This chapter applies to any person, whether public or private, operating a facility that: Provides health-related services on a regular basis to individuals: Who do not require hospital care; and Whose mental or physical condition requires services that: Are above the level of room and board; and Can be made available only through institutional facilities; and Has as its primary purpose the provision of health rehabilitative services for individuals with an intellectual disability or related conditions. An intermediate care facility for individuals with intellectual disabilities or persons with related conditions (ICF/IID) shall be considered: A “related institution” under Health-General Article, §19-301, Annotated Code of Maryland, and shall be governed by the provisions of Title 19, Subtitle 3 of that article; and A provider of “services” under Health-General Article, §7-101, Annotated Code of Maryland, and shall be governed by the applicable provisions of Title 7 of that article including: Subtitle 4: Provisions of Services; Subtitle 5: State Residential Centers for Individuals With Mental Retardation if the facility is operated by the State; Subtitle 8: Transfers; and Subtitle 10: Rights of Individuals. In this chapter, the following terms have the meanings indicated. Terms Defined. “Department” means the Maryland Department of Health. “Facility” means an intermediate care facility for individuals with intellectual disabilities or persons with related conditions (ICF/IID) within the scope of this chapter. “License” means a license issued by the Secretary to operate a facility. “Secretary” means the Secretary of Health. A person shall be licensed by the Secretary before the person may operate a facility in the State. An applicant for a license shall: Submit to the Secretary an application: In the form and manner prescribed by the Secretary on the written or electronic form provided by the Secretary; and Signed and verified by the applicant; and Pay to the Secretary an application fee in the amount provided in COMAR 10.07.15. The Secretary shall issue a license to an applicant who meets the requirements of these regulations. A license authorizes the licensee to operate a facility while it is effective and is not transferable. Term and Renewal of License. A license expires on the first anniversary of its effective date unless it is renewed for a 1-year term as provided in this section. Before the license expires, the licensee may renew it for another 1-year term, if the licensee submits to the Secretary: A renewal application in the form and manner prescribed by the Secretary on the written or electronic form provided by the Secretary; Satisfactory evidence of compliance with any requirement of the regulations for license renewal; and The license renewal fee provided in COMAR 10.07.15. The Secretary may: Deny a license to any applicant; Deny the renewal of a license to a licensee; or Revoke a license of a licensee if the applicant or licensee does not meet the requirements of this chapter. General. Whether or not a facility participates in Medicare or Medicaid, the facility shall meet the requirements set forth in 42 CFR § 483.400 et seq., which is incorporated by reference. Safety and Sanitation. The facility, its grounds, fixtures and equipment shall be: Maintained in good repair, clean, and attractive; Free of unnecessary accumulations of personal property or debris; and Free of hazards, insects, and rodents. Infection Control. The administrator shall: Establish policies and procedures to investigate, control, and prevent infections in the facility; and Ensure that facility staff follow these policies and procedures. Personnel. The administrator shall provide orientation and training for all staff and volunteers. If the center provides care for individuals with Alzheimer's disease or related disorders: The administrator shall provide annual in-service education on the care of individuals with dementia; and Each employee shall complete an instructional unit on dementia as described in COMAR 10.07.02.40H before the later of: 180 days from beginning of employment, or One year from the effective date of these regulations. Employee Health Screening. A facility shall obtain certification that an employee or volunteer is free from tuberculosis in a communicable form as provided in Regulation .06 only if the employee or volunteer: Will be involved in the direct care of tuberculosis patients; or Is an immigrant from Africa, Asia, or Latin America. Emergency Management Plans. State residential centers shall develop an emergency plan for all types of emergencies and disasters that shall include: Procedures that will be followed before, during, and after an emergency to address the following: The evacuation, transportation, or 72-hour shelter-in-place of individuals and staff served; Holding an annual practice drill coordinated with local emergency planners for sheltering-in-place or evacuating; Preparing an after action report and improvement plan after drills that evaluates the plan and takes corrective actions; Ensuring that individuals served and staff have identification with current health, contact, and other important information that is immediately accessible in the event of evacuation; The role of the resident, family member, or legal representative in the event of evacuation; Arranging for medical needs and other accommodations for individuals served and staff at alternative facilities or shelters; and Establishing a communication protocol among all appropriate parties that includes redundant communication means; The notification to families, staff, and respective DDA regional office regarding the action that will be taken concerning the safety and well-being of the individuals served; The staff coverage, organization, and assignment of responsibilities that includes: Planning staff coverage needs for ongoing shelter-in-place or evacuations; Identifying staff members available to report for work or remain during extended periods; and Establishing staff notification and recall contingency plans and procedures; The continuity of operations, including, but not limited to, redundant communications systems, preservation of records and electronic data, the procurement of essential goods, equipment, and services, plans to secure vacated facilities, and the relocation to alternate facilities; Procedures to: Backup and electronically store off-site, appropriate records and data of consumers and staff and facility