Source: http://www.dsd.state.md.us/MDR/4325/Assembled.htm
Timestamp: 2017-03-29 17:08:49
Document Index: 73187289

Matched Legal Cases: ['§7', '§7', 'art 1', '§10', '§16', '§8', '§21', '§13', '§3', '§2', '§8', '§10', '§3', '§2', '§4', '§4', '§4', '§4', '§10', '§18', '§7', '§2', '§2', '§2', '§15', '§2']

Maryland Register Issue Date: December 9, 2016
Volume 43 • Issue 25 • Pages 1375-1430
Judiciary Regulations Special Documents General Notices Pursuant to State Government Article, §7-206,
Annotated Code of Maryland, this issue contains all previously unpublished
documents required to be published, and filed on or before November 18, 2016
5 p.m. Pursuant to State Government Article, §7-206, Annotated Code of Maryland, I
as of November 18, 2016.
Administrator, Division of State Documents
part of COMAR simply by referring to it. While the text of an incorporated document
does not appear in COMAR, the provisions of the incorporated document are as
fully enforceable as any other COMAR regulation. Each regulation that proposes
to incorporate a document is identified in the Maryland Register by an Editor’s
Note. The Cumulative Table of COMAR Regulations Adopted, Amended or Repealed,
found online, also identifies each regulation incorporating a document.
Documents incorporated by reference are available for inspection in various
depository libraries located throughout the State and at the Division of State
Documents. These depositories are listed in the first issue of the Maryland
Register published each year. For further information, call 410-974-2486.
Adopted, Amended, or Repealed’’ which is found online at http://www.dsd.state.md.us/PDF/CumulativeTable.pdf.
This table lists the regulations in numerical order, by their COMAR number,
followed by the citation to the Maryland Register in which the change occurred.
The Maryland Register serves as a temporary supplement to COMAR, and the two
publications must always be used together. A Research Guide for Maryland
Regulations is available. For further information, call 410-260-3876.
Secretary of State; Brian Morris, Administrator; Gail S. Klakring, Senior Editor; Mary D. MacDonald, Editor, Maryland Register and COMAR; Elizabeth Ramsey, Editor, COMAR Online,
and Subscription Manager; Tami Cathell, Help Desk, COMAR and Maryland
Issue Dates for the Maryland Register .................................................................... 1379
of Pending Proposals ......................................................... 1380
08 Department of Natural Resources .................................... 1388
Regulation ............. 1384
10 Department of Health and Mental Hygiene ..................................................... 1384, 1387, 1392
13B Maryland Higher Education Commission ........................ 1385
22 State Retirement and Pension System .............................. 1386
26 Department of the Environment ............................. 1378, 1424
30 Maryland Institute for Emergency Medical
Services Systems (MIEMSS) .................................................... 1386
31 Maryland Insurance Administration ............. 1386, 1387, 1425
OF APPEALS OF MARYLAND DISCIPLINARY
PROCEEDINGS ........................................ 1383
Acts ......................................................................... 1384
Simulcast Betting . 1384
Private Inpatient Facilities . 1384
Facility Services . 1384
and Continuing Education Requirements . 1385
OF NURSING — LICENSED DIRECT-ENTRY MIDWIVES
of Licensed Direct-Entry Midwives . 1385
Procedures . 1385
Allocation Guidelines . 1385
Division — Brokerage Commissions ..................... 1386
Incorporated by Reference . 1386
Gift Annuities . 1386
of Nurse Anesthetist .................................................... 1387
Institutions of Higher Education .................................... 1387
of Insurer — Failure to Act in Good Faith ................. 1387
..................................................................................... 1388
in Nontidal Waters ....................................................... 1389
Diseases — Rabies .......................................... 1392
Care Services ................................................................ 1393
Therapy Services . 1393
and Periodic Screening, Diagnosis and Treatment (EPSDT) Services ................................................................. 1393
and Periodic Screening, Diagnosis, and Treatment (EPSDT) Audiology Services . 1393
Medicaid Managed Care Program: Managed Care Organizations . 1394
Medicaid Managed Care Program: Non-Capitated Covered Services . 1398
Substance Use Disorder Services .............. 1402
Registry . 1404
Restitution Fund Program .......................................... 1406
and Sale of Frozen Dairy Foods and Ices Manufactured for Sale in Maryland ....................................... 1407
Processing, Transportation, Storage, and Distribution of Grade “A” Milk ............................................. 1407
Cheese Program .. 1407
and Medication Requirements for Youth Camps .................................................................................... 1415
Health Plan for Facilities and Services: Specialized Health Care Services —Organ Transplant
Services . 1417
Nurse — Forensic Nurse Examiner 1418
OF EXAMINERS OF NURSING HOME ADMINISTRATORS
Home Administrators ................................................. 1419
OF EXAMINERS FOR AUDIOLOGISTS, HEARING AID DISPENSERS, AND SPEECH-LANGUAGE PATHOLOGISTS
and Continuing Education ........................................ 1420
Aid Dispensers . 1420
Pathology Assistants ................................... 1420
Requirements for Private Career Schools ................. 1421
Requirements for In-State Degree-Granting Institutions ............................................................................. 1422
............................................................................... 1423
Registration . 1424
OF WATER SUPPLY, SEWAGE DISPOSAL, AND SOLID WASTE
Disposal and Certain Water Systems for Homes and Other Establishments in the Counties
of Maryland Where a Public Sewage System Is Not Available . 1424
Plans . 1425
LIABILITIES, RESERVES, AND INVESTMENTS OF INSURERS
Financial Reporting . 1425
and Casualty Actuarial Opinion ................................. 1425
OF CHRONIC HOSPITAL BEDS, PATIENT DAYS, AND AVERAGE ANNUAL BED OCCUPANCY:
MARYLAND, FY 2015 1427
Meeting .......................................................................... 1428
Meeting . 1428
JUSTICE INFORMATION ADVISORY BOARD
Hearing .......................................................................... 1428
Start of Review ............................................................. 1428
of Receipt of a Letter of Intent and Review for Organ Transplant Services — Liver ................................................. 1429
of Receipt of a Letter of Intent and Review for Organ Transplant Services — Kidney .............................................. 1429
COMMISSION ON MARYLAND MILITARY MONUMENTS
Meeting . 1429
HEALTHCARE DELIVERY WORKGROUP
Meeting .......................................................................... 1429
OF NATURAL RESOURCES/FISHING AND BOATING SERVICES
Notice — 2016 Commercial Striped Bass Individual Transferable Quota Season Modification
............................... 1429
OF VETERANS AFFAIRS/MARYLAND VETERANS COMMISSION
MARYLAND WASTE DISPOSAL AUTHORITY
Meetings Notice Procedure . 1429
January 6**
January 20**
March 3**
followed by a citation to that issue of the Maryland Register in which the proposal
02 OFFICE OF THE ATTORNEY
02.06.03.01—.10 • 42:13 Md. R. 798 (6-26-15)
03.11.01.01—.14 • 43:17 Md. R. 960 (8-19-16)
07.02.14.01—.14 • 43:2 Md. R. 143 (1-22-16)
07.02.15.01—.11 • 43:17 Md. R. 964 (8-19-16)
07.02.17.03,.04,.06—.08 • 43:17 Md. R. 968 (8-19-16)
07.02.18.02,.04,.06—.14 • 43:17 Md. R. 969 (8-19-16)
07.02.19.01—.08,.10,.12—.14,.16 • 43:17 Md. R. 971 (8-19-16)
08.02.01.05 • 43:23 Md. R. 1282 (11-14-16)
08.02.01.09 • 43:25 Md. R. 1388 (12-9-16)
08.02.05.22 • 43:23 Md. R. 1283 (11-14-16)
08.02.10.01 • 43:23 Md. R. 1283 (11-14-16)
08.02.11.01,.04 • 43:25 Md. R. 1389 (12-9-16)
08.03.10.11 • 43:22 Md. R. 1225 (10-28-16)
08.03.16.01—.05 • 43:22 Md. R. 1225 (10-28-16) (ibr)
08.04.16.01—.03 • 43:2 Md. R. 162 (1-22-16)
09.11.09.02 • 43:13 Md. R. 721 (6-24-16)
09.12.21.02 • 43:22 Md. R. 1227 (10-28-16)
09.12.31 • 43:2 Md. R. 176 (1-22-16)
09.12.35.01—.05 • 43:22 Md. R. 1228 (10-28-16)
09.20.01.01—.05 • 43:16 Md. R. 904 (8-5-16) (ibr)
10.03.01.08 • 43:23 Md. R. 1284 (11-14-16)
10.06.02.02,.04,.13 • 43:25 Md. R. 1392 (12-9-16)
10.09.14.07 • 43:25 Md. R. 1393 (12-9-16)
10.09.17.06 • 43:25 Md. R. 1393 (12-9-16)
10.09.20.09—.11,.14 •
43:23 Md. R. 1284 (11-14-16)
10.09.23.01-1,.07 • 43:25 Md. R. 1393 (12-9-16) (ibr)
10.09.23.03 • 43:24 Md. R. 1354 (11-28-16)
10.09.51.07 • 43:25 Md. R. 1393 (12-9-16)
10.09.54.13—.19,.22 •
43:23 Md. R. 1285 (11-14-16)
10.09.60.01—.08 • 43:24 Md. R. 1355 (11-28-16)
10.09.65.19 • 43:25 Md. R. 1394 (12-9-16)
