this regulation.
G. Water Quality Sampling for Flooded Springs. A supplier of
water that experiences a flooded spring shall perform all of the following
requirements:
(1) Collect at least two total coliform and E. coli samples at
least 30 minutes apart from the spring after the spring has returned to normal
conditions; and
(2) If water from the flooded spring enters the distribution system, meet all of the requirements in §§D and E of this regulation.
H. Lifting a Public Notice.
(1) A supplier of water may lift a Tier 1 public notice issued
pursuant to §B of this regulation and Regulation .20B(1)(i)-(l) of this chapter
when all of the following requirements are met:
(a) Each requirement under §C of this regulation is complete;
(b) Normal operating conditions have resumed;
(c) Bacteriological tests under §D of this regulation are
negative for total coliform and E. coli; and
(d) For suppliers of water that use chemical disinfection,
disinfectant residual tests under §D of this regulation are detectable.
(2) The supplier of water shall submit all of the following
documents to the Approving Authority within 10 days after the Tier 1 public
notice is lifted:
(a) Each bacteriological test result under §D of this
regulation;
(b) Each disinfectant residual test result under §D of this
regulation;
(c) A copy of the notice to customers which lifted the Tier 1
public notice; and
(d) Any other documentation requested by the Approving Authority.
I. Record Keeping.
(1) A supplier of water shall keep a written record of all of
the following for 3 years after each event occurs:
(a) Outages;
(b) Flooded wells;
(c) Flooded springs;
(d) Public notices issued pursuant to §A(2) or B of this
regulation;
(e) Bacteriological test results under §D of this regulation;
(f) Disinfectant residual test results under §D of this regulation; and
(g) A copy of the notice to customers which lifted the Tier 1
public notice under §H of this regulation.
(2) The supplier of water shall provide the records required
under §I(1) of this regulation to the Approving Authority on request.
SERENA MCILWAIN
Secretary
Title 34
DEPARTMENT OF PLANNING
Subtitle 04 HISTORICAL AND CULTURAL PROGRAMS
34.04.09 Maryland Historical Trust African American Heritage Preservation Program
Authority: State Finance and Procurement Article, [§§5-7B-01—5-7B-10]
§§5-203, 5A-318, and 5A-330, Annotated Code of Maryland[;
Executive Orders 01.01.1992.27C and 01.01.1998.04]
Notice of Proposed Action
[23-236-P]
The Secretary of the Department of Planning proposes to amend
Regulations .06, .08, and .09 under COMAR 34.04.09 Maryland Historical Trust African American
Heritage Preservation Program.
Statement of Purpose
The purpose of this action is to delete the match requirement for grant applicants removed by Ch. 29, Acts of 2022, and to make it clear that grantees shall submit a final report and may be required to submit interim reports.
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 Stacy Montgomery, Capital Programs Administrator, Maryland Historical Trust, 100 Community Place, 3rd Floor, Crownsville, MD 21032-2023, or call 410-697-9559, or email to stacy.montgomery@maryland.gov. Comments will be accepted through April 22, 2024. A public hearing has not been scheduled.
.06 Grant Allocation Procedures.
A. Annual Application Solicitation and Submission.
(1) (text unchanged)
(2) Grant applications shall be submitted to the Trust in form prescribed by the Trust and shall include:
(a) — (b) (text unchanged)
(c) Sufficient information and documentation to:
(i) — (vii) (text unchanged)
(viii) Evaluate the
applicant’s administrative and financial capacity and capability; and
(ix) Establish that the applicant has site control of the property as required by Regulation .05C(2) of this chapter; [and
(x) Determine the availability of matching funds from other sources to support the project;]
(d) — (e) (text unchanged)
B. Selection Criteria.
(1) The Trust and the Commission shall review and evaluate grant applications in accordance with the following selection criteria:
(a) — (m) (text unchanged)
[(n) Viability of matching funds for the project;]
[(o)] (n) — [(q)] (p) (text unchanged)
(2) (text unchanged)
C. (text unchanged)
.08 Grant Terms and Conditions.
[A. Matching Requirements.
(1) Except for a nonprofit organization, the recipient of a grant under the Program must match the grant with other sources of funds contributed to the cost of the project in an amount at least equal to the amount of the grant.
(2) The match shall consist of either cash or an equivalent dollar value of an in-kind contribution to the project.
(3) The match may come from any combination of federal, county, municipal, or private sources of funds as acceptable to the Commission and the Trust.
(4) The Commission and the Trust may require a match in the case of
a grant to a nonprofit organization. The matching requirement for a nonprofit
organization, if any, shall be specified in the public announcement made
pursuant to Regulation .06A(1)(a) of this chapter and the contents of the match
shall conform with the requirements in §A(1) and (2) of this regulation.]
[B.] A. Grant Amount. [Except as may be permitted for grants awarded to nonprofit organizations, a] A grant may not exceed [50 percent of the total cost of the project for which the grant funds are awarded]$500,000.
[C.] B. — [E.] D. (text unchanged)
.09 Grantee Administration.
A. (text unchanged)
B. Reports. Grantees shall submit a final report, and interim reports as may be required by the Commission and the Trust that document project progress and evaluate project effectiveness.
C. (text unchanged)
REBECCA L. FLORA
Secretary of Planning
SUSQUEHANNA RIVER BASIN COMMISSION
Projects Approved for
Consumptive Uses of Water
AGENCY: Susquehanna River Basin Commission.
