Maryland Register Issue Date:  June 13, 2025 Volume 52  •  Issue 12  • Pages 585 — 642 IN THIS ISSUE General Assembly Judiciary Regulations Errata Special Documents General Notices

Pursuant to State Government Article, §7-206, Annotated Code of Maryland, this issue contains all previously unpublished documents required to be published, and filed on or before May 23, 2025 5 p.m. Pursuant to State Government Article, §7-206, Annotated Code of Maryland, I hereby certify that this issue contains all documents required to be codified as of May 23, 2025. Gail S. Klakring Administrator, Division of State Documents Office of the Secretary of State

Information About the Maryland Register and COMAR

MARYLAND REGISTER

The Maryland Register is an official State publication published every other week throughout the year. A cumulative index is published quarterly.

The Maryland Register is the temporary supplement to the Code of Maryland Regulations. Any change to the text of regulations published in COMAR, whether by adoption, amendment, repeal, or emergency action, must first be published in the Register.

The following information is also published regularly in the Register:

• Governor’s Executive Orders

• Attorney General’s Opinions in full text

• Open Meetings Compliance Board Opinions in full text

• State Ethics Commission Opinions in full text

• Court Rules

• District Court Administrative Memoranda

• Courts of Appeal Hearing Calendars

• Agency Hearing and Meeting Notices

• Synopses of Bills Introduced and Enacted by the General Assembly

• Other documents considered to be in the public interest

CITATION TO THE MARYLAND REGISTER

The Maryland Register is cited by volume, issue, page number, and date. Example:

• 19:8 Md. R. 815—817 (April 17, 1992) refers to Volume 19, Issue 8, pages 815—817 of the Maryland Register issued on April 17, 1992.

CODE OF MARYLAND REGULATIONS (COMAR)

COMAR is the official compilation of all regulations issued by agencies of the State of Maryland. The Maryland Register is COMAR’s temporary supplement, printing all changes to regulations as soon as they occur. At least once annually, the changes to regulations printed in the Maryland Register are incorporated into COMAR by means of permanent supplements.

CITATION TO COMAR REGULATIONS

COMAR regulations are cited by title number, subtitle number, chapter number, and regulation number. Example: COMAR 10.08.01.03 refers to Title 10, Subtitle 08, Chapter 01, Regulation 03.

DOCUMENTS INCORPORATED BY REFERENCE

Incorporation by reference is a legal device by which a document is made part of COMAR simply by referring to it. While the text of an incorporated document does not appear in COMAR, the provisions of the incorporated document are as fully enforceable as any other COMAR regulation. Each regulation that proposes to incorporate a document is identified in the Maryland Register by an Editor’s Note. The Cumulative Table of COMAR Regulations Adopted, Amended or Repealed, found online, also identifies each regulation incorporating a document. Documents incorporated by reference are available for inspection in various depository libraries located throughout the State and at the Division of State Documents. These depositories are listed in the first issue of the Maryland Register published each year. For further information, call 410-974-2486.

HOW TO RESEARCH REGULATIONS

An Administrative History at the end of every COMAR chapter gives information about past changes to regulations. To determine if there have been any subsequent changes, check the ‘‘Cumulative Table of COMAR Regulations Adopted, Amended, or Repealed’’ which is found online at http://www.dsd.state.md.us/PDF/CumulativeTable.pdf. This table lists the regulations in numerical order, by their COMAR number, followed by the citation to the Maryland Register in which the change occurred. The Maryland Register serves as a temporary supplement to COMAR, and the two publications must always be used together. A Research Guide for Maryland Regulations is available. For further information, call 410-260-3876.

SUBSCRIPTION INFORMATION

For subscription forms for the Maryland Register and COMAR, see the back pages of the Maryland Register. Single issues of the Maryland Register are $15.00 per issue.

CITIZEN PARTICIPATION IN
THE REGULATION-MAKING PROCESS

Maryland citizens and other interested persons may participate in the process by which administrative regulations are adopted, amended, or repealed, and may also initiate the process by which the validity and applicability of regulations is determined. Listed below are some of the ways in which citizens may participate (references are to State Government Article (SG),

Annotated Code of Maryland):

• By submitting data or views on proposed regulations either orally or in writing, to the proposing agency (see ‘‘Opportunity for Public Comment’’ at the beginning of all regulations appearing in the Proposed Action on Regulations section of the Maryland Register). (See SG, §10-112)

• By petitioning an agency to adopt, amend, or repeal regulations. The agency must respond to the petition. (See SG §10-123)

• By petitioning an agency to issue a declaratory ruling with respect to how any regulation, order, or statute enforced by the agency applies. (SG, Title 10, Subtitle 3)

• By petitioning the circuit court for a declaratory judgment

on the validity of a regulation when it appears that the regulation interferes with or impairs the legal rights or privileges of the petitioner. (SG, §10-125)

• By inspecting a certified copy of any document filed with the Division of State Documents for publication in the Maryland Register. (See SG, §7-213)

Maryland Register (ISSN 0360-2834). Postmaster: Send address changes and other mail to: Maryland Register, State House, Annapolis, Maryland 21401. Tel. 410-260-3876. Published biweekly, with cumulative indexes published quarterly, by the State of Maryland, Division of State Documents, State House, Annapolis, Maryland 21401. The subscription rate for the Maryland Register is $225 per year (first class mail). All subscriptions post-paid to points in the U.S. periodicals postage paid at Annapolis, Maryland, and additional mailing offices.

Wes Moore, Governor; Susan C. Lee, Secretary of State; Gail S. Klakring, Administrator; Tracey A. Johnstone, Editor, Maryland Register; Tarshia N. Neal, Subscription Manager; Tami Cathell, Help Desk, COMAR and Maryland Register Online.

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

Illustrations by Carolyn Anderson, Dept. of General Services

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

Closing Dates for the Maryland Register

Schedule of Closing Dates and Issue Dates for the
Maryland Register ..................................................................... 588

COMAR Research Aids

Table of Pending Proposals ........................................................... 589

Index of COMAR Titles Affected in This Issue

COMAR Title Number and Name Page

09 Maryland Department of Labor ................................. 599, 600

10 Maryland Department of Health ......................................... 603

11 Department of Transportation ............................................ 625

14 Independent Agencies ....................................................... 626

26 Department of the Environment ........................................ 627

29 Department of State Police ................................................ 599

30 Maryland Institute for Emergency Medical Services
Systems (MIEMSS) ....................................................... 630

33 State Board of Elections .................................................... 631

36 Maryland State Lottery and Gaming Control
Agency ........................................................................... 599

PERSONS WITH DISABILITIES

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

General Assembly

SYNOPSIS NO. 9 . 592

The Judiciary

SUPREME COURT OF MARYLAND

DISCIPLINARY PROCEEDINGS…………………………598

Final Action on Regulations

09 MARYLAND DEPARTMENT OF LABOR

HOME IMPROVEMENT COMMISSION

General Regulations . 599

Claims Against the Home Improvement Guaranty Fund . 599

Civil Citations . 599

29 MARYLAND STATE POLICE

FIRE PREVENTION COMMISSION

Fire Prevention Code . 599

36 MARYLAND STATE LOTTERY AND GAMING CONTROL AGENCY

LOTTERY PROVISIONS

Voluntary Assignment of Monetary Prizes . 599

Proposed Action on Regulations

09 MARYLAND DEPARTMENT OF LABOR

REAL ESTATE COMMISSION

Residential Property Disclosure/ Disclaimer Statement 600

JOB SERVICE

Economic Stabilization . 600

10 MARYLAND DEPARTMENT OF HEALTH

MEDICAL CARE PROGRAMS

Applied Behavior Analysis Services . 603

Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than
21 Years Old . 605

Home and Community-Based Options Waiver 606

Community-Based Substance Use Disorder Services . 607

BOARD OF NURSING

Hearing Procedures . 609

Practice of Nurse Midwifery . 609

Monetary Penalties . 609

Sanctioning Guidelines . 609

BOARD OF NURSING—LICENSED CERTIFIED MIDWIVES

Licensure of Licensed Certified Midwives . 609

Delegation of Technical Acts by a Licensed Certified Midwife . 609

Code of Ethics . 609

COMMISSION ON KIDNEY DISEASE

General Regulations . 616

Physical and Medical Standards . 616

Transmissible Diseases . 616

Dialyzer Reuse and Water Standards . 616

BOARD OF PHYSICIANS

Unlicensed Limited X-Ray Machine Operator 621

BOARD OF DENTAL EXAMINERS

Inspections—Compliance with Centers for Disease Control and Prevention Guidelines 623

BOARD OF PROFESSIONAL COUNSELORS AND THERAPISTS

General Regulations . 624

Marriage and Family Therapists—Requirements for Licensure . 624

11 DEPARTMENT OF TRANSPORTATION

MARYLAND AVIATION ADMINISTRATION

Baltimore/Washington International Thurgood Marshall Airport 625

14 INDEPENDENT AGENCIES

MARYLAND HEALTH BENEFIT EXCHANGE

Individual Exchange Navigator Certification and Training Standards 626

Insurance Producer Authorization to Sell Qualified Plans in the SHOP Exchange and Individual Exchange 626

Insurance Producer Authorization—Renewal, Reinstatement, and Suspension or Revocation of Authorization 626

Captive Producer Training and Authorization Standards . 626

Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator
Certification . 626

Application Counselor Training and Certification
Standards . 626

26 DEPARTMENT OF THE ENVIRONMENT

AIR QUALITY

Control of Fuel-Burning Equipment, Stationary Internal Combustion Engines, and Certain Fuel-Burning
Installations . 627

30 MARYLAND INSTITUTE FOR EMERGENCY MEDICAL SERVICES SYSTEMS (MIEMSS)

EMERGENCY MEDICAL SERVICES COMMUNICATIONS SYSTEM

Helicopter Communications . 630

33 STATE BOARD OF ELECTIONS

CAMPAIGN FINANCING

Campaign Accounts . 631

Errata

COMAR 20.31.03.04 . 632

Special Documents

DEPARTMENT OF THE ENVIRONMENT

SUSQUEHANNA RIVER BASIN COMMISSION

Projects Approved for Consumptive Uses of Water 633

General Permit Notice . 634

Minor Modification Notice . 635

WATER AND SCIENCE ADMINISTRATION

Grandfathering Registration Notice . 635

Water Quality Certification 24-WQC-0048 . 635

DEPARTMENT OF HUMAN RESOURCES

Statement of Need

Residential Child Care Services . 636

General Notices

CHESAPEAKE BAY TRUST

Public Meeting Sept 9, 2025 . 641

Public Meeting November 19, 2025 . 641

Public Meeting February 18, 2026 . 641

Public Meeting May 20, 2026 . 641

COMMISSION ON CRIMINAL SENTENCING POLICY

Public Meeting . 641

MARYLAND HEALTH BENEFIT EXCHANGE

Public Meeting . 641

MARYLAND DEPARTMENT OF HEALTH

Public Meeting . 641

MARYLAND STATE LOTTERY AND GAMING CONTROL COMMISSION

Public Meeting . 641

BOARD OF OCCUPATIONAL THERAPY PRACTICE

Public Meeting . 641

COMAR Online

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

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

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

Availability of Monthly List of
Maryland Documents

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

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

CLOSING DATES AND ISSUE DATES THROUGH
December 2025^†

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

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

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

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

** Note closing date changes due to holidays.

*** Note issue date changes due to holidays.

The regular closing date for Proposals and Emergencies is Monday.

Cumulative Table of COMAR Regulations
Adopted, Amended, or Repealed

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

Table of Pending Proposals

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

02 OFFICE OF THE ATTORNEY GENERAL

02.06.04 .01—.06 • 52:6 Md. R. 270 (3-21-25)

07 DEPARTMENT OF HUMAN SERVICES

07.02.25.01—.24 • 51:19 Md. R. 861 (9-20-24)

08 DEPARTMENT OF NATURAL RESOURCES

08.02.01.05 • 52:9 Md. R 406 (5-02-25)

08.02.08.09,.12 • 52:2 Md. R 362 (4-18-25)

08.02.13.03,.05,.08 • 52:2 Md. R 364 (4-18-25)

08.02.22.02 • 51:10 Md. R. 534 (5-17-24)

08.03.08.01,.04—.09 • 52:11 Md. R. 536 (5-30-2025)

08.08.05.03 • 52:7 Md. R. 326 (4-4-2025)

08.18.19.05 • 52:11 Md. R. 539 (5-30-2025)

08.18.26.07 • 52:11 Md. R. 540 (5-30-2025)

09 MARYLAND DEPARTMENT OF LABOR

09.03.06.02,.04 • 52:1 Md. R. 27 (1-10-25)

09.03.06.02,.04 • 52:2 Md. R. 79 (1-24-25) (corr)

09.03.06.02,.06,.16 • 51:14 Md. R. 685 (7-12-24)

09.03.09.06 • 52:7 Md. R. 328 (4-4-2025)

09.09.02.02 • 52:7 Md. R. 328 (4-4-2025)

09.11.07.01 • 52:12 Md. R. 600 (6-13-25)

09.13.06.07, .09, .12 • 52:7 Md. R. 329 (4-4-25)

09.14.18.01—.12 • 52:11 Md. R. 540 (5-30-2025)

09.22.01.04, .15 • 52:6 Md. R. 273 (3-21-25)

09.22.02.03, .05 • 52:6 Md. R. 273 (3-21-25)

09.30.01,.01—.10 • 52:2 Md. R 371 (4-18-25)

09.33.02.01—.06,.07—.09 • 52:12 Md. R. 600 (6-13-25)

09.34.05.02 • 52:10 Md. R. 441 (5-16-25)

09.34.06.02.—07,.14 • 52:10 Md. R. 441 (5-16-25)

09.34.07.02 • 52:10 Md. R. 441 (5-16-25)

09.34.08.01—.03,.05—.08,.10—.12 • 52:10 Md. R.441 (5-16-25)

09.34.09.02 • 52:10 Md. R. 441 (5-16-25)

09.36.07.01—.13 • 52:6 Md. R. 274 (3-21-25)

09.37.01.01—.19 • 52:7 Md. R. 330 (4-4-2025)

09.42.01.01—.03 • 51:21 Md. R. 929 (10-18-24)

09.42.02.01—.10 • 51:21 Md. R. 932 (10-18-24)

09.42.03.01—.10 • 51:21 Md. R. 933 (10-18-24)

09.42.04.01—.12 • 51:21 Md. R. 937 (10-18-24)

09.42.05.01—.05 • 52:1 Md. R. 28 (1-10-25)

10 MARYLAND DEPARTMENT OF HEALTH

Subtitles 01—08 (1st volume)

10.05.02.01—.15 • 52:10 Md. R. 446 (5-16-25)

10.07.01.24 • 52:11 Md. R. 545 (5-30-2025)

Subtitle 09 (2nd volume)

10.09.02.07 • 52:5 Md. R. 241 (3-7-25) (ibr)

10.09.05.01—.05,.07,.10 • 52:9 Md. R407 (5-02-25) (ibr)

10.09.06.09 • 52:9 Md. R 409 (5-02-25)

10.09.07.08 • 52:7 Md. R. 333 (4-4-2025)

10.09.11.11 • 52:3 Md. R. 162 (2-7-25)

10.09.12.01,.04—.06 • 52:3 Md. R. 164 (2-7-25)

10.09.16.07 • 52:6 Md. R. 277 (3-21-25)

10.09.24.02,.07,.12 • 52:3 Md. R. 162 (2-7-25)

10.09.24 .03-1 • 52:5 Md. R. 242 (3-7-25)

10.09.27.06 • 52:9 Md. R 410 (5-02-25)

10.09.28.04,.06 • 52:12 Md. R. 603 (6-13-25)

10.09.33.09 • 52:9 Md. R 411 (5-02-25)

10.09.35.08 • 52:6 Md. R. 278 (3-21-25)

10.09.36.01, .03, .04, .08 • 52:6 Md. R. 279 (3-21-25)

10.09.37.03 • 52:5 Md. R. 242 (3-7-25)

10.09.43.10,.13 • 52:3 Md. R. 164 (2-7-25)

10.09.44 .01, .03—.09, .11, .12, .15, .16, .18,.20—.24 • 52:6 Md. R. 279 (3-21-25)

10.09.48.08 • 52:7 Md. R. 333 (4-4-2025)

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

10.09.53.07 • 52:12 Md. R. 605 (6-13-25)

10.09.54.04, .22 • 52:12 Md. R. 606 (6-13-25)

10.09.76 .04,.05 • 52:5 Md. R. 243 (3-7-25)

10.09.80.08 • 52:12 Md. R. 607 (6-13-25)

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

Subtitles 10—22 (3rd volume)

10.10.01.03 • 52:11 Md. R. 545 (5-30-2025)

10.10.02.01 • 52:11 Md. R. 545 (5-30-2025)

10.10.03.02—.04 • 52:11 Md. R. 545 (5-30-2025)

10.10.04.01,.02 • 52:11 Md. R. 545 (5-30-2025)

10.10.05.02,.04,.05 • 52:11 Md. R. 545 (5-30-2025)

10.10.06.02,.07,.08,.12,.13 • 52:11 Md. R. (5-30-2025)

10.10.07.07 • 52:11 Md. R. 545 (5-30-2025)

10.10.08.02 • 52:11 Md. R. 545 (5-30-2025)

10.10.12.02,.04,.07 • 52:11 Md. R. 545 (5-30-2025)

10.21.12.01—03, .05, .06, .08—10, .12, .14 • 52:11 Md. R. 550
(5-30-2025)

10.21.13.01—.08, .10,.12 • 52:11 Md. R. 550 (5-30-2025)

Subtitles 23—36 (4th volume)

10.25.07.02,.09—.12 • 51:24 Md. R. 1086 (12-2-24)

10.27.01.13 • 52:11 Md. R. 554 (5-30-2025)

10.27.02.01 • 52:12 Md. R. 609 (6-13-25)

10.27.05.07 • 52:12 Md. R. 609(6-13-25)

10.27.11.01 • 52:11 Md. R. 555 (5-30-2025)

10.27.13.01—.03 • 52:11 Md. R. 555 (5-30-2025)

10.27.18.01,.02 • 52:12 Md. R. 609 (6-13-25)

10.27.26.02 • 52:12 Md. R. 609 (6-13-25)

10.28.02.02, .03, .05 • 52:6 Md. R. 286 (3-21-25)

10.28.03.03—.08 • 52:7 Md. R. 334 (4-4-2025)

10.28.05.03 • 52:7 Md. R. 334 (4-4-2025)

10.28.07.02 • 52:7 Md. R. 334 (4-4-2025)

10.28.08.01—.04 • 52:7 Md. R. 334 (4-4-2025)

10.28.11.04 • 52:7 Md. R. 334 (4-4-2025)

10.28.12.02 • 52:7 Md. R. 334 (4-4-2025)

10.30.01.01,.02,.03—.05, .07—.09,.11 • 52:12 Md. R. 616 (6-13-25)

10.30.02.02—.07 • 52:12 Md. R. 616 (6-13-25)

10.30.03 .02,.03 • 52:12 Md. R. 616 (6-13-25)

10.30.04.02, .03 • 52:12 Md. R. 616 (6-13-25)

10.32.05.02—.06 • 52:11 Md. R. 563 (5-30-2025)

10.32.14.01—.09 • 52:12 Md. R. 621 (6-13-25)

Subtitles 37—52 (5th volume)

10.37.01.03 • 51:17 Md. R. 779 (8-23-24)

10.38.07.02 • 52:11 Md. R. 565 (5-30-2025)

10.38.08.05 • 52:11 Md. R. 565 (5-30-2025)

10.39.06 .01—.15 • 52:10 Md. R. 555 (5-30-2025)

10.39.07.01 • 52:11 Md. R. 555 (5-30-2025)

10.42.01.02, .04, .11• 52:5 Md. R. 245 (3-7-25)

10.44.34.01—.04 • 52:12 Md. R. 623 (6-13-25)

Subtitles 53—69 (6th volume)

10.56.01.02—.04, .06, .08,.09, .09—.12 • 52:11 Md. R. 566 (5-30-2025)

10.58.01.04 • 52:12 Md. R. 624 (6-13-25)

10.58.08.06 • 52:12 Md. R. 624 (6-13-25)

10.63.01.01—.13 • 52:10 Md. R. 449 (5-16-25)

10.63.02.01—.14 • 52:10 Md. R. 449 (5-16-25)

10.63.06.01—.21 • 52:10 Md. R. 449 (5-16-25)

10.63.09.01—.10 • 52:10 Md. R. 449 (5-16-25)

10.65.01.06 • 52:11 Md. R. 568 (5-30-2025)

10.67.01.01 • 52:3 Md. R. 166 (2-7-25)

10.67.06.13 • 52:3 Md. R. 166 (2-7-25)

10.69.01.01—.13 • 52:12 Md. R. 609 (6-13-25)

10.69.02.01—.06 • 52:12 Md. R. 609 (6-13-25)

10.69.03.01—.03 • 52:12 Md. R. 609 (6-13-25)

11 DEPARTMENT OF TRANSPORTATION

Subtitles 1—10

11.03.01.13 • 52:12 Md. R. 625 (6-13-25)

11.04.15.01—.04 • 52:11 Md. R. 568 (5-30-2025)

11.04.17.04 • 52:9 Md. R 412 (5-02-25)

Subtitles 11—23 (MVA)

11.13.13.01—.03 • 52:2 Md. R. 126 (1-24-25)(err)

11.23.02.33 • 52:9 Md. R 412 (5-02-25)

13A STATE BOARD OF EDUCATION

13A.07.01,.01—.07,.09 • 52:8 Md. R.372 (4-18-25)(ibr)

13A.07.06,.03 • 52:8 Md. R 376 (4-18-25)(ibr)

13A.12.05.05 • 52:10 Md. R. 469 (5-16-25)

13A.15.01.02 • 51:25 Md. R. 1154 (12-13-24)

13A.15.04.03 • 51:25 Md. R. 1154 (12-13-24)

13A.15.13.09 • 51:25 Md. R. 1154 (12-13-24)

13B MARYLAND HIGHER EDUCATION COMMISSION

13B.02.01.07 • 52:10 Md. R. 470 (5-16-25)

13B.08.03.02,.04,.09 • 52:11 Md. R. 569 (5-30-2025)

13B.08.22.02 • 52:10 Md. R. 470 (5-16-25)

13B.08.23.07,.08 • 52:11 Md. R. 570 (5-30-2025)

14 INDEPENDENT AGENCIES

14.01.04.05 • 51:25 Md. R. 1140 (12-13-24)

14.11.01 • 52:11 Md. R. 571 (5-30-2025)

14.17.03.02,.03 • 52:9 Md. R 413 (5-02-25)

14.22.01.05 • 52:6 Md. R. 288 (3-21-25)

14.22.02.02 • 52:6 Md. R. 288 (3-21-25)

14.30.13.01 • 52:8 Md. R 377 (4-18-25)

14.35.02.04 • 52:12 Md. R. 626 (6-13-25)

14.35.04.02,.04 • 52:12 Md. R. 626 (6-13-25)

14.35.05.02 • 52:12 Md. R. 626 (6-13-25)

14.35.08.01—.06 • 52:12 Md. R. 626 (6-13-25)

14.35.10.01 • 52:12 Md. R. 626 (6-13-25)

14.35.13.06 • 52:12 Md. R. 626 (6-13-25)

14.35.18.03,.04 • 51:17 Md. R. 789 (8-23-24)

14.39.01.01 • 52:8 Md. R 377 (4-18-25)

14.39.02.04, .05, .07—.09, .12—.18,.20, .32,.33 • 52:8 Md. R 377 (4-18-25)

14.39.02.12 • 51:23 Md. R. 1046 (11-15-24)

14.39.04.05,.08 • 52:10 Md. R. 471 (5-16-25)

14.41.01.01— 16 • 52:10 Md. R. 472 (5-16-25)

15 MARYLAND DEPARTMENT OF AGRICULTURE

15.06.04.02—.07 • 52:10 Md. R. 476 (5-16-25)

17 DEPARTMENT OF BUDGET AND MANAGEMENT

17.04.11 .30 • 52:11 Md. R. 572 (5-30-2025)

20 PUBLIC SERVICE COMMISSION

20.31.01.02 • 52:6 Md. R. 290 (3-21-25)

20.31.03.04 • 52:6 Md. R. 290 (3-21-25)

20.50.02.02 • 52:8 Md. R 382 (4-18-25)(ibr)

20.50.09.02,.06,.14 • 52:8 Md. R 383 (4-18-25)

22 STATE RETIREMENT AND PENSION SYSTEM

22.01.05.02 • 52:9 Md. R 414 (5-02-25)

22.01.12.01—.05 • 52:9 Md. R 414 (5-02-25)

26 DEPARTMENT OF THE ENVIRONMENT

Subtitles 01—07 (Part 1)

26.04.01.01,.01-1,.20,.31 • 51:6 Md. R. 309 (3-22-24) (ibr)

Subtitles 08—12 (Part 2)

26.11.09.01,.07 • 52:12 Md. R. 627 (6-13-25)

26.12.01.01 • 52:11 Md. R. 573 (5-30-2025) (ibr)

Subtitles 13—18 (Part 3)

26.13.01.03—.05 • 52:10 Md. R. 478 (5-16-25)

26.13.02.01, .04, .04-1, .04-7, .05, .06, .07, .07-1, .11, .13, .16, .19,.23 • 52:10 Md. R. 478 (5-16-25)

26.13.03.01,.01-1,.02,.03-3,.03-4,.03-5,.03-7,.05,.05-4,.06 • 52:10 Md. R. 478 (5-16-25)

26.13.04.01 • 52:10 Md. R. 478 (5-16-25)

26.13.05.01, .04, .05,.14 • 52:10 Md. R. 478 (5-16-25)

26.13.06.01, .02, .05, .22 • 52:10 Md. R. 478 (5-16-25)

26.13.07.01, .02, .02-6, ,17, .20,.20-1—.20-6 • 52:10 Md. R. 478 (5-16-25)

26.13.09.01 • 52:10 Md. R. 478 (5-16-25)

26.13.10.01, .04, .06, .08, .09-1,.14, .16-1, .17, .19, .20, .25, .32—.49 • 52:10 Md. R. 478 (5-16-25)

26.13.11.01 • 52:10 Md. R. 478 (5-16-25)

29 MARYLAND STATE POLICE

29.06.01.02, .05—.09, .14 • 52:3 Md. R. 172(2-7-25) (ibr)

30 MARYLAND INSTITUTE FOR

EMERGENCY MEDICAL SERVICES SYSTEMS (MIEMSS)

30.01.01.02 • 52:6 Md. R. 291 (3-21-25)

30.02.01.01 • 52:6 Md. R. 291 (3-21-25)

30.02.02.02—.09 • 52:6 Md. R. 291 (3-21-25)

30.07.01.01 • 52:12 Md. R. 630 (6-13-25)

30.08.05.03 • 52:8 Md. R 385 (4-18-25)

30.08.06.01 • 52:8 Md. R 385 (4-18-25)

30.08.08.02 • 52:8 Md. R 385 (4-18-25)

30.08.10.01 • 52:8 Md. R 385 (4-18-25)

30.08.11.01 • 52:8 Md. R 385 (4-18-25)

30.08.12.03 • 52:8 Md. R 385 (4-18-25)

30.08.14.02 • 52:8 Md. R 385 (4-18-25)

30.08.18.01 • 52:8 Md. R 385 (4-18-25)

30.09.04.08 • 52:8 Md. R 387 (4-18-25)

31 MARYLAND INSURANCE ADMINISTRATION

31.04.22.03, .08 • 52:5 Md. R. 248 (3-7-25)

31.10.51.03—.08 • 52:10 Md. R. 507 (5-16-25)

33 STATE BOARD OF ELECTIONS

33.13.06.04 • 52:12 Md. R. 631 (6-13-25)

33.14.02.14 • 52:5 Md. R. 249 (3-7-25)

36 MARYLAND STATE LOTTERY AND GAMING CONTROL AGENCY

36.03.10.36 • 51:24 Md. R. 1118 (12-2-24)

36.04.02.02 • 51:23 Md. R. 1059 (11-15-24)

36.08.01.02 • 51:23 Md. R. 1059 (11-15-24)

36.08.02.01 • 51:23 Md. R. 1059 (11-15-24)

36.08.03.01—.04,.06 • 51:23 Md. R. 1059 (11-15-24)

36.08.04.01,.03 • 51:23 Md. R. 1059 (11-15-24)

36.09.01.02 • 51:23 Md. R. 1059 (11-15-24)

36.09.02.01,.01—.06 • 51:23 Md. R. 1059 (11-15-24

36.09.03.01—.07 • 51:23 Md. R. 1059 (11-15-24)

36.09.04.01—.07 • 51:23 Md. R. 1059 (11-15-24)

36.09.05.01—.03 • 51:23 Md. R. 1059 (11-15-24)

36.10.12.03 • 51:23 Md. R. 1059 (11-15-24)

36.10.13.06,.37,.40,.45 • 51:23 Md. R. 1059 (11-15-24)

36.10.13.39 • 51:24 Md. R. 1118 (12-2-24)

36.10.14.06 • 51:23 Md. R. 1059 (11-15-24)

36.10.18.04,.05 • 51:23 Md. R. 1059 (11-15-24)

The General Assembly

For additional up-to-date information concerning bills introduced in the General Assembly, log on to http://mlis.state.md.us and click on Bill Information and Status. You may then enter a specific bill number for information about that bill. You may also click on Senate Synopsis or House Synopsis for the most recent synopsis list for each house, or click on Synopsis Index for a listing of all bill synopses since the beginning of the legislative session.

SYNOPSIS NO. 9

Chapters

CH0601 HB0500 (Enrolled) The Spkr (Admin), et al. Procurement Reform Act of 2025.

CH0602 HB0350 (Enrolled) The Spkr (Admin). Budget Bill (Fiscal Year 2026).

CH0603 HB0351 (Enrolled) The Spkr (Admin). Creation of a State Debt - Maryland Consolidated Capital Bond Loan of 2025, and the Maryland Consolidated Capital Bond Loans of 2011, 2012, 2013, 2014, 2015, 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023, and 2024.

CH0604 HB0352 (Enrolled) The Spkr (Admin). Budget Reconciliation and Financing Act of 2025.

CH0605 HB1253 (Amended) The Spkr. Department of Social and Economic Mobility - Established.

CH0606 HB1503 (Enrolled) Chr APP (Dept). State Personnel - Paid Family and Medical Leave.

CH0607 SB0231 (Amended) Chr FIN (Dept). State Government - Public Employee Relations Act - Alterations.

CH0608 SB0026 (Enrolled) Sen Kramer. Davis Martinez Public Employee Safety and Health Act.

CH0609 HB0176 (Enrolled) Del Solomon. Davis Martinez Public Employee Safety and Health Act.

CH0610 SB0357 (Enrolled) Sen Gile, et al. Prescription Drug Affordability Board - Authority and Stakeholder Council Membership (Lowering Prescription Drug Costs for All Marylanders Now Act).

CH0611 HB0424 (Enrolled) Del Cullison, et al. Prescription Drug Affordability Board - Authority and Stakeholder Council Membership (Lowering Prescription Drug Costs for All Marylanders Now Act).

CH0612 HB1301 (Amended) Del Rosenberg, et al. Maryland Medical Assistance Program, Maryland Children’s Health Program, and Health Insurance – Transfers to Special Pediatric Hospitals – Prior Authorizations.

CH0613 SB0369 (Enrolled) Sen Watson, et al. Public Libraries - Automated External Defibrillator Program (Raymono A. Russell Act).

CH0614 HB0593 (Enrolled) Del Boafo, et al. Public Libraries - Automated External Defibrillator Program (Raymono A. Russell Act).

CH0615 HB1104 (Enrolled) Chr HGO (Dept). Maryland Department of Health - AHEAD Model Implementation - Electronic Health Care Transactions and Population Health Improvement Fund.

CH0616 SB0200 Chr B&T (Dept). Board of Trustees of the Maryland Teachers and State Employees Supplemental Retirement Plans - Renaming.

CH0617 HB0228 Chr APP (Dept). Maryland Veterans Trust – Assistance to Members of the Maryland National Guard.

CH0618 SB0246 Chr Education, Energy, and the Environmen. Maryland Veterans Trust - Assistance to Members of the Maryland National Guard.

CH0619 HB0826 (Enrolled) Chr HGO (Dept). Office of Small, Minority, and Women Business Affairs - Repeal of Interdepartmental Advisory Committee and Establishment of the Governor's Subcabinet on Socioeconomic Procurement Participation.

CH0620 HB0991 (Enrolled) Del Harris, et al. State Procurement - Minority Business Enterprise Program - Extension and Reports.

CH0621 SB0829 (Enrolled) Sen Hayes. State Procurement - Minority Business Enterprise Program - Extension and Reports.

CH0622 HB1010 Del A. Jones. African American Heritage Preservation Program and Grant Fund - Noncapital Grants and Donations.

CH0623 SB0931 (Enrolled) Sen Feldman. Public Utilities - Generating Stations - Generation and Siting (Renewable Energy Certainty Act).

CH0624 HB1036 (Amended) Dels Wilson and Crosby. Public Utilities - Generating Stations - Generation and Siting (Renewable Energy Certainty Act).

