Maryland Register Issue Date:  September 19, 2025 Volume 52  •  Issue 19  • Pages 945 — 990 IN THIS ISSUE Governor 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Pursuant to State Government Article, §7-206, Annotated Code of Maryland, this issue contains all previously unpublished documents required to be published, and filed on or before August 29, 2025 5 p.m. Pursuant to State Government Article, §7-206, Annotated Code of Maryland, I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 August 29, 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

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• 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.

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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 ..................................................................... 948

COMAR Research Aids

Table of Pending Proposals ........................................................... 949

Index of COMAR Titles Affected in This Issue

COMAR Title Number and Name Page

09 Maryland Department of Labor ......................................... 956

10 Maryland Department of Health ................................ 956, 958

11 Department of Transportation ............................................ 957

15 Maryland Department of Agriculture ........................ 957, 973

26 Department of the Environment ........................................ 974

33 State Board of Elections .................................................... 957

PERSONS WITH DISABILITIES

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

The Governor

EXECUTIVE ORDER 01.01.2025.19

ADDRESSING MARYLAND’S AFFORDABLE HOUSING CRISIS 952

The Judiciary

SUPREME COURT OF MARYLAND

DISCIPLINARY PROCEEDINGS........................................ 955

Final Action on Regulations

09 MARYLAND DEPARTMENT OF LABOR

STATE ATHLETIC COMMISSION

Muay Thai Regulations—Professional 956

10 MARYLAND DEPARTMENT OF HEALTH

BOARD OF PHYSICIANS

Licensure of Polysomnographic Technologists . 956

BOARD OF PHARMACY

Transfer and Outsourcing of Prescriptions and Prescription Orders 956

Pharmacy Equipment 956

11 DEPARTMENT OF TRANSPORTATION

MARYLAND PORT ADMINISTRATION

Vehicle Access, Parking, and Operation of Vehicles on Maryland Port Administration Property 957

15 MARYLAND DEPARTMENT OF AGRICULTURE

WEIGHTS AND MEASURES

Registration of Commercial Weighing and Measures
Devices . 957

33 STATE BOARD OF ELECTIONS

Definitions; General Provisions . 957

Election Judges . 957

EVS Voting Solution . 957

Definitions; General Provisions . 957

Issuance and Return . 957

Recount Procedures—In General 957

Appeals Process for Public Buildings . 957

Proposed Action on Regulations

10 MARYLAND DEPARTMENT OF HEALTH

MARYLAND HEALTH CARE COMMISSION

Data Reporting by Non-Hospital Healthcare Facilities . 958

HEALTH SERVICES COST REVIEW COMMISSION

Rate Application and Approval Procedures . 959

Patient Rights and Obligations; Hospital Credit and Collection and Financial Assistance Policies 959

15 MARYLAND DEPARTMENT OF AGRICULTURE

OFFICE OF THE SECRETARY

Class 4 Limited Winery License Exemption for Maryland-Grown Agricultural Products 973

26 DEPARTMENT OF THE ENVIRONMENT

AIR QUALITY

Advanced Clean Trucks Program .. 974

Maryland Heating Fuel Provider Reporting Program .. 976

Errata

COMAR 08.02.13 . 980

COMAR 09.14.18.05 . 980

Special Documents

DEPARTMENT OF THE ENVIRONMENT

SUSQUEHANNA RIVER BASIN COMMISSION

Projects Approved for Consumptive Uses of Water 981

Grandfathering Registration Notice . 982

WATER AND SCIENCE ADMINISTRATION

Water Quality Certification 25-WQC-0008 . 983

Water Quality Certification 25-WQC-0013 . 983

Updates to Maryland’s Stormwater Management Regulations and Design Manual 983

Advanced Notice of Proposed Rulemaking - Nontidal Mitigation 985

DEPARTMENT OF STATE POLICE

HANDGUN ROSTER BOARD

Proposed Additions to Handgun Roster and Notice of Right to Object or Petition 987

General Notices

FIRE PREVENTION COMMISSION

Public Meeting . 989

MARYLAND HEALTH CARE COMMISSION

Formal Start of Review .. 989

MARYLAND DEPARTMENT OF HEALTH

Public Meeting . 989

MARYLAND DEPARTMENT OF HEALTH /WORKGROUP ON NEWBORN HOME VISITING SERVICES

Public Meeting . 989

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 2026^†

Issue Date	Emergency and Proposed Regulations 5 p.m.*	Notices, etc. 10:30 a.m.	Final Regulations 10:30 a.m.
2025
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
2026
January 9	December 22	December 29	December 31
January 23	January 5	January 12	January 14
February 6**	January 16	January 26	January 28
February 20	February 2	February 9	February 11
March 6**	February 13	February 23	February 25
March 20	March 2	March 9	March 11
April 3	March 16	March 23	March 25
April 17	March 30	April 6	April 8
May 1	April 13	April 20	April 22
May 15	April 27	May 4	May 6
June 12**	May 22	June 1	June 3
June 26	June 8	June 15	June 17
July 10	June 22	June 29	July 1
July 24	July 6	July 13	July 15
August 7	July 20	July 27	July 29
August 21	August 3	August 10	August 12
September 4	August 17	August 24	August 26
September 18**	August 31	September 4	September 9
October 2	September 14	September 21	September 23
October 16	September 28	October 5	October 7
October 30**	October 9	October 19	October 21
November 13	October 26	November 2	November 4
November 30***	November 9	November 16	November 18
December 11	November 23	November 30	December 2
December 28***	December 7	December 14	December 16

^† 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)

05 DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT

05.24.01.01—.04 • 52:13 Md. R. 660 (6-27-25)

07 DEPARTMENT OF HUMAN SERVICES

07.02.07.02, .03, .11 • 52:16 Md. R. 849 (8-8-25)

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

08 DEPARTMENT OF NATURAL RESOURCES

08.01.07.10 • 52:17 Md. R 878 (8-22-25)

08.01.10.01—.06 • 52:17 Md. R 878 (8-22-25)

08.02.13.06 • 52:18 Md. R 925 (9-5-25)

• 52:18 Md. R 980 (9-19-25) (err)

08.02.15.07 • 52:18 Md. R 928 (9-5-25)

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

08.03.04.25 • 52:16 Md. R. 850 (8-8-25)

08.03.09.11 • 52:17 Md. R 880 (8-22-25)

08.07.01.25 • 52:17 Md. R 878 (8-22-25)

08.07.06.25 • 52:17 Md. R 878 (8-22-25)

08.08.05.03 • 52:7 Md. R. 326 (4-4-25)

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)

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

09.15.02.04 • 52:17 Md. R 880 (8-22-25)

09.20.01.01, .02—.04, .06—.07 • 52:16 Md. R. 850 (8-8-25)

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

• 52:16 Md. R. 850 (8-8-25)

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

• 52:16 Md. R. 850 (8-8-25)

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

09.32.01 .02, .03, .05, .06, .09, .09-1 .11, .12, .16, ,.16-1 .17, .23, .25, .26, • 52:15 Md. R. 814 (7-25-25)

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)

09.42.01.01—.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 (5-30-25)

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)

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

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)

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

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

10.09.48.08 • 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)

10.09.81.41 • 52:17 Md. R 881 (8-22-25)

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 (5-30-25)

10.10.02.01 • 52:11 Md. R. 545 (5-30-25)

10.10.03.02—.04 • 52:11 Md. R. 545 (5-30-25)

10.10.04.01,.02 • 52:11 Md. R. 545 (5-30-25)

10.10.05.02,.04,.05 • 52:11 Md. R. 545 (5-30-25)

10.10.06.02,.07,.08,.12,.13 • 52:11 Md. R. (5-30-25)

10.10.07.07 • 52:11 Md. R. 545 (5-30-25)

10.10.08.02 • 52:11 Md. R. 545 (5-30-25)

10.10.12.02,.04,.07 • 52:11 Md. R. 545 (5-30-25)

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 (5-30-25)

Subtitles 23—36 (4th volume)

10.24.06.01—.04 • 52:19 Md. R. 958 (9-19-25)

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

10.25.07.01,.02,.05,.09—.12 • 52:16 Md. R. 852 (8-8-25)

10.27.01.01,.03,.17 • 52:16 Md. R. 854 (8-8-25)

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

10.27.05.01, .06 • 52:16 Md. R. 855 (8-8-25)

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

10.27.06.06 • 52:16 Md. R. 856 (8-8-25)

10.27.07.03,.07 • 52:16 Md. R. 856 (8-8-25)

10.27.09.02 • 52:16 Md. R. 856 (8-8-25)

10.27.10.02 • 52:16 Md. R. 856 (8-8-25)

10.27.16.06 • 52:16 Md. R. 856 (8-8-25)

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

10.27.20.04 • 52:16 Md. R. 856 (8-8-25)

10.27.21.04 • 52:16 Md. R. 856 (8-8-25)

10.27.25.05 • 52:16 Md. R. 856 (8-8-25)

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

10.27.28 .01—.06 • 52:16 Md. R. 857 (8-8-25)

10.28.05.03 • 52:7 Md. R. 334 (4-4-25)

10.28.07.02 • 52:7 Md. R. 334 (4-4-25)

10.28.08.01—.04 • 52:7 Md. R. 334 (4-4-25)

10.28.11.04 • 52:7 Md. R. 334 (4-4-25)

10.28.12.02 • 52:7 Md. R. 334 (4-4-25)

10.32.05.02—.06 • 52:11 Md. R. 563 (5-30-25)

10.32.25.01—.06 • 52:13 Md. R. 670 (6-27-25)

10.34.43.01—.03 • 52:13 Md. R. 672 (6-27-25)

Subtitles 37—52 (5th volume)

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

10.37.10.26 • 52:19 Md. R. 959 (9-19-25)

10.37.13.01—.09 • 52:19 Md. R. 959 (9-19-25)

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

10.42.02.02 • 52:14 Md. R 720 (7-11-25)

10.44.01.01—.30 • 52:17 Md. R 882 (8-22-25)

10.46.05.01• 52:13 Md. R. 673 (6-27-25)

Subtitles 53—69 (6th volume)

10.53.05.02 • 52:16 Md. R. 856 (8-8-25)

10.57.02,.02, .04, .05,.07 • 52:13 Md. R. 678 (6-27-25)

10.57.03.03, .05, .08, .09, .10 • 52:13 Md. R. 678 (6-27-25) 10.57.05.04 • 52:13 Md. R. 678 (6-27-25)

10.57.07.02 • 52:13 Md. R. 678 (6-27-25)

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

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

10.65.07.02 • 52:14 Md. R 721 (7-11-25)

10.65.12.01—.05 • 52:14 Md. R 721 (7-11-25)

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..01, .04 • 52:16 Md. R. 859 (8-8-25)

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

11.04.15.01—.04 • 52:11 Md. R. 568 (5-30-25)

11.11.05.02—.04, .06 • 52:13 Md. R. 682 (6-27-25)

Subtitles 11—23 (MVA)

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

11.14.01.01—.18 • 52:14 Md. R 723 (7-11-25)

11.14.02.01—.29 • 52:14 Md. R 723 (7-11-25)

11.14.03.01—.14 • 52:14 Md. R 723 (7-11-25)

11.14.04.01—.23 • 52:14 Md. R 723 (7-11-25)

11.14.05.01—.11 • 52:14 Md. R 723 (7-11-25)

11.14.06.01—.07 • 52:14 Md. R 723 (7-11-25)

12 DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONAL SERVICES

12.04.01.10 • 52:17 Md. R 888 (8-22-25)

12.04.09.04,.06,.07 • 52:18 Md. R 929 (9-5-25)

13A STATE BOARD OF EDUCATION

13A.01.02.01 • 52:16 Md. R. 860 (8-8-25)

13A.01.05.12 • 52:17 Md. R 889 (8-22-25)

13A.03.08.01—.08 • 52:14 Md. R 783 (7-11-25)

13A.05.04.01—.03 • 52:17 Md. R 889 (8-22-25)

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

• 52:17 Md. R 891 (8-22-25)(ibr)

13A.07.12.01 • 52:16 Md. R. 860 (8-8-25)

13A.12.01.04 • 52:14 Md. R 785 (7-11-25)

13A.12.04.02 • 52:14 Md. R 785 (7-11-25)

13A.12.05.02 • 52:14 Md. R 785 (7-11-25)

13A.12.06.01—.04, .08 .09 • 52:14 Md. R 786 (7-11-25)

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.02.01.12 • 52:15 Md. R. 817 (7-25-25)

13B.02.02.16 • 52:15 Md. R. 817 (7-25-25)

13B.08.20.02—.11, .13 • 52:13 Md. R. 688 (6-27-25)

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

14 INDEPENDENT AGENCIES

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

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

14.22.01.12 • 52:17 Md. R 893 (8-22-25)

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

• 52:17 Md. R 893 (8-22-25)

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

14.35.21 .01—.07 • 52:14 Md. R 788 (7-11-25)

14.39.02.06 • 52:17 Md. R 900 (8-22-25)

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

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

15 MARYLAND DEPARTMENT OF AGRICULTURE

15.01.22.01—.04 • 52:19 Md. R. 973 (9-19-25)

15.06.02.06 • 52:16 Md. R. 861 (8-8-25)

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)

20.50.15.01—.06 • 52:18 Md. R 930 (9-5-25)

20.53.07.07 • 52:17 Md. R 901 (8-22-25)

20.62.06.01—.04 • 52:15 Md. R. 819 (7-25-25)

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)

26.11.43.02 • 52:19 Md. R. 974 (9-19-25) (ibr)

26.11.44.01—.06 • 52:19 Md. R. 976 (9-19-25) (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)

27 CRITICAL AREA COMMISSION FOR THE CHESAPEAKE AND ATLANTIC COASTAL BAYS

27.01.15.01—.06 • 52:17 Md. R 901 (8-22-25)

27.03.01.03,.04 • 52:17 Md. R 901 (8-22-25)

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)

30.03.03.03 • 52:15 Md. R. 821 (7-25-25)

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

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

33.01.08.01—.04 • 52:17 Md. R 904 (8-22-25)

33.03.02.01 • 52:17 Md. R 904 (8-22-25)

33.08.01.05-1,.09, .13 • 52:17 Md. R 904 (8-22-25)

33.11.01.04 • 52:17 Md. R 904 (8-22-25)

33.15.03.01—.02 • 52:17 Md. R 904 (8-22-25)

33.17.02.02 • 52:17 Md. R 904 (8-22-25)

33.05.01.04 • 52:13 Md. R. 690 (6-27-25)

33.07.11.01 • 52:13 Md. R. 690 (6-27-25)

33.13.06.01 • 52:14 Md. R 790 (7-11-25)

33.13.06.03 • 52:14 Md. R 790 (7-11-25)

33.13.06.05 • 52:14 Md. R 790 (7-11-25)

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

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

33.14.02.14 • 52:15 Md. R. 821 (7-25-25)

36 MARYLAND STATE LOTTERY AND GAMING CONTROL AGENCY

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

• 52:17 Md. R 908 (8-22-25)

36.10.13.39 • 52:17 Md. R 908 (8-22-25)

The Governor

EXECUTIVE ORDER 01.01.2025.19

ADDRESSING MARYLAND’S AFFORDABLE HOUSING CRISIS

WHEREAS, The State of Maryland faces an unprecedented and rapidly growing housing affordability crisis caused by a shortage of at least 96,000 housing units and driven by insufficient housing construction over the past 15 years;

WHEREAS, The increasing unavailability and unaffordability of safe, stable, livable housing for working families has created an imminent threat of widespread social and economic disruption, including severe negative impacts on Maryland's economic and business climate and the inability to retain new people entering the workforce, resulting in a lack of innovation and a stifling of overall economic development;

WHEREAS, The Moore-Miller Administration’s commitment to making Maryland a more affordable place to live, work, and raise a family includes ensuring that all Marylanders are able to obtain safe, stable, livable housing that fits their budget;

WHEREAS, State government plays a vital role in fostering an environment that is conducive to the construction of enough housing to serve the needs of the State’s residents; and

WHEREAS, In order for Maryland to address its housing crisis and prevent economic stagnation, State government must take action to spur the construction of housing by removing regulatory barriers, accelerating building supply lines, shortening permit waiting times, reforming financing for affordable housing, leveraging State-owned property, and encouraging local jurisdictions to adopt land use rules more favorable to housing construction.

NOW, THEREFORE, I, WES MOORE, GOVERNOR OF THE STATE OF MARYLAND, BY VIRTUE OF THE AUTHORITY VESTED IN ME BY THE CONSTITUTION AND LAWS OF MARYLAND, PROCLAIM THE FOLLOWING EXECUTIVE ORDER, EFFECTIVE IMMEDIATELY:

A. Developing Housing on State-Owned Land and Accelerating Funding for Affordable Housing.

(1) The Department of Housing and Community Development and the Department of Transportation shall develop strategies to implement their October 2024 Interagency Agreement on Transit Oriented Development to increase the production of housing near transit stations.

(a) In accordance with the Interagency Agreement, the Department of Transportation will lead the development of land owned by the Department of Transportation for transit-oriented development and will coordinate with the Department of Housing and Community Development on these sites. 

(b) The Department of Transportation shall commit to prioritizing development of affordable housing in the development of transit-oriented development projects on land owned by the Department of Transportation.

(c) The Department of Housing and Community Development shall commit to providing bonus points or special consideration to the extent permitted by law in the Low Income Housing Tax Credit Program and State Revitalization Programs funding rounds for projects tied to the Department of Transportation's transit-oriented development efforts.

(2) The Department of Transportation shall:

(a) Pursue the development of land owned by the Department of Transportation for dense, mixed-use, transit-oriented development, with housing as a priority goal for the development of these sites;

(b) Coordinate funding and investment with the Department of Housing and Community Development, and other State partners, to support the development of housing at these sites as a priority use; and

(c) Work with local jurisdictions through the transit-oriented development designation process to ensure local jurisdiction planning for transit-oriented development supports housing as a priority use.

(3) The Department of Housing and Community Development and the Department of General Services shall, in coordination with other executive departments and agencies, identify State-owned land that is: 

(a) Subject to the control of the Department of General Services;

(b)Determined to be surplus; and 

(c) Appropriate for consideration for the development of housing.

(4) The Department of General Services shall:

(a) Maintain a database of parcels of State-owned land identified as appropriate for the development of housing;

(b) For properties that have been identified as suitable for affordable housing by the Department of Housing and Community Development, issue:

(i) Within 30 days after determination of suitability, a notice of intent to release a request for proposals; and

(ii) Within 90 days after the issuance of the notice of intent, a request for proposals;

(c) Pursuant to statutory requirements, dispose of State-owned parcels for the development of housing by entering into land disposition agreements with parties that will develop such parcels into new housing units, selected through a competitive process; and

(d) Maximize the housing use of surplus State-owned parcels, whether the parcel remains under State ownership, is subject to long-term lease, or is disposed of, through:

(i) Reducing the cost of the land or pairing the development of land with funding to create deed-restricted low-income housing, and

(ii) Exercising the governmental immunity from local zoning laws to the extent permitted by law.

B. State Housing Permitting Acceleration/Ombudsman Creation.

(1) Definitions.

(a) “Housing development project” means the new construction or substantial renovation of a residential real estate project.

(b) “Permit related to housing construction” means a permit or approval required by law or regulation to be issued by a principal department of the Executive Branch or a division thereof, to a developer, contractor, or subcontractor in order to commence, continue, or support a housing development project.

(c) “Third-party reviewer” means an independent contractor engaged by the proponent of a housing development project to inspect, review, and provide an independent evaluation, including recommendation for approval or denial, of an application for a State permit related to the housing development project.

(2) Each principal department of the Executive Branch that issues permits related to housing construction shall:

(a) Designate a senior point of contact for coordination and efficient processing of permits related to housing construction;

(b) By January 1, 2026, submit to the Office of the Governor and the Maryland Coordinated Permitting Review Council updated permit application processing procedures with timelines for permits related to housing construction;

(c) By November 21, 2025, draft and submit to the Office of the Governor for review and approval standards and procedures for applicants for State-issued permits related to housing development projects to hire third-party reviewers to help expedite permitting timelines at the applicant’s expense, including:

(i) Registration procedures and required qualifications for third-party reviewers;

(ii) Rules governing conflicts of interest for third-party reviewers;

(iii) Procedures for review and approval or denial of recommendations made by third-party reviewers; and

(iv) Provisions requiring the principal department to follow recommendations made by third-party reviewers except in cases of clear error, serious deficiency, or conflict of interest;

(d) Upon approval by the Office of the Governor, complete implementation of the new third-party permitting standards and procedures for permits related to housing development projects by March 1, 2026;

(e) By November 21, 2025, provide to the Office of the Governor a written enumeration and assessment of additional potential legislative, regulatory, and administrative actions to increase efficiency in permitting processes;

(f) For permit applications that require review by multiple State agencies or by different levels of government, to the extent allowed by law, engage in simultaneous, rather than sequential, review of such permit applications;

(g) By November 21, 2025, provide written recommendations to the Office of the Governor for ways to increase predictability and transparency related to applications for permits related to housing construction;

(h) Fully digitize permit applications and permit fee payments within the extent of budgetary authority no later than March 1, 2026; and

(i) Seek every opportunity to provide transparency in the permit application process and, whenever possible, reduce processing times.

(3) The Department of Housing and Community Development shall:

(a) By November 21, 2025, draft and submit to the Office of the Governor for review a written plan to accelerate processes related to the distribution of funding for affordable multifamily housing projects, including:

(i) Awarding of funds and tax credits;

(ii) Closing of deals, contracts, and loan agreements; and

(iii) Distribution of awarded funds, including release of construction funds.

(b) Upon approval by the Office of the Governor, complete implementation of the plan to accelerate the distribution of funding for affordable multifamily housing projects by March 1, 2026.

(4) The Department of Housing and Community Development shall: 

(a) Designate a State Housing Ombudsman to facilitate navigation through local, State, and federal permitting processes and act as a liaison between the Department of Housing and Community Development, other State agencies, local governments and planning and zoning authorities, housing developers and other stakeholders, and local communities.

