Maryland Register Issue Date:  February 24, 2023 Volume 50 •  Issue 4  • Pages 111 — 172 IN THIS ISSUE Judiciary Regulations 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Pursuant to State Government Article, §7-206, Annotated Code of Maryland, this issue contains all previously unpublished documents required to be published, and filed on or before February 6, 2023 5 p.m. Pursuant to State Government Article, §7-206, Annotated Code of Maryland, I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 February 6, 2023. 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.

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; 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 ..................................................................... 114

COMAR Research Aids

Table of Pending Proposals ........................................................... 115

Index of COMAR Titles Affected in This Issue

COMAR Title Number and Name Page

09 Maryland Department of Labor ................................. 122, 125

10 Maryland Department of Health ................................ 119, 135

11 Department of Transportation ............................................ 122

13A State Board of Education ........................................... 124, 151

13B Maryland Higher Education Commission ......................... 153

15 Maryland Department of Agriculture ................................ 122

27 Critical Area Commission for the Chesapeake and Atlantic Coastal Bays 123

31 Maryland Insurance Administration .................................. 160

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

SUPREME COURT OF MARYLAND

DISCIPLINARY PROCEEDINGS .................................. 118

Emergency Action on Regulations

10 MARYLAND DEPARTMENT OF HEALTH

MENTAL HYGIENE REGULATIONS

Maryland Mental Health and Substance Use Disorder
Registry and Referral System .. 119

DEVELOPMENTAL DISABILITIES

Fee Payment System for Licensed Residential and Day
Programs . 120

Final Action on Regulations

09 MARYLAND DEPARTMENT OF LABOR

UNEMPLOYMENT INSURANCE

Procedures for Initial Determination of Unemployment
Insurance Overpayments and for Appeals of Overpayment
Determinations . 122

11 DEPARTMENT OF TRANSPORTATION

TRANSPORTATION SERVICE HUMAN RESOURCES
SYSTEM

Medical Examinations and Evaluations ................................... 122

15 MARYLAND DEPARTMENT OF AGRICULTURE

WEIGHTS AND MEASURES

Commercial Weighing and Measuring Devices and
Procedures for Testing Packaged Goods . 122

Packaging and Labeling . 122

BOARD OF VETERINARY MEDICAL EXAMINERS

Continuing Education Requirements ....................................... 123

Continuing Education Requirements for Registered
Veterinary Technicians . 123

27 CRITICAL AREA COMMISSION FOR THE
CHESAPEAKE AND ATLANTIC COASTAL BAYS

CRITERIA FOR LOCAL CRITICAL AREA PROGRAM
DEVELOPMENT

General Provisions ................................................................... 123

Development in the Critical Area . 123

Shoreline Stabilization Measures ............................................. 123

Habitat Protection Areas in the Critical Area .......................... 123

Renewable Energy Generating Systems . 123

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

General Provisions ................................................................... 123

State Agency Actions Resulting in Development on State-
Owned Lands . 123

Withdrawal of Regulations

13A STATE BOARD OF EDUCATION

SCHOOL PERSONNEL

Programs for Professionally Licensed Personnel 124

EDUCATOR LICENSURE

General Provisions ................................................................... 124

Teachers . 124

Professional and Technical Education and Specialized Areas
for Fine Arts . 124

Specialists . 124

Administrators and Supervisors . 124

Disciplinary Actions and Denials . 124

Professional Standards and Teacher Education Board ............ 124

Proposed Action on Regulations

09 MARYLAND DEPARTMENT OF LABOR

COMMISSIONER OF FINANCIAL REGULATION

Money Transmitters . 125

BOARD OF COSMETOLOGISTS

Continuing Education

Notice of Change to Opportunity for Public
Comment 135

10 MARYLAND DEPARTMENT OF HEALTH

MEDICAL CARE PROGRAMS

Advanced Practice Nurse Services .......................................... 135

Podiatry Services . 136

Behavioral Health Crisis Services . 136

Physical Therapy Services . 139

Home and Community-Based Services Waiver for Children
with Autism Spectrum Disorder 140

Community-Based Substance Use Disorder Services . 141

COMMUNITY-BASED BEHAVIORAL HEALTH
PROGRAMS AND SERVICES

Requirements for All Licensed Programs . 143

Programs Required to Be Accredited in Order to Be
Licensed to Provide Community-Based Behavioral
Health Services . 143

Descriptions and Criteria for Programs and Services Required
to Have an Accreditation-Based License . 143

13A STATE BOARD OF EDUCATION

SPECIAL INSTRUCTIONAL PROGRAMS

Adult High School Pilot Program .. 151

13B MARYLAND HIGHER EDUCATION COMMISSION

NONPUBLIC SCHOOLS

Minimum Requirements for Private Career Schools . 153

ACADEMIC REGULATIONS

Additional Requirements for For-Profit Institutions of Higher
Education . 153

FIRE-RESCUE EDUCATION AND TRAINING
COMMISSION

Certification Standards and Procedures for Emergency
Services Instructors ............................................................... 155

COMMUNITY COLLEGES

General Regulations and Policies for Community
Colleges . 156

FINANCIAL AID

Veterans of the Afghanistan and Iraq Conflicts Scholarship
Program .. 156

Cybersecurity Public Service Scholarship Program .. 158

31 MARYLAND INSURANCE ADMINISTRATION

HEALTH INSURANCE—GENERAL

Network Adequacy .................................................................. 160

General Notices

MARYLAND DEPARTMENT OF HEALTH

Public Meeting . 172

MARYLAND DEPARTMENT OF LABOR

Public Meeting . 172

MARYLAND HEALTH CARE COMMISSION

Formal Start of Review .. 172

WORKERS’ COMPENSATION COMMISSION

Public Meeting on Regulations . 172

GOVERNOR’S WORKFORCE DEVELOPMENT BOARD

Public Meeting . 172

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 2023^†

Issue Date	Emergency and Proposed Regulations 5 p.m.*	Notices, etc. 10:30 a.m.	Final Regulations 10:30 a.m.
2023
March 10	February 17**	February 27	March 1
March 24	March 6	March 13	March 15
April 7	March 20	March 27	March 29
April 21	April 3	April 10	April 12
May 5	April 17	April 24	April 26
May 19	May 1	May 8	May 10
June 2	May 15	May 22	May 24
June 16	May 26**	June 5	June 7
June 30	June 12	June 16 **	June 21
July 14	June 26	July 3	July 5
July 28	July 10	July 17	July 19
August 11	July 24	July 31	August 2
August 25	August 7	August 14	August 16
September 8	August 21	August 28	August 30
September 22	September 1**	September 11	September 13
October 6	September 18	September 25	September 27
October 20	October 2	October 6**	October 11
November 3	October 16	October 23	October 25
November 17	October 30	November 6	November 8
December 1	November 13	November 20	November 22
December 15	November 27	December 4	December 6
December 29	December 11	December 18	December 20

^† 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.

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

05.20.05.01—.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

08.02.04.11 • 49:15 Md. R. 742 (7-15-22)

49:18 Md. R. 855 (8-26-22) (err)

08.03.09.11 • 50:2 Md. R. 52 (1-27-23)

08.18.12.05 • 49:27 Md. R. 1113 (12-30-22)

08.18.26.06 • 50:1 Md. R. 10 (1-13-23)

09 MARYLAND DEPARTMENT OF LABOR

09.01.12.01—.08 • 50:2 Md. R. 55 (1-27-23)

09.03.14.01—.18 • 50:4 Md. R. 125 (2-24-23)

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)

09.12.50.02,.02-1,.03 • 50:2 Md. R. 55 (1-27-23) (ibr)

09.12.51.04 • 50:2 Md. R. 55 (1-27-23)

09.12.57.01,.02 • 50:2 Md. R. 62 (1-27-23) (ibr)

09.12.58.03,.04 • 50:2 Md. R. 63 (1-27-23) (ibr)

09.12.81.02 • 50:1 Md. R. 11 (1-13-23) (ibr)

09.19.02.04 • 50:3 Md. R. 91 (2-10-23)

09.22.01.13 • 50:3 Md. R. 92 (2-10-23)

09.22.04.01—.10 • 50:3 Md. R. 92 (2-10-23)

50:4 Md. R. 135 (2-24-23) (corr)

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)

10.09.01.03,.06 • 50:4 Md. R. 135 (2-24-23)

10.09.02.01,.03—.05,.07—.09,.11 • 50:1 Md. R. 11 (1-13-23) (ibr)

10.09.05.01,.03—.07 • 49:27 Md. R. 1113 (12-30-22)

10.09.15.03,.07 • 50:4 Md. R. 136 (2-24-23)

10.09.16.01—.13 • 50:4 Md. R. 136 (2-24-23)

10.09.17.03,.04 • 50:4 Md. R. 139 (2-24-23)

10.09.21.02—.04,.06 • 50:2 Md. R. 64 (1-27-23)

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

10.09.40.01—.06 • 50:1 Md. R. 13 (1-13-23)

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

10.09.46.01,.04,.05,.09-1,.12 • 50:2 Md. R. 65 (1-27-23)

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

10.09.52.01—.06 • 50:1 Md. R. 13 (1-13-23)

10.09.54.01,.04,.14,.16,.17,.22 • 50:3 Md. R. 94 (2-10-23)

10.09.55.03,.06 • 49:27 Md. R. 1115 (12-30-22)

10.09.56.22 • 50:4 Md. R. 140 (2-24-23)

10.09.76.01,.03,.05 • 50:1 Md. R. 13 (1-13-23)

10.09.77.01,.03—.07,.10 • 50:1 Md. R. 21 (1-13-23)

10.09.80.01,.05,.06,.08 • 50:4 Md. R. 141 (2-24-23)

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)

10.15.07.01 • 49:27 Md. R. 1116 (12-30-22) (ibr)

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

Subtitles 23—36 (4th volume)

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)

10.34.14.01,.03..03-1 • 50:3 Md. R. 96 (2-10-23)

Subtitles 37—52 (5th volume)

10.37.01.02 • 50:2 Md. R. 67 (1-27-23) (ibr)

10.37.10.03,.04,.05 • 50:3 Md. R. 97 (2-10-23)

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

10.38.13.01—.06 • 50:1 Md. R. 22 (1-13-23)

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)

10.43.17.01—.06 • 50:2 Md. R. 68 (1-27-23)

10.46.08.01—.06 • 49:27 Md. R. 1116 (12-30-22)

10.47.07.02—.05-1,.07—.09 • 50:1 Md. R. 24 (1-13-23)

Subtitles 53—68 (6th volume)

10.56.10.01—.06 • 49:27 Md. R. 1117 (12-30-22)

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)

10.60.01.01 • 50:1 Md. R. 26 (1-13-23)

10.60.02.06 • 50:1 Md. R. 26 (1-13-23)

10.60.03.01 • 50:1 Md. R. 26 (1-13-23)

10.60.06.01 • 50:1 Md. R. 26 (1-13-23)

10.62.01.01 • 50:3 Md. R. 98 (2-10-23)

10.62.06.01,.02 • 50:3 Md. R. 98 (2-10-23)

10.62.08.07,.08,.14 • 50:3 Md. R. 98 (2-10-23)

10.62.09.05 • 50:3 Md. R. 98 (2-10-23)

10.62.11.02,.04 • 50:3 Md. R. 98 (2-10-23)

10.62.12.06,.09 • 50:3 Md. R. 98 (2-10-23)

10.62.17.01 • 50:3 Md. R. 98 (2-10-23)

10.62.18.10 • 50:3 Md. R. 98 (2-10-23)

10.62.19.07,.12 • 50:3 Md. R. 98 (2-10-23)

10.62.20.05 • 50:3 Md. R. 98 (2-10-23)

10.62.21.06 • 50:3 Md. R. 98 (2-10-23)

10.62.22.03,.05,.06 • 50:3 Md. R. 98 (2-10-23)

10.62.23.02,.03,.07 • 50:3 Md. R. 98 (2-10-23)

10.62.25.08,.10,.13 • 50:3 Md. R. 98 (2-10-23)

10.62.26.05 • 50:3 Md. R. 98 (2-10-23)

10.62.28.03,.05,.06 • 50:3 Md. R. 98 (2-10-23)

10.62.30.03—.05,.08 • 50:3 Md. R. 98 (2-10-23)

10.62.33.06 • 50:3 Md. R. 98 (2-10-23)

10.63.01.02,.05 • 50:4 Md. R. 143 (2-24-23)

10.63.02.02 • 50:4 Md. R. 143 (2-24-23)

10.63.03.20,.21 • 50:4 Md. R. 143 (2-24-23)

10.65.10.01—.06 • 50:2 Md. R. 69 (1-27-23)

10.67.06.04 • 50:2 Md. R. 64 (1-27-23)

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

11 DEPARTMENT OF TRANSPORTATION

Subtitles 01—10

11.01.18.01—.06 • 49:27 Md. R. 1118 (12-30-22)

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)

Subtitles 11—23 (MVA)

11.21.01.02,.04-1,.04-2,.04-4,.04-5,.07,.08,
.11—.13 • 50:3 Md. R. 103 (2-10-23)

12 DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONAL SERVICES

12.04.11.01—.08 • 50:1 Md. R. 28 (1-13-23)

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)

50:3 Md. R. 103 (2-10-23) (corr)

13A.05.14.01—.13 • 50:4 Md. R. 151 (2-24-23)

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.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.01.01.17 • 50:4 Md. R. 153 (2-24-23)

13B.02.06.01,.06,.11,.14 • 50:4 Md. R. 153 (2-24-23)

13B.03.01.03,.13 • 50:4 Md. R. 155 (2-24-23)

13B.07.02.03 • 50:4 Md. R. 156 (2-24-23)

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

13B.08.12.01—.08 • 50:4 Md. R. 156 (2-24-23)

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)

13B.08.20.02—.13 • 50:4 Md. R. 158 (2-24-23)

14 INDEPENDENT AGENCIES

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

14.09.04.03 • 50:1 Md. R. 30 (1-13-23)

14.22.01.09—.11 • 50:1 Md. R. 32 (1-13-23)

14.22.02.02 • 50:1 Md. R. 32 (1-13-23)

14.40.04.01—.03 • 50:2 Md. R. 70 (1-27-23)

14.40.05.03,.04 • 50:2 Md. R. 71 (1-27-23)

15 MARYLAND DEPARTMENT OF AGRICULTURE

15.01.20.01—.11 • 50:3 Md. R. 104 (2-10-23)

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)

21 STATE PROCUREMENT REGULATIONS

21.11.11.01,.06,.07 • 50:2 Md. R. 72 (1-27-23)

26 DEPARTMENT OF THE ENVIRONMENT

Subtitles 01—07 (Part 1)

26.04.01.01,.01-1,.20,.37 • 50:3 Md. R. 106 (2-10-23) (ibr)

26.04.12.01—.07 • 50:2 Md. R. 73 (1-27-23)

Subtitles 08—12 (Part 2)

26.11.19.20 • 49:27 Md. R. 1119 (12-30-22)

26.11.42.01—.11 • 49:27 Md. R. 1119 (12-30-22) (ibr)

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)

30.08.05.13 • 50:1 Md. R. 37 (1-13-23)

31 MARYLAND INSURANCE ADMINISTRATION

31.10.44.02—.11 • 50:4 Md. R. 160 (2-24-23)

33 STATE BOARD OF ELECTIONS

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

The Judiciary

SUPREME COURT OF MARYLAND

DISCIPLINARY PROCEEDINGS

This is to certify that by an Order of this Court dated January 30, 2023, JON WILLIAM NORRIS (CPF# 9106200217), as of January 30, 2023, Jon William Norris has been placed on disability inactive status by consent, 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).

* * * * * * * * * *

This is to certify that by an Opinion & Order of this Court dated February 1, 2023, KEITH ANTHONY PARRIS (CPF# 8706010308), as of February 1, 2023, Keith Anthony Parris 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).

[23-04-01]

Emergency Action on Regulations

Symbol Key

• Roman type indicates text existing before emergency status was granted.

• Italic type indicates new text.

• [Single brackets] indicate deleted text.

Emergency Regulations

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

Title 10
MARYLAND DEPARTMENT OF HEALTH

Subtitle 21 MENTAL HYGIENE REGULATIONS

10.21.31 Maryland Mental Health and Substance Use Disorder Registry and Referral System

Authority: Health-General Article, §7.5-802, Annotated Code of Maryland

Notice of Emergency Action

[22-348-E]

The Joint Committee on Administrative, Executive, and Legislative Review has granted emergency status to new Regulations .01—.05 under a new chapter, COMAR 10.21.31 Maryland Mental Health and Substance Use Disorder Registry and Referral System.

Emergency status began: January 27, 2023.

Emergency status expires: July 26, 2023.

Economic Impact on Small Businesses

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

.01 Scope.

This chapter applies to:

A. Hospitals under Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland;

B. Freestanding medical facilities under Health-General Article, Title 19, Subtitle 3(a), Annotated Code of Maryland; and

C. Any other provider type designated by the Department by issuance of a transmittal sent to all designated providers.

.02 Definitions.

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

B. Terms Defined.

(1) “Department” means the Maryland Department of Health.

(2) “Facility” means a hospital, freestanding medical facility, or provider designated by the Department.

(3) “Hospital” means a general or special hospital licensed under Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland, and COMAR 10.07.01.

(4) “Maryland Mental Health and Substance Use Disorder Registry and Referral System” or “Bed Registry and Referral System” means the system operated by the Department through which health care providers can identify and access available inpatient and outpatient mental health and substance use services for patients.

.03 Use.

A facility shall:

A. Refer an individual who may require additional care coordination for inpatient, outpatient, or community-based behavioral health services, after undergoing an initial psychiatric evaluation, no later than 48 hours after arrival at the facility at a phone number or website address designated by the Department through written directives to implement the Bed Registry and Referral System; and

B. Provide all necessary patient information, including, but not limited to, diagnosis and level of care recommendations to the respective care coordination centers.

.04 Daily Reporting.

A facility shall, report current bed availability and census information, and any additional relevant information requested by the Department, to populate the inpatient psychiatric bed board as necessary to keep the information updated, but not less than three times per day, during the following periods:

A. 9 a.m. to 12 p.m.;

B. 1 p.m. to 3 p.m.; and

C. 4 p.m. to 7 p.m.

.05 Penalties.

A. A hospital who violates this chapter is subject to the fines, penalties, and actions specified in Health-General Article, Title 19, Annotated Code of Maryland.

B. A provider who violates this chapter is subject to the fines, penalties, and actions specified in Health-General Article, Title 7.5, Annotated Code of Maryland, and COMAR 10.63.

DENNIS R. SCHRADER
Secretary of Health

Subtitle 22 DEVELOPMENTAL DISABILITIES

10.22.17 Fee Payment System for Licensed Residential and Day Programs

Authority: Health-General Article, §§2-104(b), 7-306.1, 7-307, 7-308, 7-910(c), 15-105, 15-107, and 16-201, Annotated Code of Maryland

Notice of Emergency Action

[22-258-E]

The Joint Committee on Administrative, Executive, and Legislative Review has granted emergency status to amendments to Regulations .02 and .10 under COMAR 10.22.17 Fee Payment System for Licensed Residential and Day Programs.

Emergency status began: February 2, 2023.

Emergency status expires: August 1, 2023.

Estimate of Economic Impact

I. Summary of Economic Impact. DDA residential providers that support individuals who are absent from services for more than 18 days per calendar year will have a fiscal impact.

II. Types of Economic Impact.

Impacted Entity	Revenue (R+/R-) Expenditure (E+/E-)	Magnitude
A. On issuing agency:
Maryland Department of Health	(E-)	$3,076,380
B. On other State agencies:	NONE
C. On local governments:	NONE
	Benefit (+) Cost (-)	Magnitude
D. On regulated industries or trade groups:
DDA residential providers	(-)	$6,152,760
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.)

A. With a decrease in payments to providers in the amount of $3,076,380. The State will save $3,076,380 in expenditures from State funds.

D. DDA residential providers that support individuals who are absent from services for more than 18 days per calendar year will have a fiscal impact. Based on analysis of FY2020, both before and during the Public Health Emergency, the total estimated cost to providers would be approximately $6,152,760.

Economic Impact on Small Businesses

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

DDA residential providers that support individuals who are absent from services for more than 18 days per calendar year will have a fiscal impact. Based on analysis of FY2020, both before and during the Public Health Emergency, the aggregate cost to providers who support individuals in excess of 18 days is approximately $6,152,760.

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)—(4) (text unchanged)

(5) “Attendance day” means, for:

(a) Day habilitation and vocational services billed under the Administration’s prospective payment system in accordance with Health-General Article, §7-306.1, Annotated Code of Maryland, when the individual is present in the program for at least 4 hours a day during a regularly scheduled period of operation, with 6 to 8 hours per day as the service goal, and with Administration approval of fewer than 6 hours per day provided the individual plan indicates this lower level of service is necessary;

(b) Residential programs billed under the Administration’s prospective payment system in accordance with Health-General Article, §7-306.1, Annotated Code of Maryland, as of October 1, 2001, when the individual is present for at least 6 hours in the home or spends the night in the home, which is the primary residence for the individual; and

(c) Supported employment billed under the Administration’s prospective payment system in accordance with Health-General Article, §7-306.1, Annotated Code of Maryland, when the individual is engaged in supported employment for at least 4 hours a day, with 6 to 8 hours per day as the service goal, and with Administration approval of fewer than 6 hours per day provided the individual plan indicates this lower level of service is necessary.

(6)—(38) (text unchanged)

.10 Payment for Services Reimbursed by Rates.

A.—B. (text unchanged)

C. Reimbursement for Attendance Days of Day Habilitation, Vocational Services, and Supported Employment with Fewer than the Hours as Defined in Regulation .02 of this Chapter.

(1) [The] Except as provided in §C(3) of this regulation, for day habilitation, vocational services, and supported employment billed under the Administration’s prospective payment system in its PCIS2 electronic software system, on or after January 1, 2022, the Administration may:

(a)—(c) (text unchanged)

(2) (text unchanged)

(3) In accordance with the individual’s individual plan approved by the Administration, the Administration may approve payment to providers for fewer than the minimum hours otherwise required for meaningful day services in either of the following circumstances:

(a) In the event of a public health emergency or state of emergency, as further provided in §L of this regulation; or

(b) The provider bills for meaningful day services, including day habilitation, vocational services, and supported employment, under the Administration’s fee-for-service payment system in its electronic data management system as further provided in Health-General Article, §7-308, Annotated of Maryland, other applicable laws and regulations, and the Department’s policies, procedures, and guidance.

D.—F. (text unchanged)

G. Absences and Vacancies.

(1) [As of July 1, 2011] On or after January 1, 2022, except in the event of a public health emergency or state of emergency as provided in §L of this regulation, the Department shall only reimburse providers for [33] 18 days of absences or vacancies per year per individual when the individual is unable to be in residential services due to illness, vacation, home visits, medical appointments, or other circumstances.

(2) (text unchanged)

H. The Administration shall reimburse day and supported employment programs an additional $2,000 per year per individual for transportation to and from day habilitation and vocational programs or to and from supported employment for individuals who, because of their disabilities, must use wheelchairs or motorized scooters[,] if, on or after January 1, 2022, the:

(1) Provider bills for day habilitation, vocational services, or supported employment under the Administration’s prospective payment system, in accordance with Health-General Article, §7-306.1, Annotated Code of Maryland; and

(2) [payments] Payments are consistent with the requirements under COMAR 10.09.26 and 10.09.19.

I.—K. (text unchanged)

L. The Administration may approve payment to providers in the event of a public health emergency or state of emergency, federal or State, in accordance with applicable disaster relief authority for:

(1) From January 1, 2022 through March 31, 2022, fewer than the minimum hours otherwise required for meaningful day services as provided in §C of this regulation, but at least 1 hour;

(2) From April 1, 2022 through June 5, 2023, fewer than the minimum hours otherwise required for meaningful day services as provided in §C of this regulation, but at least 3 hours; or

(3) Additional retainer days as provided in §G(1) of this regulation.

DENNIS R. SCHRADER
Secretary of Health

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 09
MARYLAND DEPARTMENT OF LABOR

Subtitle 32 UNEMPLOYMENT INSURANCE

09.32.12 Procedures for Initial Determination of Unemployment Insurance Overpayments and for Appeals of Overpayment Determinations

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

Notice of Final Action

[22-131-F]

On February 13, 2023, the Acting Secretary of Labor adopted new Regulations .01—.05 under a new chapter, COMAR 09.32.12 Procedures for Initial Determination of Unemployment Insurance Overpayments and for Appeals of Overpayment Determinations. This action, which was proposed for adoption in 49:17 Md. R. 798—800 (August 12, 2022), has been adopted as proposed.

Effective Date: March 6, 2023.

PORTIA WU
Acting Secretary of Labor

Title 11
DEPARTMENT OF TRANSPORTATION

Subtitle 02 TRANSPORTATION SERVICE HUMAN RESOURCES SYSTEM

11.02.06 Medical Examinations and Evaluations

Authority: State Personnel and Pensions Article, §2-106; Transportation Article, §§2-102 and 2-103.4; Annotated Code of Maryland

Notice of Final Action

[22-210-F]

On February 13, 2023, the Maryland Department of Transportation adopted amendments to Regulations .01 and .02 under COMAR 11.02.06 Medical Examinations and Evaluations. This action, which was proposed for adoption in 49:26 Md. R. 1092—1093 (December 16, 2022), has been adopted as proposed.

Effective Date: March 6, 2023.

PAUL J. WIEDEFELD
Acting Secretary of Transportation

Title 15
MARYLAND DEPARTMENT OF AGRICULTURE

Subtitle 03 WEIGHTS AND MEASURES

15.03.01 Commercial Weighing and Measuring Devices and Procedures for Testing Packaged Goods

Authority: Agriculture Article, §§11-203 and 11-206, Annotated Code of Maryland

Notice of Final Action

[22-150-F-I]

On February 8, 2023, the Maryland Department of Agriculture adopted amendments to Regulation .02 under COMAR 15.03.01 Commercial Weighing and Measuring Devices and Procedures for Testing Packaged Goods. This action, which was proposed for adoption in 49:18 Md. R. 832 (August 26, 2022), has been adopted as proposed.

Effective Date: March 6, 2023.

STEVEN A. CONNELLY
Deputy Secretary of Agriculture

Subtitle 03 WEIGHTS AND MEASURES

15.03.02 Packaging and Labeling

Authority: Agriculture Article, §§11-203 and 11-207, Annotated Code of Maryland

Notice of Final Action

[22-151-F-I]

On February 8, 2023, the Maryland Department of Agriculture adopted amendments to Regulation .01 under COMAR 15.03.02 Packaging and Labeling. This action, which was proposed for adoption in 49:18 Md. R. 832—833 (August 26, 2022), has been adopted as proposed.

Effective Date: March 6, 2023.

STEVEN A. CONNELLY
Deputy Secretary of Agriculture

Subtitle 14 BOARD OF VETERINARY MEDICAL EXAMINERS

15.14.10 Continuing Education Requirements

Authority: Agriculture Article, §§2-304(a)(1) and 2-306(a)(2), Annotated Code of Maryland

Notice of Final Action

[22-179-F]

On February 8, 2023, the Maryland Department of Agriculture adopted amendments to Regulations .02 and .05 under COMAR 15.14.10 Continuing Education Requirements. This action, which was proposed for adoption in 49:20 Md. R. 920—921 (September 23, 2022), has been adopted as proposed.

Effective Date: March 6, 2023.

STEVEN A. CONNELLY
Deputy Secretary of Agriculture

Subtitle 14 BOARD OF VETERINARY MEDICAL EXAMINERS

15.14.16 Continuing Education Requirements for Registered Veterinary Technicians

Authority: Agriculture Article, §2-309, Annotated Code of Maryland

Notice of Final Action

[22-178-F]

On February 8, 2023, the Maryland Department of Agriculture adopted amendments to Regulations .02—.04 under COMAR 15.14.16, Continuing Education Requirements for Registered Veterinary Technicians. This action, which was proposed for adoption in 49:20 Md. R. 921—922 (September 23, 2022), has been adopted as proposed.

Effective Date: March 6, 2023.

