# COMAR Title 10 — Maryland Department of Health

## Subtitle 68 — Community Health Workers

### Chapter 02 — Community Health Worker Certification Training Programs

**Authority:** Health-General Article, §13-3705, Annotated Code of Maryland

**Administrative History:** Effective date: December 30, 2019 (46:26 Md. R. 1166)

#### Regulation .01 Definitions.

*COMAR 10.68.02.01*

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) “Accreditation” means the approval a community health worker certification training program receives when it has met all the requirements of this chapter.

  (2) “Accredited community health worker certification training program” means a community health worker certification training program that has been accredited by the Maryland Department of Health.

  (3) “Applicant” means a community health worker training program that applies to the Maryland Department of Health for accreditation.

  (4) “Community health worker (CHW)” has the meaning set forth in Health-General Article, §13-3701, Annotated Code of Maryland.

  (5) “Community health worker certification training program” means a training program that has been accredited by the Department.

  (6) “Department” means the Maryland Department of Health.

  (7) “Review Committee” means the CHW Training Program Application Review Committee.

  (8) “Secretary” means the Secretary of the Maryland Department of Health.

#### Regulation .02 Application Procedures.

*COMAR 10.68.02.02*

A. Accreditation Requirements.

  (1) All CHW certification training programs shall be accredited by the Department.

  (2) The accreditation shall be issued before an organization may offer a CHW certification training program.

B. To obtain accreditation of a CHW certification training program, an organization shall:

  (1) Obtain the CHW certification training program requirements and a program application from the Department;

  (2) Submit to the Department an application; and

  (3) Pay to the Department a fee set by the Department in regulation.

C. A CHW certification training program that was in operation on or before October 1, 2018:

  (1) Will be notified by the Department by certified mail, electronic mail, or MDH website posting of the training program requirements for accreditation set forth in this chapter;

  (2) Shall comply with the accreditation requirements; and

  (3) Shall complete an application for accreditation as set forth in this chapter by December 31, 2020.

D. A CHW certification training program that trained individuals from October 1, 2018, through December 31, 2020, will be eligible to apply for accreditation for that time period if the training program:

  (1) Meets the CHW certified training program requirements as set forth in Regulation .03 of this chapter;

  (2) Submits to the Department an application;

  (3) Pays to the Department a fee set by the Department in regulation;

  (4) Becomes an accredited training program; and

  (5) Provides a list of students who successfully completed the training program during the stated time period.

E. The Department may provide technical assistance to CHW certification training programs to meet the requirements set forth in this chapter.

F. Incomplete Applications.

  (1) An application is not complete until the Department has received all the materials required under this chapter.

  (2) If an incomplete application is submitted to the Department, the Department shall notify the applicant within 30 calendar days after receipt of the incomplete application of the materials that are required to be submitted to complete the application.

  (3) If the applicant fails to provide the required documentation within 120 calendar days of notification, the Department may:

    (a) Administratively close the application; or

    (b) Deny the application, pursuant to Regulation .04D of this chapter.

  (4) An applicant whose application is administratively closed or denied may reapply and submit with the new application documentation in compliance with the requirements of this chapter.

#### Regulation .03 Training Program Requirements.

*COMAR 10.68.02.03*

A. A CHW certification training program shall:

  (1) Provide a minimum of 100 hours of instruction;

  (2) Verify successful completion of an additional supervised 40-hour practicum by a student;

  (3) Employ a curriculum framework that incorporates, at a minimum, the following core competencies:

    (a) Advocacy and community capacity building skills;

    (b) Effective oral and written communication skills;

    (c) Cultural competency;

    (d) Understanding of ethics and confidentiality issues;

    (e) Knowledge of local resources and system navigation;

    (f) Care coordination support skills;

    (g) Teaching skills to promote healthy behavior change;

    (h) Outreach methods and strategies; and

    (i) Understanding of public health concepts and health literacy; and

  (4) Include an objective knowledge assessment.

B. To complete an accredited CHW certification training program, a student shall successfully meet all requirements of the program.

C. Each accredited CHW certification training program shall submit to the Department, as requested, information on the program.

D. Without the Department’s approval, an accredited CHW certification training program may not substantively modify an accredited curriculum in a way that results in the curriculum no longer satisfying the core competency requirements.

#### Regulation .04 Action on Application.

*COMAR 10.68.02.04*

A. Application Review. Upon receipt of a completed application, the Department shall:

  (1) Accept and review applications for accreditation of a CHW certification training program in accordance with a schedule established by the Department and made publicly available;

  (2) Acknowledge receipt of an application within 10 calendar days after receiving the application;

  (3) Act on an application within 60 calendar days after the training program has met all the application requirements; and

  (4) Make a decision regarding application accreditation within 120 calendar days.

B. Application Review Committee.

  (1) Training program applications will be reviewed by a Community Health Worker Training Program Application Review Committee consisting of:

    (a) A community health worker;

    (b) A State Community Health Worker Advisory Committee member;

    (c) A health professions educator with expertise in curriculum development;

    (d) AN MDH CHW certification program staff member; and

    (e) As deemed necessary by the Department, an MDH program staff member with subject matter expertise in specialty areas.

  (2) Individuals will be selected for the Training Program Application Review Committee by the Secretary after review of an application.

  (3) The Review Committee shall review training program applications to determine whether a training program application meets the requirements set forth in this chapter.

  (4) The Review Committee shall forward recommendations for accreditation of eligible training programs to the Secretary.