10.09.65.19-3 • 43:24 Md. R. 1354 (11-28-16)
10.09.67.01,.07,.12 • 43:24 Md. R. 1354 (11-28-16)
10.09.70.02 • 43:25 Md. R. 1398 (12-9-16)
10.09.80.01,.05,.06,.08 • 43:25 Md. R. 1402 (12-9-16)
10.09.84.14—.20,.23,.24
• 43:23 Md. R. 1286 (11-14-16)
10.14.01.01,.02,.02-1,.07 • 43:25 Md. R. 1404 (12-9-16) (ibr)
10.14.06.02—.06 • 43:25 Md. R. 1406 (12-9-16)
10.15.05.01,.01-1,.13,.14,.20-1,.21,
.24—.26-2 • 43:25 Md. R. 1407 (12-9-16) (ibr)
10.15.06.01-.07,.10,.12—.20 • 43:25 Md. R. 1407 (12-9-16)
10.15.07.01 • 43:22 Md. R. 1229 (10-28-16) (ibr)
10.15.08.02,.03 • 43:25 Md. R. 1407 (12-9-16)
10.16.07.03,.14 • 43:25 Md. R. 1415 (12-9-16)
10.21.01.02,.04,.08,.09 • 43:19 Md. R. 1076 (9-16-16)
10.21.25.03,.08 • 43:22 Md. R. 1229 (10-28-16)
10.22.10.05 • 43:23 Md. R. 1287 (11-14-16)
10.22.17.06—.08 • 43:22 Md. R. 1231 (10-28-16)
10.24.15.01 • 43:25 Md. R. 1417 (12-9-16) (ibr)
10.27.01.04—.18 • 43:24 Md. R. 1357 (11-28-16)
10.27.21.02—.05,.07 • 43:25 Md. R. 1418 (12-9-16)
10.32.01.08,.10,.11 • 43:22 Md. R. 1239 (10-28-16)
10.32.03.09 • 43:22 Md. R. 1239 (10-28-16)
10.32.06.07,.08 • 43:22 Md. R. 1239 (10-28-16)
10.32.08.07 • 43:22 Md. R. 1239 (10-28-16)
10.32.10.13 • 43:22 Md. R. 1239 (10-28-16)
10.32.11.09,.11 • 43:22 Md. R. 1239 (10-28-16)
10.33.01.14 • 43:25 Md. R. 1419 (12-9-16)
10.37.10.03 • 43:20 Md. R. 1115 (9-30-16)
10.37.10.07-2 • 43:22 Md. R. 1244 (10-28-16)
10.39.01.03—.09 • 43:24 Md. R. 1357 (11-28-16)
10.39.04.04 • 43:24 Md. R. 1357 (11-28-16)
10.41.03.08 • 43:25 Md. R. 1420 (12-9-16)
10.41.08.02 • 43:25 Md. R. 1420 (12-9-16)
10.41.11.02 • 43:25 Md. R. 1420 (12-9-16)
10.43.01.01—.06 • 43:20 Md. R. 1117 (9-30-16)
10.43.03.01—.03 • 43:20 Md. R. 1117 (9-30-16)
10.43.04.01 • 43:20 Md. R. 1117 (9-30-16)
10.43.05.02,.03 • 43:20 Md. R. 1117 (9-30-16)
10.43.06.02—.05 • 43:20 Md. R. 1117 (9-30-16)
10.43.07.01,.09 • 43:20 Md. R. 1117 (9-30-16)
10.43.08.01,.02 • 43:20 Md. R. 1117 (9-30-16)
10.43.09.02 • 43:20 Md. R. 1117 (9-30-16)
10.43.10.02 • 43:20 Md. R. 1117 (9-30-16)
10.43.11.02 • 43:20 Md. R. 1117 (9-30-16)
10.43.12.01—.07 • 43:20 Md. R. 1117 (9-30-16)
10.43.13.01—.10 • 43:20 Md. R. 1117 (9-30-16)
10.43.14.02 • 43:20 Md. R. 1117 (9-30-16)
10.43.15.02 • 43:20 Md. R. 1117 (9-30-16)
10.44.20.02 • 43:22 Md. R. 1245 (10-28-16)
10.53.02.01—.10 • 43:24 Md. R. 1357 (11-28-16)
10.63.01.02,.04,.05 • 43:23 Md. R. 1289 (11-14-16)
10.63.03.14,.18,.19 • 43:23 Md. R. 1289 (11-14-16)
10.63.04.03 • 43:23 Md. R. 1289 (11-14-16)
10.63.06.10 • 43:23 Md. R. 1289 (11-14-16)
10.65.01.01—.14 • 43:20 Md. R. 1117 (9-30-16)
10.65.02.01—.09 • 43:20 Md. R. 1117 (9-30-16)
10.65.03.03,.09 • 43:20 Md. R. 1117 (9-30-16)
10.65.04.01—.03,.06 • 43:20 Md. R. 1117 (9-30-16)
10.65.05.01—.04 • 43:20 Md. R. 1117 (9-30-16)
10.65.06.01,.02 • 43:20 Md. R. 1117 (9-30-16)
10.65.07.01—.04 • 43:20 Md. R. 1117 (9-30-16)
10.65.08.01,.02 • 43:20 Md. R. 1117 (9-30-16)
10.65.09.01—.06 • 43:20 Md. R. 1117 (9-30-16)
12.14.03.02,.03,.06,.09 • 43:20 Md. R. 1136 (9-30-16)
12.14.04.01,.02,.05,.08 • 43:20 Md. R. 1136 (9-30-16)
12.14.05.01,.02,.05,.08 • 43:20 Md. R. 1136 (9-30-16)
13A.02.08.01—.03 • 43:22 Md. R. 1252 (10-28-16)
13A.03.07.01—.05 • 43:22 Md. R. 1252 (10-28-16)
13A.04.03.01—.11 • 43:22 Md. R. 1253 (10-28-16)
13A.04.10.01,.02 • 43:19 Md. R. 1085 (9-16-16) (ibr)
13A.05.01 • 43:21 Md. R. 1182 (10-14-16) (err)
13A.05.01.03,.05—.08 • 43:20 Md. R. 1138 (9-30-16)
13A.05.03.01—.03 • 43:19 Md. R. 1086 (9-16-16)
13A.05.08.01—.06 • 43:19 Md. R. 1086 (9-16-16)
13A.05.12.01—.03 • 43:19 Md. R. 1087 (9-16-16)
13B.01.01.03,.15 • 43:25 Md. R. 1421 (12-9-16)
13B.02.02.08 • 43:25 Md. R. 1422 (12-9-16)
13B.05.01.05 • 43:25 Md. R. 1423 (12-9-16)
13B.05.01.06 • 43:25 Md. R. 1424 (12-9-16)
13B.07.02.07 • 43:23 Md. R. 1290 (11-14-16)
13B.08.09.01—.11 • 42:22 Md. R. 1398 (10-30-15)
13B.08.13.01—.10 • 43:8 Md. R. 506 (4-15-16)
13B.08.14.01—.15 • 43:6 Md. R. 421 (3-18-16)
14.06.03.05,.06 • 42:26 Md. R. 1638 (12-28-15)
15 DEPARTMENT OF
15.05.01.02 • 43:19 Md. R. 1088 (9-16-16)
15.06.04.06 • 43:21 Md. R. 1171 (10-14-16)
15.20.07.02 • 43:22 Md. R. 1254 (10-28-16) (ibr)
OF ASSESSMENTS AND TAXATION
18.04.11.01 • 43:22 Md. R. 1255 (10-28-16)
19A STATE ETHICS
19A.01.01.02,.04 • 43:20 Md. R. 1140 (9-30-16)
19A.01.02.02,.04 • 43:20 Md. R. 1140 (9-30-16)
19A.01.03.02,.04 • 43:20 Md. R. 1140 (9-30-16)
19A.04.Appendices A and B • 43:20 Md. R. 1140 (9-30-16)
19A.04.01.03 • 43:20 Md. R. 1140 (9-30-16)
19A.04.02.04,.05 • 43:20 Md. R. 1140 (9-30-16)
19A.04.03.01 • 43:20 Md. R. 1140 (9-30-16)
19A.05.Appendices A and B • 43:20 Md. R. 1140 (9-30-16)
19A.05.02.04,.06 • 43:20 Md. R. 1140 (9-30-16)
19A.06.01.03 • 43:20 Md. R. 1140 (9-30-16)
19A.06.02.04,.05 • 43:20 Md. R. 1140 (9-30-16)
19A.06.03.05,.07 • 43:20 Md. R. 1140 (9-30-16)
19A.07.01.04,.06—.08 • 43:20 Md. R. 1140 (9-30-16)
20.31.01.02 • 43:23 Md. R. 1291 (11-14-16)
20.31.03.01 • 43:23 Md. R. 1291 (11-14-16)
21 STATE PROCUREMENT
21.01.02.01 • 43:21 Md. R. 1172 (10-14-16)
21.02.01.04 • 43:21 Md. R. 1172 (10-14-16)
21.02.03.02,.03 • 43:21 Md. R. 1172 (10-14-16)
21.04.01.03 • 43:21 Md. R. 1172 (10-14-16)
21.05.01.01 • 43:21 Md. R. 1172 (10-14-16)
21.05.05.04 • 43:21 Md. R. 1172 (10-14-16)
21.05.08.04,.07,.08 • 43:21 Md. R. 1172 (10-14-16)
21.05.12.01—.07 • 43:21 Md. R. 1172 (10-14-16)
21.06.07.09,.10 • 43:21 Md. R. 1172 (10-14-16)
21.06.09.01—.06 • 43:21 Md. R. 1172 (10-14-16)
21.07.01.08,.18,.20,.25,.26 • 43:21 Md. R. 1172 (10-14-16)
21.07.02.04 • 43:21 Md. R. 1172 (10-14-16)
21.11.03.09 • 43:21 Md. R. 1172 (10-14-16)
21.11.09.01,.02 • 43:21 Md. R. 1172 (10-14-16)
21.11.13.02,.04 • 43:21 Md. R. 1172 (10-14-16)
21.12.04.10,.10-1 • 43:21 Md. R. 1172 (10-14-16)
21.12.05.01 • 43:21 Md. R. 1172 (10-14-16)
21.14.01.01—.07 • 43:21 Md. R. 1172 (10-14-16)
01—07 (Part 1)
26.04.02.09 • 43:25 Md. R. 1424 (12-9-16)
31.04.15.03 • 43:25 Md. R. 1425 (12-9-16)
31.05.11.02 • 43:25 Md. R. 1425 (12-9-16)
31.05.12.01 • 43:25 Md. R. 1425 (12-9-16)
31.08.01.02 • 43:24 Md. R. 1362 (11-28-16)
31.08.02.02 • 43:24 Md. R. 1362 (11-28-16)
31.08.03 • 43:24 Md. R. 1362 (11-28-16)
31.08.08.07 • 43:24 Md. R. 1362 (11-28-16)
31.08.09.06—.08,.13,.14
• 43:24 Md. R. 1362 (11-28-16)
31.08.10.02 • 43:24 Md. R. 1362 (11-28-16)
31.10.11.14 • 43:24 Md. R. 1365 (11-28-16)
31.13.01.22 • 43:23 Md. R. 1318 (11-14-16)
31.14.03.06 • 43:24 Md. R. 1365 (11-28-16)
31.15 • 43:2 Md. R. 128 (1-22-16) (err)
31.15.04.01—.07 • 43:1 Md. R. 76 (1-8-16)
43:14 Md. R. 789 (7-8-16)
31.15.15.01—.09 • 43:1 Md. R. 76 (1-8-16)
31.16.08.06 • 43:24 Md. R. 1366 (11-28-16)
33.13.07.06 • 43:24 Md. R. 1367 (11-28-16)
33.13.08.06,.07 • 43:24 Md. R. 1367 (11-28-16)
33.13.10.02—.04 • 43:24 Md. R. 1367 (11-28-16)
33.13.13.08 • 43:24 Md. R. 1367 (11-28-16)
33.14.02.03 • 43:24 Md. R. 1369 (11-28-16)
33.20.06.01 • 43:24 Md. R. 1369 (11-28-16)
36.03.10.11 • 43:22 Md. R. 1255 (10-28-16)
36.07.01.03 • 43:21 Md. R. 1180 (10-14-16)
that by an Order of the Court of Appeals dated November 14, 2016, KEITH ERIC TIMMONS, 326 St. Paul Place,
#300, Baltimore, Maryland 21202, has been replaced upon the register of
attorneys in this Court as of November 14, 2016. Notice of this action is
certified in accordance with Maryland Rule 19-761.
that by an Order of the Court of Appeals dated November 15, 2016, DAVID MICHAEL LUX, 9909 Autumnwood Way, Potomac, Maryland 20854, has been placed on
inactive status by consent, effective immediately, from the further practice of
law in this State, and his name as an attorney at law has been stricken from
the register of attorneys in this Court (Maryland Rule 19-761).
that by an Order of the Court of Appeals dated November 21, 2016, SANDRA LYNN RENO, 152 Cypress Street,
Centreville, Maryland 21617-2112, has been replaced upon the register of
attorneys in this Court as of November 21, 2016. Notice of this action is
that by an Order of the Court of Appeals dated November 21, 2016, DAVID N. HONICK, 6813 Seneca Drive,
Snow Hill, Maryland 21863, has been replaced upon the register of attorneys in
this Court as of November 21, 2016. Notice of this action is certified in
accordance with Maryland Rule 19-761.
that by an Opinion & Order of the Court of Appeals dated November 21, 2016,
SUSAN MYRA GELLER KIRWAN, 200 East
Lexington Street, Suite 407, Baltimore, Maryland 21202, has been indefinitely
suspended, effective immediately, from the further practice of law in the
State, and her name as an attorney at law has been stricken from the register
of attorneys in this Court (Maryland Rule 19-761).
that by an Opinion & Order of the Court of Appeals dated November 22, 2016
THOMAS-BELLAMY, 3503 Highwood Drive, SE, Washington, DC 20020, has been
indefinitely suspended, effective immediately, from the further practice of law
in the State, and her name as an attorney at law has been stricken from the
[16-25-18]
[16-254-F] On November 15, 2016, the Maryland Racing Commission adopted
amendments to Regulation .01 under COMAR 09.10.03 Prohibited Acts. This
action, which was proposed for adoption in 43:20 Md. R. 1113 (September 30,
2016), has been adopted as proposed. Effective Date: December 19, 2016.
