Final Action on Regulations
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Title 08
DEPARTMENT OF NATURAL RESOURCES
Subtitle 08 DEEP CREEK LAKE
08.08.05 Permits
Authority: Natural Resources
Article, §§5-209, 5-215, and 8-704, Annotated Code of Maryland
Notice of Final Action
[24-230-F]
On May 20, 2025, the Secretary of Natural Resources adopted
amendments to Regulation .03 under COMAR 08.08.05 Permits. This
action, which was proposed for adoption in 52:7 Md. R. 326—328 (April 4, 2025),
has been adopted as proposed.
Effective Date: June 9, 2025.
JOSH KURTZ
Secretary of Natural Resources
Title 10
MARYLAND DEPARTMENT OF HEALTH
Subtitle 09 MEDICAL CARE PROGRAMS
10.09.02 Physicians' Services
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105,
Annotated Code of Maryland
Notice of Final Action
[25-010-F-I]
On May 20, 2025, the Secretary of Health adopted amendments to
Regulation .07 under COMAR 10.09.02 Physicians’ Services. This
action, which was proposed for adoption in 52:5 Md. R. 241—242 (March 7, 2025),
has been adopted as proposed.
Effective Date: June 9, 2025.
MEENA SESHAMANI, MD, PHD
Secretary of Health
Subtitle
09 MEDICAL CARE PROGRAMS
10.09.37 Family Planning
Program Eligibility
Authority: Health-General Article, §§2-104(b), 13-1402, 15-103(a),
and 15-140, Annotated Code of Maryland
Notice of Final Action
[25-011-F]
On May 20, 2025, the Secretary of Health adopted amendments to
Regulation .03 under COMAR 10.09.37 Family Planning Program
Eligibility. This action, which was proposed for adoption in 52:5 Md. R.
242—243 (March 7, 2025), has been adopted as proposed.
Effective Date: June 9, 2025.
MEENA SESHAMANI, MD, PHD
Secretary of Health
Notice of Final Action
[24-235-F]
On May 19, 2025, the Secretary of Health adopted amendments to:
(1) Regulations .01 and .04—.06
under COMAR 10.09.12 Disposable Medical Supplies and Durable Medical
Equipment;
(2) Regulation .01 under COMAR 10.67.01 Maryland Medicaid
Managed Care Program: Definitions; and
(3) Regulation .13 under COMAR 10.67.06 Maryland Medicaid
Managed Care Program: Benefits.
This action, which was proposed for adoption in 52:3 Md. R. 164—166
(February 7, 2025), has been adopted with the nonsubstantive changes shown
below.
Effective Date: June 9, 2025.
Attorney General’s Certification
In accordance with the State Government Article §§10-113, Annotated
Code of Maryland, the Attorney General certifies that the following changes do
not differ substantively from the proposed text. The changes could have been
reasonably anticipated by interested parties, do not substantially change the
intended benefits of the regulation, and do not increase the burdens of the
regulations as proposed. The specific changes are as follows:
COMAR 10.09.12.01B(15): The Maryland Department of Health will
change language in the definition of “orthic device” by replacing the term
“deformed” with “misaligned” when referring to the body, to ensure more
appropriate terminology.
COMAR 10.67.01.01B(128): The Maryland Department of Health will
change language in the definition of “orthic device” by replacing the term
“deformed” with “misaligned” when referring to the body, to ensure more
appropriate terminology.
Subtitle 09 MEDICAL CARE PROGRAMS
10.09.12 Disposable Medical
Supplies and Durable Medical Equipment
Authority: Health-General Article, §§2-104(b), 15-103, 15-105, and
15-129, Annotated Code of Maryland
.01 Definitions.
A. (proposed text unchanged)
B. Terms Defined.
(1)—(14) (proposed text unchanged)
(15) “Orthotic device” means rigid and semi-rigid devices used
for the purpose of supporting a weak or [[deformed]]
misaligned body member or restricting or eliminating motion in a
diseased or injured part of the body.
(16)—(25) (proposed text unchanged)
Subtitle 67 MARYLAND
HEALTHCHOICE PROGRAM
10.67.01 Maryland Medicaid
Managed Care Program: Definitions
Authority: Health-General Article, §§15-101 and 15-103(b),
Annotated Code of Maryland
.01 Definitions.
A. (proposed text unchanged)
B. Terms Defined.
(1)—(127) (proposed text unchanged)
(128) “Orthotic device” means rigid and semi-rigid devices used
for the purpose of supporting a weak or [[deformed]]
misaligned body member or restricting or eliminating motion in a
diseased or injured part of the body.
(129)—(184) (proposed text unchanged)
MEENA SESHAMANI, M.D., PH.D
Secretary of Health
Subtitle 09 MEDICAL CARE PROGRAMS
10.09.76 School-Based Health
Centers (SBHC)
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105,
Annotated Code of Maryland
Notice of Final Action
[25-012-F]
On May 21, 2025, the Secretary
of Health adopted amendments to Regulations .04 and .05 under COMAR
10.09.76 School-Based Health Centers (SBHC). This action, which was
proposed for adoption in 52:5 Md. R. 243 (March 7, 2025), has been adopted as
proposed.
Effective Date: June 9, 2025.
MEENA SESHAMANI, MD, PHD
Secretary of Health
Subtitle 42 BOARD OF SOCIAL WORK
EXAMINERS
10.42.01 Regulations Governing
Licensure
Authority: Health Occupations Article, §§19-101—19-502, Annotated
Code of Maryland
Notice of Final Action
[25-014-F]
On May 14, 2025, the Secretary of Health adopted amendments to
Regulations .02, .04, and .11 under COMAR 10.42.01
Regulations Governing Licensure. This action, which was proposed for
adoption in 52:5 Md. R. 245—246 (March 7, 2025), has been adopted as proposed.
Effective Date: June 9, 2025.
MEENA SESHAMANI, MD, PHD
Secretary of Health
Title 20
PUBLIC SERVICE COMMISSION
Subtitle 31 TERMINATIONS OF
SERVICE
Notice of Final Action
[25-024-F]
On May 7, 2025, the Public
Service Commission adopted amendments to:
(1) Regulation .02 under COMAR 20.31.01 General
Regulations; and
(2) Regulation .04 under COMAR
20.31.03 Restrictions on Terminations.
This action, which was proposed for adoption in 52:6 Md. R. 290—291
(March 21, 2025), has been adopted as proposed.
Effective Date: June 9, 2025.
ANDREW S. JOHNSTON
Executive Secretary
Title 30
MARYLAND INSTITUTE FOR EMERGENCY MEDICAL SERVICES SYSTEMS (MIEMSS)
Notice of Final Action
[25-007-F]
On May 13, 2025, the Maryland State Emergency Medical Services
Board adopted:
(1) Amendments to Regulation .02
under COMAR 30.01.01 Definitions;
(2) Amendments to Regulation .01
under COMAR 30.02.01 Definitions; and
(3) Amendments to Regulations .02—.09 under COMAR
30.02.02 Licensure and Certification.
This action, which was proposed for adoption in 52:6 Md. R. 291—296
(March 21, 2025), has been adopted with the nonsubstantive changes shown below.
Effective Date: June 9, 2025.
Attorney General’s Certification
In accordance with State Government Article, §10-113, Annotated
Code of Maryland, the Attorney General certifies that the following changes do
not differ substantively from the proposed text. The nature of the changes and
the basis for this conclusion are as follows:
COMAR 30.02.01.01B(10): The EMS Board is correcting a discrepancy
between proposed text in §B(10) and the definition of a “physician assistant”
in the Maryland Medical Practice Act, Health Occupations Article
§15-101(q)-(r), Annotated Code of Maryland.
30.02.01 Definitions
.01 Definitions.
A. (proposed text unchanged)
B. Terms Defined.
(1)—(9) (proposed text unchanged)
(10) “Physician assistant” means an individual licensed by the
State Board of Physicians [[to practice medicine with physician
supervision]] as a physician assistant to practice under a
collaborative agreement.
(11)—(13) (proposed text unchanged)
THEODORE R. DELBRIDGE, MD, MPH
Executive Director
Title 31
MARYLAND INSURANCE ADMINISTRATION
Subtitle 04 INSURERS
31.04.22 Title Insurers
Authority: Insurance Article, §§ 2-108, 2-109, 10-121, and
10-128.1, Annotated Code of Maryland
Notice of Final Action
[25-015-F]
On April 22, 2025, the Maryland Insurance Administration adopted
amendments to Regulations .03 and .08 under COMAR 31.04.22
Title Insurers. This action, which was proposed for adoption in 52:5 Md. R.
248—249 (March 7, 2025), has been adopted as proposed.
Effective Date: June 9, 2025.
MARIE GRANT
Insurance Commissioner
Withdrawal of Regulations
Title 09
MARYLAND DEPARTMENT OF LABOR
Subtitle 03 COMMISSIONER OF FINANCIAL
REGULATION
09.03.06 Mortgage Lenders
Authority: Financial Institutions Article, §§2-105.1, 12-926, and
12-1030, Annotated Code of Maryland
Notice of Withdrawal
[24-186-W]
The Commissioner of Financial Regulation withdraws the amendments
to Regulations .02 and .04 under COMAR 09.03.06 Mortgage
Lenders, as published in 52:1 Md. R. 27 (January 10, 2025).
ANTONIO SALAZAR
Commissioner
Proposed Action on Regulations
Title 08
DEPARTMENT OF NATURAL RESOURCES
Subtitle 03 WILDLIFE
08.03.08 Threatened and
Endangered Species
Authority: Natural Resources Article, §§4-2A-01—4-2A-09 and
10-2A-01—10-2A-09, Annotated Code of Maryland
Notice of Proposed Action
[25-084-P]
The Secretary of Natural
Resources proposes to amend Regulations .01 and .04—.09 under COMAR
08.03.08 Threatened and Endangered Species.
Statement of Purpose
The purpose of this action is to list one new plant species as
endangered and to reclassify 16 species which are currently listed as
threatened, endangered or endangered extirpated by changing the status of 10
species and removing 6 species. A proposal to list a species may occur if it is
determined that the species meets the criteria for endangered species,
threatened species, or species in need of conservation, as stated in Regulation
.01 under COMAR 08.03.08. Legal protection may be warranted due to any of the
following factors: present or threatened alterations of the species' habitat or
range; overutilization; disease or predation; inadequacy of existing regulatory
mechanisms; or other natural or manmade factors affecting its continued
existence in the State. One plant is proposed to be added to the list as
endangered. Increased legal protection for this species is warranted because
populations are isolated, limited in number, and may be habitat specific;
population declines have been documented; and habitat alterations threaten the
species' continued existence in the State. The northern long-eared bat (Myotis
septentrionalis) was recently listed as endangered by the U.S. Fish and
Wildlife Service and its state status is proposed to conform with the new
federal status.
A change in status may occur if there is an increase in the
population of a listed species or additional populations are found in the State
for a given species. Intensive field inventories have documented additional
populations on protected lands for five endangered plant species and these
species are proposed as threatened due to the discovery. One plant species
listed as endangered has been found to have a greater range than previously
thought and this species is proposed as threatened. One endangered plant
species has increased on protected lands managed for rare species and now
warrants protection as threatened. Three endangered plant species are proposed
to be removed from the endangered species list because one species was reported
falsely, one species is expanding its range and its nativity to Maryland is
questionable, and one species cannot be separated taxonomically from a more
common species.
Endangered extirpated species are those species that were once a
viable component of the flora and fauna of the State but for which no naturally
occurring populations were known since 1950. Upon the discovery of a viable,
naturally occurring population or populations of a listed endangered extirpated
species, the status of the species is evaluated. Two endangered extirpated
species have been rediscovered on state lands and one species is proposed as
endangered and one species is proposed as threatened due to these discoveries
and the sizes of the populations present. Three endangered extirpated plant
species are proposed to be removed from the endangered extirpated list due to
confusion with a newly described species, uncertain range, or uncertain
population status.
Fish species designated as endangered or threatened appear both in
lists maintained by the Fisheries Service and by the Wildlife and Heritage
Service. The Fisheries Service's list appears under COMAR 08.02.12 and the
Wildlife and Heritage Service's list appears under COMAR 08.03.08. In order to
clarify that both the Fisheries Service and the Wildlife and Heritage Service
maintain lists, reference to the Fisheries Service's list is included in this
amendment.
The scientific community has changed the common and/or scientific
names of one mollusk, three crustaceans, five insects, one fish, one amphibian,
six birds, and 15 plant species, and these names are changed to conform.
Estimate of Economic Impact
I. Summary of Economic Impact. The proposed action does not
have an economic impact on the Department or other government agencies, but it
may impact businesses that have a project in an area with one of the listed
species.
II. Types of Economic Impact.
|
Impacted Entity
|
Revenue
(R+/R-)
Expenditure
(E+/E-)
|
Magnitude
|
|
A. On issuing agency:
|
NONE
|
|
|
B. On other State agencies:
|
NONE
|
|
|
|
|
|
|
C. On local governments:
|
NONE
|
|
|
|
Benefit
(+)
Cost
(-)
|
Magnitude
|
|
D. On regulated industries or
trade groups:
|
|
|
|
(1) Businesses
|
(+)
|
Indeterminable
|
|
(2) Businesses
|
(-)
|
Indeterminable
|
|
E. On other industries or
trade groups:
|
NONE
|
|
|
F. Direct and indirect
effects on public:
|
NONE
|
|
III. Assumptions. (Identified by
Impact Letter and Number from Section II.)
D(1). Projects that would have required
modification to mitigate impact to the species being proposed for delisting
will not be subject to mitigation once the currently listed species are
removed. The actual impact cannot be determined since the impact depends on the
specific location of a project and the species that could be in the project
area.
D(2). Some business development projects
have to be modified to mitigate impact to listed species. Adding to or
upgrading the species on the list may increase the number of instances when
projects are modified to accommodate the listed species. The actual impact
cannot be determined since the impact depends on the specific location of a
project and the species that could be in the project area.
Economic Impact on Small Businesses
The proposed action has a meaningful economic impact on small
businesses. An analysis of this economic impact follows:
The proposed action could have an economic impact to businesses
that have a project in an area that has one of the listed or delisted species.
Please see the assumptions for more information.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Jonathan McKnight, Wildlife and Heritage
Service, Department of Natural Resources, 580 Taylor Avenue, E-1, Annapolis, MD
21401, or call 410-260-8593, or email to Jonathan.mcknight@maryland.gov.
Comments will be accepted through June 30, 2025. A public hearing has not been
scheduled.
.01 Definitions.
A. (text unchanged)
B. Terms Defined.
(1)—(12) (text unchanged)
(13) “Species” means any
species of wildlife or plant and reptiles, amphibians, crustaceans, mollusks,
and the following finfish: Acipenser brevirostrum, Acipenser oxyrinchus, Alburnops
chalybaeus, Catostomus catostomus, Centrarchus macropterus, Enneacanthus
chaetodon, Etheostoma sellare, Etheostoma vitreum, Lethenteron appendix,
Luxilus chrysocephalus, Margariscus margarita, Notropis bifrenatus, [Notropis
chalybaeus,] Noturus flavus, Pararhinichthys bowersi, Percina
bimaculata, Percina notogramma, Percopsis omiscomaycus, or any part, egg,
offspring, or dead body of any of them.
(14)—(16) (text unchanged)
.04 Endangered Species of Wildlife, Reptiles,
Amphibians, Mollusks, Crustaceans, and Finfish.
A.—B. (text unchanged)
C. Except for the smaller
range which is indicated in §C(7)(d) and (8)(a) of this regulation, the
following wildlife, reptile, amphibian, mollusk, crustacean, and finfish
species are considered endangered throughout Maryland:
(1) (text unchanged)
(2) Mollusks:
(a) Dwarf [wedge
mussel] wedgemussel (Alasmidonta heterodon);
(b)—(d) (text unchanged)
(3) Crustaceans:
(a)—(b) (text unchanged)
[(c) Holsinger’s cave isopod (Caecidotea holsingeri);
(d) Maus’ cave isopod (Caecidotea mausi);
(e) Vandel’s cave isopod (Caecidotea vandeli;]
[(f)](c) (text unchanged)
(d) Holsinger’s cave isopod (Pseudobaicalasellus holsingeri);
(e) Maus’ cave isopod (Pseudobaicalasellus mausi);
(f) Vandel’s cave isopod (Pseudobaicalasellus vandeli);
(g)—(p) (text unchanged)
(4) Insects:
(a)—(e) (text unchanged)
[(f) Northeastern beach tiger beetle (Cicindela dorsalis);
(g) Ghost tiger beetle (Cicindela lepida);]
[(h)](f) (text unchanged)
[(i) Puritan tiger beetle (Cicindela puritana);]
[(j)](g) (text unchanged)
(h) Ghost tiger beetle (Ellipsoptera lepida);
(i) Puritan tiger beetle (Ellipsoptera puritana);
[(k)](j)—[(m)](l) (text
unchanged)
(m) Northeastern beach tiger beetle (Habroscelimorpha dorsalis);
(n)—(t) (text unchanged)
[(u) Palamedes swallowtail (Papilio palamedes);]
[(v)](u) (text unchanged)
(v) Palamedes swallowtail (Pterourus palamedes);
(w)—(dd) (text unchanged)
(5) Finfish:
(a)—(b) (text unchanged)
(c) Ironcolor shiner (Alburnops chalybaeus);
[(c)](d)—[(d)](e) (text
unchanged)
[(e) Ironcolor shiner (Notropis chalybaeus)]
(f)—(g) (text unchanged)
(6) Amphibians:
(a)—(c) (text unchanged)
[(d) Eastern narrow-mouthed toad (Gastrophryne
carolinensis);]
[(e)](d) Barking tree frog ([Hyla] Dryophytes gratiosa); [and]
(e) Eastern narrow-mouthed toad (Gastrophryne carolinensis; and
(f) (text unchanged)
(7) (text unchanged)
(8) Birds:
(a) [Northern] American goshawk (Accipiter [gentilis]
atricapillus)—Garrett and Allegany Counties only;
(b) Wilson’s plover (Anarhynchus wilsonia);
[(b)](c)—[d](e) (text unchanged)
[(e) Wilson's plover (Charadrius wilsonia);]
(f) Sedge wren (Cistothorus [platensis] stellaris);
(g)—(n) (text unchanged)
(9) Mammals:
(a)—(g) (text unchanged)
(h) Northern long-eared bat (Myotis septentrionalis);
[(h)](i)—[k](l) (text
unchanged)
.05 Endangered Species of Plants.
A.—B. (text unchanged)
C. The following plant species are considered endangered throughout
Maryland unless a smaller range is indicated:
(1)—(2) (text unchanged)
[(3) Sandplain gerardia (Agalinis acuta);]
[(4)](3) (text unchanged)
(4) Sandplain gerardia (Agalinis decemloba);
(5)—(15) (text unchanged)
[(16) Wand-like three-awn grass (Aristida virgata);]
[(17)](16)—[(21)](20)
(text unchanged)
[(22) Small-fruit beggarticks (Bidens mitis);]
[(23)](21)—[(50)](48)
(text unchanged)
(49) Dwarf dogwood (Chamaepericlymenum canadense);
[(51)](50)—[(54)](53)
(text unchanged)
[(55) Wrinkled joint grass (Coelorachis rugosa);]
[(56)](54)—[(60)](58)
(text unchanged)
[(61) Dwarf dogwood (Cornus canadensis);
(62) Roundleaf dogwood (Cornus rugosa);]
[(63)](59)—[(66)](62)
(text unchanged)
(63) Plukenet’s flatsedge (Cyperus plukenetii);
[(67)](64)—[(72)](69) (text
unchanged)
[(73) Woolly witchgrass
(Dicanthelium scabriusculum);]
[(74)](70)—[(78)](74) (text
unchanged)
[(79)](75) Flat-stem spikerush
(Eleocharis compressa var. compressa);
[(80)](76)—[(85)](81) (text
unchanged)
[(86) Tobaccoweed
(Elephantopus tomentosus):]
[(87)](82)—[(105)](100)
(text unchanged)
(101) Appalachian sandwort (Geocarpon glabrum);
[(106)](102)—[(116)](112)
(text unchanged)
[(117) Featherfoil
(Hottonia inflata);]
[(118)](113)—[(127)](122)
(text unchanged)
[(128) Torrey’s rush
(Juncus torreyi);
(129) Highland rush (Juncus trifidus);]
[(130)](123)—[(155)](148)
(text unchanged)
(149) Wrinkled joint grass (Mnesithea rugosa);
[(156)](150) (text unchanged)
[(157) Appalachian
sandwort (Mononeuria glabra);]
[(158)](151) (text unchanged)
[(159) Evergreen
bayberry (Morella carolinensis);]
[(160)](152)—[(165)](157)
(text unchanged)
(158) Highland rush (Oreojuncus trifidus);
[(166)](159)—[(176)](169)
(text unchanged)
[(177) Marsh fleabane
(Pluchea camphorata);]
[(178)](170)—[(188)](180)
(text unchanged)
(181) Mississippi buttercup (Ranunculus laxicaulis);
[(189)](182)—[(191)](184)
(text unchanged)
[(192) Harper beakrush
(Rhychospora harperi);]
[(193)](185) (text unchanged)
(186) Mid-Atlantic beaksedge (Rhynchospora mesoatlantica);
[(194)](187) (text unchanged)
(188) Virginia mallow (Ripariosida hermaphrodita);
[(195)](189)—[(204)](198)
(text unchanged)
[(205)](199) Narrowleaf willow (Salix [exigua] interior);
[(206)](200)—[(210)](204)
(text unchanged)
[(211) Shining nutrush
(Scleria nitida);]
[(212)](205)—[(215)](208)
(text unchanged)
[(216) Virginia mallow
(Sida hermaphrodita);]
[(217)](209)—[(227)](219)
(text unchanged)
(220) Roundleaf dogwood (Swida rugosa);
[(228)](221)—[(229)](222)
(text unchanged)
[(230) Spiked hoary-pea
(Tephrosia spicata);]
[(231)](223)—[(249)](241)
(text unchanged)
.06 Endangered Extirpated
Species.
A.—B. (text unchanged)
C. The following plant species are considered endangered extirpated
throughout Maryland:
(1)—(2) (text unchanged)
[(3) Chaffweed
(Anagallis minima);]
[(4)](3) Canada anemone ([Anemone] Anemonastrum canadensis);
[(5)](4)—[(7)](6) (text unchanged)
[(8) Bradley’s
spleenwort (Asplenium bradleyi);]
[(9)](7)—[(17)](15) (text unchanged)
(16) Chaffweed (Centunculus mimimus);
[(18)](17)—[(19)](18) (text
unchanged)
[(20) Plukenet’s sedge
(Cyperus plukenetii);]
[(21)](19)—[(36)](34) (text
unchanged)
[(37) Hairy lettuce
(Lactuca hirsuta);]
[(38)](35)—[(44)](41) (text
unchanged)
[(45)](42) [One-side] One-sided
wintergreen (Orthilia secunda);
[(46)](43)—[(62)](59) (text
unchanged)
[(63) Sweetscent
ladies’-tresses (Spiranthes odorata);]
[(64)](60) (text unchanged)
[(65)](61) Buffalo clover (Trifolium
reflexum); and
[(66) Navel-shape
corn-salad (Valerianella umbilicata); and]
[(67)](62) (text unchanged)
D.—E. (text unchanged)
F. The following insect species are considered endangered
extirpated throughout Maryland:
[(1) Golden
banded-skipper (Autochton cellus);]
[(2)](1)—[(7)](6) (text unchanged)
[(8)](7) Regal fritillary (Speyeria idalia); [and]
[(9)](8) Riverine clubtail (Stylurus amnicola)[.];
and
(9) Golden banded-skipper (Telegonus cellus).
G.—H. (text unchanged)
I. The following bird species are considered endangered extirpated
throughout Maryland:
(1)—(8) (text unchanged)
(9) Appalachian Bewick’s wren (Thryomanes bewickii [altus] bewickii); and
(10) (text unchanged)
J. (text unchanged)
.07 Threatened Species of
Wildlife, Reptiles, Amphibians, Mollusks, Crustaceans, and Finfish.
A.—B. (text unchanged)
C. The following species are considered to be threatened throughout
Maryland unless a smaller range is indicated:
(1)—(5) (text unchanged)
[(6) Mammals: Northern
long-eared bat (Myotis septentrionalis).]
.08 Threatened Species of
Plants.
A.—B. (text unchanged)
C. The following plant species are considered threatened throughout
Maryland unless a smaller range is indicated:
(1)—(5) (text unchanged)
(6) Wand-like three-awn grass (Aristida virgata);
(7) Bradley’s spleenwort (Asplenium bradleyi);
[(6)](8)—[(14)](16) (text unchanged)
(17) Bogfern (Coryphopteris simulata);
[(15)](18) (text unchanged)
(19) Tall swamp witchgrass (Dichanthelium scabriusculum);
[(16)](20) (text unchanged)
(21) Tobaccoweed (Elephantopus tomentosus);
[(17)](22)—[(22)](27) (text
unchanged)
(28) Featherfoil (Hottonia inflata);
[(23)](29)—[(29)](35) (text
unchanged)
[(30) Lance-leaf
loosestrife (Lysimachia hybrida);]
[(31)](36)—[(32)](37) (text
unchanged)
(38) Evergreen bayberry (Morella carolinensis);
[(33)](39)—[(41)](47) (text
unchanged)
(48) Marsh fleabane (Pluchea camphorata);
[(42)](49)—[(63)](70) (text
unchanged)
(71) Lance-leaf loosestrife (Steironema hybridum);
[(64)](72)—[(68)](76) (text
unchanged)
[(69) Bog fern
(Thelypteris simulata);]
(77) Spiked hoary-pea (Tephrosia spicata);
[(70)](78)—[(75)](83) (text
unchanged)
.09
Species in Need of Conservation.