STEVEN A. CONNELLY
Deputy Secretary of Agriculture

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

Notice of Final Action

[22-266-F]

On February 1, 2023, the Critical Area Commission for the Chesapeake and Atlantic Coastal Bays adopted:

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

(2) Amendments to Regulations .06-1 and .06-3 under COMAR 27.01.02 Development in the Critical Area;

(3) Amendments to Regulations .01, .02, and .03 and new Regulation .01-1 under COMAR 27.01.04 Shoreline Stabilization Measures;

(4) Amendments to Regulations .01, .01-2, and .01-3 under COMAR 27.01.09 Habitat Protection Areas in the Critical Area;

(5) Amendments to Regulation .06 under COMAR 27.01.14 Renewable Energy Generating Systems;

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

(7) Amendments to Regulations .05 and .15-3 under COMAR 27.02.05 State Agency Actions Resulting in Development on State-Owned Lands.

This action, which was proposed for adoption in 49:25 Md. R. 1062—1065 (December 2, 2022), has been adopted as proposed.

Effective Date: March 6, 2023.

CHARLES C. DEEGAN
Chairman

Withdrawal of Regulations

Title 13A
STATE BOARD OF EDUCATION

Subtitle 07 SCHOOL PERSONNEL

13A.07.06 Programs for Professionally Licensed Personnel

Authority: Education Article, §§2-205, 6-120, 6-121, 6-704, and 11-208, Annotated Code of Maryland

Notice of Withdrawal

[22-001-W-I]

Pursuant to State Government Article, §10-116(b), Annotated Code of Maryland, notice is given that the proposal to repeal existing Regulation .01 under COMAR 13A.07.06 Programs for Professionally Certified Personnel and adopt new Regulations .01—.15 under a new chapter, COMAR 13A.07.06 Programs for Professionally Licensed Personnel, which was published in 49:1 Md. R. 39—50 (January 3, 2022), has been withdrawn by operation of law.

GAIL S. KLAKRING
Administrator

Subtitle 12 EDUCATOR LICENSURE

Notice of Withdrawal

[22-002-W]

Pursuant to State Government Article, §10-116(b), Annotated Code of Maryland, notice is given that the following proposed action, as published in 49:2 Md. R. 92—115 (January 14, 2022), has been withdrawn by operation of law:

(1) Repeal existing Regulations .01—.14 and adopt new Regulations .01—.06 under COMAR 13A.12.01 General Provisions;

(2) Repeal existing Regulations .01—.29 and adopt new Regulations .01—.07 under COMAR 13A.12.02 Teachers;

(3) Repeal existing Regulations .01—.12 under COMAR 13A.12.03 Specialists and adopt new Regulations .01—.05 under a new chapter, COMAR 13A.12.03 Professional and Technical Education and Specialized Areas for Fine Arts;

(4) Repeal existing Regulations .01—.16 under COMAR 13A.12.04 Administrators and Supervisors and adopt new Regulations .01—.15 under a new chapter, COMAR 13A.12.04 Specialists;

(5) Repeal existing Regulations .01—.08 under COMAR 13A.12.05 Suspensions and Revocations and adopt new Regulations .01—.15 under a new chapter, COMAR 13A.12.05 Administrators and Supervisors;

(6) Repeal existing Regulations .01—.08 under COMAR 13A.12.06 Professional Standards and Teacher Education Board and adopt new Regulations .01—.09 under a new chapter, COMAR 13A.12.06 Disciplinary Actions and Denials; and

(7) Adopt new Regulations .01—.08 under a new chapter, COMAR 13A.12.07 Professional Standards and Teacher Education Board.

GAIL S. KLAKRING
Administrator

Proposed Action on Regulations

Title 09
MARYLAND DEPARTMENT OF LABOR

Subtitle 03 COMMISSIONER OF FINANCIAL REGULATION

09.03.14 Money Transmitters

Authority: Business Regulation Article, §2-105; Financial Institutions Article, §§2-105.1, 12-401, and 12-403[,]; Annotated Code of Maryland

Notice of Proposed Action

[22-315-P]

The Commissioner of Financial Regulation proposes to recodify existing Regulation .01 to be Regulation .02 and adopt new Regulations .01 and .03—.18 under COMAR 09.03.14 Money Transmitters.

Statement of Purpose

The purpose of this action is to continue the process of modernizing Maryland’s Money Transmission regulatory system that started with the Legislature’s adoption of Ch. 100 (S.B. 219), Acts of 2021, which updated Maryland’s Money Transmission law (Financial Institutions Article, §21-401 et seq., Annotated Code of Maryland) by aligning Maryland’s Money Transmission law with the nationwide standards embodied in the Money Transmitter Model Law issued by the Conference of State Bank Supervisors in 2021, which have been adopted, in full or partial form, by six states and are under consideration by many others. This action enhances the Office of the Commissioner of Financial Regulation’s (OCFR’s) money transmission regulations by adding:

(1) Definitions for certain undefined terms used in money transmission and in Maryland’s Money Transmission law;

(2) A listing of activities that do not constitute money transmission for the purpose of obtaining a money transmitter’s license;

(3) A statement ensuring harmonization of Maryland Money Transmission law with applicable federal law, if any;

(4) A description of the minimum information about an applicant required to be provided in an application for a money transmitter license;

(5) A description of the information required to be provided about an applicant’s control persons and key personnel in an application for a money transmitter license;

(6) Procedures for a money transmitter’s use of a trade name;

(7) Procedures for the processing of money transmitter licensing applications through a multistate licensing process;

(8) A requirement for an applicant to establish, document, and maintain specified corporate governance structures based on their operational complexity and risk profile, including descriptions of internal and external audit and risk management requirements;

(9) Provisions for the suspension or revocation of a money transmitter’s license;

(10) Procedures and standards applicable to an acquisition of or change in control in a money transmitter or of a money transmitter’s key individual or control person;

(11) A requirement to comply with applicable Bank Secrecy Act requirements and to file related reports;

(12) Provisions governing the conduct of business through authorized delegates;

(13) A requirement for the timely transmission of money received for transmission;

(14) Provisions governing the circumstances requiring the refunding of money received for transmission;

(15) Rules governing the provision of receipts to money senders;

(16) Disclosures required of payroll processing services; and

(17) Prudential and financial responsibility standards to be met by money transmitters, including bonding requirements and a description of permissible investments.

Estimate of Economic Impact

I. Summary of Economic Impact. The economic impact of the proposed action is expected to be low.

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:
Money transmitters	(-)	Minimal
E. On other industries or trade groups:	NONE
F. Direct and indirect effects on public:
Consumers	(+)	Impactful

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

D. The proposed action imposes no additional fees or charges. The proposed action may, in some cases, increase recordkeeping and compliance costs for regulated entities. Entities may incur costs associated with the review of an entity’s corporate governance structure to ensure compliance with proposed Regulation .08 and any modification of that structure that may be necessary. Though many regulated entities obtain external audits, some do not, and such entities may incur additional costs associated with obtaining external audits in instances in which the Commissioner determines an audit to be necessary and the entity does not currently obtain external audits. There may be costs associated with the review and/or development, if necessary, of policies required to manage the use of authorized delegates under proposed Regulation .13. There may be increased costs associated with processing refunds and the provision of receipts in accordance with the rule. Entities subject to the payroll processing rules may incur additional costs if their clients do not provide the listed information. The Commissioner cannot provide exact estimates of these costs; however, in most instances, it is expected that the aggregate impact on any licensee is unlikely to be significant. It is assumed that the corporate governance requirements specified in proposed Regulation .08 are currently being met by most of the affected businesses, that there will be few if any instances in which the Commissioner requires an external audit of an entity which does not already obtain such audits, and that affected businesses currently have policies in place that satisfy the requirements of proposed Regulation .13. These assumptions are based on information obtained during the Commissioner’s routine examination of licensed money transmitters.

F. In certain circumstances it is expected that the public will directly benefit from receiving receipts for their transactions and from receiving refunds within 10 days. It is expected that the closer coordination among state regulators fostered by this proposed action will result in more compliant, resilient, and better functioning money transmitting entities, thereby indirectly benefiting the public with a safer and sounder money transmission system.

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 Amy P. Hennen, Director of Legislative Response and Special Projects, Office of the Commissioner of Financial Regulation, Maryland Department of Labor, 1100 North Eutaw Street, Suite 611, Baltimore, MD 21201, or call 410-230-6094, or email to amy.hennen@maryland.gov. Comments will be accepted through March 27, 2023. A public hearing has not been scheduled.

.01 Definitions.

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

B. Terms Defined.

(1) “Acting in concert” means persons knowingly acting together with a common goal of jointly acquiring control of a licensee whether or not pursuant to an express agreement.

(2) “Authorized delegate” has the meaning stated in Financial Institutions Article, §12-401, Annotated Code of Maryland.

(3) “Bank Secrecy Act” means the Bank Secrecy Act, 31 U.S.C. §5311, et seq. and its implementing regulations, as amended and recodified from time to time.

(4) “Closed loop stored value” means stored value that is redeemable by the issuer only for goods or services provided by the issuer or its affiliate or franchisees of the issuer or its affiliate, except to the extent required by applicable law to be redeemable in cash for its cash value.

(5) “Control” means:

(a) The power to vote, directly or indirectly, at least 25 percent of the outstanding voting shares or voting interests of a licensee or person in control of a licensee;

(b) The power to elect or appoint a majority of key individuals or executive officers, managers, directors, trustees, or other persons exercising managerial authority of a person in control of a licensee; or

(c) The power to exercise, directly or indirectly, a controlling influence over the management or policies of a licensee or person in control of a licensee.

(6) “Corporate governance” means the management structure of the licensee and the processes by which the business is managed, including the corporate controls, rules, policies, processes, and practices used to oversee and manage the institution.

(7) “Eligible rating” means a credit rating of any of the three highest rating categories provided by an eligible rating service, whereby each category may include rating category modifiers such as “plus” or “minus” for S&P, or the equivalent for any other eligible rating service.

(8) “Eligible rating service” means any Nationally Recognized Statistical Rating Organization (NRSRO) as defined by the U.S. Securities and Exchange Commission, and any other organization designated by the Commissioner.

(9) “External audit” means the formal report prepared by an independent certified public accountant expressing an opinion on whether the financial statements are presented fairly, in all material aspects, in accordance with the applicable financial reporting framework, and is inclusive of an evaluation of the adequacy of a company’s internal control structure.

(10) “Federally insured depository financial institution” means a bank, credit union, savings and loan association, trust company, savings association, savings bank, industrial bank, or industrial loan company organized under the laws of the United States or any state of the United States, if that bank, credit union, savings and loan association, trust company, savings association, savings bank, industrial bank, or industrial loan company has federally insured deposits.

(11) “In this State” means:

(a) For a transaction requested in person, at a physical location within Maryland; and

(b) For a transaction requested electronically or by phone, the provider of money transmission may determine if the person requesting the transaction is “in this State” by relying on other information provided by the person regarding the location of the individual’s residential address or a business entity’s principal place of business or other physical address location, and any records associated with the person that the provider of money transmission may have that indicate that location, including but not limited to an address associated with an account.

(12) “Individual” means a natural person.

(13) “Internal audit” means the internal independent and objective assurance and consulting activity performed to evaluate and improve the effectiveness of a licensee’s operations, risk management, internal controls, and governance processes.

(14) “Key individual” means any individual ultimately responsible for establishing or directing policies and procedures of the licensee, such as an executive officer, manager, director, or trustee.

(15) “Licensee” has the meaning stated in Financial Institutions Article, §12-401, Annotated Code of Maryland.

(16) “Maryland Money Transmission Act” means Financial Institutions Article, Title 12, Subtitle 4, Annotated Code of Maryland.

(17) “Material litigation” has the meaning stated in Financial Institutions Article, §12-401, Annotated Code of Maryland.

(18) “Monetary value” means a medium of exchange, whether or not redeemable in money.

(19) Money Transmission.

(a) “Money transmission” has the meaning stated in Financial Institutions Article, §12-401, Annotated Code of Maryland.

(b) “Money transmission” includes a payroll processing service.

(20) “MSB accredited state” means a state agency that is accredited by the Conference of State Bank Supervisors and Money Transmitter Regulators Association for money transmission licensing and supervision.

(21) “Multistate licensing process” means any agreement entered into by and among state regulators relating to coordinated processing of applications for money transmission licenses, applications for the acquisition of control of a licensee, control determinations, or notice and information requirements for a change of key individuals.

(22) “NMLS” has the meaning stated in Financial Institutions Article, §1-101, Annotated Code of Maryland.

(23) “Outstanding money transmission obligations” has the meaning assigned to the term “outstanding money transmission” in Financial Institutions Article, §12-401, Annotated Code of Maryland.

(24) “Passive investor” means a person that:

(a) Does not have the power to elect a majority of key individuals or executive officers, managers, directors, trustees, or other persons exercising managerial authority of a person in control of a licensee;

(b) Is not employed by and does not have any managerial duties of the licensee or person in control of a licensee;

(c) Does not have the power to exercise, directly or indirectly, a controlling influence over the management or policies of a licensee or person in control of a licensee; and

(d) Either:

(i) Attests to §B(24)(a)—(c) of this regulation, in a form and in a medium prescribed by the Commissioner; or

(ii) Commits to the passivity characteristics of §B(24)(a)—(c) of this regulation in a written document.

(25) Payment Instrument.

(a) “Payment instrument” has the meaning stated in Financial Institutions Article, §12-401, Annotated Code of Maryland.

(b) “Payment instrument” does not include prepaid access or any instrument that is:

(i) Redeemable by the issuer only for goods or services provided by the issuer or its affiliate or franchisees of the issuer or its affiliate, except to the extent required by applicable law to be redeemable in cash for its cash value; or

(ii) Not sold to the public but issued and distributed as part of a loyalty, rewards, or promotional program.

(26) Payroll Processing Services.

(a) “Payroll processing services” means receiving money for transmission pursuant to a contract with a person to deliver wages or salaries, make payment of payroll taxes to state and federal agencies, make payments relating to employee benefit plans, or make distributions of other authorized deductions from wages or salaries.

(b) “Payroll processing services” does not include an employer performing payroll processing services on its own behalf or on behalf of its affiliate.

(27) “Person” has the meaning stated in Financial Institutions Article, §1-101, Annotated Code of Maryland.

(28) Prepaid Access.

(a) “Prepaid access” has the meaning stated in Financial Institutions Article, §12-401, Annotated Code of Maryland.

(b) “Prepaid access” includes, but is not limited to, “prepaid access” as defined by 31 CFR §1010.100, as amended or recodified from time to time.

(c) Prepaid access does not include a payment instrument or closed loop stored value, or stored value not sold to the public but issued and distributed as part of a loyalty, rewards, or promotional program.

(29) “Receiving money for transmission” or “money received for transmission” means receiving money or monetary value in the United States for transmission within or outside the United States by electronic or other means.

(30) “Risk management program” means the policies, procedures, and internal controls designed to identify, measure, monitor and mitigate risk.

(31) “Tangible net worth” means the aggregate assets of a licensee, excluding all intangible assets, less liabilities, as determined in accordance with United States generally accepted accounting principles.

.03 Activities Not Constituting Money Transmission for the Purpose of Licensure.

A. In accordance with the Maryland Money Transmission Act, the following activity by a person does not constitute money transmission for the purposes of necessitating a license to conduct that activity:

(1) An operator of a payment system to the extent that it provides processing, clearing, or settlement services, between or among persons exempted under the Maryland Money Transmission Act or licensees, in connection with wire transfers, credit card transactions, debit card transactions, stored-value transactions, automated clearing house transfers, or similar funds transfers.

(2) A person appointed as an agent of a payee to collect and process a payment from a payor to the payee for goods or services, other than money transmission itself, provided to the payor by the payee, if:

(a) There exists a written agreement between the payee and the agent directing the agent to collect and process payments from payors on the payee’s behalf;

(b) The terms of the written agreement required by §A(2)(a) of this regulation are consistent with a principal’s appointment of an agent under Maryland law;

(c) The payee holds the agent out to the public as accepting payments for goods or services on the payee’s behalf;

(d) Payment for the goods and services is treated as received by the payee upon receipt by the agent so that the payor’s obligation is extinguished and there is no risk of loss to the payor if the agent fails to remit the funds to the payee;

(e) The agent is not serving in an escrow capacity in connection with the transaction;

(f) The agent is not acting as agent to more than one party in the transaction; and

(g) Payment by the agent to the payee occurs promptly and is not conditioned on the occurrence of any future event or performance by any party to the transaction.

(3) A person that acts as an intermediary by processing payments between an entity that has directly incurred an outstanding money transmission obligation to a sender, and the sender’s designated recipient, if that the entity:

(a) Is properly licensed or exempt from licensing requirements under the Maryland Money Transmission Act;

(b) Provides a receipt, electronic record, or other written confirmation to the sender identifying the entity as the provider of money transmission in the transaction; and

(c) Bears sole responsibility to satisfy the outstanding money transmission obligation to the sender, including the obligation to make the sender whole in connection with any failure to transmit the funds to the sender’s designated recipient.

(4) A person expressly appointed as a third-party service provider to or agent of an entity exempt under the Maryland Money Transmission Act, other than an authorized delegate, solely to the extent that:

(a) That service provider or agent is engaging in money transmission on behalf of and pursuant to a written agreement with the exempt entity that sets forth the specific functions that the service provider or agent is to perform; and

(b) The exempt entity assumes all risk of loss and all legal responsibility for satisfying the outstanding money transmission obligations owed to purchasers and holders of the outstanding money transmission obligations upon receipt of the purchaser’s or holder’s money or monetary value by the service provider or agent.

B. The Commissioner may require that any person claiming to be either exempt from licensing pursuant to the Maryland Money Transmission Act or not engaged in activity constituting money transmission necessitating a license provide information and documentation to the Commissioner demonstrating that it qualifies for any claimed exemption or is not engaged in activities necessitating a license.

.04 Relationship to Federal Law.

A. If State money transmission jurisdiction is conditioned on a federal law, any inconsistencies between a provision of the Maryland Money Transmission Act and the federal law governing money transmission shall be governed by the applicable federal law to the extent of the inconsistency.

B. If any inconsistencies exist between the Maryland Money Transmission Act and a federal law that governs pursuant to this regulation, the Commissioner may provide interpretive guidance that:

(1) Identifies the inconsistency; and

(2) Identifies the appropriate means of compliance with federal law.

.05 Application for License.

A. In addition to the requirements set forth in Financial Institutions Article, §12-407, Annotated Code of Maryland, applications for a license shall contain at a minimum and as applicable:

(1) The legal name and residential and business addresses of the applicant and any fictitious or trade name used by the applicant in conducting its business;

(2) A list of any criminal convictions of the applicant and any material litigation in which the applicant has been involved in the 10-year period next preceding the submission of the application;

(3) A description of any money transmission previously provided by the applicant and the money transmission that the applicant seeks to provide in this State;

(4) A list of the applicant’s proposed authorized delegates and the locations in this State where the applicant and its authorized delegates propose to engage in money transmission;

(5) A list of other states in which the applicant is licensed to engage in money transmission and any license revocations, suspensions, or other disciplinary action taken against the applicant in another state;

(6) Information concerning any bankruptcy or receivership proceedings affecting the licensee or a person in control of a licensee;

(7) A sample form of contract for authorized delegates, if applicable;

(8) A sample form of payment instrument or stored value, as applicable;

(9) The name and address of any federally insured depository financial institution through which the applicant plans to conduct money transmission; and

(10) Any other information the Commissioner reasonably requires with respect to the applicant.

B. In addition to the requirements set forth in Financial Institutions Article, §12-407, Annotated Code of Maryland, if an applicant is a corporation, limited liability company, partnership, or other legal entity, the applicant shall also provide:

(1) The date of the applicant’s incorporation or formation and state or country of incorporation or formation;

(2) If applicable, a certificate of good standing from the state or country in which the applicant is incorporated or formed;

(3) A brief description of the structure or organization of the applicant, including any parents or subsidiaries of the applicant, and whether any parents or subsidiaries are publicly traded;

(4) The legal name, any fictitious or trade name, all business and residential addresses, and the employment, as applicable, in the 3-year period next preceding the submission of the application of each key individual and person in control of the applicant;

(5) A list of any criminal convictions and material litigation in which a person in control of the applicant that is not an individual has been involved in the 3-year period preceding the submission of the application;

(6) A copy of audited financial statements of the applicant for the most recent fiscal year and for the 2-year period next preceding the submission of the application or, if the audited statements are not available for good cause and the Commissioner determines the Commissioner can make findings necessary to grant or deny the license, certified unaudited financial statements for the most recent fiscal year or other period acceptable to the Commissioner;

(7) A certified copy of unaudited financial statements of the applicant for the most recent fiscal quarter;

(8) If the applicant is a publicly traded corporation, a copy of the most recent report filed with the United States Securities and Exchange Commission under §13 of the federal Securities Exchange Act of 1934, 15 U.S.C. §78m, as amended or recodified from time to time;

(9) If the applicant is a wholly owned subsidiary of:

(a) A corporation publicly traded in the United States, a copy of audited financial statements for the parent corporation for the most recent fiscal year or a copy of the parent corporation’s most recent report filed under §13 of the U.S. Securities Exchange Act of 1934, 15 U.S.C. §78m, as amended or recodified from time to time; or

(b) A corporation publicly traded outside the United States, a copy of similar documentation filed with the regulator of the parent corporation’s domicile outside the United States;

(10) The name and address of the applicant’s registered agent in this State; and

(11) Any other information the Commissioner reasonably requires with respect to the applicant.

C. The Commissioner may waive or modify the requirement to produce audited financial statements in Financial Institutions Article, §12-407, Annotated Code of Maryland, if:

(1) The applicant cannot produce audited financial statements required by Financial Institutions Article, §12-407, Annotated Code of Maryland;

(2) The Commissioner determines good cause exists for the applicant’s inability to produce audited financial statements required by Financial Institutions Article, §12-407, Annotated Code of Maryland;

(3) The applicant produces certified unaudited financial statements for the most recent fiscal year or other period required by the Commissioner; and

(4) The Commissioner determines the Commissioner can make findings necessary to grant or deny the license based on all information presented.

D. The Commissioner may waive one or more requirements of this regulation or permit an applicant to submit other information in lieu of the required information.

E. Applications.

(1) The Commissioner shall approve or deny an application for an initial license, a renewal license, or a license amendment within 60 days after the Commissioner receives a completed application, including, if applicable, a surety bond and all required fees.

(2) If the Commissioner notifies an applicant that an application for an initial license, a renewal license, or a license amendment is incomplete, the Commissioner shall itemize the steps that the applicant must take to complete the application.

(3) The application for an initial license, a renewal license, or a license amendment may not be approved until after the applicant completes all steps identified in the Commissioner’s notice.

(4) If an application for an initial license, a renewal license, or license amendment is incomplete when submitted and remains incomplete, the Commissioner may stop processing and consider the incomplete application withdrawn, if the Commissioner has previously notified the applicant of the basis for incompleteness in accordance with §E(2) of this regulation, and given the applicant not less than 15 days to correct the incompleteness.

F. Trade Names.

(1) Prior to a licensee’s use of a trade name to engage in the business of money transmission in Maryland, the licensee shall:

(a) Register the trade name with the Maryland Department of Assessments and Taxation; and

(b) Obtain the approval of the Commissioner for the use of the trade name by:

(i) Designating on an original license application, a license renewal application, or an amendment to an existing license, through NMLS, any trade name under which the licensee will engage in the business of money transmission in this State; and

(ii) Specifying on an original license application, a license renewal application, or an amendment to an existing license, through NMLS, which licensed locations will utilize the trade name.

(2) At all times after obtaining the approval of the Commissioner for the use of the trade name, a licensee shall maintain registration of the trade name in accordance with the requirements of Corporations and Associations Article, §1-406, Annotated Code of Maryland, and accompanying regulations.

(3) A licensee shall immediately notify the Commissioner if the licensee amends, cancels, or otherwise fails to renew the registration of a trade name which the Commissioner has approved previously.

.06 Information Requirements for Certain Individuals.

A. Any individual in control of a licensee or applicant, any individual that seeks to acquire control of a licensee, and each key individual shall furnish to the Commissioner through NMLS the following items:

(1) The individual’s fingerprints for submission to the Federal Bureau of Investigation and the Commissioner for purposes of a national criminal history background check unless the person currently resides outside of the United States and has resided outside of the United States for the last 10 years; and

(2) Personal history and experience in a form and in a medium prescribed by the Commissioner, to obtain the following:

(a) An independent credit report from a consumer reporting agency unless the individual does not have a Social Security number, in which case, this requirement shall be waived;

(b) Information related to any criminal convictions or pending charges; and

(c) Information related to any regulatory or administrative action and any civil litigation involving claims of fraud, misrepresentation, conversion, mismanagement of funds, breach of fiduciary duty, or breach of contract.

B. If the individual has resided outside of the United States at any time in the last 10 years, the individual shall also provide an investigative background report prepared by an independent search firm that meets the following requirements:

(1) At a minimum, the search firm:

(a) Shall demonstrate that it has sufficient knowledge, resources, and employs accepted and reasonable methodologies to conduct the research of the background report; and

(b) May not be affiliated with or have an interest with the individual it is researching.

(2) At a minimum, the investigative background report shall be written in the English language and shall contain the following:

(a) If available in the individual’s current jurisdiction of residency, a comprehensive credit report, or any equivalent information obtained or generated by the independent search firm to accomplish that report, including a search of the court data in the countries, provinces, states, cities, towns, and contiguous areas where the individual resided and worked;

(b) Criminal records information for the past 10 years, including, but not limited to, felonies, misdemeanors, or similar convictions for violations of law in the countries, provinces, states, cities, towns, and contiguous areas where the individual resided and worked;

(c) Employment history;

(d) Media history, including an electronic search of national and local publications, wire services, and business applications; and

(e) Financial services-related regulatory history, including but not limited to money transmission, securities, banking, insurance, and mortgage-related industries.

.07 Multistate Licensing Process.

A. If an applicant for licensure under the Maryland Money Transmission Act avails itself or is otherwise subject to a multistate licensing process:

(1) Subject to §B of this regulation, the Commissioner’s investigation of the applicant under Financial Institutions Article, §12-409, Annotated Code of Maryland, may include the investigation results of a lead investigative state; or

(2) If Maryland is a lead investigative state, the Commissioner may investigate the applicant pursuant to Financial Institutions Article, §12-409, Annotated Code of Maryland, and the timeframes established by agreement through the multistate licensing process, except that, in no case shall the timeframe be noncompliant with the application period in Financial Institutions Article, §12-409, Annotated Code of Maryland.

B. The Commissioner’s investigation of the applicant under Financial Institutions Article, §12-409, Annotated Code of Maryland, may include the investigation results of a lead investigative state if:

(1) The Commissioner reasonably determines that the lead investigative state possesses licensing and supervision authority over money transmission in its state substantially similar to the licensing and supervision authority of the Commissioner over money transmission in Maryland;

(2) The Commissioner reasonably determines that the investigation of the lead investigative state adequately addresses the applicant’s financial condition and responsibility, financial and business experience, character, and general fitness;

(3) The Commissioner reasonably determines the lead investigative state has sufficient staffing, expertise, and minimum standards for the purposes of investigating an applicant for a license permitting money transmission; and

(4) The Commissioner supplements the investigation of the lead investigative state with any information the Commissioner considers relevant.

.08 Corporate Governance.

A. A licensee shall establish, document, and maintain sufficient corporate governance, as follows:

(1) Each element of a licensee’s corporate governance shall be commensurate with the size, operational complexity, and overall risk profile of the licensee.

(2) For purposes of this regulation, the operational complexity and risk profile of a licensee shall, in part, be defined by the results of regulatory examinations, any external audits, and internal audits.

(3) A licensee bears the burden of demonstrating to the Commissioner that its corporate governance is sufficient and commensurate with its size, operational complexity, and overall risk profile.

(4) A licensee’s corporate governance shall, at a minimum, include:

(a) Clearly defined responsibilities and accountability;

(b) Internal controls, policies, processes, and practices for monitoring, testing, and ensuring compliance with the corporate governance framework;

(c) Internal controls, policies, processes, and practices for training of employees on corporate governance requirements; and

(d) Internal controls, policies, processes, and practices addressing internal audits, external audits, and risk management as set forth in §§B—D of this regulation.

