This chapter governs the practice of acupuncture. This chapter does not apply to: An individual employed by the federal government as an acupuncturist while practicing within the scope of that employment; A student, trainee, or visiting teacher designated as such while participating in a course of study or training under the supervision of a licensed acupuncturist in a program approved by the Board or the Maryland Higher Education Commission; or An individual practicing a health occupation who is authorized to practice under a provision of the Annotated Code of Maryland, including: A physician authorized under Health Occupations Article, Title 14, Annotated Code of Maryland, to perform acupuncture as it is defined in that title, A dentist authorized under Health Occupations Article, Title 4, Annotated Code of Maryland, to perform acupuncture in connection with the practice of dentistry, or A veterinarian licensed under the Agriculture Article, Title 2, Subtitle 3, Annotated Code of Maryland, who performs acupuncture on animals in connection with the practice of veterinary medicine. In this chapter, the following terms have the meanings indicated. Terms Defined. “ABAA” means the American Board of Animal Acupuncture. “ACAHM” means the Accreditation Commission for Acupuncture and Herbal Medicine. “Acupoint injection therapy” means a form of acupuncture that stimulates acupuncture points by subcutaneous, intramuscular, and intradermal injection with approved sterile substances, specifically manufactured for non-intravenous injection. “Acupuncture” means a form of health care based on East Asian medical theories of energetic physiology that describe the interrelationship of the body organs and functions of a human or animal. “Applicant” means an individual who has applied to the Board for a license to practice acupuncture in this State. “Auricular detoxification” means an acupuncture technique that involves needling the external auricle of the human ear to assist individuals undergoing detoxification from addictive substances and restore health. “Board” means the State Board of Acupuncture. “CCAHM” means the Council of Colleges of Acupuncture and Herbal Medicine. “License” means a license issued by the Board to practice acupuncture in this State. “NADA” means the National Acupuncture Detoxification Association. “NCCAOM” means the National Commission for the Certification of Acupuncture and Oriental Medicine. “Practice acupuncture” means the use of East Asian medical therapies for the purpose of normalizing energetic physiological functions including pain control, and for the promotion, maintenance, and restoration of health including, but not limited to: Stimulation of a human or animal body by the insertion of needles; The application of moxibustion; and Manual, mechanical, thermal, or electrical therapies only when performed in accordance with the principles of] East Asian medical theories. “Pro bono work” means work provided within the scope of practice of the licensee: Without financial reimbursement; or Without direct financial gain. “TOEFL” means the Test of English as a Foreign Language. To qualify for a license, an applicant shall: Submit a completed application in the format provided by the Board; Provide at the applicant's expense, in English, all documentation required by §§B and C of this regulation or copies of original documents with English translations; Pay the necessary fees established in COMAR 10.26.01.03; Submit a current copy of a: Government-issued photographic identification; or Passport-size photograph; and Meet with the Board to review the application if requested by the Board. To prove that the applicant is 18 years old or older, the applicant shall provide a certified copy of an official government or institutional record, if requested by the Board. The applicant shall provide documentary evidence of having met one of the following standards for education, training, or demonstrated experience: Graduation with a master’s degree from an accredited educational institution with a practice relevant course of training that is equivalent to or exceeds at least 1,800 hours in acupuncture, including 300 clinical hours, that is: Approved by the Maryland Higher Education Commission; Accredited by the ACAHM; or Found by the Board to be equivalent to a course approved or accredited by the authority listed under §C(1)(a) or (b) of this regulation; or Achievement of a: Diplomate in Acupuncture from the NCCAOM; or Passing score on an examination that is determined by the Board to be equivalent to the examination given by the NCCAOM. An applicant shall demonstrate proof of proficiency in the written and oral communication of the English language by providing documentary evidence that the applicant has: Completed at least 30 classroom credits from: An English-speaking undergraduate school; An English-speaking