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

2. B. Terms Defined.

   1. (1) “Accrual basis” means recording revenue in the period when earned, regardless of when collected, and recording expenses in the period when incurred, regardless of when paid.
   2. (2) “Administrative day” means a day of care rendered to a recipient who no longer requires the level of care being provided.
   3. (3) “Allowable cost” means costs that are includable in the per diem rate and that represent the provider's actual cost as verified by the Department or the Department's designee.
   4. (4) “Appropriate facility” means a facility located within a 25-mile radius of the location of the facility currently rendering care to the recipient or a more distant facility if acceptable to the recipient, which facility is licensed and certified to render the recipient's required level of care.
   5. (5) “Bad debts” means amounts considered to be uncollectible from accounts and notes receivable that were created or acquired in providing services. “Accounts receivable” and “notes receivable” are designations for claims arising from rendering services which, when made or entered, were considered collectible in money in the relatively near future.
   6. (6) “Case mix index (CMI)” means a numeric score that identifies the average relative nursing resource needs for the residents classified under the Resource Utilization Group (RUG) based on the assessed nursing needs of the resident, whose values are set forth as CMI Set F01, located at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation.html.
   7. (7) “Centers for Medicare and Medicaid Services (CMS)” means the federal agency that is located in the U.S. Department of Health and Human Services that administers the Medicare and Medicaid programs.

   8. (8) “Change of ownership” means:

      1. (a) One of the following occurs:

         1. (i) The merger of the provider into the acquiring entity and the acquiring entity's tax identification number remains;
         2. (ii) The assignment, transfer, disposition, lease, or sale of all or substantially all of a provider’s assets to another entity;
         3. (iii) The consolidation of two or more providers, resulting in the creation of a new entity; or
         4. (iv) The merger of the provider into another entity, or the consolidation of two or more entities, resulting in the creation of a new entity;
      2. (b) A provider’s Medical Assistance participating provider number dissolves or will no longer be utilized for purposes of billing the Program for covered services; and
      3. (c) A new Medical Assistance participating provider number or tax identification number is used instead.
   9. (9) “Cost center” means one of the groups into which similar categories of costs are assigned for reimbursement rate determination: Administrative and Routine, Other Patient Care, Nursing Service, and Capital.
   10. (10) “Cost report period case mix index” means the simple average of the day weighted facility case mix indices for residents of all payer sources from the final quarterly resident rosters for a nursing facility, carried to four decimal places, for the quarterly resident roster periods that most closely match a cost reporting period.

   11. (11) “Credit balance” means:

       1. (a) A third party payment, which is in addition to the Medicaid payment;
       2. (b) The Medicaid payment in excess of the amount due the provider; or
       3. (c) A duplicate payment.
   12. (12) “Department” means the Maryland Department of Health, which is the single State agency designated to administer the Maryland Medical Assistance Program pursuant to Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.
   13. (13) “Facility” means a facility licensed under COMAR 10.07.02 and certified as meeting the requirements of Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq., for participation as a nursing facility.
   14. (14) “Facility average Medicaid case mix index” means the day-weighted average case mix index for all identified Medicaid days from each nursing facility's final resident roster for each resident roster quarter calculated as the sum of the number of days each assessment associated with a Medicaid payer source is active times the assessment CMI divided by the sum of all Medicaid payer source days.
   15. (15) “Final report” means the third party liability audit report issued to a provider stating the total amount due to the Department as a result of the completed audit.
   16. (16) “Fiscal year” means a 12-month reporting period covering the same period as the facility's tax return, unless waived by the Department according to standards found in Medicare Provider Reimbursement Manual, HCFA Publication 15-1.
   17. (17) “Indemnity bond” means a bond posted by the provider to ensure that the provider is able to fulfill any financial obligations to the Department upon sale of the facility.
   18. (18) “Interim Working Capital Fund” means funding made available to providers on a temporary basis that shall be repaid to the Department.
   19. (19) “Market basket index” means inflation indices from the latest Skilled Nursing Home without Capital Market Basket Index, published 2 months before the period in which rates are being calculated and which is available from CMS at www.cms.gov, or a comparable index available from, and used by, CMS, if this index ceases to be published by Global Insight, Inc. or its successor.
   20. (20) “Maryland Health Care Commission” means the agency established by Health-General Article, Title 19, Subtitle 1, Annotated Code of Maryland.
   21. (21) “Medicaid” means Medical Assistance provided under the State Plan approved under Title XIX of the Social Security Act.
   22. (22) “Medical Assistance Program” means a program of comprehensive medical and other health-related care for indigent and medically indigent persons.
   23. (23) “Medicare upper payment limit” means that aggregate payments to nursing facilities may not exceed the limits established for such payment in 42 CFR §447.272.
   24. (24) “Minimum Data Set (MDS)” means the MDS required by 42 CFR §483.20 and set forth in the Resident Assessment Instrument published by CMS, and available at www.cms.gov, incorporated herein by reference, as amended and supplemented, a core set of screening, clinical, and functional status elements, including common definitions and coding categories that forms the foundation of the assessment required for all residents in Medicare-certified or Medicaid-certified nursing facilities.

   25. (25) “New facility” means:

       1. (a) A facility that has not been a provider during the previous 12-month period or, for rates effective January 1, 2015 and after, does not have a cost report in the price database as set forth in Regulation .09B(1) of this chapter; and
       2. (b) A facility not defined as a replacement facility.

   26. (26) “Noncompliant” means:

       1. (a) A provider fails to submit to the Department the required quarterly report of credit balances;
       2. (b) A provider fails to submit a quarterly report which provides sufficient data relating to the credit balances it maintained during that quarter; or
       3. (c) A random audit by the Department reveals errors or omissions in a provider's credit balance report.