CH0625 SB0937 (Enrolled) The Pres, et al. Electricity and Gas - Emissions Reductions, Rate Regulation, Cost Recovery, Infrastructure, Planning, Renewable Energy Portfolio Standard, and Energy Assistance Programs (Next Generation Energy Act).

CH0626 HB1035 (Amended) The Spkr and Del Wilson. Electricity and Gas - Emissions Reductions, Rate Regulation, Cost Recovery, Infrastructure, Planning, Renewable Energy Portfolio Standard, and Energy Assistance Programs (Next Generation Energy Act).

CH0627 HB0376 (Enrolled) Chr HGO. Maryland Cybersecurity Council - Alterations.

CH0628 SB0294 (Enrolled) Sen Feldman, et al. Maryland Cybersecurity Council - Alterations.

CH0629 HB0614 (Amended) Chr W&M (Office of the Comptroller). Local Earned Income Tax Credit - Calculation - County Income Tax Rate.

CH0630 SB0663 The Pres (Office of the Comptroller). Earned Income Tax Credit - Notice of Eligibility - Alteration.

CH0631 HB0603 The Spkr (Office of the Comptroller). Earned Income Tax Credit - Notice of Eligibility - Alteration.

CH0632 SB0664 (Amended) The Pres (Office of the Comptroller). Business Regulation - Enforcement for Miscellaneous State Business Licenses - Study.

CH0633 HB0577 (Amended) The Spkr (Office of the Comptroller). Business Regulation - Enforcement for Miscellaneous State Business Licenses - Study.

CH0634 HB0617 Chr W&M (Dept). Comptroller - Recording and Monitoring Telephone Calls - Clarification.

CH0635 SB0665 (Enrolled) The Pres (Office of the Comptroller). Maryland Uniform Disposition of Abandoned Property Act – Revisions.

CH0636 HB0761 (Amended) The Spkr (Office of the Comptroller). Maryland Uniform Disposition of Abandoned Property Act - Revisions.

CH0637 HB0619 Chr W&M (Dept). Sales and Use Tax - Sales Between Cannabis Businesses and Cannabis Nurseries - Exemption.

CH0638 SB0979 (Amended) Sen Guzzone. Local Government - Accommodations Intermediaries - Hotel Rental Tax - Collection by Comptroller and Alterations.

CH0639 HB0757 (Amended) Del Kaiser, et al. Professional and Volunteer Firefighter Innovative Cancer Screening Technologies Program - Funding.

CH0640 SB0849 (Enrolled) Sen Guzzone. Professional and Volunteer Firefighter Innovative Cancer Screening Technologies Program - Funding.

CH0641 SB1005 Sen Benson. Federally Qualified Health Centers Grant Program - Acquisition of Land.

CH0642 HB0043 Del J. Lewis. Federally Qualified Health Centers Grant Program - Acquisition of Land.

CH0643 HB1519 (Enrolled) Del Chang. Prior Authorizations of State Debt - Alterations.

CH0644 SB0854 (Amended) Sen Lewis Young. Health Occupations - Licensed Direct-Entry Midwives - Revisions.

CH0645 HB0838 (Amended) Del Cullison, et al. Health Occupations - Licensed Direct-Entry Midwives - Revisions.

CH0646 SB0032 Sen Gile. Real Property - Holding Over - Expedited Hearing and Service of Summons for Active Duty Service Members.

CH0647 HB0953 (Amended) Del Kaiser, et al. Tax Sales - Homeowner Protection Program - Funding and Alterations.

CH0648 HB1292 (Enrolled) Del Kaiser, et al. Health Insurance - Provider Directory - Required Updates.

CH0649 HB1474 (Enrolled) Del Kaiser, et al. State Board of Professional Counselors and Therapists - Temporary Telehealth Licenses - Establishment.

CH0650 HB1344 (Enrolled) Del D. Jones, et al. Department of General Services - Assessment of State-Owned Facilities - Child Care Centers.

CH0651 HB0039 (Amended) Del Fair, et al. Public Health - Repeal of Prohibition on Transfer of Human Immunodeficiency Virus (Carlton R. Smith Act).

CH0652 SB0356 (Amended) Sen Smith, et al. Public Health - Repeal of Prohibition on Transfer of Human Immunodeficiency Virus (Carlton R. Smith Act).

CH0653 SB0373 (Amended) Sen Beidle. State Personnel - BWI Airport Fire and Rescue Department - Collective Bargaining and Arbitration Processes.

CH0654 HB0599 (Enrolled) Del Pruski. State Personnel - BWI Airport Fire and Rescue Department - Collective Bargaining and Arbitration Processes.

CH0655 HB0459 (Amended) Del Pruski, et al. Counties - Cancer Screening for Professional Firefighters - Required Coverage (James "Jimmy" Malone Act).

CH0656 SB0374 (Amended) Sen Beidle, et al. Counties - Cancer Screening for Professional Firefighters - Required Coverage (James "Jimmy" Malone Act).

CH0657 HB0971 (Amended) Del Pruski. Anne Arundel County Crownsville Hospital Memorial Park Advisory Committee.

CH0658 SB0900 (Amended) Sen Augustine. Maryland Behavioral Health Crisis Response System - Integration of 9-8-8 Suicide and Crisis Lifeline Network and Outcome Evaluations.

CH0659 HB1146 (Enrolled) Del White Holland, et al. Maryland Behavioral Health Crisis Response System – Integration of 9–8–8 Suicide and Crisis Lifeline Network and Outcome Evaluations.

CH0660 HB0011 (Amended) Del Sample-Hughes, et al. Health Insurance - Access to Nonparticipating Providers - Referrals, Additional Assistance, and Coverage.

CH0661 SB0902 (Amended) Sen Augustine. Health Insurance - Access to Nonparticipating Providers - Referrals, Additional Assistance, and Coverage.

CH0662 SB0684 (Enrolled) Sen Augustine. Public Health - Health Equity Dashboard.

CH0663 HB1100 (Amended) Del White Holland, et al. Public Health - Health Equity Dashboard.

CH0664 HB0331 (Amended) Del White Holland, et al. Public Information Act - Public Access Ombudsman - Delegation of Powers.

CH0665 SB0296 (Amended) Sen Augustine. Public Information Act – Public Access Ombudsman – Delegation of Powers.

CH0666 SB0599 Sens Hettleman and Augustine. Behavioral Health Crisis Response Grant Program - Funding.

CH0667 SB0669 (Amended) Sen Hettleman, et al. Public Safety - Rape Kit Testing - Tracking Program and Grant Fund.

CH0668 HB0675 (Amended) Del Bartlett, et al. Public Safety - Rape Kit Testing - Tracking Program and Grant Fund.

CH0669 HB0848 (Enrolled) Del Pena-Melnyk, et al. Health Insurance - Adverse Decisions - Notices, Reporting, and Examinations.

CH0670 SB0474 (Enrolled) Sen Beidle. Health Insurance - Adverse Decisions - Notices, Reporting, and Examinations.

CH0671 SB0776 (Enrolled) Sen Beidle. Workgroup to Study the Rise in Adverse Decisions in the State Health Care System - Establishment.

CH0672 HB0995 (Enrolled) Del Pena-Melnyk, et al. Workgroup to Study the Rise in Adverse Decisions in the State Health Care System - Establishment.

CH0673 HB0602 Dels Hutchinson and Adams. State Board of Nursing - Advanced Practice Nursing Licensure and Specialty Certification - Reciprocity Discussions (Maryland Border States Advanced Practice Nursing Act).

CH0674 SB0407 Sen Beidle, et al. State Board of Nursing - Advanced Practice Nursing Licensure and Specialty Certification - Reciprocity Discussions (Maryland Border States Advanced Practice Nursing Act).

CH0675 SB0423 (Amended) Sen Beidle. Maryland Medical Practice Act and Maryland Physician Assistants Act - Revisions.

CH0676 HB0776 (Amended) Del Pena-Melnyk, et al. Maryland Medical Practice Act and Maryland Physician Assistants Act - Revisions.

CH0677 HB0546 Del Feldmark. Digital Advertising Gross Revenues Tax - Assessments - Appeals and Corrections.

CH0678 SB0605 Sen Zucker. Digital Advertising Gross Revenues Tax - Assessments - Appeals and Corrections.

CH0679 HB0859 (Amended) Del Solomon, et al. Access to Health Insurance for Child Care Professionals - Outreach.

CH0680 SB0376 (Enrolled) Sen Kramer, et al. Maryland Department of Health and Office of Health Care Quality - Nursing Home Inspections - Reporting.

CH0681 HB1004 (Amended) Del Martinez, et al. Public Health - Alzheimer's Disease and Related Dementias - Information on Prevalence and Treatment.

CH0682 SB0748 (Amended) Sen Kramer. Public Health - Alzheimer's Disease and Related Dementias - Information on Prevalence and Treatment.

CH0683 HB1086 (Amended) Del Martinez, et al. Maryland Medical Assistance Program and Health Insurance - Coverage for Anesthesia - Prohibiting Time Limitations.

CH0684 HB0666 (Amended) Del Woods, et al. Maryland Medical Assistance Program and Health Insurance - Required Coverage for Calcium Score Testing.

CH0685 SB0060 (Amended) Sen Augustine. Maryland Medical Assistance Program and Health Insurance - Required Coverage for Calcium Score Testing.

CH0686 SB0790 (Amended) Sen Augustine. Behavioral Health Advisory Council and the Commission on Behavioral Health Care Treatment and Access - Plan to Implement Early and Periodic Screening, Diagnostic, and Treatment Requirements.

CH0687 HB1083 (Amended) Del Woods, et al. Behavioral Health Advisory Council and the Commission on Behavioral Health Care Treatment and Access - Plan to Implement Early and Periodic Screening, Diagnostic, and Treatment Requirements.

CH0688 HB0970 (Enrolled) Del Woods, et al. Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols.

CH0689 SB0646 (Amended) Sen Muse. Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols.

CH0690 HB0798 (Amended) Del Lehman, et al. Opioid Restitution Fund - Interactive Dashboard.

CH0691 SB0589 (Amended) Sen Augustine. Opioid Restitution Fund - Interactive Dashboard.

CH0692 SB0773 (Enrolled) Sen Hershey. Health Benefit Plans - Calculation of Cost-Sharing Contribution - Requirements.

CH0693 HB0268 (Amended) Del Charkoudian, et al. Hospitals - Financial Assistance and Collection of Debts - Policies.

CH0694 SB0981 (Amended) Sen Hershey, et al. Hospitals - Financial Assistance and Collection of Debts - Policies.

CH0695 HB1510 (Enrolled) Del Pippy, et al. Medical Records - Notice of Destruction - Method.

CH0696 HB0718 (Enrolled) Del Rosenberg, et al. Maryland Health Insurance Coverage Protection Commission - Established.

CH0697 HB0722 Del Rosenberg. Maryland Department of Health - Report on Oversight of Substance Use Disorder Treatment Programs and Recovery Residences.

CH0698 HB0729 (Amended) Del Rosenberg, et al. Public Health - Use of Opioid Restitution Fund and Training Under the Overdose Response Program.

CH0699 SB0594 (Enrolled) Sen Ellis. Public Health - Use of Opioid Restitution Fund and Training Under the Overdose Response Program.

CH0700 HB0728 (Amended) Del Rosenberg, et al. Opioid Restitution Fund - Authorized Uses.

CH0701 SB0495 (Amended) Sen Ellis. Opioid Restitution Fund - Authorized Uses.

CH0702 HB1347 (Enrolled) Del Adams. Security Guards and Security Guard Employers - Registration, Certification, and Regulation.

CH0703 SB0299 (Enrolled) Sens Carozza and Feldman. Security Guards and Security Guard Employers - Registration, Certification, and Regulation.

CH0704 HB0996 (Amended) Del Bhandari, et al. Public Health - Phenibut Consumer Protection Act (JT Alvey Phenibut Consumer Protection Act).

CH0705 HB1310 (Enrolled) Del Bhandari. Prescription Drug Repository Program - Revisions.

CH0706 HB1087 (Amended) Del Bhandari, et al. Health Insurance - Step Therapy or Fail-First Protocols - Drugs to Treat Associated Conditions of Advanced Metastatic Cancer.

CH0707 SB0921 (Amended) Sen Gile. Health Insurance - Step Therapy or Fail-First Protocols - Drugs to Treat Associated Conditions of Advanced Metastatic Cancer.

CH0708 SB0676 (Amended) Sen Gile. Health Care Facilities - Hospitals and Freestanding Birthing Centers - Perinatal Care Standards.

CH0709 HB1380 (Amended) Del Pena-Melnyk, et al. Health Care Facilities - Hospitals and Freestanding Birthing Centers - Perinatal Care Standards.

CH0710 SB0459 Sen Gile. Education and Health - Emergency Use Epinephrine - Alterations.

CH0711 HB0420 Del Palakovich Carr. Education and Health - Emergency Use Epinephrine - Alterations.

CH0712 HB0018 Del Palakovich Carr. Vehicle Laws - Noise Abatement Monitoring Systems Pilot Program - Inspection and Extension.

CH0713 HB0443 Del Taveras, et al. Baby Food Labeling - Statement Regarding Toxic Heavy Metal Testing - Terminology.

CH0714 HB0553 (Amended) Del Taveras, et al. Maryland Medical Assistance Program - Maternal Health Self-Measured Blood Pressure Monitoring.

CH0715 SB0094 (Amended) Sen Ellis. Maryland Medical Assistance Program - Maternal Health Self-Measured Blood Pressure Monitoring.

CH0716 SB0003 (Amended) Sen Ellis. Workgroup on the Creation of a Data Dashboard for Public Work Contracts and Apprentices - Establishment.

CH0717 HB0850 (Enrolled) Del Williams, et al. Workgroup on the Creation of a Data Dashboard for Public Work Contracts and Apprentices - Establishment.

CH0718 HB1222 (Enrolled) Del Williams, et al. Public Safety - Immigration Enforcement (Maryland Values Act).

CH0719 HB0334 (Amended) Del Kerr, et al. Workgroup on Newborn Nurse Home Visiting Services - Establishment.

CH0720 SB0156 (Enrolled) Sen Lewis Young. Workgroup on Newborn Home Visiting Services - Establishment.

CH0721 HB0297 (Amended) Del Kerr, et al. Maryland Health Benefit Exchange - State-Based Young Adult Health Insurance Subsidies Pilot Program - Sunset Repeal.

CH0722 SB0005 Sen Lam, et al. Maryland Health Benefit Exchange – State–Based Young Adult Health Insurance Subsidies Pilot Program – Sunset Repeal.

CH0723 SB0453 Sen King. State Contracts - Prohibited Provisions.

CH0724 HB0507 Del Kerr. State Contracts - Prohibited Provisions.

CH0725 HB0508 Del Kerr. State Procurement Preferences - Blind Industries and Services of Maryland - Packaging and Repackaging.

CH0726 SB0795 Sen Mautz. State Procurement Preferences - Blind Industries and Services of Maryland - Packaging and Repackaging.

CH0727 SB0962 (Amended) Sen Mautz. Municipalities - Legislative Audit - Exemption.

CH0728 SB0975 (Amended) Sen Lam. Health Insurance - Coverage for Specialty Drugs.

CH0729 HB1243 (Amended) Del S. Johnson, et al. Health Insurance - Coverage for Specialty Drugs.

CH0730 HB0813 (Enrolled) Del S. Johnson, et al. Maryland Insurance Administration and Maryland Department of Health - Workgroup to Study Pharmacy Benefits Managers.

CH0731 HB0367 (Amended) Del Martinez, et al. Health Occupations Boards - English Proficiency Requirements and Licensure by Endorsement for Nursing.

CH0732 SB0072 (Amended) Sen Lam. Health Occupations Boards - English Proficiency Requirements and Licensure by Endorsement for Nursing.

CH0733 HB0933 (Amended) Del Martinez, et al. Nursing Homes - Cost Reports.

CH0734 HB0634 (Enrolled) Dels Wims and Mireku-North. Income Tax - Income Tax Reconciliation Program - Established (Maryland Fair Taxation for Justice-Involved Individuals Act).

CH0735 SB0295 Sen McCray. Income Tax - Income Tax Reconciliation Program - Established (Maryland Fair Taxation for Justice-Involved Individuals Act).

CH0736 SB0653 (Enrolled) Sen McCray. Procurement - Employee Stock Ownership Plan Preference - Pilot.

CH0737 HB0819 (Enrolled) Del Guzzone, et al. Procurement - Employee Stock Ownership Plan Preference - Pilot.

CH0738 HB1315 (Amended) Del Guzzone, et al. Vaccinations by Pharmacists and Health Insurance Coverage for Immunizations.

CH0739 HB0406 (Amended) Del Guzzone, et al. State Board of Examiners for Audiologists, Hearing Aid Dispensers, Speech-Language Pathologists, and Music Therapists - Appointment of Hearing Aid Dispenser Members.

CH0740 SB0956 (Amended) Sen West. Health Insurance - Medicare Supplement Policies - Insurance Producer Commission.

CH0741 SB0547 (Amended) Sen James, et al. Commission to Study Health Insurance Pooling - Establishment.

CH0742 HB1355 Del Reilly, et al. Health Insurance - Required Coverage - Hearing Aids.

CH0743 SB0641 (Amended) Sen Gallion. Health Insurance - Required Coverage - Hearing Aids.

CH0744 HB0936 (Amended) Del Shetty, et al. Health Insurance - Cancellation and Nonrenewal of Coverage - Required Notice.

CH0745 HB0974 (Enrolled) Del Shetty, et al. Health Insurance - Preventive Services - High Deductible Health Plans and Enforcement Authority.

CH0746 HB1351 (Enrolled) Del Ghrist, et al. Health Insurance - Provider Panels - Credentialing for Behavioral Health Care Professionals.

CH0747 HB0820 (Amended) Del Hill, et al. Health Insurance - Utilization Review - Use of Artificial Intelligence.

CH0748 HB1478 (Amended) Del Hill, et al. Public Health - Report on Establishing a Directory of Home Health Care Providers.

CH0749 HB0855 Del Hill. Workgroup on Establishing a Science and Technology Best Practices and Innovation Network - Alterations.

CH0750 HB0765 (Amended) Del Ivey, et al. Hospitals - Medical Debt Collection - Sale of Patient Debt.

CH0751 HB1251 (Amended) Del Toles, et al. Hospitals and Medical Professional Liability Insurers - Obstetric Services Policies (Doula and Birth Policy Transparency Act).

CH0752 HB0871 (Enrolled) Del Bagnall, et al. Health Services Cost Review Commission - Community Benefits - Community Health Worker Workforce Program.

CH0753 HB1143 (Amended) Del Bagnall, et al. Maryland Collaborative to Improve Children's Oral Health Through School-Based Programs - Establishment.

CH0754 HB1142 (Enrolled) Del Bagnall, et al. Public Health - Maryland Interested Parties Advisory Group - Establishment.

CH0755 HB0745 (Amended) Del Guyton, et al. State Board of Professional Counselors and Therapists - Behavior Analysts - Licensure Applications.

CH0756 HB1244 (Enrolled) Del Guyton, et al. Maryland Developmental Disabilities Administration Waiver Advisory Council - Establishment.

CH0757 SB0740 (Enrolled) Sen Folden, et al. Health Care Facilities - Service Member Community Members (SFC Matthew Fast Act ).

CH0758 HB1502 Del Wells (BCA). Baltimore City - AIDS Prevention Sterile Needle and Syringe Exchange Pilot Program - Revisions.

CH0759 HB1131 Dels Vogel and Tomlinson. Public Health - Buprenorphine - Training Grant Program and Workgroup.

CH0760 SB0163 (Amended) Sen M. Washington. Health – General Article – References to Mental Health.

CH0761 SB0544 (Amended) Sens Bailey and M. Jackson. Food Establishments - Portable Chemical Toilets.

CH0762 HB0559 (Enrolled) Del T. Morgan. Food Establishments - Portable Chemical Toilets.

CH0763 HB1066 (Amended) Del Ruth, et al. Commission on Behavioral Health Care Treatment and Access - Workgroups.

CH0764 HB1072 (Amended) Del Forbes (Chr Jt Com on Pnsns). State Retirement and Pension System - Administrative Fees - Repeal.

CH0765 SB0862 (Amended) Sen M. Jackson (Chr Jt Com on Pnsns). State Retirement and Pension System - Administrative Fees - Repeal.

CH0766 SB0692 Sen M. Jackson (Chr Jt Com on Pnsns). State Retirement and Pension System - Alterations and Clarifications.

CH0767 HB1034 Del Forbes (Chr Jt Com on Pnsns). State Retirement and Pension System – Alterations and Clarifications.

CH0768 SB0457 (Amended) Sen M. Jackson (Chr Jt Com on Pnsns). State Retirement and Pension System - Transfers Between Systems - Workgroup.

CH0769 HB0584 (Amended) Del Forbes (Chr Jt Com on Pnsns). State Retirement and Pension System - Transfers Between Systems - Workgroup.

CH0770 HB0886 (Amended) Del Forbes (Chr Jt Com on Pnsns). State Retirement and Pension System – Deferred Vested Former Members – Return to Service.

CH0771 SB0612 (Amended) Sen M. Jackson (Chr Jt Com on Pnsns). State Retirement and Pension System - Deferred Vested Former Members - Return to Service.

CH0772 SB0810 (Amended) Sen M. Jackson (Chr Jt Com on Pnsns). Board of Trustees for the State Retirement and Pension System - Investment Division - Compensation and Staffing.

CH0773 HB1028 (Enrolled) Del Forbes (Chr Jt Com on Pnsns). Board of Trustees for the State Retirement and Pension System - Investment Division - Compensation and Staffing.

CH0774 HB1033 Del Forbes (Chr Jt Com on Pnsns). State Retirement and Pension System - Reemployment Earnings Limitations - Maximum Average Final Compensation.

CH0775 SB0693 Sen M. Jackson (Chr Jt Com on Pnsns). State Retirement and Pension System - Reemployment Earnings Limitations - Maximum Average Final Compensation.

CH0776 SB0768 Sen M. Jackson (Chr Jt Com on Pnsns). Correctional Officers' Retirement System - Membership - Clarifications.

CH0777 HB1029 Del Forbes (Chr Jt Com on Pnsns). Correctional Officers' Retirement System - Membership - Clarifications.

CH0778 SB0639 Sen McKay. Garrett County - Bids and Contracts - Advertisement Exceptions.

CH0779 HB1334 Del Hinebaugh. Garrett County - Bids and Contracts - Advertisement Exceptions.

CH0780 HB1167 (Amended) Mont Co Deleg and PG Co Deleg. Montgomery County - Municipal Authority to Regulate Structures - Alterations MC/PG 116-25.

CH0781 HB0490 (Amended) St. Mary's County Delegation. St. Mary's County - Competitive Bidding - Threshold.

CH0782 HB0515 Dels Rogers and Pruski. Anne Arundel County - Alcoholic Beverages Licenses - Veterans' Organizations.

CH0783 SB0017 (Amended) Sen Simonaire, et al. Anne Arundel County - Alcoholic Beverages Licenses - Veterans' Organizations.

CH0784 HB0835 Charles County Delegation. Charles County - Alcoholic Beverages - Baseball Stadium License - Alterations.

CH0785 SB0731 Charles County Senators. Charles County - Alcoholic Beverages - Baseball Stadium License - Alterations.

CH0786 HB1238 Del Otto, et al. Somerset County - Alcoholic Beverages - Liquor Tasting License.

CH0787 HB0486 St. Mary's County Delegation. St. Mary's County - Alcoholic Beverages - Civil Penalty for Sales Violations.

CH0788 HB0714 Harford County Delegation. Harford County - Alcoholic Beverages - Performing Arts Nonprofit Organization License - Record-Keeping Requirements.

CH0789 SB0745 (Amended) Harford County Senators. Harford County - Alcoholic Beverages - Performing Arts Nonprofit Organization License - Record-Keeping Requirements.

CH0790 HB0685 (Amended) Del Hinebaugh. Garrett County Alcoholic Beverages Act of 2025.

CH0791 SB0826 Sen McKay. Garrett County Alcoholic Beverages Act of 2025.

CH0792 SB0746 (Amended) Harford County Senators. Harford County - Alcoholic Beverages - Multiple Licenses - Golf Simulator Facilities.

CH0793 HB0712 Harford County Delegation. Harford County - Alcoholic Beverages - Multiple Licenses - Golf Simulator Facilities.

CH0794 SB0798 Wicomico County Senators. Wicomico County - Alcoholic Beverages - Temporary To-Go Event Permit and Class C Per Diem Municipal To-Go Beer, Wine, and Liquor License.

CH0795 HB0655 Wicomico County Delegation. Wicomico County - Alcoholic Beverages - Temporary To-Go Event Permit and Class C Per Diem Municipal To-Go Beer, Wine, and Liquor License.

CH0796 HB0571 (Amended) Del Kipke. Anne Arundel County - Alcoholic Beverages - Class C Licenses - Events.

CH0797 HB0987 (Amended) Baltimore County Delegation. Baltimore County - Alcoholic Beverages - Class B-OB-CRD (Office Building - Commercial Revitalization District) Beer, Wine, and Liquor License.

CH0798 HB1494 (Amended) Howard County Delegation. Howard County - Alcoholic Beverages - Class MT (Movie Theater) License.

CH0799 SB0800 (Amended) Dorchester County Senators. Dorchester County – Alcoholic Beverages – Arts Beer and Wine License.

CH0800 HB0567 (Amended) Dorchester County Delegation. Dorchester County - Alcoholic Beverages - Arts Beer and Wine License.

CH0801 HB0476 St. Mary's County Delegation. St. Mary's County - Alcoholic Beverages - Class A License Quota.

CH0802 HB0715 Harford County Delegation. Harford County - Alcoholic Beverages - Alteration of License Quota.

CH0803 SB1036 Sen Guzzone. Howard County – Alcoholic Beverages – Class D Licenses – Delivery Ho. Co. 21–25.

CH0804 HB1387 Howard County Delegation. Howard County - Alcoholic Beverages - Class D Licenses - Delivery.

CH0805 HB0346 (Amended) Dels Boyce and Embry. Baltimore City - Alcoholic Beverages - 43rd Alcoholic Beverages District - Class B-D-7 Licenses.

CH0806 SB0788 (Amended) Sen M. Washington. Baltimore City - Alcoholic Beverages - 43rd Alcoholic Beverages District - Class B-D-7 Licenses.

CH0807 HB0472 Del Addison. Baltimore City - Alcoholic Beverages - 45th Alcoholic Beverages District - Licenses.

CH0808 SB0304 Sen McCray. Baltimore City - Alcoholic Beverages - 45th Alcoholic Beverages District - Licenses.

CH0809 SB0744 (Amended) Harford County Senators. Harford County – Alcoholic Beverages – Hearing Notice.

CH0810 HB0754 Harford County Delegation. Harford County - Alcoholic Beverages - Hearing Notice.

CH0811 SB0939 (Amended) Sen Hayes. Baltimore City - Alcoholic Beverages - Authorizations and Revisions.

CH0812 HB1172 (Amended) Del Amprey. Baltimore City – Alcoholic Beverages – Authorizations and Revisions.

CH0813 HB0784 (Enrolled) Del Clippinger, et al. Baltimore City - Alcoholic Beverages Licenses - Alterations.

CH0814 SB0662 (Enrolled) Sen Ferguson. Baltimore City - Alcoholic Beverages Licenses - Alterations.

CH0815 HB0746 (Amended) Baltimore County Delegation. Baltimore County - Alcoholic Beverages Licenses - Transfers.

CH0816 HB0409 Del Pruski. Anne Arundel County - Board of License Commissioners - Part-Time Deputy Chief Inspector - Compensation.

CH0817 SB0568 Anne Arundel County Senators. Anne Arundel County - Board of License Commissioners - Part-Time Deputy Chief Inspector - Compensation.

CH0818 SB0571 (Amended) Anne Arundel County Senators. Anne Arundel County - Class A (Off-Sale) and Class D (Off-Sale) Licenses - Population Ratio Quota.

CH0819 HB0099 (Enrolled) Del Rogers. Anne Arundel County - Class A (Off-Sale) and Class D (Off-Sale) Licenses - Population Ratio Quota.

CH0820 HB0564 (Amended) Dorchester County Delegation. Dorchester County - Alcoholic Beverages - Venue Beer, Wine, and Liquor License.

CH0821 SB0802 (Amended) Dorchester County Senators. Dorchester County - Alcoholic Beverages - Venue Beer, Wine, and Liquor License.

CH0822 HB0866 Frederick County Delegation. Frederick County - Alcoholic Beverages - Class C (Theater) Beer, Wine, and Liquor License.

CH0823 SB0670 Frederick County Senators. Frederick County - Alcoholic Beverages - Class C (Theater) Beer, Wine, and Liquor License.

CH0824 HB1026 Frederick County Delegation. Frederick County - Alcoholic Beverages - Tasting Permits.

CH0825 SB0636 (Amended) Frederick County Senators. Frederick County - Alcoholic Beverages - Tasting Permits.

CH0826 SB0284 Sen McCray. Baltimore City - Alcoholic Beverages - Hours of Operation Violations - Civil Penalties.

CH0827 SB1013 Sen Attar. Baltimore City - Alcoholic Beverages - License Extension.

CH0828 HB0569 Dorchester County Delegation. Dorchester County - Alcoholic Beverages - Beer, Wine, and Liquor Tasting License.

CH0829 SB0839 Dorchester County Senators. Dorchester County – Alcoholic Beverages – Beer, Wine, and Liquor Tasting License.

CH0830 SB0910 (Amended) Caroline County Senators. Caroline County - Alcoholic Beverages - Special Event Venue License and Multiple Event Licenses.

CH0831 HB1335 (Enrolled) Caroline County Delegation. Caroline County - Alcoholic Beverages - Special Event Venue License and Multiple Event Licenses.

CH0832 HB0566 Dorchester County Delegation. Dorchester County - Alcoholic Beverages Licenses - Fees.

CH0833 SB0869 Sen Mautz. Dorchester County - Alcoholic Beverages Licenses - Fees.

CH0834 HB0512 Frederick County Delegation. Frederick County - Barbershop and Beauty Salon Beer and Wine License - Alterations.

CH0835 SB0738 (Amended) Frederick County Senators. Frederick County – Barbershop and Beauty Salon Beer and Wine License – Alterations.

CH0836 HB1095 (Amended) Montgomery County Delegation. Montgomery County - Alcoholic Beverages - Beauty Salon and Barbershop License MC 3-25.

CH0837 HB1174 (Enrolled) Montgomery County Delegation. Montgomery County - Alcoholic Beverages - Class BD-BWL Licenses - Multiple Licenses MC 18-25.

CH0838 SB0888 Sen Henson. Anne Arundel County - Alcoholic Beverages - License and Permit Distance Requirements.

CH0839 HB1259 Del Howard. Anne Arundel County - Alcoholic Beverages - License and Permit Distance Requirements.

CH0840 HB0574 (Amended) St. Mary's County Delegation. St. Mary's County - Alcoholic Beverages Licenses - Multiple Licensing Plans.

CH0841 HB1145 (Amended) Baltimore County Delegation. Baltimore County - Alcoholic Beverages - Waiting Period After License Denial.

CH0842 HB1281 (Amended) Del Kipke. Anne Arundel County - Alcoholic Beverages - Limited Special Event Permit.

CH0843 HB1108 Allegany County Delegation. Allegany County - Alcoholic Beverages - Minimum Age for Employment of Underage Individuals.

CH0844 HB0049 (Enrolled) Chr ENT (Dept). Environment - Building Energy Performance Standards - Alterations and Analysis.

CH0845 HB0738 (Amended) Del Kaiser, et al. Department of Information Technology - Major Information Technology Development Projects - Oversight.

CH0846 SB0705 (Amended) Sens Hester and Hershey. Department of Information Technology - Major Information Technology Development Projects - Oversight.

CH0847 HB1294 (Amended) Dels Wilson and Amprey. Commercial Law - Credit Regulation - Earned Wage Access and Credit Modernization.

CH0848 HB0788 (Amended) Chr JUD (Md Jud Conf), et al. Judiciary Department - Commission on Judicial Disabilities - Temporary Appointment.

CH0849 SB0619 (Enrolled) Chr JPR (Md Jud Conf). Judiciary Department - Commission on Judicial Disabilities - Temporary Appointment.

The Judiciary

SUPREME COURT OF MARYLAND

DISCIPLINARY PROCEEDINGS

This is to certify that by an Order of this Court dated May 21, 2025, SARI KARSON KURLAND (CPF# 0007170001) As of May 21, 2025, Sari Karson Kurland has been disbarred effective immediately, and her name has been stricken from the register of attorneys in this Court. Notice of this action is given in accordance with Maryland Rule 19-761(b).

* * * * * * * * * *

This is to certify that by an Order of this Court dated May 21, 2025, AUBREY PAIGE POPPLETON (CPF# 1512160190) As of May 21, 2025, Aubrey Paige Poppleton name has been replaced on the register of attorneys permitted to practice law in the Supreme Court of Maryland. Notice of this action is given in accordance with Maryland Rule 19-761(b).