(5) Each licensee shall, not less than annually, conduct a review of its corporate governance to determine its overall effectiveness, address emerging risks and otherwise assure that the corporate governance remains commensurate with the size, operational complexity, and overall risk profile of the licensee.

(6) Any documentation, controls, policies, procedures, requirements, audits, reports, or other materials included in this regulation shall be made available to the Commissioner upon the Commissioner’s request.

B. Internal Audit.

(1) A licensee shall establish internal audit requirements that are appropriate for the size, complexity, and risk profile of the licensee.

(2) Unless impracticable given the size of the licensee, internal audit functions shall be performed by employees of the licensee who report to the licensee’s owners or board of directors and who are not otherwise supervised by the persons who directly manage the activities being reviewed.

(3) Employees performing internal audit functions shall have sufficient knowledge, training, and resources to provide a reliable evaluation of the licensee’s operations, risk management, internal controls, and governance processes.

C. External Audit.

(1) If the Commissioner determines, based on the size, operational complexity, and overall risk profile of the licensee, that an external audit is appropriate, the Commissioner may direct a licensee to receive an external audit.

(2) If the Commissioner directs a licensee to receive an external audit, that external audit shall include:

(a) Annual financial statements including a balance sheet, statement of operations (income statement), and cash flows, including notes and supplemental schedules prepared in accordance with generally accepted accounting principles;

(b) Assessment of the internal control structure;

(c) Computation of tangible net worth;

(d) Validation of permissible investments;

(e) Verification of adequate fidelity and errors and omissions (E&O) insurance;

(f) Testing of controls related to risk management activities, including compliance and stress testing, if applicable; and

(g) Any other element the Commissioner considers appropriate.

(3) Nothing in this regulation is intended to abrogate a requirement of a licensee to receive an external audit under any other law, rule, regulation, or by-law, policy, or procedure of the licensee.

D. Risk Management.

(1) A licensee shall at all times maintain a risk management program that identifies, measures, monitors, and controls risk sufficient for the size, operational complexity, and overall risk profile of the licensee.

(2) The risk management program shall have appropriate processes and models in place to measure, monitor, and mitigate financial risks and changes to the risk profile of the licensee.

(3) Evidence of risk management activities throughout the year shall be maintained, including findings of issues and the response to address those findings.

E. Authority to Address Risk as Necessary. If risk is determined by a formal review of a licensee to be extremely high, the Commissioner may order or direct the licensee to satisfy additional conditions necessary to ensure that the licensee will continue to operate in a safe and sound manner and be able to continue to engage in the business of money transmission in compliance with state and federal law and regulation.

.09 Maintenance of License.

A. If a licensee does not continue to meet the qualifications or satisfy the requirements that apply to an applicant for a new license, the Commissioner may suspend or revoke the licensee’s license in accordance with the procedures established under the Maryland Money Transmission Act.

B. An applicant for a license shall demonstrate that it meets or will meet, and a money transmission licensee shall at all times meet, the requirements in Regulation .18 of this chapter.

.10 Acquisition of Control and Change of Key Individual.

A. Any person, or group of persons acting in concert, seeking to acquire control of a licensee shall comply with Financial Institutions Article, §12-415, Annotated Code of Maryland.

B. Any person, or group of persons acting in concert, seeking the Commissioner’s approval under Financial Institutions Article, §12-415, Annotated Code of Maryland, to acquire control of a licensee shall, in cooperation with the licensee, submit an application in a form and in a medium prescribed by the Commissioner, together with any information the Commissioner requires or requests.

C. The application required by this regulation shall include information required by Regulation .06 of this chapter for any new key individuals that have not previously completed the requirements of Regulation .06 of this chapter for a licensee.

D. When an application for acquisition of control under this regulation appears to include all the items and address all matters that are required, the application shall be considered complete, and the Commissioner shall promptly notify the applicant in a record of the date on which the application was determined to be complete and:

(1) Except as provided in Financial Institutions Article, §12-415(b)(2) or (3)(ii), Annotated Code of Maryland:

(a) The Commissioner shall approve or deny the application within 60 days after the completion date; or

(b) If the application is not approved or denied within 60 days after the completion date:

(i) The application is approved; and

(ii) The person, or group of persons acting in concert, are not prohibited from acquiring control.

(2) The Commissioner may for good cause extend the application period.

E. A determination by the Commissioner that an application is complete and is accepted for processing means only that the application, on its face, appears to include all the items and address all the matters that are required, and is not an assessment of the substance of the application or of the sufficiency of the information provided.

F. When an application is filed and considered complete under this regulation, the Commissioner shall investigate the financial condition and responsibility, financial and business experience, character, and general fitness of the person, or group of persons acting in concert, seeking to acquire control. The Commissioner shall approve an acquisition of control pursuant to this regulation if the Commissioner finds that all of the following conditions have been fulfilled:

(1) The requirements of §§B and C of this regulation have been met, as applicable;

(2) Following the change in control, the financial condition and responsibility, financial and business experience, competence, character, and general fitness of the licensee will remain consistent with State licensure requirements; and

(3) That it is in the interest of the public to permit the person, or group of persons acting in concert, to control the licensee.

G. Under the following circumstances, the Commissioner may consider the investigation of an applicant by another State:

(1) If an applicant avails itself or is otherwise subject to a multistate licensing process:

(a) Subject to §G(2) of this regulation, the Commissioner’s investigation of the applicant under §F of this regulation may include the investigation results of a lead investigative state; or

(b) If Maryland is a lead investigative state, the Commissioner may investigate the applicant pursuant to §F of this regulation and the timeframes established by agreement through the multistate licensing process, except that, in no case shall the timeframe be noncompliant with the application period in Financial Institutions Article, §12-415, Annotated Code of Maryland.

(2) The Commissioner’s investigation of the applicant under §F of this regulation may include the investigation results of the lead investigative state under §G(1)(a) of this regulation if:

(a) The Commissioner reasonably determines that the lead investigative state possesses licensing and supervision authority over money transmission in its state substantially similar to the licensing and supervision authority of the Commissioner over money transmission Maryland;

(b) The Commissioner reasonably determines that the lead investigative state adequately addresses the applicant’s anticipated financial condition and responsibility, financial and business experience, character, and general fitness following the proposed change of control;

(c) The Commissioner reasonably determines the lead investigative state has sufficient staffing, expertise, and minimum standards for the purposes of investigating a change of control application; and

(d) The Commissioner supplements the investigation of the lead investigative state with any information the Commissioner considers relevant.

H. The Commissioner shall issue a formal written notice of the denial of an application to acquire control within 30 days of the decision to deny the application. The Commissioner shall set forth in the notice of denial the specific reasons for the denial of the application. A licensee whose application is denied by the Commissioner under this regulation may request a hearing within 30 days after receipt of the written notice of the denial pursuant to State Government Article, §10-207, Annotated Code of Maryland.

I. The requirements of Financial Institutions Article, §12-415, Annotated Code of Maryland, as applied to a change of control of a licensee and as provided for in §§A and B of this regulation do not apply to any of the following:

(1) A person that acts as a proxy for the sole purpose of voting at a designated meeting of the shareholders or holders of voting shares or voting interests of a licensee or a person in control of a licensee;

(2) A person that acquires control of a licensee as a personal representative, custodian, guardian, conservator, or trustee, or as an officer appointed by a court of competent jurisdiction or by operation of law;

(3) A public offering of securities of a licensee or a person in control of a licensee, except that, if a single person or group of persons acting in concert acquire control of the licensee as a result of the public offering, the licensee shall obtain the Commissioner’s approval under Financial Institutions Article, §12-415, Annotated Code of Maryland, and this regulation; or

(4) An internal reorganization of a person in control of the licensee if the ultimate person in control of the licensee remains the same.

J. Persons in §I(2)—(4) of this regulation in cooperation with the licensee shall notify the Commissioner within 15 days after the acquisition of control.

K. Streamlined Acquisition of Control.

(1) The requirements of Financial Institutions Article, §12-415, Annotated Code of Maryland, as applied to a change of control of a licensee shall be considered satisfied and no application under §B of this regulation will be required of a person that has complied with and received approval to engage in money transmission under the Maryland Money Transmission Act or was identified as a person in control in a prior application filed with and approved by the Commissioner or by an MSB accredited state pursuant to a multistate licensing process, if:

(a) The person has not had a license revoked or suspended or controlled a licensee that has had a license revoked or suspended while the person was in control of the licensee in the previous 5 years;

(b) If the person is a licensee, the person is well managed and has received at least a satisfactory rating for compliance at its most recent examination by an MSB accredited state if that rating was given;

(c) The licensee to be acquired is projected to meet the qualifications for licensure under the Maryland Money Transmission Act, including the requirements of Regulation .18 of this chapter, after the acquisition of control is completed, and if the person acquiring control is a licensee, that licensee is also projected to meet the qualifications for licensure under the Maryland Money Transmission Act, including the requirements of Regulation .18 of this chapter, after the acquisition of control is completed;

(d) The licensee to be acquired will not implement any material changes to its business plan as a result of the acquisition of control, and if the person acquiring control is a licensee, that licensee also will not implement any material changes to its business plan as a result of the acquisition of control;

(e) The person provides notice of the acquisition in cooperation with the licensee and attests to §K(1)(a)—(d) of this regulation in a form and in a medium prescribed by the Commissioner; and

(f) The person provides the Commissioner with any additional information the Commissioner requests in connection with the notice.

(2) If the Commissioner requests additional information in connection with a notice, the notice may not be considered complete until that information is provided to the Commissioner.

(3) If the notice is not disapproved within 30 days after the date on which the notice was determined to be complete, the notice is considered approved.

(4) A licensee whose notice is disapproved by the Commissioner under this regulation may request a hearing within 30 days after receipt of the written notice of the disapproval pursuant to State Government Article, §10-207, Annotated Code of Maryland.

L. Before filing an application or notice under §B or K of this regulation, a person or group of persons acting in concert may request in writing a determination from the Commissioner as to whether the person or group of persons acting in concert would be considered a person in control of a licensee upon consummation of a proposed transaction. If the Commissioner determines that the person or group of persons acting in concert would not be a person in control of a licensee, the proposed person or group of persons acting in concert is not subject to the requirements of Financial Institutions Article, §12-415(b), Annotated Code of Maryland, as applied to a change of control of a licensee.

M. Rebuttable Presumption of Control.

(1) A person is presumed to exercise a controlling influence if the person holds the power to vote, directly or indirectly, at least 10 percent of the outstanding voting shares or voting interests of a licensee or person in control of a licensee.

(2) A person presumed to exercise a controlling influence can rebut the presumption of control if the person is a passive investor.

(3) For purposes of determining the percentage of a person controlled by any other person, the person’s interest shall be aggregated with the interest of any other immediate family member, including the person’s spouse, parents, children, siblings, mothers- and fathers-in law, sons- and daughters-in-law, brothers- and sisters-in-law, and any other person who shares that person’s home.

.11 Notice and Information Requirements for a Change of Key Individuals.

A. A licensee adding or replacing any key individual shall:

(1) Provide notice in a manner prescribed by the Commissioner as soon as reasonably practicable, but in no event later than 15 days after the effective date of the key individual’s appointment; and

(2) Provide information as required by Regulation .06 of this chapter within 30 days of the date on which the notice was provided pursuant to this regulation.

B. Within 90 days of the date on which the notice provided pursuant to this regulation was determined to be complete, the Commissioner may issue a notice of disapproval of a key individual if the competence, experience, character, or integrity of the individual would not be in the best interests of the public or the customers of the licensee to permit the individual to be a key individual of that licensee.

C. A notice of disapproval shall contain a statement of the basis for disapproval and shall be sent to the licensee and the disapproved individual. A licensee receiving a notice of disapproval under this regulation may request a hearing within 30 days after receipt of the written notice of the disapproval pursuant to State Government Article, §10-207, Annotated Code of Maryland.

D. If the notice provided pursuant to this regulation is not disapproved within 90 days after the date on which the notice was determined to be complete, the key individual is considered approved.

.12 Bank Secrecy Act Reports.

A licensee and an authorized delegate shall file all reports required by federal currency reporting, record keeping, and suspicious activity reporting requirements as set forth in the Bank Secrecy Act and other federal and state laws pertaining to money laundering. The timely filing of a complete and accurate report required under this regulation with the appropriate federal agency is considered compliant with the requirements of this regulation.

.13 Authorized Delegates.

A. For purposes of this regulation, “remit” means to make direct payments of money to a licensee or its representative authorized to receive money or to deposit money in a bank in an account specified by the licensee.

B. Before a licensee may conduct business through an authorized delegate or allows a person to act as the licensee’s authorized delegate, the licensee shall:

(1) Adopt, and update as necessary, written policies and procedures reasonably designed to ensure that the licensee’s authorized delegates comply with applicable state and federal law;

(2) Enter into a written contract pursuant to Financial Institutions Article, §12-413(b), Annotated Code of Maryland; and

(3) Conduct a reasonable risk-based background investigation sufficient for the licensee to determine whether the authorized delegate has complied and will likely comply with applicable state and federal law.

C. An authorized delegate shall operate in full compliance with the Maryland Money Transmission Act and any regulations implementing the Maryland Money Transmission Act.

D. The written contract required by Financial Institutions Article, §12-413(b), Annotated Code of Maryland, shall be signed by the licensee and the authorized delegate and, at a minimum, shall:

(1) Appoint the person signing the contract as the licensee’s authorized delegate with the authority to conduct money transmission on behalf of the licensee;

(2) Set forth the nature and scope of the relationship between the licensee and the authorized delegate and the respective rights and responsibilities of the parties;

(3) Require the authorized delegate to agree to fully comply with all applicable state and federal laws, rules, and regulations pertaining to money transmission, including the Maryland Money Transmission Act and any regulations implementing the Maryland Money Transmission Act, relevant provisions of the Bank Secrecy Act, and the USA PATRIOT ACT;

(4) Require the authorized delegate to remit and handle money and monetary value in compliance with Financial Institutions Article, §12-418, Annotated Code of Maryland;

(5) Impose a trust on money and monetary value net of fees received for money transmission for the benefit of the licensee;

(6) Require the authorized delegate to prepare and maintain records as required by the Maryland Money Transmission Act and any regulations implementing the Maryland Money Transmission Act, or as reasonably requested by the Commissioner;

(7) Acknowledge that the authorized delegate consents to examination or investigation by the Commissioner;

(8) State that the licensee is subject to regulation by the Commissioner and that, as part of that regulation, the Commissioner may suspend or revoke an authorized delegate designation or require the licensee to terminate an authorized delegate designation; and

(9) Acknowledge receipt of the written policies and procedures required under Financial Institutions Article, §12-413(c), Annotated Code of Maryland.

E. If the licensee’s license is suspended, revoked, surrendered, or expired, the licensee shall, within 5 business days, provide documentation to the Commissioner that the licensee has notified all applicable authorized delegates of the licensee whose names are in a record filed with the Commissioner of the suspension, revocation, surrender, or expiration of a license. Upon suspension, revocation, surrender, or expiration of a license, applicable authorized delegates shall immediately stop providing money transmission as an authorized delegate of the licensee.

F. An authorized delegate of a licensee holds in trust for the benefit of the licensee all money net of fees received from money transmission. If any authorized delegate commingles any funds received from money transmission with any other funds or property owned or controlled by the authorized delegate, all commingled funds and other property shall be considered held in trust in favor of the licensee in an amount equal to the amount of money net of fees received from money transmission.

G. An authorized delegate may not use a subdelegate to conduct money transmission on behalf of a licensee without the written consent of the Commissioner.

H. A person may engage in the business of money transmission as an authorized delegate only on behalf of a person licensed or exempt from licensure under the Maryland Money Transmission Act.

I. A person that engages in the business of money transmission on behalf of an unlicensed and nonexempt person shall be considered to be providing money transmission services in violation of the Maryland Money Transmission Act and shall be jointly and severally liable with the unlicensed or nonexempt person.

.14 Timely Transmission.

A. Every licensee shall forward all money received for transmission in accordance with the terms of the agreement between the licensee and the sender unless the licensee has a reasonable belief or a reasonable basis to believe that the sender may be a victim of fraud or that a crime or violation of law, rule, or regulation has occurred, is occurring, or may occur.

B. If a licensee fails to forward money received for transmission in accordance with this regulation, the licensee shall respond to inquiries by the sender with the reason for the failure unless providing a response would violate a state or federal law, rule, or regulation.

.15 Refunds.

A. This regulation does not apply to:

(1) Money received for transmission subject to the federal Remittance Rule (12 CFR Part 1005, Subpart B), as amended or recodified from time to time; or

(2) Money received for transmission pursuant to a written agreement between the licensee and payee to process payments for goods or services provided by the payee.

B. Every licensee shall refund to the sender within 10 days of receipt of the sender’s written request for a refund of any money received for transmission unless any of the following occurs:

(1) The money has been forwarded within 10 days of the date on which the money was received for transmission and prior to receipt of the request for a refund;

(2) Instructions have been given committing an equivalent amount of money to the person designated by the sender within 10 days of the date on which the money was received for transmission and prior to receipt of the request for a refund;

(3) The agreement between the licensee and the sender instructs the licensee to forward the money at a time that is beyond 10 days of the date on which the money was received for transmission. If funds have not yet been forwarded in accordance with the terms of the agreement between the licensee and the sender, the licensee shall issue a refund in accordance with the other provisions of this regulation;

(4) The refund request does not enable the licensee to:

(a) Identify the sender’s name and address or telephone number; or

(b) Identify the particular transaction to be refunded if the sender has multiple transactions outstanding;

(5) The refund is requested for a transaction that the licensee has not completed based on a reasonable belief or a reasonable basis to believe that a crime or violation of law, rule, or regulation has occurred, is occurring, or may occur; or

(6) The licensee attempted in good faith to forward the money within 10 days of receipt from the sender and forwarded the money prior to the receipt of the request for a refund.

.16 Receipts.

A. This regulation does not apply to:

(1) Money received for transmission subject to the federal Remittance Rule (12 CFR Part 1005, Subpart B), as amended or recodified from time to time;

(2) Money received for transmission pursuant to a written agreement between the licensee and payee to process payments for goods or services provided by the payee; or

(3) Payroll processing services.

B. For purposes of this regulation “receipt” means a paper receipt, electronic record, or other written confirmation. For a transaction conducted in person, the receipt may be provided electronically if the sender requests or agrees to receive an electronic receipt. For a transaction conducted electronically or by phone, a receipt may be provided electronically. All electronic receipts shall be provided in a retainable form.

C. Contents of Receipt.

(1) Every licensee or its authorized delegate shall provide the sender a receipt for money received for transmission.

(2) The receipt shall contain the following information, as applicable:

(a) The name of the sender;

(b) The name of the designated recipient;

(c) The date of the transaction;

(d) The unique transaction or identification number;

(e) The name of the licensee, NMLS Unique ID, the licensee’s business address, and the licensee’s customer service telephone number;

(f) The amount of the transaction in United States dollars;

(g) Any fee charged by the licensee to the sender for the transaction; and

(h) Any taxes collected by the licensee from the sender for the transaction.

(3) The receipt required by this regulation shall be in English and in the language principally used by the licensee or authorized delegate to advertise, solicit, or negotiate, either orally or in writing, for a transaction conducted in person, electronically, or by phone, if other than English.

.17 Disclosures for Payroll Processing Services.

A. A licensee that provides payroll processing services shall:

(1) Issue reports to clients detailing client payroll obligations in advance of the payroll funds being deducted from an account; and

(2) Make available worker paystubs or an equivalent statement to workers.

B. If the licensee’s client designates the intended recipients to the licensee and is responsible for providing the disclosures required by §A(2) of this regulation, §A of this regulation does not apply to a licensee providing payroll processing services.

.18 Prudential Standards.

A. Financial Responsibility.

In considering the financial responsibility of a licensee, the Commissioner may consider the amount of tangible net worth a licensee maintains in excess of the statutory requirement under Financial Institutions Article, §12-406, Annotated Code of Maryland.

B. Surety Bonds.

A licensee may exceed the maximum required bond amount in Financial Institutions Article, §12-412(d), Annotated Code of Maryland.

C. Maintenance of Permissible Investments.

(1) A licensee shall maintain at all times permissible investments in accordance with Financial Institutions Article, §12-418(a), Annotated Code of Maryland.

(2) Except for permissible investments enumerated in §D(1) of this regulation, the Commissioner, with respect to any licensee, may by order limit the extent to which a specific investment maintained by a licensee within a class of permissible investments may be considered a permissible investment, if the specific investment represents undue risk to customers, not reflected in the market value of investments.

(3) Permissible investments, even if commingled with other assets of the licensee, are held in trust for the benefit of the purchasers and holders of the licensee’s outstanding money transmission obligations. Permissible investments held in trust for the benefit of the purchasers and holders of the licensee’s outstanding money transmission obligations are considered held in trust for the benefit of those purchasers and holders on a pro rata and equitable basis in accordance with statutes pursuant to which permissible investments are required to be held in Maryland, and other states, as applicable.

(4) Any trust established under this regulation shall be terminated upon extinguishment of all of the licensee’s outstanding money transmission obligations.

(5) The Commissioner may allow other types of investments that the Commissioner determines are of sufficient liquidity and quality to be a permissible investment. The Commissioner may participate in efforts with other state regulators to determine that other types of investments are of sufficient liquidity and quality to be a permissible investment.

D. Types of Permissible Investments.

(1) The following investments meet the definition of permissible investments pursuant to Financial Institutions Article, §12-401(r), Annotated Code of Maryland:

(a) Cash (including demand deposits, savings deposits, and funds in those accounts held for the benefit of the licensee’s customers in a federally insured depository financial institution) and cash equivalents including ACH items in transit to the licensee and ACH items or international wires in transit to a payee, cash in transit via armored car, cash in smart safes, cash in licensee-owned locations, debit card or credit card-funded transmission receivables owed by any bank, or money market mutual funds rated “AAA” by S&P, or the equivalent from any eligible rating service;

(b) Certificates of deposit or senior debt obligations other than a capital note of an insured depository institution, as defined in §3 of the Federal Deposit Insurance Act, 12 U.S.C. §1813, as amended or recodified from time to time, or as defined under the federal Credit Union Act, 12 U.S.C. §1781, as amended or recodified from time to time;

(c) An obligation of the United States or a commission, agency, or instrumentality of the United States, an obligation that is guaranteed fully as to principal and interest by the United States, or an obligation of a state or a governmental subdivision, agency, or instrumentality of the United States;

(d) The full drawable amount of an irrevocable standby letter of credit for which the stated beneficiary is the Commissioner that stipulates that the beneficiary need only draw a sight draft under the letter of credit and present it to obtain funds up to the letter of credit amount within 7 days of presentation of the items required by §D(4) of this regulation; and

(e) One hundred percent of the surety bond or deposit that exceeds the amount required under Financial Institutions Article, §12-412, Annotated Code of Maryland.

(2) A letter of credit under §D(1) of this regulation:

(a) Shall be issued by a federally insured depository financial institution, a foreign bank that is authorized under federal law to maintain a federal agency or federal branch office in a state or states, or a foreign bank that is authorized under state law to maintain a branch in a state that:

(i) Bears an eligible rating or whose parent company bears an eligible rating; and

(ii) Is regulated, supervised, and examined by United States federal or state authorities having regulatory authority over banks, credit unions, and trust companies;

(b) Shall be irrevocable, unconditional and indicate that it is not subject to any condition or qualification outside of the letter of credit;

(c) May not contain reference to any other agreements, documents, or entities, or otherwise provide for any security interest in the licensee; and

(d) Shall contain an issue date and expiration date, and expressly provide for automatic extension, without a written amendment, for an additional period of 1 year from the present or each future expiration date, unless the issuer of the letter of credit notifies the Commissioner in writing by certified or registered mail or courier mail or other receipted means, at least 60 days prior to any expiration date, that the irrevocable letter of credit will not be extended.

(3) If the issuer of a letter of credit under §D(2) of this regulation issues any notice of expiration or nonextension of that letter of credit, the licensee shall be required to demonstrate to the satisfaction of the Commissioner, 15 days prior to expiration, that the licensee maintains and will maintain permissible investments in accordance with Financial Institutions Article, §12-418(a), Annotated Code of Maryland, upon the expiration of the letter of credit. If the licensee is not able to do so, the Commissioner may draw on the letter of credit in an amount up to the amount necessary to meet the licensee’s requirements to maintain permissible investments in accordance with Financial Institutions Article, §12-418(a), Annotated Code of Maryland. Any draw shall be offset against the licensee’s outstanding money transmission obligations. The drawn funds shall be held in trust by the Commissioner or the Commissioner’s designated agent, to the extent authorized by law, as agent for the benefit of the purchasers and holders of the licensee’s outstanding money transmission obligations.

(4) A letter of credit under §D(1) of this regulation shall provide that the issuer of the letter of credit will honor, at sight, a presentation made by the beneficiary to the issuer of the following documents on or prior to the expiration date of the letter of credit:

(a) The original letter of credit (including any amendments); and

(b) A written statement from the beneficiary stating that any of the following events have occurred:

(i) The filing of a petition by or against the licensee under the United States Bankruptcy Code, 11 U.S.C. §101-110, as amended or recodified from time to time, for bankruptcy or reorganization;

(ii) The filing of a petition by or against the licensee for receivership, or the commencement of any other judicial or administrative proceeding for its dissolution or reorganization;

(iii) The Commissioner has issued an order of restitution pursuant to an enforcement action against the licensee;

(iv) The Commissioner sought the seizure of assets of a licensee pursuant to a judicial or administrative order; or

(v) The beneficiary has received notice of expiration or nonextension of a letter of credit and the licensee failed to demonstrate to the satisfaction of the beneficiary that the licensee will maintain permissible investments in accordance with Financial Institutions Article, §12-418(a), Annotated Code of Maryland, upon the expiration or nonextension of the letter of credit.

(5) The Commissioner may designate an agent to serve on the Commissioner’s behalf as beneficiary to a letter of credit under §D(1) of this regulation if the agent and letter of credit meet requirements established by the Commissioner. The Commissioner’s agent may serve as agent for multiple licensing authorities for a single irrevocable letter of credit if the proceeds of the drawable amount satisfy the purposes of the letter of credit under §D(1) of this regulation and are assigned to the Commissioner.

(6) The Commissioner may participate in multistate processes designed to facilitate the issuance and administration of letters of credit, including but not limited to services provided by the NMLS and State Regulatory Registry, LLC.

(7) Unless permitted by the Commissioner by rule or by order to exceed the limit as set forth in this regulation, the following investments are permissible pursuant to Financial Institutions Article, §12-401(r), Annotated Code of Maryland, to the extent specified:

(a) Receivables that are payable to a licensee from its authorized delegates in the ordinary course of business that have not been held by an authorized delegate in excess of the time permitted under Financial Institutions Article, §12-418(b), Annotated Code of Maryland, up to 50 percent of the aggregate value of the licensee’s total permissible investments.

(b) Of the receivables permissible under §D(7)(a) of this regulation, receivables that are payable to a licensee from a single authorized delegate in the ordinary course of business may not exceed 10 percent of the aggregate value of the licensee’s total permissible investments.

(c) The following investments are permissible up to 20 percent per category and combined up to 50 percent of the aggregate value of the licensee’s total permissible investments:

(i) A short-term (up to 6 months) investment bearing an eligible rating;

(ii) Commercial paper bearing an eligible rating;

(iii) A bill, note, bond, or debenture bearing an eligible rating;

(iv) U.S. tri-party repurchase agreements collateralized at 100 percent or more with U.S. government or agency securities, municipal bonds, or other securities bearing an eligible rating;

(v) Money market mutual funds rated less than “AAA” and equal to or higher than “A-” by S&P, or the equivalent from any other eligible rating service; and

(vi) A mutual fund or other investment fund composed solely and exclusively of one or more permissible investments listed in §D(7)(a)—(c) of this regulation.