   27. (27) Nursing Facility (NF).

       1. (a) “Nursing facility” means an institution which is primarily engaged in providing to residents:

          1. (i) Skilled nursing care and related services for residents who require medical or nursing care;
          2. (ii) Rehabilitation services for the rehabilitation of injured, disabled, or sick persons; or
          3. (iii) On a regular basis, health-related care and services to individuals who, because of their mental or physical condition, require care and services (above the level of room and board) which can be made available to them only through institutional facilities.
       2. (b) “Nursing facility” means an institution which is licensed by the Department under COMAR 10.07.02.
       3. (c) “Nursing facility” does not include an institution which is primarily for the care and treatment of mental diseases, an intellectually disability or a developmental disability.
   28. (28) “Nursing facility services” means services provided to individuals who do not require hospital care, but who, because of their mental or physical condition, require skilled nursing care and related services, rehabilitation services, or, on a regular basis, health-related care and services (above the level of room and board) which can be made available to them only through institutional facilities.
   29. (29) “Owner” means a party or entity having any ownership interest in the facility.
   30. (30) “Patient day” means care of one patient for 1 day of service. The day of admission is counted as 1 day of care, but the day of discharge is not counted. If a patient is discharged on his day of admission, 1 patient day will be counted.
   31. (31) “Payroll-Based Journal” means a system for facilities to submit staffing information to meet the requirements of §6106 of the Affordable Care Act (ACA) that requires facilities to electronically submit direct care staffing information (including agency and contract staff) based on payroll and other auditable data.
   32. (32) “Personal needs fund” means that portion of the recipient's resource retained by the recipient for his personal use.

   33. (33) “Predischarge plan” means:

       1. (a) A written document describing who has operational responsibility for discharge planning;
       2. (b) The manner in and methods by which that person will function;
       3. (c) The time period in which each recipient's need for discharge planning will be determined;
       4. (d) The maximum time period after which a reevaluation of each recipient's discharge plan will be made;
       5. (e) The local resources available to the provider, the individual, and the attending physician to assist in developing and implementing individual discharge plans; and
       6. (f) Provisions for periodic review and reevaluation of the provider's discharge planning program.
   34. (34) “Program” means the Medical Assistance Program.

   35. (35) “Prospective rate” means a facility-specific quarterly per diem rate based on the RUG classification system, and calculated as the sum of:

       1. (a) Administrative and Routine rate as calculated in accordance with Regulation .09 of this chapter;
       2. (b) Other Patient Care Rate as calculated in accordance with Regulation .10 of this chapter;
       3. (c) Capital Rate as calculated in accordance with Regulation .11 of this chapter; and
       4. (d) Nursing Rate as calculated in accordance with Regulation .12 of this chapter.
   36. (36) “Provider” means a facility which has in effect a provider agreement with the Department.
   37. (37) “Provider agreement” means the contract between the Department and the provider covering the obligations of the parties under the Medical Assistance Program.

   38. (38) “Purchaser” means an entity that participates in a change of ownership with a provider by:

       1. (a) Having a provider merge into the entity;
       2. (b) Accepting the assignment, transfer, disposition, or sale of all or substantially all of a provider’s assets; or
       3. (c) Being a new entity that results from the consolidation of the provider with a third party.
   39. (39) “Quality measure” means a specific performance criterion, as described in Regulation .15 of this chapter, used to assess a facility’s performance level.
   40. (40) “Random sample” means the selection for audit by the Department of representative share of the providers complying with the requirement of submitting a quarterly report of credit balances to the Department.
   41. (41) “Recipient” means a person who is certified as eligible for, and is receiving, Medical Assistance benefits.
   42. (42) “Recreational services” means those organized activities provided for the enjoyment of the patients that are designed to promote their physical, social, and mental well-being.
   43. (43) “Reimbursement class” means the group of providers for which a separate per diem rate will be prepared in the Administrative and Routine, Other Patient Care, and Nursing Service cost centers based on geographic region as set forth in Regulation .30 of this chapter.
   44. (44) “Relative of the owner” means the owner's husband, wife, natural parent, natural child, sibling, adopted child, adoptive parent, stepparent, stepchild, stepbrother, stepsister, father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, grandparent, or grandchild.

   45. (45) “Replacement facility” means:

       1. (a) A newly constructed nursing facility that replaces an existing licensed and certified facility; or
       2. (b) A facility that was closed for significant renovation that reopens and is approved by the Department as a replacement facility.
   46. (46) “Resident roster” means a list of all residents in a nursing facility for a calendar quarter based on MDS assessments and tracking forms, accurately and successfully transmitted by the nursing facility into the CMS-approved submission system, used for the calculated day-weighted case mix indices for Medicaid, Medicare, and other payment sources.
   47. (47) “Resource” means that portion of a recipient's income available toward the cost of medical and remedial care as determined by the Department or its designee.
   48. (48) “Resource Utilization Group (RUG)” means the version IV (RUG-IV), 48-Group classification system, that has been developed by CMS for grouping nursing facility residents according to the residents’ functional status and anticipated uses of services and resources as identified from data supplied by the MDS.
   49. (49) “Secretary” means the Secretary of Health.