Final Action on Regulations

Symbol Key

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

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

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

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

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

Title 09
MARYLAND DEPARTMENT OF LABOR

Subtitle 08 HOME IMPROVEMENT COMMISSION

Notice of Final Action

[25-028-F]

On May 30, 2025, the Home Improvement Commission adopted amendments to:

(1) Regulations .04 and .19 under COMAR 09.08.01 General Regulations,

(2) Regulations .02 and .03 under COMAR 09.08.03 Claims Against the Home Improvement Guaranty Fund; and

(3) Regulation .02 under COMAR 09.08.06 Civil Citations.

This action, which was proposed for adoption in 52:6 Md. R. 271—273 (March 21, 2025), has been adopted as proposed.

Effective Date: June 23, 2025.

KENNETH SIGMAN
Assistant Attorney General

Title 29
MARYLAND STATE POLICE

Subtitle 06 FIRE PREVENTION COMMISSION

29.06.01 Fire Prevention Code

Authority: Public Safety Article, §§6-206 and 6-501, Annotated Code of Maryland

Notice of Final Action

[24-207-F-I]

On June 6, 2025, the Department of State Police adopted amendments to Regulations .02, .05—.09, and .14 under COMAR 29.06.01 Fire Prevention Code. This action, which was proposed for adoption in 52:3 Md. R. 172—178 (February 7, 2025), has been adopted as proposed.

Effective Date: June 23, 2025.

ROLAND L. BUTLER JR.

Superintendent of State Police

Title 36
MARYLAND STATE LOTTERY AND GAMING CONTROL AGENCY

Subtitle 02 LOTTERY PROVISIONS

36.02.08 Voluntary Assignment of Monetary Prizes

Authority: Criminal Procedure Article, §11-618; Family Law Article, §10-113.1; State Finance and Procurement Article, §3-307; State Government Article, §§9-109, 9-110, and 9-122, Annotated Code of Maryland.

Notice of Final Action

[24-185-F]

On May 22, 2025, the Maryland Lottery and Gaming Control Commission adopted amendments to Regulations .01—.04, the repeal of existing Regulations .05 and .09, and the amendment and recodification of existing Regulations .06—.08 to be Regulations .05—.07 under COMAR 36.02.08 Voluntary Assignment of Monetary Prizes. This action, which was proposed for adoption in 51:25 Md. R. 1170—1172 (December 13, 2024), has been adopted as proposed.

Effective Date: June 23, 2025.

JOHN MARTIN
Director

Proposed Action on Regulations

Title 09
MARYLAND DEPARTMENT OF LABOR

Subtitle 11 REAL ESTATE COMMISSION

09.11.07 Residential Property Disclosure/ Disclaimer Statement

Authority: Business Occupations and Professions Article, §17-208; Real Property Article, §10-702(c)(2), Annotated Code of Maryland

Notice of Proposed Action

[24-168-P]

The Maryland Real Estate Commission proposes to amend the Commission's Real Property Disclosure/Disclaimer Statement form. This action was considered at the Commission's public meeting held on February 19, 2025.

Statement of Purpose

The purpose of this action is to update the Maryland Real Estate Commission's Real Property Disclosure/Disclaimer Statement form.

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 Scott Lederer, Executive Director, Maryland Real Estate Commission, Maryland Real Estate Commission, 100 S. Charles St., Tower 1, 3rd Floor, Baltimore, MD 21201 , or call 410-230-6227, or email to scott.lederer@maryland.gov. Comments will be accepted through July 14, 2025. A public hearing has not been scheduled.

Open Meeting

Final action on the proposal will be considered by Maryland Real Estate Commission during a public meeting to be held on July 16, 2025 at 10:30 a.m. To access the meeting using video conferencing go to meet.google.com/mve-nbse-fgv
To access the meeting by dialing in from a phone: (US)+1 515-329-5263. PIN: 461 304 044#.

NOTE: The form referred to in this proposal appears at the end of the Proposed Action on Regulations section of this issue .

DONNA HORGAN
Chair, Maryland Real Estate Commission

Subtitle 33 JOB SERVICE

09.33.02 Economic Stabilization

Authority: Labor and Employment Article, §§11-301—[11-304]11-306, State Government Article, §10-206; Annotated Code of Maryland

Notice of Proposed Action

[25-054-P]

The Maryland Department of Labor proposes to amend existing Regulations .01—.03, adopt new Regulations .04, .08, and .09, and amend and recodify existing Regulations .04—.06 to be Regulations .05—.07 under COMAR 09.33.02 Economic Stabilization.

Statement of Purpose

The purpose of this action is to amend the regulations based on the passing of Senate Bill 780, which became law in the 2020 legislative session and Senate Bill 801, which was adopted in 2021, both of which amend certain aspects of the Economic Stabilization Act. Updated regulations are needed to reflect these changes and to ensure proper procedures in administration, execution, and oversight of the Economic Stabilization Act. These regulations will:

(1) Change reporting guidelines for eligible employers from voluntary to mandatory;

(2) Outline exceptions to the act;

(3) Add definitions for “Employer,” “Employee,” and “Secretary” and update the definition to “reduction in operations;” change the timeline of written notice from an employer before a reduction in operations;

(4) Give the Maryland Labor Secretary or the Secretary’s designee authority to compel compliance; and

(5) Grant violation and penalty discretion to the Maryland Labor Secretary or the Secretary’s designee.

Estimate of Economic Impact

I. Summary of Economic Impact. For businesses that have a permanent reduction in operations, they will be required to report to the Maryland Department of Labor or may be subject to a fine of up to $10,000 per day. Assuming that businesses comply as required, there would be no economic impact from these regulations.

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:
Business	(-)	Small
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). Any business that that has a permanent reduction in operations will be required to report to the Maryland Department of Labor or may be subject to a fine of up to $10,000 per day. Assuming that businesses comply as required, there would be no economic impact from these regulations.

Economic Impact on Small Businesses

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

For small businesses that meet the size threshold for compliance under these regulations and that have a permanent reduction in operations, they will be required to report to the Maryland Department of Labor or may be subject to a fine of up to $10,000 per day. Assuming that businesses comply as required, there would be no economic impact from these regulations.

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

Comments may be sent to Dylan McDonough, Senior Policy Analyst, Maryland Department of Labor Division of Workforce Development and Adult Learning, 100 South Charles St. (Tower I, Suite 2000) Baltimore, MD 21201, or call 410-767-1890, or email to dylan.mcdonough@maryland.gov. Comments will be accepted through July 14, 2025. A public hearing has not been scheduled.

.01 Purpose.

The Economic Stabilization Act regulations provide [voluntary] notice requirements and guidelines for employers faced with a major reduction in the [work force] workforce.

.02 [Exceptions.] Exemptions.

[This law does not apply to reductions in operations if the reduction:

A. Results solely from labor disputes;

B. Occurs in a commercial, industrial, or agricultural enterprise operated by this State or its political subdivisions;

C. Occurs at construction sites or other temporary work places;

D. Results from seasonal factors that are determined to be customary in the industry; or

E. Results when an employer files for bankruptcy under federal bankruptcy laws.] This chapter does not apply to a reduction in operations as described in Labor and Employment Article, §11-302, Annotated Code of Maryland.

.03 Definitions.

[A. "Employer" means a person, corporation, or other entity that employs at least 50 individuals and operates an industrial, commercial, or business enterprise in the State. "Employer" does not mean the State or its political subdivisions. "Employer" does not include any employer who has been doing business in the State for less than 1 year.

B. "Reduction in operations" means the:

(1) Relocation of a part of an employer's operation from one work place to another site; or

(2) Shutting down of a work place or a portion of the operations of a work place that reduces the number of employees by at least 25 percent or 15 employees, whichever is greater, over any 3-month period.

C. Work Place.

(1) "Work place" means:

(a) A factory;

(b) A plant;

(c) An office; or

(d) Other facility where employees produce goods or provide services.

(2) "Work place" does not mean a:

(a) Construction site; or

(b) Temporary work place.]

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

B. Terms Defined.

(1) “Bulk claims” means deploying Maryland Division of Unemployment Insurance to the employer’s and employees’ place of business to assist the employees in filing unemployment claims through the unemployment online claim filing system for incidents where 25 or more workers are laid off at one time.

(2) “Employee” has the meaning stated in Labor and Employment Article, §11-301(b), Annotated Code of Maryland.

(3) Employer.

(a) “Employer” means a person, corporation, or other entity that:

(i) Operates an industrial, commercial, or business enterprise;

(ii) Employs at least 50 employees;

(iii) Has been operating for at least 1 year; and

(iv) Is operating in the State of Maryland.

(b) “Employer” does not mean the State or its political subdivisions.

(4) “Permanent” has the meaning stated in Labor and Employment Article, §11-301(d), Annotated Code of Maryland.

(5) "Reduction in operations" has the meaning stated in Labor and Employment Article, §11-301(e), Annotated Code of Maryland.

(6) “Remote worker” refers to an employee, or multiple employees operating under the same Employer Identification Number, with a permanent work arrangement under which they are scheduled to perform duties, responsibilities, and other authorized activities of such employee’s position at an approved worksite other than the assigned workplace.

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

(8) “Telework” refers to a worksite flexibility agreement for the purpose of allowing an employee or employees to perform their duties, responsibilities, and other authorized activities of such employee’s position from an approved alternative worksite other than the employee’s official duty station.

(9) Workplace.

(a) “Workplace” has the meaning stated in Labor and Employment Article, §11-301(f), Annotated Code of Maryland.

(b) “Workplace” includes the official duty station or agency worksite for telework employees within the State of Maryland.

(c) “Workplace” includes the entire State of Maryland, which is considered a single workplace for any remote worker or collection of remote workers.

.04 Notice.

At least 60 calendar days prior to initiating a reduction in operations, an employer shall provide written notice as required by Labor and Employment Article, §11-305, Annotated Code of Maryland.

[.04] .05 [Voluntary] Guidelines for Employers Anticipating a Permanent Reduction in [Work Force] Operations.

A. Employers facing a reduction in operations [should:

(1) Meet] shall use their best efforts to meet with employee representatives regarding concessions or alternatives, or both, [to closure in order to save the place and save jobs] in an effort to prevent closure and the reduction in operations.

[(2) Notify all impacted employees if a reduction in operation is required:

(a) At least 90 days before the termination date; and

(b) By written notice to each employee.]

B. Termination Phase-In.

(1) (text unchanged)

(2) If collective bargaining agreements are in force, then the employer shall implement the provisions of [the] each agreement as the agreement pertains to termination and seniority.

C.—D. (text unchanged)

[.05] .06 Assistance from the Maryland Department of Labor.

A. The Maryland Department of Labor shall make the [Quick] Rapid Response Program available to employers consisting of:

(1)—(6) (text unchanged)

B. (text unchanged)

[.06] .07 Mechanisms to Start Assistance Programs from the Maryland Department of Labor.

A. Employers may contact the Assistant Secretary for the Division of [Employment and Training] Workforce Development and Adult Learning.

B. The Secretary [of the Maryland Department of Labor] shall:

(1)—(2) (text unchanged)

(3) Contact all employers in the State who appear to be faced with or planning a permanent reduction in operations. This contact shall be:

[(a) Made by telephone;]

(a) Consider confidential, commercial, and financial information;

[(c)](b) Directed to the chief executive of the business, or designee; and

[(d)](c) (text unchanged)

C. If the employer approves, the Maryland Department of Labor [shall contact the Department of Housing and Community Development to provide whatever assistance is deemed appropriate.] may contact other partner organizations to provide whatever assistance and resources are deemed appropriate.

.08 Order Compelling Compliance.

A. Issuance.

(1) If, after investigation, the Secretary, or the Secretary’s designee, believes an employer has violated Labor and Employment Article, §11-305, Annotated Code of Maryland, or a regulation adopted pursuant to this Act, the Secretary shall, with reasonable promptness, issue an order compelling compliance.

(2) An order shall:

(a) Be in writing;

(b) Describe with specificity the nature of the alleged violation;

(c) State the penalty, if any, that the Secretary proposes to assess under Labor and Employment Article, §11-306, Annotated Code of Maryland; and

(d) Inform a party of the requirements of §B(2) of this regulation.

B. Enforcement.

(1) A party to whom an order is issued may file with the Secretary, or the Secretary’s designee, a written notice of contest to the proposed penalty.

(2) Notice shall be:

(a) In writing; and

(b) Postmarked within 15 business days of the date of the order.

(3) If a party does not file proper notice of contest, any proposed penalty becomes final upon the expiration of 15 business days following the party's receipt of the order.

(4) If a party files a notice of contest in accordance with this regulation, the Secretary, or the Secretary’s designee, shall delegate the hearing to the Office of Administrative Hearings.

(5) A contested hearing shall be governed by COMAR 09.01.03.

.09 Penalties and Scope.

A. This regulation applies to the assessment of civil penalties by the Secretary, or the Secretary’s designee, under Labor and Employment Article, §11-306, Annotated Code of Maryland, in all cases arising from a violation of Labor and Employment Article, §11-305, Annotated Code of Maryland.

B. In assessing a penalty for a violation of the law, a regulation, or an order, the Secretary or the Secretary’s designee shall consider the factors listed in Labor and Employment Article, §11-306(b), Annotated Code of Maryland.

PORTIA WU
Secretary of Labor

Title 10
MARYLAND DEPARTMENT OF HEALTH

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.28 Applied Behavior Analysis Services

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

Notice of Proposed Action

[25-108-P]

The Secretary of Health proposes to amend Regulations .04 and .06 under COMAR 10.09.28 Applied Behavior Analysis Services.

Statement of Purpose

The purpose of this action is to:

(1) Update reimbursement rates for Applied Behavioral Analysis (ABA) services for Fiscal Year 2024 and Fiscal Year 2025; and

(2) Update covered services to reflect new in-person requirements for certain services.

Estimate of Economic Impact

I. Summary of Economic Impact. In accordance with the Fiscal Year 2025 Budget Bill, this action includes a 3 percent rate increase for Applied Behavioral Analysis (ABA) services effective July 1, 2024; the total impact for Fiscal Year 2025 is $3,404,488.

II. Types of Economic Impact.

Impacted Entity	Revenue (R+/R-) Expenditure (E+/E-)	Magnitude
A. On issuing agency:
Maryland Department of Health	(E+)	$3,833,925
B. On other State agencies:	NONE
C. On local governments:	NONE
	Benefit (+) Cost (-)	Magnitude
D. On regulated industries or trade groups:
ABA Medicaid Providers	(+)	$3,833,925
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. (a) Applied Behavioral Analysis utilization will continue at current levels—approximately $127,797,497 in FY24.

(b) Effective July 1, 2024, ABA providers received a 3 percent rate increase. For the period July 1, 2024 through June 30, 2025, the total anticipated impact is $3,833,924.91.

(c) This amount is subject to a 65.6 percent federal match.

D. See A., above.

Economic Impact on Small Businesses

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

To the extent that Applied Behavioral Analysis providers qualify as small businesses, they will benefit from increased reimbursement during Fiscal Year 2024 and Fiscal Year 2025.

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 July 14, 2025. A public hearing has not been scheduled.

.04 Covered Services.

A. (text unchanged)

B. The Program covers the following ABA services:

(1)—(5) (text unchanged)

(6) Multiple-family group adaptive behavior treatment guidance that:

(a) Is provided in person or remotely with parents or caregivers of multiple participants without the presence of the participants by:

(i)—(ii) (text unchanged)

(b) Identifies maladaptive behaviors and skills deficits; [and]

(c) Instructs parents or caregivers on how to utilize ABA treatments to reduce maladaptive behaviors and skill deficits; and

(d) Is performed in person for at least 25 percent of the session time each month;

(7) Family adaptive behavior treatment guidance which:

(a) (text unchanged)

(b) Identifies maladaptive behaviors and skills deficits; [and]

(c) Instructs the parent or caregiver on how to utilize ABA strategies to reduce maladaptive behaviors and skill deficits; and

(d) Is performed in person for at least 25 percent of the session time each month;

(8)—(9) (text unchanged)

(10) Adaptive behavior treatment direction of a technician which is the clinical direction and oversight of a BCaBA, RBT, or a BT by a licensed psychologist or an LBA that:

(a) Requires the licensed psychologist or the LBA to directly or remotely observe the BCaBA, RBT, or BT administering ABA services to the participant, group of participants, parent, or caregiver; [and]

(b) Is performed on an ongoing basis, equal to at least 10 percent of the amount of hours that the BCaBA, RBT, or BT is providing direct ABA services to the participant, or group of participants; and

(c) Is performed in person for at least 25 percent of the session time each month;

(11)—(12) (text unchanged)

C.—F. (text unchanged)

.06 Payment Procedures.

A.—E. (text unchanged)

[F. For dates of service from November 1, 2021 through June 30, 2022, reimbursement for ABA services covered under this chapter is as follows:

(1) Behavior identification assessment at a rate of $29.60 per 15 minutes;

(2) Behavior identification assessment follow-up at a rate of $14.80 per 15 minutes;

(3) Exposure behavior identification supporting assessment at a rate of $40.37 per 15 minutes;

(4) Adaptive exposure behavior treatment with protocol modification at a rate of $40.37 per 15 minutes;

(5) Group adaptive behavior treatment by protocol at a rate of:

(a) $8.07 per 15 minutes, per participant, when provided by a licensed psychologist or an LBA;

(b) $6.46 per 15 minutes, per participant, when provided by a BCaBA; and

(c) .38 per 15 minutes, per participant, when provided by an RBT;

(6) Adaptive behavior treatment with protocol modification at a rate of $29.60 per 15 minutes;

(7) Multiple-family group adaptive behavior treatment guidance at a rate of $9.96 per 15 minutes per family;

(8) Family adaptive behavior treatment guidance with the participant present at a rate of:

(a) $29.60 per 15 minutes when provided by a licensed psychologist or an LBA; and

(b) $16.15 per 15 minutes when provided by a BcaBA;

(9) Family adaptive behavior treatment guidance without the participant present at a rate of:

(a) $16.15 per 15 minutes when provided by a licensed psychologist or an LBA; and

(b) $9.42 per 15 minutes when provided by a BcaBA;

(10) Behavior identification reassessment at a rate of $29.60 per 15 minutes;

(11) Group adaptive treatment with protocol modification at a rate of $8.07 per 15 minutes per participant;

(12) Adaptive behavior treatment direction at a rate of $29.60 per 15 minutes;

(13) Adaptive behavior treatment by protocol at a rate of:

(a) $18.84 per 15 minutes when provided by a licensed psychologist or an LBA;

(b) $16.15 per 15 minutes when provided by a BcaBA; and

(c) $14.80 per 15 minutes when provided by an RBT; and

(14) Adaptive behavior treatment planning:

(a) At a rate of $29.60 per 15 minutes; and

(b) For a maximum of 4 hours per month.]

[G.] F. Effective July 1, 2022 through June 30, 2023, reimbursement for ABA services covered under this chapter is as follows:

(1)—(14) (text unchanged)

G. Effective July 1, 2023 through January 1, 2024, reimbursement for ABA services covered under this chapter is as follows:

(1) Behavior identification assessment at a rate of $34.46 per 15 minutes;

(2) Behavior identification assessment follow-up at a rate of $17.23 per 15 minutes;

(3) Exposure behavior identification supporting assessment at a rate of $47.00 per 15 minutes;

(4) Adaptive exposure behavior treatment with protocol modification at a rate of $47.00 per 15 minutes;

(5) Group adaptive behavior treatment by protocol at a rate of:

(a) $9.40 per 15 minutes, per participant, when provided by a licensed psychologist or an LBA;

(b) $7.52 per 15 minutes, per participant, when provided by a BCaBA; and

(c) $6.26 per 15 minutes, per participant, when provided by an RBT or BT;

(6) Adaptive behavior treatment with protocol modification at a rate of $33.46 per 15 minutes;

(7) Multiple-family group adaptive behavior treatment guidance at a rate of $11.60 per 15 minutes per family;

(8) Family adaptive behavior treatment guidance with the participant present at a rate of:

(a) $34.46 per 15 minutes when provided by a licensed psychologist or an LBA; and

(b) $18.80 per 15 minutes when provided by a BCaBA;

(9) Family adaptive behavior treatment guidance without the participant present at a rate of:

(a) $18.80 per 15 minutes when provided by a licensed psychologist or an LBA; and

(b) $10.97 per 15 minutes when provided by a BCaBA;

(10) Behavior identification reassessment at a rate of $34.46 per 15 minutes;

(11) Group adaptive treatment with protocol modification at a rate of $9.40 per 15 minutes per participant;

(12) Adaptive behavior treatment direction at a rate of $34.46 per 15 minutes;

(13) Adaptive behavior treatment by protocol at a rate of:

(a) $21.94 per 15 minutes when provided by a licensed psychologist or an LBA;

(b) $18.80 per 15 minutes when provided by a BCaBA; and

(c) $17.23 per 15 minutes when provided by an RBT or BT; and

(14) Adaptive behavior treatment planning:

(a) At a rate of $34.46 per 15 minutes; and

(b) For a maximum of 4 hours per month.

H. Effective January 1, 2024 through June 30, 2024, reimbursement for ABA services covered under this chapter is as follows:

(1) Behavior identification assessment at a rate of $37.22 per 15 minutes;

(2) Behavior identification assessment follow-up at a rate of $18.61 per 15 minutes;

(3) Exposure behavior identification supporting assessment at a rate of $50.76 per 15 minutes;

(4) Adaptive exposure behavior treatment with protocol modification at a rate of $50.76 per 15 minutes;

(5) Group adaptive behavior treatment by protocol at a rate of:

(a) $10.15 per 15 minutes, per participant, when provided by a licensed psychologist or an LBA;

(b) $8.12 per 15 minutes, per participant, when provided by a BCaBA; and

(c) $6.76 per 15 minutes, per participant, when provided by an RBT or BT;

(6) Adaptive behavior treatment with protocol modification at a rate of $37.22 per 15 minutes;

(7) Multiple-family group adaptive behavior treatment guidance at a rate of $12.53 per 15 minutes per family;

(8) Family adaptive behavior treatment guidance with the participant present at a rate of:

(a) $37.22 per 15 minutes when provided by a licensed psychologist or an LBA; and

(b) $20.30 per 15 minutes when provided by a BCaBA;

(9) Family adaptive behavior treatment guidance without the participant present at a rate of:

(a) $20.30 per 15 minutes when provided by a licensed psychologist or an LBA; and

(b) $11.85 per 15 minutes when provided by a BCaBA;

(10) Behavior identification reassessment at a rate of $37.22 per 15 minutes;

(11) Group adaptive treatment with protocol modification at a rate of $10.15 per 15 minutes per participant;

(12) Adaptive behavior treatment direction at a rate of $37.22 per 15 minutes;

(13) Adaptive behavior treatment by protocol at a rate of:

(a) $23.70 per 15 minutes when provided by a licensed psychologist or an LBA;

(b) $20.30 per 15 minutes when provided by a BCaBA; and

(c) $18.61 per 15 minutes when provided by an RBT or BT; and

(14) Adaptive behavior treatment planning:

(a) At a rate of $37.22 per 15 minutes; and

(b) For a maximum of 4 hours per month.

I. Effective July 1, 2024, reimbursement for ABA services covered under this chapter is as follows:

(1) Behavior identification assessment at a rate of $38.34 per 15 minutes;

(2) Behavior identification assessment follow-up at a rate of $19.17 per 15 minutes;

(3) Exposure behavior identification supporting assessment at a rate of $52.28 per 15 minutes;

(4) Adaptive exposure behavior treatment with protocol modification at a rate of $52.28 per 15 minutes;

(5) Group adaptive behavior treatment by protocol at a rate of:

(a) $10.45 per 15 minutes, per participant, when provided by a licensed psychologist or an LBA;

(b) $8.36 per 15 minutes, per participant, when provided by a BCaBA; and

(c) $6.96 per 15 minutes, per participant, when provided by an RBT or BT;

(6) Adaptive behavior treatment with protocol modification at a rate of $38.34 per 15 minutes;

(7) Multiple-family group adaptive behavior treatment guidance at a rate of $12.91 per 15 minutes per family;

(8) Family adaptive behavior treatment guidance with the participant present at a rate of:

(a) $38.34 per 15 minutes when provided by a licensed psychologist or an LBA; and

(b) $20.91 per 15 minutes when provided by a BCaBA;

(9) Family adaptive behavior treatment guidance without the participant present at a rate of:

(a) $20.91 per 15 minutes when provided by a licensed psychologist or an LBA; and

(b) $12.21 per 15 minutes when provided by a BCaBA;

(10) Behavior identification reassessment at a rate of $38.34 per 15 minutes;

(11) Group adaptive treatment with protocol modification at a rate of $10.45 per 15 minutes per participant;

(12) Adaptive behavior treatment direction at a rate of $38.34 per 15 minutes;

(13) Adaptive behavior treatment by protocol at a rate of:

(a) $24.41 per 15 minutes when provided by a licensed psychologist or an LBA;

(b) $20.91 per 15 minutes when provided by a BCaBA; and

(c) $19.17 per 15 minutes when provided by an RBT or BT; and

(14) Adaptive behavior treatment planning:

(a) At a rate of $38.34 per 15 minutes; and

(b) For a maximum of 4 hours per month.

LAURA HERRERA SCOTT
Secretary of Health

Subtitle 09 MEDICAL CARE PROGRAMS

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

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

Notice of Proposed Action

[25-106-P]

The Secretary of Health proposes to amend Regulation .07 under COMAR 10.09.53 Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old.

Statement of Purpose

The purpose of this action is to implement a 3 percent increase for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Private Duty Nursing services in accordance with the State’s FY 2025 Budget.

Estimate of Economic Impact

I. Summary of Economic Impact. The proposed action implements a 3 percent rate increase for EPSDT Private Duty Nursing providers. The total impact of this change is $10,641,264.

II. Types of Economic Impact.

Impacted Entity	Revenue (R+/R-) Expenditure (E+/E-)	Magnitude
A. On issuing agency:
Maryland Department of Health	(E+)	$10,641,264
B. On other State agencies:	NONE
C. On local governments:	NONE
	Benefit (+) Cost (-)	Magnitude
D. On regulated industries or trade groups:
EPSDT Private Duty Nursing Providers	(+)	$10,641,264
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). (a) Effective July 1, 2024, EPSDT providers will receive a 3 percent rate increase.

(b) The current quarterly cost for these services is $ 88,677,200. The new quarterly cost will be $91,337,516. This reflects a quarterly total cost difference of $2,660,316.

(c) $2,660,316 x 4 = $10,641,264.

(d) For the period July 1, 2024 through June 30, 2025, the total impact ($10,641,264) is subject to a 50 percent blended federal match ($5,320,632 federal funds and $5,320,632 general funds).

D. See A., above.

Economic Impact on Small Businesses

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

Many of the providers of EPSDT services under this chapter are small businesses that will benefit from additional rate increases under the provisions of the proposed action.

Impact on Individuals with Disabilities

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

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

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 July 14, 2025. A public hearing has not been scheduled.

.07 Payment Procedures.

A.—B. (text unchanged)

C. Rates.

(1) Effective July 1, 2022 through December 31, 2023, rates for the services outlined in this regulation shall be as follows:

(a)—(i) (text unchanged)

[(2) Effective July 1, 2021, the Program’s rates as specified in this regulation shall increase by 4 percent each year, subject to the limitations of the State budget.]

(2) Effective January 1, 2024 through June 30, 2024, rates for the services outlined in this regulation shall be as follows:

(a) $19.2951 for 15 minutes of services provided by a registered nurse to one participant;

(b) $13.3101 for 15 minutes of services provided by a registered nurse to each of two or more participants in the same residence;

(c) $12.5061 for 15 minutes of services provided by a licensed practical nurse to one participant;

(d) $8.6266 for 15 minutes of services provided by a licensed practical nurse to each of two or more participants in the same residence;

(e) $6.6105 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to one participant;

(f) $4.5611 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to each of two or more participants in the same residence;

(g) $5.4874 for 15 minutes of services provided by a CNA or HHA to one participant;

(h) $3.7848 for 15 minutes of services provided by a CNA or HHA to two or more participants in the same residence; and

(i) A flat rate of $77.13 per visit for a registered nurse supervisory visit of a nurse, CNA, or HHA.

(3) Effective July 1, 2024, rates for the services outlined in this regulation shall be as follows:

(a) $19.8739 for 15 minutes of services provided by a registered nurse to one participant;

(b) $13.7094 for 15 minutes of services provided by a registered nurse to each of two or more participants in the same residence;

(c) $12.8813 for 15 minutes of services provided by a licensed practical nurse to one participant;

(d) $8.8854 for 15 minutes of services provided by a licensed practical nurse to each of two or more participants in the same residence;

(e) $6.8088 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to one participant;

(f) $4.6979 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to each of two or more participants in the same residence;

(g) $5.6520 for 15 minutes of services provided by a CNA or HHA to one participant;

(h) $3.8983 for 15 minutes of services provided by a CNA or HHA to two or more participants in the same residence; and

(i) A flat rate of $79.44 per visit for a registered nurse supervisory visit of a nurse, CNA, or HHA.

(4) The Program’s rates as specified in this regulation shall adjust each year, subject to the limitations of the State budget.

D. (text unchanged)

LAURA HERRERA SCOTT
Secretary of Health

10.09.54 Home and Community-Based Options Waiver

Authority: Health-General Article, §§2-104(b), 15-103, 15-105, 15-132, and 15-141.2, Annotated Code of Maryland

Notice of Proposed Action

[25-109-P]

The Acting Secretary of Health proposes to amend Regulations .04 and .22 under COMAR 10.09.54 Home and Community-Based Options Waiver.

Statement of Purpose

The purpose of this action is to:

(1) Update requirements to include that all service providers conduct a background check to align with current Department policy;

(2) Prohibit a provider with a conviction or history of behavior that could be harmful to participants from serving as a provider of services under this chapter; and

(3) Update the rates for services to reflect the rates for Fiscal Year 2025.

Estimate of Economic Impact

I. Summary of Economic Impact. The proposed action updates reimbursement rates for existing Home and Community-Based Options Waiver services covered under this chapter, including a 3 percent rate increase in accordance with the Fiscal Year 2025 budget. The total impact of this rate increase on the Fiscal Year 2025 budget is $1,247,330.

II. Types of Economic Impact.

Impacted Entity	Revenue (R+/R-) Expenditure (E+/E-)	Magnitude
A. On issuing agency:
Maryland Department of Health	(E+)	$1,247,330
B. On other State agencies:	NONE
C. On local governments:	NONE
	Benefit (+) Cost (-)	Magnitude
D. On regulated industries or trade groups:
Medicaid Providers	(+)	$1,247,330
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. (a) The current rates for waiver services, which are inclusive of all rate increases, statutory or otherwise, as of July 1, 2024.

(b) The Fiscal Year 2024 quarterly cost for these services was $602,794.19. The new quarterly cost will be $914,626.74. This reflects a quarterly total cost difference of $311,832.55, and a yearly total cost difference of $1,247,330.

(c) This estimate includes a small number of procedure codes that are shared across specific programs.

(d) The total cost is subject to a 50 percent federal match ($623,665 federal funds and $623,665 general funds).

D. See A, 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 July 14, 2025. A public hearing has not been scheduled.

.04 Conditions for Provider Participation—General Requirements.

A. To participate as a provider of a service covered under this chapter a provider shall:

(1)—(14) (text unchanged)

(15) Obtain a state and federal background check through the Criminal Justice Information System on all staff in accordance with the procedure for a State criminal history records check established under Health-General Article, Title 19, Subtitle 19, Annotated Code of Maryland;

[(15)] (16)— [(16)] (17) (text unchanged)

B.—C. (text unchanged)

D. A provider, its principals, or its staff may not have a history of behavior or convictions that could be harmful to participants, as evidenced through a State and federal background check conducted in accordance with §A(15) of this regulation.

.22 Payment Procedures.

A. [Request for Payment.] To receive payment as a provider of services covered under Regulations [.13.19] .13—.19 of this chapter, a provider shall submit claims in accordance with procedures outlined in the Department's billing manual.

B. (text unchanged)

C. Payments.

(1) (text unchanged)

(2) [Providers] A provider shall be paid the lesser of:

(a) (text unchanged)

(b) The [rate] rates established in §D of this regulation.

D. Rates.

(1) For dates of service beginning July 1, 2022 through June 30, 2024, fees per unit of service shall be as follows:

(a)—(i) (text unchanged)

(j) Family [I/I] 1/1 Training: reimbursed at the maximum rate of $89.22 per hour;

(k)—(l) (text unchanged)

(2) For dates of service beginning July 1, 2024, fees per unit of service shall be as follows:

(a) Assisted Living Level II, No Medical Day Care: reimbursed at the maximum rate of $90.74 per day;

(b) Assisted Living Level III, No Medical Day Care: reimbursed at the maximum rate of $114.51 per day;

(c) Assisted Living Level II, Medical Day Care: reimbursed at the maximum rate of $68.09 per day;

(d) Assisted Living Level III, Medical Day Care: reimbursed at the maximum rate of $85.86 per day;

(e) Behavioral Consultation: reimbursed at the maximum rate of $99.25 per hour;

(f) Case Management — Administrative: reimbursed at the maximum rate of $93.06 per hour or $23.2645 per 15-minute unit;

(g) Case Management — Comprehensive: reimbursed at the maximum rate of $93.06 per hour or $23.2645 per 15-minute unit;

(h) Case Management — Ongoing: reimbursed at the maximum rate of $93.06 per hour or $23.2645 per 15-minute unit;

(i) Dietitian and Nutritionist Services: reimbursed at the maximum rate of $99.25 per hour;

(j) Family 1/1 Training: reimbursed at the maximum rate of $99.25 per hour;

(k) Medical Day Care Services: reimbursed at the maximum rate of $116.59 per day; and

(l) Senior Center Plus: reimbursed at the maximum rate of $72.19 per day.

