Maryland Register

Issue Date: February 23, 2024

Volume 51 • Issue 4 • Pages 193 — 220

IN THIS ISSUE

Judiciary

Regulatory Review and Evaluation

Regulations

Special Documents

General Notices

Pursuant to State Government Article, §7-206, Annotated Code of Maryland, this issue contains all previously unpublished documents required to be published, and filed on or before February 5, 2024 5 p.m.

Pursuant to State Government Article, §7-206, Annotated Code of Maryland, I hereby certify that this issue contains all documents required to be codified as of February 5, 2024.

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, Maryland21401. 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 ................................................................ 196

COMAR Research Aids

Table of Pending Proposals ....................................................... 197

Index of COMAR Titles Affected in This Issue

COMAR Title Number and Name Page

08 Department of Natural Resources ................................... 202

09 Maryland Department of Labor ...................................... 202

10 Maryland Department of Health ..................................... 203

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 ................................ 200

Regulatory Review and Evaluation

DEPARTMENT OF TRANSPORTATION

Notice of Opportunity for Comment 201

Final Action on Regulations

08 DEPARTMENT OF NATURAL RESOURCES

BOATING—SPEED LIMITS AND OPERATION OF VESSELS

Ocean City—Back Bay Areas .............................................. 202

09 MARYLAND DEPARTMENT OF LABOR

STATE BOARD OF HEATING, VENTILATION, AIR-
CONDITIONING, AND REFRIGERATION
CONTRACTORS

General Regulations . 202

BOARD OF PLUMBING

Fees . 202

Proposed Action on Regulations

10 MARYLAND DEPARTMENT OF HEALTH

MEDICAL CARE PROGRAMS

General Medical Assistance Provider Participation
Criteria . 203

Home and Community-Based Services Waiver for Individuals
with Brain Injury ............................................................... 204

Targeted Case Management for People with Developmental
Disabilities . 205

Early and Periodic Screening, Diagnosis, and Treatment:
Nursing Services for Individuals Younger than 21 Years
Old . 206

Home and Community-Based Services Waiver for Children
with Autism Spectrum Disorder 207

Maryland Medicaid Managed Care Program: Rare and
Expensive Case Management 209

1915(i) Intensive Behavioral Health Services for Children,
Youth, and Families .......................................................... 210

DANGEROUS DEVICES AND SUBSTANCES

Controlled Dangerous Substances 211

Special Documents

DEPARTMENT OF THE ENVIRONMENT

SUSQUEHANNA RIVER BASIN COMMISSION

Commission Meeting . 219

WATER AND SCIENCE ADMINISTRATION

Water Quality Certification 23-WQC-0030 . 219

General Notices

STATE COLLECTION AGENCY LICENSING BOARD

Public Meeting . 220

MARYLAND DEPARTMENT OF HEALTH

Public Meeting .................................................................... 220

MARYLAND DEPARTMENT OF HEALTH/HARM
REDUCTION STANDING ADVISORY COMMITTEE

Public Meeting . 220

BOARD OF PUBLIC ACCOUNTANCY

Public Meeting . 220

Public Hearing . 220

STATE ADVISORY COUNCIL ON QUALITY CARE AT
THE END OF LIFE

Public Meeting .................................................................... 220

BOARD OF WATERWORKS AND WASTE SYSTEMS
OPERATORS

Public Meeting . 220

COMAR Online

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

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

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

Availability of Monthly List of
Maryland Documents

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

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

CLOSING DATES AND ISSUE DATES THROUGH
DECEMBER 2024^†

Issue Date	Emergency and Proposed Regulations 5 p.m.*	Notices, etc. 10:30 a.m.	Final Regulations 10:30 a.m.
2024
March 8	February 16**	February 26	February 28
March 22	March 4	March 11	March 13
April 5	March 18	March 25	March 27
April 19	April 1	April 8	April 10
May 3	April 15	April 22	April 24
May 17	April 29	May 6	May 8
May 31	May 13	May 20	May 22
June 14	May 24**	June 3	June 5
June 28	June 10	June 17	June 18**
July 12	June 24	July 1	July 3
July 26	July 8	July 15	July 17
August 9	July 22	July 29	July 31
August 23	August 5	August 12	August 14
September 6	August 19	August 26	August 28
September 20	August 30**	September 9	September 11
October 4	September 16	September 23	September 25
October 18	September 30	October 7	October 9
November 1	October 11**	October 21	October 23
November 15	October 28	November 4	November 6
December 2***	November 8**	November 18	November 20
December 13	November 25	December 2	December 4
December 27	December 9	December 16	December 18

^† Please note that this table is provided for planning purposes and that the Division of State Documents (DSD) cannot guarantee submissions will be published in an agency’s desired issue. Although DSD strives to publish according to the schedule above, there may be times when workload pressures prevent adherence to it.

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

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

** Note closing date changes.

*** Note issue date changes.

The regular closing date for Proposals and Emergencies is Monday.

Cumulative Table of COMAR Regulations
Adopted, Amended, or Repealed

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

Table of Pending Proposals

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

05 DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT

05.03.09.01—.11 • 50:7 Md. R. 304 (4-7-23)

05.20.05.01—.09 • 51:3 Md. R. 156 (2-9-24)

08 DEPARTMENT OF NATURAL RESOURCES

08.02.03.01,.10,.12—.14 • 51:1 Md. R. 17 (1-12-24)

08.02.03.07 • 51:1 Md. R. 20 (1-12-24)

08.02.04.04 • 51:1 Md. R. 27 (1-12-24)

08.02.05.07 • 51:1 Md. R. 29 (1-12-24)

08.02.15.04,.05,.07 • 50:20 Md. R. 904 (10-6-23)

08.02.23.04 • 51:1 Md. R. 27 (1-12-24)

08.02.26.01—.06 • 51:1 Md. R. 30 (1-12-24)

09 MARYLAND DEPARTMENT OF LABOR

09.08.01.18 • 50:25 Md. R. 1093 (12-15-23)

09.08.07.02 • 50:25 Md. R. 1093 (12-15-23)

09.09.01.03 • 51:1 Md. R. 32 (1-12-24)

09.10.02.43,.53 • 50:24 Md. R. 1046 (12-1-23)

09.11.09.02 • 50:26 Md. R. 1135 (12-29-23)

09.13.05.03 • 50:26 Md. R. 1136 (12-29-23)

09.14.02.01,.02,.06-1,.06-2 • 50:25 Md. R. 1094 (12-15-23)

09.14.07.03,.05 • 50:25 Md. R. 1094 (12-15-23)

09.15.01.03 • 50:25 Md. R. 1094 (12-15-23)

09.16.01.08 • 50:25 Md. R. 1095 (12-15-23)

09.17.03.03 • 50:25 Md. R. 1096 (12-15-23)

09.18.01.03 • 50:25 Md. R. 1097 (12-15-23)

09.21.04.03 • 50:26 Md. R. 1136 (12-29-23)

09.22.01.12 • 50:25 Md. R. 1099 (12-15-23)

09.23.04.03 • 50:26 Md. R. 1137 (12-29-23)

09.24.01.09 • 50:26 Md. R. 1138 (12-29-23)

09.28.03.03 • 50:26 Md. R. 1139 (12-29-23)

09.33.02.01—.09 • 50:25 Md. R. 1100 (12-15-23)

09.34.01.01,.02,.04,.05 • 51:1 Md. R. 33 (1-12-24)

09.34.01.13 • 51:1 Md. R. 34 (1-12-24)

09.34.02.01 • 51:1 Md. R. 33 (1-12-24)

09.34.03.01,.02 • 51:1 Md. R. 35 (1-12-24)

09.34.04.01—.03 • 51:1 Md. R. 33 (1-12-24)

09.36.07.02 • 50:17 Md. R. 772 (8-25-23)

09.36.08.02 • 50:25 Md. R. 1101 (12-15-23)

10 MARYLAND DEPARTMENT OF HEALTH

Subtitle 09 (2nd volume)

10.09.02.05,.07 • 50:24 Md. R. 1048 (12-1-23) (ibr)

10.09.06.09 • 51:1 Md. R. 36 (1-12-24)

10.09.10.07,.08 • 51:2 Md. R. 78 (1-26-24)

10.09.11.11 • 51:2 Md. R. 79 (1-26-24)

10.09.16.01—.12 • 51:3 Md. R. 159 (2-9-24)

10.09.21.02—.06 • 51:2 Md. R. 82 (1-26-24)

10.09.24.02,.07,.12 • 51:2 Md. R. 79 (1-26-24)

10.09.24.03 • 50:18 Md. R. 814 (9-8-23)

10.09.33.09 • 51:3 Md. R. 161 (2-9-24)

10.09.36.01,.04 • 51:4 Md. R. 203 (2-23-24)

10.09.36.03-2 • 50:18 Md. R. 814 (9-8-23)

10.09.39.02,.06 • 50:24 Md. R. 1049 (12-1-23)

10.09.43.10,.13 • 51:2 Md. R. 79 (1-26-24)

10.09.44.01,.15,.21,.23 • 51:3 Md. R. 162 (2-9-24)

10.09.46.12 • 51:4 Md. R. 204 (2-23-24)

10.09.48.08 • 51:4 Md. R. 205 (2-23-24)

10.09.53.04,.05 • 51:4 Md. R. 206 (2-23-24)

10.09.56.02,.04,.10,.14—.17,.19,.21,.22 • 51:4 Md. R. 207 (2-23-24)

10.09.64.01—.09 • 51:3 Md. R. 164 (2-9-24)

10.09.69.02,.11,.12 • 51:4 Md. R. 209 (2-23-24)

10.09.80.01,.05,.08 • 51:1 Md. R. 37 (1-12-24)

10.09.89.14 • 51:4 Md. R. 210 (2-23-24)

10.09.92.04,.05 • 51:1 Md. R. 38 (1-12-24)

Subtitles 10—22 (3rd volume)

10.11.08.01—.06 • 51:1 Md. R. 39 (1-12-24)

10.15.06.02,.03,.05,.10,.11 • 51:2 Md. R. 82 (1-26-24) (ibr)

10.18.05.01—.03 • 51:3 Md. R. 166 (2-9-24)

10.18.06.05,.08,.10 • 51:3 Md. R. 166 (2-9-24)

10.19.03.01—.20 • 51:4 Md. R. 211 (2-23-24)

10.21.31.01—.06 • 51:3 Md. R. 167 (2-9-24)

Subtitles 23—36 (4th volume)

10.24.10.01 • 50:24 Md. R. 1050 (12-1-23) (ibr)

10.25.07.02,.04,.05,.09 • 51:1 Md. R. 41 (1-12-24)

10.25.18.01—.04,.06,.07,.09—.11 • 51:1 Md. R. 43 (1-12-24)

10.27.01.05 • 50:20 Md. R. 907 (10-6-23)

10.32.01.10 • 51:2 Md. R. 83 (1-26-24)

10.34.42.01—.03 • 51:2 Md. R. 84 (1-26-24)

Subtitles 37—52 (5th volume)

10.41.01.01—.04 • 50:16 Md. R. 738 (8-11-23)

10.41.02.01,.02,.04 • 50:16 Md. R. 738 (8-11-23)

10.41.03.02,.03,.05,.06 • 50:16 Md. R. 738 (8-11-23)

10.41.04.01,.02,.06,.08 • 50:16 Md. R. 738 (8-11-23)

10.41.05.01—.07 • 50:16 Md. R. 738 (8-11-23)

10.41.08.01-1,.02,.06,.08,.11,.12,.14 • 50:16 Md. R. 738 (8-11-23)

10.41.09.02 • 50:16 Md. R. 738 (8-11-23)

10.41.11.01—.10 • 50:16 Md. R. 738 (8-11-23)

10.41.13.02,.04 • 50:16 Md. R. 738 (8-11-23)

10.44.01.01—.39 • 50:20 Md. R. 911 (10-6-23)

10.44.19.05—.12 • 50:24 Md. R. 1051 (12-1-23)

10.44.20.02 • 50:20 Md. R. 918 (10-6-23)

10.44.22.02,.04—.06,.08—.15 • 50:20 Md. R. 918 (10-6-23)

10.46.09.01—.04 • 51:2 Md. R. 85 (1-26-24)

Subtitles 53—68 (6th volume)

10.53.08.05 • 50:17 Md. R. 773 (8-25-23)

10.53.09.01—.04 • 50:17 Md. R. 773 (8-25-23)

10.60.01.03,.05 • 50:18 Md. R. 816 (9-8-23)

