Maryland Register

Issue Date: December 16, 2022

Volume 49 • Issue 26 • Pages 1071 —1102

IN THIS ISSUE

Judiciary

Regulations

Special Documents

General Notices

Pursuant to State Government Article, §7-206, Annotated Code of Maryland, this issue contains all previously unpublished documents required to be published, and filed on or before November 28, 2022 5 p.m.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 November 28, 2022.

Gail S. Klakring
Acting Administrator, Division of State Documents
Office of the Secretary of State

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.

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

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

Illustrations by Carolyn Anderson, Dept. of General Services

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

Closing Dates for the Maryland Register

Schedule of Closing Dates and Issue Dates for the
Maryland Register ................................................................... 1074

COMAR Research Aids

Table of Pending Proposals ......................................................... 1075

Index of COMAR Titles Affected in This Issue

COMAR Title Number and Name Page

08 Department of Natural Resources ................................... 1078

09 Maryland Department of Labor ............................. 1078, 1083

10 Maryland Department of Health ...................................... 1084

11 Department of Transportation .......................................... 1092

13A State Board of Education ................................................. 1093

14 Independent Agencies ..................................................... 1080

20 Public Service Commission ............................................. 1095

26 Department of the Environment ...................................... 1080

29 Department of State Police .................................... 1081, 1082

31 Maryland Insurance Administration ................................ 1081

PERSONS WITH DISABILITIES

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

The Judiciary

COURT OF APPEALS OF MARYLAND

DISCIPLINARY PROCEEDINGS ................................ 1077

Final Action on Regulations

08 DEPARTMENT OF NATURAL RESOURCES

FISHERIES SERVICE

Oysters . 1078

09 MARYLAND DEPARTMENT OF LABOR

COMMISSIONER OF FINANCIAL REGULATION

Foreclosure Procedures for Residential Property . 1078

UNEMPLOYMENT INSURANCE

Reconsideration of Unemployment Insurance Overpayment
Recovery and Waiver Request 1079

14 INDEPENDENT AGENCIES

ALCOHOL AND TOBACCO COMMISSION

Alcoholic Beverages ................................................................ 1080

Maryland Cigarette Sales Below Cost Act 1080

Beer Franchises and Local Alcoholic Beverage
Reporting . 1080

Alcoholic Beverage Trade Practices ........................................ 1080

Fire Safety Performance Standard for Cigarettes .................... 1080

MARYLAND HEALTH BENEFIT EXCHANGE

State-Based Young Adult Health Insurance Subsidies
Program .. 1080

26 DEPARTMENT OF ENVIRONMENT

REGULATION OF WATER SUPPLY, SEWAGE DISPOSAL,
SOLID WASTE, AND RECYCLABLE MATERIALS

Food Residuals — Organics Recycling and Waste
Diversion . 1080

29 MARYLAND STATE POLICE

LICENSING AND PERMITS

Special Police Commission . 1081

31 MARYLAND INSURANCE ADMINISTRATION

HEALTH INSURANCE—GENERAL

Pharmacy Services Administrative Organizations . 1081

Filing of PSAO Contracts and Amendments ........................... 1081

Withdrawal of Regulations

29 MARYLAND STATE POLICE

FIRE PREVENTION COMMISSION

Fire Prevention Code . 1082

Proposed Action on Regulations

09 MARYLAND DEPARTMENT OF LABOR

WORKFORCE DEVELOPMENT AND ADULT LEARNING

Maryland New Start Grant Program .. 1083

10 MARYLAND DEPARTMENT OF HEALTH

BOARD OF EXAMINERS IN OPTOMETRY

Telehealth . 1084

BOARD OF PODIATRIC MEDICAL EXAMINERS

Telehealth ................................................................................. 1085

BOARD OF EXAMINERS FOR AUDIOLOGISTS,
HEARING AID DISPENSERS, SPEECH-LANGUAGE
PATHOLOGISTS, AND MUSIC THERAPISTS

Telehealth . 1087

BOARD OF SOCIAL WORK EXAMINERS

Teletherapy . 1088

BOARD OF PROFESSIONAL COUNSELORS AND
THERAPISTS

Teletherapy ............................................................................... 1090

Behavior Analyst Advisory Committee ................................... 1090

11 DEPARTMENT OF TRANSPORTATION

TRANSPORTATION SERVICE HUMAN RESOURCES
SYSTEM

Medical Examinations and Evaluations ................................... 1092

13A STATE BOARD OF EDUCATION

GENERAL INSTRUCTIONAL PROGRAMS

Administration of Home and Hospital Teaching for
Students . 1093

SUPPORTING PROGRAMS

Purple Star Schools Program ................................................... 1093

STUDENTS

General Regulations . 1095

20 PUBLIC SERVICE COMMISSION

SERVICE SUPPLIED BY ELECTRIC COMPANIES

Small Generator Facility Interconnection Standards . 1095

Special Documents

DEPARTMENT OF THE ENVIRONMENT

WATER AND SCIENCE ADMINISTRATION

Final Determination to Issue Stormwater Permit —
Prince George’s County, Maryland — No. 20-DP-3314,
NPDES No. MD 0068284 . 1098

Water Quality Certification 22-WQC-0044 ......................... 1098

MARYLAND HEALTH CARE COMMISSION

AVERAGE ANNUAL OCCUPANCY RATES BY
   JURISDICTION AND FACILITY — SPECIAL
   CHRONIC HOSPITAL BEDS — MARYLAND, FISCAL
   YEARS 2020 — 2022 .................................................. 1099

USE OF SPECIAL CHRONIC HOSPITAL BEDS:
MARYLAND, FY 2022 .............................................. 1100

General Notices

MARYLAND HEALTH CARE COMMISSION

Formal Start of Review ............................................................ 1101

NORTHEAST MARYLAND WASTE DISPOSAL
AUTHORITY

Public Meetings Notice Procedure ........................................... 1101

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
JANUARY 2023^†

Issue Date	Emergency and Proposed Regulations 5 p.m.*	Notices, etc. 10:30 a.m.	Final Regulations 10:30 a.m.
2022
December 30	December 12	December 19	December 21
2023
January 13	December 23**	December 30**	January 4
January 27	January 9	January 13**	January 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.

