This chapter establishes the methodology that the Department shall use to reimburse: Licensed residential alternative living units, residential group homes, day habilitation programs, and vocational programs that provide services to individuals with disabilities after June 30, 1998; Supported employment provided by licensed providers of services to individuals after June 30, 2001; Add-on component services for individuals in these programs; and Supplemental services for individuals in these programs. Services reimbursed under this chapter are funded by Medicaid funds and, in whole or in part, by State general funds. When the reimbursement for a service is based on an established rate under this chapter, the rate is based on the service needs of the individual, an allowance for indirect expenses incurred by providers, and the regional location of the services. The Administration may contract for additional services according to the State procurement laws. This reimbursement system is subject to the Administration's approved budget appropriation. This chapter does not affect any cost settlement or litigation related to funding commenced before July 1, 1998. In this chapter, the following terms have the meanings indicated. Terms Defined. “Add-on component” means one or more units of service, each one of which includes funding for direct service and other nondirect costs not covered by the sum of the provider and individual components. “Administration” means the Developmental Disabilities Administration. “Agreement” means a legal document setting forth the rights and responsibilities of the Administration and the provider under the fee payment system. “Appropriate evaluation” means the assessment of an individual by a qualified developmental disability professional using accepted professional standards to document the presence of a: Developmental disability as defined in Health-General Article, §7-101(e), Annotated Code of Maryland; or Severe, chronic disability that qualifies the individual for support services as defined in Health-General Article, §7-403(c), Annotated Code of Maryland. “Attendance day” means, for: Day habilitation and vocational services, when the individual is present in the program for at least 4 hours a day during a regularly scheduled period of operation, with 6 to 8 hours per day as the service goal, and with Administration approval of fewer than 6 hours per day provided the individual plan indicates this lower level of service is necessary; Residential programs, as of October 1, 2001, when the individual is present for at least 6 hours in the home or spends the night in the home, which is the primary residence for the individual; and Supported employment, when the individual is engaged in supported employment for at least 4 hours a day, with 6 to 8 hours per day as the service goal, and with Administration approval of fewer than 6 hours per day provided the individual plan indicates this lower level of service is necessary. “Copayment” means that portion of the provider's charge for services for which the individual is responsible. “Cost report” means a document on a form approved by the Administration that details a provider's allowable operating expenses for a single fiscal year using prescribed cost centers. “Department” means the Maryland Department of Health. “Day habilitation” means services for individuals with developmental disabilities licensed under COMAR 10.22.07 and for purposes of COMAR 10.09.26 includes prevocational services. “Direct services” means staff services provided directly to the individual. “Existing service” means a service continuously provided to an individual by the same provider beginning on or before June 30, 1998. “Existing supported employment service” means a service provided continuously to an individual by the same provider beginning before July 1, 2001. “Fee payment system” means the system for rate setting and reimbursement for services provided by licensed residential, day habilitation, vocational, and supported employment programs. “Fiscal management services (FMS)” means a person approved by the Administration and designated as an Organized Health Care Delivery System under COMAR 10.22.20 that: Assists individuals and families in managing their funds and paying for services; and Is responsible for submitting financial reports to the individual and Administration. “Funding level” means the total annual amount of money awarded by the Administration under the fee payment system or under a contract for a day habilitation, vocational, or residential program. “Individual” means a person who receives services funded by the Administration from a residential, day habilitation, vocational, or supported employment program. “Individual component” means one of the two parts of the rate that is based on an assessment of an individual's level