A.—B. (text unchanged)
C. The following species are considered to be in need of
conservation throughout Maryland unless a smaller range is indicated:
(1)—(6) (text unchanged)
(7) Birds:
(a) (text unchanged)
(b) Least bittern (Botaurus exilis);
[(b)](c)—[(f)](g) (text unchanged)
[(g) Least bittern
(Ixobrychus exilis);]
(h)—(j) (text unchanged)
(k) [Barn] American barn owl (Tyto [alba] furcata); and
(l) (text unchanged)
(8) (text unchanged)
JOSH KURTZ
Secretary
of Natural Resources
Subtitle 18 BOATING—SPEED LIMITS AND
OPERATION OF VESSELS
08.18.19 Patapsco River
Authority: Natural
Resources Article, §8-704, Annotated Code of Maryland
Notice of Proposed
Action
[25-062-P]
The Secretary of Natural
Resources proposes to adopt new Regulation .05 under COMAR 08.18.19
Patapsco River.
Statement of Purpose
The purpose of this action
is to establish two 6-knot effective at all times speed zones in the Patapsco
River for the area surrounding the demolition and construction site of the
Francis Scott Key Bridge Project. The zones will encompass the waters upstream
and downstream of the bridge project, but will not affect the main shipping
channel. A similar speed zone was in place on the east side of the river for a
period of time after the bridge collapsed. The Department considered input from
boaters, the Association of Maryland Pilots, the United States Coast Guard, and
the construction company to determine the best siting of these zones.
The construction project
is necessary for the demolition and rebuilding of the Francis Scott Key Bridge.
Construction activities may be subject to unpredictable hazards due to the size
and speed of vessels transiting this section of the Patapsco River. Construction
for this project is scheduled to be completed in approximately four years. The
Department anticipates removing the speed zones when the construction project
is completed, however due to the extended timeline of the project and
possibility of delay, the Department has not considered a sunset provision for
this zone as it has with other speed zones instituted for construction projects
with much smaller time durations.
The proposed action
creates two zones and a speed limit of 6-knots at all times in each zone. The
speed limit in the zones will help protect workers, vessel operators, barges,
and other equipment, from excessive wake actions. Each zone extends 1,500 feet
upstream and 1,500 feet downstream of the bridge. The zones extend towards the
federal channel from the shoreline, but do not extend into the federal channel.
There is a 1,000 foot channel, centered on the centerline of the main shipping
channel, between the zones where the speed limit does not apply. The federal
shipping channel is 800 feet wide and there is a buffer of 100 feet on each
side of the shipping channel. Boat traffic will be able to maintain speed
through that channel.
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 Key Bridge Regulations, Regulatory Staff,
Maryland Department of Natural Resources Fishing and Boating Services, 580
Taylor Avenue, E-4, Annapolis, MD 21401, or call 410-260-8300, or email to
boatingregspubliccomment.dnr@maryland.gov or complete the google comment form
at
https://dnr.maryland.gov/boating/Pages/regulations/changes_boating.aspx#pr-fsk.
Comments will be accepted through June 30, 2025. A public hearing has not been
scheduled.
.05 Patapsco River — Francis Scott Key Bridge Construction Areas.
A. The speed limit for the areas described in this regulation is
6 knots at all times.
B. East Area. The east construction area encompasses all of the
waters of the Patapsco River enclosed by a line beginning at a point defined by
Lat. 39°12.892' N, Long. 76°31.423' W; then running 321° True to a point
defined by Lat. 39°13.276' N, Long. 76°31.827' W; then running 46° True to a
point defined by Lat. 39°13.575' N, Long. 76°31.428' W; then running 141° True
to a point defined by Lat. 39°13.191' N, Long. 76°31.025' W; then running 226°
True to the point of beginning.
C. West Area. The west construction area encompasses all of the
waters of the Patapsco River enclosed by a line beginning at a point defined by
Lat. 39°12.574' N, Long. 76°31.828' W; then running 320° True to a point
defined by Lat. 39°12.953' N, Long. 76°32.238' W; then running 45° True to a
point defined by Lat. 39°13.158' N, Long. 76°31.976' W; then running 141° True
to a point defined by Lat. 39°12.773' N, Long. 76°31.572' W; then running 225°
True to the point of beginning.
JOSH KURTZ
Secretary of Natural
Resources
08.18.26 Susquehanna River
Authority: Natural Resources Article, §8-704, Annotated Code of
Maryland
Notice of Proposed Action
[25-061-P]
The Secretary of Natural Resources proposes to amend Regulation .06
and adopt new Regulation .07 under COMAR 08.18.26 Susquehanna River.
Statement of Purpose
The purpose of this action is to establish a 6-knot effective at
all times speed zone in the Susquehanna River for the area surrounding the
construction site of the Susquehanna River Rail Bridge Project. The speed zone
is necessary to help protect workers, vessel operators, barges, and other
equipment during construction. This construction project is located on the
waters between Havre de Grace and Perryville, Maryland. The construction
project is designed to improve speed and reliability by replacing the existing
Susquehanna River Bridge with a modern, two-track, high-level, fixed structure.
Additionally, this project will add a second two-track bridge to facilitate
higher speeds and increase capacity. Construction for this project began in
June 2024 and is scheduled to continue through 2036.
The upper end of the new speed zone is the US-40 bridge and the
zone terminates approximately 500 yards downstream of the current Amtrak
bridge. The new area overlaps two existing speed zones. The east side of the
Susquehanna River upstream of the Amtrak bridge, adjacent to Perryville,
currently has a speed zone of 6-knots at all times, while a portion of the west
side of the Susquehanna River downstream of the bridge, adjacent to Havre de
Grace, has a speed zone of 6-knots on Saturdays, Sundays, and holidays during
the boating season. The proposed action addresses the overlap by creating a new
regulation for the construction area and modifying the description of the west
side of the Susquehanna River downstream of the bridge, ensuring that the
entire construction area has a speed limit of 6-knots at all times.
The Department anticipates removing this speed zone when the
construction project is completed, however due to the extended timeline of the
project and possibility of delay, the Department is not proposing a sunset
provision for this zone as it has with other speed zones instituted for
construction projects with much smaller time durations.
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
Susquehanna River Regulations, Regulatory Staff, Maryland Department of Natural
Resources Fishing and Boating Services, 580 Taylor Avenue, E-4, Annapolis, MD
21401, or call 410-260-8300, or email to boatingregspubliccomment.dnr@maryland.gov
or complete the google comment form at
https://dnr.maryland.gov/boating/Pages/regulations/changes_boating.aspx#sr-am.
Comments will be accepted through June 30, 2025. A public hearing has not been
scheduled.
.06 Havre de Grace.
A. Area. [All] Excluding the area defined in
Regulation .07 of this chapter, the area encompasses all of the waters
enclosed by a line beginning at a point at or near Lat. 39° 32.262' N., Long.
76° 5.541' W., then running 176° to a point, at or near Lat. 39° 32.113' N.,
Long. 76° 5.526' W., then running along the North shore of Tydings Island
Eastward to a point, at or near Lat. 39° 32.193' N., Long. 76° 5.31' W., then
running 93° to a point, at or near Lat. 39° 32.177' N., Long. 76° 4.902' W.,
then running 2° to a point, at or near Lat. 39° 32.502' N., Long. 76° 4.888'
W., then running 355° to a point, at or near Lat. 39° 32.742' N., Long. 76°
4.913' W., then running 338° to a point, at or near Lat. 39° 32.87' N., Long.
76° 4.98' W., then running 328° to a point, at or near Lat. 39° 33.226' N.,
Long. 76° 5.273' W., then running 252° to a point, at or near Lat. 39° 33.185'
N., Long. 76° 5.438' W., then running South along shore to the point of
beginning.
B. (text unchanged)
.07 Susquehanna River Rail Bridge Project.
A. The construction area encompasses all of the waters of the
Susquehanna River enclosed by a line beginning at a point defined by Lat.
39°32.969' N, Long. 76°5.268' W; then running 329° True to a point defined by
Lat. 39°33.509' N, Long. 76°5.682' W; then running 60° True to a point defined
by Lat. 39°33.927' N, Long. 76°4.762' W; then running 168° True to a point
defined by Lat. 39°33.178' N, Long. 76°4.548' W; then running 249° True to the
point of beginning.
B. The speed limit for the area described in this regulation is
6 knots at all times.
JOSH KURTZ
Secretary of Natural
Resources
Title 09
DEPARTMENT OF LABOR
Subtitle 14 STATE ATHLETIC
COMMISSION
09.14.18 Muay
Thai Regulations—Professional
Authority: Business Regulations Article, §§4-205, 4-301, and
4-303 Annotated Code of Maryland
Notice of Proposed Action
[25-016-P]
The Maryland State Athletic
Commission proposes to adopt new Regulations .01—.12 under a new
chapter, COMAR 09.14.18 Muay Thai Regulations—Professional. This action was considered at a public
meeting of the Maryland State Athletic Commission on September 18, 2024.
Statement of Purpose
The purpose of this action is to add Muay Thai as new combative
sport under the regulation of the Maryland State Athletic Commission.
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 Johnston
Brown, Executive Director, Maryland Department of Labor, 100 S. Charles Street,
Tower, 1, 3rd Floor, Baltimore, MD 21201, or call 410-230-6223, or email to
johnston.brown@maryland.gov. Comments will be accepted through June 30, 2025. A
public hearing has not been scheduled.
.01 Applicable Boxing Regulations.
Unless otherwise indicated, the regulations in this subtitle
pertaining to the sport of boxing shall apply to the sport of Professional Muay
Thai.
.02 Definitions.
A. In this chapter, the following terms have the meanings
indicated and, unless otherwise indicated, the regulations in this subtitle
pertaining to the sport of boxing shall apply to the sport of Professional Muay
Thai.
B. Terms Defined.
(1) "Commission" means the State
Athletic Commission of Maryland.
(2) “Contest” means any
Muay Thai:
(a) Competition;
(b) Match;
(c) Performance; or
(d) Show.
(3) “Contestant” means a Muay Thai fighter who participates
against an opponent in a contest.
(4) Manager.
(a) “Manager” means a person who, under contract, agreement, or
other arrangement, undertakes to control or administer, directly or indirectly,
a Muay Thai contest-related matter on behalf of a contestant.
(b) “Manager” includes, but is not limited to:
(i) A booking agent; and
(ii) An advisor.
(5) “Muay Thai” means a competition in which contestants use interdisciplinary forms of
fighting, including striking with the hands, feet, knees, or elbows.
(6) “Official record” means the cumulative results of Muay Thai
contests, sanctioned by a regulatory agency, in which a contestant has
participated.
(7) “Promoter” means an individual, partnership, corporation,
club, association or other organization that gives, holds, or otherwise
conducts a Muay Thai contest within the State.
(8) “Regulatory agency” means a commission, board, or other
entity of a state, commonwealth, territory, or country, created by law or
executive order, which regulates Muay Thai contests.
(9) “Second” means an individual who assists a Muay Thai
contestant during a contest.
.03 Weights and Classes.
A. The Commission recognizes the following weights and classes
in Professional Muay Thai:
(1) Mini-Flyweight up to and including
105 pounds
(2) Light-Flyweight over 105 to 108 pounds;
(3) Flyweight over 108 to 112 pounds;
(4) Super-Flyweight over 112 to 115 pounds;
(5) Bantamweight over 115 to 118 pounds;
(6) Super-Bantamweight over 118 to 122 pounds;
(7) Featherweight over 122 to 126 pounds;
(8) Super-Featherweight over 126 to 130 pounds;
(9) Lightweight over 130 to 135 pounds;
(10) Super Lightweight over 135 to 140 pounds ;
(11) Welterweight over 140 to 147 pounds;
(12) Super-Welterweight over 147 to 154 pounds;
(13) Middleweight over 154 to 160 pounds;
(14) Super Middleweight over 160 to 168 pounds;
(15) Light Heavyweight over 168 to 175 pounds;
(16) Cruiserweight over 175 to 200 pounds;
(17) Heavyweight over 200 to 225 pounds; and
(18) Super Heavyweight over 225 pounds
B. If a Muay Thai contestant’s weight is greater than the
specified weight in the promoter-contestant contract, the contest may not take
place without special permission of the Commission.
.04 Muay Thai Contestants Equipment.
A. General. Each Muay Thai contestant
shall use the equipment, and in the manner, specified in this regulation.
B. Bandage. For all
weight classes, bandages shall be:
(1) A maximum of one
roll (no more than 2 inches wide and 20 yards in length) of white, soft, cloth
gauze is permitted per hand;
(2) A maximum of one roll (no more than 2 inches wide and 10
feet in length) of white athletic tape is permitted per hand, which shall:
(a) Be placed directly on each hand for protection near the
wrist;
(b) Cross the back of the hand twice but may not extend within
three-fourths of an inch of the knuckles when the hand is clenched to make a
fist;
(c) Placed
between the fingers; and
(d) Not be allowed to cover the knuckles.
(3) Placed on a Muay Thai contestant’s hands in the dressing
room in the presence of the chief second of the Muay Thai contestant’s
opponent; and
(4) Be inspected and approved by the Commission prior to the
gloves being placed on the hands of the Muay Thai contestant.
C. Gloves. Gloves worn by each Muay Thai contestant during the
contest shall:
(1) Be open-fingered;
(2) Conform to specifications as determined by the Commission;
(3) Weigh 8 ounces from weight classes Mini-Flyweight to
Super-Welterweight; and
(4) Weigh 10 ounces from weight classes Middleweight to
Super-Heavyweight.
D. A mouth guard shall be approved by the Commission.
E. Groin protection shall be approved by the Commission.
.05 Proper Attire and Appearance.
A. Rules for Shorts/trunks Worn in Competition.
(1) Fighters shall wear shorts approved by the Commission;
(2) Rules for male and female fighters are the same.
(3) The hem of trunks shall not extend below the mid-thigh;
(4) Long pants or leggings are prohibited.
(5) Compression shorts may be worn under the approved fight
trunks, but they may not extend down the leg below the bottom of the trunks.
B. Male fighters shall not wear any form of clothing on their
upper body.
C. Clothing Rules for Female Fighters.
(1) Female fighters shall wear short sleeved (above the elbow)
or sleeveless form fitting rash guard and or sports bra.
(2) No loose-fitting tops shall be allowed.
(3) The use of breast protectors is optional for female fighters
as determined by the Commission.
(4) Female fighters shall follow the same requirements for
bottom coverings as male fighters, minus the requirement for groin protection.
D. No clothing worn in the ring shall have exposed Velcro,
clasps, pockets, zippers, or other items that may be harmful to the fighter or
their opponent.
E. Fighters shall not wear shoes in the cage or ring.
F. When deemed necessary by the referee, or Commission, all
fighters shall have their hair secured in a manner that does not interfere with
the vision and safety of either fighter.
G. No object can be worn to secure the fighter’s hair which may
cause injury to their opponent.
H. The wearing of jewelry will be strictly prohibited during all
contests.
I. Fighters may wear an inscribed cloth, an amulet, or an
inscribed charm around the upper arm or strung around the waist, but neatly
wrapped and covered with cloth.
J. Wrapping the ankles or legs with pieces of cloth is
prohibited.
K. If during the contest, the Pra Jiad (arm band) loosens or
moves in a way that may be harmful, or a distraction, it may be removed at the
discretion of the referee.
L. Cosmetics
(1) Body cosmetics are any product applied to the body for
cleansing, beautifying, or altering appearance and shall be prohibited during
all contests.
(2) Facial cosmetics are products used improve the appearance of
the face, and. the use of such products shall be at the discretion of the
Commission and/or referee.
M. Protective garments:
(1) Other than the fighter’s hands, as previously listed, there
will be no taping, covering, or protective gear of any kind on the upper body,
which includes but is not limited to;
(i) Joint sleeves;
(ii) Padding; and
(iii) Any form of brace or body gauze/tape.
(b) Ankle joint sleeves:
(i.) A fighter may use one soft neoprene type sleeves to cover
each ankle joint; and
(ii) Approved sleeves may not have padding, Velcro, plastic,
metal, ties, or any other material considered to be unsafe or that may create
an unfair advantage
(10) Tape and gauze, or any materials other than the approved
sleeves, are not permitted on the lower body.
(11) The allowable length and color of sleeves shall be
determined by the Commission.
B. A Muay Thai contestant shall have properly trimmed
fingernails and toenails.
.06 Fighting Area.
A. A Muay Thai contest shall be held in a ring or in a fenced
area.
B. A ring used for a Muay Thai contest shall meet the following
requirements.
(1) The ring may not be smaller than 20 feet square and may not
be larger than 32 feet square within the ropes.
(2) The ring floor shall:
(a) Extend at least 18 inches beyond the ropes;
(b) Be padded with Ensolite or another similar closed-cell foam,
with at least a 1-inch layer of foam padding, which shall extend beyond the
ring ropes and over the edge of the platform;
(c) Have a top covering of canvas, duck, or similar material
that:
(i) Does not tend to gather in lumps or ridges; and
(ii) Is tightly stretched and laced to the ring platform; and
(d) Be free of any obstruction or object, including a triangular
border;
(3) The ring platform:
(a) May not be more than 4 feet above the floor of the building;
and
(b) Shall have suitable steps for the use of the Muay Thai
contestant;
(4) The ring posts:
(a) Shall be made of metal;
(b) May not be more than 3 inches in diameter, extending from
the floor of the building to a minimum height of 58 inches above the ring
floor;
(c) Shall be at least 18 inches away from the ring ropes; and
(d) Shall be properly padded in a manner approved by the
Commission.
(5) The ring ropes:
(a) Shall be five in number;
(b) May not be less than 1 inch in diameter;
(c) Shall be wrapped in soft material; and
(d) Shall be at least 12 inches above the ring floor.
C. A fenced area used for a contest of mixed martial arts shall
meet the following requirements:
(1) The fenced area shall be circular or have at least four
equal sides.
(2) The fenced area may not be smaller than 20 feet wide and may
not be larger than 32 feet wide in diameter.
(3) The floor of the fenced area shall:
(a) Be padded with Ensolite or another similar closed-cell foam,
with at least a 1-inch layer of foam padding; and
(b) Have a top covering of canvas, duck, or similar material
that:
(i). Does not tend to gather in lumps or ridges; and
(ii.) Is tightly stretched and laced to the platform of the
fenced area.
(4) The platform of the fenced area:
(a) May not be more than 4 feet above the floor of the building;
and
(b) Shall have suitable steps for the use of the Muay Thai
contestants.
(5) The fence posts of the fenced area shall be:
(a) Made of metal, not more than 6 inches in diameter, extending
from the floor of the building to between 5 and 7 feet above the floor of the
fenced area; and
(b) Properly padded in a manner approved by the Commission.
(6) The fencing used to enclose the fenced area shall be made of
a material that will prevent a Muay Thai contestant from falling out of, or
breaking through, the fenced area onto the floor of the building or onto the
spectators.
(7) Any metal portion of the fenced area shall be covered and
padded in a manner approved by the Commission and may not be abrasive to the
Muay Thai contestant.
(8) The fenced area shall have two entrances.
(9) There may not be any obstruction on any part of the fence
surrounding the area where Muay Thai Contestant are to be competing.
.07 Rounds.
A. Each round shall be 3 minutes in duration, with a 1 minute
rest period between rounds.
B. Bouts shall ordinarily be scheduled for either three or five
rounds.
C. When a tournament and/or another format is approved, the
total number of rounds allowed to be contested in a day shall be determined by
the Commission.
D. At the discretion of the Commission, bouts will begin after
the completion of any pre-fight rituals, in accordance with Thai traditions.
.08 Referee.
A. The referee is the sole arbiter of a bout.
B. The referee and/or the ringside physician are the only
individuals authorized to stop the contest, as determined by the Commission.
C. The referee shall confirm with the fighter that the
mouthpiece is inserted and shall confirm with male fighters that a groin
protector is inserted before the start of the contest.
.09 Knockdown.
A. In the event of a knockdown the referee shall send the
standing fighter to a neutral corner and administer a mandatory eight count to
the downed fighter.
B. When a fighter is knocked through the ropes and off the
platform of the ring and onto a table or the floor by a legal blow or blows,
the fighter will receive a mandatory 18 count and must be standing before the
count of 20.
C. There is no standing eight count.
D. A fighter who has been knocked down cannot be saved by the
bell in any round, including the final round.
.10 Method of Judging.
A. Judges shall consider damage, domination, and duration when
evaluating the relative merits of each fighter’s performance in each round.
Towards that end they shall use the following prioritized criteria to establish
their score.
(1) A fighter who has an advantage in the number or quality of
knockdowns in a round shall never lose that round.
(2) If there is no advantage in knockdowns, the fighter with a
clear advantage in cumulative damage shall win the round.
(3) If there is not a clear advantage in cumulative damage, the
fighter with the greater number and/or variety of clean scoring Muay Thai
techniques shall win the round.
B. If the criteria in §A of this regulation fails to distinguish
either fighter, the round may be awarded to the fighter who was more successful
in applying either aggressiveness, control or effective defense in their
efforts to win the round.
C. All bouts will be evaluated and scored by a minimum of three
judges.
D. The 10 Point Must System will be the standard system for
scoring a bout.
(1) Under the 10 Point Must Scoring System, ten points must be
awarded to the winner of the round.
(2) The fighter who has lost the round may be awarded nine or
less points depending on the margin of advantage.
(3) In the very rare case that neither fighter has shown even a
marginal advantage, a 10-10 round may be awarded.
(4) Partial or incomplete rounds shall be scored. If no
significant action has occurred, the round shall be scored as 10-10. This is at
the discretion of the judges.
(5) Any time the referee penalizes either fighter, then the
appropriate points shall be deducted when the scorekeeper calculates the final
score including partial rounds.
E. The following objective scoring criteria shall be utilized by
the judges when scoring a round:
(1) An extremely rare 10-10 round is not a score to be used as
an excuse by a judge that cannot assess the differences in the action of a
round. It should only be used to score an incomplete round where nothing
occurred in the round.
(2) A round is to be scored as a 10-9 round when there is a
slight or clear advantage in overall action favoring one fighter, but not an
overwhelming advantage.
(3) A round is to be scored as a 10-8 round when there is an
overwhelming advantage without a knockdown, or a fighter won the round and
scored a knockdown.
(4) A round is to be scored as a 10-7 round when a fighter won
the round and scored two knockdowns.
(5) A round is to be scored as a 10-6 round when a fighter won
the round and scored three knockdowns.
.11 Permissible Strikes.
The following strikes are permitted during a contest:
A. Punches;
B. Kicks;
C. Knees; and
D. Elbows.
.12 Fouls.
A. The following acts are prohibited:
(1) Head butts;
(2) Groin strikes;
(3) Thumbing or eye gouging;
(4) Biting;
(5) Spiting at the opponent;
(6) Hair pulling;
(7) Attacks to the throat;
(8) Striking your opponent while grounded;
(9) Strikes directed to the back of the head or the spine;
(10) Tripping or sweeping an opponent;
(11) Hip, shoulder, or leg throws;
(12) Grasping the opponent’s lower back while also forcing an
opponent's spine to hyperextend;
(13) Intentionally falling on a downed opponent, pressing elbow
or knee upon the opponent;
(14) Wrestling, back or arm locks or any similar judo or wrestling
hold;
(15) Attempting to pile-drive an opponent's head into the
canvas;
(16) Catching an opponent's kick and pushing an opponent for
more than one step in any direction without attempting to deliver an attacking
technique;
(17) If a fighter’s leg is caught while kicking, the opponent
may not intentionally ground themselves;
(18) Striking a downed fighter or fighter entangled in the
ropes;
(19) Failure to obey the referee’s commands;
(20) Striking on a break;
(21) Striking after a bell;
(22) Holding the ropes/cage or using the ropes/cage while
striking or clinching;
(23) Holding the opponent’s shorts;
(24) Timidity or causing intentional delays in the action;
(25) Unsportsmanlike behavior including use of abusive language
and/or gestures; and
(26) Attacking an opponent who is under the care of the referee.
B. Time Considerations for Fouls.
(1) Low Blow.
(a) A fighter who has been struck with a low blow as called by
the referee, is allowed up to 5 minutes to recover from the foul, as long as,
in the ringside physician’s opinion, the fighter may possibly continue on in
the contest.
(b) If the fighter states that they can continue before the 5
minutes of time have expired, the referee shall restart the fight as soon as
practical.
(c) If the fighter goes over the 5 minutes time allotment, the
fight cannot be restarted and the contest must come to an end with the outcome
determined by how the low blow occurred the round, and time in which the fight
was stopped.
(2) Eye Poke.
(a) A fighter, who has received an eye poke as called by the
referee, is allowed up to 5 minutes to recover from the foul as long as the
ringside physician confirms the fighter may possibly continue in the contest
once recovered.