(d) Cash (including demand deposits, savings deposits, and funds in those accounts held for the benefit of the licensee’s customers) at foreign depository institutions are permissible up to 10 percent of the aggregate value of the licensee’s total permissible investments if the licensee has received a satisfactory rating in its most recent examination and the foreign depository institution:

(i) Has an eligible rating;

(ii) Is registered under the Foreign Account Tax Compliance Act;

(iii) Is not located in any country subject to sanctions from the Office of Foreign Asset Control; and

(iv) Is not located in a high-risk or noncooperative jurisdiction as designated by the Financial Action Task Force.

E. Eligibility Ratings.

(1) Long-term credit ratings are considered eligible if the rating is equal to A- or higher by S&P, or the equivalent from any other eligible rating service.

(2) Short-term credit ratings are considered eligible if the rating is equal to or higher than A-2 or SP-2 by S&P, or the equivalent from any other eligible rating service.

(3) If the ratings differ among eligible rating services, the highest rating shall apply when determining whether a security bears an eligible rating.

ANTONIO P. SALAZAR
Commissioner

Subtitle 22 BOARD OF COSMETOLOGISTS

09.22.04 Continuing Education

Authority: Business Occupations and Professions Article, §§5-205 and 5-311, Annotated Code of Maryland

Notice of Change to Opportunity for Public Comment

[22-289-P]

The notice of Opportunity for Public Comment that appeared in 50:3 Md. R. 92 (February 10, 2023) has been changed. The deadline for public comment is March 13, 2023, not February 13, 2023, as originally published. The corrected notice follows.

Opportunity for Public Comment

Comments may be sent to Renee Robertson, Education Coordinator, Board of Cosmetologists, Maryland Department of Labor, 1100 N. Eutaw Street, 5th Floor, Baltimore, MD 21201, or call 410-230-6216, or email to renee.robertson@maryland.gov. Comments will be accepted through March 13, 2023. A public hearing has not been scheduled.

TAMMY EHRBAKER
Chair
Board of Cosmetologists

Title 10
MARYLAND DEPARTMENT OF HEALTH

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.01 Advanced Practice Nurse Services

Authority: Health-General Article, §§2-104(b), 15-103, [and] 15-105, and
15-141.2, Annotated Code of Maryland

Notice of Proposed Action

[22-286-P]

The Secretary of Health proposes to amend Regulations .03 and .06 under COMAR 10.09.01 Advanced Practice Nurse Services.

Statement of Purpose

The purpose of this action is to:

(1) Align regulations with current practices for rendering of telehealth in compliance with COMAR 10.09.49; and

(2) Remove the term “recipient” and replace it with “participant”.

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, or email to mdh.regs@maryland.gov. Comments will be accepted through March 27, 2023. A public hearing has not been scheduled.

.03 Conditions for Participation.

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

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

To participate in the Program, a provider shall:

A. Meet all conditions for participation as set forth in COMAR 10.09.36.03; and

B. If delivering services via telehealth, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department.

.06 Payment Procedures.

A.—G. (text unchanged)

H. The provider may not bill the Program for:

(1)—(2) (text unchanged)

(3) Professional services rendered by mail [or telephone].

I. The Program may not make direct payment to [recipients] participants.

J.—M. (text unchanged)

DENNIS R. SCHRADER
Secretary of Health

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.15 Podiatry Services

Authority: Health-General Article, §§2-104(b), 15-103, [and] 15-105, and
15-141.2, Annotated Code of Maryland

Notice of Proposed Action

[22-291-P]

The Secretary of Health proposes to amend Regulations .03 and .07 under COMAR 10.09.15 Podiatry Services.

Statement of Purpose

The purpose of this action is to:

(1) Allow reimbursement for services rendered via telehealth in compliance with COMAR 10.09.49 Telehealth Services; and

(2) Replace the term “recipient” with “participant”.

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, or email to mdh.regs@maryland.gov. Comments will be accepted through March 27, 2023. A public hearing has not been scheduled.

.03 Conditions for Participation.

A. General requirements for participation in the Program are that a provider shall [meet all conditions for participation as set forth in COMAR 10.09.36.03.]:

(1) Comply with requirements set forth in COMAR 10.09.36; and

(2) If delivering services via telehealth, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department.

B. (text unchanged)

.07 Payment Procedures.

A.—F. (text unchanged)

G. The provider may not bill the Department or the participant for:

(1)—(2) (text unchanged)

(3) Professional services rendered by mail [or telephone];

(4) (text unchanged)

(5) Photocopying of medical records when requested by another licensed provider on behalf of the [recipient] participant.

H.—J. (text unchanged)

DENNIS R. SCHRADER
Secretary of Health

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.16 Behavioral Health Crisis Services

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

Notice of Proposed Action

[22-351-P]

The Secretary of Health proposes to adopt new Regulations .01—.13 under a new chapter, COMAR 10.09.16 Behavioral Health Crisis Services.

Statement of Purpose

The purpose of this action is to implement Maryland Medicaid’s coverage of behavioral health crisis services. Pursuant to the 2023 Governor’s Supplemental Budget (No. 5), which provides funds to expand capacity for individuals experiencing mental health crises, this proposal will establish the behavioral health crisis stabilization center service. This proposal also establishes the mobile crisis team service and codifies the coverage, requirements, and reimbursement procedures for these two new benefits.

Estimate of Economic Impact

I. Summary of Economic Impact. For Fiscal Year 2024, the Department estimates total expenditures of $21,556,726 for crisis stabilization center services and $17,565,306 for mobile crisis team services; the total magnitude of this proposal is $39,122,032.

II. Types of Economic Impact.

Impacted Entity	Revenue (R+/R-) Expenditure (E+/E-)	Magnitude
A. On issuing agency:
Maryland Department of Health	(E+)	$39,122,032
B. On other State agencies:	NONE
C. On local governments:	NONE
	Benefit (+) Cost (-)	Magnitude
D. On regulated industries or trade groups:
Maryland Medicaid providers	(+)	$39,122,032
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.)

A and D. This amount assumes:

(1) For the anticipated expenditures associated with mobile crisis teams:

(a) The Department expects 45 mobile crisis teams to be operating in FY 2024, with an estimated annual billing volume of $1,115,257 for each mobile crisis team, resulting in a total operating cost of $50,186,588.

(b) The Department assumes that 35 percent of the individuals utilizing mobile crisis services will be Medicaid recipients, resulting in a projected total Medicaid cost of $17,565,306.

(c) This amount is subject to an enhanced federal match of 85 percent ($14,930,510 in federal funds; $2,634,796 in general funds).

(2) For the anticipated expenditures associated with crisis stabilization centers:

(a) The Department estimates that 13 crisis stabilization centers will operate Statewide

with a projected yearly expenditure for each center of $4,737,742, resulting in a total operating cost of $61,590,646.

(b) The Department assumes that 35 percent of individuals utilizing this service will be Medicaid recipients, resulting in a projected total cost to Medicaid of $21,556,726.

(c) This amount is subject to a 63.02 percent blended federal match ($13,585,049 federal funds; $7,971,677 general funds).

Economic Impact on Small Businesses

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

To the extent that providers are small businesses and are eligible to enroll in Maryland Medicaid to provide these services, providers may receive a portion of the increased $39,122,032 in revenue.

Impact on Individuals with Disabilities

The proposed action has an impact on individuals with disabilities as follows:

The proposed action implements coverage for two new services. To the extent that individuals with disabilities utilize mobile crisis team and crisis stabilization center services, they may benefit from the new service coverage.

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, or email to mdh.regs@maryland.gov. Comments will be accepted through March 27, 2023. A public hearing has not been scheduled.

.01 Definitions.

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

B. Terms Defined.

(1) “Administrative services organization (ASO)” means the contractor procured by the State to provide the Department with administrative support services to operate the Maryland Public Behavioral Health System.

(2) “Behavioral Health Administration (BHA)” means the administration within the Department that establishes regulatory requirements that behavioral health programs are to maintain in order to become licensed by the Department.

(3) “Crisis” has the meaning stated in COMAR 10.63.01.02.

(4) “Crisis intervention and stabilization” has the meaning stated in COMAR 10.63.01.02.

(5) “Department” means the Maryland Department of Health, as defined in COMAR 10.09.36.01, or its authorized agents acting on behalf of the Department.

(6) “Medical Assistance” has the meaning stated in COMAR 10.09.24.02.

(7) “Medically necessary” has the meaning stated in COMAR 10.09.36.01.

(8) “Mobile crisis response” is the provision of professional, same-day intervention for children or adults who are experiencing crises and whose behaviors are consistent with mental illness or substance abuse, or both, including individuals experiencing a behavioral health crisis that is secondary to mental illness, substance abuse, developmental or intellectual disability, brain injury, or any combination of these.

(9) “Participant” means an individual who is certified as eligible for, and is receiving, medical assistance benefits.

(10) “Program” has the meaning stated in COMAR 10.09.36.01.

(11) “Provider” means an organization or an individual practitioner furnishing the services covered under this chapter that, through appropriate agreement with the Department, has been identified as a Program provider by the issuance of a provider account number.

.02 License Requirements.

To participate in the Program, a provider shall meet the license requirements stated in COMAR 10.09.36.02, 10.63.01.05, and 10.63.02.03.

.03 Provider Requirements for Participation.

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

B. To participate in the Program, a provider of behavioral health crisis services shall:

(1) Meet the conditions for licensure and practice as set forth in COMAR 10.63.01, 10.63.02, and 10.63.06;

(2) Have clearly defined and written patient care policies; and

(3) Maintain, either manually or electronically, adequate documentation of each contact with a participant as part of the medical record, which, at a minimum, meets the following requirements:

(a) Includes the date of service with service start and end times;

(b) Includes the participant’s primary behavioral health complaint or reason for the visit;

(c) Includes a brief description of the service provided, including progress notes;

(d) Includes an official e-Signature, or a legible signature, along with the printed or typed name, and appropriate title of each individual providing services, including each separate member of the mobile crisis team;

(e) Is made available to the following as requested:

(i) The Department;

(ii) The ASO;

(iii) The Core Service Agency;

(iv) The Local Behavioral Health Authority;

(v) The Office of Inspector General of the Department; and

(vi) The Office of the Attorney General Medicaid Fraud Control Unit; and

(f) Complies with all federal statutes and regulations, including the Health Insurance Portability and Accountability Act, 42 U.S.C. §1320D et seq., and implementing regulations at 45 CFR Parts 160 and 164.04.

C. A mobile crisis team provider shall:

(1) Comply with COMAR 10.63.03.20;

(2) Be available to provide services outlined in Regulation .05 of this chapter 24 hours a day, 7 days a week;

(3) Provide a timely response with a two-person team, which may include:

(a) A licensed mental health professional as defined in COMAR 10.63.01.02;

(b) A certified peer recovery specialist or certified family peer specialist; or

(c) Other staff, pre-approved by the Department, who have completed the required training specified in COMAR 10.63.03.20E;

(4) Employ at least one board-approved supervisor who is:

(a) A licensed mental health professional licensed at the independent practice level as defined in COMAR 10.63.01.02 and eligible to supervise all members of the mobile crisis team;

(b) Available at all times either face-to-face or through telehealth; and

(c) Eligible to complete an emergency petition; and

(5) Ensure all crisis team staff members receive training as required and approved by the Department.

D. A behavioral health crisis stabilization center provider shall:

(1) Comply with COMAR 10.63.03.21;

(2) Be open and accessible to walk-ins 24 hours a day, 7 days a week;

(3) Comply with the staffing requirements described in COMAR 10.63.03.21, including:

(a) A full-time on-site program director who is a licensed mental health professional licensed at the independent practice level as defined in COMAR 10.63.01.02;

(b) A medical director employed at least 16 hours per week who is:

(i) A psychiatrist; and

(ii) May also serve as the program director if employed full-time;

(c) In addition to the medical director, at least one psychiatrist or psychiatric nurse practitioner;

(d) A nurse manager who supervises the nursing staff;

(e) At least two registered nurses on-site per shift; and

(f) One full-time licensed certified social worker-clinical (LCSW-C) or licensed professional counselor (LCPC);

(4) Maintain the ability to initiate withdrawal management capabilities for all substances as well as initiate medication-assisted treatment for opioid use disorder; and

(5) Equally accept individuals presenting due to an emergency petition and individuals presenting voluntarily.

.04 Participant Eligibility.

A participant is eligible for behavioral health crisis services if the:

A. Individual meets the Department’s medical necessity criteria; and

B. Service is appropriate to the specific provider type listed in Regulation .05 of this chapter.

.05 Covered Services.

A. The Department shall reimburse for the services in §§B—C of this regulation under behavioral health crisis services when these services have been documented, pursuant to the requirements in this chapter, as necessary.

B. Mobile crisis team services shall:

(1) Comply with COMAR 10.63.03.20;

(2) Consist of an in-person response by a two-person team;

(3) Include an initial assessment by a licensed mental health professional as defined in COMAR 10.63.01.02, which may be rendered via telehealth only when the licensed mental health professional functions as a third team member;

(4) Involve the following interventions and objectives:

(a) Crisis intervention and stabilization of the individual’s behavioral health crisis;

(b) Safety planning; and

(c) Referrals to community supports, including behavioral health providers, health providers, or social and other services as needed; and

(5) Include post-crisis follow up outreach by means of telephone, telehealth, or in-person contact with the individual served or family member and referred providers, if applicable.

C. Behavioral health crisis stabilization center services shall:

(1) Comply with COMAR 10.63.03.21;

(2) Consist of an initial assessment by a registered nurse; and

(3) Involve the following interventions and objectives:

(a) Crisis intervention and stabilization of the individual’s behavioral health crisis;

(b) Safety planning;

(c) Evaluation from an on-site psychiatrist or psychiatric nurse practitioner within 6 hours or sooner if clinically indicated, which may be rendered via telehealth if compliant with the telehealth requirements specified in COMAR 10.63.03.21;

(d) Pharmacological interventions, including the ability to initiate withdrawal management capabilities for all substances, and initiate medications for medication-assisted treatment for opioid use disorder; and

(e) Referrals to community-based services or to higher levels of care as clinically indicated.

.06 Limitations.

A. The Program does not cover the following:

(1) Services not delivered in compliance with Regulation .05 of this chapter;

(2) Services not medically necessary;

(3) Investigational or experimental drugs and procedures;

(4) Services solely for the purpose of:

(a) Prescribing medication;

(b) Administering medication;

(c) Drug or supply pick-up;

(d) Collecting laboratory specimens;

(e) Interpreting laboratory tests or panels; or

(f) Administering injections;

(5) Separate reimbursement to an employee of a program for services that have been provided by and reimbursed directly to a program;

(6) Services provided to or for the primary benefit of individuals other than the participant;

(7) Mobile crisis team services rendered by telehealth with the exception of those specified in Regulation .05 of this chapter;

(8) Behavioral health crisis stabilization center services rendered by telehealth with the exception of those specified in COMAR 10.63.03.21;

(9) Nonemergency services not authorized by the ASO;

(10) Services provided to participants in a hospital inpatient setting; and

(11) Services rendered but not appropriately documented.

B. Providers may not be reimbursed by the Program for:

(1) Behavioral health crisis stabilization center services exceeding 23 hours;

(2) Presumptive and definitive drug testing; and

(3) Transportation costs.

.07 Authorization Requirements.

A. As directed by Department policy, the ASO agent shall authorize services that are:

(1) Medically necessary; and

(2) Of a type, frequency, and duration that are consistent with expected results and cost-effectiveness.

B. Preauthorization is not required before a provider renders behavioral health crisis stabilization center services.

.08 Payment Procedures.

A. General policies governing payment procedures that are applicable to all providers are set forth in COMAR 10.09.36.04.

B. Billing time limitations for claims submitted under this chapter are set forth in COMAR 10.09.36.06.

C. Effective July 1, 2023, rates for the services outlined in this chapter shall be as follows:

(1) For mobile crisis team service, per 1 hour unit increment, the provider shall receive $135.80 per unit.

(2) For mobile crisis team service follow-up, per 15 minute unit increment, the provider shall receive $33.95 per unit.

(3) For crisis stabilization center services, per 1 hour unit increment, the provider shall receive $27.05 per unit.

.09 Recovery and Reimbursement.

Recovery and reimbursement are as set forth in COMAR 10.09.36.07.

.10 Cause for Suspension or Removal and Imposition of Sanctions.

Cause for suspension or removal and imposition of sanctions are as set forth in COMAR 10.09.36.08.

.11 Appeal Procedures for Providers.

Appeal procedures for providers are as set forth in COMAR 10.09.36.09.

.12 Appeal Rights — Denial of Services.

Appeal procedures for applicants and participants are as set forth in COMAR 10.01.04.

.13 Interpretive Regulation.

State regulations are interpreted as set forth in COMAR 10.09.36.10.

DENNIS R. SCHRADER
Secretary of Health

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.17 Physical Therapy Services

Authority: Health-General Article, §§2-104(b), 15-103, [and] 15-105, and
15-141.2, Annotated Code of Maryland

Notice of Proposed Action

[22-288-P]

The Secretary of Health proposes to amend Regulations .03 and .04 under COMAR 10.09.17 Physical Therapy Services.

Statement of Purpose

The purpose of this action is to permit services rendered via telehealth to be reimbursed in compliance with COMAR 10.09.49 Telehealth Services.

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, or email to mdh.regs@maryland.gov. Comments will be accepted through March 27, 2023. A public hearing has not been scheduled.

.03 Conditions for Participation.

To participate in the Program, the provider shall:

A. [Comply with the conditions for participation as set forth in COMAR 10.09.36; and] Comply with all requirements established in COMAR 10.09.36;

B. If delivering services via telehealth, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department; and

[B.] C. (text unchanged)

.04 Covered Services.

A. The Physical Therapy Program covers medically necessary physical therapy services ordered in writing by a physician, doctor of dental surgery or of dental medicine, physician assistant, nurse practitioner, nurse midwife, or podiatrist when the services are:

(1) (text unchanged)

(2) Provided in the provider’s office, the patient’s home, [or] a domiciliary level facility, or via telehealth in accordance with COMAR 10.09.49 or other subregulatory guidance issued by the Department;

(3)—(6) (text unchanged)

B.—C. (text unchanged)

DENNIS R. SCHRADER
Secretary of Health

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.56 Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder

Authority: Health-General Article, §§2-104(b), 15-103, 15-105, and 15-130, Annotated Code of Maryland

Notice of Proposed Action

[22-338-P]

The Secretary of Health proposes to amend Regulation .22 under COMAR 10.09.56 Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder.

Statement of Purpose

The purpose of this action is to incorporate the Autism Waiver services fee schedule into regulations, including increased reimbursement rates for services covered under COMAR 10.09.56, pursuant to Ch. 484 (S.B. 290), Acts of 2022, Fiscal Year 2023 Budget Bill, and the Governor’s Supplemental Budget.

Estimate of Economic Impact

I. Summary of Economic Impact. Effective July 1, 2022, reimbursement rates for Autism Waiver services increased by 12 percent. The impact of the change on the FY 2023 budget is $7,393,965.

II. Types of Economic Impact.

Impacted Entity	Revenue (R+/R-) Expenditure (E+/E-)	Magnitude
A. On issuing agency:
Maryland Department of Health	(E+)	$7,393,965
B. On other State agencies:	NONE
C. On local governments:	NONE
	Benefit (+) Cost (-)	Magnitude
D. On regulated industries or trade groups:
Maryland Medicaid Providers	(+)	$7,393,965
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.)

A and D. This amount assumes:

(1) The program anticipates that FY 2022 utilization will continue at current levels throughout FY 2023.

(2) Effective July 1, 2022, Autism Waiver providers will receive a 12 percent rate increase.

(3) The total cost difference ($7,393,965) is subject to a 56.2 percent blended federal match ($4,155,408 federal funds, $3,238,557 general funds).

Economic Impact on Small Businesses

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

Many of the providers of home and community-based services under COMAR 10.09.56 are small businesses that will benefit from additional rate increases under the provisions of the proposed action.

Impact on Individuals with Disabilities

The proposed action has an impact on individuals with disabilities as follows:

Individuals with disabilities receive services provided under this chapter and will benefit to the extent that improved funding will enable providers to maintain quality services.

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, or email to mdh.regs@maryland.gov. Comments will be accepted through March 27, 2023. A public hearing has not been scheduled.

.22 Payment Procedures.

A. Request for Payment.

(1) (text unchanged)

(2) The provider shall:

(a) Bill the Program in accordance with the payment methodology specified in [§C] §§D and E of this regulation;

(b)—(c) (text unchanged)

B.—D. (text unchanged)

E. Rates.

(1) (text unchanged)

(2) [Effective July 1, 2018, the] Subject to the limitations of the State budget, the Program’s rates as specified in [the Department’s fee schedule] this regulation shall increase [on July 1 of each year] by [3] 4 percent[, subject to the limitations of the State budget] each year through Fiscal Year 2026.

(3) Effective July 1, 2022, the Program shall pay according to the following fee-for-service schedule:

(a) Residential habilitation services and retainer payments reimbursed at one of the following all-inclusive, maximum rates for a participant:

(i) $283.69 per unit for the regular level of service; or

(ii) $567.45 per unit for the intensive level of service.

(b) Therapeutic integration services reimbursed at the maximum rate of $17.19 per unit.

(c) Intensive therapeutic integration services reimbursed at the maximum rate of $21.49 per unit.

(d) Intensive individual support services reimbursed at the maximum rate of $21.49 per unit.

(e) Respite care reimbursed at the maximum rate of $16.80 per unit.

(f) Family consultation reimbursed at the maximum rates of $70.55 per unit.

(g) Adult life planning services reimbursed at the maximum rate of $70.55 per unit.

(h) Environmental accessibility adaptations reimbursed at the maximum rate of $2,104 per 36-month period amount billed by the provider, which shall be the lesser of the:

(i) Amount authorized by the State Department of Education; or

(ii) Actual cost of the job.

DENNIS R. SCHRADER
Secretary of Health

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.80 Community-Based Substance Use Disorder Services

Authority: Health-General Article, §§2-104(b), 7.5-204, 7.5-205(d), 7.5-402, 8-204(c)(1), 15-103(a)(1), and 15-105(b), Annotated Code of Maryland

Notice of Proposed Action

[23-003-P]

The Secretary of Health proposes to amend Regulations .01, .05, .06, and .08 under COMAR 10.09.80 Community-Based Substance Use Disorder Services.

Statement of Purpose

The purpose of this action is to update the listed provider reimbursement rate to the 7.25 percent increased rate, effective for Fiscal Year 2023, pursuant to Ch. 484 (S.B. 290), Acts of 2022, Fiscal Year 2023 Budget and the Governor’s Supplemental Budget. This proposal also adds the new peer recovery support service benefit, defines the providers eligible to utilize this service, and sets the conditions under which the service may be rendered.

Estimate of Economic Impact

I. Summary of Economic Impact. The budget for Fiscal Year 2023 includes a 3.25 percent rate increase as well as a supplemental rate increase of 4 percent. The total fiscal impact of this 7.25 percent rate increase on community-based substance use disorder services providers is $20,746,809.81. The peer recovery support service benefit (estimated $8,000,000 for FY 2023) plus the rate increase impact totals a combined magnitude of $28,746,809.

II. Types of Economic Impact.

Impacted Entity	Revenue (R+/R-) Expenditure (E+/E-)	Magnitude
A. On issuing agency:
Maryland Department of Health	(E+)	$28,746,809
B. On other State agencies:	NONE
C. On local governments:	NONE
	Benefit (+) Cost (-)	Magnitude
D. On regulated industries or trade groups:
Maryland Medicaid providers	(+)	$28,746,809
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.)

A and D. This amount assumes:

(1) Estimated impacts are based on FY 2022 expenditures. Utilization is expected to remain consistent in FY 2023.

(3) In FY 2023, the total impact of the rate increases on Medicaid expenditures for community-based substance use disorder services will be equal to the difference between projected FY 2023 expenditures ($306,909,703.70) and FY 2022 costs ($286,162,893.89) for these services. The total estimated impact of the rate increase in FY 2023 is $20,746,809.81.

(4) The fiscal impact for this rate increase ($20,746,809.81) is subject to a 63.02 percent blended federal match ($7,672,170.27 general funds; $13,074,639.54 federal funds).

(5) The estimated $8,000,000 for the new peer recovery support services benefit assumes a March 1, 2023 start date. The $8,000,000 estimated impact is subject to a 60 percent federal match ($4,800,000) and 40 percent state general fund match ($3,200,000).

Economic Impact on Small Businesses

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

Small businesses, to the extent that they are Medicaid enrolled community-based substance use disorder providers, will benefit from the 7.25 percent rate increase for a total impact of $20,746,809.81 for Fiscal Year 2023. Providers eligible to provide peer recovery services will also see an additional an estimated $8,000,000 increase in reimbursement for Fiscal Year 2023.

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. Comments will be accepted through March 27, 2023. A public hearing has not been scheduled.

.01 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)—(13) (text unchanged)

(14) “Peer recovery support services” means a set of nonclinical activities provided by individuals in recovery from behavioral health concerns, including substance use or addictive disorders or mental health concerns, who use their personal, lived experiences and training to support other individuals with substance use or addictive disorders.

[(14)] (15)—[(20)] (21) (text unchanged)

.05 Covered Services.

A. (text unchanged)

B. Peer recovery support services shall:

(1) Be included as part of a written individualized treatment plan that includes specific individualized goals;

(2) Be delivered through a BHA licensed:

(a) Outpatient substance use disorder treatment provider in compliance with COMAR 10.63.03.06, 10.63.03.03 or 10.63.03.07; or

(b) Opioid treatment program in compliance with COMAR 10.63.03.19;

(3) Be provided by staff who, at a minimum:

(a) Maintains active certification by BHA or its designee;

(b) Self-identifies as an individual with life experience of being diagnosed with behavioral health concerns, including substance use disorders, addictive disorders, or mental health concerns;

(c) Completes ongoing training as approved by BHA or its designee; and

(d) Receives supervision by:

(i) A registered peer supervisor approved by BHA or its designee; or

(ii) An individual practitioner as defined in COMAR 10.09.59.04A(2) or a certified alcohol and drug counselor who is approved to supervise by the relevant board and who must be an approved registered peer supervisor on or after September 1, 2023; and

(4) Be provided directly to the participant either in-person or via telehealth.

[B.] C.—[H.] I. (text unchanged)

.06 Limitations.

A. The Program under this chapter does not cover the following:

(1)—(9) (text unchanged)

(10) Presumptive and definitive drug testing when billed by:

(a)—(b) (text unchanged)

(c) A partial hospitalization program provider; [and]

(11) Peer recovery support services that are not provided either in-person or via telehealth; and

[(11)] (12) (text unchanged)

B. Providers may not be reimbursed by the Program for:

(1)—(4) (text unchanged)

(5) More than 24 units of individual peer recovery support services per day per participant;

(6) More than 6 units of group peer recovery support services per day per participant;

[(5)] (7)—[(7)] (9) (text unchanged)

[(8)] (10) Psychiatric day treatment service as described in COMAR [10.09.02.01] 10.63.03.08 or an intensive outpatient mental health service on the same day as a Level 2.1 Intensive Outpatient program or Level 2.5 Partial Hospitalization program;

[(9)] (11)—[(16)] (18) (text unchanged)

[(17)] (19) Broken or missed appointments; [and]

[(18)] (20) Travel to and from site of service[.]; and

(21) Transportation costs.

C.—I. (text unchanged)

J. Peer recovery support services may not be used to supplant the minimum billing requirements for:

(a) Level 2.1 Intensive Outpatient treatment as described in §C of this regulation;

(b) Level 2.5 Partial Hospitalization half day session as described in §D of this regulation;

(c) Level 2.5 Partial Hospitalization full day session as described in §E of this regulation; and

(d) Opioid treatment program services as described in §F of this regulation.

[J.] K. (text unchanged)

.08 Payment Procedures.

