1. A. An MCO shall provide health care services to enrollees who are members of special needs populations.

2. B. Special needs populations consist of the following non-mutually exclusive populations:

   1. (1) Children with special health care needs;
   2. (2) Individuals with a physical disability;
   3. (3) Individuals with a developmental disability;
   4. (4) Pregnant and postpartum women;
   5. (5) Individuals who are homeless;
   6. (6) Individuals with HIV/AIDS; and
   7. (7) Children in State-supervised care.

3. C. General Requirements for Special Needs Populations.

   1. (1) An MCO shall demonstrate that its pediatric and adult primary care providers (PCPs) and specialists are clinically qualified based upon generally accepted community standards to provide or arrange for the provision of appropriate health care services to individuals who are members of a special needs population. The MCO shall submit to the Department referral protocols that demonstrate the conditions under which PCPs will make the arrangements for referrals to specialty care networks.
   2. (2) Clinical qualifications are to be determined through the MCO's credentialing and recredentialing processes, including a review of the provider's medical education, special training, and work history and experience.

   3. (3) Specialty and subspecialty providers shall:

      1. (a) Have experience in treating individuals within a special needs population;
      2. (b) Have experience in interdisciplinary medical management; and
      3. (c) Understand the relationship between somatic and behavioral health care issues and interventions.
   4. (4) The MCO shall demonstrate the use of a primary care system of care delivery which includes a comprehensive plan of care for an enrollee who is a member of a special needs population and which uses a coordinated and continuous case management approach, involving the enrollee and, as appropriate, the enrollee's family, guardian, or caregiver, in all aspects of care, including primary, acute, tertiary, and home care.

   5. (5) To meet the commitment outlined in §C(4) of this regulation, an MCO shall:

      1. (a) Provide case management services to adult and pediatric enrollees as appropriate;
      2. (b) Have the capacity to perform home visits as part of the ongoing case management program and have the ability to respond to urgent care needs while in the enrollee's home;
      3. (c) Ensure that, if warranted, a case manager is assigned to an enrollee at the time of the initial health screen by the MCO;
      4. (d) Ensure that the PCP, who may also be the specialist, shall be the admitting or referring provider for all hospital admissions;

      5. (e) Ensure that it will:

         1. (i) Collaborate with inpatient facilities in facilitating preadmission and discharge planning, and
         2. (ii) Communicate all post-discharge home and community arrangements to the enrollee, the PCP, and, as appropriate, the enrollee's family, guardian, and caregiver;

      6. (f) Document the plan of care and treatment modalities provided to enrollees in special populations, assuring that the plan of care:

         1. (i) Is updated at least annually, when the enrollee’s circumstances or needs change significantly, or at the enrollee’s request; and
         2. (ii) Involves the enrollee and, as appropriate, the enrollee's family, guardian, and caregiver in care decisions; and
      7. (g) Be familiar with community and social support providers for the special populations.

   6. (6) An MCO shall make documented outreach efforts to contact and educate enrollees who fail to appear for appointments or who have been noncompliant with a regimen of care. These efforts may include, but may not be limited to, notification:

      1. (a) By mail;
      2. (b) By telephone;
      3. (c) By email;
      4. (d) By text messaging; and
      5. (e) Through face-to-face contact.

   7. (7) Referral to Local Health Department.

      1. (a) An MCO shall make a written referral, or ensure that the enrollee's provider makes a written referral, to the local health department (LHD) for the county in which an enrollee resides, for assistance in bringing into care an enrollee for whom the MCO has been unsuccessful in its documented out-reach efforts pursuant to §C(6) of this regulation, within 10 business days of whichever first occurs:

         1. (i) The third consecutive missed appointment; or
         2. (ii) The MCO or the enrollee's provider identifies the enrollee's repeated noncompliance with a regimen of care.
      2. (b) The MCO may not include information about an enrollee's HIV status on the form used to refer an enrollee to the local health department.
   8. (8) An MCO shall subject its decision to deny a service authorization request or to authorize a service in an amount, duration, or scope that is less than requested, for an enrollee who is a member of special needs population to utilization review that includes review by a health care professional who has appropriate clinical expertise in treating the enrollee's condition or disease.

