# COMAR Title 10 — Maryland Department of Health

## Subtitle 22 — Developmental Disabilities

### Chapter 03 — Procedures for License Denials and Disciplinary Sanctions

**Authority:** Health-General Article, §7-904, Annotated Code of Maryland

**Administrative History:** Effective date: January 7, 1974

**Administrative History:** Regulations .01 — .27 amended effective July 25, 1980 (7:15 Md. R. 1425)

**Administrative History:** Regulations .01 — .27, Group Homes for the Mentally Retarded, repealed effective September 21, 1986 (13:19 Md. R. 2121)

**Administrative History:** Regulations .01 — .07, Community Residential Services for Mentally Retarded and Nonretarded Developmentally Disabled Individuals, adopted effective September 12, 1986 (13:19 Md. R. 2121)

**Administrative History:** Chapter revised effective December 26, 1988 (15:26 Md. R. 2983)

**Administrative History:** Chapter, Community Residential Services for Individuals with Developmental Disability, repealed and new chapter, General Provisions for Sanctions and Appeals, adopted effective July 26, 1999 (26:15 Md. R. 1148)

#### Regulation .01 Purpose.

*COMAR 10.22.03.01*

This chapter describes the procedures for a license denial and disciplinary action against a licensee.

#### Regulation .02 Definitions.

*COMAR 10.22.03.02*

A. In addition to the definitions set forth in COMAR 10.22.01, in this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) “Isolated scope” means that the identified deficiency has occurred only once, in only one location, or for only one individual.

  (2) “Low scope” means that the deficiency has occurred only occasionally, in sporadic locations, or for only a few individuals.

  (3) “Minor impact” means there has been little or no negative effect on an individual's health, safety, rights, or quality of life.

  (4) “Moderate impact” means an individual has experienced a significant health or safety consequence, a violation of rights, or infringement on quality of life, or that these consequences may likely occur in the near future.

  (5) “Repeated scope” means that the deficiency has occurred on a regular basis, in several locations, or for several individuals.

  (6) “Severe impact” means an individual has experienced a deterioration in the individual's medical or psychological condition, has been exposed to a serious safety risk, has experienced frequent rights violations, or infringements on the individual's quality of life, or that these consequences may likely occur in the near future.

  (7) “Widespread scope” means that the deficiency has occurred consistently, in most locations, or for a majority of people.

#### Regulation .03 Failure to Submit Acceptable Plan of Correction.

*COMAR 10.22.03.03*

A licensee, including a licensee with deficiencies having only a minor impact, is subject to any intermediate sanction set forth in Regulation .04 of this chapter for failure to comply with COMAR 10.22.02.04E and F.

#### Regulation .04 Intermediate Sanctions.

*COMAR 10.22.03.04*

A. After notice and an opportunity for a hearing, the Director may impose any intermediate sanctions listed in §B of this regulation if:

  (1) Deficiencies have a moderate impact and the scope of the deficiencies occurs on an isolated, low, repeated, or widespread basis; or

  (2) Deficiencies have a severe impact and the scope of the deficiencies occurs on an isolated, low, repeated, or widespread basis.

B. For purposes of §A of this regulation, intermediate sanctions include:

  (1) A directed plan of correction, when the licensee is directed to take a specific action by a certain date;

  (2) A mandatory staffing pattern, when the Administration defines for the licensee the level of individual supervision required at a particular site or program;

  (3) Mandatory training, when the Administration identifies deficient areas in which training is needed;

  (4) Individual relocation, when the Administration reserves the right to relocate an individual to another licensee in order to protect the health or safety of the individual;

  (5) Expansion ban, when the Administration retains the authority to prohibit the licensee from obtaining additional sites, admitting individuals, or providing additional services at the site;

  (6) Imposition of an intensive monitoring protocol by the Administration; or

  (7) Imposition of a temporary site monitor, when the Administration maintains an on-going physical presence for the purpose of providing assistance and evaluating the extent of the licensee's corrective actions.

#### Regulation .05 Summary Suspension.

*COMAR 10.22.03.05*

A. Pursuant to State Government Article, §10-226(c)(2), Annotated Code of Maryland, and if appropriate, after a pre-deprivation hearing, the Director may summarily order the suspension of a license if the Administration finds that the public health, safety, or welfare imperatively requires emergency action.