of need as documented in the approved individual information form. “Individual indicator rating scale” means the instrument, approved by the Administration, to assess an individual's level of need. “Individual information form” means the form, approved by the Administration, used for documenting the results of an assessment using the individual indicator rating scale. “Individual plan (IP)” means the written plan of specific action that is developed and modified by an individual's team. “Individual's team” means: The individual; The individual's proponent; Representatives of the licensee; The resource coordinator; and Others the individual may choose to develop the IP. “New individuals” means those individuals starting service with a new provider. “Personal needs allowance” means the amount per month that a provider must allow an individual to retain from their monthly income for personal needs. “Professional services” means services provided by an individual authorized to perform these services under the Health Occupations Article, Annotated Code of Maryland. “Provider” means a person that is licensed and funded by the Administration to provide services to individuals under COMAR 10.22.08 or 10.22.07. “Provider component” means one of two parts of the rate that reimburses providers for indirect expenses. “Rate” means the reimbursement amount for an attendance day of service. “Regional director” means the designee of the Director of the Administration who is responsible for the administration of services in an assigned area of the State. “Residential program” means services for individuals with developmental disabilities licensed under COMAR 10.22.08. “Self-directed services” means services, as approved by the Administration: That an individual arranges; and For which the individual reimburses the provider. “Service approval” means the Administration's written approval for an individual to receive services from a provider. “Supplemental security income (SSI)” means income paid to the aged, blind, or disabled under Title XVI of the Social Security Act. “Supplemental services” means preauthorized services that directly benefit the individual and are not covered by the rate. “Support broker” means a person employed by individuals and families, who have been determined eligible by the Administration, that helps them: Decide what services and supports are best for them; and Access and manage the chosen services and supports. Supported Employment. “Supported employment” means services licensed under COMAR 10.22.07 when the individual is employed outside of the individual's home. “Supported employment” includes volunteer work when the volunteer work is for job training and preparation. Unit of service means: For day habilitation, vocational and supported employment programs awake direct support services, 1 hour; For residential programs: For awake direct support services, 1hour; A preauthorized unit of service available to the individual and identified in the approved service funding plan; or For support services other than awake direct support services, the provider cost multiplied by the number of approved hours and divided by the rate; or For professional services, 1 hour. “Utilization review” means the examination of an individual indicator rating scale to ascertain if the service needs level is appropriate and to verify that the indicated level of service is being provided. “Vocational services” means services provided by a licensed provider under COMAR 10.22.07 that are provided outside of the individual's home and for purposes of COMAR 10.09.26 are part of habilitation services. The provider shall sign an agreement with the Administration. The rights of the Administration include but are not limited to the following: Approving the individuals to be served; Performing a utilization review of individual indicator rating scales; and Auditing provider operations. Personal Needs Allowance. On January 1, 2009, the Administration set the personal needs allowance at $299 per month for an individual. The Administration may increase this amount annually not to exceed the: Social Security Administration's cost-of-living increase to Supplemental Security Income; or Medically needy income level as set forth in COMAR 10.09.24. The Administration shall notify all licensees whenever any increase to the personal needs allowance takes effect. To receive reimbursement under this chapter, a provider shall: Be licensed in accordance with Health-General Article, Title 7, Annotated Code of Maryland, and COMAR 10.22.08 or 10.22.07; and Comply with COMAR 10.09.26 and all other applicable regulations under COMAR 10.09. The provider shall submit an annual cost report not later than 6 months after the end of the State fiscal year that: Documents the provider's actual expenditures for the fiscal year being reported; Is