# COMAR Title 32 — Maryland Department of Aging

## Subtitle 03 — Grants and Subsidies

### Chapter 04 — Congregate Housing Services Program

**Authority:** Human Services Article, §§10-209 and 10-210, Annotated Code of Maryland

**Administrative History:** Effective date: July 1, 2005 (32:10 Md. R. 926)

**Administrative History:** Regulation .01B amended effective June 4, 2018 (45:11 Md. R. 580)

**Administrative History:** Regulation .07 amended effective June 4, 2018 (45:11 Md. R. 580)

**Administrative History:** Regulation .14B amended effective June 4, 2018 (45:11 Md. R. 580)

**Administrative History:** Regulation .16C amended effective June 4, 2018 (45:11 Md. R. 580)

**Administrative History:** Regulation .17 amended effective June 4, 2018 (45:11 Md. R. 580)

**Administrative History:** Regulation .18 amended effective June 4, 2018 (45:11 Md. R. 580)

**Administrative History:** Regulation .19 amended effective June 4, 2018 (45:11 Md. R. 580)

**Administrative History:** Regulation .22 amended effective June 4, 2018 (45:11 Md. R. 580)

**Administrative History:** Regulation .23A—C amended effective June 4, 2018 (45:11 Md. R. 580)

**Administrative History:** Regulation .26A amended effective June 4, 2018 (45:11 Md. R. 580)

**Administrative History:** Regulation .28 amended effective June 4, 2018 (45:11 Md. R. 580)

**Administrative History:** Regulation .32A amended effective June 4, 2018 (45:11 Md. R. 580)

#### Regulation .01 Definitions.

*COMAR 32.03.04.01*

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

B. Terms Defined.

  (1) Allowable Medical Expenses.

    (a) “Allowable medical expenses” means the total recurring, nonreimbursable medical expenses an individual or a couple reasonably expects to pay out-of-pocket during the 12 months following the date on which a calculation is made to determine a subsidy amount.

    (b) “Allowable medical expenses” does not include expenses:

      (i) Paid by a source other than the participant, such as insurance, Medicare, grants, or charitable organizations; or

      (ii) For medical day care or attendant care, unless prescribed by a physician.

    (c) “Allowable medical expenses” may include recurring, nonreimbursable expenses for:

      (i) Services of physicians and other health care professionals;

      (ii) Hospital expenses;

      (iii) Medical insurance premiums;

      (iv) Prescription and nonprescription medicines;

      (v) Dental expenses;

      (vi) Eyeglasses; and

      (vii) Payments on accumulated medical bills.

  (2) Assets.

    (a) “Assets” means all real and personal property, including:

      (i) Checking and savings account balances;

      (ii) Any automobiles in excess of one per family;

      (iii) Certificates of deposit;

      (iv) Stocks;

      (v) Bonds; and

      (vi) Revocable trusts.

    (b) “Assets” does not include:

      (i) Customary household goods;

      (ii) Personal effects;

      (iii) One automobile per family;

      (iv) Irrevocable funeral trusts;

      (v) Personal burial space; or

      (vi) Life insurance with a cash surrender value of not more than $5,000.

  (3) “Certificate” means a certificate issued by the Maryland Department of Aging authorizing a named provider to operate a congregate housing services program at a specified location.

  (4) “Congregate housing services” means congregate meals, housekeeping, laundry, personal assistance services, and service management provided in an apartment building, which services are to promote independent living for:

    (a) An individual 62 years old or older who has temporary or periodic difficulty with one more essential activities of daily living such as feeding, bathing, grooming, dressing, or transferring; and

    (b) The spouse of an individual described in §B(4)(a) of this regulation who is 55 years old or older and who has temporary or periodic difficulty with one or more essential activities of daily living such as feeding, bathing, grooming, dressing, or transferring.

  (5) “Congregate Housing Services Program” means the Program operated by the Department under the authority of Human Services Article, §10-209, Annotated Code of Maryland, which, among other activities, certifies providers willing to provide congregate housing services to participants and subsidizes congregate housing services for low income seniors under:

    (a) The Standard Congregate Housing Services Plan; and

    (b) The Individualized Congregate Housing Services Plan.

  (6) “Contact person” means an individual designated by a participant to receive information about the participant's needs or health.

  (7) “Department” means the Maryland Department of Aging.

  (8) “Elderly” means an individual who is 62 years old or older.

  (9) “Emergency” means conditions that:

    (a) Present a substantial risk of death or serious physical harm; and

    (b) Require immediate action.

  (10) “Essential activities of daily living” means the normal daily activities associated with independent living including feeding, bathing, grooming, dressing, and transferring.

  (11) “Facility” means a specific senior housing building in which:

    (a) A provider furnishes congregate housing services; or

    (b) An applicant for a certificate intends to furnish congregate housing services.

  (12) “Fee for service” means a single congregate housing service offered by a provider, the cost of which has been approved but not subsidized by the Department.

  (13) “Feeding” means providing meals.

  (14) “Fiscal year” means the 12-month period that constitutes the State fiscal year, beginning July 1 and ending on June 30.

  (15) “Income” means the gross amount of all earned and unearned income from all sources, including:

    (a) Employment;

    (b) Annuities;

    (c) Social Security benefits;

    (d) Workers' Compensation;

    (e) Pensions;

    (f) Disability payments;

    (g) Alimony;

    (h) Interest;

    (i) Dividends; and

    (j) Net income from a business or profession.

