Approval Without Conditions. The Secretary shall grant approval without conditions to a program if, based on an on-site review, the Department's designated approval unit determines that the program complies with the requirements for approval. Unless the program has been granted deemed status under Regulation .10 of this chapter, within not more than 3 years of the date of the program's last full on-site review, the Department's designated approval unit shall conduct a full, on-site review of the program. Based on the review conducted under §A(2) of this regulation, the Secretary shall redetermine the program's approval status according to the provisions of this chapter. Approval with Conditions. The Secretary may grant approval with conditions to a program if, based on an on-site review, the Department's designated approval unit determines that the program: Is deficient in one or more of the requirements under this chapter, COMAR 10.21.17, or the chapter under the subtitle for the specific program; Has no deficiencies that constitute a threat to health, safety, or welfare of the individuals served; Has documented that the program will collaborate with the CSA, as required under COMAR 10.21.17.06; and Has submitted an acceptable program improvement plan within the time frame established under §B(3) of this regulation. If the Secretary grants a program an approval with conditions under §B(1) of this regulation, the Secretary shall notify the program that the Department's designated approval unit may conduct a focused review under the provisions of §B(4) of this regulation. Program Improvement Plan (PIP). Within 10 working days of receipt of the list of deficiencies cited during the on-site review, the program director shall: Submit a proposed PIP that addresses the identified deficiencies to the CSA or lead CSA; and Collaborate with the CSA or lead CSA to finalize the PIP. Within 30 calendar days of receipt of the list of deficiencies cited during the on-site review, the program director shall submit: The PIP to the Department's designated approval unit; and Documentation of the collaboration with the CSA or lead CSA. Unless an extension has been granted by the Department's designated approval unit, if a program fails to submit a completed PIP within the time frames established in §B(3)(a) and (b) of this regulation, the Secretary may pursue disciplinary action under Regulation .12C of this chapter. Focused Review. For programs that have been granted approval with conditions, the Department's designated approval unit may conduct a focused review to: Reevaluate the deficiencies cited during the on-site review conducted under §B(1) of this regulation; and Review the program's progress on the PIP. Based on the focused review conducted under §B(4)(a) of this regulation, the Secretary shall redetermine the program's approval status according to the provisions of this chapter. Regular Program Review. Within 3 years of the date of the program's last full on-site review, the Department's designated approval unit shall conduct a full, on-site review of the program. Based on the review conducted under §B(5)(a) of this regulation, the Secretary shall redetermine the program's approval status according to the provisions of this chapter. Certificate of Approval. If the Department's designated approval unit determines that a program is eligible for approval, the Secretary shall issue a certificate of approval to the program director that specifies the: Chapter under which the program has been approved; Type of approval; and Beginning and expiration dates of the approval period. The Secretary shall notify the Administration, the CSA of the jurisdiction where the program provides services, the Medical Assistance Program, and the ASO of the program's approval. The program director shall ensure that the certificate of approval is available during the regular hours of operation. Sale or Transfer of Certificate of Approval. The Secretary's certificate of approval of a program, issued according to the provisions of §C(1) of this regulation, is valid only for the program to which the Secretary's certificate of approval is issued. A program may not sell, assign, or transfer a certificate of approval to another program. Extension of Approval Status. The Secretary shall maintain the program's existing approval status if, before the expiration of approval period, the: Department's designated approval unit does not complete an on-site review; or Department does not reach a decision regarding approval.