[(2)] (3) The Program’s rates [as specified in the Department’s fee schedule] for covered services under Regulations .13—.19 of this chapter shall [increase by 4 percent on July 1 of each year through Fiscal Year 2026,] be adjusted subject to the limitations of the State budget.

RYAN B. MORAN, DRPH, MHSA
Acting Secretary of Health

10.09.80 Community-Based Substance Use Disorder Services

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

Notice of Proposed Action

[25-110-P]

The Secretary of Health proposes to amend Regulation .08 under COMAR 10.09.80 Community-Based Substance Use Disorder Services.

Statement of Purpose

The purpose of this action is to:

(1) Implement an 8 percent provider reimbursement rate increase effective on January 1, 2024 pursuant to the Fiscal Year 2024 Budget and Senate Bill 555/House Bill 549, Fair Wage Act of 2023; and

(2) Implement a 3 percent provider reimbursement rate increase, effective July 1, 2024, pursuant to the Fiscal Year 2025 Budget.

Estimate of Economic Impact

I. Summary of Economic Impact. This action implements the Fiscal Years 2024 and 2025 Budgets; the FY25 Budget includes a 3 percent rate increase for community-based substance use disorder (SUD) providers. The total fiscal impact of this rate increase for Fiscal Year 2025 on community-based substance use disorder services is estimated at $14,539,819.

II. Types of Economic Impact.

Impacted Entity	Revenue (R+/R-) Expenditure (E+/E-)	Magnitude
A. On issuing agency:
Maryland Department of Health	(E+)	$14,539,819
B. On other State agencies:	NONE
C. On local governments:	NONE
	Benefit (+) Cost (-)	Magnitude
D. On regulated industries or trade groups:
Maryland Medicaid Community-Based SUD Providers	(+)	$14,539,819
E. On other industries or trade groups:	NONE
F. Direct and indirect effects on public:	NONE

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

A. This amount assumes:

(a) Fiscal Year 2024 expenditures for community-based SUD services total approximately $484,660,619.

(b) The Fiscal Year 2024 expenditure $484,660,619 x 0.03 (the FY 2025 rate increase) = $14,539,819. $14,539,819+ $484,660,619 = $499,200,438.

(c) This amount ($14,539,819) is subject to a blended federal match, utilizing 65.6 percent federal funds ($9,538,121) and 34.4 percent general funds ($5,001,698).

D. See A, above.

Economic Impact on Small Businesses

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

To the extent that Medicaid community-based substance use disorder providers qualify as small businesses, they will benefit from this rate increase.

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 July 14, 2025. A public hearing has not been scheduled.

.08 Payment Procedures.

A.—C. (text unchanged)

[D. For dates of service from July 1, 2022, through June 20, 2023, rates for the services outlined in this regulation shall be as follows:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(d) Opioid Maintenance Therapy — $83.76 per participant per week;

(e) Medication Assisted Treatment Induction — $271.22 per participant per week;

(f) Buprenorphine Maintenance Therapy — $74.46 per participant per week; and

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

E. For dates of service from March 1, 2023, through June 30, 2023, peer support services as outlined in Regulation .05 of this chapter as delivered a BHA licensed substance use disorder treatment provider or an opioid treatment program:

(1) Individual peer support services — $16.38 per 15-minute increment; and

(2) Group peer support services — $4.55 per 15-minute increment;]

[F.].D. [Effective] For dates of service July 1, 2023[,] through December 31, 2023, rates for the services outlined in this [regulation] chapter shall be as follows:

(1)—(2) (text unchanged)

E. For dates of service January 1, 2024, through June 30, 2024, rates for the services outlined in this chapter shall be as follows:

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

(a) Comprehensive substance use disorder assessment — $214.22;

(b) Level 1 group substance use disorder counseling — $58.85 per session;

(c) Level 1 individual substance use disorder counseling — $30.16 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Level 2.1 Intensive Outpatient treatment — $188.57 per diem;

(e) Level 2.5 Partial Hospitalization half day session — $196.11 per diem;

(f) Level 2.5 Partial Hospitalization full day session — $316.77 per diem;

(g) Ambulatory Withdrawal Management —$105.60 per diem;

(h) Individual peer support services — $18.22 per 15-minute increment;

(i) Group peer support services — $5.07 per 15-minute increment;

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

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

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

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

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

(a) Comprehensive substance use disorder assessment — $214.22;

(b) Level 1 group substance use disorder counseling — $58.85 per session;

(c) Level 1 individual substance use disorder counseling — $30.16 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Opioid Maintenance Therapy — $93.17 per participant per week;

(e) Medication Assisted Treatment Induction — $301.71 per participant per week;

(f) Buprenorphine Maintenance Therapy — $82.83 per participant per week;

(g) Individual peer support services — $18.22 per 15-minute increment;

(h) Group peer support services — $5.07 per 15-minute increment; and

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

F. Effective July 1, 2024, rates for the services outlined in this chapter shall be as follows:

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

(a) Comprehensive substance use disorder assessment — $220.65;

(b) Level 1 group substance use disorder counseling — $60.62 per session;

(c) Level 1 individual substance use disorder counseling — $31.06 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Level 2.1 Intensive Outpatient treatment — $194.23 per diem;

(e) Level 2.5 Partial Hospitalization half day session — $201.99 per diem;

(f) Level 2.5 Partial Hospitalization full day session — $326.27 per diem;

(g) Ambulatory Withdrawal Management —$108.77 per diem;

(h) Individual peer support services — $18.77 per 15-minute increment;

(i) Group peer support services — $5.22 per 15-minute increment;

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

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

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

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

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

(a) Comprehensive substance use disorder assessment — $220.65;

(b) Level 1 group substance use disorder counseling — $60.62 per session;

(c) Level 1 individual substance use disorder counseling — $31.06 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Opioid Maintenance Therapy — $95.97 per participant per week;

(e) Medication Assisted Treatment Induction — $310.76 per participant per week;

(f) Buprenorphine Maintenance Therapy — $85.31 per participant per week;

(g) Individual peer support services — $18.77 per 15-minute increment;

(h) Group peer support services — $5.22 per 15-minute increment; and

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

G.—I. (text unchanged)

LAURA HERRERA SCOTT
Secretary of Health

Notice of Proposed Action

[25-091-P]

The Secretary of Health proposes to:

(1) Amend Regulation .01 under COMAR 10.27.02 Hearing Procedures;

(2) Repeal existing Regulation .07 under COMAR 10.27.05 Practice of Nurse Midwifery;

(3) Amend Regulations .01 and .02 under COMAR 10.27.18 Monetary Penalties;

(4) Amend Regulation .02 under COMAR 10.27.26 Sanctioning Guidelines;

(5) Adopt new Regulations .01—.13 under new chapter, COMAR 10.69.01 Licensure of Licensed Certified Midwives under a new subtitle, Subtitle 69 Board of Nursing—Licensed Certified Midwives;

(6) Adopt new Regulations .01—.06 under new chapter, COMAR 10.69.02 Delegation of Technical Acts by a Licensed Certified Midwife under a new subtitle, Subtitle 69 Board of Nursing—Licensed Certified Midwives; and

(7) Adopt new Regulations .01—.03 under new chapter, COMAR 10.69.03 Code of Ethics under a new subtitle, Subtitle 69 Board of Nursing—Licensed Certified Midwives.

This action was considered by the public at a public meeting held on December 13, 2023, 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 licensed certified midwives in Maryland, pursuant to HB 758, Maryland Licensure of Certified Midwives Act, 2021 Chapter 462, and HB 717, State Board of Nursing—Peer Advisory Committees, Scopes of Practice, Licensure Requirements 2023 Chapter 368, and Health Occupations Article, §§8-6D-01 — 8-6D-15, Annotated Code of Maryland.

Estimate of Economic Impact

I. Summary of Economic Impact. The proposed action will have an economic impact; however, the quantified amount is indeterminate, as the Board does not know of how many individuals will apply to become licensed as a licensed certified midwife.

II. Types of Economic Impact.

Impacted Entity	Revenue (R+/R-) Expenditure (E+/E-)	Magnitude
A. On issuing agency:
Maryland Board of Nursing	(R+)	Indeterminable
B. On other State agencies:	NONE
C. On local governments:	NONE
	Benefit (+) Cost (-)	Magnitude
D. On regulated industries or trade groups:
Licensed Certified Midwives	(-)	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.)

A. This proposal includes an initial application fee of $150 and a biennial renewal fee of $120. The Maryland Board of Nursing is unable to estimate how many individuals will seek licensure, as such, the impact is indeterminate but potentially meaningful.

D. See A., 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 July 14, 2025. A public hearing has not been scheduled.

Subtitle 27 BOARD OF NURSING

10.27.02 Hearing Procedures

Authority: Health Occupations Article, §§8-205(a)(1), and 8-317, Annotated Code of Maryland

.01 Scope.

These regulations apply only to formal hearings before the Board based on charges or notices of proposed action issued pursuant to Health Occupations Article, §§8-316, 8-404, 8-6A-10, [or] 8-6B-18, 8-6C-20 or 8–6D–10, Annotated Code of Maryland.

10.27.18 Monetary Penalties

Authority: Health Occupations Article, §§8-316, 8-6C-20, and 8–6D–10, Annotated Code of Maryland

.01 Scope.

This chapter establishes standards for the imposition of monetary penalties not exceeding $5,000 against a registered nurse, licensed practical nurse, direct-entry midwife, licensed certified midwife, or advanced practice registered nurse if the Board finds that there are grounds to take action under Health Occupations Article, §8-316, Annotated Code of Maryland.

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1) (text unchanged)

(2) “Licensee” means, unless the context requires otherwise, a:

(a) [registered] Registered nurse, a licensed practical nurse, or an advanced practice registered nurse as defined in Health Occupations Article, §8-101, Annotated Code of Maryland;

(b) A licensed direct-entry midwife as defined in Health Occupations Article, §8-6C-01, Annotated Code of Maryland; and

(c) A licensed certified midwife as defined in Health Occupations Article, §8-6D-01, Annotated Code of Maryland.

(3) (text unchanged)

10.27.26 Sanctioning Guidelines

Authority: Health Occupations Article, §§1-606, 8-205(a)(1), 8-316, 8-6A-10, [and] 8-6B-18, 8-6C-20, and 8-6D-10, Annotated Code of Maryland

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1) (text unchanged)

(2) “Certificate holder” means an individual who has been issued a certificate by the Board to practice as a certified nursing assistant, a certified dialysis technician, or a certified medication technician.

(3)—(4) (text unchanged)

(5) “Licensee” means an individual who:

(a) Has been issued a license or certification by the Board to practice as:

(i)—(iii) (text unchanged)

(iv) An electrologist; [or]

(v) A licensed direct-entry midwife; or

(vi) A licensed certified midwife; or

(b) (text unchanged)

(6)—(8) (text unchanged)

Subtitle 69 BOARD OF NURSING—LICENSED CERTIFIED MIDWIVES

10.69.01 Licensure of Licensed Certified Midwives

Authority: Health Occupations Article, §§ 8-101, 8-205, 8-208, 8-508, 8-601, 8-6A-02, 8-6D-01 through 8-6D-15, 8-701, 8-708, and 8-710, Annotated Code of Maryland

.01 Exceptions.

This chapter does not apply to an individual who:

A. Assists at a birth in an emergency;

B. Is licensed as a health care practitioner in accordance with the Health Occupations Article, Annotated Code of Maryland whose scope of practice allows the individual to practice certified midwifery; or

C. Is a student practicing certified midwifery while engaged in an approved clinical midwifery education experience under the supervision of an individual licensed by the Board as a licensed certified midwife or a licensed nurse certified as a nurse midwife.

.02 Definitions.

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

B. Terms Defined.

(1) “Accreditation Commission for Midwifery (ACME)” means the accrediting agency for midwifery education programs and institutions, or a successor organization, which is approved by the United States Department of Education.

(2) “American College of Nurse Midwives (ACNM)” means the national professional association, or a successor organization, that represents advanced practice midwives, including certified nurse-midwives and certified midwives in the United States

(3) “American Midwifery Certification Board (AMCB)” means the certifying agency for midwifery education programs, or a successor organization, which is approved by the National Commission for Certifying Agencies.

(4) “Board” means the Maryland Board of Nursing.

(5) “Central Repository” has the meaning stated in Health Occupations Article, §8-303(a), Annotated Code of Maryland.

(6) “Clinical practice guidelines” means written standards using guidelines established by:

(a) The ACNM in Standards for the Practice of Midwifery, as amended or supplemented; or

(b) Any other national certifying body recognized by the Board.

(7) “Licensed certified midwife (LCM)” means an individual who has been issued a license by the Board to practice certified midwifery.

(8) “Newborn” means an infant in the first 28 days after birth.

(9) “Practice certified midwifery” has the meaning stated in Health Occupations Article, §8-6D-01(h), Annotated Code of Maryland.

(10) “Physician” means an individual licensed to practice medicine in the State.

.03 Qualifications for Applicants for Initial Licensure.

An applicant for initial licensure as a certified midwife shall:

A. Be of good moral character;

B. Submit to a criminal history records check in accordance with Health Occupations Article, §8-303, Annotated Code of Maryland;

C. Hold a current, valid national certification as a certified midwife from the AMCB;

D. Have graduated from a graduate-level midwifery education program accredited by the ACME; and

E. Have passed the AMCB certification examination.

.04 Requirements for Application for Initial Licensure.

A. An applicant for initial licensure as a certified midwife shall submit to the Board:

(1) A completed application on the form that the Board requires;

(2) Written, verified evidence that the applicant has met the requirements of Regulation .03C—E of this chapter;

(3) Written, verified evidence that the applicant has submitted to a criminal history records check as required by Regulation .03B of this chapter 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 FBI;

(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) In accordance with Health Occupations Article, §8-303, Annotated Code of Maryland;

(b) In an answer to a question on the Board’s application form; or

(c) From any other source;

(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; and

(6) A fee for initial licensure as specified under Regulation .13 of this chapter.

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:

(1) Complete the application; and

(2) 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 in §A of this regulation within 12 months from the date the application is received by the Board, then the application:

(1) Shall be considered abandoned; and

(2) May be destroyed.

D. Once an application is deemed abandoned under §C of this regulation, an individual seeking licensure shall:

(1) Submit a new application;

(2) Meet all of the requirements for licensure; and

(3) Pay the required fees in accordance with Regulation .13 of this chapter in effect at the time of re-application.

.05 Practice Before Certification.

A. An individual who has graduated from a graduate level accredited program for midwifery education program approved by the ACME and who has taken the AMCB national certification examination but is waiting for results may practice as a certified midwife graduate before certification if the:

(1) Practice is under the supervision of a licensed certified midwife or certified nurse midwife who shall be physically present at the location of service and available to the certified midwife graduate;

(2) Supervising midwife and certified midwife graduate execute a written supervision agreement on the form required by the Board; and

(3) Certified midwife graduate files with the Board a copy of the:

(a) Admission slip to the Board-approved certification examination; and

(b) Signed supervision agreement.

B. A certified midwife graduate who has entered into a supervision agreement under this regulation shall immediately notify the Board and the supervising midwife of the results of the AMCB certification examination.

C. A certified midwife graduate may not continue to practice under a supervision agreement under this regulation for more than 1 year from the filing of all documents required under §A(3) of this regulation, or after the denial of AMCB certification, whichever occurs first.

.06 Term and Renewal of License.

A. A license issued under this regulation authorizes the licensee to practice licensed certified midwifery while the license is active.

B. Unless renewed, a license expires on October 28 of every even-numbered year, except that an initial license shall not expire within 180 days of the date of issuance.

C. Before a license expires, the licensed certified midwife may renew the license for an additional 2-year term if the licensed certified midwife:

(1) Is otherwise entitled to be licensed;

(2) Pays to the Board the renewal fee specified in Regulation .13 of this chapter; and

(3) Submits to the Board:

(a) A renewal application on the form that the Board requires;

(b) Satisfactory evidence of current national certification as a certified midwife by AMCB; and

(c) If required to submit to a criminal history records check in accordance with § C of this regulation, evidence of submission to a criminal history records check as required by the Board.

D. A licensed certified midwife shall submit to a criminal history records check in order to renew a license in accordance with the following schedule:

(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; and

(11) In 2035—all applicants with a June or July birth month.

(12) In 2036—all applicants with a July or August birth month;

E. The Board may grant a 30-day extension beyond a license’s expiration date so that the license may be renewed before it expires.

.07 Change in Name or Address.

A licensed certified midwife shall provide written notice to the Board, on the form required by the Board, within 60 days of a change of:

A. Name, along with legal documentation of the change; or

B. Address.

.08 Required Documentation.

A. A licensed certified midwife who provides clinical midwifery services across the reproductive lifespan in accordance with this subtitle shall:

(1) Maintain a health record for each client;

(2) In the case of a transfer of care to another provider or a facility, transfer the client’s health records with the client; and

(3) Comply with applicable State laws and regulations governing the creation and maintenance of health care records.

B. A licensed certified midwife who provides clinical midwifery services shall have available at all times for examination by the Board, written clinical practice guidelines that cover all aspects of care, practice, and quality assurance, including but not limited to:

(1) A plan for emergency consultation;

(2) A plan for transfer of care; and

(3) A plan for admission of the client or newborn to a hospital within the client’s geographic area.

.09 Scope of Practice.

A. A licensed certified midwife may perform the following functions:

(1) Independent management of clients appropriate to the skill and educational preparation of the licensed certified midwife and the licensed certified midwife's clinical practice guidelines;

(2) Consultation or collaboration with a physician or other health care provider as needed; and

(3) Referral of clients with complications beyond the scope of practice of the licensed certified midwife to another licensed health care practitioner, including a licensed physician.

B. A licensed certified midwife shall keep a record of all cases attended.

C. A licensed certified midwife has the right and obligation to refuse to perform any delegated medical act, oral or written, if, in the licensed certified midwife’s judgment, it is unsafe or an invalidly prescribed medical act or beyond the competence of the licensed certified midwife, in which case the licensed certified midwife shall immediately notify the delegating physician.

.10 Compliance.

The certified midwife shall develop and comply with clinical practice guidelines as defined in Regulation .01B of this chapter.

.11 Prescribing and Dispensing of Substances by a Licensed Certified Midwife.

A. Pursuant to Health Occupations Article, §8-6D-01, Annotated Code of Maryland, a licensed certified midwife may:

(1) Prescribe substances commonly used in the practice of midwifery; and

(2) Prescribe controlled dangerous substances on Schedules II-V under Criminal Law Article, §§5-403—5-406, Annotated Code of Maryland, commonly used in the practice of midwifery; and

(3) Dispense substances prescribed in accordance with §A(1)—(2)of this regulation in the course of treating a client at a:

(a) Nonprofit medical facility or clinic;

(b) Health center operating on the campus of an institution of higher education;

(c) Public health facility;

(d) Medical facility under contract with a State or local health department; or

(e) Facility funded with public funds.

B. A licensed certified midwife who personally prepares and dispenses a drug in the course of treating a client as authorized under §A(3) of this regulation shall:

(1) Comply with the labeling requirements of Health Occupations Article, §12-505, Annotated Code of Maryland;

(2) Record the dispensing of the prescription drug on the client's chart;

(3) Allow the Office of Controlled Substances Administration to enter and inspect the licensed certified midwife's office at all reasonable hours in accordance with Health Occupations Article, §8-508, Annotated Code of Maryland ; and

(4) Except for starter dosages or samples dispensed without charge:

(a) Provide the client with a written prescription;

(b) Maintain prescription files; and

(c) Maintain a separate file for Schedule II prescriptions for a period of at least 7 years.

(5) A licensed certified midwife may personally prepare and dispense a starter dosage of any drug the licensed certified midwife is authorized to prescribe to a client if:

(a) The starter dosage complies with the labeling requirements of Health Occupations Article, §12-505, Annotated Code of Maryland;

(b) No charge is made for the starter dosage; and

(c) The licensed certified midwife enters an appropriate record in the client’s medical record.

.12 Unlawful Practices.

Pursuant to Health Occupations Article, Title 8, Subtitle 6D, Annotated Code of Maryland, an individual may not:

A. Practice licensed certified midwifery unless licensed under this subtitle or otherwise permitted by law to engage in those activities;

B. Use the title “certified midwife” or the abbreviation “CM” unless licensed by the Board with the intent to represent that the individual practices licensed certified midwifery in the State;

C. Represent to the public by title, description of service, method, procedure, or otherwise that the individual is authorized to practice licensed certified midwifery in this State unless licensed under this subtitle; or

D. Advertise in a manner that is unreasonable, misleading, or fraudulent.

.13 Licensure Fees.

A. The fees listed in this regulation are nonrefundable.

B. The fees are as follows:

(1) Initial application fee—$150;

(2) Biennial renewal fee—$120;

(3) Biennial reinstatement fee—$70;

(4) Verification of licensure fee—$45; and

(5) Returned check fee—$30.

C. Health Care Practitioner User Fee.

(1) In addition to a license fee, each licensed certified midwife shall pay a non-refundable health care practitioner user fee assessed by the Maryland Health Care Commission in accordance with Health-General Article, §19-111(b)(4), Annotated Code of Maryland.

(2) The health care practitioner user fee shall be:

(a) In addition to the licensing fee paid to the Board; and

(b) Collected with the application for an initial or renewal license.

(3) The amount of the assessed health care practitioner user fee shall be double the amount of the annual health care practitioner user fee for biennial licensure.

(4) The Board shall:

(a) Account for the health care practitioner user fees; and

(b) Transfer the health care practitioner user fees to the Maryland Health Care Commission on a quarterly basis.

10.69.02 Delegation of Technical Acts by a Licensed Certified Midwife

Authority: Health Occupations Article, §§ 8-101, 8-205, 8-208, 8-508, 8-601, 8-6A-02, 8-6D-01 through 8-6D-15, 8-701, 8-708, and 8-710, Annotated Code of Maryland

.01 Scope.

A. This chapter governs the delegation of other technical tasks by a licensed certified midwife to an assistant not otherwise authorized under Health Occupations Article, Annotated Code of Maryland.

B. This chapter may not be construed:

(1) As establishing the licensure, certification, or registration of assistants by the Board;

(2) To apply to an individual who is licensed, certified, or registered by a health occupations regulatory board, or health occupation students, acting pursuant to Health Occupations Article, Annotated Code of Maryland; and

(3) To mean that this chapter overrides, or is to be used in lieu of, more stringent regulations, policies, and procedures established by State licensure or certification requirements.

.02 Definitions.

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

B. Terms Defined.

(1) “Advanced Practice Registered Nurse (APRN)” has the meaning stated in COMAR 10.27.05.01.

(2) “Assistant” means an individual:

(a) To whom only routine technical tasks are delegated by a licensed certified midwife;

(b) Who is trained; and

(c) Who is not licensed, certified, registered, or otherwise authorized by law by the Board, or any other State health occupations board, to practice any health occupation in the State.

(3) “Asynchronous telehealth interaction” has the meaning stated in Health Occupations Article, §1-1001(b), Annotated Code of Maryland.

(4) “Board” means the Maryland Board of Nursing.

(5) “Delegating Licensed Certified Midwife (LCM)” means a licensed certified midwife who directs an assistant to perform technical tasks.

(6) “Direct supervision” means oversight exercised by a delegating licensed certified midwife who is:

(a) Personally treating the client; and

(b) In the physical presence of the client and the assistant.

(7) “Licensed Certified Midwife (LCM)” means an individual who has been issued a license by the Board to practice certified midwifery in accordance with COMAR 10.69.01.

(8) Mechanical Act.

(a) “Mechanical act” means an act which does not require professional judgment, medical or pharmaceutical training, or discretion.

(b) “Mechanical act” does not include:

(i) Selecting a drug;

(ii) Labeling;

(iii) Measuring or calculating dosages;

(iv) Substituting one drug for another, including substituting a generic or brand drug for the prescribed drug;

(v) Substituting one dosage form of a drug for another;

(vi) Altering the route of administration; or

(vii) Counseling client.

(9) “On-site supervision” means oversight exercised by a delegating licensed certified midwife who is:

(a) Present at the same site as the assistant and the client; and

(b) Able to be immediately available in person during the assistant’s performance of a delegated act; or

(c) In the context of a synchronous telehealth interaction, able to be immediately available via secure telecommunications technology to the telehealth visit during the assistant’s performance of a delegated act; or

(d) In the context of an asynchronous telehealth interaction, is able to review the assistant’s work and interact with the assistant before communication with the client.

(10) “Site” means any facility or location, including those defined in Health-General Article, §§19-114 and 19-3B-01(b), Annotated Code of Maryland, used for the delivery of health services.

(11) “Synchronous telehealth interaction” has the meaning stated in Health Occupations Article, §1-1001(d), Annotated Code of Maryland.

(12) “Technical task” means a routine clinical act or task that does not require clinical or midwifery judgment and is performed with supervision as specified within this chapter.

(13) “Trained” means possessing the knowledge, skills, and abilities, as determined by the delegating licensed certified midwife, to perform delegated technical tasks.

.03 Standards for Delegation.

A. A licensed certified midwife who delegates shall:

(1) Assess the risk to the client and the outcome of the delegated acts;

(2) Delegate only those technical tasks that are customary to the practice of a licensed certified midwife;

(3) Delegate only those technical tasks for which the assistant has been trained;

(4) Be responsible for the acts of the assistant;

(5) Supervise the assistant in accordance with this chapter; and

(6) If dispensing prescription medication under Health Occupations Article, Title 8, Annotated Code of Maryland, perform a final check of the prescription medication before it is provided to the client.

B. The responsibility for the delegated act cannot be transferred from the delegating licensed certified midwife to another licensed certified midwife, or to another licensed health care provider that is authorized to delegate clinical and technical tasks, without:

(1) The expressed consent of the other licensed certified midwife or licensed health care provider; and

(2) Informing the assistant.

.04 Scope of Delegation to an Assistant.

A. A licensed certified midwife may not delegate technical tasks to an assistant which shall, by law or regulation, be performed only by an individual that is required to be licensed, certified, registered, or otherwise recognized pursuant to any State laws.

B. A licensed certified midwife may delegate technical tasks, consistent with the approved policies and procedures of the site, in the following categories:

(1) Surgical technical tasks that the delegating licensed certified midwife directly orders while present and personally performing the surgery in the same surgical field; and

(2) Nonsurgical technical tasks while the assistant is under the delegating licensed certified midwife’s direct supervision or on-site supervision.

C. Except as provided in §§B(1) and D of this regulation, a licensed certified midwife shall provide a minimum of on-site supervision when delegating technical tasks to an assistant, including, but not limited to, the following:

(1) Client preparation for physical examination;

(2) Client history interview;

(3) Collecting and processing specimens, such as performing phlebotomy, inoculating culture media, pregnancy tests; dipstick and microscopic urinalysis, and microbiology including rapid streptococcal testing and throat cultures;

(4) Preparing and performing laboratory tests under State and Clinical Laboratory Improvement Amendments regulations;

(5) Clinical tests;

(6) Transmitting prescriptions to a pharmacy;

(7) Preparing and administering oral drugs;

(8) Establishing a peripheral intravenous line; and

(9) Preparing and administering injections including small amounts of local anesthetics if provided either:

(a) Intradermal;

(b) Subcutaneous; or

(c) Intramuscular in the deltoid, gluteal, or vastus lateralis.

D. When delegating injecting intravenous drugs or contrast materials to an assistant, a licensed certified midwife shall provide direct supervision.

E. A licensed certified midwife who is dispensing prescription medication under Health Occupations Article, Title 8, Annotated Code of Maryland may delegate only mechanical acts involved in dispensing a drug.

F. A licensed certified midwife may not delegate to an assistant any act that requires the exercise of clinical judgment by a licensed certified midwife, including, but not limited to:

(1) Conducting physical examinations;

(2) Administering any form of anesthetic agent or agent of conscious sedation other than topical anesthetics or small amounts of local anesthetics;

(3) Initiating independently any form of treatment, except for cardiopulmonary resuscitation, or other forms of emergency treatment authorized to be performed by non-clinicians under State law;

(4) Establishing a diagnosis or giving clinical advice; and

(5) Providing physical therapy.

.05 Prohibited Conduct and Penalties.

A. An assistant acting beyond the scope of this chapter may be:

(1) Considered to be engaged in the unlicensed practice of licensed certified midwifery or any other health occupation regulated by the State; and

(2) Subject to all applicable fines and penalties in accordance with Health Occupations Article, §§8-701 et seq., Annotated Code of Maryland and applicable regulations, or any other applicable provision of Health Occupations Article, Annotated Code of Maryland.

B. A delegating licensed certified midwife, through either act or omission, facilitation, or otherwise enabling or forcing an assistant to practice beyond the scope of this chapter, may be subject to discipline as set forth in Health Occupations Article, §8-6D-10, Annotated Code of Maryland.

C. A delegating licensed certified midwife may not:

(1) Require an assistant to perform a delegated technical task; or

(2) Permit an assistant to delegate any act to another individual.

.06 Enforcement.

The Board shall conduct any necessary investigation regarding the failure to comply with the requirements of Health Occupations Article, Title 8, Annotated Code of Maryland, and this chapter, and it may refer any complaint or investigation to any other appropriate licensing or regulatory authority in accordance with applicable laws and regulations.

10.69.03 Code of Ethics

Authority: Health Occupations Article, §§ 8-101, 8-205, 8-208, 8-508, 8-601, 8-6A-02, 8-6D-01 through 8-6D-15, 8-701, 8-708, and 8-710, Annotated Code of Maryland

.01 Definitions.

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

B. Terms Defined.

(1) Abandonment.

(a) “Abandonment” means failure to provide or make reasonable arrangements for the continuation of care for a client in need of immediate care or failure to provide reasonable notice to a facility or practice under circumstances that seriously impair the delivery of clinical care to clients.

(b) “Abandonment” does not include the declining by a licensed certified midwife of employer-stipulated mandatory overtime.

(2) “Board” means the Board of Nursing.

(3) “Client” means a patient, resident, or recipient of care.

(4) “Electronic devices” means, but is not limited to, any of the following:

(a) Telephones with recording and picture-taking ability;

(b) Digital cameras or any other device that can record pictures and data;

(c) Facsimile machines, photocopiers, and scanners for copying; and

(d) Recording devices.

(5) “Licensed certified midwife (LCM)” means an individual who has been issued a license by the Board to practice certified midwifery in accordance with COMAR 10.69.01.

(6) Social Media.

(a) “Social media” means any form of electronic communication.

(b) “Social media” includes but is not limited to communication by use of websites or other electronic applications for social networking, commentary, and blogging through which users create online communities to share information, ideas, personal messages, and other content such as videos.

.02 Ethical Responsibilities.

A. A licensed certified midwife shall:

(1) Provide services with respect for human dignity and the uniqueness of a client unrestricted by consideration of social or economic status, religious affiliation, personal attributes, race, sexual orientation, gender identity, or the nature of health problems;

(2) Safeguard a client's right to privacy by maintaining confidentiality of information;

(3) Act to safeguard a client and the public if health care and safety are affected by the incompetent, unethical, or illegal practice of any person;

(4) Promptly report a breach of confidentiality or privacy;

(5) Assume responsibility and accountability for individual clinical judgments and actions;

(6) Maintain competence in licensed certified midwifery;

(7) Exercise informed judgment and use individual competence and qualifications as criteria in seeking consultation, accepting responsibilities, and when delegating; and

(8) Inform the Board regarding unethical conduct by another licensed certified midwife.

B. A licensed certified midwife may not, when acting in the capacity or identity of a licensed certified midwife:

(1) Knowingly participate in or condone dishonesty, fraud, deceit, or misrepresentation;

(2) Engage or participate in an action that violates or diminishes the civil or legal rights of a client;

(3) Perform new techniques and procedures without adequate education and practice;

(4) Assume duties and responsibilities in the practice of licensed certified midwifery without adequate preparation or without maintaining competency;

(5) Practice clinically if unfit to perform procedures or make decisions because of physical or mental impairment, including, but not limited to, the effects of prescription drugs;

(6) If engaged in research, coerce or pressure a subject to participate or continue to participate in the research; or

(7) Abandon a client.