RegCodificationSystem
Cumulative Table of COMAR Regulations
Adopted, Amended, or Repealed

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

Table of Pending Proposals

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

03 COMPTROLLER OF THE TREASURY

03.02.01.03—.07,.09,.11—.22 • 49:21 Md. R. 954 (10-7-22)

03.02.03.01—.08 • 49:21 Md. R. 954 (10-7-22)

03.02.05.01—.12 • 49:21 Md. R. 954 (10-7-22)

03.02.06.01—.05 • 49:21 Md. R. 954 (10-7-22)

05 DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT

05.20.05.01—.12 • 49:25 Md. R. 1054 (12-2-22)

07 DEPARTMENT OF HUMAN SERVICES

07.02.01.10 • 49:9 Md. R. 532 (4-22-22)

08 DEPARTMENT OF NATURAL RESOURCES

08.03.03.01 • 49:22 Md. R. 981 (10-21-22)

09 MARYLAND DEPARTMENT OF LABOR

09.09.03.03 • 49:25 Md. R. 1057 (12-2-22)

09.12.32.01—06 • 49:21 Md. R. 953 (10-7-22)

09.32.12.01—.05 • 49:17 Md. R. 798 (8-12-22)

09.37.05.01—.08 • 49:26 Md. R. 1083 (12-16-22)

10 MARYLAND DEPARTMENT OF HEALTH

Subtitle 09 (2nd volume)

10.09.31.01,.03—.06 • 49:22 Md. R. 982 (10-21-22)

10.09.41.04,.07 • 49:16 Md. R. 762 (7-29-22)

10.09.49.03—.10 • 49:24 Md. R. 1028 (11-18-22)

10.09.95.05 • 49:23 Md. R. 999 (11-4-22)

10.09.96.01,.02,.05,.06 • 49:24 Md. R. 1028 (11-18-22)

Subtitles 10—22 (3rd volume)

10.21.01.04,.08 • 49:23 Md. R. 1000 (11-4-22)

Subtitles 23—36 (4th volume)

10.25.17.01—.05 • 49:19 Md. R. 876 (9-9-22)

10.25.19.02—.04,.07,.08 • 49:20 Md. R. 916 (9-23-22)

10.28.01.01—.06 • 49:26 Md. R. 1084 (12-16-22)

10.32.01.03 • 49:16 Md. R. 768 (7-29-22)

10.32.02.03 • 49:16 Md. R. 768 (7-29-22)

10.32.02.10 • 49:16 Md. R. 769 (7-29-22)

Subtitles 37—52 (5th volume)

10.37.10.26 • 49:18 Md. R. 822 (8-26-22)

10.40.12.01—.06 • 49:26 Md. R. 1085 (12-16-22)

10.41.06.01—.06 • 49:26 Md. R. 1087 (12-16-22)

10.42.10.01—.06 • 49:26 Md. R. 1088 (12-16-22)

Subtitles 53—68 (6th volume)

10.58.06.01—.06 • 49:26 Md. R. 1090 (12-16-22)

10.58.16.02,.13—.19 • 49:26 Md. R. 1090 (12-16-22)

10.67.06.26-6 • 49:22 Md. R. 982 (10-21-22)

11 DEPARTMENT OF TRANSPORTATION

Subtitles 01—10

11.02.06.01,.02 • 49:26 Md. R. 1092 (12-16-22)

11.03.01.01,.04 • 49:25 Md. R. 1057 (12-2-22)

11.07.07.02,.06,.09 • 49:23 Md. R. 1001 (11-4-22)

Subtitles 11—23 (MVA)

11.14.08.01—.20 • 49:19 Md. R. 787 (9-9-22)

49:20 Md. R. 918 (9-23-22) (corr)

11.17.09.08 • 49:24 Md. R. 1031 (11-18-22)

12 DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONAL SERVICES

12.04.09.01—.07 • 49:23 Md. R. 1002 (11-4-22)

12.04.10.01—.05 • 49:23 Md. R. 1005 (11-4-22)

13A STATE BOARD OF EDUCATION

13A.03.02.02,.04,.06,.07,.09,.09-1 • 49:9 Md. R. 533 (4-22-22)

13A.03.05.02—.04 • 49:26 Md. R. 1093 (12-16-22)

13A.06.10.01—.05 • 49:26 Md. R. 1093 (12-16-22)

13A.07.06.01—.15 • 49:1 Md. R. 39 (1-3-22) (ibr)

13A.07.14.03 • 48:25 Md. R. 1091 (12-3-21) (err)

13A.08.01.01 • 49:26 Md. R. 1095 (12-16-22)

13A.12.01.01—.14 • 49:2 Md. R. 92 (1-14-22)

13A.12.02.01—.29 • 49:2 Md. R. 92 (1-14-22)

13A.12.03.01—.12 • 49:2 Md. R. 92 (1-14-22)

13A.12.04.01—.16 • 49:2 Md. R. 92 (1-14-22)

13A.12.05.01—.15 • 49:2 Md. R. 92 (1-14-22)

13A.12.06.01—.09 • 49:2 Md. R. 92 (1-14-22)

13A.12.07.01—.08 • 49:2 Md. R. 92 (1-14-22)

13A.15.01.02 • 49:24 Md. R. 1032 (11-18-22)

13A.15.04.03 • 49:24 Md. R. 1032 (11-18-22)

13A.15.13.01—.10 • 49:24 Md. R. 1032 (11-18-22)

13A.15.14.01—.09 • 49:24 Md. R. 1032 (11-18-22)

13A.15.15.01—.08 • 49:24 Md. R. 1032 (11-18-22)

13A.15.16.01—.04 • 49:24 Md. R. 1032 (11-18-22)

13B MARYLAND HIGHER EDUCATION COMMISSION

13B.08.01.02 • 49:16 Md. R. 772 (7-29-22)

13B.08.13.03 • 49:17 Md. R. 802 (8-12-22)

13B.08.14.02,.06,.07 • 49:17 Md. R. 803 (8-12-22)

14 INDEPENDENT AGENCIES

14.04.09.01—.04 • 49:9 Md. R. 536 (4-22-22)