ACTION: Notice.
SUMMARY: This notice lists Approvals by Rule for projects by the Susquehanna River Basin Commission during the period set forth in DATES.
DATES: February 1-29, 2024.
ADDRESSES: Susquehanna River Basin Commission, 4423 North Front Street, Harrisburg, PA 17110-1788.
FOR FURTHER INFORMATION CONTACT: Jason E. Oyler, General Counsel and Secretary to the Commission, telephone: (717) 238-0423, ext. 1312; fax: (717) 238-2436; e-mail: joyler@srbc.gov. Regular mail inquiries may be sent to the above address.
SUPPLEMENTARY INFORMATION: This notice lists the projects, described below, receiving approval for the consumptive use of water pursuant to the Commission’s approval by rule process set forth in 18 CFR §806.22 (f) for the time period specified above.
Water Source Approval—Issued Under 18 CFR §806.22(f):
RENEWAL - Chesapeake Appalachia, L.L.C.; Pad ID: Hurley Drilling Pad #1; ABR-201201040.R2; Cherry Township, Sullivan County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: February 5, 2024.
RENEWAL - Chesapeake Appalachia, L.L.C.; Pad ID: Manahan; ABR-201201036.R2; Albany Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: February 5, 2024.
RENEWAL - Chesapeake Appalachia, L.L.C.; Pad ID: Messersmith; ABR-201201037.R2; Wilmot Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: February 5, 2024.
RENEWAL - Chesapeake Appalachia, L.L.C.; Pad ID: SGL289C; ABR-201201034.R2; West Burlington Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: February 5, 2024.
RENEWAL - Chesapeake Appalachia, L.L.C.; Pad ID: Warburton; ABR-201201033.R2; Forks Township, Sullivan County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: February 5, 2024.
RENEWAL - Seneca Resources Company, LLC; Pad ID: My TB INV LLC 6076; ABR-201702001.R1; Deerfield Township, Tioga County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: February 8, 2024.
RENEWAL - Seneca Resources Company, LLC; Pad ID: Rich Valley Pad F; ABR-201402002.R2; Shippen Township, Cameron County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: February 8, 2024.
RENEWAL - Seneca Resources Company, LLC; Pad ID: Rich Valley Pad G; ABR-201402001.R2; Shippen Township, Cameron County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: February 8, 2024.
RENEWAL - Range Resources - Appalachia, LLC; Pad ID: Cornwall 1H-5H; ABR-201402006.R2; Lewis Township, Lycoming County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: February 13, 2024.
RENEWAL - Repsol Oil & Gas USA, LLC; Pad ID: COREY (07 089) J; ABR-201402008.R2; Choconut Township, Susquehanna County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: February 13, 2024.
RENEWAL - Repsol Oil & Gas USA, LLC; Pad ID: KROPIEWNICKI (07 038) J; ABR-201402004.R2; Apolacon Township, Susquehanna County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: February 13, 2024.
RENEWAL - Repsol Oil & Gas USA, LLC; Pad ID: YORK (07 088) R; ABR-201402005.R2; Little Meadows Borough, Susquehanna County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: February 13, 2024.
RENEWAL - Chesapeake Appalachia, L.L.C.; Pad ID: Ferraro; ABR-201202007.R2; Terry Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: February 14, 2024.
RENEWAL - Chesapeake Appalachia, L.L.C.; Pad ID: Makayla; ABR-201202008.R2; Wilmot Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: February 14, 2024.
RENEWAL - Chesapeake Appalachia, L.L.C.; Pad ID: Schlapfer; ABR-201202006.R2; Albany Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: February 14, 2024.
RENEWAL - Chesapeake Appalachia, L.L.C.; Pad ID: Moyer; ABR-201202019.R2; Overton Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: February 19, 2024.
RENEWAL - Chesapeake Appalachia, L.L.C.; Pad ID: Yadpad; ABR-201202020.R2; Wilmot Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: February 19, 2024.
RENEWAL - Coterra Energy Inc.; Pad ID: Jeffers Farms P2; ABR-201702002.R1; Harford Township, Susquehanna County, Pa.; Consumptive Use of Up to 5.0000 mgd; Approval Date: February 19, 2024.
RENEWAL - Repsol Oil & Gas USA, LLC; Pad ID: CAPRIO (07 077) S; ABR-201402011.R2; Apolacon Township, Susquehanna County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: February 19, 2024.
RENEWAL - SWN Production Company, LLC; Pad ID: RU-65-LEONARD-PAD; ABR-201402010.R2; Jackson Township, Susquehanna County, Pa.; Consumptive Use of Up to 4.9990 mgd; Approval Date: February 19, 2024.
RENEWAL - Chesapeake Appalachia, L.L.C.; Pad ID: HEMLOCK RIDGE ESTATES PAD; ABR-201902003.R1; McNett Township, Lycoming County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: February 26, 2024.
RENEWAL - Coterra Energy Inc.; Pad ID: MakoskyT P1; ABR-201402012.R2; Brooklyn Township, Susquehanna County, Pa.; Consumptive Use of Up to 5.0000 mgd; Approval Date: February 26, 2024.
RENEWAL - Coterra Energy Inc.; Pad ID: MillardK P1; ABR-201402013.R2; Jessup Township, Susquehanna County, Pa.; Consumptive Use of Up to 5.0000 mgd; Approval Date: February 26, 2024.
