<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".70" citation="COMAR 10.07.02.70" title_num="10" subtitle_num="07" chapter_num="02" heading="Civil Money Penalties — Imposition.">
  <paragraph num="A.">
    <text>A civil money penalty may be imposed when:</text>
    <paragraph num="(1)">
      <text>A deficiency exists; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An ongoing pattern of deficiencies exist in a nursing facility.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>In determining whether a civil money penalty is to be imposed, the Department shall consider the following factors:</text>
    <paragraph num="(1)">
      <text>The number, nature, and seriousness of the deficiencies;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The extent to which the deficiency or deficiencies are part of an ongoing pattern during the preceding 24 months;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The degree of risk to the health, life, or safety of the residents of the nursing facility caused by the deficiency or deficiencies;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The efforts made by, and the ability of, the nursing facility to correct the deficiency or deficiencies;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>A nursing facility's prior history of compliance in general and specifically with reference to the cited deficiencies; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Such other factors as justice may require.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>When the Department determines that a deficiency or an ongoing pattern of deficiencies exists, the Department shall notify the nursing facility of the deficiency or deficiencies and may:</text>
    <paragraph num="(1)">
      <text>Impose a per day civil money penalty until sustained compliance has been achieved;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Permit the facility the opportunity to correct the deficiencies by a specific date; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Impose a per instance civil money penalty for each instance of violation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>When the Department permits a facility the opportunity to correct the deficiencies by a specific date, and the facility fails to comply with this requirement, the Department may impose a per day civil money penalty for each day of violation until correction of the deficiency or deficiencies has been verified and sustained compliance has been maintained.</text>
  </paragraph>
  <paragraph num="E.">
    <text>When a civil money penalty is imposed, the Department shall issue an order which includes the:</text>
    <paragraph num="(1)">
      <text>Deficiency or deficiencies on which the order was based;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Amount of civil money penalty to be imposed; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Manner in which the amount of civil money penalty was calculated.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>An order issued pursuant to §E of this regulation is void unless issued within 60 days of the inspection or reinspection at which the deficiency or deficiencies are identified.</text>
  </paragraph>
</regulation>