professional school; A community college; or An undergraduate or graduate program at a college or university; Achieved a passing score on the TOEFL within the 2 years preceding license application; or Provided proof of passing scores on the NCCAOM written and practical examination components in English. The Board shall determine whether an application is complete as received, with all required documentation enclosed. Within 90 days of its receipt of a completed application and required information or documentation, the Board shall approve or deny the application. The Board may close an incomplete application when the information needed to complete the application is not received within 120 days of the submission date. Upon approval of an application, the Board shall issue a document authorizing the applicant to practice acupuncture in this State in accordance with Health Occupations Article, §1A-304, Annotated Code of Maryland, and the regulations in this chapter. Except with approval of the Board, an applicant may not withdraw an application while under investigation or after having received a notice of denial of licensure. Unless renewed, the term of a license is valid through the expiration date. Renewal. At least 1 month before a license expires, the Board shall send to the licensee a renewal notice that states the: Date on which the current license expires; Date by which the renewal application is to be received by the Board for the renewal to be issued and mailed before the license expires; and Amount of the renewal fee. Before a license expires, the licensee may renew if the licensee: Submits to the Board a completed renewal application in the format required by the Board along with documentation that the licensee meets the requirements for a license; Pays the renewal fee specified in COMAR 10.26.01.03; and If requested, submits to the Board documentation that the licensee has complied with the continuing education requirements established under COMAR 10.26.06. A licensee shall keep the Board apprised of the licensee's current address and telephone number or shall pay a fee as specified in COMAR 10.26.01.03. A licensee has a grace period of 30 days after the licensee's license expires to renew retroactively if the licensee: Otherwise is entitled to have the license renewed; and Pays to the Board the renewal fee and late fee set by the Board. If the applicant’s license expires, an applicant may not practice acupuncture in the State until the renewal application is approved by the Board. Reinstatement. Thirty-one days after the expiration date of a license, a licensee whose license has expired without seeking inactive status may have the license reinstated upon meeting all of the following: Submission of a completed reinstatement application in the format required by the Board; Payment of the reinstatement fee, and renewal fee, specified in COMAR 10.26.01.03; and One of the following: Thirty hours of continuing education within the 2 years that are most recent to the requested reinstatement date; or Passage of the acupuncture exam given by the NCCAOM within 4 years from the date of reinstatement. Inactive Status. The Board shall place a licensee on inactive status for a maximum period of 6 years if the licensee submits to the Board within 30 days after the expiration of a license: An application for inactive status in the format required by the Board; and The inactive status application fee specified in COMAR 10.26.01.03. To reactivate a license from inactive status, the applicant shall: Satisfy the renewal requirements in §B(2)(a) and (b) of this regulation that exist at the time the individual changes from inactive to active status; and Complete 30 hours of continuing education as specified under COMAR 10.26.06. The licensee shall renew inactive status every 2 years, but not to exceed 6 years, in the format required by the Board and pay the fee as set forth in COMAR 10.26.01.03. Continuing Education. A licensee applying for renewal shall complete 30 hours of relevant continuing education during the 2-year period preceding the expiration of the license which include the following: At least 20 hours in formally organized programs which are relevant to the practice of acupuncture and Oriental medicine and are approved by the Board or sponsored by, but not limited to, the following organizations and their member organizations: American Academy of Medical Acupuncture; American Association of Acupuncture and Oriental Medicine (AAAOM); Council of Colleges of Acupuncture and Oriental Medicine (CCAOM); Colleges and universities accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM); National Commission for the Certification of Acupuncture and Oriental Medicine (NCCAOM); Society for Acupuncture Research; or The National Acupuncture Detoxification Association; Not more than 10 hours of formally organized