Repsol Oil & Gas USA, LLC; Pad ID: DECRISTO (01-128); ABR-202402002; Sullivan Township, Tioga County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: February 26, 2024.
RENEWAL - Chesapeake Appalachia, L.L.C.; Pad ID: Muzzy Drilling Pad #1; ABR-201202027.R2; Ulster Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: February 29, 2024.
RENEWAL - Seneca Resources Company, LLC; Pad ID: Kreitzer 505; ABR-201202030.R2; Rutland Township, Tioga County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: February 29, 2024.
Repsol Oil & Gas USA, LLC; Pad ID: UPHAM (05-093); ABR-202402001; Pike Township, Bradford County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: February 29, 2024.
AUTHORITY: Public Law 91-575, 84 Stat. 1509 et seq., 18 CFR parts 806 and 808.
DATED: March 7, 2024
JASON E. OYLER
General Counsel and Secretary to the Commission
[24-06-16]
SUSQUEHANNA RIVER BASIN COMMISSION
AGENCY: Susquehanna River Basin Commission.
ACTION: Notice.
SUMMARY: This notice lists Grandfathering Registration for projects by the Susquehanna River Basin Commission during the period set forth in DATES.
DATES: February 1-29, 2024.
ADDRESSES: Susquehanna River Basin Commission, 4423 North Front Street, Harrisburg, PA 17110-1788.
FOR FURTHER INFORMATION CONTACT: Jason E. Oyler, General Counsel and Secretary to the Commission, telephone: (717) 238-0423, ext. 1312; fax: (717) 238-2436; e-mail: joyler@srbc.gov. Regular mail inquiries may be sent to the above address.
SUPPLEMENTARY INFORMATION: This notice lists General Permits for projects described below, pursuant to 18 CFR Part § 806.17©(4), for the time period specified above:
Cherokee Pharmaceuticals LLC, General Permit Approval of Coverage No. GP-01-20240204, Riverside Borough, Northumberland County, Pa.; groundwater remediation system withdrawal approved up to 0.600 mgd (30-day average); Approval Date: February 9, 2024.
AUTHORITY: Public Law 91-575, 84 Stat. 1509 et seq., 18 CFR parts 806 and 808.
DATED: March 7, 2024
JASON E. OYLER
General Counsel and Secretary to the Commission
[24-06-17]
SUSQUEHANNA RIVER BASIN COMMISSION
Projects Approved for Minor Modifications
AGENCY: Susquehanna River Basin Commission.
ACTION: Notice.
SUMMARY: This notice lists the minor modifications approved for a previously approved project by the Susquehanna River Basin Commission during the period set forth in DATES.
DATES: January 1, 2024 – February 29, 2024
ADDRESSES: Susquehanna River Basin Commission, 4423 North Front Street, Harrisburg, PA 17110-1788.
FOR FURTHER INFORMATION CONTACT: Jason E. Oyler, General Counsel and Secretary to the Commission, telephone: (717) 238-0423, ext. 1312; fax (717) 238-2436; e-mail: joyler@srbc.net. Regular mail inquiries may be sent to the above address.
SUPPLEMENTARY INFORMATION: This notice lists previously approved projects, receiving approval of minor modifications, described below, pursuant to 18 CFR § 806.18 or to Commission Resolution Nos. 2013-11 and 2015-06 for the time period specified above.
Koppers Inc., Docket No. 20231209, Clinton Township, Lycoming County, Pa.; correction in Section 3 of source name; Correction Issue Date: January 9, 2024.
Dart Container Corporation of Pennsylvania, Docket No. 20040910-3, Upper Leacock Township, Lancaster County, Pa.; modification approval to add public water supply (Upper Leacock Township Municipal Authority) as an additional source of consumptive use, with no changes to existing quantities; Approval Date: February 23, 2024.
Murry Development Corporation – Crossgates Golf Club, Docket No. 20231223, Manor Township and Millersville Borough, Lancaster County, Pa.; modification approval to change the consumptive use mitigation method; Approval Date: February 29, 2024.
AUTHORITY: Public Law 91-575, 84 Stat. 1509 et seq., 18 CFR parts 806 and 808.
DATED: March 7, 2024
JASON E. OYLER
General Counsel and Secretary to the Commission
[24-06-18]
WATER AND SCIENCE ADMINISTRATION
Water Quality
Certification 23-WQC-0038
Baltimore City, Dept. of Recreation and Parks
C/o GreenVest, LLC
Attn: Andrew Forbes, PE
4201 Northview Dr, Ste 202
Bowie, Maryland 20716
Add’l. Info: Pursuant to COMAR 26.08.02.10F(3)(c), The Maryland Department of the Environment is providing notice of its issuance of a Water Quality Certification 23-WQC-0038
Location: Site 5a. East side of Reed Bird Island, east of the Hanover Street Bridge Baltimore City, MD 21225
Remove an existing 4.3-acres phragmites marsh, and construct approximately 1,600 linear feet of segmented stone sill, fill and grade with 13,200 cubic yards of clean sand fill and a carbon layer to contain existing legacy contaminants to create 4.3 acres of marsh enhancement and 4.4 acres of marsh creation all extending a maximum of 200 feet channelward of the existing marsh. The proposed work consists of the following:
· Marsh enhancement: placement of 3,870 cubic yards of clean fill and plant with 4.3 acres of high marsh vegetation;
· Marsh creation: placement of 9,330 cubic yards of clean fill and plant with 1.6 acres of high marsh and 2.8 acres of low marsh vegetation;
· The marsh area includes various woody debris features for both stability and habitat located within the marsh and at the sill vents and 0.12 acres of tidal weirs (unplanted sand and cobble sections to facilitate fish passage); and
· Construct a 158.5-foot long by 6-foot wide “L” walkway, which includes a 10-foot by 10-foot mid-walkway platform.