09.10.05 Satellite Simulcast
[16-255-F] On November 15, 2016, the Maryland Racing Commission adopted
amendments to Regulation .05 under COMAR 09.10.05 Satellite Simulcast Betting.
This action, which was proposed for adoption in 43:20 Md. R. 1114 (September
30, 2016), has been adopted as proposed. Effective Date: December 19, 2016.
10.07.16 Limited Private
Authority: Health-General Article, §10-502, Annotated Code of
[16-258-F] On November 18, 2016, the Secretary of Health and Mental Hygiene
adopted new Regulation .23 under COMAR 10.07.16 Limited Private Inpatient
Facilities. This action, which was proposed for adoption in
43:20 Md. R. 1114—1115 (September 30, 2016), has been adopted as
proposed. Effective Date: December 19, 2016.
10.09.10 Nursing Facility
[16-219-F] On November 22, 2016, the Secretary of Health and Mental Hygiene
adopted amendments to Regulations .07-1,
.07-2, .10-1, .11-2, .11-7, .11-8, .15-1, and .25 under COMAR 10.09.10 Nursing Facility Services. This action, which was
proposed for adoption in 43:18 Md. R. 1023-1025 (September 2, 2016), has been
adopted with the nonsubstantive changes shown below. Effective Date: December 19, 2016.
Regulation .15-1D(2)(a)(iii): In response to comments received, the
Department reviewed its criteria and agreed that a reduced percentage of annual
billings would be sufficient to protect the Program regarding potential
financial liabilities of a provider anticipating a change of ownership. The
percentage is within the scope of the proposed text.
Regulation .15-1D(2)(b): In response to comments received, language has
been added to clarify the duration of a provider’s obligation to maintain an
indemnity bond or standby letter of credit. This does not represent a change in
Regulation .15-D(2)(c): A typographical error is corrected in this text.
.15-1 New Nursing Facilities, Replacement
Facilities, and Change of Ownership for Rates Effective January 1, 2015.
(a) The indemnity bond or standby letter of credit required by §D(1)(a)(ii) or
(b)(iii) of this regulation shall be in the amount of:
(i)―(ii) (proposed text unchanged)
(iii) [[10]]
5 percent of the Program billings for the most recent annual fiscal
(iv) (text
(b) The indemnity bond or
standby letter of credit obligation under §D(2)(a) of
this regulation shall remain in effect until all financial liabilities are
[[(b)]] (c)
If a court of competent jurisdiction discharges the debt of a bankrupt
provider, the Program shall release to the purchaser the difference between the
indemnity bond [[of]] or
standby letter of credit required under §D(1)(b)(iii)
of this regulation and the amount of the financial obligation discharged by the
Subtitle 40 BOARD OF PODIATRIC
10.40.02 Licensing and
Authority: Health Occupations Article, §§16–205(a), 16–301, 16–302(h), 16–302.1, 16–303(a), 16–307, 16–308, and 16–311(28), Annotated Code of Maryland Notice of Final Action
[16-257-F] On November 22, 2016, the Secretary of Health and Mental Hygiene
adopted amendments to Regulation .03
under COMAR 10.40.02 Licensing and Continuing
Education Requirements. This action, which was proposed for adoption in
43:20 Md. R. 1116 (September 30, 2016), has been adopted as proposed. Effective Date: December 19, 2016.
Subtitle 64 BOARD OF NURSING —
10.64.01 Practice of Licensed Direct-Entry
Authority: Health Occupations
Article, §§8-205 and Title 8, Subtitle 6C, Annotated Code of Maryland; Ch. 383,
Acts of 2015 Notice of Final Action
[16-249-F] On November 17, 2016, the Secretary of Health and Mental Hygiene
adopted new Regulations .01—.19
under a new chapter, COMAR 10.64.01
Practice of Licensed Direct-Entry Midwives under a new subtitle, Subtitle 64 Board of Nursing — Licensed
Direct-Entry Midwives. This action, which was proposed for adoption in 43:20 Md. R. 1128—1136 (September 30, 2016), has been
adopted as proposed. Effective Date: December 19, 2016.
[16-227-F] On November 16, 2016, the Maryland Higher Education Commission
(1) Regulations .01—.04
under COMAR 13B.07.04 Construction Procedures; and (2) Regulations .01 and
.02 under COMAR 13B.07.05 Space Allocation Guidelines. This action, which was proposed for adoption in
43:18 Md. R. 1038—1039 (September 2, 2016), has been adopted as
Title 22 STATE RETIREMENT AND PENSION SYSTEM
Subtitle 03 BOARD OF TRUSTEES
22.03.05 Investment Division —
Authority: State Personnel and Pensions Article, §§21-110 and
21-122(d), Annotated Code of Maryland Notice of Final Action
[16-247-F] On November 17, 2016, the Board of Trustees for the State
Retirement and Pension System adopted the repeal of Regulations .01 — .03 under COMAR 22.03.05 Investment Division — Brokerage Commission. This
action, which was proposed for adoption in 43:20 Md. R.
1097—1154 (September 30, 2016), has been adopted as proposed. Effective Date: December 19, 2016.
R DEAN KENDERDINE
Title 30 MARYLAND INSTITUTE FOR EMERGENCY MEDICAL SERVICES SYSTEMS (MIEMSS)
30.01.02 Documents
Authority: Education Article, §13-516, Annotated Code of Maryland Notice of Final Action
[16-199-F-I] On November 15, 2016, the Maryland State Emergency Medical
Services Board adopted amendments to Regulation .01 under COMAR 30.01.02
Documents Incorporated by Reference. This action was taken at a public
meeting, notice of which was given by publication on the Maryland Institute for
Emergency Medical Services Systems website, www.miemss.org, from September 1,
2015 through November 15, 2015, pursuant to General Provisions Article,
§3-302(c), Annotated Code of Maryland. This action, which was proposed for
adoption in 43:16 Md. R. 930—931 (August 5, 2016), has been adopted as
Subtitle 09 LIFE INSURANCE AND
31.09.07 Charitable Gift
Authority: Insurance Article, §§2-109 and 16-114, Annotated Code of
[16-251-F] On November 21, 2016, the Insurance Commissioner adopted
amendments to Regulation .04 under COMAR 31.09.07 Charitable Gift Annuities.
This action, which was proposed for adoption in 43:20 Md. R. 1147 (September
10.27.06 Practice of Nurse Anesthetist Authority: Health Occupations Article, §§8-205(a)(1)(2)(4)
and (5) and 8-302(b)(2)(ii),
[15-354-W]
Pursuant to State Government Article, §10-116(b), Annotated Code
of Maryland, notice is given that the proposal to amend Regulations .01—.04 and .06 and recodify existing Regulations .07 and .08 to be
Regulations .08 and .07 under COMAR 10.27.05 Practice of Nurse Anesthetist, which was published
in 42:23 Md. R. 1451—1452 (November 13, 2015), has been withdrawn by operation
of law. BRIAN MORRIS
13B.06.01 Public Institutions of Higher Education
Code of Maryland Notice of Withdrawal
[16-195-W] The Maryland Higher Education Commission withdraws its proposal to
amend Regulations .02, .02-1, and .04 — .08 in COMAR 13B.06.01 Public Institutions of Higher
Education, as published in
43:16 Md. R. 927—930 (August 5, 2016). At its November 16, 2016 meeting, the
Maryland Higher Education Commission adopted a new proposed action to amend
Regulations .02, .02-1, and .04 — .10 under the same chapter. JAMES D. FIELDER, JR., Ph.D.
31.08.11 Liability of Insurer — Failure to Act in Good Faith
Authority: Courts and Judicial Proceedings Article, §3-1701;
Insurance Article, §§2-109(a)(1) and 27-1001; Annotated
[16-256-W] The Insurance Commissioner withdraws the proposal to amend
Regulations .01, .02, .04, .05, and .07 under COMAR 31.08.11 Liability of Insurer—Failure to Act in Good Faith,
as published in 43:20 Md. R. 1145—1146 (September 30, 2016). Substantively
similar text will be proposed as new chapter, COMAR 31.15.16 Liability of
Insurer—Failure to Act in Good Faith. ALFRED W. REDMER, JR.
Authority: Natural Resources Article, §4-205, Annotated Code of Maryland Notice of Proposed Action
[16-328-P]
The Secretary of Natural Resources proposes to amend Regulation .09 under COMAR 08.02.01 General. Statement of Purpose
The purpose of this action is to establish a dividing line on
Barren Creek for tidal and nontidal waters. Barren Creek is a large tributary
to the Nanticoke River. Each water body in Maryland is assigned a use class by
the Maryland Department of the Environment. The use class is a grouping or set
of designated uses that apply to a water body which individually may or may not
be supported now, but should be attainable. Barren Creek is designated as Use Class
I (nontidal) upstream of the U.S. Route 50 Bridge and Use Class II (tidal)
downstream of the bridge. Use Class I designated uses include: water contact
recreation and protection of nontidal warm water aquatic life. Use Class II
designated uses include: support of estuarine and marine aquatic life and
shellfish harvesting. The proposed action establishes a dividing line on Barren
Creek at the U.S. Route 50 Bridge located in Mardela Springs to maintain
consistency with the state use classifications. Dividing lines are established
for the purpose of delineating those areas in which nontidal fishing licenses
or Chesapeake Bay and coastal sport fishing licenses are required and tidal or
nontidal fishing regulations apply.
I. Summary of Economic Impact. The proposed action may have
an impact on anglers and the Department.
(1) Nontidal Angler’s
(2) Chesapeake Bay &
Coastal Fishing License
III. Assumptions. (Identified
by Impact Letter and Number from Section II.)
A(1). There could be an increase in
nontidal angler’s license sales since an individual will now need a nontidal
license to fish above the dividing line. However, this action also provides
additional fishing areas for individuals that already have a nontidal
license. The actual magnitude is indeterminable.
A(2). There could be a decrease in
Chesapeake Bay & Coastal fishing license sales since an individual will now
need a nontidal license to fish above the dividing line instead of the tidal
license. The actual magnitude is indeterminable because it is unknown how
many individuals will be affected by this action.