training programs in Western science and medical practices, medical ethics, medical research, or cardiopulmonary resuscitation which are relevant to the practice of acupuncture and are sponsored by, but not limited to, organizations listed in §F(1)(a) of this regulation and the following organizations: World Health Organization (WHO); National Institutes of Health (NIH); American Medical Association (AMA); American Nurses Association (ANA); American Psychiatric Association (APA); Red Cross; Local colleges; or Local hospitals; Not more than 10 hours of training in approved programs which will assist a licensee to carry out the licensee's professional responsibilities, including, but not limited to: Management courses for a school administrator; Foreign language training for translators of relevant texts; Educational methodology for teachers of acupuncture; Not more than 10 hours teaching acupuncture and related Oriental medical therapies in an accredited school or in a program approved for acupuncture continuing education; Not more than 7 hours of pro bono work as outlined in §F(3) of this regulation; or Not more than 7 hours in published writing or articles in acupuncture and Oriental medicine that are: Peer-reviewed research or peer-reviewed clinically relevant articles in acupuncture and Oriental medicine; and Limited to 4 hours per article. Pro Bono Work. Pro bono work shall earn 1 credit hour for each 3 hours of pro bono activity up to a maximum of 7 credit hours per renewal cycle. Pro bono work shall be for the provision of acupuncture services provided through an organization offering humanitarian services such as, but not limited to: Domestic or international victims in an emergency situation or disaster area; Low income or underserved areas or populations; Special needs populations; or United States military personnel. Upon completion of the pro bono work, the licensee shall obtain from the facility written documentation of completion of pro bono hours including: The name of the facility; The address where the pro bono work was provided; The type of work that was done; The number of hours of actual work provided for which the licensee desires credit hours; and A statement guaranteeing that the work provided no financial benefit to licensee. Licensees shall maintain the documentation of their continuing education credits for 4 years from the date of their acupuncture renewal. If requested by the Board, a licensee shall provide proof of continuing education attendance by providing documentation of: Name of the program; Date of the program; Number of continuing education hours earned; and Name of the sponsoring organization. Change of Mailing Address, Legal Name, or Email Address. A licensee shall give the Board written notice within 30 days of a change of: Mailing address; Legal name; or Email address if the licensee has previously submitted an email address to the Board. Failure to notify the Board of any change of mailing address, legal name, or email address within 30 days of the change may result in a fee as set forth under COMAR 10.26.01.03. To obtain certification from the Board as qualified to practice acupuncture on animals, an applicant shall: Possess a current active license to practice acupuncture in Maryland; Successfully complete a Board-approved specialty training program in animal acupuncture from a school accredited by ABAA, ACAHM, or approved by the Maryland Higher Education Commission that consists of a minimum of 135 hours of theory and clinical training and includes at a minimum in each of the following: 90 hours in diagnosis of energy dynamics and treatment of animals, 15 hours in comparative functional anatomy and physiology of animals, 15 hours in animal handling, restraints, and emergencies, and 20 hours in introduction to animal diseases and zoonotics that require the immediate attention of a veterinary practitioner; Complete and submit the application provided by the Board; and Pay the fee as specified in COMAR 10.26.01.03. To practice acupuncture on animals, the licensed acupuncturist: Shall possess certification for animal acupuncture from the Board; Shall cooperate and consult with a veterinarian licensed in the State by: Beginning acupuncture treatment on an animal only if the animal has been seen by a veterinary practitioner within the previous 14 days, Adhering to the terms and conditions of treatment decided by the veterinary practitioner, including the degree of communication and collaboration between the veterinary practitioner and the individual practicing acupuncture, and Reporting to the veterinary practitioner at the end of the animal's acupuncture treatment or at monthly intervals at the discretion of the veterinary practitioner; and May not practice acupuncture on an animal for which the licensed acupuncturist has not been appropriately trained in accordance