1. A. Application for License.

   1. (1) To obtain and maintain a license, an applicant shall meet all of the requirements of:

      1. (a) This chapter;
      2. (b) Other applicable federal, State, and local laws and regulations; and
      3. (c) Health-General Article, §19-311, Annotated Code of Maryland, if the program provides services to 17 or more residents.

   2. (2) An applicant shall submit:

      1. (a) An application on a written or electronic form developed by the Department;
      2. (b) The completed Uniform Disclosure Statement on a form developed by the Department; and
      3. (c) All other reasonable documents as required by the Department.

   3. (3) At a minimum, the applicant shall provide:

      1. (a) Verification that the applicant or corporate representative is 21 years old or older;
      2. (b) Documentation of any prior denial, suspension, or revocation of a license or certification to provide care to third parties;
      3. (c) Identification of any individual or corporate owner of 25 percent or more interest in the assisted living program;
      4. (d) Documentation of any conviction and current background check or criminal history records check of the owner, the applicant, the assisted living manager, the alternate assisted living manager, other staff, and any household member;
      5. (e) Ownership information as specified on an addendum to the application;
      6. (f) Verification that the facility is owned, leased, or otherwise under the control of the applicant;
      7. (g) The level of care to be provided by the assisted living program, its location, and the name of the proposed assisted living manager;
      8. (h) Documentation of zoning approval, if zoning approval is required by the local jurisdiction in which the assisted living program will be located; and
      9. (i) Where applicable, approvals from the local health department, local or State fire authority, and local area agency on aging.

2. B. Additional Requirements for Initial Licensure. The Secretary shall require an applicant for initial licensure to submit:

   1. (1) Information concerning any license or certification held by the applicant under Health Occupations Article or Health-General Article, Annotated Code of Maryland, including the prior or current operation by the applicant of a health care facility or similar health care program;
   2. (2) Information demonstrating financial or administrative ability to operate an assisted living program in compliance with this chapter, which shall include a business plan and 1-year operating budget;
   3. (3) Policies and procedures to be implemented as designated in the application for licensure; and

   4. (4) Other reasonably relevant information, if required by law or local jurisdiction, such as:

      1. (a) Verification of Workers’ Compensation insurance;
      2. (b) Facility plan review documentation;
      3. (c) Food service permit; and
      4. (d) Rental license.

3. C. License Suspension or Revocation.

   1. (1) The owner, assisted living manager, alternate assisted living manager, or board member of an assisted living program that has had its license suspended or revoked by the Department may not own, operate, lease, or manage another assisted living program for 10 years from the date the license was suspended or revoked without good cause shown.
   2. (2) After 10 years, the applicant shall submit evidence to the Department that the applicant is capable of owning, managing, or operating an assisted living program.

4. D. Sanctions and Uncorrected Deficiencies.

   1. (1) If an owner, assisted living manager, or alternate assisted living manager of an assisted living program operates, leases, or manages an assisted living program that has had sanctions imposed or deficiencies cited within the past 3 years and has not corrected the deficiencies which present a risk to the health or safety of residents for a currently licensed assisted living program, that owner, assisted living manager, or alternate assisted living manager may not apply to open an additional assisted living program until those deficiencies have been corrected as approved by the Department.
   2. (2) The Department may not approve a license application for an assisted living program if the owner, assisted living manager, or alternate assisted living manager operates, leases, or manages a licensed assisted living program that has uncorrected deficiencies.
   3. (3) In making a determination about a pending assisted living program license application, the Department may consider any sanctions or uncorrected deficiencies that were imposed before or after the application submission which present a risk to the health or safety of residents for a currently licensed assisted living program that is operated, leased, or managed by an owner, assisted living manager, or alternate assisted living manager in the pending license application.

5. E. Violations and Criminal Convictions.

   1. (1) The Department reserves the right to deny licensure to an applicant based on the owner’s, assisted living manager’s, or alternate assisted living manager’s prior:

      1. (a) History of violations of assisted living regulations;
      2. (b) Criminal history that the Department determines may be potentially harmful to residents;
      3. (c) Convictions as described in 42 U.S.C. §1320a–7(a) or Criminal Law Article, §14-101, Annotated Code of Maryland; and
      4. (d) History of final actions of a Health Occupations Board.