14.22.01.03 • 49:23 Md. R. 1010 (11-4-22)

14.39.02.06 • 49:23 Md. R. 1011 (11-4-22)

15 MARYLAND DEPARTMENT OF AGRICULTURE

15.03.01.02 • 49:18 Md. R. 832 (8-26-22) (ibr)

15.03.02.01 • 49:18 Md. R. 832 (8-26-22) (ibr)

15.14.10.02,.05 • 49:20 Md. R. 920 (9-23-22)

15.14.16.02—.04 • 49:20 Md. R. 921 (9-23-22)

20 PUBLIC SERVICE COMMISSION

20.50.02.02 • 49:25 Md. R. 1058 (12-2-22) (ibr)

20.50.09.01,.06,.14 • 49:26 Md. R. 1095 (12-16-22)

22 STATE RETIREMENT AND PENSION SYSTEM

22.03.04.01—.11 • 49:25 Md. R. 1059 (12-2-22)

26 DEPARTMENT OF THE ENVIRONMENT

Subtitles 08—12 (Part 2)

26.11.18.05 • 49:20 Md. R. 927 (9-23-22)

26.11.20.02 • 49:20 Md. R. 927 (9-23-22)

27 CRITICAL AREA COMMISSION FOR THE CHESAPEAKE AND ATLANTIC COASTAL BAYS

27.01.01.01 • 49:25 Md. R. 1062 (12-2-22)

27.01.02.06-1,.06-3 • 49:25 Md. R. 1062 (12-2-22)

27.01.04.01,.01-1,.02,.03 • 49:25 Md. R. 1062 (12-2-22)

27.01.09.01,.01-2,.01-3 • 49:25 Md. R. 1062 (12-2-22)

27.01.14.06 • 49:25 Md. R. 1062 (12-2-22)

27.02.01.01 • 49:25 Md. R. 1062 (12-2-22)

27.02.05.05,.15-3 • 49:25 Md. R. 1062 (12-2-22)

30 MARYLAND INSTITUTE FOR EMERGENCY MEDICAL SERVICES SYSTEMS (MIEMSS)

30.01.02.01 • 49:19 Md. R. 896 (9-9-22) (ibr)

33 STATE BOARD OF ELECTIONS

33.01.07.01—.06 • 49:9 Md. R. 537 (4-22-22)

33.11.04.04 • 49:25 Md. R. 1065 (12-2-22)

The Judiciary

COURT OF APPEALS OF MARYLAND

DISCIPLINARY PROCEEDINGS

This is to certify that by an Order of this Court dated November 18, 2022, JEFFREY LAWSON (CPF# 0404010001), As of December 5, 2022, Jeffrey Lawson’s name has been replaced on the register of attorneys permitted to practice law in the Court of Appeals of Maryland. Notice of this action is given in accordance with Maryland Rule 19-761(b).

[22-26-02]

Final Action on Regulations

Symbol Key

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

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

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

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

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

Title 08
DEPARTMENT OF NATURAL RESOURCES

Subtitle 02 FISHERIES SERVICE

08.02.04 Oysters

Authority: Natural Resources Article, §4-1015(a), Annotated Code of Maryland

Notice of Final Action

[22-115-F]

On November 28, 2022, the Secretary of Natural Resources adopted amendments to Regulation .11 under COMAR 08.02.04 Oysters. This action which was proposed for adoption in 49:15 Md. R. 742—743 (July 15, 2022) has been adopted as proposed.

Effective Date: December 26, 2022.

JEANNIE HADDAWAY-RICCIO

Secretary of Natural Resources

Title 09
MARYLAND DEPARTMENT OF LABOR

Subtitle 03 COMMISSIONER OF FINANCIAL REGULATION

09.03.12 Foreclosure Procedures for Residential Property

Authority: Financial Institutions Article, §2-105.1; Real Property Article, §§7-105.1, 7-105.13, and 7-105.18; Annotated Code of Maryland

Notice of Final Action

[22-015-F]

On July 22, 2022, the Commissioner of Financial Regulation adopted amendments to existing Regulations .01 and .02, amendments to and the recodification of existing Regulations .03, .04, .05, .08, .09, and .10 to be Regulations .05, .06, .08, .07, .04, and .09, respectively, the recodification of existing Regulations .06 and .07 to be Regulations .03 and .10, respectively, and new Regulations .13 and .14 under COMAR 09.03.12 Foreclosure Procedures for Residential Property. This action, which was proposed for adoption in 49:2 Md. R. 81—85 (January 14, 2022), has been adopted with the nonsubstantive changes shown below.

Effective Date: March 1, 2023.

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 a general matter, these changes do not substantively affect the benefits or burdens of any party subject to the Regulations. Rather, the changes provide additional clarity by: moving language within the proposed text to better suited locations; restating certain language to better highlight an applicable timeframe for borrowers and removing unnecessary language.

Regulation .09 I: In response to comments received, Regulation .09 I is eliminated with the language contained in Regulation .09 I moved to Regulation .04 F and .08 C. This change and the two which immediately follow relate to the same comment. The proposed text of Regulation .09 I imposed a duty of good faith and fair dealing on the secured party and its representatives in any foreclosure mediation. A commenter suggested this duty should be moved to those Regulations expressly addressing mediation. The Final Rule moves the language from the proposed text of Regulation .09 I to Regulation .04 F, which addresses prefile mediation, and Regulation .08 C, which addresses post file mediation. Other than specifying either prefile or postfile mediation, the Final Rule moved identical language from the proposed text. As such, the Final Rule does not alter the burden or benefit of any party.

Regulation .04 F: As indicated above, in response to comments received, this section is added to contain language moved from Regulation .09 I, with additional language added to refer to prefile mediation.

Regulation .08 C: As indicated above, in response to comments received, this section is added to contain language moved from Regulation .09 I, with additional language added to refer to postfile mediation.