   50. (50) “Special focus facility” means a facility identified by the Centers for Medicare and Medicaid Services as having:

       1. (a) More problems than other nursing homes;
       2. (b) More serious problems than other nursing homes; and
       3. (c) A pattern of serious problems that has persisted over a long period of time.
   51. (51) “Specialized rehabilitative therapy services” means those services furnished by a provider as an integral part of a patient's care plan ordered by a physician and provided in conjunction with continuous nursing care for the purpose of the restoration of normal form and function after injury or illness. The services shall be performed by a licensed physical therapist, licensed physical therapy assistant, or registered occupational therapist.
   52. (52) “Standby letter of credit” means a written instrument prepared by a provider's bank authorizing the Department to draw on the bank, upon sale of the facility.
   53. (53) “Statewide average case mix index” means the simple average of all of the cost report period case mix indices for the rate year.
   54. (54) “Statewide average Medicaid case mix index” means the Medicaid day weighted average of all nursing facilities’ case mix indices for the Medicaid days identified on the final resident rosters for each resident roster quarter.
   55. (55) “Substandard quality of care” means a finding of substandard care in accordance with 42 CFR §488.301.
   56. (56) “Third party” means any individual entity or program that is or may be liable to pay all or part of the medical cost of any medical assistance furnished to a recipient under the Medical Assistance Program, including private health insurance, employment related health insurance, medical support from absent parents, automobile insurance, court judgments or settlements from a liability insurer, state workers' compensation, first party probate-estate recoveries, or any federal programs.
   57. (57) “Third party liability audit” means a financial review of Medical Assistance payments to a provider to ascertain the legal liability of third parties to pay for care and services available under the Medical Assistance Program.
   58. (58) “Third party liability review” means a financial review of the credit balances of a nursing facility to ascertain the legal liability of third parties to pay for care and services available under the Medical Assistance Program.
   59. (59) “Uniform cost report” means the cost report format which each facility is required to use in the submission of its fiscal year cost and utilization data, including supplemental schedules and other balance sheet and administrative data.

Authority: Health-General Article, §§2-104(b), 15-103, 15-105, 19-14B-01, and 19-310.1, Annotated Code of Maryland

Effective date: July 9, 1975 (2:15 Md. R. 1070)

Regulation .03E amended effective January 30, 1976 (3:4 Md. R. 216)

Regulation .03H amended effective December 31, 1975 (3:4 Md. R. 216)

Regulation .03Q adopted as an emergency provision effective July 1, 1977 (4:15 Md. R. 1143); adopted permanently effective October 21, 1977 (4:22 Md. R. 1671)

Regulation .03X amended effective September 29, 1976 (3:20 Md. R. 1143)

Regulation .05 amended effective August 17, 1977 (4:17 Md. R. 1298)

Regulation .06 amended as an emergency provision effective April 1, 1977 (4:8 Md. R. 631); emergency status extended at 4:17 Md. R. 1291)

Regulation .06 amended effective August 17, 1977 (4:17 Md. R. 1298)

Regulation .06B amended effective January 30, 1976 (3:4 Md. R. 216)

Regulation .06C adopted as an emergency provision effective July 1, 1977 (4:15 Md. R. 1143); adopted permanently effective October 21, 1977 (4:22 Md. R. 1671)

Regulation .07 amended effective August 17, 1977 (4:17 Md. R. 1298)

Regulation .09 amended effective August 17, 1977 (4:17 Md. R. 1298)

Regulation .09A amended effective September 29, 1976 (3:20 Md. R. 1143)

Regulation .09B amended as an emergency provision effective April 1, 1977 (4:8 Md. R. 631); emergency status extended at 4:17 Md. R. 1291

Regulation .09B, D amended effective January 30, 1976 (3:4 Md. R. 216)

Regulation .09A amended as an emergency provision effective July 1, 1977 (4:15 Md. R. 1143); amended permanently effective October 21, 1977 (4:22 Md. R. 1671)

Regulation .09A amended as an emergency provision effective June 13, 1978 (5:13 Md. R. 1039)

Regulations .03 and .09 amended as an emergency provision effective January 1, 1978 (5:1 Md. R. 15)

Regulations .03, .06, .08, and .09 amended as an emergency provision effective March 15, 1978 (5:9 Md. R. 681)

Chapter revised effective July 1, 1978 (5:13 Md. R. 1051)

Regulations .01U, HH, II, LL; .02; .03; .04G; .07; .09; .11E amended effective December 14, 1979 (6:25 Md. R. 1980)

Regulation .01M-1 and M-2 adopted effective July 1, 1980 (7:13 Md. R. 1278)

Regulations .01O, .03D, and .11E amended effective January 1, 1980 (6:26 Md. R. 2074)

Regulations .01JJ, KK; .07-1; .08A-1 adopted effective December 14, 1979 (6:25 Md. R. 1980)

Regulation .01P repealed effective January 1, 1980 (6:26 Md. R. 2074)

Regulation .05A repealed effective December 14, 1979 (6:25 Md. R. 1980)

Regulation .07B amended as an emergency provision effective July 1, 1978 (5:14 Md. R. 1132); adopted permanently effective November 3, 1978 (5:22 Md. R. 1673)

Regulation .07-2 adopted effective July 1, 1980 (7:13 Md. R. 1278)

Regulation .08E amended as an emergency provision effective July 1, 1978 (5:14 Md. R. 1131); adopted permanently effective November 3, 1978 (5:22 Md. R. 1673)

Regulation .11 amended effective December 20, 1982 (9:25 Md. R. 2482)

Regulation .16A, B amended effective August 17, 1981 (8:16 Md. R. 1365)

Regulation .18 adopted effective October 25, 1982 (9:21 Md. R. 2106)

Chapter revised effective January 1, 1983 (9:25 Md. R. 2480)

Regulation .01B amended effective June 6, 1983 (10:11 Md. R. 975); August 10, 1987 (14:16 Md. R. 1773)

Regulation .01B amended as an emergency provision effective July 1, 1986 (13:14 Md. R. 1627); adopted permanently effective December 1, 1986 (13:21 Md. R. 2320)