(b) The State Housing Ombudsman’s duties shall include:

(i) Coordinating and reporting on the activities undertaken by executive departments and State agencies pursuant to section B.2 of this Order;

(ii) Facilitating and participating on the Department of Housing and Community Development’s behalf in discussions between units of State government, local government, and housing developers to assist with navigation through permitting requirements and processes;

(iii) Evaluating if there are opportunities for the state to acquire land to further housing development opportunities; 

(iv) Evaluating methods to improve the housing building materials supply chain in the State;

(v) Gathering and compiling information on local permitting and planning and zoning processes throughout the State and identifying “pain points” in those processes; and

(vi) Tracking the progress of housing development projects throughout the State and providing periodic updates to the Department of Housing and Community Development leadership and the Office of the Governor on housing production in Maryland.

C. Establishment of Housing Targets.

(1) The Department of Housing and Community Development shall: 

(a) Publish on or before January 1, 2026, and every five years thereafter, housing production targets for the State, each county, and each municipality that exercises zoning or planning authority; 

(b) Conduct a public engagement process on draft housing targets; and 

(c) Publish a methodology and supporting basis for calculating the housing production targets. 

(2) The Department of Housing and Community Development shall publish an annual report on January 1, 2027, and each year thereafter that:

(a) assesses the progress of the State and each local jurisdiction with meeting applicable housing production targets; and

(b) provides potential solutions to assist the state or a local jurisdiction with meeting applicable housing production targets.

D. Housing Leadership Award

(1) The Secretary of the Department of Housing and Community Development shall establish an annual Maryland Housing Leadership Award to recognize local jurisdictions that demonstrate outstanding progress in advancing housing opportunities.

(2) The Award may be granted to jurisdictions that:

(a) Are on track to meet or exceed housing production targets; or

(b) Enact policies or legislation that significantly promote the development of housing.

(3) The Department of Housing and Community Development may award bonus points to applications for department funding to local jurisdictions that have received a Maryland Housing Leadership Award. 

E. General Provisions.

(1) This Executive Order shall be implemented in a manner that is consistent with all applicable statutes and regulations. Nothing in this Executive Order shall operate to contravene any State or federal law or to affect the State’s receipt of federal funding.

(2) If any provision of this Executive Order or its application to any person, entity, or circumstance is held invalid by any court of competent jurisdiction, all other provisions or applications of the Executive Order shall remain in effect to the extent possible without the invalid provision or application. To achieve this purpose, the provisions of this Executive Order are severable.

Effective Date: September 3, 2025.

GIVEN Under My Hand and the Great Seal of the State of Maryland, in the City of Columbia, this 3rd Day of September, 2025.

WES MOORE

Governor

ATTEST:

SUSAN C. LEE

Secretary of State

[25-19-12]

The JudiciarySUPREME COURT OF MARYLAND

DISCIPLINARY PROCEEDINGS

This is to certify that by a Per Curiam Order of this Court dated September 4, 2025 DAVID B. MINTZ (CPF# 9512130232) as of September 4, 2025, David B. Mintz has been disbarred, effective immediately, and his name has been stricken from the register of attorneys in this Court. Notice of this action is given in accordance with Maryland Rule 19-761(b).

* * * * * * * * * *

[25-19-09]

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 14 STATE ATHLETIC COMMISSION

09.14.18 Muay Thai Regulations—Professional

Authority: Business Regulations Article, §§4-205, 4-301, and 4-303, Annotated Code of Maryland

Notice of Final Action

[25-016-F]

On July 16, 2025, the Maryland State Athletic Commission adopted new Regulations .01—.13 under a new chapter, COMAR 09.14.18 Muay Thai Regulations—Professional. This action, which was proposed for adoption in 52:11 Md. R. 540—544 (May 30, 2025), has been adopted as proposed.

Effective Date: September 29, 2025.

DAVID NORMAN
Chairman

Title 10
MARYLAND DEPARTMENT OF HEALTH

Subtitle 32 BOARD OF PHYSICIANS

10.32.06 Licensure of Polysomnographic Technologists

Authority: Health Occupations Article, §§1-213, 1-221, 1-606, 14-205, and 14-5C-01—14-5C-23, Annotated Code of Maryland

Notice of Final Action

[25-123-F]

On August 28, 2025, the Secretary of Health adopted amendments to Regulations .02, .04, .06, .07, and .09—.13 under COMAR 10.32.06 Licensure of Polysomnographic Technologists. This action, which was proposed for adoption in 52:14 Md. R. 716—719 (July 11, 2025), has been adopted as proposed.

Effective Date: September 29, 2025.

MEENA SESHAMANI, MD, PHD
Secretary of Health

Subtitle 34 BOARD OF PHARMACY

10.34.04 Transfer and Outsourcing of Prescriptions and Prescription Orders

Authority: Health Occupations Article, §12-205(a)(3)(ii), Annotated Code of Maryland

Notice of Final Action

[25-117-F]

On August 28, 2025, the Secretary of Health adopted amendments to Regulations .01 and .03, new Regulation .06, and the recodification of existing Regulations .06—.09 to be Regulations .07—.10 under COMAR 10.34.04 Transfer and Outsourcing of Prescriptions and Prescription Orders. This action, which was proposed for adoption in 52:14 Md. R. 719—720 (July 11, 2025), has been adopted as proposed.

Effective Date: September 29, 2025.

MEENA SESHAMANI, MD, PHD
Secretary of Health

Subtitle 34 BOARD OF PHARMACY

10.34.07 Pharmacy Equipment

Authority: Health Occupations Article, §§12-205 and 12-403, Annotated Code of Maryland

Notice of Final Action

[25-126-F]

On August 28, 2025, the Secretary of Health adopted amendments to Regulation .01-1 under COMAR 10.34.07 Pharmacy Equipment. This action, which was proposed for adoption in 52:14 Md. R. 720 (July 11, 2025), has been adopted as proposed.

Effective Date: September 29, 2025.

MEENA SESHAMANI, MD, PHD
Secretary of Health

Title 11
DEPARTMENT OF TRANSPORTATION

Subtitle 05 MARYLAND PORT ADMINISTRATION

11.05.03 Vehicle Access, Parking, and Operation of Vehicles on Maryland Port Administration Property

Authority: Transportation Article, §§6-201 and 6-211, Annotated Code of Maryland

Notice of Final Action

[25-088-F]

On September 2, 2025, the Maryland Port Administration adopted amendments to Regulations .02 and .03 under COMAR 11.05.03 Vehicle Access, Parking, and Operation of Vehicles on Maryland Port Administration Property. This action, which was proposed for adoption in 52:13 Md. R. 680—682 (June 27, 2025), has been adopted as proposed.

Effective Date: September 29, 2025.

JONATHAN DANIELS
Executive Director

Title 15
MARYLAND DEPARTMENT OF AGRICULTURE

Subtitle 03 WEIGHTS AND MEASURES

15.03.08 Registration of Commercial Weighing and Measures Devices

Authority: Agriculture Article, §11-204.7, Annotated Code of Maryland

Notice of Final Action

[25-144-F]

On September 9, 2025, the Maryland Department of Agriculture adopted amendments to Regulation .05 under COMAR 15.03.08 Registration of Commercial Weighing and Measuring Devices. This action, which was proposed for adoption in 52:15 Md. R. 818—819 (July 25, 2025), has been adopted as proposed.

Effective Date: September 29, 2025.

STEVEN A. CONNELLY
Deputy Secretary

Title 33
STATE BOARD OF ELECTIONS

Notice of Final Action

[25-111-F]

On August 28, 2025, the State Board of Elections adopted:

(1) New Regulation .04 under COMAR 33.05.01 Definitions; General Provisions;

(2) Amendments to Regulation .01 under COMAR 33.07.11 Election Judges;

(3) New Regulation .30 under COMAR 33.10.01 EVS Voting Solution;

(4) New Regulation .05 under COMAR 33.11.01 Definitions; General Provisions;

(5) Amendments to Regulation .06 under COMAR 33.11.03 Issuance and Return;

(6) New Regulation .07 under COMAR 33.12.04 Recount Procedures—In General; and

(7) New Regulations .01—.10 under a new chapter, COMAR 33.17.08 Appeals Process for Public Buildings. This action, which was proposed for adoption in 52:13 Md. R. 690—692 (June 27, 2025), has been adopted as proposed.

Effective Date: September 29, 2025.

JARED DEMARINIS
State Administrator

Proposed Action on Regulations

Title 10
MARYLAND DEPARTMENT OF HEALTH

Subtitle 24 MARYLAND HEALTH CARE COMMISSION

10.24.06 Data Reporting by [Freestanding Medical] Non-Hospital Healthcare Facilities

Authority: Health-General Article, [§19-131,] §§19-109 and 19-116, Annotated Code of Maryland

Notice of Proposed Action

[25-185-P]

The Maryland Health Care Commission proposes to amend Regulations .01 and .02, repeal existing Regulation .03 and recodify existing Regulation .04 to be Regulation .03 under COMAR 10.24.06 Data Reporting by Non-Hospital Health Care Facilities. This action was considered by the Commission at an open meeting held on July 17, 2025, a notice of which was given through publication in the Maryland Register, in accordance with General Provisions Article, §3-302(c), Annotated Code of Maryland.

Statement of Purpose

The purpose of these amendments is to repeal outdated language where the statutory authority has been repealed and clarify the Maryland Health Care Commission’s authority to collect data from all non-hospital health care 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 Wynee Hawk, Director, Center for Health Care Facility Planning and Development, Maryland Health Care Commission, 4160 Patterson Avenue, Baltimore, Maryland 21215, or call 410-764-3261 (office) or 410-925-1218 (cell), or email to [email protected]. Comments will be accepted through October 20, 2025. A public hearing has not been scheduled.

Open Meeting

Final action on the proposal will be considered by the Maryland Health Care Commission during a public meeting to be held on November 20, 2025 at 1:00 pm, at 4160 Patterson Avenue, Baltimore, Maryland 21215. Register to attendee virtually at https://mhcc.maryland.gov/mhcc/pages/home/meeting_schedule/meeting_schedule.aspx.

.01 Definitions.

A. (text unchanged)

B. Terms Defined.

(1) (text unchanged)

[(2) "Freestanding medical facility" has the meaning stated in Health-General Article, §19-3A-01, Annotated Code of Maryland, and COMAR 10.07.08.

(3) "Freestanding medical facility pilot project" means one freestanding medical facility pilot project under Health-General Article, §19-3A-07, Annotated Code of Maryland.]

(2) “Non-hospital health care facility” means:

(a) A related institution, as defined in Health-General Article, §19-301, Annotated Code of Maryland;

(b) An ambulatory surgical facility, as defined in Health-General Article, §19-114, Annotated Code of Maryland;

(c) A facility providing intermediate care, as that term is defined in COMAR 10.24.01.01;

(d) A home health agency, as defined in Health-General Article, §19-401, Annotated Code of Maryland;

(e) A hospice, as defined in Health-General Article, §19-901, Annotated Code of Maryland;

(f) A freestanding medical facility, as defined in Health-General Article, §19-3A-01, Annotated Code of Maryland;

(g) A comprehensive care facility, as defined in COMAR 10.24.01.01; and

(h) Other non-hospital health institutions, services, or programs that may be specified as requiring a certificate of need under State law.

.02 Collection and Reporting of Data.

A. A [freestanding medical facility] non-hospital health care facility shall submit accurate, timely, and complete data which the Commission considers to be necessary for planning and analysis purposes, as requested by the Commission.

B. (text unchanged)

C. The Commission shall provide notice of the form, format, and schedule for data reporting by [freestanding medical facilities] non-hospital health care facilities.

D. Failure to report the data required under this regulation may subject a [freestanding medical facility] non-hospital health care facility to penalties under COMAR 10.25.12.

E. The requirements of this chapter are in addition to any other obligation to report information to the Commission by law or as a condition on a certificate of need or other Commission approval.

[E.] F. Extension.

(1) A [freestanding medical facility] non-hospital health care facility, by letter to the Executive Director of the Commission, may request an extension of its data submission date.

(2) (text unchanged)

MARCIA BOYLE
Acting Chair

Subtitle 37 HEALTH SERVICES COST REVIEW COMMISSION

Notice of Proposed Action

[25-184-P]

The Health Services Cost Review Commission proposes to:

(1) Amend Regulation .26 under COMAR 10.37.10 Rate Application and Approval Procedures; and

(2) Adopt new Regulations .01—.09 under a new chapter, COMAR 10.37.13 Patient Rights and Obligations; Hospital Credit and Collection and Financial Assistance Policies.

This action was considered and approved for promulgation by the Commission at an open meeting held on July 30, 2025, notice of which was given through publication on the Commission’s website under General Provisions Article, §3-302(c), Annotated Code of Maryland.

Statement of Purpose

The purpose of this action is to have the Commission’s existing regulations on Patient Rights and Obligations—Hospital Credit and Collection and Financial Assistance Policies conform to legislation enacted by the Maryland General Assembly since 2021.

Estimate of Economic Impact

I. Summary of Economic Impact. The proposed amendments update the Commission’s existing regulations to conform to legislation enacted by the Maryland General Assembly since 2021 relating to hospital financial assistance and hospital medical debt.

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:
Hospitals	(-)	Indeterminable
E. On other industries or trade groups:	NONE
F. Direct and indirect effects on public:
Public	(+)	Indeterminable

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

D. The assumption is that hospitals will be affected by the additional requirements imposed on them by law, and as reflected in this proposal, relating to their financial assistance and credit and collection policies. However, the extent to which they will be affected cannot be determined at this time.

F. The assumption is that the public will benefit from expanded rights for hospital patients and their families, as required by law and as reflected in this proposal, relating to hospital financial assistance and credit and credit and collection policies. However, the extent of the benefit to the public cannot be determined at this time.

Economic Impact on Small Businesses

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

Impact on Individuals with Disabilities

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

To the extent that individuals with disabilities are hospital patients, this extends protections related to access to financial assistance and medical debt collections. However, the extent of the benefit to individuals with disabilities cannot be determined at this time.

Opportunity for Public Comment

Comments may be sent to Hannah Friedman-Bell, Chief, Health Services Cost Review Commission, 4160 Patterson Avenue, Baltimore, Maryland 21215, or call 410-764-2605, or email to [email protected]. Comments will be accepted through October 20, 2025. A public hearing has not been scheduled.

10.37.10 Rate Application and Approval Procedures

Authority: Health-General Article, §§19-207 and 19-214.1 Annotated Code of Maryland

.26 [Patient Rights and Obligations; Hospital Credit and Collection and Financial Assistance Policies] Working Capital Differentials—Payment of Charges.

[A. Hospital Information Sheet.

(1) Each hospital shall develop an information sheet that:

(a) Describes the hospital's financial assistance policy;

(b) Describes a patient's rights and obligations with regard to hospital billing and collection under the law;

(c) Provides contact information for the individual or office at the hospital that is available to assist the patient, the patient's family, or the patient's authorized representative in order to understand:

(i) The patient's hospital bill;

(ii) The patient’s rights and obligations with regard to the hospital bill, including the patient’s rights and obligations with regard to reduced-cost, medically necessary care due to a financial hardship;

(iii) How to apply for free and reduced-cost care; and

(iv) How to apply for the Maryland Medical Assistance Program and any other programs that may help pay the bill;

(d) Provides contact information for the Maryland Medical Assistance Program;

(e) Includes a statement that physician charges, to both hospital inpatients and outpatients, are generally not included in the hospital bill and are billed separately;

(f) Informs patients that the hospital is permitted to bill outpatients a fee, commonly referred to as a “facility fee”, for their use of hospital facilities, clinics, supplies and equipment, and nonphysician services, including but not limited to the services of nonphysician clinicians, in addition to physician fees billed for professional services provided in the hospital;

(g) Informs patients of their right to request and receive a written estimate of the total charges for the hospital nonemergency services, procedures, and supplies that reasonably are expected to be provided and billed for by the hospital;

(h) Informs a patient or a patient’s authorized representative of the right to file a complaint with the Commission or jointly with the Health Education and Advocacy Unit of the Maryland Attorney General’s Office against a hospital for an alleged violation of Health-General Article, §§19-214.1 and 19-214.2, Annotated Code of Maryland, which relate to financial assistance and debt collection; and

(i) Provides the patient with the contact information for filing the complaint.

(2) The information sheet shall be in:

(a) Simplified language in at least 10-point type; and

(b) The patient’s preferred language or, if no preferred language is specified, each language spoken by a limited English proficient population that constitutes 5 percent of the overall population within the city or county in which the hospital is located as measured by the most recent census.

(3) The information sheet shall be provided to the patient, the patient’s family, or the patient’s authorized representative:

(a) Before the patient receives scheduled medical services;

(b) Before discharge;

(c) With the hospital bill;

(d) On request; and

(e) In each written communication to the patient regarding collection of the hospital bill.

(4) The hospital bill shall include a reference to the information sheet.

(5) The Commission shall:

(a) Establish uniform requirements for the information sheet; and

(b) Review each hospital's implementation of and compliance with the requirements of this section.

A-1. Hospital Credit and Collection Policies.

(1) Each hospital shall submit to the Commission, at times prescribed by the Commission, the hospital's policy on the collection of debts owed by patients.

(2) The policy shall:

(a) Prohibit the charging of interest on bills incurred by self-pay patients before a court judgment is obtained;

(b) Describe in detail the consideration by the hospital of patient income, assets, and other criteria;

(c) Describe the hospital's procedures for collecting any debt;

(d) Describe the circumstances in which the hospital will seek a judgment against a patient;

(e) Provide for a refund of amounts collected from a patient or the guarantor of a patient who was later found to be eligible for free care on the date of service, in accordance §A-1(3) of this regulation;

(f) If the hospital, has obtained a judgment against or reported adverse information to a consumer reporting agency about a patient who later was found to be eligible for free care on the date of the service for which the judgment was awarded or the adverse information was reported, require the hospital to seek to vacated the judgment or strike the adverse information;

(g) Provide a mechanism for a patient to file with the hospital a complaint against the hospital or an outside collection agency used by the hospital regarding the handling of the patient’s bill;

(h) Provide detailed procedures for the following actions:

(i) When a patient debt may be reported to a credit reporting agency;

(ii) When legal action may commence regarding a patient debt;

(iii) When garnishments may be applied to a patient’s or patient guarantor’s income; and

(iv) When a lien on a patient’s or patient guarantor’s personal residence or motor vehicle may be placed.

(3) Beginning October 1, 2010, as provided by Health-General Article, §19-214.2(c):

(a) A hospital shall provide for a refund of amounts exceeding $25 collected from a patient or the guarantor of a patient who, within a 2-year period after the date of service, was found to be eligible for free care on the date of service;

(b) A hospital may reduce the 2-year period under §A-1(3)(a) of this regulation to no less than 30 days after the date the hospital requests information from a patient, or the guarantor of a patient, to determine the patient’s eligibility for free care at the time of service, if the hospital documents the lack of cooperation of the patient or the guarantor of a patient in providing the required information; and

(c) If a patient is enrolled in a means-tested government health care plan that requires the patient to pay out-of-pocket for hospital service, a hospital shall have a refund policy that complies with the terms of the patient’s plan.

(4) For at least 120 days after issuing an initial patient bill, a hospital may not report adverse information about a patient to a consumer reporting agency or commence civil action against a patient for nonpayment unless the hospital documents the lack of cooperation of the patient or the guarantor of the patient in providing information needed to determine the patient’s obligation with regard to the hospital bill.

(5) A hospital shall report the fulfillment of a patient’s payment obligation within 60 days after the obligation is fulfilled to any consumer reporting agency to which the hospital had reported adverse information about the patient.

(6) A hospital may not force the sale or foreclosure of a patient’s primary residence to collect a debt owed on a hospital bill. If a hospital holds a lien on a patient’s primary residence, the hospital may maintain its position as a secured creditor with respect to other creditors to whom the patient may owe a debt.

(7) If a hospital delegates collection activity to an outside collection agency, the hospital shall:

(a) Specify the collection activity to be performed by the outside collection agency through an explicit authorization or contract;

(b) Specify procedures the outside collection agency must follow if a patient appears to qualify for financial assistance; and

(c) Require the outside collection agency to:

(i) In accordance with the hospital’s policy, provide a mechanism for a patient to file with the hospital a complaint against the hospital or the outside collection agency regarding the handing of patient’s bill; and

(ii) If a patient files a complaint with the collection agency, forward the complaint to the hospital.

(8) The Board of Directors of each hospital shall review and approve the financial assistance and debt collection policies of the hospital every 2 years. A hospital may not alter its financial assistance or debt collection policies without approval by the Board of Directors.

(9) The Commission shall review each hospital's implementation of and compliance with the hospital's policy and the requirements of §A-1(2) of this regulation.

A-2. Hospital Financial Assistance Responsibilities.

(1) Definitions.

(a) In this regulation, the following terms have the meanings indicated.

(b) Terms Defined.

(i) “Financial hardship” means medical debt, incurred by a family over a 12-month period that exceeds 25 percent of family income.

(ii) “Medical debt” means out-of-pocket expenses, excluding copayments, coinsurance, and deductibles, for medical costs billed by a hospital.

(2) Financial Assistance Policy.

(a) On or before June 1, 2009, each hospital and, on or before October 1, 2010, each chronic care hospital under the jurisdiction of the Commission shall develop a written financial assistance policy for providing free and reduced-cost care to low-income patients who lack health care coverage or to patients whose health insurance does not pay the full cost of the hospital bill. A hospital shall provide notice of the hospital’s financial assistance policy to the patient, the patient’s family, or the patient’s authorized representative before discharging the patient and in each communication to the patient regarding collection of the hospital bill. The financial assistance policy shall provide at a minimum:

(i) Free medically necessary care to patients with family income at or below 200 percent of the federal poverty level;

(ii) Reduced-cost, medically necessary care to low-income patients with family income between 200 and 300 percent of the federal poverty level, in accordance with the mission and service area of the hospital;

(iii) A maximum patient payment for reduced-cost care not to exceed the charges minus the hospital mark-up;

(iv) A payment plan available to patients irrespective of their insurance status with family income between 200 and 500 percent of the federal poverty level who request assistance; and

(v) A mechanism for a patient, irrespective of that patient’s insurance status, to request the hospital to reconsider the denial of free or reduced care, including the address, phone number, facsimile number, email address, mailing address, and website of the Health Education and Advocacy Unit, which can assist the patient or patient’s authorized representative in filing and mediating a reconsideration request.

