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

2. B. Terms Defined.

   1. (1) “Accredited hospital” means a hospital accredited by The Joint Commission or other accreditation organization approved by the Department.
   2. (2) “Accredited special rehabilitation hospital” means a hospital that is accredited by the Commission on Accreditation of Rehabilitation Facilities for providing comprehensive physical rehabilitation services.
   3. (2-1) “Accreditation organization” means a private entity that conducts inspections and surveys of health care facilities based on nationally recognized and developed standards.
   4. (3) “Administrative day” means a day of care rendered to a patient who no longer requires the level of care the hospital is licensed to provide.
   5. (4) “Admission” means the formal acceptance by a hospital of a patient who is to be provided with room, board, and medical services.

   6. (4-1) Aftercare.

      1. (a) “Aftercare” means any assistance provided by a lay caregiver to a patient after discharge of the patient.
      2. (b) “Aftercare” includes tasks that are limited to the patient’s condition at the time of discharge that do not require a licensed professional.
   7. (5) “Agent” means the individual or individuals, or organization that shall conduct utilization review activities in fulfillment of a hospital's responsibilities under these regulations. The agent may be a hospital employee or employees, or it may be an independent group or organization.
   8. (6) “Appointment” means designation of a physician to have staff privileges at the hospital.
   9. (7) “Authorized decision maker” means the health care agent, guardian of the person, or surrogate decision maker who is making health care decisions on behalf of a patient in accordance with the Health Care Decisions Act, Health-General Article, §§5-601—5-618, Annotated Code of Maryland.
   10. (8) “Calculated licensed bed capacity” means the total number of inpatient beds recalculated annually as 140 percent of a general hospital's average daily census as determined by the Health Services Cost Review Commission for the most recent 12-month period.
   11. (9) “Claim” means a written demand for damages as a result of alleged professional malpractice.
   12. (10) “Commission on Accreditation of Rehabilitation Facilities” means the private, nonprofit organization formed in 1966 which has established standards of quality for rehabilitation services and accredits those who provide the services.
   13. (11) “Comprehensive physical rehabilitation services” has the same meaning as defined in Health-General Article, §19-1201(b), Annotated Code of Maryland.

   14. (12) “Credentialing process” means the process by which a hospital:

       1. (a) Verifies qualifications of a physician;
       2. (b) Delineates clinical privileges of a physician; and
       3. (c) Monitors performance of a physician.
   15. (13) “Department” means the Maryland Department of Health.
   16. (14) “Elective”, when applied to admission or to a health care service, means an admission or service that can be delayed without substantial risk to the health of the individual.

   17. (15) “Healthcare-associated infection” means an infection that:

       1. (a) Develops in a patient who is cared for in any setting where healthcare is delivered; and
       2. (b) Was not incubating or present at the time the healthcare was provided.

   18. (16) “Hospital” means an institution that:

       1. (a) Has a group of at least five physicians who are organized as a medical staff for the institution;
       2. (b) Maintains facilities to provide, under the supervision of the medical staff, diagnostic and treatment services for two or more unrelated individuals; and
       3. (c) Admits or retains the individuals for overnight care.
   19. (17) “Incident” means any circumstance or occurrence that may be injurious to a patient or that may result in an adverse outcome to a patient.
   20. (18) “The Joint Commission” means the voluntary national healthcare accreditation service recognized for Medicare certification purposes by Public Law 89-97 and for Maryland State licensure purposes by Health-General Article, §19-2302, Annotated Code of Maryland.

   21. (18-1) “Lay caregiver” means an individual who:

       1. (a) Is an adult;
       2. (b) Is designated as a lay caregiver by a patient or the legal guardian of a patient; and
       3. (c) Performs aftercare for the patient at the residence of the patient.
   22. (19) “License” means a license issued by the Secretary to operate a hospital in this State.
   23. (20) “Long-term care” means, for the purpose of this chapter, care provided in a hospital, but is designed to treat conditions requiring treatment at a level below that of acute hospital care.
   24. (21) “Maryland Medical Assistance Program” means the program administered by the State under Title XIX of the Social Security Act which provides comprehensive medical and other health-related care for eligible categorically and medically needy persons. For the purpose of this chapter, this shall include those persons provided care under the program administered and financed by the State for eligible needy persons who do not meet the technical requirements of federally funded Medical Assistance.
   25. (22) “Medical Orders for Life Sustaining Treatment (MOLST) form” means the form required to be developed pursuant to Health-General Article, §5-608.1, Annotated Code of Maryland.
   26. (23) “Medicare Program” means the federal program of health insurance for the aged and disabled established pursuant to 42 U.S.C. §1395 et seq.

