Title 10 — Subtitle 33. Board of Long-Term Care Administrators

Designated by an assisted living program to oversee the overall day-to-day operations of an assisted living program; and

Responsible for the duties set forth under COMAR 10.07.14.15.

“Assisted living program” means a residential or facility-based program for two or more residents that provides long-term housing and supportive services, supervision, personalized assistance, health-related services, or a combination of those that meets the needs of the individuals who are unable to perform or who need assistance in performing the activities of daily living or instrumental activities of daily living in a way that promotes optimum dignity and independence for the individuals.

“Assisted living program” does not include:

A spouse;

A child;

A sibling;

A parent;

A grandparent;

A niece or nephew; or

An uncle or aunt.

A spouse;

A parent;

A child;

A sibling;

A grandparent;

A grandchild;

A stepparent;

A stepchild;

An uncle or aunt;

A first cousin;

A nephew or niece;

A father-in-law or mother-in law;

A son-in-law or daughter-in-law; or

A brother-in-law or sister-in-law.

A nursing home administrator under Health Occupations Article, Title 9, Subtitle 3, Annotated Code of Maryland; or

An assisted living manager under Health Occupations Article, Title 9, Subtitle 3A, Annotated Code of Maryland.

A nursing home administrator; or

An assisted living manager.

A comprehensive care facility or extended care facility which offers non-acute inpatient care to residents who:

A nursing facility as defined under federal or State law.

Administers, directs, manages, supervises, or is in general administrative charge of a nursing home, whether or not the individual has an ownership interest in the facility, and whether or not the individual's functions and duties are shared with one or more individuals; or

Is in supervisory control over one or more nursing home administrators of one or more nursing homes and has authority to substitute the supervisor's judgment for that of the administrator of record in the day-to-day operation of the facility.

COMAR 10.07.02;

COMAR 10.07.09;

COMAR 10.09.10;

COMAR 10.09.24; and

COMAR 10.15.03.

Healthcare, health administration, or healthcare management, or the equivalent, with a concentration in healthcare administration or health administration or a master’s degree in business with a concentration in healthcare administration or health administration from an accredited college or university; or

A field other than as described in §C(3)(a) of this regulation and has completed within the last 5 years a minimum 100-hour course approved by the Board in healthcare administration or health administration;

Who shall attest to the good moral character of the applicant; and

Which may not be those from current employers or members of the applicant's family; and

The NAB national exams—scale score of 113 on the:

The State standards exam—75 percent correct answers.

Administration;

Business office;

Nursing;

Resident activities;

Social services;

Medical records;

Dietary services;

Maintenance;

Environmental services, including housekeeping and laundry;

Rehabilitation services; and

Quality assurance.

The 11 basic service areas set forth in §A(2) of this regulation;

The AIT's past experience and allocation of clinical experiences in the nursing home; and

Approval by the Board.

Application by the proposed new preceptor;

Evidence satisfactory to the Board that the proposed preceptor is certified by the Board; and

A new signed AIT contract by the AIT and preceptor.

The applicant is at least 21 years old;

The applicant is of good moral character;

The applicant's training will be supervised by a Board-certified preceptor; and

The AIT program meets the other requirements set forth in this regulation.

A nursing home licensed in the State, as defined in COMAR 10.33.01.02B; and

Not more than two licensed nursing homes in the State approved by the Board for training. If two nursing homes are utilized for training, one shall have at least 60 beds.

Six months for a hospital assistant administrator;

Eight months for a hospital administrator;

Six months for a nursing home assistant administrator;

Six months for a department head;

Three months for an Executive Director of a continuing care retirement community;

Three months for an assisted living manager;

Three months for a healthcare-related senior management official; or

Three months for a non-healthcare-related senior management official.

A minimum of 18 months as a full-time employee, with line responsibility for hiring, firing, budget, and supervision of at least one department comprised of ten or more employees; and

Reporting directly to the nursing home administrator or chief executive officer.

Minimum of 18 months as a full-time senior management official of a single nursing home or entity; and

Administrative responsibility for the total operation of the nursing home or entity and its multiple departments, as applicable.

An individual who has worked as a licensed nursing home administrator in another state;

A resident or intern in a program offered by an accredited college or university for the purpose of satisfying the requirements for a baccalaureate or master's degree in healthcare administration; or

An individual who has successfully completed an AIT program in another state, if the program is substantially comparable to the AIT program in the State, as determined by the Board.