(b) A hospital whose financial assistance policy as of May 8, 2009, provides for free or reduced-cost medical care to a patient at an income threshold higher than those set forth above may not reduce that income threshold.

(c) Presumptive Eligibility for Free Care. Unless otherwise eligible for Medicaid or CHIP, patients who are beneficiaries/recipients of the following means-tested social services programs are deemed eligible for free care, provided that the patient submits proof of enrollment within 30 days unless the patient or the patient’s representative requests an additional 30 days:

(i) Households with children in the free or reduced lunch program;

(ii) Supplemental Nutritional Assistance Program (SNAP);

(iii) Low-income-household energy assistance program;

(iv) Primary Adult Care Program (PAC), until such time as inpatient benefits are added to the PAC benefit package;

(v) Women, Infants and Children (WIC); or

(vi) Other means-tested social services programs deemed eligible for hospital free care policies by the Maryland Department of Health and the HSCRC, consistent with HSCRC regulation COMAR 10.37.10.26.

(d) A hospital that believes that an increase to the income thresholds as set forth above may result in undue financial hardship to it may file a written request with the Commission that it be exempted from the increased threshold. In evaluating the hospital’s request for exemption, the Commission shall consider the hospital’s:

(i) Patient mix;

(ii) Financial condition;

(iii) Level of bad debt experienced;

(iv) Amount of charity care provided; and

(v) Other relevant factors.

(e) Based on staff’s evaluation of the written request for an exemption, the Executive Director shall respond in writing within a reasonable period of time approving or disapproving the hospital’s exemption request.

(f) A hospital denied an exemption request shall be afforded an opportunity to address the Commission at a public meeting on its request. Based on arguments made at the public meeting, the Commission may approve, disapprove, or modify the Executive Director’s decision on the exemption request.

(3) Each hospital shall submit to the Commission within 60 days after the end of each hospital’s fiscal year:

(a) The hospital’s financial assistance policy developed under this section; and

(b) An annual report on the hospital’s financial assistance policy that includes:

(i) The total number of patients who completed or partially completed an application for financial assistance during the prior year;

(ii) The total number of inpatients and outpatients who received free care during the immediately preceding year and reduced-cost care for the prior year;

(iii) The total number of patients who received financial assistance during the immediately preceding year, by race or ethnicity and gender;

(iv) The total number of patients who were denied financial assistance during the immediately preceding year, by race or ethnicity and gender;

(v) The total cost of hospital services provided to patients who received free care; and

(vi) The total cost of hospital services provided to patients who received reduced-cost care that was covered by the hospital as financial assistance or that the hospital charged to the patient.

(4) Financial Hardship Policy.

(a) Subject to §A-2(3)(b) and (c) of this regulation, the financial assistance policy required under this regulation shall provide reduced-cost, medically necessary care to patients with family income below 500 percent of the federal poverty level who have a financial hardship.

(b) A hospital may seek and the Commission may approve a family income threshold that is different than the family income threshold under §A-2(C)(1) of this regulation.

(c) In evaluating a hospital’s request to establish a different family income threshold, the Commission shall take into account:

(i) The median family income in the hospital’s service area;

(ii) The patient mix of the hospital;

(iii) The financial condition of the hospital;

(iv) The level of bad debt experienced by the hospital;

(v) The amount of the charity care provided by the hospital; and

(vi) Other relevant factors.

(d) If a patient has received reduced-cost, medically necessary care due to a financial hardship, the patient or any immediate family member of the patient living in the same household:

(i) Shall remain eligible for reduced-cost, medically necessary care when seeking subsequent care at the same hospital during the 12-month period beginning on the date on which the reduced-cost, medically necessary care was initially received; and

(ii) To avoid an unnecessary duplication of the hospital’s determination of eligibility for free and reduced-cost care, shall inform the hospital of the patient’s or family member’s eligibility for the reduced-cost, medically necessary care.

(5) If a patient is eligible for reduced-cost medical care under a hospital’s financial assistance policy or financial hardship policy, the hospital shall apply the reduction in charges that is most favorable to the patient.

(6) A notice shall be posted in conspicuous places throughout the hospital including the billing office informing patients of their right to apply for financial assistance and who to contact at the hospital for additional information.

(7) The notice required under §A-2(6) of this regulation shall be in:

(a) Simplified language in at least 10-point type; and

(b) The patient’s preferred language or, if no preferred language is specified, each language spoken by a limited English proficient population that constitutes 5 percent of the overall population within the city or county in which the hospital is located as measured by the most recent census.

(8) Each hospital shall use a Uniform Financial Assistance Application in the manner prescribed by the Commission in order to determine eligibility for free and reduced-cost care.

(9) Each hospital shall establish a mechanism to provide the Uniform Financial Assistance Application to patients regardless of their insurance status. A hospital may require from patients or their guardians only those documents required to validate the information provided on the application.

(10) Asset Test Requirements. A hospital may, in its discretion, consider household monetary assets in determining eligibility for financial assistance in addition to the income-based criteria, or it may choose to use only income-based criteria. If a hospital chooses to utilize an asset test, the following types of monetary assets, which are those assets that are convertible to cash, shall be excluded:

(a) At a minimum, the first $10,000 of monetary assets;

(b) A “safe harbor” equity of $150,000 in a primary residence;

(c) Retirement assets to which the Internal Revenue Service has granted preferential tax treatment as a retirement account, including, but not limited to, deferred-compensation plans qualified under the Internal Revenue Code or nonqualified deferred-compensation plans;

(d) One motor vehicle used for the transportation needs of the patient or any family member of the patient;

(e) Any resources excluded in determining financial eligibility under the Medical Assistance Program under the Social Security Act; and

(f) Prepaid higher education funds in a Maryland 529 Program account.

(11) Monetary assets excluded from the determination of eligibility for free and reduced-cost care under these provisions shall be adjusted annually for inflation in accordance with the Consumer Price Index.

(12) In determining the family income of a patient, a hospital shall apply a definition of household size that consists of the patient and, at a minimum, the following individuals:

(a) A spouse, regardless of whether the patient and spouse expect to file a joint federal or State tax return;

(b) Biological children, adopted children, or stepchildren; and

(c) Anyone for whom the patient claims a personal exemption in a federal or State tax return.

(13) For a patient who is a child, the household size shall consist of the child and the following individuals:

(a) Biological parents, adoptive parents, stepparents, or guardians;

(b) Biological siblings, adopted siblings, or step siblings; and

(c) Anyone for whom the patient’s parents or guardians claim a personal exemption in a federal or State tax return.

A-3. Patient Complaints. The Commission shall post a process on its website for a patient or a patient’s authorized representative to file with the Commission a complaint against a hospital for an alleged violation of Health-General Article, §19-214.1 or 19-214.2, Annotated Code of Maryland. The process established shall include the option for a patient or a patient’s authorized representative to file the complaint jointly with the Commission and the Health Education and Advocacy Unit. The process shall conform to the requirements of Health-General Article, §19-214.3, Annotated Code of Maryland.

B. Working Capital Differentials—Payment of Charges.]

A. Definitions.

(1) In this regulation, the following terms have the meanings indicated.

(2) Terms Defined.

(a) “Debt collector” has the meaning stated in COMAR 10.37.13.01.

(b) “Hospital” means a “facility” as defined in Health-General Article, §19- 301, Annotated Code of Maryland.

(c) “Income-based payment plan” means a payment plan based on the patient’s household income as set forth in COMAR 10.37.13.05.

(d) “Payment plan” has the meaning stated in COMAR 10.37.13.01.

[(1)] B. A third-party payer may obtain a discount in rates established by the Commission if it provides current financing monies in accordance with the following terms.

[(a)] (1) (text unchanged)

[(b)] (2) A third-party payer that provides current financing equal to the average amount of outstanding charges for discharged patients plus the average daily charges times the average length of stay, shall be entitled to a 2.25-percent discount. The current financing provided [in here] to hospitals corresponds to a third party's paying on admission.

[(c)] (3)—[(e)](5) (text unchanged)

[(2)] C. The third-party payer shall promptly provide the Commission with a verified record of the detailed calculation of the current financing and of each recalculated balance as adjustments are made. The detailed calculations shall become a part of the public record. The Commission may, at any time, evaluate the amount of current financing monies provided to a hospital to assure that it meets the discount of requirements specified in [§B(1)] §B of this regulation. If the Commission finds that the amount of current financing is inconsistent with the requirements of [§B(1)] §B of this regulation, the Commission may, at its sole discretion, require an adjustment to the working capital advance or to the discount.

[(3)] D. Discounts.

(1) A payer or self-paying patient, who does not provide current financing under [§B(1)(a)—(e)] §B of this regulation, shall receive a 2-percent discount if payment is made at the earlier of the end of each regular billing period or upon discharge from the hospital.

(2) Payment within 30 days of the earlier of the end of each regular billing period or discharge entitles a payer or self-pay patient to a 1-percent discount.

(3) For those payers not subject to Insurance Article, §15-1005, Annotated Code of Maryland, after 60 days from the date of the earlier of the end of each regular billing period or discharge, interest or late payment charges may accrue on any unpaid charges at a simple rate of 1 percent per month.

(4) The interest or late payment charges may be added to the charge on the 61st day after the date of the earlier of the end of each regular billing period or discharge and every 30 days after that.

(5) For patients that have entered into a hospital income-based payment plan under COMAR 10.37.13.05, the interest rate shall be established in accordance with the Guidelines set forth in COMAR 10.37.13.05.

[(4)] E. Hospital Billing Responsibilities.

[(a) A patient shall be given a bill for services at the earlier of the end of each regular billing period or upon discharge or dismissal (when dismissal for outpatients is analogous to discharge for inpatients).

(b) This bill shall cover substantially all care rendered and should, except for some last day ancillary services and excepting arithmetic errors, represent the full charge for the patient's care. In addition, a notice shall be posted prominently at the billing office of the hospital clearly notifying all patients of the availability of the discounts mentioned above.

(c) The bill and the notice shall state that the:

(i) Charge is due within 60 days of discharge or dismissal;

(ii) Patient shall receive a 2-percent discount by paying upon discharge or a 1-percent discount by paying within 30 days; and

(iii) Payers not subject to Insurance Article, §15-1005, Annotated Code of Maryland, may be subject to interest or late payment charges at a rate of 1 percent per month beginning on the 61st day after the date of the earlier of the end of each regular billing period or discharge and every 30 days after that.]

(1) A patient shall be given a bill for services at the earlier of the end of each regular billing period or upon discharge or dismissal, when dismissal for outpatients is analogous to discharge for inpatients.

(2) This bill shall cover substantially all care rendered and should, except for some last day ancillary services and excepting arithmetic errors, represent the full charge for the patient's care.

(3) A notice shall be posted prominently at the billing office of the hospital clearly notifying all patients of the availability of the discounts referred to in §D of this regulation.

(4) The bill and the notice shall state that the patient shall receive a 2-percent discount by paying upon discharge or a 1-percent discount by paying within 30 days of discharge.

[(5) Hospital Written Estimate.

(a) On request of a patient made before or during treatment, a hospital shall provide to the patient a written estimate of the total charges for the hospital services, procedures, and supplies that reasonably are expected to be provided and billed to the patient by the hospital.

(b) The written estimate shall state clearly that it is only an estimate and actual charges could vary.

(c) A hospital may restrict the availability of a written estimate to normal business office hours.

(d) The provisions set forth in §B(5)(a)—(c) of this regulation do not apply to emergency services.]

[C.] F. (text unchanged)

10.37.13 Patient Rights and Obligations; Hospital Credit and Collection and Financial Assistance Policies

Authority: Health-General Article, §§19-214.2, 19-214.3, 19-207, and 19-219, Annotated Code of Maryland

.01 Definitions.

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

B. Terms Defined.

(1) “Credit and collection policy” means a hospital’s policy on the collection of medical debt.

(2) Debt Collector.

(a) “Debt collector” means a person who engages directly or indirectly in the business of:

(i) Collecting for, or soliciting from another, medical debt;

(ii) Giving, selling, attempting to give or sell to another, or using, for collection of medical debt, a series or system of forms or letters that indicates directly or indirectly that a person other than the hospital is asserting the medical debt; or

(iii) Employing the services of an individual or business to solicit or sell a collection system to be used for collection of medical debt.

(b) “Debt collector” includes a “collection agency” as defined in Business Regulation Article, §7-101, Annotated Code of Maryland.

(3) “Financial hardship” means medical debt, incurred by a family over a 12-month period, that exceeds 25 percent of family income.

(4) “Hospital” has the meaning stated in Health-General Article, §19- 301(f), Annotated Code of Maryland.

(5) Hospital Services.

(a) “Hospital services” means:

(i) Inpatient hospital services as enumerated in 42 C.F.R. §409.10, as amended;

(ii) Emergency services, including services provided at a freestanding medical facility licensed under Health Occupations Article, Title 19, Subtitle 3A, Annotated Code of Maryland

(iii) Outpatient services provided at a hospital as defined in COMAR 10.37.10.07-2;

(iv) Outpatient services, as specified by the Commission in COMAR 10.37.10.07-2, provided at a freestanding medical facility licensed under Health-General Article, Title 19, Subtitle 3A, Health-General Article, Annotated Code of Maryland that has received a certificate of need under Health-General Article, §19–120(o)(1), Annotated Code of Maryland, or an exemption from obtaining a certificate of need under Health-General Article, §19–120(o)(3), Annotated Code of Maryland; and

(v) Identified physician services for which a facility has Commission–approved rates on June 30, 1985.

(b) “Hospital services” includes a hospital outpatient service:

(i) Of a hospital that, on or before June 1, 2015, is under a merged asset hospital system;

(ii) That is designated as a part of another hospital under the same merged asset hospital system to make it possible for the hospital outpatient service to participate in the 340B Program under the federal Public Health Service Act; and

(iii) That complies with all federal requirements for the 340B Program and applicable provisions of 42 C.F.R. §413.65.

(c) “Hospital services” does not include:

(a) Outpatient renal dialysis services;

(b) Outpatient services provided at a limited service hospital as defined in Health-General Article, §19–301, Annotated Code of Maryland except for emergency services; or

(c) Physician services that are billed separately.

(6) Household.

(a) “Household” means, at a minimum, for an adult patient, the patient and the following individuals that live in the same dwelling:

(i) A spouse, regardless of whether the patient and spouse expect to file a joint federal or State tax return;

(ii) Biological children, adopted children, or stepchildren; and

(iii) All individuals on the same federal or State tax return, including anyone for whom the patient claims a personal exemption in a federal or State tax return.

(b) “Household” means, at a minimum, for a patient who is a child, the patient and the following individuals that live in the same dwelling:

(i) Biological parents, adoptive parents, stepparents, or guardians;

(ii) Biological siblings, adopted siblings, or step siblings; and

(iii) All individuals on the same federal or State tax return, including anyone for whom the patient’s parents or guardians claim a personal exemption in a federal or State tax return.

(c) The terms "household” and “family” are synonymous for the purposes of this chapter.

(7) Income.

(a) “Income” means total taxable income, before taxes.

(b) “Income” includes:

(i) If a hospital uses state or federal tax returns to verify income, the adjustments listed on Schedule 1 of Form 1040; and

(ii) If a hospital utilizes an asset test, the value of household monetary assets, consistent with Regulation 06J of this chapter.

(8) “Initial bill” means the first billing statement provided to an individual by a hospital after the care, whether inpatient or outpatient, is provided and the individual has left the hospital.

(9) “Medical debt” means out-of-pocket expenses, including co-payments, coinsurance, and deductibles, for hospital services that are regulated by the Commission that are billed to a patient or a co-signer for the patient, excluding amounts contractually paid by another payer such as insurers, including Medicare, Medicaid, or CHIP .

(10) “Medically necessary care” including care provided in accordance with the Emergency Medical Treatment and Labor Act of 1986), means care that is:

(a) Directly related to diagnostic, preventative, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability or health condition;

(b) Consistent with current accepted standards of good medical practice; and

(c) Not primarily for the convenience of the patient, the patient’s family, or the provider.

(11) Monetary Assets.

(a) “Monetary assets” means assets in excess of $100,000 that can readily be converted into a fixed or precisely determinable amount of money, including cash and cash equivalents.

(b) “Monetary assets” include cash on hand, bank deposits, investment accounts, accounts receivable, and notes receivable.

(c) “Monetary assets” do not include retirement assets to which the Internal Revenue Service has granted preferential tax treatment, including deferred–compensation plans qualified under the Internal Revenue Code or nonqualified deferred–compensation plans.

(12) Payment Plan.

(a) “Payment plan” means an agreement between a patient, or a guarantor, to pay for a hospital service over a period of time.

(b) “Payment plan” includes:

(i) An “income-based payment plan” set forth in Regulation .05 of this chapter; and

(ii) A “non-income-based payment plan” set forth in Regulation .05W of this chapter.

(13) “Qualified Maryland resident” means someone who lives in Maryland for more than 6 months of the year or whose primary residence is in Maryland, including those in Maryland for school or work.

(14) Written.

(a) “Written” means communications in paper form and communications delivered electronically, including through electronic mail, a secure web, or mobile based application such as a patient portal.

(b) “Written” does not include oral communications, including communications delivered by phone.

.02 Electronic Delivery of Written Communications.

A. A patient may opt out of receiving written communications required by Regulations .03—.08 of this chapter through electronic delivery methods, such as through email or a patient portal.

B. A hospital or debt collector who communicates with a patient electronically must include in such communication, or attempt to communicate, a clear and conspicuous statement describing a reasonable and simple method by which the patient can opt out of further electronic communications by the hospital or debt collector.

C. A hospital or debt collector may not require, directly or indirectly, that the patient, in order to opt out of electronic communication, pay any fee or provide any information other than:

(1) The patient’s opt out preferences; and

(2) The email address, telephone number for text messages, or other electronic-medium address subject to the opt-out request.

D. If a hospital or debt collector receives notice from a patient that the patient is opting out of receiving written communications through electronic delivery methods, the hospital or the debt collector:

(1) May not provide the written communications required by Regulations .03—.08 of this chapter through electronic delivery methods; and

(2) Shall deliver the written communications through non-electronic delivery methods.

E. Notice of Patient Opting Out of Written Communications.

(1) If a hospital receives notice from a patient that the patient is opting out of receiving written communications through electronic delivery methods, and the hospital uses a debt collector with respect to that patient, the hospital shall immediately inform the debt collector that the patient is opting out of electronic delivery methods.

(2) If a debt collector receives notice from a patient that the patient is opting out of receiving written communications through electronic delivery methods, the debt collector shall immediately inform the hospital that controls that patient account that the patient is opting out of electronic delivery methods.

.03 Hospital Information Sheet.

A. Each hospital shall develop an information sheet that:

(1) Describes clearly:

(a) The hospital's financial assistance policy as required in Regulation .06 of this chapter and Health-General Article, §19-214.1, Annotated Code of Maryland; and

(b) A patient's legal rights and obligations with regard to hospital billing and collection;

(2) Informs the patient, the patient’s family, the patient’s authorized representative, or the patient’s legal guardian:

(a) That the hospital is permitted to bill outpatients a fee, commonly referred to as a facility fee, for their use of hospital facilities, clinics, supplies, and equipment, and nonphysician services, including but not limited to the services of nonphysician clinicians, in addition to physician fees billed for professional services provided in the hospital;

(b) Of the patient’s right to request and receive a written estimate of the total charges for the hospital non-emergency services, procedures, and supplies that reasonably are expected to be provided and billed for by the hospital, in addition to the good faith estimate requirements in 42 U.S.C §2799B-6, the No Surprises Act;

(c) Of the patient’s right to file a complaint with the Commission or jointly with the Health Education and Advocacy Unit of the Maryland Attorney General’s Office against a hospital for an alleged violation of Health-General Article, §§19-214.1 and 19-214.2, Annotated Code of Maryland;

(d) Of the availability of an income-based payment plan; and

(e) That physician charges, to both hospital inpatients and outpatients, are generally not included in the hospital bill and are billed separately;

(3) Provides contact information for:

(a) The individual or office at the hospital that is available to assist the patient, the patient's family, or the patient's authorized representative in order to understand:

(i)The patient's hospital bill;

(ii) The patient’s rights and obligations with regard to the hospital bill, including the patient’s rights and obligations with regard to reduced-cost medically necessary care due to a financial hardship;

(iii) How to apply for financial assistance;

(iv) How to apply for the Maryland Medical Assistance Program and any other programs that may help pay the bill; and

(v) How to apply for a payment plan;

(b) The Maryland Medical Assistance Program;

(c) Filing a complaint with the Commission or jointly with the Health Education and Advocacy Unit of the Maryland Attorney General’s Office against a hospital for an alleged violation of Health-General Article, §§19-214.1 and 19-214.2, Annotated Code of Maryland; and

(4) Includes a section that allows the patient to initial that the patient has been made aware of the financial assistance policy.

B. The information sheet shall be written in:

(1) Simplified language;

(2)At least 12-point type; and

(3) The patient’s preferred language or, if no preferred language is specified, each language spoken by a limited English proficient population that constitutes at least 5 percent of the overall population within the city or county in which the hospital is located as measured by the most recent census.

C. The information sheet shall conform with Health-General Article, §19–342(d)(7) and (10), Annotated Code of Maryland.

D. The information sheet shall be provided in writing to the patient, the patient’s family, the patient’s authorized representative, or the patient’s legal guardian:

(1) Before the patient receives scheduled medical services;

(2) Before discharge;

(3) With the hospital bill;

(4) On request; and

(5) In each written communication to the patient regarding collection of the hospital bill.

E. The hospital bill shall include a reference to the information sheet.

F. The Commission shall:

(1) Establish uniform requirements for the information sheet; and

(2) Review each hospital's implementation of and compliance with the requirements of this regulation.

.04 Hospital Credit and Collection Responsibilities.

A. Each hospital shall submit to the Commission, at times prescribed by the Commission, the hospital's credit and collection policy.