Regulation .09 H(1)(d): In response to comments received, Regulation .09 H(1)(d) of the proposed text is eliminated from the Final Rule as unnecessary. Regulation .09 H specified the report of mediation (Report) the Office of Administrative Hearing (OAH) must file with the Court pursuant to applicable law must include three mandatory items listed in paragraphs (a)-(c) and could include one item within the OAH’s discretion listed in paragraph (d). The Final Rule eliminates paragraph (d). Elimination of Regulation .09 H(1)(d) from the Final Rule does not limit what the OAH may include in the Report nor prohibit the OAH from including any information the OAH deems relevant. Further, neither consumers nor secured parties possessed any ability under the proposed text to compel or even request the OAH to include additional information in the Report. For these reasons, elimination of (d) does not alter the burden or benefit of any party.

Regulation .09 H(3): In response to comments received, the Final Rule eliminates language recognizing the Court’s ability to deem all or any portion of the Report as not privileged. Specifically, the proposed text stated the content of the Report is privileged and added “unless the court deems all, or any portion thereof, otherwise.” Because this language simply noted the Court’s ability to override the privilege, it is eliminated as unnecessary. The elimination of this language does not impact the Court’s ability to override the privilege and therefore does not alter the burden or benefit of any party.

Appendix F: In response to comments received, the Final Rule makes two changes to Appendix F. First, the proposed text of Appendix F allowed a borrower to supply its preferred contact information but included this language at the bottom of the page. The Final Rule moves this language to the top of the page to make it more visible to the borrower. As this change simply moves existing language, it does not alter the burden or benefit of any party. Second, Appendix F listed the website address for Maryland Homeowner Assistance in 2 places. This website address has changed and the Final Rule revises Appendix F to substitute the new website address in the 2 places where this website address appears. This change corrects outdated information and does not alter the benefit or burden of any party.

Appendix OAH-1 and Appendix OAH-2: In response to comments received, identical language contained in the proposed text of Appendix OAH-1 and OAH-2 is changed to better highlight the timeframe in which a borrower may request a correspondence log in the mediation process. Specifically, the proposed text for each Appendix stated: “Correspondence log from the time the loan went into default until the date of submission, if requested by the borrower prior to the document submission deadline.” The Final Rule revises this language on both Appendix OAH-1 and OAH-2 to state: “Correspondence log from the time the loan went into default until the date of submission, if requested by the borrower. NOTE: If the borrower requests the correspondence log, their request must be made to the servicer prior to the document submission deadline.” This change simply rewords the proposed text without any change in meaning to better highlight the time frame in which a borrower may request the correspondence log. As such, it does not alter the benefit or burden of either party.

Note: Any appendices referenced in this chapter that have been amended since the publication of the proposed action appear at the end of the Final Action on Regulations section of this issue.

.04 Prefile Mediation Process.

A.—E. (proposed text unchanged)

F. Good Faith and Fair Dealing. The secured party, or any representative of the secured party, has a duty of good faith and fair dealing in its participation at a prefile foreclosure mediation, including, but not limited to:

(1) Providing the borrower with an accurate accounting of the debt owed;

(2) Making the borrower aware of all loss mitigation options and services offered by the secured party; and

(3) Pursuing loss mitigation when reasonably possible.

.08 Postfile Foreclosure Mediation.

A.—B. (proposed text unchanged)

C. Good Faith and Fair Dealing. The secured party, or any representative of the secured party, has a duty of good faith and fair dealing in its participation at a postfile foreclosure mediation, including, but not limited to:

(1) Providing the borrower with an accurate accounting of the debt owed;

(2) Making the borrower aware of all loss mitigation options and services offered by the secured party; and

(3) Pursuing loss mitigation when reasonably possible.

.09 Office of Administrative Hearings.

A.—G. (proposed text unchanged)

H. Mediation Outcome.

(1) Pursuant to the time frame provided for in Real Property Article, §7-105.1(l)(4), Annotated Code of Maryland, the Office of Administrative Hearings shall file a report with the court that states the outcome of the request for foreclosure mediation that will include:

(a) (proposed text unchanged)

(b) If applicable, a copy of the mediation checklist as provided for in this regulation; and

(c) If applicable, the documented postfile mediation agreement term sheet provided for in §G of this regulation[[; and]].

[[(d) Any other information deemed relevant by the Office of Administrative Hearings.]]

(2) (proposed text unchanged)

(3) The contents of the report filed by the Office of Administrative Hearings pursuant to Real Property Article, §7-105.1(l)(4), Annotated Code of Maryland, shall be privileged [[unless the court deems all, or any portion thereof, otherwise.]]

[[I. Good Faith and Fair Dealing. The secured party, or any representative of the secured party, has a duty of good faith and fair dealing in its participation at a foreclosure mediation, including, but not limited to:

(1) Providing the borrower with an accurate accounting of the debt owed;

(2) Making the borrower aware of all loss mitigation options and services offered by the secured party; and

(3) Pursuing loss mitigation when reasonably possible.]]

ANTONIO P. SALAZAR
Commissioner of Financial Regulation

Subtitle 32 UNEMPLOYMENT INSURANCE

09.32.07 Reconsideration of Unemployment Insurance Overpayment Recovery and Waiver Request

Authority: Labor and Employment Article, §§8-305 and 8-809, Annotated Code of Maryland

Notice of Final Action

[22-130-F]

On December 5, 2022, the Secretary of Labor adopted amendments to Regulations .02—.04 and .08 under COMAR 09.32.07 Reconsideration of Unemployment Insurance Overpayment Recovery and Waiver Request. This action, which was proposed for adoption in 49:17 Md. R. 798 (August 12, 2022), has been adopted as proposed.

Effective Date: December 26, 2022.