B. The Director shall notify the licensee in writing of the suspension, the findings, and the reasons that support the findings, and, when appropriate, the opportunity for a pre-deprivation hearing. The notice shall include:

  (1) The proposed order for summary suspension which includes:

    (a) The statutory and regulatory authority upon which the order is based,

    (b) The facts supporting the alleged violations of law,

    (c) The facts supporting the belief that there is an imminent danger to the health, safety, and welfare of individuals, and

    (d) The licensee's right to appeal the summary suspension, if executed by the Director; and

  (2) A show cause notice providing an opportunity for the licensee to show cause as to why the order should not be issued if the public health, safety, and welfare permits.

C. The Director may suspend a license without prior notice and the opportunity to be heard if:

  (1) The Director determines that the health, welfare, and safety of the public imperatively requires immediate suspension;

  (2) Notice of an opportunity to be heard before the action is not feasible; and

  (3) The Administration provides the licensee with a post-deprivation hearing opportunity within 15 working days of the suspension.

D. The Administration shall:

  (1) Notify the individuals being served by the licensee and, if appropriate, their families or proponents, regarding the summary suspension; and

  (2) Assist the individuals in finding alternative services if the license is summarily suspended.

#### Regulation .06 Denial, Probation, Suspension, or Revocation.

*COMAR 10.22.03.06*

A. In addition to any intermediate sanctions, the Director may deny a license or take disciplinary action against a licensee if:

  (1) An applicant fails to meet the regulations governing the services for which it is applying for a license;

  (2) A licensee fails to comply with the regulations governing its services; or

  (3) A licensee fails to cooperate with the Department during an investigation or licensing survey.

B. If the Director proposes to deny approval to an applicant or take disciplinary action against a licensee, the Director shall give written notice to the governing body, the executive director, the regional director, the Health Care Financing Administration, and, as appropriate, other interested parties.

C. In the written notice under §B of this regulation, the Director shall include:

  (1) The statutory and regulatory authority upon which the proposed action is based;

  (2) The facts supporting the alleged violations of law; and

  (3) The applicant's or licensee's right to a hearing under Regulation .07 of this chapter before final action.

#### Regulation .07 Procedures for Hearings.

*COMAR 10.22.03.07*

A. If the Secretary proposes to deny a license or take disciplinary action against a licensee, the Director shall give the licensee written notice according to Regulation .06 of this chapter.

B. Within 10 working days of receipt of the notice, the governing body or health officer may file a written request for a hearing with the Office of Administrative Hearings with copies of the request to the:

  (1) Director;

  (2) Regional director; and

  (3) Administrative prosecutor.

C. If the governing body or the health officer does not file a request for a hearing within 10 working days of receipt of the notification, the licensee waives its right to request a hearing, and the Director may implement the proposed action.

D. If a timely request for a hearing has been received, the Office of Administrative Hearings shall:

  (1) Notify the Director, the governing body or health officer, the regional director, and administrative prosecutor of the date, time, and location of the hearing; and

  (2) In accordance with COMAR 28.02.01, hold a hearing and, unless the final decision is delegated to the Office of Administrative Hearings, render a proposed decision to the Director.

E. After giving the parties the opportunity to file exceptions under the provisions of State Government Article, §10-216, Annotated Code of Maryland, the Secretary shall issue a final decision according to State Government Article, §10-221, Annotated Code of Maryland, and send notice to the:

  (1) Governing body or the health officer;

  (2) Regional director;

  (3) Medical Care Programs;

  (4) Individual and, if appropriate, their family or proponents; and

  (5) Health Care Financing Administration.

F. A licensee may appeal a final decision from a contested case by following the provisions of Health-General Article, §2-207, and State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.

G. In addition to disposing of a case by a hearing, the Director may dispose of a contested case by:

  (1) Stipulation;

  (2) Settlement;

  (3) Consent order;

  (4) Default;

  (5) Withdrawal;

  (6) Summary disposition; or

  (7) Dismissal.

H. If disciplinary action is taken against a licensee, the Director shall notify the appropriate parties which include, but are not limited to the:

  (1) Health Care Financing Administration;

  (2) Medical Care Programs;

  (3) Licensing and Certification Administration;

  (4) MDH Corporate Compliance Office; and

  (5) Maryland Disability Law Center.