B. The policy shall:

(1) Provide for active oversight by the hospital of any contract for collection of debts on behalf of the hospital;

(2) Prohibit the hospital from selling any debt, except as permitted by Health-General Article, §19–214.2(m), Annotated Code of Maryland and §O of this regulation;

(3) Prohibit the hospital from:

(a) Engaging in collection activities on 100 percent of the outstanding amount of the Commission-set charge for debt sold under §O of this regulation and Health-General Article, §19-214.2(m), Annotated Code of Maryland; and

(b) Collecting on judgments entered into on patient debt that was sold under §O of this regulation and Health-General Article, §19-214.2(m), Annotated Code of Maryland;

(c) Reporting adverse information to a consumer reporting agency;

(d) Filing a civil action to collect a debt against a patient within 240 days after the initial bill is provided;

(e) Filing a civil action to collect a debt against a patient whose outstanding hospital medical debt is at or below $500;

(f) Forcing the sale or foreclosure of a patient’s primary residence to collect medical debt;

(g) Requesting a lien against a patient’s primary residence in an action to collect medical debt;

(h) Requesting the issuance of or otherwise knowingly taking action that would cause a court to issue a body attachment against a patient or an arrest warrant against a patient, if the hospital files an action to collect medical debt; and

(i) Requesting a writ of garnishment of wages or filing an action that would result in an attachment of wages against a patient to collect medical debt if the patient is eligible for free or reduced-cost medically necessary care, in accordance with Regulation .06 of this chapter and Health-General Article, §19-214.1, Annotated Code of Maryland;

(4) In accordance with Health-General Article, §19-214.2(c), Annotated Code of Maryland and §G of this regulation, provide for a refund of amounts collected from a patient or the guarantor of a patient who was later found to be eligible for free medically necessary care within 240 days after the initial bill was provided under Health General Article, §19-214.1, Annotated Code of Maryland and §G of this regulation;

(5) If the hospital has obtained a judgment against or had reported adverse information to a consumer reporting agency about a patient who later was found to be eligible for free medically necessary care, in accordance with Regulation .06 of this chapter and Health-General Article, §19-214.1, Annotated Code of Maryland, within 240 days after the initial bill was provided, require the hospital to seek to vacate the judgment or strike the adverse information;

(6) Provide a mechanism for a patient to:

(a) Request the hospital to reconsider the denial of free or reduced–cost care; and

(b) File with the hospital a complaint against the hospital or a debt collector used by the hospital regarding the handling of the patient’s bill;

(7) For a patient who is eligible for free or reduced cost-care under the hospital’s financial assistance policy, prohibit the hospital from:

(a) Charging interest on the debt owed on a bill for the patient before a court judgement is obtained; or

(b) Collecting fees or any other amount that exceeds the approved charge for the hospital service as established by the Commission;

(8) Establish a process for making payment plans available to all patients in accordance with Regulation .05 of this chapter and Health-General Article, §19-214.2(e)(3), Annotated Code of Maryland;

(9) Provide detailed procedures for the following actions:

(a) When garnishments may be applied to a patient’s or patient guarantor’s income in accordance with §I of this regulation and Health-General Article, §19-214.2(f)(4), Annotated Code of Maryland;

(b) When a lien on a patient’s or patient guarantor’s personal residence, excluding a primary resident in accordance with §I of this regulation and Health-General Article, §19-214.2(g)(2), Annotated Code of Maryland, or motor vehicle may be placed;

(c) The hospital's procedures for collecting any medical debt, consistent this regulation;

(d) The circumstances in which the hospital will seek a judgment against a patient for the patient’s medical debt, subject to §I of this regulation and Health-General Article, §19–214.2, Annotated Code of Maryland;

(e) The consideration by the hospital of patient income, assets, and other criteria set forth in this regulation; and

(10) Comply with Health-General Article, §24-2502, Annotated Code of Maryland.

C. Consistent with Health-General Article, §19-214.2(e)(5), Annotated Code of Maryland, a hospital shall demonstrate that it attempted in good faith to meet the requirements of Health-General Article, §19-214.2(e), Annotated Code of Maryland, and the Guidelines set forth in Regulation .05 of this chapter before the hospital:

(1) Files an action to collect the patient’s medical debt; or

(2) Delegates collection activity to a debt collector for a patient’s medical debt.

D. The hospital shall be deemed to have demonstrated that it attempted to act in good faith under Health-General Article, §19-214.2(e)(5)(i)(2), Annotated Code of Maryland and §C(2) of this regulation if, before delegating collection of a patient’s medical debt to a debt collector, the hospital:

(1) Provides the information sheet before the patient receives scheduled medical services and before discharge in accordance with Health-General Article, §19-214.2(e)(1) and (2), Annotated Code of Maryland, and in Regulation .03D(1) and (2) of this chapter; and

(2) Establishes a process for making payment plans available to all patients in accordance with Health-General Article, §19-214.2(e)(3), Annotated Code of Maryland and Regulation .05 of this chapter.

E. In delegating any or all collection to a debt collector for a patient’s medical debt, the hospital may rely on a debt collector to engage in various activities, including:

(1) Facilitating and servicing payment plans in accordance with the Guidelines, including receiving and forwarding any payments received under a payment plan approved by the hospital; and

(2) Such other activities as the hospital may direct in collecting and forwarding payments under a payment plan.

F. A hospital may not seek legal action to collect a patient’s medical debt until the hospital has established and implemented a payment plan policy that complies with the Guidelines.

G. As provided by Health-General Article, §19-214.2(c), Annotated Code of Maryland:

(1) A hospital shall provide:

(a) For a refund of amounts exceeding $25 collected from a patient or the guarantor of a patient who was found to be eligible for free medically necessary care within 240 days after the initial bill is provided to the patient; and

(b) The refund to the patient not later than 30 days after determining that the patient was eligible for free medically necessary care.

(2) If a patient is enrolled in a means-tested government health care plan that requires the patient to pay out-of-pocket for hospital service, a hospital shall have a refund policy that complies with the terms of the patient’s plan.

H. Consumer Reporting.

(1) A hospital may not commence civil action against a patient for nonpayment or delegate collection activity to a debt collector, if the hospital:

(a) Was notified in accordance with federal law by the patient or the insurance carrier that an appeal or a review of a health insurance decision is pending within the immediately preceding 60 days;

(b) Is processing a requested reconsideration of the denial of free or reduced-cost medically necessary care under Regulation .06A(1)(c)(v) of this chapter and Health-General Article, §19-214.1(b)(2)(iv), Annotated Code of Maryland, that was appropriately completed by the patient or has completed the reconsideration within the immediately preceding 60 days; or

(c) Sold the debt under §O of this regulation and Health-General Article, §19-214.2(m).

(2) A hospital shall comply with Health-General Article, §24-2502, Annotated Code of Maryland.

(3) A hospital shall report the fulfillment of a patient’s payment obligation within 60 days after the obligation is fulfilled to any consumer reporting agency to which the hospital had reported adverse information about the patient, including if the debt was sold under §O of this regulation and Health-General Article, §19-214.2(m), Annotated Code of Maryland.

(4) Not later than November 1, 2025, a hospital that had reported adverse information about a patient to a consumer reporting agency shall instruct the consumer reporting agency to delete the adverse information about the patient.

I. Civil Action.

(1) Deceased Patients.

(a) A hospital may not make a claim against the estate of a deceased patient to collect medical debt if the deceased patient was known by the hospital to be eligible for free medically necessary care, in accordance with Regulation .06 of this chapter and Health-General Article, §19-214.1, Annotated Code of Maryland, or if the value of the estate after tax obligations are fulfilled is less than half of the medical debt owed.

(b) A hospital may offer the family of the deceased patient the ability to apply for financial assistance.

(2) A hospital may not file an action to collect medical debt until the hospital determines whether the patient is eligible for free or reduced-cost medically necessary care under Regulation .06 of this chapter and Health-General Article, §19-214.1, Annotated Code of Maryland.

(3) At least 45 days before filing an action against a patient to collect medical debt, but not within 240 days after the initial bill is provided, a hospital shall send written notice of the intent to file an action to the patient.

(4) The notice required in §I(3) of this regulation shall:

(a) Be sent to the patient by certified mail and first class mail;

(b) Be in simplified language;

(c)Be in at least 12-point type;

(d) Include:

(i) The name and telephone number of the hospital, the debt collector, if applicable, and an agent of the hospital authorized to modify the terms of the payment plan, if any;

(ii) The amount required to cure the nonpayment of medical debt, including past due payments, interest, penalties, and fees;

(iii) A statement recommending that the patient seek debt counseling services;

(iv) Telephone numbers and internet addresses of the Health Education Advocacy Unit of the Office of the Attorney General, available to assist patients experiencing medical debt; and

(v) An explanation of the hospital's financial assistance policy;

(e) Be provided in the patient’s preferred language or, if no preferred language is specified, English and each language spoken by a limited English proficient population that constitutes at least 5 percent of the population within the jurisdiction in which the hospital is located as measured by the most recent federal census; and

(f) Be accompanied by:

(i) An application for financial assistance under the hospital's financial assistance policy, along with instructions for completing the application for financial assistance, specific instructions about where to send the application, and the telephone number to call to confirm receipt of the application;

(ii) Language explaining the availability of an income-based payment plan to satisfy the medical debt that is the subject of the hospital debt collection action; and

(ii) The information sheet required under Regulation .03 of this chapter and Health-General Article, §19-214.1(f), Annotated Code of Maryland.

J. Delegation of Collection to a Debt Collector. If a hospital delegates collection activity to a debt collector, the hospital shall:

(1) Specify the collection activity to be performed by the debt collector through an explicit authorization or contract;

(2) Require the debt collector to abide by the hospital’s credit and collection policy;

(3) Specify procedures the debt collector must follow if a patient appears to qualify for financial assistance under Regulation .06 of this chapter and Health-General Article, §19-214.1, Annotated Code of Maryland; and

(4) Require the debt collector to:

(a) In accordance with the hospital’s credit and collection policy, provide a mechanism for a patient to file with the hospital a complaint against the hospital or the debt collector regarding the handling of patient’s bill;

(b) If a patient files a complaint with the debt collector, forward the complaint to the hospital; and

(c) Along with the hospital, be jointly and severally responsible for meeting the requirements of this regulation, Regulation .06 of this chapter, and Health-General Article, §19-214.2, Annotated Code of Maryland.

K. Consent to Assume Liability for Medical Debt.

(1) A spouse or another individual may not be held liable for the medical debt of an individual 18 years old or older unless the individual voluntarily consents to assume liability for the patient’s medical debt.

(2) The consent shall be:

(a) Made on a separate document signed by the individual;

(b) Not solicited in an emergency room or during an emergency situation; and

(c) Not required as a condition of providing emergency or non-emergency health care services.

L. The Board of Directors of each hospital shall review and approve the hospital’s financial assistance policy required under Regulation .06 of this chapter and Health-General Article, §19-214.1, Annotated Code of Maryland and debt collection policy required under Regulation .04 of this chapter and Health-General Article, §19-214.2, Annotated Code of Maryland at least every 2 years. A hospital may not alter its financial assistance or credit and collection policies without approval of the Board of Directors.

M. The Commission shall review each hospital's implementation of and compliance with the hospital's policy and the requirements of §B of this regulation.

N. Reporting Requirements.

(1) Each hospital shall annually submit to the Commission within 120 days after the end of each hospital’s fiscal year a report including:

(a) The total number of patients by race or ethnicity, gender, and zip code of residence against whom the hospital or a debt collector used by the hospital, filed an action to collect medical debt;

(b) The total number of patients by race or ethnicity, gender, and zip code of residence with respect to whom the hospital has and has not reported or classified a bad debt;

(c) The total dollar amount of charges for hospital services provided to patients but not collected by the hospital for patients covered by insurance, including the out-of-pocket costs for patients covered by insurance, and patients without insurance; and

(d) For hospital debts owed by patients of the hospital that the hospital sold to a governmental unit, contractor, or nonprofit organization under Health-General Article, §19-214.2(m), Annotated Code of Maryland and §O of this regulation:

(i) The total dollar amount of the debt sold by the hospital for the reporting year;

(ii) The total dollar amount paid by the hospital to the unit, contractor, or nonprofit organization who purchased the debt; and

(iii) The total number of patients whose debt was sold, in full or in part, to the unit, contractor, or nonprofit organization who purchased the debt.

(2) The Commission shall post the information submitted under §N(1) of this regulation on its website.

O. Selling Medical Debt.

(1) Consistent with Health-General Article, §19-214.2(m), Annotated Code of Maryland, a hospital may sell debt owed to the hospital by a patient for hospital services to a governmental unit, an entity that is under contract with the governmental unit, or to a nonprofit organization that is exempt from taxation under 26 U.S.C. §501(c)(3) of the Internal Revenue Code for the sole purpose of canceling the debt.

(2) The contract between the hospital and the governmental unit, entity that is under contract with the governmental unit, or nonprofit organization purchasing the debt shall state that the sole purpose of the sale of the debt is to cancel the debt.

(3) The patient is not responsible to the hospital, the governmental unit, the entity that is under contract with the governmental unit, or the nonprofit organization for any amount of the debt that is sold, or any interest, fees, or costs associated with the debt or the sale.

(4) Debt sold under this regulation and Health-General Article, §19-214.2(m), Annotated Code of Maryland:

(a) Must be for hospital services provided at least 2 years before the date of the sale;

(b) May not be expected to yield additional reimbursements from a third-party payor;

(c) May not be subject to an open appeal with an insurance company; and

(d) Must be for an individual whose family income is at or below 500 percent of the federal poverty level or who has medical debt exceeding 5 percent of the patient’s family income, as determined by the governmental unit, contractor, or nonprofit organization purchasing the debt.

(5) Debt sold under this regulation and Health-General Article, §19-214.2(m), Annotated Code of Maryland, may be sold with a reduction of Commission charges.

(6) The Commission shall treat the amount of payments to hospitals under this subsection as an offset to uncompensated care amounts reported by hospitals.

(7) The purchaser of the debt shall:

(a) Notify the patient that the debt has been canceled; and

(b) If the hospital obtained a judgment against the patient or reported adverse information to a consumer reporting agency about the patient, seek to vacate the judgment or strike the adverse information.

(8) If a hospital sells hospital medical debt under this regulation and Health-General Article, §19-214.2(m), Annotated Code of Maryland, the hospital must immediately dismiss actions pending against a patient for collection of that debt.

.05 Guidelines for Hospital Payment Plans.

A. Scope.

(1) As described in this regulation, the Guidelines for Hospital Payment Plans apply to any income-based payment plan offered by a hospital to a patient to pay for medically necessary hospital services after the services are provided.

(2) “Income” in this regulation means household monthly income.

(3) Prepayment Plans. Nothing in the Guidelines prevents a hospital from offering patients arrangements to make payments prior to service, provided that:

(a) A hospital may not require or steer a patient to enter into such an arrangement solely to avoid the application of these Guidelines;

(b) Before a hospital requests pre-payment for a hospital service, the hospital shall:

(i) Comply with the notice provisions of Health-General Article, §19-214.1, Annotated Code of Maryland, and Regulations .03 and .06 of this chapter;

(ii) Advise the patient about the availability of financial assistance;

(iii) Process any request for financial assistance; and

(iv) Advise the patient about the availability of income-based payment plans, including information about the 5 percent cap on monthly payment amounts under §F(1) of this regulation; and

(c) Such an arrangement terminates once the hospital service is rendered.

(4) Unregulated Services. These Guidelines apply only to hospital services that are regulated by the Commission. These Guidelines do not apply to services that are not regulated by the Commission, including physician services.

(5) Limitation of the Guidelines. These Guidelines do not prevent hospitals from extending payment plans for services, such as physician services, or at times that are outside the parameters of the Guidelines. Except as otherwise required by law or regulation, payment plans that are outside the parameters of these Guidelines are not subject to the Guidelines.

B. Access to Income-Based Payment Plans.

(1) Availability of Income-Based Payment Plans. Maryland hospitals shall make income-based payment plans available to all patients who are Maryland residents, including individuals temporarily residing in Maryland due to work or school, irrespective of their:

(a) Insurance status;

(b) Citizenship status;

(c) Immigration status; or

(d) Eligibility for reduced-cost medically necessary care, including reduced-cost medically necessary care due to financial hardship, under Regulation .06 of this chapter.

(2) Treatment of Nonresidents and Unregulated Services.

(a) These Guidelines do not prevent a hospital from extending payment plans to patients who are not described in §B(1) of this regulation.

(b) These Guidelines do not prevent a hospital from extending payment plans to patients for services that are not regulated by the Commission.

(c) Except as required by §U of this regulation or by other law or regulation, payment plans for patients which are not described in §B(1) of this regulation and payment plans for services that are not regulated by the Commission are not subject to the Guidelines under this regulation.

C. Notice Requirements.

(1) Notice of Availability of an Income-Based Payment Plan.

(a) Posted Notice.

(i) A notice shall be posted in conspicuous places throughout the hospital, including the billing office, informing Maryland residents of the availability of an income-based payment plan and whom to contact at the hospital for additional information.

(ii) If the hospital uses a vendor to assist with financial assistance eligibility, billing, or debt collection, such as a debt collector or eligibility vendor, the hospital shall ensure that the vendor posts a notice in a conspicuous place on their website or online payment portal, informing Maryland residents of the availability of an income-based payment plan and whom to contact at the hospital or debt collector for additional information. Placement on the website or online payment portal should be based on the best interest of the patient.

(b) Information Sheet. A written notice of the availability of an income-based payment plan shall be contained in the information sheet required under Regulation .03 of this chapter, including clarity on the availability of income-based payment plans for Maryland residents, and, if payment plans for non-residents are included in the hospital’s credit and collection policy, the availability of such plans for non-residents.

(c) Before a Prepayment Plan. Before a patient enters into a prepayment plan as described in §A(2) of this regulation for a medically necessary hospital service, a hospital shall provide a written notice of the availability of an income-based payment plan to a patient.

(d) On a Bill. On the same page of the bill that includes the amount due and due date, the hospital shall provide notice that a lower monthly payment amount may be possible through an income-based plan, in the same font and style as the total amount due notification.

(e) Online Payment Portal. On both the page of the online payment portal that states the amount due, and where the consumer enters the amount being paid by the consumer, the hospital shall provide, in the same font and style as the amount due notification, notice informing Maryland residents of the availability of an income-based monthly payment plan and information, including a telephone number and email address, in order to contact the hospital for additional information.

(2) Notice of Terms Before Execution. A hospital shall provide written notice of the terms of an income-based payment plan to a patient before the patient agrees to enter the income-based payment plan. The terms of the income-based payment plan shall include:

(a) The amount of medical debt owed to the hospital;

(b) The interest rate applied to the income-based payment plan and the total amount of interest expected to be paid by the patient under the income-based payment plan;

(c) The amount of each periodic payment expected from the patient under the income-based payment plan;

(d) The number of periodic payments expected from the patient under the income-based payment plan;

(e) The expected due dates for each payment from the patient;

(f) The expected date by which the account will be paid off in full;

(g) The treatment of any missed payments, including missed payments and default as described in §P and T of this regulation;

(h) That there are no penalties for early payments; and

(i) Whether the hospital plans to apply a periodic recalculation of monthly payment amounts as described in §N of this regulation and the process for such recalculation.

(3) Notice of Plan After Execution. A hospital shall promptly provide a written income-based payment plan, including items listed in §C(2) of this regulation, to the patient following execution by all parties. The income-based payment plan shall be provided to the patient at least 20 days before the due date of the patient’s first payment under the income-based payment plan.

D. Financial Assistance.

(1) Before entering into an income-based payment plan with a patient, hospitals shall evaluate if the patient is eligible for financial assistance, including free and reduced-cost medically necessary care, including reduced-cost medically necessary care due to financial hardship, in accordance with Regulation .06 of this chapter.

(2) Hospitals shall:

(a) Apply the financial assistance reduction before entering into an income-based payment plan with a patient; and

(b) Use any information collected for determining financial assistance under Regulation .06 of this chapter to establish the 5 percent monthly payment threshold for payment plans under Regulation .05F of this chapter.

E. Offer Required. Hospitals must offer income-based payment plans that meet the requirements of these Guidelines.

F. Monthly Payment Amounts.

(1) Under an income-based payment plan subject to these Guidelines, a hospital may not require a patient to make total payments in a month that exceed 5 percent of the lesser of the patient’s household income.

(2) §F(1) of this regulation applies to total amounts due under the plan, including both principal and interest, but does not apply to any catch-up payments, such as payments described under §P(1) of this regulation.

(3) A hospital shall calculate the monthly payment amount threshold under §F(1) of this regulation by dividing income level by household size and multiplying by .05 percent.

(4) Determining the Household Size.

(a) The hospital shall determine the size of the patient’s household using the number reported on tax returns, if provided the number of tax filers and dependents listed on the tax return provided by the patient. For example, if a married couple files jointly and has three dependents, the number of tax filers and dependents would equal five.

(b) If a patient files as an individual and the patient is not a dependent and has no dependents, the number of tax filers would equal one.

(c) If the patient has not provided a tax return, the hospital shall ask the patient to provide the number of individuals in the household.

G. Expenses. A hospital may reduce the amount of the monthly payment due under an income-based payment plan upon consideration of household expense information provided by a patient.

H. Application to Multiple Income-based Payment Plans.

(1) Hospitals. A hospital shall ensure that the total monthly payment amount for all income-based payment plans provided to a patient by the hospital, when added up collectively, does not exceed the income limitation under §F(1) of this regulation.

(2) Hospital System. A hospital system shall ensure that the total monthly payment amount for all income-based payment plans provided to a patient by all hospitals in the hospital system, when added up collectively, does not exceed the income limitation under §F(1) of this regulation.

I. Duration of Income-Based Payment Plan. The duration of an income-based payment plan, in months, is determined by the total amount owed, and interest, if interest applies, divided by the total amount of the payment due each month, subject to the limitation that no monthly payment may exceed 5 percent of the patient’s income as calculated under §F(1)of this regulation.

J. Solicitation of Early Payments Prohibited. Hospitals may not solicit, steer, or mandate patients to pay an amount in excess of the monthly payment amount provided for in an income-based payment plan.