C. A licensed certified midwife may not engage in behavior that dishonors the profession whether or not they are acting in the capacity or identity of a licensed certified midwife, including, but not limited to:

(1) Verbal abuse, including use of racial or ethnic slurs, directed toward a coworker, employer, Board staff member, client, or client’s family member;

(2) Physically abusing, threatening, or intimidating a coworker, employer, Board staff member, client, or client’s family member;

(3) Deceiving, defrauding, or stealing from a coworker, employer, client, or client’s family member;

(4) Diverting any medication or providing false or misleading information to an authorized prescriber or a pharmacist to obtain or attempt to obtain any medication;

(5) Knowingly employ another person to practice, engage in, or attempt to practice, or engage in an occupation or profession licensed by the Board if the employee is not licensed to do so in accordance with Health Occupations Article, Title 8, Annotated Code of Maryland;

(6) Performing acts beyond the authorized scope of the level of midwifery practice for which the individual is licensed;

(7) Obtaining or copying any part of a client’s health record for purposes other than:

(a) Providing health care to the client;

(b) Conducting quality improvement activities;

(c) Complying with legal requirements such as a subpoena; or

(d) Allowing a midwifery student to use records for educational purposes if client identification has been redacted or disguised;

(8) Using, possessing, supplying, administering, or attempting to use, possess, supply, or administer prescription drugs or controlled dangerous substances without valid clinical indication;

(9) Reporting for employment under the influence of alcohol or a controlled dangerous substance or submitting a pre-employment sample that is positive for alcohol or a controlled dangerous substance without having provided evidence of valid prescriptions for all controlled dangerous substances in the sample;

(10) Reporting for employment under the influence of an illicit drug or submitting a pre-employment sample that is positive for an illicit drug;

(11) Using the power, influence, or knowledge, inherent in or obtained during the provider-client relationship, for the licensee’s personal gratification or benefit;

(12) Engaging in unprofessional or immoral conduct;

(13) Misrepresenting or concealing a material fact in obtaining a license, renewing a license, or reinstating a license; or

(14) Committing an act of moral turpitude, dishonesty, or corruption when the act directly or indirectly affects the health, welfare, or safety of the citizens of this State, and, if the act constitutes a crime, conviction thereof in a criminal proceeding is not a condition precedent to disciplinary action.

D. A licensed certified midwife may not engage in sexual misconduct. Sexual misconduct includes, but is not limited to:

(1) Sexual behavior with a client in the context of a professional evaluation, treatment, procedure, or service to the client, regardless of the setting in which the professional service is rendered;

(2) Sexual behavior with a client under the pretext of diagnostic or therapeutic intent or benefit;

(3) Solicitation of a sexual relationship, whether consensual or nonconsensual, with a client;

(4) Sexual advances toward, or the request of sexual favors from, a coworker, student, employer, client, or client’s family member;

(5) Discussion of nontherapeutic sexual matters while treating a client;

(6) Taking photographs of a client for a sexual purpose;

(7) Sexual harassment of a coworker, student, employer, client, or client’s family member;

(8) Sexual contact with an incompetent or unconscious client;

(9) Intentionally exposing any of the licensee's sexual body parts; and

(10) Intentionally exposing any of the client’s sexual body parts for a nontherapeutic purpose.

E. Electronic devices may not be used to record medical records and take pictures or videos of clients without written client authorization.

F. A licensed certified midwife:

(1) May not make use of electronic devices and social media to transmit or place any client information online; and

(2) Shall adhere to the following principles for the use of electronic devices and social media:

(a) Every licensed certified midwife has an obligation to understand the nature, benefits, and consequences of the use of electronic devices and participating in social media networking;

(b) Licensed certified midwives are bound to observe ethically prescribed client-provider boundaries online as in any other setting;

(c) Client information shall be maintained in separate encrypted and secured files on personal computers and online;

(d) A licensed certified midwife has an obligation to report any electronically generated material that could harm a client’s privacy rights; and

(e) The standards of professionalism are the same when using electronic devices and social media as in any other circumstance.

.03 Penalties.

Violation of this chapter may result in the Board taking disciplinary action against a licensed certified midwife pursuant to Health Occupations Article, §8-6D-10, Annotated Code of Maryland.

LAURA HERRERA SCOTT
Secretary of Health

Subtitle 30 COMMISSION ON KIDNEY DISEASE

Notice of Proposed Action

[25-100-P]

The Chairman of the Maryland Commission on Kidney Disease proposes to:

(1) Amend Regulations .01, .02, .03—.05, .07—.09, and .11 under COMAR 10.30.01 General Regulations;

(2) Amend Regulations .02—.07 under COMAR 10.30.02 Physical and Medical Standards;

(3) Amend Regulations .02 and .03 under COMAR 10.30.03 Transmissible Diseases; and

(4) Repeal existing Regulation .02 and amend and recodify existing Regulation .03 to be Regulation .02 under COMAR 10.30.04 Dialyzer Reuse and Water Standards.

This action was considered by the Maryland Commission on Kidney Disease at a public meeting held on October 31, 2024, notice of which was given by publication on the Commission’s website at health.maryland.gov/mdckd/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 make the following updates in accordance with the Maryland Regulatory Review and Evaluation Act:

(1) Update and remove obsolete language throughout the subtitle;

(2) Clarify Commission responsibilities;

(3) Remove repealed cross-references; and

(4) Update staffing requirements for home dialysis programs and self-care dialysis facilities.

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 July 14, 2025. A public hearing has not been scheduled.

10.30.01 General Regulations

Authority: Health-General Article, §§13-301—13-316 and 16-204, Annotated Code of Maryland

.01 Purpose.

In recognition of its continuing responsibility to its citizens to aid in reduction of the personal financial hardships associated with end-stage [renal] kidney disease, the State continues its commitment of resources to the Kidney Disease Program of Maryland. This subtitle is designed so that Maryland may provide help and support for its citizens whose needs are partially or wholly unmet by present federal or private support, or both, for end stage [renal] kidney disease.

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1) (text unchanged)

(2) "Acute dialysis" means dialysis employed in the treatment of temporary [renal] kidney failure, with the expectation that dialysis may be necessary for 4 weeks or less because recovery of kidney function is anticipated.

(3)—(6) (text unchanged)

(7) "Chronic dialysis" means dialysis employed to compensate for the severe and irreversible loss of [renal] kidney function and is a permanent treatment modality unless replaced by [renal] kidney transplantation.

(8)—(14) (text unchanged)

(15) “In-center hemodialysis” means a hemodialysis treatment that:

(a)—(b) (text unchanged)

(c) Is provided in a kidney dialysis facility [center during daytime hours].

(16)—(17) (text unchanged)

(18) "Nurse manager" means an individual who is responsible for nursing services and provides oversight and direction to all direct care staff that provide dialysis and nursing care in [the] a kidney dialysis facility [including:

(a) Input into hiring; and

(b) Evaluating staff].

.03 Categories of Dialysis.

A.—B. (text unchanged)

C. Chronic Dialysis.

(1) (text unchanged)

(2) Chronic dialysis may be preceded by adequate studies to confirm that the [renal] kidney failure is irreversible.

D.—E. (text unchanged)

F. Chronic Peritoneal Dialysis.

(1) This process can substitute for [renal] kidney function that has been permanently lost and represents a permanent treatment unless replaced by either hemodialysis or [renal] kidney transplantation.

(2) Long-term care of end-stage [renal] kidney disease by chronic peritoneal dialysis may be carried out either in a dialysis facility or in the home.

G. (text unchanged)

.04 Classifications of Facilities.

A. [Renal] Kidney Transplant Center.

(1) A [renal] kidney transplant center shall be a physically discrete unit or division within a hospital approved by the Joint Commission on Accreditation of Healthcare Organizations having the staff and facilities capable of evaluating potential candidates for [renal] kidney transplantation.

(2) (text unchanged)

B. Freestanding Dialysis Facility. The freestanding dialysis facility's functions include:

(1) A dialysis facility capable of providing chronic staff-assisted dialysis which may be performed in a freestanding dialysis facility or in an end-stage [renal] kidney disease certified [hospital based] hospital-based unit;

(2)—(4) (text unchanged)

C. (text unchanged)

[D. Self-Care Dialysis Facility. A self-care dialysis facility's functions include:

(1) Qualified supervision to patients who perform part or most of the patient's own dialysis treatment; and

(2) Supervision of treatment by qualified staff members of the facility for the protection of the interest of the patient and of the facility.]

.05 Patient [Selection] Standards.

A. General Considerations.

(1) [Selection of patients] Patients who are accepted for dialysis and [renal] kidney transplantation:

(a) [shall] Shall be accepted on medical grounds alone[.];

[(2) Selection may] (b) May not be accepted based on age, race, sex, social background, national origin, religion, or financial resources[.]; and

(c) Are the responsibility of the dialysis or transplant centers, or both, but shall conform to the medical guidelines established in §B of this regulation.

[(3)] (2)—[(5)] (4) (text unchanged)

[(6) Patient selection is the responsibility of the dialysis or transplant centers, or both, but shall conform to the medical guidelines established in §B of this regulation.]

[(7)] (5)—[(9)] (7) (text unchanged)

B. Medical Guidelines. A patient may be accepted for treatment if the patient meets any of the following criteria:

(1) Has end-stage [renal] kidney disease requiring [renal] kidney replacement therapy to sustain life;

(2) (text unchanged)

(3) Has chronic end-stage [renal] kidney disease and is a qualified resident of this State, except when documented medical reasons contraindicate dialysis; or

(4) (text unchanged)

C. Abusive and Dangerous Patients.

(1)—(2) (text unchanged)

(3) The Commission shall review each facility's policy for the management of abusive and dangerous patients and the facility's method of implementation of this policy during the Commission's [annual] survey.

D. (text unchanged)

.07 Procedures for Certification of Facilities.

A. (text unchanged)

B. The Department or the Commission, or both, shall:

(1) Review the facility application; [and]

(2) Survey for compliance with this subtitle[.]; and

(3) Certify the facility’s existing Office of Health Care Quality license.

C. (text unchanged)

D. Certified patients are eligible for reimbursement of medical care only after a dialysis facility or transplant center has received Kidney Disease Program certification.

E. (text unchanged)

.08 Affiliation Guidelines.

A. (text unchanged)

B. Affiliation agreements shall include, but not necessarily be limited to, the:

(1)—(4) (text unchanged)

(5) Specific provisions by hospitals to end-stage [renal] kidney disease patients for dialysis services as well as adequate:

(a)—(c) (text unchanged)

C. The [primary] dialysis facility shall review and revise the affiliation agreements periodically and if a change in ownership or other details of operation [change] changes during the period while the affiliation agreement is in force.

.09 Residency Requirements.

To be eligible for the Kidney Disease Program, an individual shall be one of the following:

A. A citizen of the United States residing in Maryland; or

B. An alien lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law, including an alien who is lawfully present in the United States pursuant to 8 U.S.C. §1101 et seq. and who is residing in Maryland[; or].

[C. An alien lawfully admitted under authority of the Indo-China Migration and Refugee Assistance Act of 1975 and who is residing in Maryland.]

.11 Miscellaneous Items.

A.—B. (text unchanged)

C. Emergency Management.

(1)—(6) (text unchanged)

(7) Information Regarding the Status of Generators. A kidney dialysis [center] facility shall have:

(a)—(c) (text unchanged)

(8) (text unchanged)

10.30.02 Physical and Medical Standards

Authority: Health-General Article, §§13-301—13-316 and 16-204, Annotated Code of Maryland

.02 Transplant Centers.

A. (text unchanged)

B. Physical Standards. The transplant center shall be located in a hospital that is participating as a provider of services in the Medicare program and is approved by Centers for Medicare and Medicaid Services as a [renal] kidney transplantation center.

C. Staffing.

(1) Director of Transplantation Center. The [renal] kidney transplantation center shall be under the general supervision of:

(a)—(b) (text unchanged)

(2)—(7) (text unchanged)

D.—F. (text unchanged)

G. The transplant center shall make arrangements for medical records, patient care policies, dietetic services, sanitation standards, and fire and life safety standards as referenced in [Regulation .01B of this chapter and] this subtitle.

H. Patient [Selection] Treatment Eligibility.

(1) In general, the patient [selection] eligibility standards as established for the dialysis program shall apply to the transplantation program, recognizing that constant improvements in the immunology and treatment of the rejection process are increasing the number of disease processes in which transplantation is applicable.

(2) (text unchanged)

(3) Since transplantation is at present the best means of treating most patients with irreversible [renal] kidney failure, transplantation shall be considered for all patients accepted into this program when reasonable benefit and success are anticipated. However, candidacy for transplantation may not be a basic criteria for [selection] eligibility into the overall Kidney Disease Program.

(4) (text unchanged)

I. Administration.

(1)—(2) (text unchanged)

(3) When a patient is placed on a center's waiting list or is selected to receive a transplant, the center shall document in the patient's medical record the patient's [selection] eligibility criteria used.

(4)—(10) (text unchanged)

(11) The transplant center shall develop, implement, and maintain a written comprehensive data driven Quality Assessment and Performance Improvement (QAPI) program designed to monitor and evaluate performance of all transplantation services. The QAPI program shall include, but not be limited to:

(a) Patient and donor [selection] eligibility criteria;

(b)—(h) (text unchanged)

(12)—(15) (text unchanged)

J. Compliance. Transplant centers shall comply with the provisions set forth in [Regulation .01B of this chapter, and with the requirements of] this subtitle.

.03 Freestanding Dialysis Facilities—General.

A. Location and Program Affiliation.

(1) Freestanding dialysis facilities seeking a certification as a freestanding dialysis facility, under the terms of Health-General Article, Title 13, Subtitle 3, Annotated Code of Maryland, shall have, for the diagnosis and treatment of irreversible [renal] kidney failure and its complications, arrangements with:

(a) A laboratory that meets the needs of end-stage [renal] kidney disease patients;

(b) A hospital that can provide acute care services to meet the needs of end-stage [renal] kidney disease patients;

(c)—(d) (text unchanged)

(2)—(3) (text unchanged)

B. Physical Standards. The freestanding dialysis facility shall:

(1)—(6) (text unchanged)

(7) Utilize water of sufficient purity, according to current Association for the Advancement of Medical Instrumentation's recommendations which are incorporated by reference in [Regulation .01B(4) and (5) of] this [chapter] subtitle to prevent bacterial or endotoxin contamination or toxic accumulation of trace elements in patients undergoing long-term dialysis;

(8) Comply with medical records, patient care policies, sanitation standards, and fire and life safety standards as [defined in Regulation .01B of this chapter and] set forth in this subtitle; and

(9) (text unchanged)

C. Administration.

(1) The freestanding dialysis facility shall be under the supervision of the governing body. The governing body shall:

(a) Identify the [center] facility administrator who has been given the authority and responsibility for the overall policy and fiscal management of the facility; and

(b) (text unchanged)

(2)—(4) (text unchanged)

D. Compliance. Freestanding dialysis facilities shall comply with:

(1) The provisions set forth in [Regulation .01B of] this [chapter] subtitle;

(2)—(3) (text unchanged)

E. (text unchanged)

F. Administrator.

(1) Qualifications.

(a) The kidney dialysis facility administrator, if not the chief executive officer, shall at a minimum:

(i) Be certified or licensed as a health care professional;

[(i)] (ii)—[(iii)] (iv) (text unchanged);

[(iv)] (v) Have no criminal conviction or other criminal history that indicates behavior that is potentially harmful to patients, documented through [either] a criminal history records check [or a criminal background check] completed within 1 month before employment.

(b) (text unchanged)

(2) (text unchanged)

(3) Waiver of Requirements for Administrator.

(a) The [Department] Commission may grant a kidney dialysis facility a waiver, with or without conditions, for a [center] facility that operates an administrator-in-training program.

(b) A facility with an administrator-in-training program shall submit to the [Department] Commission the:

(i) (text unchanged)

(ii) Facility requirements for individuals who are [selected] eligible to participate in the administrator-in-training program; and

(iii) (text unchanged)

(c) In evaluating a waiver request submitted under this regulation, the [Department] Commission shall review the statements in the application and may:

(i)—(ii) (text unchanged)

(d) Grant or Denial of Waiver. The [Department] Commission may grant a waiver request if it determines that:

(i)—(ii) (text unchanged)

(e) If the [Department] Commission determines that the conditions of §F(1) and (2) of this regulation are not met, the [Department] Commission shall deny the request for a waiver. The denial of a waiver may not be appealed.

(f) Written Decision.

(i) The [Department] Commission shall issue and mail to the licensee a final written decision regarding a waiver request submitted under this regulation within 45 days from receipt of the request.

(ii) If the [Department] Commission grants a waiver, the written decision shall include the waiver's duration and any conditions imposed by the Department.

(g) (text unchanged)

(h) Any substantive changes to the administrator-in-training program shall be submitted to the [Department] Commission for prior approval.

(4) Policies and Procedures. The administrator shall:

(a) (text unchanged)

(b) Ensure that all policies and procedures are:

(i) Reviewed by [staff] the governing body at least annually and are revised as necessary;

(ii)—(iii) (text unchanged)

.04 Freestanding Dialysis Facilities — Staffing.

A. Nephrologist or Physician.

(1) (text unchanged)

(2) Each freestanding dialysis facility shall have:

(a) [at] At least one additional nephrologist or physician trained in dialysis techniques to provide adequate continuous coverage[.]; or

(b) A licensed professional trained in dialysis.

B. Medical Director.

(1) (text unchanged)

(2) The medical director shall be a physician who is board eligible, or board certified by the American Board of Internal Medicine or the American Board of Pediatrics and:

(a) Has at least 12 months of experience or training in the care of patients at end-stage [renal] kidney disease facilities; or

(b) (text unchanged)

(3) The medical director shall:

(a)—(b) (text unchanged)

(c) Coordinate the comprehensive [renal] kidney health care team to assure quality of care;

(d) Assure there are written policies which address [a long term] patient care [plan] plans to select the appropriate end stage [renal] kidney disease modality;

(e) (text unchanged)

(f) Assure that the end stage [renal] kidney disease patient has appropriate consultation with a renal dietitian, renal social worker, and other individuals as needed;

(g)—(l) (text unchanged)

(m) Supervise the development of [a] freestanding dialysis [facility-specific policy] policies on the administration of [epogen and intradialytically administered] intradialytic medications;

(n)—(q) (text unchanged)

(r) Assure that there are written policies regarding freestanding dialysis [facility-specific] policies for [dialyzer reuse/reprocessing,] anemia management, adequacy of dialysis measures, infection control, dialysis water standards, immunization guidelines for Hepatitis B, influenza, [and] pneumococcal vaccines, and any other applicable vaccines, and use of [I.V.] Vitamin D analogues and monitoring parameters associated with the development of [renal osteodystropy] kidney osteodystrophy;

(s) Assure quality improvement programs to monitor the facility policies [listed in §B(3)(n)—(r) of this regulation] and actively participate in the facility's quality improvement program;

(t)—(u) (text unchanged)

(v) Establish documented practice goals within the freestanding dialysis facility[, which should exceed minimal requirements] to assure optimal patient care.

C. Nursing Services.

(1)—(2) (text unchanged)

(3) Staffing Exception Reporting.

(a) The freestanding dialysis facility shall have a staffing exception reporting protocol in a format approved by the [Department] Commission for reporting to the governing body when emergency staffing situations arise that require the charge nurse to be included in the staffing ratio. The report shall include:

(i)—(iv) (text unchanged)

(b) (text unchanged)

(c) The staffing exception reports shall be made available to the Office of Health Care Quality and the Commission on Kidney Disease when they are conducting an inspection or survey of the center to assure compliance with [§F(1)] §C(3)(a) of this regulation.

D.—G. (text unchanged)

H. Social Worker.

(1) (text unchanged)

(2) Annual Psychosocial Update.

(a)—(b) (text unchanged)

(c) The annual psychosocial update may be included [as] with the mandatory quarterly documentation for psychosocially stable patients.

(3)—(4) (text unchanged)

(5) The social worker shall:

(a) (text unchanged)

(b) Provide case work and group work services to patients and their families in dealing with the special problems associated with end stage [renal] kidney disease;

(c)—(d) (text unchanged)

.05 Nocturnal Hemodialysis Programs.

A. Nephrologist [or Physician].

(1) The director of a freestanding dialysis facility shall be a nephrologist [or a physician] with at least 1 year of experience in chronic hemodialysis.

(2) A freestanding dialysis facility shall have at least one additional nephrologist [or physician] trained in dialysis techniques to provide adequate continuous coverage.

B. Medical Director.

(1)—(2) (text unchanged)

(3) The medical director shall:

(a) Assure that the facility has documented [selection] eligibility criteria for the nocturnal dialysis patient;

(b) Determine the patient’s appropriateness and suitability for nocturnal hemodialysis by considering and documenting the patient’s:

(i)—(iv) (text unchanged)

(c) (text unchanged)

(d) Assure that an order from a [physician] nephrologist, nurse practitioner, or physician assistant for nocturnal hemodialysis is written;

(e)—(g) (text unchanged)

(h) Coordinate the comprehensive [renal] kidney health care team to assure quality of care;

(i) Assure there are written policies which address [a long term] patient care [plan] plans to select the appropriate end-stage [renal] kidney disease modality;

(j) (text unchanged)

(k) Assure that the end-stage [renal] kidney disease patient has appropriate consultation with a renal dietitian, renal social worker, and other individuals as needed;

(l)—(q) (text unchanged)

(r) Supervise the development of [a] freestanding dialysis [facility-specific policy] policies on the administration of [epogen and intradialytically administered] intradialytic medications;

(s)—(u) (text unchanged)

(v) Assure that there are written policies regarding medical staff bylaws and [physician] licensed and certified staff credentialing;

(w) Assure that there are written freestanding dialysis [facility-specific] policies for:

[(i) Dialyzer reuse or reprocessing;]

[(ii)] (i) Anemia management;

[(iii)] (ii) Adequacy of dialysis measures;

[(iv)] (iii) Dialysis water standards;

[(v)] (iv) Immunization guidelines for Hepatitis B, influenza, [and] pneumococcal, and any other applicable vaccines;

[(vi)] (v) Use of [I.V.] Vitamin D analogues; and

[(vii)] (vi) Monitoring parameters associated with the development of [renal osteodystropy] kidney osteodystrophy;

(x) Assure quality improvement programs to monitor the facility policies [listed in §B(3)(o)—(s) of this regulation] and actively participate in the facility's quality improvement program;

(y) Assure attending physicians and any other licensed or certified personnel comply with State and federal mandates applicable to the freestanding dialysis facility;

(z) (text unchanged)

(aa) Establish documented practice goals within the freestanding dialysis facility, which should [exceed minimal requirements to] assure optimal patient care.

C.—G. (text unchanged)

H. Social Worker.

(1) (text unchanged)

(2) Annual Psychosocial Update.

(a)—(b) (text unchanged)

(c) The annual psychosocial update may be included [as] with the mandatory quarterly documentation for psychosocially stable patients.

(3)—(4) (text unchanged)

(5) The social worker shall:

(a) (text unchanged)

(b) Provide case work and group work services to patients and their families in dealing with the special problems associated with end-stage [renal] kidney disease;

(c)—(d) (text unchanged)

.06 Home Dialysis Programs.

A. Location and Program Affiliation.

(1) (text unchanged)

(2) To assure quality and continuity of patient care, the home dialysis program shall negotiate a formal affiliation agreement compliant with [COMAR 10.30.01.08] this subtitle.

(3)—(7) (text unchanged)

B. (text unchanged)

C. Staffing.

(1) Nephrologist [or Physician] and Additional Licensed Staff.

(a) The director of the home dialysis program shall be a nephrologist [or a physician] with at least 1 year of experience in chronic dialysis including experience in home dialysis training.

(b) One additional nephrologist, [or physician] physician’s assistant, or certified registered nurse practitioner trained in dialysis shall be available to provide adequate continuous coverage.

(2)—(3) (text unchanged)

(4) Social Worker. The social worker shall comply with the duties and responsibilities set forth in Regulation [.04G] .04H of this chapter.

D. (text unchanged)

E. Compliance. Home dialysis programs shall comply with the provisions set forth in [Regulation .01B of this chapter, and with the requirements of] this subtitle for certification purposes with the Commission.

.07 Self-Care Dialysis Facilities.

A. Location and Program Affiliation.

(1) (text unchanged)

(2) To assure quality and continuity of patient care, including backup dialysis, the self-care dialysis facility or a hospital shall negotiate a formal affiliation agreement compliant with [COMAR 10.30.01.08] this subtitle.

(3)—(5) (text unchanged)

B. Physical Standards.

(1) A self-care dialysis facility shall:

(a)—(e) (text unchanged)

(f) Utilize water of sufficient purity, according to current Association for the Advancement of Medical Instrumentation recommendations which are incorporated by reference in [Regulation .01B(4) and (5) of this chapter,] this subtitle to prevent bacterial contamination, endotoxin, or toxic accumulation of trace elements in patients undergoing long-term dialysis.

(2) (text unchanged)

C. Staffing.

(1) Nephrologist [or Physician] and Additional Licensed Staff.

(a) The director of the self-care dialysis facility shall be a nephrologist [or a physician] with at least 1 year of experience in chronic dialysis.

(b) At least one additional nephrologist, [or a physician] physician’s assistant, or certified registered nurse practitioner trained in dialysis shall be available to provide adequate continuous coverage.

(2) (text unchanged)

(3) Additional Self-Care Dialysis Facilities Requirements.

(a)—(b) (text unchanged)

(c) Staffing Exception Reporting. The facility shall have a staffing exception reporting protocol in a format approved by the [Department] Commission for reporting to the governing body when emergency staffing situations arise that require the charge nurse to be included in the staffing ratio. The report shall include, at a minimum:

(i)—(ii) (text unchanged)

(d)—(e) (text unchanged)

(4)—(6) (text unchanged)

(7) Social Worker. The social worker shall comply with the duties and responsibilities set forth in Regulation [.04G] .04H of this chapter.

D. (text unchanged)

E. Compliance. Self-care dialysis programs shall comply with the provisions set forth in [Regulation .01B of this chapter and with the requirements of] this subtitle for certification purposes with the Commission.

10.30.03 Transmissible Diseases

Authority: Health-General Article, §§13-301—13-316 and 16-204, Annotated Code of Maryland

.02 [Patient Selection—] Unrestricted Access to Care.

A. An end stage [renal] kidney disease patient with any transmissible disease, may not be denied dialysis or transplantation by a certified Maryland dialysis or transplantation facility solely because of the potential for transmission of the transmissible disease, to other patients or treatment personnel.

B. (text unchanged)

.03 Preventive Measures.

A. A facility shall follow the infection control procedures established in the Control of Communicable Diseases Manual designed by the Centers for Disease Control and Prevention (CDC) to control the spread of transmissible diseases.

B. General.

(1) The cardinal measure for preventing the spread of transmissible diseases is an understanding on the part of dialysis and transplantation personnel that each end-stage [renal] kidney disease patient is potentially a transmitter of transmissible diseases.

(2)—(7) (text unchanged)

C. Infection Control and Hygiene.

(1) (text unchanged)

(2) Dialysis personnel shall:

(a) Wear personal protective equipment (PPE) at all times while providing patient care in the treatment area;

(b)—(e) (text unchanged)

(f) Remove[,] and dispose of[, and replace patient linen and other] station coverings immediately after the patient's dialysis session has ended and thoroughly sanitize the dialysis station.

(3) (text unchanged)

(4) A dialysis facility shall follow the [Control of Communicable Diseases Manual recommendations] advice of the Centers for Disease Control and Prevention (CDC) for staff immunization and surveillance for hepatitis B.

D.—E. (text unchanged)

10.30.04 Dialyzer Reuse and Water Standards

Authority: Health-General Article, §§13-301—13-316 and 16-204, Annotated Code of Maryland

[.03] .02 Water Standards — Water Treatment System — Dialysis Facilities.

A.—D. (text unchanged)

E. Boiled Water Advisory.

(1)—(9) (text unchanged)

(10) Shocking of Water System.

(a)—(b) (text unchanged)

(c) The half-hour testing described in [§E(9)(b)] §E(10)(b) of this regulation shall continue until 24 hours after feed water results return to normal.

SUMESKA THAVARAJAH, M.D.
Chairman, Maryland Commission on Kidney Disease

Subtitle 32 BOARD OF PHYSICIANS

10.32.14 Unlicensed Limited X-Ray [Assistant] Machine Operator

Authority: Health Occupations Article, §§14-207, 14-306, and 14-308.1, Annotated Code of Maryland

Notice of Proposed Action

[25-097-P]

The Acting Secretary of Health proposes to amend Regulation .01 and adopt new Regulations .02––.09 under COMAR 10.32.14 Unlicensed Limited X-Ray Machine Operator. This action was considered at public meetings on August 8, 2024, October 23, 2024, and February 26, 2025, notice of which was provided on the Board’s website at https://www.mbp.state.md.us/ pursuant to General Provisions Article, §3-302(c), Annotated Code of Maryland.

Statement of Purpose

The purpose of this action is to establish regulations to implement a Limited X-Ray Machine Operator registration. These regulations authorize individuals who meet the qualifications and register with the Board to perform certain X-ray duties without a license.

Estimate of Economic Impact

I. Summary of Economic Impact. Eligible individuals will pay the initial and biennial registration renewal fees to practice as a registered LXMO—fees are $65 and $125, respectively. The Board does not anticipate a significant increase in application fee revenue.

II. Types of Economic Impact.

Impacted Entity	Revenue (R+/R-) Expenditure (E+/E-)	Magnitude
A. On issuing agency:
Maryland Board of Physicians	(R+)	Minimal
B. On other State agencies:	NONE
C. On local governments:	NONE
	Benefit (+) Cost (-)	Magnitude
D. On regulated industries or trade groups:
Limited X-Ray Machine Operators	(-)	Minimal
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. Eligible individuals may seek registration as a LXMO. Initial registration fees are $65 with a $125 biennial registration renewal fee. As this is a new registration, the Board is unable to estimate the demand for this registration type. But, the Board anticipates that any increases in fee revenue will be minimal.

D. See A., 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 July 14, 2025. A public hearing has not been scheduled.

.01 Scope.

[Upon written receipt of notice from the Maryland Radiological Society that, before October 1, 2002, an individual met the requirements of Health Occupations Article, §14-306(e), Annotated Code of Maryland, the Board shall issue a certificate authorizing the individual to perform X-ray duties without a license as described in Health Occupations Article, §14-306(e), Annotated Code of Maryland.]

A. This chapter governs the performance of certain X-ray duties without a license to a registered Limited X-ray Machine Operator.

B. This chapter may not be construed to:

(1) Apply to certified, registered, or licensed professionals or health occupation students acting pursuant to Health Occupations Article, Annotated Code of Maryland; and

(2) Mean that this chapter overrides or is to be used in lieu of more stringent regulations, policies, and procedures established by State licensure or certification requirements or Board-recognized accrediting agencies.

.02 Definitions.

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

B. Terms Defined.

(1) “ARRT” means American Registry of Radiologic Technologists.

(2) “Authorized supervisor” means a Maryland licensed physician or a Maryland licensed radiologic technologist.

(3) “Board” means the State Board of Physicians.

(4) “Certified radiologic technologist” means an individual who holds an active license and is certified in radiologic technology by the ARRT.

(5) “Competency” means the successful completion of supervised clinical procedures to verify the individual’s professional knowledge, skills, and ability.

(6) “Direct supervision” means oversight exercised by an authorized supervisor who is in the physical presence of the unlicensed individual and is able to provide instruction during the performance of an X-ray procedure.

(7) “Licensed physician” means, unless the context requires otherwise, a physician, including a doctor of osteopathy, licensed by the Board to practice medicine in the State.

(8) “Licensed radiologic technologist” means, unless the context requires otherwise, an individual licensed by the Board as a radiographer in the State.

(9) Limited Scope X-ray Educational Program.

(a) “Limited scope X-ray educational program” means an educational program that meets the requirements of Health Occupations Article, §14-306, Annotated Code of Maryland.

(b) “Limited scope X-ray educational program” is not a radiography educational program.

(10) “LXMO” means a Limited X-Ray Machine Operator registered with the Board.

(11) “Immediately available supervision" means oversight exercised by an authorized supervisor who can be immediately available to provide direction in person, by telephone, or by other electronic means.

(12) “Readily retrievable” means maintained in a method by which an office can retrieve and produce the record for the Board upon request.

.03 Application, Renewal, and Reinstatement.

A. To apply for LXMO registration, an applicant shall:

(1) Pay the fee determined by the Board established in Regulation .09 of this chapter; and

(2) Complete a form provided by the Board attesting to:

(a) Completion of at least 6 months of clinical care experience;

(b) Completion of a limited scope X-ray educational program consisting of at least 115 hours of didactic training delivered by a certified radiologic technologist providing instruction in:

(i) Radiographic anatomy, procedures, and pathology;

(ii) Digital image acquisition and display;

(iii) Fundamentals, ethics, and laws of health care;

(iv) Human anatomy and physiology;

(v) Image production and analysis;

(vi) Imaging equipment and radiation production;

(vii) Medical terminology; and

(viii) Patient care;

(c) Completion of at least 480 hours of clinical training performed under the direct supervision of a certified radiologic technologist;

(d) Completion of a minimum of five competencies in each body part listed in Regulation .06B(2) of this chapter performed under the direct supervision of a certified radiologic technologist; and

(e) Achievement of a passing result of 75 percent or higher on the ARRT Examination for Limited Scope of Practice in Radiography or a passing result on an alternative exam as determined by the Board.