The WQC and its attachments may be viewed at the following link:
https://mde.maryland.gov/programs/Water/WetlandsandWaterways/Pages/WQC.aspx
Appeal of Final Decision. This Water Quality Certification is a final agency decision. Any person aggrieved by the Department’s decision to issue this WQC may appeal such decision in accordance with COMAR 26.08.02.10F(4). A request for appeal shall be filed with the Department within 30 days of publication of the final decision and specify in writing the reason why the final decision should be reconsidered. A request for appeal shall be submitted to: Secretary of the Environment, Maryland Department of the Environment, 1800 Washington Boulevard, Baltimore, MD 21230. Any request for an appeal does not stay the effectiveness of this WQC.
Contact: Matt Wallach at matthew.wallach@maryland.gov or 410-207-0893
[24-06-19]
_________________________________
Proposed Additions to Handgun
Roster and Notice of Right to Object or Petition
The following is a list of handguns that
the Handgun Roster Board proposes to add to the official handgun roster. These handguns will be officially placed on
the Handgun Roster if no timely objection is received or if all timely
objections are dismissed.
Under the Public Safety Article, §5-405,
Annotated Code of Maryland and COMAR 29.03.03.13 and .14, any person may object
to the placement of any of those handguns on the Handgun Roster. Objections must be filed within 30 days after
March 22, 2024. In
addition, any person may petition for the placement of an additional handgun on
the Handgun Roster. Forms for objections
or petitions may be obtained from: Rachel Rosenberg, Administrator, Handgun
Roster Board, 1201 Reisterstown Road, Baltimore, Maryland 21208 (Phone:
410-653-4247).
|
Make |
Model |
Caliber |
Additional Comments |
|
GIRSAN (EAA) |
WITNESS2311C |
9 mm, 10 mm, 45 ACP |
Model addition |
|
GIRSAN (EAA) |
MC 1911 C |
10 mm |
Caliber addition |
|
ZASTAVA
ARMS (ZASTAVA ARMS USA) |
CZ999 |
9
mm |
Model addition |
|
CARL
WALTHER (WALTHER ARMS) |
PDP
Match Steel Frame |
9
mm |
Model addition |
|
GRAND POWER S.R.O. (GLOBAL ORDNANCE LLC) |
STRIBOG
SP45A3 |
45
ACP |
Model addition |
|
GRAND
POWER S.R.O. (GLOBAL ORDNANCE LLC) |
STRIBOG SP10A3 |
10 mm |
Model addition |
|
METRO ARMS |
AMERICAN CLASSIC II - 1911 GOVERNMENT MODEL |
10 mm |
Caliber addition |
|
FMK |
9C1 Gen 3 |
9 mm |
Model addition |
|
STURM RUGER |
SUPER REDHAWK |
22 Hornet |
Caliber addition |
|
ALDO UBERTI & CO. (CIMARRON ARMS) |
1858 New Model Army |
38 Spl, 45 LC |
Model addition |
|
ALDO UBERTI & CO. (CIMARRON ARMS) |
1858 New Model Navy |
38 Spl |
Model addition |
|
GIRSAN (EAA) |
MC 14T Lady |
380 ACP |
Model addition |
|
GIRSAN (EAA) |
MC14BDA |
380 ACP |
Model addition |
|
ISRAEL WEAPON INDUSTRIES (IWI US) |
Jericho 941 FS9 |
9 mm |
Model addition |
|
SIG SAUER/SIGARMS INC. |
M17X |
9 mm |
Model addition |
|
SIG SAUER/SIGARMS INC. |
M18X |
9 mm |
Model addition |
|
TAURUS |
Tracker 44 |
44 Mag |
Model addition |
|
TISAS |
1911 Duty B45 |
45 ACP |
Model addition |
|
MC14G84 |
380 ACP |
Model addition |
|
|
NIGHTHAWK CUSTOM |
DELEGATE |
38 Super |
Caliber addition |
|
KIMBER |
PRO RL |
45 ACP |
Model addition |
|
CHARTER ARMS/CHARCO INC. |
The Boxer |
38 Spl |
Model addition |
|
GLOCK |
19M
GEN 5 |
9
mm |
Model addition |
|
CARL WALTHER (WALTHER ARMS) |
PDP Match Polymer Frame |
9 mm |
Model addition |
|
DAN WESSON FIREARMS/NYI |
HEIRLOOM |
38 Super |
Caliber addition |
|
STURM RUGER |
75th Anniversary Mark IV Target |
22 LR |
Model addition |
|
STURM RUGER |
75th Anniversary LCP Max |
380 ACP |
Model addition |
|
ARMSCOR PHILIPPINES-ROCK ISLAND ARMORY
(ARMSCOR PRECISION INTERNATIONAL) |
M1911 A1 CS TACT II |
9 mm |
Caliber addition |
|
NIGHTHAWK CUSTOM |
BDS9 GOVERNMENT |
9 mm |
Model addition |
|
NIGHTHAWK CUSTOM |
BDS9 COMMANDER |
9
mm |
Model addition |
|
F.