  (16) “Individualized Congregate Housing Services Plan” means a plan that offers participants a choice of different service packages, which may contain fewer, or more, services than the complete set of congregate housing services a Standard Congregate Housing Services Plan provider is required to provide.

  (17) “Instrumental activities of daily living” means:

    (a) Using the telephone;

    (b) Interpreting and responding to mail;

    (c) Shopping for personal needs;

    (d) Remembering to take medication;

    (e) Arranging for prescription refills;

    (f) Making transportation arrangements; and

    (g) Performing chores.

  (18) “Net annual income” means total income projected to be received by an individual or couple in the 12 months after submission of an application for a program subsidy, minus any recurring, nonreimbursable medical expenses projected for the 12-month period that exceed 3 percent of the total income.

  (19) “Net monthly income” means net annual income divided by 12.

  (20) “Participant” means an individual who:

    (a) Lives in an apartment in a facility; and

    (b) Receives congregate housing services from a provider.

  (21) “Personal assistance services” means services that assist a participant with feeding, bathing, grooming, or dressing.

  (22) “Physically or mentally impaired” means having a physical or mental condition that prevents an individual from performing one or more essential activities of daily living.

  (23) “Program” means the Congregate Housing Services Program.

  (24) “Projected monthly income” means 1/12 of the income an individual or couple reasonably expects to receive during the 12 months after the date on which a subsidy calculation is made for the individual or couple.

  (25) “Provider” means an individual or other legal entity certified by the Department to provide congregate housing services at a facility.

  (26) “Secretary” means the Secretary of the Department.

  (27) “Senior housing” means a multiple-family apartment building that:

    (a) Provides housing under a landlord-tenant arrangement; and

    (b) Is specifically designed to meet the physical or social needs of elderly individuals.

  (28) “Service management” means the administrative services needed to insure an individual's access to congregate housing services including:

    (a) Assessing participant needs;

    (b) Determining eligibility;

    (c) Documenting services received;

    (d) Billing for services;

    (e) Communicating with families and the contact person;

    (f) Generally supervising participants;

    (g) Discharge planning; and

    (h) Supervising services provided by staff.

  (29) “Service package” means a group of congregate housing services offered as a package by an Individualized Congregate Housing Services Plan provider that may include fewer, or more, services than the complete set of congregate housing services a Standard Congregate Housing Services Plan provider is required to provide.

  (30) “Service plan” means a written plan developed by a provider in conjunction with an Individualized Congregate Housing Services Plan participant that identifies:

    (a) The particular congregate housing services, and any optional services under Regulation .14F of this chapter, that the provider will provide to the participant;

    (b) When the services will be provided; and

    (c) Who will provide the services.

  (31) “Standard Congregate Housing Services Plan” means a single plan that includes the complete set of congregate housing services including:

    (a) Congregate meals;

    (b) Housekeeping;

    (c) Laundry;

    (d) Personal assistance services; and

    (e) Service management.

  (32) “Subsidy” means the State funds paid by the Department to a provider for providing congregate housing services to a participant in accordance with a subsidy services agreement and this chapter.

  (33) “Subsidy services agreement” means a grant agreement between a provider and the Department that specifies the obligations of both parties.

#### Regulation .02 Congregate Housing Services Certificate.

*COMAR 32.03.04.02*

A. Certificate Required. An individual or other legal entity shall obtain a certificate from the Department before representing that it is a part of the Program or a Department-approved congregate housing services provider. The requirements of this chapter shall be met in order for a provider to obtain a certificate.

B. Application. In order to obtain a certificate, an individual or legal entity that wants to be certified as a provider shall apply to the Department for a certificate on a form provided by the Department.

C. Separate Certificate Required. A separate certificate is required for each facility.

D. Term of Certificate. A certificate is valid for the period specified on the certificate.

E. Owner of Certificate. If a certificate is issued, it shall be:

  (1) For a specific facility; and

  (2) In the name of the individual or legal entity that made the application.

F. Posting of Certificate. A provider shall post its certificate conspicuously in a public area of the facility at all times.

G. Certificate Contents.

  (1) A certificate shall state:

    (a) The name and address of the provider;

    (b) The name and address of the facility; and

    (c) The expiration date of the certificate.

  (2) For each facility, a certificate shall identify whether the provider is certified as a Standard Congregate Housing Services Plan or an Individualized Congregate Housing Services Plan. A provider may not be certified as both for a single facility.

#### Regulation .03 Certificate Requirements.

*COMAR 32.03.04.03*

A. An applicant for a certificate shall submit to the Department:

  (1) Documentation that verifies that:

    (a) The facility in which the applicant proposes to provide congregate housing services is owned, leased, or otherwise under the control of the applicant; or

    (b) The applicant has entered into a written agreement with the owner or management of the facility that specifies that the applicant is to be the sole congregate housing services provider for residents in the facility; and

  (2) A statement under oath from the owner or manager of the facility stating that:

    (a) The facility is in compliance with applicable local laws and regulations that govern housing, life safety, zoning, and environmental health; and

    (b) The facility's structural systems, heating, hot and cold water, electricity, plumbing, artificial and natural lighting, sewage, ventilation, and any other physical components governed by law or regulation, are safe, sanitary, functional, adequate, and in compliance with State and local law.

B. A facility shall conform to all of the applicable rules, regulations, and standards of any government agency through which it is financed, insured, or subsidized, including the U. S. Department of Housing and Urban Development, Rural Housing Service, or the Maryland Department of Housing and Community Development.

C. An applicant shall also submit evidence to the Department that demonstrates that the applicant has the capacity to deliver the services required by this chapter.