A.—C. (text unchanged)

[D. For dates of service July 1, 2020 through December 31, 2020, rates for the services outlined in this regulation shall be as follows:

(1) For services outlined in this regulation, as delivered through a BHA licensed substance use disorder treatment provider:

(a) Comprehensive substance use disorder assessment — $164.59;

(b) Level 1 group substance use disorder counseling — $45.21 per session;

(c) Level 1 individual substance use disorder counseling — $23.18 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Level 2.1 Intensive Outpatient treatment — $144.88 per diem;

(e) Level 2.5 Partial Hospitalization half day session — $150.68 per diem;

(f) Level 2.5 Partial Hospitalization full day session — $243.40 per diem;

(g) Ambulatory Withdrawal Management — $81.14 per diem;

(h) Point of care presumptive drug test — $11.81 per test; and

(i) Buprenorphine and other medication assisted treatment through office based evaluation and management visits, according to COMAR 10.09.02.07D.

(2) For services outlined in this regulation as delivered through an opioid treatment program:

(a) Comprehensive substance use disorder assessment — $164.59;

(b) Level 1 group substance use disorder counseling — $45.21 per session;

(c) Level 1 individual substance use disorder counseling — $23.18 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Opioid Maintenance Therapy — $71.59 per participant per week;

(e) Medication Assisted Treatment Induction — $231.82 per participant per week;

(f) Buprenorphine Maintenance Therapy — $63.64 per participant per week; and

(g) Periodic medication management through office based evaluation and management visits, according to COMAR 10.09.02.07D.

E. For dates of service January 1, 2021 through October 31, 2021, rates for the services outlined in this regulation shall be as follows:

(1) For services outlined in this regulation, as delivered through a BHA certified or licensed substance use disorder treatment provider:

(a) Comprehensive substance use disorder assessment —$170.35;

(b) Level 1 group substance use disorder counseling — $46.79 per session;

(c) Level 1 individual substance use disorder counseling — $23.99 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Level 2.1 Intensive Outpatient treatment — $149.95 per diem;

(e) Level 2.5 Partial Hospitalization half day session — $155.95 per diem;

(f) Level 2.5 Partial Hospitalization full day session — $251.91 per diem;

(g) Ambulatory Withdrawal Management —$83.98 per diem;

(h) Point of care presumptive drug test read with direct optical observation only — $10.02 per test;

(i) Point of care presumptive drug test read with instrument-assisted direct optical observation — $10.02 per test;

(j) Point of care presumptive drug test read with instrumented chemistry analyzers — $49.40 per test; and

(k) Periodic medication management through office based evaluation and management visits, according to COMAR 10.09.02.07D.

(2) For services outlined in this regulation as delivered through an opioid treatment program:

(a) Comprehensive substance use disorder assessment — $170.35;

(b) Level 1 group substance use disorder counseling — $46.79 per session;

(c) Level 1 individual substance use disorder counseling — $23.99 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Opioid Maintenance Therapy — $74.10 per participant per week;

(e) Medication Assisted Treatment Induction — $239.93 per participant per week;

(f) Buprenorphine Maintenance Therapy — $65.87 per participant per week; and

(g) Periodic medication management through office based evaluation and management visits, according to COMAR 10.09.02.07D.]

[F.] D. [Effective] For dates of service from November 1, 2021 through June 30, 2022, rates for the services outlined in this regulation shall be as follows:

(1)—(2) (text unchanged)

E. Effective July 1, 2022, rates for the services outlined in this regulation shall be as follows:

(1) For services outlined in this regulation, as delivered through a BHA licensed substance use disorder treatment provider:

(a) Comprehensive substance use disorder assessment — $192.57;

(b) Level 1 group substance use disorder counseling — $52.90 per session;

(c) Level 1 individual substance use disorder counseling — $27.12 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Level 2.1 Intensive Outpatient treatment — $169.51 per diem;

(e) Level 2.5 Partial Hospitalization half day session — $176.29 per diem;

(f) Level 2.5 Partial Hospitalization full day session — $284.77 per diem;

(g) Ambulatory Withdrawal Management —$94.93 per diem;

(h) Point of care presumptive drug test read with direct optical observation only — $10.02 per test;

(i) Point of care presumptive drug test read with instrument-assisted direct optical observation — $10.02 per test;

(j) Point of care presumptive drug test read with instrumented chemistry analyzers — $49.40 per test; and

(k) Periodic medication management through office-based evaluation and management visits, according to COMAR 10.09.02.07D.

(2) For services outlined in this regulation as delivered through an opioid treatment program:

(a) Comprehensive substance use disorder assessment — $192.57;

(b) Level 1 group substance use disorder counseling — $52.90 per session;

(c) Level 1 individual substance use disorder counseling — $27.12 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Opioid Maintenance Therapy — $83.76 per participant per week;

(e) Medication Assisted Treatment Induction — $271.22 per participant per week;

(f) Buprenorphine Maintenance Therapy — $74.46 per participant per week; and

(g) Periodic medication management through office-based evaluation and management visits, according to COMAR 10.09.02.07D.

F. Effective March 1, 2023, peer support services as outlined in Regulation .05 of this chapter as delivered a BHA licensed substance use disorder treatment provider or an opioid treatment program:

(1) Individual peer support services — $16.38 per 15-minute increment; and

(2) Group peer support services — $4.55 per 15-minute increment;

G.—I. (text unchanged)

DENNIS R. SCHRADER
Secretary of Health

Subtitle 63 COMMUNITY-BASED BEHAVIORAL HEALTH PROGRAMS AND SERVICES

Notice of Proposed Action

[22-334-P]

The Secretary of Health proposes to:

(1) Amend Regulations .02 and .05 under COMAR 10.63.01 Requirements for All Licensed Programs;

(2) Amend Regulations .02 under COMAR 10.63.02 Programs Required to Be Accredited in Order to Be Licensed to Provide Community-Based Behavioral Health Services; and

(3) Adopt new Regulations .20 and .21 under COMAR 10.63.03 Descriptions and Criteria for Programs and Services Required to Have an Accreditation-Based License.

Statement of Purpose

The purpose of this action is to implement coverage of behavioral health crisis services. Pursuant to Ch. 484 (S.B. 290), Acts of 2022, Governor’s Supplemental Budget (No. 5), which provides funds to expand capacity for individuals experiencing mental health crises. This proposal will establish the behavioral health crisis stabilization center and mobile crisis team services.

Estimate of Economic Impact

I. Summary of Economic Impact. For Fiscal Year 2024, the Department estimates total expenditures of $21,556,726 for crisis stabilization center services and $17,565,306 for mobile crisis team services; the total magnitude of this proposal is $39,122,032.

II. Types of Economic Impact.

Impacted Entity	Revenue (R+/R-) Expenditure (E+/E-)	Magnitude
A. On issuing agency:
Maryland Department of Health	(E+)	$39,122,032
B. On other State agencies:	NONE
C. On local governments:	NONE
	Benefit (+) Cost (-)	Magnitude
D. On regulated industries or trade groups:
Providers	(+)	$39,122,032
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.)

A and D. This amount assumes:

(1) For the anticipated expenditures associated with mobile crisis teams:

(a) The Department expects 45 mobile crisis teams to be operating in FY 2024, with an estimated annual billing volume of $1,115,257 for each mobile crisis team, resulting in a total operating cost of $50,186,588.

(b) The Department assumes that 35 percent of the individuals utilizing mobile crisis services will be Medicaid recipients, resulting in a projected total Medicaid cost of $17,565,306.

(c) This amount is subject to an enhanced federal match of 85 percent ($14,930,510 in federal funds; $2,634,796 in general funds).

(2) For the anticipated expenditures associated with crisis stabilization centers:

(a) The Department estimates that 13 crisis stabilization centers will operate Statewide with a projected yearly expenditure for each center of $4,737,742, resulting in a total operating cost of $61,590,646.

(b) The Department assumes that 35 percent of individuals utilizing this service will be Medicaid recipients, resulting in a projected total cost to Medicaid of $21,556,726.

(c) This amount is subject to a 63.02 percent blended federal match ($13,585,049 federal funds; $7,971,677 general funds).

Economic Impact on Small Businesses

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

To the extent that providers are small businesses and are eligible to enroll in Maryland Medicaid to provide these services, providers may receive a portion of the increased $39,122,032 in revenue.

Impact on Individuals with Disabilities

The proposed action has an impact on individuals with disabilities as follows:

The proposed action implements coverage for two new services. To the extent that individuals with disabilities utilize mobile crisis team and crisis stabilization center services, they may benefit from the new service coverage.

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, or email to mdh.regs@maryland.gov. Comments will be accepted through March 27, 2023. A public hearing has not been scheduled.

10.63.01 Requirements for All Licensed Programs

Authority: Health-General Article, §§7.5-204, 8-402, 8-404, [and] 10-901, and 10-1402, Annotated Code of Maryland

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)—(2) (text unchanged)

(3) “Active treatment” means psychiatric services which involve implementation of a professionally developed and supervised individual treatment plan.

[(3)] (4)—[(5)] (6) (text unchanged)

[(6)] (7) “American Society of Addiction Medicine (ASAM) Criteria” means an instrument designed [to indicate] by ASAM to determine placement guidelines for admission, continued stay, transfer, and discharge of individuals with [a]:

(a) A substance-related disorder[.];

(b) An addictive disorder; or

(c) Co-occurring disorders.

[(7)] (8)—[(9)] (10) (text unchanged)

(11) “Behavioral health professional” means:

(a) A licensed mental health professional; or

(b) An individual licensed or certified to treat substance use disorders.

[(10)] (12)—[(11)] (13) (text unchanged)

(14) “Campus setting” means the physical area immediately adjacent to the provider's main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas specifically approved by the Department.

(15) “Care coordination” means the act or practice of organizing participant care-related activities among all the providers and parties concerned with a participant’s care in an effort to achieve safer and more effective care.

(16) “Case management” means the services designed to assist an individual in gaining access to needed financial, educational, social, medical, behavioral health, and other services.

[(12)] (17)—[(18)] (23) (text unchanged)

(24) “Crisis” means the experience of stress, emotional or behavioral symptoms, difficulties with substance use, or a traumatic event that compromises an individual’s ability to function within their current family/living situation, school, workplace, or community. The behavioral health crisis is defined by the individual experiencing the crisis.

(25) “Crisis intervention” means the ability to perform or provide crisis assessment, crisis de-escalation, psychoeducation, brief behavioral support, and referral and linkage to appropriate services and supports.

(26) “Crisis stabilization center” is a place of direct service that assists with the de-escalation of an individual’s clinical behavioral health crisis.

[(19)] (27) (text unchanged)

(28) “Culturally and linguistically appropriate services” means effective, equitable, understandable, and respectful quality care, services, and supports.

(29) "Cultural and linguistic competency" means cultural and linguistic abilities as defined in Health-General Article, §20-1301, Annotated Code of Maryland.

[(20)] (30)—[(32)] (42) (text unchanged)

(43) Independent Practice Level.

(a) “Independent practice level” means a mental health professional licensed under Health Occupations Article, Annotated Code of Maryland, to diagnose and treat mental disorders.

(b) “Independent practice level” does not include:

(i) Licensed bachelor social worker (LBSW);

(ii) Licensed graduate professional counselor (LGPC);

(iii) Licensed master social worker (LMSW); or

(iv) Licensed certified social worker (LCSW).

(44) “Informed choice” means the decision of the individual after having considered the full range of available options based on adequate, accurate, and objective information and knowledge.

(45) In-Person or in Person.

(a) “In-person” or “in person” means physical face-to-face presence.

(b) “In-person” or “in person” does not include presence by telehealth or audio.

(46) “Instrumental activities of daily living” means activities related to living independently as provided in Estates and Trusts Article, §13-601, Annotated Code of Maryland.

(47) “Intern” means an individual who is:

(a) Pursuing a degree at an accredited college or university toward state licensure as a behavioral health professional;

(b) Delivering services or performing work as part of a formal supervised fieldwork placement through an accredited college or university;

(c) Complying with respective professional licensing laws, including supervision requirements; and

(d) Appropriately screened and oriented to the program’s policies and procedures.

[(33)] (48) (text unchanged)

(49) “Key staff” means staff in a position of executive or managerial responsibility whose performance affects the viability of the business.

[(34)] (50) (text unchanged)

(51) “Licensed mental health professional” means a:

(a) Psychiatrist;

(b) Licensed psychologist;

(c) Psychiatric nurse practitioner (CRNP-PMH);

(d) Clinical nurse specialist in psychiatric and mental health nursing (APRN-PMH);

(e) Licensed certified social worker-clinical (LCSW-C);

(f) Licensed clinical alcohol and drug counselor (LCADC);

(g) Licensed clinical marriage and family therapist (LCMFT);

(h) Licensed clinical professional art therapist (LCPAT);

(i) Licensed clinical professional counselor (LCPC); or

(j) Properly supervised:

(i) Licensed master social worker (LMSW);

(ii) Licensed graduate alcohol and drug counselor (LGADC);

(iii) Licensed graduate marriage and family therapist (LGMFT);

(iv) Licensed graduate professional art therapist (LGPAT);

(v) Licensed graduate professional counselor (LGPC); or

(vi) Psychology associate.

[(35)] (52)—[(36)] (53) (text unchanged)

[(37)] (54) “Maintenance” means medically supervised continuation of the administration of methadone, buprenorphine, naltrexone, or other drugs approved by the Administration.

[(38) “Medical director” means a physician who oversees the medical practice of a program.]

(55) “Medical director” means a:

(a) Physician who oversees the medical practice of a program;

(b) Psychiatrist or psychiatric nurse practitioner who oversees an outpatient mental health center; or

(c) Psychiatrist who oversees a behavioral health crisis stabilization center.

(56) “Medication administration” means the giving or application of a pharmacological or therapeutic agent by an individual licensed to administer medication under Health Occupations Article, §8-6A-02, Annotated Code of Maryland.

(57) Medication Monitoring.

(a) “Medication monitoring” means:

(i) Providing in-person assistance to an individual to achieve compliance with treatment with all prescribed psychiatric or somatic medications; and

(ii) As needed, reviewing the individual's existing medication regimen with the appropriate physician.

(b) “Medication monitoring” does not mean:

(i) Prescribing medication;

(ii) Measuring or pouring medicine;

(iii) Preparation of a syringe for injection; or

(iv) Administration of medication.

(58) “Medications for opioid use disorder (MOUD)” means the use of medications, in combination with counseling and behavioral therapies as defined in Health-General Article, §21-2A-01, Annotated Code of Maryland.

(59) “Mobile crisis response” means the provision of professional, same-day intervention for children or adults who are experiencing crises and whose behaviors are consistent with mental illness or substance abuse, or both, including individuals experiencing a behavioral health crisis that is secondary to mental illness, substance abuse, developmental or intellectual disability, brain injury, or any combination of these.

[(39)] (60)—[(41)] (62) (text unchanged)

(63) “On-site” means a licensed program’s physical location, exclusive of a licensed group home, which is generally used in the context of on-site PRP services or OMHC services.

(64) “Organization” means a legal entity under which programs and services operate.

(65) “Participant” means an individual receiving care, treatment, or services in a community behavioral health program.

[(42)] (66) (text unchanged)

[(43) “Peer support services” means a set of non-clinical activities provided by individuals in recovery from mental health or substance-related and addictive disorders who use their personal, lived experiences and training to support other individuals with mental health or substance-related and addictive disorders.]

(67) “Peer support services” means a set of non-clinical activities provided by individuals in recovery from mental health, substance-related, or addictive disorders as defined in Health-General Article, §7.5-101, Annotated Code of Maryland.

(68) “Person-centered care planning” means a well-defined, multidimensional approach that provides a conceptual and operational framework within which participants partner with providers to direct their care through developing a plan rooted in the participant’s strengths, resources, and values, while taking into consideration barriers related to the participant’s behavioral health condition that impede the attainment of the participant’s life goals, all the while meeting the requirements of medical necessity.

[(44)] (69)—[(46)] (71) (text unchanged)

[(47) “Program” means an organization that provides or seeks a license to provide community-based behavioral health services.

(48) “Program director” means the individual who has over-all responsibility for the day-to-day activities of the program, including staff, records, policies, and procedures.

(49) “Provider” means a program that is approved, certified or licensed to provide community-based behavioral health services.]

(72) “Program director” means the individual who has overall responsibility for the day-to-day activities of the program, including staff, records, policies, and procedures.

[(50)] (73)—[(52)] (75) (text unchanged)

(76) “Required management staff” means mandated supervisory or management staff.

(77) “Required staff” means staff required to provide behavioral health services.

[(53)] (78)—[(55)] (80) (text unchanged)

(81) “Site” means a single physical location which is either a single street address or a campus setting, used by an organization to provide behavioral health treatment or rehabilitation services.

(82) “Social determinants of care” means the social, economic, and environmental factors identified in Health-General Article, §13-3801, Annotated Code of Maryland.

(83) “Social skills” means socially acceptable learned behaviors that enable a person to interact with others in ways that elicit positive responses and assist in avoiding negative responses.

[(56)] (84)—[(58)] (86) (text unchanged)

(87) “Warm hand-off” means ongoing communication between the referring provider, receiving provider, and participant to ensure that the participant has engaged in the services or accessed the resources to which an individual has been referred prior to the referring provider discharging the participant or ceasing communication with the individual and the receiving provider.

[(59) “Withdrawal management” means direct or indirect services for an individual manifesting the symptoms that occur on cessation or reduction of use of a substance or medication, by:

(a) Monitoring the amount of alcohol and other toxic agents in the body of the individual;

(b) Managing withdrawal symptoms; and

(c) Motivating an individual to participate in the appropriate substance-related disorder programs.]

(88) “Withdrawal management” means direct or indirect services for an individual manifesting the symptoms that occur on cessation or reduction of the use of a substance or medication as defined in Health-General Article, §8-101, Annotated Code of Maryland.

[(60)] (89) (text unchanged)

.05 Requirements for Licensed Community-Based Behavioral Health Programs.

A.—G. (text unchanged)

H. Required Management Staff Vacancies. If a required management staff position becomes vacant, the program shall:

(1) Notify BHA’s licensing unit and the CSA, LAA, or LBHA within 14 calendar days of the vacancy of required management staff;

(2) Implement a good faith effort to fill the position;

(3) Notify BHA’s licensing unit of the name and credentials of the individual that the program hires to fill the vacancy;

(4) Submit a variance application within 30 days of the vacancy; and

(5) Provide the following information on the variance application:

(a) Title and description of the vacant position;

(b) Efforts made to fill the position; and

(c) How the participants’ needs are being met.

10.63.02 Programs Required to Be Accredited in Order to Be Licensed to Provide Community-Based Behavioral Health Services

Authority: Health-General Article, §§7.5-204, 8-402, 8-404, [and] 10-901, and 10-1402, Annotated Code of Maryland

.02 Covered Programs and Services.

A. The following programs shall require an accreditation-based license under this chapter:

(1)—(16) (text unchanged)

(17) Respite Care Services (RPCS) programs; [and]

(18) Supported Employment Program (SEP) programs[.];

(19) Mobile Crisis Team programs; and

(20) Behavioral Health Crisis Stabilization Center (BHCSC) program.

B.—C. (text unchanged)

10.63.03 Descriptions and Criteria for Programs and Services Required to Have an Accreditation-Based License

Authority: Health-General Article, §§7.5-204, 8-402, 8-404, [and] 10-901, and 10-1402, Annotated Code of Maryland

.20 Mobile Crisis Team Services (MCT).

A. Definition.

(1) In this regulation, the following term has the meaning indicated.

(2) Term Defined. “Program” means the site and service combination which is recognized through licensure to offer an organized system of activities performed for the benefit of persons served.

B. In order to be licensed under this subtitle, a mobile crisis team shall:

(1) Meet the requirements of COMAR 10.63.01, 10.63.02, and 10.63.06 and this regulation;

(2) Provide professional, same-day intervention for children or adults whose behaviors are consistent with experiencing:

(a) A mental health crisis;

(b) A substance use disorder crisis; or

(c) Both;

(3) Meet the requirements defined in Mental Health Law, Title 10, Subtitle 14, Annotated Code of Maryland;

(4) Be pre-approved by the Department to participate in the PBHS to receive funding through the Department;

(5) Respond to urgent, non-threatening emotional symptoms or behaviors that are disrupting an individual’s functioning.

C. Program Services. A mobile crisis team shall provide the following services:

(1) In-person, community-based professional and peer intervention services which shall:

(a) Be age and culturally appropriate;

(b) Be designed to:

(i) De-escalate an individual’s behavioral health crisis;

(ii) Evaluate the nature of the crisis;

(iii) Stabilize the individual to the pre-crisis level of functioning; and

(iv) Maintain continuity of care by coordinating access to various treatment and support services;

(c) Be deployed in real time to the location of an individual in crisis;

(d) Address immediate dynamics that may be contributing to the crisis;

(e) Be delivered within 60 minutes of determining an individual in crisis;

(f) Use evidence-based tools to screen, assess, stabilize, and refer persons, as clinically indicated;

(g) Be provided by a mobile crisis team that is nearest to the location of the individual in crisis; and

(h) Be provided under the documented supervision of a licensed mental health professional approved by the appropriate board to supervise.

(2) Crisis Intervention Services. The MCT shall provide a crisis intervention service that is:

(a) Available 24 hours per day, 7 days per week;

(b) Designed to be implemented in the event of a crisis in the home or other setting in which the individual is involved; and

(c) Explained in terms understandable to the individual.

(3) Triage/Screening: Screening to determine the level of risk faced by the individual in crisis and assess the most appropriate response.

(4) Assessment: A licensed mental health professional shall conduct an immediate assessment to determine whether the service is appropriate for the individual. The assessment shall:

(a) Be conducted in person or through the use of a telemedicine-assisted assessment;

(b) Include, at a minimum:

(i) Information on the circumstances of the crisis event;

(ii) Safety and risk related to the individual and others involved;

(iii) Medication and substance use;

(iv) Strengths and resources of the individual;

(v) Recent inpatient hospitalizations or involvement in mental health services;

(vi) Mental health conditions and mental status;

(vii) Medical history; and

(viii) Other pertinent information; and

(c) Plan for de-escalation and resolution of the crisis, including on-site interventions for immediate de-escalation of presenting emotional or behavioral symptoms.

(5) Brief therapeutic and skill-building interventions: Brief therapeutic counseling techniques specific to the crisis that aims to lower risks and resolve the crisis so that a higher level of care is not needed.

(6) Case Management and Care Coordination: Case management and care coordination services may include referrals to other services as well as follow-up contacts.

(7) Engaging peer and natural and family support.

(8) Safety crisis planning: The safety plan shall aim to keep an individual in crisis and their environment safe and may include the distribution of opioid overdose reversal drugs, lethal means counseling, and other evidence-based interventions.

(9) Stabilization Services to ensure the individual’s safety and connection to needed resources which reduce the conditions leading to crisis.

(10) Follow-up screening and assessment for ongoing risk.

(11) Follow-up Services.

(a) Mobile Crisis Teams shall provide crisis follow-up contacts, when indicated by the needs of persons served, in-person, via phone or telehealth following the initial crisis intervention.

(b) Follow-up services shall include, but are not limited to:

(i) Coordination and warm hand-offs with other service providers; and

(ii) Ongoing coordination to meet identified resource needs; and

(c) Follow-up screening and assessment for ongoing risk.

D. Staff Requirements.

(1) The team involved in a mobile response shall offer 24 hours per day, 7 days per week; capability to respond to an individual in crisis, and include, at minimum:

(a) At least two staff responding in person to each crisis situation; and

(b) A licensed mental health professional who is qualified to serve individuals of all ages and individuals with intellectual or developmental disabilities, and who may:

(i) Be a member of the two-person team; or

(ii) Respond by telehealth as a third team member.

(2) The team involved in a mobile response shall have at least one licensed mental health professional available at all times, either face-to-face or through telehealth who is:

(a) Licensed at the independent practice level;

(b) Eligible to supervise the members of the team; and

(c) Eligible to complete an emergency petition.

(3) An MCT may also include:

(a) Other mental health professionals to ensure shift coverage;

(b) Certified peer and family recovery support specialists; or

(c) Other staff pre-approved by the Department and who shall have completed the training requirements in Regulation .05D of this chapter.

E. Staff Training Requirements.

(1) MCT staff shall be trained in any practices required by the Department.

(2) Staff shall be trained in mobile response stabilization services to respond to individuals younger than 24 years old.

(3) MCT shall have a training and competency plan in place that:

(a) Is reviewed annually;

(b) Is consistent with:

(i) Accreditation requirements; and

(ii) Requirements published by the Department;

(c) Defines the core competencies needed to provide reliable and high-quality care for each clinical discipline at each level of care within the program;

(d) Ensures that all staff receives needed training and competency verification during orientation, which can be achieved by a combination of training, shadowing, observation, and demonstration;

(e) Ensures that all staff, including supervisors, receive ongoing refresher training and competency verification as required by the Department; and

(f) Is used as a primary mechanism for:

(i) Documented ongoing clinical review; and

(ii) Documented supervision.

F. An MCT shall offer services to individuals meeting all of the following eligibility criteria:

(1) The individual is experiencing an active behavioral health crisis; and

(2) Immediate intervention is necessary to safely stabilize the individual.

G. Required management staff in this program, as defined in COMAR 10.63.01.02 and subject to the requirements for reporting of vacancies under COMAR 10.63.01.05, includes the clinical supervisor.

H. Reporting of Outcomes and Social Determinants of Care Data. The program shall provide data on outcomes and social determinants of care to the State in the format and frequency required by the Department.

I. Required staff in this program, as defined in COMAR 10.63.01.02 and subject to the requirements for reporting of vacancies under COMAR 10.63.01.05 includes licensed mental health professionals.

.21 Behavioral Health Crisis Stabilization Center Program (BHCSC).

A. Definition.

(1) In this regulation, the following term has the meaning indicated.

(2) Term Defined. “Program” means the site and service combination which is recognized through licensure to offer an organized system of activities performed for the benefit of persons served.

B. In order to be licensed under this subtitle, a behavioral health crisis stabilization center program shall meet the requirements of:

(1) This regulation;

(2) Health-General Article, Title 10, Annotated Code of Maryland; and

(3) COMAR 10.63.01—10.63.02 and 10.63.06.

C. Operation. The program shall:

(1) Provide crisis response services as outlined in Health-General Article, Title 10, Subtitle 14, Annotated Code of Maryland;

(2) Prioritize admission of individuals presenting on an emergency petition or other involuntary category, with a no rejection policy for first responders, and a referral acceptance rate of at least 90 percent;

(3) Provide the services required in §D of this regulation 24 hours a day, 7 days a week;

(4) Provide mental health and substance use disorder crisis services in a supportive, non-hospital setting;

(5) Provide crisis services to children, youth, and adults who are:

(a) Experiencing a mental health, substance use disorder, substance use related, or combined crisis; or

(b) Are at risk of experiencing a mental health, substance use disorder, substance use related, or combined crisis;

(6) Provide an alternative to emergency departments for behavioral health crisis care, and divert from psychiatric hospitalization and incarceration;

(7) Provide counseling, de-escalation, treatment, and safety planning;

(8) Provide withdrawal management services for all substances;

(9) Maintain the capability to prescribe the following medication:

(a) PRN intramuscular medication over objection;

(b) Long-acting injectable antipsychotic medication;

(c) Current psychiatric and somatic medications prescribed to an individual and over-the-counter medications as indicated;

(d) Medications used for withdrawal management; and

(e) Medications for opioid use disorder (MOUD);

(10) Maintain compliance with the model program structure and facility standards designed by the Maryland Department of Health, as required by Health-General Article, §10-621, Annotated Code of Maryland;

(11) Establish and implement an ongoing communication system and protocols to:

(a) Ensure a less than 15 minutes turnaround time for law enforcement, mobile crisis, or medical services transport of an individual to the facility; and

(b) Arrange law enforcement transport, upon discharge, of those individuals whose legal status requires such transport; and

(12) Be pre-approved by BHA to receive PBHS funding before participating in the PBHS.

D. Program Services. A program shall:

(1) Provide a 23-hour crisis receiving service, designed to provide crisis stabilization within 23 hours that includes clinical crisis services for individuals who walk in or are admitted on an emergency petition or other involuntary status, including:

(a) Triage for initial assessment;

(b) Crisis stabilization services; and

(c) Linkage to treatment services, family and peer support groups, and other health and human services programs;

(2) Serve as a critical access point for individuals experiencing a mental health, substance use disorder, substance use related, or combined crisis; and

(3) Accept individuals with the following admission status:

(a) Emergency petition;

(b) Other involuntary categories; and

(c) Voluntary.