(b) If the fighter states that they can see and wishes to
continue before the 5 minutes of time have expired, and confirmed by the
ringside physician, the referee shall restart the fight as soon as practical.
(c) If the fighter goes over the 5 minutes time allotment, the
fight cannot be restarted and the contest must come to an end with the outcome
determined by how the eye poke occurred, the round, and time in which the fight
was stopped.
C. Intentional Fouls.
(1) If an intentional foul causes an injury, and the injury is
severe enough to terminate the bout immediately, the fighter causing the injury
shall lose by disqualification.
(2) If an intentional foul causes an injury and the bout is
allowed to continue, the referee shall notify the authorities and deduct two
points from the fighter who caused the foul. Point deductions for intentional
fouls will be mandatory.
(3) If an injury caused by an intentional foul results in the
contest being stopped in any round after half of the scheduled rounds have been
completed, by either another legal or illegal strike, the judges will score the
incomplete round and:
(a) If the injured fighter is ahead on the scorecards, he shall
be declared the winner by a Technical Decision; or
(b) If the injured fighter is behind or even on the scorecards,
the contest shall be declared a Technical Draw.
(4) If a fighter injures themselves while attempting to
intentionally foul their opponent, but is able to continue fighting, the
referee shall take no action and treat the injury as if produced by a fair
blow. If the referee determined the fighter who injured themselves is unable to
continue, that fighter will lose by Technical Knockout/Knockout.
D. Accidental Fouls.
(1) If an accidental foul causes an injury severe enough for the
referee to terminate the bout immediately, the bout will result in either a No
Contest or Disqualification if stopped before:
(a) A completed 2 rounds of a scheduled 3 round bout; or
(b) A completed 3 rounds of a scheduled 5 round bout.
(2) If an accidental foul causes an injury severe enough for the
referee to terminate the bout, the bout will result in a Technical Decision
awarded to the fighter who is ahead on the score cards at the time the bout is
stopped immediately, after:
(a) A completed 2 rounds of a scheduled 3 round bout; or
(b) A completed 3 rounds of a scheduled 5 round bout.
(3) If a fighter, during the course of a round, visibly loses
control of bodily function (vomit, urine, feces), the fight shall be stopped by
the referee and the fighter shall lose the contest by a Technical Knockout
(TKO) due to Medical Stoppage.
(a) In the event a loss of bodily function occurs in the rest
period between rounds, the ringside physician shall be called in to evaluate if
the fighter can continue. If the fighter is not cleared by the ringside
physician to continue, that fighter shall lose by a Technical Knockout (TKO)
due to Medical Stoppage
(b) If fecal matter becomes apparent at any time, the contest
shall be halted by the referee, and the offending fighter shall lose by a
Technical Knockout (TKO) due to Medical Stoppage.
.13 Result of the Contest.
A. The winner of the match may be decided in the following ways:
(1) Points Decision.
(a) Unanimous Decision—when all three judges score the bout for
the same fighter;
(b) Split Decision—when two judges score the bout for one
fighter and one judge scores the bout for the opponent;
(c) Majority Decision—when two judges score the bout for one
fighter and one judge scores the bout a draw;
(d) Technical Decision—when a bout is prematurely stopped due to
injury from an accidental foul and a fighter is leading on the score cards.
(2) Draws occur when:
(a) Unanimous Draw—when all three judges score the bout a draw;
(b) Majority Draw—when two judges score the bout a draw;
(c) Split Draw—when one judge scores the bout for one fighter,
one judge scores the bout for the opponent, and one judge scores the bout a
draw;
(d) Technical Draw—when an injury is sustained during
competition as a result of an intentional foul and the bout is allowed to
continue, then later the injury requires stoppage from either a legal or
illegal strike to the affected area; and
(e) Draw—when both fighters go down at the same time, and
neither can resume the fight within the referee’s ten count.
(3) Knockouts occur when a fighter is incapable of resuming the
fight within the referee’s ten-count due to legal strikes or the referee stops
the contest because a fighter cannot effectively defend themselves.
(4) Technical Knockouts occur when:
(a) Referee Stoppage occurs when a referee terminates a contest
if:
(i) The referee determines a fighter shows no will to or is
incapable of resuming the fight due to a legal technique;
(ii) The referee determines the fighter is not effectively
defending themselves;
(iii) The fighter does not leave their corner to take part in
the fight following the sounding of the bell; or
(iv) The referee is of the opinion that one fighter is
outmatched by the opponent and continuing the match would jeopardize the
fighter’s health and safety;
(v) A fighter or their corner indicates to the referee or
regulatory representative they no longer wish to continue the contest.
(b) Medical Stoppage occurs when a ringside physician terminates
a contest if:
(i) The bout is terminated for medical reasons due to injury
resulting from a legal technique.
(ii) The bout is terminated on the advice of the ringside
physician.
(iii) There is a loss of control of bodily function.
(5) Disqualification occurs when an injury sustained during the
bout as a result of an intentional foul is severe enough to terminate the bout,
multiple fouls have been assessed, interference from a fighter’s corner, and/or
there is a flagrant disregard for the rules and/or referee’s commands.
B. No Decision/No Contest occurs when:
(1) When a bout is prematurely stopped due to an accidental
injury and a sufficient number of rounds have not been completed to render a
decision via the scorecards.
(2) If the referee decides both fighters must be disqualified.
DAVID NORMAN
Chair, Maryland State Athletic
Commission
Title 10
MARYLAND DEPARTMENT OF HEALTH
Subtitle 07 HOSPITALS
10.07.01 Acute General
Hospitals and Special Hospitals
Authority: Health-General Article, §§19-307.2, 19-308, 19-308.6,
19-308.8, 19-318—19-320, 19-323, 19-342, 19-349.1, and 19-380—19-385; Insurance
Article, Title 4, Subtitle 4; Public Safety Article, §14-110.1; Annotated Code
of Maryland
Notice of Proposed Action
[25-064-P]
The Secretary of Health proposes to amend Regulation .24
under COMAR 10.07.01 Acute General Hospitals and Special Hospitals.
Statement of Purpose
The purpose of this action is to:
(1) Reflect current Maryland law;
(2) Require that the credential reappointment process for physician
staff included in minimum standards for hospitals licensed in the State be
conducted in accordance with standards of the accreditation organization that
accredits a hospital, rather than every 2 years; and
(3) Address concerns brought about by the hospital industry.
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 Jordan Fisher Blotter, Director, Office of
Regulation and Policy Coordination, Maryland Department of Health, 201 W.
Preston Street, Room 534 Baltimore, Maryland 21201, or call 410-767-0938, or
email to mdh.regs@maryland.gov. Comments will be accepted through June 30,
2025. A public hearing has not been scheduled.
.24 Physician Credentialing Process.
A.—B. (text unchanged)
C. Specific Standard — Appointment and Employment Process.
(1) (text unchanged)
(2) The term of an appointment [shall be 2 years or less]
may not exceed the term established by the standards of the accreditation
organization that accredits the hospital.
(3)—(6) (text unchanged)
D.—J. (text unchanged)
LAURA HERRERA SCOTT
Secretary
Subtitle 10 LABORATORIES
Notice of Proposed Action
[25-092-P]
The Acting Secretary of Health proposes to:
(1) Amend Regulation .03 under COMAR 10.10.01 General;
(2) Amend Regulation .01 under COMAR 10.10.02 Medical
Laboratories—General;
(3) Amend Regulations .02 and .04 under COMAR
10.10.03 Medical Laboratories—Licenses;
(4) Repeal existing Regulations .01 and .02 under COMAR
10.10.04 Medical Laboratories;
(5) Amend Regulations .02, .04, and .05 under COMAR
10.10.05 Medical Laboratories—Proficiency Testing;
(6) Amend Regulations .02, .07, .08, .12,
and .13 and repeal existing Regulation .06 under COMAR
10.10.06 Medical Laboratories—Quality Assurance;
(7) Amend Regulation .07 under COMAR 10.10.07 Medical
Laboratories—Personnel;
(8) Amend Regulation .02 under COMAR 10.10.08 Medical
Laboratories—Sanctions; and
(9) Amend Regulations .02, .04, and .07 under COMAR
10.10.12 Medical Laboratories—Public Health HIV Testing Programs.
Statement of Purpose
The purpose of this action is to amend COMAR 10.10.01—10.10.08, and
10.10.12 to protect the public and individual health by requiring medical
laboratories to employ qualified personnel, operate under reliable procedures,
have in place effective quality control and quality assurance programs, and
have qualified supervision. This is accomplished by setting minimum, reasonable
standards in regulation for the licensing of laboratories in Maryland.
The updated regulations will:
(1) Reflect current Maryland law;
(2) Delete obsolete terminology;
(3) Address concerns brought forth by the industry;
(4) Align with regulations from the Department of Health and Human
Services, Clinical Laboratory Improvement Amendments (CLIA), where appropriate;
and
(5) Reflect current quality and safety standards of medical
laboratories.
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 Jordan Fisher Blotter, Director, Office of
Regulation and Policy Coordination, Maryland Department of Health, 201 West
Preston Street, Room 534 Baltimore, Maryland 21201, or call 410-767-0938, or
email to mdh.regs@maryland.gov. Comments will be accepted through June 30,
2025. A public hearing has not been scheduled.
10.10.01 General
Authority: Courts and Judicial Proceedings Article, §10-1001;
Health General Article, §§17-201, 17-202, 17-205, 17-214, and 17-501; Annotated
Code of Maryland
.03 Definitions.
A. (text unchanged)
B. Terms Defined.
(1)—(12) (text unchanged)
(12-1) “CLIA waived test” means a test system, assay, or
examination that the federal Department of Health and Human Services has
determined meets the Clinical Laboratory Improvement Amendments (CLIA)
statutory criteria as specified for waiver under the federal CLIA Amendments of
1988 in Section 353 of the Public Health Service Act of 42 U.S.C. §263a.
(13)—(23) (text unchanged)
(24) “Excepted test” means a medical laboratory test[, as
set forth in COMAR 10.10.03.02B, that is authorized by the Secretary to be
offered or performed by a laboratory operating under a letter of exception]
that is a CLIA waived test.
(25)—(70) (text unchanged)
[(71) "Single-use test device for forensic
testing" means the reagent-containing unit of a test system that:
(a) Is in the form of a sealed container or cartridge possessing a
validity check;
(b) Possesses a nonresealable closure or an evidentiary tape to
ensure detection of tampering;
(c) Is self-contained and individually packaged;
(d) Is discarded after each test; and
(e) Does not allow any test component or constituent of a test
system to interact from test to test.
(72) "Single-use test device for nonforensic testing"
means the reagent-containing unit of a test system in the form of a cartridge,
test pack, or other container that:
(a) Includes a validity check;
(b) Is self-contained and individually packaged;
(c) Is discarded after each test; and
(d) Does not allow any test component or constituent of a test
system to interact from test to test.]
[(73)] (71)—[(88)] (86) (text
unchanged)
(87) “Test System” means the instructions, instrumentation,
equipment, and reagents necessary to perform an assay or examination that
generates test results.
[(89)] (88) “Validity check” means a
procedural, testing process, or analytical verification of proper performance
of one or more analytical steps performed by the test system operator, built
into a [single-use test device,] test system, and carried out by
a [single-use test device] test system to detect environmental
damage or interfering substances that may have affected the device or the
results of the testing process.
10.10.02 Medical Laboratories—General
Authority: Courts and Judicial Proceedings Article, §10-1001;
Health General Article, §§17-201, 17-202, 17-205, 17-214, and 17-501, Annotated
Code of Maryland
.01 Responsibilities of the Department.
A.—B. (text unchanged)
C. Issuance of Licensing Documents. The OHCQ shall:
(1) (text unchanged)
(2) Issue a license that includes the:
(a) (text unchanged)
(b) Name of the licensee or laboratory director; and
(c) Name of the laboratory owner[; and].
[(d) Expiration date of the license; and]
(3) (text unchanged)
D. Administration and Information Management. The OHCQ shall:
(1)—(2) (text unchanged)
(3) Monitor the proficiency testing performance of a laboratory
required to participate in proficiency testing; and
[(4) Conduct a cytology proficiency testing program for each
cytotechnologist and pathologist who performs gynecological examinations;
(5) Set and collect fees as set forth in COMAR 10.10.04.]
[(6)] (4) [Impose] For tests that are not CLIA waived,
impose alternative sanctions and initiate actions leading to
imposition of principal sanctions against a laboratory under the appropriate
provisions of this subtitle.
E. Recommending Excepted Test Status.
[(1)] (text unchanged)
[(2) The Laboratory Advisory Committee's responsibilities
shall include making a recommendation to the Secretary in favor of or against
granting a test excepted status.
(3) The Laboratory Advisory Committee shall consider a test for
excepted test status and make a recommendation to the Secretary if:
(a) The Laboratory Advisory Committee is requested in writing by:
(i) The Secretary;
(ii) A Maryland chapter of a specialty medical society; or
(iii) The Medical and Chirurgical Faculty of Maryland;
(b) The test on which the request is based is waived under CLIA, by
the CDC, or by the federal Food and Drug Administration;
(c) The test employs a directly collected specimen not subjected to
post-collection manipulation or processing; and
(d) The test is a manual test or is a test system employing a
single use test device for nonforensic testing that tests for one or more
analytes in a single specimen.
(4) The Laboratory Advisory Committee shall make a recommendation
to the Secretary concerning excepted test status based on:
(a) Immediate patient need for the test in order to:
(i) Provide rapid patient follow-up;
(ii) Order additional tests; or
(iii) Make an immediate diagnostic or therapeutic decision;
(b) Whether the test is core to a physician's practice, based on:
(i) Physician specialty;
(ii) Usefulness of the test in the specialty; and
(iii) Who actually performs the test;
(c) Access, applicability, and ease of performance by personnel in
a POL and POC setting;
(d) Whether all analytes testable on a multi-test, single-use test
device are recommended for excepted status;
(e) Consideration of the known benefits and risks of the test or
test system, especially those involving an infectious disease; and
(f) The potential harm to a patient if the test:
(i) Is performed incorrectly; or
(ii) Produces a false positive or false negative test result.
(5) In recommending a test for excepted status, the Laboratory
Advisory Committee may specify certain conditions to be met based on factors
set forth in §E(4) of this regulation.
F. Authorizing Excepted Test Status.
(1) The Secretary may authorize a test for excepted status if:
(a) The test is recommended for excepted test status by the
Laboratory Advisory Committee; or
(b) The Secretary:
(i) Determines that the test meets the criteria of §E(3)(b)—(d) of
this regulation; and
(ii) Bases the authorization for excepted status on the factors set
forth in §E(4) of this regulation.
(2) In authorizing a test for excepted status, the Secretary may
specify certain requirements to be met based on factors set forth in §E(4) of
this regulation.]
10.10.03 Medical Laboratories—Licenses
Authority: Environment Article, §6-303; Health-General Article,
§§2-104(b), 17-202, 17-205—17-210, 17-212, 17-502, 17-503, 17-505, [17-508],
and 17-510, Annotated Code of Maryland
.02 Letters of Exception.
A. (text unchanged)
B. Excepted Tests. A POL or POCL operating under a letter of
exception may perform one or more [of the following excepted tests or
types of tests:
(1) Whole blood glucose by glucose monitoring devices cleared by
the FDA for home use or a CLIA waived analyzer;
(2) Dermatophyte screen;
(3) Dipstick glucose;
(4) Dipstick urinalysis using reagent test pads affixed to plastic
strips that detect one or a combination of any of the following urine
characteristics or constituents:
(a) Glucose;
(b) Bilirubin;
(c) Ketones detected in the form of acetoacetic acid;
(d) Specific gravity;
(e) Red blood cells or hemoglobin;
(f) pH;
(g) Protein;
(h) Urobilinogen;
(i) Nitrites; and
(j) Leukocytes;
(5) Gram stain;
(6) Group A streptococcal screen;
(7) Hematocrit;
(8) Hemoglobin;
(9) Infectious mononucleosis slide or card test;
(10) Microscopic urinalysis;
(11) Occult blood;
(12) Pinworms;
(13) Potassium hydroxide skin preparations;
(14) Rheumatoid factor slide agglutination test;
(15) Sickle-cell screen;
(16) H. pylori test with a single-use test device for nonforensic
testing, using a whole-blood specimen;
(17) Fructosamine test with a single-use test device for
nonforensic testing, using a whole-blood specimen;
(18) Heterophile antibodies test with a single-use test device for
nonforensic testing, using a whole-blood specimen;
(19) Urine bacteria colony count;
(20) Urine pregnancy test;
(21) Wet mounts;
(22) Influenza antigen test using a direct nasal or throat swab
specimen;
(23) Hemoglobin A1c test using a whole blood specimen;
(24) Qualitative test for bladder cancer markers in voided urine
including a test to detect:
(a) Human complement factor H-related protein; or
(b) Nuclear mitotic apparatus protein (NMP);
(25) Brain natriuretic peptide (BNP) test using a whole blood
specimen to detect:
(a) Heart disease; or
(b) The response of treatment for heart failure;
(26) Fern test for qualitative detection of:
(a) Amniotic fluid crystallization; or
(b) Estrogenic activity;
(27) Qualitative semen analysis, limited to detecting:
(a) The presence or absence of sperm; or
(b) Sperm motility;
(28) Nitrazine vaginal pH test using phenaphthazine reagent paper
strips;
(29) Qualitative immunochromatographic test to detect the presence
of adenovirus antigens directly from eye fluid;
(30) Microalbumin-creatinine urinalysis test utilizing an
instrument based dip-and-read reagent test strip for determining urine albumin
and creatinine levels, including the urinary albumin-to-creatinine ratio (UACR)
in a random urine specimen;
(31) Screening tests for urine or saliva performed on FDA-cleared
for home use or FDA approved single-use test devices for the presence of
alcohol and drugs of abuse solely for the purpose of directing patient
counseling;
(32) Qualitative enzyme activity test using a chromogenic substrate
of bacterial sialidase for use in the detection of bacterial vaginosis directly
from vaginal fluid specimens;
(33) Qualitative immunochromatographic test to detect the presence
of Trichomonas vaginalis antigens directly from a vaginal swab;
(34) CLIA-waived Prothrombin Time/International Normalized Ratio
(PT/INR) with the additional requirements that:
(a) The licensee shall enroll into a Proficiency Testing program
offered by an entity that has been approved by the Centers for Medicare and
Medicaid Services (CMS) to ensure validation of all measurement capabilities
for the instrument used to perform the test; and
(b) When the numerical score is less than 80 percent, the licensee
shall submit the official proficiency test results to the Office of Health Care
Quality for review and monitoring with evidence of documented remedial actions
taken;
(35) CLIA waived blood lipid analysis for cholesterol, HDL, LDL,
and triglycerides;
(36) Whole blood lead testing on a CLIA waived analyzer with the
additional requirements:
(a) The licensee shall enroll into a Proficiency Testing program
offered by an entity that has been approved by the Centers for Medicare and
Medicaid Services to ensure validation of all measurement capabilities for the
instrument used to perform the test;
(b) When the numerical score is less than 80 percent, the licensee
shall submit the official proficiency test result to the Office of Health Care
Quality for review and monitoring with evidence of documented remedial actions
taken;
(c) All staff involved in testing shall undergo training on the
testing device and testing techniques with annual competencies;
(d) Records of training and competencies for staff shall be:
(i) Maintained by the laboratory; and
(ii) Made available for review by the Department; and
(e) Reporting requirements stated in §C of this regulation shall be
followed; and
(37) CLIA Waived Urine Drug Screens with the following additional
requirements:
(a) The licensee shall enroll into a proficiency testing program
offered by an entity that has been approved by the Centers for Medicare and
Medicaid Services; and
(b) When the numerical score is less than 80 percent, the licensee
shall submit the official proficiency test result to the Office of Health Care
Quality for review and monitoring with evidence of documented remedial actions
taken] CLIA waived tests.
C.—D. (text unchanged)
.04 Letter of Exception and Permit — Administrative Procedures.
A. Application — Filing.
(1)—(5) (text unchanged)
[(6) A person shall submit with the application the
nonrefundable partial licensing fee set forth in COMAR 10.10.04.02C.]
B.—D. (text unchanged)
E. Amending a Permit. Except as prescribed in §D of this
regulation, a licensee holding an unexpired permit who wishes to amend it
shall:
(1) (text unchanged)
[(23)] (2) (text unchanged)
[F. Expiration and Renewal.
(1) A letter of exception or permit expires on the date shown on
the license.
(2) The OHCQ shall mail a renewal application to a laboratory not
less than 30 days before the expiration date shown on the license.
(3) A licensee shall file an application to renew a license using
forms provided by the OHCQ and following the same procedures prescribed in §§A
and B of this regulation.
(4) A licensee who fails to submit a completed renewal application
before the expiration date may not operate the laboratory after its letter of
exception or permit has expired.]
[G.] F. (text unchanged)
G. Letter of Exception. A person applying for a letter of
exception for a POL or POCL shall submit an initial application.
H. Letter of Exception — Limited Testing for Rare Diseases. A
person applying for a letter of exception—limited testing for rare diseases for
a laboratory shall submit an initial application.
10.10.05 Medical Laboratories—Proficiency
Testing
Authority: Health General Article, §§17-202 and 17-211, Annotated
Code of Maryland
.02 Discipline, Specialty, and Subspecialty.
A. (text unchanged)
B. Discipline Standards.
(1) (text unchanged)
(2) Gynecologic Cytology. A licensee operating under a permit to
perform gynecologic cytology shall ensure that the laboratory enrolls and
maintains successful participation in[:
(a) A cytology PT program operated by the Secretary if the
laboratory is located inside this State; or
(b) A] a cytology PT program approved by CMS [if
the laboratory is located outside this State].
(3) (text unchanged)
.04 Cytology—Departmental Requirements.
A. The Secretary may not issue a license to operate a laboratory
that examines gynecologic cytology specimens if the laboratory does not enroll
and participate satisfactorily in a cytology PT program [operated or approved
by the Secretary] approved by CMS.
[B. The OHCQ shall conduct annual PT for each pathologist
and cytotechnologist who examines gynecological cytology slides acquired in the
State.
C. The OHCQ or an agent of the Department shall hand carry test
materials for first-event testing in a PT cycle to a laboratory and shall
conduct and supervise all testing.
D. The OHCQ shall:
(1) Conduct announced and unannounced on-site testing for
individuals during an annual PT cycle; and
(2) Schedule and conduct a retesting event for an individual who
has failed the annual PT testing event not more than 45 days after receipt of
the notification of the PT testing event failure by the:
(a) Individual who failed the annual PT testing event; and
(b) Laboratory director of the individual who failed the annual PT
testing event.
E. The OHCQ may conduct unannounced PT at any time during normal
laboratory working hours when the testing is conducted as part of routine PT, a
complaint investigation, a follow-up certification, or a regulatory compliance
survey.
F. The OHCQ shall conduct announced retesting within an annual PT
cycle at a site selected by the Department.
G. The OHCQ shall schedule an individual who misses a laboratory's
annual PT event to make up the missed test.]
[H.] B. (text unchanged)
.05 Cytology—Laboratory and Individual Standards.
A. Primary Standard. A pathologist or cytotechnologist who examines
gynecological cytology specimens from individuals in this State shall
participate satisfactorily in an annual cytology PT program approved by [the
Secretary] CMS.
B. Laboratory Standards.
(1) A licensee operating under a permit to examine gynecologic
cytology specimens shall ensure that each pathologist and cytotechnologist who
examines gynecologic cytology specimens participates in a cytology PT program
conducted by the Department or approved by [the Secretary] CMS.
[(2) An in-State laboratory shall participate in the
Department's PT program.
(3) An out-of-State laboratory shall participate in either the
Department's PT program or another equivalently rigorous cytology PT program
approved by the Secretary].
[(4)] (2) A licensee employing an individual
who has failed a second testing event in an annual PT cycle shall:
(a) (text unchanged)
(b) Document the individual's completion of education and training [using
a form provided by the OHCQ].
[(5)] (3) (text unchanged)
C. (text unchanged)
10.10.06 Medical Laboratories — Quality
Assurance
Authority: Health-General
Article, §§17-202, 17-202.1, 17-214, and 17-504, Annotated Code of Maryland
.02 Authorization to Request Laboratory Tests.
A. (text unchanged)
B. Other Authorized Persons. Other persons authorized to order
laboratory tests include:
(1)—(5) (text unchanged)
(6) Clinical staff who:
(a)—(b) (text unchanged)
(c) Is authorized to order tests to detect the presence of
controlled dangerous substances on patients enrolled in the substance abuse
treatment program; [and]
(7) A pharmacist, for tests that qualify for a letter of exception
under COMAR 10.10.03.02B and for glucose, A1c, lipids (including total
cholesterol, HDL, LDL, and triglycerides), AST, and ALT[.];
and
(8) A naturopathic physician consistent with Health Occupations
Article, §14–5F–01 through §14–5F–32, Annotated Code of Maryland and COMAR
10.32.21.
C. (text unchanged)
.07 Quality Control—Specialty and Subspecialty.
A. (text unchanged)
B. Standards.
(1) General. A licensee shall ensure that the laboratory meets the
applicable quality control requirements for each specialty and subspecialty
under:
(a) (text unchanged)
(b) Regulations .07—[.16] .15 of this chapter.