based on the provider's audited financial statement; Includes a worksheet reconciling the cost report to the financial statement; and Contains a certification by an independent certified public accountant, who is not an employee of the licensee or any affiliated organization, for the: Individual copayments collected, and Actual attendance days. The provider shall: Maintain a record for each individual that includes but is not limited to the: Results of the individual indicator rating scale, Appropriate evaluation, with approval by the regional director responsible for the individual's service approval, and Individual plan that identifies the individual's service needs, signed and dated by the provider; and Report to the Administration regarding the individual's eligibility for Supplemental Security Income (SSI). The provider shall submit an annual wage and benefits survey in a format approved by the Administration by the later of 60 days after: The last day of the pay period for which the data is requested; or Receipt of a request from the Administration for wage survey information. The Administration may require a provider to complete other reports and furnish information relating to the provider and the cost of services in formats approved by the Administration. For reports and data required under this chapter, the Administration may, with notice, suspend payment of the provider component until the report or data is received. For the annual cost report and the annual wage and benefits survey, the Administration may, after notice and an opportunity to be heard, fiscally sanction providers as set forth in Health-General Article, §7-910(c), Annotated Code of Maryland. The individual component is for costs the provider incurs in providing direct services to the individual. The Administration shall establish an individual component for new and existing services that is based on the: Individual indicator rating scale; and Geographic region in which the service is provided. Individuals who have been receiving services from a provider and who are transferring to a different provider shall retain the individual component established by the Administration. Except as set forth in §C of this regulation, the following apply: The regional director shall establish a temporary individual component for each service the individual is to receive by taking the average of the individual components for all the individuals served by the provider in the service category; The provider shall forward the individual information form reflecting the results of the individual indicator rating scale assessment to the regional director within 35 days for approval; The Administration shall establish a permanent individual component within 6 months based on the approved individual indicator rating scale assessment; and The permanent individual component shall be retroactive to the date the individual entered service. The geographic regions are as follows: Region 1 represents Baltimore City, Baltimore County, Anne Arundel County, Harford County, Howard County, Carroll County, and Queen Anne's County; Region 2 represents Calvert County, Frederick County, Prince George's County, Montgomery County, and Charles County; Region 3 represents St. Mary's County, Garrett County, Caroline County, Dorchester County, Kent County, Somerset County, Talbot County, Wicomico County, and Worcester County; Region 4 represents Allegany County; Region 5 represents Cecil County; and Region 6 represents Washington County. For purposes of this regulation, levels 1—5 in supervision/assistance and levels 1—5 in health/medical in §G of this regulation represent levels of services needed by individuals as assessed by the individual indicator rating scale. Table of Individual Components Effective July 1, 2019. Residential Programs. Day Programs. Supported Employment Programs. Community Learning Services. Employment Discovery and Customization. Effective July 1, 2019 the provider components for all regions are as follows: The residential program provider component is $70.91; and The day habilitation, vocational, supported employment, community learning services, and employment discovery and customization program provider component is $39.26. An add-on component is for: Residential programs; Day habilitation, vocational, and supported employment programs; and Professional services. The Administration may preauthorize and approve one or more units of add-on components for additional support: Not to exceed 1 year for individuals whose need for additional support is the result of a temporary condition; or Exceeding 1 year for individuals whose need for additional support is on-going. The per-unit amounts have been calculated to cover all costs incidental to providing the service. In order to preauthorize and approve one or more units of add-on