K. Application of Partial Payments. A hospital shall apply partial payments in a manner most favorable to the patient.

L. Interest and Fees.

(1) No Interest for Patients Eligible for Financial Assistance. For a patient who is eligible for free or reduced-cost medically necessary care under the hospital’s financial assistance policy under Regulation .06 of this chapter and Health-General Article, §19–214.1, Annotated Code of Maryland, the hospital may not charge interest or fees on any medical debt amount owed under an income-based payment plan.

(2) Allowable Interest. A hospital may charge interest under an income-based payment plan for a patient who is not eligible for free or reduced-cost medically necessary care, as described in §L of this regulation. A hospital is not required to charge interest for a payment plan.

(3) Interest Rate.

(a) An income-based payment plan may not provide for interest in excess of an effective rate of simple interest of 6 percent per annum on the unpaid principal balance of the payment plan.

(b) A hospital may not set an interest rate that results in negative amortization.

(c) Payers subject to Insurance Article, §15-1005, Annotated Code of Maryland, shall comply with its provisions.

(4) Timing. Interest may not begin before 240 days after the initial bill is provided.

(5) Late payments. A hospital may not charge additional fees or interest for late payments.

M. Early Payment.

(1) Prepayment Allowed.

(a) Patients may, on a voluntary basis, pre-pay, in whole or in part, any amounts owed under an income-based payment plan.

(b) Any prepayment made under §M(1) of this regulation is not subject to the monthly income payment limitations of §F(1) of this regulation.

(2) No Fees or Penalties. A hospital may not assess fees or otherwise penalize early payment of an income-based payment plan.

N. Limited Modifications of Income-based Payment Plans.

(1) Change in Income. If a patient with an income-based payment plan notifies a hospital that the patient’s income has changed, then the hospital shall offer to modify the income-based payment plan to meet the requirement of §N(6) of this regulation.

(2) Expenses. Before modifying an income-based payment plan, a hospital shall consider information provided by a patient about changes in household expenses in considering a patient request to modify a payment plan.

(3) No Increase in Interest Rate. A hospital may not increase the interest rate on an income-based payment plan when making a modification to an income-based payment plan under this Guideline.

(4) Limitation on Payment Amount. A hospital may not modify an income-based payment plan in a way that requires a patient to make a monthly payment that exceeds the percent of the patient’s income used to set the monthly payment amount under the initial income-based payment plan as provided for in §F of this regulation.

(5) Change in Duration. The duration of a modified income-based payment plan, in months, is determined by the total amount owed, and interest, if interest applies, divided by the total amount of the payment due each month, subject to the limitation under §F of this regulation.

(6) Process for Modifying an Income-Based Payment Plan.

(a) Prompt Response to Patient Request. If a patient requests a modification to the terms of the payment plan, the hospital shall respond in a timely manner and may not refer the outstanding balance owed to a collection agency or for legal action until 30 days after providing a written response to the patient’s request for a modification of the payment plan.

(b) Reconsideration for Financial Assistance. If a patient makes a request for modification of a payment plan, the hospital shall consider if such patient is eligible for financial assistance, including free medically necessary care, reduced-cost medically necessary care, and reduced-cost care due to financial hardship under Regulation .06 of this chapter. The hospital will apply the financial assistance reduction in its modification of the payment plan.

(c) Mutual Agreement. A hospital may not modify a payment plan without mutual agreement between the hospital and the patient before the changes are made.

(d) Notice of Terms. The hospital shall provide the patient with a written notice of all payment plan terms, consistent with the requirements of §C of this regulation, upon modifying a payment plan under this Guideline.

O. Hospital-Initiated Changes to Income-Based Payment Plans Based on Changes to Patient Income.

(1) Recalculation Allowed. A hospital may, in the terms of an initial income-based payment plan under §C(2) of this regulation that exceeds 3 years in length, provide for periodic recalculations to the amount of the monthly payments and the duration of the payment plan based on changes in the patient’s income as subject to and calculated under §N(5) of this regulation.

(2) Notice Included in Initial Income-Based Payment Plan.

(a) The hospital may only recalculate payment amounts under an income-based payment plan if the hospital included the process for such recalculation in the notice provided to the patient before they entered into the income-based payment plan, in accordance with §C(2) of this regulation.

(b) The patient’s agreement to enter into the income-based payment plan after receiving that notice constitutes consent to the payment recalculations allowed under §P of this regulation.

(3) Limitations on Modification Apply. The provisions of §N of this regulation relating to limitations of payment plan modifications apply to payment recalculations for income-based payment plans under §O of this regulation.

(4) Frequency of Recalculation. A hospital may not seek a recalculation of the monthly payment amount under an income-based payment plan, as provided for under §O(1) of this regulation more than once every 3 years.

(5) Treatment of Missing Information. If a patient does not provide income information on the request of the hospital seeking to make a change to an income-based payment plan under §O of this regulation and the patient is in good standing on the patient's payments under the income-based payment plan, the hospital may not change the monthly payment amounts under the income-based payment plan.

P. Treatment of Missed Payments.

(1) First Missed Payment.

(a) A hospital may not deem a patient to be noncompliant with an income-based payment plan if the patient makes at least 11 scheduled monthly payments within a 12-month period.

(b) Subject to §P(1)(c) of this regulation, the hospital shall permit the patient to repay the missed payment amount at any time, as determined by the patient, including through a set of partial payments.

(c) No later than 30 days after the first missed payment in a 12-month period, the hospital shall notify the patient of the missed payment and inform the patient that the patient may be in default if they do not pay the amount of the missed payment within 12 months or if they miss additional payments within the 12-month period. The notice will give the patient the option to pay the missed payment by paying the amount of the missed payments in one of the following ways:

(i) 11 increments over the subsequent 11 months;

(ii) A single payment; or

(iii) Another approach, as specified by the patient.

(d) With respect to a patient that has missed a single monthly payment in a 12-month period, the hospital shall provide the patient with a method to designate whether any amount of a payment paid in the subsequent 12-month period is to be applied to the amount of missed payment or applied in a different manner.

(e) With respect to a patient that has missed a single monthly payment in a 12-month period, if the hospital receives a payment and the patient has not designated how that payment is to be applied, the hospital shall first apply the amount to any payment that is due in the 31-day period following the date the payment is received. If there is no payment due in the next month, the hospital shall apply the amount of the payment to the missed payment. If the amount of the payment exceeds the amount of any payment that is due in the 31-day period following the date the payment is received, the excess amount shall be applied to the missed payment.

(f) The hospital may consider a patient to be in default on the income-based payment plan if the missed payment is not repaid in full by the end of the 12-month period that begins on the date of the missed payment under §P(1) of this regulation.

(2) Additional Missed Payments.

(a) A hospital may forbear the amount of any additional missed payments that occur in a 12-month period.

(b) If a hospital forbears the amount of any additional missed payments that occur in a 12-month period, the hospital shall allow the patient to continue to participate in the income-based payment plan.

(c) If a hospital forbears the amount of any additional missed payments that occur in a 12-month period, the hospital may not refer the outstanding balance owed to a collection agency or for legal action.

(d) The hospital shall recapitalize the amount of any missed payments that were subject to forbearance under this §P of this regulation as additional payments at the end of the income-based payment plan, thereby extending the length of the income-based payment plan.

(e) The hospital shall provide written notice to the patient of the treatment of the missed payments, including any extension of the length of the income-based payment plan.

Q. Treatment of Loans and Extension of Credit. After a hospital service is provided to the patient, a hospital, hospital affiliate, or third-party in partnership with a hospital may not make any loan or extension of credit to the patient in connection with a medically necessary hospital service that is inconsistent with the guidelines for payment plans in this regulation resulting from that service.

R. Application of Credit Provisions of Maryland Commercial Law Article and Licensing Provisions of Financial Institutions Article. An income-based payment plan is an extension of credit subject to Maryland credit regulations under Commercial Law Article, Title 12, Annotated Code of Maryland and any applicable licensing provisions of Financial Institutions Article, Title 11, Annotated Code of Maryland.

S. Books and Records. A hospital shall retain books and records on income-based payment plans for at least 3 years after the income-based payment plan is closed.

T. Default.

(1) If a patient defaults on an income-based payment plan and the parties are unable to agree to a modification, then the hospital shall follow the provisions of its credit and collection policy established in accordance with Regulation .04 of this chapter, before a hospital may write this medical debt off as bad debt.

(2) With respect to the amounts covered by the income-based payment plans, a patient who is on an income-based payment plan and is not in default on that payment plan may not be considered in arrears on their debt to the hospital when the hospital is making decisions about scheduling health care services.

U. Non-Income-Based Payment Plans.

(1) Other Payment Plans Allowed. A hospital may offer a non-income-based payment plan under these Guidelines, but must first offer the patient an income-based payment plan.

(2) Application of Guidelines. Consistent with the Guidelines for Hospital Payment Plans and consistent with the intent of Health-General Article, §19-214.2, Annotated Code of Maryland, the following provisions of this regulation apply to non-income-based payment plans in the same manner such provisions apply to income-based payment plans:

(a) §A of this regulation, regarding scope;

(b) §B of this regulation, regarding access to payment plans;

(c) §C(2) of this regulation, regarding notice of payment plan terms before execution;

(d) §C(3) of this regulation, regarding notice of plan after execution;

(e) §D of this regulation, regarding financial assistance;

(f) §L of this regulation, regarding interest and fees;

(g) §M(1)(a) and (2) of this regulation, regarding early payments;

(h) §N(6) of this regulation, regarding modifications of payment plans;

(i) §Q of this regulation, relating to treatment of loans and extensions of credit;

(j) §R of this regulation, relating to the application of credit provisions of Maryland Commercial Law Article and the licensing provisions of Financial Institutions Article;

(k) §S of this regulation, relating to books and records; and

(l) §T of this regulation, relating to default.

(3) Notice.

(a) Notice of Terms Before Execution. In addition to complying with the terms of §C(2) of this regulation, the hospital must include notice that the patient may apply for an income-based payment plan at any time in the notice of terms before execution of a non-income-based payment plan.

(b) Notice of Plan After Execution. The hospital must include the notice required in §U(3)(a) of this regulation in the notice of the payment plan after execution that is required by §C(3) of this regulation.

(c) Notice with Bills. Each bill for a non-income-based payment plan shall include a notice that informs the patient that income-based payment plans are available, which could result in lower monthly payments and provides information on how to apply for such plans.

(4) Consent. Before entering into a non-income-based repayment plan with a patient, the hospital must obtain consent from the patient that records that the patient affirms the following:

(a) The hospital offered the patient an income-based payment plan;

(b) The income-based payment plan limits monthly payment amounts to 5 percent of the patient’s monthly income;

(c) The income-based payment plan may result in lower monthly payment amounts than the monthly payment amounts under the non-income-based repayment plan;

(d) The patient has the opportunity to disclose their income and determine the payment amount under the income-based payment plan; and

(e) The patient is declining to enter an income-based payment plan and is consenting to enter a non-income-based repayment plan.

(5) Modification of a Non-Income-Based Payment Plan: In addition to complying with the terms of §N(6) of this regulation, before modifying a non-income-based payment plan:

(a) The hospital shall offer the patient an income-based payment plan; and,

(b) If the patient declines the income-based payment plan, obtain the consent required under §U(4) of this regulation.

(6) Default on a Non-Income-Based Payment Plan.

(a) If the patient defaults on a non-income-based payment plan, the hospital must offer an income-based payment plan to the patient before the hospital follows the provisions of its credit and collection policy to collect the debt.

(b) The offer provided under §U(6)(a) of this regulation must be sent separately from a bill.

V. Steering.

(1) A hospital may not steer patients to non-income-based payment plans, or third-party credit providers, in such a manner that discourages patients from entering into income-based payment plans.

(2) A hospital may not steer patients to revolving credit products in such a manner that discourages patients from entering into either income-based payment plans or non-income based payment plans under this regulation.

.06 Hospital Financial Assistance Responsibilities.

A. Financial Assistance Policy.

(1) Requirements.

(a) Each hospital and each chronic care hospital under the jurisdiction of the Commission shall develop a written financial assistance policy for providing free and reduced-cost medically necessary care to low-income patients who lack health care coverage or to patients whose health insurance does not pay the full cost of the hospital bill.

(b) A hospital shall provide written notice of the hospital's financial assistance policy to the patient, the patient's family, or the patient's authorized representative before discharging the patient and in each communication to the patient regarding collection of the hospital bill.

(i) The required notice shall state that the patient has up to 240 days after the day the patient receives the initial hospital bill to apply for financial assistance from the hospital.

(ii) The hospital shall obtain documentation ensuring that the patient or the patient’s authorized representative acknowledges the patient’s receipt of the notice before discharging the patient.

(iii) If a patient chooses not to apply for financial assistance, the patient’s documented acknowledgement shall indicate that the patient is not applying for financial assistance on the day of the acknowledgment but may apply within 240 days immediately following the patient’s receipt of the initial hospital bill.

(c) The financial assistance policy shall provide at a minimum:

(i) Free medically necessary care to patients with family income at or below 200 percent of the federal poverty level, consistent with the provisions of §A(2) of this regulation;

(ii) Reduced-cost medically necessary care to patients with family income between 200 and 300 percent of the federal poverty level, consistent with the provisions of §A(2) of this regulation;

(iii) A description of the payment plan required under Health-General Article, §19-214.2(d), Annotated Code of Maryland and Regulation .05 of this chapter; and

(iv) A mechanism for a patient, irrespective of that patient’s insurance status, to request the hospital to reconsider the denial of free or reduced-cost medically necessary care, including the address, phone number, facsimile number, email address, mailing address, and website of the Health Education and Advocacy Unit, which can assist the patient or patient’s authorized representative in filing and mediating a reconsideration request.

(d) If a patient is eligible for reduced-cost medically necessary care under §A(1)(c)(ii) of this regulation, the hospital shall, at a minimum, reduce the patient’s out-of-pocket expenses for the hospital services:

(i) For a patient with family income of at least 201 percent but not more than 250 percent of the federal poverty level, by 75 percent; and

(ii) For a patient with family income of more than 250 percent but not more than 300 percent of the federal poverty level, by 60 percent.

(e) The hospital shall provide free and reduced-cost medically necessary care to all qualified Maryland residents, regardless of their citizenship or immigration status.

(f) The hospital shall provide free and reduced-cost medically necessary care under §A(1)(c) of this regulation to all qualified Maryland residents, regardless of whether the patient resides in the hospital’s service area.

(g) The financial assistance policy applies to all medically necessary hospital services provided to qualified Maryland residents. Hospitals may not exclude non-urgent or elective, but medically necessary, care from their financial assistance policy.

(2) The financial assistance policy shall calculate a patient’s eligibility for free medically necessary care under §A(1)(c)(i) of this regulation and Health-General Article, §19-214.1(b)(2)(i), Annotated Code of Maryland, or reduced-cost medically necessary care under §A(1)(c)(ii) of this regulation and Health-General Article, §19-214.1(b)(2)(ii), Annotated Code of Maryland, at the date of service or updated, as appropriate, to account for any change in the financial circumstances of the patient that occurs within 240 days after the initial bill is provided.

(3) The hospital shall consider any change in the patient’s financial circumstance in accordance with Health-General Article, §19-214.1(b)(11), Annotated Code of Maryland.

(4) Income Documentation.

(a) Hospitals shall accept generally acceptable forms of documentation that verify income, such as tax returns, pay stubs, and W2s to evaluate if the patient is eligible for financial assistance, including free and reduced-cost medically necessary care, including reduced-cost medically necessary care due to financial hardship, in accordance with this regulation .

(b) Hospitals shall use available information, including information provided by the patient, to approximate the patient’s income if the patient has not provided their tax returns, pay stubs, W2s, or another form of documentation.

(c) Income Attestations.

(i) Hospitals may accept patient attestation of the patient’s monthly or annual income and the number of filers and dependents on their tax return without documentation.

(ii) Such an attestation shall include the patient’s income and the number of filers and dependents on their tax return.

(iii) If the patient provides an attestation of income the hospital is not required to conduct any additional income verification.

(d) A hospital’s inability to obtain complete income information does not preclude the hospital's ability to reasonably predict a patient’s income for the purposes of providing financial assistance. For example, a hospital may multiply income reported at the monthly level by 12 to determine income at the annual level, allowing for reasonably predictable changes in income throughout the year.

(5) Presumptive Eligibility for Free Medically Necessary Care. Unless otherwise eligible for Medicaid or CHIP, patients who are beneficiaries/recipients of the following means-tested social services programs are deemed eligible for free medically necessary care:

(a) Households with a child in the free or reduced lunch program and is eligible for the program based on the household’s income;

(b) Supplemental Nutritional Assistance Program (SNAP);

(c) Low-income-household energy assistance program;

(d) Primary Adult Care Program (PAC), until such time as inpatient benefits are added to the PAC benefit package;

(e) Women, Infants and Children (WIC); or

(f) Other means-tested social services programs deemed eligible for hospital free medically necessary care policies by the Maryland Department of Health and the Commission, consistent with this regulation.

B. Hospital Reports. Each hospital shall submit to the Commission within 120 days after the end of each hospital’s fiscal year:

(1) The hospital’s financial assistance policy developed in accordance with this regulation; and

(2) An annual report on the hospital's financial assistance policy that includes:

(a) The total number of patients who completed or partially completed an application for financial assistance during the prior year;

(b) The total number of inpatients and outpatients who received free medically necessary care during the immediately preceding year and reduced-cost medically necessary care for the prior year;

(c) The total number of patients who received financial assistance during the immediately preceding year, by race or ethnicity and gender;

(d) The total number of patients who were denied financial assistance during the immediately preceding year, by race or ethnicity and gender;

(e) The total cost of hospital services provided to patients who received free medically necessary care; and

(f) The total cost of hospital services provided to patients who received reduced-cost medically necessary care that was covered by the hospital as financial assistance or that the hospital charged to the patient.

C. Financial Hardship Policy.

(1) Subject to Regulation .05D of this chapter, the financial assistance policy required under §A of this regulation and Health-General Article, §19-214.1, Annotated Code of Maryland, shall provide reduced-cost medically necessary care to patients with family income below 500 percent of the federal poverty level who have a financial hardship.

(2) If a patient has received reduced-cost medically necessary care due to a financial hardship, the patient or any immediate family member of the patient living in the same household:

(a) Shall remain eligible for reduced-cost medically necessary care when seeking subsequent care at the same hospital during the 12-month period beginning on the date on which the reduced-cost medically necessary care was initially received; and

(b) To avoid an unnecessary duplication of the hospital’s determination of eligibility for free and reduced-cost medically necessary care, shall inform the hospital of the patient’s or family member’s eligibility for the reduced-cost medically necessary care.

(3) If a patient is eligible for reduced-cost medically necessary care under a hospital’s financial hardship policy, the hospital shall, at a minimum, reduce the patient’s out-of-pocket expenses for hospital services:

(a) For a patient with family income of at least 201 percent but not more than 250 percent of the federal poverty level, by 75 percent;

(b) For a patient with family income of more than 250 percent but not more than 300 percent of the federal poverty level, by 60 percent;

(c)For a patient with family income of more than 300 percent but not more than 350 percent of the federal poverty level, by 50 percent;

(d) For a patient with family income of more than 350 percent but not more than 400 percent of the federal poverty level, by 45 percent;

(e) For a patient with family income of more than 400 percent but not more than 450 percent of the federal poverty level, by 40 percent; and

(f) For a patient with family income of more than 450 percent but not more than 500 percent of the federal poverty level, by 35.

D. The Commission may, by regulation, establish income thresholds higher than those in this regulation:

(a) Patient mix;

(b) Financial condition;

(c) Level of bad debt experienced;

(d) Amount of financial assistance provided; and

(e) Other relevant factors.

E. Notice Requirements.

(1) A notice shall be posted in conspicuous places throughout the hospital including the billing office informing patients of their right to apply for financial assistance and who to contact at the hospital for additional information.

(2) If the hospital uses a vendor to assist with financial assistance eligibility, billing, or debt collection, such as a debt collector or eligibility vendor, that vendor shall post a notice in a conspicuous place on their website or online payment portal, informing patients of their right to apply for financial assistance, providing a link to the financial assistance application, and providing information on how to submit the application. Placement on the website or online payment portal should be based on the best interest of the patient.

F. The notice required under §E of this regulation shall be in:

(1) Simplified language;

(2) At least 10-point type; and

(3) The patient’s preferred language or, if no preferred language is specified, each language spoken by a limited English proficient population that constitutes at least 5 percent of the overall population within the city or county in which the hospital is located as measured by the most recent census.

G. Financial Assistance Application. Each hospital shall:

(1) Use a Financial Assistance Application in the manner prescribed by the Commission in order to determine eligibility for free and reduced-cost medically necessary care;

(2) Use a Financial Assistance Application that meets the requirements of this regulation and is consistent with the Uniform Financial Assistance Application; and

(3) Establish a mechanism to provide a Financial Assistance Application to patients regardless of their insurance status. A hospital may require from patients or their guardians only those documents required to validate the information provided on the application.

H. Asset Test Requirements. A hospital may utilize a monetary asset test when determining eligibility for financial assistance, using the definition of monetary assets as defined in Regulation 01B of this chapter.

.07 Patient Complaints.

A. The Commission shall post a process on its website for a patient or a patient’s authorized representative to file with the Commission a complaint against a hospital for an alleged violation of Health-General Article, §§19-214.1 or 19-214.2, Annotated Code of Maryland.

B. The process established by the Commission shall include the option for a patient or a patient’s authorized representative to file the complaint jointly with the Commission and the Health Education and Advocacy Unit.

C. The process shall conform to the requirements of Health-General Article, §19-214.3, Annotated Code of Maryland.

.08 Hospital Written Estimate.

A. In addition to the good faith estimate requirements set forth in the Public Health Service Act, 42 U.S.C §2799B-6, the No Surprises Act, on request of a patient made before or during treatment, a hospital shall provide to the patient a written estimate of the total charges for the hospital services, procedures, and supplies that reasonably are expected to be provided and billed to the patient by the hospital.

B. The written estimate shall state clearly that it is only an estimate and actual charges could vary.

C. A hospital may restrict the availability of a written estimate to normal business office hours.

D. The provisions set forth in §A—C of this regulation do not apply to emergency services.

.09 Other Obligations of Debt Collectors.