10.60.02.08,.09 • 50:25 Md. R. 1102 (12-15-23)

10.60.03.01—.05 • 50:25 Md. R. 1102 (12-15-23)

10.63.02.02 • 51:3 Md. R. 168 (2-9-24)

10.63.03.20,.21 • 51:3 Md. R. 168 (2-9-24)

10.63.07.02,.03,.05,.11 • 51:3 Md. R. 173 (2-9-24)

10.65.02.06,.09 • 51:2 Md. R. 86 (1-26-24)

10.65.03.02—.09 • 51:2 Md. R. 86 (1-26-24)

10.65.04.01—.06 • 51:2 Md. R. 86 (1-26-24)

10.65.05.01—.04 • 51:2 Md. R. 86 (1-26-24)

10.65.06.01,.02 • 51:2 Md. R. 86 (1-26-24)

10.65.09.01—.06 • 51:2 Md. R. 86 (1-26-24)

10.67.01.01 • 51:3 Md. R. 164 (2-9-24)

10.67.02.01 • 51:3 Md. R. 174 (2-9-24)

10.67.04.03-1,.03-2,.15,.19,.19-4 • 51:3 Md. R. 174 (2-9-24)

10.67.04.20 • 50:24 Md. R. 1049 (12-1-23)

10.67.05.02 • 51:3 Md. R. 174 (2-9-24)

10.67.06.26 • 51:3 Md. R. 164 (2-9-24)

10.67.06.26-1,.26-3,.27,.30 • 51:3 Md. R. 174 (2-9-24)

10.67.06.28 • 50:24 Md. R. 1049 (12-1-23)

10.67.08.03 • 51:3 Md. R. 174 (2-9-24)

11 DEPARTMENT OF TRANSPORTATION

Subtitles 11—23 (MVA)

11.11.13.04 • 51:3 Md. R. 177 (2-9-24)

11.12.01.14 • 50:15 Md. R. 698 (7-28-23)

11.13.10.04,.10,.14,.20 • 51:3 Md. R. 177 (2-9-24)

11.20.01.01,.03—.12,.14—.33 • 51:3 Md. R. 178 (2-9-24)

12 DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONAL SERVICES

12.11.10.06 • 51:2 Md. R. 95 (1-26-24)

13A STATE BOARD OF EDUCATION

13A.07.06.01—.15 • 50:14 Md. R. 621 (7-14-23) (ibr)

13A.08.01.17 • 50:20 Md. R. 924 (10-6-23)

13A.12.01.01—.14 • 50:14 Md. R. 633 (7-14-23)

13A.12.02.01—.29 • 50:14 Md. R. 633 (7-14-23)

13A.12.03.01—.12 • 50:14 Md. R. 633 (7-14-23)

13A.12.04.01—.16 • 50:14 Md. R. 633 (7-14-23)

13A.12.05.01—.15 • 50:14 Md. R. 633 (7-14-23)

13A.12.06.01—.09 • 50:14 Md. R. 633 (7-14-23)

13A.12.07.01—.08 • 50:14 Md. R. 633 (7-14-23)

50:15 Md. R. 707 (7-28-23) (err)

13A.15.05.06 • 51:1 Md. R. 50 (1-12-24)

13A.15.09.01 • 51:1 Md. R. 50 (1-12-24)

13A.15.10.06 • 51:1 Md. R. 50 (1-12-24)

13A.16.08.03 • 51:2 Md. R. 95 (1-26-24)

13A.16.09.01,.04 • 51:1 Md. R. 50 (1-12-24)

13A.16.10.02 • 51:2 Md. R. 95 (1-26-24)

13A.16.10.05 • 51:1 Md. R. 50 (1-12-24)

13A.17.10.02 • 51:2 Md. R. 95 (1-26-24)

13A.18.09.01,.04 • 51:1 Md. R. 50 (1-12-24)

13A.18.10.05 • 51:1 Md. R. 50 (1-12-24)

13B MARYLAND HIGHER EDUCATION COMMISSION

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

14 INDEPENDENT AGENCIES

14.26.02.01—.12 • 50:26 Md. R. 1140 (12-29-23)

14.26.03.01—.13 • 50:26 Md. R. 1142 (12-29-23)

14.26.04.01—.13 • 51:3 Md. R. 183 (2-9-24)

14.26.06.01—.11 • 51:3 Md. R. 183 (2-9-24)

14.30.01.01 • 51:2 Md. R. 97 (1-26-24)

14.30.02.01—.05 • 51:2 Md. R. 97 (1-26-24)

14.30.03.01,.02 • 51:2 Md. R. 97 (1-26-24)

14.30.04.01—.12 • 51:2 Md. R. 97 (1-26-24)

14.30.05.01—.17 • 51:2 Md. R. 97 (1-26-24)

14.30.06.01,.02 • 51:2 Md. R. 97 (1-26-24)

14.30.07.01—.04 • 51:2 Md. R. 97 (1-26-24)

14.30.08.01—.26 • 51:2 Md. R. 97 (1-26-24)

14.30.09.01—.03 • 51:2 Md. R. 97 (1-26-24)

14.30.10.01—.24 • 51:2 Md. R. 97 (1-26-24)

14.30.11.01—.27 • 51:2 Md. R. 97 (1-26-24)

14.30.12.01—.05 • 51:2 Md. R. 97 (1-26-24)

14.30.13.01 • 51:2 Md. R. 97 (1-26-24)

14.30.14.01—.05 • 51:2 Md. R. 97 (1-26-24)

14.30.15.01,.02 • 51:2 Md. R. 97 (1-26-24)

14.32.01.01—.06 • 51:2 Md. R. 109 (1-26-24)

14.32.02.01—.22 • 51:2 Md. R. 109 (1-26-24)

14.32.03.01—.07 • 51:2 Md. R. 109 (1-26-24)

14.32.04.01—.06 • 51:2 Md. R. 109 (1-26-24)

14.32.05.01—.05 • 51:2 Md. R. 109 (1-26-24)

14.32.06.01—.03 • 51:2 Md. R. 109 (1-26-24)

14.32.07.01 • 51:2 Md. R. 109 (1-26-24)

14.32.08.01 • 51:2 Md. R. 109 (1-26-24)

14.34.01.01—.03 • 51:2 Md. R. 110 (1-26-24)

14.34.02.01 • 51:2 Md. R. 110 (1-26-24)

14.34.03.01 • 51:2 Md. R. 110 (1-26-24)

14.34.04.01—.17 • 51:2 Md. R. 110 (1-26-24)

14.34.05.01—.12 • 51:2 Md. R. 110 (1-26-24)

14.34.06.01—.04 • 51:2 Md. R. 110 (1-26-24)

14.38.01.03 • 50:23 Md. R. 1011 (11-17-23)

15 MARYLAND DEPARTMENT OF AGRICULTURE

15.01.05.10 • 51:2 Md. R. 110 (1-26-24)

15.14.09.03 • 50:25 Md. R. 1103 (12-15-23)

15.14.12.02 • 51:2 Md. R. 111 (1-26-24)

18 DEPARTMENT OF ASSESSMENTS AND TAXATION

18.01.02.03 • 51:3 Md. R. 184 (2-9-24)

18.06.03.01 • 51:3 Md. R. 184 (2-9-24)

21 STATE PROCUREMENT REGULATIONS

21.03.05.03 • 51:2 Md. R. 112 (1-26-24)

21.05.07.01,.04,.05 • 51:2 Md. R. 112 (1-26-24)

21.05.08.05 • 51:2 Md. R. 112 (1-26-24)

21.05.09.05 • 51:2 Md. R. 112 (1-26-24)

21.11.01.06 • 51:2 Md. R. 112 (1-26-24)

21.11.14.02—.04,.06,.07,.09,.12 • 51:2 Md. R. 115 (1-26-24)

21.11.15.04 • 51:2 Md. R. 112 (1-26-24)

21.13.01.03,.15 • 51:2 Md. R. 112 (1-26-24)

26 DEPARTMENT OF THE ENVIRONMENT

Subtitles 08—12 (Part 2)

26.11.40.02,.03 • 50:24 Md. R. 1059 (12-1-23)

Subtitles 19—28 (Part 4)

26.28.01.01—.03 • 50:25 Md. R. 1104 (12-15-23) (ibr)

26.28.02.01—.05 • 50:25 Md. R. 1104 (12-15-23)

26.28.03.01,.02 • 50:25 Md. R. 1104 (12-15-23)

26.28.04.01—.03 • 50:25 Md. R. 1104 (12-15-23)

26.30.01.01—.08 • 51:1 Md. R. 52 (1-12-24)

26.30.02.01—.09 • 51:1 Md. R. 52 (1-12-24)

26.30.03.01—.03 • 51:1 Md. R. 52 (1-12-24)

26.30.04.01,.02 • 51:1 Md. R. 52 (1-12-24)

30 MARYLAND INSTITUTE FOR EMERGENCY MEDICAL SERVICES SYSTEMS (MIEMSS)

30.01.01.02 • 50:24 Md. R. 1061 (12-1-23)

30.01.02.01 • 50:24 Md. R. 1064 (12-1-23) (ibr)

30.02.02.04,.06—.09 • 50:24 Md. R. 1061 (12-1-23)

30.09.01.02 • 51:2 Md. R. 117 (1-26-24)

30.09.14.04 • 51:2 Md. R. 117 (1-26-24)

31 MARYLAND INSURANCE ADMINISTRATION

31.10.30.03—.05 • 51:3 Md. R. 185 (2-9-24)

33 STATE BOARD OF ELECTIONS

33.07.07.01 • 50:26 Md. R. 1147 (12-29-23)

33.07.09.01—.04 • 50:26 Md. R. 1147 (12-29-23)

33.11.01.04 • 50:26 Md. R. 1148 (12-29-23)

33.11.03.02,.08 • 50:26 Md. R. 1147 (12-29-23)

33.11.03.06 • 50:23 Md. R. 1029 (11-17-23)

33.11.04.03 • 50:23 Md. R. 1029 (11-17-23)

33.11.05.04 • 50:26 Md. R. 1148 (12-29-23)

33.16.03.01 • 50:26 Md. R. 1147 (12-29-23)

33.16.06.04 • 50:23 Md. R. 1029 (11-17-23)

33.17.06.10 • 50:26 Md. R. 1147 (12-29-23)

35 DEPARTMENT OF VETERANS AFFAIRS

35.01.01.02 • 50:25 Md. R. 1115 (12-15-23)

35.03.01.03,.05,.09,.10 • 50:25 Md. R. 1115 (12-15-23)

51:1 Md. R. 58 (1-12-24) (err)

36 MARYLAND STATE LOTTERY AND GAMING CONTROL AGENCY

36.03.01.02 • 50:26 Md. R. 1149 (12-29-23)

36.03.02.06,.12—.14,.16,.17 • 50:26 Md. R. 1149 (12-29-23)

36.03.03.01,.05—.07,.10 • 50:26 Md. R. 1149 (12-29-23)

36.03.06.03 • 50:26 Md. R. 1149 (12-29-23)

36.03.08.02,.04 • 50:26 Md. R. 1149 (12-29-23)

36.03.10.16,.20,.21,.34 • 50:26 Md. R. 1149 (12-29-23)

36.03.11.05 • 50:26 Md. R. 1149 (12-29-23)

36.04.01.11 • 50:26 Md. R. 1149 (12-29-23)

36.04.02.01,.02 • 50:26 Md. R. 1149 (12-29-23)

36.07.02.12,.18 • 50:26 Md. R. 1149 (12-29-23)

36.10.01.02 • 50:26 Md. R. 1149 (12-29-23)

36.10.02.10,.14 • 50:26 Md. R. 1149 (12-29-23)

36.10.03.02,.04 • 50:26 Md. R. 1149 (12-29-23)

36.10.04.02—.06 • 50:26 Md. R. 1149 (12-29-23)

36.10.05.01,.02 • 50:26 Md. R. 1149 (12-29-23)

36.10.06.02—.07,.09,.11 • 50:26 Md. R. 1149 (12-29-23)

36.10.10.03 • 50:26 Md. R. 1149 (12-29-23)

36.10.13.20,34,.40,.41 • 50:26 Md. R. 1149 (12-29-23)

36.10.14.03,.06 • 50:26 Md. R. 1149 (12-29-23)

36.10.15.03,.04 • 50:26 Md. R. 1149 (12-29-23)

36.11.02.20 • 50:26 Md. R. 1149 (12-29-23)

The Judiciary

SUPREME COURT OF MARYLAND

DISCIPLINARY PROCEEDINGS

This is to certify that by an Order of this Court dated January 31, 2024, GAIL D. SAUSSER (CPF# 9912160125), as of January 31, 2024, Gail D. Sausser has resigned, effective immediately and her name has been stricken from the register of attorneys in this Court. Notice of this action is given in accordance with Maryland Rule 19-735(e).