components for an individual, the Administration shall determine that the: Individual's particular circumstances warrant units of add-on components to implement the IP; and Individual requires more services than the provider can provide with the sum of the provider and individual components. Circumstances that warrant units of add-on components include a need for: Additional support for an individual whose individual component is less than level 5 and for whom approval of an add-on component would be more cost effective than an increase in the individual component; Ongoing, intensive support, such as one-to-one support, for an individual whose individual component is level 5; Ongoing support in a residential program for an individual who does not attend day services; Awake-overnight support for an individual; and Professional services not covered by Medicaid or other payers. Procedures for Requesting Authorization of Add-On Components. On forms approved by the Administration, the provider shall submit documentation that justifies the request for add-on components. For all requests for add-on components, the justification shall include: Recommendations from the individual's team and appropriate professionals; Services the provider can provide with existing resources; and Any other information required by the Administration. For requests for professional add-on components, additional justification shall include: The individual's IP and any additional documentation the administration requires indicating the service is necessary; and Documentation that: The individual is not eligible for Medical Assistance; For individuals who are Medicaid eligible, the service sought is not a service covered by the Maryland Medical Assistance Program; or If the individual is Medicaid eligible and the service is covered by the Maryland Medical Assistance Program, the Maryland Medical Assistance Program has denied coverage, and the agency is pursuing an appeal. Administration Approval of Add-on Components. In deciding whether to preauthorize an add-on component, the Administration shall: Consider the documentation submitted by the provider in §F of this regulation that identifies the needs of the individual; Consider the proposed cost for the add-on component; Consider the existing funding levels for other individuals at the service site and the availability of State funds; If appropriate, visit the individual in the setting where the service is to be provided; and Review the provider's efforts to meet the individual's needs with existing resources available at the site such as staffing levels and revenue for all services provided at the site. When determining the number of units of add-on components to authorize, the Administration shall conduct the cost analysis described in §G(1) of this regulation. The Administration may authorize the number of units of add-on components necessary to fund the amount identified by the cost analysis. Review of Add-on Components. Unless justification for a less frequent review is documented, the Administration shall review the appropriateness of the add-on component: For individuals receiving temporary additional support, quarterly for up to 1 year after which the Administration shall: Reassess the appropriateness of the individual component and increase the individual component if justified; Continue the temporary additional support for up to 1 year if the individual's prognosis indicates that the condition remains temporary; or Discontinue the temporary additional support; and For other individuals, quarterly during the first year and annually after that. The add-on component is calculated by multiplying the number of units of service per week approved by the Administration by the per unit amount and dividing by seven for residential programs and by the number of approved days of service per week for day habilitation, vocational, and supported employment programs. Reimbursement for Add-On Components. Unless the Administration preauthorizes an add-on component, the Administration may not reimburse the provider. Effective July 1, 2019, the amount per unit of service for residential programs is as follows: In Baltimore City and Allegany, Anne Arundel, Baltimore, Caroline, Carroll, Dorchester, Garrett, Harford, Howard, Kent, Queen Anne's, St. Mary's, Somerset, Talbot, Washington, Wicomico, and Worcester counties — $21.19; In Cecil County — $22.31; and In Calvert, Charles, Frederick, Montgomery, and Prince George's counties — $22.59. Effective July 1 2019, the amount per unit of service for day habilitation and community learning services is as follows: In Baltimore City and Allegany, Anne Arundel, Baltimore, Caroline, Carroll, Dorchester, Garrett, Harford, Howard, Kent, Queen Anne's, St. Mary's, Somerset, Talbot, Washington, Wicomico, and Worcester counties — $23.68; In Cecil County — $24.80; and In Calvert, Charles, Frederick, Montgomery, and Prince George's counties — $25.09. Effective July 1 2019, the amount per unit of service for supported employment and employment discovery and customization is as follows: In Baltimore City and Allegany, Anne Arundel, Baltimore, Caroline, Carroll, Dorchester, Garrett, Harford, Howard, Kent, Queen Anne's, St. Mary's, Somerset, Talbot, Washington, Wicomico, and Worcester counties — $23.68; In Cecil County — $24.80; and In Calvert, Charles, Frederick, Montgomery, and Prince George's counties — $25.09. Effective July 1 2019, the amount per unit of service per individual for professional services is as follows: In Baltimore City and Allegany, Anne Arundel, Baltimore, Caroline, Carroll, Dorchester, Garrett, Harford, Howard, Kent, Queen Anne's, St. Mary's, Somerset, Talbot, Washington, Wicomico, and Worcester counties — $34.93; In Cecil County — $36.89; and In Calvert, Charles, Frederick, Montgomery, and Prince George's counties — $37.39. The Administration may preauthorize supplemental services. Supplemental services do not include any services that are in the State Medical Assistance Plan and can be provided to an individual and reimbursed under the Medical Assistance Program, or any services covered by private insurance or federal and State funded health programs. Supplemental services include: Household furnishings and equipment, normally funded once per individual; Transportation equipment and expenses; Assistive technology; Medical equipment; Structural modifications for accessibility; and Other services as preauthorized by the Administration that directly benefit the individual. Procedures for Requesting Authorization of Supplemental Services. On forms approved by the Administration, the provider shall submit documentation that justifies the: Request for supplemental services, and includes: Recommendations from the individual's team; Documentation from appropriate individuals; and Any other information required by the Administration; and Basis of the proposed costs, such as: Bids from vendors; Advertisements or invoices from retail or wholesale outlets selling goods and services to the general public; and Rates of a proposed vendor. Administration Approval of Supplemental Services. In deciding whether to preauthorize a supplemental service, the Administration shall: Consider the documentation submitted by the provider in §D of this regulation that identifies the needs of the individual; Consider the proposed cost for the supplemental service and the availability of State funds; If appropriate, visit the individual in the setting where the service is to be provided; and Review the provider's efforts to meet the individual's needs with existing resources available at the site. The Department shall pay the provider the rate set forth under this chapter. The rate is the sum of the individual component, the provider component, and any add-on component. Reimbursement for Attendance Days of Day Habilitation, Vocational Services, and Supported Employment with Fewer than the Hours as Defined in Regulation .02 of this chapter. The Administration may: Not approve reimbursement for an attendance day if the individual receives fewer than 4 hours of service; Approve reimbursement for fewer hours than the normal attendance day if the IP: Documents that the individual is not able to engage in the program activities for the normal attendance day; and Includes a plan for enabling the individual to be engaged in a normal attendance day; and Approve reimbursement for an attendance day of supported employment when the individual receives fewer than 4 hours of supported employment services if the: IP documents that the individual is not able to engage in supported employment activities for 4 hours a day; IP includes a plan for enabling the individual to be engaged in supported employment for at least 4 hours with the goal being a normal attendance day; and Individual is engaged in at least 4 hours of activity that may include day habilitation and vocational services, with the majority of time spent in supported employment. The Administration's approval of electronic or paper attendance documentation as specified by the Administration and submitted by the provider shall constitute approval of an attendance day of fewer than 6 to 8 hours if the approved individual plan indicates this lower level of service is necessary. Conversion of Existing Supported Employment Services from a Contract to the Rate System. There is a presumption that the cost of care for existing supported employment services reimbursed by the Administration under the rate system will be the same as under the contract. The Administration shall reimburse the provider at least the same amount for cost of care for existing supported employment services as the Administration reimbursed