TIFFANY P. ROBINSON
Secretary of Labor

Title 14
INDEPENDENT AGENCIES

Subtitle 23 ALCOHOL AND TOBACCO COMMISSION

Notice of Final Action

[22-185-F]

On November 23, 2022, the Executive Director of the Alcohol and Tobacco Commission adopted under a new subtitle, Subtitle 23 Alcohol and Tobacco Commission:

(1) Amendments to and the recodification of existing Regulations .03, .04, .11—.13, .15—.20, .22, and .05 under COMAR 03.02.01 Alcoholic Beverages to be Regulations .02, .03, .07—.09, .11—.16, .18, and .19 under a new chapter, COMAR 14.23.01 Alcoholic Beverages, respectively; the recodification of existing Regulations .06, .07, .09, .14, and .21 under COMAR 03.02.01 to be Regulations .04, .05, .06, .10, and .17 under COMAR 14.23.01, respectively; and new Regulation .01 under COMAR 14.23.01;

(2) Amendments to and the recodification of existing Regulations .02, .07, and .08 under COMAR 03.02.03 Maryland Cigarette Sales Below Cost Act to be Regulations .03, .08, and .09 under a new chapter, COMAR 14.23.02 Maryland Cigarette Sales Below Cost Act, respectively; the recodification of existing Regulations .01 and .03—.06 under COMAR 03.02.03 to be Regulations .02 and .04—.07 under COMAR 14.23.02, respectively; and new Regulation .01 under COMAR 14.23.02;

(3) New Regulations .01 and .02 under a new chapter, COMAR 14.23.03 Beer Franchises and Local Alcoholic Beverage Reporting;

(4) Amendments to and the recodification of existing Regulations .01, .03, .05, and .07—.12 under COMAR 03.02.05 Alcoholic Beverage Trade Practices to be Regulations .01, .03, .05, .07—.12 under COMAR 14.23.04 Alcoholic Beverage Trade Practices, respectively; and the recodification of existing Regulations .02, .04, and .06 under COMAR 03.02.05 to be Regulations .02, .04, and .06 under COMAR 14.23.04, respectively; and

(5) Amendments to and the recodification of Regulations .01 and .03—.05 under COMAR 03.02.06 Fire Safety Performance Standard for Cigarettes to be Regulations .01 and .03—.05 under COMAR 14.23.05 Fire Safety Performance Standard for Cigarettes, respectively, and the recodification of Regulation .02 under COMAR 03.02.06 to be Regulation .02 under COMAR 14.23.05.

This action, which was proposed for adoption in 49:21 Md. R. 954—963 (October 7, 2022), has been adopted as proposed.

Effective Date: December 26, 2022.

JEFFREY A. KELLY
Executive Director
Alcohol and Tobacco Commission

Subtitle 35 MARYLAND HEALTH BENEFIT EXCHANGE

14.35.19 State-Based Young Adult Health Insurance Subsidies Program

Authority: Insurance Article, §31-106(c)(1)(iv), Annotated Code of Maryland

Notice of Final Action

[22-143-F]

On November 21, 2022, the Maryland Health Benefit Exchange adopted amendments to Regulation .04 under COMAR 14.35.19 State-Based Young Adult Health Insurance Subsidies Program. This action which was proposed for adoption in 49:18 Md. R. 831 (August 26, 2022) has been adopted as proposed.

Effective Date: December 26, 2022.

MICHELE S. EBERLE
Executive Director

Title 26
DEPARTMENT OF ENVIRONMENT

Subtitle 04 REGULATION OF WATER SUPPLY, SEWAGE DISPOSAL, SOLID WASTE, AND RECYCLABLE MATERIALS

26.04.13 Food Residuals — Organics Recycling and Waste Diversion

Authority: Environment Article, §§1-101, 9-201, 9-1701, 9-1702, and
9-1724.1, Annotated Code of Maryland

Notice of Final Action

[22-184-F]

On December 6, 2022, the Secretary of the Environment adopted new Regulations .01—.05 under a new chapter, COMAR 26.04.13 Food Residuals — Organics Recycling and Waste Diversion. This action, which was proposed for adoption in 49:20 Md. R. 923—927 (September 23, 2022), has been adopted with the nonsubstantive changes shown below.

Effective Date: December 26, 2022.

Attorney General’s Certification

Regulation .03E(1): In response to comments received, to clarify that the types of documentation the Department may request from a person subject to the food residuals diversion requirements of the regulation include, in addition to the specific items identified, any other information the Department deems necessary.

.03 Food Residuals Diversion Requirement.

A.—D. (proposed text unchanged)

E. Documentation.

(1) In order to administer and enforce the food residuals diversion requirements of this regulation, the Department may request that a person subject to the food residuals diversion requirements under §B of this regulation provide documentation of:

(a) (proposed text unchanged)

(b) Any correspondence between the person and an organics recycling facility located within a 30-mile radius of the person demonstrating the organics recycling facility’s willingness to accept all of the person’s food residuals or enter into a contract to accept and process all of the person’s food residuals; [[and]]

(c) Any correspondence from an organics recycling facility located within a 30-mile radius of the person that the organics recycling facility is unable or unwilling to enter a contract with a person and accept and process all of the person’s food residuals[[.]]; and

(d) Any other information the Department deems necessary.

(2) (proposed text unchanged)

HORACIO TABLADA
Secretary of the Environment

Title 29
MARYLAND STATE POLICE

Subtitle 04 LICENSING AND PERMITS

29.04.02 Special Police Commission

Authority: Public Safety Article, §§3-301—3-316, Annotated Code of Maryland.

Notice of Final Action

[22-093-F]

On August 29, 2022, the Secretary of the Department of State Police adopted the repeal of existing Regulations .01—.03 and new Regulations .01—.13 under COMAR 29.04.02 Special Police Commission. This action, which was proposed for adoption in 49:10 Md. R. 584—588 (May 6, 2022), has been adopted as proposed.

Effective Date: December 26, 2022.

WOODROW W. JONES III
Secretary of State Police

Title 31
MARYLAND INSURANCE ADMINISTRATION

Subtitle 10 HEALTH INSURANCE—GENERAL

Notice of Final Action

[21-200-F]

On December 1, 2022, the Insurance Commissioner adopted:

(1) New Regulations .01—.05 under a new chapter, COMAR 31.10.49 Pharmacy Services Administrative Organizations; and

(2) New Regulations .01—.05 under a new chapter, COMAR 31.10.50 Filing of PSAO Contracts and Amendments.

This action which was proposed for adoption in 48:26 Md. R. 1156—1159 (December 17, 2021) and reproposed for adoption in 49:21 Md. R. 964—965 (October 7, 2022), has been adopted as reproposed.

Effective Date: December 26, 2022.