* * * * * * * * * *

This is to certify that by an Order of this Court dated January 31, 2024, SCOTT GROVE PATTERSON (CPF# 7201010153), as of January 31, 2024, Scott Grove Patterson has resigned, 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 19-735(e).

[24-04-10]

Regulatory Review and Evaluation

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

Title 10
MARYLAND DEPARTMENT OF HEALTH

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.36 General Medical Assistance Provider Participation Criteria

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

Notice of Proposed Action

[23-343-P]

The Secretary of Health proposes to amend Regulations .01 and .04 under COMAR 10.09.36 General Medical Assistance Provider Participation Criteria.

Statement of Purpose

The purpose of this action is to update existing regulations to better align them with globally applicable payment procedures for participation in the Maryland Medicaid Program.

Estimate of Economic Impact

The proposed action has no economic impact.

Economic Impact on Small Businesses

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

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

Comments may be sent to Jourdan Green, Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov. Comments will be accepted through March 25, 2024. A public hearing has not been scheduled.

.01 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)—(5) (text unchanged)

(6) “Current Procedural Terminology (CPT)” means the American Medical Association’s uniform nomenclature for coding medical procedures and services.

[(6)] (7)—[(8)] (9) (text unchanged)

(10) “Healthcare Common Procedure Coding System (HCPCS)” means the specified code set for procedures and services, according to the Health Insurance Portability and Accountability Act (HIPAA).

[(9)] (11)—[(20)] (22) (text unchanged)

.04 Payment Procedures.

A. The provider shall submit the request for payment of services rendered according to procedures established by the Department and in the [form] format designated by the Department.

B. The Department reserves the right to return to the provider, before payment, all [invoices] claims not properly signed, completed, and accompanied by properly completed forms required by the Department.

[C. Payment advances are not made routinely.]

[D.] C. The Program will make no direct payment to [recipients] participants.

D. All payments are contingent upon a provider’s full compliance with the requirements of its enrollment and applicable conditions of participation.

E. Unless the service is free to the general public, the provider shall charge the Program its customary charge to the general public for similar services.

F. Unless otherwise excepted, the provider shall be paid the lesser of:

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

(2) The Department’s applicable rate.

G. Unless otherwise excepted, if a service is free to individuals not covered by the Program:

(1) The provider:

(a) May charge the Program; and

(b) Shall be reimbursed in accordance with §F of this regulation; and

(2) The provider's reimbursement is not limited to the provider's customary charge.

H. Providers may not bill the Department or the Program for:

(1) Completion of forms and reports;

(2) Broken or missed appointments;

(3) Professional services rendered by:

(a) Mail;

(b) Email; or

(c) Fax; or

(4) Providing a copy of a participant’s medical record when requested by another licensed provider on behalf of the participant.

I. Unless otherwise excepted, payments on Medicare claims are authorized, if:

(1) Services are covered by the Medicare Program;

(2) The provider accepts Medicare assignments;

(3) Medicare makes direct payment to the provider;

(4) Medicare has determined that services were medically justified; and

(5) Initial billing is made directly to Medicare according to Medicare guidelines.

J. Unless otherwise provided by regulation, supplemental payments on Medicare claims are made subject to the following provisions:

(1) Deductible insurance will be paid in full;

(2) Beginning with August 1, 2010 dates of service and subject to the limitations of the State budget, coinsurance shall be paid:

(a) In full for the following:

(i) Mental health services;

(ii) CPT codes that are priced by report;

(iii) Claims for anesthesia services;

(iv) Claims from a federally qualified health center; and

(v) HCPCS codes beginning with A through W; and

(b) For all other claims, at the lesser of:

(i) 100 percent of the coinsurance amount; or

(ii) The balance remaining after the Medicare payment is subtracted from the Medicaid rate; and

(3) Services not covered by Medicare are payable according to §F of this regulation.

K. An individual or entity who is employed by or under contract to any group provider, clinic, or hospital may not bill for any service for which reimbursement is sought by the group provider, clinic, or hospital.

LAURA HERRERA SCOTT
Secretary of Health

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.46 Home and Community-Based Services Waiver for Individuals with Brain Injury

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

Notice of Proposed Action

[23-345-P]

The Secretary of Health proposes to amend Regulation .12 under COMAR 10.09.46 Home and Community-Based Services Waiver for Individuals with Brain Injury.

Statement of Purpose

The purpose of this action is to update the Brain Injury Waiver services fee schedule.

Estimate of Economic Impact

I. Summary of Economic Impact. Brain Injury Waiver: For dates of service beginning July 1, 2023, the Maryland Medical Assistance reimbursement rates for Brain Injury Waiver services will increase by 3 percent. This represents an estimated $446,521 increase in total expenditures.

II. Types of Economic Impact.

Impacted Entity	Revenue (R+/R-) Expenditure (E+/E-)	Magnitude
A. On issuing agency:
Maryland Department of Health	(E+)	$446,521
B. On other State agencies:	NONE
C. On local governments:	NONE

	Benefit (+) Cost (-)	Magnitude
D. On regulated industries or trade groups:
Maryland Medicaid providers	(+)	$446,521
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. This amount assumes effective July 1, 2023, Brain Injury providers will receive a 3 percent rate increase.

D. See A above.

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 this chapter are small businesses that will benefit from additional rate increases under the provisions of the proposed action. To the extent that Brain Injury Waiver providers qualify as small businesses, they will benefit from the rate increase included in this 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

.12 Payment Procedures.

A.—B. (text unchanged)

C. Payments.

(1) (text unchanged)

(2) The Program shall pay according to the following fee-for-service schedule:

(a) Residential habilitation reimbursed at:

(i) [$276.59] $266.64 from [July 1,] October 1, 2022 [to] through [September 30, 2022,] June 30, 2023, then effective [October 1, 2022] July 1, 2023 at [$266.64] $274.64 per day for Level 1;

(ii) [$366.22] $353.06 from [July 1,] October 1, 2022 [to] through [September 30, 2022,] June 30,2023, then effective [October 1, 2022] July 1, 2023 at [$353.06] $363.65 per day for Level 2; and

(iii) [$506.64] $488.43 from [July 1,] October 1, 2022 [to] through [September 30, 2022,] June 30, 2023, then effective [October 1, 2022] July 1, 2023 at [$488.43] $503.08 per day for Level 3;

(b) Day habilitation reimbursed at:

(i) [$71.41] $68.84 from [July 1,] October 1, 2022 [to] through [September 30, 2022,] June 30, 2023, then effective [October 1, 2022] July 1, 2023 at [$68.84] $70.91 per day for Level 1;

(ii) [$124.57] $120.09 from [July 1,] October 1, 2022 [to] through [September 30, 2022,] June 30, 2023, then effective [October 1, 2022] July 1, 2023 at [$120.09] $123.69 per day for Level 2; and

(iii) [$175.24] $168.84 from [July 1,] October 1, 2022 [to] through [September 30, 2022,] June 30, 2023, then effective [October 1, 2022] July 1, 2023 at [$168.84] $174.01 per day for Level 3;

(i) [$42.36] $40.84 from [July 1,] October 1, 2022 [to] through [September 30, 2022,] June 30, 2023, then effective [October 1, 2022] July 1, 2023 at [$40.84] $42.07 per day for Level 1;

(ii) [$71.41] $68.84 from [July 1,] October 1, 2022 [to] through [September 30, 2022,] June 30, 2023, then effective [October 1, 2022] July 1, 2023 at [$68.84] $70.91 per day for Level 2; and

(d) Individual support services (ISS): reimbursed at the maximum rate of [$8.6553] $8.3440 per 15 minutes from [July 1,] October 1, 2022 [to] through [September 30, 2022,] June 30, 2023, then effective [October 1, 2022] July 1, 2023 at [$8.3440] $8.6000 per 15 minutes.

(3)—(4) (text unchanged)

LAURA HERRERA SCOTT
Secretary of Health

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.48 Targeted Case Management for People with Developmental Disabilities

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

Notice of Proposed Action

[23-340-P]

The Secretary of Health proposes to amend Regulation .08 under COMAR 10.09.48 Targeted Case Management for People with Developmental Disabilities.

Statement of Purpose

The purpose of this action is to increase the reimbursement rate for Developmental Disabilities Administration (DDA) targeted case management (TCM) providers by 4 percent for Fiscal Year (FY) 2024.

Estimate of Economic Impact

I. Summary of Economic Impact. The proposed action implements a 4 percent increase in the reimbursement rate for Developmental Disabilities Administration (DDA) targeted case management (TCM) providers for Fiscal Year 2024. The total impact of this change in rates for Fiscal Year 2024 is $3,486,940.

II. Types of Economic Impact.

Impacted Entity	Revenue (R+/R-) Expenditure (E+/E-)	Magnitude
A. On issuing agency:
Maryland Department of Health	(E+)	$3,486,940
B. On other State agencies:	NONE
C. On local governments:	NONE

	Benefit (+) Cost (-)	Magnitude
D. On regulated industries or trade groups:
Medicaid DDA TCM providers	(+)	$3,486,940
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. This amount assumes:

(1) Utilization of services covered under this chapter in Fiscal Year 2024 will remain consistent with Fiscal Year 2023 rates.

(2) Effective July 1, 2023, Developmental Disabilities Administration (DDA) targeted case management (TCM) providers will receive an increased reimbursement rate of 4 percent.

(3) In total, these rate increases reflect an estimated $3,486,940 total fund increase. The 4 percent increase is subject to 48 percent federal match ($1,813,209 general funds and $1,673,731 federal funds).

D. See A above.

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 Medicaid enrolled targeted case management providers qualify as small businesses, they will share in the benefit of this rate increase.

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

.08 Payment Procedures.

A. (text unchanged)

B. Payment Rates.

(1)—(5) (text unchanged)

(6) For all other services rendered to Maryland Medicaid participants residing in counties other than those listed in §B(7) of this regulation, providers shall be reimbursed:

[(a) For dates of service January 1, 2021 through October 31, 2021, $21.55 per unit of service;

(b) For dates of service November 1, 2021 through June 30, 2022, $22.74 per unit of service;]

[(c)] (a) (text unchanged)

[(d)] (b) For dates of service October 1, 2022 through December 31, 2022, $27.02 per unit; [and]

[(e)] (c) For dates of service January 1, 2023 through June 30, 2023, $24.56 per unit[.]; and

(d) For dates of service July 1, 2023 through June 30, 2024, $25.54 per unit.

(7) Providers rendering services to Maryland Medicaid participants residing in Calvert, Charles, Frederick, Montgomery, and Prince George’s counties shall be reimbursed:

[(a) For dates of service January 1, 2021 through October 31, 2021, $22.69 per unit;

(b) For dates of service November 1, 2021 through June 30, 2022, $23.94 per unit;]

[(c)] (a) (text unchanged)

[(d)] (b) For dates of service October 1, 2022 through December 31, 2022, $28.45 per unit; [and]

[(e)] (c) For dates of service January 1, 2023 through June 30, 2023, $25.86 per unit[.]; and

(d) For dates of service July 1, 2023 through June 30, 2024, $26.89 per unit.

C.—E. (text unchanged)

LAURA HERRERA SCOTT
Secretary of Health

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.53 Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old

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

Notice of Proposed Action

[23-347-P]

The Secretary of Health proposes to amend Regulations .04 and .05 under COMAR 10.09.53 Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old.

Statement of Purpose

The purpose of this action is to clarify covered private duty nursing (PDN) services when provided to participants who are younger than 21 years old and eligible for early and periodic screening, diagnosis, and treatment (EPSDT) 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 an impact on individuals with disabilities as follows:

Individuals with disabilities receive services provided under this chapter and will benefit to the extent that clarification of the application of the current regulations improve transparency to the medically complex population served.

Opportunity for Public Comment

.04 Covered Services.

A. The Program shall cover services rendered by a nurse, CNA, or HHA when the:

(1)—(6) (text unchanged)

[(7) Services are determined medically necessary after the provider has completed an initial nursing assessment;]

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

[(9)] (8) Services are received by the participant as documented by the signature of the participant or the participant’s representative on the nursing provider’s official form; [and]

[(10) Participant has at least one caregiver willing and able to accept responsibility for the participant’s care when the nurse, CNA, or HHA is not available.]