This chapter does not diminish any obligations of a debt collector, as defined under Regulation .01 of this chapter, under other applicable laws or regulations, including, without limitation, any requirement for the debt collector to obtain a collection agency license from the State Collection Agency Licensing Board in accordance with Business Regulation Article, Title 7, Subtitle 3, Annotated Code of Maryland.

JOSHUA SHARFSTEIN

Chair, Health Services Cost Review Commission

Title 15
MARYLAND DEPARTMENT OF AGRICULTURE

Subtitle 01 OFFICE OF THE SECRETARY

15.01.22 Class 4 Limited Winery License Exemption for Maryland-Grown Agricultural Products

Authority: Agriculture Article, §2-103; and Alcoholic Beverages and Cannabis Article, §2-206; Annotated Code of Maryland

Notice of Proposed Action

[25-169-P]

The Maryland Department of Agriculture proposes to adopt new Regulations .01—.04 under a new chapter, COMAR 15.01.22 Class 4 Limited Winery License Exemption for Maryland-Grown Agricultural Products.

Statement of Purpose

The purpose of this action is to establish the criteria and procedure under which the Secretary of Agriculture may grant an exemption to a Class 4 Limited Winery License holder from the ingredient percentage requirement set forth in the Alcoholic Beverages and Cannabis Article, §2-206(c)(2)(ii), Annotated Code of Maryland.

Estimate of Economic Impact

I. Summary of Economic Impact. Under State law, a holder of a Class 4 Limited Winery License, who owns or has under contract less than 20 acres of Maryland-grown agricultural products in cultivation for use in the production of wine, shall ensure that at least 51 percent of the ingredients used in the annual production of the wine are Maryland-grown agricultural products. If the holder is unable to meet this statutory percentage requirement, the holder, pursuant to Alcoholic Beverages and Cannabis Article, §2-206, Annotated Code of Maryland, may apply to the Secretary of Agriculture for a 1-year exemption. This chapter sets forth the process under which the Secretary may grant this exemption. The exemption would benefit, not burden, such persons.

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:
Class 4 Limited Wineries	(+)	Meaningful
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. If a holder of a Class 4 Limited Winery License who owns or has under contract less than 20 acres of Maryland-grown agricultural products in cultivation for use in the production of wine is unable to meet the statutory percentage requirement, the proposed action can have a meaningful economic impact on that person. The Proposed Action sets forth a process under which the Secretary may grant the exemption from this requirement.

Economic Impact on Small Businesses

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

If a holder of a Class 4 Limited Winery License who owns or has under contract less than 20 acres of Maryland-grown agricultural products in cultivation for use in the production of wine is unable to meet the statutory percentage requirement, the proposed action can have a meaningful economic impact on that person. The Proposed Action sets forth a process under which the Secretary may grant the exemption from this requirement.

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

Comments may be sent to Cassie Shirk, Assistant Secretary, Maryland Department of Agriculture, 50 Harry S. Truman Parkway, Annapolis, Maryland, 21401 , or call (443) 534-5782, or email to [email protected]. Comments will be accepted through October 20, 2025. A public hearing has not been scheduled.

.01 Purpose.

This chapter establishes the criteria and procedure for the Secretary to grant exemptions to Class 4 Limited Winery License applicants from the ingredient percentage requirement set forth in Alcoholic Beverages and Cannabis Article, §2-206(c)(2)(ii), Annotated Code of Maryland.

.02 Definitions.

A. The following terms have the meanings indicated.

B. Terms Defined.

(1) “Class 4 Limited Winery License holder” means a person who holds a Class 4 Limited Winery License that owns or has under contract less than 20 acres of Maryland-grown agricultural products in cultivation.

(2) “Maryland-grown agricultural product” means any product produced or cultivated on a farm or vineyard in the State

other than cannabis or any other product containing tetrahydrocannabinol as defined in Alcoholic Beverages and Cannabis Article, §36-1102, Annotated Code of Maryland.

(3) “Secretary” means the Secretary of Agriculture.

.03 Application for Exemption.

A. Time of Application. A Class 4 Limited Winery License holder may submit a written application to the Secretary requesting a 1-year exemption from the requirement set forth in Alcoholic Beverages and Cannabis Article, §2-206(c)(2)(ii), Annotated Code of Maryland, that at least 51 percent of the ingredients used in the annual production of the license holder’s wine are Maryland-grown agricultural products.

B. Decision on Application. Within 30 days after a completed exemption application is received pursuant to §A of this regulation, the Secretary shall issue a decision granting or denying the application.

C. Duration of Exemption. An exemption granted by the Secretary under this chapter shall be valid for 1 year following the date the application is granted by the Secretary.

.04 Criteria and Basis for Granting Exemption.

A. Criteria. In deciding whether to grant a Class 4 Limited Winery holder’s request for an exemption under Regulation .03 of this chapter, the Secretary shall consider how the following events or factors may have affected the person within the year before filing the application:

(1) Weather disasters, including but not limited to excessive moisture, frost, winter kill, or hurricanes;

(2) Disease;

(3) Pest pressure;

(4) Chemical damage;

(5) Steps taken by the applicant to minimize the need for the requested exemption; and

(6) Any other event or factor that the Secretary deems relevant for deciding whether to grant an applicant’s request for a 1-year exemption from the ingredient percentage requirement set forth in Alcoholic Beverages and Cannabis Article, §2-206(c)(2)(ii), Annotated Code of Maryland, including, but not limited to, whether the Secretary:

(a) Determines that the event or factor is deemed to be one that was outside the control of the applicant; or

(b) Has previously granted the Class 4 Limited Winery License holder an exemption from the ingredient percentage requirement set forth in Alcoholic Beverages and Cannabis Article, §2-206(c)(2)(ii), Annotated Code of Maryland, and, if so, the number of times that the person has been granted this exemption.

B. Basis for Exemption. The Secretary may grant the Class 4 Limited Winery License holder’s request for an exemption if the person can demonstrate that:

(1) The failure to meet the ingredient percentage requirement set forth in Alcoholic Beverages and Cannabis Article, §2-206(c)(2)(ii), Annotated Code of Maryland, resulted from at least one of the events or factors identified in §A of this regulation; and

(2) Despite having taken reasonable steps to secure at least 51 percent of the ingredients used in the annual production of the licensed holder’s wine are Maryland-grown agricultural products, the Class 4 Limited Winery License holder is unable to meet the statutory percentage requirement.

C. The Secretary may deny a Class 4 Limited Winery License holder’s request for an exemption if the person has been granted an exemption for each of the previous 4 years.

STEVEN A. CONNELLY
Deputy Secretary

Title 26
DEPARTMENT OF THE ENVIRONMENT

Subtitle 11 AIR QUALITY

26.11.43 Advanced Clean Trucks Program

Authority: Environment Article, §§1-404, 2-102, 2-103, 2-301, 2-1102, and 2-1103, 2-1103.1, Annotated Code of Maryland

Notice of Proposed Action

[25-149-P-I]

The Secretary of the Environment proposes to amend Regulation .02 under COMAR 26.11.43 Advanced Clean Trucks Program.

Statement of Purpose

The purpose of this action is to adjust language which clarifies compliance determinations and sales reporting requirements for vehicle manufacturers and add an additional certification pathway for medium-duty zero-emission vehicles. This will result in increased time for manufacturers to make up deficits, and prevent earned credits from being double counted under both the Advanced Clean Cars II and Advanced Clean Trucks rule.

This action is being taken in accordance with the Clean Air Act, 42 U.S.C. §7507, requiring Maryland to maintain consistency with amendments made by California to that state’s Advanced Clean Trucks regulation, which was adopted and incorporated by reference into Maryland law. However, MDE acknowledges that the waiver granted to California by the EPA to establish its Advanced Clean Truck emission standards was reviewed as a final agency action under the Congressional Review Act, and a resolution disapproving the waiver was signed by the President on June 12, 2025. The validity of that action was timely challenged and is currently in active litigation (State of California, et al. v. United States, et al., Case No. 3:25-cv-04966 (N.D.Ca.)). Notwithstanding these amendments, which provide additional compliance flexibilities to vehicle manufacturers consistent with California’s program, MDE explicitly acknowledges the purported waiver rescission. In recognition of that action and Executive Order 01.01.2025.10 issued by Governor Moore, MDE will not enforce any aspect of its Advanced Clean Trucks Program unless and until a resolution of the waiver litigation, Case No. 3:25-cv-04966 (N.D.Ca.), results in a legally recognized reinstatement of California’s waiver. If such reinstatement occurs, the Advanced Clean Trucks Program will be submitted to the U.S. Environmental Protection Agency (EPA) for approval as part of Maryland's State Implementation Plan (SIP).

Background:

The Clean Air Act established the framework for controlling harmful emissions from mobile sources. At the time, California had already established its own emission standards for mobile sources, and so was granted the sole authority to continue adopting vehicle emission standards, so long as they were at least as protective as the standards set by EPA.

The harmful emissions from Medium- and Heavy-Duty Trucks (MHD) pose a serious threat to both public health and climate change. Recognizing this, California has adopted the Advanced Clean Trucks regulation that aims to reduce on-road emissions from the MHD Truck sector to a greater extent than the current EPA standards.

Section 177 of the Clean Air Act allows other states to adopt the California standards if they are identical. The Clean Trucks Act of 2023 requires the Maryland Department of the Environment (MDE) to exercise this authority and adopt regulations implementing the California Advanced Clean Truck Program in Maryland. MDE has adopted implementing regulations through incorporation by reference of the applicable California regulations.

There are several changes which MDE intends to adopt via amendments to the incorporation by reference regulation. Definitions under the program are specified, including battery-electric vehicles, hydrogen fuel-cell electric vehicles, incomplete vehicles, and secondary vehicle manufacturer. A vehicle is eligible to generate a deficit only once, which addresses the double-counting of Class 2b-3 vehicles under ACC II and ACT. Next, manufacturers are given a consecutive three- model year flexibility to make up a deficit for credits earned under the programs. Reporting and recordkeeping specifications are updated: data such as vehicle weight class, family name, identification of an incomplete/complete vehicle, and others are required. There is additional documentation required for retention of records, such as certain invoices, receipts, contracts, or purchase orders, registration information, and statements from secondary vehicle manufacturers. An additional flexibility asked for by the truck manufacturers allows vehicles to generate ZEV Credits when delivered for sale instead of when delivered to the ultimate purchaser as currently adopted. Last, the Zero-Emission Powertrain Certification Standard would be an optional certification pathway for medium-duty zero-emission vehicles.

Sources Affected and Location:

This regulatory program will apply to manufacturers that sell vehicles in Maryland that have a gross vehicle weight rating over 8,500 pounds.

Requirements:

Manufacturers are required to specify the vehicles counted towards compliance with each program so they are not double counted. Certain sales and vehicle data will be required for reporting and recordkeeping purposes.

Projected Emission Reductions:

There are no projected emission reductions associated with these proposed amendments.

Economic Summary:

Cost impacts are expected to be minimal. The amendments require certain records to be maintained that the industry already records, and the amendments add time and flexibility for the industry to generate credits.

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 Mr. Justin Mabrey, Division Chief of Engineering & Tech, Mobile Sources Program, Maryland Department of the Environment, 1800 Washington Boulevard, Suite 705, Baltimore, Maryland 21230-1720, or call (410) 537-4165, or fax (410) 537-4435, or email to [email protected]. Comments will be accepted through October 21, 2025. A public hearing will be held on October 21, 2025 at 10 a.m. Interested persons are invited to attend the virtual hearing and express their views. For information on how to join the virtual public hearing—and to review this public hearing announcement, the proposed action, and supporting documents—see the Maryland Department of the Environment’s website at https://mde.maryland.gov/programs/regulations/air/Pages/reqcomments.aspx

Editor’s Note on Incorporation by Reference

Pursuant to State Government Article, §7-207, Annotated Code of Maryland, Title 13, California Code of Regulations (CCR), Division 3, Chapter 1, Article 2, §1963 Advanced Clean Trucks Purpose, Applicability, Definitions, and General Requirements, as effective May 9, 2025.; Title 13, California Code of Regulations (CCR), Division 3, Chapter 1, Article 2, §1963.1 Advanced Clean Truck Deficits, as effective May 9, 2025; Title 13, California Code of Regulations (CCR), Division 3, Chapter 1, Article 2, §1963.2 Advanced Clean Trucks Credit Generation, Banking, and Trading, as effective May 9, 2025; Title 13, California Code of Regulations (CCR), Division 3, Chapter 1, Article 2, §1963.3 Advanced Clean Trucks Compliance Determination, as effective May 9, 2025; Title 13, California Code of Regulations (CCR), Division 3, Chapter 1, Article 2, §1963.4 Advanced Clean Trucks Reporting and Recordkeeping, as effective May 9, 2025; and Title 13, California Code of Regulations (CCR), Division 3, Chapter 1, Article 2, §1963.5 Advanced Clean Trucks Enforcement, as effective May 9, 2025, have been declared documents generally available to the public and appropriate for incorporation by reference. For this reason, they will not be printed in the Maryland Register or the Code of Maryland Regulations (COMAR).

Copies of these documents are filed in special public depositories located throughout the State. A list of these depositories was published in 52:2 Md. R. 53 (January 24, 2025), and is available online at www.dsd.maryland.gov. These documents may also be inspected at the office of the Division of State Documents, 16 Francis Street, Annapolis, Maryland 21401.

.02 Incorporation by Reference.

A. (text unchanged)

B. Documents Incorporated.

(1) Title 13, California Code of Regulations (CCR), Division 3, Chapter 1, Article 2, §1963 Advanced Clean Trucks Purpose, Applicability, Definitions, and General Requirements, as effective [March 15, 2021] May 9, 2025.

(2) Title 13, California Code of Regulations (CCR), Division 3, Chapter 1, Article 2, §1963.1 Advanced Clean Truck Deficits, as effective [March 15, 2021] May 9, 2025.

(3) Title 13, California Code of Regulations (CCR), Division 3, Chapter 1, Article 2, §1963.2 Advanced Clean Trucks Credit Generation, Banking, and Trading, as effective [March 15, 2021] May 9, 2025.

(4) Title 13, California Code of Regulations (CCR), Division 3, Chapter 1, Article 2, §1963.3 Advanced Clean Trucks Compliance Determination, as effective [March 15, 2021] May 9, 2025.

(5) Title 13, California Code of Regulations (CCR), Division 3, Chapter 1, Article 2, §1963.4 Advanced Clean Trucks Reporting and Recordkeeping, as effective [March 15, 2021] May 9, 2025.

(6) Title 13, California Code of Regulations (CCR), Division 3, Chapter 1, Article 2, §1963.5 Advanced Clean Trucks Enforcement, as effective [March 15, 2021] May 9, 2025.

SERENA MCILWAIN
Secretary of the Environment

Subtitle 11 AIR QUALITY

26.11.44 Maryland Heating Fuel Provider Reporting Program

Authority: Environmental Article, §§1-404(b), 2-101(b), 2-103(b)(1), 2-301(a)(1), §2-1203, 2-1204.2, Annotated Code of Maryland

Notice of Proposed Action

[25-150-P-I]

The Secretary of the Environment proposes to adopt new Regulations .01—.06 under a new chapter, COMAR 26.11.44 Maryland Heating Fuel Provider Reporting Program.

Statement of Purpose

The purpose of this action is to establish reporting requirements for heating fuel providers of the amount of heating fuel delivered for final sale or consumption in Maryland.

This reporting program, which is for data collection only, is a critical component of the Maryland Department of the Environment’s (MDE or the Department) ongoing efforts to quantify and reduce greenhouse gas (GHG) emissions as required by the Climate Solutions Now Act of 2022. It will also serve to improve and refine data used to support the Department’s triennial Statewide GHG Emissions Inventory.

Background.

In 2022, the Maryland General Assembly passed the Climate Solutions Now Act (CSNA) that modified Maryland’s GHG emissions reduction goals in response to the latest science indicating that more stringent goals are necessary to combat climate change. The CSNA set new goals to reduce statewide GHG emissions by 60% below 2006 levels by 2031 and achieve net-zero emissions by 2045.

On June 4, 2024, Governor Wes Moore signed an Executive Order (EO) 01.01.2024.19 – “Leadership by State Government: Implementing Maryland’s Climate Pollution Reduction Plan.” The EO mandates that the Department propose a clean heat standard regulation to expand Maryland's Renewable Portfolio Standard to the thermal energy system, mobilizing investment in clean heat solutions for homes and businesses.

This chapter establishes the reporting framework to deliver on the EO mandates. Per the EO, the Department is considering a future clean heat standard regulation that could include early action credits based on data submitted under this chapter. Reporting inaccuracies may have regulatory impacts in the future.

Built on approaches taken by the U.S. Energy Information Administration (EIA), this reporting framework will also improve and refine data used to support the Department’s triennial Statewide GHG Emissions Inventory. The inventory is required by Environment Article §2-1203, Annotated Code of Maryland.

Sources Affected and Location.

These regulations apply to approximately 175 heating fuel providers across Maryland. Heating fuel providers include companies that deliver natural gas, fuel oil, propane, kerosene, and coal in Maryland.

The estimated number of sources is based on accounting by the Public Service Commission for natural gas utilities, the Department’s Oil Control Program permitting data for heating oil providers, and an extrapolation based on EIA data for propane providers.

Requirements.

The purpose of this chapter is to establish reporting requirements for heating fuel providers of the amount of heating fuel delivered for final sale or consumption in Maryland.

Reporting requirements: Those subject to the provisions of this chapter must report data to the Department. Data must be reported quarterly.

See the table below for reporting deadlines:

Reporting period Due date

Jan—March (Q1) June 1

April—June (Q2) Sept 1

July—Sept (Q3) Dec 1

Oct—Dec (Q4) March 1

Quarterly reporting detail requirements are as follows:

The following is required in the report, separated by county in Maryland:

· The total volumes of heating fuels delivered, categorized by heating fuel type. (Heating fuel types are specified in the regulations)

· The sector that receives the heating fuel: commercial, electric power, industrial, residential, or other energy-consuming. (Sector types are defined in the regulations and specified in .05 Fuel Delivery Reports.)

• Motor gasoline, diesel fuel for vehicles, wood, and solid waste are not considered heating fuels for the purpose of this chapter.

• For any missing data, the heating fuel provider must provide an estimate of the heating fuel delivered that is at least as large as the amount actually delivered.

• If a heating fuel provider does not report, the Department may estimate the amount of fuel for the provider based on information that the Department deems relevant for estimating the amount of that heating fuel that was delivered.

Recordkeeping requirements: A person subject to the chapter must retain all records required under this chapter for at least 5 years.

Privileged or Confidential Data: The Maryland Department of the Environment (MDE) is a public agency and subject to the Maryland Public Information Act set forth in General Provisions Article, Title 4, Annotated Code of Maryland. Information supplied to MDE pursuant to this Regulation may be shared publicly, unless protected from public disclosure by General Provisions Article, Title 4, Subtitle 3, Annotated Code of Maryland, such as material determined to be privileged or confidential.

Projected Emission Reductions.

There are no projected emissions reductions resulting from this reporting rule; however, this rule will help the Department track and estimate GHG emissions and criteria pollutants in Maryland and consider opportunities to reduce emissions.

Economic Summary.

Under this chapter, there is a minimal economic impact upon heating fuel providers (affected source). Heating fuel providers routinely report non-tax-exempt fuel sales to the Comptroller, the federal government, and potentially other entities. This rule requires similar data to be reported to the Department but ensures that all heating fuels delivered for final sale or consumption in Maryland are included. The requirement to report fuel deliveries at the county level may be a new requirement for some fuel providers.

Overall, the new regulations affecting heating fuel providers have a minimal economic impact on the Department. The Department will need to process reports required by this chapter. The Department intends to use data collected for input into the existing statewide GHG emissions inventory.

There will be no anticipated impact on local government, other state agencies, other industries, trade groups, or the public.

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 Mark Stewart, Program Manager, Climate Change Program, Maryland Department of the Environment, 1800 Washington Boulevard, Suite 730, Baltimore, MD 21230-1720, or call 410-537-3890, or email to [email protected]. Comments will be accepted through October 21, 2025. The Department of the Environment will hold a virtual public hearing on the proposed action on October 21, 2025 at 1:00 p.m. 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 October 21, 2025. Comments may be sent to Mark Stewart, Program Manager of the Climate Change Program, Department of the Environment, 1800 Washington Boulevard, Suite 730, Baltimore, MD 21230-1720, or by email at [email protected]. For more information, contact the Clean Heat Team at [email protected] or via phone at (410) 537-3890.

Editor’s Note on Incorporation by Reference

Pursuant to State Government Article, §7-207, Annotated Code of Maryland, ASTM International, ASTM Designation: D396-24, “Standard Specification for Fuel Oils”; ASTM International, ASTM Designation: D3699-25, “Standard Specification for Kerosine”; ASTM International, ASTM Designation: D975-24a, “Standard Specification for Diesel Fuel”; ASTM International, ASTM Designation: D1835-22, “Standard Specification for Liquefied Petroleum (LP) Gases”; ASTM International, ASTM Designation: D4814-25, “Standard Specification for Automotive Spark-Ignition Engine Fuel”; and Federal Specification VV-F-815C, “Federal Specification: Fuel Oil, Burner” have been declared documents generally available to the public and appropriate for incorporation by reference. For this reason, they will not be printed in the Maryland Register or the Code of Maryland Regulations (COMAR). Copies of these documents are filed in special public depositories located throughout the State. A list of these depositories was published in 52:2 Md. R. 53 (January 24, 2025), and is available online at www.dsd.maryland.gov. These documents may also be inspected at the office of the Division of State Documents, 16 Francis Street, Annapolis, Maryland 21401.

.01 Purpose.

The purpose of this chapter is to establish reporting requirements for heating fuel providers of the amount of heating fuel delivered for final sale or consumption in Maryland.

.02 Applicability.

This chapter applies to heating fuel providers delivering heating fuel in Maryland.

.03 Definitions.

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

B. Terms Defined.

(1) “Biofuel” means a liquid fuel and blending components produced from biomass feedstocks.

(2) “Biomethane” means a mixture of methane and other gases produced by decomposing matter in an oxygen-free environment with the assistance of microbes.