KATHLEEN A. BIRRANE
Insurance Commissioner

Title 09
MARYLAND DEPARTMENT OF LABOR

Subtitle 37 WORKFORCE DEVELOPMENT AND ADULT LEARNING

09.37.05 Maryland New Start Grant Program

Authority: Labor and Employment Article, §11-606, Annotated Code of Maryland

Notice of Proposed Action

[22-204-P]

The Division of Workforce Development and Adult Learning proposes to adopt new Regulations .01—.08 under a new chapter, COMAR 09.37.05 Maryland New Start Grant Program.

Statement of Purpose

The purpose of this action is to define the requirements of the Maryland New Start Grant Program.

Estimate of Economic Impact

I. Summary of Economic Impact. Organizations with entrepreneurship development programs that support covered individuals can apply for a maximum of $60,000 in a fiscal year for the Maryland New Start Grant Program.

	Revenue (R+/R-)
II. Types of Economic Impact.	Expenditure (E+/E-)	Magnitude


A. On issuing agency	NONE
B. On other State agencies:	NONE
C. On local governments:	NONE

	Benefit (+) Cost (-)	Magnitude


D. On regulated industries or trade groups:	NONE
E. On other industries or trade groups:	+	Up to $200,000
F. Direct and indirect effects on public:	NONE
III. Assumptions. (Identified by Impact Letter and Number from Section II.) E. Organizations with entrepreneurship development programs that support covered individuals can apply for a maximum of $60,000 in a fiscal year for the Maryland New Start Grant Program.

Economic Impact on Small Businesses

The proposed action has a meaningful economic impact on small businesses. An analysis of this economic impact follows:

The Maryland New Start Grant Program is designed to support covered individuals through entrepreneurship development so they are prepared to start their own small businesses. This funding will provide covered individuals with an opportunity they may not have otherwise had, and may result in an increased number of total small businesses that exist throughout the State.

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

Comments may be sent to Dylan McDonough, Policy Analyst, Division of Workforce Development and Adult Learning, 1100 N Eutaw Street, Baltimore, MD 21202, or call 410-767-1890, or email to Dylan.mcdonough@maryland.gov or fax to 410-333-5162. Comments will be accepted through January 17, 2023. A public hearing has not been scheduled.

.01 Purpose.

These regulations prescribe the policies, procedures, and authorizations for administering the Maryland New Start Grant Program.

.02 Definitions.

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

B. Terms Defined.

(1) "Act" means Labor and Employment Article, §11-606, Annotated Code of Maryland.

(2) "Department" means the Department of Labor.

(3) “Division” means the Division of Workforce Development and Adult Learning.

(4) “Grant” means an award under the terms of this chapter.

(5) “Grantee” means an organization to whom an award is made under the terms of this chapter.

(6) “Program” means the Maryland New Start Grant Program.

(7) “Secretary” means the Secretary of Labor.

.03 Eligible Grantees.

Eligible grantees shall meet the following requirements to qualify for a grant:

A. Have all requisite legal capacity and due authority to enter into the grant;

B. Satisfy all legal requirements to operate in the State; and

C. Meet the performance standards of the Department, as follows:

(1) Not have defaulted on a prior grant or loan from the Department; and

(2) Not be currently barred or suspended from any of the Department's programs.

.04 Proposal and Review Procedures.

A. The Department shall ensure that the Program guidelines, information and application forms are publicly available on the Department’s website and at its physical locations.

B. Grant Proposal. The Department shall provide guidelines and detailed instructions for submitting a proposal for the Department’s consideration. Each proposal shall include:

(1) The information required by Labor and Employment Article, §11-606(d)(2)(iii), Annotated Code of Maryland;

(2) A description of the entrepreneurship development program as described in Labor and Employment Article, §11-606(d)(3), Annotated Code of Maryland;

(3) An explanation of how the requirement of matching funds required by Labor and Employment Article, §11-606(e), Annotated Code of Maryland, will be satisfied; and

(4) Any other information the Secretary requires related to the Program.

C. Review Procedures.

(1) Upon receipt of the grant proposal and any required documentation, the Department shall review each application to determine whether an applicant will be awarded a grant.

(2) The Secretary may delegate to the Assistant Secretary of the Division or an employee of the Department the authority to review grant proposals and supporting documentation.

.05 Grant Agreement.

Upon approval of a grant proposal by the Department, the applicant, on a Departmental form, shall execute a grant agreement. The grant agreement shall at least require an applicant to meet the following obligations:

A. Establish and operate the project according to the project description;

B. Maintain and provide records and reports as required by Labor and Employment Article, §11-606(g), Annotated Code of Maryland, to the Department; and

C. Use grant funds for only those activities provided in the approved project proposal.

.06 Grant Monitoring.

The Department may monitor grants and disbursement of grant funds to ensure that grant funds are properly disbursed by a grantee.

.07 Retention of Grant Records.

A. Grantees shall retain and maintain all records regarding the application for at least 3 years after the final disbursement of grant funds.

B. The records shall be open to the inspections of representatives of the Department during reasonable working hours.

.08 Expiration of the Program.

This chapter remains in effect until the earlier of:

A. The date that funding for the Program ceases to be available; or

B. June 30, 2029.

TIFFANY P. ROBINSON
Secretary of Labor

Title 10
MARYLAND DEPARTMENT OF HEALTH

Subtitle 28 BOARD OF EXAMINERS IN OPTOMETRY

10.28.01 Telehealth

Authority: Health Occupations Article, §§1-1001—1-1006, Annotated Code of Maryland

Notice of Proposed Action

[22-205-P]

The Secretary of Health proposes to adopt new Regulations .01—.06 under a new chapter, COMAR 10.28.01 Telehealth. This action was considered by the Board of Optometry at a public meeting held on September 30, 2020, notice of which was given by publication on the Board’s website at https://health.maryland.gov/optometry/Pages/index.aspx pursuant to General Provisions Article, §3–302(c), Annotated Code of Maryland.

Statement of Purpose

The purpose of this action is to provide new guidelines for optometrists for the practice of telehealth pursuant to Chs. 15 and 16 (H.B. 448 and S.B. 402), Acts of 2020.

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 Jourdan Green, Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through January 17, 2023. A public hearing has not been scheduled.

.01 Scope.

A. This chapter governs the practice of optometry using telehealth as an adjunct to, or replacement for, in-person patient visits.

B. Nothing in this chapter restricts or limits reimbursement requirements pursuant to Health-General Article and Insurance Article, Annotated Code of Maryland.