(9) Services are determined medically necessary for a participant after the provider has completed an initial nursing assessment that reflects the participant’s need for an awake and alert caregiver;

(10) Participant has at least one caregiver willing and able to accept responsibility for the participant’s care when the nurse, CNA, or HHA is not available;

(11) Caregiver provides documentation of each of the following when applicable:

(a) The caregiver’s work schedule along with commuting times;

(b) The caregiver’s school attendance as defined in Regulation .02 of this chapter along with commuting times; and

(c) Emergency circumstances, as determined by the Department, including but not limited to the inability of the primary caregiver to provide care due to hospitalization or an acute debilitating illness for up to a 60-day period; and

(12) Services are provided only in the absence of the willing and able caregiver during sleeping hours and during the times documented in §A(11) of this regulation.

.05 Limitations.

A. (text unchanged)

[B. Services to substitute for care ordinarily rendered by the caregiver or caregivers shall be considered medically necessary:

(1) When the services meet the requirements of Regulation .04A of this chapter; and

(2) When the:

(a) Participant requires an awake and alert caregiver at all times;

(b) Caregiver or caregivers provide documentation, including work schedule, commuting times, and school attendance records as defined in Regulation .01 of this chapter, that substitute care is necessary to allow employment or school attendance; or

(c) Caregiver or caregivers provide documentation of emergency circumstances, as determined by the Department, including but not limited to the inability of the primary caregiver to provide care due to hospitalization or an acute debilitating illness for up to a 60-day period.]

[C.] B.—[E.] D. (text unchanged)

LAURA HERRERA SCOTT
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

[23-341-P]

The Secretary of Health proposes to amend Regulations .02, .04, .10, .14—.17, .19, .21, and .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 update regulations to reflect changes to the approved CMS waiver document. Additionally, the proposed action will update the fee schedule for autism waiver providers, effective July 1, 2023.

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

.02 Participant Eligibility.

A. Medical Eligibility for the Autism Waiver.

(1) To be medically eligible for the services covered under the chapter, an applicant shall be certified by the licensed psychologist [or certified school psychologist, who is a member of the participant’s multidisciplinary team and is employed by the local Infants and Toddlers Program, the local school system, the Program, or the Program’s designee], licensed social worker, licensed clinical professional counselor, certified school psychologist, or approved service coordinator employed or contracted by the local lead agency, the local education agency, the State, or the State’s designee to need ICF-IID level of care using the standardized process for determination of eligibility for level of care in an ICF-IID.

(2) Every 12 months, or more frequently if determined necessary by the service coordinator or multidisciplinary team due to a significant change in the participant’s condition or needs, a participant’s medical need for ICF-IID level of care shall be reevaluated by the licensed psychologist [or certified school psychologist on the multidisciplinary team], licensed social worker, licensed clinical professional counselor, certified school psychologist, or approved service coordinator employed or contracted by the local lead agency, the local education agency, the State, or the State’s designee, as part of the multidisciplinary team process and using the form for determination of eligibility for level of care in an ICF-IID.

(3) The form certifying ICF-IID level of care shall be signed by the:

(a) (text unchanged)

(b) Team's licensed psychologist [or certified school psychologist], licensed social worker, licensed clinical professional counselor, certified school psychologist, or approved service coordinator employed or contracted by the local lead agency, the local education agency, the State, or the State’s designee.

B.—D. (text unchanged)

.04 Conditions for Participation — General.

To provide Autism Waiver services, the provider:

A.—D. (text unchanged)

E. Shall assure that direct care workers who render services under this chapter:

(1) [Have at least a high school degree or GED, including equivalency review by an accredited agency for credentials obtained outside of the United States] Meet the minimum age requirement, set forth by service, before rendering services to any Autism Waiver participant;

(2)—(6) (text unchanged)

F.—K. (text unchanged)

L. If an agency, shall require supervisory and direct care employees of provider agencies to:

(1) (text unchanged)

(2) Request the Department of Public Safety and Correctional Services to send the child care criminal history report to the [agency of employment] Department’s Division of Community Long Term Care; and

(3) (text unchanged)

M. If an agency, shall:

(1) (text unchanged)

(2) [Maintain the original child care criminal history report for all agency and contracted employees as well as any updated criminal history reports from the Department of Public Safety and Correctional Services in the employee's personnel record] Request clearance from the Department for all applicants prior to an offer of employment; and

(3) (text unchanged)

N. If self-employed, shall:

(1) (text unchanged)

(2) Request the Department of Public Safety and Correctional Services to send the child care criminal history report to the [Department] Department’s Division of Community Long Term Care;

(3)—(5) (text unchanged)

O.—II. (text unchanged)

.10 Specific Conditions for Participation — Adult Life Planning Services.

A. To provide the services covered under Regulation .19 of this chapter, the provider shall:

(1) Be an individual with a [Master's Degree in Human Services] bachelor’s degree; and

(2) Have [5] 3 years of full-time experience serving adults with autism disabilities.

B.—E. (text unchanged)

.14 Covered Services — Therapeutic Integration Services.

A. (text unchanged)

B. [A] For dates of service before July 1, 2023, a unit of service is a 30-minute increment of service rendered to a participant by a qualified provider in the community setting.

C. For dates of service on or after July 1, 2023, a unit of service is a 15-minute increment of service rendered to a participant by a qualified provider in the community setting.

.14-1 Covered Services — Intensive Therapeutic Integration Services.

A. (text unchanged)

B. [A] For dates of service before July 1, 2023, a unit of service is a 30-minute increment of service rendered to a participant by a qualified provider in the community setting.

C. For dates of service on or after July 1, 2023, a unit of service is a 15-minute increment of service rendered to a participant by a qualified provider in the community setting.

.15 Covered Services — Intensive Individual Support Services.

A.—C. (text unchanged)

D. [A] For dates of service before July 1, 2023, a unit of service is a 30-minute increment of service rendered to a participant by a qualified provider in the participant’s home or a community setting.

E. For dates of service on or after July 1, 2023, a unit of service is a 15-minute increment of service rendered to a participant by a qualified provider in the participant’s home or a community setting.

.16 Covered Services — Respite Care.

A.—B. (text unchanged)

C. [A] For dates of service before July 1, 2023, a unit of service is a 30-minute increment of service rendered to a participant by a qualified provider in the participant’s home or a community setting.

D. For dates of service on or after July 1, 2023, a unit of service is a 15-minute increment of service rendered to a participant by a qualified provider in the participant’s home or a community setting.

.17 Covered Services — Family Consultation.

A.—D. (text unchanged)

E. [A] For dates of service before July 1, 2023, a unit of service is a 30-minute increment of service rendered to a participant by a qualified provider in the participant’s home or a community setting.

F. For dates of service on or after July 1, 2023, a unit of service is a 15-minute increment of service rendered to a participant by a qualified provider in the participant’s home or a community setting.

.19 Covered Services — Adult Life Planning Services.

A. (text unchanged)

B. Adult life planning services shall:

(1)—(2) (text unchanged)

(3) Be provided only to participants [age 16] 14 years old or older.

.21 Limitations.

A.—D. (text unchanged)

E. Therapeutic integration and intensive therapeutic integration services may include transportation time when at least 2 units of service have been provided on-site, and the maximum units of service billed may not exceed:

(1) For dates of service before July 1, 2023, 24 units; or

(2) For dates of service on or after July 1, 2023, 12 units.

F.—G. (text unchanged)

H. The Program may reimburse for a participant not more than:

(1) For dates of service before July 1, 2023:

[(1)] (a) [One] 1 unit per date of service for residential habilitation services at either the regular or intensive level;

[(2)] (b)—[(3)] (c) (text unchanged)

[(4)] (d) 12 units or fewer than [two] 2 units of therapeutic integration or intensive therapeutic integration services for a date of service;

[(5)] (e)—[(13)] (m) (text unchanged)

[(14)] (n) 15 units of retainer payment per calendar year at either the regular or intensive level when the participant is absent from the residential habilitation program for the purposes of family visitation, hospitalization, or other overnight stays[.]; or

(2) For dates of service on or after July 1, 2023:

(a) 1 unit per date of service for residential habilitation services at either the regular or the intensive level;

(b) 80 units of therapeutic integration services per week;

(c) 60 units of intensive therapeutic integration services per week;

(d) 24 units or fewer than 2 units of therapeutic integration or intensive therapeutic integration services for a date of service;

(e) 160 units of intensive individual support services per week;

(f) 96 units of respite care for a date of service;

(g) 1344 units of respite care per State fiscal year;

(h) 24 units of family consultation for a date of service;

(i) 160 units of family consultation per State fiscal year;

(j) A total of $2,104 for environmental accessibility adaptations over a 36-month period;

(k) 32 units of intensive individual support services per day;

(l) 80 units of adult life planning services per State fiscal year, for participants 14 years old or older;

(m) 16 units of adult life planning services per date of service, for participants 14 years old or older; and

(n) 15 units of retainer payment per calendar year at either the regular or intensive level when the participant is absent from the residential habilitation program for the purposes of family visitation, hospitalization, or other overnight stays.

I.—L. (text unchanged)

.22 Payment Procedures.

A.—D. (text unchanged)

E. Rates.

(1)—(3) (text unchanged)

(4) Effective July 1, 2023, 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 $8.5950 per unit.

(c) Intensive therapeutic integration services reimbursed at the maximum rate of $10.7450 per unit.

(d) Intensive individual support services reimbursed at the maximum rate of $10.7450 per unit.

(e) Respite care reimbursed at the maximum rate of $8.4000 per unit.

(f) Family consultation reimbursed at the maximum rate of $35.2750 per unit.

(g) Adult life planning services reimbursed at the maximum rate of $35.2750 per unit.

(h) Environmental accessibility adaptions 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.

LAURA HERRERA SCOTT
Secretary of Health

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.69 Maryland Medicaid Managed Care Program: Rare and Expensive Case Management

Authority: Health-General Article, §§2-104(b), 15-103(b)(4)(i), and 15-105, Annotated Code of Maryland

Notice of Proposed Action

[23-349-P]

The Secretary of Health proposes to amend Regulations .02, .11, and .12 under COMAR 10.09.69 Maryland Medicaid Managed Care Program: Rare and Expensive Case Management.

Statement of Purpose

The purpose of this action is to clarify covered optional private duty nursing (PDN) services when provided to participants eligible for rare and expensive case management (REM) 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 an impact on individuals with disabilities as follows:

Opportunity for Public Comment

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)—(22) (text unchanged)

(23) “Home” [has the meaning stated in COMAR 10.09.53.01] means the place of residence, occupied by the participant, other than a residence or facility where nursing services are included in the living arrangement by regulation or statute, or otherwise provided for payment.

(24)—(55) (text unchanged)

(56) “REM optional services” means the services listed in Regulations [.09] .10 and [.10] .11 of this chapter, which meet the general requirements under Regulation [.08] .09 of this chapter.

(56)—(58) (text unchanged)

(59) “School” means courses or classes for the acquisition of a General Education Diploma, a high school diploma, an associate degree, or a first-time bachelor’s degree.

[(59)] (60)—[(60)] (61) (text unchanged)

.11 Covered Optional Services — Private Duty Nursing, Certified Nursing Assistant, Certified Nursing Assistant Certified as a Certified Medication Technician, Home Health Aide and Home Health Aide Certified as a Certified Medication Technician.

A. The Program shall cover shift nursing services provided by an RN or LPN when:

(1)—(3) (text unchanged)

(4) Services are [rendered in accordance with COMAR 10.09.53;] determined medically necessary for a participant after the provider has completed an initial nursing assessment that reflects the participant’s need for an awake and alert caregiver;

(5) The participant has at least one caregiver willing and able to accept responsibility for the participant’s care when the nurse, CNA, or HHA is not available;

(6) The caregiver provides documentation of each of the following when applicable:

(a) The caregiver’s work schedule along with commuting times;

(b) The caregiver’s school attendance as defined in Regulation .02 of this chapter along with commuting times; and

(7) Services are provided only in the absence of the willing and able caregiver during the sleeping hours and during the times documented in §A(6) of this regulation;

[(5)] (8)—[(7)] (10) (text unchanged)

[(8)] (11) Services are rendered by an RN or an LPN who is certified in cardiopulmonary resuscitation and the certification is renewed every 2 years; and

[(9) Services are preauthorized in accordance with the criteria set forth in COMAR 10.09.53; and]

[(10)] (12) (text unchanged)

B.—C. (text unchanged)

.12 Limitations.