   2. (2) In making a determination about a license application, the Department shall consider the following factors related to a criminal conviction:

      1. (a) The age at which the crime was committed;
      2. (b) The circumstances surrounding the crime;
      3. (c) The length of time that has passed since the crime; and
      4. (d) Subsequent work history.

   3. (3) In making a determination about a license application, the Department shall consider the following factors related to a violation of assisted living regulations:

      1. (a) The circumstances surrounding the violation;
      2. (b) The length of time since the violation occurred;
      3. (c) The scope of the violation;
      4. (d) The severity of the violation; and
      5. (e) The implementation of a plan of correction.
   4. (4) The Department shall consider other evidence that demonstrates whether the applicant poses a threat to the health or safety of residents in an assisted living program.

6. F. Determination of License Application.

   1. (1) Based on information provided to the Department by the applicant and the Department’s own investigation, the Secretary shall:

      1. (a) Approve the application unconditionally;
      2. (b) Approve the application conditionally, which may include, among other conditions, requiring the applicant to use the services of a management firm approved by the Secretary; or
      3. (c) Deny the application.
   2. (2) The Secretary may not require use of a management firm for a period in excess of 24 months.

   3. (3) A person may not:

      1. (a) Operate an assisted living program until a provisional license or license has been issued; or
      2. (b) Operate multiple sites until each site has been inspected and approved by the Department.
   4. (4) A person aggrieved by a decision of the Secretary under this section to deny a license application may appeal the Secretary’s action by filing a request for a hearing consistent with Regulation .65 of this chapter.

7. G. Provisional Licenses for Less than 1 Year. The Department may issue a provisional license if:

   1. (1) An assisted living program is not in full compliance with this chapter;
   2. (2) The Department determines that the noncompliance does not constitute a safety or health hazard; and
   3. (3) The applicant or assisted living program has submitted a plan of correction acceptable to the Department which satisfactorily addresses the correction of each deficiency within a time frame acceptable to the Department.

8. H. License Application Administratively Closed.

   1. (1) An application is not complete until the Department has received the completed license application and all required documents.
   2. (2) After 180 calendar days from the date of initial receipt, the Department may deem an incomplete license application inactive and administratively close the application.
   3. (3) An applicant whose application is administratively closed may reapply for a license by submitting a new application.

Authority: Health-General Article, Title 19, Subtitle 18, Annotated Code of Maryland

Effective date: January 1, 1999 (25:26 Md. R. 1923)

Regulation .02B amended effective November 1, 1999 (26:22 Md. R. 1692); July 22, 2002 (29:14 Md. R. 1074)

Regulation .02B amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .03 amended effective August 21, 2000 (27:16 Md. R. 1523)

Regulation .04 amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .06 amended as an emergency provision effective August 15, 2000 (27:18 Md. R. 1664); amended permanently effective November 27, 2000 (27:23 Md. R. 2147)

Regulation .06E adopted effective March 29, 2004 (31:6 Md. R. 508)

Regulation .09B, C amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .12D, E amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .15-1 adopted effective October 10, 2005 (32:20 Md. R. 1655)

Regulation .15-2 adopted effective October 10, 2005 (32:20 Md. R. 1655)

Regulation .17B amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .17E—G adopted effective October 10, 2005 (32:20 Md. R. 1655)

Regulation .21F, K amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .21P adopted effective March 29, 2004 (31:6 Md. R. 508)

Regulation .26A amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .27C, E amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .28D amended, and E—K adopted, effective November 1, 1999 (26:22 Md. R. 1692)

Regulation .29B amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .36A amended effective March 29, 2004 (31:6 Md. R. 508); December 19, 2005 (32:25 Md. R. 1941)

Regulation .46 amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .49B amended effective July 22, 2002 (29:14 Md. R. 1074)

Regulations .01—.53 repealed and new Regulations .01—.64 adopted effective December 29, 2008 (35:26 Md. R. 2249)

Regulation .07A amended effective August 19, 2013 (40:16 Md. R. 1344); August 29, 2016 (43:17 Md. R. 953); March 13, 2017 (44:5 Md. R. 292)

Regulation .07C amended effective March 13, 2017 (44:5 Md. R. 292)

Regulation .13A amended effective June 25, 2012 (39:12 Md. R. 745)

Regulation .24D amended effective June 25, 2012 (39:12 Md. R. 745)

Regulation .29 amended effective June 25, 2012 (39:12 Md. R. 745)

Chapter revised effective April 28, 2025 (52:8 Md. R. 357)