Regulation .03 amended as an emergency provision effective February 18, 1983 (10:6 Md. R. 536)

Regulation .03P amended, Q adopted effective June 6, 1983 (10:11 Md. R. 975)

Regulation .03R adopted effective January 30, 1984 (11:2 Md. R. 113)

Regulation .03S adopted effective July 28, 1986 (13:15 Md. R. 1734)

Regulation .03T and U adopted effective August 10, 1987 (14:16 Md. R. 1773)

Regulation .04G amended effective October 29, 1984 (11:21 Md. R. 1812)

Regulation .05 amended effective June 1, 1988 (15:11 Md. R. 1331)

Regulation .07B amended and .07H adopted as an emergency provision effective June 27, 1983 (10:14 Md. R. 1257); adopted permanently effective October 24, 1983 (10:21 Md. R. 1901)

Regulation .07B amended effective June 6, 1983 (10:11 Md. R. 975); August 10, 1987 (14:16 Md. R. 1773)

Regulation .07B and E amended effective July 1, 1984 (11:12 Md. R. 1063)

Regulation .07B, C, F, G amended and .07C-1 adopted as an emergency provision effective July 1, 1986 (13:15 Md. R. 1729); adopted permanently effective December 1, 1986 (13:22 Md. R. 2398)

Regulation .07C amended effective October 29, 1984 (11:21 Md. R. 1812)

Regulation .07D amended effective July 18, 1983 (10:14 Md. R. 1262); July 1, 1987 (14:13 Md. R. 1473); June 1, 1988 (15:11 Md. R. 1331); July 1, 1988 (15:13 Md. R. 1553)

Regulation .07D amended as an emergency provision effective January 26, 1988 (15:4 Md. R. 469); adopted permanently effective May 15, 1988 (15:8 Md. R. 1009)

Regulation .07E amended effective January 27, 1986 (13:2 Md. R. 137); July 1, 1988 (15:13 Md. R. 1533); September 5, 1988 (15:18 Md. R. 2147)

Regulation .07E amended as an emergency provision effective July 1, 1986 (13:14 Md. R. 1627); adopted permanently effective December 1, 1986 (13:21 Md. R. 2320)

Regulation .07G amended effective December 29, 1986 (13:26 Md. R. 2807)

Regulation .07H repealed effective August 10, 1987 (14:16 Md. R. 1773)

Regulation .08 amended as an emergency provision effective July 1, 1985 (12:14 Md. R. 1427); emergency status expired November 4, 1985

Regulation .08 amended effective November 4, 1985 (12:22 Md. R. 2103)

Regulation .09A amended effective September 5, 1988 (15:18 Md. R. 2147)

Regulation .10E amended effective August 10, 1987 (14:16 Md. R. 1773)

Regulation .10I amended effective January 30, 1984 (11:2 Md. R. 113); September 10, 1984 (11:18 Md. R. 1584)

Regulation .12D repealed effective August 10, 1987 (14:16 Md. R. 1773)

Regulation .13E amended as an emergency provision effective January 1, 1983 (10:1 Md. R. 21); adopted permanently effective May 1, 1983 (10:7 Md. R. 634)

Regulation .13F amended as an emergency provision effective July 1, 1986 (13:15 Md. R. 1729); adopted permanently effective December 1, 1986 (13:22 Md. R. 2398)

Regulation .14K adopted as an emergency provision effective June 27, 1983 (10:14 Md. R. 1257); adopted permanently effective October 24, 1983 (10:21 Md. R. 1901)

Regulation .14K repealed effective August 10, 1987 (14:16 Md. R. 1773)

Regulation .17A amended effective May 12, 1986 (13:9 Md. R. 1029)

Regulation .19 amended effective June 6, 1983 (10:11 Md. R. 974)

Chapter revised effective November 27, 1989 (16:23 Md. R. 2505)

Regulations .01, .07—.12, .16, and .25 amended as an emergency provision effective January 14, 1992 (19:3 Md. R. 299); emergency status expired June 30, 1992

Regulations .01, .07—.13, .16, .17, .23, and .25 amended as an emergency provision effective July 1, 1992 (19:14 Md. R. 1272); amended permanently effective November 1, 1992 (19:21 Md. R. 1891)

Regulations .01, .04, .08—.11, .16, .17, .20, .21, and .23 amended as an emergency provision effective July 1, 2005 (32:19 Md. R. 1584); emergency status expired August 31, 2005

Regulation .01B amended effective March 19, 1990 (17:5 Md. R. 638); December 29, 1997 (24:26 Md. R. 1758)

Regulation .01B amended as an emergency provision effective May 1, 2004 (31:12 Md. R. 908); amended permanently effective August 16, 2004 (31:16 Md. R. 1255)

Regulation .01B amended effective May 9, 2005 (32:9 Md. R. 848); December 9, 2005 (32:24 Md. R. 1904)

Regulation .01B amended as an emergency provision effective July 16, 2009 (36:17 Md. R. 1310); amended permanently effective October 5, 2009 (36:20 Md. R. 1527)

Regulation .01B amended effective January 24, 2011 (38:2 Md. R. 84); October 3, 2011 (38:20 Md. R. 1202); October 14, 2013 (40:20 Md. R. 1652)

Regulation .02 amended effective December 29, 1997 (24:26 Md. R. 1758)

Regulation .03 amended effective March 19, 1990 (17:5 Md. R. 638); December 29, 1997 (24:26 Md. R. 1758)

Regulation .03V amended effective October 3, 2011 (38:20 Md. R. 1202)

Regulation .03W adopted effective October 3, 2011 (38:20 Md. R. 1202)