D. Evidence submitted to meet the requirements of §C of this regulation shall include:

  (1) A statement of the mission, goals, and objectives of the applicant;

  (2) Information about the applicant's experience providing services to the elderly;

  (3) A description of:

    (a) All the services to be provided; and

    (b) A proposed fee schedule;

  (4) An operating budget that supports the proposed fee schedule and identifies:

    (a) The anticipated sources of revenue; and

    (b) Service utilization assumptions;

  (5) A proposed weekly staffing pattern;

  (6) Proposed salary schedules;

  (7) A sample 4-week menu cycle that has been reviewed and approved in writing by a registered dietician;

  (8) A statement of the applicant's goals and objectives for providing services at the facility; and

  (9) Any other relevant information requested by the Department.

#### Regulation .04 Issuance of a Certificate.

*COMAR 32.03.04.04*

The Department may not issue a certificate until:

A. A completed application for certification has been submitted to the Department;

B. The Department has verified that the requirements in Regulation .03 of this chapter have been met; and

C. The Department has inspected and approved the facility.

#### Regulation .05 Waiver.

*COMAR 32.03.04.05*

A. The Department may waive any requirement in this chapter if a waiver request from a provider:

  (1) Is submitted to the Department in writing and contains specific facts upon which the waiver is requested;

  (2) Demonstrates that:

    (a) Compliance with the regulation for which a waiver is requested will impose a hardship; or

    (b) The waiver, if granted, will improve the operation of the Program;

  (3) Demonstrates that an alternative procedure proposed by the provider will meet or produce the intended effect of each regulation for which a waiver is requested; and

  (4) Demonstrates that the issuance of a waiver will not adversely affect the health and safety of a participant.

B. Within 60 days after the date a request for a waiver is received by the Department, the Department shall inform the applicant in writing whether the waiver request will be granted. If granted, the waiver shall remain in effect for the term specified in the notification.

#### Regulation .06 Annual Renewal of Certificate.

*COMAR 32.03.04.06*

A. A provider with a certificate, including a certificate issued before the adoption of these regulations, may apply to have the certificate renewed. An updated application for renewal shall be submitted on forms approved by the Department.

B. An application for renewal shall be filed with the Department by a date specified annually by the Department.

C. The Department shall renew a certificate if:

  (1) The provider is in compliance with this chapter; and

  (2) The Department has verified that the requirements of Regulation .03 of this chapter have been met.

#### Regulation .07 Change of Provider During Term of Subsidy Services Agreement.

*COMAR 32.03.04.07*

A. A certificate is not transferable. An entity other than the current provider may become the certificate holder and the new provider for a facility, only if:

  (1) The Department agrees to the change; and

  (2) The proposed new provider obtains a certificate for the facility.

B. An existing provider seeking to have a new entity become the provider for a facility shall notify the Department at least 90 days before the proposed effective date of the change. The entity seeking to be the new provider shall apply for a certificate at least 60 days before the proposed date for the change.

C. A provider shall remain responsible for the operation of the Program at the facility until the Department approves the proposed change by:

  (1) Rescinding the provider's certificate; and

  (2) Issuing a new certificate to a new provider.

D. A provider shall notify its participants in writing of a proposed change to a new provider at least 60 days prior to the proposed effective date of the change. The notification shall contain at least:

  (1) A proposed date of the change;

  (2) A name, address, and telephone number of the proposed new provider; and

  (3) A name and telephone number of an individual in the Department or local agency on aging that a participant may call with questions.

#### Regulation .08 Qualifications of Provider or Supervisor.

*COMAR 32.03.04.08*

A. An individual employed by a provider to work in a supervisory position in a facility and, if the provider is an individual, the provider, shall have at least the minimum qualifications set forth in §B of this regulation.

B. To qualify to work in a supervisory position for a provider, an individual:

  (1) Shall be 21 years old or older;

  (2) Shall be literate and able to communicate effectively with participants;

  (3) Shall have sufficient skills, education, training, and experience to perform the required services;

  (4) Shall have sufficient physical, emotional, and mental capacity to perform the duties required;

  (5) Shall be of good moral character;

  (6) Shall fully cooperate with a provider's efforts to comply with Health-General Article, Title 19, Subtitle 19, Annotated Code of Maryland (Adult Dependent Care Programs—Criminal History Records Checks and Background Checks);

  (7) May not have been convicted of, received a probation before judgment for, or entered a plea of nolo contendere to a felony or any crime involving moral turpitude or theft, or have any other criminal history that indicates behavior which is potentially harmful to participants;

  (8) May not be cited on the Maryland Geriatric Nursing Assistants Registry under COMAR 10.07.02.42 with a determination of:

    (a) Abuse;

    (b) Misappropriation of resident property; or

    (c) Neglect; and

  (9) May not have violated any State or local law regulating residential care facilities, which violation resulted in revocation or nonrenewal of a license or certificate.

#### Regulation .09 Staffing.

*COMAR 32.03.04.09*

A. A provider shall have a staff-to-participant ratio which is adequate to provide the services required in Regulation .14 of this chapter.

B. The provider shall provide or assure that its staff participates in training, as necessary, to ensure that each participant obtains quality congregate housing services consistent with the participant's needs.

C. If a provider provides services to individuals with Alzheimer's disease or related disorders:

  (1) The provider shall provide annual education to staff on the care of individuals with dementia; and

  (2) Employees shall complete an in-service training on dementia that addresses the physical, intellectual, and behavioral manifestations of dementia and techniques to assist and manage dementia participants before the later of:

    (a) 180 days from the beginning of staff member's employment; or

    (b) December 31, 2005.