D. This action could benefit some anglers and could be a cost
for others. There are several different scenarios that could happen with the
license type needed for fishing in this area. The impact would be different
for each situation and the magnitude cannot be determined since the
Department cannot predict the actions of anglers. There are anglers who
currently purchase a Nontidal Sport Fishing License that will not be affected
economically, but will have another area to fish. There are anglers that traditionally
had to purchase a Chesapeake Bay and Coastal Sport Fishing license to fish in
the area that will now have to purchase a Nontidal Sport Fishing License if
they want to fish upstream of the dividing line. The cost of a Nontidal Sport
Fishing License is $20.50 per year. The cost of a Chesapeake Bay and Coastal
Sport Fishing License is $15 per year. Some individuals will only need one
license type and others will need both license types. The magnitude of the
impact is indeterminable because the Department does not know the numbers of
individuals that fish in those areas and which license type they currently
Comments may be sent to Dividing Lines, Regulatory Staff,
Department of Natural Resources Fishing and Boating Services, 580 Taylor Ave.,
B-2, Annapolis, MD 21401, or call 410-260-8300, or email to
fisheriespubliccomment.dnr@maryland.gov, or fax to 410-260-8310. Comments will
be accepted through January 9, 2016. A public hearing has not been scheduled.
.09 Dividing Lines; Tidal and Nontidal Waters.
The following boundaries are designated as official dividing lines
for tidal and nontidal waters. These boundary lines are for the purpose of
delineating those areas in which nontidal fishing licenses or Chesapeake Bay
and coastal sport fishing licenses are required and tidal or nontidal fishing
regulations apply, and have no other legal significance.
H. Wicomico and Worcester Counties.
(1)—(4) text unchanged) (5) Barren Creek: U.S. Route
I.—M. (text unchanged)
08.02.11 Fishing in Nontidal
Authority: Natural Resources Article, §§4-215, 4-602 and 4-614,
[16-315-P]
The Secretary of Natural Resources proposes to amend Regulations .01 and .04 under COMAR 08.02.11 Fishing in Nontidal Waters. Statement of Purpose
The purpose of this action is to amend and clarify existing
regulations for fishing in nontidal waters. Specifically, the proposed action
increases the possession limits for trout, changes the closures for four
put-and-take areas (Accident Pond, Georges Creek, Muddy Creek, and Little
Youghiogheny River), extends the boundary on the North Branch Potomac River
upper catch-and-return trout fishing area; makes possession limits for game
fish consistent, defines when an individual needs a trout stamp, and clarifies
the regulation by removing duplicate text.
The proposed action increases the trout possession limit.
Increasing the possession to twice the daily creel will allow someone who may
be on a multi-day fishing trip the ability to keep more than one daily limit
without having to consume the fish they catch each day.
The proposed action changes the closure period from a “1” to a “0”
on four streams (Georges Creek, Accident Pond, Muddy Creek and Little
Youghiogheny River) managed under put–and–take trout fishing areas. The areas
where the closure period is being changed to “0” are currently closed to
fishing for up to three weeks after the initial stocking. The Department has
received calls during the past several years that catch rates were low or
non-existent by opening day. Georges Creek still has acid mine drainage (AMD)
issues and is a very “flashy” stream during rain events. The Little
Youghiogheny River within the Town of Oakland becomes quite turbid during rain
events. Muddy Creek has experienced fish kills due to acidification; however,
fish kills have been avoided since limestone was deposited in the stream (1999
- present), but during heavy snowmelt events the pH can still dip below 6.0.
Removing the closure provides increased angler opportunity and a better return
(catch) on the stocked trout. A change from a “1” closure to a “0” closure will
allow fishing immediately after the initial stocking. All four locations
combined will provide for an additional 84 days of recreational fishing
opportunities. Water quality issues that may occur during the three week
closure period may be less of an issue if anglers can fish for the trout
immediately after stocking. All areas have the approval from local
The proposed action extends the upper boundary on the North Branch
Potomac River’s upper catch–and–return trout fishing area. The purpose of this
action is to increase angler access and fishing opportunities in the North
Branch Potomac River. The United States Army Corps of Engineers (USACE)
approached the Department regarding increasing public access to the upper catch-and-return
trout fishing area in May 2016. Currently the public has access along the river
via the Senator Sarbanes Trail; however, one must walk downstream approximately
165 yards before legally being able to fish. The USACE would like to provide
fishing opportunities in this stretch of the river. The boundary is being moved
upstream to the point where the Senator Sarbanes Trail meets the river, at a
location agreed upon by the USACE. This may also provide additional stocking
locations since it will be open to public fishing.
The proposed action increases the possession limit to twice the
daily creel limit for certain fish species and changes the areas where size
limits apply for yellow perch. The proposed action creates consistency with
having the possession limit be double the daily creel on all species except
American eel and baitfish. Increasing the possession to twice the daily creel
will allow someone who may be on a multi–day fishing trip the ability to keep
more than one daily limit without having to consume the fish they catch each
day. Even though the possession is increased, the daily creel limit will remain
the same. Daily creel is the number of fish that an angler can keep after a
single day of fishing and possession limit is the maximum number of fish that
an angler may have in their possession after two or more days of fishing. The
proposed action establishes a creel limit, possession limit and size limit for
yellow perch caught in reservoirs, lakes, ponds, impoundments, and waters
upstream of them. Establishing creel and possession limits for yellow perch in
nontidal lakes and ponds provides resource protection from excessive harvest
and wanton waste. The proposed action specifies where the size limits for
yellow perch occur and makes them consistent throughout the state, rather than
by area. The proposed action requires an individual to have a trout stamp
to catch, attempt to catch or possess trout. Prior to the 2016 legislative
session, it was unclear where an individual needed a trout stamp. Legislation
became effective in 2016 that allows the Department to clarify the trout stamp
requirements and remove any confusion about the management areas covered by the
trout stamp. A trout stamp is required when you are fishing for or possessing
trout anywhere in the state. Areas are not specified because a person may be
fishing for species other than trout in the same area. Catch is defined in
Natural Resources Article, §4-101, Annotated Code of Maryland and means to
take, kill, trap, gather, harvest or in any manner reduce any fish to personal
The proposed action removes the section that applies to Fishery
Management Areas because those areas and their rules are located elsewhere in
the Code of Maryland Regulations (COMAR 08.02.01.13) and do not need to be
duplicated in this regulation.
an impact on the Department, anglers, and fishing supply stores.
(1) Removal of Trout Closure
(2) Extending the Boundary on
A. Prior to the 2016 legislative session only certain
individuals were required to obtain a trout stamp. The proposed action
requires a trout stamp for anyone who catches or attempts to catch a trout.
This could result in an increased number of trout stamps being sold. The
amount is indeterminable because it is unknown how many anglers will fish for
trout and need a trout stamp each year. Most anglers fishing for trout likely
already purchase the stamp each year so the magnitude of additional revenue
D. Prior to the 2016 legislative session only certain
This could result in an angler needing to spend an additional $5 per year for
E(1). Removing the closure period for
four locations may increase fishing pressure in those areas which may
increase business at local bait and tackle stores. The actual amount is
E(2). Increasing the public access on
the North Branch of the Potomac River may increase fishing pressure in that
area which may increase business at local bait and tackle stores. The actual
amount is indeterminable.
Comments may be sent to 2017 Nontidal Regulations, Regulatory
Staff, Department of Natural Resources Fishing and Boating Services, 580 Taylor
Ave., B-2, Annapolis, MD 21401, or call 410-260-8300, or email to
be accepted through January 9, 2017. A public hearing has not been scheduled.
.01 Trout Fishing and Management Areas.
A. Basic Statewide Trout Fishing. Except as listed in §§B—H of this
regulation, the following shall be in effect for trout fishing in all nontidal
(3) Creel and possession limits (all species of trout) in aggregate
— daily: 2, possession: [2] 4;
B. Put-and-Take Trout Fishing Areas.
— Daily: 5, Possession: [5] 10;
(6) Except as provided in §C(1) of this
regulation the following areas are subject to the provisions in §B(1)—(4) of
(a) Allegany County:
(i)—(xi) (text unchanged)
(xii) Georges Creek
mainstem from the upper extent of Town Park in Westernport upstream to Neff
(xiii)—(xvi) (text unchanged)
(i) Garrett County:
(v) Muddy Creek mainstem
(vi)—(xi) (text unchanged)
(xii) Accident Pond
(xiii) Little Youghiogheny
River mainstem, from Maryland Route 219 downstream to the Youghiogheny River
(xiv)—(xvii) (text
(j)—(n) (text unchanged)
C. Catch-and-Return Trout Fishing Areas.
(3) Areas Limited to Use of Artificial Lures Only.
(b) Areas subject to the provisions of this section are:
(i)—(iv) (text
unchanged) (v) North Branch Potomac River from an overhead cable and red bank
post located approximately [510] 345
yards below the Jennings Randolph Reservoir spillway downstream approximately 1
mile to a red post, located approximately 100 yards above the upstream concrete
abutments at Barnum, West Virginia, and from a red post located below a pool
known as Blue Hole approximately 1/3 mile upstream of Bench Mark 1110 on the
Westernport U.S.G.S. Quadrangle, downstream approximately 4 miles to the
confluence of Piney Swamp Run.
(vi)—(vii) (text unchanged)
D.—H. (text unchanged) .04 Statewide General Regulations.
A. Open Seasons, Creel, Possession, and Size Limits on Game and
Fresh Water Fish in Nontidal Waters. Except as otherwise provided in this
chapter for specific areas, the following apply Statewide:
(a) Trout (all species) in
(ii) Other areas not
described in Regulation .03 of this chapter
(f) Muskellunge and hybrids
including tiger musky
(g)—(r) (text unchanged) (s) Yellow Perch
[(i) Nontidal waters
10, except no limit in
reservoirs, lakes, ponds, impoundments, and waters upstream of them.
(t) (text unchanged)
(a)—(q) (text unchanged)
(r) Yellow Perch
(i) Nontidal [waters] streams
9 inches[,
except no minimum size in reservoirs, lakes, ponds, impoundments, and upstream
(ii) [Deep Creek Lake] Nontidal
B.—L. (text unchanged)
M. [License to Fish] Licenses
catch or attempt to catch game or freshwater fish without first [procuring] obtaining an angler’s license in accordance with Natural Resources
Article, §4-604, Annotated Code of Maryland. (b) A person may not catch,
attempt to catch or possess trout without first obtaining a trout stamp.
Feeding Wildlife on Fisheries Management Areas.
(1) In this section, “wildlife” has the meaning stated in Natural
Resources Article, §10-101(cc), Annotated Code of Maryland.
(2) Except for lawful fishing and hunting activities, a person may
not feed wildlife in the following Fisheries Management Areas owned and
controlled by the Department of Natural Resources:
(a) Albert Powell Hatchery — Washington
(b) Bear Creek Rearing Station — Garrett County;
(c) Big Mill Pond — Kent County;
(d) Brownsville Pond — Washington County;
(e) Brunswick Pond — Frederick County;
(f) Bynum Run Pond — Harford County;
(g) Evitts Creek Pond — Allegany County;
(h) Forest Hill Pond — Harford County;
(i) Frank Bentz Pond — Frederick County;
(j) Hughesville Pond — Charles County;
(k) Lewistown Work Center — Frederick County;
(l) Manning Hatchery — Charles County;
(m) North Branch Potomac River — Gary A. Yoder Landing — Allegany
(n) North Branch Potomac River — McCoole — Allegany County;
(o) North Branch Potomac River — Folly and Laurel Runs — Garrett
(p) Piney Point Aquaculture Center — St.