.02 Definitions.

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

B. Terms Defined.

(1) “Asynchronous” means not occurring in real time.

(2) “In-person” means within the physical presence of the patient.

(3) “Interpretive services” means reading and analyzing images, tracings, or specimens through telehealth or giving interpretations based on visual, auditory, thermal, or ultrasonic patterns or other patterns as may evolve with technology.

(4) “Synchronous” means occurring in real time.

(5) “Telehealth” has the meaning stated in Health Occupations Article, §1-1001, Annotated Code of Maryland.

(6) “Telehealth practitioner” means a Maryland licensed optometrist performing telehealth services within the scope of practice.

.03 Licensure.

A. Subject to the provisions of Health Occupations Article, §11-301, Annotated Code of Maryland, a telehealth practitioner shall be licensed in Maryland when providing telehealth services to a patient located in the State.

B. Telehealth practitioners licensed in this State are subject to the jurisdiction of the State and shall abide by the telehealth requirements of this chapter if either the telehealth practitioner or patient is physically located in this State.

.04 Standards of Practice for Telehealth.

A. Before performing telehealth services, a telehealth practitioner shall develop and follow a procedure to:

(1) Verify the identification of the patient receiving telehealth services within a reasonable degree of certainty through the use of:

(a) A government-issued photograph identification;

(b) An insurance, Medicaid, or Medicare card; or

(c) Documentation of the patient’s:

(i) Date of birth; and

(ii) Home address;

(2) For an initial patient-telehealth practitioner interaction, disclose the telehealth practitioner’s

(a) Name;

(b) Contact information;

(c) Maryland license number; and

(d) Medical specialty, if applicable;

(3) Except for interpretive services, obtain oral or written consent from a patient or patient’s parent or guardian if State law requires the consent of a parent or guardian, including informing patients of the risks, benefits, and side effects of prescribed treatments;

(4) Securely collect and transmit a patient’s medical information, clinical data, clinical images, laboratory results, and self-reported medical history, as necessary, and prevent access to data by unauthorized persons through encryption or other means;

(5) Notify patients in the event of a data breach;

(6) Ensure that the telehealth practitioner provides a secure and private telehealth connection that complies with federal and state privacy laws; and

(7) Establish safety protocols to be used in the case of an emergency.

B. Except when providing asynchronous telehealth services, a telehealth practitioner shall:

(1) Obtain or confirm an alternative method of contacting the patient in case of a technological failure;

(2) Confirm whether the patient is in Maryland and identify the practice setting in which the patient is located; and

(3) Identify all individuals present at each location and confirm they are allowed to hear personal health information.

C. A telehealth practitioner shall be held to the same standards of practice and documentation as those applicable for in-person health care settings.

D. The requirements set forth under §§A and B of this regulation may be delegated.

.05 Patient Evaluation.

A. Subject to the provisions of Health Occupations Article, §11-208, Annotated Code of Maryland, a telehealth practitioner shall:

(1) Perform a synchronous or asynchronous clinical patient evaluation that is appropriate for the patient and the condition with which the patient presents before providing treatment or issuing a prescription through telehealth; and

(2) If clinically appropriate for the patient, provide or refer a patient to:

(a) In-person health care services; or

(b) Another type of telehealth service.

B. A telehealth practitioner may not treat a patient or issue a prescription based solely on a static online questionnaire.

.06 Telehealth Practitioner Discipline.

A. The Board shall use the same standards of evaluating and investigating a complaint about and in disciplining a licensee who practices telehealth as it would use for a licensee who does not use telehealth technology in the licensee’s practice.

B. The failure of a telehealth practitioner to comply with Regulations .04 and .05 of this chapter shall constitute unprofessional conduct and may be subject to disciplinary action by the Board.

DENNIS R. SCHRADER
Secretary of Health

Subtitle 40 BOARD OF PODIATRIC MEDICAL EXAMINERS

10.40.12 Telehealth

Authority: Health Occupations Article, §§1-1001—1-1006, Annotated Code of Maryland

Notice of Proposed Action

[22-206-P]

The Secretary of Health proposes to adopt new Regulations .01—.06 under a new chapter, COMAR 10.40.12 Telehealth. This action was considered by the Board of Podiatric Medical Examiners at a public meeting held on October 8, 2020, notice of which was
given by publication on the Board’s website at https://health.maryland.gov/mbpme/Pages/index.aspx pursuant to General Provisions Article, §3–302(c), Annotated Code of Maryland.

Statement of Purpose

The purpose of this action is to provide new guidelines for podiatrists for the practice of telehealth pursuant to Chapters 15 and 16 (H.B. 448 and S.B. 402), Acts of 2020.

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

.01 Scope.

A. This chapter governs the practice of podiatry using telehealth as an adjunct to, or replacement for, in-person patient visits.

B. Nothing in this chapter restricts or limits reimbursement requirements pursuant to Health-General Article and Insurance Article, Annotated Code of Maryland.

.02 Definitions.

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

B. Terms Defined.

(1) “Asynchronous” means not occurring in real time.

(2) “In-person” means within the physical presence of the patient.

(4) “Remote patient monitoring” means the use of telehealth devices to collect medical and other forms of health data from patients that are securely provided to a telehealth practitioner in a different location for assessment, recommendation, and diagnosis.

(5) “Store and forward technology” means the asynchronous transmission of digital images, documents, and videos electronically through secure means.

(6) “Synchronous” means occurring in real time.

(7) “Telehealth” has the meaning stated in Health Occupations Article, §1-1001, of the Annotated Code of Maryland.

(8) “Telehealth devices” means devices that gather visual or other data and remotely send the images or data to a telehealth practitioner in a different location from the patient.

(9) “Telehealth practitioner” means a Maryland-licensed podiatrist performing telehealth services within the scope of practice.

.03 Licensure.

A. Subject to the provisions of Health Occupations Article, Title 16, Subtitle 3, Annotated Code of Maryland, a telehealth practitioner shall be licensed in Maryland when providing telehealth services to a patient located in the State.

.04 Standards of Practice for Telehealth.