the provider under the contract. The Administration shall convert the contract reimbursement for individuals into a base rate together, if appropriate, with add-on components. If a utilization review audit indicates that add-on components were not required for the individual, the Administration may recover unnecessary expenditures. A provider may request additional services as set forth in Regulation .08F of this chapter. The Administration shall review any add-on components for existing services every 3 years unless the Administration documents a need for more frequent review. The Department shall reimburse providers of existing supported employment services by converting those contracts to reimbursement under this chapter between June 30, 2001, and July 1, 2002. For add-on components, the Department shall reimburse providers of existing augmentation services by converting those contracts to reimbursement under this chapter between June 30, 2001, and July 1, 2003. For a single calendar day, the Administration may not reimburse a provider for two or more attendance days of any combination of: Residential services under this chapter, community supported living arrangements under COMAR 10.22.18, and personal care services under COMAR 10.09.20; or Day habilitation services under this chapter, supported employment services under this chapter, vocational services under this chapter, and medical day care services under COMAR 10.09.07. Absences and Vacancies. As of July 1, 2011, the Department shall only reimburse providers for 33 days of absences or vacancies per year per individual when the individual is unable to be in residential services due to illness, vacation, home visits, medical appointments, or other circumstances. As of July 1, 2003, the Department may claim federal financial participation for residential absence days as permitted by the Centers for Medicare and Medicaid Services under the Home and Community-Based Waiver. The Administration shall reimburse day and supported employment programs an additional $2,000 per year per individual for transportation to and from day habilitation and vocational programs or to and from supported employment for individuals who, because of their disabilities, must use wheelchairs or motorized scooters, if the payments are consistent with the requirements under COMAR 10.09.26 and 10.09.19. For residential services only, the Administration shall subtract from the payment, as appropriate, SSI contributions by individuals or other copayments. The provider shall: Assist the individual in obtaining SSI, if applicable; and Collect all applicable individual copayment obligations while assuring that the individual retains the personal needs allowance. To be reimbursed under this chapter, the provider shall submit: Attendance data for individuals served; and Other information as required by the Administration. The Administration shall pay the lower of either: Reasonable customary and actual costs not to exceed the cost to the general public; or Medicaid-approved rates. Reasonable customary and actual costs are determined and authorized by the Administration before the delivery of the service. The Department shall reimburse the providers for preauthorized supplemental services upon submission of an invoice. If the Department preauthorizes a professional service, the Administration shall reimburse the provider for professional services according to the rate schedule in Regulation .08J(4) of this chapter except that the Administration may procure services to be reimbursed at a higher rate if: The provider submits documentation that it cannot find a professional to render services at this rate; The usual and customary rate charged by the professional for the service is above the rate in Regulation .08J(4) of this chapter; and The rate that the Maryland Medical Assistance Program reimburses the professional for this service is higher than the rate established by Regulation .08J(4) of this chapter. The Administration may procure services needed by an individual as documented in the IP and preauthorized but not covered by rates or supplemental services in accordance with the State's requirements. If there is an existing contract to buy vocational and supported employment services, the contract amount less the amount to be paid for fiscal management services shall be used in determining the amount of money available for purchasing supported employment services and support brokerage services in an individual's budget. If there is no existing contract to buy vocational and supported employment services, the supported employment rates less the amount to be paid for fiscal management services shall be used in determining the amount of money available for purchasing supported employment services and support brokerage services in an individual's budget. If an individual