   9. (9) An MCO shall identify a special needs coordinator, who shall:

      1. (a) Serve as a point of contact for health care services information and referral for members of special needs populations;
      2. (b) Be skilled in communications with, and sensitive to the unique needs of, members of special needs populations, their families, guardians, and caregivers;
      3. (c) Participate on the MCO's consumer advisory board, pursuant to Regulation .12 of this chapter, as a representative of special needs populations;
      4. (d) Serve as a resource to MCO providers and enrollees on the requirements of P.L. 101-330, Americans with Disabilities Act of 1990, 42 U.S.C. §12101 et seq.; and
      5. (e) Maintain a log of each denial of treatment and the outcome of the utilization review conducted pursuant to §C(8) of this regulation.
   10. (10) An MCO shall have mechanisms in place to allow enrollees with special health care needs to access a specialist directly as appropriate for the enrollee’s condition and identified needs.

Authority: Health-General Article, §§2-104, 15-101, 15-102.3, and 15-103; Insurance Article, §§15-112, 15-605, and 15-1008; Annotated Code of Maryland

Effective date:

Regulations .01—.23 adopted as an emergency provision effective November 8, 1996 (23:25 Md. R. 1730)

Regulations .01—.23 adopted effective March 10, 1997 (24:5 Md. R. 408)

Regulation .01 amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 28, 2002 (29:21 Md. R. 1645)

Regulations .02C, .04C, .08, .11, .15, .17A, .18, .20B, and .22C amended and Regulation .11-1 adopted as an emergency provision effective July 1, 1997 (24:16 Md. R. 1151); emergency status expired December 31, 1997

Regulation .02 amended effective February 9, 1998 (25:3 Md. R. 144); November 1, 1999 (26:22 Md. R. 1692); February 18, 2002 (29:3 Md. R.220)

Regulation .02 amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 28, 2002 (29:21 Md. R. 1645)

Regulation .02 amended effective December 23, 2002 (29:25 Md. R. 1981)

Regulation .02G amended as an emergency provision effective July 1, 1998 (25:16 Md. R. 1261); adopted permanently effective January 1, 1999 (25:26 Md. R. 1925)

Regulation .02G and H amended as an emergency provision effective July 1, 2003 (30:21 Md. R. 1527); amended permanently effective November 10, 2003 (30:22 Md. R. 1580)

Regulation .03P amended as an emergency provision effective July 1, 1998 (25:16 Md. R. 1261); adopted permanently effective January 1, 1999 (25:26 Md. R. 1925)

Regulation .03T adopted effective February 18, 2002 (29:3 Md. R.220)

Regulation .03 repealed and new Regulation .03 adopted effective December 23, 2002 (29:25 Md. R. 1981)

Regulation .04C amended effective February 9, 1998 (25:3 Md. R. 144)

Regulation .05 amended as an emergency provision effective July 1, 1998 (25:16 Md. R. 1261); adopted permanently effective January 1, 1999 (25:26 Md. R. 1925)

Regulation .05 amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 28, 2002 (29:21 Md. R. 1645)

Regulation .05K amended effective December 23, 2002 (29:25 Md. R. 1981)

Regulation .08 amended effective February 9, 1998 (25:3 Md. R. 144)

Regulation .08 amended as an emergency provision effective July 1, 1998 (25:16 Md. R. 1261); adopted permanently effective January 1, 1999 (25:26 Md. R. 1925)

Regulation .10B amended effective February 18, 2002 (29:3 Md. R.220)

Regulation .11 amended effective February 9, 1998 (25:3 Md. R. 144)