(2) (text unchanged)
.08 Quality Control—Job-Related Alcohol and Drug Testing.
A. Primary Standard. A licensee shall ensure that a laboratory has
in place a quality assurance program designed to monitor and evaluate all
phases of the testing process including but not limited to:
(1)—(6) (text unchanged)
[(7) Single-use test devices;]
[(8)](7) — [(9)](8) (text
unchanged)
B. Standards.
(1)—(7) (text unchanged)
(8) Cutoff Levels.
(a) (text unchanged)
(b) Urine. A laboratory testing urine shall use the cutoff levels
set forth in [49 CFR §40.87] 49 CFR §40.85.
(c)—(d) (text unchanged)
[(9) Single-Use Test Devices. A laboratory that performs
screening tests using single-use test devices, as defined in COMAR
10.10.01.03B, may meet the quality assurance and quality control standards set
forth in Regulation .06 of this chapter instead of the standards set forth at
§B(1) of this regulation.]
[(10)](9) —[(11)](10)
(text unchanged)
.12 Quality Control—Temporary and Mobile Laboratories: General.
A. (text unchanged)
B. Standards.
(1)—(9) (text unchanged)
(10) Disposal of Special Medical Waste. A licensee operating a
temporary or mobile laboratory shall dispose of special medical waste as
required in [COMAR 10.06.06] COMAR 10.06.06.01—10.06.06.07.
.13 Quality Control — Temporary and Mobile Laboratories: Personnel
Training.
A. (text unchanged)
B. Standards.
(1) All Personnel. A licensee shall ensure that all personnel are
trained to:
(a)—(c) (text unchanged)
(d) Dispose of special medical waste as set forth in [COMAR
10.06.06.] COMAR 10.06.06.01—10.06.06.07.
(2)—(4) (text unchanged)
10.10.07 Medical Laboratories — Personnel
Authority: Health General Article, §§17-202, 17-203, 17-206,
Annotated Code of Maryland
.07 Permitted Laboratory Other than POL or POCL—Testing Personnel.
A. (text unchanged)
B. Standards — General.
(1) Personnel Qualifications. An individual performing one or more
laboratory tests shall meet the applicable qualifications set forth in [42
CFR §493.1489] 42 CFR §493.1423.
(2) Responsibilities. Testing personnel shall carry out the
responsibilities set forth in [42 CFR §493.1495] 42 CFR §493.1425.
C.—D. (text unchanged)
10.10.08 Medical Laboratories—Sanctions
Authority: Health General Article, §§17-202, 17-206, 17-210,
17-211, and 17-509, Annotated Code of Maryland
.02 Departmental Actions—General.
A. (text unchanged)
B. Deficiency Not Posing Immediate Jeopardy.
(1)—(2) (text unchanged)
(3) [Unsuccessful] Unsatisfactory Proficiency
Testing. If a laboratory exhibits [unsuccessful] unsatisfactory
proficiency testing performance, as set forth in COMAR 10.10.01.03B, the
Secretary may impose the training and technical assistance requirements set
forth in Regulation .04 of this chapter as a directed plan of correction, as
well as any other sanction.
(4) (text unchanged)
C.—D. (text unchanged)
10.10.12 Medical Laboratories—Public
Health HIV Testing Programs
Authority: Health-General
Article, Annotated Code of Maryland
|
Regulation
|
Sections
|
|
.01 Scope
|
17-202
|
|
.02 Definitions
|
17-202
|
|
.03 Incorporation by Reference
|
17-201, 17-202
|
|
.04 Public Health Testing License, for Rapid
HIV Antibody Testing
|
17-202, [17-204,] 17-205, 17-206,
17-207, 17-208, [17-209,] 17-210
|
|
.05 Quality Assessment Plan and Quality
Control Requirements
|
17-202, 17-206
|
|
.06 Personnel Training and Competency
|
17-202, 17-206
|
|
.07 Standard Operating Procedures Manual
|
17-202
|
|
.08 Public Health Testing Program Director
|
17-203, 17-206
|
|
.09 Manufacturer's Requirements
|
17-202
|
|
.10 Confirmatory Test
|
17-202
|
.02 Definitions.
A. (text unchanged)
B. Terms Defined.
(1)—(8) (text unchanged)
(8-1) “Rapid hepatitis C virus test” means a public health
hepatitis test that:
[(a) Is a single-use test device as defined in COMAR
10.10.01.03B;]
[(b)] (a) — [(d)] (c)
(text unchanged)
(9) “Rapid HIV antibody test” means a public health HIV test that:
[(a) Is a single-use test device as defined in COMAR
10.10.01.03B;]
[(b)] (a)—[(d)] (c) (text
unchanged)
(10) (text unchanged)
.04 Public Health Testing License for Rapid HIV Antibody Testing
and HCV Testing.
A.—C. (text unchanged)
D. The Department shall issue a public health testing license that:
[(1) Is valid for a period of not more than 2 years;]
[(2)](1) —[(3)](2) (text
unchanged)
E.—G. (text unchanged)
.07 Standard Operating Procedures Manual.
A. (text unchanged)
B. A person seeking or holding a public health testing license
shall ensure that the SOPM includes the step-by-step instructions for the
operations, tasks, and techniques occurring before, during, and after testing,
including:
(1)—(8) (text unchanged)
(9) How to refer an individual who has been tested for HIV
antibodies or hepatitis C antibodies, or both, for services as prescribed in
COMAR 10.18.08.10C [and 10.18.09.07].
RYAN B. MORAN, DRPH, MHSA
Acting Secretary of
Health
Subtitle 21 MENTAL
HYGIENE REGULATIONS
Notice of Proposed Action
[25-071-P]
The Secretary of Health proposes to:
(1) Amend Regulations .01—03, .05, .06, .08—10,
and .12, and .14 under COMAR 10.21.12 Use of Quiet Room and
Use of Restraint; and
(2) Amend Regulations .01—08, .10, and .12
under COMAR 10.21.13 Use of Quiet Room and Use of Seclusion.
Statement of Purpose
The purpose of this action is to guide the development of
facility-based and community-based behavioral health emergency protocols for
the utilization of restraint, seclusion, and quiet room.
The updated regulations will:
(1) Reflect current Maryland law;
(2) Delete obsolete terminology;
(3) Address concerns brought forth by the disability advocacy
community;
(4) Align with regulations from the Centers for Medicare and
Medicaid Services where appropriate; and
(5) Reflect current quality and safety standards of care.
These revisions will eliminate vague language, clarify existing
regulatory language, and direct the use of restraint and seclusion only in an
emergency. Further, by guiding the development of facility-based and
community-based behavioral health emergency protocols involving the use of
restraint and seclusion, these revisions will have enhanced safety implications
for patients and staff.
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:
The proposed action will provide additional protection for
individuals with disabilities that may require occasional use of quiet room,
restraint, or seclusion in an emergency by removing vague regulatory language
and deleting obsolete terms. The proposed action will bring the regulations
into compliance with current law and adopt CMS language as appropriate.
Opportunity for Public Comment
Comments may be sent to Jordan Fisher Blotter, Director, Office of
Regulation and Policy Coordination , Maryland Department of Health, 201 West
Preston Street, Room 534 Baltimore, Maryland 21201, or call 410-767-0938, or
email to mdh.regs@maryland.gov. Comments will be accepted through June 30,
2025. A public hearing has not been scheduled.
10.21.12 Use of Quiet Room and Use of
Restraint
Authority: Health-General Article, [§§10-101(e)] §§10-101(g)
and 10-701, Annotated Code of Maryland
.01 Scope.
These regulations govern the use of quiet rooms and restraint in
all facilities as defined in Health-General Article, [§§10-101(e)]
§§10-101(g) and 10-701, Annotated Code of Maryland. These regulations
are supplemental to any other applicable law and regulation. In the event of
conflict between these regulations and any other regulations or laws, the more
stringent apply.
.02 Definitions.
A. (text unchanged)
B. Terms Defined.
(1) Category I Restraint.
(a) (text unchanged)
(b) "Category I restraint" includes, but is not limited
to, four-point restraints [and safety suits].
(2) "Category II restraint" means any device which is not
considered by the facility as a category I restraint and includes, but is not
limited to, mittens and [camisoles] vests.
(3)—(11) (text unchanged)
(12) Prone Restraint.
(a) “Prone restraint” means restricting the free movement of all
or a portion of a patient’s body through the use of physical force or
mechanical devices while the patient is in a prone position.
(b) “Prone restraint” does not mean a technique for
transitioning a patient to a restraint position that involves momentarily
placing the individual face down.
[(12)] (13)—[(13)] (14)
(text unchanged)
[(14)] (15) Restraint.
(a) "Restraint" means: [a mechanical device or
devices approved by the facility which restrict the movement of the whole or a
portion of a patient's body for the purpose of preventing intentional harm to
self or others and is grouped into two categories, category I and category II]
(i) Any manual method, physical or mechanical device, material,
or equipment that immobilizes or reduces the ability of a patient to move their
arms, legs, body, or head freely; or
(ii) A drug or medication when it is used as a restriction to
manage the patient’s behavior or restrict the patient’s freedom of movement and
is not a standard treatment or dosage for the patient’s condition.
(b) "Restraint" does not include a [helmets]
helmet when used as a sole form of restraint [, chemotherapy,]
or a protective [devices, or cold wet sheet packs used
as a treatment procedure ordered by a physician] device.
[(15)] (16) (text unchanged)
[(16) "Serious disruption to a therapeutic
environment" means imminent danger of damage to the physical environment,
or behavior of such a grave or protracted nature that significantly interferes
with the emotional well-being of other patients or with their treatment.]
(17) “Trauma-informed care” means mental health treatment that
includes:
(a) An appreciation for the high prevalence of trauma
experienced by individuals receiving mental health services;
(b) An understanding of the neurological, biological,
psychological, and social effects of trauma and violence, including sexual
abuse and exploitation, on an individual; and
(c) An understanding of the environment, practices, and
treatments that may need to be modified to address trauma issues.
[(17)] (18) "Treatment team" means
the patient's mental health professional treatment team as defined in
COMAR 10.21.03.02C.
.03 Use of Restraint.
[A. Staff authorized under the provisions of Regulation .05A
of this chapter shall use a restraint only to:
(1) Prevent and reduce serious, destructive, and damaging actions
by a patient to the patient or to another;
(2) Prevent serious disruption of the therapeutic environment.]
A. Staff authorized under the provisions of Regulation .05B of
this chapter may use a restraint:
(1) Only during an emergency in which the behavior of the
patient places the patient or others in serious threat of violence or injury;
(2) If ordered by a physician in writing; or
(3) If at the direction of a registered nurse, if a physician's
order is obtained within 2 hours of the action.
B. Staff may not use a restraint:
(1) (text unchanged)
(2) As punishment[;], coercion, discipline, or
retaliation; [or]
(3) For the convenience of staff[.];
(4) To prevent damage or destruction to property; or
(5) To prevent serious disruption of the therapeutic
environment.
C. Staff shall use a restraint:
(1) In a humane, safe, and effective manner; [and]
(2) Without intent to harm or create undue discomfort to the
patient[.]; and
(3) For the shortest possible length of time, regardless of the
length of time in the physician's order.
D. Staff authorized under the provisions of Regulation [.05A]
.05B of this chapter may order the use of a restraint only if the
physician, following a clinical evaluation of the patient, determines that:
(1) The patient's behavior poses [:
(a) An emergency situation; or
(b) A serious disruption to the therapeutic environment; and]
an emergency situation; and
(2) Less restrictive or alternative approaches have been [considered
and, if clinically indicated and reasonable, have been attempted, and are
considered ineffective] determined to be ineffective to ensure the
safety of the patient, staff, or others.
E. The approaches referred to in §D(2) of this regulation may
include, but are not limited to:
(1) (text unchanged)
(2) Quiet room; [or]
(3) Medication or medications[.];
(4) Deescalation techniques;
(5) Trauma-informed care interventions;
(6) Calling the hospital's response team for assistance; and
(7) Consulting the patient's care plan for personalized
strategies.
.05 Procedures in the Use of Restraint.
A. A facility shall:
(1) Have a written policy specifying the method used to ensure
that a patient whose primary language or method of communication is nonverbal
is able to effectively communicate distress during a physical restraint or
hold; and
(2) Ensure that all staff at the facility who are authorized to
participate in a physical restraint or hold of a patient are trained in the
method specified in the written policy in accordance with §A(1) of this
regulation.
[A.] B. A physician who is responsible
either for the care of the patient or for assessment of the appropriateness of
a restraint or, when the appropriate physician is not readily available to
assess the patient, a registered nurse shall conduct a clinical evaluation of
the patient to determine [:
(1) Whether an emergency situation is present; or
(2) The degree to which the patient presents a serious disruption
to the therapeutic environment] whether an emergency situation is
present.
[B.] C. Before using restraint, the
physician or registered nurse shall assess whether less restrictive [alternative
approaches are appropriate and, if so, whether and what approaches have been
attempted] or alternative approaches have been determined to be
ineffective to ensure the safety of the patient, staff, or others.
[C.] D. When a physician, as identified
in [§A] §B of this regulation, is immediately available,
the physician shall be responsible for determining a patient's need for a
restraint and make the decision whether to restrain.
[D.] E. Authorization in the Absence of
a Physician.
(1) When a physician, as identified in [§A] §B
of this regulation, is not immediately available, a registered nurse shall
determine a patient's need for restraint and may initiate and direct the use of
restraint.
(2) Within [1 hour] 2 hours of the
implementation of the restraint, a physician shall give a written or verbal
order for any restraint initiated by a registered nurse and, at that time,
shall make the clinical determination to continue or to discontinue the
restraint.
.06 Placement of Patient in Restraint.
A.—C. (text unchanged)
D. [To the extent consistent with] For the
patient's safety and the safety of others:
(1) Staff shall place the patient in the restraint in as dignified
a manner as the situation permits, using the least amount of physical force
necessary; [and]
(2) As necessary, additional staff shall participate in the
placement of a patient in [seclusion.] restraint;
(3) The patient shall be free from subject prone restraint; and
(4) The patient shall be free from a restraint that:
(a) Applies pressure to the patient’s back;
(b) Obstructs the airway of the patient or impairs the patient’s
ability to breathe;
(c) Obstructs a staff member’s view of the patient’s face; or
(d) Restricts the patent’s ability to communicate distress.
E.—J. (text unchanged)
.08 Clinical Interventions During Restraint.
A.—C. (text unchanged)
D. [Unless circumstances suggest a medical problem may
exist, staff may not disrupt a patient's sleep during the night to implement
the clinical procedures described in §§B and C of this regulation] When
the patient's behavior no longer places the patient or others in serious threat
of violence or injury, the patient shall be released from restraint.
.09 Limitations on Restraint and Continuous Restraint.
A. (text unchanged)
[B. A physician may write an order for restraint for a
period of up to, but not more than, 24 hours.
C. If a patient in restraint requires continuous restraint for over
a 24-hour period, a physician shall:
(1) Conduct a face-to-face evaluation of the patient to determine
whether continuous restraint is appropriate;
(2) Document the evaluation in the patient's medical record; and
(3) If the patient is restrained under the provisions of §§D and E
of this regulation, carry out the requirements of §C(1) and (2) of this
regulation every 24 hours throughout the period that the patient continues in
restraint.
D. If restraint is required for a period greater than a continuous
48 hours, the physician may continue restraint only:
(1) In conjunction with the requirements outlined in this chapter;
(2) If the treating physician's documented clinical opinion is that
the patient, if released from restraint, would continue to present a danger to
self or others or would present a serious disruption to the therapeutic
environment; and
(3) With the authorization of the clinical director or the clinical
director's physician designee, neither of whom may be the treating physician.
E. Upon a request from a patient's treating physician, the clinical
director or the clinical director's designee identified in §D(3) of this
regulation, following a face-to-face evaluation of the patient who is
restrained, may authorize continued restraint:
(1) For category I restraints, for additional periods of not more
than 48 hours each over the initial 48-hour period that a patient is restrained
under the provisions of §C of this regulation; and
(2) For category II restraints:
(a) For an initial period of not more than 7 days over the initial
48-hour period that a patient is restrained under the provisions of §C of this
regulation; and
(b) For additional periods of not more than 7 days each over the
7-day period of restraint authorized under §E(2)(a) of this regulation, if the
patient's treatment team:
(i) Recommends continued restraint and documents the recommendation
in the patient's medical record; and
(ii) Incorporates into the treatment plan and any subsequent
revisions to the plan the proposed strategies to accomplish discontinuance of
the restraint.
F. Each time that restraint is authorized under the provisions of
§E of this regulation, the clinical director or the clinical director's
designee identified in §D(3) of this regulation shall countersign the
physician's order in the patient's medical record for continued restraint.]
B. Each order for restraint, used for the management of an
emergency in which the behavior of the patient places the patient or others in
serious threat of violence or injury, may only be renewed in accordance with
the following limits not to exceed 24 hours total:
(1) Four hours for adults 18 years of age or older;
(2) Two hours for children and adolescents 9 to 17 years of age;
or
(3) One hour for children under 9 years of age.
C. After 24 hours, before writing a new order for the use of
restraint for the management of an emergency in which the behavior of the
patient places the patient or others in serious threat of violence or injury, a
physician must:
(1) See, assess, and conduct a face-to-face evaluation of the
patient to determine whether continuous restraint is appropriate;
(2) Document in the patient's medical record the observed
behavior that confirms that the patient, if released from restraint, would
continue to present a danger to self or others;
(3) Follow all requirements outlined in this chapter, including
but not limited to §B of this regulation; and
(4) Obtain the authorization of the clinical director or the
clinical director's physician designee, neither of whom may be the treating
physician.
D. Upon a request from a patient's treating physician, prior to
authorizing continued restraint in accordance with §C(4) of this regulation,
the clinical director or the clinical director's designee shall perform a
face-to-face evaluation of the patient who is restrained.
E. Following the initial 24 hours of restraint authorized under
§C of this regulation, additional periods of restraint, not to exceed 24 hours
each, may be authorized only if the restraint is provided in accordance with
§§B—D of this regulation.
[G.] F. Treatment Team Involvement.
(1) (text unchanged)
(2) Within [7] 5 working days from the
initiation of continuous restraint, regardless of whether the patient remains
in restraint, the treatment team shall:
(a) (text unchanged)
(b) Establish and implement a plan [calculated] to
eliminate the need for further restraint; and
(c) (text unchanged)
.10 Documentation.
A.—C. (text unchanged)
D. Release from Restraint.
(1) (text unchanged)
(2) When a registered nurse clinically determines that the release
of the patient before the maximum period specified on a physician's order is
appropriate, the registered nurse shall:
(a) [Order] Direct termination of the
restraint [with or without a physician's order, unless the physician's
order specifically requires physician concurrence with the termination];
and
(b) (text unchanged)
.12 Quality Assurance.
A.—C. (text unchanged)
D. Staff who implement orders for restraint:
(1) Shall have documented annual training in the proper use of physical
restraint and hold including training for special populations which
include, but are not limited to, children and the elderly; [and]
(2) Shall have documented annual training in trauma-informed
care and demonstrate competency in providing trauma-informed care services; and
[(2)] (3) (text unchanged)
E. (text unchanged)
F. If seclusion is used in conjunction with restraint, staff shall
also comply with [regulations for the use of seclusion] COMAR
10.21.13.
10.21.13 Use of Quiet Room and Use of Seclusion
Authority: Health-General Article, [§§10-101(e)] §§10-101(g)
and 10-701, Annotated Code of Maryland
.01 Scope.
These regulations govern the use of quiet rooms and seclusion in
all facilities as defined in Health-General Article, [§§10-101(e)]
§§10-101(g) and 10-701, Annotated Code of Maryland. These regulations
are supplemental to any other applicable law and regulation. In the event of
conflict between these regulations and any other regulations or laws, the more
stringent apply.
.02 Definitions.
A. (text unchanged)
B. Terms Defined.
(1)—(6) (text unchanged)
(7) Prone Restraint.
(a) “Prone restraint” means restricting the free movement of all
or a portion of a patient’s body through the use of physical force or
mechanical devices while the patient is in a prone position.
(b) “Prone restraint” does not mean a technique for
transitioning a patient to a restraint
position that involves momentarily placing the individual face down.
[(7)] (8)—[(9)] (10) (text
unchanged)
[(10) "Serious disruption to a therapeutic
environment" means imminent danger of damage to the physical environment,
or behavior of such a grave or protracted nature that it significantly
interferes with the emotional well-being of other patients or with their
treatment.]
(11) “Trauma-informed care” means mental health treatment that
includes:
(a) An appreciation for the high prevalence of trauma
experienced by individuals receiving mental health services;
(b) An understanding of the neurological, biological,
psychological, and social effects of trauma and violence, including sexual
abuse and exploitation, on an individual; and
(c ) An understanding of the environment, practices, and
treatments that may need to be modified to address trauma issues.
[(11)] (12) "Treatment team" means the
patient's mental health professional treatment team as defined in COMAR
10.21.03.02C.
.03 Use of Seclusion.
[A. Staff authorized under the provisions of Regulation .04A
of this chapter shall use seclusion only to:
(1) Prevent and reduce serious, destructive, and damaging actions
by a patient to the patient or to another; or
(2) Prevent serious disruption of the therapeutic environment.]
A. Staff authorized under the provisions of Regulation .04C of
this chapter may use seclusion:
(1) Only during an emergency in which the behavior of the
patient places the patient or others in serious threat of violence or injury;
and
(2) If ordered by a physician in writing; or
(3) If at the direction of a registered nurse if a physician's
order is obtained within 2 hours of the action.
B. Staff may not use seclusion:
(1) (text unchanged)
(2) As punishment[; or], coercion, discipline, or
retaliation;
(3) For the convenience of staff[.];
(4) To prevent damage or destruction to property; or
(5) To prevent serious disruption of the therapeutic
environment.
C. Staff shall conduct seclusion:
(1) In a humane, safe, and effective manner; [and]
(2) Without intent to harm or create undue discomfort to the
patient[.]; and
(3) For the shortest possible length of time, regardless of the
length of time in the physician's order.
D. Staff authorized under the provisions of Regulation [.04A]
.04C of this chapter may order the use of seclusion only if that staff
person, following a clinical evaluation of the patient, determines that:
(1) The patient's behavior poses[:
(a) An emergency situation; or
(b) A serious disruption to the therapeutic environment; and]
an emergency situation; and
(2) Less restrictive or alternative approaches have been [considered
and, if clinically indicated and reasonable, have been attempted, and are
considered ineffective] determined to be ineffective to ensure the
safety of the patient, staff, or others.
E. The approaches referred to in §D(2) of this regulation may
include, but are not limited to:
(1) (text unchanged)
(2) Quiet room; [or]
(3) Medication or medications[.];
(4) Deescalation techniques;
(5) Trauma-informed care interventions;
(6) Calling the hospital's response team for assistance; and
(7) Consulting the patient's
care plan for personalized strategies.
.04 Procedures in the Use of Seclusion.
A. A facility shall have a written policy specifying the method
used to ensure that a patient whose
primary language or method of communication is nonverbal is able to effectively
communicate distress during a seclusion.
B. A facility shall ensure that all staff at the facility who
are authorized to participate in a seclusion of patients are trained in the
method specified in the written policy in accordance with §A(1) of this
regulation.
[A.] C. A physician who is responsible either
for the care of the patient or for assessment of the appropriateness of
seclusion or, when the appropriate physician is not readily available to assess
the patient, a registered nurse shall conduct a clinical evaluation of the
patient to determine[:
(1) Whether an emergency situation is present; or
(2) The degree to which the patient presents a serious disruption
to the therapeutic environment] whether an emergency situation is
present.
[B.] D. Before instituting seclusion, the
physician or registered nurse shall assess whether less restrictive or
alternative approaches [are appropriate and, if so, whether and what
approaches have been attempted] have been determined to be
ineffective to ensure the safety of the patient, staff, or others.
[C.] E. When a physician, as identified in [§A]
§C of this regulation, is immediately available, the physician shall be
responsible for determining a patient's need for seclusion and make the
decision whether to seclude.
[D.] F. Authorization in the Absence of a
Physician
(1) When a physician, as identified in [§A] §C
of this regulation, is not immediately available, a registered nurse shall
determine a patient's need for seclusion and may initiate and direct the use of
seclusion.
(2) Within [1 hour] 2 hours of the
implementation of the seclusion, a physician shall give a written or verbal
order for any seclusion initiated by a registered nurse and, at that time,
shall make the clinical determination to continue or discontinue the seclusion.
.05 Placement of a Patient in a Seclusion Room.
A.—B. (text unchanged)
C. [To the extent consistent with the] For
patient's safety and the safety of others:
(1) Staff shall place the patient in the seclusion room in as
dignified a manner as the situation permits, using the least amount of physical
force necessary; [and]
(2) As necessary, additional staff shall participate in the
placement of a patient in seclusion[.];
(3) The patient shall be free from prone restraint; and
(4) The patient shall be free from restraint that:
(a) Applies pressure to the individual’s back;
(b) Obstructs the airway of the individual or impairs the
individual’s ability to breathe;
(c) Obstructs a staff member’s view of the individual’s face; or
(d) Restricts the individual’s ability to communicate distress.
D.—H. (text unchanged)
I. If a patient is confined to a room in a manner that meets the
definition of seclusion in accordance with Regulation .02B of this chapter, the
patient is considered to be subject to seclusion, regardless of whether the
room used is typically used as a seclusion room.