   27. (24) “Nonaccredited hospital” means a:

       1. (a) Hospital not accredited by The Joint Commission or other accreditation organization approved by the Department; or
       2. (b) Special rehabilitation hospital not accredited by The Joint Commission.
   28. (25) “Nonelective”, when applied to admission or to a health care service, means an admission or service that cannot be delayed without substantial risk to the health of the individual.

   29. (26) “Palliative care” means specialized medical care for individuals with serious illnesses or conditions that:

       1. (a) Is focused on providing patients with relief from the symptoms, pain, and stress of a serious illness or condition, whatever the diagnosis;
       2. (b) Has the goal of improving quality of life for the patient, the patient’s family, and other caregivers;
       3. (c) Is provided at any age and at any stage in a serious illness or condition; and
       4. (d) Can be provided along with curative treatment.
   30. (27) “Palliative care program” means an interdisciplinary team that provides palliative care services.
   31. (28) “Physician” has the meaning stated under Health Occupations Article, §14-101(j), Annotated Code of Maryland.
   32. (29) “Plan” means a thorough written specification of how the elements of review required by these regulations shall be performed.

   33. (30) “Privilege” means the authority granted to a physician by a hospital to:

       1. (a) Admit patients to the hospital; or
       2. (b) Perform specific procedures or treatments on patients at the hospital.

   34. (30-1) Residence.

       1. (a) “Residence” means a dwelling that a patient considers to be home.

       2. (b) “Residence” does not include:

          1. (i) A rehabilitation facility;
          2. (ii) A hospital;
          3. (iii) A nursing home;
          4. (iv) An assisted living; or
          5. (v) A group home licensed by the State.
   35. (31) “Secretary” means the Secretary of Health.
   36. (32) “Specialized rehabilitation program” has the meaning stated in Health-General Article, §19-1201(e), Annotated Code of Maryland.

   37. (33) Telemedicine.

       1. (a) “Telemedicine” means the use of interactive audio, video, or other telecommunications or electronic technology by a physician in the practice of medicine outside the physical presence of the patient.

       2. (b) “Telemedicine” does not include:

          1. (i) An audio only telephone conversation between the physician and patient;
          2. (ii) An electronic mail message between a physician and a patient; or
          3. (iii) A facsimile transmission between a physician and a patient.
   38. (34) “Unexpected adverse outcomes” means unanticipated negative outcomes related to a patient’s medical treatment and not related to the natural course of the patient’s illness or underlying disease condition.

   39. (35) “Uniform standard credentialing form” means:

       1. (a) The form designated by the Department through COMAR 10.07.01.24C(6) for credentialing physicians who seek to be employed by or have staff privileges at a hospital; or
       2. (b) The uniform credentialing form that the Insurance Commissioner designates under Insurance Article, §15–112.1, Annotated Code of Maryland.
   40. (36) “Utilization review” means a system for reviewing the appropriate and efficient allocation of hospital resources and services given or proposed to be given to a patient or group of patients.
   41. (37) “Utilization review plan” means a description of the standards governing utilization review activities performed by a private review agent or hospital utilization review agent.