(3) Commercial Sector.

(a) “Commercial sector” means the part of the State’s economy that consists of service-providing facilities and equipment.

(b) “Commercial sector” includes:

(i) Businesses;

(ii) Federal, state, and local government facilities;

(iii) Institutional living quarters;

(iv) Private and public organizations; and

(iv) Sewage treatment facilities.

(4) “Coal” means a combustible rock that includes carbonaceous material and is formed from plant remains that have been compacted, hardened, chemically altered, and metamorphosed by heat and pressure over geologic time.

(5) “Conservative missing data parameter” means data that are:

(a) Substituted for missing data; and

(b) Known to result in an amount of reported cubic feet, gallons, or tons for a delivery of a heating fuel under Regulation .05 of this chapter at least as large as the actual amount of the delivery.

(6) “Deliver” means, regarding a heating fuel, to physically transfer or instruct or otherwise cause to be physically transferred.

(7) “Department” means the Maryland Department of the Environment.

(8) “Diesel fuel” means a fuel composed of distillates obtained in petroleum refining operations or blends of such distillates with residual oil used in motor vehicles.

(9) Electric Power Sector.

(a) “Electric power sector” means the part of the State’s economy whose primary business is to sell electricity, or electricity and heat, to the public.

(b) “Electric power sector” includes:

(i) Electric generating stations; and

(ii) Combined heat and power (CHP) plants.

(10) “Gallon” means a unit of volume (U.S. gallon) equaling 231 cubic inches.

(11) Heating Fuel.

(a) “Heating fuel” means any material substance, whether solid, liquid, or gaseous, that can be used to supply heat.

(b) “Heating fuel” includes:

(i) Biofuel;

(ii) Biomethane;

(iii) Coal;

(iv) Hydrogen;

(v) Kerosene;

(vi) Natural gas;

(vii) No. 1 fuel oil;

(viii) No. 2 fuel oil;

(ix) No. 4 fuel oil;

(x) No. 5 fuel oil;

(xi) No. 6 fuel oil;

(xii) Other fuel oil; and

(xiii) Propane.

(c) “Heating fuel” excludes:

(i) Diesel fuel;

(ii) Motor gasoline;

(iii) Wood and wood-derived fuels; and

(iv) Solid waste.

(12) “Heating fuel provider” means a person that delivers heating fuel for final sale or consumption in Maryland.

(13) “Hydrogen fuel” means the use of hydrogen as a fuel source.

(14) Industrial Sector.

(a) “Industrial sector” means the part of the State’s economy that consists of all facilities and equipment used for producing, processing, or assembling goods.

(b) “Industrial sector” includes the following types of activity:

(i) Agriculture;

(ii) Construction;

(iv) Forestry;

(vi) Manufacturing;

(vii) Mining; and

(viii) Oil and gas extraction.

(15) “Kerosene” means a light petroleum distillate that has a maximum distillation temperature of 400 degrees Fahrenheit at the 10-percent recovery point, a final boiling point of 572 degrees Fahrenheit, and a minimum flash point of 100 degrees Fahrenheit and includes No. 1-K and No. 2-K, as defined in ASTM D3699-25, and range or stove oil.

(16) “Motor gasoline” means a complex mixture of relatively volatile hydrocarbons with or without small quantities of additives, blended to form a fuel suitable for use in spark-ignition engines and, as defined in ASTM D 4814-25 or Federal Specification VV-G-1690C, is characterized as having a boiling range of 122 to 158 degrees Fahrenheit at the 10 percent recovery point to 365 to 374 degrees Fahrenheit at the 90 percent recovery point.

(17) “Natural gas” means a gaseous mixture of hydrocarbon compounds with methane as the primary compound and sufficient energy content and a small enough share of impurities for transport through commercial gas pipelines and sale to end-users.

(18) “No. 1 fuel oil” means a light distillate fuel oil that has distillation temperatures of 400 degrees Fahrenheit at the 10-percent recovery point and 550 degrees Fahrenheit at the 90-percent recovery point and meets the specifications in ASTM D396-24.

(19) “No. 2 fuel oil” means a distillate fuel oil that has distillation temperatures of 400 degrees Fahrenheit at the 10-percent recovery point and 640 degrees Fahrenheit at the 90-percent recovery point and meets the specifications in ASTM D396-24.

(20) “No. 4 fuel oil” means fuel oil made by blending distillate fuel oil and residual fuel oil stocks and meeting the specifications in ASTM D396-24 or Federal Specification VV-F-815C.

(21) “No. 5 fuel oil” means heavier oils that remain after the distillate fuel oils and lighter hydrocarbons are distilled away in refinery operations and that meet the specifications in ASTM D396-24, ASTM D975-24a, and Federal Specification VV-F-815C.

(22) “No. 6 fuel oil” means the heaviest oils that remain after the distillate fuel oils and lighter hydrocarbons are distilled away in refinery operations and that meet the specifications in ASTM D396-24, ASTM D975-24a, and Federal Specification VV-F-815C.

(23) “Other fuel oil” means a blend of fuel oils.

(24) “Other energy-consuming sectors” means any consumption of heating fuel that is not associated with the commercial sector, electric power sector, industrial sector, or residential sector.

(25) “Person” means any individual, corporation, partnership, association, joint-stock company, business trust, unincorporated organization, firm, company, limited liability company, government agency, or any other legal entity or form of organization.

(26) “Propane” means a straight-chain, paraffinic hydrocarbon, C3H8, extracted from natural gas or refinery gas streams, which is gaseous at standard temperature and pressure, boils at a temperature of -44 degrees Fahrenheit, and meets the specifications in ASTM D1835-22 and includes HD-5 and HD-10.

(27) “Residential sector” means the part of the State’s economy that consists of living quarters for private households.

(28) “Ton” means a unit of weight equaling 2,000 pounds.

(29) Wood and Wood-Derived Fuels.

(a) “Wood and wood-derived fuels” means wood and products derived from wood that are used as a fuel.

(b) “Wood and wood-derived fuels” include:

(i) Round wood (cord wood);

(ii) Limb wood;

(iii) Wood chips;

(iv) Bark;

(v) Sawdust;

(vi) Forest residues;

(vii) Charcoal;

(viii) Paper pellets;

(ix) Railroad ties;

(x) Utility poles;

(xi) Black liquor;

(xii) Red liquor;

(xiii) Sludge wood;

(xiv) Spent sulfite liquor;

(xv) Densified biomass (which includes wood pellets); and

(xvi) Other wood-based solids and liquids.

.04 Incorporation by Reference.

A. In this chapter, the following documents are incorporated by reference.

B. Documents Incorporated.

(1) ASTM International, ASTM Designation D396-24, “Standard Specification for Fuel Oils”.

(2) ASTM International, ASTM Designation D3699-25, “Standard Specification for Kerosene”.

(3) ASTM International, ASTM Designation D975-24a, “Standard Specification for Diesel Fuel”.

(4) ASTM International, ASTM Designation D1835-22, “Standard Specification for Liquefied Petroleum (LP) Gases”.

(5) ASTM International, ASTM Designation D4814-25, “Standard Specification for Automotive Spark-Ignition Engine Fuel”.

(6) Federal Specification VV-F-815C, “Federal Specification: Fuel Oil, Burner”.

.05 Fuel Delivery Reports.

A. Beginning June 1, 2026 and quarterly thereafter, a heating fuel provider shall submit to the Department a fuel delivery report of any heating fuel that the provider delivered for final sale or consumption in Maryland during the previous quarter.

(1) The quarterly fuel delivery report required under §A of this regulation shall contain:

(a) The provider’s name;

(b) The quarter covered by the report; and

(c) The following information delineated by month:

(i) Separately for each county in Maryland, the total amount of cubic feet, gallons, or tons of each heating fuel delivered by type, as specified in Table 1 of §C of this regulation;

(ii) Separately for each county in Maryland, list the sector or sectors (i.e., commercial, electric power, industrial, residential, or other energy-consuming sectors) receiving the heating fuel as specified under §A(1)(c)(i) of this regulation; and

(iii) Separately for each county in Maryland, if the total amount or the amount for any delivery of a heating fuel is not specified in the provider’s records, invoices, or other documentation, a conservative missing data parameter for the total amount for that product.

(2) The quarterly fuel delivery report shall include an attestation that the report contains the required information, which is true and correct to the best available knowledge.

(3) The quarterly report to be submitted pursuant to §A of this regulation shall be submitted to the Department:

(a) In an electronic format specified by the Department; and

(b) No later than the first day of the third month after the quarter covered by the report, as follows:

(i) June 1 for the reporting period January through March;

(ii) September 1 for the reporting period April through June;

(iii) December 1 for the reporting period July through September; and

(iv) March 1 for the reporting period October through December.

B. Missing Data.

(1) If a conservative missing data parameter is submitted pursuant to §A(1)(c)(iii) of this regulation, the heating fuel provider shall also submit documentation in the required report providing identification of, and explanation for, the data elements selected and utilized to develop the conservative missing data parameter.

(2) If a heating fuel provider fails to submit a complete fuel delivery report in accordance with §A(1) of this regulation, the Department may assign, for each heating fuel specified in Table 1 of §C of this regulation, an estimated amount of cubic feet, gallons, or tons at least as large as the amount actually delivered based on information that the Department deems relevant.

C. Heating Fuels.

Table 1. Heating Fuels.

Biofuel

Biomethane

Coal

Hydrogen Fuel

Kerosene

Natural Gas

No. 1 Fuel Oil

No. 2 Fuel Oil

No. 4 Fuel Oil

No. 5 Fuel Oil

No. 6 Fuel Oil

Other Fuel Oil

Propane

Other (specify)

.06 Recordkeeping Requirements.

A. Recordkeeping requirements. A person subject to this chapter shall maintain the following records for at least 5 years:

(1) Copies of the quarterly reports submitted to the Department pursuant to Regulation .05 of this chapter;

(2) All material received, reviewed, generated, or used to complete the report; and

(3) Any additional information requested by the Department.

B. A person shall provide, by request of the Department, the records required under this regulation.

SERENA MCILWAIN
Secretary of the Environment

Errata

COMAR 08.02.13

At 52:18 Md. R. 926 (September 5, 2025), column 1, line 14 from the top:

For: (ii) When renewing the license;

Read: (ii) When renewing the license; and

COMAR 09.14.18.05

At 52:11 Md. R. 542 (May 30, 2025), column 1, lines 29—47 from the top:

For:

M. Protective garments:

(1) Other than the fighter’s hands, as previously listed, there will be no taping, covering, or protective gear of any kind on the upper body, which includes but is not limited to;

(i) Joint sleeves;

(ii) Padding; and

(iii) Any form of brace or body gauze/tape.

(b) Ankle joint sleeves:

(i.) A fighter may use one soft neoprene type sleeves to cover each ankle joint; and

(ii) Approved sleeves may not have padding, Velcro, plastic, metal, ties, or any other material considered to be unsafe or that may create an unfair advantage

(10) Tape and gauze, or any materials other than the approved sleeves, are not permitted on the lower body.

(11) The allowable length and color of sleeves shall be determined by the Commission.

B. A Muay Thai contestant shall have properly trimmed fingernails and toenails.

Read:

M. Protective Garments.

(1) Other than the fighter’s hands, as previously listed, there will be no taping, covering, or protective gear of any kind on the upper body, which includes but is not limited to:

(a) Joint sleeves;

(b) Padding; and

(c) Any form of brace or body gauze/tape.

(2) Ankle joint sleeves:

(a) A fighter may use one soft neoprene type sleeves to cover each ankle joint; and

(b) Approved sleeves may not have padding, Velcro, plastic, metal, ties, or any other material considered to be unsafe or that may create an unfair advantage.

N. Tape and gauze, or any materials other than the approved sleeves, are not permitted on the lower body.

O. The allowable length and color of sleeves shall be determined by the Commission.

P. A Muay Thai contestant shall have properly trimmed fingernails and toenails.

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 projects by the Susquehanna River Basin Commission during the period set forth in DATES.

DATES: August 1—31, 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: [email protected]. 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 (f) for the time period specified above.

Approvals By Rule - Issued Under 18 CFR 806.22(f):

1. Coterra Energy Inc.; Pad ID: BlaisureJe P2; ABR-202508001; Dimock Township, Susquehanna County, Pa.; Consumptive Use of Up to 6.5000 mgd; Approval Date: August 14, 2025.

2. EQT ARO LLC; Pad ID: Hemlock Pad A; ABR-202508003; McNett Township, Lycoming County, Pa.; Consumptive Use of Up to 5.0000 mgd; Approval Date: August 14, 2025.

3. EQT ARO LLC; Pad ID: RBP; ABR-202508002; McNett Township, Lycoming County, Pa.; Consumptive Use of Up to 5.0000 mgd; Approval Date: August 14, 2025.

4. MODIFICATION - Coterra Energy Inc.; Pad ID: BennerJ P1; ABR-201903005.R1.1; Forest Lake Township, Susquehanna County, Pa.; Consumptive Use of Up to 6.5000 mgd; Approval Date: August 22, 2025.

5. MODIFICATION - Coterra Energy Inc.; Pad ID: LauerD P1; ABR-202203004.1; Springville Township, Susquehanna County, Pa.; Consumptive Use of Up to 6.5000 mgd; Approval Date: August 22, 2025.

6. MODIFICATION - Coterra Energy Inc.; Pad ID: PalkoJ P1; ABR-202309002.1; Lathrop Township, Susquehanna County, Pa.; Consumptive Use of Up to 6.5000 mgd; Approval Date: August 22, 2025.

7. MODIFICATION - Expand Operating LLC; Pad ID: Powers Pad Site; ABR-20090511.R3.1; Forest Lake Township, Susquehanna County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 22, 2025.

8. RENEWAL - BKV Operating, LLC; Pad ID: Sickler 5H; ABR-20100679.R3; Washington Township, Wyoming County, Pa.; Consumptive Use of Up to 5.0000 mgd; Approval Date: August 22, 2025.

9. RENEWAL - EQT ARO LLC; Pad ID: COP Tr 728 Pad A; ABR-20100631.R3; Watson Township, Lycoming County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: August 22, 2025.

10. RENEWAL - Expand Operating LLC; Pad ID: Lattimer; ABR-201008038.R3; Litchfield Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 22, 2025.

11. RENEWAL - S.T.L. Resources, LLC; Pad ID: Coon Hollow 904; ABR-20100560.R3; West Branch Township, Potter County, Pa.; Consumptive Use of Up to 4.9900 mgd; Approval Date: August 22, 2025.

12. RENEWAL - XPR Resources LLC; Pad ID: Alder Run Land LP #2H; ABR-20100454.R3; Cooper Township, Clearfield County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: August 22, 2025.

13. RENEWAL - XTO Energy Inc.; Pad ID: Brown 8519H; ABR-20100604.R3; Moreland Township, Lycoming County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: August 22, 2025.

14. RENEWAL - XTO Energy Inc.; Pad ID: Moser 8521H; ABR-20100641.R3; Franklin Township, Lycoming County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: August 22, 2025.

15. RENEWAL - XTO Energy Inc.; Pad ID: Tome 8522H; ABR-20100556.R3; Moreland Township, Lycoming County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: August 22, 2025.

16. Beech Resources, LLC; Pad ID: Echo Pad; ABR-202508004; Anthony Township, Lycoming County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: August 28, 2025.

17. RENEWAL - Expand Operating LLC; Pad ID: Dave; ABR-201008107.R3; Albany Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 28, 2025.

18. RENEWAL - Repsol Oil & Gas USA, LLC; Pad ID: FEUSNER (03 053) J; ABR-201006100.R3; Columbia Township, Bradford County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: August 28, 2025.

19. RENEWAL - Repsol Oil & Gas USA, LLC; Pad ID: LYON (01 078) S; ABR-20100696.R3; Troy Township, Bradford County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: August 28, 2025.

20. RENEWAL - Repsol Oil & Gas USA, LLC; Pad ID: ROY (03 040) B; ABR-20100650.R3; Wells Township, Bradford County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: August 28, 2025.

21. RENEWAL - Repsol Oil & Gas USA, LLC; Pad ID: ROY (03 046) B; ABR-20100629.R3; Wells Township, Bradford County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: August 28, 2025.

22. RENEWAL - S.T.L. Resources, LLC; Pad ID: Pierson 810; ABR-20100633.R3; Elk and Gaines Townships, Tioga County, Pa.; Consumptive Use of Up to 4.9900 mgd; Approval Date: August 28, 2025.

23. RENEWAL - XTO Energy Inc.; Pad ID: Everbe Farms 8518H; ABR-20100533.R3; Franklin and Penn Townships, Lycoming County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: August 28, 2025.

24. RENEWAL - EXCO Resources (PA), LLC; Pad ID: Confer (Pad 32); ABR-20100669.R3; Burnside Township, Centre County, Pa.; Consumptive Use of Up to 3.0000 mgd; Approval Date: August 29, 2025.

25. RENEWAL - Expand Operating LLC; Pad ID: Bedford; ABR-201008139.R3; Elkland Township, Sullivan County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 29, 2025.

26. RENEWAL - Expand Operating LLC; Pad ID: Benspond; ABR-201008146.R3; Elkland Township, Sullivan County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 29, 2025.

27. RENEWAL - Expand Operating LLC; Pad ID: Fremar; ABR-201008147.R3; Fox Township, Sullivan County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 29, 2025.

28. RENEWAL - Expand Operating LLC; Pad ID: Hottenstein; ABR-201008148.R3; Forks Township, Sullivan County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 29, 2025.

29. RENEWAL - Expand Operating LLC; Pad ID: Redmond; ABR-201007005.R3; Meshoppen Township, Wyoming County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 29, 2025.

30. RENEWAL - Expand Operating LLC; Pad ID: Robinson NEW; ABR-201007036.R3; Orwell Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 29, 2025.

31. RENEWAL - Expand Operating LLC; Pad ID: Roundtop; ABR-201008067.R3; Colley Township, Sullivan County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 29, 2025.

32. RENEWAL - Expand Operating LLC; Pad ID: Shingle Ridge; ABR-202007004.R1; North Branch Township, Wyoming County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 29, 2025.

33. RENEWAL - Expand Operating LLC; Pad ID: Signore Drilling Pad #1; ABR-20100697.R3; Elkland Township, Sullivan County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 29, 2025.

34. RENEWAL - Expand Operating LLC; Pad ID: Simpson; ABR-201007030.R3; West Burlington Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 29, 2025.

35. RENEWAL - Expand Operating LLC; Pad ID: Slumber Valley; ABR-201008015.R3; Meshoppen Township, Wyoming County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 29, 2025.

36. RENEWAL - Expand Operating LLC; Pad ID: Stalford; ABR-20100617.R3; Wyalusing Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 29, 2025.

37. RENEWAL - Expand Operating LLC; Pad ID: Tanner & Hana; ABR-202007003.R1; Wyalusing Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 29, 2025.

38. RENEWAL - Expand Operating LLC; Pad ID: Towner; ABR-20100638.R3; Rome Township, Bradford County, Pa.; Consumptive Use of Up to 7.5000 mgd; Approval Date: August 29, 2025.

39. RENEWAL - Repsol Oil & Gas USA, LLC; Pad ID: SCHUCKER (03 006) A; ABR-20100654.R3; Columbia Township, Bradford County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: August 29, 2025.

40. RENEWAL - S.T.L. Resources, LLC; Pad ID: Simonetti 817 (rev); ABR-20100545.R3; Gaines Township, Tioga County, Pa.; Consumptive Use of Up to 4.9900 mgd; Approval Date: August 29, 2025.

Authority: Public Law 91-575, 84 Stat. 1509 et seq., 18 CFR parts 806 and 808.

Dated: September 10, 2025

JASON E. OYLER,
General Counsel and Secretary to the Commission.

[25-19-10]

SUSQUEHANNA RIVER BASIN COMMISSION

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: August 1-31, 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: [email protected]. 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. Lehigh White Cement Company, LLC – York Plant, GF Certificate No. GF-202508300, West Manchester Township and West York Borough, York County, Pa.; combined withdrawals from Wells 1 and 2 and consumptive use; Issue Date: August 19, 2025.

2. Ward Manufacturing, LLC – Blossburg Facility, GF Certificate No. GF-202508301, Blossburg Borough, Tioga County, Pa.; Water Tower Well, Johnson Creek, and consumptive use; Issue Date: August 19, 2025.

3. Pennsylvania – American Water Company – Forest City Service Territory, GF Certificate No. GF-202508302, Clifford Township, Susquehanna County, and Clinton Township, Wayne County, Pa.; combined withdrawals from the Lackawanna River near Stillwater Lake Reservoir and the Lackawanna River at the Forest City Water Treatment Plant, Brace Brook Reservoir, and Roy Brook Dam; Issue Date: August 19, 2025.

4. Cleveland-Cliffs Steel LLC – Cleveland-Cliffs Steelton LLC, GF Certificate No. GF-202508303, Steelton Borough, Dauphin County, Pa.; Susquehanna River and consumptive use; Issue Date: August 19, 2025.

Authority: Public Law 91-575, 84 Stat. 1509 et seq., 18 CFR parts 806 and 808.

Dated: September 10, 2025.

JASON E. OYLER,

General Counsel and Secretary to the Commission.

[25-19-11]

WATER AND SCIENCE ADMINISTRATION

Water Quality Certification 25-WQC-0008

McDaniel Yacht Basin, Inc

c/o Philip A Cianelli

15 Grandview Ave

North East, Maryland 21901

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 25-WQC-0008.

Location: 15 Grandview Ave, 39.577529 / -75.950196, North East, MD 21901

The purpose of the project is to reconfigure an existing marina, improve navigable access and control shoreline erosion.

Description of Authorized Work:

The project proposes to reconfigure an existing marina, dredge within the existing basin, and control erosion along the shoreline by performing the following: (1) removal of existing piers, finger piers, and mooring piles and replacement and construction of piers, walkways, finger piers, boatlifts, boathouse, a floating double kayak launch, and mooring piles of various lengths and channelward encroachments; (2) construction of a boat ramp and access piers; (3) replacement in-kind of 4,077 linear feet of existing bulkhead; (4) construction of a breakwater and a wave screen; and (5) mechanically dredging a total of 16,433 square feet (0.38 acres) within the marina to various depths and to provide periodic maintenance dredging for six years. Mitigation for 8,364 square feet of new dredging in shallow water habitat was satisfied by payment into the Wetland Compensation Fund of $17,313.48.