.06 Clinical Interventions During Seclusion.
A.—B. (text unchanged)
C. [Unless circumstances suggest a medical problem may
exist, staff may not disrupt a patient's sleep during the night to implement
the clinical procedures described in §§A and B of this regulation] When
the patient's behavior no longer places the patient or others in serious threat
of violence or injury, the patient shall be released from seclusion.
.07 Limitations on Seclusion and Continuous Seclusion.
A. (text unchanged)
[B. Excluding requirements outlined in §D of this
regulation, each order or subsequent order for seclusion may be written for a
period up to, but not more than, 24 hours.
C. If a patient in seclusion requires continuous seclusion for over
a 24-hour period, a physician shall:
(1) Conduct a face-to-face evaluation of the patient to determine
whether continuous seclusion is appropriate;
(2) Document the evaluation in the patient's medical record; and
(3) If the patient is secluded under the provisions of §D of this
regulation, carry out the requirements of §C(1) and (2) of this regulation
every 24 hours throughout the period that the patient continues in seclusion.
D. If seclusion is required for a period greater than a continuous
48 hours, the physician may continue seclusion only:
(1) In conjunction with the requirements outlined in this chapter;
(2) If the treating physician's clinical opinion is that the
patient, if released from seclusion, would continue to present a danger to self
or others or would present a serious disruption to the therapeutic environment;
and
(3) With the authorization of the clinical director or the clinical
director's physician designee, neither of whom may be the treating physician.
E. Following a request from a patient's treating physician, the
clinical director or the clinical director's designee identified in §D(3) of
this regulation, following a face-to-face evaluation of the patient in
seclusion, may authorize continued seclusion:
(1) For an additional 48 hours over the initial 48-hour period that
a patient is secluded under the provisions of §C of this regulation; and
(2) For each period of 7 days over the 48-hour period authorized
under §E(1) of this regulation.
F. Each time that seclusion is authorized under the provisions of
§E of this regulation, the clinical director or the clinical director's
designee identified in §D(3) of this regulation shall countersign the
physician's order in the patient's medical record for continued seclusion.]
B. Each order for seclusion, used for the management of an
emergency in which the behavior of the patient places the patient or others in
serious threat of violence or injury, may only be renewed in accordance with
the following limits not to exceed 24 hours total:
(1) Four hours for adults 18 years of age or older;
(2) Two hours for children and adolescents 9 to 17 years of age;
or
(3) One hour for children under 9 years of age.
C. After 24 hours, before writing a new order for the use of
seclusion for the management of an emergency in which the behavior of the
patient places the patient or others in serious threat of violence or injury, a
physician must:
(1) See, assess, and conduct a face-to-face evaluation of the
patient to determine whether continuous seclusion is appropriate; and
(2) Document in the patient's medical record the observed
behavior that confirms that the patient, if released from seclusion, would
continue to present a danger to self or others;
(3) Follow all requirements outlined in this chapter, including
but not limited to §B of this regulation; and
(4) Obtain the authorization of the clinical director or the
clinical director's physician designee, neither of whom may be the treating
physician.
D. Upon a request from a patient's treating physician, prior to
authorizing continued seclusion, in accordance with §C(4) of this regulation,
the clinical director or the clinical director's designee shall perform a
face-to-face evaluation of the patient who is secluded.
E. . Following the initial 24 hours of seclusion authorized
under §C of this regulation, additional periods of restraint, not to exceed 24
hours each, may be authorized only if the seclusion is provided in accordance
with §§B—D of this regulation.
[G.] F. Treatment Team Involvement.
(1) (text unchanged)
(2) Within [7] 5 working days from the
initiation of continuous seclusion, regardless of whether the patient remains
in seclusion, the treatment team shall:
(a) (text unchanged)
(b) Establish and implement a plan [calculated] to
eliminate the need for further seclusion; and
(c) (text unchanged)
.08 Documentation.
A.—C. (text unchanged)
D. Release from Seclusion.
(1) When a physician clinically determines that a patient is to be
released from seclusion, the physician shall:
(a) [Order] Direct the release and write,
sign, and date a note indicating the rationale for the release; and
(b) (text unchanged)
(2) When a registered nurse clinically determines that the release
of the patient before the maximum period specified on a physician's order is
appropriate, the registered nurse shall:
(a) [Order] Direct termination of the
seclusion with or without a physician's order[, unless the physician's
order specifically requires physician concurrence with the termination];
and
(b) (text unchanged)
.10 Quality Assurance.
A.—C. (text unchanged)
D. Staff who implement orders for seclusion:
(1) Shall have documented annual training in the proper use of
seclusion including training for special populations which include, but are not
limited to, children and the elderly; [and]
(2) Shall have documented annual training in trauma-informed
care and demonstrate competency in providing trauma-informed care services;
[(2)] (3) (text unchanged)
E. (text unchanged)
F. If restraint is used in conjunction with seclusion, staff shall
also comply with [regulations for use of restraint] COMAR 10.21.12.
.12 Variance with Standards.
A.(text unchanged)
B. There may not be any variance with standards established in:
[this regulation and in Regulations .03, and .04, .05B—E and G, I, .07A,
.09, .10A, D, E(1), and F, .11, and .12 of this chapter]
(1) This regulation;
(2) Regulation .03 of this chapter;
(3) Regulation .04 of this chapter;
(4) Regulation .05B—E, G, and I of this chapter;
(5) Regulation .07A of this chapter;
(6) Regulation .09 of this chapter;
(7) Regulation .10A, D, E(1), and F of this chapter; and
(8) Regulation .11 of this chapter.
C.—E. (text unchanged)
LAURA HERRERA SCOTT
Secretary
of Health
Subtitle 27 BOARD OF NURSING
10.27.01 Examination and
Licensure
Authority: Health Occupations Article, §§1-213, 8-201, 8-205,
8-206, 8-301—8-315, 8-6A-05(a), 8-701, 8-7A-01, Article 1116(b)(2), and 8-703;
Ch. 486, Acts of 2012; Chs. 281 and 282, Acts of 2013; Chs. 385 and 386, Acts
of 2016; and Chs. 234 and 234, Acts of 2017
Notice of Proposed Action
[25-089-P]
The Secretary of Health proposes to amend Regulation .13
under COMAR 10.27.01 Examination and Licensure. This action was considered by constituents
and stakeholders during a public meeting held on February 22, 2023, notice of
which was given by publication on the Board’s website at:
https://health.maryland.gov/mbon/, pursuant to General Provisions Article,
§3–302(c), Annotated Code of Maryland.
Statement of Purpose
The purpose of this action is to propose amendments to extend the
scheduled years in which applicants applying for a license or certificate
renewal must complete their criminal history records check.
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 Jordan Fisher Blotter, Director, Office of
Regulation and Policy Coordination, Maryland Department of Health, 201 West
Preston Street, Room 534 Baltimore, Maryland 21201 , or call 410-767-0938, or
email to mdh.regs@maryland.gov. Comments will be accepted through June 30,
2025. A public hearing has not been scheduled.
.13 Renewal of License
A.—M.
(text unchanged)
N.
Criminal history record checks for renewal applicants shall be scheduled
according to the licensee’s birth month as follows:
[(1) In 2010 — all applicants with
a June birth month;
(2)
In 2011 — all applicants with a July birth month;
(3)
In 2012 — all applicants with an August birth month;
(4)
In 2013 — all applicants with a September birth month;
(5)
In 2014 — all applicants with an October birth month;
(6)
In 2015 — all applicants with a November birth month;
(7)
In 2016 — all applicants with a December birth month;
(8)
In 2017 — all applicants with a January birth month;
(9)
In 2018 — all applicants with a February birth month;
(10)
In 2019 — all applicants with a March birth month;
(11)
In 2020 — all applicants with an April birth month; and
(12)
In 2021 — all applicants with a May birth month.]
(1) In 2025 — all applicants with
an August or September birth month;
(2) In 2026 — all applicants with
a September or October birth month;
(3) In 2027 — all applicants with
an October or November birth month;
(4) In 2028 — all applicants with
a November or December birth month;
(5) In 2029 — all applicants with
a December or January birth month;
(6) In 2030 — all applicants with
a January or February birth month;
(7) In 2031 — all applicants with
a February or March birth month;
(8) In 2032 — all applicants with
a March or April birth month;
(9) In 2033 — all applicants with
an April or May birth month;
(10) In 2034 — all applicants with
a May or June birth month;
(11) In 2035 — all applicants with
a June or July birth month; and
(12) In 2036 — all applicants with
a July or August birth month.
O.
(text unchanged)
LAURA HERRERA SCOTT
Secretary of Health
Notice of Proposed Action
[25-090-P]
The Secretary of Health
proposes to:
(1) Amend Regulation .01
under COMAR 10.27.11 Delegation of Nursing Functions;
(2) Amend Regulations .01—.03
under COMAR 10.27.13 Safe Practice Committee;
(3) Adopt new Regulations .01—.15
under COMAR 10.39.06 Certified Dialysis Technicians; and
(4) Amend Regulation .01
under COMAR 10.39.07 Certificate Holders–Code of Ethics;
This action was considered
by the Board at a public meeting held on May 22, 2024, notice of which was
given by publication on the Board’s website at
https://health.maryland.gov/mbon/Pages/meetings-index.aspx, pursuant to General
Provisions Article, §3–302(c), Annotated Code of Maryland.
Statement of Purpose
The purpose of this action
is to provide regulatory guidance for dialysis technicians certified in
Maryland, pursuant to HB 218, Dialysis Technicians, 2022 Chapter 681.
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 Jordan Fisher Blotter, Director, Office of
Regulation and Policy Coordination, Maryland Department of Health, 201 West
Preston Street, Room 534 Baltimore, Maryland 21201, or call 410-767-0938, or
email to mdh.regs@maryland.gov. Comments will be accepted through June 30,
2025. A public hearing has not been scheduled.
10.27.11 Delegation of Nursing Functions
Authority: Health Occupations Article, §§8-102, 8-205, 8-6A-01, 8-6A-02,
8-6A-03, 8-6A-05(a)(4), and 8-6A-08(f)(5), Annotated Code of Maryland
.01 Exclusion from Regulations.
This chapter is not applicable to and does not restrict or limit:
A.—H. (text unchanged)
I. A certified
dialysis technician regulated in accordance with COMAR 10.39.06.
10.27.13 Safe Practice Committee
Authority: Health
Occupations Article, §§1-606, [8-205 and 8-208,] 8-205(a)(1), 8-316,
8-6A-01, 8-6A-10, and 8-6B-18, Annotated Code of Maryland
.01 Definitions.
A. (text unchanged)
B. Terms Defined.
(1) “Applicant” means an individual who has submitted an
application to the Board to be licensed as a registered nurse, licensed
practical nurse, electrologist, licensed certified midwife or
direct-entry midwife or to be certified as an advanced practice registered
nurse, a certified nursing assistant, a certified dialysis technician,
or medication technician in this State.
(2)—(3) (text unchanged)
(4) “Certificate holder” means a certified nursing assistant, a
certified dialysis technician, or medication technician.
(5) “Certified dialysis technician” means an individual
certified as a dialysis technician by the Board in accordance with COMAR
10.39.06.
[(5)] (6) (text unchanged)
[(6)] (7) “Licensee” means a licensed
certified midwife, direct-entry midwife, electrologist, licensed practical
nurse, registered nurse, or advanced practice registered nurse.
[7] (8)—[(10)] (11) (text
unchanged)
[(11)] (12) “Participant” means a registered
nurse, an advanced practice registered nurse, a licensed practical nurse, a
certified nursing assistant, a certified dialysis technician, a
medication technician, an electrologist, a licensed direct-entry midwife, a
licensed certified midwife or an applicant enrolled in the Safe Practice
Program.
[(12)] (13)—[14] (15) (text unchanged)
.02 Safe Practice Committee.
A.---D. (text unchanged)
E. Powers and Duties of the Committee.
(1)—(2) (text unchanged)
(3) At the request of the Board, the committee may evaluate a
nurse, certified nursing assistant, certified dialysis technician,
medication technician, electrologist, [or] direct-entry midwife,
or licensed certified midwife with a substance use disorder or mental
illness for readiness to return to practice.
F. (text unchanged)
.03 Criteria for Participation in the Program.
A. (text unchanged)
B. Registered nurses, licensed practical nurses, direct-entry
midwives, electrologists, medication technicians, advanced practice registered
nurses, certified nursing assistants, certified dialysis technicians, licensed
certified midwives or applicants for licensure or certification with a
substance use disorder or mental illness, may be referred to the program
through self-report, formal complaint, or the Board of Nursing.
C.—E. (text unchanged)
Subtitle 39 BOARD OF NURSING–CERTIFIED
NURSING ASSISTANTS
10.39.06 [Medication
Technicians – Vacant] Certified Dialysis Technicians
Authority: Health Occupations Article, §§ 8-205, 8-6A-01 through
8-6A-10, 8-6A-12, 8-6A-14.1, 8-6A-15, 8-701, 8-703, 8-705, and 8-706, Annotated
Code of Maryland
.01 Exceptions.
This chapter does not apply to an individual who:
A. Practices a health occupation, other than certified dialysis
technician, that the individual is authorized to practice in accordance with Health
Occupations Article, Annotated Code of Maryland;
B. Provides for the gratuitous care of friends, domestic
partners, or family members;
C. Performs dialysis technician tasks as a student while under
the direct supervision of qualified faculty;
D. Performs nursing tasks delegated by a registered nurse or
licensed practical nurse so long as the delegated nursing tasks do not become a
routine part of the unlicensed or uncertified individual’s job duties; and
E. Is an unlicensed caregiver hired by a cognitively
capable adult to assist the individual at their home in treatments of a routine
nature and in self-administration of medication.
.02 Definitions.
A. In this chapter, the following terms have the meanings
indicated.
B. Terms Defined.
(1) “Accountability” means being answerable for actions of self
or others.
(2) “Board” means the Maryland Board of Nursing.
(3) “Central Repository” means the Maryland Criminal Justice
Information System Central Repository of the Department of Public Safety and
Correctional Services.
(4) “Certificate” means a certificate issued by the Board to
practice as a certified dialysis technician in this State.
(5) Certified Dialysis Technician (CDT).
(a) “Certified dialysis technician” means an individual who is
certified by the Board to practice as a dialysis technician.
(b) “Certified dialysis technician” does not include a:
(i) Medication technician; or
(ii) Certified nursing assistant.
(6) “Certified nursing assistant (CNA)” means an individual
certified by the Board as a nursing assistant in accordance with COMAR
10.39.01.
(7) “Clinical facility” means a setting where patients are
present and that provides facilities for supervised clinical training.
(8) “Criminal history records check (CHRC)” means the
performance of both a State criminal history records check by the Central
Repository and a national criminal history records check performed by the
Federal Bureau of Investigation.
(9) “Criminal history record information” means information
provided by the criminal history records check regarding an applicant’s
criminal arrests, charges, convictions, and other dispositions of criminal
charges.
(10) “Delegation” means the act of authorizing a certified
dialysis technician to perform acts of registered nursing or licensed practical
nursing.
(11) “Direct supervision” means the individual is on site,
physically present, accessible in the immediate patient care area, and
available to intervene if necessary.
(12) “Evaluation” means the review and analysis of the extent to
which the assessment, nursing diagnosis, planning, and implementation phases of
the nursing process were effective in resolving the patient’s identified
problems.
(13) “Family” means related family members, foster parents,
domestic partners, and legal guardians.
(14) “Good standing” means without an encumbrance that limits or
restricts practice, such as revocation, suspension, or probation.
(15) “Licensed practical nurse (LPN)” means an individual who:
(a) Is licensed by the Board to practice licensed practical
nursing; or
(b) Has a multistate licensure privilege to practice licensed
practical nursing.
(16) Licensed Practitioner.
(a) “Licensed practitioner” means an individual licensed in the
healthcare field.
(b) “Licensed practitioner” includes RNs, LPNs, advanced
practice registered nurses, physicians, physician’s assistants, physical
therapists, and respiratory therapists.
(17) Model of Nursing Practice.
(a) “Model of nursing practice” means the policies, procedures,
and practice guidelines:
(i) Established by the facility, which are consistent with this
chapter regarding delegation of nursing functions and regulations governing the
facility; and
(ii) That provide direction to nursing staff on the delivery of
care to the patient population which the facility serves.
(b) “Model of nursing practice” may not supersede a delegating
nurse’s prudent judgment regarding:
(i) Delegation of a nursing function to a dialysis technician;
or
(ii) A particular delegated nursing function to that individual
or individuals.
(18) “Multistate licensure privilege” has the meaning set forth
in COMAR 10.27.01.01B.
(19) “National certification” means certification as a:
(a) Certified Clinical Hemodialysis Technician issued by the Nephrology Nursing
Certification Commission;
(b) Clinical Nephrology Technician issued by the National
Nephrology Certification Organization; or
(c) Certified Hemodialysis Technician issued by the Board of
Nephrology Examiners Nursing Technology.
(20) “Nurse” means a registered nurse or licensed practical
nurse.
(21) “Patient” means the recipient of nursing care.
(22) “Practice as a certified dialysis technician” means to
provide, under the supervision of a registered nurse or licensed practical
nurse, direct care to patients undergoing renal dialysis treatments.
(23) “Program completion” means that the student:
(a) Completed and demonstrated competency in the program
objectives and performance indicators during the didactic, laboratory, and
clinical portions of the training program; and
(b) Passed the final written examination.
(24) “Qualified faculty” means an instructor or instructors as
described in Regulation .10A of this chapter.
(25) “Readily available” means:
(a) The delegating nurse is physically present on the unit; and
(b) The nurse may transfer responsibility for the nursing
supervision and delegation to another nurse who then becomes the nurse
delegating the nursing functions.
(26) “Registered nurse (RN)” means an individual who:
(a) Is licensed by the Board to practice registered nursing; or
(b) Has a multistate licensure privilege to practice registered
nursing.
(27) “Routine care” means those activities necessary on a daily
basis for the patient to gain or maintain a level of functioning.
(28) “Structured setting” means a dialysis facility, hospital,
nursing home, long-term care facility, ambulatory care setting, or any other
acute care, chronic care, or correctional facility that has a location in which
dialysis care is provided.
(29) “Supervised clinical training” means training in person in
a clinical facility during which the student demonstrates knowledge and skills
while performing tasks on a patient under the direct supervision of an RN.
(30) “Supervision” means
the process of critical watching, directing, and evaluating another's
performance.
(32) “Unlicensed individual” means an individual who is not
licensed or certified to provide nursing care in accordance with Health
Occupations Article, Title 8, Annotated Code of Maryland.
(33) “Written agreement” means a contract between a training
program and a clinical facility outlining the terms required, by both the
program and the facility, for supervised clinical training of students.
.03 General Provisions for Applications.
A. An applicant shall submit:
(1) A completed application to the Board on the form required by
the Board;
(2) To a CHRC in accordance with Health Occupations Article,
§8-303, Annotated Code of Maryland;
(3) Written evidence satisfactory to the Board that the
applicant has submitted to a CHRC as required by §A(2) of this regulation by
submitting:
(a) Two sets of fingerprints, as required by the Central
Repository and the Federal Bureau of Investigation; and
(b) All fees required by the Central Repository and the Federal
Bureau of Investigation;
(4) Any documentation requested from the applicant by the Board
including, but not limited to, official certified or true test court documents
and a signed, dated explanation written by the applicant, regarding the facts
and circumstances, outcome, and current status of any criminal history record
information received by the Board:
(a) Under §A(2) of this regulation;
(b) In an answer to a question on the Board's application form;
or
(c) From any other source; and
(5) Any additional documentation requested by the Board if the
documentation received from the applicant under §A(4) of this regulation is
incomplete or insufficient.
B. If an application is not complete when initially submitted to
the Board by the applicant, the applicant shall have no longer than 12 months
from the date the application is received by the Board to complete the
application and provide all information and documents required in §A of this
regulation.
C. If an applicant fails to provide to the Board a complete
application and any additional documentation requested by the Board under §A of
this regulation within 12 months from the date the application is received by
the Board, then the application shall be considered abandoned and may be
destroyed.
D. Once an application is deemed abandoned under §C of this
regulation, an individual seeking certification as a dialysis technician shall
submit a new application on the form required by the Board and meet all the
requirements for certification as a dialysis technician and pay the required
fees that are in effect at the time of re-application.
.04 Qualifications for Certification.
A. Initial certification.
Except as provided in §D of this regulation, an applicant for initial
certification as a dialysis technician shall have successfully completed a
dialysis technician training program approved by the Board.
B. Certification by Endorsement.
An applicant for certification as a dialysis technician by endorsement
shall:
(1) Hold a certificate to practice as a dialysis technician
that:
(a) Was issued by another state or territory of the United
States that has certification requirements that are essentially similar to
those set forth in Health Occupations Article, §8-6A-05, Annotated Code of
Maryland; and
(b) Is in good standing; and
(2) Have successfully completed a dialysis technician training
program that meets the standards for an approved dialysis technician training
program set by the Board.
C. A certified dialysis technician shall obtain national
dialysis technician certification within 18 months of the date of hire as a
certified dialysis technician.
D. An individual certified as a certified nursing assistant with
the status of dialysis technician (CNA-DT) shall be deemed to meet the
requirements for initial certification as a dialysis technician under §A of
this regulation.
.05 Application for Certification.
A. Initial Certification.
(1) Except as otherwise provided in this chapter, an applicant
for initial certification as a dialysis technician shall:
(a) Comply with all of the requirements under Regulation .03 of
this chapter;
(b) Pay the required fee to the Board; and
(c) Submit to the Board an application that has been signed by
the administrator or faculty of the approved dialysis technician training
program completed by the applicant.
(2) An applicant shall submit an application for initial
certification within 24 months of the date of completion of an approved
dialysis technician training program.
(3) If an applicant fails to comply with §A(2) of this
regulation, an applicant still seeking certification shall re-take an approved
dialysis technician training program and comply with §A(1) of this
regulation.
B. Certification by Endorsement.
An applicant for certification as a dialysis technician by endorsement
shall:
(1) Comply with all of the requirements under Regulation .03 of
this chapter;
(2) Pay the required fee to the Board; and
(3) Submit the following verifications directly to the Board
from the appropriate authority:
(a) A certificate to practice as a dialysis technician in good
standing from another state or territory with certification requirements that
are essentially similar to the requirements in this State; and
(b) A certificate of completion from a dialysis technician
training program in that state or territory that meets the standards for an
approved dialysis technician training program set by the Board.
.06 Temporary Practice Certificate.
A. The Board may issue a temporary practice certificate to an
applicant who:
(1) Has met the appropriate certification requirements to the
satisfaction of the Board;
(2) Does not have a criminal record; and
(3) Has not been the subject of a health professional
disciplinary action in this State or another jurisdiction.
B. Unless the Board suspends or revokes a temporary practice
certificate, the temporary practice certificate expires 90 days after the date
of issuance.
C. A temporary practice certificate may be extended up to an
additional 90 days if the applicant is awaiting the completion of the criminal
history records check.
.07 Issuance of Certification.
A. The Board may not issue a certificate to an applicant until
the Board has:
(1) Received and reviewed the criminal history record
information of the applicant; and
(2) Approved the application.
B. Unless an applicant is subject to discipline, the Board shall
issue a dialysis technician certificate to each applicant who meets all the
requirements of this chapter and Health Occupations Article, §§8-6A-05 and
8-6A-06, Annotated Code of Maryland.
C. CNA-DT Certificates.
(1) On or after the effective date of this regulation, the Board
shall issue an initial dialysis technician certificate to all individuals
then-certified as a CNA-DT.
(2) The status of an
initial dialysis technician certificate issued pursuant to §C(1) of this
regulation shall be the same as the status of the individual’s CNA-DT
certificate.
.08 Expiration and Renewal of Certification.
A. Expiration. Unless renewed for an additional 2-year term, and
except as otherwise provided in this regulation, a certificate expires in
accordance with the following schedule:
(1) The certificate of a certificate holder with an odd-numbered
birth year expires on the 28th day of the certificate holder’s birth month in
an odd-numbered year; and
(2) The certificate of a certificate holder with an
even-numbered birth year expires on the 28th day of the certificate holder’s
birth month in an even-numbered year.
B. Unless an initial certificate is issued pursuant to
Regulation .07C of this chapter, an initial dialysis technician certificate
shall not expire within 180 days of the date of issuance.
C. Certificate Holder Responsibility.
(1) It is the responsibility of the certificate holder to:
(a) Be aware of the expiration date of the certificate; and
(b) Renew the certificate before it expires.
(2) Failure of a certificate holder to receive the renewal
notice sent by the Board does not relieve the certificate holder of the
responsibility to renew a certificate before it expires.
D. Renewal Requirements.
(1) The Board shall renew a certificate if the certificate
holder:
(a) Is otherwise entitled to be certified;
(b) Submits a complete application for renewal on the form
required by the Board;
(c) Pays the renewal fee to the Board;
(d) Provides satisfactory evidence, as required by the Board,
of:
(i) 16 hours of active practice as a dialysis technician, for
monetary compensation, in the last 24 months immediately preceding the date of
expiration;
(ii) Three hours of continuing education approved by the Board;
and
(iii) Except as provided in §D(3) of this regulation, an active
national certification.
