# COMAR Title 10 — Maryland Department of Health ## Subtitle 07 — Hospitals ### Chapter 07 — Nursing Referral Service Agencies **Authority:** Health-General Article, Subtitle 19-4B, Annotated Code of Maryland **Administrative History:** Effective date: November 6, 2006 (33:22 Md. R. 1732) **Administrative History:** Regulation .04A, E amended effective March 13, 2017 (44:5 Md. R. 292) #### Regulation .01 Purpose. *COMAR 10.07.07.01* The purpose of this chapter is to set minimum standards for licensure of nursing referral service agencies in Maryland. This chapter does not preclude a nursing referral service agency from operating with independent contractors. #### Regulation .02 Definitions. *COMAR 10.07.07.02* A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Activities of daily living” means normal daily activities including: (a) Bathing, toileting, and personal hygiene; (b) Dressing; (c) Meal preparation and eating; (d) Companionship; and (e) Assistance with physical transfer and ambulation. (2) “Agency” means a licensed nursing referral service agency as defined in §B(8) of this regulation. (3) “Care provider” means an individual who provides health care services and assistance to a client in the activities of daily living including: (a) Bathing, toileting, and personal hygiene; (b) Dressing; (c) Meal preparation and eating; (d) Companionship; and (e) Assistance in physical transfer and ambulation. (4) “Department” means the Maryland Department of Health. (5) “Home health aid services” means personal and health care services delivered to a client by a care provider. (6) “License” means a document issued by the Secretary to a person to operate a nursing referral service agency in Maryland. (7) “Licensed or certified health professional” means an individual who is licensed or certified under the Health Occupations Article, Annotated Code of Maryland, to provide health care services in this State. (8) “Licensee” means a person to whom a license is issued by the Secretary to operate a nursing referral service agency. (9) “Nursing referral service agency” means one or more individuals engaged in the business of screening and referring, directly or in accordance with contractual arrangements that may include independent contractors, licensed health professionals or care providers to clients for the provision of nursing services, home health aid services, or other home health care services at the request of the client. (10) “Residence” means a place where an individual resides and may include a private home, a nursing facility, an assisted living program, or other type of residential unit. (11) “Secretary” means the Secretary of Health. #### Regulation .03 License Required. *COMAR 10.07.07.03* A. A person, partnership, corporation, association, or other business entity may not conduct, operate, or maintain a nursing referral service agency in this State before being licensed by the Secretary. B. This chapter does not limit the right of any person who holds a license issued under Health-General Article or Health Occupations Article, Annotated Code of Maryland, to act as authorized by that license. #### Regulation .04 Licensing Procedures. *COMAR 10.07.07.04* A. Application for License. (1) A person desiring to conduct, operate, or maintain a nursing referral service agency in this State shall file an application with the Secretary, on the written or electronic form provided by the Secretary. (2) The application for licensure shall contain the name and address of each officer and the director of the nursing referral service agency. (3) Along with the application, the applicant shall submit a: (a) Nonrefundable 3-year license fee of $1,000 payable to the Department; and (b) Copy of the agency's policies and procedures as specified in Regulation .08B(1) of this chapter. B. Additional Requirements. The applicant shall: (1) Demonstrate compliance with all applicable federal, State, and local laws and regulations; and (2) Maintain records to support compliance with the regulations of this chapter and make the records available to the Department upon request. C. After reviewing the application for licensure, the Secretary shall: (1) Approve the application and issue a 3-year license to the applicant if the applicant complies with all requirements of this chapter; or (2) Deny the application if the applicant does not comply with the requirements of this chapter. D. A 3-year license expires 3 years from the date of its issuance, unless it is otherwise revoked or suspended by the Department. E. License Renewal. (1) The agency shall file an application for relicensure on the written or electronic form provided by the Secretary at least 60 days before the expiration of its current license. (2) A licensee shall submit to the Department: (a) An application for license renewal; (b) A nonrefundable license renewal fee of $1,000 payable to the Department; and (c) Updates, if any, to the agency's policies and procedures as specified in Regulation .08B(1) of this chapter. #### Regulation .05 Posting Of License. *COMAR 10.07.07.05* A nursing referral service agency shall post its license conspicuously onsite so that it is clearly visible to the general public. #### Regulation .06 Restrictions on a License. *COMAR 10.07.07.06* A. A licensee may not, under any circumstances, transfer or reassign its nursing referral service agency license to another person. B. If the agency ceases to operate for any reason, the license is void and the licensee shall immediately return the license to the Department. #### Regulation .07 Inspections by the Secretary of Health. *COMAR 10.07.07.07* A. An applicant or a licensee shall maintain records to support compliance with this chapter and ensure that all records are open to inspection by the Department. B. An applicant or a licensee shall assist the Department in conducting an inspection if the Department determines that the assistance is necessary to enable the Department to conduct the inspection. C. If the Department issues deficiencies after an inspection, an agency shall submit a written plan of correction to the Department within 10 business days of receiving the Department's notice of deficiencies. #### Regulation .08 Administration. *COMAR 10.07.07.08* A. Contractual Arrangements. The regulations of this chapter do not preclude a nursing referral service agency from operating with independent contractors. B. Agency Referrals. An agency shall: (1) Develop and implement policies and procedures to screen licensed or certified health professionals and care providers that include the following: (a) A State criminal history records check or a private agency background check in accordance with Health-General Article, §19-4B-03(c), Annotated Code of Maryland; (b) Verification of current professional licensure or certification under the Health Occupations Article, Annotated Code of Maryland; (c) A basic health screening including tuberculosis screening; (d) Verification of references; (e) Verification of employment history; (f) Completion of I-9 forms; and (g) An in-person interview of a licensed or certified health professional and care provider before any referral of the individual is made to a client; and (2) Disclose to the client or the client's representative whether or not the agency has made a determination that the referral is appropriate to the needs of a client and is in compliance with applicable titles of Health Occupations Article, Annotated Code of Maryland. C. Complaint Process. (1) An agency shall institute an internal client complaint investigation process that includes: (a) Notice to the client or the client's representative of the complaint process; and (b) Protocols to investigate complaints. (2) An agency shall provide notice to clients of the Department's complaint hotline number for complaints about services provided by an individual that is referred by the agency. D. Client Participation. An agency shall allow clients to accept or reject, at their discretion, any licensed or certified health professional or care provider that is referred by the agency. #### Regulation .09 Sanctions. *COMAR 10.07.07.09* A. The Secretary may deny, suspend, revoke, or refuse to reissue any license for inability or failure to comply with this chapter. Any action taken to deny, suspend, or refuse to issue a license is subject to provisions of the Administrative Procedure Act, State Government Article, §10-201 et seq., Annotated Code of Maryland. B. The Secretary, in addition to or instead of the sanctions set forth in §A of this regulation may direct the licensee to establish certain conditions for continued operation, including time limits for compliance. #### Regulation .10 Penalty for Unlicensed Operation. *COMAR 10.07.07.10* A person that operates a nursing referral services agency without a license is guilty of a misdemeanor, and on conviction is subject to a fine not exceeding $1,000 for the first offense and $10,000 for each subsequent offense. Each day that a violation is continued after the first conviction is a separate offense.