(3) Criminal History Records Check. An applicant shall submit to a criminal history records check in accordance with Health Occupations Article, §14-308.1, Annotated Code of Maryland, by submitting to the Central Repository:

(a) Two complete sets of legible fingerprints taken on forms approved 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.

B. Renewal.

(1) Before the expiration of the registration, an individual applying for renewal shall complete an application for renewal on the form supplied by the Board.

(2) LXMO registration shall be renewed every 2 years on the date set by the Board.

(3) An LXMO shall pay the renewal fee, and any additional charges set by the Board in accordance with Regulation .09 of this chapter.

(4) An LXMO shall attest to the completion of continuing education activities as specified in Regulation .04 of this chapter.

(5) The Board may request an LXMO to submit evidence of having met the continuing education requirement specified in Regulation .04 of this chapter.

(6) If an LXMO cannot demonstrate completion of the required continuing education credit hours, the Board may impose a civil penalty of up to $100 per missing continuing education hour.

(7) If an LXMO fails to renew their registration for any reason, the registration will expire.

(8) After the expiration of the registration, an individual is no longer authorized to practice as an LXMO.

(9) The Board may impose a civil penalty of up to $1,000 on the individual and a civil penalty of up to $5,000 on the employer of the individual for practicing without registration if a formerly registered individual:

(a) Fails to submit an application and pay the requisite renewal fee before the expiration of the registration; and

(b) Practices as a LXMO after the expiration of the registration.

C. Reinstatement.

(1) The Board shall reinstate the registration of an LXMO if the individual:

(a) Completes the reinstatement application on the form approved by the Board.

(b) Pays a reinstatement fee as determined by the Board in accordance with Regulation .09 of this chapter; and

(c) Documents evidence of completion of at least 24 hours of approved continuing education earned during the 2-year period preceding the date of the submission of the application for reinstatement for the registration as an LXMO.

(2) The applicant shall submit to a criminal history records check in accordance with Health Occupations Article, §14-308.1, Annotated Code of Maryland, by submitting to the Central Repository:

(a) Two complete sets of legible fingerprints taken on forms approved 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.

.04 Continuing Education.

A. An LXMO shall complete at least 24 hours of approved continuing education credits earned during the 2 years preceding the expiration of the registration.

B. Approved continuing education is as follows:

(1) In-service programs at a hospital or related institution as defined in Health-General Article, §19-301, Annotated Code of Maryland, or a health maintenance organization certified by the State; or

(2) Programs relevant to the practice of an LXMO approved by the:

(a) Maryland Society of Radiologic Technologists;

(b) American Medical Association;

(c) MedChi, the Maryland State Medical Society; or

(d) American Society of Radiologic Technologists.

C. An LXMO shall obtain documentation of continuing education attendance and retain this documentation for the succeeding 6 years for possible inspection by the Board.

D. The required documentation of attendance at a continuing education course shall contain, at a minimum:

(1) Program title;

(2) Sponsor’s name;

(3) LXMO’s name;

(4) Inclusive date or dates and location of the continuing education event;

(5) Number of designated continuing education hours; and

(6) Documented verification of a successful completion.

.05 Physician Office Requirements.

A. An LXMO shall wear an identification badge while on-site that states in readily visible type:

(1) The name of the LXMO; and

(2) The title “Limited X-Ray Machine Operator.”

B. A physician’s office employing an LXMO shall:

(1) Issue the LXMO an identification badge described in §A of this regulation;

(2) Verify all credentials of the LXMO;

(3) Keep readily retrievable, on-site documentation that the LXMO meets the requirements of Health Occupations Article, §14-306, Annotated Code of Maryland and this chapter;

(4) Permit the Board to inspect the documentation to ensure compliance with Health Occupations Article, §14-306, Annotated Code of Maryland and this chapter; and

(5) Verify all X-ray examinations performed by the LXMO are in accordance with Health Occupations Article, §14-306, Annotated Code of Maryland and this chapter.

.06 Scope of Practice.

A. An LXMO shall perform X-ray duties in a physician’s office under the immediately available supervision of a licensed physician or licensed radiologic technologist and in accordance with §B of this regulation.

B. An individual registered as an LXMO may perform X-ray duties without a license only if the duties:

(1) Do not include:

(a) Computerized or non-computerized tomography;

(b) Fluoroscopy;

(c) Invasive radiology;

(d) Mammography;

(e) Nuclear medicine;

(f) Radiation therapy; or

(g) Xerography; and

(2) Are limited to X-ray procedures of the:

(a) Chest;

(b) Spine, including the:

(i) Cervical spine;

(ii) Lumbar spine;

(iii) Sacroiliac joints;

(iv) Sacrum and coccyx; and

(v) Thoracic spine;

(c) Lower extremities, including:

(i) Toes;

(ii) The foot;

(iii) The ankle;

(iv) The calcaneus;

(v) The tibia and fibula;

(vi) The knee and patella; and

(vii) The femur; and

(d) Upper extremities, including:

(i) Fingers;

(ii) The hand;

(iii) The wrist;

(iv) The forearm;

(v) The elbow;

(vi) The humerus;

(vii) The shoulder;

(viii) The clavicle;

(ix) Acromioclavicular joints; and

(x) The scapula.

.07 Prohibited Conduct and Penalties.

A. An LXMO acting beyond the scope of this chapter may be:

(1) Considered to be engaged in the unlicensed practice of radiography; and

(2) Subject to all applicable penalties and fines in accordance with Health Occupations Article, §§14-601, 14-602 and 14-5B-17, Annotated Code of Maryland, and COMAR 10.32.02.

B. A supervising licensed physician or licensed radiologic technologist, through either act or omission, facilitation, or otherwise enabling or forcing an LXMO to practice beyond the scope of this chapter, may be subject to discipline for grounds within Health Occupations Article, §§14-404(a) or 14-5B-14, Annotated Code of Maryland, including, but not limited to, practicing medicine with an unauthorized person or aiding an unauthorized person in the practice of medicine.

C. A supervising licensed physician or licensed radiologic technologist may not:

(1) Require an LXMO to perform an X-ray procedure; and

(2) Permit an LXMO to delegate to another individual.

D. A physician’s office that employs an individual authorized to perform X-ray duties without a license is responsible for ensuring that all requirements of Health Occupations Article, §14-306, Annotated Code of Maryland, and this chapter are met for each X-ray examination performed.

.08 Enforcement.

A. The Board shall conduct any necessary investigation regarding the failure to comply with the requirements of Health Occupations Article, §14-306, Annotated Code of Maryland, and this chapter.

B. The Board may impose a civil penalty of up to $5,000 per incident on a physician’s office for failure to comply with Health Occupations Article, §14-306, Annotated Code of Maryland, and this chapter.

C. The Board may impose a civil penalty of up to $5,000 per incident on a physician's office who employs an unregistered individual to practice as an LXMO.

D. The Board may impose a civil penalty of up to $1,000 per incident on an individual for failure to comply with Health Occupations Article, §14-306, Annotated Code of Maryland, and this chapter.

.09 Fees.

The following fees are applicable to LXMOs:

A. Application for initial registration—$65;

B. Renewal Fees:

(1) Renewal of registration fee—$125; and

(2) Maryland Health Care Commission (MHCC) fee—As determined by MHCC in accordance with COMAR 10.25.03;

C. Reinstatement of registration fee—$135;

D. Application to take the Limited Scope of Practice in Radiology examination—$10;

E. LXMO registration fee per month until expiration of initial registration—$2; and

F. Written verification fee—$25.

RYAN B. MORAN, DrPH, MHSA

Acting Secretary of Health

Subtitle 44 BOARD OF DENTAL EXAMINERS

10.44.34 Inspections—Compliance with Centers for Disease Control and Prevention Guidelines

Authority: Health Occupations Article, §§4-205(c)(1) and 4-205(a)(6), Annotated Code of Maryland

Notice of Proposed Action

[25-093-P]

The Secretary of Health proposes to adopt new Regulations .01—.04 under a new chapter, COMAR 10.44.34 Inspections—Compliance with Centers for Disease Control and Prevention Guidelines. This action was considered by the Board of Dental Examiners at a public meeting held on July 19, 2023 notice of which was given under the Notice of Public Meetings link on the Board’s website pursuant to General Provisions Article, §3-302(c), Annotated Code of Maryland.

Statement of Purpose

The purpose of this action is to prescribe procedures for unannounced inspections of a dental office to determine compliance with the Centers for Disease Control and Prevention’s guidelines on universal precautions in accordance with Health Occupations Article, §4-205(a)(6), Annotated Code of Maryland.

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 July 14, 2025. A public hearing has not been scheduled.

.01 Purpose.

The purpose of this chapter is to prescribe procedures for unannounced inspections of a dental office to determine compliance at that office with the Centers for Disease Control and Prevention's guidelines on universal precautions in accordance with the Health Occupations Article, §4-205(a)(6), Annotated Code of Maryland.

.02 Inspections.

A. On receipt of a written and signed complaint, including a referral from the Commissioner of Labor and Industry, alleging potential non-compliance with the Centers for Disease Control and Prevention's guidelines on universal precautions, the Board may conduct an unannounced inspection of the dental office.

B. A Board inspector or designee shall inspect the dental office in accordance with the Centers for Disease Control and Prevention's guidelines on universal precautions and shall produce an inspection report.

C. The Board shall review the inspection report and make a determination as to whether any violations exist.

D. Within 2 weeks of the inspection, the Board shall notify the appropriate licensee or licensees of the results of the inspection in writing. If the inspection found violations, the notification shall include a notice of those violations and the specified time to correct those violations.

.03 Correction of Violations.

A. Except as provided in §§C and D of this regulation, if the Board’s inspection indicated violations, the appropriate licensee or licensees within the dental office shall correct violations within 30 days after receipt of the Board’s written notification.

B. The Board may require less than 30 days to correct a violation if the Board considers the correction necessary to the interest of public health.

C. A licensee may request an extension of time for correction of violations.

D. The Board may approve or deny an extension of time for correction of violations.

E. Upon completion of correction of all violations, the licensee shall notify the Board in writing within 1 week of the corrections with adequate documentation of all corrections.

F. Upon notification of the corrections, the Board or its designee shall re-inspect the dental office.

G. The Board shall notify the appropriate licensee or licensees in writing of the results of the re-inspection within 1 week of the re-inspection.

H. If re-inspection reveals additional violations not cited in the first inspection report, the appropriate licensee or licensees shall correct those violations in the time period specified unless an extension of time is requested by a licensee and approved by the Board in accordance with §§C and D of this regulation.

.04 Penalties.

A. Failure to allow an inspection of a dental office may result in disciplinary action against a licensee in accordance with COMAR 10.44.07, subject to the hearing requirements set forth in Health Occupations Article, §4-318, Annotated Code of Maryland.

B. Failure to comply with a notice to correct violations within a 30-day period, or any extension granted by the Board under Regulation .03 of this chapter, may result in disciplinary action against a licensee in accordance with COMAR 10.44.07, subject to the hearing requirements set forth in Health Occupations Article, §4-318, Annotated Code of Maryland.

C. Nothing in this chapter precludes the Board from taking concurrent or subsequent disciplinary action, including summary action, against a licensee found to have violated applicable Centers for Disease Control and Prevention guidelines, subject to the Administrative Procedure Act, the notice and hearing requirements set forth in Health Occupations Article, §4-318, Annotated Code of Maryland, and Board regulations.

LAURA HERRERA SCOTT
Secretary of Health

Subtitle 58 BOARD OF PROFESSIONAL COUNSELORS AND THERAPISTS

Notice of Proposed Action

[25-101-P]

The Acting Secretary of Health proposes to amend:

(1) Regulation .04 under COMAR 10.58.01 General Regulations; and

(2) Regulation .06 under COMAR 10.58.08 Marriage and Family Therapists—Requirements for Licensure.

This action was considered by the Board of Professional Counselors and Therapists at a public meeting held on February 21, 2025, notice of which was given by publication on the Board’s website at health.maryland.gov/bopc/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 update the licensing requirements for out-of-state marriage and family therapists pursuant to Chs. 45 and 46, 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 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 July 14, 2025. A public hearing has not been scheduled.

10.58.01 General Regulations

Authority: Health Occupations Article, §§17-101, 17-205, 17-301, 17-304, 17-307, 17-308, and 17-509, Annotated Code of Maryland

.04 Application Process.

A. In order to obtain a certificate or license, an applicant shall:

(1) (text unchanged)

(2) [Submit] Except for out-of-state Marriage and Family Therapist applicants, submit an official transcript from an accredited educational institution awarding the highest degree attained in counseling or a related field;

(3)—(7) (text unchanged)

B. (text unchanged)

10.58.08 Marriage and Family Therapists — Requirements for Licensure

Authority: Health Occupations Article, §§17-101, 17-205, 17-301, 17-303, 17-306, 17-308, 17-309, 17-507, and 17-509, Annotated Code of Maryland

.06 Licensure Eligibility: Out-of-State Applicants.

A. An applicant licensed as a clinical marriage and family therapist or its equivalent, as established by the Board, in another state, territory, or jurisdiction is eligible for licensure if the applicant:

(1) Provides:

(a) (text unchanged)

[(b) An official transcript from the educational institution which awarded the master’s or doctoral degree;]

[(c)] (b)—[(e)] (d) (text unchanged)

(2) (text unchanged)

(3) Has achieved a passing score on[:

(a) An] an examination of:

[(i)] (a) (text unchanged)

[(ii)] (b) This subtitle; [and]

[(b) A national certification exam approved by the Board;]

(4) (text unchanged)

[(5) Meets the educational requirements for licensure in this State as a clinical marriage and family therapist:

(a) As established in Regulation .05 of this chapter; or

(b) By providing documentation of the substitute educational and experience requirements outlined in §§B—E of this regulation;]

[(6)] (5)—[(7)] (6) (text unchanged)

B. Waiver of Examination. The Board may waive any examination requirements for an applicant who satisfies the Board that the applicant:

(1) Obtained licensure in a state or country that grants a similar endorsement to licensees of this State; and

[(2) Became licensed in another state or country after passing an examination approved by the Board; and]

[(3)] (2) (text unchanged)

[C. Equivalent Educational Requirements. The applicant shall provide documentation or transcripts confirming completion of a master's or doctoral degree in a marriage and family therapy field from an accredited educational institution.

D. Waiver of Course Requirements. The Board may waive one or more course requirements specified in Regulation .05 of this chapter, except for documentation showing completion of a minimum of 3 graduate semester credit hours or 5 graduate quarter credit hours covering each of the following primary topics or content areas:

(1) Diagnosis and psychopathology;

(2) Sexual issues in marriage and family therapy;

(3) Couples therapy, theory, and techniques; and

(4) Professional, legal, and ethical responsibilities in marriage and family therapy.

E. Equivalent Experience Requirements. The Board may waive the clinical experience requirements specified in Regulation .04 of this chapter as follows:

(1) The applicant shall provide documentation, satisfactory to the Board, of one of the following for an applicant with:

(a) A master’s or doctoral degree in a marriage and family therapy field from an accredited educational institution as approved by the Board, as specified in Regulation .05 of this chapter; or

(b) Program of studies judged by the Board to be substantially equivalent in subject matter and extent of training; and

(2) The applicant shall provide verification on a Board-approved form, from employers,

supervisors, or colleagues that the applicant has practiced clinical marriage and family therapy

for the length of time specified as follows:

(a) A master's or doctoral degree consisting of:

(i) A minimum of 60 graduate credit hours or 90 graduate quarter credit hours; and

(ii) Not less than 2 years, with a minimum of 2,000 hours, of supervised clinical experience in marriage and family therapy, completed after the award of the master's degree; or

(b) A master's or doctoral degree consisting of:

(i) Less than 60 graduate credit hours or 90 graduate quarter credit hours; and

(ii) Not less than 2 years’ experience practicing as a licensed clinical marriage and family therapist, with a minimum of 2,000 hours of clinical marriage and family therapy experience.]

RYAN B. MORAN, DRPH, MHSA
Acting Secretary of Health

Title 11
DEPARTMENT OF TRANSPORTATION

Subtitle 03 MARYLAND AVIATION ADMINISTRATION

11.03.01 Baltimore/Washington International Thurgood Marshall Airport

Authority: Transportation Article, §§5-204 and 5-208, Annotated Code of Maryland

Notice of Proposed Action

[25-059-P]

The Executive Director of the Maryland Aviation Administration proposes to amend Regulation .13 under COMAR 11.03.01.13 Baltimore/Washington International Thurgood Marshall Airport. This action was considered by the Maryland Aviation Commission in an open meeting on February 19, 2025, notice of which was given, pursuant to General Provisions Article, §3-302, Annotated Code of Maryland.

Statement of Purpose

The purpose of this action is to amend the established public hours of operations at Baltimore/Washington International Thurgood Marshall Airport (BWI Marshall) from 4:00 a.m. until 11:00 p.m. to twenty-four hours a day. Once amended, no individual may enter or be present in the terminal, pedestrian bridges, hourly garage, or the on-Airport consolidated rental car facility at BWI Marshall except: Airline passengers and on-Airport consolidated rental car facility customers; Individuals meeting, accompanying, or assisting passengers on an arriving or departing flight; Individuals whose employment requires their presence in the terminal, pedestrian bridges, hourly garage, or on-Airport consolidated rental car facility; and Other individuals specifically authorized by the Executive Director to enter and be present in some or all of these locations.

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 Stacey Hicks-Johnson, Regulations Coordinator , MAA, PO Box 8766, BWI Airport, MD 21240, or call 410-859-7351, or email to shicks-johnson@bwiairport.com. Comments will be accepted through July 14, 2025. A public hearing has not been scheduled.

.13 [Public] Business Hours of Operation of the Terminal and Other Locations at the Airport.

A. General Regulations. The terminal at the Airport, the pedestrian bridges connecting the hourly garage at the Airport to the terminal, the hourly garage, and the on-Airport consolidated rental car facility are open to the public [from 4:00 a.m. to 11:00 p.m. each day] twenty-four hours a day. No individual may enter or be present in the terminal, pedestrian bridges, hourly garage, or on-Airport consolidated rental car facility [from 11 p.m. to 4 a.m. the next day] except:

(1)—(4) (text unchanged)

B. (text unchanged)

RICKY D. SMITH, SR.
Executive Director

Maryland Aviation Administration

Title 14
INDEPENDENT AGENCIES

Subtitle 35 MARYLAND HEALTH BENEFIT EXCHANGE

Notice of Proposed Action

[25-086-P]

The Maryland Health Benefit Exchange proposes to:

(1) Amend Regulation .04 under COMAR 14.35.02 Individual Exchange Navigator Certification and Training Standards;

(2) Amend Regulations .02 and .04 under COMAR 14.35.04 Insurance Producer Authorization to Sell Qualified Plans in the SHOP Exchange and Individual Exchange;

(3) Amend Regulation .02 under COMAR 14.35.05 Insurance Producer Authorization—Renewal, Reinstatement, and Suspension or Revocation of Authorization;

(4) Repeal existing Regulations .01—.06 under COMAR 14.35.08 Captive Producer Training and Authorization Standards;

(5) Amend Regulation .01 under COMAR 14.35.10 Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator Certification; and

(6) Amend Regulation .06 under COMAR 14.35.13 Application Counselor Training and Certification Standards.

This action was considered at the April 21, 2025 meeting of the MHBE Board of Trustees.

Statement of Purpose

The purpose of this action is to require insurance producers to pass an examination after training in order to achieve authorization to sell health plans on Maryland Health Connection and to allow MHBE discretion to refuse to reauthorize producers who have had disciplinary action taken against them. This action also proposes to codify existing examination and certification requirements for navigators and application counselors, and to codify the termination of the Captive Producer Program.

Estimate of Economic Impact

The proposed action has no economic impact.

Economic Impact on Small Businesses

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

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

Comments may be sent to Becca Lane, Senior Health Policy Analyst, Maryland Health Benefit Exchange, 750 E Pratt St., 6th Floor, Baltimore, MD 21202, or call 410-547-7371, or email to becca.lane@maryland.gov. Comments will be accepted through July 14, 2025. A public hearing has not been scheduled.

14.35.02 Individual Exchange Navigator Certification and Training Standards

Authority: Insurance Article, §§31-106 and 31-113, Annotated Code of Maryland

.04 Training Standards.

A.—C. (text unchanged)

D. Examination.

(1)—(3) (text unchanged)

(4) Applicants must successfully pass the examination within 45 calendar days of completing the training described under §A of this regulation.

(5) Applicants are allowed three attempts to pass the examination in a 12-month period.

(6) If the applicant does not pass the examination on the third attempt, they must wait 12 months before they are eligible to train and test again.

E. Training Frequency. The Exchange shall conduct trainings:

(1)—(2) (text unchanged)

F. (text unchanged)

14.35.04 Insurance Producer Authorization to Sell Qualified Plans in the SHOP Exchange and Individual Exchange

Authority: Insurance Article, §§31-106, 31-112(f), (g), and (h), and 31-113(m), (n), and (o), Annotated Code of Maryland

.02 Eligibility Requirements.

To be eligible to apply for initial insurance producer authorization, an applicant shall:

A. [be] Be licensed by the Maryland Insurance Commissioner as an insurance producer authorized to sell health insurance[.]; and

B. Successfully complete and comply with any ongoing requirements of the training programs set forth under Regulation .04 of this chapter.

.04 Training.

A.—D. (text unchanged)

E. An applicant for Individual Exchange or SHOP insurance producer authorization shall meet the examination requirements specified under COMAR 14.35.02.04D.

14.35.05 Insurance Producer Authorization—Renewal, Reinstatement, and Suspension or Revocation of Authorization

Authority: Insurance Article, §§31-106, 31-112(f), (g), and (h), and 31-113(m), (n), and (o), Annotated Code of Maryland

.02 Renewal.

A. (text unchanged)

B. Eligibility for Renewal. An insurance producer authorization may be renewed for an additional 2-year term if the holder:

(1)—(2) (text unchanged)

(3) Pays to the Exchange a renewal fee if permitted by law and in the manner specified by the Exchange; [and]

(4) Completes the annual training requirements set forth in COMAR 14.35.04.04[.], and

(5) Is not denied by the Exchange for reasons set forth under §E of this regulation.

C.—D. (text unchanged)

E. Denial.

(1) The Exchange may deny a renewal application if the insurance producer has:

(a) Committed any act described in Insurance Article, §31-113(l)(1), Annotated Code of Maryland; or

(b) Had any professional license or certification suspended or revoked for a fraudulent or dishonest practice.

(2) Denial of a renewal application is subject to the contested case hearing provisions of State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.

14.35.10 Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator Certification

Authority: Insurance Article, §§31-106(c)(1)(iv), 31-112, and 31-113; State Government Article, Title 10, Subtitle 2; Annotated Code of Maryland

.01 Scope.

A.—B. (text unchanged)

C. Determinations entitled to contested case appeals. This chapter applies only to the appeal of an Exchange determination regarding:

(1)—(5) (text unchanged)

(6) Renewal of Individual Exchange producer authorization; and

[(7) Suspension of captive producer authorization;

(8) Revocation of captive producer authorization;

(9) Renewal of captive producer authorization; and]

[(10)] (7) (text unchanged)

14.35.13 Application Counselor Training and Certification Standards

Authority: Insurance Article, §§31-106 and 31-113(r), Annotated Code of Maryland

.06 Training Requirements.

In order to obtain application counselor certification, an individual shall[:

A. Complete the training program under COMAR 14.35.02.04A; and

B. Pass the examination specified under COMAR 14.35.02.04D.] meet the training and examination requirements specified under COMAR 14.35.02.04.

MICHELE EBERLE
Executive Director

Title 26
DEPARTMENT OF THE ENVIRONMENT

Subtitle 11 AIR QUALITY

26.11.09 Control of Fuel-Burning Equipment, Stationary Internal Combustion Engines, and Certain Fuel-Burning Installations

Authority: Environment Article, §§1-101, 1-404, 2-101—2-103, 2-301—2-303, 10-102, and 10-103, Annotated Code of Maryland

Notice of Proposed Action

[24-227-P]

The Secretary of the Environment proposes to amend Regulations .01 and .07 under COMAR 26.11.09 Control of Fuel-Burning Equipment, Stationary Internal Combustion Engines, and Certain Fuel-Burning Installations.

Statement of Purpose

The purpose of this action is to propose amendments to update a grammatical error within the definition of “Residual fuel oil” and to lower the amount of sulfur allowed in petroleum-based fuel oils combusted at stationary sources. Lowering sulfur from fuel oils will reduce emissions of sulfur dioxide (SO2), which also leads to increased formation of fine particulate matter (PM2.5). This action will reduce visibility-impairing pollutants that contribute to regional haze, as required by the federal Clean Air Act, and to protect public health from the adverse health effects of SO2 and PM2.5 pollution.

This action will be submitted to the U.S. Environmental Protection Agency (EPA) for approval as part of Maryland's State Implementation Plan (SIP).

Background

Section 169A of the Clean Air Act requires the EPA to address impaired visibility, also known as regional haze, in 156 national parks, forests and wilderness areas that have been federally designated as Class I areas. In 1999, EPA issued regulations, known as the Regional Haze Rule, which require states to develop SIPs to reduce haze-causing pollution to improve visibility in Class I areas.

The EPA established five regional planning organizations across the nation to coordinate regional haze efforts. Maryland is a member of one of these regional organizations, the Mid-Atlantic Northeast Visibility Union (MANE-VU), comprised of Mid-Atlantic and Northeast states, tribes, and federal agencies.

In June 2007, the MANE-VU states agreed to pursue several regional strategies to reduce SO2 emissions, the main contributor to visibility impairment in the MANE-VU region, including lowering the allowable sulfur content in distillate and residual fuel oils to specified levels.

On August 25, 2017, MANE-VU signed a statement containing six “Asks” concerning controls and analyses that the states with Class I Federal areas in MANE-VU wanted to be addressed in the long-term strategy of any MANE-VU member.

“Ask 3” of the 2017 MANE-VU statement pertains to Ultra Low-Sulfur Fuel Oil Regulations. Each MANE-VU state that has not yet fully adopted an ultra-low sulfur fuel oil standard as originally requested by MANE-VU in 2007 should pursue this standard as expeditiously as possible and before 2028, depending on supply availability, where the standards are as follows:

(1) Distillate oil to 0.0015 percent sulfur by weight (15 parts per million (ppm));

(2) No. 4 residual oil within a range of 0.25 to 0.5 percent sulfur by weight; and

(3) No. 6 residual oil within a range of 0.3 to 0.5 percent sulfur by weight.

Maryland adopted amendments to COMAR 03.03.05.04, Specifications for No. 1 and No. 2 Fuel Oil in 2014 under the Comptroller of the Treasury. The amendments lowered the maximum allowable amount of sulfur in several stages. The first stage reduced the maximum No. 1 and No. 2 fuel oil sulfur levels from 3,000 ppm to 2,000 ppm in 2014. The second stage reduced sulfur levels further to a level of 500 ppm in 2016. The third stage reduced sulfur levels further for No. 1 and No. 2 fuel oil to the MANE-VU “ASK” level of 15 ppm in 2019. This proposed action will align the sulfur levels for distillate fuel in COMAR 26.11.09.07 under the Department of Environment with the previously adopted requirements specified in COMAR 03.03.05.04.

There is not an equivalent federal standard to the proposed regulations, however, under the Regional Haze Rule, states are required to develop a series of SIPs to address visibility impairment in Class I Federal areas and make reasonable progress toward achieving natural visibility conditions. 40 CFR § 51.308 requires best available retrofit technology (BART) to improve visibility. The state of Maryland is following MANE-VU’s six “asks” when preparing a SIP and developing BART requirements. One of MANE-VU’s “asks” specifies percent by weight standards for No. 2 distillate oil, No. 4 residual oil, and No. 6 residual oil. The State of Maryland has already finalized standards for No. 2 distillate oil and this action will align COMAR 26.11.09.07 with the requirements specified under COMAR 03.03.05.04. The amendments to COMAR 26.11.09.07 “Control of Sulfur Oxides from Fuel Burning Equipment” will fulfill MANE-VU’s “Ask 3” of the 2017 MANE-VU statement of lowering sulfur content in No. 4 and No. 6 residual oil before 2028. The amendments to Regulation .01 and .07 under COMAR 26.11.09 will be submitted to EPA as part of the SIP.

Currently, the amount of No. 4 or No. 6 residual oil combusted in Maryland is comparatively low (less than 0.2 percent of the national consumption total) and sources that utilize residual oil are relatively uncommon. Within Maryland, there are several electricity generating units (EGUs) and combustion turbines, along with oil-fired emergency generators that operate infrequently. Several asphalt plants also combust residual oil, whereas the majority solely combust distillate oil. Despite the infrequent and limited use of residual fuel-oil, regulating the amount of sulfur in fuel-oil is critically important in reducing a variety of different pollutants emitted into the atmosphere. SO2 is the main pollutant emitted from burning fuel-oil incorporated with sulfur, with byproducts being emitted such as PM2.5. In addition to limiting these pollutants, ozone formulating pollutants are released into the atmosphere with the burning of fuel-oil, specifically Nitrogen Oxides (NOx) and Volatile Organic Compounds (VOCs). The release of VOCs from the burning of fuel-oil is nearly nine times higher than the burning of coal, a fossil fuel critically damaging our atmosphere and impacting our climate. A Maryland Department of the Environment (MDE) analysis conducted during the summer of 2021 demonstrated the direct impact resulting from the burning of fuel-oil at local EGUs and combustion turbines, causing ozone to quickly form in the atmosphere. A significant increase in VOCs and NOx were emitted into the atmosphere during the episodes due to fuel-oil being burned contributing to an exceedance of the ozone National Ambient Air Quality Standard at local air monitors.

In accordance with Maryland’s Regional Haze SIP and ongoing efforts to reduce emissions of SO2, PM2.5, NOx, and VOCs in order to protect public health, MDE proposes to amend COMAR 26.11.09.07 to lower sulfur content limits for stationary sources beginning January 1, 2026.

Sources Affected and Location

This regulation applies to the owner or operator of fuel-burning equipment combusting distillate or residual fuel oil, on or after January 1, 2026, within the state of Maryland. This regulation is applicable throughout the entire State.

Requirements

The proposed amendments to COMAR 26.11.09.07 establish lower sulfur limits for distillate and residual oil beginning January 1, 2026. Under these amendments a person may not burn, sell, or make available for sale any fuel with a sulfur content by weight in excess of or which otherwise exceeds the following limitations:

(1) 0.0015 percent (15 parts per million or ppm) sulfur by weight for distillate oil (No. 1 and No. 2 fuel oil); and

(2) 0.3 percent (3,000 ppm) sulfur by weight for residual oil (No. 4, No. 5, and No. 6 fuel oil).

The proposed amendments to COMAR 26.11.09.07 provide carry over provisions so that a person may burn fuel containing sulfur limits in excess of the amounts specified above that were purchased prior to January 1, 2026. After January 1, 2026, a person combusting or storing distillate or residual fuels containing sulfur in excess of the amounts specified above must submit documentation, as specified under the new recordkeeping and reporting requirements, to the Department including the amount, type, and sulfur content the of distillate, residual, or blended fuel on-site no later than March 31, 2026. After January 1, 2026, a person must purchase fuel oil containing the sulfur weight limitations as stated above.

New recordkeeping and reporting requirements are added to the regulation that apply to a person offering to sell or deliver fuel, or a person responsible for the equipment in which the fuel or process gas is burned. This section requires affected sources to maintain records of information for the Department to be able to determine compliance with the regulation. All records required must be made available to the Department upon request and maintained for five years from the date of creation.

The Department is removing sections of the regulation that provided exemptions for specific facilities that are no longer in operation and have permanently closed down. These sections of the regulation will be repealed as there are no facilities in Maryland that meet the criteria as detailed in the exemptions.

The requirements of the regulation will no longer be delineated by areas of the state. All regulatory requirements will now be applicable state-wide.

Projected Emission Reductions

According to an analysis conducted by Massachusetts Department of Environmental Protection, MDE’s research indicates that the proposed amendments to COMAR 26.11.09.07 will reduce SO2 emissions from current limits over 80 percent by reducing the sulfur content in No. 6 oil and 99.5 percent by reducing the sulfur content in No. 2 oil. The Department believes that similar reductions will be gained for No. 4 and No. 5 oil as compared to No. 6 oil reductions. Lowering sulfur emissions will help to allow Maryland to continue to meet the 1-hour SO2 National Ambient Air Quality Standard. Reducing the sulfur content in fuel oil will benefit Class I areas (designated under the Regional Haze rules) by continuing to improve visibility, reduce the negative impacts on public health, and reduce the chances of the creation of sulfuric acid, which can cause acidification of lakes and trees, damage trees and soils, and accelerates the decay of building materials and paints.

Economic Summary

In 2018, Maryland’s Comptroller of the Treasury adopted regulations which starting July 1, 2019, required the maximum allowed sulfur content in No. 1 and No. 2 home heating oil sold in Maryland to be limited 15 ppm. The Comptroller’s Office noted that the regulations will have minimal cost impacts on the fuel oil industry and consumers based on the experience of other states that had already required reduced sulfur content in fuel oils. The industry is already producing compliant fuel oil and Maryland will benefit from economies of scale.