with this regulation. Certification Renewal, Reinstatement, and Reactivation. The licensee may, as a part of the 30 continuing education unit renewal requirement, complete at least 5 continuing education units directly related to the certification of veterinary or animal related acupuncture. The licensee may, as a part of the 30 continuing education unit reinstatement requirement, complete at least 5 continuing education units directly related to the certification of veterinary or animal related acupuncture. The licensee may, as a part of the 30 continuing education unit reactivation requirement, complete at least 5 continuing education units directly related to the certification of veterinary or animal related acupuncture. The Board shall maintain a registry of all: Licensed acupuncturists certified by the Board as qualified to practice acupuncture on animals; and Animal acupuncture training programs that the Board approves. On or after the effective date of this regulation, unless the person is certified by the Board as qualified to practice acupuncture on animals, an individual may not: Represent to the public that the individual is an animal acupuncturist; and Practice acupuncture on animals. Exception to Certification. This regulation does not apply to an individual who practices acupuncture on an animal under a research protocol which has been approved by an Animal Use and Care Committee as provided in 9 CFR Ch. 1, Part 2, Subpart C, §§2.30—2.38. Violation of this regulation constitutes unprofessional conduct and may result in disciplinary action as set forth in Health Occupations Article, §4-315, Annotated Code of Maryland. Qualification. To qualify as an auricular detoxification specialist, an applicant shall be a certified or licensed practitioner in the State as one of the following health care professionals who works directly with chemically dependent clients of a chemical dependency program in the counseling or treatment of those clients: A certified professional counselor—alcohol and drug; A certified associate counselor—alcohol and drug; A supervised counselor—alcohol and drug; A licensed clinical alcohol and drug counselor; A licensed nurse; A licensed psychologist who works directly with chemically dependent clients of a chemical dependency program in the counseling or treatment of those clients; or A licensed certified social worker—clinical who works directly with the chemically dependent clients of a chemical dependency program in the counseling or treatment of those clients. A practitioner that is a medical doctor shall obtain a medical acupuncture certification specific to physicians in accordance with COMAR 10.32.15. Registration. The Board shall maintain a registry of all certified auricular detoxification specialists. To apply for certification with the Board as an auricular detoxification specialist, an applicant shall: Provide documentation of successful completion of a Board and NADA approved training program that consists of a minimum 70-hour basic training of which 40 hours are clinical training which includes the following training and subject matter: At least 5 treatments during a 10-minute period with good point location and techniques; The uses and limitations of the treatment; Communal treatment effect and maintaining an appropriate atmosphere; Clean needle technique; The limited scope of practice of auricular detoxification and other ethical principles; The implications of the role of auricular acupuncture for addition in the larger addition treatment context; Preparation of written chart notes regarding status, treatment given, and patient response; Adjunctive nature of auricular acupuncture for addiction and the importance of collaboration and communication with the treatment team; The psycho-spiritual nature of recovery and the ability to respect and support the client's individual beliefs and cognitive process; Methods to modify treatment appropriately and to respond to adverse clinical situations should they occur; Sensitivity, compassion, and respect for clients; and Understanding of addictions from the perspective of basic concepts of East Asian medicine; Complete an application provided by the Board; Provide the name and address of the acupuncturist licensed by the State who shall supervise the applicant; Provide verification of active licensure in good standing in the State from the appropriate Health Occupations Board; Provide verification that an applicant works in a State-approved professional setting that specializes in the treatment of addiction; and Pay the registration fee in COMAR 10.26.01.03. Certification Renewal. A certified practitioner shall renew their certification every 2 years. As part of the renewal, the practitioner shall provide proof to the Board of: Licensure in the approved health profession; Employment working directly with chemically dependent