Mary’s County;
(q) Rising Sun Pond — Cecil County;
(r) Smithville Lake — Caroline County;
(s) Unicorn Lake — Queen Anne’s County;
(t) Urbana Lake — Frederick County; or
(u) Urieville Lake — Kent County.]
[Q.] P. (text unchanged)
Secretary of Natural Resources Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE
10.06.02 Communicable Diseases
Authority: Health-General Article, §§18-102, 18-312—18-313, 18-316,
18-318—18-320, Annotated Code of Maryland Notice of Proposed Action
[16-320-P]
The Secretary of Health and Mental Hygiene proposes to amend
Regulations .02, .04, and .13 under COMAR 10.06.02
Communicable Diseases — Rabies. Statement of Purpose
The purpose of this action is to amend this chapter to implement
selected aspects of the updated version of the Compendium of Animal Rabies
Prevention and Control, 2016 published by the National Association of State
Public Health Veterinarians. These changes include reducing the minimum time
for strict quarantine of a domestic animal that has been exposed to a rabid
animal from 6 to 4 months according to the updated Compendium of Animal Rabies
Prevention and Control, and replacing the term “isolation” with “quarantine” to
refer to the action taken when animals have been exposed to rabies, but have
not developed clinical illness.
Regulation and Policy Coordination, Department of Health and Mental Hygiene,
201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499
(TTY 800-735-2258), or email to dhmh.regs@maryland.gov, or fax to 410-767-6483.
Comments will be accepted through January 9, 2017. A public hearing has not
(1)—(20) (text unchanged)
(21) “Provoked [bite]” means [a] that bite or non-bite contact
from an animal [that] resulted from human activity, such as
an individual attempting to play with, pet, feed, handle, hold, harm, or
redirect an animal’s actions.
(22)—(26) (text unchanged)
(27) “Serologic monitoring”
means monitoring of a dog or cat that was previously vaccinated against rabies
to see if the animal demonstrates sufficient evidence of an immune response
within seven days of being vaccinated against rabies. [(27)] (28)
(text unchanged) [(28)] (29)
“Strict [isolation] quarantine”
[(29)] (30)—[(30)] (31) (text unchanged)
.04 Animal Rabies.
B. Disposition of a Suspected Rabid Animal —— No Bite or Non-Bite
(1) Dogs, Cats, and Ferrets.
(a) Except as provided in §B(3) of this
regulation, the director of a Department-approved facility shall hold in strict
[isolation] quarantine, in a manner
and place as established by the local health officer or the Public Health
Veterinarian, any dog, cat, or ferret suspected of having rabies that has not
had bite or non-bite contact with an individual in the preceding 10 days.
(b) Except as provided in §B(3) of this
regulation, unless otherwise specified by the Public Health Veterinarian, the
director of a Department-approved facility shall continue the strict [isolation] quarantine of the
suspected rabid animal for at least 10 days and maintain proper, humane care of
the animal during the period of [isolation] strict
quarantine, after which the animal may be humanely killed or released to
its owner or custodian or for adoption.
(c) At any time during the [isolation] strict
quarantine period, the local health officer, the Public Health
Veterinarian, the owner, or the custodian of the animal may direct that the
animal suspected of having rabies be humanely killed for the purpose of rabies
(d) At any time during the [isolation] strict
quarantine period, the owner or custodian of the animal may direct that the
animal be humanely killed.
(e) (text unchanged)
regulation, the Public Health Veterinarian shall direct the owner or custodian
of livestock that has not had bite or non-bite contact with an individual and
is suspected of having rabies to hold the livestock in strict [isolation] quarantine for at least
10 days and shall designate the place and manner in which the strict [isolation] quarantine is to be
carried out, after which the livestock may be humanely killed or released to
the owner or custodian.
(b) At any time during the strict [isolation] quarantine period, the local health
officer, the Public Health Veterinarian, the owner, or the custodian of the
animal may direct that the animal be humanely killed for the purpose of rabies
(3) Wild Animals.
(a)—(b) (text
(c) If an owner or custodian of the wild
animal claims the animal within 24 hours, the Public Health Veterinarian may
order the owner to hold the animal in strict [isolation] quarantine in a place and manner
determined by the Public Health Veterinarian for at least 30 days, after which
it may be released to the owner or custodian if the animal has not developed
(d) At any time during the [isolation] strict quarantine
period, the local health officer, the Public Health Veterinarian, or the owner
or custodian of the animal may direct that the animal be humanely killed for
the purpose of rabies testing.
D. Disposition of an Animal Exposed to a
Rabid Animal or to an Animal Suspected of Having Rabies.
(1) If the owner or custodian of a domestic animal that has been
exposed to a rabid animal, or to an animal suspected of having rabies, is able
to provide a current or expired
rabies vaccination certificate for the animal, the owner or custodian shall:
(a) (text
(b) [Hold the animal in
quarantine] Keep the animal under the owner or custodian’s control and observed
for 45 calendar days or for such time as specified by the Public Health
(2) If the owner or custodian of a domestic animal that has been
exposed to a rabid animal, or to an animal suspected of having rabies, is
unable to provide a current or expired rabies
vaccination certificate [but has an
expired rabies vaccination certificate, the local health officer or animal
control authority shall consult with the Public Health Veterinarian to
determine the disposition of the animal considering the:
(a) Animal’s:
(ii) Health status; and
(iii) Number of prior vaccinations;
(b) Severity of the exposure; and
(c) Time elapsed since last rabies vaccination.
(3) If the owner or custodian of a domestic animal that has been exposed
to a rabid animal, or to an animal suspected of having rabies, is unable to
provide any rabies vaccination certificate, the]: (a) The owner or
[(a)] (i)
[(b)] (ii) Have the animal
vaccinated against rabies immediately, and hold [the animal] dogs and cats in strict [isolation] quarantine for a
minimum of [6] 4 months and other animals in strict quarantine for a
minimum of 6 months in a facility and a manner approved by the Public
Health Veterinarian; or
(b) The local health officer
or animal control authority may consult with the Public Health Veterinarian to
determine if serologic monitoring can be used to keep a dog or cat under the
owner or custodian’s control and observed for 45 calendar days rather than
under strict quarantine for 4 months if the
owner or custodian of a dog or cat states that the dog or cat was previously
[(4)] (3) The
owner or custodian of a domestic animal that is being held in strict [isolation or] quarantine is
responsible for all costs related to [isolation
or] strict quarantine of the animal.
[(5)] (4) The local health
officer [or], the Public Health
Veterinarian, or the local animal control
authority may make inspections of the site where an animal is being held in
strict [isolation] quarantine
to assure that the animal is being held in [isolation] strict
quarantine under the terms specified in this chapter.
[(6)] (5) The local health
officer or the Public Health Veterinarian may order the humane killing for
rabies testing of an animal exposed to a rabid animal or to an animal suspected
of having rabies if:
(a) The [isolation] strict
quarantine agreement defined in Regulation .02B(28)
of this chapter is violated;
.13 Disposition of Animals by Animal
Shelters, Pounds, or Veterinarians.
B. Except as provided in §C of this
regulation, if the animal has had bite or non-bite contact with an individual
within the time periods specified in §A of this regulation, the animal shelter,
pound, or veterinarian shall:
(1) (text
(2) If the animal is a wild animal,
immediately humanely kill the animal and submit its [brain] head for rabies testing.
[16-325-P-I]
The Secretary of Health and Mental Hygiene proposes to:
(1) Amend Regulation .07
under COMAR 10.09.14 Vision Care Services;
(2) Amend Regulation .06
under COMAR 10.09.17 Physical Therapy Services;
(3) Adopt new Regulation .01-1
and amend Regulation .07 under COMAR 10.09.23 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services;
(4) Amend Regulation .07
under COMAR 10.09.51 Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
The purpose of this action is to incorporate by reference the
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Provider Manual.
This proposal also updates references to this document in other chapters.
Comments will be accepted through January 9, 2016. A public hearing has not
Pursuant to State Government
Article, §7-207, Annotated Code of Maryland, the Early Periodic, Screening,
Diagnosis, and Treatment (EPSDT) Provider Manual (Maryland Medical Assistance
Program, Effective January 1, 2017) has been declared a document generally
available to the public and appropriate for incorporation by reference. For
this reason, it will not be printed in the Maryland Register or the Code of
Maryland Regulations (COMAR). Copies of this document are filed in special
public depositories located throughout the State. A list of these depositories
was published in 43:1 Md. R. 10 (January 8, 2016), and is available online at
www.dsd.state.md.us. The document may also be inspected at the office of the
Division of State Documents, 16 Francis Street, Annapolis, Maryland 21401. 10.09.14 Vision Care Services
E. [The Maryland
Medicaid Vision Services—Provider Type 12, Procedure Code and Fee Schedule—2008
is contained in the Medical Assistance Provider Fee Manual, dated October 1,
1986, all the provisions of which are incorporated by reference] Vision
care services are reimbursed according to COMAR 10.09.23.01-1.
F.—N. (text unchanged)
E. The [fee schedule for] services covered in this chapter [is contained in the Maryland Medical
Assistance Program Physicians’ Services Provider Fee Manual, Revision
July—December 2011, contained in the Medical Assistance Provider Fee Manual,
dated October 1986. All the provisions of this document, unless specifically excepted, are incorporated by reference] are reimbursed according to
COMAR 10.09.23.01-1.
F.—K. (text unchanged)
10.09.23 Early and Periodic Screening, Diagnosis and Treatment
(EPSDT) Services Authority: Health-General Article, §§2-104(b), 15-103, and 15-105,
The Early Periodic,
Screening, Diagnosis, and Treatment (EPSDT) Provider Manual (Maryland Medical
Assistance Program, Effective January 1, 2017) is incorporated by reference.
.07 Payment Procedures. A.—B. (text unchanged)
C. Rates for services provided by chiropractors, speech therapists,
occupational therapists, [professional
counselors, psychologists, social workers,]
and nutritionists [, and nurse psychotherapists] covered under this chapter are
included in the [current Program
Physicians’ Provider Fee Manual, which is contained in the Medical Assistance
Provider Fee Manual, dated October 1986, all the provisions of which, unless
specifically excepted, are incorporated by reference in COMAR 10.09.02.07] Early
Periodic, Screening, Diagnosis, and Treatment (EPSDT) Provider Manual.
10.09.51 Early and Periodic Screening, Diagnosis, and Treatment
(EPSDT) Audiology Services Authority: Health-General Article, §§2-104(b), 15-103, and 15-105,
B. [The Audiology
Procedure Code and Fee Schedule, Revision 2010 is incorporated by reference and
is contained in the Medical Assistance Audiology Provider Manual dated
November, 2010.] Audiology services are reimbursed according
to COMAR 10.09.23.01-1.
C.—O. (text unchanged)
10.09.65 Maryland Medicaid
Managed Care Program: Managed Care Organizations
Authority: Health-General Article, §§2-104, 15-102.3, and 15-103;
Insurance Article, §§15-112, 15-605, and 15-1008; Annotated Code of Maryland Notice of Proposed Action
[16-327-P]
Regulation .19 under COMAR 10.09.65 Maryland Medicaid Managed
Care Program: Managed Care Organizations. Statement of Purpose
The purpose of this action is to repeal the calendar year 2015
HealthChoice MCO’s rates, to implement the calendar year 2017 HealthChoice
MCO’s rates and to clarify the interim rate adjustment methodology. Comparison to Federal Standards
I. Summary of Economic Impact. The HealthChoice CY 2016,
MCO interim rate adjustment is an overall increase of $23,393,246. This was
primarily the result of increasing physician fees to 94 percent of Medicare
rates, adjusting for HSCRC hospital rate changes and the redetermination
impact. The HealthChoice CY 2017 MCO rate adjustment is an increase of
$109,202,607 above the appropriation or a 1.0 percent rate increase. This
increase includes an observed medical trend increase of 2.8 percent overall. The combined total related to the MCO CY 2016 Interim rate
adjustment of $23,393,246 and the CY 2017 rate increase of $109,202,607 is
$132,595,853.