Regulation .11 amended as an emergency provision effective July 1, 1998 (25:16 Md. R. 1261); adopted permanently effective January 1, 1999 (25:26 Md. R. 1925)

Regulation .11 amended as an emergency provision effective July 1, 2000 (27:15 Md. R. 1397); amended permanently effective October 16, 2000 (27:20 Md. 1838)

Regulation .11 amended effective February 18, 2002 (29:3 Md. R.220); December 23, 2002 (29:25 Md. R. 1981)

Regulation .11-1 and .11-2 adopted February 9, 1998 (25:3 Md. R. 144)

Regulation .11-1 and .11-2E amended as an emergency provision effective July 1, 1998 (25:16 Md. R. 1261); adopted permanently effective January 1, 1999 (25:26 Md. R. 1925)

Regulations .11-1 and .11-2 amended as an emergency provision effective July 1, 2000 (27:15 Md. R. 1397); amended permanently effective October 16, 2000 (27:20 Md. R. 1838)

Regulation .15 amended effective February 9, 1998 (25:3 Md. R. 144); December 25, 2000 (27:25 Md. R. 2281); February 18, 2002 (29:3 Md. R.220)

Regulation .15B amended as an emergency provision effective July 1, 1998 (25:16 Md. R. 1261); adopted permanently effective January 1, 1999 (25:26 Md. R. 1925)

Regulation .15D, E amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 28, 2002 (29:21 Md. R. 1645)

Regulation .16 amended as an emergency provision effective July 1, 1998 (25:16 Md. R. 1261); adopted permanently effective January 1, 1999 (25:26 Md. R. 1925)

Regulation .17A amended effective February 9, 1998 (25:3 Md. R. 144); December 23, 2002 (29:25 Md. R. 1981)

Regulation .17B amended effective February 18, 2002 (29:3 Md. R.220)

Regulation .18 amended effective February 9, 1998 (25:3 Md. R. 144)

Regulation .18-1 adopted as an emergency provision effective April 7, 1998 (25:9 Md. R. 676); adopted permanently effective June 29, 1998 (25:13 Md. R. 993)

Regulation .18-1 amended effective December 25, 2000 (27:25 Md. R.2281)

Regulation .18-1C adopted effective November 1, 1999 (26:22 Md. R. 1692)

Regulation .19 amended as an emergency provision effective July 1, 1998 (25:16 Md. R. 1261); emergency status extended at 26:1 Md. R. 17, 26:6 Md. R. 480, and 26:8 Md. R. 614; emergency status expired May 1, 1999

Regulation .19 amended as an emergency provision effective May 1, 1999 (26:9 Md. R. 727 and 26:10 Md. R. 794); emergency status expired November 1, 1999

Regulation .19 amended effective November 1, 1999 (26:22 Md. R. 1692)

Regulation .19 amended as an emergency provision effective December 1, 1999 (26:25 Md. R. 1888); emergency status expired December 25, 2000

Regulation .19 amended effective December 25, 2000 (27:25 Md. R.2281)

Regulation .19 amended effective December 23, 2002 (29:25 Md. R. 1981)

Regulation .19A amended as an emergency provision effective March 31, 2001 (28:7 Md. R. 685); emergency status extended at 28:22 Md. R. 1931 and 29:4 Md. R. 413

Regulation .19B amended effective December 24, 2001 (28:25 Md. R. 2190)

Regulation .19B amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 28, 2002 (29:21 Md. R. 1645)

Regulation .19D amended as an emergency provision effective July 1, 2003 (30:21 Md. R. 1527); amended permanently effective November 10, 2003 (30:22 Md. R. 1580)

Regulations .19-1—.19-3 adopted as an emergency provision effective December 1, 1999 (26:25 Md. R. 1888); emergency status expired December 25, 2000

Regulations .19-1—.19-4 adopted effective December 25, 2000 (27:25 Md. R. 2281)