(2) If a renewal applicant cannot meet the requirements of §D(1)(d)(i)—(ii)
of this regulation, the applicant shall re-take a Board-approved dialysis
technician training program.
(3) If a renewal applicant is not yet eligible for a national
certification before the first renewal, the applicant:
(a) May renew the certificate; and
(b) Shall submit evidence of an active national certification at
the next renewal.
E. National Certification.
(1) A dialysis technician shall not practice on an expired
national certification.
(2) The dialysis technician shall submit a record of a renewed
national certification to the Board if the national certification expires
before renewal.
F. Continuing Education Courses.
The Board may review and approve continuing education courses that
provide didactic instruction in the principles and applications of
dialysis.
.09 Training Program Approval.
A. Approval.
(1) Before a training program is offered, the dialysis
technician training program shall be approved by the Board.
(2) Board approval of a dialysis technician training program is
valid for 2 years.
B. Procedure for Initial Approval.
(1) At least 90 days before the proposed start date of the
program, a program provider seeking initial approval of a dialysis technician
training program shall:
(a) Submit to the Board a complete application on the form
required by the Board;
(b) Demonstrate that the training program meets all the
requirements of this regulation; and
(c) Provide any additional information requested by the Board
during the Board’s review of the application.
(2) Board Action.
(a) Following receipt of a complete application, the Board’s
professional staff may conduct a survey visit and submit a survey visit report
to the Board.
(b) The Board shall:
(i) Approve a training program that meets all the requirements
of this regulation; or
(ii) Deny approval of a training program that does not meet all
the requirements of this regulation.
C. Ongoing Responsibilities.
(1) Board Approval of Substantial Program Changes.
(a) An approved dialysis technician training program shall
obtain approval from the Board before making any substantial changes to the
program.
(b) Substantial program changes include:
(i) Changes to faculty;
(ii) Significant changes to curriculum, including an increase or
decrease in program hours and changes to the modality of teaching; and
(iii) Removal or addition of clinical facilities or classroom
locations.
(2) An approved training program shall submit to the Board an
annual report, on the form required by the Board, that includes:
(a) Statistics on enrollments;
(b) Program completions; and
(c) Attrition rates.
(3) The Board may make survey visits from time to time, without
prior notice, to all approved dialysis technician training programs.
D. Renewal of Approval.
(1) Expiration. Unless renewed, Board approval of a training
program expires 2 years from the last date of approval.
(2) Renewal application. At least 90 days before the date of
expiration of approval, an approved training program applying for renewal shall
submit:
(a) A complete application on the form required by the Board;
and
(b) All accompanying documentation required by the application
or requested by the Board.
(3) Survey visit. Following receipt of a renewal application,
the Board’s professional staff may conduct an announced or unannounced on-site
survey visit and submit a survey visit report to the Board.
(4) Board Action. The Board shall:
(a) Renew approval of a training program for another 2-year term
if the training program meets the requirements of this regulation; or
(b) Initiate withdrawal proceedings in accordance with §E of
this regulation if the training program fails to meet the requirements of this
regulation.
(5) Enrollment. A training program that fails to renew its
approval:
(a) Shall be listed on nonrenewed status in the Board’s records;
and
(b) May not enroll any new students to the program following the
expiration of approval.
E. Withdrawal of Approval.
(1) Notice of Deficiencies.
(a) If the Board determines that there is a basis for withdrawal
of approval under §E(3) of this regulation, the Board shall issue a written
notice of deficiencies to the training program.
(b) The notice of deficiencies shall notify the training program
of the:
(i) Requirements with which the program has not complied;
(ii) Reasons for the Board’s determination; and
(iii) Requirement to submit a written plan of correction in
accordance with §E(2) of this regulation.
(2) Plan of Correction.
(a) A training program shall submit a written plan of correction
within 30 days of the date of the notice of deficiencies unless granted an
extension by the Board for good cause.
(b) The written plan of correction shall:
(i) Address all deficiencies noted by the Board; and
(ii) Include dates of completion for correcting the
deficiencies.
(c) The Board shall review the plan of correction and may
approve or modify the dates of completion for correcting deficiencies.
(d) The training program shall correct the deficiencies within
the time frame approved by the Board.
(3) Grounds for withdrawal. The Board may withdraw approval of a
training program that:
(a) Fails to comply with any of the requirements of this
regulation;
(b) Fails to correct deficiencies within the time frame approved
by the Board; or
(c) Enrolls new students after expiration of approval.
(4) Procedure for
Withdrawal.
(a) Before withdrawing approval of a training program, the Board
shall:
(i) Notify the program of its intent to withdraw approval; and
(ii) Give the program an opportunity to request an evidentiary
hearing before the Board.
(b) The notice of intent to withdraw approval and hearing shall
comply with State Government Article, Title 10, Subtitle 2, Annotated Code of
Maryland.
F. Reinstatement. A dialysis technician training program whose
approval was withdrawn may apply for reinstatement of approval by submitting a
reinstatement application demonstrating that the program meets all of the
requirements of this regulation.
.10 Training Program Requirements.
A. Faculty.
(1) The training program shall be administered by a registered
nurse approved by the Board who meets the following qualifications:
(a) An active license to practice as a registered nurse in good
standing in the State or a multistate licensure privilege to practice
registered nursing in the State;
(b) A minimum of 2 years of experience practicing as a
registered nurse, of which at least 1 year was in the care of renal patients;
and
(c) Education or experience in adult education in the form of:
(i) Experience as a staff development instructor for a minimum
of 1 year;
(ii) Completion of at least 6 credit hours of an adult education
program at a college or university; or
(iii) Completion of an adult education course approved by the
Board.
(2) The registered nurse who is responsible for administering
the training program may utilize other licensed practitioners to assist in
conducting classroom and clinical portions of the program in accordance with
the professional’s educational background and applicable scope of practice.
(3) CDT Assistance.
(a) A certified dialysis technician may assist in aspects of
supervised clinical training in a clinical facility, under the direct
supervision of the registered nurse.
(b) A certified dialysis technician assisting in aspects of the
training program shall:
(i) Hold a Certified Dialysis Technician certificate from the
Board;
(ii) Possess a current national certification; and
(iii) Have at least 2 years' experience in hemodialysis
services.
(4) The course instructor is responsible for:
(a) Participating in development and evaluation of the training
program, including the acquisition of learning resources and instructional
materials;
(b) Implementing the approved training program;
(c) Supervising classroom laboratory experiences;
(d) Evaluating student performance during didactic and
laboratory training; and
(e) Providing direct supervision and clinical evaluation of each
student at the clinical facility.
B. Facilities and Resources.
(1) Classroom, laboratory, and clinical facilities shall be
approved by the Board.
(2) All instructional learning resources and materials shall:
(a) Be accessible and relevant to the role of a dialysis
technician;
(b) Be written at a level appropriate for a dialysis technician;
and
(c) Have a publication date not older than 5 years from the
current year.
(3) Clinical Facilities.
(a) Clinical facilities shall:
(i) Have a sufficient number and variety of patients to provide
training experiences for all students to achieve the stated course objectives;
(ii) Have a sufficient number of RNs and other nursing personnel
to ensure safe and continuous care of patients; and
(iii) Conform with accepted standards of nursing care and
practice.
(b) There shall be a minimum of one course instructor for each
eight students in the clinical area.
(c) Except for facility-based programs, the training program
shall have a written agreement with a clinical facility that shall:
(i) Be developed jointly with the clinical facility and the
training program;
(ii) Be reviewed periodically by the clinical facility and the
training program;
(iii) Include a provision for adequate notice of termination;
(iv) Specify the responsibility of the training program to the
clinical facility and the responsibility of the clinical facility to the
training program; and
(v) Identify the functions and responsibilities of the parties
involved.
C. Curriculum.
(1) A dialysis technician training program shall provide a
minimum of 220 hours of instruction, of which a minimum of:
(a) 80 hours shall be devoted to didactic instruction and
classroom laboratory training; and
(b) 140 hours shall be devoted to supervised clinical training
in a clinical facility.
(2) A dialysis training program shall include curriculum content
that ensures sufficient preparation for national certification and for safe and
effective practice as a dialysis technician.
(3) Didactic instruction shall include the following content:
(a) Content required under 42 CFR §494.140E(3);
(b) A review of the relevant laws and regulations regarding the
practice of a dialysis technician and appropriate program policies;
(c) Data collection;
(d) Environment;
(e) Renal anatomy and physiology;
(f) Infection control and universal precautions;
(g) Basic chemistry of body fluids and electrolytes;
(h) Manifestations of renal failure;
(i) Blood work and laboratory values related to dialysis;
(j) Principles of dialysis;
(k) Pharmacology of the drugs commonly used during dialysis;
(l) Medication administration techniques specific to the drugs
used in dialysis, including lidocaine, heparin, and normal saline;
(m) Management of the complications of dialysis and renal
failure;
(n) The role of the dialysis technician in a dialysis setting
including, but not limited to, legal and ethical considerations and concepts of
delegation;
(o) Water treatment relevant to dialysis;
(p) Principles of patient education related to renal failure;
(q) Principles of and requirements for documentation;
(r) Communication and teamwork skills, including:
(i) Observing, recording, and reporting;
(ii) Interpersonal skills; and
(iii) Listening;
(s) Operation of dialysis delivery systems that includes the
machines, dialysate, and dialyzer;
(t) Principles of safe effective dialysis care;
(u) Principles related to the nutritional considerations for
patients receiving dialysis;
(v) Psychosocial aspects of renal disease;
(w) Principles of dialyzer reprocessing;
(x) Principles for initiating, monitoring, and discontinuing
dialysis;
(y) Principles related to the adequacy of dialysis; and
(z) Establishing and maintaining professional boundaries with a
patient.
(4) Clinical instruction shall:
(a) Provide the student with the opportunity to practice the
cognitive, psychomotor, and affective skills required for the safe performance
of dialysis care by the dialysis technician;
(b) Meet the learning needs of each student;
(c) Meet the established program objectives or outcomes; and
(d) Be provided concurrently with the related classroom theory
instruction.
(5) Each training program shall identify the unit objectives and
performance indicators for each of the areas in §F(3) of this regulation in its
training criteria.
(6) A training program shall provide at least 16 hours of
didactic and classroom laboratory training before a trainee’s direct assignment
to patient care. This instruction shall include the following topics:
(a) The role of the dialysis technician;
(b) Infection control;
(c) Safety and environment;
(d) Data collection;
(e) Treatments; and
(f) Laboratory procedures.
D. Evaluation.
(1) Each training program shall have an objective final written
examination that measures achievement of the performance indicators.
(2) To successfully complete the program, each student shall:
(a) Complete the required minimum hours provided in §F(1) of
this regulation;
(b) Achieve a passing score of at least 75 percent on the
written final examination; and
(c) Demonstrate competence in meeting the objectives and
performance indicators during didactic, laboratory, and clinical instruction.
(3) The training program shall provide a certificate of
completion, using the form required by the Board, to students upon program
completion.
(4) An administrator or faculty of a training program:
(a) May sign a student’s application for certification as a
dialysis technician before graduation; and
(b) Shall submit to the Board written verification, as required
by the Board, of each student’s program completion within 5 business days of
program completion.
.11 Scope of Practice.
A. Medication Administration.
(1) A certified dialysis technician shall administer only the
following medications:
(a) Intradermal lidocaine or another single therapeutically
equivalent local anesthetic for the purpose of initiating dialysis treatment;
(b) Intravenous heparin or other single therapeutically
equivalent anti-coagulant for the purpose of initiating and maintaining
dialysis treatment;
(c) Intravenous normal saline; and
(d) Oxygen, when the administration of the oxygen has been
delegated to the certified dialysis technician by a registered nurse.
(2) When administering the medications set forth in §A(1) of
this regulation, the certified dialysis technician shall:
(a) Ensure that the right dose of the right medication is given
to the right individual through the right route of administration at the right
time;
(b) Accurately and timely document the administration of the
medication and notify a physician or licensed nurse of the patient’s response
to the medication as appropriate;
(c) Consult with an appropriate licensed practitioner when the
certified dialysis technician believes or has reason to believe that a
prescribed medication is inaccurate, not properly authorized, harmful or
potentially harmful to a patient, or contraindicated by other documented
information; and
(d) Take any other action needed to ensure the safety of the
patient.
(3) A certified dialysis technician shall administer the
medications authorized under §A(1) of this regulation only if the task has been
delegated to the dialysis technician by a registered nurse or licensed
practical nurse in accordance with Regulations .11—.13 of this chapter.
(4) The certified dialysis technician shall be under the direct
supervision of a registered nurse or licensed practical nurse when
administering medications.
B. Practice Standards.
(1) A certified dialysis technician shall provide dialysis care
only when the performance of the care is delegated to the certified dialysis
technician by a registered nurse or licensed practical nurse.
(2) A certified dialysis technician shall demonstrate competence
and accountability in all areas of dialysis care in which the technician is
engaged, including, but not limited to, the following:
(a) Consistent performance of all aspects of dialysis care
according to acceptable standards; and
(b) Appropriate recognition, referral, consultation, or
intervention when a complication arises in conjunction with dialysis or when a
change in patient status occurs.
(3) A certified dialysis technician shall timely:
(a) Implement the prescribed dialysis care order for a patient
unless the technician believes or should have reason to believe that the
prescribed order is inaccurate, not properly authorized, not current or valid,
harmful or potentially harmful to the patient, or contraindicated by other
documented information; and
(b) Clarify any prescribed dialysis care order for a patient
when the technician believes or should have reason to believe that the order is
inaccurate, not properly authorized, not current or valid, harmful or
potentially harmful to the patient, or contraindicated by other documented
information.
(4) When clarifying the prescribed dialysis care order, the
certified dialysis technician shall timely:
(a) Consult with an appropriate licensed practitioner;
(b) Notify the delegating nurse when the technician believes
that it would not be appropriate to follow the prescribed dialysis care order;
(c) Document:
(i) That the delegating nurse was notified;
(ii) The outcome of the consultation with the delegating nurse;
and
(iii) The treatment plan for the patient; and
(d) Take any other action needed to ensure the safety of the
patient.
(5) A dialysis technician shall timely report to and consult as
necessary with other members of the dialysis care team, including, but not
limited to, the licensed nurse or physician when a patient refuses to follow
the prescribed dialysis care order.
(6) A dialysis technician shall comply with the code of ethics
for certificate holders set forth in COMAR 10.39.07.
(7) A dialysis technician shall do the following to promote
patient safety:
(a) Display the applicable CDT title or initials at all times
when providing dialysis care;
(b) Completely, accurately, and timely document and report all
patient data obtained while providing dialysis care and the patient’s response
to the care;
(c) Completely, accurately, and timely document and report to
the appropriate practitioner all errors in or deviations from the prescribed
dialysis care regimen;
(d) Not falsify any patient record or any other documents
prepared in the course of or in conjunction with the provision of dialysis
care. This includes, but is not limited
to, case management documents or reports, time records or reports, and other
documents related to billing for dialysis services; and
(e) Implement measures to provide a safe environment for the
patient.
(8) A dialysis technician shall only work in a structured
setting.
.12 Criteria for Delegation.
A. The nurse may delegate the responsibility to perform a
dialysis-related nursing task to a certified dialysis technician. The
delegating nurse retains the accountability for the dialysis-related nursing
task.
B. A dialysis-related nursing task delegated by the nurse shall
be:
(1) Within the area of responsibility of the nurse delegating
the act;
(2) Such that, in the judgment of the nurse, it can be properly
and safely performed by the certified dialysis technician without jeopardizing
patient welfare; and
(3) A task that a reasonable and prudent nurse would find is
within the scope of sound nursing judgment.
C. A dialysis-related nursing task delegated by the nurse may
not require the certified dialysis technician to exercise nursing judgment or
intervention except in an emergency situation.
D. When delegating a dialysis-related nursing task to a
certified dialysis technician, the nurse shall:
(1) Make an assessment of the patient's nursing care needs
related to the delegated task;
(2) Either instruct the certified dialysis technician in the
delegated task or verify the certified dialysis technician's competency to
perform the nursing task;
(3) Supervise the performance of the delegated nursing task in
accordance with Regulation .13 of this chapter;
(4) Be accountable and responsible for the delegated task;
(5) Evaluate the performance of the delegated nursing task; and
(6) Be responsible for ensuring accurate documentation of
outcomes on the medical record.
E. The nurse shall be the primary decision maker when delegating
a dialysis-related nursing task to a certified dialysis technician. Nursing
judgment shall be exercised within the context of the employer’s model of nursing
practice which includes a mechanism for:
(1) Identifying those individuals to whom nursing tasks may be
delegated;
(2) Reevaluation of the competency of those to whom nursing
tasks may be delegated;
(3) Recognizing that the final decision regarding delegation is
within the scope of the nurse's professional judgment;
(4) Determining the competency of the nurse to delegate; and
(5) Determining to whom nursing tasks may be delegated, which includes
input by nurses employed in the structured setting.
.13 Supervision of Delegated Nursing Tasks.
A. Except as provided in §B(2) of this regulation, the nurse
shall determine the required degree of supervision after an evaluation of
appropriate factors including, but not limited to, the:
(1) Stability of the condition of the patient;
(2) Training of the individual to whom the nursing task is being
delegated;
(3) Nature of the nursing task being delegated;
(4) Orientation of the certified dialysis technician to the
specific patient environment;
(5) Ability of the certified dialysis technician to perform the
delegated nursing task in a safe and competent manner; and
(6) Reevaluation of the patient's health status.
B. The delegating nurse shall:
(1) Be readily available when delegating a nursing task to a
certified dialysis technician; and
(2) Provide direct supervision of the certified dialysis
technician when the certified dialysis technician is administering medications.
.14 Delegation of Nursing Functions.
A. The following nursing functions require nursing knowledge,
judgment, and skill and may not be delegated:
(1) The nursing assessment including, but not limited to, the
admission, shift, transfer, or discharge assessment;
(2) Development of the nursing diagnosis;
(3) The establishment of the nursing care goal;
(4) Development of the nursing care plan;
(5) Evaluation of the patient's progress, or lack of progress,
toward goal achievement; and
(6) Any nursing task which requires nursing knowledge, judgment,
and skill.
B. The nurse may delegate treatments of a routine nature if:
(1) The licensed nursing staff of the specific dialysis setting
has identified the function as being routinely performed;
(2) The specific treatments are performed at a high frequency
necessary to retain competency;
(3) The treatment has an inherently low risk to the patient, as
determined by weighing the following factors:
(a) Type of equipment utilized to perform the function;
(b) Nurse staffing ratio that allows for close supervision;
(c) Basic educational preparation of the certified dialysis
technician performing the delegated function; and
(d) Knowledge and skill set of the nurse delegating and supervising
the delegated function; and
(4) There is a quality assurance mechanism in place to ensure
the function is performed safely and patient outcomes meet accepted
professional nursing standards, including, but not limited to:
(a) An ongoing formalized documented performance appraisal
mechanism designed to ensure that the certified dialysis technician’s
revalidation of continued competency is a component of the quality assurance
mechanism; and
(b) Patient outcomes meeting accepted professional standards, as
reflected by:
(i) Infection rates;
(ii) Rates of adverse events;
(iii) Error rates; and
(iv) Patient satisfaction surveys.
C. The nurse may delegate the obtaining of specific information
to a certified dialysis technician.
D. When implementing the interdisciplinary plan of care, the
nurse may delegate a nursing task to a certified dialysis technician when the
delegation of that task does not jeopardize the patient's welfare.
E. Administration of medication is a nursing function. As such,
the nurse retains full responsibility for medication administration.
F. The following activities related to medication administration
may not be delegated except as provided in Regulation .11A(1) of this chapter:
(1) Calculation of any medication dose;
(2) Administration of medications by injection route;
(3) Administration of medications by way of a tube inserted in a
cavity of the body; and
(4) Administration of medication by intravenous route.
G. Delegation of Medication Administration.
(1) The administration of medication may be delegated to
certified dialysis technicians only in structured settings.
(2) A nurse may delegate the administration of only the
medications set forth in Regulation .11A(1) of this chapter to a certified
dialysis technician.
.15 Patient Health Teaching and Health Counseling.
A. The registered nurse shall be accountable and responsible for
the development and initiation of the health teaching plan and for health
counseling of the patient.
B. The nurse shall be accountable and responsible for
facilitating and promoting:
(1) Patient education; and
(2) Participation of the patient and significant others in
implementation of health goals.
C. Certified dialysis technicians given instruction and
direction by the nurse may supplement the health teaching by providing
standardized information to the patient.
D. The certified dialysis technician is responsible and
accountable for reporting information to the nurse regarding the patient's:
(1) Request for information; and
(2) Response to teaching provided by the nurse or reinforcement
provided by the certified dialysis technician.
10.39.07 [Certified Nursing Assistants/Certified
Medication Technicians (CNA/CMT)] Certificate Holders–Code of Ethics
Authority: Health Occupations Article, [§§8-205(a)(1) and (2),
8-6A-05(a)(5), and 8-6A-10,] §§ 8-205
and 8-6A-01, Annotated Code of Maryland
.01 Definitions.
A. (text unchanged)
B. (text unchanged)
(1)—(3) (text unchanged)
(4) "Certificate holder" means an individual who is
certified [under Health Occupations Article, §8-6A-05 or 8-6A-08,
Annotated Code of Maryland, as either] by the Board as a
certified nursing assistant in any category, a certified dialysis
technician, or a medication technician.
(5)—(7) (text unchanged)
LAURA HERRERA SCOTT
Secretary of Health
Subtitle
32 BOARD OF PHYSICIANS
10.32.05 Telehealth
Authority: Health
Occupations Article, §§1-903, 1–1001—1–1006, 14-205, 14-301, and 14-601,
Annotated Code of Maryland
Notice of Proposed
Action
[25-096-P]
The Acting Secretary of
Health proposes to amend Regulations .02—.06 under COMAR 10.32.05
Telehealth. This action was
considered at a public meeting held on August 26, 2020, notice of which was
given by publication on the Board’s website at https://www.mbp.state.md.us/forms/Aug20Bagenda.pdf
from August 12, 2020, through August 26, 2020, pursuant to State Government
Article, §10-506(c)(1), Annotated Code of Maryland.
Statement of Purpose
The purpose of this action
is to amend the regulations to reflect statutory changes as a result of the
passage of Ch. 15 (H.B. 448), Acts of 2020. This legislation authorizes all
licensees under the Health Occupations Article to use telehealth (synchronous
and asynchronous) to establish a patient relationship among other changes.
Estimate of Economic Impact
I. Summary of Economic Impact. The fiscal note that
accompanied H.B. 448 and S.B. 402, Acts of 2020, predicted that revenues will
increase, potentially significantly, for health care practitioners who can
provide additional treatment based on the ability to use asynchronous
telehealth interaction under the bill. The potential increase is unknown and
dependent on a practitioner’s choice to utilize telehealth as this is not a
mandate.
II. Types of Economic Impact.
|
Impacted Entity
|
Revenue
(R+/R-)
Expenditure
(E+/E-)
|
Magnitude
|
|
A. On issuing agency:
|
NONE
|
|
|
B. On other State agencies:
|
|
|
|
(1) Maryland State
Agencies
|
(R+)
|
Indeterminable
|
|
C. On local governments:
|
|
|
|
(1) Local Health
Departments
|
(R+)
|
Indeterminable
|
|
|
Benefit
(+)
Cost
(-)
|
Magnitude
|
|
D. On regulated industries or
trade groups:
|
|
|
|
(1) Regulated Industry
|
(+)
|
Indeterminable
|
|
E. On other industries or
trade groups:
|
|
|
|
(1) Trade Groups
|
(+)
|
Indeterminable
|
|
F. Direct and indirect
effects on public:
|
|
|
|
(1) Public
|
(+)
|
Indeterminable
|
III. Assumptions. (Identified by Impact Letter and Number
from Section II.)
B(1). State agency revenues would potentially increase to the
extent that telehealth allows for more treatment by state employee
practitioners and state facilities. State health entity revenues will increase
by allowing asynchronous telehealth interactions for the required clinical
evaluation before providing treatment or issuing a prescription. This will
expand treatment provided by state entity health care practitioners. State
health entity expenditures are not materially affected.
C(1). Local revenues would
increase, potentially significantly, to the extent more treatment is provided
at local health departments (LHDs). LHD Revenues will increase by allowing
asynchronous telehealth interactions for the required clinical evaluation
before providing treatment or issuing a prescription. This will expand
treatment provided by LHD health care practitioners. LHD expenditures are not
materially affected.
D(1). Practitioners, state agencies, local health departments,
regulated industries, and trade groups all have the potential for increased
revenue to the extent the use of telehealth increases the volume of patient
encounters. At the same time, the need for updated and secure technology will
incur expenses. Because there is no way to predict who will use telehealth as a
modality, both benefit and costs are of unknown magnitude.
E(1). See D. above.
F(1). See D. above.
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:
Expanded telehealth access has the potential to create greater
access to healthcare for all potential clients including individuals with
disabilities.
Opportunity for Public Comment
Comments may be sent to Jordan Fisher Blotter, Director, Office of
Regulation and Policy Coordination, Maryland Department of Health, 201 West
Preston Street, Room 534 Baltimore, Maryland 21201, or call 410-767-0938, or
email to mdh.regs@maryland.gov. Comments will be accepted through June 30,
2025. A public hearing has not been scheduled.
.02 Definitions.