$132,595,853
A. For CY 2016 the interim rate adjustment is an overall increase
of $23,393,246 in general funds.
For CY 2017, there is a 1.0 percent rate increase or
$109,202,607 increase to the Department’s expenses.
D. For CY 2016 the interim rate adjustment is an overall
increase of $23,393,246 in general funds.
$109,202,607 increase to the MCOs revenue.
.19 MCO Reimbursement. A. (text unchanged)
B. Capitation Rate-Setting Methodology. (1)—(3) (text unchanged)
(4) Except to the extent of adjustments required by §D of this
regulation or by Regulations .19-1—.19-4 of this chapter, the Department shall
make payments monthly at the rates specified in the following tables: [(a)—(h)]
(proposed for repeal)
(a) Rate Table for Families and Children Effective January 1,
2017 — December 31, 2017.
Under age 1 Birth Weight 1500
grams or less Both $9,079.56 $8,246.40 $8,469.74 Under age 1 Birth Weight over
1500 grams Both $516.80 $469.38 $482.09 1-5 Male $199.52 $181.21 $186.12 Female $169.36 $153.82 $157.98
6-14 Male $108.93 $98.93 $101.61 Female $99.99 $90.82 $93.28 15-20 Male $116.34 $105.67 $108.53 Female $160.01 $145.32 $149.26 21-44 Male $237.39 $182.28 $200.17 Female $364.91 $280.20 $307.70 45-64 Male $494.42 $379.64 $416.90 Female $562.02 $431.54 $473.90 ACG-adjusted cells ACG 100, 200, 300, 400, 500,
600, 700, 900, 1000, 1100, 1200, 1300, 1600, 1710, 1711, 1712, 1720, 1721,
1722, 1730, 1731, 1732, 1800, 1900, 2000, 2100, 2200, 2300, 2400, 2500, 2800,
2900, 3000, 3100, 3200, 3300, 3400, 3500, 3800, 4210, 5100, 5110, 5200 5230,
5310, 5339 RAC 1F Both $234.90 $180.37 $198.07 ACG 800, 1740, 1741, 1742,
1750, 2700, 3600, 1750, 1751, 1752, 2700, 3600, 3700, 3900, 4000, 4100, 4220,
4310, 4410, 4510, 4610, 4710, 4720, 4810, 5340 RAC 2F Both $376.44 $289.05 $317.42 ACG 1400, 1500, 1750, 1761,
1762, 1770, 1771, 1772, 2600, 4320, 4520, 4620, 4820 RAC 3F Both $523.51 $401.98 $441.43 ACG 4330, 4420, 4830, 4910,
4920, 5010, 5020, 5040 RAC 4F Both $722.68 $554.91 $609.38 ACG 4430, 4730, 4930, 5030,
5050 RAC 5F Both $957.37 $735.12 $807.28 ACG 4940, 5060 RAC 6F Both $1,263.62 $970.27 $1,065.51 ACG 5070 RAC 7F Both $1,962.90 $1,507.21 $1,655.16 ACG 100, 200, 300, 500, 600,
1100, 1600, 2000, 2400, 3400, 5100, 5110, 5200 RAC 1G Both $86.50 $78.56 $80.69 ACG 400, 700, 900, 1000, 1200,
1300, 1710, 1711, 1712, 1800, 1900, 2100, 2200, 2300, 2800, 2900, 3000, 3100,
5310 RAC 2G Both $111.43 $101.21 $103.95 ACG 1720, 1721, 1722, 1731,
1732, 1730, 2500, 3200, 3300, 3500, 3800, 4210, 5230, 5339 RAC 3G Both $144.82 $131.53 $135.09 ACG 800, 1740, 1741, 1742,
4310, 4410, 4510, 4610, 4710, 4720, 4810, 5340 RAC 4G Both $198.35 $180.14 $185.02 ACG 1400, 1500, 1750, 1761,
1762, 1770, 1771, 1772, 2600, 4320, 4520, 4620, 4820 RAC 5G Both $306.82 $278.67 $286.21 ACG 4330, 4420, 4830, 4910,
4920, 5010, 5020, 5040 RAC 6G Both $349.10 $317.07 $325.65 ACG 4430, 4730, 4930,4940,
5030, 5050, 5060, 5070 RAC 7G Both $885.12 $803.90 $825.67 SOBRA Mothers $850.46 $653.02 $717.12 Persons with HIV ALL Both $648.67 $648.67 $648.67 (b) Rate Table for Disabled Individuals Effective January 1,
2017—December 31, 2017.
PMPM Baltimore City
Under Age 1 Both $6,465.12 $6,465.12 $6,465.12 1-5 Male $1,664.34 $1,664.34 $1,664.34 Female $1,444.43 $1,444.43 $1,444.43 6-14 Male $311.82 $311.82 $311.82 Female $546.20 $546.20 $456.20 15-20 Male $225.06 $225.06 $225.06 Female $326.94 $326.94 $326.94 21-44 Male $856.35 $726.80 $793.46 Female $1,160.01 $984.52 $1,074.82 45-64 Male $1,942.90 $1,648.96 $1,800.21 Female $1,808.14 $1,534.59 $1,675.35 ACG-adjusted cells ACG 100, 200, 300, 1100, 1300,
1400, 1500, 1600, 1710, 1711, 1712, 1720, 1721, 1722, 1730, 1731, 1732, 1900,
2400, 2600, 2900, 3400, 5100, 5110, 5200, 5310 RAC 10 Both $281.02 $238.50 $260.38 ACG 400, 500, 700, 900, 1000,
1200, 1740, 1741, 1742, 1750, 1751, 1752 1800, 2000, 2100, 2200, 2300, 2500, 2700,
2800, 3000, 3100, 3200, 3300, 3500, 3900, 4000, 4310, 5330 RAC 11 Both $339.48 $288.12 $314.55 ACG 600, 1760, 1761, 1762,
3600, 3700, 4100, 4320, 4410, 4710, 4810, 4820 RAC 12 Both $658.09 $558.53 $609.76 ACG 3800, 4210, 4220, 4330,
4420, 4720, 4910, 5320 RAC13 Both $748.80 $635.51 $693.80 ACG 800, 4430, 4510, 4610,
5040, 5340 RAC14 Both $931.42 $790.51 $863.02 ACG 1770, 1771, 1772, 4520,
4620, 4830, 4920, 5050 RAC15 Both $1,265.48 $1,074.03 $1,172.54 ACG 4730, 4930, 5010 RAC16 Both $1,344.28 $1,140.90 $1,245.55 ACG 4940, 5020, 5060 RAC17 Both $1,967.45 $1,669.79 $1,822.95 ACG 5030, 5070 RAC 18 Both $3,491.82 $2,963.55 $3,235.37 Persons with AIDS All Both $2,229.83 $1,259.72 $1,259.72 Persons with HIV All Both $1,860.15 $1,860.15 $1,860.15 (c) Rate Table for Supplemental Payments for Delivery/Newborn and
Hepatitis C Therapy Effective January 1, 2017—December 31, 2017.
Supplemental Payment Cells Delivery/Newborn-all births except
live birth weight 1,500 grams or less All Both $13,946.08 $10,543.25 $11,299.98 Delivery/Newborn-live birth
weight 1,500 grams or less All Both $69,697.48 $69,697.48 $69,697.48 Delivery/Newborn by same enrollee-subsequent
live birth weight 1,500 grams or less All Both $13,946.08 $10,543.25 $11,299.98 Hepatitis C Therapy (per
member per month) All Both $30,527.57 $30,527.57 $30,527.57 (d) Rate Table for Childless Adult Population Effective January
1, 2017—December 31, 2017.
ACG-adjusted cells
ACG 100, 200, 300, 400, 500, 600,
700, 900, 1000, 1100, 1200, 1300, 1600, 1710, 1711, 1712, 1720, 1721, 1722,
1730, 1731, 1732, 1800, 1900, 2000, 2100, 2200, 2300, 2400, 2500, 2800, 2900,
3000, 3100, 3200, 3300, 3400, 3500, 3800, 4210, 5100, 5110, 5200 5230, 5310,
5339 RAC 1H
ACG 800, 1740, 1741, 1742,
4310, 4410, 4510, 4610, 4710, 4720, 4810, 5340 RAC 2H
ACG 1400, 1500, 1750, 1761,
1762, 1770, 1771, 1772, 2600, 4320, 4520, 4620, 4820 RAC 3H
ACG 4330, 4420, 4830, 4910,
4920, 5010, 5020, 5040 RAC 4H
ACG 4430, 4730, 4930, 5030,
RAC 5H
RAC 6H
RAC 7H
[(i)] (e)—[l]
D. Interim Rates Adjustments. (1) (text unchanged)
(2) The Department shall adjust the payment rates specified in §B(4)(a)—(d) of this regulation to reflect service cost
changes that qualify under §D(3) of this regulation and result from: (a)—(b) (text unchanged) (c) Effective January 1, [2015] 2017, an
increase or decrease in the [preliminary
current year Statewide Medicaid MCO]
inpatient hospital per capita as
calculated [using data provided
annually by the Health Services Cost Review Commission (HSCRC) during the
agreed on rate setting timeline as compared to the data originally available
relative to the Statewide HSCRC derived inpatient all-payer per capita and
updated information for the prior period years; or] by the multiplication of:
(i) The change in the
restated unit cost provided annually by the Health Service Cost Review
Commission (HSCRC) as compared to the data originally provided; and
(ii) The change in the
restated recommended utilization, adjusted for case mix, position of the
Department’s rate certifying actuary as compared to the originally provided
utilization position; or (d) An increase or decrease in the [preliminary current year Statewide Medicaid MCO] outpatient hospital per capita as calculated [using data provided
annually by the Health Services Cost Review Commission during the agreed on rate setting timeline as compared to
the data originally available relative to the Statewide HSCRC derived outpatient all-payer per capita and updated information for prior
period years] by the multiplication of: (i) The change in the restated unit cost provided annually by the
HSCRC as compared to the data originally provided; and
(ii) The change in the restated recommended utilization,
adjusted for case mix, position of the Department’s rate certifying actuary as
compared to the originally provided utilization position; or
(e) Other changes or circumstances the Department determines are
necessary to ensure the rates are actuarially sound. (3)—(6) (text unchanged)
10.09.70 Maryland Medicaid
Managed Care Program: Non-Capitated Covered Services
[16-326-P]
Regulation .02 under COMAR 10.09.70 Maryland Medicaid Managed
Care Program: Non-Capitated Covered Services. Statement of Purpose
The purpose of this action is to update the ICD-10 diagnosis codes
included in the behavioral health carve out. The amendment delineates which
claims the Administrative Service Organization is responsible for paying and
which claims the Managed Care Organizations are responsible for paying. This
will bring the regulations up to date with the latest CMS mandated updates.