Regulations .19-1 and .19-2 repealed and new Regulation .19-1 adopted effective December 24, 2001 (28:25 Md. R. 2190)

Regulation .19-1 repealed as an emergency provision effective July 1, 2003 (30:21 Md. R. 1527); repealed permanently effective November 10, 2003 (30:22 Md. R. 1580)

Regulations .19-3 and .19-4 amended and recodified to be new Regulations .19-2 and .19-3 effective December 24, 2001 (28:25 Md. R. 2190)

Regulation .19-3 amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 28, 2002 (29:21 Md. R. 1645)

Regulation .19-3 amended effective December 23, 2002 (29:25 Md. R. 1981)

Regulation .19-4 adopted effective December 23, 2002 (29:25 Md. R. 1981)

Regulations .19-5 and.19-6 adopted as an emergency provision effective March 31, 2001 (28:7 Md. R. 685); emergency status extended at 28:22 Md. R. 1931; emergency status extended at 29:4 Md. R. 413

Regulation .20 amended as an emergency provision effective July 1, 1998 (25:16 Md. R. 1261); amended permanently effective January 1, 1999 (25:26 Md. R. 1925)

Regulation .20 amended as an emergency provision effective July 1, 2003 (30:21 Md. R. 1527); amended permanently effective November 10, 2003 (30:22 Md. R. 1580)

Regulation .20A amended effective December 23, 2002 (29:25 Md. R. 1981)

Regulation .20B amended effective February 9, 1998 (25:3 Md. R. 144)

Regulation .21 amended effective December 25, 2000 (27:25 Md. R. 2281); December 24, 2001 (28:25 Md. R. 2190); July 7, 2003 (30:13 Md. R. 854)

Regulation .22 amended as an emergency provision effective May 1, 1999 (26:9 Md. R. 727 and 26:10 Md. R. 794); emergency status expired November 1, 1999

Regulation .22 amended as an emergency provision effective December 1, 1999 (26:25 Md. R. 1888); emergency status expired December 25, 2000

Regulation .22 amended as an emergency provision effective December 1, 2000 (27:26 Md. R. 2355); emergency status extended at 28:7 Md. R. 685; adopted permanently effective June 25, 2001 (28:12 Md. R. 1109)

Regulation .22 amended effective December 24, 2001 (28:25 Md. R. 2190)

Regulation .22A amended and F—J adopted effective November 1, 1999 (26:22 Md. R. 1692)

Regulation .22C amended effective February 9, 1998 (25:3 Md. R. 144)

Regulations .24 and .25 adopted as an emergency provision effective July 1, 1998 (25:16 Md. R. 1261); adopted permanently effective January 1, 1999 (25:26 Md. R. 1925)

Regulation .24 amended as an emergency provision effective December 1, 1999 (26:25 Md. R. 1888); emergency status expired December 25, 2000

Regulation .24 amended effective December 25, 2000 (27:25 Md. R.2281); December 23, 2002 (29:25 Md. R. 1981)

Regulation .24-1 adopted as an emergency provision effective December 1, 1999 (26:25 Md. R. 1888); emergency status expired December 31, 2000

Regulation .26 adopted effective February 18, 2002 (29:3 Md. R. 220)

Regulation .27 adopted effective February 18, 2002 (29:3 Md. R. 220)

Chapter revised effective February 2, 2004 (31:2 Md. R. 82)

Regulation .01 repealed effective February 16, 2015 (42:3 Md. R. 316)

Regulation .01B amended effective December 27, 2010 (37:26 Md. R. 1787)

Regulation .02 amended effective June 30, 2008 (35:13 Md. R. 1180); April 28, 2014 (41:8 Md. R. 471); February 16, 2015 (42:3 Md. R. 316); February 26, 2018 (45:4 Md. R. 205)

Regulation .02G amended as an emergency provision effective January 5, 2005 (32:6 Md. R. 634); amended permanently effective April 11, 2005 (32:7 Md. R. 679)