is denied services, the individual may request a hearing in accordance with all applicable federal and State laws and regulations, including COMAR 10.09.24. The Administration shall phase in the provider component for existing services. The Administration shall determine providers' increases and decreases as described in this regulation. The individual components and the day habilitation and vocational program provider component in Regulations .06 and .07 of this chapter include increases funded by allocations in the fiscal year 1999 budget. The Administration shall calculate the phase-in of provider components before adding these increases to the rate. Until the rate reaches the rate in Regulation .07 of this chapter, the phase-in for providers with current provider components higher than that stated in Regulation .07 of this chapter shall be calculated as follows: Each provider's provider component for existing services given after June 30, 1998, shall be adjusted to reflect not more than a 3 percent decrease in the provider's July 1, 1997, funding level; Each provider's provider component for existing services given after June 30, 1999, shall be adjusted to reflect not more than a 7 percent decrease in the provider's July 1, 1997, funding level; Each provider's provider component for existing services given after June 30, 2000, shall be adjusted to reflect not more than a 12 percent decrease in the provider's July 1, 1997, funding level; and Beginning July 1, 2001, the provider component for all existing services is the provider component stated in Regulation .07 of this chapter. Until the rate reaches the rate in Regulation .07 of this chapter, the phase-in for providers with current provider components lower than that stated in Regulation .07 of this chapter shall be calculated within the allocated budget for these services as follows: Each provider's provider component for existing services given after June 30, 1998, shall be adjusted to reflect at least a 2.5 percent increase in the provider's July 1, 1997, funding level; Each provider's provider component for existing services given after June 30, 1999, shall be adjusted to reflect at least a 5 percent increase in the provider's July 1, 1997, funding level; Each provider's provider component for existing services given after June 30, 2000, shall be adjusted to reflect at least a 7.5 percent increase in the provider's July 1, 1997, funding level; and Beginning July 1, 2001, the provider component for all existing services is the provider component stated in Regulation .07 of this chapter. The provider component for new services or changes in services for any individual after April 30, 1998, is the provider component stated in Regulation .07 of this chapter. Health-General Article, §§2-104(b), 7-306.1, 7-307, 7-910(c), 15-105, 15-107, and 16-201, Annotated Code of Maryland Effective date: August 10, 1987 (14:16 Md. R. 1775) Regulations .01—.03, .06, and .08 amended as an emergency provision effective October 16, 1995 (22:22 Md. R. 1654) Regulation .01B amended effective April 8, 1996 (23:7 Md. R. 552) Regulation .02A amended effective April 8, 1996 (23:7 Md. R. 552) Regulation .02F repealed effective June 21, 1993 (20:12 Md. R. 997) Regulation .03D amended effective April 8, 1996 (23:7 Md. R. 552) Regulation .06 amended effective April 8, 1996 (23:7 Md. R. 552) Regulation .08C adopted effective April 8, 1996 (23:7 Md. R. 552) Regulation .08D adopted as an emergency provision effective July 11, 1996 (23:16 Md. R. 1167); emergency status extended at 24:2 Md. R. 113; emergency status expired June 30, 1997 Chapter repealed and new chapter adopted effective July 1, 1998 (25:13 Md. R. 993) Regulation .02B amended as an emergency provision effective July 1, 2000 (27:15 Md. R. 1397); amended permanently effective October 16, 2000 (27:20 Md. R. 1839) Regulation .03C adopted as an emergency provision effective July 1, 2000 (27:15 Md. R. 1397); amended permanently effective October 16, 2000 (27:20 Md. R. 1839) Regulation .06G amended as an emergency provision effective June 29, 1999 (26:15 Md. R. 1145); amended permanently effective October 4, 1999 (26:20 Md. R. 1545) Regulation .06G amended as an emergency provision effective July 1, 2000 (27:15 Md. R. 1397); amended permanently effective October 16, 2000 (27:20 Md. R. 1839) Regulation .07 amended as an emergency provision effective July 1, 2000 (27:15 Md. R. 1397); amended permanently effective October 16, 2000 (27:20 Md. R. 1839) Chapter revised as an emergency provision effective July 1, 2001 (28:15 Md. R. 1394); revised permanently effective December 24, 2001 (28:25 Md. R. 2190) Regulation .01A amended as an emergency provision effective July 1, 2003 (30:14 Md. R. 934); amended permanently effective September 29, 2003 (30:19 Md. R. 1332) Regulation .02B amended as an emergency provision