LLI PIETTA (KC LLC) |
1873
SA GEN II |
357
Mag |
Model addition |
|
SMITH & WESSON |
Texas Rangers 200th Anniversary |
357 Mag |
Model addition |
|
BOND ARMS |
Rowdy XL |
45 Colt/410 Bore |
Model addition |
|
TISAS (SDS IMPORTS) |
1911 Manta Ray Duty B45B |
45 ACP |
Model addition |
|
17 Design and Manufacturing |
17DM-15 |
300 BLK |
|
|
Akkurt Silah Sanayi Ithalat Ve Ihracat
A.S. (Garaysar) |
FEAR-118 |
12 Gauge |
|
|
BOND ARMS |
CYCLOPS |
44 Mag |
Caliber addition |
|
CANIK (CENTURY ARMS) |
TTI COMBAT |
9 mm |
Model addition |
|
SIG
SAUER/SIGARMS INC. |
P322-COMP
RX Competition |
22
LR |
Model addition |
|
PALMETTO STATE ARMORY |
PA-15 |
300 BLK |
Caliber addition |
|
Ikon Weapons |
G223 |
5.56 NATO/223 Rem |
|
|
F. TANFOGLIO (ITALIAN FIREARMS GROUP) |
Defiant Force Compact |
9 mm |
Model addition |
|
CABOT GUNS |
APOCALYPSE |
45 ACP, 9 mm |
Model addition |
|
CABOT GUNS |
APOCALYPSE COMMANDER SIZE |
45 ACP |
Caliber addition |
|
CABOT
GUNS |
Insurrection |
45 ACP, 9 mm |
Model addition |
|
CABOT GUNS |
Insurrection Commander |
45 ACP, 9 mm |
Model addition |
|
CABOT GUNS |
NATIONAL STANDARD COMMANDER |
45 ACP, 9 mm |
Model addition |
|
CABOT GUNS |
NERO |
45 ACP |
Caliber addition |
|
CABOT
GUNS |
NERO
COMMANDER |
45
ACP, 9 mm |
Model addition |
|
CABOT GUNS |
THE GRAN TORINO SS COMMANDER |
45 ACP |
Caliber addition |
|
CABOT GUNS |
THE GRAN TORINO SS FULL SIZE |
45 ACP |
Caliber addition |
|
ALCHEMY CUSTOM WEAPONRY |
PRIME COMPACT |
9 mm |
Caliber addition |
|
ALCHEMY CUSTOM WEAPONRY |
QUANTICO CARRY |
45 ACP, 9 mm |
Model addition |
|
ALCHEMY CUSTOM WEAPONRY |
QUANTICO HI-CAP CARRY |
45 ACP, 9 mm |
Model addition |
|
ALCHEMY CUSTOM WEAPONRY |
QUANTICO HI-CAP FULL SIZE |
45 ACP |
Caliber addition |
|
SMITH & WESSON |
SD9 2.0 |
9 mm |
Model addition |
|
CIMARRON ARMS (ALDO UBERTI) |
1860 RICHARDS TYPE II TRANSITION MODEL |
44 Spl |
Caliber addition |
|
Rost Martin |
RM1C |
9 mm |
|
|
NIGHTHAWK CUSTOM |
FIREHAWK |
10 mm |
Caliber addition |
|
FN AMERICA LLC |
509 CC Edge XL |
9 mm |
Model addition |
|
TISAS (SDS IMPORTS) |
1911 Duty B9 |
9 mm |
Model addition |
|
TISAS |
1911 Carry B45 |
45 ACP |
Model addition |
|
TISAS (SDS IMPORTS) |
1911 Duty SS45 |
45 ACP |
Model addition |
|
ROCK ISLAND ARMORY |
PF-14 |
12 Gauge |
|
|
CARL WALTHER (WALTHER ARMS) |
PD380 |
380 ACP |
|
|
PHOENIX TRINITY |
H-Pro |
9 mm |
|
|
BCG |
BCG-AR9 |
9 mm |
|
|
Soviet Arms |
SA-V |
9 mm |
|
|
PHOENIX
TRINITY |
H-Tac |
9
mm |
Model addition |
|
PHOENIX TRINITY |
H-Duty |
9 mm |
Model addition |
|
PHOENIX TRINITY |
Morph 1776 |
9 mm, 40 S&W |
Model addition |
|
PHOENIX TRINITY |
Morph Switch |
9 mm, 40 S&W |
Model addition |
|
PHOENIX TRINITY |
Honcho Race Shop |
9 mm, 40 S&W, 38 Super Comp |
Model addition |
|
PHOENIX TRINITY |
Honcho Race Ready |
9 mm, 40 S&W, 38 Super Comp |
Model addition |
|
PHOENIX TRINITY |
Honcho 3 Gun |
9 mm, 40 S&W, 38 Super Comp |
Model addition |
|
Watchtower Firearms |
Apache |
9 mm |
|
|
FOSTECH/SIG SAUER |
Drone Predator |
9 mm |
|
|
GLOCK/Apollo Custom Inc. |
43X |
9 mm |
Model addition |
|
GLOCK/Apollo Custom Inc. |
19 GEN 5 |
9 mm |
Model addition |
|
TISAS |
ZIG PC9 1911 RAIDER |
9 mm |
Model addition |
|
TISAS |
ZIG M1911 A1 Service Special |
45 ACP |
Model addition |
|
GIRSAN (EAA) |
MC 1911 C |
45 ACP |
Caliber addition |
|
SMITH & WESSON |
66-5 |
357 Mag |
Model addition |
|
TAURUS S.A. FORJAS (TAURUS INTERNATIONAL INC.) |
PT-99 AFS |
9 mm |
Model addition |
|
TISAS (SDS IMPORTS) |
MAC 9 DS |
9 mm |
Model addition |
|
Q |
MINI FIX |
5.56 NATO |
Caliber addition |
|
Q (MOE-K) |
HONEY BADGER |
5.56 NATO |
Caliber addition |
|
SHADOW SYSTEMS CORP |
MR920P |
9 mm |
Model addition |
|
SHADOW SYSTEMS CORP |
XR920P |
9 mm |
Model addition |
|
SMITH & WESSON |
PERFORMANCE CENTER M&P 9 M2.0 METAL |
9 mm |
Model addition |
|
BERETTA (BERETTA USA) |