Regulation .02G, J, X amended effective November 7, 2016 (43:22 Md. R. 1221)

Regulation .02K amended effective December 24, 2012 (39:25 Md. R. 1613)

Regulation .02O, S amended as an emergency provision effective November 1, 2008 (35:24 Md. R. 2069); amended permanently effective February 23, 2009 (36:4 Md. R. 353)

Regulation .02V amended effective December 27, 2010 (37:26 Md. R. 1787)

Regulation .02Z adopted effective November 5, 2007 (34:22 Md. R. 1977)

Regulation .02CC amended effective October 5, 2009 (36:20 Md. R. 1528); March 14, 2016 (43:5 Md. R. 385)

Regulation .02DD adopted effective February 6, 2012 (39:2 Md. R. 141)

Regulation .02EE adopted effective December 24, 2012 (39:25 Md. R. 1613)

Regulation .02K, L amended effective October 28, 2013 (40:21 Md. R. 1775)

Regulation .02FF adopted effective October 28, 2013 (40:21 Md. R. 1775)

Regulation .03 amended effective February 12, 2018 (45:3 Md. R. 156)

Regulation .03A, B amended effective October 26, 2015 (42:21 Md. R. 1301)

Regulation .03B amended effective December 19, 2005 (32:25 Md. R. 1941); April 9, 2007 (34:7 Md. R. 698); November 5, 2007 (34:22 Md. R. 1977); June 30, 2008 (35:13 Md. R. 1180)

Regulation .03B amended as an emergency provision effective November 1, 2008 (35:24 Md. R. 2069); amended permanently effective February 23, 2009 (36:4 Md. R. 353)

Regulation .03B amended effective October 5, 2009 (36:20 Md. R. 1528); April 19, 2010 (37:8 Md. R. 615); December 27, 2010 (37:26 Md. R. 1787); February 6, 2012 (39:2 Md. R. 141); December 24, 2012 (39:25 Md. R. 1613); December 12, 2013 (40:24 Md. R. 2017); August 29, 2016 (43:17 Md. R. 955); November 7, 2016 (43:22 Md. R. 1221); December 31, 2018 (45:26 Md. R. 1245)

Regulation .04B amended effective April 10, 2006 (33:7 Md. R. 668); February 16, 2015 (42:3 Md. R. 316)

Regulation .04C amended effective June 30, 2008 (35:13 Md. R. 1180); February 26, 2018 (45:4 Md. R. 205)

Regulation .05I amended as an emergency provision effective November 1, 2008 (35:24 Md. R. 2069); amended permanently effective February 23, 2009 (36:4 Md. R. 353)

Regulation .05G amended effective February 16, 2015 (42:3 Md. R. 316)

Regulation .05K amended effective December 31, 2018 (45:26 Md. R. 1244)

Regulation .06C amended effective November 6, 2006 (33:22 Md. R. 1732)

Regulation .08 amended effective April 28, 2014 (41:8 Md. R. 471)

Regulation .08C, E amended effective February 16, 2015 (42:3 Md. R. 316)

Regulation .08I amended effective December 24, 2012 (39:25 Md. R. 1613)

Regulation .08K amended effective April 10, 2006 (33:7 Md. R. 668)

Regulation .08M repealed effective April 19, 2010 (37:8 Md. R. 615)

Regulation .10C amended effective November 6, 2006 (33:22 Md. R. 1732)

Regulation .10D amended effective April 10, 2006 (33:7 Md. R. 668)

Regulation .10E amended effective February 16, 2015 (42:3 Md. R. 316)

Regulation .10F amended as an emergency provision effective January 5, 2005 (32:6 Md. R. 634); amended permanently effective April 11, 2005 (32:7 Md. R. 679)

Regulation .11 repealed effective February 16, 2015 (42:3 Md. R. 316)

Regulation .11E amended effective October 5, 2009 (36:20 Md. R. 1528)