D. Employees of a provider whose jobs require them to enter a participant's apartment or have physical contact with a participant:

  (1) Shall be 18 years old or older;

  (2) Shall be of good moral character;

  (3) Shall be literate if job responsibilities require reading or writing;

  (4) Shall be able to communicate effectively with the participant;

  (5) Shall have sufficient skills, education, training, and experience to perform the required services;

  (6) Shall have sufficient physical, emotional, and mental capacity to perform the duties required;

  (7) Shall fully cooperate with a provider's efforts to comply with Health-General Article, Title 19, Subtitle 19, Annotated Code of Maryland (Adult Dependent Care Programs — Criminal History Records Checks and Background Checks);

  (8) May not have been convicted of, received a probation before judgment for, or entered a plea of nolo contendere to a felony or any crime involving moral turpitude or theft, or have any other criminal history that indicates behavior which is potentially harmful to participants;

  (9) May not be cited on the Maryland Geriatric Nursing Assistant Registry under COMAR 10.07.02.42 with a determination of:

    (a) Abuse;

    (b) Misappropriation of resident property; or

    (c) Neglect; and

  (10) May not have violated any State or local law regulating residential care facilities that resulted in revocation or nonrenewal of a license or certificate.

#### Regulation .10 Participant Rights.

*COMAR 32.03.04.10*

A. In addition to any other rights, a participant shall have the right to:

  (1) Be treated with consideration, respect, and full recognition of human dignity and individuality;

  (2) Receive care and services that are adequate and appropriate;

  (3) Privacy;

  (4) Be free from emotional and physical abuse;

  (5) Practice the religion of the participant's choice or to abstain from religious practice;

  (6) Be free from discrimination, as provided by State and federal law; and

  (7) Refuse or consent to medical treatment.

B. A provider shall:

  (1) Conspicuously post at all times the list of participant rights identified in §A of this regulation:

    (a) In the facility; and

    (b) In the provider's office; and

  (2) Give a copy of the list of participant rights to each participant at the time of admission.

#### Regulation .11 Provider-Participant Service Agreement.

*COMAR 32.03.04.11*

A. A provider shall enter into a written agreement with a participant on a form provided or approved by the Department that specifies the obligations of both parties, including:

  (1) The services to be provided;

  (2) The fees to be charged by the provider;

  (3) If applicable, the amount of subsidy to be paid on behalf of the participant; and

  (4) That the provider give at least 30 days notice of any proposed change in a fee charged by the provider for a particular service.

B. The provider shall give one copy of the executed agreement to the participant and keep a second copy on file for 3 years after the termination date of the agreement. Any modifications to the agreement shall be reflected in an addendum signed and dated by both parties.

C. A change in the amount of a participant's required contribution following a reassessment of the participant's financial eligibility:

  (1) May be imposed immediately; and

  (2) Is not subject to the 30 day notice requirement of §A(4) of this regulation.

#### Regulation .12 Termination of Provider-Participant Service Agreement.

*COMAR 32.03.04.12*

A. A provider-participant service agreement shall allow termination by a provider only for the following reasons:

  (1) A change in the health status or behavior of the participant that constitutes a substantial threat to the health or safety of a participant, other residents, or the provider's staff;

  (2) Chronic disruptive behavior that is offensive and threatens participants' peaceful enjoyment of their apartments;

  (3) Nonpayment of fees by the participant;

  (4) Termination of the Program at the facility through no fault of the provider; or

  (5) The participant's health has improved sufficiently so that the participant no longer needs congregate housing services.

B. A provider shall give at least 30 days' written notice of termination to a participant. The notice shall include:

  (1) A statement of intent to terminate;

  (2) The reason for termination;

  (3) The proposed termination date, which may not be less than 30 days from the date of the notification;

  (4) Assurance that services will be provided up to the proposed termination date; and

  (5) A list of resources in the community that may be able to assist the participant to relocate.

C. The existence of an emergency does not necessarily mean that any of the standards in §A of this regulation have been met.

D. If an emergency involving a participant arises, including one that may require a participant to be transferred to a hospital, the participant's provider shall:

  (1) Take immediate steps to obtain necessary care for the participant by calling 9-1-1;

  (2) Notify the participant's contact person within 1 hour of learning of the emergency;

  (3) Notify the participant and the participant's contact person of the conditions or behavior that created the emergency and, if applicable, the reasons why a transfer was necessary; and

  (4) Record the appropriate information in an incident report.

#### Regulation .13 Record Keeping.

*COMAR 32.03.04.13*

A. A provider shall maintain on-site an accurate and current file for each participant.

B. A participant's file shall contain the following:

  (1) A completed copy of the following forms prescribed by the Department:

    (a) Participant assessment form;

    (b) Application form;

    (c) Provider-participant service agreement and any addenda; and

    (d) Subsidy application, if any;

  (2) Personal data of participant including:

    (a) Name;

    (b) Date of birth;

    (c) Admission date and, if applicable, termination date;

    (d) The type of housing the participant lived in before admission into the Program;

    (e) Name, address, and telephone number of the participant's physician;

    (f) Name, address, and telephone number of the participant's contact person;

    (g) If obtained by the provider, relevant medical history of the participant, including physicians' health reports and information on recent hospitalizations; and

    (h) A copy of any advance health care directive the participant voluntarily provides in response to the provider's inquiring whether it may have a copy of any advance health care directive of participant;

  (3) For participants in an Individualized Congregate Housing Services Plan, a service plan;

  (4) Incident reports related to the participant;

  (5) Documentation verifying on a weekly basis the housekeeping, laundry, and personal assistance services received by the participant during the prior month;

  (6) Reasons for any termination or transfer and, if applicable, the location to which the participant was transferred;

  (7) Any assessments or recommendations concerning the participant which were made by the local health department and received by the provider; and

  (8) If the participant receives a subsidy, a completed copy of the subsidy calculation form and written documentation of the participant's:

    (a) Net annual income;

    (b) Assets; and

    (c) Allowable medical expenses.