A.—B. (text unchanged)

C. The REM program does not cover the following:

(1)—(7) (text unchanged)

(8) Speech, language, or occupational therapy services rendered in a classroom setting; [and]

(9) Shift private duty nursing, CNA, CNA-CMT, HHA, or HHA-CMT services ordered by a physician assistant[.];

(10) Custodial services;

(11) Services provided to a participant in a:

(a) Hospital;

(b) Residential treatment center;

(c) Intermediate care facility for individuals with intellectual disabilities; or

(d) Residence or facility where nursing services are included in the living arrangement by regulation or statute, or otherwise provided for payment;

(12) Services not directly related to the participant’s plan of care;

(13) Services described in the plan of care whenever a major change occurs in the participant's medical condition or skilled nursing care needs that indicates such services are no longer necessary;

(14) Services which are not initially ordered before the start of care and renewed every 60 days by the participant’s primary medical provider;

(15) Services provided by a nurse, CNA, or HHA who does not possess a valid, current, and nontemporary nursing license or certifications to provide services in the jurisdiction in which nursing services are rendered;

(16) Services provided by a nurse, CNA, or HHA who does not have a current cardiopulmonary resuscitation (CPR) certification for the period during which the services are rendered;

(17) Direct payment for supervisory visits that do not meet acceptable standards of practice in accordance with COMAR 10.27.09, 10.27.10, and 10.27.11;

(18) Services rendered to a participant by a nurse, CNA, or HHA in the assigned staff’s home;

(19) Services not documented; and

(20) Respite services.

D. The Program shall only cover one-to-one nursing when a participant’s condition requires that level of service and shared services are not an option.

E. The Program shall only cover nursing services ordered by an individual who is enrolled as a provider in the Program with an active status on the date of service.

LAURA HERRERA SCOTT
Secretary of Health

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.89 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families

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

Notice of Proposed Action

[23-346-P]

The Secretary of Health proposes to amend Regulation .14 under COMAR 10.09.89 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families.

Statement of Purpose

The purpose of this action is to update the listed provider reimbursement rate to the 3 percent increased rate, effective for Fiscal Year 2024, pursuant to Ch. 101 (H.B. 200), Acts of 2023, Fiscal Year 2024 Budget.

Estimate of Economic Impact

I. Summary of Economic Impact. The budget for Fiscal Year 2024 includes a 3 percent rate increase. The total fiscal impact for this rate increase on 1915(i) services is $982.35.

II. Types of Economic Impact.

Impacted Entity	Revenue (R+/R-) Expenditure (E+/E-)	Magnitude
A. On issuing agency:
Maryland Department of Health	(E+)	$982.35
B. On other State agencies:	NONE
C. On local governments:	NONE

	Benefit (+) Cost (-)	Magnitude
D. On regulated industries or trade groups:
Maryland Medicaid 1915(i) providers	(+)	$982.35
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. This amount assumes:

(1) The estimated economic impact of the proposed action is based on Fiscal Year 2023 program expenditures and projected expenditure for Fiscal Year 2024.

(2) Annual 1915(i) service utilization is expected to remain consistent between Fiscal Year 2023 and Fiscal Year 2024.

(3) The Fiscal Year 2024 impact is the difference in projected expenditures between Fiscal Year 2023 ($32,745.10) and Fiscal Year 2024 ($33,727.45).

(4) This amount ($982.53) is subject to a 66.49 percent federal match, utilizing 66.49 percent funds ($653.17) and 33.51 percent general funds ($329.19).

D. See A above.

Economic Impact on Small Businesses

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

Providers enrolled as Maryland Medicaid 1915(i) providers will benefit from increased reimbursement.

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

.14 Payment Procedures.

A.—D. (text unchanged)

E. Family peer support services as described in Regulation .09 of this chapter shall be reimbursed at the following rates:

(1) For dates of service from [January 1, 2021] July 1, 2022 through [October 31, 2021] June 30, 2023:

(a) [$19.16] $21.65 per 15-minute unit for face-to-face services; or

(b) [$9.57] $10.82 per 15-minute unit for telephonic or other non-face-to-face activities.

[(2) For dates of service from November 1, 2021 through June 30, 2022:

(a) $20.19 per 15-minute unit for face-to-face services; or

(b) $10.09 per 15-minute unit for telephonic or other non-face-to-face activities.]

[(3)] (2) Effective July 1, [2022] 2023:

(a) [$21.65] $22.30 per 15-minute unit for face-to-face services; or

(b) [$10.82] $11.14 per 15-minute unit for telephonic or other non-face-to-face activities.

F. Respite services as described in Regulation .10 of this chapter shall be reimbursed at the following rates:

(1) For dates of service from [January 1, 2021] July 1, 2022 through [October 31, 2021] June 30, 2023:

(a) [$30.18] $34.12 per 1-hour unit of service for community-based respite services; or

(b) [$239.26] $270.46 per unit of out-of-home respite care.

[(2) For dates of service from November 1, 2021 through June 30, 2022:

(a) $31.81 per 1-hour unit of service for community-based respite services; or

(b) $252.18 per unit of out-of-home respite care.]

[(3)] (2) Effective July 1, [2022] 2023:

(a) [$34.12] $35.14 per 1-hour unit of service for community-based respite services; or

(b) [$270.46] $278.57 per unit of out-of-home respite care.

G. Expressive and experiential behavioral services as described in Regulation .11 of this chapter, when provided by a licensed mental health professional, shall be reimbursed at the following rates:

(1) For dates of service from [January 1, 2021] July 1, 2022 through [October 31, 2021] June 30, 2023:

(a) For individual therapy:

(i) [$82.07] $92.77 per 45—50-minute session; or

(ii) [$107.52] $121.55 per 75—80-minute session; and

(b) For group therapy:

(i) [$32.62] $36.87 per 45—60-minute session; or

(ii) [$42.42] $47.95 per prolonged (75—90-minute) session.

[(2) For dates of service from November 1, 2021 through June 30, 2022:

(a) For individual therapy:

(i) $86.50 per 45—50-minute session; or

(ii) $113.33 per 75—80-minute session; and

(b) For group therapy:

(i) $34.38 per 45—60-minute session; or

(ii) $44.71 per prolonged (75—90-minute) session.]

[(3)] (2) Effective July 1, [2022] 2023:

(a) For individual therapy:

(i) [$92.77] $95.55 per 45—50-minute session; or

(ii) [$121.55] $125.20 per 75—80-minute session; and

(b) For group therapy:

(i) [$36.87] $37.98 per 45—60-minute session; or

(ii) [$47.95] $49.39 per prolonged (75—90-minute) session.

H. Expressive and experiential behavioral services as described in Regulation .11 of this chapter, when provided by a non-licensed mental health professional, shall be reimbursed at the following rates:

(1) For dates of service from [January 1, 2021] July 1, 2022 through [October 31, 2021] June 30, 2023:

(a) For individual therapy:

(i) [$74.60] $84.33 per 45-minute session; or

(ii) [$96.99] $109.64 per 75—80-minute session; and

(b) For group therapy:

(i) [$28.99] $32.78 per 45—60-minute session; or

(ii) [$37.68] $42.59 per prolonged (75—90-minute) session.

[(2) For dates of service from November 1, 2021 through June 30, 2022:

(a) For individual therapy:

(i) $78.68 per 45-minute session; or

(ii) $102.23 per 75—80-minute session; and

(b) For group therapy:

(i) $30.56 per 45—60-minute session; or

(ii) $39.71 per prolonged (75—90-minute) session.]

[(3)] (2) Effective July 1, [2022] 2023:

(a) For individual therapy:

(i) [$84.33] $86.86 per 45-minute session; or

(ii) [$109.64] $112.93 per 75—80-minute session; and

(b) For group therapy:

(i) [$32.78] $33.76 per 45—60-minute session; or

(ii) [$42.59] $43.87 per prolonged (75—90-minute) session.

I. Intensive in-home services as described in Regulation .12 of this chapter shall be reimbursed at the following rates:

(1) For dates of service from [January 1, 2021] July 1, 2022 through [October 31, 2021] June 30, 2023:

(a) [$298.60] $337.54 per week of service for EBP-IIHS providers; or

(b) [$236.89] $267.78 per week of service for non-EBP IIHS providers.

[(2) For dates of service from November 1, 2021 through June 30, 2022:

(a) $314.72 per week of service for EBP-IIHS providers; or

(b) $249.68 per week of service for non-EBP IIHS providers.]

[(3)] (2) Effective July 1, [2022] 2023:

(a) [$337.54] $347.67 per week of service for EBP-IIHS providers; or

(b) [$267.78] $275.81 per week of service for non-EBP IIHS providers.

LAURA HERRERA SCOTT
Secretary of Health

Subtitle 19 DANGEROUS DEVICES AND SUBSTANCES

10.19.03 Controlled Dangerous Substances

Authority: Criminal Law Article, Title 5; Health-General Article, §21-220; Annotated Code of Maryland

Notice of Proposed Action

[23-335-P]

The Secretary of Health proposes to repeal existing Regulations .01—.13 and adopt new Regulations .01—.20 under COMAR 10.19.03 Controlled Dangerous Substances.

Statement of Purpose

The purpose of this action is to evaluate COMAR 10.19.03 for the purpose of satisfying the requirement of State Government Article, §§10-130—10-139, Annotated Code of Maryland, to update the regulations per statutory changes, and to reorganize and clarify existing language.

Estimate of Economic Impact

The proposed action has no economic impact.

Economic Impact on Small Businesses

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

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

.01 Scope and Purpose.

A. The Secretary of the Maryland Department of Health recognizes that the public interest requires control over the use of controlled substances in the legitimate manufacturing, distributing, dispensing, storing, and ordering of controlled substances.

B. This chapter applies to every registrant who manufactures, distributes, dispenses, stores, and orders any controlled substances within the State of Maryland, unless exempted from registration by Criminal Law Article, §5-301(d), Annotated Code of Maryland, or 21 CFR §§1301.22 — 1301.24.

C. In the event of conflict between a provision of the Code of Federal Regulations referenced under a provision of this chapter and the provision of this chapter, the registrant shall comply with the more stringent provision.

.02 Incorporation by Reference.

In this chapter, 21 CFR §§1300 —1317, as amended, are incorporated by reference.

.03 Definitions.

A. Applicability to Chapter. In this chapter, the terms defined in §B of this regulation have the meanings indicated. In addition, and unless otherwise provided in this chapter, the definitions appearing in Criminal Law Article, §5-101, Annotated Code of Maryland, shall also apply to this chapter.

B. Terms Defined.

(1) “Act” means the Maryland Controlled Dangerous Substances Act, Criminal Law Article, §§5-101—5-1101, Annotated Code of Maryland.

(2) “Administrative probable cause” means a valid public interest, sufficient to justify an administrative warrant, allowing the inspection of the area, premises, or building to enforce this chapter.

(3) “Agent” means a person who acts on behalf of the Department.

(4) “Authorized provider” or “provider” means a:

(a) Person licensed, registered, or otherwise allowed to dispense, order, and store controlled substances;

(b) Pharmacy, laboratory, hospital, or other institution licensed, registered, or otherwise allowed to manufacture, distribute, dispense, store, and order controlled substances; or

(c) Person licensed, registered, or otherwise allowed to conduct research on a controlled substance in the State in the course of professional practice or research.

(5) “Board” means the Maryland Boards of Physicians, Podiatry, Dental Examiners, Nursing, and Veterinary Medicine.

(6) “Chemical analysis” means the act of decomposing a substance into its constituent elements.

(7) “Civil fine” means a fine assessed by the Department against an authorized provider, including establishments.

(8) Commercial Container.

(a) “Commercial container” means any bottle, jar, tube, ampule, or other receptacle in which a substance is held for distribution or dispensing to an ultimate user.

(b) “Commercial container” includes any box or package in which a receptacle is held for distribution or dispensing to an ultimate user.

(c) “Commercial container” does not include any package liner, package insert, or other material kept with or within a commercial container, or any carton, crate, drum, or other package in which commercial containers are stored or are used for shipment of controlled substances.

(9) Controlled Premises.

(a) “Controlled premises” means places where original or other records or documents required under the Act are kept or required to be kept.

(b) “Controlled premises” includes factories, warehouses, other establishments, and conveyances, where persons registered under the Act or exempt from registration under the Act may lawfully hold, manufacture, distribute, dispense, administer, or otherwise dispose of controlled substances.