E. Administration.

(1) A program shall ensure that within 60 minutes or less of the individual’s arrival, a registered nurse initiates an in-person assessment, which shall include medical history, medications, full review of symptoms, vital signs, and a comprehensive nursing physical exam with full skin assessment.

(2) The assessment results shall be reviewed by a psychiatrist or psychiatric nurse practitioner.

(3) Program nursing staff shall perform, at a minimum:

(a) Daily in-person assessment of all individuals; and

(b) Vital signs obtained every 8 hours.

(4) The initial psychiatrist or psychiatric nurse practitioner evaluation shall be conducted in person, or via telehealth if part of a staffing plan approved by the Department, and shall include the following:

(a) A medical evaluation and physical exam;

(b) Initial behavioral assessment of suicide and violence risk; and

(c) Development of an initial care plan.

(5) Admission evaluations conducted by telehealth shall be followed by an in-person physical exam conducted when a psychiatrist or psychiatric nurse practitioner is on-site, but no later than 23 hours after admission.

(6) A psychiatrist or psychiatric nurse practitioner shall evaluate a person on voluntary status as clinically indicated but no later than within 6 hours of admission.

(7) A psychiatrist shall evaluate an individual admitted on an emergency petition as clinically indicated but no later than within 6 hours after the individual is brought to the facility, to determine if the individual meets the requirements for involuntary admission as required under Health-General Article, §10-624, Annotated Code of Maryland.

(8) A psychiatrist or psychiatric nurse practitioner shall conduct at least daily follow-up examinations for individuals that have not been discharged.

(9) Individuals are discharged to one of the following, as clinically appropriate and based on disposition availability:

(a) The community with appropriate follow-up;

(b) A residential crisis bed;

(c) A higher level of care, including an emergency department or psychiatric unit when medically necessary; or

(d) Another setting appropriate to the individual's safety risk.

(10) Program shall ensure that services provided are well integrated with existing community behavioral health service providers, including:

(a) Development of mechanisms to connect individuals to follow-up and outpatient support services upon discharge; and

(b) Written referral agreements and relationships with nearby community providers, including, but not limited to:

(i) Providers of medications for opioid use disorders;

(ii) Residential substance use treatment programs;

(iii) Residential crisis programs;

(iv) Respite programs;

(v) Hospital psychiatric units; or

(vi) Somatic care programs.

(11) The program shall make documented attempts to contact and follow-up with all individuals who initially presented, or were later evaluated, as a danger to self or others within 72 hours after discharge.

F. Required Staff.

(1) The program shall have a full-time on-site program director who is a licensed mental health professional operating at the independent level of practice.

(2) The Program shall have at least one full-time licensed social worker or professional counselor, who shall provide services on-site, except as specifically authorized for telehealth in a Department-approved staffing plan.

(3) The program shall employ psychiatrists or psychiatric nurse practitioners who:

(a) Are DATA-waived clinicians able to prescribe buprenorphine;

(b) Provide services on-site;

(c) Are authorized to provide telehealth to the extent permitted in a staffing plan approved by the Department; and

(d) Are scheduled so that at any time one of them is available for consultation with staff or emergency departments and EMS.

(4) The program shall have a medical director that:

(a) Is a psychiatrist;

(b) If employed full time by the program, may also serve as program director;

(c) Has overall responsibility for clinical services, including, at a minimum:

(i) Establishing and maintaining appropriate standards for diagnosis and treatment, including therapeutic modalities and prescribing practices;

(ii) Medical aspects of quality management;

(iii) Adequate clinical coverage; and

(iv) Ensuring adequate clinical supervision of treatment staff;

(d) Is responsible for assuring all treatment services are conducted in compliance with State and federal regulations at all times;

(e) Is employed at least 16 hours per week, which may include clinical duties, and is on-site at least 8 hours per week; and

(f) If employed by more than one organization as a medical director, does not exceed 60 hours per week across all organizations as a medical director or program director.

(5) The program shall employ a nurse manager who supervises nursing staff, and who may provide direct clinical care.

(6) The program shall have sufficient registered nursing staff to ensure coverage by a minimum of two registered nurses per shift.

(7) The program shall have coverage on all shifts, with eligible staff as identified in this regulation, meeting the higher requirement of either:

(a) At least six on-site staff for all shifts, as identified in this regulation; or

(b) On-site staff minimum levels for all shifts as determined by the Department under Health-General Article, §10-621, Annotated Code of Maryland.

(8) Staff eligible to be counted in the minimum levels of shift coverage includes:

(a) Licensed mental health professionals, as defined in COMAR 10.63.01.02;

(b) Certified nursing assistants;

(c) One security personnel, if they are specifically trained for and can participate in both de-escalation and psychiatric emergencies, including those that involve seclusion or restraint;

(d) Certified peer recovery specialists; and

(e) Other qualified staff as pre-approved in writing by the Department.

(9) Shift staffing coverage shall be maintained at sufficient levels to ensure safe responses to psychiatric or medical emergencies, while also maintaining quality care and a safe level of observation for individuals not involved in the emergency.

(10) Additional staff shall be on-site as needed to allow for a 1:1 staffing level of observations due to an individual’s risk of harm to self or others. A 1.1 observation may be:

(a) Ordered by a psychiatrist or psychiatric nurse practitioner for when an:

(i) Individual’s risk of harm to self or others indicates the need for a 1:1 observation; or

(ii) Individual is in seclusion or restraint; or

(b) Initiated by a registered nurse or licensed practical nurse prior to obtaining an order from a psychiatrist or psychiatric nurse practitioner, but the order shall be obtained within 2 hours.

(11) Staffing Plan. The program shall develop and maintain a written staffing plan designed to ensure sufficient coverage, discipline mix, service quality, and safety and shall:

(a) Outline the qualifications and duties of each staff position; and

(b) Be approved by the Department, including clarification on the limits of the use of telehealth for each program.

(12) The program shall assign to each individual a treatment coordinator who shall ensure that the individual receives service as described in the individual’s plan of care.

(13) A psychiatrist or psychiatric nurse practitioner shall round daily with the charge nurse and any other professional staff who are available.

G. Medical Evaluation and Intervention. The program shall ensure that:

(1) Medical stability is assessed on admission and then periodically during admission;

(2) Needed medical treatment interventions are provided, either directly or through referral;

(3) Stat and routine laboratory evaluations are performed as indicated;

(4) Psychiatrists and psychiatric nurse practitioners shall collaborate with local emergency departments;

(5) An automated external defibrillator and naloxone are on-site;

(6) Staff are available to prescribe medication to bridge until an individual’s community follow-up appointment;

(7) Written procedures are developed to securely hold all take-home opioid therapy medication for patients who are on opioid maintenance therapy;

(8) Naloxone is supplied upon discharge as indicated; and

(9) The program has written policies and procedures to govern medications.

H. Documentation.

(1) The program shall maintain, either manually or electronically, adequate documentation of each contact with a participant as part of the medical record, which, at a minimum, meets the following requirements:

(a) Includes the date of service with service start and end times;

(b) Includes the participant’s primary behavioral health complaint or reason for the visit;

(c) Includes a brief description of the service provided, including progress notes; and

(d) Includes an official e-Signature, or a legible signature, along with the printed or typed name, and appropriate title of each individual providing services.

(2) The Program shall maintain:

(a) A discharge plan which shall indicate the follow-up for all individuals served;

(b) Informed consent to treat;

(c) Informed consent to medicate;

(d) A medical problem list;

(e) A nursing assessment to include at least the following areas:

(i) Medical history including a review of symptoms;

(ii) Clinical Opioid Withdrawal Scale, if applicable;

(iii) Mental health and substance use history including screening for suicide risk and violence risk;

(iv) Communicable diseases including TB screening; and

(v) Medication list prescribed/non-prescribed;

(f) A psychiatrist or psychiatric nurse practitioner assessment;

(g) Medication evaluation and management throughout the stabilization period;

(h) Biopsychosocial assessment by the clinical staff;

(i) Mental health and substance use history, including screening for suicide risk and violence risk; and

(j) ASAM crosswalk assessment.

I. Seclusion and Restraint.

(1) A program shall have the capacity for both seclusion and restraint.

(2) A program shall be compliant with State and federal seclusion and restraint regulations and laws, including 42 CFR §482.13 and Health-General Article, §10-701, Annotated Code of Maryland, and any successor laws and regulations.

(3) An individual may only be physically secluded or placed in restraints after a clinical assessment by a psychiatrist, psychiatric nurse practitioner, or a registered nurse and, as a last resort, only after less restrictive interventions have been considered or tried, unless the emergency nature of the situation precludes the latter.

(4) Seclusion or Restraint.

(a) Seclusion or restraint requires an order from a physician or other clinician permitted by law.

(b) If a physician is not present, and an emergency situation warrants immediate seclusion or restraint, a registered nurse may authorize initiation of the seclusion or restraint, but shall obtain an order as soon as possible, but no later than within 1 hour.

(c) An order for seclusion or restraint may not exceed 4 hours for adults, 2 hours for adolescents, and 1 hour for children younger than 9 years old. Such an order does not require continuation of the seclusion or restraint for the entire time specified by the order. The seclusion or restraint shall be discontinued as soon as clinically indicated.

(d) If a registered nurse has conducted an in-person evaluation and initiated seclusion or restraint, or renewed a previous order, an evaluation by a psychiatrist or psychiatric nurse practitioner shall occur within 1 hour of initiation or renewal.

(e) Patients in seclusion or restraints shall be maintained on 1:1 observation the entire time they are secluded or restrained to protect them from harm.

(f) Restraint and seclusion shall never occur simultaneously for an individual.

J. Environmental/Life Safety Requirements.

(1) The Program shall:

(a) Provide a comfortable, furnished admission pre-triage waiting area for individuals who voluntarily present;

(b) Provide a locked and secure dedicated drop-off admission space, designed to accommodate those individuals who have been emergency petitioned;

(c) Provide a comfortable, furnished waiting area for individuals accompanying participants in the program;

(d) Ensure a safe environment of care for anyone served younger than 18 years old by having a separation from adults, with appropriate staff maintaining an adequate level of supervision;

(e) Ensure that the 23-hour crisis receiving service shall have at least one locked door seclusion room which:

(i) Shall be a minimum of 80 square feet;

(ii) Allows for continual visual observation and monitoring that allows for immediate emergency response; and

(iii) Uses a locking mechanism consistent with National Fire Protection Association (NFPA) standards for the facility; and

(f) Ensure that there is least one quiet room that is separate from the seclusion room and remains unlocked whenever in use.

(2) The Maryland Department of Health may require the program to add additional seclusion or quiet rooms, based on the intended capacity of the Program.

(3) The program facility shall be free from fire hazards and have:

(a) Adequate smoke detectors;

(b) Working and updated fire extinguishers;

(c) Fire sprinklers as required by law;

(d) A written fire evacuation plan; and

(e) A current fire inspection certification.

(4) The program shall conduct and document an annual environmental safety review and take actions to replace items that create an unnecessary risk of self-harm with safer items designed for behavioral health settings, including, but not limited to:

(a) Anchor points;

(b) Door handles;

(c) Curtains;

(d) Hooks; and

(e) Shower rods and curtains.

(5) The program shall comply with applicable federal, State, and local sanitation, building, fire codes, and zoning requirements.

(6) The program shall maintain documentation of legally and accreditation required periodic evacuation drills.

(7) Within the first 30 days of employment, the program shall provide staff training in emergency evacuation procedures.

(8) The program shall have:

(a) Bathrooms;

(b) Telephones;

(c) Space for privacy for visits;

(d) Confidential office space for treatment; and

(e) Office space designated for administrative and treatment personnel.

K. Special Accommodations. The program shall have protocols, which may include referral agreements with other programs, that provide for admission and treatment of individuals with:

(1) Limited English proficiency;

(2) Hearing and speaking disabilities; and

(3) Physical and mental disabilities.

L. Dietary Services. Dietary services shall be as follows:

(1) At least three meals plus an evening snack provided daily with no more than 14 hours between any two meals;

(2) Dietary services shall comply with applicable local, State, and federal laws;

(3) The program shall have a written plan describing the organization and delivery of dietary services; and

(4) A dietitian licensed under the Health Occupations Article, §5-101, Annotated Code of Maryland, shall develop and implement the dietary service plan.

M. Infection Control — Universal Precautions. A program shall observe universal precautions as required under COMAR 10.07.02.21-1.

N. Site Inspection. At a minimum, an annual site inspection shall be conducted by the assigned LBHA.

O. Involuntary Admissions. Involuntary admissions shall be processed according to Health-General Article, §10-613, Annotated Code of Maryland.

P. Training and Competency Development Plan. Crisis organizations should have an annually reviewed training and competency plan in place that:

(1) Defines the core competencies needed to provide reliable and high-quality care for each clinical discipline at each level of care within the program;

(2) Ensures that staff receive needed training and competency verification during orientation, which can be achieved by a combination of training, shadowing, observation, and demonstration;

(3) Ensures that all staff, including supervisors, receive ongoing refresher training and competency verification at least every 2 years;

(4) Is used as a primary mechanism for ongoing clinical review and supervision; and

(5) Includes, at minimum, basic competencies related to engagement, assessment, and intervention, to include:

(a) Crisis intervention and de-escalation;

(b) Common behavioral health diagnoses;

(c) Common behavioral health medications;

(d) Lethality assessment and intervention;

(e) Suicidality/danger to self;

(f) Risk of homicide/danger to others;

(g) Safety and crisis planning;

(h) Care coordination and planning;

(i) Active rescue, voluntary, and involuntary hospitalization procedures;

(j) Community safety/situational awareness;

(k) Diversity and equity, including the ability to respond with competence and consideration to:

(i) Race;

(ii) Culture;

(iii) Ethnicity;

(iv) Language;

(v) Sexual orientation and gender identity and expression;

(vi) Disability; and

(vii) Religion;

(l) MRSS;

(m) Trauma-responsive care;

(n) Harm reduction;

(o) Special populations;

(p) Mandated reporting requirements;

(q) HIPAA;

(r) Use of an automated defibrillator and CPR;

(s) Administration of naloxone; and

(t) Other competencies as determined necessary by the State.

Q. Quality Improvement Program.

(1) A management-level licensed mental health professional or registered nurse shall be designated to be the quality improvement coordinator who oversees a quality improvement program.

(2) The quality improvement coordinator shall monitor the training and competency development plan by:

(a) Reviewing unusual incidents, deaths, and other sentinel events;

(b) Reviewing utilization patterns, lengths of stay, referral sources, and other data such as the number of individuals who:

(i) Are discharged to the community;

(ii) Have a follow-up appointment scheduled within 7 days of discharge;

(iii) Keep their follow-up appointment within 7 days of discharge;

(iv) Present on emergency petition;

(v) Are admitted to residential behavioral health settings;

(vi) Are psychiatrically hospitalized;

(vii) Are transferred to an emergency department or another crisis stabilization center;

(viii) Are readmitted; and

(ix) Are secluded or restrained;

(c) Reviewing other data as determined by the Department; and

(d) Managing complaints and grievances.

R. Reporting of Outcomes and Social Determinants of Care Data. The program shall provide data on outcomes and social determinants of care to the State in the format and frequency required by the Department.

S. Required Management Staff. The required management staff in a program, as defined in COMAR 10.63.01 and subject to the requirements for reporting of vacancies under COMAR 10.63.01.05, includes the:

(1) Program director;

(2) Medical director; and

(3) Nurse manager.

DENNIS R. SCHRADER
Secretary of Health

Title 13A
STATE BOARD OF EDUCATION

Subtitle 05 SPECIAL INSTRUCTIONAL PROGRAMS

13A.05.14 Adult High School Pilot Program

Authority: Education Article, §§2-205 and 9.7-101—9.7-110, Annotated Code of Maryland

Notice of Proposed Action

[22-311-P]

The Maryland State Board of Education proposes to adopt new Regulations .01—.13 under a new chapter, COMAR 13A.05.14 Adult High School Pilot Program. This action was considered by the State Board of Education at its December 6, 2022, public meeting.

Statement of Purpose

The purpose of this action is to establish requirements and policy for the establishment of up to six adult high school pilot programs, each of which may enroll up to 350 students.

Estimate of Economic Impact

I. Summary of Economic Impact. MSDE awards grants of $250,000 for each adult high school pilot. Pilots raise funding of approximately $16,000 per pupil for operational expenses.

II. Types of Economic Impact.

Impacted Entity	Revenue (R+/R-) Expenditure (E+/E-)	Magnitude
A. On issuing agency:
Maryland State Department of Education	(E+)	Unknown
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:	(+)	Unknown
F. Direct and indirect effects on public:	(+)	Unknown

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

A. Per Ch. 352 (S.B. 630), Acts of 2021, MSDE awards $250,000 grants to each adult high school. Magnitude is unknown at this time and is dependent on the number of pilot school programs.

E. The nonprofit organizations that establish the pilot adult high school programs will need to raise approximately $16,000 per pupil for operating costs of the programs.

F. The adult high school pilot program provides an alternative method for adults who did not graduate from high school to earn a high school diploma in an environment that meets the needs of the adult learner.

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 an impact on individuals with disabilities as follows:

Adult high schools may be an appropriate match for some adult individuals with disabilities who are seeking a high school diploma.

Opportunity for Public Comment

Comments may be sent to Susan Spinnato, Director of Instructional Programs, Maryland State Department of Education, 200 West Baltimore Street, Baltimore, MD 21201, or call 410-767-0349, or email to susan.spinnato@maryland.gov. Comments will be accepted through March 27, 2023. A public hearing has not been scheduled.

Open Meeting

Final action on the proposal will be considered by the Maryland State Board of Education during a public meeting to be held on April 25, 2023, at 9 a.m., at 200 West Baltimore Street, Baltimore, MD 21201.

.01 Purpose.

The Adult High School Pilot Program establishes an alternative method for adults who did not graduate from high school to earn a high school diploma and, if applicable, a pathway to earn postsecondary credits or an industry-recognized certification in an environment that meets the needs of the adult learner.

.02 Authority.

The Adult High School Pilot Program is under the authority and supervision of the Maryland State Department of Education and the Maryland Department of Labor.

.03 Definitions.

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

B. Terms Defined.

(1) “Department” means the Maryland State Department of Education.

(2) “Operator” means a private non-profit entity that establishes a pilot under the Program.

(3) “Pilot” means an adult high school established by an operator under the Program.

(4) “Program” means the Adult High School Pilot Program.

(5) Wraparound Services.

(a) “Wraparound services” means individualized services, excluding regular school programs and services, that are provided to the student and the student’s family.

(b) “Wraparound services” includes:

(i) Child care;

(ii) Transportation;

(iii) Housing referrals;

(iv) Mental health;

(v) Crisis intervention;

(vi) Substance abuse prevention or treatment; and

(vii) Legal aid.

.04 Program Requirements.

A. A pilot established under the Program shall:

(1) Operate from a fixed physical location;

(2) Offer wraparound services necessary for the adult learner;

(3) Grant a Maryland high school diploma on completion of the required course of study;

(4) Adopt written standards for the admission and dismissal of students;

(5) Comply with the requirements of §504 of the Rehabilitation Act of 1973; and

(6) Provide accommodations equal to those a student would qualify for under the Individuals with Disabilities Education Act if the student has a disability with an educational impact.

B. Enrollment. A pilot shall enroll:

(1) A maximum of 350 students at any given time; and

(2) Students who:

(a) Are 21 years or older;

(b) Do not have a high school diploma; and

(c) Did not complete the requirements for high school graduation through GED testing or the National External Diploma Program.

.05 Operator Qualifications.

A. The operator of a pilot established under the Program shall:

(1) Be registered as a nonprofit organization in the State;

(2) Have previous experience and measured success in providing education or workforce development services, including industry certification and job placement services, to adult learners who have been limited by educational disadvantages, a disability, a criminal record, or similar barriers to employment opportunities;

(3) Have secured financing to develop or the capability to secure financing for the development of a physical site for the pilot; and

(4) Hire appropriately trained instructional personnel.

B. An operator may be a partnership of two or more persons that meet the qualifications required under §A of this regulation.

C. The operator may partner with a public institution of higher education in the State, if the operator intends to provide coursework for college credit, or a county board of education.

.06 Advisory Board.

A. An advisory board shall govern a pilot established under the Program.

B. Membership.

(1) The advisory board shall consist of at least 11 and no more than 25 members.

(2) Of the advisory board members:

(a) One member shall be appointed by the Department;

(b) One member shall be appointed by the Maryland Department of Labor; and

(c) The remaining members shall be selected in accordance with the bylaws of the pilot.

C. A vacancy shall be filled in the same manner in which the vacating member was selected.

D. The advisory board shall determine its officers.

.07 Considerations for Approval.

A. The Department, in consultation with the Maryland Department of Labor, may approve up to six pilots under the Program.

B. When considering whether to approve a pilot under §A of this regulation, the Department and the Maryland Department of Labor shall:

(1) Give priority to a pilot located in a county or geographic area located within a county that has a high school attainment rate that is lower than the State average high school attainment rate;

(2) Consider geographic diversity in locations for pilots; and

(3) Approve one pilot in a rural area for each two pilots approved in urban areas.

.08 Application.

A. The Department, in consultation with the Maryland Department of Labor, will periodically post a solicitation for a pilot.

B. In response to a solicitation under §A of this regulation, an eligible organization that seeks approval to establish a pilot through the Program shall submit a detailed application that includes:

(1) A description and background of the pilot operator or operators;

(2) A program description;

(3) The pilot’s bylaws;

(4) The proposed curriculum and performance standards that align with Maryland high school graduation requirements and the Maryland College and Career Ready Standards;

(5) Initial student intake assessment procedures;

(6) Plans for the provision of remedial instruction, if necessary;

(7) Plans for working with students with disabilities and providing accommodations for qualified students as required under Regulation .04 of this chapter.;

(8) A description of assessment instruments and procedures for measuring student progress and college and career readiness;

(9) A description of any programs or partnerships with organizations or businesses for providing job skills, industry certifications, or higher education credits;

(10) The wraparound services offered;

(11) A description of the advisory and coaching services that provide support for students to establish career pathways in high need and growth industries and make effective transitions into postsecondary education and industry credentialing opportunities;

(12) The pilot’s governance plan;

(13) A detailed budget for the initial 3-year operating period that demonstrates the pilot’s financial self-sufficiency; and

(14) Plans for working with English learners.

.09 Approval.

A. Within 60 days of the receipt of a plan submitted under Regulation .08 of this chapter:

(1) The Department, in consultation with the Maryland Department of Labor, shall approve or disapprove the curriculum; and

(2) If the curriculum is approved, the Department, in consultation with the Maryland Department of Labor, shall approve or disapprove the applicant’s plan.

B. The operator may submit curriculum revisions to the Department for review and approval in consultation with the Maryland Department of Labor.

.10 Waivers.

A. Within 30 days of approval of the pilot, the operator may request waivers from certain regulations.

B. Except as provided in §C of this regulation, the State Board of Education shall grant an approved pilot a waiver from any regulation that conflicts with the purpose and goals of the pilot’s plan, including the student service requirement set forth in COMAR 13A.03.02.05.

C. A waiver may not be granted related to assessment requirements in COMAR 13A.03.02.06.

.11 Funding.

A. The operator or advisory board of a pilot may apply for and accept donations, grants, or other financial assistance from a government entity or any nonprofit or other private organization.

B. The Program may provide grants to pilots approved and operating in accordance with these regulations, if funding is available.

C. A pilot established under the Program is not a public school for public financing purposes under Education Article, Title 5, Annotated Code of Maryland.

.12 Evaluation.

A. An operator shall conduct an evaluation of the pilot each year. After receiving approval of the advisory board, the operator shall submit an evaluation report to the Department and the Maryland Department of Labor for the prior fiscal year that includes:

(1) Academic and career progress of each student enrolled in the pilot; and

(2) The pilot’s fiscal year financial report.

B. On or before October 1 of each year, the operator shall submit to the Department and the Maryland Department of Labor the following information for the prior fiscal year:

(1) Whether students enrolled in the pilot are on track for completion in a time determined reasonable by the advisory board;

(2) The academic levels of the students at the time of enrollment in the pilot;

(3) The academic progress of students as measured by pre-test and post-test assessments and the assessment instruments used;

(4) Graduation rates; and

(5) The number of:

(a) Credits students have completed;

(b) Students who completed the program and graduated;

(c) Postsecondary credits earned by the students concurrently and the type of credit sought;

(d) Industry credentials earned by students and the types of industry credentials; and

(e) Students in post-graduation employment.

C. If the Department and the Maryland Department of Labor determine that the pilot is not effective, they shall send written notice to the operator:

(1) Of any corrective action needed to prevent termination of the pilot; and

(2) The time period during which corrective action must be completed.

.13 Termination.

A. If the Department and the Maryland Department of Labor determine that the pilot is not effective after a period of corrective action required under Regulation .12C of this chapter, they shall send written notice to the operator that the pilot has been terminated.

B. Any termination notice shall address any remaining issues for any enrolled students and existing funding.

MOHAMMED CHOUDHURY
State Superintendent of Schools

Title 13B
MARYLAND HIGHER EDUCATION COMMISSION

Notice of Proposed Action

[22-329-P]

The Maryland Higher Education Commission proposes to:

(1) Amend Regulation .17 under COMAR 13B.01.01 Minimum Requirements for Private Career Schools; and

(2) Amend Regulations .01, .06, and .11 and adopt new Regulation .14 under COMAR 13B.02.06 Additional Requirements for For-Profit Institutions of Higher Education.

This action was considered at an open meeting of the Commission held on October 26, 2022.

Statement of Purpose

The purpose of this action is to implement Ch. 546, Acts of 2020, Veterans’ Education Protection Act, which is codified at Education Article, §11-210, Annotated Code of Maryland. The proposed regulatory amendments and new regulation create a process for MHEC to monitor and enforce applicable institutions’ compliance with Education Article, §11-210, Annotated Code of Maryland, by requiring them to submit specific information regarding their revenues to the Commission on an annual basis.

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 Emily A. A. Dow, Ph.D., Assistant Secretary for Academic Affairs, Maryland Higher Education Commission, 6 N. Liberty St., 10th Fl., Baltimore, MD 21201, or call 410-767-3041, or email to emily.dow@maryland.gov. Comments will be accepted through March 27, 2023. A public hearing has not been scheduled.

Subtitle 01 NONPUBLIC SCHOOLS

13B.01.01 Minimum Requirements for Private Career Schools

Authority: Education Article, Title 11, Subtitles 1, 2, and 4; State Government Article, Title 10, Subtitle 2; Annotated Code of Maryland

.17 Finances.

A.—I. (text unchanged)

J. Revenue Requirements for Certain Schools.

(1) In this section, “year” means July 1 through the following June 30.

(2) This section applies to private career schools that:

(a) Are for-profit institutions;

(b) Participate in and receive funds through Title IV of the federal Higher Education Act of 1965; and

(c) Are approved by the Commission, in its role as State Approving Agency, to enroll students who receive financial assistance for education under the federal Post-9/11 Veterans Educational Assistance Act of 2008.

(3) A school described under §J(2) of this regulation may not enroll new Maryland residents unless the percentage of annual revenue from non-federal funds that has been or will be reported to the U.S. Department of Education under 34 CFR §668.28 in 2 of the 3 immediately preceding years is at least 10 percent.

(4) Institutional Responsibility.

(a) Annually and as part of an institution’s annual report submitted under Regulation .06 of this chapter, an institution described under §J(2) of this regulation shall:

(i) Provide to the Secretary, in the form and manner requested by the Secretary, the percentages of revenue from federal and non-federal funds most recently reported to the U.S. Department of Education under 34 CFR §668.28; and

(ii) Review the percentages provided under §J(4)(a)(i) of this regulation and the percentages reported in the 2 preceding years to determine if the institution has met the revenue requirements in §J(3) of this regulation.