As a result of state actions to implement the MANE-VU low sulfur fuel strategy, refiners have made upgrades to produce low sulfur fuel oils. For residual oil, sufficient supplies of lower sulfur oils (e.g., 0.3 percent sulfur content for No. 4, No. 5, and No. 6 oil) are readily available and already are being used by many states throughout the Mid-Atlantic and Northeast. Any potential increase in fuel costs for affected sources will likely be offset by lower maintenance costs and higher fuel efficiency. Higher sulfur contents in fuels contributes to corrosiveness of combustion byproducts, so the use of low sulfur fuel can extend the life of boilers and other equipment while potentially reducing the cost of new oil-burning equipment.

The amount of uncontrolled SO2 emitted from equipment is almost entirely dependent on the sulfur content of fuel and is essentially independent of burner design. Domestic oil refiners have made the capital investments required to produce lower sulfur distillate fuels to comply with EPA’s national ultra-low sulfur transportation diesel fuel requirements. For residual oil, sufficient supplies of lower sulfur oils are readily available and already are being used as required by several MANE-VU states for fuel burning facilities.

The Department’s research indicates that the majority of fuel oil being combusted within facilities that are required to follow this regulation, such as electric generating boilers and turbines and stationary emergency generators, is primarily distillate oil and has been meeting the limit previously required under COMAR 03.03.05.04. The Department’s research further indicates that the residual oil being combusted at asphalt plants currently meets the proposed limit in this action (0.3 percent). Facilities in Maryland are already purchasing residual fuel with a sulfur content percentage as low as 0.1% and up to 0.19%. For the reasons stated above, MDE believes that the proposed amendments to COMAR 26.11.09.07 are cost-effective and will not result in economic hardship to facilities that use distillate or residual fuel oil.

This action will not have an economic impact on State agencies or local governments.

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 Randy Mosier, Deputy Program Manager, Air Quality Planning Program, Maryland Department of the Environment, 1800 Washington Blvd. Baltimore, Maryland 21230, or call 410-537-4488, or email to randy.mosier@maryland.gov. Comments will be accepted through July 15, 2025. A public hearing will be held on The Department of the Environment will hold a virtual public hearing on the proposed action on July 15, 2025. See the Department’s website for virtual hearing information, https://mde.maryland.gov/programs/Regulations/air/Pages/reqcomments.aspx.

Interested persons are invited to attend and express their views. Comments must be received by 5 p.m. on July 15, 2025. Comments may be sent to Randy Mosier, Deputy Program Manager of the Air Quality Planning Program, Department of the Environment, 1800 Washington Boulevard, Suite 730, Baltimore, MD 21230-1720, or by email at randy.mosier@maryland.gov. For more information, contact Mr. Mosier at (410) 537-4488 or email randy.mosier@maryland.gov.

.01 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)—(11) (text unchanged)

(12) “Residual fuel oil” means [that] fuel oil that meets the specifications of the American Society for Testing and Materials for Numbers 4, 5, or 6 (bunker C) oils or crude oils when used as a fuel.

(13)—(18) (text unchanged)

.07 Control of Sulfur Oxides [From] from Fuel Burning Equipment.

A. Sulfur Content Limitations for Fuel. [A person may not burn, sell, or make available for sale fuel with a sulfur content by weight in excess of, or which otherwise exceeds, the following limitations:]

(1) [In Areas I, II, V, and VI:] Except as provided in §§A(2) and B of this regulation, beginning January 1, 2026, a person may not burn, sell, or make available for sale in the state of Maryland any fuel with a sulfur content by weight in excess of, or which otherwise exceeds, the following limitations:

[(a) The combustion of all solid fuels on a premises where the sum total maximum rated heat input of all fuel burning equipment located on the premises is 100 million Btu (106 gigajoules) per hour or greater may not result in a total emission of oxides of sulfur in excess of 3.5 pounds per million Btu (1.50 kilograms per gigajoule) actual heat input per hour;

(b) Residual fuel oils, 2.0 percent;

(c) Distillate fuel oils, 0.3 percent;

(d) Process gas used as fuel, 0.3 percent;

(2) In Areas III and IV:

(a) All solid fuels, 1.0 percent;

(b) Distillate fuel oils, 0.3 percent;

(c) Residual fuel oils, 1.0 percent.]

(a) The combustion of all solid fuels on a premises where the sum total maximum rated heat input of all fuel burning equipment located on the premises is 100 million Btu (106 gigajoules) per hour or greater may not result in a total emission of oxides of sulfur in excess of 3.5 pounds per million Btu (1.50 kilograms per gigajoule) actual heat input per hour;

(b) Distillate fuel oils, 0.0015 percent;

(c) Residual fuel oils, 0.3 percent;

(d) Process gas used as fuel, 0.3 percent; and

(e) All solid fuels, 1.0 percent.

(2) Carry Over Provisions.

(a) A person may burn distillate or residual fuel oil containing sulfur in excess of the amounts specified in §A(1)(b) or (c) of this regulation that was purchased prior to January 1, 2026.

(b) After January 1, 2026, a person combusting or storing distillate or residual fuel oil per §A(2)(a) of this regulation shall submit documentation as specified under §C(5)(b) of this regulation to the Department including the amount, type, and sulfur content of distillate, residual, or blended fuel oil remaining on-site by March 31, 2026.

B. Exceptions.

(1) (text unchanged).

(2) Fuel burning installations on ships [and the sale of fuel for these installations are exempt from the provisions of this regulation pertaining to the burning of fuel of specified sulfur content.] The provisions of this regulation do not apply to the following:

(a) The burning of fuel on ships; and

(b) The offering for sale and sale of fuel intended to be burned on a ship.

[(3) For any premises located in Area I, for which the Department determines that compliance with this regulation will cause or exacerbate a violation of the National Ambient Air Quality Standards or federal Prevention of Significant Deterioration of Air Quality increments, the applicable emission standard is as follows:

(a) For solid fuel, 1.8 pounds oxides of sulfur per million Btu (0.75 kilogram per gigajoule) actual heat input per hour;

(b) For residual oil, 1.0 percent sulfur content by weight.]

[(4) In Areas III and IV, for any existing fuel-burning equipment of the cyclone type, in excess of 1000 million Btu (1055 gigajoules) actual heat input per hour, the emission standard for solid fuel is 3.5 pounds oxides of sulfur per million Btu (1.6 kilograms per gigajoule) actual heat input.]

[(5)] (3) The provisions of [§§A(1)(a) and A(2)(a)] §A(1)(a) and (e) of this regulation shall not apply to fuel-burning equipment installed after May 1, 2014 that burns only biomass fuels.

[C. Request for Analyses. Any person offering to sell or deliver fuel or any person responsible for equipment in which fuel or process gas is burned, upon request, shall submit to the Department or control officer such analyses of fuel or process gas as may be required to determine compliance with this regulation.]

C. Recordkeeping and Reporting

(1) A person offering to sell or deliver fuel shall maintain records of information necessary for the Department to determine compliance with the requirements of §§A and B of this regulation.

(2) A person responsible for the equipment in which fuel or process gas is burned shall maintain records of information necessary for the Department to determine compliance with the requirements of §§A and B of this regulation.

(3) A person responsible for the equipment in which fuel or process gas is burned shall maintain records of the amount, type, and sulfur content of the fuel purchased and combusted.

(4) A person offering to sell or deliver fuel shall maintain records of the heating value, amount, type, and sulfur content of the fuels sold.

(5) All records made to demonstrate compliance with the requirements of this section shall be:

(a) Made available to the Department upon request;

(b) Made available via electronic format; and

(c) Maintained for 5 years from the date the record is created.

SERENA MCILWAIN
Secretary of the Environment

Title 30
MARYLAND INSTITUTE FOR EMERGENCY MEDICAL SERVICES SYSTEMS (MIEMSS)

Subtitle 07 EMERGENCY MEDICAL SERVICES COMMUNICATIONS SYSTEM

30.07.01 Helicopter Communications

Authority: Education Article, §13-509(d), Annotated Code of Maryland

Notice of Proposed Action

[25-077-P]

The Maryland State Emergency Medical Services Board proposes to amend Regulation .01 under COMAR 30.07.01 Helicopter Communications. This action was considered by the State EMS Board at its open meeting held on September 10, 2024, pursuant to General Provisions Article, §3-302(c), Annotated Code of Maryland.

Statement of Purpose

The purpose of this action is to update the communication requirements for helicopters responding to an incident or transporting a patient to a hospital in order to reflect the modernization of the radio systems currently used and being installed throughout Maryland.

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 Randy Linthicum, Deputy Director, MIEMSS, 653 West Pratt Street, Baltimore, MD 21201, or call 410-706-5074, or email to rlinthicum@miemss.org. Comments will be accepted through July 14, 2025. A public hearing has not been scheduled.

.01 Helicopter Communications to SYSCOM.

A. Definitions.

(1) “7AG60” means the conventional 700MHz National Interoperability channel designated for commercial and non-allied helicopter communications with SYSCOM.

(2) “7AIRMED” means the conventional 700MHz multicast radio system operated by MIEMSS to provide medical communications with commercial and non-allied helicopters.

(3) “EMRC” means the Emergency Medical Resource Center operated by MIEMSS for the Emergency Medical Services Communications System.

[(1)] (4) (text unchanged)

(5) “HELIMED1” means the Maryland FiRST statewide radio system talkgroup utilized by Maryland State Police Aviation Command helicopters as a secondary means of medical communications with EMRC.

[(2)] (6)—[3] (7) (text unchanged)

[(4) “MULTICOM” means a mobile radio service not open to public correspondence, used to provide communications essential to conduct the activities being performed by or directed from private aircraft.]

[(5)] (8)—[(7)] (10) (text unchanged)

[(8) “UNICOM” means an aeronautical advisory radio station used for advisory and civil defense communications primarily with private aircraft stations.]

(11) “SYSCOM-TG” means the Maryland FiRST statewide radio system talkgroup utilized by Maryland State Police Aviation Command helicopters as a secondary means of communications with SYSCOM.

B. Notice of Patient Transports.

(1) (text unchanged)

(2) The pilot shall contact SYSCOM directly using law enforcement frequency 44.74 MHz, tone code 110.9 Hz[.], SYSCOM-TG, or 7AG60.

(3) The [aeromedical communication radio stations designated in §B(2) of this regulation are located in the following locations:] programming information for 7AG60 is:

[(a) SYSCOM, University of Maryland, Baltimore City;

(b) Eagle Rock, Garrett County;

(c) Sideling Hill, Washington County;

(d) Dans Rock, Allegany County;

(e) Gambrill Mountain, Frederick County;

(f) Stoney Forest, Harford County;

(g) Crownsville, Anne Arundel County;

(h) Waldorf, Charles County;

(i) Denton, Caroline County;

(j) Salisbury, Wicomico County;

(k) Solomons, Calvert County.]

Mobile/Aircraft Programming 7AG60
SYSCOM Operations	Site Name	Aircraft Rx & NAC	Aircraft Tx & NAC
Statewide	All	769.63125 (NAC = F7E)	799.63125 (NAC = 293)

(4)—(7) (text unchanged)

(8) Helicopters which do not have frequency 44.74 MHz, tone code 110.9 Hz, or 7AG60, but have air-to-ground telephone capability shall call SYSCOM at (410) 706-7814 via air-to-ground telephone to provide the data required in §B(4)—(7) of this regulation.

(9) Helicopter services not having operational communications on any of the radio or air-to-ground telephone services described in this section shall contact its base medical or dispatching operations center to have patient and estimated time of arrival data forward to SYSCOM at (410) 706-7814 via a conventional public switched telephone.

C. Medical Communications.

(1) [The] Upon the helicopter medic’s request for medical communications, [shall contact] SYSCOM shall instruct the helicopter medic to switch to [directly using] medical frequency 47.66 MHz, tone code 100.0 Hz, [through the radio station locations listed in §B(3) of this regulation] HELIMED1, or 7AIRMED.

(2) The programming information for 7AIRMED is:

Mobile/Aircraft Programming 7AIRMED
EMRC Operations	Site Name	Aircraft Rx & NAC	Aircraft Tx & NAC
Baltimore	Dundalk Marine Terminal	773.61875 (NAC = F7E)	800.13125 (NAC = 293)
Hagerstown	Lambs Knoll	769.13125 (NAC = F7E)	800.13125 (NAC = 293)
Salisbury	Salisbury SHA	770.63125 (NAC = F7E)	800.13125 (NAC = 293)
Western Maryland	Dan’s Rock	774.11875 (NAC = F7E)	800.13125 (NAC = 293)
Washington, DC/Metro	Temple Hills	770.13125 (NAC = F7E)	800.13125 (NAC = 293)
Southern Maryland	Leonardtown	773.11875 (NAC = F7E)	800.13125 (NAC = 293)

[(2)] (3) (text unchanged)

[D. Alternate Methods of Communication with SYSCOM.]

[(1)] (4) Helicopters which do not have communications capability on medical frequency 47.66 MHz, tone code 100.0 Hz, or 7AIRMED, but have air-to-ground telephone capability shall call SYSCOM [directly] at (410) 706-7814 via air-to-ground telephone to provide the data required in [§C(2)] §C(3) of this regulation.

[(2)] (5) Helicopter services not having operational communications capabilities on any of the [above] radio or air-to-ground telephone services described in this section shall contact their home base medical or dispatching operations center to have patient and estimated time of arrival data forwarded to SYSCOM at (410) 706-7814 via a conventional public switched telephone.

THEODORE R. DELBRIDGE, MD, MPH
Executive Director

Title 33
STATE BOARD OF ELECTIONS

Subtitle 13 CAMPAIGN FINANCING

33.13.06 Campaign Accounts

Authority: Election Law Article, §2-102(b)(4) and Title13, Subtitle 2, Part IV, Annotated Code of Maryland

Notice of Proposed Action

[25-104-P]

The State Board of Elections proposes to amend Regulation .04 under COMAR 33.13.06 Campaign Accounts. This action was considered by the State Board of Elections at its April 29, 2025 meeting.

Statement of Purpose

The purpose of this action is to give the Chair the authority to approve disbursements on behalf of the political committee.

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 Erin W. Dennis, Deputy Director of Candidacy and Campaign Finance, State Board of Elections, P.O. Box 6486, Annapolis, Maryland 21401, or call 410-269-2928, or email to dl_regcomments_SBE@maryland.gov. Comments will be accepted through July 14, 2025. A public hearing has not been scheduled.

.04 Disbursements.

A.—B. (text unchanged)

C. Disbursements by Treasurer. Except as provided in §D of this regulation, the treasurer shall [make] authorize all disbursements for the political committee.

D. Disbursements by Chair. The chair of a political committee may [make] approve a disbursement on behalf of the political committee in the manner prescribed under Election Law Article, §13-220(b), Annotated Code of Maryland, only if the treasurer is temporarily unable to perform the duties of the office due to:

(1)—(4) (text unchanged)

JARED DEMARINIS
State Administrator

FORMS FOR 09.11.07

MARYLAND RESIDENTIAL PROPERTY DISCLOSURE AND DISCLAIMER STATEMENT

Property Address:_________________________________________

Legal Description: _________________________________________

NOTICE TO SELLER AND PURCHASER

Section 10-702 of the Real Property Article, Annotated Code of Maryland, requires the seller of certain residential real property to furnish to the purchaser either (a) a RESIDENTIAL PROPERTY DISCLAIMER STATEMENT stating that the seller is selling the property "as is" and makes no representations or warranties as to the condition of the property or any improvements on the real property, except as otherwise provided in the contract of sale, or in a listing of latent defects; or (b) a RESIDENTIAL PROPERTY DISCLOSURE STATEMENT disclosing defects or other information about the condition of the real property actually known by the seller. Certain transfers of residential property are excluded from this requirement (see the exemptions listed below).

10-702. EXEMPTIONS. The following are specifically excluded from the provisions of §10-702:

1. The initial sale of single family residential real property:

A. that has never been occupied; or

B. for which a certificate of occupancy has been issued within 1 year before the seller and buyer enter into a contract of sale;

2. A transfer that is exempt from the transfer tax under §13-207 of the Tax-Property Article, except land installment contracts of sales under §13-207(a) (11) of the Tax-Property Article and options to purchase real property under §13- 207(a)(12) of the Tax-Property Article;

3. A sale by a lender or an affiliate or subsidiary of a lender that acquired the real property by foreclosure or deed in lieu of foreclosure;

4. A sheriff’s sale, tax sale, or sale by foreclosure, partition, or by court appointed trustee;

5. A transfer by a fiduciary in the course of the administration of a decedent’s estate, guardianship, conservatorship, or trust;

6. A transfer of single family residential real property to be converted by the buyer into use other than residential use or to be demolished; or

7. A sale of unimproved real property.

Section 10-702 also requires the seller to disclose information about latent defects in the property that the seller has actual knowledge of. The seller must provide this information even if selling the property “as is.” “Latent defects” are defined as: Material defects in real property or an improvement to real property that:

(1) A purchaser would not reasonably be expected to ascertain or observe by a careful visual inspection of the real property; and

(2) Would pose a direct threat to the health or safety of:

(i) the purchaser; or

(ii) an occupant of the real property, including a tenant or invitee of the purchaser.

MARYLAND RESIDENTIAL PROPERTY DISCLOSURE STATEMENT

NOTICE TO SELLERS: Complete and sign this statement only if you elect to disclose defects, including latent defects, or other information about the condition of the property actually known by you; otherwise, sign the Residential Property Disclaimer Statement. You may wish to obtain professional advice or inspections of the property; however, you are not required to undertake or provide any independent investigation or inspection of the property in order to make the disclosure set forth below. The disclosure is based on your personal knowledge of the condition of the property at the time of the signing of this statement.

NOTICE TO PURCHASERS: The information provided is the representation of the Seller(s) based upon the actual knowledge of Seller(s) as of the date of their signature(s) on this form; it is not the representation of the real estate broker or salesperson, if any. You may wish to obtain professional advice about, or an inspection of, the property. Disclosure by the Seller(s) is not a substitute for an inspection by an independent home inspection company, and you may wish to obtain such an inspection. The information contained in this statement is not a warranty by the Seller(s) as to; the condition of the property of which the Seller(s) has no actual knowledge, or other conditions of which the Seller(s) has no actual knowledge.

How long have you owned the property?

Property System: Water, Sewage, Heating & Air Conditioning (Answer all that apply)

Water Supply □ Public □ Well □ Other

Sewage Disposal □ Public □ Septic System: What type of Septic System? □ Holding Tank □ Other Describe: _____________

Garbage Disposal □ Yes □ No

Dishwasher □ Yes □ No

Heating □ Oil □ Natural Gas □ Electric □ Heat Pump Age _____ □ Other Describe: _______________________

Air Conditioning □ Central Air □ Window Units □ Wall Mounted A/C □ Other Describe: _______________________

Hot Water □ Oil □ Natural Gas □ Electric □ Electric Capacity ____ □ Age ___ □ Other ___________________

Please indicate your actual knowledge with respect to the following:

1. Foundation: Any settlement or other problems? □ Yes □ No □ Unknown

Comments: _________________________________________________________________________________________________

2. Basement: Does your house have a basement or crawl space? □ Yes □ No

If yes, select one: □ Basement □ Crawl Space

2A. Is there any water damage, leaks, or evidence of moisture? □ Yes □ No □ Unknown

Comments: _________________________________________________________________________________________________

2B. Does the basement or crawl space have a sump pump? □ Yes □ No

If yes, is it operational? □ Yes □ No □ Unknown

Comments: _________________________________________________________________________________________________

3. Roof: Any leaks or evidence of moisture? □ Yes □ No □ Unknown

Type of Roof: Age

Comments: _________________________________________________________________________________________________

Is there any existing fire-retardant treated plywood? □ Yes □ No □ Unknown

Comments: _________________________________________________________________________________________________

4. Other Structural Systems, including walls and floors:

Comments: _________________________________________________________________________________________________

Any defects (structural or otherwise)? □ Yes □ No □ Unknown

Comments: ____________________________________________________________________________________________________

5. Plumbing system: Is the system in operating condition including the absence of leaks? □ Yes □ No □ Unknown

Comments: ____________________________________________________________________________________________________

6. Heating Systems: Is heat supplied to all finished rooms? □ Yes □ No □ Unknown

Comments: ____________________________________________________________________________________________________

Is the system in operating condition? □ Yes □ No □ Unknown

Comments: ____________________________________________________________________________________________________

7. Air Conditioning System: Is there an air conditioning system? □Yes □ No

If yes, select one: □ Central Air □ Window Units □ Wall Mounted A/C □ Other Describe: _____________________________

Comments: ____________________________________________________________________________________________________

7A. Is cooling supplied to all finished rooms? □ Yes □ No □ Unknown □ Does Not Apply

Comments: ____________________________________________________________________________________________________

7B. Is the system in operating condition? □ Yes □ No □ Unknown □ Does Not Apply

Comments: ____________________________________________________________________________________________________

8. Electric Systems: Are there any problems with electrical fuses, circuit breakers, outlets, or wiring? □ Yes □ No □ Unknown

Comments: ____________________________________________________________________________________________________

9. Does the property have a sprinkler system? □ Yes □ No

10. Do the smoke alarms comply with all requirements for smoke alarms as set forth in Title 9 of the Public Safety article, including with respect to their number, location, arrangement, type, power source, and any other requirement?  (See sections 9-101-109 of the Public Safety article.)  □ Yes □ No □ Unknown

Comments: ____________________________________________________________________________________________________

10A. Will all smoke alarms provide an alarm in the event of a power outage? □ Yes □ No □ Unknown

10B. Are any of the smoke alarms over 10 years old? □ Yes □ No □ Unknown

10C. Are all battery-operated smoke alarms sealed, tamper resistant units incorporating a silence/hush button and using long-life batteries. □ Yes □ No □ Unknown □ N/A (no battery operated units)

9.

10.

11. Sewer/Septic Systems: What type of sewer/septic system? Select one: □ Public □ Septic

11A. If septic, what type: □ Holding Tank □ Other Describe: _____________________________________________________

11B. Is the septic system functioning properly? □ Yes □ No □ Unknown □ Does Not Apply

If not sure, contact your local health department.

11C. When was the system last pumped? Date _______________ □ Unknown

Comments: ___________________________________________________________________________________________________

12. Water Supply: Any problem with water supply? □ Yes □ No □ Unknown

Comments: ___________________________________________________________________________________________________

Home water treatment system: □ Yes □ No □ Unknown

Comments: ___________________________________________________________________________________________________

Fire sprinkler system: □ Yes □ No □ Unknown □ Does Not Apply

Comments: ___________________________________________________________________________________________________

Are the systems in operating condition? □ Yes □ No □ Unknown

Comments: ___________________________________________________________________________________________________

13. Insulation:

In exterior walls? □ Yes □ No □Unknown

In ceiling/attic? □ Yes □ No □ Unknown

In any other areas? □ Yes □ No Where?

Comments: _________________________________________________________________________________________________

Page 2 of 4

14. Exterior Drainage: Does water stand on the property for more than 24 hours after a heavy rain? □ Yes □ No □ Unknown

Comments: _____________________________________________________________________________________________________

Are gutters and downspouts in good repair? □ Yes □ No □ Unknown

Comments: _____________________________________________________________________________________________________

15. Wood-destroying insects: Any infestation and/or prior damage? □ Yes □ No □ Unknown

Comments: ______________________________________________________________________________________________________

Any treatments or repairs? □ Yes □ No □ Unknown

Any warranties? □ Yes □ No □ Unknown

Comments: ______________________________________________________________________________________________________

16. Are there any hazardous or regulated materials (including, but not limited to, licensed landfills, asbestos, radon gas, lead-based paint, oil tank, propane tank, underground storage tanks, or other contamination) on the property? □ Yes □ No □ Unknown

If yes, specify below.

Comments: _____________________________________________________________________________________________________

16A. If you or a contractor have made improvements to the property, were the required permits issued by the county or local permitting office, and did the improvements pass all required inspections? □ Yes □ No □ Does Not Apply □ Unknown

Comments: ______________________________________________________________________________________________________

17. If the property relies on fossil fuel combustion for heat, ventilation, hot water, clothes dryer operation, or other purposes,

is a carbon monoxide alarm installed in the property? □ Yes □ No □ Unknown

Comments: ______________________________________________________________________________________________________

18. Are there any zoning violations, nonconforming uses, violation of building restrictions or setback requirements or any recorded or unrecorded easement, except for utilities, on or affecting the property? □ Yes □ No □ Unknown If yes, specify below.

Comments: ______________________________________________________________________________________________________

19. Is the property located in a flood zone, conservation area, wetland area, Chesapeake Bay critical area or Designated Historic District?

□ Yes □ No □ Unknown If yes, specify below.

Comments: ______________________________________________________________________________________________________

20. Is the property subject to any restriction imposed by a Homeowners Association or any other type of community association?

□ Yes □ No □ Unknown

Comments: ______________________________________________________________________________________________________

21. Is the property subject to any restrictions imposed by a covenant? □ Yes □ No □ Unknown If yes, specify below.

Comments: ______________________________________________________________________________________________________

22.Has the property ever had flooding or a fire? □ Yes □ No □ Unknown

Comments: ______________________________________________________________________________________________________

23.Are there any other material defects, including latent defects, affecting the physical condition of the property?

□ Yes □ No □ Unknown

Comments: ______________________________________________________________________________________________________

NOTE: Seller(s) may wish to disclose the condition of other buildings on the property on a separate RESIDENTIAL

PROPERTY DISCLOSURE STATEMENT.

The seller(s) acknowledges having carefully examined this statement, including any comments, and verify that it is complete and accurate as of the date signed. The seller(s) further acknowledge that they have been informed of their rights and obligations under §10-702 of the Maryland Real Property Article.

Seller(s) ____________________________________________________ Date

Seller(s) ____________________________________________________ Date ________________________

The purchaser(s) acknowledge receipt of a copy of this disclosure statement and further acknowledge that they have been informed of their rights and obligations under §10-702 of the Maryland Real Property Article.

Purchaser __________________________________________________ Date _________________________

Purchaser ___________________________________________________ Date _________________________

NOTE: This Disclosure statement is not a substitute for a home inspection. YOU HAVE A RIGHT TO OBTAIN A HOME INSPECTION.

Page 3 of 4

MARYLAND RESIDENTIAL PROPERTY DISCLAIMER STATEMENT

NOTICE TO SELLER(S): Sign this statement only if you elect to sell the property without representations and warranties as to its condition, except as otherwise provided in the contract of sale and in the listing of latent defects set forth below; otherwise, complete and sign the RESIDENTIAL PROPERTY DISCLOSURE STATEMENT.

Section 10-702 also requires the seller to disclose information about latent defects in the property that the seller has actual knowledge of. The seller must provide this information even if selling the property “as is.” “Latent defects” are defined as: Material defects in real property or an improvement to real property that:

(1) A purchaser would not reasonably be expected to ascertain or observe by a careful visual inspection of the real

property; and

(2) Would pose a direct threat to the health or safety of:

(i) the purchaser; or

(ii) an occupant of the real property, including a tenant or invitee of the purchaser.

Except for the latent defects listed below, the undersigned seller(s) of the real property make no representations or warranties as to the condition of the real property or any improvements thereon, and the purchaser will be receiving the real property "as is" with all defects, including latent defects, which may exist, except as otherwise provided in the real estate contract of sale. The seller(s) acknowledge having carefully examined this statement and further acknowledge that they have been informed of their rights and obligations under §10-702 of the Maryland Real Property Article.

Does the seller(s) have actual knowledge of any latent defects? □ Yes □ No If yes, specify:

Seller Date

Seller Date

The purchaser(s) acknowledge receipt of a copy of this disclaimer statement and further acknowledge that they have been informed of their rights and obligations under §10-702 of the Maryland Real Property Article.

Purchaser Date

Purchaser Date

NOTE: This Disclaimer statement is not a substitute for a home inspection. YOU HAVE A RIGHT TO OBTAIN A HOME INSPECTION.

Page 4 of 4

FORM: MREC/DLLR: Rev 02/19/2025

Errata

COMAR 20.31.03.04

At 52:6 Md. R. 291 (March 21, 2025), column 1, line 14 from the top:

For: B. A utility may not terminate, either gas service that is used for

Read: [A.] B. A utility may not terminate, either gas service that is used for

Special Documents

DEPARTMENT OF THE ENVIRONMENT

SUSQUEHANNA RIVER BASIN COMMISSION

Projects Approved for Consumptive Uses of Water

AGENCY: Susquehanna River Basin Commission.

ACTION: Notice.

SUMMARY: This notice lists Approvals by Rule for consumptive use projects by the Susquehanna River Basin Commission during the period set forth in DATES.

DATES: April 1 – 30, 2025.

ADDRESSES: Susquehanna River Basin Commission, 4423 North Front Street, Harrisburg, PA 17110-1788.

FOR FURTHER INFORMATION CONTACT: Jason E. Oyler, General Counsel and Secretary to the Commission, telephone: (717) 238-0423, ext. 1312; fax: (717) 238-2436; e-mail: joyler@srbc.gov. Regular mail inquiries may be sent to the above address.

SUPPLEMENTARY INFORMATION: This notice lists the projects, described below, receiving approval for the consumptive use of water pursuant to the Commission’s approval by rule process set forth in 18 CFR §806.22 (e) and (f) for the time period specified above.

Approvals By Rule - Issued Under 18 CFR 806.22(e):

1. Hunlock Energy, LLC; Hunlock Creek Unit – 4; ABR-202504001; Hunlock Township, Luzerne County, Pa.; Consumptive Use of Up to 0.1260 mgd; Approval Date: April 3, 2025.

Approvals By Rule - Issued Under 18 CFR 806.22(f):

1. RENEWAL - Blackhill Energy LLC; Pad ID: GUINAN 2H; ABR-20091117.R3; Springfield Township, Bradford County, Pa.; Consumptive Use of Up to 1.9990 mgd; Approval Date: April 17, 2025.

2. RENEWAL - Blackhill Energy LLC; Pad ID: HARKNESS 3H; ABR-20091221.R3; Springfield Township, Bradford County, Pa.; Consumptive Use of Up to 1.9990 mgd; Approval Date: April 17, 2025.

3. RENEWAL - Blackhill Energy LLC; Pad ID: HOPPAUGH 2H; ABR-20091120.R3; Springfield Township, Bradford County, Pa.; Consumptive Use of Up to 1.9990 mgd; Approval Date: April 17, 2025.

4. RENEWAL - Coterra Energy Inc.; Pad ID: LaRueC P2; ABR-20100138.R3; Dimock Township, Susquehanna County, Pa.; Consumptive Use of Up to 5.0000 mgd; Approval Date: April 17, 2025.

5. RENEWAL - Expand Operating LLC; Pad ID: Blye Pad Site; ABR-20100204.R3; Middletown Township, Susquehanna County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 17, 2025.

6. RENEWAL - Expand Operating LLC; Pad ID: Clear Springs Dairy Drilling Pad #1; ABR-20091214.R3; Burlington Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 17, 2025.

7. RENEWAL - Expand Operating LLC; Pad ID: Ferguson; ABR-20100201.R3; Herrick Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 17, 2025.

8. RENEWAL - Expand Operating LLC; Pad ID: Readinger; ABR-20091210.R3; West Burlington Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 17, 2025.

9. RENEWAL - Expand Operating LLC; Pad ID: SGL-12 HARDY EAST UNIT PAD; ABR-202003001.R1; Overton Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 17, 2025.

10. RENEWAL - Formentera Operations LLC; Pad ID: Hannan Well Site; ABR-201412010.R2; Hepburn Township, Lycoming County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: April 17, 2025.

11. RENEWAL - Range Resources - Appalachia, LLC; Pad ID: Gentner 3; ABR-20100153.R3; Cummings Township, Lycoming County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: April 17, 2025.

12. RENEWAL - Range Resources - Appalachia, LLC; Pad ID: Laurel Hill 1; ABR-20100154.R3; Jackson Township, Lycoming County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: April 17, 2025.

13. RENEWAL - S.T.L. Resources, LLC; Pad ID: Button B 901 Pad; ABR-20091234.R3; West Branch Township, Potter County, Pa.; Consumptive Use of Up to 4.9900 mgd; Approval Date: April 17, 2025.

14. RENEWAL - S.T.L. Resources, LLC; Pad ID: Ken-Ton 902; ABR-20100102.R3; West Branch Township, Potter County, Pa.; Consumptive Use of Up to 4.9900 mgd; Approval Date: April 17, 2025.

15. RENEWAL - S.T.L. Resources, LLC; Pad ID: Lick Run Pad; ABR-20091232.R3; Gaines Township, Tioga County, Pa.; Consumptive Use of Up to 4.9900 mgd; Approval Date: April 17, 2025.

16. RENEWAL - S.T.L. Resources, LLC; Pad ID: Marshlands K. Thomas Unit #1; ABR-20091231.R3; Elk Township, Tioga County, Pa.; Consumptive Use of Up to 4.9900 mgd; Approval Date: April 17, 2025.

17. RENEWAL - S.T.L. Resources, LLC; Pad ID: Mitchell A 903; ABR-20100152.R3; West Branch Township, Potter County, Pa.; Consumptive Use of Up to 4.9900 mgd; Approval Date: April 17, 2025.