Regulation .11F amended effective April 19, 2010 (37:8 Md. R. 615)

Regulation .11G amended as an emergency provision effective November 1, 2008 (35:24 Md. R. 2069); amended permanently effective February 23, 2009 (36:4 Md. R. 353)

Regulation .11-1 repealed effective February 16, 2015 (42:3 Md. R. 316)

Regulation .11-2 repealed effective February 16, 2015 (42:3 Md. R. 316)

Regulation .12B amended effective February 16, 2015 (42:3 Md. R. 316)

Regulation .12D repealed effective December 31, 2018 (45:26 Md. R. 1244)

Regulation .13F amended effective February 6, 2012 (39:2 Md. R. 141)

Regulation .14 amended effective February 16, 2015 (42:3 Md. R. 316)

Regulation .14A amended effective November 6, 2006 (33:22 Md. R. 1732)

Regulation .15 amended effective February 16, 2015 (42:3 Md. R. 316); February 26, 2018 (45:4 Md. R. 205); December 31, 2018 (45:26 Md. R. 1244)

Regulation .15B amended as an emergency provision effective November 1, 2008 (35:24 Md. R. 2069); amended permanently effective February 23, 2009 (36:4 Md. R. 353)

Regulation .15C amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .15D amended effective June 30, 2008 (35:13 Md. R. 1180)

Regulation .15E amended effective December 19, 2005 (32:25 Md. R. 1941); April 19, 2010 (37:8 Md. R. 615)

Regulation .15F amended effective April 10, 2006 (33:7 Md. R. 668)

Regulation .15L adopted effective June 30, 2008 (35:13 Md. R. 1180)

Regulation .16 repealed effective November 5, 2007 (34:22 Md. R. 1977)

Regulation .17 amended effective February 26, 2018 (45:4 Md. R. 205)

Regulation .17A amended effective November 6, 2006 (33:22 Md. R. 1732); June 30, 2008 (35:13 Md. R. 1180); February 6, 2012 (39:2 Md. R. 141)

Regulation .17B amended effective April 10, 2006 (33:7 Md. R. 668); June 30, 2008 (35:13 Md. R. 1180); October 5, 2009 (36:20 Md. R. 1528); February 1, 2016 (42:23 Md. R. 1434)

Regulation .18H amended effective November 5, 2007 (34:22 Md. R. 1977)

Regulation .18I, J adopted effective February 6, 2012 (39:2 Md. R. 141)

Regulation .19 amended as an emergency provision effective January 5, 2005 (32:6 Md. R. 634)

Regulation .19 amended as an emergency provision effective April 1, 2005 (32:9 Md. R. 847); amended permanently effective July 18, 2005 (32:14 Md. R. 1276)

Regulation .19 amended effective April 15, 2013 (40:7 Md. R. 611)

Regulation .19A, B amended as an emergency provision effective January 1, 2008 (35:3 Md. R. 286); amended permanently effective June 16, 2008 (35:12 Md. R. 1120)

Regulation .19A amended effective February 26, 2018 (45:4 Md. R. 205)

Regulation .19B amended effective December 20, 2004 (31:25 Md. R.1790); December 19, 2005 (32:25 Md. R. 1941); April 10, 2006 (33:7 Md. R. 669)

Regulation .19B amended as an emergency provision effective July 1, 2006 (33:20 Md. R. 1610); amended permanently effective October 23, 2006 (33:21 Md. R. 1675)

Regulation .19B amended as an emergency provision effective January 1, 2007 (34:4 Md. R. 396); amended permanently effective April 9, 2007 (34:7 Md. R. 699)

Regulation .19B amended as an emergency provision effective September 14, 2007 (34:21 Md. R. 1911); amended permanently effective November 19, 2007 (34:23 Md. R. 2027)