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

(11) “Disciplinary action” includes but is not limited to a penalty, reprimand, restriction, suspension, or revocation of a license.

(12) “Federal Act” means the Controlled Substance Act (84 Stat. 1242; 21 U.S.C. 801) or the Controlled Substance Import and Export Act (84 Stat. 1285; 21 U.S.C. 951).

(13) “Fee exempt” means an authorized provider that is required to register with the Department but is not required to pay the registration fee.

(14) “In good standing” means having a professional license that is not subject to any form of sanction by the Board or Criminal Law.

(15) “Inspector” means an officer or employee of the Department authorized by the Secretary to make inspections under the Act.

(16) “Labeling” means all labels and other written, printed, or graphic matter on any controlled substance or any of its commercial containers or wrappers accompanying controlled substances.

(17) “License” has the same meaning as State Government Article, §10-226, Annotated Code of Maryland.

(18) Manufacture.

(a) “Manufacture” means:

(i) Producing, preparation, propagation, compounding, or processing of a drug or other substance;

(ii) Packaging or repackaging of the substance; or

(iii) Labeling or re-labeling of the commercial container of the substance.

(b) “Manufacture” does not include the activities of a provider who, as an incident to the provider’s administration or dispensing the substance in the course of the provider’s professional practice, prepares, compounds, packages, or labels the substance.

(19) “Manufacturer” means a person who manufactures a drug or other substance under:

(a) A registration as a manufacturer; or

(b) Authority of registration as a researcher or chemical analyst.

(20) “Office of Controlled Substances Administration (OCSA)” refers to the division within the Maryland Department of Health responsible for administering the enforcement of Criminal Law Article, Title 5, Annotated Code of Maryland.

(21) “Penalty” means monetary penalty, including but not limited to a fine.

(22) “Person” means:

(a) An authorized provider;

(b) The responsible party listed on the application licensed by the DEA; or

(c) The responsible party listed on the application for an establishment not licensed by the DEA.

(23) “Peyote” means the controlled substance in Schedule I under Criminal Law Article, §5-402, Annotated Code of Maryland. This schedule I listing does not apply to the nondrug use of peyote in bona fide religious ceremonies of the Native American Church, and members of the Native American Church using peyote in this manner are exempt from registration.

(24) “Pharmacist” means:

(a) A pharmacist licensed in the State or otherwise authorized to dispense controlled substances; or

(b) An individual, for example, a pharmacist intern, authorized by a state to dispense controlled substances under the supervision of a pharmacist licensed by that state.

(25) Prescription.

(a) “Prescription” means an order for medication that is dispensed to or for an ultimate user.

(b) “Prescription” does not include an order for medication which is dispensed for immediate administration to the ultimate user, such as an order to dispense a drug to a bed patient for immediate administration in a hospital.

(26) “Registration” means initial registration or subsequent re-registration with OCSA.

(27) “Secretary” means the Secretary of the Maryland Department of Health.

(28) “Sufficient application” means an application that is completed in full and has provided all of the information required by the Department.

.04 Registration: Requirements and Qualifications.

A. Except for military and federal employees working within the scope of federal employment, a person shall register with the Department and obtain a registration certificate before the person:

(1) Manufactures, distributes, dispenses, stores, and orders controlled substances;

(2) Conducts research or instructional activities with controlled substances listed in Schedules II through V of Criminal Law Article, §§5-403—5-406, Annotated Code of Maryland;

(3) Conducts research or instructional activities with a controlled substance listed in Schedule I of Criminal Law Article, §5-402, Annotated Code of Maryland, with prior registration from the DEA;

(4) Conducts a chemical analysis with controlled substances listed in any schedule;

(5) Installs and maintains an automated dispensing machine containing controlled substances; or

(6) Manufactures peyote for, or distributes peyote to, the Native American Church for bona fide religious ceremonies of the Native American Church.

B. An authorized provider shall:

(1) Apply for a registration certificate on a form made available by the Department to:

(a) Obtain one registration for all locations that a provider prescribes only and no controlled substances are stored; or

(b) Obtain a single registration for each separate location where the provider prescribes, dispenses, orders, and stores controlled substances;

(2) Have a professional license in good standing;

(3) Be of good moral character;

(4) Have no convictions for crimes of moral turpitude;

(5) Be 18 years of age or older;

(6) Be registered with the Prescription Drug Monitoring Program if the authorized provider is also a prescriber as defined under Health-General Article, §21-2A-04.1, Annotated Code of Maryland; and

(7) Except for researchers, have completed 2 continuing education credit hours:

(a) Prior to applying for an initial controlled substance registration occurring on or after October 1, 2018; or

(b) Prior to the first renewal of a controlled substance registration occurring on or after October 1, 2018.

C. Continuing Education.

(1) The continuing education shall:

(a) Be accredited by the Accreditation Council for Continuing Medical Education; or

(b) Meet the requirements for approval by the authorized providers professional board.

(2) The continuing education shall pertain to the prescribing or dispensing of controlled substances.

(3) Authorized providers shall meet the requirements of §§B and C of this regulation upon the completion of the 2 credit hours of continuing education.

(4) Recent graduates meet the requirements of §§B and C of this regulation upon initial application if two academic course credits were issued relating to controlled substances.

D. An establishment shall:

(1) Apply for a registration certificate on a form made available by the Department;

(2) Obtain one registration for each separate place of business, professional practice, or location where controlled substances are:

(a) Ordered;

(b) Purchased;

(c) Administered;

(d) Delivered to the ultimate user;

(e) Stored;

(f) Manufactured; or

(g) Distributed; and

(3) Have a professional or occupational license in good standing to perform any of the following functions related to controlled substances:

(a) Manufacture;

(b) Distribute;

(c) Deliver to the ultimate user;

(d) Administer;

(e) Store;

(f) Order;

(g) Prescribe;

(h) Package;

(i) Label; or

(j) Compound.

.05 Registration: Application.

A. A person shall complete an application to be considered for a registration certificate.

B. The applicant shall:

(1) Submit a completed application made available by the Department;

(2) Except for fee exempt applicants, pay the appropriate fee as set forth in Regulation .06 of this chapter;

(3) Unless exempt from payment of a registration fee, apply for and obtain a registration certificate;

(4) Provide an explanation for any not-applicable responses on the applications;

(5) Notify the Department of any criminal convictions related to controlled substances;

(6) Notify the Department of any actions taken on the applicant’s professional license;

(7) Have the application and accompanying documents required for registration signed by the:

(a) Applicant, if an individual;

(b) General partner, if the applicant is a partnership; or

(c) Officer responsible for the applicant, if the applicant is a corporation or other entity; and

(8) Provide additional documentation required by the Department pertinent to the registration, to:

(a) Clarify application information; and

(b) Determine if the applicant meets the requirements of this chapter.

C. New applications that are unable to be processed 6 months from the payment deposit date:

(1) May be determined invalid;

(2) Will not be issued a refund, unless:

(a) The payment is a duplicate; or

(b) Approved by the Department; and

(3) Will require a new application to be resubmitted.

D. Renewal applications that are unable to be processed 45 days from the payment deposit date:

(1) May be determined invalid;

(2) Will not be issued a refund, unless:

(a) The payment is a duplicate; or

(b) Approved by the Department; and

(3) Will require a new renewal application to be submitted.

.06 Registration: Fees.

A. An authorized provider or establishment required to obtain and maintain a registration certificate as set forth under this chapter shall pay the appropriate fees as follows:

(1) New registration certificate — $120;

(2) Renewal registration certificate — $120;

(3) Amend a registration certificate — $50;

(4) Change of ownership fee — $144;

(5) Duplicate registration certificate — $30; and

(6) Reinstatement — $50.00.

B. Applicants exempt from registration fees include:

(1) Except for contractual positions, an employee of a hospital, clinic, institution, facility, or unit operated by a local or State government agency;

(2) An agency, excluding a State agency and its employees, for which the State is responsible for payment of the fee, provided that the exemption is approved by the Secretary; or

(3) A person included in 21 CFR §§1301.21.

C. Refunds and Credits.

(1) The Secretary may not issue a credit towards or refund any registration fees to an applicant, including but not limited to, an applicant who:

(a) Withdraws a registration application;

(b) Voluntarily or involuntarily ceases to manufacture, distribute, dispense, order, and store a controlled substances before a registration certificate expires; or

(c) Does not complete the application as set forth in Regulation .05 of this chapter.

(2) The Secretary, or the Secretary’s designee, shall review the refund request and determine if a refund of any amount is appropriate.

D. A registrant who has lost a registration certificate is required to pay a duplicate registration fee as set forth in §A of this regulation.

E. The Department may not issue a new or a renewed registration certificate until all required fees are paid.

F. The Department-issued registration certificate shall be readily available to any agent or representative of the Secretary within the registered location.

.07 Registration: Term, Expiration, Renewal, and Reinstatement.

A. Term. The Secretary may issue a registration certificate that is valid for not more than 3 years.

B. Expiration.

(1) A registration certificate expires on the date shown on the certificate.

(2) The Secretary shall notify the registrant that the registration will expire not less than 30 days before the expiration date shown on the certificate.

C. Renewal.

(1) A registration for which a sufficient application for renewal was submitted:

(a) Shall be received at least 2 weeks before the expiration; and

(b) Will remain in effect until the Department takes a final action.

(2) The failure to receive a renewal notice does not excuse a registrant from complying with this chapter.

D. Reinstatement.

(1) A registrant whose registration has been surrendered in lieu of further investigation, revoked, suspended, or limited may not be eligible to request reinstatement for a:

(a) 2-year period;

(b) Specified period designated in a consent order from the Department; or

(c) Specified time period determined by the Department.

(2) To apply for reinstatement, a registrant shall:

(a) Complete and submit an application on a form provided by the Department; and

(b) Pay a reinstatement fee shown in Regulation .06 of this chapter.

.08 Registration Certificate: Assignment, Transfer, or Termination.

A. A registration certificate is not transferable.

B. A registration certificate becomes void when the registrant:

(1) Dies;

(2) Discontinues business or professional practice in the State; or

(3) Changes ownership, including when:

(a) Partners are added or deleted from the partnership;

(b) There is a change in the president or chief executive officer of the corporation; or

(c) There is a change in the ownership of 10 percent or more of the outstanding shares in the corporation.

C. A registrant who discontinues business or professional practice in the State shall:

(1) Notify the Secretary in writing;

(2) Surrender the registrant’s current registration certificate; and

(3) Legally transfer or dispose of any controlled substances relative to the registrant’s operation.

D. A registrant who changes ownership of the business or professional practice shall:

(1) Notify the Secretary in writing at least 30 days before the change occurs;

(2) Complete and submit a change of ownership application to the Department;

(3) Pay the change-of-ownership fee in Regulation .06 of this chapter;

(4) Surrender the registrant’s current registration certificate after the ownership change is finalized; and

(5) Allow the Department to inspect the business or professional practice of the new owners.

E. A registrant who changes the location of a registrant’s place of business or professional practice shall:

(1) Notify the Department at least 30 days before there is a change in the location of the registrant’s place of business or professional practice;

(2) Apply to amend a current registration certificate; and

(3) Pay the fee to amend a certificate in Regulation .06 of this chapter.

F. During the 3-year registration period, the registrant shall notify the Office of Controlled Substances Administration within 30 days of the following:

(1) Any criminal convictions;

(2) Any disciplinary actions taken against the registrant’s professional or occupational license; or

(3) Any disciplinary actions taken against the registrant’s federal Drug Enforcement Agency registration.

G. After an application for registration has been filed, the Secretary may:

(1) Inspect the place of business or professional practice described in the application; and

(2) Investigate the applicant to determine whether the applicant meets the requirements of this chapter.

H. The registrant shall inform the Office of Controlled Substances Administration prior to any address changes.

.09 Labeling and Packaging Requirements for Controlled Substances.

A registrant shall comply with the provisions of 21 CFR §1302, as amended.

.10 Records and Reports Required of Registrants.

A. Pursuant to Criminal Law Article, §5-306, Annotated Code of Maryland, a registrant shall comply with the provisions of 21 CFR §1304, as amended.

B. Inventories developed under the Federal Act dated May 1, 1971, and subsequent biennial inventory dates are acceptable for purposes of the Maryland Act.

C. On the effective date a substance is added to any schedule of controlled substances pursuant to Criminal Law Article, §5-202, Annotated Code of Maryland, registrants required to keep records, who possess that substance, shall take an inventory of all stocks of that substance on hand. Thereafter, that substance shall be included in each inventory made by the registrant.