clients of a chemical dependency program in the counseling or treatment of those clients; Employment working in a State-approved setting, working with chemically dependent patients of a chemical dependency program in the counseling or treatment of those patients; and Completion of three continuing education units relevant to the practice of auricular detoxification and the counseling or treatment of chemically dependent patients. At least 1 month before a certification expires, the Board shall send a renewal notice to an auricular detoxification specialist that states: The date the current certification expires; The date the renewal application is to be received by the Board for the renewal to be issued before the certification expires; and The amount of the renewal fee. Before a certification expires, a practitioner certified to perform auricular detoxification may renew the certification if the individual submits: A completed renewal application in the format required by the Board; and Verification from the appropriate Health Occupation Board under §A of this regulation, that confirms that the individual has a current certification or license in good standing; and The renewal fee specified in COMAR 10.26.01.03. An individual registered to perform auricular detoxification shall maintain a current address and telephone number with the Board. A practitioner listed on the registry to perform auricular detoxification: May not practice using any other name than the name on their certification; and Shall immediately inform the Board of any name change. Certification Reinstatement. An auricular detoxification specialist holding an expired certification may apply for reinstatement if the individual: Completes an application for reinstatement approved by the Board; Submits the auricular detoxification specialist registration reinstatement fee specified in COMAR 10.26.01.03; and Submits proof of completion of at least three continuing education units directly related to the certification. Supervision. The Board may approve a Maryland licensed acupuncturist for supervision of a practitioner on the registry to perform auricular detoxification if the licensee: Holds an active license in good standing to practice acupuncture in Maryland; Has completed a training program in auricular detoxification as set forth in §C of this regulation; and Submits to the Board a completed application in the format provided by the Board. Supervisor Responsibilities. A supervisor shall ensure that: Auricular detoxification specialists are sufficiently competent in the areas listed in §C(1) of this regulation; The supervised auricular detoxification specialist and the Board are notified if the supervisor cannot or is unwilling to fill the role of supervisor; and An on-site visit with the auricular detoxification specialist occurs at least once annually before renewal to: View the setting where services are being provided; and Observe at least five treatments, within an hour, performed according to the NADA group protocol. Setting. The clinical substance abuse program or professional setting where an individual performs auricular detoxification on patients with documented substance abuse concerns shall meet best practices within community healthcare standards. Complaints. The Board may investigate a complaint filed against an auricular detoxification specialist or the supervising licensed acupuncturist. The Board may withdraw the certification of the auricular detoxification specialist or take action against the license of the supervising acupuncturist if either individual violates an applicable law, regulation, or standard of practice while performing auricular detoxification. Registration. To obtain the required registration from the Board as qualified to practice acupoint injection therapy, an applicant shall: Possess an active license in good standing to practice acupuncture and East Asian medicine in the State; Successfully complete an NCCAOM, or other appropriate accreditation body endorsed specialty training program and assessment in acupoint injection therapy that consists of at least 60 hours including: A minimum of 40 hours of theoretical training in the required topics; A minimum of 20 hours of live face-to-face clinical practical experience; and Instruction that meets the requirements of §C of this regulation; Possess a current certification by the American Heart Association or approved equivalent in basic life support; Hold a current Clean Needle Technique Certificate through CCAHM or NCCAOM; If licensed in the State for less than 2 years, possess a valid license in good standing to practice acupuncture and East Asian medicine, in any state, for at least 2 years before applying to perform acupoint injection therapy in the State; and Complete and submit an application in the format provided by the Board. The Board shall accept