C. Incident Reports.

  (1) A provider shall record on an incident report a description of each accident, injury, or other incident that occurs at the facility and impacts the amount of congregate housing services needed by a participant.

  (2) All incident reports shall include the following information:

    (a) The time, date, and place of the incident;

    (b) The identity of individuals present at the incident;

    (c) A complete description of the incident;

    (d) The response of the staff; and

    (e) Any appropriate follow-up action taken, including notifying the participant's contact person and licensing or law enforcement authorities.

D. Confidentiality. A provider shall protect the confidentiality of a participant's file. A provider may not disclose information contained in a participant's file to any person or agency other than the participant, the participant's contact person or legal representative, or the Department's authorized employees unless:

  (1) The participant consents in writing to the disclosure; or

  (2) State or federal law or a court order otherwise requires or permits the disclosure.

E. During ordinary business hours and at other reasonable times, a participant shall have the right to inspect and obtain a copy of the file referred to in §B of this regulation. Upon request by a participant, a provider shall make a copy for the participant of any portion of the file and may charge the participant a reasonable cost for making a copy, not to exceed 30 cents per page.

F. A provider shall keep a participant's file for at least 3 years after the participant stops participating in the Program at the provider's facility.

#### Regulation .14 Mandatory and Optional Services.

*COMAR 32.03.04.14*

A. A provider shall elect to participate in either the Standard Congregate Housing Services Plan or the Individualized Congregate Housing Services Plan.

B. Meals.

  (1) A Standard Congregate Housing Services Plan provider shall provide at least two nutritionally balanced meals daily.

  (2) An Individualized Congregate Housing Services Plan provider shall offer a service package that includes at least one nutritionally balanced meal daily.

  (3) All meals served to participants shall be prepared by a licensed food service establishment in an approved food preparation facility that complies with the requirements of COMAR 10.15.03.

  (4) At least one meal a day shall be offered in a congregate setting.

  (5) If a participant requests that a meal be delivered to the participant's apartment, the provider shall deliver it at no additional charge if the provider determines that the participant is unable to participate in a congregate meal due to a temporary mental or physical condition.

  (6) A provider or its food service contractor shall prepare in advance a weekly menu of the meals to be serviced.

  (7) If more than one food service contractor is retained by a provider to prepare meals for participants in a facility, the provider shall assure that menus are coordinated to avoid duplication and to maintain overall nutritional balance.

  (8) A provider shall retain copies of weekly menus at the facility for a period of 1 year and shall have the menus available during monitoring visits conducted by the Department. If a substitution is made for an item on the approved menu, the substitution shall be documented on the menu.

  (9) A provider shall keep a record of participants' attendance at each congregate meal provided, investigate a participant's failure to attend a meal, and document why the participant did not attend. Records of meal attendance and documentation of why a participant did not attend shall be kept for at least 3 months.

  (10) If a provider contracts with another entity to provide meal services for the participants, the provider shall solicit competitive bids from qualified food service establishments at least once every 3 years. Competitive bidding may be waived by the Department if the meals are provided by a food service establishment that is under contract with:

    (a) The owner or management of the facility, if the provider is not the owner or manager; or

    (b) The local area agency on aging to provide congregate or home-delivered meals pursuant to Title III C of the federal Older Americans Act, 42 U.S.C. §§3030e — 3030g-22.

  (11) If a provider contracts with another entity to provide meals to participants, the provider shall arrange for participants to meet periodically with the other entity to discuss menus and other concerns.

C. Housekeeping and Laundry.

  (1) A provider shall provide the supplies and equipment necessary for housekeeping required by this regulation.

  (2) A provider may require that its participants provide laundry supplies and pay for the cost of operating laundry equipment to clean the participants' laundry.

  (3) A Standard Congregate Housing Services Plan provider shall provide a minimum of 1.5 hours per week of general housekeeping and laundry services for each participant.

  (4) A Standard Congregate Housing Services Plan provider shall clean a participant's apartment and change the bed linens at least weekly. If a temporary condition requires cleaning an apartment or changing bed linens more often than weekly in order to maintain a clean, safe, and sanitary living environment, a provider shall do so on a temporary basis.

  (5) A Standard Congregate Housing Services Plan provider shall provide laundry services to participants at least weekly.

  (6) An Individualized Congregate Housing Services Plan provider shall offer at least one service package that includes at least 1.5 hours per week of assistance with housekeeping and laundry.

  (7) An Individualized Congregate Housing Services Plan provider may offer service packages that provide 3, 6, or 9 hours per week of any combination of personal assistance services and weekly housekeeping and laundry services.

D. Personal Assistance Services.

  (1) If a participant needs and wants personal assistance services, a Standard Congregate Housing Services Plan provider shall provide the services. At a minimum a Standard Congregate Housing Services Plan provider shall have staff available at a facility to provide 1.5 hours per week of personal assistance services for each participant at the facility.

  (2) An Individualized Congregate Housing Services Plan provider shall offer at least one service package that includes at least 3 hours of personal assistance services weekly.