18. RENEWAL - Seneca Resources Company, LLC; Pad ID: Thomas 503R; ABR-201408007.R2; Sullivan Township, Tioga County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: April 17, 2025.

19. RENEWAL - Seneca Resources Company, LLC; Pad ID: York 480-5H; ABR-20100106.R3; Sullivan Township, Tioga County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: April 17, 2025.

20. RENEWAL - Coterra Energy Inc.; Pad ID: AustinE P1; ABR-202003004.R1; Lenox Township, Susquehanna County, Pa.; Consumptive Use of Up to 5.0000 mgd; Approval Date: April 26, 2025.

21. RENEWAL - Expand Operating LLC; Pad ID: Acla; ABR-20100324.R3; Terry Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 26, 2025.

22. RENEWAL - Expand Operating LLC; Pad ID: Claude; ABR-20100319.R3; Auburn Township, Susquehanna County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 26, 2025.

23. RENEWAL - Expand Operating LLC; Pad ID: Coyote Run; ABR-202004002.R1; Tuscarora Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 26, 2025.

24. RENEWAL - Expand Operating LLC; Pad ID: Engelke; ABR-20100323.R3; Troy Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 26, 2025.

25. RENEWAL - Expand Operating LLC; Pad ID: Stone Drilling Pad #1; ABR-20100228.R3; Springville Township, Susquehanna County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 26, 2025.

26. RENEWAL - Expand Operating LLC; Pad ID: Updike; ABR-20100305.R3; West Burlington Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 26, 2025.

27. RENEWAL - Expand Operating LLC; Pad ID: Yengo; ABR-20100206.R3; Cherry Township, Sullivan County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 26, 2025.

28. RENEWAL - Formentera Operations LLC; Pad ID: Winter Well Site; ABR-201410009.R2; Eldred Township, Lycoming County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: April 26, 2025.

29. RENEWAL - LPR Energy, LLC ; Pad ID: Ritchey Unit Drilling Pad; ABR-20091010.R3; Juniata Township, Blair County, Pa.; Consumptive Use of Up to 1.9900 mgd; Approval Date: April 26, 2025.

30. RENEWAL - Repsol Oil & Gas USA, LLC; Pad ID: BARRETT (03 009) L; ABR-20100230.R3; Columbia Township, Bradford County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: April 26, 2025.

31. RENEWAL - Repsol Oil & Gas USA, LLC; Pad ID: DCNR 587 (02 018); ABR-20100219.R3; Ward Township, Tioga County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: April 26, 2025.

32. RENEWAL - Repsol Oil & Gas USA, LLC; Pad ID: HARVEST HOLDINGS (01 036); ABR-20100225.R3; Canton Township, Bradford County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: April 26, 2025.

33. RENEWAL - Repsol Oil & Gas USA, LLC; Pad ID: LUTZ (01 015); ABR-20100213.R3; Troy Township, Bradford County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: April 26, 2025.

34. RENEWAL - Repsol Oil & Gas USA, LLC; Pad ID: PUTNAM (01 076) L; ABR-20100233.R3; Armenia Township, Bradford County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: April 26, 2025.

35. RENEWAL - Repsol Oil & Gas USA, LLC; Pad ID: PUTNAM (01 077) L; ABR-20100212.R3; Armenia Township, Bradford County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: April 26, 2025.

36. RENEWAL - S.T.L. Resources, LLC; Pad ID: T Pierson Pad; ABR-20090903.R3; Gaines Township, Tioga County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: April 26, 2025.

37. RENEWAL - Seneca Resources Company, LLC; Pad ID: DCNR 595 Pad E; ABR-20100307.R3; Blossburg Borough, Tioga County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: April 26, 2025.

38. RENEWAL - Seneca Resources Company, LLC; Pad ID: Johnson 435; ABR-20091102.R3; Shippen Township, Tioga County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: April 26, 2025.

39. RENEWAL - Expand Operating LLC; Pad ID: Kupscznk Drilling Pad #1; ABR-20100224.R3; Springville Township, Susquehanna County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 28, 2025.

40. RENEWAL - Expand Operating LLC; Pad ID: LaRue 1A; ABR-202004003.R1; Rush Township, Susquehanna County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 28, 2025.

41. RENEWAL - Expand Operating LLC; Pad ID: LaRue 1B; ABR-202004004.R1; Rush Township, Susquehanna County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 28, 2025.

42. RENEWAL - Expand Operating LLC; Pad ID: Masso; ABR-20100216.R3; Auburn Township, Susquehanna County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 28, 2025.

43. RENEWAL - Expand Operating LLC; Pad ID: Plymouth; ABR-20100341.R3; Terry Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 28, 2025.

44. RENEWAL - Expand Operating LLC; Pad ID: Sivers; ABR-20100320.R3; Tuscarora Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 28, 2025.

45. RENEWAL - Expand Operating LLC; Pad ID: Hoffman; ABR-20100328.R3; Towanda Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: April 29, 2025.

Authority: Public Law 91-575, 84 Stat. 1509 et seq., 18 CFR parts 806 and 808.

JASON E. OYLER,
General Counsel and Secretary to the Commission.

Dated: May 15, 2025

[25-12-07]

SUSQUEHANNA RIVER BASIN COMMISSION

General Permit Notice

AGENCY: Susquehanna River Basin Commission.

ACTION: Notice.

SUMMARY: This notice lists General Permits approved by the Susquehanna River Basin Commission during the period set forth in DATES.

DATES: April 1-30, 2025

ADDRESSES: Susquehanna River Basin Commission, 4423 North Front Street, Harrisburg, PA 17110-1788.

FOR FURTHER INFORMATION CONTACT: Jason E. Oyler, General Counsel and Secretary to the Commission, telephone: (717) 238-0423, ext. 1312; fax (717) 238-2436; e-mail: joyler@srbc.gov. Regular mail inquiries may be sent to the above address.

SUPPLEMENTARY INFORMATION: This notice lists General Permits for projects, described below, pursuant to 18 CFR § 806.17(c)(4), for the time period specified above.

1. Pennsylvania Fish & Boat Commission – Orbisonia-Rockhill Sportsmen Association Nursery, General Permit Approval of Coverage No. GP-03-202504011, Cromwell Township, Huntingdon County, Pa.; Cooperative Fish Nursery withdrawal approved up to 0.432 mgd (peak day) from an unnamed tributary to Blacklog Creek and 0.130 mgd (30-day average) from Well 1; Approval Date: April 2, 2025.

Authority: Public Law 91-575, 84 Stat. 1509 et seq., 18 CFR parts 806 and 808.

Dated: May 15, 2025.

Jason E. Oyler,

General Counsel and Secretary to the Commission.

SUSQUEHANNA RIVER BASIN COMMISSION

Minor Modification Notice

AGENCY: Susquehanna River Basin Commission.

ACTION: Notice.

SUMMARY: This notice lists the minor modifications approved for previously approved projects by the Susquehanna River Basin Commission during the period set forth in DATES.

DATES: April 1-30, 2025

ADDRESSES: Susquehanna River Basin Commission, 4423 North Front Street, Harrisburg, PA 17110-1788.

FOR FURTHER INFORMATION CONTACT: Jason E. Oyler, General Counsel and Secretary to the Commission, telephone: (717) 238-0423, ext. 1312; fax (717) 238-2436; e-mail: joyler@srbc.gov. Regular mail inquiries may be sent to the above address.

SUPPLEMENTARY INFORMATION: This notice lists previously approved projects, receiving approval of minor modification or a corrective modification, described below, pursuant to 18 CFR § 806.18 or to Commission Resolution Nos. 2013-11 and 2015-06, for the time period specified above.

1. Graymont (PA) Inc. – Pleasant Gap, Docket No. 20191203, Spring Township, Centre County, Pa.; correction in Section 2 to replace the “Gentzel Quarry” with the “Gentzel/Tressler Quarry”; Correction Issue Date: April 8, 2025.

Authority: Public Law 91-575, 84 Stat. 1509 et seq., 18 CFR parts 806 and 808.

Dated: May 15, 2025.

Jason E. Oyler,

General Counsel and Secretary to the Commission.

WATER AND SCIENCE ADMINISTRATION

Grandfathering Registration Notice

AGENCY: Susquehanna River Basin Commission.

ACTION: Notice.

SUMMARY: This notice lists Grandfathering Registration for projects by the Susquehanna River Basin Commission during the period set forth in DATES.

DATES: April 1-30, 2025.

ADDRESSES: Susquehanna River Basin Commission, 4423 North Front Street, Harrisburg, PA 17110-1788.

FOR FURTHER INFORMATION CONTACT: Jason E. Oyler, General Counsel and Secretary to the Commission, telephone: 717-238-0423, ext. 1312; fax: 717- 238-2436; e-mail: joyler@srbc.gov. Regular mail inquiries may be sent to the above address.

SUPPLEMENTARY INFORMATION: This notice lists GF Registration for projects, described below, pursuant to 18 CFR Part 806, Subpart E, for the time period specified above:

1. Anchor Glass Container Corporation – Elmira Plant, GF Certificate No. GF-202504292, City of Elmira and Town of Elmira, Chemung County, N.Y.; consumptive use; Issue Date: April 10, 2025.

2. Rosebud Mining Company – Lady Jane Plant, GF Certificate No. GF-202504293, Huston Township, Clearfield County, Pa.; consumptive use; Issue Date: April 10, 2025.

Authority: Public Law 91-575, 84 Stat. 1509 et seq., 18 CFR parts 806 and 808.

Dated: May 15, 2025.

JASON E. OYLER,
General Counsel and Secretary to the Commission.

[25-12-06]

WATER AND SCIENCE ADMINISTRATION

Water Quality Certification 24-WQC-0048

U.S. Department of the Navy –

Naval Support Activity Annapolis

181 Wainwright Rd

Annapolis, MD 21402

Add’l. Info: Pursuant to COMAR 26.08.02.10F(3)(c), The Maryland Department of the Environment is providing notice of its issuance of a Water Quality Certification 24-WQC-0048.

Location: Along Bigelow Rd, 38.982832, -76.467334, Annapolis, MD 21402

The purpose of the project is to stabilize an eroding shoreline and improve navigable access by:

(1) Removing an existing marine railway, relieving platform, and existing piers with associated dolphin pilings;

(2) Mechanically dredging a 160-foot long by 25-foot wide area (2,925 square feet) to a depth of 11 feet at mean low water and to provide for periodic maintenance dredging for six years; to deposit approximately 325 cubic yards of dredged material on an approved upland disposal site located at 4944 Sands Rd, Lothian, MD 20711;

(3) Constructing a 144-foot long by 50-foot wide concrete boat ramp with a 700 SF floating dock and gangway extending a maximum of 144 feet channelward of the mean high water line, and replace 101 linear feet of bulkhead within 1.5 feet channelward of an existing bulkhead;

(4) Constructing 101 linear feet of new bulkhead adjacent to an existing boat ramp and add 2,592 SF of clean fill behind it;

(5) Replacing 650 linear feet of bulkhead within 18 inches of an existing bulkhead;

(6) Replacing in-kind 13,364 square feet of an existing relieving platform with associated pilings;

(7) Constructing a 130-foot long by 12-foot wide pier and emplace 8 mooring piles within a maximum of 130-feet channelward of the mean high water line;

(8) Constructing a 258-foot long by 13-foot wide parallel platform which includes two gangways measuring 40-foot long by 4.5-foot wide, two gangways measuring 16.5-foot long by 4.5 foot wide, two 22-foot long by 10-foot wide access platforms, and five 50-foot long by 8-foot wide floating piers, and emplace eight mooring piles, all within a maximum of 63 feet channelward of the mean high water line.

The WQC and its attachments may be viewed at the following link:

https://mde.maryland.gov/programs/Water/WetlandsandWaterways/Pages/WQC.aspx

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

Contact: Mel Throckmorton at mel.throckmorton@maryland.gov or 410-375-2803 with any questions.

[25-12-17]

DEPARTMENT OF HUMAN RESOURCES

Statement of Need

Residential Child Care Services

The Department of Human Services (DHS) is dedicated to assisting those in economic need, providing prevention services, and protecting vulnerable individuals. DHS is issuing this Statement of Need (SON) for the establishment of Residential Child Care (RCC) programs to respond to the increased need for placement resources and support for children who have complex behavioral and medical needs in the State of Maryland. This SON is issued pursuant to COMAR 14.31.09.04 to solicit prospective licensees to submit a proposal for the RCC program described herein and in accordance with COMAR 14.31.02.

Specifically, DHS is seeking providers to operate programming through the following program categories:

(1) Diagnostic, Evaluation and Treatment Programs (DETPs),

(2) Psychiatric Respite (PR),

(3) Medically Fragile (MF), and

(4) High Intensity Group Home Services - Emotional and Cognitive Developmentally Disabled (HIGH- ECDD).

These programs will service transgender, male and female youth.

I. Background and Purpose

The need for residential child care services tailored to children with complex medical and behavioral health needs has grown due to a rise in reported cases of severe emotional disturbances, developmental disabilities, and chronic medical conditions. Studies indicate that children with multiple placement disruptions are at higher risk for long-term emotional, social, and educational difficulties. Children with complex medical and behavioral health needs require specialized residential care services that provide a structured, therapeutic, and supportive environment. Many of these children have experienced severe trauma, multiple foster care placements, or disruptions in their home environment, leading to difficulties in maintaining stability in traditional family or foster home settings.

Historically, group homes have served as an essential component of the child welfare system, providing a more structured alternative to foster care for children who require higher levels of supervision and support. However, traditional models have often lacked integration between behavioral health and medical services, leaving a subset of children without appropriate placement options. Many existing group homes do not have the specialized staff, training, or medical resources necessary to meet the complex needs of these children, leading to inadequate care, repeated placement disruptions, and poor long-term outcomes.

To address this, there is a growing need for high-quality residential programs that integrate trauma-informed care, clinical treatment, and medical oversight within a cohesive service model. Quality Residential Treatment Programs (QRTPs), established under the Family First Prevention Services Act, represent a key solution. QRTPs are designed to provide specialized, short-term, and intensive treatment in a setting that is trauma-informed, family-focused, and staffed with licensed medical and clinical professionals. Expanding access to QRTP-level care is essential to ensuring children with complex medical and behavioral health challenges receive the support they need to heal and thrive.

Due to a lack of appropriate residential care options, many of these children experience prolonged hospital overstays or temporary placements in hotels, which are not equipped to provide the necessary medical or behavioral health support. Such placements contribute to further instability, increased emotional distress, and delays in receiving proper therapeutic interventions. Despite an increasing demand for high-quality residential care placements, there remains a gap in available resources tailored specifically to children with both behavioral and medical challenges. Therefore, there is a growing push for residential programs that combine trauma-informed care, specialized behavioral interventions, and medical oversight within a cohesive service model.

DHS is requesting services in the following four (4) geographical regions in the state of Maryland:

II. Residential Child Care Categories and Beds:

DHS is seeking high intensity services in the following program categories:

(1) RCC PROGRAM CATEGORIES

(2) Number of Beds

(3) DETP 30

(4) MFP 20

(5) HIGH-ECDD 100

(6) PR 20

The projected need for placements is based on the number of children that have been placed previously and the most recent data concerning requested placements.

III. Qualified Residential Treatment Provider Certification

The Department desires to have all providers certified as a Qualified Residential Treatment Provider (QRTP). To achieve this goal, the following criteria and services are required to ensure that the provider is able to become designated as a QRTP. A QRTP must meet the following criteria:

• Provide a trauma-informed model of care designed to address the needs, including clinical needs, of youth with serious emotional or behavioral disorders or disturbances.

• Have registered or licensed nursing staff and other licensed clinical staff who provide care within the scope of their practice as defined by state law, consistent with the treatment model, and who are available 24 hours/7 days a week (need not be direct employees of the QRTP).

• Facilitate family participation in a youth’s treatment program (to the extent appropriate, and in accordance with the youth’s best interest).

• Facilitate and document family outreach and maintain contact information for any known biological family and kin of the youth.

• Document on how the youth’s family is integrated into the youth’s treatment, including post discharge, and how sibling connections are maintained.

• Provide discharge planning and family-based aftercare support for at least 6 months post discharge; and

• Have a program that is licensed in accordance with Title IV-E of the Social Security Act requirements and nationally accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), the Joint Commission on Accreditation of Healthcare Organizations (the Joint Commission), the Council on Accreditation (COA); Educational Assessment Guidelines Lading toward Excellence (EAGLE) and Teaching-Family Association, which is accredited by the Secretary of U.S. Department of Health and Human Services (DHHS).

If the provider is not certified as a QRTP, a detailed timeline for qualifying as a QRTP shall be provided in response to the SON.

IV. Target Population

Providers must provide placements and resources for females, males and transgender youth, ages 12-20. In addition, the target population includes children and youth who may have co-occurring treatment needs and/or history of neglect, sexual and physical abuse. Youth may also be co-committed to the Maryland Department of Juvenile Services or Maryland Department of Health.

V. Provider Capacity to Serve

A. Providers are required to categorize residents based on congruent gender, age, and phase of recovery. Furthermore, they must possess the ability to accommodate a minimum of six (6) beds. The maximum number of beds will be determined by the facility's ability to maintain housing spaces that are age-appropriate and conducive to safe interpersonal interaction. Additionally, the provision of programs and services should be tailored to align with the respective age demographics. Beds and other living arrangements shall meet the requirements of COMAR 14.31.06.

B. Provider must be available to accept referrals 24 hours a day, 7 days a week and every day of the year.

C. Providers shall maintain a no eject, no reject policy for all youth placed by DHS. Ejections will be permitted only in exceptional circumstances after all reasonable efforts to accommodate the youth have been exhausted, and in coordination with the local department of social services and SSA. The provider must work through challenging behaviors with youth in accordance with COMAR 14.31.06.15.

VI. Facility Security

A. Provider shall maintain 100% compliance for child protective services (CPS) clearances and criminal background checks for all employees and prospective employees. Each employee shall meet the requirements in COMAR 14.31.06.05, standards for indicated child abuse and criminal convictions.

B. Title IV-E requirements:

Any adult working in a child-care institution, including a group home, residential treatment center, shelter, or other congregate care settings, including a CPA foster family home, shall not have a felony conviction involving:

i. child abuse or neglect

ii. spousal abuse

iii. a crime against a child or children (including child pornography)

iv. a crime involving violence (defined in Maryland Criminal Law §14-101), including rape, sexual assault, or homicide, but not including other physical assault or battery

And within the last five years, been convicted of a felony involving:

i. physical assault

ii. battery

iii. a drug-related offense

C. To ensure the safety of the children and staff, the facility should utilize undisclosed locations, security cameras, alarm systems, 24-hour staffing, and on-site security. This creates a secure environment that is essential for establishing physical and emotional safety, which is key to the recovery process.

VII. Program Requirements

All Providers must provide high intensity group home services in a campus type or community-based facility.

A. Diagnostic and Evaluation Treatment Program (DETP)

The DETP shall provide short-term care, not to exceed ninety (90) calendar days, to identify and facilitate diagnostic services for children in need of stabilization prior to transitioning into a longer-term placement. The DETP serves children exhibiting significant emotional and behavioral challenges and who have a history of abuse, neglect, or have been victims of sex trafficking.

The Program shall:

(1) Complete a written Diagnostic Assessment of a child according to the Diagnostic Statistical Manual (DSM-5) standards for submission to the LDSS within sixty (60) business days of placement. The Diagnostic Assessment shall include a psychiatric, psychological, educational, psycho-social, and medical plan for stabilizing the child and developing a plan to transition and maintain the child in the most appropriate and least restrictive placement to meet that child’s needs.

(2) Have an on-site MSDE approved Type III school or utilize the local school systems when appropriate, to ensure that each school-aged child attends an educational or vocational program in accordance with all applicable federal, State and local laws.

(3) Provide a milieu of services offered in diagnostic and evaluation treatment programs.

(4) Offer evidence based and/or trauma-informed treatment services. Contractors must be able to provide individual trauma therapy, and individual and group therapy.

(5) Provide the Certificate of Need (CON) to the LDSS Case Manager for children recommended for a Residential Treatment Center (RTC).

(6) Ensure on-site availability to provide nursing and clinical/counseling needs consistent with treatment models and to meet the needs of children in care 24/7.

(7) Ensure a minimum resident to staff ratio (excluding volunteers and staff not providing direct care and supervision of residents) of 4:1 during waking hours and 8:1 during sleeping hours.

B. Psychiatric Respite (PR)

The PR program will provide short-term residential services for children and youth discharged from psychiatric hospitalization with placement recommendations for a residential treatment center, a less restrictive environment, or as a diversion from psychiatric admission. The program will deliver enhanced staffing ratios and specialized supportive services to address the needs of children with serious behavioral and mental health challenges. This program is intended to offer a more secure environment and a higher intensity of therapeutic services for DHS youth placed within the state.

A. The PR Program shall:

(1) Provide a combination and sequence of intensive, interdisciplinary, or generic care, treatment, or other services that are individually planned and coordinated for the individual.

(2) Have an on-site MSDE approved Type III school or utilize the local school systems when appropriate, to ensure that each school-aged child attends an educational or vocational program in accordance with all applicable federal, State and local laws.

(3) Offer evidence based and/or trauma-informed treatment services. Contractors must be able to provide individual trauma therapy, individual, and group therapy.

(4) Provide the CON to the LDSS Case Manager for children recommended for a RTC.

(5) Provide on-site counseling services and appropriate therapeutic modalities necessary to meet the needs of children in care.

(6) Ensure a minimum resident to staff ratio (excluding volunteers and staff not providing direct care and supervision of residents) of 3:1 during waking hours and 8:1 during sleeping hours.

C. Medically Fragile Providers (MFP)

The MFP program provides specialized residential care for children and youth with complex medical conditions and disabilities requiring ongoing medical support. This program offers a safe, structured environment where individuals receive personalized care to address their medical, physical, and developmental needs. Services include 24-hour skilled nursing care, medication management, physical and occupational therapy, and other medically necessary interventions tailored to each child's specific condition. Children in the program may have multiple disabilities and may be dually diagnosed with emotional and/or behavioral disorders.

The MFP program is designed to serve a child who is dependent upon any combination of the following: mechanical ventilation for at least part of each day; intravenous administration of nutritional substances or drugs; device-based respiratory or nutritional support on a daily basis, including tracheotomy tube care, suctioning, or oxygen support; medical devices that compensate for vital body functions, including, apnea or cardio-respiratory monitors, renal dialysis; and other mechanical devices, or substantial nursing care in connection with disabilities. The MFP must meet the requirements outlined in Class 4 of the rate reform model.

The Program shall:

(1) Provide 24/7 nursing services to meet the physical health needs of children and youth served.

(2) Provide multiple services which include, but are not limited to, medical, nursing, psychological, social services, occupational and physical therapy interventions.

(3) Ensure direct care staff have specialized training, qualifications, and/or experience in working with the specific population of children and youth served or will have completed specialized training within 180 days of employment.

(4) Provide transportation to any clinical or behavioral health services that the Contractor is not required to provide directly.

(5) Meet all requirements outlined by COMAR 14.31.07.07.

(6) Ensure that a health care professional licensed to practice in the State trains child care staff based on the individual medical needs of each child.

(7) Obtain consultation services from a pediatric medical specialist for input (oral and written) on the placement of any ongoing care decisions for the children.

D. Emotional and Cognitive Developmentally Disabled (HIGH-ECDD)

The HIGH-ECDD program provides services to children presenting a high level of behavioral, emotional and/or behavioral, educational and medical conditions requiring a high level of on-site therapeutic care and intense structured supervision, behavior management and clinical intervention. These children require 24-hour supervision by awake staff.

The Program shall:

(1) Offer a staff to youth ratio of 2:1.

(2) Provide on-site counseling services and appropriate therapeutic modalities necessary to meet the needs of children in care.

(3) Offer a trauma certified treatment practice which is preferred over trauma informed. The Contractor shall provide individual and group trauma therapy; family therapy; medication management; and crisis intervention services.

(4) House and care for no more than 4 children in one facility, with one youth per bedroom.

(5) Ensure the program’s Certified Program Administrator, as outlined in COMAR 14.31.06.06, shall have experience providing a range of services that may include individual, group, milieu, family, educational, and behavioral treatment approaches.

(6) Ensure that each school-aged child attends an educational or vocational program in accordance with all applicable federal, State and local laws.

VIII. General Program Services

DHS is seeking providers with the ability to provide ongoing intensive services to youth (male, female and/or transgendered) who have experienced abuse and neglect as well as present with complex medical and behavioral health needs. Providers must collaborate with the Department to provide all the service needs. Those services include the following:

A. Basic needs (i.e., food, shelter, clothing, toiletries, appropriate place to sleep)

B. Intensive case management

C. Delivery of trauma-informed therapeutic services to include:

(1) Individual trauma therapy tailored to each child's specific needs and history.

(2) Group therapy to foster peer support and relational healing.

(3) Mental health counseling and treatment utilizing evidence-based approaches such as:

• Cognitive Behavioral Therapy (CBT) to address maladaptive thought patterns and behaviors;

• Dialectical Behavior Therapy (DBT) to build emotional regulation and interpersonal effectiveness skills; and

• Eye Movement Desensitization and Reprocessing (EMDR) to support the processing and resolution of traumatic memories.

D. Medical screening and routine medical care

E. Program Participation such as:

(1) Youth Sports Programs

(2) Arts and Creative Programs

(3) Summer Camps

(4) Community Service and Volunteer Programs

(5) Cultural and Diversity Programs

(6) Career Development and Job Training Programs

(7) Health and Wellness Programs

(8) Academic Enrichment Programs

F. Family involvement and reunification services

G. Educational services

H. Services to a population of male, female, and transgendered children ages 12-20 with the following treatment needs that may be co-occurring:

(1) Inappropriate sexual behavior (to include victims and/or offenders)

(2) Violence and aggression

(3) Fire setting

(4) Autism Spectrum Disorder

(5) High elopement risk

(6) Developmental Disabilities

(7) Learning Disabilities

(8) Self-injurious behaviors

(9) Physical Disabilities

These needs may be accompanied by medical conditions that further contribute to the complexity of the child's care. Youth may be stepping down from more restrictive environments such as Residential Treatment Centers, Juvenile Justice Facilities, In-patient hospitalizations, High Intensity Respite, or Diagnostic Centers.

IX. Program Staffing

It is crucial for staff working with individuals who present with complex behavioral health needs to be well-prepared and trained in several key areas. The provider must ensure the program’s Certified Program Administrator, as outlined in COMAR 14.31.06.06, shall have experience providing individualized services that may include individual, group, milieu, family, educational, and behavioral treatment approaches as applicable. In addition, below is a breakdown of the essential components of staff training:

A. Trauma-Informed Care

(1) Recognizing and addressing the physical, psychological, and spiritual impact of trauma on survivors.

(2) Understanding trauma-informed care principles, such as creating safe and empowering environments and avoiding re-traumatization.

B. Boundaries and Healthy Relationships

(1) Maintaining appropriate boundaries is crucial to ensure the safety and well-being of both staff and youth.

(2) Ethical conduct and professional boundaries, while still maintaining empathy.

(3) Legal and ethical considerations related to working with children and youth, including issues related to confidentiality, informed consent, and child abuse reporting requirements.

(4) Cultural competence is crucial, as youth come from diverse backgrounds. Staff must be trained to be culturally sensitive and responsive to the unique needs and experiences.

C. Transition Planning

Reintegrating youth into their families or communities after being in out-of-home placement can be challenging. Working with DHS is crucial to the development of a transition plan that prepares the youth and family for their return to the community.

D. Crisis Intervention

(1) Immediate crisis intervention and post incident processing preparedness. Both clinical and program management remain on call 24 hours a day for emergencies and crisis management.

(2) Knowledge and implementation of DHS’s Incident Reporting Policy to ensure the safety and well-being of youth.

X. Program Location

The provider is expected to accommodate youth from all Maryland jurisdictions, including transportation of youth to court appearances, off grounds activities, family visits, educational services and other prosocial activities.

XI. The priority selection criteria are:

A. The provision of high-intensity services

B. The availability of the beds in a facility that meets all core regulation requirements and is ready to place children by April 1, 2026

C. Previous experience operating a high-intensity program serving the identified populations

D. The establishment of facility(s) accessible to all Eastern and Western Shore Local Departments of Social Services (LDSS)

E. A facility for females ages 14-16 or 17-20

F. Ability to obtain QRTP Designation within one year of the award of contract

XII. Rate Setting

All providers are required to submit a rate application to the Maryland State Department of Education to obtain a rate aligned with the State of Maryland's rate reform methodology and consistent with COMAR 14.31.04. Specific requirements for classes outlined in the rate reform process are described in the guidance below by following the links.

RCC/FAQ-Maryland-Children’s-Quality-Service-Reform- January 2024

FY2026 RCC Class Determination Guidelines

XIII. Proposal Submissions and Closing Date

Proposals addressing the above items are to be submitted to Placementand.Permanency@maryland.gov within 21 days from the date notice of the SON is published in the Maryland Register. Please also include Torrez Ackers-Hardy, Management Associate torrez.ackershardy@maryland.gov, and Desiree Hill, Administrative Assistant Desiree.Hill3@maryland.gov on any documentation sent.

XIV. Residential beds must be available by: April 1, 2026

XVI. Opportunity for Public Comment

may be sent to Tennille Thomas, Principal Deputy Executive Director for Programs, Social Services Administration, Department of Human Services, via email to Tennille.Thomas2@maryland.gov. Please also include Desiree.Hill3@maryland.gov.

Comments will be accepted through June 27, 2025. A public hearing has not been scheduled.

[25-12-11]

General Notices

Notice of ADA Compliance

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

CHESAPEAKE BAY TRUST

Subject: Public Meeting

Date and Time: September 19, 2025, 10 a.m.—1 p.m.

Place: 10090 Wades Point Road, McDaniel, MD

Contact: Jana Davis 410-974-2941

[25-12-12]

CHESAPEAKE BAY TRUST

Subject: Public Meeting

Date and Time: November 19, 2025, 3—6 p.m.

Place: 108 Severn Avenue, Annapolis, MD

Contact: Jana Davis 410-974-2941

[25-12-13]

CHESAPEAKE BAY TRUST

Subject: Public Meeting

Date and Time: February 18, 2026, 3—6 p.m.

Place: 108 Severn Avenue, Annapolis, MD

Contact: Jana Davis 410-974-2941

[25-12-14]

CHESAPEAKE BAY TRUST

Subject: Public Meeting

Date and Time: May 20, 2026, 3— 6 p.m.

Place: 108 Severn Avenue, Annapolis, MD

Contact: Jana Davis 410-974-2941

[25-12-15]

COMMISSION ON CRIMINAL SENTENCING POLICY

Subject: Public Meeting

Date and Time: July 8, 2025, 5:30—7:30 p.m.

Add'l. Info: The MSCCSP will meet via videoconference. A livestream of the meeting is available at:
https://www.youtube.com/live/ykNqSlRYyMU
Contact: David Soule 301-403-4165

[25-12-02]

MARYLAND HEALTH BENEFIT EXCHANGE

Subject: Public Meeting

Date and Time: July 23, 2025, 1—2 p.m.

Place: Virtual. Register in advance for this meeting:
https://maryland-gov.zoomgov.com/meeting/register/1sW9oeKsRI2jzsc-LoTajw

Add'l. Info: MHBE will hold its Seventh Annual Reinsurance Forum pursuant to 31 CFR §33.120(c) and 45 CFR §155.1320(c) to give the public an opportunity to comment on its 1332 State Innovation Waiver.

Contact: Becca Lane 410-547-7371

[25-12-03]

MARYLAND DEPARTMENT OF HEALTH

Subject: Public Meeting

Date and Time: July 16, 2025, 4—6 p.m.

Place: Google Meet joining info
Video call link: https://meet.google.com/idv-zjzd-uvt
Or dial: (US) +1 727-325-2351 PIN: 395 351 560#

Add'l. Info: This is a public meeting of the Cannabis Public Health Advisory Council.
https://health.maryland.gov/phpa/ohpetup/council/Pages/default.aspx

Contact: Dana Moncrief 410-767-5316

[25-12-09]

MARYLAND STATE LOTTERY AND GAMING CONTROL COMMISSION

Subject: Public Meeting

Date and Time: June 26, 2025, 10 a.m.—12 p.m.

Place: Montgomery Business Park
1800 Washington Blvd., Ste. 330, Baltimore, MD

Add'l. Info: The meeting will be held in person at Lottery Headquarters. The link to view the meeting will be available on the website the day of the meeting - https://www.mdgaming.com/commission-meeting-6-26-2025/

Contact: Kathy Lingo 410-230-8790

[25-12-04]

BOARD OF OCCUPATIONAL THERAPY PRACTICE

Subject: Public Meeting

Date and Time: June 20, 2025, 9:30a.m.—12 p.m.

Place: via Google Meet

Add'l. Info: Health Occupations Article, Title 10, Annotated Code of Maryland, and COMAR 10.46 amendments, additions, and revisions, including fee changes, may be discussed/voted on. Budget information may also be discussed. It may be necessary to go into executive session. Sign language interpreters and/or appropriate accommodations for qualified individuals with disabilities will be provided upon request. Please call 1-800-735-2255.

Contact: Lauren Murray 410-402-8556

[25-12-01]