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: Willem Brown at [email protected] or 410-537-3622.

[25-19-05]

WATER AND SCIENCE ADMINISTRATION

Water Quality Certification 25-WQC-0013

Indian landing Boat Club

930 Indian Landing Road

Millersville, MD 21108

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 25-WQC-0013.

Location: 930 Indian Landing Road, 39.07962282 / -76.61016644, Annapolis, MD 21108

The purpose of the project is beach nourishment and shoreline stabilization.

Description of Authorized Work:

1. Construct a living shoreline with eight low profile stone, sand containment structures totaling 1,160 feet in length and varying between 6 and 10-feet wide, extending a maximum of 48-feet channelward of the mean high water line;

2. Construct a living shoreline on an existing eroding island with nine stone, sand containment structures totaling 497 feet in length and varying between 7 and 13-feet wide, extending a maximum of 54-feet channelward of the mean high water line;

3. Construct a living shoreline on an eroding island with two stone sand containment structures totaling 73 feet in length by 6-feet wide and one 207-foot long by 15-foot wide living breakwater, extending a maximum of 52-feet channelward of the mean high water line;

4. Fill and grade with 2,900 cubic yards of sand fill and plant with approximately 40,961 square feet of marsh vegetation.

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: Alaina Johnson at [email protected] or 410-537-4272.

[25-19-06]

WATER AND SCIENCE ADMINISTRATION

Advanced Notice of Proposed Rulemaking (ANPRM)

Updates to Maryland’s Stormwater Management Regulations and Design Manual

The Maryland Department of the Environment (MDE) is considering revisions to regulations in COMAR 26.17.02, with a focus on updating stormwater management requirements and the design manual to reflect modern rainfall data, climate-driven flood risks, and statewide consistency.

Background and Authority

Maryland law, beginning in 2021, requires MDE to review precipitation data and update stormwater regulations at least once every five years. The last major update occurred in 2010, prior to this new statutory requirement. Since then, rainfall patterns, storm intensity, and flood risks have shifted significantly. MDE has completed a multi-year effort that included conducting broad-scoping research, collecting flooding data, engaging with outside experts, and collaborating with key stakeholders. MDE has drafted regulatory and design manual updates that reflect this multi-year collaborative effort. MDE is initiating early public engagement through a process known as an Advanced Notice of Proposed Rulemaking (ANPRM).

Stakeholder Engagement Process

The draft updated regulations and design manual released with this ANPRM are the product of a two‑year collaborative process under the Advancing Stormwater Resiliency in Maryland (A‑StoRM) stakeholder workgroup (2023–2025). This group included representatives from local governments, state and federal agencies, engineers, developers, environmental organizations, and academic experts. The workgroup’s charge was to:

● Review technical standards and precipitation data

● Assess climate and flood resiliency needs

● Evaluate redevelopment and equity considerations

● Recommend practical and defensible revisions

Consensus was achieved on many technical standards, such as adoption of updated rainfall data, while balanced middle‑ground approaches were developed for more complex issues like peak‑flow management. The outcomes of the stakeholder workgroup provide the foundation for these draft materials. Through this ANPRM, MDE is seeking broader public input to strengthen that foundation, address any remaining considerations, and ensure the final regulations are both technically sound and responsive to communities statewide.

How to Use This Notice

This ANPRM is an early opportunity for stakeholders and the public to provide input on potential updates to Maryland’s stormwater management regulations and design manual. It is not a formal rulemaking. Feedback received at this stage will guide MDE in shaping the draft regulations before they are formally proposed for adoption in the Code of Maryland Regulations (COMAR). At that point, the proposed regulations will also be published in the Maryland Register and subject to public comment.

Supporting materials, including the draft updated regulations and design manual, are available on MDE’s Stormwater Management Updates webpage. Stakeholders are encouraged to review these materials together with this notice and provide comments on both the specific language and broader policy questions.

Goals of the Revisions

Since the last major stormwater regulation update in 2010, Maryland has faced new and evolving challenges that make revisions necessary. These proposed updates to COMAR 26.17.02 and the design manual are both timely and essential. The goals are to:

● Address Climate Change and Flood Risk
Maryland is experiencing more intense short-duration storms, higher total annual rainfall, and increased localized flooding, particularly in urban areas. Outdated design rainfall values do not adequately capture these risks, leaving communities more vulnerable. Updated rainfall data and design standards are needed to strengthen resiliency.

● Overcome Performance Limitations of Current Practices
Smaller Environmental Site Design (ESD) practices are frequently overwhelmed during larger storm events. Minimum design criteria require recalibration to balance water quality protection, groundwater recharge, and flood management. Revised standards will ensure practices are effective under today’s storm conditions.

● Ensure Consistency Across Jurisdictional Boundaries
Inconsistent local application of standards has created uncertainty for developers, regulators, and communities. Clearer, updated statewide standards will provide a predictable, enforceable framework for project design and approval, improving efficiency and equity.

● Meet Statutory Mandates and Advance the A-StoRM Initiative
The updates will fulfill the requirements of SB227 (2021), which directs MDE to periodically review precipitation data and update stormwater standards, and implement outcomes from the A-StoRM stakeholder workgroup.

Major Topics for Review

MDE is seeking input on the following draft updates to Maryland’s stormwater management regulations and design manual. These topics represent areas where stakeholder feedback is especially important to ensure the regulations are practical, science-based, and effective in protecting communities and waterways:

● Update Rainfall Data
Stakeholders are invited to comment on replacing outdated design storm values (TP-40) with modern NOAA Atlas 14 data, and on the proposed region-specific rainfall capture amounts for water quality treatment:

○ Western Maryland: capture/treat 1.0 inch of rain

○ Central, Eastern, Southern Maryland: capture/treat 1.5 inches of rain
MDE seeks input on whether these capture values appropriately reflect regional differences in rainfall and storm intensity.

● Improve Stream and Flood Protection
MDE seeks comment on requiring management of the 1-year storm with a climate change adjustment to reduce streambank erosion, and on requiring 10-year storm peak flow management statewide (with climate adjustments) to reduce local flooding risks. Feedback is requested on whether these measures will provide adequate protection while remaining feasible to implement.

● Balanced Approach for Using Stormwater Practices
MDE proposes to clarify the roles of different practices and seeks stakeholder feedback on:

○ Requiring the use of ESD practices to provide stormwater quality treatment and groundwater recharge.

○ Requiring the use of ESD practices to provide channel protection for small runoff volumes.

○ Requiring the use of larger structural practices to provide channel protection for larger volumes and for flood control.

Input is requested on whether these requirements strike the right balance between water quality, recharge, channel protection, and flood management.

● Implementation and Transition
To ensure effective implementation, MDE is specifically requesting input on:

○ Effective Date of New Standards: Are the proposed 6- and 18-month compliance deadlines for local approval authorities reasonable?

○ Transitioning of Vested Projects: What thresholds (e.g., plan approval or design completion percentages) should define a vested project, and what transition timelines are most appropriate?

○ Local Ordinance and Manual Updates: What are realistic timelines for local governments to align ordinances and technical manuals, and would a state-developed model ordinance be helpful?

○ Training and Certification: What training formats (online, in-person, exams) and target audiences will best ensure designers, reviewers, and inspectors are prepared?

○ State Support and Technical Assistance: What additional tools (e.g., checklists, templates, guidance documents) should MDE provide to support consistent implementation statewide?

Who Are Affected by the Regulations?

The draft stormwater regulations and design manual will apply to both private and public land development projects across the state. This includes:

● Residential subdivisions and redevelopment projects

● Commercial and industrial facilities

● Institutional projects such as schools and hospitals

● Public infrastructure projects, including transportation and utility facilities

Consideration will also be given to vested projects that have already reached certain milestones in the design or approval process. These projects will be allowed to proceed under the prior standards. MDE seeks input on how vested projects should be defined and treated during the transition.

Comment Period

MDE invites written comments on this ANPRM through December 19, 2025. Please include your name/organization and, where possible, cite specific sections of the draft regulations or design manual your comments address.

How to submit:
Email: [email protected]
Mail: Raymond P. Bahr, Maryland Department of the Environment, 1800 Washington Boulevard, Baltimore, MD 21230

Attachments and supporting analyses are welcome. All comments received during the comment period will inform the development of the formal, proposed regulations.

Listening Sessions

To ensure broad participation, MDE will host three listening sessions at different times and in different formats. These sessions provide an opportunity to ask questions and share feedback directly with MDE staff.

● October 22, 2025 – Virtual Session, 7:00–9:00 PM

● October 28, 2025 – Virtual Session, 2:00–4:00 PM

● November 13, 2025 – In-person Session at MDE Headquarters (1800 Washington Boulevard, Baltimore, MD), 10:00 AM.

Registration details, access links, and instructions for participation are posted on the Stormwater Management Updates webpage. All sessions will include time for public comment, and written feedback is welcome in addition to oral remarks shared during the sessions.

Schedule

MDE anticipates the following timeline for the regulatory update process:

● ANPRM Public Comment Period: September 19 – December 19, 2025. Stakeholder input during this period will guide revisions to the draft regulations and design manual.

● Proposed Regulations: Spring 2026. A formal proposal will be published in the Maryland Register, reflecting public and stakeholder feedback from the ANPRM stage.

● Final Regulations: Fall 2026. Following formal notice, comment, and review, MDE expects to adopt final regulations and publish the updated design manual.

Supporting Materials

To support stakeholder review and comment, MDE has prepared the following draft materials:

● Draft Regulations (PDF): Early draft text illustrating proposed revisions to COMAR 26.17.02.

● Draft Updated Design Manual (PDF): Proposed updates to technical standards and design requirements.

In addition, supporting visual aids (such as figures, diagrams, and appendices) will be finalized and added after the comment period to ensure alignment with the adopted text.

[25-19-07]

WATER AND SCIENCE ADMINISTRATION

Advanced Notice of Proposed Rulemaking - Nontidal Mitigation

The Maryland Department of the Environment (MDE) is considering revisions to regulations in COMAR 26.23.01 through 26.23.05, with a focus on the nontidal wetland mitigation regulations. This notice is intended to highlight the main areas where MDE is inviting input and providing context for the draft revisions. Stakeholders are encouraged to read the narrative overview together with the draft regulations and provide feedback on both the specific language and the broader policy questions outlined below.

The revisions are intended to:

1. Improve consistency with federal requirements under the 2008 Federal Mitigation Rule (Code of Federal Regulations 33 CFR Parts 325 and 332 for the Department of the Army and 40 CFR Part 230 for the U.S. Environmental Protection Agency for Compensatory Mitigation for Losses of Aquatic Resources);

2. Achieve consistency with Maryland law, specifically statutory amendments (§§5-901 and 5-910, Environment Article, Annotated Code of Maryland; adopted in 2016 for Nontidal Wetlands – Nontidal Wetland Mitigation Banking) to support mitigation banking and remove barriers to its use;

3. Strengthen MDE’s regulatory authority to implement in-lieu fee and mitigation banking programs in a manner consistent with federal requirements (e.g., establishing an in-lieu fee program that can also be used to satisfy federal requirements);

4. Enable MDE to continue to require and oversee compensatory mitigation on behalf of the U.S. Army Corps of Engineers through a State Programmatic General Permit; and

5. Improve mitigation outcomes, by increasing the likelihood that compensatory mitigation requirements will be successfully completed in a timely manner.

MDE welcomes feedback on both the draft regulatory text and the broader concepts described above. Input received during this ANPRM stage will guide whether and how MDE moves forward with formal rulemaking. MDE is inviting the public’s input on several areas in need of revision, including:

1. Clarifying the order of preference among mitigation options, emphasizing environmentally preferable approaches and accounting for impacts to overburdened and underserved communities.

2. Expanding and clarifying mitigation options, thereby reducing permitting hurdles and resulting in higher-functioning mitigation projects:

a. Encouraging establishment of mitigation banks - include consistent requirements for mitigation banks, in-lieu fee, and permittee-responsible mitigation.

b. Developing a robust in-lieu fee program that is recognized by the U.S. Army Corps of Engineers, which includes establishing realistic in-lieu fee rates.

3. Improve replacement of lost nontidal wetland acreage and function.

4. Consider the effects of changing environmental conditions.

5. Update requirements for mitigation plan approval and construction timing, financial assurances, and performance monitoring.

In addition to the option to submit written comments, three Listening Sessions have been scheduled at different times and formats to give the public multiple ways to provide comments to MDE:

● A virtual Listening Session has been scheduled for October 15, 2025, starting at 7:00 PM and ending no later than 9:00 PM. To participate in this Listening Session, please use the following link: meet.google.com/zvo-dche-qav or dial 1-240-200-0677 PIN: 556 633 964#

● An in-person Listening Session with a virtual listen-only option will be held on October 23, 2025, at the Maryland Department of the Environment, 1800 Washington Boulevard, Baltimore, MD, 21230, starting at 9:30 AM and ending no later than 11:30 AM. To join this Listening Session virtually, please use the following link: meet.google.com/emz-ysyp-nes or dial 1-513-463-8951 PIN: 330 540 281#

● A virtual Listening Session has been scheduled for October 30, 2025, starting at 2:00 PM and ending no later than 4:00 PM. To participate in this Listening Session, please use the following link: meet.google.com/fyv-bxuy-noo 1-209-783-9110 PIN: 665 265 782#

Comments on these regulations should be sent by December 18, 2025, to: Ms. Kelly Neff, Wetlands and Waterways Protection Program, Maryland Department of the Environment, 1800 Washington Boulevard, Baltimore, MD 21230. Email: [email protected]

More information on the proposed regulations can be found at https://mde.maryland.gov/programs/Water/WetlandsandWaterways/AboutWetlands/Pages/ANPRM-Nontidal-Wetland-Mitigation.aspx.

[25-19-08]

DEPARTMENT OF STATE POLICE

HANDGUN ROSTER BOARD

Proposed Additions to Handgun Roster and Notice of Right to Object or Petition

     The following is a list of handguns that the Handgun Roster Board proposes to add to the official handgun roster.  These handguns will be officially placed on the Handgun Roster if no timely objection is received or if all timely objections are dismissed.

     Under the Public Safety Article, §5-405, Annotated Code of Maryland and COMAR 29.03.03.13 and .14, any person may object to the placement of any of those handguns on the Handgun Roster.  Objections must be filed within 30 days after September 19, 2025.  In addition, any person may petition for the placement of an additional handgun on the Handgun Roster.  Forms for objections or petitions may be obtained from: Rachel Rosenberg, Administrator, Handgun Roster Board, 1201 Reisterstown Road, Baltimore, Maryland 21208 (Phone: 410-653-4247).

Make	Model	Caliber	Additional Comments
SMITH & WESSON	66-6	357 Mag	Model addition
ZASTAVA (SOUTHERN TACTICAL)	M1983/1990	357 Mag	Model addition
BERETTA (BERETTA USA)	PX4 Storm Compact	9 mm	Model addition
BUL TRANSMARK, LTD (MAGNUM RESEARCH)	MR1911CSS	45 ACP	Model addition
PALMETTO STATE ARMORY	JAKL-9	9 mm	Model addition
PALMETTO STATE ARMORY	JAKL-V	9 mm	Model addition
CZ (CZ USA)	Shadow 2 Target	9 mm	Model addition
SIG SAUER/SIGARMS INC.	P320-XTEN ENDURE COMP	10 mm	Model addition
BERETTA (BERETTA USA)	80X Cheetah Tactical Urban	380 ACP	Model addition
TISAS (MILITARY ARMAMENT CORPORATION)	MAC 9 DS-D COMP	9 mm	Model addition
AMERICAN TACTICAL	FXH-45C	45 ACP	Model addition
AMERICAN TACTICAL	FXH-45DSC	45 ACP	Model addition
TISAS (SDS Arms)	1911 A1 U.S. ARMY	45 ACP	Model addition
SMITH & WESSON	617-6	22 LR	Model addition
SMITH & WESSON	629 Mountain Gun	44 Mag	Model addition
SMITH & WESSON	686 Plus Mountain Gun	357 Mag	Model addition
SMITH & WESSON	642-2 LADY SMITH	38 S&W SPL +P	Model addition
Taylor's & Company	TC9 1873 Single Action	9 mm	Model addition
CHARTER ARMS	Target Mastiff	357 Mag	Model addition
BOND ARMS	The First Lady	38 Spl	Model addition
TISAS	M1911 A1 U.S. Army CMP	45 ACP	Model addition
BUL ARMORY (BUL ARMORY USA, LLC)	1911 COMMANDER	45 ACP, 9 mm	Model addition
CZ (CZ USA)	P-10 C PORTED	9 mm	Model addition
RADIKAL (GFORCE ARMS)	RPX9 EXODUS TACTICAL	9 mm	Model addition
TAURUS ARMAS (TAURUS INTERNATIONAL MFG.)	605 Executive Grade	357 Mag	Model addition
F. TANFOGLIO (ITALIAN FIREARMS GROUP)	DEFIANT STOCK MASTER	10 mm	Caliber addition
LugerMan Inc.	Luger P2020	45 ACP
STURM RUGER	NEW MODEL BLACKHAWK BISLEY	44 Spl	Model addition
SHADOW SYSTEMS CORP	CR920XL	9 mm	Model addition
DARK FORGE	REAPER	9 mm	Model addition
DARK FORGE	WRAITH	9 mm	Model addition
F. TANFOGLIO (ITALIAN FIREARMS GROUP)	DEFIANT STOCK MASTER	38 SA	Caliber addition
SMITH & WESSON	M&P SHIELD X	9 mm	Model addition
KIMBER	Comp X Hunter 10	10 mm	Model addition
DERYA ARMS (DERYA)	DY9Z	9 mm	Model addition
ROCK ISLAND ARMORY	M1911 A2 Tac Ultra FS HC	10 mm	Model addition
ROST MARTIN	RM1S	9 mm	Model addition
SMITH & WESSON	629-9 Mountain Gun	44 Mag	Model addition
SMITH & WESSON	Performance Center Bodyguard 2.0 Carry Comp	380 ACP	Model addition
KIMBER	Micro 9 Hero Custom	9 mm	Model addition
Advanced Small Arms Industries (Magnum Research)	One Pro .45	45 ACP	Model addition
FN AMERICA LLC	High Power	9 mm
SIG SAUER/SIGARMS INC.	P226-XFIVE Reserve	9 mm	Model addition
KORTH (MMB IMPORTS, LLC)	National Standard	357 Mag/9 mm	Model addition
SMITH & WESSON	625 "Model of 1989"	45 ACP	Model addition
SMITH & WESSON	625 Mountain Gun	45 Colt	Model addition
HECKLER & KOCH	P9S	9 mm	Caliber addition
MATRIX ARMS	MXI	9 mm	Model addition
ROST MARTIN	RM1C Comp	9 mm	Model addition
SIG SAUER/SIGARMS INC.	P211-GTO	9 mm	Model addition

[25-19-03]

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.

FIRE PREVENTION COMMISSION

Subject: Public Meeting

Date and Time: October 16, 2025, 10 a.m.

Place: Maryland State Police Headquarters Museum Building 1201 Reisterstown Road, Pikesville, MD

Add'l. Info: Portions of the meeting may be held in closed session. If public schools in Baltimore County are CLOSED due to inclement weather, the meeting and any appeals will be rescheduled.

Contact: Heidi Ritchie 877-890-0199

[25-19-02]

MARYLAND HEALTH CARE COMMISSION

Subject: Formal Start of Review

Add’l Info: The Maryland Health Care Commission (MHCC) hereby gives notice of docketing of the following application for Certificate of Need:

AAMC Surgery Center---Annapolis,—AAMC Surgery Center operates in its current location as an ASC-2, with two operating rooms and no procedure rooms. It seeks to operate an Ambulatory Surgical Facility (ASF) with three total operating rooms and one procedure room. Space adjacent to the current facility will be leased and renovated for the purpose of expanding to accommodate the additional OR and procedure room. The services will be provided in Anne Arundel County at AAMC Surgery Center located at 904 Commerce Road, Annapolis, MD 21401.

MHCC shall review the applications under Maryland Health-General Code Annotated, Section 19-101 et seq., COMAR 10.24.01, and the applicable State Health Plan standards. Any affected person may make a written request to the Commission to receive copies of relevant notices concerning the application(s). All further notices of proceedings on the application(s) will be sent only to affected persons who have registered as interested parties.

Persons desiring to become interested parties in the Commission’s review of the above- referenced application(s) must meet the requirements of COMAR 10.24.01.01B(20) and (2) and must also submit written comments to the Commission at [email protected] no later than close of business October 20, 2025. These comments must state with particularity the State Health Plan standards or review criteria that you believe have not been met by the applicant(s) as stated in COMAR 10.24.01.08F.

Please refer to the Docket Number listed above in any correspondence on the application(s). Copies of the application are available for review in the office of MHCC during regular business hours by appointment. All correspondence should be addressed to:

Wynee Hawk,

Director Center for Health Care Facilities and Planning

Maryland Health Care Commission

4160 Patterson Avenue

Baltimore, Maryland 21215

[25-19-13]

MARYLAND DEPARTMENT OF HEALTH

Subject: Public Meeting

Date and Time: November 6, 2025, 9 a.m. —1p.m.

Place: Virtual meeting — please see details below., MD

Add'l. Info: Please be advised that the Nov 6, 2025, Pharmacy and Therapeutics (P&T) Committee public meeting will be conducted virtually via a Webinar.

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

Contact: Sierra Roberson (410) 767-1455

[25-19-01]

MARYLAND DEPARTMENT OF HEALTH/WORKGROUP ON NEWBORN HOME VISITING SERVICES

Subject: Public Meeting

Date and Time: October 6, 2025, 2—4:30 p.m. October 31, 2025; November 20, 2025

Place: Video call link: https://meet.google.com/hiv-yjfv-nse
Or dial: (US) +1 727-258-2453 PIN: 782 196 722#

More phone numbers: https://tel.meet/hiv-yjfv-nse?pin=6127904358243 ,

Contact: Jody Sheely 443-683-1511

[25-19-04]