E. Service Management.

  (1) A Standard Congregate Housing Services Plan provider shall provide service management as part of the services provided to participants.

  (2) An Individualized Congregate Housing Services Program provider shall offer at least one service package that includes service management.

F. Optional Services. A provider may provide:

  (1) Assistance with instrumental activities of daily living;

  (2) Assistance with arrangements for regular health care appointments;

  (3) A service to escort a participant to a health care appointment;

  (4) Meal delivery to a participant's apartment, for a nominal fee, if:

    (a) A participant elects not to participate in the congregate meal program; and

    (b) The provider has sufficient staff to provide this service;

  (5) Opportunities for individual or group activities in accordance with participants' interests, abilities, and needs;

  (6) Assistance with completing and submitting benefit applications;

  (7) Assistance with securing additional services needed;

  (8) Subject to the prior approval of the Department and in accordance with §G of this regulation, medication reminders or administration; and

  (9) Subject to the prior approval of the Department, other services participants may need if a provider has an adequate number of staff with the qualifications necessary to provide the proposed services.

G. Medications.

  (1) Medication shall be self-administered by a participant unless a provider successfully demonstrates to the Department that the provider and its staff have the qualifications to offer medication reminders or administer medications.

  (2) A provider approved by the Department to offer as an optional service medication reminders may:

    (a) Remind a participant to take medication; or

    (b) Provide physical assistance with opening and removing medications from a container.

  (3) A provider approved by the Department to offer as an optional service the administration of medications shall:

    (a) Assure that staff who administer medications do so under the supervision of a registered nurse pursuant to COMAR 10.27.11;

    (b) Assure that all staff responsible for medication administration complete a Medication Administration Training Program approved by the Board of Nursing pursuant to Health-General Article, §8-6A-01(f), Annotated Code of Maryland;

    (c) Assure that every 2 years all staff responsible for medication administration complete a clinical update refresher course; and

    (d) For each participant whose medication is administered by staff of the provider, arrange for an on-site review by a delegating registered nurse at least every 45 days pursuant to COMAR 10.27.11.

#### Regulation .15 Award of Subsidies to a Provider.

*COMAR 32.03.04.15*

A. The Department may award subsidies to a provider if:

  (1) The Department has certified the facility;

  (2) Sufficient State funds for congregate housing service subsidies are available in the Department's budget;

  (3) The cost of services to be provided and the amount of subsidies required per participant are consistent with costs in comparable facilities; and

  (4) The provider and the Department have entered into a purchase of services agreement for the applicable fiscal year.

B. If a provider desires subsidies for its participants beyond the initial fiscal year that subsidies are awarded, the provider shall request annually that the Department renew the subsidy award.

#### Regulation .16 Renewal of Subsidy Award.

*COMAR 32.03.04.16*

A subsidy award may be renewed annually if:

A. Sufficient State funds for subsidies are available in the Department's budget;

B. The provider's budget for the next fiscal year has been approved by the Department;

C. The Department and the provider have executed a subsidy services agreement for the next fiscal year; and

D. The provider and facility are in compliance with this chapter.

#### Regulation .17 Award of Subsidies to New Sites.

*COMAR 32.03.04.17*

If funds are made available in the Department’s budget to award subsidies to more facilities than the budget supported in the past, the Department shall issue a request for proposals to persons who want to be providers that are eligible to receive subsidies.

#### Regulation .18 Subsidy Services Agreement.

*COMAR 32.03.04.18*

A. A provider that is approved by the Department to receive State subsidies shall enter into a written subsidy services agreement with the Department.

B. The Department shall give a copy of the executed agreement to the provider.

#### Regulation .19 Administration of Subsidy Award.

*COMAR 32.03.04.19*

A. If funds are available the Department shall advance subsidy payments to a provider in good standing on a quarterly basis.

B. For the term of a subsidy services agreement, the Department shall:

  (1) During the first quarter, advance to the provider a subsidy payment equal to 1/4 of the total subsidy award; and

  (2) During each subsequent quarter, advance an amount equal to the total amount of subsidies earned during the previous quarter.

C. At the end of each quarter, the provider shall submit the following to the Department on forms provided by the Department:

  (1) A report of subsidies earned; and

  (2) A request for funds for the next quarter.

D. By January 30 of each year, a provider shall submit to the Department a year-to-date report covering the first 6 months of the provider's actual revenues and expenses allocable to the operation of the Program.

E. At the end of a fiscal year in which subsidies are awarded, or at any time the Department believes that the amount of subsidies advanced significantly exceeds the amount of subsidies earned, the Department shall reconcile:

  (1) The amount of subsidies advanced to the provider by the Department during the fiscal year; and

  (2) The amount of subsidies earned by the provider during the fiscal year.

F. If the subsidies advanced to a provider during a fiscal year are projected to be significantly greater than the subsidies earned, the Department may withhold from the provider an amount equal to the projected overpayment from the next quarterly advance.

G. If the subsidies advanced to a provider during a fiscal year are greater than the amount of subsidies earned, the provider shall refund the subsidy overpayment to the Department within 60 days of a request by the Department for reimbursement. If a provider does not refund the overpayment within 60 days, the Department may offset the overpayment against any future subsidies earned by the provider.

H. If the subsidies advanced to a provider during a fiscal year are less than the amount of subsidies earned, the Department shall pay the subsidy amount due the provider, up to the maximum grant amount of the subsidy services agreement.

I. Not later than 10 days after the end of the third quarter of a fiscal year, a provider may request an amendment to its subsidy services agreement if it projects that the amount of subsidies earned will exceed the maximum grant amount of the subsidy services agreement. If funds are available, the Department may agree to amend the subsidy services agreement for all or part of the projected amount.

