As soon as practicable, but not later than 45 business days after completion of the on-site review, MIEMSS shall provide written notice to a hospital of its designation status. MIEMSS may: Designate the hospital as a trauma or specialty referral center as proposed by the applicant; Designate the hospital at a level of designation lower than the applicant proposed, if the on-site review determined that the hospital does not meet the standards for the level of designation proposed; Adjust the level of an applicant's designation based on system needs and the hospital's ability to meet those needs; or Deny designation as a trauma center at any level or as a specialty referral center. Provisional or Full Designation. MIEMSS may initially designate a trauma or specialty referral center as provisional on the conditions and for the provisional period, including any extensions, which MIEMSS deems appropriate; MIEMSS shall require each provisional trauma or specialty referral center to: Have a written work plan to rectify deficiencies; and Demonstrate progress on the work plan throughout the provisional period. At the end of the provisional period, including any extensions, MIEMSS may: Grant full designation to the trauma or specialty referral center; or Deny the trauma or specialty referral center's designation under §D of this regulation. MIEMSS may grant full designation to a hospital in full compliance with this chapter for a period not to exceed 5 years, excluding an extension during the reverification process as set forth in Regulation .10 of this chapter. Denial of Designation. MIEMSS may deny a hospital's designation as a trauma or specialty referral center if it finds that the hospital: Does not meet the requirements of this subtitle for the level of designation or specialty; Has engaged in unauthorized contact with an on-site review team member, as prohibited by Regulation .05B(7) of this chapter; Made a false statement or omitted a material fact in the hospital records, documentation, or materials required to be submitted that pertain to the designation process; Is less qualified than another applicant hospital in the same geographic service area; or Should not be designated for another relevant reason. Notice of Denial of Designation. MIEMSS shall issue a written notice of denial of designation to a hospital. The notice of denial of designation shall conform to State Government Article, §10-207, Annotated Code of Maryland. MIEMSS shall send the notice of denial of designation to the chief executive officer of the hospital. MIEMSS shall notify the EMS Board of the action taken. If MIEMSS approves a hospital's designation as a trauma or specialty referral center as proposed by the applicant, MIEMSS shall require the hospital to accept or decline the proposed designation within 30 business days from the date the hospital receives the notice. A hospital may file an appeal with the EMS Board in accordance with Regulation .08 of this chapter if MIEMSS: Approves the hospital at a level of designation lower than the applicant proposed; Designates the hospital as provisional; or Denies designation as a trauma center at any level or as a specialty center. If the EMS Board overturns MIEMSS' decision, MIEMSS shall designate the hospital as a trauma or specialty referral center as directed by the EMS Board. If the hospital does not timely appeal MIEMSS' decision, MIEMSS' decision is the final agency decision.