(b) An institution that determines that it has not met the revenue requirements in §J(3) of this regulation shall:

(i) Immediately cease enrollment of new Maryland residents;

(ii) Immediately notify the Secretary; and

(iii) No more than 30 days after notifying the Secretary, submit a plan to the Secretary outlining the steps the institution will take to come into compliance with this section prior to the due date of the institution’s next annual report.

(5) Enforcement by Secretary.

(a) The Secretary annually shall review an institution’s three most recent financial statements to determine if an institution has complied with this section and Education Article, §11-210, Annotated Code of Maryland.

(b) The Secretary may issue an order to any institution in violation of this section or Education Article, §11-210, Annotated Code of Maryland, to cease and desist enrollment and may impose a fine of up to $5,000.

(c) The Secretary is not prohibited from employing any other enforcement mechanism permitted by this chapter or Education Article, Title 11, Annotated Code of Maryland.

(6) Subsequent Compliance.

(a) An institution in violation of this section may, upon submission of its next annual report under Regulation .06 of this chapter, submit a written request to the Secretary to determine if the institution has come into compliance.

(b) The Secretary shall make a determination within 15 days of any request made under §J(6)(a) of this regulation.

(c) An institution in violation of this section may not enroll new Maryland residents until the Secretary has notified the institution, in writing, that it is in compliance with this section.

Subtitle 02 ACADEMIC REGULATIONS

13B.02.06 [Financial Guarantees and the Maryland Guaranty Student Tuition Fund] Additional Requirements for For-Profit Institutions of Higher Education

Authority: Education Article, §§11-105(u) [and], 11-203, and 11-210, Annotated Code of Maryland

.01 Purpose.

The purpose of this chapter is to:

A.—B. (text unchanged)

C. Provide for the creation and administration of the Maryland Guaranty Student Tuition Fund for For-Profit Institutions of Higher Education; [and]

D. Set forth standards and procedures for processing claims filed by students of for-profit institutions of higher education under Education Article, §11-203, Annotated Code of Maryland[.]; and

E. Set forth reporting requirements for for-profit institutions of higher education operating in Maryland.

.06 Requirements for the Financial Guarantee.

A.—B. (text unchanged)

C. Amount of Guarantee.

(1) By each [October] December 1, a school shall provide to the Commission a financial guarantee in an amount equal to the school’s non-Title IV adjusted gross tuition and fees for the prior July 1 through June 30.

(2) (text unchanged)

.11 Reporting.

A. Each school shall file with the Secretary by [September] November 1 of each year:

(1)—(2) (text unchanged)

(3) A Financial Reporting Form, as prescribed by the Secretary, that requires, at a minimum, the following information for the most recent year beginning July 1 and ending June 30:

(a)—(b) (text unchanged)

(c) The total amount of non-Title IV adjusted gross tuition and fees; [and]

(d) If applicable under Regulation .14 of this chapter, the percentages of revenue from federal and non-federal funds most recently reported to the U.S. Department of Education under 34 CFR §668.28; and

[(d)] (e) (text unchanged)

B. (text unchanged)

.14 Revenue Requirements for Certain Institutions.

A. In this regulation, “year” means July 1 through the following June 30.

B. This regulation applies to schools that:

(1) Are approved to operate in Maryland under COMAR 13B.02.01 or COMAR 13B.02.02;

(2) Are for-profit institutions;

(3) Participate in and receive funds through Title IV of the federal Higher Education Act of 1965; and

(4) Are approved by the Commission, in its role as State Approving Agency, to enroll students who receive financial assistance for education under the federal Post-9/11 Veterans Educational Assistance Act of 2008.

C. A school described under §B of this regulation may not enroll new Maryland residents unless the percentage of annual revenue from non-federal funds that has been or will be reported to the U.S. Department of Education under 34 CFR §668.28 in 2 of the 3 immediately preceding years is at least 10 percent.

D. Institutional Responsibility.

(1) Annually and as part of an institution’s report submitted under Regulation .11 of this chapter, an institution described in §B of this regulation shall:

(a) Provide to the Secretary, in the form and manner requested by the Secretary, the percentages of revenue from federal and non-federal funds most recently reported to the U.S. Department of Education under 34 CFR §668.28; and

(b) Review the percentages provided under §D(1)(a) of this regulation and the percentages reported in the 2 preceding years to determine if the institution has met the revenue requirements in §C of this regulation.

(2) An institution that determines that it has not met the revenue requirements in §C of this regulation shall:

(a) Immediately cease enrollment of new Maryland residents;

(b) Immediately notify the Secretary; and

(c) No more than 30 days after notifying the Secretary, submit a plan to the Secretary outlining the steps the institution will take to come into compliance with the revenue requirements in §C of this regulation by the date the institution’s next report to the U.S. Department of Education under 34 CFR §668.28 is due.

E. Enforcement by Secretary.

(1) The Secretary annually shall review an institution’s three most recent revenue percentages provided under §D of this regulation to determine if an institution has complied with this regulation and Education Article, §11-210, Annotated Code of Maryland.

(2) The Secretary may issue an order to any institution in violation of this regulation or Education Article, §11-210, Annotated Code of Maryland, to cease and desist enrollment and may impose a fine of up to $5,000.

(3) The Secretary is not prohibited from employing any other enforcement mechanism permitted by this chapter or Education Article, Title 11, Annotated Code of Maryland.

F. Subsequent Compliance.

(1) An institution in violation of this regulation may, upon submission of its next revenue percentage under §D of this chapter, submit a written request to the Secretary to determine if the institution has come into compliance.

(2) The Secretary shall make a determination within 15 days of any request made under §F(1) of this regulation.

(3) An institution in violation of this regulation may not enroll new Maryland residents until the Secretary has notified the institution, in writing, that it is in compliance with this section.

JAMES D. FIELDER, JR., Ph.D.
Secretary of Higher Education

Subtitle 03 FIRE-RESCUE EDUCATION AND TRAINING COMMISSION

13B.03.01 Certification Standards and Procedures for Emergency Services Instructors

Authority: Education Article, §11-105 and Title 11, Subtitle 5, Annotated Code of Maryland

Notice of Proposed Action

[22-326-P]

The Maryland Higher Education Commission proposes to amend Regulations .03 and .13 under COMAR 13B.03.01 Certification Standards and Procedures for Emergency Services Instructors. This action was considered at an open meeting of the Commission held on August 24, 2022.

Statement of Purpose

The purpose of this action is to change certain emergency services instructor certification standards to emphasize core knowledge. By eliminating the requirement for Instructor 1 and Instructor 2 candidates to have knowledge of course design and administration, which is not necessary to successfully train emergency services personnel, emergency services instructor training for these certification levels can spend more time on effective course delivery.

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 Emily A. A. Dow, Ph.D., Assistant Secretary for Academic Affairs, Maryland Higher Education Commission, 6 N. Liberty St., 10th Fl., Baltimore, MD 21201, or call 410-767-3041, or email to emily.dow@maryland.gov. Comments will be accepted through March 27, 2023. A public hearing has not been scheduled.

.03 State Emergency Services Instructor Certification Standard.

A.—D. (text unchanged)

E. Six Sequential Stages of Instructor Candidate System.

(1)—(2) (text unchanged)

(3) Instructor Training.

(a) (text unchanged)

(b) The instructor training program shall fulfill the professional requirements and qualifications in Regulation .13 of this chapter, as taught by an instructor trainer approved by the MICRB. The course shall also include [examinations at mid-course and] an examination at the end of [the] each course, performance evaluations, and [one term project] performance testing items to be completed before the end of the course. The MICRB may consider credentials of a degreed applicant verified by a sponsoring agency as having completed this requirement. Evidence of academic achievement in the field of education (adult education preferred) shall be submitted to the MICRB.

(c) (text unchanged)

(d) [A level I instructor] An Instructor I training program shall be taught by an MICRB-approved State emergency services instructor approved as an instructor evaluator or instructor trainer. [A level II instructor] An Instructor II training program shall be taught by an MICRB-approved State emergency services instructor trainer.

(4)—(6) (text unchanged)

F.—I. (text unchanged)

.13 Local Emergency Service Instructor Standards.

A. Except as set forth in §B of this regulation, the instructor candidate shall meet the requirements of NFPA 1041 Standard for Fire and Emergency Services Instructor Professional Qualifications, chapters [1—6] 1—5.

B. The instructor candidate may meet the requirements of a recognized instructor training agency or educational institution if the requirements:

(1) Cover all the elements specified in NFPA 1041 Standard for Fire and Emergency Services Instructor Professional Qualifications, chapters 1—5; and

(2) (text unchanged)

C. The instructor candidate shall demonstrate knowledge and skills based on the general categories of NFPA 1041 Standard for Fire and Emergency Services Instructor Professional Qualifications, chapters 1—5, and the requisite knowledge and skills of each section.

JAMES D. FIELDER, JR., Ph.D.
Secretary of Higher Education

Subtitle 07 COMMUNITY COLLEGES

13B.07.02 General Regulations and Policies for Community Colleges

Authority: Education Article, §§15-106.11 and 16-305, Annotated Code of Maryland

Notice of Proposed Action

[22-325-P]

The Maryland Higher Education Commission proposes to amend Regulation .03 under COMAR 13B.07.02 General Regulations and Policies for Community Colleges. This action was considered at an open meeting of the Commission held on August 24, 2022.

Statement of Purpose

The purpose of this action is to adjust the Cade funding formula for community colleges to include a nonresidency waiver for returned Peace Corps volunteers, pursuant to Ch. 75, Acts of 2022.

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 Geoff Newman, Assistant Secretary for Finance and Administration, Maryland Higher Education Commission, 6 N. Liberty St., 10th Fl., Baltimore, MD 21201, or call 410-767-3085, or email to geoff.newman@maryland.gov. Comments will be accepted through March 27, 2023. A public hearing has not been scheduled.

.03 Student Residency Policy.

A.—E. (text unchanged)

F. The following students shall be considered to be Maryland residents (not applicable to Baltimore City Community College):

(1)—(2) (text unchanged)

(3) A student enrolled in a program designated by the Commission as a health manpower shortage program; [and]

(4) A student from outside the State who enrolls as part of a reciprocity agreement negotiated between Maryland and another state[.]; and

(5) A returned Peace Corps volunteer under Education Article, §15-106.11, Annotated Code of Maryland, who is domiciled in the State and attends a public institution of higher education in the State.

G.—H. (text unchanged)

JAMES D. FIELDER, JR., Ph.D.
Secretary of Higher Education

Subtitle 08 FINANCIAL AID

13B.08.12 Veterans of the Afghanistan and Iraq Conflicts Scholarship Program

Authority: Education Article, §§11-105(u), 18-204(c), and 18-604, Annotated Code of Maryland

Notice of Proposed Action

[22-327-P]

The Maryland Higher Education Commission proposes to adopt new Regulations .01—.08 under a new chapter, COMAR 13B.08.12 Veterans of the Afghanistan and Iraq Conflicts Scholarship Program. This action was considered at an open meeting of the Commission held on September 29, 2022.

Statement of Purpose

The purpose of this action is to formalize MHEC guidelines for awarding Veterans of the Afghanistan and Iraq Conflicts scholarships and scholarship procedures. Pursuant to Ch. 23, Acts of 2022, the regulations also expand eligibility for family members by including stepchildren in addition to children and spouses.

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 Geoff Newman, Assistant Secretary for Finance and Administration, Maryland Higher Education Commission, 6 N. Liberty St., 10th Fl., Baltimore, MD 21201, or call 410-767-3085, or email to geoff.newman@maryland.gov. Comments will be accepted through March 27, 2023. A public hearing has not been scheduled.

.01 Program Established.

A. There is a Veterans of the Afghanistan and Iraq Conflicts Scholarship Program, which is administered by the Office pursuant to Education Article, §18-604, Annotated Code of Maryland.

B. The Program may be referred to as the Senator Douglas J.J. Peters Veterans of the Afghanistan and Iraq Conflicts Scholarship Program.

C. The purpose of the program is to provide financial assistance to attend a Maryland institution of higher education for United States armed forces personnel who served in the Afghanistan or Iraq Conflicts and their families.

.02 Definitions.

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

B. Terms Defined.

(1) “Commission” means the Maryland Higher Education Commission.

(2) “Director” means the Director of the Office.

(3) “Educational expenses” means:

(a) Tuition and mandatory fees; and

(b) Costs of room and board.

(4) “Eligible institution” means:

(1) A community college in the State;

(2) A public senior higher education institution in the State; or

(3) A private nonprofit institution of higher education in the State that:

(a) Is approved to operate by the Commission under Education Article, §11-202, Annotated Code of Maryland; or

(b) May operate without a Certificate of Approval from the Commission under Education Article, §11-202.1(a), Annotated Code of Maryland.

(5) Extenuating Circumstances.

(a) “Extenuating circumstances” means the occurrence of an extraordinary event or condition that prevents a recipient from fulfilling a scholarship requirement.

(b) “Extenuating circumstances” may include, but is not limited to:

(i) Disability or serious illness or injury of the student;

(ii) Pregnancy or adoption of a child;

(iii) Fulfillment of military service;

(iv) Extreme financial hardship of the student or the student’s immediate family; or

(v) Serious illness or injury or death of an immediate family member.

(6) “Family member” means son, daughter, stepson, stepdaughter, or spouse.

(7) “Full-time” means enrollment at an eligible institution in at least 12 credits per semester in an undergraduate program.

(8) “Office” means the Office of Student Financial Assistance within the Maryland Higher Education Commission.

(9) “Part-time” means enrollment at an eligible institution in at least 6, but fewer than 12, credits per semester in an undergraduate degree program.

(10) “Scholarship” means a Senator Douglas J.J. Peters Veterans of the Afghanistan and Iraq Conflicts Scholarship under this chapter.

(11) “Veteran” has the meaning stated in State Government Article, §9-901, Annotated Code of Maryland.

.03 Use and Amount of Award.

A. A scholarship may be used for educational expenses at any eligible institution.

B. The annual award may not exceed the amount of 50 percent of the equivalent annual tuition and mandatory fees and room and board of a resident undergraduate at a 4-year public institution of higher education within the University System of Maryland, other than the University of Maryland Global Campus and the University of Maryland, Baltimore, with the highest annual expenses for a full-time resident undergraduate.

C. If a recipient of a scholarship receives federal education benefits for which the recipient qualifies as a result of the individual’s military service, status as a dependent of a member of the armed forces, or status as a veteran of the armed forces, the amount of the federal education benefits received for the purposes of educational expenses shall be credited against the recipient’s educational expenses before the calculation of the scholarship award amount.

.04 Initial Awards—Eligibility.

A. Subject to the State budget, the Office annually shall determine individuals’ initial eligibility to receive a scholarship.

B. An applicant is eligible for a scholarship if the applicant is:

(1) A resident of Maryland;

(2) Accepted for admission or enrolled in an eligible institution in:

(a) An undergraduate degree program; or

(b) A 2-year lower division certificate program in which the coursework is acceptable for transfer credit toward a bachelor’s degree program at an eligible institution; and

(3) One of the following:

(a) A veteran or active duty member of the United States armed forces who served in:

(i) Afghanistan or contiguous air space, as defined in federal military regulations, on or after October 24, 2001, and before a terminal date prescribed by the United States Secretary of Defense; or

(ii) Iraq or contiguous waters or air space, as defined in federal military regulations, on or after March 19, 2003, and before a terminal date prescribed by the United States Secretary of Defense;

(b) A member of a reserve component of the United States armed forces or the Maryland National Guard who was activated as a result of the United States military conflict in:

(i) Afghanistan or contiguous air space, as defined in federal military regulations, on or after October 24, 2001, and before a terminal date prescribed by the United States Secretary of Defense; or

(ii) Iraq or contiguous waters or air space, as defined in federal military regulations, on or after March 19, 2003, and before a terminal date prescribed by the United States Secretary of Defense; or

(c) The son, daughter, stepson, stepdaughter, or spouse of an individual described in §B(3)(a) or (b) of this regulation.

.05 Initial Awards—Application Process.

A. To be considered for an initial scholarship award, an individual shall submit to the Office, no later than March 1:

(1) A complete Senator Douglas J.J. Peters Veterans of the Afghanistan and Iraq Conflicts Scholarship application form;

(2) All applicable documentation of military service and family relationship described in §§B and C of this regulation; and

(3) Any other documents requested by the Office.

B. Documentation of Military Service in Afghanistan or Iraq Conflicts.

(1) An active duty member of the United States armed forces or a family member of an active duty member of the United States armed forces shall submit a copy of the member’s official military orders.

(2) A veteran of the United States armed forces, a family member of a veteran of the United States armed forces, a member of a reserve component of the United States armed services or the Maryland National Guard, or a family member of a member of a reserve component of the United States armed services or the Maryland National Guard shall submit a copy of the veteran’s or member’s Certificate of Release or Discharge from Active Duty.

C. Documentation of Family Relationship.

(1) The son or daughter or an individual described in Regulation .04B(3)(a) or (b) of this chapter shall submit a copy of their birth certificate or proof of adoption.

(2) The spouse of an individual described in Regulation .04B(3)(a) or (b) of this chapter shall submit a copy of their marriage certificate.

(3) The stepson or stepdaughter of an individual described in Regulation .04B(3)(a) or (b) of this chapter shall submit:

(a) A copy of the marriage certificate of their parent and stepparent; and

(b) A copy of their birth certificate or proof of adoption.

D. An application form or any required documentation under §§B and C of this regulation that is received after March 1 may not be considered in the determination of award eligibility.

E. Additional Information or Documentation.

(1) The Office may request additional information or documentation, or a signed authorization for the release of information or documentation from a third party, before determining eligibility for the award.

(2) Any requested information, documentation, or signed authorization submitted after any deadline established by the Office will not be considered in the determination of award eligibility.

.06 Renewal Awards.

A. An initial scholarship award under this chapter may be renewed annually for a maximum of:

(1) Four renewal awards, if the student is enrolled full-time; or

(2) Eight renewal awards, if the student is enrolled part-time.

B. A student shall be eligible for a renewal award if the student:

(1) Continues to meet the requirements in Regulation .04B(1) and (2) of this chapter; and

(2) Except as set forth in §C of this regulation, has achieved and maintained a cumulative grade point average (GPA) of at least 2.5 on a 4.0 scale.

C. Waiver of GPA Requirement Based on Extenuating Circumstances.

(1) A student who has not achieved or maintained the required cumulative GPA shall be eligible to receive a renewal award if the student provides the Office with documentation of extenuating circumstances and the Office determines that the documentation provides sufficient evidence of the extenuating circumstances.

(2) No later than 30 days after receiving notice of ineligibility for a renewal award, a student requesting a waiver of the GPA requirement shall submit to the Office:

(a) A letter explaining the extenuating circumstances and why they prevented the student from achieving the required GPA;

(b) Any documentation of the occurrence of the extenuating circumstances;

(c) Any other relevant supporting information; and

(d) Any other documents requested by the Office.

(3) Waiver determinations made by the Office are final and not subject to additional review or appeal.

.07 Recipient Selection, Notification, and Acceptance.

A. If the number of eligible applicants for awards exceeds the amount of funds available, eligible applicants will be selected pursuant to §§B—D of this regulation.

B. Renewal Awards. Priority shall be given to applicants who are renewing an award under Regulation .06 of this chapter.

C. Veterans, Active Duty Military, and Reserve and National Guard Members.

(1) If funds remain after awards are made to students under §B of this regulation, priority shall be given to initial applicants who are eligible for a scholarship under Regulation .04B(3)(a) or (b) of this chapter.

(2) If the number of applicants under this section exceeds the amount of funds available, applicants shall be ranked by application completion date.

D. Family Members.

(1) If funds remain after awards are made to students under §§B and C of this regulation, awards shall be made to initial applicants who are eligible for a scholarship under Regulation .04B(3)(c) of this chapter.

(2) If the number of applicants under this section exceeds the amount of funds available, applicants shall be ranked by application completion date.

E. An eligible applicant who does not receive an award shall be notified and placed on a waiting list.

F. Notification and Acceptance of Award.

(1) Applicants who are selected for a scholarship shall be notified of an award offer in writing, which may include electronic mail.

(2) A recipient of an award offer who wishes to accept the award shall provide written notification to the Office, in the form prescribed by the Office, by the deadline established by the Office.

.08 Certification and Disbursement.

A. Annual awards shall be disbursed in two installments, one per semester.

B. Before disbursing an award, the Office may require an institution to certify, in the form and manner requested by the Office, that a recipient has met certain eligibility requirements for the award.

C. In addition to any certification required under §B of this regulation, before disbursement of a renewal award, an institution shall certify, in the form and manner requested by the Office, that a recipient maintained a cumulative GPA of at least 2.5 on a 4.0 scale.

D. An award will not be disbursed by the Office until all required certification is received.

E. An institution shall provide certification to the Office and request payment for all recipients on a semester basis, no later than:

(1) December 15, for the fall semester; and

(2) May 15, for the spring semester.

F. An institution that fails to timely certify and request payment for all recipients under §D of this regulation may not certify recipients for the subsequent semester until all prior semester awards have been certified and disbursed.

JAMES D. FIELDER, JR., Ph.D.
Secretary of Higher Education

Subtitle 08 FINANCIAL AID

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 Proposed Action

[22-328-P]

The Maryland Higher Education Commission proposes to amend Regulations .02—.13 under COMAR 13B.08.20 Cybersecurity Public Service Scholarship Program. This action was considered at an open meeting of the Commission held on September 29, 2022.

Statement of Purpose

The purpose of this action is to amend regulations relating to the Cybersecurity Public Service Scholarship Program to allow part-time students to be eligible for support from the Program, in addition to making changes regarding eligible employers for the mandatory service obligation. The amendments reflect those made in Ch. 209, Acts of 2022. Additionally, the amendments streamline the renewal process, limit the bases for deferment of the service obligation, and make stylistic and language changes to enhance clarity.

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 Geoff Newman, Assistant Secretary for Finance and Administration, Maryland Higher Education Commission, 6 N. Liberty St., 10th Fl., Baltimore, MD 21201, or call 410-767-3085, or email to geoff.newman@maryland.gov. Comments will be accepted through March 27, 2023. A public hearing has not been scheduled.

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)—(3) (text unchanged)

(4) “Education expenses” mean:

(a) Tuition and mandatory fees;

[(b) Mandatory fees;] and

[(c)] (b) (text unchanged)

(5) “Eligible institution” means: [a public or private nonprofit institution of higher education that operates in the State under Education Article, §§11-201 and 11-201.1, Annotated Code of Maryland.]

(a) A community college in the State;

(b) A public senior higher education institution in the State; or

(c) A private nonprofit institution of higher education in the State that:

(i) Is approved to operate by the Commission under Education Article, §11-202, Annotated Code of Maryland; or

(ii) May operate without a Certificate of Approval from the Commission under Education Article, §11-202.1(a), Annotated Code of Maryland.

(6) (text unchanged)

(7) “Full-time” means enrollment at an eligible institution in:

(a) At least 12 credits per semester in a certificate or undergraduate degree program at the time of certification of the Scholarship; or

(b) At least 9 credits per semester in a graduate certificate, graduate degree, or doctoral degree program at the time of certification of the Scholarship.

(8) “Local educational agency” has the meaning stated in 20 U.S.C. §7801(30).

[(8)] (9) (text unchanged)

(10) “Part-time” means enrollment at an eligible institution in:

(a) At least 6 credits, but fewer than 12 credits, per semester in an undergraduate certificate or degree program at the time of certification of the Scholarship; or

(b) At least 6 credits, but fewer than 9 credits, per semester in a graduate certificate or degree program at the time of certification of the Scholarship.

[(9)] (11)—[(10)] (12) (text unchanged)

.03 Student Eligibility.

A. (text unchanged)

B. An applicant is eligible for a scholarship if the applicant:

(1) Is enrolled full-time or part-time at an eligible institution in a cybersecurity program;

(2) Is:

(a) If enrolled full-time, within [2] 3 years of graduation from the cybersecurity program; or

(b) If enrolled part-time, within 6 years of graduation from the cybersecurity program;

(3)—(6) (text unchanged)

.04 Application Process.

A.—B. (text unchanged)

C. An applicant shall submit the following required documentation:

(1) (text unchanged)

(2) Proof from the eligible institution that the applicant is [2]:

(a) Enrolled full-time and is within 3 years from graduation in a cybersecurity program; or

(b) Enrolled part-time and is within 6 years from graduation in a cybersecurity program; and

(3) (text unchanged)

[D. For the 2018—2019 award year only, applicants shall apply and submit all required documentation to the Office by February 1, 2019.]

.05 Scholarship Renewal.

A. Subject to Regulation .06 of this chapter, [an applicant shall be eligible to renew] a scholarship shall be renewed for a subsequent year if the applicant[:] continues to meet the requirements of Regulation .03 of this chapter.

[(1) Timely submits an application under Regulation .04 of this chapter; and

(2) Continues to meet the requirements of Regulation .03 of this chapter.]

B. A recipient enrolled full-time may receive a scholarship for a maximum of [2] 3 years.

C. A recipient enrolled part-time may receive a scholarship for a maximum of 6 years.

.06 Amount of Scholarship.

A. An annual scholarship for a full-time student shall be in the amount prescribed by the Director, [which may not exceed the recipient’s education expenses] and shall be appropriately prorated by the Director for the part-time status of a recipient.

B. [Priority of Scholarship Awards. Priority for scholarships shall be given to prior year recipients who remain eligible under this chapter.] The amount of an annual scholarship may not exceed the recipient’s education expenses.

.07 Selection and Notification of Recipients.

A. Renewal Awards. Priority for scholarships shall be given to prior year recipients who remain eligible under Regulation .05 of this chapter.

[A.] B. [Eligible] If funds remain after awards are made to students under §A of this regulation, eligible applicants shall be ranked on the basis of cumulative grade point average.

[B.] C. Grades for credits earned for an applicant attending a public or private nonprofit institution [2] 3 years prior to graduation shall be used to calculate the cumulative grade point average.

[C.] D.—[F.] G. (text unchanged)

.08 Verification and Payment.

A. Verification. The Office shall verify that the applicant:

(1) (text unchanged)

(2) Is [2]:

(a) Enrolled full-time and is within 3 years from graduating in a cybersecurity program; or

(b) Enrolled part-time and is within 6 years from graduating in a cybersecurity program; and

(3) (text unchanged)

B. Payment. Eligible institutions shall certify on billing rosters provided by the Office that the recipient is:

(1)—(2) (text unchanged)

(3) Enrolled full-time or part-time in a cybersecurity program;

(4)—(5) (text unchanged)

.09 Scholarship Conditions and Service Requirement.

A.—B. (text unchanged)

C. As a precondition of receiving a scholarship, a recipient shall provide a promissory note and shall enter into a written agreement with the Commission, in the form and manner prescribed by the Office, requiring the recipient to:

(1) Earn credit as a full-time or part-time student;

(2)—(3) (text unchanged)

D. Service Obligation. [For each year] Except as set forth in §§E and F of this regulation, for each semester that the recipient receives a scholarship, the recipient shall:

(1) Maintain full-time employment in the State for at least [1 year in a unit of State government] 6 months in the cybersecurity field for a:

(a) Local educational agency;

(b) Public high school;

(c) Community college; or

(d) A unit of State government, county government, or city or municipal government; or

(2) Teach full-time in the State for at least 1 [year] semester in [a public high school in] an education program that is directly relevant to cybersecurity[.], in:

(a) A public high school; or

(b) A community college.

E. The work obligation for a part-time student shall equal the amount of time needed for an equivalent full-time student to complete the obligation in §D of this regulation.

F. The work obligation for a part-time student may not exceed 3 years.

.10 [Conversion of Scholarship to Loan] Failure to Meet Conditions of Scholarship.

A.—E. (text unchanged)

.11 Deferment of the Service Obligation and Repayment.

A. (text unchanged)

B. A recipient may request that the service obligation be deferred during the time the recipient is:

(1) Enrolled full-time [(12 or more credits per semester) or part-time (6—11 credits per semester)] in a matriculated program of study, as an undergraduate student taking 12 or more credits per semester or a graduate student taking 9 or more credits per semester, in a course of study that would further their career in cybersecurity, at any [post-secondary] institution of higher education in the State;

(2)—(4) (text unchanged)

(5) Assigned military duty outside of the State, not to exceed [3] 4 years[, without filing an appeal]; or

(6) Married to a spouse assigned military duty outside of the State, not to exceed [3] 4 years[, without filing an appeal].