Regulations .04, .10L, .11F, O, and .25B amended as an emergency provision effective July 3, 1990 (17:16 Md. R. 1986); amended permanently effective November 1, 1990 (17:21 Md. R. 2529)

Regulations .04, .05, .07—.11, .13, .16, and .25 amended and new Regulation .09-1 adopted as an emergency provision effective October 1, 1999 (26:23 Md. R. 1775); adopted permanently effective January 9, 2000 (26:27 Md. R. 2015)

Regulation .04 amended effective August 15, 1994 (21:16 Md. R. 1383); December 29, 1997 (24:26 Md. R. 1758)

Regulation .04D repealed effective March 18, 2013 (40:5 Md. R. 411)

Regulation .04E amended effective December 9, 2005 (32:24 Md. R. 1904); March 18, 2013 (40:5 Md. R. 411)

Regulation .04BB adopted as an emergency provision effective April 1, 2008 (35:9 Md. R. 892); emergency status expired September 3, 2008

Regulation .04BB adopted effective September 22, 2008 (35:19 Md. R. 1716)

Regulation .05 amended as an emergency provision effective July 1, 2003 (30:15 Md. R. 990); emergency status expired December 31, 2003

Regulation .05 amended effective February 16, 2004 (31:3 Md. R. 207)

Regulation .05G amended effective December 29, 1997 (24:26 Md. R. 1758)

Regulation .06 amended effective December 29, 1997 (24:26 Md. R. 1758); July 8, 2002 (29:13 Md. R. 990)

Regulations .07—.11 amended as an emergency provision effective December 1, 2001 (29:1 Md. R. 17)

Regulations .07—.11-1 and .26 amended as an emergency provision effective July 1, 1995 (22:15 Md. R. 1114); emergency status expired November 1, 1995; amended permanently effective November 6, 1995 (22:22 Md. R. 1658)

Regulation .07 amended effective July 8, 2002 (29:13 Md. R. 990)

Regulation .07 amended as an emergency provision effective July 1, 2003 (30:15 Md. R. 990); emergency status expired December 31, 2003

Regulation .07 amended effective February 16, 2004 (31:3 Md. R. 207)

Regulation .07 amended as an emergency provision effective July 16, 2009 (36:17 Md. R. 1310); amended permanently effective October 5, 2009 (36:20 Md. R. 1527)

Regulation .07 amended effective November 28, 2011 (38:24 Md. R. 1502); March 18, 2013 (40:5 Md. R. 411); December 12, 2013 (40:24 Md. R. 2016); December 11, 2014 (41:24 Md. R. 1427)

Regulation .07A amended effective June 25, 1990 (17:12 Md. R. 1494)

Regulation .07A-2 adopted effective February 12, 2007 (34:3 Md. R. 297)

Regulation .07A-2 amended as an emergency provision effective July 1, 2007 (34:15 Md. R. 1345); emergency status extended at 35:3 Md. R. 286; emergency status expired June 24, 2008

Regulation .07A-2, C amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 892); emergency status expired September 3, 2008

Regulation .07A-2, C amended effective September 22, 2008 (35:19 Md. R. 1716)

Regulation .07A-3 adopted effective September 22, 2008 (35:19 Md. R. 1716)

Regulation .07A-3 amended effective April 6, 2009 (36:7 Md. R. 523)

Regulation .07A-4 adopted effective April 6, 2009 (36:7 Md. R. 523)

Regulation .07B amended effective February 12, 2007 (34:3 Md. R. 297)

Regulation .07C amended effective March 19, 1990 (17:5 Md. R. 638)

Regulation .07C-1 amended effective April 5, 2010 (37:7 Md. R. 570)

Regulation .07C-2 and C-3 adopted effective April 5, 2010 (37:7 Md. R. 570)

Regulation .07C-4 adopted effective December 27, 2010 (37:26 Md. R. 1787)

Regulation .07-1 adopted as an emergency provision effective May 1, 2004 (31:12 Md. R. 908); adopted permanently effective August 16, 2004 (31:16 Md. R. 1255)

Regulation .07-1F, I amended effective April 10, 2006 (33:7 Md. R. 668); August 27, 2007 (34:17 Md. R. 1508); September 22, 2008 (35:19 Md. R. 1716)

Regulation .07-1I amended as an emergency provision effective July 16, 2009 (36:17 Md. R. 1310); amended permanently effective October 5, 2009 (36:20 Md. R. 1527)

Regulation .07-1I amended effective January 24, 2011 (38:2 Md. R. 84); October 3, 2011 (38:20 Md. R. 1202); February 18, 2013 (40:3 Md. R. 218); February 3, 2014 (41:2 Md. R. 91); December 11, 2014 (41:24 Md. R. 1427)

Regulations .08—.11-1, .17, .20, and .21 amended as an emergency provision effective July 1, 1996 (23:15 Md. R. 1081); amended permanently effective November 4, 1996 (23:22 Md. R. 1496)

Regulations .08—.11 amended as an emergency provision effective July 1, 1997 (24:16 Md. R. 1149) (Emergency provisions are temporary and not printed in COMAR)

Regulations .08—.11 amended as an emergency provision effective July 1, 1998 (25:15 Md. R. 1181); amended permanently effective October 19, 1998 (25:21 Md. R. 1574)

Regulations .08—.11, .13, and .16 amended as an emergency provision effective July 1, 1999 (26:16 Md. R. 1237 and 26:18 Md. R. 1369); emergency status expired September 30, 1999

Regulation .08 amended as an emergency provision effective July 1, 2003 (30:15 Md. R. 990); emergency status expired December 31, 2003

Regulation .08 amended effective February 16, 2004 (31:3 Md. R. 207); September 22, 2008 (35:19 Md. R. 1716); March 18, 2013 (40:5 Md. R. 411)