Authority: Health-General Article, §§19-307.2, 19-308, 19-308.6, 19-308.8, 19-318—19-320, 19-323, 19-342, 19-349.1, and 19-380—19-385; Insurance Article, Title 4, Subtitle 4; Public Safety Article, §14-110.1; Annotated Code of Maryland

Effective date: December 19, 1946

Amended effective March 20, 1959

Amended effective September 1, 1964

Regulations .03C, G, I, K; .04B, D; .05A, B; .06C; .07B, E; .08A, B; .09B, C; .10F; .11A, B; .12F amended effective February 24, 1978 (5:4 Md. R. 226)

Regulations .01—.13 repealed and new Regulations .01—.10 adopted effective August 1, 1983 (10:15 Md. R. 1350)

Regulation .01 amended as an emergency provision effective August 12, 1985 (12:18 Md. R. 1756), emergency status expired December 10, 1985; adopted permanently effective December 16, 1985 (12:25 Md. R. 2471)

Regulation .01 amended effective May 23, 1994 (21:10 Md. R. 844)

Regulations .01, .02B, .04A, .05A, .07, .08B amended; .02C, .09D, and new .10 and .11 adopted; existing .10—.20 recodified as .12—.22 as an emergency provision effective July 1, 1986 (13:15 Md. R. 1726); adopted permanently effective December 1, 1986 (13:24 Md. R. 2558)

Regulation .01B amended effective December 28, 1987 (14:26 Md. R. 2746); August 6, 1990 (17:15 Md. R. 1858)

Regulation .01B amended as an emergency provision effective July 1, 2000 (27:15 Md. R. 1396); amended permanently effective October 30, 2000 (27:21 Md. R. 1975)

Regulation .01B amended effective November 11, 2002 (29:22 Md. R. 1721); April 21, 2008 (35:8 Md. R. 804); June 28, 2010 (37:13 Md. R. 852); April 16, 2012 (39:7 Md. R. 491); March 31, 2014 (41:6 Md. R. 378); March 27, 2017 (44:6 Md. R. 325); April 23, 2018 (45:8 Md. R. 420)

Regulation .02 recodified to be Regulation .03 and new Regulation .02 adopted effective July 4, 2016 (43:13 Md. R. 712)

Regulation .02 amended effective April 13, 2026 (53:7 Md. R. 328)

Regulation .02D adopted effective November 11, 2002 (29:22 Md. R. 1721)

Regulation .02D repealed effective June 28, 2010 (37:13 Md. R. 852)

Regulation .03 repealed and Regulation .02 recodified to be Regulation .03 effective July 4, 2016 (43:13 Md. R. 712)

Regulation .03 amended effective June 24, 1991 (18:12 Md. R. 1338)

Regulation .03A amended effective November 11, 2002 (29:22 Md. R. 1721); June 28, 2010 (37:13 Md. R. 852)

Regulation .04 amended effective June 28, 2010 (37:13 Md. R. 852)

Regulation .04A amended effective November 11, 2002 (29:22 Md. R. 1721)

Regulation .04A, C amended effective March 13, 2017 (44:5 Md. R. 292)

Regulation .04D amended effective February 26, 2007 (34:4 Md. R. 400)

Regulation .05 amended effective November 11, 2002 (29:22 Md. R. 1721)

Regulation .05A amended effective June 28, 2010 (37:13 Md. R. 852)

Regulation .06A amended as an emergency provision effective November 20, 2019 (46:26 Md. R. 1162); emergency status expired May 18, 2020

Regulation .06C adopted as an emergency provision effective November 20, 2019 (46:26 Md. R. 1162); emergency status expired May 18, 2020

Regulation .06-1 adopted as an emergency provision effective July 1, 2000 (27:15 Md. R. 1396); adopted permanently effective October 30, 2000 (27:21 Md. R. 1975)

Regulation .07 amended effective December 28, 1987 (14:26 Md. R. 2746); June 28, 2010 (37:13 Md. R. 852)

Regulation .07A amended effective November 11, 2002 (29:22 Md. R. 1721)

Regulation .08 amended effective November 11, 2002 (29:22 Md. R. 1721)

Regulation .08B adopted effective June 28, 2010 (37:13 Md. R. 852)

Regulation .08B amended effective April 13, 2026 (53:7 Md. R. 328)

Regulation .09 amended effective June 24, 1991 (18:12 Md. R. 1338); November 11, 2002 (29:22 Md. R. 1721); June 28, 2010 (37:13 Md. R. 852)