Regulation .19B amended effective January 12, 2009 (36:1 Md. R. 21); July 27, 2009 (36:15 Md. R. 1166); January 25, 2010 (37:2 Md. R. 67); June 14, 2010 (37:12 Md. R. 800); December 27, 2010 (37:26 Md. R. 1788); April 4, 2011 (37:8 Md. R. 431); April 30, 2012 (39:8 Md. R. 534); December 10, 2012 (39:24 Md. R. 1577); July 7, 2014 (41:13 Md. R. 752); February 16, 2015 (42:3 Md. R. 316); October 26, 2015 (42:21 Md. R. 1301); May 9, 2016 (43:9 Md. R. 530); February 27, 2017 (44:4 Md. R. 253); March 26, 2018 (45:6 Md. R. 319); August 26, 2019 (46:17 Md. R. 726)

Regulation .19D amended as an emergency provision effective February 11, 2004 (31:5 Md. R. 446); amended permanently effective May 24, 2004 (31:10 Md. R. 795)

Regulation .19D amended effective June 14, 2010 (37:12 Md. R. 800); October 26, 2015 (42:21 Md. R. 1301); February 27, 2017 (44:4 Md. R. 253); March 26, 2018 (45:6 Md. R. 319)

Regulation .19-1 adopted as an emergency provision effective January 5, 2005 (32:6 Md. R. 634); adopted permanently effective April 11, 2005 (32:7 Md. R. 679)

Regulation .19-3 amended as an emergency provision effective January 5, 2005 (32:6 Md. R. 634); amended permanently effective April 11, 2005 (32:7 Md. R. 679)

Regulation .19-3 amended effective June 19, 2006 (33:12 Md. R. 997); April 9, 2007 (34:7 Md. R. 698); June 14, 2010 (37:12 Md. R. 800); April 30, 2012 (39:8 Md. R. 534)

Regulation .19-3 repealed effective October 28, 2013 (40:21 Md. R. 1775)

Regulation .19-3 adopted effective April 28, 2014 (41:8 Md. R. 471)

Regulation .19-3A, B amended as an emergency provision effective November 1, 2008 (35:24 Md. R. 2069); amended permanently effective February 23, 2009 (36:4 Md. R. 353)

Regulation .19-3A, B amended effective October 5, 2009 (36:20 Md. R. 1528)

Regulation .19-3B amended effective December 24, 2012 (39:25 Md. R. 1613); February 3, 2014 (41:2 Md. R. 91)

Regulation .19-3C amended effective February 27, 2017 (44:4 Md. R. 253)

Regulation .19-3C, D amended effective October 26, 2015 (42:21 Md. R. 1301)

Regulation .19-5 adopted effective December 19, 2005 (32:25 Md. R. 1941)

Regulation .19-5 repealed and new Regulation .19-5 adopted effective December 31, 2018 (45:26 Md. R. 1244)

Regulation .19-5F amended effective February 16, 2015 (42:3 Md. R. 316)

Regulation .19-5G amended effective April 19, 2010 (37:8 Md. R. 615)

Regulation .19-5H amended effective April 19, 2010 (37:8 Md. R. 615); February 16, 2015 (42:3 Md. R. 316)

Regulation .20 amended effective August 8, 2011 (38:16 Md. R. 945); February 26, 2018 (45:4 Md. R. 205)

Regulation .20A amended as an emergency provision effective January 5, 2005 (32:6 Md. R. 634); amended permanently effective April 11, 2005 (32:7 Md. R. 679)

Regulation .20A amended effective April 10, 2006 (33:7 Md. R. 668); November 5, 2007 (34:22 Md. R. 1977); December 24, 2012 (39:25 Md. R. 1613); October 28, 2013 (40:21 Md. R. 1775); February 16, 2015 (42:3 Md. R. 316)

Regulation .20A, B amended effective November 6, 2006 (33:22 Md. R. 1732); April 19, 2010 (37:8 Md. R. 615)

Regulation .20A, D amended effective April 28, 2014 (41:8 Md. R. 471)