Regulation .08B amended effective July 1, 1993 (20:12 Md. R. 996); October 20, 1997 (24:21 Md. R. 1449); December 9, 2005 (32:24 Md. R. 1904)

Regulation .08B, E amended as an emergency provision effective July 1, 2007 (34:15 Md. R. 1345); emergency status extended at 35:3 Md. R. 286; emergency status expired June 24, 2008

Regulation .08B, E amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 892); emergency status expired September 3, 2008

Regulation .08B, E amended effective April 6, 2009 (36:7 Md. R. 523); December 27, 2010 (37:26 Md. R. 1787); November 28, 2011 (38:24 Md. R. 1502); December 12, 2013 (40:24 Md. R. 2016)

Regulation .08B, E, H amended effective September 22, 2008 (35:19 Md. R. 1716)

Regulation .08E amended effective July 1, 1993 (20:12 Md. R. 996); June 6, 1994 (21:11 Md. R. 951); November 7, 1994 (21:22 Md. R. 1876); October 20, 1997 (24:21 Md. R. 1449); December 9, 2005 (32:24 Md. R. 1904)

Regulations .08E, .09E, and .10L amended as an emergency provision effective January 6, 1994 (21:2 Md. R. 95); emergency status extended at 21:9 Md. R. 744; emergency status expired June 5, 1994

Regulations .08E, .09E, and .10L amended as an emergency provision effective July 1, 1994 (21:16 Md. R. 1379); emergency status expired November 7, 1994

Regulation .08H adopted effective September 11, 2006 (33:18 Md. R. 1505)

Regulation .08H repealed as an emergency provision effective July 1, 2007 (34:15 Md. R. 1345); emergency status extended at 35:3 Md. R. 286; emergency status expired June 24, 2008

Regulation .08H repealed as an emergency provision effective April 1, 2008 (35:9 Md. R. 892); emergency status expired September 3, 2008

Regulation .09B amended effective July 1, 1993 (20:12 Md. R. 996); October 20, 1997 (24:21 Md. R. 1449)

Regulation .09E amended effective July 1, 1993 (20:12 Md. R. 996); June 6, 1994 (21:11 Md. R. 951); November 7, 1994 (21:22 Md. R. 1876); October 20, 1997 (24:21 Md. R. 1449)

Regulation .09E amended as an emergency provision effective July 1, 2003 (30:15 Md. R. 990); emergency status expired December 31, 2003

Regulation .09E amended effective February 16, 2004 (31:3 Md. R. 207); December 9, 2005 (32:24 Md. R. 1904)

Regulation .09E amended as an emergency provision effective July 1, 2007 (34:15 Md. R. 1345); emergency status extended at 35:3 Md. R. 286; emergency status expired June 24, 2008

Regulation .09E amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 892); emergency status expired September 3, 2008

Regulation .09E amended effective April 6, 2009 (36:7 Md. R. 523); December 27, 2010 (37:26 Md. R. 1787); November 28, 2011 (38:24 Md. R. 1502)

Regulation .09E, F amended effective March 18, 2013 (40:5 Md. R. 411)

Regulation .09E, H amended effective September 22, 2008 35:19 Md. R. 1716)

Regulation .09H adopted effective September 11, 2006 (33:18 Md. R. 1505)

Regulation .09H repealed as an emergency provision effective July 1, 2007 (34:15 Md. R. 1345); emergency status extended at 35:3 Md. R. 286

Regulation .09H repealed as an emergency provision effective April 1, 2008 (35:9 Md. R. 892); emergency status expired September 3, 2008

Regulation .10 amended as an emergency provision effective July 1, 2003 (30:15 Md. R. 990); emergency status expired December 31, 2003

Regulation .10 amended effective February 16, 2004 (31:3 Md. R. 207)

Regulation .10C amended effective September 20, 2010 (37:19 Md. R. 1283)

Regulation .10G amended effective December 9, 2005 (32:24 Md. R. 1904)

Regulation .10G amended as an emergency provision effective July 1, 2007 (34:15 Md. R. 1345); emergency status extended at 35:3 Md. R. 286; emergency status expired June 24, 2008

Regulation .10G amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 892); emergency status expired September 3, 2008

Regulation .10G amended effective September 22, 2008 35:19 Md. R. 1716); April 6, 2009 (36:7 Md. R. 523); December 27, 2010 (37:26 Md. R. 1787); November 28, 2011 (38:24 Md. R. 1502); March 18, 2013 (40:5 Md. R. 411); December 12, 2013 (40:24 Md. R. 2016)

Regulation .10I amended as an emergency provision effective July 1, 2001 (28:16 Md. R. 1480); amended permanently effective October 1, 2001 (28:19 Md. R. 1684)

Regulation .10L amended effective July 1, 1993 (20:12 Md. R. 996); June 6, 1994 (21:11 Md. R. 951); November 7, 1994 (21:22 Md. R. 1876); October 20, 1997 (24:21 Md. R. 1449)

Regulation .10N adopted as an emergency provision effective April 1, 2008 (35:9 Md. R. 892); emergency status expired September 3, 2008

Regulation .10N adopted effective September 22, 2008 35:19 Md. R. 1716)

Regulation .11 amended as an emergency provision effective July 1, 2001 (28:16 Md. R. 1480); amended permanently effective October 1, 2001 (28:19 Md. R. 1684)

Regulation .11 amended effective July 8, 2002 (29:13 Md. R. 990)

Regulation .11 amended as an emergency provision effective July 1, 2003 (30:15 Md. R. 990); emergency status expired December 31, 2003; March 18, 2013 (40:5 Md. R. 411)