Be submitted by the AIT and the preceptor to the Board's office on the dates specified by the Board; and

Include the following:

Works on the same property as the nursing home where the AIT program will be conducted;

Is able to demonstrate to the Board the proposed preceptor’s active, direct, and material management and daily operations of the nursing home; and

Has been actively licensed as a nursing home administrator for a minimum of 5 years immediately before application to precept.

Completes an application form for reactivation of the license before expiration of the 2-year term of inactive status on the form required by the Board;

Complies with the renewal requirements in effect at the time the licensee seeks to reactivate the license;

Meets the continuing education requirements set by the Board;

Has not practiced as a nursing home administrator in the State while on inactive status;

Pays all appropriate fees set by the Board under COMAR 10.33.05.02D;

Has been on inactive status for less than 5 years; and

Is otherwise entitled to be licensed.

Submit a new online application;

Pay all appropriate fees set by the Board under COMAR 10.33.05.02D;

Complete a 100-hour Board–approved course in healthcare administration or health administration;

Pass the State standards exam for nursing home administrators; and

Submit satisfactory evidence of having completed a State and national criminal history records check in accordance with Health Occupations Article, §9–302.1, Annotated Code of Maryland.

The completed Board online application;

The application fee as set forth in COMAR 10.33.05.02D; and

A passport type and size photograph of self, which shall have been taken within 3 months prior to the date of application;

Has obtained a high school diploma, a high school equivalency diploma, or other appropriate education as specified under COMAR 10.07.14.15; or

For level 3 licensed programs, set forth under COMAR 10.07.14.05, has completed at least one of the following:

Completed an 80-hour assisted living manager training course and passed the course examination as required under Health–General Article, §19–1807(a), Annotated Code of Maryland, and Health Occupations Article, §9-3A-02(a)(5)(i), Annotated Code of Maryland.

Submitted to a State and national criminal history records check in accordance with Health Occupations Article, §9-302.1, Annotated Code of Maryland. The Board’s receipt of the State and national criminal history records check from the Central Repository, as provided in Health Occupations Article, §9-302.1(c), Annotated Code of Maryland, satisfies Health Occupations Article, §9-3A-03(3), Annotated Code of Maryland;

Is certified in:

Completed training in:

Has obtained a high school diploma, a high school equivalency diploma, or other appropriate education as specified under COMAR 10.07.14.15; or

For level 3 licensed programs, set forth under COMAR 10.07.14.05, has completed at least one of the following:

Completed an 80-hour assisted living manager training course and passed the course examination as required under Health–General Article, §19–1807(a), Annotated Code of Maryland, and Health Occupations Article, §9-3A-02(a)(5)(i), Annotated Code of Maryland;

The completed Board online application;

The application fee as set forth in COMAR 10.33.05.02D; and

A passport type and size photograph of self, which shall have been taken within 3 months prior to the date of application;

Submitted to a State and national criminal history records check in accordance with Health Occupations Article, §9-302.1, Annotated Code of Maryland; and

Is certified in:

Completed training in:

Completes an application form for reactivation of the license before expiration of the 2–year term of inactive status on the form required by the Board;

Complies with the renewal requirements in effect at the time the licensee seeks to reactivate the license;

Meets the continuing education requirements set by the Board under COMAR 10.33.04.02;

Has not practiced as an assisted living manager in the State while on inactive status;

Pays all appropriate fees set by the Board under COMAR 10.33.05.02D; and

Is otherwise entitled to be licensed.

Submit a new online application;

Pay all appropriate fees set by the Board;

Complete a Department-approved assisted living manager training course; and

Submit to a State and national criminal history records check in accordance with Health Occupations Article, §9–3A-05, Annotated Code of Maryland.

A disciplinary action against a licensee that may result in sanctions against a licensee;

Intent to deny an initial application for licensure;

An action against an individual practicing nursing home administration or assisted living management without a license; or

Other action authorized by law or regulation against an individual, licensee, or applicant that entitles the respondent to a contested case hearing.

“Complaint” means an allegation or report received by the Board that indicates:

“Complaint” may include, but is not limited to, the following:

Is under investigation by the Board; or

Has been charged by the Board.

A licensee has failed to meet any standard governing the practice of the licensee’s profession;

A licensee or an applicant has violated disciplinary grounds of the Board; or

An unlicensed individual:

The respondent; or

An attorney who is:

Shall send an acknowledgement to the complainant;

Shall present the complaint to the disciplinary committee of the Board; and

May forward the complaint to another regulatory agency that has jurisdiction over the matter.

Review a complaint over which the Board has jurisdiction; and

Make a recommendation to the Board on whether to open a formal investigation of a complaint. The disciplinary committee may recommend to the Board closure of the case based on a preliminary investigation of the complaint.