A. (text unchanged)
B. Terms Defined.
(1) “Asynchronous” means not occurring [at the same]
in real time.
(2)—(3) (text unchanged)
[(4) “Remote patient monitoring” means the use of telehealth
devices to collect from patients medical and other forms of health data that
are securely provided to a telehealth practitioner in a different location for
assessment, recommendation, and diagnosis.
(5) “Store and forward telehealth services” means a type of
asynchronous telehealth service involving a response to or interpretation of
digital images, documents, audio files, or videos transmitted electronically
through secure means.
(6) “Surrogate examiner” means an individual examining a patient at
the direction of a telehealth practitioner during a synchronous audio-visual
telehealth encounter and providing the telehealth practitioner with
observations and information.]
[(7)](4) “Synchronous”
means [simultaneously or quickly enough to allow two or more individuals
to conduct a conversation] occurring in real time.
[(8)] (5) Telehealth.
(a) “Telehealth” means [the use of interactive audio, video,
audio-visual, or other telecommunications or electronic technology by a
Maryland licensed physician or licensed allied health practitioner to deliver
clinical services within the scope of practice of the Maryland licensed
physician or licensed allied health practitioner at a location other than the
location of the patient] a mode of delivering health care services
through the use of telecommunications technologies by a health care
practitioner to a patient at a different physical location than the telehealth
practitioner.
(b) “Telehealth” includes synchronous and asynchronous
interactions.
[(b)] (c) “Telehealth” does not include[:
(i) An audio-only telephone conversation between a Maryland
licensed physician or licensed allied health practitioner and a patient;
(ii) An electronic mail message between a Maryland licensed
physician or licensed allied health practitioner and a patient; or
(iii) A facsimile transmission between a Maryland licensed
physician or licensed allied health practitioner and a patient] the
provision of health care services solely through:
(i) Audio–only calls;
(ii) E–mail messages; or
(iii) Facsimile transmissions.
[(9) “Telehealth devices” means devices that gather visual
or other data and remotely sends the images or data to a telehealth
practitioner in a different location from that of the patient.]
[(10)] (6) (text unchanged)
.03 Licensure.
A. Except as specified in Health Occupations Article,
§14-302, Annotated Code of Maryland, a Maryland telehealth practitioner
[may practice] shall be licensed when providing telehealth
[if one or both of the following occurs:] services to a patient
located in the State.
[A. The individual practicing telehealth is physically
located in Maryland; or
B. The patient is in Maryland.]
B. Telehealth practitioners licensed in the State are subject to
the jurisdiction of the State and shall abide by the telehealth requirements of
this chapter if either the practitioner or patient is physically located in
this State.
.04 Specific Telehealth Requirements.
A. Before performing telehealth services, a telehealth practitioner
shall develop and follow a procedure to:
(1) Verify the identification of the patient receiving telehealth
services[;] within a reasonable degree of certainty through
use of:
(a) Government issued photograph identification;
(b) Insurance, Medicaid, or Medicare card; or
(c) Documentation of the patient’s:
(i) Date of birth; and
(ii) Home address;
(2) For an initial patient encounter, disclose the telehealth
practitioner’s name, contact information, license type, and medical specialty,
if any;
[(2)] (3) Except for interpretive services,
obtain oral or written [acknowledgement] consent from a patient
or [person in interest as defined by Health-General Article, §4-301(m),
Annotated Code of Maryland, to perform telehealth services] the patient’s
parent or guardian if State law requires the consent of a parent or guardian
including informing patients of the risks, benefits, and side effects of
prescribed treatments;
[(3)] (4) Securely collect and transmit a
patient’s medical information, clinical data, clinical images, laboratory
results, and self–reported medical history, as necessary and [Prevent]
prevent access to data by unauthorized persons through encryption or
other means;
[(4)] (5)—[(6)] (7) (text
unchanged)
B. Except when providing [store and forward telehealth
services, remote patient monitoring, or other] asynchronous telehealth
services, a telehealth practitioner shall:
(1) (text unchanged)
(2) Confirm whether the patient is in Maryland and identify the
practice setting in which the patient is located; and
[(3) For an initial patient-telehealth practitioner
interaction only, disclose the telehealth practitioner’s name, contact
information, and medical specialty; and]
[(4)] (3) Identify
all individuals present at each location and confirm they are allowed to hear
personal health information.
C. (text unchanged)
.05 Patient Evaluation.
A. A telehealth practitioner shall perform a synchronous[,
audio-visual] or asynchronous clinical patient evaluation [adequate
to establish diagnoses and identify underlying conditions or contraindications
to recommended treatment options] that is appropriate for the patient
and the condition with which the patient presents before providing
treatment or [prescribing medication] issuing a prescription
through telehealth.
B. [Subject to Regulation .06 of this chapter, the
requirements of §A of this regulation do not apply to:
(1) Interpretive services where a prior patient evaluation was
performed by another provider;
(2) Remote patient monitoring; or
(3) Asynchronous telehealth services for a patient who has had a
prior synchronous, audio-visual telehealth patient evaluation or in-person
patient evaluation that complies with the requirements of §A of this regulation]
A telehealth practitioner shall, if clinically appropriate for the patient,
provide or refer a patient to in-person health care services or another type of
telehealth service.
[C. To comply
with section A of this regulation, a health care practitioner may use:
(1) A surrogate examiner; or
(2) A patient evaluation performed by another licensed health care
practitioner providing coverage.]
.06 Standard Related to Telehealth.
A. (text unchanged)
B. A telehealth practitioner may not treat a patient or prescribe
medication based solely on [an] a static online
questionnaire.
C. A telehealth practitioner may not prescribe [opioids]
an opiate described in the list of Schedule II substances under Criminal Law
Article, §5-403, Annotated Code of Maryland for the treatment of pain
through telehealth [except if] unless:
(1) [the] The patient is in a health
care facility as defined in Health-General Article, §19-114(d)(1), Annotated
Code of Maryland[.]; or
(2) The Governor has declared a state of emergency due to a
catastrophic health emergency.
D. A telehealth practitioner shall comply with all State and
federal laws and regulations related to dispensing including the prohibition on
mail order dispensing.
RYAN B. MORAN, DRPH, MHDSA
Acting
Secretary of Health
Subtitle
38 BOARD OF PHYSICAL THERAPY EXAMINERS
Notice of Proposed
Action
[25-099-P]
The Acting Secretary of
Health proposes to amend:
(1) Regulation .02
under COMAR 10.38.07 Fee Schedule; and
(2) Regulation .05
under COMAR 10.38.08 Continuing Education Requirements.
This action was considered
by the Board of Physical Therapy Examiners at a public meeting held on
September 17, 2024, notice of which was given by publication on the Board’s
website at health.maryland.gov/bphte/Pages/index.aspx pursuant to General
Provisions Article, §3–302(c), Annotated Code of Maryland.
Statement of Purpose
The purpose of this action
is to:
(1) Add new fees for
continuing education (CE) course review and dry needling registration;
(2) Update the fee for
approval for CE hours to course provider; and
(3) Update the renewal
dates to complete CE hours.
Estimate of Economic Impact
I. Summary of Economic Impact. This proposal has an
anticipated economic impact of $69,200 through the review of courses for
continuing education (CE) hours, approval of CE hours to course providers, and
one-time registration fee for licensees who provide dry needling. The
associated fee for course review for CE hours will offset the administrative
costs due to increasing requests by licensees to approve courses not already
approved by the Board or the American Physical Therapy Association. The CE
approval fee for course providers will be increased due to increasing demand.
While the Board authorized in COMAR 10.38.12.03H(2)(b) a fee associated with
dry needling in 2017 when the initial regulations were promulgated, the
one-time dry needling registration fee was not implemented. The Board seeks to
implement this fee now due to increased direct administrative costs and demand
for this specialty. This fee is not retroactive for licensees currently
licensed to provide this service – this fee will apply for all new licensees
seeking the dry-needling registration.
II. Types of Economic Impact.
|
Impacted Entity
|
Revenue
(R+/R-)
Expenditure
(E+/E-)
|
Magnitude
|
|
A. On issuing agency:
|
|
|
|
(1) Board of Physical
Therapy Examiners - Review of Course CE Hours
|
(R+)
|
$6,200
|
|
(2) Board of Physical
Therapy Examiners - Approval of CE Hours to Course Provider
|
(R+)
|
$51,800
|
|
(3) Board of Physical
Therapy Examiners - Dry Needling One-Time Registration
|
(R+)
|
$11,200
|
|
B. On other State agencies:
|
NONE
|
|
|
C. On local governments:
|
NONE
|
|
|
|
Benefit
(+)
Cost
(-)
|
Magnitude
|
|
D. On regulated industries or
trade groups:
|
|
|
|
(1) PT CE Providers for Approval of CE Hours to
Course Provider
|
(-)
|
$51,800
|
|
(2) PT Licensees Dry
Needling One-Time Registration
|
(-)
|
$11,200
|
|
(3) PT Licensees for
Review of Course CE Hours
|
(-)
|
$6,200
|
|
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(1). Based on FY 2024, 248 applications were received for course
review. 248 x $25 = $6,200 estimated additional funds for FY 2026.
A(2). Based on FY 2024, 1,036 applications were received. 1,036 x
$50 = $51,800 estimated additional funds for FY 2026.
A(3). There are 112 PTs registered to provide dry needling. While
this fee is not retroactive, the number of current PTs registered to provide
this service is used to estimate the economic impact. 112 x $100 = $11,200.
D(1). See A(2) above.
D(2). See A(3) above.
D(3). See A(1) above.
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 Jordan Fisher Blotter, Director, Office of
Regulation and Policy Coordination, Maryland Department of Health, 201 West
Preston Street, Room 534 Baltimore, Maryland 21201, or call 410-767-0938, or
email to mdh.regs@maryland.gov. Comments will be accepted through June 30,
2025. A public hearing has not been scheduled.
10.38.07 Fee Schedule
Authority: Health Occupations Article, §§13-206, 13-207, and
13-3A-01(3)(d)(2), Annotated Code of Maryland
.02 Fees.
A. The following fees are established by the Board:
(1)—(7) (text unchanged)
[(8) Law booklet (free to applicants) — $20;]
(8) Review of course CE hours for licensee — $25;
(9) Approval for [CEUs] CE hours to
course [sponsor — $50] provider — $100;
(10) Penalty for failure to maintain correct address with the Board
— $100; [and]
(11) Interstate physical therapy licensure compact fee — $125[.];
and
(12) Dry needling one-time registration fee — $100.
B. The Federation of State Boards of Physical Therapy determines
the fees for the National Licensure Examination and the Maryland
Jurisprudence Assessment for physical therapists and physical therapist
assistants.
C. (text unchanged)
10.38.08 Continuing Education Requirements
Authority: Health Occupations Article, §§13-206 and 13-311,
Annotated Code of Maryland
.05 Renewal Requirements.
A. A licensee shall:
(1) Earn CE hours between [April 1 and March 31] June
1 and May 31 during the 2-year period before renewal; and
(2) (text unchanged)
B. CE hours completed after [March 31] May 31
of the year of the renewal may not be accepted.
C.—H. (text unchanged)
RYAN B. MORAN, DRPH, MHSA
Acting Secretary of
Health
Subtitle
56 BOARD OF DIETETIC PRACTICE
10.56.01 Licensure
Authority: Health
Occupations Article, §§5-205, 5-301, 5-303, 5-306, and [5-310]
5-308––5-310, Annotated Code of Maryland
Notice of Proposed
Action
[25-072-P]
The Secretary of Health
proposes to amend Regulations .02—.04, .06, .08, repeal Regulation .09,
and adopt new Regulations .09—.12 under COMAR 10.56.01 Licensure. This action was considered by the Board of
Dietetic Practice at a public meeting held on May 16, 2024, notice of which was
given by publication on the Board’s website at:
https://health.maryland.gov/dietetic/Pages/Index.aspx pursuant to General
Provisions Article, §3–302(c), Annotated Code of Maryland.
Statement of Purpose
The purpose of this action
is to:
(1) Update certain
definitions;
(2) Make updates pursuant
to Ch. 961, Acts of 2024;
(3) Update and clarify
academic requirements;
(4) Clarify ineligibility
or denial of license applications;
(5) Add language for
license renewal, reinstatement, and inactive status;
(6) Update requirement for
changes in mailing address, legal name, or email address; and
(7) Make other revisions
or technical corrections as needed.
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 Jordan Fisher Blotter, Director, Office of
Regulation and Policy Coordination, Maryland Department of Health, 201 West
Preston Street, Room 534 Baltimore, Maryland 21201 , or call 410-767-0938, or
email to mdh.regs@maryland.gov. Comments will be accepted through June 30,
2025. A public hearing has not been scheduled.
.02 Definitions.
A. (text unchanged)
B. Terms Defined.
(1) “Accredited institution” means a college or university
accredited by a regional educational accrediting association through the [Council
on Post-Secondary Accreditation] Council for Higher Education
Accreditation and the United States Department of Education.
(2) “Act” means the Maryland [Dietitians and]
Licensed [Nutritionists] Dietitian-Nutritionists Act,
Health Occupations Article, §§5-101—5-502, Annotated Code of Maryland.
(2-1)—(4) (text unchanged)
(4-1) “Certified nutrition specialist” means an individual
certified by the [Certification] Board for Certification of
Nutrition Specialists.
(5)—(9) (text unchanged)
(10) “Licensed [dietitian (LD)] dietitian-nutritionist
(LDN)” means an individual who is licensed by the Board to practice
dietetics in the State.
[(11) “Licensed nutritionist (LN)” means an individual who
is licensed by the Board to practice dietetics in the State.]
[(12)] (11)—[(14)] (13)
(text unchanged)
[(15)] (14) “Registered dietitian (RD)” means [a
person] an individual registered by the Commission.
[(16)] (15) (text unchanged)
.03 Application Procedures.
A. In order to obtain a license, the applicant shall:
[A.] (1) (text unchanged)
[B.] (2) Pay to the Board the application fee
set forth in COMAR 10.56.02; and
[C.] (3) Submit evidence that the applicant:
[(1)] (a) (text unchanged)
[(2)] (b) Meets the requirements of Regulations .04, .05,
and .07 of this chapter[;].
[D. If the applicant is required under Regulation .07 of
this chapter to take an examination, the applicant shall send to the Board a
completed application form for licensure at least 90 days before the date of
the examination.]
[E.] B.—[F.] C. (text
unchanged)
.04 Academic Requirements.
[A. Degrees.] For initial licensure as a
dietitian or nutritionist, an applicant shall submit proof of one of the
following to the Board:
[(1)] A. Registration through the Commission
on Dietetic Registration of the American Dietetic Association and receipt of, [a
baccalaureate or post baccalaureate] at a minimum, a degree from
a college or university accredited by an educational accrediting association [recognized
by the Council on Higher Education and Accreditation] as required by
the Commission on Dietetic Registration, including a minimum of 24 semester
hours in:
(1) [the] The field of human nutrition[,];
(2) [food] Food and nutrition[,];
(3) [dietetics,] Dietetics; or
(4) [food] Food systems management with
at least 3 semester hours from each of the following areas:
(a)—(d) (text unchanged)
[(2)] B. Certification by the [Certification]
Board for Certification of Nutrition Specialists and receipt of a
master's or doctoral degree from a college or university accredited by an
educational accrediting association [recognized by the Council on Higher
Education and Accreditation] as required by the Commission on
Dietetic Registration in nutrition sciences with emphasis in:
(1) [human] Human nutrition[,];
(2) [food] Food and nutrition[,];
(3) [dietetics] Dietetics[,];
(4) [community] Community nutrition[,];
(5) [public] Public health nutrition[,];
or
(6) [equivalent] Equivalent academic
training such as nutrition education and food science.
[B. Course work acquired at a foreign college or university
shall be accepted by the Board only if that course work is accepted as transfer
credit by an accredited institution of the United States.
C. The applicant may be required to substantiate the relevance of
an academic degree, the title of which is not self-explanatory to the licensure
requirements:
(1) Through course descriptions in official school catalogs;
(2) Through bulletins; or
(3) By other means acceptable to the Board.
D. Recency of Education. The Board may consider an applicant to
have met the academic requirements of this regulation only if the applicant:
(1) Has fulfilled the academic requirements in dietetics or human
nutrition within the 5 years before the date of application; or
(2) Submits to the Board proof of continuing education as approved
by the Board of at least 30 hours within the past 2 years, before the date of
application.]
.06 A Preplanned, Professional Experience Program.
A.—A-1. (text unchanged)
B. The preplanned professional experience program shall be under
the supervision of:
(1) [a] A licensed dietitian[,];
(2) [a] A licensed nutritionist[,];
(3) [a] A licensed physician[,];
(4) [a] A registered dietitian[,];
(5) [a] A certified nutrition
specialist[,]; or
(6) An individual with a doctoral degree with a major
course of study in:
(a) [human] Human nutrition[,];
(b) [nutrition] Nutrition education[,];
(c) [food] Food and nutrition[,];
(d) [dietetics,] Dietetics; or
(e) [food] Food systems management that
is conferred by a U.S. regionally accredited college or university.
C.—E. (text unchanged)
.08 Action on Application.
A.—C. (text unchanged)
D. Upon review of an application, the Board shall either:
(1) Approve the applicant for licensure[.]; or
(2) Deny a license.
[(3) Notify the applicant that the applicant is qualified to
take the examination and require the applicant to take an examination. Before
the notice is given, the applicant shall have completed the:
(a) Academic requirements of Regulation .04 of this chapter; and
(b) Experience requirements of Regulation .05 of this chapter.]
E. Ineligibility or Denial of Applications.
(1) The Board may [deny]:
(a) Determine an applicant is ineligible for a license if
the applicant has:
[(a)] (i)—[(c)] (iii)
(text unchanged)
[(d)] (iv) Failed to remit a fee; or
[(e)] (v) Failed to properly complete the
application form[;].
(b) Deny a license if the applicant has:
[(f)] (i)—[(g)] (ii)
(text unchanged)
(2) If the Board denies a license under [§E(1)(f) or (g)]
§E(1)(b) of this regulation, the Board or the Board's designee shall:
(a)—(b) (text unchanged)
(3) An applicant [whose license has been denied] who
has been determined to be ineligible may reapply and shall submit with the
new application proof of compliance with:
(a)—(b) (text unchanged)
F.—G. (text unchanged)
.09 Renewal.
A. The Board may not renew a license until the Comptroller of
Maryland has verified that the individual has paid all undisputed taxes and
unemployment insurance contributions, or arranged for repayment, as required by
COMAR 10.31.02.
B. A licensee shall renew the license every 2 years.
C. The Board shall send each licensee a renewal notice that
states the:
(1) Date on which the current license expires;
(2) Latest date by which the renewal application and
documentation can be received by the Board in order for the renewal license to
be issued before the current license expires; and
(3) Amount of the renewal fee as specified in COMAR 10.56.02.
D. At least 30 days before the current license or registration
expires, the Board shall send the renewal notice by electronic means or
first-class mail to the last known electronic or physical address of the
licensee.
E. The failure to receive a renewal notice does not excuse a
licensee from complying with §B of this regulation.
F. Licensees shall satisfactorily complete the minimum
continuing education requirements set forth under COMAR 10.56.05.
G. Licensees applying for renewal are required to meet the
current education requirements and be in good standing with:
(1) The Commission on Dietetic Registration; or
(2) The Board for Certification of Nutrition Specialists.
H. After the expiration date of the license, the
dietitian-nutritionist is no longer licensed to practice dietetics in the
State.
10. Reinstatement.
A. The Board shall reinstate an individual whose license has
expired if the individual:
(1) Is otherwise entitled to be licensed;
(2) Meets the renewal requirements of this chapter and Health
Occupations Article, §5-309, Annotated Code of Maryland;
(3) Pays the license reinstatement and renewal fees as specified
in COMAR 10.56.02;
(4) Satisfactorily completes the minimum continuing education
requirements set forth under COMAR 10.56.05; and
(5) Applies to the Board for reinstatement of a license within 5
years of the license expiration.
B. The Board may not reinstate the license of an individual who
fails to apply for reinstatement within 5 years after the license expiration.
C. An individual who fails to apply for reinstatement of a
license within 5 years after expiration, may become licensed by meeting the
requirements for obtaining an initial license under this chapter.
11. Inactive Status.
A. In accordance with Health Occupations Article, §5-309,
Annotated Code of Maryland, a request by an active licensee to transfer a
license to inactive status shall be granted upon receipt of the:
(1) Completed Board-approved inactive status application; and
(2) Payment of the required, non-refundable inactive status fee
set forth in COMAR 10.56.02.
B. An individual:
(1) May apply for inactive status only if the individual’s
license is still active and in good standing at the time the inactive status
application request is made; and
(2) On inactive status is not authorized to and may not practice
as a licensed dietitian-nutritionist.
C. An individual seeking to be reactivated shall be required, as
a condition of reactivation, to submit:
(1) Proof of having completed the minimum continuing education
requirements set forth under COMAR 10.56.05; and
(2) Payment of a reactivation fee set forth in COMAR 10.56.02.
.12 Change of Mailing
Address, Legal Name, or Email Address.
A. A licensed dietitian-nutritionist shall give the Board
written notice within 30 days of a change of:
(1) Mailing address;
(2) Legal name; or
(3) Email address if the licensee has previously submitted an
email address to the Board.
B. Failure to notify the Board of any change of mailing address,
legal name, or email address within 30 days of the change may result in a $50
fee as set forth under COMAR 10.56.02.
LAURA HERRERA SCOTT
Secretary of Health
Subtitle 65 BOARD OF MASSAGE THERAPY
EXAMINERS
10.65.01 General Regulations
Authority: General Provisions Article, §4-333(c); Health
Occupations Article, §§6-101, 6-102, 6-201—6-206, 6-301—6-306, and 6-504;
Annotated Code of Maryland
Notice of Proposed Action
[25-095-P]
The Secretary of Health proposes to amend Regulation .06
under COMAR 10.65.01 General Regulations. This action was considered by the Board of
Massage Therapy Examiners at a public meeting held on October 23, 2024, notice
of which was given by publication on the Board’s website at
health.maryland.gov/massage/Pages/home.aspx pursuant to General Provisions
Article, §3–302(c), Annotated Code of Maryland.
Statement of Purpose
The purpose of this action is to update the conversion requirements
of a registration to a license pursuant to Chs. 705 and 706, Acts of 2022.
Estimate of Economic Impact
The proposed action has no economic impact.
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small
businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Jordan Fisher Blotter, Director, Office of
Regulation and Policy Coordination, Maryland Department of Health, 201 West
Preston Street, Room 534 Baltimore, Maryland 21201, or call 410-767-0938, or
email to mdh.regs@maryland.gov. Comments will be accepted through June 30,
2025. A public hearing has not been scheduled.
.06 Application for
Licensure or Registration.
A.—E. (text unchanged)
F. Conversion.
(1) In order for an individual to convert from a registered
massage practitioner to a licensed massage therapist, a minimum of one of the
following shall be met by the conversion applicant:
[(1)] (a) Has held a registration continuously
in good standing for a minimum of 10 years preceding the conversion request;
[(2)] (b) Attest to the accumulation of 1,000
hours of hands-on experience within the practice of massage therapy over
the previous 2 years between:
(i) [work] Work hours; and
(ii) Board-approved continuing education hours; or
[(3)] (c) Provide documentation verifying a
total of 750 hours of massage therapy education which may include
[program]:
(i) Contact hours from a Board-approved program of study
of massage therapy [and]; or
(ii) Board-approved continuing education hours.
(2) It is the burden of the conversion applicant to demonstrate
that the applicant is eligible for conversion.
(3) The Board:
(a) May request additional documentation from the conversion
applicant to substantiate or clarify the applicant’s conversion application;
and
(b) May not convert the registration of an applicant whose
registration has been suspended or revoked.
LAURA HERRERA SCOTT
Secretary of Health
Title 11
DEPARTMENT OF TRANSPORTATION
Subtitle
04 STATE HIGHWAY ADMINISTRATION
11.04.15 Work Zone Speed Control Systems
Authority: Transportation
Article(s), §§21-810(m), Annotated Code of Maryland
Notice of Proposed
Action
[25-005-P]
The Administrator of State
Highway Administration proposes to amend Regulations .01—.04 under COMAR
11.04.15 Work Zone Speed Control Systems.
Statement of Purpose
The purpose of this action
is to align regulations with HB 513 Motor Vehicles—Work Zone Speed Control
Systems—Revisions (Maryland Road Worker Protection Act of 2024), which was
introduced and passed during the 2024 legislative session
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 April
King, Deputy Director, Office of Government Affairs, SHA, 707 North Calvert
Street, Baltimore, MD 21202, or call 410-210-5780, or email to
AKing5@mdot.maryland.gov. Comments will be accepted through June 30, 2025. A
public hearing has not been scheduled.
.01 Definitions.
A. (text unchanged)
B. Terms Defined.
(1)—(4) (text unchanged)
(5) "Work zone" means a segment of a highway:
(a) That is identified as a temporary traffic control zone by
traffic control devices that are placed or installed in general conformance
with the State manual and specifications adopted for a uniform system of
traffic control devices; [and]
(b) Where highway construction, repair, maintenance, utility work,
or related activity, including the placement, installation, maintenance, or
removal of a work zone traffic control device, is being performed regardless of
whether workers are present[.]; and
(c)That is equipped with:
(i) Signage designating each entrance and exit to the work zone;
and
(ii) Flashing lights that operate whenever workers are present
at the work zone.