D. Reports required in this section shall be accessible to the representative of the Secretary.

.11 Order Forms.

A registrant shall comply with the provisions of 21 CFR 1305, as amended.

.12 Prescriptions.

A. Persons Entitled to Issue Prescriptions.

(1) A prescription for a controlled substance may be issued only by an authorized provider who is:

(a) Authorized to prescribe controlled substances in the State of Maryland; and

(b) Either registered or exempted from registration pursuant to 21 CFR §1301.22(c) and 21 CFR §1301.23.

(2) A prescription issued by an authorized provider may be communicated to a pharmacist by an employee or agent of the authorized provider.

B. Purpose of Issue of Prescription.

(1) A controlled substance prescription shall only be issued for a legitimate medical purpose by a provider.

(2) A controlled substance prescription shall be issued by a provider in the usual course of the individual provider’s professional practice.

(3) The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing provider.

(4) A pharmacist has a corresponding responsibility to ensure, prior to dispensing, that a controlled substance prescription is issued for a legitimate medical purpose.

(5) An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is not a prescription within the meaning and intent of the Maryland Controlled Dangerous Substances Act, Criminal Law Article, §§5-501—5-505, Annotated Code of Maryland.

(6) A prescription may not be issued in order for an individual provider to obtain controlled substances for supplying the individual provider for the purpose of general dispensing to patients.

C. A prescription for a Schedule II-V controlled substance shall be dispensed within 120 days from the date of issue.

D. Unless the State has stricter requirements, if a provider has complied with 21 CFR §1306, the provider is deemed to have complied with this chapter.

.13 Partial Fill of a Prescription.

A partial fill of a C-II prescription is permitted if:

A. The pharmacist is unable to fill the full quantity of the prescription, pursuant to 21 CFR §1306.13(a);

B. The prescription is issued for a patient in a long-term care facility or for a patient with a medical diagnosis documenting a terminal illness pursuant to 21 CFR 1306.13(b) or (c);

C. Requested by the patient or the practitioner that wrote the prescription, pursuant to 21 CFR §1306.13(b); or

D. The total quantity dispensed in all partial fillings does not exceed the total quantity prescribed.

.14 Refilling of Prescriptions.

A. A prescription for a controlled substance listed in Schedule II may not be refilled.

B. A prescription for a controlled substance listed in Schedule III, IV, or V:

(1) May not be refilled more than 6 months after the date on which the prescription was issued;

(2) May not be refilled more than five times; and

(3) Shall require a new and separate prescription to be issued if additional quantities are deemed necessary by the authorized prescribing provider.

C. The prescribing provider may authorize additional refills of Schedule III, IV, or V substances on the original prescription through an oral refill authorization transmitted to the pharmacist if the following conditions are met:

(1) The total quantity authorized, including the amount of the original prescription, does not exceed five refills or extend beyond 6 months from the date of issue of the original prescription;

(2) The pharmacist obtaining the oral authorization records on the reverse of the original paper prescription or annotates the electronic prescription record with the date, quantity of refill, and number of additional refills authorized, and initials the paper prescription or annotates the electronic prescription record showing who received the authorization from the prescribing practitioner who issued the original prescription;

(3) The quantity of each additional refill authorized is equal to or less than the quantity authorized for the initial filling of the original prescription; and

(4) The prescribing practitioner executes a new and separate prescription for any additional quantities beyond the five-refill, 6-month limitation.

D. Required Documentation.

(1) Each refilling of a prescription shall be documented on the:

(a) Back of the prescription;

(b) With Department approval, on another appropriate uniformly maintained, readily retrievable record, such as medication records; or

(c) electronic prescription record.

(2) The documentation shall indicate the:

(a) Number of the prescription;

(b) Name of the controlled substance;

(c) Dosage form of the controlled substance;

(d) Date of each refilling;

(e) Quantity dispensed;

(f) Identity or initials of the dispensing pharmacist in each refilling;

(g) Total number of refills for that prescription;

(h) Pharmacist’s initials; and

(i) Date by the pharmacist as of the date of dispensing.

(3) Each refilling of a prescription shall:

(a) State the amount dispensed; or

(b) If the amount dispensed is not specifically stated, be deemed to have been dispensed for the full face amount of the prescription.

.15 Physical Security Controls for Registrants.

A registrant shall comply with the provisions of 21 CFR §§1301.71—1301.77 as amended.

.16 Controlled Substance Disposal.

A. Any registrant in possession of legally obtained controlled substances and desiring or required to dispose of any of these substances may ask the Office of Controlled Substances Administration of the Maryland Department of Health for authority and instructions to dispose of this substance. This does not eliminate the requirement on registrants under federal regulations to report destruction of controlled dangerous substances.

B. Disposal of Medical Waste.

(1) A registrant in possession of legally obtained controlled substances deemed medical waste shall render the controlled substances irretrievable by disposing of:

(a) Liquid waste in an approved containment unit; or

(b) Non-liquid in a receptacle.

(2) Two licensed personnel shall keep Waste Destruction Logbooks and maintain the record for 2 years. The Destruction Log shall be readily available upon inspection.

C. Disposal for Registrants Required to Register with the DEA.

(1) The Office of Controlled Substances Administration shall authorize and instruct the registrant to dispose of the controlled substance in one of the following manners, provided complete records of the disposition are maintained by the registrant:

(a) By transfer to a person registered under the Act and authorized to possess the substance;

(b) By destruction in the presence of an agent of the Office of Controlled Substances Administration or another authorized person;

(c) By forwarding to the District Office of the Drug Enforcement Administration pursuant to the procedures of that agency;

(d) By returning unused controlled substances dispensed by registered hospital pharmacies for administration to in-patients to the pharmacy for appropriate disposition; or

(e) By other means that the Secretary may determine to assure that the substance does not become available to unauthorized persons.

(2) A registrant that has complied with 21 CFR §1304 is deemed to have complied with this section.

(3) If a registrant is required regularly to dispose of controlled substances, the Special Agent in Charge of the Federal Drug Enforcement Administration may authorize the registrant to dispose of these substances, in accordance with 21 CFR §1307.

D. Disposal for Registrants Not required to Register with the DEA. Any registrant who is registered to administer only and is in possession of legally obtained controlled substances shall:

(1) List the controlled substance or substances which the registrant desires to dispose of on a drug destruction form provided by the Department;

(2) Have two members of the professional staff, limited to an administrator, nurse, or pharmacist, destroy controlled drugs on premises;

(3) Dispose per instructions given in §B of this regulation.

(4) Forward a copy of the completed drug destruction form to the Office of Controlled Substances Administration within 10 days of destruction; and

(5) Keep a copy of the drug disposal form on location for a period of 2 years.

E. Abandoned controlled substances may be:

(1) Destroyed in the presence of an agent of the Office of Controlled Substances Administration or another authorized person or persons;

(2) Disposed of by other means that the Secretary may determine to assure that the substance does not become available to unauthorized persons; or

(3) Impounded under Health-General Article, §21-1113, Annotated Code of Maryland.

F. Aforementioned procedures do not preclude release of medication to discharged patients if ordered in writing by the attending physician.

.17 Transfer of Controlled Substances.

A. When closing business activities, a registrant shall:

(1) Dispose of all controlled dangerous substances in accordance with Regulation .16 of this chapter; and

(2) Return the controlled substances registration certificate to the Office of Controlled Substances Administration inspector at the time of the closing inspection.

B. Change of Ownership.

(1) A Change of Ownership requires the registrant to notify the Department in writing, Attention to the Office of Controlled Substances Administration.

(2) The written notification shall be submitted:

(a) In person;

(b) By registered mail; or

(c) By certified mail with a return receipt request.

(3) The written notification must be received 14 days before the transfer occurs.

(4) The Secretary has the authority to waive the 14-day time limitation in individual instances.

(5) The written notification shall contain the following information:

(a) The name;

(b) The address;

(c) The registration number; and

(d) The authorized business activity of the:

(i) Registrant-transferor discontinuing the business; and

(ii) Registrant-transferee acquiring the business;

(e) Whether the business activities will be:

(i) Continued at the location registered by the person discontinuing business; or

(ii) Moved to another location and, if so, the address of the new location; and

(f) The date on which the transfer of controlled substances will occur.

(6) Except for transfer denials by the Secretary, the registrant-transferor may distribute, without being registered to distribute, controlled substances in the registrant-transferor’s possession to the registrant-transferee in accordance with the following procedures, on the date of transfer of the controlled substances:

(a) A complete inventory of all controlled substances being transferred shall be taken and serve as the final inventory of the registrant-transferor and the initial inventory of the registrant-transferee;

(b) A copy of the inventory shall be included in the records of both the transferor and transferee;

(c) A copy of the inventory shall be filed with the Department if requested by the Secretary;

(d) Transfers of Schedule I or II controlled substances shall require the use of order forms in accordance with 21 CFR §1305;

(e) All transferor-controlled substance records shall be transferred to the transferee; and

(f) Pursuant to 21 CFR §1304, transferors are required to make reports, which shall be marked as “Final”.

.18 Administrative Inspections and Warrants.

A. Administrative Inspections.

(1) Procedures regarding administrative inspections and warrants pursuant to Criminal Law Article, §§5-305, 5-804, and 5-805, Annotated Code of Maryland, are governed generally by those sections of the Annotated Code and specifically by this regulation.

(2) Authority to make inspections is authorized in accordance with Criminal Law Article, §§5-804 and 5-805, Annotated Code of Maryland, to enter controlled premises and conduct administrative inspections for the purpose of the following:

(a) Documents required to be kept or made pursuant to 21 CFR §1304, under the Act, or regulations promulgated under the Act may be:

(i) Inspected;

(ii) Copied;

(iii) Verified for correctness; and

(iv) Inventoried;

(b) Collecting samples of controlled substances or precursors (if samples are collected during an inspection, the inspector shall issue a receipt for these samples to the owner, operator, or agent in charge of the premises);

(c) Review of records and information on the distribution of controlled substances by the authorized provider;

(d) Reviewing the authorized providers processes;

(e) Reviewing the authorized providers controls; and

(f) Inspecting the authorized providers facility operations;

(3) Entry.

(a) An inspection shall be carried out by an inspector.

(b) An inspector shall have the right to enter the premises and conduct inspections at reasonable times and in a reasonable manner, upon the following conditions:

(i) Stating the inspector’s purpose; and

(ii) Presenting to the owner, operator, or agent in charge of the premises to be inspected, appropriate credentials and written notice of the inspector’s inspection authority under Criminal Law Article, §5-305, 5-804, or 5-805, Annotated Code of Maryland.

(4) Consent to Inspection of Financial Data, Sales Data Other than Shipment Data, or Pricing Data.

(a) If inspection is desired of financing, sales, or pricing data, written consent shall first be obtained from the owner, operator, or agent in charge of the premises to be inspected.

(b) This written consent shall contain the following information:

(i) That the owner, operator, or agent in charge has the right to refuse to consent to an inspection of these items;

(ii) That anything of an incriminating nature which may be found may be seized and used against the owner, operator, or agent in charge in a criminal prosecution;

(iii) That the owner, operator, or agent in charge has been presented with a notice of inspection;

(iv) That the consent is given by the owner, operator, or agent in charge voluntarily and without threats of any kind; and

(v) That the owner, operator, or agent in charge may withdraw the owner’s, operator’s, or agent in charge’s consent at any time during the course of inspection.

(c) The written consent shall be produced in duplicate and be distributed as follows:

(i) The original will be retained by the inspector; and

(ii) The duplicate will be given to the authorized provider inspected.

B. Administrative Warrants.

(1) Probable Cause. If the Department is satisfied that administrative probable cause exists, the Department shall issue an administrative warrant.

(2) Execution of Warrants. An administrative inspection warrant shall be executed as required by Criminal Law Article, §5-804(d), Annotated Code of Maryland.

(3) Refusal to Allow Inspection with an Administrative Warrant. If an authorized provider or any person subject to the Act refuses to permit execution of an administrative warrant, or impedes the inspector in the execution of that warrant, the authorized provider or person shall be advised that this refusal or action constitutes a violation of Criminal Law Article, §5-902(a)(3), Annotated Code of Maryland.

.19 Hearings, Enforcement, and Disciplinary Sanctions.

A. Authority for Enforcement Proceeding.

(1) A hearing may be ordered or granted by the Secretary, at the Secretary’s discretion, to permit any person against whom criminal or civil action is contemplated under the Controlled Dangerous Substances Act an opportunity to present the individual’s views and the individual’s proposals for bringing the individual’s alleged violations into compliance with the law. The hearing will also permit the individual to show cause why prosecution should not be instituted, or to present the individual’s views on the contemplated proceeding.