30X Tomcat |
32 ACP |
Model addition |
|
MAXIM DEFENSE |
MD9 |
9 mm |
Model addition |
|
GLOCK |
29 GEN 5 |
10 mm |
Model addition |
|
GLOCK |
30 GEN 5 |
45 ACP |
Model addition |
|
CABOT GUNS |
American Joe
Commander |
45 ACP, 9 mm |
Model addition |
|
MASTERPIECE ARMS |
DS9 Commander |
9 mm |
Model addition |
|
MASTERPIECE ARMS |
DS9 DL Steel Challenge |
9 mm |
Model addition |
|
ROCK ISLAND ARMORY |
RIA 5.0E |
9 mm |
|
|
Avidity Arms, LLC |
PD10-OC |
9 mm |
|
|
Avidity Arms, LLC |
PD10-OC |
30 Super Carry |
Caliber addition |
|
Avidity Arms, LLC |
PD10 |
9 mm, 30 Super Carry |
Model addition |
|
PALMETTO STATE ARMORY |
Jakl |
300 BLK, 5.56 NATO |
|
[24-06-12]
Notice
of ADA Compliance
The State of Maryland is committed to
ensuring that individuals with disabilities are able to fully participate in
public meetings. Anyone planning to
attend a meeting announced below who wishes to receive auxiliary aids,
services, or accommodations is invited to contact the agency representative at
least 48 hours in advance, at the telephone number listed in the notice or
through Maryland Relay.
Date and Time: May 15, 2024, 3:00PM — 6:00PM
Place: Chesapeake Bay Trust, 108 Severn Ave., Annapolis, MD
Contact: Jana Davis 410-974-2941
[24-06-01]
STATE COLLECTION AGENCY LICENSING BOARD
Date and Time: April 9, 2024, 2 — 3 p.m.; Thereafter, the public meetings will take place the second Tuesday of every month, accessed via the Google Meet information below.
Add’l. Info: Google Meet joining info:
Video call link:
https://meet.google.com/ahz-mgnk-jsu
Or dial: (US) +1 530-738-1353
PIN: 815 799 863#
If necessary, the Board will convene in a closed session to seek the advice of counsel or review confidential materials, pursuant to General Provisions Article, §3-305, Annotated Code of Maryland.
Contact: Ayanna Daugherty 410-230-6019
[24-06-13]
MARYLAND INSTITUTE FOR EMERGENCY MEDICAL SERVICES SYSTEMS
Subject: Listing of Pediatric Trauma Center Requesting Reverification of Status and Call for Applications from Those Wishing to Be Considered for Designation
Place: MIEMSS, Office of Hospital Programs, 653 W. Pratt St., Baltimore, MD 21201
Add’l. Info: Pursuant to COMAR 30.08.02.03C, the Maryland Institute for Emergency Medical Services Systems gives notice that the following hospital has requested reverification as a Pediatric Trauma Center:
• Johns Hopkins Hospital Pediatric Trauma Center
Any person with knowledge of any reason why any of the above-listed hospital should not be reverified and redesignated is requested to submit a written statement of the reason to MIEMSS by May 22, 2024.
In addition, pursuant to COMAR 30.08.02.03C, hospitals that are not designated but that wish to be considered for designation as a Pediatric Trauma Center should submit a written letter of intent to the office listed above. Letters of intent are due to MIEMSS by May 22, 2024. For more information contact Elizabeth Wooster, Director, Trauma and Injury Specialty Program, at 443-467-7361 or email ewooster@miemss.org.
Contact: Elizabeth Wooster 443-467-7361
[24-06-07]
MARYLAND INSTITUTE FOR EMERGENCY MEDICAL SERVICES SYSTEMS
Subject: Listing of Pediatric Burn Center Requesting Reverification of Status and Call for Applications from Those Wishing to Be Considered for Designation
Place: MIEMSS, Office of Hospital Programs, 653 W. Pratt St., Baltimore, MD 21201
Add’l. Info: Pursuant to COMAR 30.08.02.03C, the Maryland Institute for Emergency Medical Services Systems gives notice that the following hospital has requested reverification as a Pediatric Burn Center:
• Johns Hopkins Hospital Pediatric Burn Center
Any person with knowledge of any reason why any of the above-listed hospital should not be reverified and redesignated is requested to submit a written statement of the reason to MIEMSS by May 22, 2024.