Regulation .11 amended effective February 16, 2004 (31:3 Md. R. 207)

Regulation .11C amended effective July 1, 1993 (20:12 Md. R. 996)

Regulation .11C amended as an emergency provision effective January 6, 1994 (21:2 Md. R. 95); emergency status extended at 21:9 Md. R. 744 and 21:16 Md. R. 1379; emergency status expired August 14, 1994

Regulation .11C amended effective August 15, 1994 (21:16 Md. R. 1383); November 7, 1994 (21:22 Md. R. 1876); October 20, 1997 (24:21 Md. R. 1449); December 9, 2005 (32:24 Md. R. 1904)

Regulation .11C amended as an emergency provision effective July 1, 2007 (34:15 Md. R. 1345); emergency status extended at 35:3 Md. R. 286; emergency status expired June 24, 2008

Regulation .11C amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 892); emergency status expired September 3, 2008

Regulation .11C amended effective September 22, 2008 35:19 Md. R. 1716); April 6, 2009 (36:7 Md. R. 523); December 27, 2010 (37:26 Md. R. 1787); December 12, 2013 (40:24 Md. R. 2016)

Regulation .11G amended effective August 15, 1994 (21:16 Md. R. 1383); October 20, 1997 (24:21 Md. R. 1449); December 9, 2005 (32:24 Md. R. 1904); April 5, 2010 (37:7 Md. R. 570); December 12, 2013 (40:24 Md. R. 2016)

Regulation .11U adopted effective August 15, 1994 (21:16 Md. R. 1383)

Regulation .11U adopted as an emergency provision effective April 1, 2008 (35:9 Md. R. 892; emergency status expired September 3, 2008

Regulation .11U adopted effective September 22, 2008 35:19 Md. R. 1716)

Regulation .11-1 adopted as an emergency provision effective January 6, 1994 (21:2 Md. R. 96); adopted permanently effective May 1, 1994 (21:7 Md. R. 530)

Regulation .11-1 repealed as an emergency provision effective July 1, 2003 (30:15 Md. R. 990); emergency status expired December 31, 2003

Regulation .11-1 repealed effective February 16, 2004 (31:3 Md. R. 207)

Regulations .11-1—.11-6 adopted effective January 24, 2011 (38:2 Md. R. 84)

Regulation .11-1A amended effective November 28, 2011 (38:24 Md. R. 1502)

Regulation .11-2E amended effective November 28, 2011 (38:24 Md. R. 1502)

Regulation .12A amended effective February 12, 2007 (34:3 Md. R. 297)

Regulation .13 amended effective March 19, 1990 (17:5 Md. R. 638)

Regulation .13E amended as an emergency provision effective July 1, 2001 (28:16 Md. R. 1480); amended permanently effective October 1, 2001 (28:19 Md. R. 1684)

Regulation .13I amended as an emergency provision effective January 28, 1991 (18:3 Md. R. 301); emergency status expired April 8, 1991 (18:9 Md. R. 1004)

Regulation .13I amended as an emergency provision effective April 9, 1991 (18:9 Md. R. 1005); amended permanently effective October 7, 1991 (18:18 Md. R. 2004)

Regulation .13L adopted effective August 15, 1994 (21:16 Md. R. 1383)

Regulation .13P adopted as an emergency provision effective April 1, 2008 (35:9 Md. R. 892); emergency status expired September 3, 2008

Regulation .13P adopted effective September 22, 2008 35:19 Md. R. 1716)

Regulation .14 amended effective June 6, 1994 (21:11 Md. R. 951)

Regulation .14C-1 adopted as an emergency provision effective July 1, 2001 (28:16 Md. R. 1480); adopted permanently effective October 1, 2001 (28:19 Md. R. 1684)

Regulation .14G amended effective March 19, 1990 (17:5 Md. R. 638)

Regulation .15 amended effective March 19, 1990 (17:5 Md. R. 638); October 3, 2011 (38:20 Md. R. 1202)

Regulation .15A amended effective March 17, 2003 (30:5 Md. R. 366)

Regulation .15B amended as an emergency provision effective May 1, 2004 (31:12 Md. R. 908); amended permanently effective August 16, 2004 (31:16 Md. R. 1255)

Regulation .16 amended effective February 19, 1990 (17:3 Md. R. 297); December 29, 1997 (24:26 Md. R. 1758); July 8, 2002 (29:13 Md. R. 990); March 18, 2013 (40:5 Md. R. 411)

Regulation .16D amended effective April 5, 2010 (37:7 Md. R. 570)

Regulations .16E and G, and .17J amended and .17K adopted as an emergency provision effective April 4, 1991 (18:9 Md. R. 1004); adopted permanently effective July 22, 1991 (18:14 Md. R. 1609)

Regulations .16E and G amended and .30 adopted as an emergency provision effective January 1, 1991 (18:2 Md. R. 146); emergency status expired April 8, 1991 (18:9 Md. R. 1005)

Regulation .16E amended effective September 27, 2004 (31:19 Md. R. 1432); October 14, 2013 (40:20 Md. R. 1652)

Regulation .16F amended effective March 17, 2003 (30:5 Md. R. 366)

Regulation .16F amended as an emergency provision effective July 1, 2003 (30:15 Md. R. 990); emergency status expired December 31, 2003

Regulation .16F amended effective February 16, 2004 (31:3 Md. R. 207); December 9, 2005 (32:24 Md. R. 1904); April 6, 2009 (36:7 Md. R. 523); December 27, 2010 (37:26 Md. R. 1787); November 28, 2011 (38:24 Md. R. 1502)

Regulation .16G amended effective June 3, 1996 (23:11 Md. R. 810)