Signed by:

Served by:

Charge the licensee with a violation or violations of Health Occupations Article, §§9-314 or 9-3A-12, Annotated Code of Maryland, or a violation or violations of Regulation .06 of this chapter;

Summarily suspend a license or issue a Notice of Intent to Summarily Suspend;

Issue an intent to deny an application for licensure;

Issue a cease and desist order; or

Take any action against a respondent authorized by the subtitle or law that entitles the respondent to a contested case hearing.

Any proceedings scheduled before the Board and the consequences of failing to appear for those proceedings; and

An opportunity to request a hearing within a certain period of time and the consequences of failing to request a hearing; and

Accept the proposed resolution; or

Modify a proposed settlement.

At least 15 days before the prehearing conference, if scheduled, or 45 days before the scheduled hearing date, whichever is earlier, each party shall provide to the other party:

Upon motion, if the Board Chair or the Board Chair’s designee, who shall be a Board member, or the Office of Administrative Hearings, as appropriate, finds that the expert report is not sufficiently specific, or otherwise fails to comply with the requirements of this section, or the proposed expert is unqualified, the testimony of the expert and any report of the expert shall be excluded from the hearing.

If an expert adopts a sufficiently specific charging document as the expert report, that adoption shall satisfy the requirements set forth in this section.

Be in writing and filed with the Board and shall include the pertinent facts and legal authorities relied upon;

Be decided by the Chair of the Board or the Chair’s designee, who shall be a Board member;

Be served upon the opposing party’s legal counsel, if the opposing party is represented, and upon the opposing party, if not represented by legal counsel; and

Contain a certificate of service.

A Board member shall attend; and

Both parties shall disclose any:

If a prehearing conference is scheduled, witnesses or documents may not be added to the list after the prehearing conference; or

If no prehearing conference is scheduled, witnesses or documents may not be added to the list later than 15 days before the hearing.

Have complete charge of the hearing proceedings;

Rule on any matter to facilitate the hearing;

Permit the examination of witnesses;

Rule on the admissibility of evidence;

Admit evidence; and

Adjourn or recess the hearing from time to time.

The Board may request the Office of the Attorney General, Health Occupations and Prosecution Unit to participate as the administrative prosecutor in any hearing to present the case on behalf of the State.

The administrative prosecutor that presents the case on behalf of the State shall have the same rights with regard to the submission of evidence, examination, cross-examination of witnesses, presentation of summation and argument, and filing of objections, exceptions, and motions as does the respondent and respondent’s counsel for any party.

The rules of evidence in all hearings under these regulations shall be as set forth in State Government Article, §10-213, Annotated Code of Maryland.

Every party has the right to call witnesses and present evidence, cross-examine every witness called on behalf of the Board or other party, and present summation and argument and file objections, exceptions, and motions.

When a party is represented by counsel, all submission of evidence, examination and cross-examination of witnesses, and filing of objections, exceptions, and motions shall be done and presented solely by counsel.

The presiding officer, or any person designated by the presiding officer for that purpose, may examine any witness called to testify. Any member of the Board may examine any witness called to testify.

The licensed nursing home administrator or licensed assisted living manager of the Board action administered or managed the facility that is the subject of the Department’s action; and

The issues and facts in the cases are sufficiently similar.

Proposed findings of fact;

Proposed conclusions of law; and

A proposed sanction.

Finding of fact;

Conclusion of law or other matter excepted to; and

Relevant portions of the record supporting the party’s exception.

A response to an exception; and

The relevant portions of the record supporting that response.

An exceptions hearing shall be held before the Board.

The hearing shall be a non-evidentiary hearing to provide the parties with an opportunity for oral argument on the exceptions and answers to exceptions.

The Board member presiding at the hearing shall determine all procedural issues and may impose reasonable time limits on each party’s oral argument.

The presiding Board member shall make rulings reasonably necessary to facilitate the exceptions hearing.

The respondent and the administrative prosecutor may not exceed 30 minutes to present oral argument per side, unless approved by the presiding officer.

The party who filed the exceptions shall proceed first and may reserve part of the allotted time for rebuttal.

Proposed decision of the administrative law judge; and

Record of the evidentiary hearing.