documents, for access under emergency conditions; and Ensure access to an electronic copy of the emergency plans when requested by local, State, or federal emergency management organizations; Provisions to ensure that the facility's emergency and disaster plans are shared with local emergency management organizations for the purpose of coordinating local emergency planning; An executive summary of the evacuation procedures that shall be provided to the family member of a resident on request; and A summary statement of the facility's community surge capacity abilities. An employee or volunteer may be certified as required in Regulation .05D(3) in one of the following four ways: If the individual has documentation of a negative tuberculin test by the Mantoux method within the past 24 months and has, by history, no contact with a person with tuberculosis in a communicable form subsequent to this documentation or no symptoms consistent with tuberculosis, the individual shall be considered to be a negative tuberculin reactor and to be free from tuberculosis in a communicable form. Further skin testing may not be necessary except for epidemiologic diagnostic purposes which may be required by the local health officer or the Department. If the individual does not have documentation of a negative tuberculin test by the Mantoux method within the past 24 months and does not have a history of having had a positive tuberculin test by the Mantoux method, the following procedure shall be done: Five Tuberculin Units (TU) of Purified Protein Derivative (PPD) shall be administered intradermally and the results read 48—72 hours subsequent to the administration of the test; An individual with induration of 5—9 mm and no history of contact with a person with tuberculosis in a communicable form or an individual with induration of 0—4 mm shall be considered to be a negative tuberculin reactor and to be free from tuberculosis in a communicable form; An individual with induration of 5—9 mm and a history of contact with a person with tuberculosis in a communicable form or an individual with induration of 10 mm or more shall be considered to be a positive tuberculin reactor and shall be handled as described in §A(3)(a),(b), and (c), of this regulation. If the individual is a positive tuberculin reactor as defined in §A(2)(c), of this regulation, or if the individual has a history of a positive tuberculin test by the Mantoux method without documentation of having received an adequate course of therapy, as defined by the local health officer, for tuberculosis disease or received adequate prophylaxis, as defined by the local health officer, for tuberculosis infection, the following procedure shall be done: If the individual does not have documentation of a negative chest X-ray within the past 12 months, the individual shall be evaluated by a chest X-ray. If the chest X-ray is negative, the individual shall be considered to be free from tuberculosis in a communicable form and shall have a repeat chest X-ray in 12 months, unless isoniazid therapy is instituted, in which case the second chest X-ray is unnecessary. If the individual has documentation of a negative chest X-ray within the past 12 months, the individual shall be considered to be free from tuberculosis in a communicable form and shall have a repeat chest X-ray 12 months after the most recent documented chest X-ray unless isoniazid therapy has been instituted, in which case the second chest X-ray is unnecessary. If the individual has had two successive negative chest X-rays 12 months apart, no further chest X-rays are necessary and the individual shall be considered to be free from tuberculosis in a communicable form unless the individual has symptoms consistent with tuberculosis. If the individual has documentation of an adequate course of therapy, approved by the local health officer, for tuberculosis disease or adequate prophylaxis, approved by the local health officer, for tuberculosis infection, no further chest X-rays are necessary and the individual shall be considered to be free from tuberculosis in a communicable form unless the individual has symptoms consistent with tuberculosis. The facility shall instruct each employee and volunteer in the signs and symptoms of active tuberculosis and advise the individual to seek immediate medical care should the individual detect these signs or symptoms. If the individual meets any of the following criteria, the facility shall have written policies and procedures, acceptable to the Department, for the evaluation, management, and surveillance of this individual: A history of tuberculosis or tuberculosis infection without documentation of adequate treatment as defined and determined by the local health officer; Is currently being treated for tuberculosis disease or tuberculosis infection; Has chest X-rays consistent with tuberculosis without documentation of adequate treatment as defined and determined by the local health officer; or Symptoms consistent with tuberculosis or a history of contact with a person with tuberculosis in a communicable form within the past 12 months. The facility shall maintain the following records: Results of Mantoux tests, recorded in millimeters of induration with dates of administration, dates of reading and results of tests; Results of X-rays required in §A(3)(a),(b), and (c), of this regulation; and Documentation of any Mantoux test, chest X-ray, chemotherapy, and chemoprophylaxis which is the basis for the certification that the individual is free from tuberculosis in a communicable form. The Department shall inspect each facility at least annually to determine compliance with these regulations. A licensed facility and any facility applying for a license shall be open to inspection by the Department at all times. Health-General Article, §§19-318, 19-320, and 19-323, Annotated Code of Maryland Effective date: December 28, 1987 (14:26 Md. R. 2747) (COMAR 10.07.20 amended and transferred from COMAR 10.22.04 Public and Private Residential Care Facilities Serving the Mentally Retarded (ICF-MR)) Regulation .01B amended effective January 20, 2014 (41:1 Md. R. 13) Regulation .02 amended effective January 20, 2014 (41:1 Md. R. 13) Regulation .03B amended effective January 20, 2014 (41:1 Md. R. 13) Regulation .04B, E amended effective March 13, 2017 (44:5 Md. R. 292) Regulation .05A amended effective February 20, 1989 (16:3 Md. R. 342) Regulation .05E adopted effective December 17, 2007 (34:25 Md. R. 2210)