D. An MCO is not responsible for reimbursing for the following
substance use disorder services if the MCO is billed with a primary diagnosis
listed in [§J] §K of this regulation:
MCO is not responsible for reimbursing the behavioral poisoning diagnoses
listed in §N of this regulation in an
[G.] H. An MCO is not
responsible for services billed by specialty mental health providers listed in
COMAR 10.09.59 when the bill includes the specialty behavioral health diagnoses
listed in [§J or K] §K
or L in the primary diagnosis
[H.] I. — [J.]
[K.] L. Table of mental
health diagnoses:
(2) For dates of
service on or after October 1, 2015:
F200—F325
[F328
Other depressive
episodes]
Other specified depressive
F329—F341
[F348
mood (affective) disorders]
Other specified persistent mood disorders
F349—F419
[F42
Other obsessive compulsive disorder
F430—F502
[F508
F509—F639
F641—Z046
[L.] M. (text unchanged)
N. Table of poisoning diagnoses, for dates of service on or
T360X2A
Poisoning by penicillins, intentional
T361X2A
Poisoning by cephalosporins and other
beta-lactam antibiotics, intentional self-harm
T362X2A
Poisoning by chloramphenicol group,
T363X2A
Poisoning by macrolides, intentional
T364X2A
Poisoning by tetracyclines, intentional
T365X2A
Poisoning by aminoglycosides, intentional
T366X2A
Poisoning by rifampicins, intentional
T367X2A
Poisoning by antifungal antibiotics, systemically
used, intentional self-harm
T368X2A
Poisoning by other systemic antibiotics,
T369X2A
Poisoning by unspecified systemic
antibiotic, intentional self-harm
T370X2A
T371X2A
Poisoning by antimycobacterial drugs,
Poisoning by antimalarials and drugs acting
on other blood protozoa, intentional self-harm
T373X2A
Poisoning by other antiprotozoal drugs, intentional
T374X2A
Poisoning by anthelminthics, intentional
T375X2A
Poisoning by antiviral drugs, intentional
T378X2A
Poisoning by other specified systemic anti-infectives
and antiparasitics, intentional self-harm
T3792XA
anti-infective and antiparasitics, intentional self-harm
T380X2A
Poisoning by glucocorticoids and synthetic
analogues, intentional self-harm
T381X2A
Poisoning by thyroid hormones and
substitutes, intentional self-harm
T382X2A
Poisoning by antithyroid drugs, intentional
T383X2A
Poisoning by insulin and oral hypoglycemic
[antidiabetic] drugs, intentional self-harm
T384X2A
Poisoning by oral contraceptives,
T385X2A
Poisoning by other estrogens and
progestogens, intentional self-harm
T386X2A
Poisoning by antigonadotrophins, antiestrogens,
antiandrogens, not elsewhere classified, intentional self-harm
T387X2A
Poisoning by androgens and anabolic
congeners, intentional self-harm
T38802A
Poisoning by unspecified hormones and
synthetic substitutes, intentional self-harm
T38812A
Poisoning by anterior pituitary
[adenohypophyseal] hormones, intentional self-harm
T38892A
Poisoning by other hormones and synthetic
T38902A
Poisoning by unspecified hormone
antagonists, intentional self-harm
T38992A
Poisoning by other hormone antagonists,
T39012A
T39092A
Poisoning by salicylates, intentional
T391X2A
Poisoning by 4-Aminophenol derivatives,
T392X2A
Poisoning by pyrazolone derivatives,
T39312A
Poisoning by propionic acid derivatives,
T39392A
Poisoning by other nonsteroidal
anti-inflammatory drugs [NSAID], intentional self-harm
T394X2A
Poisoning by antirheumatics, not elsewhere
classified, intentional self-harm
T398X2A
Poisoning by other nonopioid analgesics and
antipyretics, not elsewhere classified, intentional self-harm
T3992XA
Poisoning by unspecified nonopioid
analgesic, antipyretic and antirheumatic, intentional self-harm
T400X2A
Poisoning by opium, intentional self-harm
T401X2A
T402X2A
Poisoning by other opioids, intentional
T403X2A
Poisoning by methadone, intentional
T404X2A
Poisoning by other synthetic narcotics,
T405X2A
Poisoning by cocaine, intentional self-harm
T40602A
Poisoning by unspecified narcotics,
T40692A
Poisoning by other narcotics, intentional
T407X2A
Poisoning by cannabis (derivatives),
T408X2A
Poisoning by lysergide [LSD], intentional self-harm
T40902A
Poisoning by unspecified psychodysleptics
[hallucinogens], intentional self-harm
T40992A
Poisoning by other psychodysleptics
T410X2A
Poisoning by inhaled anesthetics, intentional
T411X2A
Poisoning by intravenous anesthetics,
T41202A
Poisoning by unspecified general
anesthetics, intentional self-harm
T41292A
Poisoning by other general anesthetics,
T413X2A
Poisoning by local anesthetics, intentional
T4142XA
Poisoning by unspecified anesthetic,
T415X2A
Poisoning by therapeutic gases, intentional
T420X2A
Poisoning by hydantoin derivatives, intentional
T421X2A
Poisoning by iminostilbenes, intentional
T422X2A
Poisoning by succinimides and
oxazolidinediones, intentional self-harm
T423X2A
Poisoning by barbiturates, intentional
T424X2A
Poisoning by benzodiazepines, intentional
T425X2A
Poisoning by mixed antiepileptics,
T426X2A
Poisoning by other antiepileptic and
sedative-hypnotic drugs, intentional self-harm
T4272XA
Poisoning by unspecified antiepileptic and
T428X2A
Poisoning by antiparkinsonism
drugs and other central muscle-tone depressants, intentional self-harm
T43012A
Poisoning by tricyclic antidepressants,
T43022A
Poisoning by tetracyclic antidepressants,
T431X2A
Poisoning by monoamine-oxidase-inhibitor
antidepressants, intentional self-harm
T43202A
Poisoning by unspecified antidepressants, intentional
T43212A
Poisoning by selective serotonin and
norepinephrine reuptake inhibitors, intentional self-harm
T43222A
Poisoning by selective serotonin reuptake
inhibitors, intentional self-harm
T43292A
Poisoning by other antidepressants,
T433X2A
Poisoning by phenothiazine antipsychotics
and neuroleptics, intentional self-harm
T434X2A
Poisoning by butyrophenone
and thiothixene neuroleptics, intentional self-harm
T43502A
Poisoning by unspecified antipsychotics and
neuroleptics, intentional self-harm
T43592A
Poisoning by other antipsychotics and
T43602A
Poisoning by unspecified psychostimulants,
T43612A
T43622A
Poisoning by amphetamines, intentional
T43632A
Poisoning by methylphenidate, intentional
T43692A
Poisoning by other psychostimulants,
T438X2A
Poisoning by other psychotropic drugs,
T4392XA
Poisoning by unspecified psychotropic drug,
T440X2A
Poisoning by anticholinesterase agents,
T441X2A
Poisoning by other parasympathomimetics
[cholinergics], intentional self-harm
T442X2A
Poisoning by ganglionic blocking drugs,
T443X2A
Poisoning by other parasympatholytics
[anticholinergics and antimuscarinics] and spasmolytics, intentional self-harm
Poisoning by predominantly alpha-adrenoreceptor agonists, intentional self-harm
T445X2A
T446X2A
Poisoning by alpha-adrenoreceptor
T447X2A
Poisoning by beta-adrenoreceptor
T448X2A
Poisoning by centrally-acting and
adrenergic-neuron-blocking agents, intentional self-harm
T44902A
Poisoning by unspecified drugs primarily
affecting the autonomic nervous system, intentional self-harm
T44992A
Poisoning by other drug primarily affecting
the autonomic nervous system, intentional self-harm
T450X2A
Poisoning by antiallergic
and antiemetic drugs, intentional self-harm
Poisoning by antineoplastic and
immunosuppressive drugs, intentional self-harm
T452X2A
T453X2A
Poisoning by enzymes, intentional self-harm
T454X2A
Poisoning by iron and its compounds,
T45512A
Poisoning by anticoagulants, intentional
T45522A
Poisoning by antithrombotic drugs,
T45602A
Poisoning by unspecified fibrinolysis-affecting
drugs, intentional self-harm
T45612A
Poisoning by thrombolytic drug, intentional
T45622A
Poisoning by hemostatic drug, intentional
T45692A
Poisoning by other fibrinolysis-affecting drugs,
T457X2A
Poisoning by anticoagulant antagonists,
vitamin K and other coagulants, intentional self-harm
T458X2A
Poisoning by other primarily systemic and
hematological agents, intentional self-harm
Poisoning by unspecified primarily systemic
and hematological agent, intentional self-harm
T460X2A
Poisoning by cardiac-stimulant glycosides
and drugs of similar action, intentional self-harm
T461X2A
Poisoning by calcium-channel blockers, intentional
T462X2A
Poisoning by other antidysrhythmic
T463X2A
Poisoning by coronary vasodilators,
T464X2A
Poisoning by angiotensin-converting-enzyme
T465X2A
Poisoning by other antihypertensive drugs,
T466X2A
Poisoning by antihyperlipidemic
and antiarteriosclerotic drugs, intentional
T467X2A
Poisoning by peripheral vasodilators,
T468X2A
Poisoning by antivaricose
drugs, including sclerosing agents, intentional
T46902A
Poisoning by unspecified agents primarily
affecting the cardiovascular system, intentional self-harm
T46992A
Poisoning by other agents primarily
T470X2A
Poisoning by histamine H2-receptor blockers,
T471X2A
Poisoning by other antacids and anti-gastric-secretion
T472X2A
Poisoning by stimulant laxatives,
T473X2A
Poisoning by saline and osmotic laxatives,
T474X2A
Poisoning by other laxatives, intentional self-harm
T475X2A
Poisoning by digestants, intentional
T476X2A
Poisoning by antidiarrheal drugs,
T477X2A
T478X2A
affecting gastrointestinal system, intentional self-harm
T4792XA
affecting the gastrointestinal system, intentional self-harm
T480X2A
Poisoning by oxytocic drugs, intentional
T481X2A
[neuromuscular blocking agents], intentional self-harm
T48202A
Poisoning by unspecified drugs acting on
muscles, intentional self-harm
T48292A
Poisoning by other drugs acting on muscles,
Poisoning by antitussives, intentional
T484X2A
Poisoning by expectorants, intentional
T485X2A
Poisoning by other anti-common-cold drugs,
T486X2A
Poisoning by antiasthmatics,
T48902A
acting on the respiratory system, intentional self-harm
T48992A
Poisoning by other agents primarily acting
on the respiratory system, intentional self-harm
T490X2A
Poisoning by local antifungal,
anti-infective and anti-inflammatory drugs, intentional self-harm
T491X2A
Poisoning by antipruritics,
detergents, intentional self-harm
T493X2A
Poisoning by emollients, demulcents and
protectants, intentional self-harm
T494X2A
Poisoning by keratolytics,
keratoplastics, and other hair treatment drugs and
preparations, intentional self-harm
T495X2A
Poisoning by ophthalmological drugs and
T496X2A
Poisoning by otorhinolaryngological
drugs and preparations, intentional self-harm
T497X2A
Poisoning by dental drugs, topically
applied, intentional self-harm
T498X2A
Poisoning by other topical agents,
T4992XA
Poisoning by unspecified topical agent,
T500X2A
Poisoning by mineralocorticoids and their
T501X2A
Poisoning by loop [high-ceiling] diuretics,
Poisoning by carbonic-anhydrase inhibitors,
benzothiadiazides and other diuretics, intentional self-harm
T503X2A
Poisoning by electrolytic, caloric and
water-balance agents, intentional self-harm
T504X2A
Poisoning by drugs affecting uric acid
metabolism, intentional self-harm
T505X2A
Poisoning by appetite depressants,
T506X2A
Poisoning by antidotes and chelating agents,
T507X2A
Poisoning by analeptics and opioid receptor
T508X2A
Poisoning by diagnostic agents, intentional
T50902A
Poisoning by unspecified drugs, medicaments and
biological substances, intentional self-harm
T50992A
Poisoning by other drugs, medicaments and
Authority: Health-General Article, §§2-104(b), 7.5-204, 7.5-402,
15-103(a)(1), and 15-105(b), Annotated Code of
[16-330-P]
Regulations .01, .05, .06, and .08 under COMAR 10.09.80 Community-Based Substance
Use Disorder Services. Statement of Purpose
The purpose of this action is to
change methadone reimbursement to better align service delivery with payment.