C.—E. (text unchanged)

[F. The Office shall, on a case-by-case basis, review appeals from individuals assigned military duty outside the State, and from spouses of individuals assigned military duty outside the State, that exceed the 3-year deferral limit. Appeals shall be in writing and include a copy of the military orders, and the Director shall determine if an appeal is granted.]

.12 Waiver of the Service Obligation and Repayment.

[The Office shall waive a recipient's service and repayment obligations if it determines:]

A. [On] The Office shall waive a recipient's service and repayment obligations if it determines, on the basis of a sworn affidavit of 2 qualified physicians, that the recipient is permanently unable to fulfill the service obligation, on a full-time or part-time basis, because of a permanent impairment[; or].

B. [On] The Office shall waive a recipient's service and repayment obligations if it determines, on the basis of a death certificate or other evidence of death that is conclusive under State law, that the recipient has died.

.13 Determinations of the Office.

Decisions of the Office under this chapter regarding [whether to grant an award or whether to grant an appeal] award eligibility, recipient selection, and deferment or waiver of the service obligation are final and not subject to additional review.

JAMES D. FIELDER, JR., Ph.D.
Secretary of Higher Education

Title 31
MARYLAND INSURANCE ADMINISTRATION

Subtitle 10 HEALTH INSURANCE—GENERAL

31.10.44 Network Adequacy

Authority: Insurance Article, §§2-109(a)(1) and 15-112(a)—(d), Annotated Code of Maryland

Notice of Proposed Action

[22-368-P]

The Insurance Commissioner proposes to amend Regulation .02, adopt new Regulations .03 and .08, and amend and recodify existing Regulations .03—.06 and .07—.09 to be Regulations .04—.07 and .09—.11 under COMAR 31.10.44 Network Adequacy.

Statement of Purpose

The purpose of this action is to improve the Maryland Insurance Commissioner’s ability to evaluate the sufficiency of carrier health care provider networks under Maryland health benefit plans, in accordance with Insurance Article, §15-112, Annotated Code of Maryland. This action establishes uniform methodologies for measuring the existing network adequacy standards, incorporates new standards to enhance measurement of the sufficiency of behavioral health care networks, and makes other changes determined to be necessary based on the reviews of network access plans filed by carriers under the existing regulations.

Estimate of Economic Impact

I. Summary of Economic Impact. The cost to insurance carriers will increase in order to meet these new requirements. The regulation imposes specific data collection and reporting requirements on carriers, and standardizes the methodology for measuring certain quantitative criteria to evaluate network sufficiency. Some of the required data elements are already tracked by carriers, and some of the required methodologies are based on current industry standards, but to the extent carriers need to modify their systems or procedures to report the required information and utilize the required methodology from the regulations, there may be additional costs.

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:
Insurance carriers	(-)	Unknown
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 some of the required data elements are not already tracked by carriers, and that carriers need to modify their systems or procedures to report the required information and utilize the required methodology from the regulations, there may be additional costs

Economic Impact on Small Businesses

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

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

Comments may be sent to Lisa Larson, Director of Hearings, Maryland Insurance Administration, 200 St. Paul Place, Suite 2700, Baltimore, Maryland 21202, or call 410-468-2007, or email to insuranceregreview.mia@maryland.gov. Comments will be accepted through March 27, 2023. A public hearing has not been scheduled.

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1) (text unchanged)

(2) “Ambulatory infusion therapy center” means any location authorized to administer chemotherapy or infusion services on an outpatient basis.

[(2)] (3) — [(4)] (5) (text unchanged)

(6) “Continuing care patient” means an individual who, with respect to a provider or facility:

(a) Is undergoing a course of treatment for a serious and complex condition from the provider or facility;

(b) Is undergoing a course of institutional or inpatient care from the provider or facility;

(c) Is scheduled to undergo nonelective surgery from the provider or facility, including receipt of postoperative care from such provider or facility with respect to such a surgery;

(d) Is pregnant and undergoing a course of treatment for the pregnancy from the provider or facility; or

(e) Is or was determined to be terminally ill, as determined under Section 1861(dd)(3)(A) of the Social Security Act, and is receiving treatment for such illness from such provider or facility.

[(5)] (7) “Enrollee” means a person entitled to health care benefits from a carrier under a policy or contract subject to Maryland law.

[(6)] (8) “Essential community provider” means a provider that serves predominantly low-income or medically underserved individuals. “Essential community provider” includes:

(a) (text unchanged)

(b) Outpatient [behavioral] mental health and community based substance use disorder programs; [and]

(c) Any entity listed in 45 CFR §156.235(c)[.];and

(d) School-based health centers.

[(7)] (9) — [(12)] (14) (text unchanged)

(15) “Hospital-based physician” has the meaning stated in Insurance Article, §14-201, Annotated Code of Maryland.

[(13)] (16) — [(14)] (17) (text unchanged)

[(15)] (18) “Network adequacy waiver [request]” means [a written request from a carrier to the Commissioner wherein the carrier seeks] the Commissioner’s [approval to be relieved] decision to relieve a carrier of the obligation to comply with certain network adequacy standards in this chapter for 1 year.

(19) “On-call physician” has the meaning stated in Insurance Article, §14-201, Annotated Code of Maryland.

(20) “Opioid treatment services provider” means a program with a valid and current accreditation-based license under COMAR 10.63 to provide community-based behavioral health services, and authorized to provide opioid treatment services.

[(16)] (21) — [(17)] (22) (text unchanged)

[(18)] (23) “Primary care [physician] provider” means:

(a) A [physician] provider who is responsible for:

(i)—(iii) (text unchanged)

(b) “Primary care [physician] provider” includes:

(i)—(ii) (text unchanged)

[(19)] (24) — [(20)] (25) (text unchanged)

(26) “Residential crisis services” has the meaning stated in Insurance Article, §15-840, Annotated Code of Maryland.

(27) “Road travel distance” means:

(a) Actual driving distance measured between two geographic locations based on turn-by-turn directions along public roads; or

(b) Subject to approval by the Commissioner, driving distance between two geographic locations estimated using a methodology that, in the discretion of the Commissioner, sufficiently accounts for significant geographic barriers that are impassable by automobile, such as the Chesapeake Bay.

[(21] (28) (text unchanged)

(29) “School-based health center” means a community health resource described in Health-General Article, §19-2101, Annotated Code of Maryland that is located within an elementary, middle, or high school and approved by the Maryland Department of Health.

[(22)] (30) — [(23)] (31) (text unchanged)

[(24)] (32) “Telehealth” [means:

(a) As it relates to the delivery of health care services, the use of interactive audio, video, or other telecommunications or electronic technology by a provider to deliver a health care service within the scope of practice of the provider at a location other than the location of the patient.

(b) “Telehealth” does not include:

(i) An audio-only telephone conversation between a provider and a patient;

(ii) An electronic mail message between a provider and a patient; or

(iii) A facsimile transmission between a provider and a patient.] has the meaning stated in Insurance Article, §15-139, Annotated Code of Maryland.,

[(25)] (33) — [(26)] (34) (text unchanged)

[(27)] (35) “Waiting time” means the time from the initial request for health care services by an enrollee or by the enrollee’s treating provider to the earliest date offered for the appointment for services with a provider possessing the appropriate skill and expertise to treat the condition.

.03 Network Adequacy Standards.

A. Sufficiency Standards.

(1) A carrier shall develop and maintain a network of providers in sufficient numbers, geographic locations, and practicing specialties to ensure enrollees have access to participating providers for the full scope of benefits and services covered under the carrier’s health benefit plan.

(2) A carrier shall establish written policies and procedures to implement a process for addressing network deficiencies that result in an enrollee lacking access to any providers with the professional training and expertise necessary to deliver a covered service without unreasonable travel or delay.

(3) A carrier shall clearly define and specify referral requirements, if any, to specialty and other providers.

(4) A carrier shall take reasonable steps to ensure that participating providers provide physical access, reasonable accommodations, and accessible equipment for enrollees with physical or mental disabilities.

(5) A carrier’s written policies and procedures to monitor availability of services shall include how the carrier will monitor the availability of services for:

(a) Continuing care patients;

(b) Individuals with physical or mental disabilities, including individuals who have disabilities that limit their physical ability to access services; and

(c) Individuals with limited English proficiency, including diverse cultural and ethnic backgrounds.

(6) A carrier shall take reasonable steps to ensure services are delivered in a culturally competent manner to all enrollees, including enrollees:

(a) With limited English proficiency;

(b) With diverse cultural, racial, and ethnic backgrounds; and

(c) Of all genders, sexual orientations, and gender identities.

(7) A carrier must have the ability to identify, by county and for the City of Baltimore, the number of participating providers for each facility type listed in the charts in Regulation .05A(5) and B(5) of this chapter and each provider type code and specialty code listed on the uniform credentialing form described in Insurance Article, §15-112.1, Annotated Code of Maryland.

(8) The identification of the number of participating providers described in §A(7) of this regulation:

(a) Shall include all participating providers who reported a specific provider type or specialty code when completing the uniform credentialing form described in Insurance Article, §15-112.1, Annotated Code of Maryland; and

(b) May include additional participating providers identified by the carrier through other documented means.

(9) A carrier shall retain copies of its policies and procedures required by this chapter for a period of 3 years following the date the policies and procedures were last effective.

(10) At the request of the Commissioner, a carrier shall file with the Commissioner a copy of its current and retained past policies and procedures required by this chapter. A carrier may request a finding by the Commissioner that its policies and procedures are considered confidential commercial information.

B. Monitoring Sufficiency Standards.

(1) A carrier shall continuously monitor its provider network for compliance with this chapter and shall conduct internal compliance audits for the standards listed in Regulations .05, .06, and .07 of this chapter on at least a quarterly basis; and

(2) A carrier shall continuously verify and update its network directory consistent with Insurance Article, §15-112, Annotated Code of Maryland and §2799A-5of the Public Health Service Act, enacted by 116 of the federal No Surprises Act.

[.03] .04 Filing and Content of Access Plan.

A. Using the instructions on the Maryland Insurance Administration's website for submission method and to determine rural, suburban, and urban zip code areas, each carrier subject to this chapter shall file an annual access plan with the Commissioner [through the System for Electronic Rate and Form Filing (SERFF)] on or before July 1 of each year for each provider panel used by the carrier, with the first access plan filing due on or before July 1, 2018.

B. (text unchanged)

C. Each annual access plan filed with the Commissioner shall include the following information in the standardized format described on the Maryland Insurance Administration’s website:

(1) An executive summary in the form set forth in Regulation [.09] .11 of this chapter;

(2) (text unchanged)

(3) A description of out-of-network claims received by the carrier in the prior calendar year, which shall include:

(a) The percentage of total claims received that are out-of-network claims;

(b) The percentage of out-of-network claims received that are paid;

(c) The percentage of claims described in §C(3)(a) and (b) of this regulation that the carrier identifies as claims for emergency services, on-call physicians, or hospital-based physicians;

(d) The percentage of total claims received that are out-of-network claims for:

(i) Subject to §G of this regulation, all enrollees with a residence in a zip code where less than 100 percent of enrollees have access to a provider within the applicable travel distance standard in Regulation .05 of this chapter for the provider type in the claim, listed by provider type for each of the rural, suburban, and urban areas;

(ii) Subject to §G of this regulation, the ten provider types with the highest number of out-of-network claims for enrollees with a residence in each of the rural, suburban, and urban areas, listed by provider type and geographic area; and

(iii) Subject to §G of this regulation, the ten provider types with the highest percentage of total claims that are out-of-network claims for enrollees with a residence in each of the rural, suburban, and urban areas, listed by provider type and geographic area;

(e) For each provider type and geographic area described in §C(3)(d) of this regulation, the following information regarding requests to obtain a referral to an out-of-network provider in accordance with Insurance Article, §15-830, Annotated Code of Maryland:

(i) The number of referral requests received;

(ii) The number of referral requests granted;

(iii) The percentage of out-of-network claims received for which a referral was requested;

(iv) The percentage of out-of-network claims received for which a referral was granted;

(v) The number of single case agreements requested between the carrier and an out-of-network provider;

(vi) The number of single case agreements entered between the carrier and an out-of-network provider;

(vii) The percentage of out-of-network claims received for which a single case agreement was requested between the carrier and an out-of-network provider; and

(viii) The percentage of out-of-network claims received for which a single case agreement was entered between the carrier and an out-of-network provider; and

(f) Any additional information deemed necessary by the carrier to provide context for the information described in §C(3)(a)—(e) of this regulation;

(4) A description of complaints received by the carrier in the prior calendar year relating to access to or availability of providers, which shall include:

(a) The total number of complaints made by enrollees relating to the waiting time or distance of participating providers;

(b) The total number of complaints made by providers, whether or not under contract, relating to the waiting time or distance of participating providers;

(c) The total number of complaints relating to the accuracy of the network directory;

(d) The total number of complaints relating to the dollar amount of reimbursement for out-of-network claims, including balance billing; and

(e) The percentage of complaints described in §C(4)(d) of this regulation that are for claims subject to the federal No Surprises Act;

(5) A description of the carrier’s procedures, including training of customer service representatives, detailing how claims will be handled when participating providers are not available and an enrollee obtains health care services pursuant to Insurance Article, §15-830, Annotated Code of Maryland;

(6) A description of the procedures that the carrier will utilize to assist enrollees in obtaining medically necessary services when no participating provider is available without unreasonable travel or delay, including procedures to coordinate care and to limit the likelihood of costs to the enrollee that exceed the amount that would have been incurred had the health care services been provided by a participating provider;

(7) A description of whether the carrier’s provider contracts require health care providers to engage in appointment management, including procedures related to:

(a) No show policies;

(b) Patient appointment confirmation;

(c) Same day appointment slotting;

(d) Patient portals;

(e) Access to a provider performance dashboard to monitor appointment lag time, no show rate, bump rate (health care provider initiated cancelation of a scheduled appointment), and new patient appointments; and

(f) Weekly polling programs of providers to check for appointment availability;

(8) An indication of whether the network directory is searchable by covered benefit, for example, hearing aid, knee surgery, or physical therapist;

(9) An indication of whether the carrier has a patient portal for enrollees to make health care appointments;

(10) A description of whether the carrier has a formal process for assisting enrollees who have been unsuccessful in using the network directory to locate an appropriate provider with the necessary skill and expertise to treat the enrollee’s condition;

(11) A description of whether and how the carrier considered the role of public transportation in addressing the needs of enrollees who do not own a personal automobile when evaluating enrollees’ access to care under the travel distance standards described in Regulation .05 of this chapter;

(12) A description of telehealth utilization as described in Regulation .08 of this chapter;

[(3)] (13) Documentation justifying to the Commissioner how the access plan meets each network sufficiency standard set forth in Regulations [.04] .05 — [.06] .07 of this chapter; and

[(4)] (14) (text unchanged)

D. The Commissioner may require a carrier to include in the annual access plan a report of the number of participating providers described in Regulation .03A(7) of this chapter for designated facility types, provider type codes, and specialty codes, if the Commissioner notifies the carrier in writing and identifies the particular facility types, provider type codes, and specialty codes that must be reported.

E. The description required by Insurance Article, §15-112(c)(4)(iii), Annotated Code of Maryland shall identify whether the carrier has:

(1) Engaged in outreach to minority health care providers; and

(2) Offered financial incentives, such as payment towards loans previously incurred for health care provider education, to encourage health care providers to contract with the carrier.

F. The description required by Insurance Article, §15-112(c)(4)(iv), Annotated Code of Maryland shall include:

(1) The number of primary care providers who report to the carrier that they use any of the following languages in their practices:

(a) American Sign Language;

(b) Spanish;

(c) Korean;

(d) Chinese (Mandarin or Cantonese);

(e) Tagalog; or

(f) French;

(2) A description of outreach efforts to recruit and retain providers from diverse cultural, racial, or ethnic backgrounds;

(3) A copy of the most recent enrollees’ language needs assessment made by or on behalf of the carrier, if one was made;

(4) A copy of the most recent demographic profile of the enrollee population made by or on behalf of the carrier, if one was made;

(5) A copy of any analysis or assessment made of provider network requirements based on an assessment of language needs or demographic profile of the enrollee population;

(6) A copy of any provider manual provisions that describe requirements for access to individuals with physical or mental disabilities; and

(7) Copies of policies and procedures designed to ensure that the provider network is sufficient to address the needs of both adult and child enrollees, including adults and children with:

(a) Limited English proficiency or illiteracy;

(b) Diverse cultural, racial, or ethnic backgrounds;

(c) Physical or mental disabilities; and

(d) Serious, chronic, or complex health conditions.

G. For a group model HMO plan, when an enrollee’s place of employment is used instead of residence to calculate travel distance under Regulation .05B of this chapter, the data described in §C(3) of this regulation that is based on enrollee residence shall be reported based on the enrollee’s place of employment.

H. The requirements found in §§C(3)—(12) and D— G of this regulation shall apply to annual access plans submitted on or after July 1, 2024.

[.04] .05 Travel Distance Standards.

A. Sufficiency Standards.

(1) Standard and Methodology.

[(1)] (a) Except as stated in §B of this regulation, each provider panel of a carrier shall have within the geographic area served by the carrier’s network or networks, sufficient primary care [physicians] providers, specialty providers, [behavioral] mental health and substance use disorder providers, hospitals, and health care facilities to meet the maximum travel distance standards listed in the chart in §A(5) of this regulation for each type of geographic area.

(b) The distances listed in §A(5) of this regulation shall be:

(i) [measured] Measured from the enrollee’s place of residence to the practicing location of the provider or facility[.]; and

(ii) Calculated based on road travel distance.

(c) Except for those provider types excluded under §A(3) of this regulation, for each provider type and facility type included on the carrier’s provider panel, the carrier shall:

(i) Map the residences of all Maryland enrollees covered under health benefit plans that use the provider panel;

(ii) Calculate the road travel distance for each enrollee to the provider or facility with the closest practicing location;

(iii) For each zip code, identify the total number of enrollees residing in the zip code and the number of enrollees residing within an area where the applicable distance standard is not met;

(iv) For each zip code, calculate the percentage of enrollees residing within an area where the applicable distance standard is met;

(v) For each zip code that includes enrollees for whom the applicable travel distance standard is not met, calculate the average distance to the closest provider or facility for all enrollees residing in the zip code;

(vi) For each of the urban, rural, and suburban areas identify the total number of enrollees residing in the geographic area;

(vii) For each of the urban, rural, and suburban areas identify the total number of enrollees residing within an area where the applicable distance standard is not met; and

(viii) For each of the urban, rural, and suburban areas identify the percentage of enrollees residing within an area where the applicable distance standard is met.

(d) Instead of independently calculating the road travel distance for each enrollee as described in §A(1)(c)(i) and (ii) of this regulation, a carrier may use a methodology that:

(i) Maps the practicing locations of every participating provider within the geographic area served by the carrier’s network or networks;

(ii) Identifies any geographic areas within each Maryland zip code that fall outside of the applicable distance standard based on road travel distance from the provider locations; and

(iii) Enables the carrier to accurately identify the information and perform the calculations described in §A(1)(c)(iii)-(viii) of this regulation.

(e) A carrier shall submit, as part of its documentation justifying to the Commissioner how the access plan meets the network sufficiency standards in this regulation:

(i) Geo-access maps for each provider type and facility type except for those excluded under §A(3) of this regulation showing the practicing locations of participating providers, and identifying either the geographic areas within each zip code where the applicable distance standard is not met, or the locations of enrollees with a residence outside the applicable distance standard;

(ii) For any facility types listed in §A(5) of this regulation that provide services for substance use disorders, the percentage of facilities on the carrier’s provider panel that provide adolescent services; and

(iii) For any facility types listed in §A(5) of this regulation that provide services for substance use disorders, the percentage of facilities on the carrier’s provider panel that provide services for alcohol treatment only, drug abuse treatment only, and alcohol and drug abuse treatment.

(f) A carrier shall report each number and percentage described in §A(1)(c)(iii)—(viii) of this regulation as part of the annual access plan filing.

(2)—(3) (text unchanged)

(4) All other providers and facility types included on the carrier’s provider panel but not listed in the chart in §A(5) of this regulation, including physical therapists and licensed dietitian-nutritionist, shall individually be required to meet maximum distances standards of 15 miles for Urban Areas, 40 miles for Suburban Areas, and 90 miles for Rural Areas.

(5) Chart of Travel Distance Standards.

	Urban Area Maximum Distance (miles)	Suburban Area Maximum Distance (miles)	Rural Area Maximum Distance (miles)
Provider Type:
Addiction Medicine	10	25	60
Allergy and Immunology	15	30	75
Applied Behavioral Analyst	15	30	60
Cardiovascular Disease	10	20	60
Chiropractic	15	30	75
Dermatology	10	30	60
Endocrinology	15	40	90
ENT/Otolaryngology	15	30	75
Gastroenterology	10	30	60
General Surgery	10	20	60
Gynecology, OB/GYN, Nurse-Midwifery/Certified Midwifery	5	10	30
[Gynecology Only	15	30	75]
Licensed Clinical Social Worker	10	25	60
Licensed Professional Counselor	10	25	60
Nephrology	15	25	75
Neurology	10	30	60
Oncology-Medical and Surgical	10	20	60
Oncology-Radiation/Radiation Oncology	15	40	90
Ophthalmology	10	20	60
Pediatrics-Routine/Primary Care	5	10	30
Physiatry, Rehabilitative Medicine	15	30	75
Plastic Surgery	15	40	90
Podiatry	10	30	60
Primary Care [Physician] (non-pediatric)	5	10	30
Psychiatry-Adolescent and Child, Outpatient	10	25	60
Psychiatry-Geriatric, Outpatient	10	25	60
Psychiatry-Outpatient	10	25	60
Psychology	10	25	60
Pulmonology	10	30	60
Rheumatology	15	40	90
Urology	10	30	60
All Other licensed or certified providers under contract with a carrier not listed	15	40	90
Facility Type:
Acute Inpatient Hospitals	10	30	60
Ambulatory Infusion Therapy Centers	10	30	60
Critical Care Services — Intensive Care Units	10	30	100
Diagnostic Radiology	10	30	60
Inpatient Psychiatric Facility	15	45	75
Opioid Treatment Services Provider	15	25	60
Outpatient Dialysis	10	30	50
[Outpatient Infusion/Chemotherapy	10	30	60]
Outpatient Mental Health Clinic	15	30	60
Outpatient Substance Use Disorder Facility	15	30	60
Pharmacy	5	10	30
Residential Crisis Services	10	30	60
Skilled Nursing Facilities	10	30	60
Substance Use Disorder Residential Treatment Facility	10	25	60
Surgical Services (Outpatient or Ambulatory Surgical Center)	10	30	60
[Other Behavioral Health/Substance Abuse Facilities	10	25	60]
All other licensed or certified facilities under contract with a carrier not listed	15	40	90

B. Group Model HMO Plans Sufficiency Standards.

(1) Standard and Methodology.

[(1)] (a) Each group model HMO’s health benefit plan’s provider panel shall have within the geographic area served by the group model HMO’s network or networks, sufficient primary care [physicians] providers, specialty providers, [behavioral] mental health and substance use disorder providers, hospitals, and health care facilities to meet the maximum travel distance standards listed in the chart in §B(5) of this regulation for each type geographic area.

(b) The distances listed in §B(5) of this regulation shall be:

(i)[measured] Measured from the enrollee’s place of residence or, at the option of the carrier, place of employment from which the enrollee gains eligibility for participation in the group model HMO’s health benefit plan to the practicing location of the provider or facility[.]; and

(ii) Calculated based on road travel distance.

(c) Except for those provider types excluded §B(3) of this regulation, for each provider type and facility type included on the group model HMO’s provider panel, the carrier shall:

(i) Map the residences or places of employment of all Maryland enrollees covered under health benefit plans that use the provider panel;

(ii) Calculate the road travel distance for each enrollee to the provider or facility with the closest practicing location;

(iii) For each zip code identify the total number of enrollees with a residence or place of employment in the zip code and the number of enrollees with a residence or a place of employment within an area where the applicable distance standard is not met;

(iv) For each zip code calculate the percentage of enrollees with a residence or place of employment within an area where the applicable distance standard is met;

(v) For each zip code that includes enrollees for whom the applicable travel distance standard is not met, calculate the average distance to the closest provider or facility for all enrollees with a residence or place of employment within the zip code;

(vi) For each of the urban, rural, and suburban areas identify the total number of enrollees with a residence or place of employment in the geographic area;

(vii) For each of the urban, rural, and suburban areas identify the number of enrollees with a residence or place of employment within an area where the applicable distance standard is not met; and

(viii) For each of the urban, rural, and suburban areas identify the percentage of enrollees with a residence or place of employment within an area where the applicable distance standard is met.

(d) Instead of independently calculating the road travel distance for each enrollee as described in §B(1)(c)(i) and (ii) of this regulation, a carrier may use a methodology that:

(i) Maps the practicing locations of every participating provider within the geographic area served by the group model HMO’s network or networks;

(ii) Identifies any geographic areas within each Maryland zip code that fall outside of the applicable distance standard based on road travel distance from the provider locations; and

(iii) Enables the carrier to accurately identify the information and perform the calculations described in §B(1)(c)(iii)—(viii) of this regulation.

(e) When calculating the number or percentage of enrollees with a place of employment within an area or zip code under §B(1)(c)(iii)—(viii) of this regulation, the carrier shall include only those enrollees who gain eligibility for participation in the group model HMO’s health benefit plan from their place of employment.

(f) A carrier shall submit, as part of its documentation justifying to the Commissioner how the access plan meets the network sufficiency standards in this regulation:

(i) Geo-access maps for each provider type and facility type except for those excluded under §B(3) of this regulation showing the practicing locations of participating providers, and identifying either the geographic areas within each zip code where the applicable distance standard is not met, or the locations of enrollees with a residence or place of employment outside the applicable distance standard;

(ii) For any facility types listed in §B(5) of this regulation that provide services for substance use disorders, the percentage of facilities on the carrier’s provider panel that provide adolescent services; and

(iii) For any facility types listed in §B(5) of this regulation that provide services for substance use disorders, the percentage of facilities on the carrier’s provider panel that provide services for alcohol treatment only, drug abuse treatment only, and alcohol and drug abuse treatment.

(g) A carrier shall report each number and percentage described in §B(1)(c)(iii)—(viii) of this regulation as part of the annual access plan filing.

(2)—(3) (text unchanged)

(4) All other provider and facility types included on the carrier’s provider panel, but not listed in the chart at §B(5) of this regulation, including physical therapists and licensed dietitian-nutritionist, shall individually be required to meet maximum distances standards of [15] 20 miles for Urban Areas, 40 miles for Suburban Areas, and 90 miles for Rural Areas.

(5) Chart of Travel Distance Standards.

	Urban Area Maximum Distance (miles)	Suburban Area Maximum Distance (miles)	Rural Area Maximum Distance (miles)
Provider Type:
Addiction Medicine	15	30	75
Allergy and Immunology	20	30	75
Applied Behavioral Analyst	15	20	60
Cardiovascular Disease	15	25	60
Chiropractic	20	30	75
Dermatology	20	30	60
Endocrinology	20	40	90
ENT/Otolaryngology	20	30	75
Gastroenterology	20	30	60
General Surgery	20	30	60
Gynecology, OB/GYN, Nurse-Midwifery/Certified Midwifery	15	20	45
[Gynecology Only	15	30	60]
Licensed Clinical Social Worker	15	30	75
Licensed Professional Counselor	15	30	75
Nephrology	15	30	75
Neurology	15	30	60
Oncology-Medical, Surgical	15	30	60
Oncology-Radiation/Radiation Oncology	15	40	90
Ophthalmology	15	20	60
Pediatrics-Routine/Primary Care	15	20	45
Physiatry, Rehabilitative Medicine	15	30	75
Plastic Surgery	15	40	90
Podiatry	15	30	90
Primary Care [Physician] (non-pediatric)	15	20	45
Psychiatry-Adolescent and Child, Outpatient	15	30	60
Psychiatry-Geriatric, Outpatient	15