J. If the total subsidy awards received by a provider in a fiscal year are equal to or greater than $25,000, the provider shall submit to the Department, within 90 days of the last day of the fiscal year, an annual audit report, prepared in accordance with generally accepted accounting principles. Providers that receive in any one fiscal year $25,000 or more in subsidies and that have a certificate for more than one facility shall maintain their financial records so that revenues and expenses can be tracked on a facility-by-facility basis.

K. If the total subsidy awards for a fiscal year are less than $25,000, the provider shall submit to the Department, within 90 days of the last day of the fiscal year, an annual report of the provider's actual revenue and expenditures allocable to its operation under the Program.

L. The Department shall review a report required by §J or K of this regulation and reconcile the report with the amount of subsidy payments made to the provider during the fiscal year.  After the Department has reconciled the subsidy payments, it shall pay any subsidy amount due to the provider, up to the maximum grant amount in the provider’s subsidy services agreement.

#### Regulation .20 Eligibility for Services.

*COMAR 32.03.04.20*

A. To be eligible to be a participant and receive congregate housing services, an individual shall:

  (1) Be 62 years old or older;

  (2) Be physically or mentally impaired;

  (3) Need assistance with one or more of the essential activities of daily living;

  (4) Need one or more of the congregate housing services available in the facility; and

  (5) Be able to function in the facility if provided with those services.

B. The spouse of a participant is eligible to be a participant and receive congregate housing services if the spouse is 55 years old or older and meets the requirements of §A(2)—(5) of this regulation.

#### Regulation .21 Determination of Eligibility to Receive Services.

*COMAR 32.03.04.21*

A. An individual who wants to apply to be a participant in the Program shall file an application with the provider from which the individual wants to receive services. The Department shall provide an application form that individuals applying for the Program shall use.

B. Upon receipt of an application to receive services, the provider shall determine if the applicant meets the requirements of Regulation .20 of this chapter.

C. To determine whether an applicant meets the requirements of §A(4) and (5) of Regulation .20 of this chapter, a provider shall assess the applicant's functional abilities using an assessment form approved by the Department or arrange for an assessment through the Maryland Department of Health's Adult Evaluation and Review Services program. Unless more frequent evaluation is warranted, a reassessment to determine whether the applicant still meets the requirements of §A(4) and (5) of Regulation .20 of this chapter shall be conducted every 2 years using either the Adult Evaluation and Review Services program or an assessment form approved by the Department.

D. If a provider determines an applicant is eligible to receive services and if sufficient financial resources are available through participant's payments, State subsidies, or other sources to cover the cost of providing the congregate housing services needed by the applicant, the provider shall:

  (1) Accept the applicant as a participant if the applicant has a signed lease for an apartment in the facility; or

  (2) Place the applicant's name on a waiting list if the applicant does not have a signed lease for an apartment in the facility.

E. If a provider determines an applicant is eligible to receive services, but there are not sufficient financial resources available to cover the cost of providing the services needed, the provider shall place the applicant's name on a waiting list for subsidies.

F. If a provider determines that an applicant is ineligible for services, the provider shall notify the applicant in writing of the determination within 10 days after making the determination. The provider shall send a copy of the written determination immediately to the Department by mail and by fax machine.

G. A denial of eligibility notice issued under §F of this regulation shall include:

  (1) The determination;

  (2) The reason for denial;

  (3) The specific regulation supporting the denial; and

  (4) Information about other resources in the community that may be able to assist the applicant.

#### Regulation .22 Participant Application for Subsidy.

*COMAR 32.03.04.22*

If an individual resides in a facility that has a subsidy services agreement with the Department, the individual may file an application for a subsidy with the provider at the facility on a form provided by the Department.  An application for a subsidy may be filed at the same time as an application for eligibility is filed or may be filed after an application for eligibility is filed.

#### Regulation .23 Participant Eligibility for Subsidy.

*COMAR 32.03.04.23*

A. An individual in a facility whose provider has a subsidy services agreement for a Standard Congregate Housing Services Plan is eligible to receive a subsidy if:

  (1) The individual has been determined to be eligible to be a participant and receives services in the facility;

  (2) The individual’s net monthly income is insufficient to pay the full monthly fee approved by the Department in the subsidy services agreement with the provider;

  (3) The individual's net annual income is less than 60 percent of the State median income as most recently published by the Maryland Department of Human Services;

  (4) None of the exclusions under §G of this regulation applies; and

  (5) The individual's assets do not exceed $27,375.

B. A couple in a facility whose provider has a subsidy services agreement for a Standard Congregate Housing Services Plan shall be eligible to receive a subsidy if:

  (1) Both members of the couple have been determined to be eligible to be participants and receive services in the facility;

  (2) The couple’s net monthly income is insufficient to pay the full monthly fee for a couple approved by the Department in the subsidy services agreement with the provider;

  (3) The combined net annual income of the members of the couple is less than 60 percent of the State median income for a couple as most recently published by the Maryland Department of Human Services;

  (4) None of the exclusions under §G of this regulation applies; and

  (5) The couple's combined assets do not exceed $35,587.

C. An individual in a facility whose provider has a subsidy services agreement for an Individualized Congregate Housing Services Plan shall be eligible for a subsidy if:

  (1) The individual has been determined to be eligible to be a participant and receive services in the facility;

  (2) The individual's net annual income is less than 60 percent of the State median income as most recently published by the Maryland Department of Human Services;

  (3) None of the exclusions under §G of this regulation applies; and

  (4) The individual's assets do not exceed $27,375.