Regulation .20B, C amended effective June 30, 2008 (35:13 Md. R. 1180)

Regulation .20C amended as an emergency provision effective November 1, 2008 (35:24 Md. R. 2069); amended permanently effective February 23, 2009 (36:4 Md. R. 353)

Regulation .20E adopted effective August 29, 2016 (43:17 Md. R. 955)

Regulation .21 amended as an emergency provision effective January 5, 2005 (32:6 Md. R. 634); amended permanently effective April 11, 2005 (32:7 Md. R. 679)

Regulation .21 amended effective February 16, 2015 (42:3 Md. R. 316)

Regulation .21B amended effective June 19, 2006 (33:12 Md. R. 997); April 19, 2010 (37:8 Md. R. 615)

Regulation .22 amended as an emergency provision effective January 5, 2005 (32:6 Md. R. 634); amended permanently effective April 11, 2005 (32:7 Md. R. 679)

Regulation .22C, D amended effective November 6, 2006 (33:22 Md. R. 1732)

Regulation .23 amended effective June 30, 2008 (35:13 Md. R. 1180)

Regulation .23C amended effective November 7, 2016 (43:22 Md. R. 1221)

Regulation .23D amended as an emergency provision effective November 1, 2008 (35:24 Md. R. 2069); amended permanently effective February 23, 2009 (36:4 Md. R. 353)

Regulation .23D amended effective April 28, 2014 (41:8 Md. R. 471)

Regulation .24 amended as an emergency provision effective November 1, 2008 (35:24 Md. R. 2069); amended permanently effective February 23, 2009 (36:4 Md. R. 353)

Regulation .24 repealed effective April 19, 2010 (37:8 Md. R. 615)

Regulation .25B amended effective November 6, 2006 (33:22 Md. R. 1732)

Regulation .28 adopted effective June 30, 2008 (35:13 Md. R. 1180)

Regulation .28 amended effective February 6, 2012 (39:2 Md. R. 141)

Regulation .28 repealed effective February 26, 2018 (45:4 Md. R. 205)

Chapter transferred from COMAR 10.09.65 effective November 1, 2019 (46:22 Md. R. 977)

Regulation .03B amended effective April 19, 2021 (48:8 Md. R. 309)

Regulation .15D amended effective May 18, 2020 (47:10 Md. R. 515)

Regulation .25B amended effective May 18, 2020 (47:10 Md. R. 515)

Regulation .27C amended effective May 18, 2020 (47:10 Md. R. 515)

Chapter revised effective October 18, 2021 (48:21 Md. R. 889)

Regulation .03-1 repealed and new Regulation .03-1 adopted effective June 24, 2024 (51:12 Md. R. 620)

Regulation .03-2B amended effective June 24, 2024 (51:12 Md. R. 620)

Regulation .03-2L adopted effective June 24, 2024 (51:12 Md. R. 620)

Regulation .03-2L repealed and new Regulation .03-2 adopted effective April 28, 2025 (52:8 Md. R. 359)

Regulation .03-2M adopted effective April 28, 2025 (52:8 Md. R. 359)

Regulation .15E amended effective June 24, 2024 (51:12 Md. R. 620)

Regulation .17B amended effective June 13, 2022 (49:12 Md. R. 641)

Regulation .18K adopted effective April 28, 2025 (52:8 Md. R. 359)

Regulation .19 amended effective April 4, 2022 (49:7 Md. R. 468)

Regulation .19B, D amended effective June 24, 2024 (51:12 Md. R. 620)

Regulation .19D amended effective April 28, 2025 (52:8 Md. R. 359)

Regulation .19E adopted effective April 28, 2025 (52:8 Md. R. 359)

Regulation .19-4A amended effective June 24, 2024 (51:12 Md. R. 620)

Regulation .19-4M, N amended effective June 13, 2022 (49:12 Md. R. 641)

Regulation .20A, C amended effective June 24, 2024 (51:12 Md. R. 618)