(2) The rules of procedure for hearings before the Secretary of the Maryland Department of Health shall be governed by COMAR 10.01.03 and State Government Article, §§10-201—10-226, Annotated Code of Maryland.

(3) Administrative Hearings. Procedures for administrative hearings shall be governed by the rules set forth in Criminal Law Article, §5-308, if applicable, Health-General Article, §2-207, and State Government Article, §§10-201—10-226, Annotated Code of Maryland, and COMAR 10.01.03.

B. After a hearing pursuant to Criminal Law Article, §5-308, if applicable, and State Government Article, §§10-201—10-226, Annotated Code of Maryland, and COMAR 10.01.03, the Secretary may impose a sanction or penalty against any registrant that possesses a Maryland-issued controlled substances registration pursuant to Criminal Law Article, Title V, Annotated Code of Maryland, instead of or in addition to:

(1) The denial of an application;

(2) The refusal to renew a registration;

(3) Suspending a registration;

(4) Revoking a registration;

(5) Placing restrictions on a registration pursuant to Criminal Law Article, §5-307, Annotated Code of Maryland; or

(6) Issuing a nonpublic advisory letter.

C. Imposition of Monetary Penalty.

(1) After a hearing pursuant to Criminal Law Article, §5-308, Annotated Code of Maryland, the Department may impose a monetary penalty against a controlled substance registration holder pursuant to Criminal Law Article, §5-908, Annotated Code of Maryland.

(2) The monetary penalty may be imposed instead of or in addition to the:

(a) Suspension of the controlled substances registration;

(b) Revocation of the controlled substances registration; or

(c) Restrictions placed on the controlled substances registration.

(3) The monetary penalty shall be paid within 30 calendar days of the order, unless the order specifies otherwise.

(4) Until the imposed fine is paid, the registration may not be:

(a) Restored;

(b) Reinstated; or

(c) Renewed.

(5) In its discretion, the Department may refer all cases of delinquent payment to the Central Collection Unit of the Department of Budget and Management for collection.

D. Notwithstanding the guidelines set forth in this chapter, in order to resolve a pending disciplinary action, the Department and the registrant may agree to a surrender of a registration, or a consent order with terms, sanction, and penalties agreed to by the Department and the registrant.

E. Nothing in this chapter prohibits the Department from staying any period of non-active suspension.

.20 Additional Controlled Substances in Maryland.

A. The following substance, also known as a “bath salt”, is added to the Maryland Controlled Dangerous Substances Act, Schedule I of the Criminal Law Article, §5-402, Annotated Code of Maryland: F. 4-Methoxymethcathinone (Methedrone, bk-PMMA, PMMC).

B. The following substances are added to the Maryland Controlled Dangerous Substances Act, Schedule III of the Criminal Law Article, §5-404, Annotated Code of Maryland:

(1) Butalbital, Acetaminophen, caffeine C-III Fioricet®; and

(2) Opium < or = 100mg per 100Gm or 100ml or not more than 5mg per dosage unit C-III.

LAURA HERRERA SCOTT
Secretary of Health

Special Documents

DEPARTMENT OF THE ENVIRONMENT

SUSQUEHANNA RIVER BASIN COMMISSION

Commission Meeting

AGENCY: Susquehanna River Basin Commission.

ACTION: Notice.

SUMMARY: The Susquehanna River Basin Commission will conduct its regular business meeting on March 14, 2024 in Harrisburg, Pennsylvania. Details concerning the matters to be addressed at the business meeting are contained in the Supplementary Information section of this notice. Also the Commission published a document in the Federal Register on January 10, 2024, concerning its public hearing on February 1, 2024, in Harrisburg, Pennsylvania.

DATES: The meeting will be held on Thursday, March 14, 2024, at 9 a.m.

ADDRESSES: This public meeting will be conducted in person and digitally from the Susquehanna River Basin Commission,4423 N. Front Street, Harrisburg, Pennsylvania.

FOR FURTHER INFORMATION CONTACT: Jason E. Oyler, General Counsel and Secretary to the Commission, telephone: 717-238-0423; fax: 717-238-2436.

SUPPLEMENTARY INFORMATION: The business meeting will include actions or presentations on the following items: (1) approval of contracts, grants and agreements; (2) request to ratify General Permit GP-03, Cooperative Fish Nursery (3) a motion to release a proposed rulemaking for public comment; and (4) actions on 25 regulatory program projects.

This agenda is complete at the time of issuance, but other items may be added, and some stricken without further notice. The listing of an item on the agenda does not necessarily mean that the Commission will take final action on it at this meeting. When the Commission does take final action, notice of these actions will be published in the Federal Register after the meeting. Any actions specific to projects will also be provided in writing directly to project sponsors.

The meeting will be conducted both in person at the Susquehanna River Basin Commission, 4423 N. Front Street, Harrisburg, Pennsylvania and digitally. The public is invited to attend the Commission’s business meeting. You can access the Business Meeting remotely via Zoom: https://us02web.zoom.us/j/‌89292000071?pwd=S1E2Qi9QNHUyTkhjY3ZoRUJJeXpqUT09 Meeting ID 892 9200 0071; Passcode: SRBC4423! or via telephone: 305-224-1968 or 309-205-3325; Meeting ID 892 9200 0071.

Written comments pertaining to items on the agenda at the business meeting may be mailed to the Susquehanna River Basin Commission, 4423 North Front Street, Harrisburg, Pennsylvania 17110-1788, or submitted electronically at the link Business Meeting Comments. Such comments are due to the Commission on or before March 11, 2024. Comments will not be accepted at the business meeting noticed herein.

AUTHORITY: Pub. L. 91-575, 84 Stat. 1509 et seq., 18 CFR Parts 806, 807, and 808.

DATED: February 2, 2024.

JASON E. OYLER
General Counsel and Secretary to the Commission

[24-04-04]

WATER AND SCIENCE ADMINISTRATION

Water Quality Certification 23-WQC-0030

Pulaski Highway

968 Postal Road

Allentown, PA 18109

Add’l. Info: Pursuant to COMAR 26.08.02.10F(3)(c), The Maryland Department of the Environment is providing notice of its issuance of a Water Quality Certification 23-WQC-0030.

Location: Pulaski Highway (US Route 40 east), which is north of Old Philadelphia Road east (MD Route 7, Bacon Hill area), Elkton, in Cecil County.

The purpose of the project is to construct roads, paved truck parking lots, culverts, outfalls, end walls, and retaining walls for a 407,500.000 square foot warehouse distribution facility, Jackson Property.

1. Permanent impact to 27,955 square feet of forested nontidal wetland, 10,398 square feet of forested (isolated) nontidal wetland, 29,201 square feet of emergent nontidal wetland, 18,118 square feet of emergent (isolated) nontidal wetland, 148,379 square feet of 25-foot nontidal wetland buffer, and 154 linear feet (542 square feet) of an intermittent Use I stream (Mill Creek). Temporary impact to 2,256 square feet of forested nontidal wetland, 32 square feet of emergent nontidal wetland, 15 square feet of emergent (isolated) nontidal wetland, and 5,497 square feet of the 25-foot nontidal wetland buffer to Mill Creek (Use I).

The WQC and its attachments may be viewed at the following link: https://mde.maryland.gov/programs/Water/WetlandsandWaterways/Pages/WQC.aspx

Appeal of Final Decision. This Water Quality Certification is a final agency decision. Any person aggrieved by the Department’s decision to issue this WQC may appeal such decision in accordance with COMAR 26.08.02.10F(4). A request for appeal shall be filed with the Department within 30 days of publication of the final decision and specify in writing the reason why the final decision should be reconsidered. A request for appeal shall be submitted to: Secretary of the Environment, Maryland Department of the Environment, 1800 Washington Boulevard, Baltimore, MD 21230. Any request for an appeal does not stay the effectiveness of this WQC.

Contact: Louis Parnes at louis.parnes@maryland.gov or 410-537-3786.

[24-04-09]

General Notices

Notice of ADA Compliance

The State of Maryland is committed to ensuring that individuals with disabilities are able to fully participate in public meetings. Anyone planning to attend a meeting announced below who wishes to receive auxiliary aids, services, or accommodations is invited to contact the agency representative at least 48 hours in advance, at the telephone number listed in the notice or through Maryland Relay.

STATE COLLECTION AGENCY LICENSING BOARD

Subject: Public Meeting

Date and Time: March 12, 2024, 2 — 3 p.m.; Thereafter, the public meetings will take place the second Tuesday of every month, accessed via the Google Meet information below.

Add’l. Info: Google Meet joining info:

Video link:

https://meet.google.com/ahz-mgnk-jsu

Or dial: (US) +1 530-738-1353&#8236

PIN: 815 799 863#

If necessary, the Board will convene in a closed session to seek the advice of counsel or review confidential materials, pursuant to General Provisions Article, §3-305, Annotated Code of Maryland.

Contact: Ayanna Daugherty 410-230-6019

[24-04-03]

MARYLAND DEPARTMENT OF HEALTH

Subject: Public Meeting

Date and Time: May 2, 2024, 9 a.m. — 1 p.m.

Place: Virtual meeting — please see details below.

Add’l. Info: Please be advised that the May 2, 2024, Pharmacy and Therapeutics (P&T) Committee public meeting will be conducted virtually via a Webinar.

As soon as available, classes of drugs to be reviewed, speaker registration guidelines, and procedure to register to attend the virtual meeting will be posted on the Maryland Pharmacy Program website at https://health.maryland.gov/mmcp/pap/Pages/Public-MeetingAnnouncement-and-Procedures-for-Public-Testimony.aspx.

Submit questions to:

mdh.marylandpdlquestions@maryland.gov.

Contact: Deborah Washington 410-767-1455

[24-04-13]

MARYLAND DEPARTMENT OF HEALTH/HARM REDUCTION STANDING ADVISORY COMMITTEE

Subject: Public Meeting

Date and Time: March 8, 2024, 10 a.m. —12 p.m.

Place: Via Zoom — please see details below.

Add’l. Info: Log In:

https://us06web.zoom.us/j/86782287446?pwd=Ly03TKaRZHcl4OfLDOSr7UBSqVqZZT.1

Meeting ID: 867 8228 7446

Passcode: 388339

Contact: Katy Edwards,

katylaurel.edwards@maryland.gov

[24-04-02]

BOARD OF PUBLIC ACCOUNTANCY

Subject: Public Meeting

Date and Time: March 5, 2024, 9 a.m.

Place: Via Google Meet and in person at Maryland Dept. of Labor, 1100 N. Eutaw St., 5th Fl., Baltimore, MD

Add’l. Info: Video link:

meet.google.com/yai-nvov-tdm

Or join by phone:

(‪US)‪+1 314-666-1864

PIN: ‪334 472 909#

Contact: Christopher E. Dorsey, Exec. Dir., 410-230-6318

[24-04-11]

BOARD OF PUBLIC ACCOUNTANCY

Subject: Public Hearing

Date and Time: March 5, 2024, 10:30 a.m. and 12:30 p.m.

Place: Maryland Dept. of Labor, 1100 N. Eutaw St., 5th Fl., Baltimore, MD

Add’l. Info: The Board of Public Accountancy has scheduled two application (reinstatement) hearings to take place at its March meeting.

Contact: Christopher E. Dorsey, Exec. Dir., 410-230-6318

[24-04-12]

STATE ADVISORY COUNCIL ON QUALITY CARE AT THE END OF LIFE

Subject: Public Meeting

Date and Time: March 4, 2024, 10 a.m. — 12 p.m.

Place: Via Google Meet — please see details below.

Add’l. Info: Video link:

meet.google.com/aiv-dneh-vko

Or join by phone:

(US) +1 551-236-4103

PIN: 113 236 819#

The public is welcome to attend the videoconference.

Contact: Paul Ballard 410-767-6918

[24-04-06]

BOARD OF WATERWORKS AND WASTE SYSTEMS OPERATORS

Subject: Public Meeting

Date and Time: March 21, 2024, 10 a.m. — 12p.m.

Place: Online via Google Chat — please see the Board’s webpage for meeting details at:

https://mde.maryland.gov/programs/Permits/EnvironmentalBoards/Pages/BWW.aspx

Add’l. Info: A portion of this meeting may be held in closed session

Contact: J. Martin Fuhr 410-537-3588

[24-04-01]