The proposal includes a new bundled rate specifically for medication assisted
treatment services and a separate reimbursement for Level 1 counseling services
when delivered by appropriately licensed professionals. This proposal adds the
ability for opioid treatment programs to be reimbursed separately for services,
including an induction service of the selected medication (methadone or
buprenorphine), periodic medication management visits, and guest dosing
An additional purpose of this proposal is to update regulations to
allow certified or licensed addictions programs (provider type 50s) who employ
a DATA 2000 waiver physician to be reimbursed for periodic medication
management visits and the cost of buprenorphine itself through their certified
(text unchanged) (5) “DATA 2000 waived
provider” means a physician who has received a waiver under the Drug Addiction
and Treatment Act of 2000 which expands the clinical context of medication
assisted opioid dependency treatment and permits qualified physicians to
dispense or prescribe certain narcotic medications that have a lower risk of
abuse, like buprenorphine, in settings other than an opioid treatment program.
[(5)] (6)—[(10)] (11) (text unchanged) [(11)] (12)
“Office of Health Care Quality (OHCQ)”
means the office within the Department responsible for certification and
inspection of programs for the Behavioral Health Administration.
[(12)] (13)—[(18)] (19) (text
A. Comprehensive substance use disorder assessment at a minimum
(1) Be delivered through an:
(a) OHCQ certified or
licensed substance use disorder treatment provider; or (b) Opioid treatment program;
(2) Be completed before providing the community based behavioral
health services listed in §§B—I
of this regulation; [(1)] (3)—[(2)] (4) (text unchanged) B. Level 1 group and individual substance use disorder counseling
shall [include]:
(a) OHCQ certified or licensed substance use disorder treatment
provider; or (b) Opioid treatment program;
[(1)] (2) [Services] Include services for participants who require less than 9 hours
weekly for adults and 6 hours weekly
[(2)] (3) [A]
Include a written individualized
treatment plan, with the participation of the participant based on the
comprehensive assessment that shall:
[(3)] (4) [Family] Include family members, if necessary, as long as the participant
is also present in a Level 1 group counseling session.
C. Level 2.1 Intensive Outpatient services shall [include]:
(1) Be delivered through an OHCQ certified or licensed substance
use disorder treatment provider only;
[(1)] (2) [Services] Include services for participants
who require outpatient treatment for 9 or more hours weekly for an adult and 6
or more hours weekly for an adolescent;
[(2)] (3) [A] Include a written individualized
treatment plan, with the participation of the participant based on the comprehensive
assessment that shall:
[(3)] (4) [A]
Include a discharge plan, which
includes written recommendations to assist the participant with continued
recovery efforts, as well as appropriate referral services.
D. Level 2.5 partial hospitalization services shall [include]:
use disorder treatment provider; [(1)] (2) [Services]
Include services for participants who require a minimum of 20 hours weekly
of structured outpatient treatment delivered in the following ways:
(a)—(b) (text unchanged) [(2)] (3) [A]
[(3)] (4) [A] Include a discharge plan, which includes written recommendations to assist
the participant with continued recovery efforts, as well as appropriate
E. Ambulatory withdrawal
management service shall:
use disorder treatment provider;
(2) Include the following services as medically necessary:
(a) Administration and monitoring of medication, including
administration and monitoring of psychotropic medication by qualified staff, as
(b) Managing withdrawal symptoms;
(3) Include a participant progress note added to the
participant’s record after each session.
F. Buprenorphine and other medication assisted treatment
delivered by an OHCQ certified or licensed substance use disorder treatment
provider that employs a DATA 2000 waived provider shall:
(1) Be delivered by a DATA 2000 waived provider;
(2) Include pharmacological interventions, including the use of
FDA-approved opiate agonist and partial agonist treatment medications to
provide treatment, support, and recovery to opioid-addicted participants;
(3) Include, at a minimum, medical services required to be
provided by the Program that:
(a) Ensure that participants receive a dose adequate to
alleviate withdrawal symptoms;
(b) Employ dose increases and behavior therapy before mandatory
detoxification for participants continuing to use drugs;
(c) Establish participant dosing based on an individual need;
(d) Provide flexible dosage tapering and withdrawal management
with dosage reductions at the participant’s request; (4) Include ordering and administering non-narcotic drugs; and
(5) Include point of care presumptive drug testing that shall
(a) Presumptive in nature and performed
at the point of care; and
(b) Capable of being read by direct
optical observation only.
[E.] G. Opioid maintenance
therapy service delivered through the use
of methadone or buprenorphine by opioid treatment programs shall include:
[(1) A comprehensive
substance use disorder assessment as described in §A of this regulation;]
[(2)] (1) (text unchanged) [(3)] (2) The
(b) Point of care presumptive drug testing;
(c) Definitive drug testing when completed by a laboratory;
[(b)] (d)
Substance use disorder and related counseling as recommended in the
individualized treatment plan; [and]
(e) Periodic medication management; and
[(c)] (f)
Ordering and administering non-narcotic drugs; [and]
(4) A discharge plan, which includes written recommendations to
assist the participant with continued recovery efforts, as well as appropriate
referral services[.];
(5) Guest dosing arrangements with other opioid treatment
programs, as medically necessary.
[F.] H. [Buprenorphine] Medication assisted treatment induction
service delivered by opioid treatment programs shall include the
following services, as medically necessary:
substance use disorder assessment as described in §A of this regulation; and
(2) The following services as clinically
indicated:]
(1) Pharmacological
interventions, including the use of one
of the following FDA-approved opiate agonist and partial agonist treatment
medications to provide treatment, support, and recovery to opioid-addicted
participants[;]:
(a) Buprenorphine; or (b) Methadone;
[(b)] (2)—[(c)] (3) (text unchanged)
[G. Buprenorphine
maintenance therapy delivered by an opioid treatment program shall include:
(1) An individualized treatment plan that shall be reviewed and
approved by a licensed physician or licensed practitioner of the healing arts,
within the scope of his or her practice under State law;
(2) The following services as clinically indicated:
(a) Pharmacological interventions, including the use of
(b) Substance use disorder and related counseling as recommended in
the individualized treatment plan;
(c) Medical services, including, but not limited to, those required
to be provided by the Program that:
(i) Ensure that participants receive a
dose adequate to alleviate withdrawal symptoms;
(ii) Employ dose increases and behavior therapy before mandatory
(iii) Establish participant dosing on an individual need;
(iv) Provide flexible dosage tapering at
the participant’s request; and
(v) Include a withdrawal management plan with dosage reductions;
(d) Ordering and administering non-narcotic drugs; and
(3) A discharge plan, which includes written recommendations to
H. Ambulatory withdrawal management service shall include:
(1) A comprehensive substance use disorder assessment as described
in §A of this regulation;
(3) A participant progress note added to the participant’s record
after each session.]
B. Providers may not be reimbursed
by the Program for:
(5) Level 1 group or individual
counseling during the same week as a Level 2.1 Intensive Outpatient treatment[,]
or Level 2.5 Partial
Hospitalization[, Buprenorphine
Induction, or Buprenorphine Maintenance Therapy] service unless the participant has been discharged from or
admitted to a new level of care[:];
[(7) Opioid maintenance therapy
delivered by an opioid treatment program during the same week as a Level 1
group or individual counseling session, Level 2.1 Intensive Outpatient
treatment or Level 2.5 Partial Hospitalization;]
(7) Level 1 group or individual
counseling during the same week as Level 1 group or individual counseling
offered by another provider;
[(9) Buprenorphine induction
treatment, Level 2.5 Partial Hospitalization or Opioid Maintenance Therapy;]
[(10)] (9) Buprenorphine
maintenance therapy delivered by an opioid treatment program, an OHCQ certified, or a licensed substance
use disorder treatment provider during the same week as [a Level 1 group or individual
counseling session, Level 2.1 Intensive Outpatient treatment, Level 2.5 Partial
Hospitalization or Opioid] Methadone
[(11)] (10) Ambulatory
withdrawal management during the same week as [an opioid maintenance therapy, buprenorphine induction, or
buprenorphine maintenance] services delivered by an opioid treatment
[(12)] (11) (text unchanged)
[(13)] (12) Services delivered
by federally qualified health centers other than those billed using T-codes that
may include the following delivered by two separate appropriately licensed
(a) One T-code for mental health
services per day with associated mental
health procedure code; and
(b) One T-code for substance use
disorder services with associated H-code
[(14)] (13) Services rendered
but not appropriately documented to the
[(15)] (14)—[(18)] (17) (text unchanged) C.—E. (text unchanged)
F. The Department shall pay
participating opioid treatment programs, per participant, per week provided the
participant received ongoing opioid
treatment medications and at least one face-to-face documented treatment
service in the [week] month
for which the Program is billed.
G. In order for an opioid treatment
program to bill for [buprenorphine] medication
assisted treatment induction, the provider shall bill this service only in
the first week of treatment per participant or
in the first week of treatment after a break from treatment of at least 6
J. All drug screening lab claims
submitted to the ASO by providers other
than opioid treatment programs shall list the applicable substance use
A.—C. (text unchanged) D. [Rates] Effective July 1, 2016, rates for the
services outlined in this regulation shall be as follows:
(1) For services outlined in this
regulation, as delivered through an OHCQ certified or licensed substance use
disorder treatment provider:
[(1)] (a) Comprehensive
substance use disorder assessment — [$142] $144.82;
[(2)] (b) Level 1 group
substance use disorder counseling — [$39] $39.78 per
[(3)] (c) Level 1 individual
substance use disorder counseling — [$20] $20.40 per
15-minute increment with a maximum of six 15-minute increments per day;
[(4)] (d) Level [2.5] 2.1 Intensive
Outpatient treatment — [$125] $127.50 per
[(5)] (e) Level 2.5 Partial
Hospitalization half day session — [$130] $132.60 per
[(6)] (f) Level 2.5 Partial
Hospitalization full day session — [$210] $214.20 per
— $80 per participant per week;
(8) Buprenorphine Induction — $200
per participant per week;
(9) Buprenorphine Maintenance
Therapy — $75 per participant per week;
[(10)] (g) Ambulatory
Withdrawal Management — [$70] $71.40
per diem[.];
(h) Point of care presumptive
drug test — $11.81 per test; and
(i) Buprenorphine and other
medication assisted treatment through office based evaluation and management
visits, according to COMAR 10.09.02.07D.
(2) For services outlined in this
regulation as delivered through an opioid treatment program