(6) "Work zone speed control system" means a device [having]
that:
(a) Has one or more motor
vehicle sensors connected to a camera system capable of producing recorded
images of motor vehicles traveling at or above a predetermined speed in or
approaching a work zone[.]; and
(b) Is equipped with flashing blue lights.
(7) (text unchanged)
.02 Authorization, Site Qualification, and Operator Selection.
A.—D. (text unchanged)
E. A work zone speed control system operator does not need to be
present in person or remotely at the work zone when the speed control system is
in use.
F. Multiple work zone speed control systems may be implemented
and used in a work zone. If a work zone
has more than one work zone speed control system in use, not more than one
citation may be issued for the same registration plate for alleged violations
that occur within a 1-hour period in the work zone.
.03 Public Notification and Advance Warning.
A. (text unchanged)
B. A minimum of two [sets of] signs approved by the
State Highway Administration's Director of Traffic and Safety, alerting drivers
to the possible operation of a work zone speed control system within the work
zone [, each set comprised of two signs, one on each side of the
roadway,] shall be conspicuously placed in advance of each work zone
speed control system. The positioning and spacing of these signs shall be as
approved by the agency that maintains the highway on which the work zone is
located.
C. (text unchanged)
D. A device that flashes when workers are present in the work
zone shall be placed in advance of the first work zone speed control system in
the work zone. The positioning of the device that flashes when workers are
present shall be as approved by the agency that maintains the highway on which
the work zone is located.
.04 Training, Logs, and Calibration.
A.—C. (text unchanged)
D. A work zone speed control system operator shall complete the
daily set-up log required by Transportation Article,[§10-810(b)(5)]
[10] §21-810(b)(5), Annotated Code of Maryland, that
states:
(1)—(2) (text unchanged)
E.—F. (text unchanged)
WILL N. PINE
Administrator State
Highway Administration
Title 13B
MARYLAND HIGHER EDUCATION COMMISSION
Subtitle 08 FINANCIAL AID
13B.08.03 Charles W. Riley
Firefighter and Ambulance and Rescue Squad Member Scholarship Program
Authority: Education Article, §§11-105, 18-204, and 18-603.1,
Annotated Code of Maryland
Notice of Proposed Action
[25-081-P]
The Maryland Higher Education Commission proposes to amend
Regulations .02, .04, and .09 under COMAR
13B.08.03 Charles W. Riley Firefighter
and Ambulance and Rescue Squad Member Scholarship Program. This action was considered at an open meeting
of the Commission held on March 26, 2025.
Statement of Purpose
The purpose of this action is to:
(1) Eliminate the current eligibility requirement that an applicant
enroll in an undergraduate degree or certificate program;
(2) Amend or remove outdated text; and
(3) Make other changes to align
the regulations with the requirements of Chs. 223 and, Acts of 2024.
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 Al Dorsett, Executive Director, Office of
Student Financial Assistance, Maryland Higher Education Commission, 217 E.
Redwood Street, Suite 2100, Baltimore, MD
21202, or call 410-767-3300, or email to al.dorsett@maryland.gov.
Comments will be accepted through June 30, 2025. A public hearing has not been
scheduled.
.02 Eligibility.
A. (text unchanged)
B. To be eligible for a Riley Scholarship, an individual
shall be:
(1)—(2) (text unchanged)
(3) Accepted for admission or enrolled [as a full-time (12
or more credits per semester) or part-time (6-11 credits per semester) student]
in a[:] course offered at a public
institution of higher education in the State or a private nonprofit institution
of higher education in the State.
[(a) Regular undergraduate program at an eligible
institution (public or private nonprofit institution of higher education in the
State that possesses a certificate of approval from the Commission); or
(b) 2-year terminal certificate program in which the course
work is acceptable for transfer credit toward an accredited baccalaureate
degree program in an eligible institution.]
.04 Award Amount.
[A.] The Office for Student Financial Assistance shall
determine each recipient’s scholarship award [as provided in §B of this
regulation] in accordance with Education
Article § 18-603.1(d), Annotated Code of Maryland.
[B. An
annual award shall be at least 50 percent of the student’s actual annual
tuition and mandatory fees at an eligible institution, but may not exceed the
annual tuition and mandatory fees of a resident undergraduate student at the 4-year
public institution of higher education within the University System of
Maryland, other than the University of Maryland University College and the
University of Maryland, Baltimore, with the highest annual expenses for a
full-time resident undergraduate for courses credited toward a degree in fire
service technology, emergency medical technology, fire service management, or
public safety administration with a minor or concentration in fire service
technology or fire service management.]
.09 Service Obligation.
A. A recipient shall serve for 1 year after completion of [an
eligible program] study as a
volunteer or career firefighter or ambulance or rescue squad member, in a
full-time or part-time capacity, of an organized fire department or ambulance
or rescue squad in the State.
B.—C. (text unchanged)
SANJAY RAI
Secretary
13B.08.23 Workforce Development Sequence
Scholarship
Authority: Education
Article, §§11-105 and 18-204, and Title 18, Subtitle 33, Annotated Code of
Maryland
Notice of Proposed
Action
[25-083-P]
The Maryland Higher
Education Commission proposes to amend Regulation .07 and repeal
existing Regulation .08 under COMAR 13B.08.23 Financial Aid —
Workforce Development Sequence Scholarship.
This action was considered at a public meeting held on March 26, 2025,
notice of which was provided by posting on the Commission's website, pursuant
to General Provisions Article, §3-302(c)(3)(ii), Annotated Code of Maryland.
Statement of Purpose
The purpose of this action
is to:
(1) Make an adjustment to
the allocation method for the Workforce Development Sequence Scholarship,
allowing community colleges to receive initial funding notifications by August
15;
(2) Allocate funds
annually based on each college's proportional share of total FTE enrollment in
workforce development sequences;
(3) Allow colleges to
receive half of their calculated annual allocation, with the remaining funds to
be distributed at a later date determined by the Office. After the initial
disbursement.
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 Al Dorsett, Executive Director, Office of
Student Financial Assistance, Maryland Higher Education Commission, 217 E.
Redwood Street, Suite 2100, Baltimore, MD
21202, or call 410-767-3300, or email to al.dorsett@maryland.gov.
Comments will be accepted through June 30, 2025. A public hearing has not been
scheduled.
.07 Institutional Allocation
[and Notification].
A. At the beginning of each State fiscal year, and no later than
[September] August 15, the Office
shall notify each participating community
college of the total dollar amount of [Scholarships that may be awarded to
students attending the college during the fiscal year] funds allocated to the institution for awards.
B. The Office
shall annually allocate [equally
among the community colleges up to 50 percent of the annual dollar amount
budgeted] the funds appropriated for
the Workforce Development Sequence Scholarship in the State budget based on a community college’s pro rata share of
the total FTE enrollment in workforce development sequences, based on the most
recently available Enrollment Report for Equated Credit Continuing Courses (CC3
report).
[C. The amount
remaining after the allocation required under §B of this regulation shall be
allocated proportionately to participating community colleges based upon
student enrollment as follows:
(1) Each college’s most recent FTE enrollment in workforce
development sequences, based upon the previous year’s Enrollment Report for
Equated Credit Continuing Education Courses (CC3 report), shall be divided by
the total FTE enrollment for all workforce development sequences offered by all
participating colleges; and
(2) The percentage derived from the calculation in §C(1) of this
regulation shall be multiplied by the total number of awards (in $2,000
increments) not allocated, and the result shall be the additional allocation to
the college.]
C. On a date established by the Office, each community college
shall be initially disbursed half of the amount of their annual allocation as
calculated under §B of this regulation.
D. The amount of total funds remaining after the initial
disbursement shall be disbursed as follows:
(1) A community college that has awarded at least 66 percent of
their initial disbursement by December 31 shall receive the remaining half of
the amount calculated under §B of this regulation in a second disbursement on a
date established by the Office.
(2) A community college that has awarded 95 percent of their
initial disbursement prior to December 31 shall notify the Office and the
Office may, at its discretion, provide the second disbursement to the community
college at an earlier date.
(3) If a community college has awarded less than 66 percent of
their initial disbursement by December 31, the community college shall consult
with the Office. If the community college determines, after consultation with
the Office, that the community college is unlikely to need the entirety of the
remaining 50 percent of the amount calculated under §B of this regulation, the
community college may authorize the Office to retain all or part of the
remaining 50 percent of their annual allocation for reallocation to community
colleges that have awarded a higher percentage of their disbursement.
(4) The Office shall calculate the reallocation of the funds
retained under §D (3) of this regulation to community colleges based on a
community college’s pro rata share of the amount of funds from the initial
disbursement awarded to students by each community college by December 31.
(5) The Office shall notify the community colleges of the amount
of any reallocated funds they will receive no later than January 21.
SANJAY RAI
Secretary
Title 14
INDEPENDENT AGENCIES
Subtitle
11 PROGRAM SERVICES
14.11.01 Attendant Care Program
Authority: Human Services
Article, §§7-401—7-406, Annotated Code of Maryland
Notice of Proposed
Action
[25-085-P]
The Department of Disabilities proposes to amend Regulations .01—.07,
repeal existing Regulation .08, amend and recodify existing Regulations .09
and .13 to be Regulations .08 and .12, and recodify
existing Regulations .10—.12 to be Regulations .09—.11 under COMAR
14.11.01 Attendant Care Program.
Statement of Purpose
The purpose of this action is to amend the regulations to be in
accordance with Ch. 35 (S.B. 226), which expands the purpose of the Attendant
Care Program in the Department of Disabilities to include providing financial
assistance to an eligible individual for “ongoing additional supports.” It also
provides clarifying language on the general operations of the Program and
repeals the provision on Advanced Payments.
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:
The regulations will allow participants of the Program to request
reimbursement for services that constitute “ongoing additional supports” in
addition to the existing reimbursable attendant/personal care services. This
change intends to increase the utilization of the Program for current
participants and intends to recruit more participants to the Program.
Opportunity for Public Comment
Comments may be sent to Jennifer Eastman, Director, Community
Living Policy and Programs, Department of Disabilities, 217 E. Redwood Street,
Suite 1300, Baltimore, MD 21202, or call (410) 767-7901, or email to
jennifer.eastman@maryland.gov. Comments will be accepted through June 30, 2025.
A public hearing has not been scheduled.
.01 Purpose.
The Attendant Care Program provides financial reimbursement to
assist individuals with severe chronic or permanent physical disabilities who
require attendant care services or ongoing additional supports to direct
their own care and select their own service providers. Reimbursement may be
available for attendant care services or ongoing additional supports that
are provided in the home, school, workplace, or other community locations.
.02 Definitions.
A. (text unchanged)
B. Terms Defined.
[(1) “Advanced payment” means a reimbursement payment that:
(a) Is requested by a participant for a future pay period; and
(b) Is not greater than the participant's approved maximum
reimbursement.]
[(2)] (1) (text unchanged)
[(3)](2) “Applicant” means an individual who
has submitted an application to participate in the Program in order to receive
reimbursement of the cost of attendant care services or ongoing additional
supports.
[(4)](3) “Attendant” means an individual or
provider agency who provides attendant care services to a participant.
[(5)](4)—[(9)](8) (text
unchanged)
[(10)](9) “Duplicative services” means
comparable care services or ongoing additional supports provided through
any other federal or State assistance programs, such as but not limited to the
programs described in COMAR 07.06.12, 10.09.04, or 10.09.20[, at the
same time and on the same day as services reimbursed by the Program].
(10) “Episodic” means when an impairment or medical
condition varies in frequency, intensity and duration and renders the person
unable to engage in major life activities when onset.
(11) “Financial assistance” means reimbursement by the Department
of the eligible percentage of the cost paid by a participant for attendant care
services or ongoing additional supports.
(12) “Fiscal payment schedule” means the list of [26 2-week
periods, established annually by the Program Director, in which attendant care
services are provided and certification of service forms and time sheets are
due for reimbursement processing] 12
1-month periods, established annually by the Program Director, in which Attendant Care Program benefits are provided, and
participants are required to submit certification of service forms
and receipts for reimbursement processing.
(13) (text unchanged)
(14)“Ongoing additional supports” means a continual support that
increases an eligible individual’s independent performance of an essential
activity of daily living, self-care, or mobility, and is requested by a
Participant and approved by the Department.
[(14)](15)—[(17)](18)
(text unchanged)
[(18)](19) “Review of financial or
programmatic eligibility” means initiating verification that the
participant remains [financially] eligible within [one]
1 calendar year since the completion of the most recent review or more
frequently if requested by the Department or the individual.
[(19)](20) “Severe chronic disability” means a
recurring medical condition that substantially limits an individual's mobility
or ability to perform activities of daily living, instrumental activities of
daily living, or self-care:
(a) (text unchanged)
(b) On an ongoing basis [as a result of a serious medical
condition] or episodically, as defined by Regulation .02B(10) of this
chapter.
[(20)](21) (text unchanged)
[(21)](22) “Standard assessment of functional
capability” means the document designated by the Department to evaluate an
applicant's:
(a)—(c) (text unchanged)
(d) Need for attendant care services or ongoing additional
supports.
[(22)] (23) ["Time
sheet" means a form designated by the Department to record the start and
stop times for the delivery of attendant care services to the participant for
billing and documentation purposes.] “Receipts” means proof of payment made for an
approved service designated by the Department.
.03 Eligibility.
A. To be eligible for the Program, an applicant:
(1)—(2) (text unchanged)
(3) Shall be determined by the applicant's attending physician,
registered nurse, or certified nurse practitioner to have a severe chronic or
permanent physical disability that:
(a) (text unchanged)
(b) Is subject to eligibility review at a frequency determined by
the Department[, if the condition is likely to improve];
(4)—(7) (text unchanged)
B. The Program Director, or designee, shall initiate an annual
review of financial or programmatic eligibility for each participant at
least once every 12 months from completion of the last review, or more
frequently if needed.
C. (text unchanged)
.04 Limitations on Service and Participation in the Program.
A. (text unchanged)
B. The Program Director shall limit Program participation to
achieve the following demographic:
(1) At least 50 percent of the participants shall be:
(a) (text unchanged)
(b) Actively seeking employment and reasonably be
expected to become employed within 6 months of the date of application
approval, which the Program Director may extend once for an additional 6
months; or
(c) (text unchanged)
(2) (text unchanged)
C.—D. (text unchanged)
E. Applicants to the Program shall be encouraged to complete an
application for medical assistance and utilize personal care services under the
following programs, if applicable:
(1) [Medical Assistance Personal Care Program;]Examples
of such services or programs include:
(a) Community Personal Assistance Services;
(b) Community First Choice Program; or
(c) a Home and Community-Based Waiver.
[(2) Community First Choice Program; or
(3) a Home and Community Based Waiver.]
(2) The Program is entitled to evaluate whether such services
are duplicative.
.05 Application Process.
A. (text unchanged)
B. The Program Director or designee shall determine an applicant's
eligibility in accordance with Regulation .03 of this chapter and the
regulations governing this Program as a whole.
.06 Priority for Approval of Applications.
A. (text unchanged)
B. Waiting List.
(1) (text unchanged)
(2) As funds allow, the Program shall enroll applicants on the
waiting list generally in the following order:
(a)—(b) (text unchanged)
(3) With the explicit written consent of the Secretary, and
after obtaining a waiver of the proportionality requirement set forth in
Regulation .04B(1) of this chapter as necessary, in limited emergency
circumstances, the Program Director may prioritize certain individuals meeting
the criteria under Regulation .04B(2)(a) of this chapter before other
individuals meeting the criteria under .04B(2)(a) of this chapter.
.07 Payment.
A. A participant shall submit a signed certification of service
form and receipts for attendant care services or ongoing additional supports
in accordance with the Program's fiscal payment schedule.
B.—C. (text unchanged)
D. The Department may return the certification of service form to
the participant without making payment if more than [two pay periods]
2 months have passed since the date of service.
E. The Department reserves the right to deny reimbursement of
expenses that it determines are not representative of ongoing additional
supports or attendant care services.
[.09] .08 Participant's Responsibilities.
A. (text unchanged)
B. A participant shall employ an attendant who is 18 years old or
older, and who is not a spouse or the representative payee of the
participant.
C. (text unchanged)
[.13] .12 Financial Assistance.
A. (text unchanged)
B. The participant's reimbursement rate shall be based on:
(1)—(2) (text unchanged)
(3) The participant's cost of attendant care services or ongoing
additional supports.
C. A participant eligible in the category set forth in Regulation
.04B(1) of this chapter shall pay a minimum of 2 percent of the cost of
attendant care services or ongoing additional supports, unless the
Program Director determines that the minimum copayment causes the participant
financial hardship and issues a written waiver of the copayment.
D. A participant eligible in the category set forth in Regulation
.04B(2) of this chapter shall pay a minimum of 5 percent of the cost of
attendant care services or ongoing additional supports, unless the
Program Director determines that the minimum copayment causes the participant
financial hardship and issues a written waiver of the copayment.
KIMBERLY MCKAY
Assistant Secretary for
Programs
Title 17
DEPARTMENT OF BUDGET AND MANAGEMENT
Subtitle
04 PERSONNEL SERVICES AND BENEFITS
17.04.11 Leave
Authority: State Personnel
and Pensions Article, §§ 4-106 and 9-101 Annotated Code of Maryland
Notice of Proposed
Action
[25-080-P]
The Secretary of Budget
and Management proposes to adopt new Regulation .30 under COMAR
17.04.11 Leave.
Statement of Purpose
The purpose of this action
is to comply with 2024 Senate Bill 109, which provides certain State employees
with Parental Bereavement Leave with pay after the death of the employee's
child; an employee who experiences a stillbirth, or death of the employee's
infant effective October 1, 2024.
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 Misty Caleb, Personnel Director, Department
of Budget and Management, 301 W. Preston Street, Rm 705, Baltimore, MD 21201,
or call 410-767-4718, or email to misty.caleb@maryland.gov. Comments will be
accepted through June 30, 2025. A public hearing has not been scheduled.
.30 Parental Bereavement Leave.
A. Scope. This regulation applies to all employees, including
temporary employees, in the Executive, Judicial, and Legislative Branches of
State government, including any unit with an independent personnel system.
B. Definitions.
(1) In this regulation, the following terms have the meanings
indicated.
(2) Terms Defined.
(a) “Parental bereavement leave” means paid leave granted to an
employee who experiences a stillbirth or death of an employee’s infant or
child.
(b) “Parental bereavement leave of absence” means an approved
absence of an employee within 60 days after and for the purpose of grieving a
stillbirth experienced by the employee, the death of the employee’s infant, or
the death of the employee’s child.
(c) “Child” means an adopted, biological, or foster child, a
stepchild or a legal ward, who is at least 6 months old and under the age of 27
years.
(d) “Infant” means an adopted, biological, or foster child, a
stepchild, or a legal ward, who is under the age of 6 months.
(e) “Stillbirth” means the death of a fetus after 20 weeks or
more of pregnancy.
C. Use of Leave.
(1) An eligible employee using parental bereavement leave is
paid up to a maximum of 8 hours per workday, up to a maximum of 40 hours per
workweek.
(2) An employee approved for parental bereavement leave may use
up to 10 days (80 hours) of parental bereavement leave within 60 calendar days
after the death of the employee’s child.
(3) An employee approved for parental bereavement leave may use
up to 60 days (480 hours) of parental bereavement leave within 60 calendar days
after:
(a) The employee experiences a stillbirth; or
(b) The death of the employee’s infant.
(4) An employee entitled to and eligible for parental
bereavement leave may apply the leave consecutively or intermittently within
the allowable timeframe and up to the stated maximum days/hours.
(5) An employee entitled to and eligible for parental
bereavement leave will not be required to use any of the employee’s accrued
leave for this purpose.
D. Administration of the Parental Bereavement Leave of Absence.
(1) An employee may request a parental bereavement leave of
absence by submitting a form provided by the Secretary to the employee’s
appointing authority or appointing authority designee.
(2) A request shall be accompanied by all documentation required
by the form.
(3) The employee’s appointing authority or appointing authority
designee shall render a decision on a request for a parental bereavement leave
of absence within 5 working days of receiving the request.
E. Criteria for Reviewing Requests for Parental Bereavement
Leave of Absence.
(1) An appointing authority may grant a request for a parental
bereavement leave absence if the employee:
(a) Has submitted the proper form requesting the leave along
with the required documentation;
(b) Has not already exceeded the maximum amount of parental
bereavement leave allowed; and
(c) The use of the leave occurs within 60 calendar days after
the death or stillbirth event.
(2) In general, requests for parental bereavement leave may not
be denied; however, the timing of use of parental bereavement leave is subject
to the approval of the employee’s appointing authority.
F. Administration of Parental Bereavement Leave of Absence. An
employee who is approved for a parental bereavement leave of absence is
required to properly designate the period of absence using the leave codes
provided for this purpose in the time-keeping system of record.
HELENE GRADY
Secretary
Title 26
DEPARTMENT OF ENVIRONMENT
Subtitle 12 RADIATION MANAGEMENT
26.12.01 Radiation Protection
Authority: Environment Article, §§8-106, 8-301, and 8-304,
Annotated Code of Maryland
Notice of Proposed Action
[25-009-P-I]
The Secretary of the Environment proposes to amend Regulation .01
under COMAR 26.12.01 Radiation Protection.
Statement of Purpose
The purpose of this action is to amend COMAR 26.12.01.01,
Incorporate by Reference to incorporate Supplement 35 “Regulations for the
Control of Ionizing Radiation” with the following:
(1) Correct the phrase from “21 CFR 207.20(a)” to “21 CFR
207.17(a)” in Section C.28(j), on page C37;
(2) Remove Note 1 and Note 2 of Part C Appendix B, on page C68;
(3) Remove Sections F.3(a)(1)(viii), F.3(a)(1)(ix), and
F.3(a)(1)(x), on page F11;
(4) Remove the phrase “in addition to any lead equivalency provided
by the protective apron referred to in Section F.3(a)(1)(v)” in Section
F.5(i)(2)(ii), on page F22-5;
(5) Remove Section F.7(i)(4)(vi) and the phrase “Provisions for
protection of persons other than the patient set forth in F.3(a)(1)(v) shall be
enforced” in Section F.7(i)(4)(vii), on page F31-1;
(6) Remove Section F.7(j), on page F31-2;
(7) Add Section G.204(b), on page G29-1;
(8) Correct the phrase from “Each licensee or registrant shall
furnish a report to each worker annually, and within 90 days following
termination, of the worker's dose as shown in records maintained by the
licensee or registrant pursuant to D.1107 of these regulations” to “Each
licensee or registrant shall furnish a report to each worker annually of the
worker’s dose as shown in records maintained by the licensee or registrant
pursuant to D.1107 of these regulations if the individual’s occupational dose
exceeds 1 millisievert (0.1 rem) TEDE or 1millisievert (0.1 rem) to any
individual organ or tissue for the monitoring year” in Section J.13(b), on page
J2; and
(9) Miscellaneous edits regarding formatting and punctuation.
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 Shannon Page,
Division Chief, Radiological Health Program, Air and Radiation Administration,
Maryland Department of the Environment, 1800 Washington Boulevard, Suite 750,
Baltimore, Maryland 21230, or call 410-537-4214, or email to
spage@maryland.gov. Comments will be accepted through June 30, 2025. A public
hearing has not been scheduled.
Editor’s Note on Incorporation by Reference
Pursuant to State Government Article, §7-207, Annotated Code of
Maryland, the Regulations for the Control of Ionizing Radiation (1994)
Supplement 35 has been declared a document generally available to the public
and appropriate for incorporation by reference. For this reason, it will not be
printed in the Maryland Register or the Code of Maryland Regulations (COMAR).
Copies of this document are filed in special public depositories located
throughout the State. A list of these depositories was published in 52:2 Md. R.
53 (January 24, 2025), and is available online at www.dsd.maryland.gov. The
document may also be inspected at the office of the Division of State
Documents, 16 Francis Street, Annapolis, Maryland 21401.
.01 Incorporation by Reference.
All
provisions of the Regulations for the Control of Ionizing Radiation (1994) as
amended by Supplement 1 through Supplement [34] 35 are incorporated
by reference.
SERENA MCILWAIN
Secretary of the
Environment
Title 31
MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 HEALTH INSURANCE—GENERAL
31.10.51
Mental Health Benefits and Substance Use Disorder Benefits—Reports on
Nonquantitative Treatment Limitations and Data
Notice of Change to Opportunity for Public Comment
Notice of Proposed Action
[25-018-P]
The Opportunity for Public Comment which appeared in 52:10 Md. R
507—508 (May 16, 2025) has been changed. The correct notice follows.
Opportunity for Public Comment
Comments
may be sent to Jessica Blackmon, Administrative Law Clerk, Maryland Insurance
Administration, 200 Saint Paul Place, Suite 2700, Baltimore, MD 21202, or call
410-468-2019, or email to insuranceregreview.mia@maryland.gov. Comments will be
accepted through June 16, 2025. A public hearing has not been scheduled.
MARIE GRANT
Insurance Commissioner
Special Documents