Regulation .17 amended effective July 8, 2002 (29:13 Md. R. 990); May 9, 2005 (32:9 Md. R. 848); December 9, 2005 (32:24 Md. R. 1904); March 18, 2013 (40:5 Md. R. 411); December 11, 2014 (41:24 Md. R. 1427)

Regulation .17K amended and L—O adopted effective June 6, 1994 (21:11 Md. R. 951)

Regulation .18A amended effective March 18, 2013 (40:5 Md. R. 411)

Regulations .20—.23 amended as an emergency provision effective January 6, 1994 (21:2 Md. R. 96); adopted permanently effective May 1, 1994 (21:7 Md. R. 531)

Regulation .20 amended as an emergency provision effective July 1, 1998 (25:15 Md. R. 1181); amended permanently effective October 19, 1998 (25:21 Md. R. 1574)

Regulation .20 amended effective December 9, 2005 (32:24 Md. R. 1904)

Regulation .21 amended effective December 9, 2005 (32:24 Md. R. 1904)

Regulation .22 amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 892); emergency status expired September 3, 2008

Regulation .22 amended effective September 22, 2008 35:19 Md. R. 1716)

Regulation .23 amended effective December 9, 2005 (32:24 Md. R. 1904)

Regulation .24A, B amended as an emergency provision effective July 1, 2003 (30:15 Md. R. 990); emergency status expired December 31, 2003

Regulation .24A, B amended effective February 16, 2004 (31:3 Md. R. 207); March 18, 2013 (40:5 Md. R. 411)

Regulation .25B amended effective August 15, 1994 (21:16 Md. R. 1383); February 16, 2004 (31:3 Md. R. 207); February 12, 2007 (34:3 Md. R. 297); March 18, 2013 (40:5 Md. R. 411)

Regulation .25C amended as an emergency provision effective July 1, 2003 (30:15 Md. R. 990); emergency status expired December 31, 2003

Regulation .27A amended effective June 6, 1994 (21:11 Md. R. 951)

Regulation .27A-1 adopted as an emergency provision effective October 16, 1995 (22:22 Md. R. 1654); adopted permanently effective January 15, 1996 (23:1 Md. R. 25)

Regulation .27C amended effective December 29, 1997 (24:26 Md. R. 1758)

Regulation .28 amended effective January 24, 2011 (38:2 Md. R. 84)

Regulation .30 adopted effective May 9, 2005 (32:9 Md. R. 848)

Chapter revised effective April 13, 2015 (42:7 Md. R. 567)

Regulation .07-1I amended effective December 19, 2016 (43:25 Md. R. 1384); January 1, 2018 (44:26 Md. R. 1214)

Regulation .07-2 amended effective February 29, 2016 (43:4 Md. R. 331)

Regulation .07-2L, M adopted effective December 19, 2016 (43:25 Md. R. 1384)

Regulation .07-2N adopted effective January 1, 2018 (44:26 Md. R. 1214)

Regulation .10-1B amended effective February 29, 2016 (43:4 Md. R. 331); December 19, 2016 (43:25 Md. R. 1384)

Regulation .11-2B amended effective December 19, 2016 (43:25 Md. R. 1384)

Regulation .11-7C amended effective December 19, 2016 (43:25 Md. R. 1384)

Regulation .11-8C amended effective December 19, 2016 (43:25 Md. R. 1384)

Regulation .12-1A, B amended effective February 29, 2016 (43:4 Md. R. 331)

Regulation .13O amended effective February 29, 2016 (43:4 Md. R. 331)

Regulation .15-1 amended effective February 29, 2016 (43:4 Md. R. 331)

Regulation .15-1D amended effective December 19, 2016 (43:25 Md. R. 1384)

Regulation .16-1G amended effective February 29, 2016 (43:4 Md. R. 331)

Regulation .16-1I adopted effective February 29, 2016 (43:4 Md. R. 331)

Regulation .25C adopted effective December 19, 2016 (43:25 Md. R. 1384)

Regulation .28B amended effective February 29, 2016 (43:4 Md. R. 331)

Chapter revised effective July 2, 2018 (45:13 Md. R. 664)

Regulation .01B amended effective June 14, 2021 (48:12 Md. R. 472)

Regulation .07 amended effective August 7, 2023 (50:15 Md. R. 681)

Regulation .07G amended effective May 20, 2019 (46:10 Md. R. 486); December 30, 2019 (46:26 Md. R. 1164); November 14, 2022 (49:23 Md. R. 995); September 16, 2024 (51:18 Md. R. 808), March 31, 2025 (52:6 Md. R. 267)

Regulation .07H, I adopted effective November 14, 2022 (49:23 Md. R. 995)

Regulation .08H amended effective May 20, 2019 (46:10 Md. R. 486); December 30, 2019 (46:26 Md. R. 1164); June 14, 2021 (48:12 Md. R. 472); November 14, 2022 (49:23 Md. R. 995); August 7, 2023 (50:15 Md. R. 681); September 16, 2024 (51:18 Md. R. 808); March 31, 2025 (52:6 Md. R. 267)

Regulation .11B amended effective May 20, 2019 (46:10 Md. R. 486)

Regulation .13A amended effective May 20, 2019 (46:10 Md. R. 486)

Regulation .15 amended effective June 14, 2021 (48:12 Md. R. 472)

Regulation .19 amended effective June 14, 2021 (48:12 Md. R. 472

Regulation .19A amended effective November 14, 2022 (49:23 Md. R. 995)

Regulation .21P adopted effective November 14, 2022 (49:23 Md. R. 995)

Regulation .22B amended effective November 14, 2022 (49:23 Md. R. 995)

Regulation .30 amended effective December 30, 2019 (46:26 Md. R. 1164)