  (5) The Secretary may approve and direct the Department to accredit a training program if the training program:

    (a) Satisfies the requirements set forth in this chapter;

    (b) Pays to the Department a fee set by the Department in regulation; and

    (c) Participates in an on-site visit, if deemed necessary by the Department.

C. Approval of Accreditation Application. If the Department accredits a training program, the Department shall send the applicant written notice that the program is accredited.

D. Denial of Accreditation Application.

  (1) The Department may deny accreditation if it determines that the training program has:

    (a) Not complied fully with the applicable requirements described in this chapter;

    (b) Failed to remit a fee; or

    (c) Failed to complete the application form.

  (2) If the Department denies accreditation, the Department shall:

    (a) Send the applicant written notice of the Department’s denial of accreditation, including specific deficiencies; and

    (b) Notify the applicant of the right to appeal the denial and to request a formal hearing.

  (3) Within 30 calendar days after receipt of the denial, the training program may submit to the Department either:

    (a) A written plan that sets forth the steps taken by the program to meet the applicable requirements described in this chapter; or

    (b) A written response setting forth documentation that the program is meeting and maintaining each of the applicable requirements described in this chapter.

  (4) Based on the deficiencies and the program’s written response, if any, the Department may approve or deny the application.

  (5) Appealing a Decision to Deny an Application for Accreditation. A CHW certification training program may appeal the decision to deny an application by submitting the request in writing to the Department within 30 calendar days of the date on the notice of denial of application.

  (6) If a CHW certification training program submits an appeal, the Department, within 60 calendar days, shall:

    (a) Grant or deny the appeal; and

    (b) Provide written notice to the applicant:

      (i) Indicating whether the appeal has been granted or denied; and

      (ii) Providing an explanation of the decision.

  (7) The Department may not refund a fee if an accreditation is denied.

  (8) An applicant may request a hearing within 10 calendar days after receipt of written notice of the Department’s denial. After receiving the request, the Department shall follow hearing procedures in accordance with COMAR 10.01.03.

#### Regulation .05 Expiration and Renewal.

*COMAR 10.68.02.05*

A. Unless the Department suspends or revokes a CHW certification training program accreditation, the accreditation is effective for 3 years from the date issued.

B. At least 90 calendar days before the accreditation expires, the Department shall send to the accredited CHW certification training program by electronic or first-class mail to the last known electronic or physical address a renewal notice that states:

  (1) The date on which the current accreditation expires;

  (2) Any required renewal submission requirements;

  (3) The date by which the renewal application shall be received by the Department for the renewal to be issued; and

  (4) The amount of a renewal fee.

C. The accredited CHW certification training program shall notify the Department if a renewal notice is not received within 60 calendar days of the renewal date.

D. The Department shall renew the accredited CHW certification training program that:

  (1) Is eligible to obtain accreditation;

  (2) Pays to the Department a renewal fee set by the Department in regulation; and

  (3) Submits to the Department a renewal application on a form that the Department requires.

E. Renewal applications received less than 30 calendar days before the expiration date may not be processed before the expiration date.

#### Regulation .06 Reinstatement of Accreditation Due to Nonrenewal.

*COMAR 10.68.02.06*

A. The Department shall reinstate the accreditation of a CHW certification training program that has failed to renew their accreditation, if the program:

  (1) Has not had the accreditation suspended or revoked;

  (2) Applies to the Department for reinstatement of the accreditation before 2 years after the accreditation expires;

  (3) Pays to the Department a renewal fee set by the Department in regulation; and

  (4) Meets the requirements for accreditation set forth by the Department.

B. If a CHW certification training program is not eligible for reinstatement of accreditation under this chapter, the program may be eligible for accreditation by meeting the current requirements for obtaining a new accreditation under this chapter.

#### Regulation .07 Suspension or Revocation of Accreditation of a Training Program.

*COMAR 10.68.02.07*

A. The Department may suspend or revoke the accreditation from any program which:

  (1) No longer meets the requirements established under this chapter;

  (2) Fails to submit in a timely manner:

    (a) Any information requested by the Department; or

    (b) Notification of curriculum modification;

  (3) Falsifies training program information; or

  (4) Fails to comply with applicable laws or regulations.

B. The Department shall proceed with the suspension or revocation in accordance with the provisions in COMAR 10.01.03.

C. The Department shall send written notice of the suspension or revocation of accreditation to the training program and identify the specific deficiencies.

D. Within 30 calendar days after receipt of written notice, the CHW certification training program may submit to the Department:

  (1) A written plan by the CHW certification training program to meet the applicable deficiencies; or

  (2) A written response setting forth documentation that the program is meeting and maintaining each of the applicable requirements described in this chapter.

E. Based on deficiencies and the program’s response, if any, the Department may suspend, revoke or reinstate accreditation.

F. Appealing a Decision to Suspend or Revoke Accreditation.

  (1) A CHW certification training program may appeal the decision to suspend or revoke the accreditation by submitting a request in writing to the Department within 30 calendar days of the date on the notice of suspension or revocation of accreditation.

  (2) If a CHW certification training program submits an appeal, the Department shall within 60 calendar days:

    (a) Grant or deny the appeal; and

    (b) Respond in writing to the applicant:

      (i) Indicating whether the appeal has been granted or denied; and

      (ii) Providing an explanation of the decision.

  (3) The Department may not refund a fee if an accreditation is suspended or revoked.

G. An applicant may request a hearing within 10 calendar days after receipt of written notice.

H. After receiving the request, the Department shall follow hearing procedures in accordance with COMAR 10.01.03.