Licensing or oversight authority or agency of the State for nursing homes or assisted living programs; or

Federal entity having jurisdiction over the operation of nursing homes;

Sexual behavior with a resident or patient in the context of a professional evaluation, treatment, procedure, or service to the resident or patient, regardless of the setting in which the professional service is rendered;

Sexual behavior with a resident or patient under the pretext of diagnostic or therapeutic intent or benefit;

Solicitation of a sexual relationship, whether consensual or nonconsensual, with a resident or patient;

Sexual advances requesting sexual favors;

Therapeutically inappropriate or intentional touching of a sexual nature;

A verbal comment of a sexual nature;

Physical contact of a sexual nature with a resident or patient;

Discussion of unnecessary sexual matters with a resident or patient;

Direct or indirect observation of a resident or patient while the resident or patient is undressing or dressing;

Taking photographs or video of a resident or patient for a sexual purpose;

Sexual harassment of staff, students, or volunteers;

An unnecessary sensual act or comment;

Sexual contact with an incompetent or unconscious client, patient, or resident; or

Offering to provide services or material in exchange for sexual favors;

Absence of a prior disciplinary record;

That the licensee reported the violation to the Board;

That the licensee:

That the licensee implemented remedial measures to correct or mitigate harm arising from the violation;

That the licensee made a timely good-faith effort to make restitution or otherwise rectify the consequences of the violation;

Evidence of the licensee’s rehabilitation or potential for rehabilitation;

Absence of premeditation to commit the violation;

Absence of potential harm to or adverse impact on the public;

That the incident was isolated and is not likely to recur; or

If the licensee has worked at the nursing home or assisted living program for a limited period, and the violation was present before beginning work at the facility or program.

The licensee’s previous criminal or administrative disciplinary history;

If the violation was committed deliberately or with gross negligence or recklessness;

If the violation had the potential for, or caused, serious resident harm;

If the violation was part of a pattern of detrimental conduct;

If the licensee pursued the licensee’s financial gain over a resident’s welfare;

That the resident was especially vulnerable;

That the licensee attempted to:

That the licensee failed to cooperate with the Board’s investigation; or

That the licensee’s previous attempts at rehabilitation were unsuccessful.

The circumstances that resulted in the surrender;

The time period before the respondent may apply for reinstatement if the surrender is not permanent; and

Conditions before the respondent may apply for reinstatement.

General Provisions Article, §4-333, Annotated Code of Maryland; and

Health Occupations Article, §1-607, Annotated Code of Maryland.

A proposed order of summary suspension which is unexecuted by the Board and includes:

An order or summons to appear before the Board to show cause as to why the Board should not execute the order of summary suspension, which notifies the respondent of the consequences of failing to appear.

The Board shall serve a respondent with a notice of intent to summarily suspend a license no later than 5 days before a pre-deprivation show cause hearing is scheduled before the Board.

Service of the notice of intent to summarily suspend shall be made as provided under COMAR 10.33.07.04G and H that includes proof of delivery.

If the Board is unable to serve the notice of intent to summarily suspend a license upon the respondent as described in §B(4)(a) and (b) of this regulation, the Board may nevertheless proceed to prosecute the case.

The hearing shall be a non-evidentiary hearing to provide the parties with an opportunity for oral argument on the proposed summary suspension.

The Board member presiding at the hearing shall determine all procedural issues and may impose reasonable time limits on each party’s oral argument.

The presiding Board member shall make rulings reasonably necessary to facilitate the effective and efficient operation of the hearing.

The respondent and the administrative prosecutor may not exceed 30 minutes each to present oral argument.

The respondent shall proceed first and may reserve part of the allotted time for rebuttal.

The presiding officer:

A Board member may be recognized by the presiding member to ask questions of either party appearing before the Board.

The public health, safety, or welfare imperatively requires the immediate suspension of the license; and

Prior notice and an opportunity to be heard are not feasible.

An order of summary suspension under §D(1) of this regulation shall be served on the respondent promptly after its execution as provided by COMAR 10.33.07.04G and H that includes proof of delivery.

The respondent shall be provided an opportunity for a post-deprivation hearing before the Board within 15 days after the effective date of the summary suspension, which shall provide the respondent with an opportunity to show cause as to why the Board should lift the summary suspension and reinstate the license.

Be conducted before the Board; and

Provide the respondent with an opportunity to show cause as to why the Board should lift the summary suspension and reinstate the license.

Order a summary suspension;

Deny the summary suspension; or

Issue an order agreed to by the parties.

Affirm its order of summary suspension;

Terminate or rescind the order for summary suspension; or

Issue an order agreed to by the parties.

Proposed findings of fact;

Proposed conclusions of law; and

A proposed disposition.

Health Occupations Article, §1-607, Annotated Code of Maryland; and

General Provisions Article, §4-333, Annotated Code of Maryland.