In addition, pursuant to COMAR 30.08.02.03C, hospitals that are not designated but that wish to be considered for designation as Pediatric Burn Centers should submit a written letter of intent to the office listed above. Letters of intent are due to MIEMSS by May 22, 2024. For more information, contact Elizabeth Wooster, Director, Trauma and Injury Specialty Program, at 443-467-7361 or email ewooster@miemss.org.
Contact: Elizabeth Wooster 443-467-7361
[24-06-08]
MARYLAND INSTITUTE FOR EMERGENCY MEDICAL SERVICES SYSTEMS
Subject: Listing of Freestanding Emergency Medical Facilities Requesting Reverification of Status and Call for Applications from Those Wishing to Be Considered for Designation
Place: MIEMSS, Office of Hospital Programs, 653 W. Pratt
Street, Baltimore, MD 21201
Add’l. Info: Pursuant to COMAR 30.08.02.03C, the Maryland Institute
for Emergency Medical Services Systems gives notice that the following hospitals
have requested reverification as Freestanding Emergency Medical Facilities:
• UM Shore Medical Center at Queenstown
• Edward W. McCready Memorial Hospital
Any person with knowledge of any reason why any of the above-listed hospitals should not be reverified and redesignated is requested to submit a written statement of the reason to MIEMSS by May 22, 2024.
In addition, pursuant to COMAR 30.08.02.03C, hospitals that are not designated but that wish to be considered for designation as Freestanding Emergency Medical Facilities should submit a written letter of intent to the office listed above. Letters of intent are due to MIEMSS by May 22, 2024. For more information, contact Elizabeth Wooster, Director, Trauma and Injury Specialty Program, at 443-467-7361 or email ewooster@miemss.org.
Contact: Elizabeth Wooster 443-467-7361
[24-06-09]
MARYLAND INSTITUTE FOR EMERGENCY MEDICAL SERVICES SYSTEMS
Subject: Listing of Perinatal and Neonatal Referral Center Requesting Reverification of Status and Call for Applications from Those Wishing to Be Considered for Designation
Place: MIEMSS, Office of Hospital Programs, 653 W. Pratt St.,
Baltimore, MD 21201
Add’l. Info: Pursuant to COMAR 30.08.02.03C, the Maryland Institute for Emergency Medical Services Systems gives notice that the following hospitals have requested reverification as Perinatal and Neonatal Referral Centers:
• University of Maryland Medical Center
• Johns Hopkins Hospital
Any person with knowledge of any reason why any of the above-listed hospitals should not be reverified and redesignated is requested to submit a written statement of the reason to MIEMSS by May 22, 2024.
In addition, pursuant to COMAR 30.08.02.03C, hospitals that are not designated but that wish to be considered for designation as Perinatal and Neonatal Referral Center Facilities should submit a written letter of intent to the office listed above. Letters of intent are due to MIEMSS by May 22, 2024. For more information contact Abby Butler, Director, Perinatal and Neonatal Referral Centers, at 443-531-3311 or email abutler@miemss.org.
Contact: Abby Butler 443-531-3311
[24-06-10]
Date and Time: April 18, 2024, 10 a.m.
Place: Laurel Municipal Center, 8103 Sandy Spring Rd., Council Chambers, Laurel, MD
Add’l. Info: Portions of the meeting may be held in closed session. Attendees must register with the receptionist and show identification.
Contact: Heidi Ritchie 301-766-3899
[24-06-04]
MARYLAND DEPARTMENT OF HEALTH/PHARMACY AND THERAPEUTICS (P&T) COMMITTEE
Date and Time: May 2, 2024, 9 a.m. — 1 p.m.
Place: Virtual meeting — please see details below.
Add’l. Info: Please be advised that the May 2, 2024, Pharmacy and Therapeutics (P&T) Committee public meeting will be conducted virtually via a Webinar.
As soon as available, classes of drugs to be reviewed, speaker registration guidelines, and procedure to register to attend the virtual meeting will be posted on the Maryland Pharmacy Program website at https://health.maryland.gov/mmcp/pap/pages/Public-Meeting-Announcement-and-Procedures-for-Public-Testimony.aspx. Submit questions to mdh.marylandpdlquestions@maryland.gov.
Contact: Deborah Washington 410-767-1455
[24-06-03]
DIVISION OF LABOR AND INDUSTRY/MARYLAND OCCUPATIONAL SAFETY AND HEALTH (MOSH) ADVISORY BOARD
Date and Time: April 3, 2024, 10 a.m. — 12 p.m.
Place: Via Google Meet and in-person at MOSH Headquarters, 10946 Golden West Dr., Ste. 160, Hunt Valley, MD 21031
Add’l. Info: Google Meet joining info:
Video call link:
https://meet.google.com/ipm-efvi-avt
Or dial: (US) +1 574-404-7617
PIN: 993 533 941#
Contact: Tiffany Jones 410 767-2182
[24-06-21]
MARYLAND STATE LOTTERY AND GAMING CONTROL COMMISSION
Date and Time: March 28, 2024, 10 a.m. — 12 p.m.