A. Before providing telehealth services, a telehealth practitioner shall develop and follow a procedure to:

(1) Verify the identification of the patient receiving telehealth services within a reasonable degree of certainty through use of:

(a) A government-issued photograph identification;

(b) An insurance, Medicaid, or Medicare card; or

(c) Documentation of the patient’s:

(i) Date of birth; and

(ii) Home address;

(2) For an initial patient-telehealth practitioner encounter, disclose the telehealth practitioner’s:

(a) Name;

(b) Contact information; and

(c) Maryland license number;

(3) Except for interpretive services, obtain oral or written acknowledgement from a patient or a patient’s parent or guardian if State law requires the consent of a parent or guardian, including informing patients of the risks, benefits, and side effects of prescribed treatments;

(4) Securely collect and transmit a patient’s medical health information, clinical data, clinical images, laboratory results, and self-reported medical health and clinical history, as necessary, and prevent access to data by unauthorized persons through encryption or other means;

(5) Notify patients in the event of a data breach;

(6) Ensure that the telehealth practitioner provides a secure and private telehealth connection that complies with federal and state privacy laws; and

(7) Establish safety protocols to be used in the case of an emergency, including contact information for emergency services at the patient’s location.

B. Except when utilizing store and forward technology to provide telehealth services or remote patient monitoring, a telehealth practitioner shall:

(1) Obtain or confirm an alternative method of contacting the patient in case of a technological failure;

(2) Confirm whether the patient is in Maryland and identify the specific practice setting in which the patient is located; and

(3) Identify all individuals present at each location and confirm they are allowed to hear the patient’s health information.

C. A telehealth practitioner shall be held to the same standards of practice and documentation as those applicable for in-person health care settings.

D. A telehealth practitioner may not prescribe opioids for the treatment of pain through telehealth except if the patient is in a health care facility as defined in Health-General Article, §19-114, Annotated Code of Maryland.

.05 Patient Evaluation.

A. Except when providing asynchronous telehealth services or remote patient monitoring, a telehealth practitioner shall:

(1) Perform a clinical patient evaluation adequate to establish a diagnosis and identify underlying conditions or contraindications to recommended treatment options before providing treatment or prescribing medication through telehealth; and

(2) If clinically appropriate for the patient, provide or refer a patient to:

(a) In-person health care services; or

(b) Another type of telehealth service.

B. If the evaluation is adequate to comply with §A of this regulation, a telehealth practitioner may use:

(1) Telehealth devices;

(2) Live synchronous audio-visual communication;

(3) Other methods of performing a medical examination remotely; or

(4) A patient evaluation performed by another licensed health care practitioner providing coverage.

C. A telehealth practitioner may not treat a patient or issue a prescription based solely on an online questionnaire.

.06 Telehealth Practitioner Discipline.

B. The failure of a telehealth practitioner to comply with Regulations .04 and .05 of this chapter shall constitute unprofessional conduct and may be subject to disciplinary action by the Board.

DENNIS R. SCHRADER
Secretary of Health

Subtitle 41 BOARD OF EXAMINERS FOR AUDIOLOGISTS, HEARING AID DISPENSERS, SPEECH-LANGUAGE PATHOLOGISTS, AND MUSIC THERAPISTS

10.41.06 Telehealth

Authority: Health Occupations Article, §§2-201, 2-205, and 1-1001—1-1006, Annotated Code of Maryland

Notice of Proposed Action

[22-207-P]

The Secretary of Health proposes to repeal existing Regulations .01—.05 under existing COMAR 10.41.06 Telehealth Communication and adopt new Regulations .01—.06 under new COMAR 10.41.06 Telehealth. This action was considered by the Board of Examiners for Audiologists, Hearing Aid Dispensers, Speech-Language Pathologists, and Music Therapists at a public meeting held on October 15, 2020, notice of which was given by publication on the Board’s website at https://health.maryland.gov/boardsahs/Pages/Index.aspx pursuant to General Provisions Article, §3–302(c), Annotated Code of Maryland.

Statement of Purpose

The purpose of this action is to provide new guidelines for audiologists, hearing aid dispensers, speech-language pathologists, and music therapists for the practice of telehealth pursuant to Chs. 15 and 16 (H.B. 448 and S.B. 402), Acts of 2020.

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

.01 Scope.

A. This chapter governs the practice of audiology, hearing aid dispensing, speech-language pathology, and music therapy using telehealth as an adjunct to, or replacement for, in-person patient visits.

B. Nothing in this chapter restricts or limits reimbursement requirements pursuant to Health-General Article and Insurance Article, Annotated Code of Maryland.

.02 Definitions.

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

B. Terms Defined.

(1) “Asynchronous” means not occurring in real time.

(2) "Board" means the State Board of Examiners for Audiologists, Hearing Aid Dispensers, Speech-Language Pathologists, and Music Therapists.

(3) “In-person” means in the physical presence of the patient.

(4) “Interpretive services” means reading and analyzing images, tracings, or specimens through telehealth or giving interpretations based on visual, auditory, thermal, or ultrasonic patterns or other patterns as may evolve with technology.

(5) “Synchronous” means occurring in real time.

(6) “Telehealth” has the meaning stated in Health Occupations Article, §1-1001, Annotated Code of Maryland.

(7) “Telehealth practitioner” means a licensee of the Board of Examiners for Audiologists, Hearing Aid Dispensers, Speech-Language Pathologists, and Music Therapists performing telehealth services within their respective scope of practice.

.03 Licensure.

A. Subject to the provisions of Health Occupations Article, Title 2, Subtitle 3, Annotated Code of Maryland, a telehealth practitioner shall be licensed in Maryland when providing telehealth services to a patient located in the State.

.04 Standards of Practice for Telehealth.

A. Before performing telehealth services, a telehealth practitioner shall develop and follow a procedure to:

(1) Verify the identification of the patient receiving telehealth services within a reasonable degree of certainty through use of:

(a) A government issued photograph identification;

(b) An insurance, Medicaid, or Medicare card; or

(c) Documentation of the patient’s:

(i) Date of birth; and

(ii) Home address;

(2) For an initial patient-telehealth practitioner encounter, disclose the telehealth practitioner’s:

(a) Name;

(b) Contact information;

(c) Maryland license number and type; and