the documentation from a licensee that has completed the training required to perform acupoint injection therapy prior to the effective date of this regulation if: The licensee provides a certificate, or other valid documentation, confirming successful completion of 60 hours of acupoint injection therapy training that complies with this regulation; or The previously completed training does not meet the requirements of this regulation, but the licensee provides documentation of completion of supplemental training that, together with the initial training, fulfills the coursework requirements of §C of this regulation. Training Program Curriculum. The curriculum for the acupoint injection therapy program shall include: 20 hours of clinical practice on a patient or patients; History and development of acupuncture injection therapy; Differential diagnosis; Definitions, concepts, and pathophysiology; The nature, function, channels entered, and contraindications of the substances stated in §F(2) of this regulation; Diseases amenable to treatment with acupuncture injection therapy and the substances appropriate to treat them; Identification of appropriate points for treatment, including palpatory diagnosis; A review of physical examination, anatomy, and referral zones; Universal precautions including management of blood borne pathogens and hazardous waste; Procedures for injections, including preparing the substances, contraindications, and precautions; Administration techniques and equipment required; Administration of the prepackaged substances authorized for acupoint injection therapy, including aseptic technique, recordkeeping and storage of substances prepared and authorized for use in acupoint injection therapy; Safety and emergency procedures; and 2 hours of training in the use of intramuscular epinephrine and emergency oxygen which count toward the required theoretical and clinical training hours. Clinical Instructors. In addition to the requirements of NCCAOM, or other appropriate accreditation body, an instructor for acupoint injection therapy shall: Ensure that the curriculum meets the training requirements set forth under §C of this regulation; Be a licensed practitioner in acupuncture in good standing in the State and be registered to practice acupoint injection therapy in the State; Possess at least 5 years of experience in the practice of acupuncture that includes acupoint injection therapy; Retain proof of compliance as set forth under this section for as long as they provide acupoint injection therapy training; and Provide proof of compliance to the Board upon request. Training Programs. All training programs shall provide each successful student with: A certificate of successful completion of the program; A course syllabus outlining the schedule and curriculum of the program; and Testing requirements and the performance measure for successful completion. Practice. To practice acupoint injection therapy, the licensed acupuncturist shall: Possess a registration for acupoint injection therapy from the Board; Explain acupoint injection therapy to the patient in advance of treatment; Obtain written informed consent specific to acupoint injection therapy that shall be included in the patient’s medical record; Only perform subcutaneous, intradermal, or intramuscular injection in accordance with the principles of acupuncture; Have an adverse event or emergency plan in place for allergic reactions to injected substances; Maintain professional liability coverage for this procedure; and Only use prepackaged and sterile acupoint injectable therapeutic substances that are: Acquired from an appropriately licensed entity in compliance with federal and State law; and Stored securely and in accordance with manufacturer's specifications. In the practice of acupoint injection therapy, the licensed acupuncturist, provided they have been trained on utilization of the specific therapeutic substance, may only use the following therapeutic substances for acupoint injection therapy: Sterile and bacteriostatic water; Saline solution; Alkalizing agents such as sodium bicarbonate; Nutritional or dietary substances; Vitamins and minerals including B-12, B-complex, C, cyanocobalamin, hydroxocobalamin, and methylcobalamin; Proteins, enzymes, and amino acids including methionine, choline, inositol, and glutathione; Sugars including dextrose and glucose; Ozone; Procaine and lidocaine; Herbal and botanical extracts including astragalus and Sarapin; Biological products including hyaluronic acid and epinephrine; and Homeopathic substances including Traumeel and Zeel. A licensed acupuncturist in the practice of acupoint injection therapy may not: Administer substances other than those specified under §F(2) of this regulation; Administer substances that the licensed acupuncturist has not been appropriately trained in accordance with this