Regulation .09A amended effective February 26, 2007 (34:4 Md. R. 400); March 31, 2014 (41:6 Md. R. 378); April 13, 2026 (53:7 Md. R. 328)

Regulation .10A amended effective June 24, 1991 (18:12 Md. R. 1338); November 11, 2002 (29:22 Md. R. 1721)

Regulations .11—.20 adopted as an emergency provision effective August 12, 1985 (12:18 Md. R. 1756), emergency status expired December 10, 1985; adopted permanently effective December 16, 1985 (12:25 Md. R. 2471)

Regulation .13 amended effective May 23, 1994 (21:10 Md. R. 844)

Regulation .20 amended effective December 28, 1987 (14:26 Md. R. 2746)

Regulation .21 repealed effective March 13, 2017 (44:5 Md. R. 292)

Regulation .22 repealed effective May 23, 1994 (21:10 Md. R. 844)

Regulation .22 adopted effective April 16, 2012 (39:7 Md. R. 491)

Regulation .23 adopted effective February 22, 1988 (15:4 Md. R. 473)

Regulation .23A and C amended as an emergency provision effective June 9, 1988 (15:14 Md. R. 1653); emergency status expired December 9, 1988; adopted permanently effective December 26, 1988 (15:26 Md. R. 2982)

Regulations .24—.26 adopted effective December 28, 1987 (14:26 Md. R. 2746)

Regulation .24 amended effective March 1, 2004 (31:4 Md. R. 315); March 31, 2014 (41:6 Md. R. 378)

Regulation .24C amended as an emergency provision effective May 6, 2025 (52:11 Md. R. 531); adopted permanently effective October 13, 2025 (52:20 Md. R. 1001)

Regulation .24E amended effective April 16, 2012 (39:7 Md. R. 491)

Regulation .25 repealed effective March 15, 2004 (31:5 Md. R. 448)

Regulation .25 adopted effective February 25, 2008 (35:4 Md. R. 514)

Regulation .26 recodified to Regulation .27, and new Regulation .26 adopted effective March 20, 1989 (16:5 Md. R. 629)

Regulation .26 amended effective April 2, 1990 (17:6 Md. R. 741)

Regulations .27—.31 adopted effective August 6, 1990 (17:15 Md. R. 1858)

Regulation .27 recodified to Regulation .32 effective August 6, 1990 (17:15 Md. R. 1858)

Regulations .27—.31 repealed effective May 23, 1994 (21:10 Md. R. 844)

Regulation .27 adopted effective March 13, 2006 (33:5 Md. R. 520)

Regulation .28 adopted effective June 28, 2010 (37:13 Md. R. 852)

Regulation .28A amended effective April 13, 2026 (53:7 Md. R. 328)

Regulation .29 adopted effective March 31, 2014 (41:6 Md. R. 378)

Regulation .29F adopted effective April 23, 2018 (45:8 Md. R. 420)

Regulation .30 adopted effective July 4, 2016 (43:13 Md. R. 712)

Regulation .30A amended effective April 13, 2026 (53:7 Md. R. 328)

Regulation .31 adopted effective March 27, 2017 (44:6 Md. R. 325)

Regulation .32D amended effective November 11, 2002 (29:22 Md. R. 1721); June 28, 2010 (37:13 Md. R. 852)

Regulation .32-1 adopted effective March 13, 2006 (33:5 Md. R. 520)

Regulation .32-2 adopted effective March 13, 2006 (33:5 Md. R. 520)

Regulation .32-3 adopted effective March 13, 2006 (33:5 Md. R. 520)

Regulation .33 adopted effective November 11, 2002 (29:22 Md. R. 1721)

Regulation .33A amended effective March 2, 2015 (42:4 Md. R. 433)

Regulation .34 adopted effective April 21, 2008 (35:8 Md. R. 804)

Regulation .35 adopted effective April 23, 2018 (45:8 Md. R. 420)

Regulation .36 adopted effective April 23, 2018 (45:8 Md. R. 420)

Regulation .37 adopted effective April 23, 2018 (45:8 Md. R. 420)