effective July 1, 2002 (29:14 Md. R. 1073); amended permanently effective September 30, 2002 (29:19 Md. R. 1524) Regulation .02B amended effective March 13, 2006 (33:5 Md. R. 520); May 30, 2011 (38:11 Md. R. 671); April 15, 2013 (40:7 Md. R. 611) Regulation .02B amended as an emergency provision effective August 12, 2021 (48:19 Md. R. 798); emergency status expired December 31, 2021 Regulation .02B amended as an emergency provision effective January 20, 2022 (49:4 Md. R. 296); emergency status expired effective March 31, 2022 Regulation .02B amended as an emergency provision effective May 27, 2022 (49:13 Md. R. 686); emergency status expired effective June 30, 2022 Regulation .02B amended as an emergency provision effective February 2, 2023 (50:4 Md. R. 120); emergency status expired effective August 1, 2023 Regulation .03C amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 14, 2002 (29:20 Md. R. 1588) Regulation .03C amended as an emergency provision effective July 1, 2003 (30:14 Md. R. 934); amended permanently effective September 29, 2003 (30:19 Md. R. 1332) Regulation .03C amended effective December 20, 2004 (31:25 Md. R. 1790); March 13, 2006 (33:5 Md. R. 520); January 1, 2007 (33:26 Md. R. 1997); December 31, 2007 (34:26 Md. R. 2263); March 23, 2009 (36:3 Md. R. 491); May 30, 2011 (38:11 Md. R. 671) Regulation .05 amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 14, 2002 (29:20 Md. R. 1588) Regulation .05A amended as an emergency provision effective July 1, 2003 (30:14 Md. R. 934); amended permanently effective September 29, 2003 (30:19 Md. R. 1332) Regulation .06G repealed and new regulation.06G adopted as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); adopted permanently effective October 14, 2002 (29:20 Md. R. 1588) Regulation .06G amended as an emergency provision effective July 1, 2003 (30:14 Md. R. 934); amended permanently effective September 29, 2003 (30:19 Md. R. 1332) Regulation .06G amended effective December 20, 2004 (31:25 Md. R. 1790); March 13, 2006 (33:5 Md. R. 520); January 1, 2007 (33:26 Md. R. 1997); December 31, 2007 (34:26 Md. R. 2263); March 23, 2009 (36:3 Md. R. 491); May 30, 2011 (38:11 Md. R. 671); April 15, 2013 (40:7 Md. R. 611); July 7, 2014 (41:13 Md. R. 752); October 12, 2015 (42:20 Md. R. 1265); January 2, 2017 (43:26 Md. R. 1445); April 9, 2018 (45:7 Md. R. 345); May 20, 2019 (46:10 Md. R. 488); October 5, 2020 (47:20 Md. R. 875) Regulation .07 amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 14, 2002 (29:20 Md. R. 1588) Regulation .07 amended as an emergency provision effective July 1, 2003 (30:14 Md. R. 934); amended permanently effective September 29, 2003 (30:19 Md. R. 1332) Regulation .07 amended effective December 20, 2004 (31:25 Md. R. 1790); March 13, 2006 (33:5 Md. R. 520); January 1, 2007 (33:26 Md. R. 1997); December 31, 2007 (34:26 Md. R. 2263); March 23, 2009 (36:3 Md. R. 491); May 30, 2011 (38:11 Md. R. 671); April 15, 2013 (40:7 Md. R. 611); July 7, 2014 (41:13 Md. R. 752); October 12, 2015 (42:20 Md. R. 1265); January 2, 2017 (43:26 Md. R. 1445); April 9, 2018 (45:7 Md. R. 345); May 20, 2019 (46:10 Md. R. 488); October 5, 2020 (47:20 Md. R. 875) Regulation .08J amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 14, 2002 (29:20 Md. R. 1588) Regulation .08J amended as an emergency provision effective July 1, 2003 (30:14 Md. R. 934); amended permanently effective September 29, 2003 (30:19 Md. R. 1332) Regulation .08J amended effective December 20, 2004 (31:25 Md. R. 1790); March 13, 2006 (33:5 Md. R. 520); January 1, 2007 (33:26 Md. R. 1997); December 31, 2007 (34:26 Md. R. 2263); March 23, 2009 (36:3 Md. R. 491); May 30, 2011 (38:11 Md. R. 671); April 15, 2013 (40:7 Md. R. 611); July 7, 2014 (41:13 Md. R. 752); October 12, 2015 (42:20 Md. R. 1265); January 2, 2017 (43:26 Md. R. 1445); April 9, 2018 (45:7 Md. R. 345); May 20, 2019 (46:10 Md. R. 488); October 5, 2020 (47:20 Md. R. 875) Regulation .10 amended as an emergency provision effective August 12, 2021 (48:19 Md. R. 798); emergency status expired December 31, 2021 Regulation .10 amended as an emergency provision effective January 20, 2022 (49:4 Md. R. 296); emergency status expired effective March 31, 2022 Regulation .10 amended as an emergency provision effective May 27, 2022 (49:13 Md. R. 686); emergency status expired June 30, 2022 Regulation .10 amended as an emergency provision effective February 2, 2023 (50:4 Md. R. 120); emergency status expired effective August 1, 2023 Regulation .10G amended as an emergency provision effective April 8, 2004 (31:9 Md. R. 711); amended permanently effective August 2, 2004 (31:15 Md. R. 1185) Regulation .10G amended effective April 15, 2013 (40:7 Md. R. 611) Regulations .13 and .14 recodified to be Regulations .14 and .15 respectively, and new Regulation .13 adopted effective March 13, 2006 (33:5 Md. R. 520)