Place: MEETING STATUS CHANGED—VIRTUAL ONLY
Add’l. Info: This meeting has been changed to virtual only. The link will be available on the day of the meeting at https://www.mdgaming.com/commission-meeting-3-28-2024/.
Contact: Kathy Lingo 410-230-8790
[24-06-11]
MARYLAND HEALTH CARE COMMISSION
Subject: Notice of Request for Proposed Project Change to Approved Exemption Request
Add’l. Info: On February 21, 2024, the Maryland Health Care Commission (MHCC) received a notice and a request for approval of project changes under COMAR 10.24.01.17B from Hygea Detox at Camp Meade — Docket No. 23-02-2468 — An increase of $114,844 in its total current project budget of $127,038 for a total revised project budget of $241,882, with $186,882 related to capital costs.
Please refer to the Docket No. listed above in any correspondence on this request. A copy of the Request for Project Change is available for review in the office of the MHCC, during regular business hours by appointment, or on the Commission’s website at www.mhcc.maryland.gov.
All correspondence should be addressed to Jeanne Marie Gawel, Acting Chief, Chief, Certificate of Need, MHCC, 4160 Patterson Avenue, Baltimore, Maryland 21215.
Contact: Ruby Potter 410-744-3276
[24-06-05]
MARYLAND HEALTH CARE COMMISSION
Subject: Receipt of Application
Add’l. Info: On February 27, 2024, the Maryland Health Care
Commission (MHCC) received a Certificate of Need application submitted by
Sterling Care Hillhaven — Matter No.
24-16-2469 — Construction and the addition of 32 skilled nursing home
beds from the MHCC Bed Need Projections for Comprehensive Care Facility (32
beds in Prince George’s County for the Target Year 2022). Two private rooms in
the new addition will replace the semiprivate room that will be removed to
create a connection to the new addition. At project completion, Hillhaven will
operate 98 total CCF beds, 44 private and 54 semi-private; Proposed Cost: $7,500,000.
The MHCC shall review the applications under Health-General Article, §19-101 et seq., Annotated Code of Maryland, and COMAR 10.24.01. Any affected person may make a written request to the Commission to receive copies of relevant notices concerning the application. All further notices of proceedings on the application will be sent only to affected persons who have registered as interested parties.
Please refer to the Matter No. listed above in any correspondence on the application. A copy of the application is available for review in the office of the MHCC, during regular business hours by appointment, or on the Commission’s website at www.mhcc.maryland.gov.
All correspondence should be addressed to Wynee Hawk, Director, Center for Health Care Facilities Planning and Development, MHCC, 4160 Patterson Avenue, Baltimore, Maryland 21215.
Contact: Ruby Potter 410-764-3276
[24-06-06]
BOARD OF WATERWORKS AND WASTE SYSTEMS OPERATORS
Date and Time: April 18, 2024, 10:00AM — 12:00PM
Place: Via Google Chat — please see the Board’s webpage for meeting details at https://mde.maryland.gov/programs/Permits/EnvironmentalBoards/Pages/BWW.aspx.
Add’l. Info: A portion of this meeting may be held in closed session.
Contact: J. Martin Fuhr 410-537-3588
[24-06-02]
GOVERNOR’S WORKFORCE DEVELOPMENT BOARD
Subject: Solicitaion of Public Feedback
Dates: March 15—April 14, 2024
Add’l. Info: The
Governor’s Workforce Development Board’s Career and Technical Education (CTE)
Committee is soliciting feedback from the public on drafted guidance addressing
what types of industry-recognized credentials and apprenticeship programs count
within the Blueprint for Maryland’s Future. The Blueprint for Maryland’s
Future, a landmark law transforming the education system across the State, set
the goal that by the 2030-31 school year, 45% of public high school graduates
will have completed the high school level of a Registered Apprenticeship or
another industry-recognized credential by the time of graduation. The CTE
Committee has released a draft framework defining industry-recognized
credentials
(http://www.gwdb.maryland.gov/ctecomm/ctecomm-industryguidancefeb2024.pdf) and
the high school level of a Registered Apprenticeship (http://www.gwdb.maryland.gov/ctecomm/ctecomm-apprenticeshipguidancefeb2024.pdf)
that will count toward the Blueprint’s goal.
The CTE Committee requests your input and
feedback on the draft definitions. This feedback will be reviewed and
considered when refining the guidance, with final guidance being presented to
the CTE Committee for approval at their May 22, 2024, public meeting. The
public comment period opens March 15, 2024.
Industry-Recognized Credential (IRC) Feedback:
1. Please review the draft IRC
definition and criteria here:
http://www.gwdb.maryland.gov/ctecomm/ctecomm-industryguidancefeb2024.pdf
2. This is being released for a second
2-week public comment period from March 15-March 31. If you desire to give new
feedback, please complete the survey by Sunday, March 31, 2024:
https://forms.gle/c9dHtb4oXU25RVYm8
Apprenticeship Feedback:
1. Please review the draft
apprenticeship framework here:
http://www.gwdb.maryland.gov/ctecomm/ctecomm-apprenticeshipguidancefeb2024.pdf
2. The 30-day public comment period opens March 15, 2024. Complete this survey and submit your feedback by Sunday, April 14, 2024: https://forms.gle/4uuMrzFYBw1uYFDLA.
Contact: Molly Mesnard 443-401-0709, molly.mesnard@maryland.gov
[24-06-15]