regulation; Give an injectable substance to a patient for self-injection; or Administer intravenous injections. The Board shall maintain a list of all: Licensed acupuncturists registered by the Board as qualified to practice acupoint injection therapy; and Acupoint injection therapy training programs endorsed by the NCCAOM, or other appropriate accreditation body updated at least annually. On or after the effective date of this regulation, unless the person is registered by the Board as qualified to practice acupoint injection therapy, an individual may not: Practice acupoint injection therapy; or Represent to the public that the individual is an acupoint injection therapy registered acupuncturist. Violation of this regulation constitutes unprofessional conduct and may result in disciplinary action as set forth in Health Occupations Article, §4-315, Annotated Code of Maryland. A licensee shall be licensed to practice acupuncture only under the name indicated on the license. A licensee wishing to change the name under which the licensee practices shall obtain prior Board approval. The failure of a licensee to practice under the name on the license may: Result in a fine; or Be considered unprofessional conduct by the Board and constitute grounds for disciplinary action. Agriculture Article, §§2-301(g) and 2-304; Health Occupations Article, §§1-211, 1A-101, 1A-205, 1A-301, 1A-302, 1A-306, 1A-307, and 1A-316; Annotated Code of Maryland Effective date: Regulations .01—.05 adopted as an emergency provision effective February 22, 1996 (23:6 Md. R. 472); adopted permanently effective August 12, 1996 (23:16 Md. R. 1175) Regulation .02 amended effective October 1, 2001 (28:19 Md. R. 1685) Regulation .02B amended effective December 11, 2003 (30:24 Md. R. 1741); January 1, 2007 (33:26 Md. R. 1997) Regulation .03D amended effective March 9, 1998 (25:5 Md. R. 369); December 11, 2003 (30:24 Md. R. 1741) Regulation .03D, E amended effective October 1, 2001 (28:19 Md. R. 1685) Regulation .03E amended effective January 1, 2007 (33:26 Md. R. 1997) Regulation .03G adopted effective February 16, 2004 (31:3 Md. R. 207) Regulation .05 amended effective October 1, 2001 (28:19 Md. R. 1685); December 11, 2003 (30:24 Md. R. 1741) Regulation .05E amended effective April 11, 2005 (32:7 Md. R. 681) Regulation .05F amended effective January 1, 2007 (33:26 Md. R. 1997) Regulation .06 adopted as an emergency provision effective December 5, 1997 (24:26 Md. R. 1752); adopted permanently effective May 4, 1998 (25:9 Md. R. 680) Regulation .06A amended effective January 1, 2007 (33:26 Md. R. 1997) Regulation .06B amended effective February 22, 1999 (26:4 Md. R. 273) Regulation .07 adopted effective June 15, 1998 (25:12 Md. R. 947) Regulation .07A amended effective January 1, 2007 (33:26 Md. R. 1997) Regulation .08 adopted effective June 15, 1998 (25:12 Md. R. 947) Regulation .08A, D amended effective January 1, 2007 (33:26 Md. R. 1997) Regulation .09 adopted as an emergency provision effective December 7, 2001 (28:26 Md. R. 2270); emergency status expired June 4, 2002 Regulation .09 adopted as an emergency provision effective June 1, 2002 (29:12 Md. R. 924); adopted permanently effective August 5, 2002 (29:15 Md. R. 1142) Regulation .09 amended as an emergency provision effective January 19, 2005 (32:3 Md. R. 287); amended permanently effective April 11, 2005 (32:7 Md. R. 681) Regulation .09 amended effective November 7, 2005 (32:22 Md. R. 1756) Chapter revised effective April 20, 2009 (36:8 Md. R. 596) Regulation .02B amended effective December 28, 2009 (36:26 Md. R. 1995); October 16, 2023 (50:20 Md. R. 887); April 13, 2026 (53:7 Md. R 328) Regulation .03 amended effective April 13, 2026 (53:7 Md. R 328) Regulation .03D amended effective January 29, 2018 (45:2 Md. R. 69); October 16, 2023 (50:20 Md. R. 887) Regulation .03E amended effective October 16, 2023 (50:20 Md. R. 887) Regulation .03F repealed effective October 16, 2023 (50:20 Md. R. 887) Regulation .03G repealed effective January 29, 2018 (45:2 Md. R. 69) Regulation .04 amended effective April 13, 2026 (53:7 Md. R 328) Regulation .04E repealed effective October 16, 2023 (50:20 Md. R. 887) Regulation .05 amended effective February 20, 2012 (39:3 Md. R. 259); August 5, 2013 (40:15 Md. R. 1229); April 13, 2026 (53:7 Md. R 328) Regulation .05D amended effective May 12, 2014 (41:9 Md. R. 521) Regulation .05F amended effective December 28, 2009 (36:26 Md. R. 1995) Regulation .05F repealed effective October 16, 2023 (50:20 Md. R. 887) Regulation .06 amended effective April 13, 2026 (53:7 Md. R 328) Regulation .07 amended effective October 18, 2010 (37:21 Md. R. 1436); October 17, 2011 (38:21 Md. R. 1279); January 7, 2013 (39:26 Md. R. 1665); April 13, 2026 (53:7 Md. R 328) Regulation .08 adopted effective April 13, 2026 (53:7 Md. R 328) Regulation .09 effective April 13, 2026 (53:7 Md. R 328)