D. Real property that was the primary residence of a participant immediately before admission to the Program may not be counted towards the asset limit for 1 year after the date of admission to the Program. If after 1 year from admission the participant retains any ownership interest in the real property that was the primary residence of the participant immediately before admission, the value of the participant's ownership interest shall be counted against the asset limit.

E. An individual applying for a subsidy shall submit, along with the subsidy application, written documentation of all income and assets.

F. If an individual is placed on a waiting list under Regulation .21D(2) of this chapter, the provider may process an advisory subsidy application and subsidy calculation form in order to estimate for the individual the probable amount of subsidy, if any, the individual could receive if enrolled in the program.

G. An individual is not eligible to receive a subsidy if the individual is enrolled in:

  (1) A Medicaid waiver program under 26 U.S.C. §1915(c) in Title XIX of the federal Social Security Act;

  (2) The Program of All-Inclusive Care for the Elderly, commonly known as PACE; or

  (3) A Medicaid capitated program that includes long-term care services.

#### Regulation .24 Enrollment of Participant for Subsidy.

*COMAR 32.03.04.24*

A. A provider shall enroll an individual or couple as subsidized participants if:

  (1) The individual or couple has been determined to be eligible to receive services according to the requirements of Regulation .21 of this chapter and to receive a subsidy according to the requirements of Regulation .23 of this chapter; and

  (2) State funds are available to pay the subsidy.

B. If an individual or couple is enrolled to receive a subsidy, the provider shall:

  (1) Determine the amount of the individual's or couple's subsidy on a form provided by the Department; and

  (2) Annually, or more frequently if the individual or couple has a significant change in their finances, redetermine:

    (a) The continued eligibility to receive a subsidy; and

    (b) The amount of the subsidy.

#### Regulation .25 Notification of Ineligibility to Receive a Subsidy.

*COMAR 32.03.04.25*

A. If an individual or couple is determined to be ineligible to receive a subsidy or no longer eligible to receive a subsidy, a provider shall notify the individual or couple in writing of the ineligibility determination within 10 days.

B. A notice of ineligibility for a subsidy shall include:

  (1) The decision;

  (2) The reason for denial of eligibility;

  (3) The participant's right to request a review of the decision; and

  (4) What must be done to obtain a review, including the relevant time frames.

C. Request for Review. An individual or couple may obtain a review of a determination of ineligibility for a subsidy by requesting in writing a review of the provider's determination. A written request for a review shall be mailed within 30 days of receipt of the notice of ineligibility to the Congregate Housing Services Program Manager, Maryland Department of Aging, 301 West Preston Street, Baltimore, MD 21201. Upon receipt of a request for review, the Congregate Housing Services Program Manager shall examine and investigate the basis for the denial, gather additional information considered necessary by the Congregate Housing Services Program Manager, and issue a new determination.

D. Determination. If the new determination from the Congregate Housing Services Program Manager finds an individual or couple ineligible, the Department shall issue a notice of ineligibility, which shall include:

  (1) The decision;

  (2) The reason for denial of eligibility;

  (3) The participant's right to appeal the determination; and

  (4) What must be done to file an appeal, including the relevant time frames.

E. An individual or couple may appeal a determination of ineligibility issued by the Department in accordance with Regulation .33 of this chapter and COMAR 32.01.01.

#### Regulation .26 Determination of Participant Subsidy Amount.

*COMAR 32.03.04.26*

A. In the Standard Congregate Housing Services Program, the amount of the subsidy to be paid monthly on behalf of an eligible participant shall equal the difference between the participant’s projected monthly income, less approved allowances set forth in §B of this regulation, and the monthly fee for congregate housing services as approved by the Department in the subsidy services agreement.

B. Approved allowances are:

  (1) 10 percent of the individual's or couple's net monthly income;

  (2) The applicable monthly personal allowance for an individual or couple as established on the subsidy calculation form approved by the Department for the Standard Congregate Housing Services Plan;

  (3) If the provider is regulated by the U.S. Department of Housing and Urban Development, any monthly elderly allowance provided for under the U.S. Department of Housing and Urban Development's applicable regulations;

  (4) The monthly rent paid by the individual or couple for an apartment in the facility;

  (5) If the U. S. Department of Housing and Urban Development permits a monthly utility allowance in the calculation of the participant's rent at the facility, the amount of the monthly utility allowance;

  (6) The individual's or couple's allowable medical expenses; and

  (7) If the provider provides two meals a day, a food allowance as established on the Standard Congregate Housing Services Program subsidy calculation form approved by the Department.

C. In the Individualized Congregate Housing Services Program, the amount of the subsidy to be paid monthly on behalf of an eligible participant shall be determined by using the Individualized Congregate Housing Services Program Subsidy Calculation Form issued by the Department to the provider.

#### Regulation .27 Monitoring.

*COMAR 32.03.04.27*

A. The Department or its designee may conduct reviews of a provider's administration of the Program and conduct announced or unannounced on-site visits of a facility at any time.

B. The Department may designate another entity to perform monitoring.

C. The Department shall have the right to review a provider's records to ensure compliance with this chapter, including participant files and files that contain the results of the background checks required by Regulations .08 and .09 of this chapter.

#### Regulation .28 Notification of Intent Not to Renew Subsidy Services Agreement.

*COMAR 32.03.04.28*

A. If a provider does not intend to seek the award of another subsidy services agreement after the current one expires, the provider shall give the Department written notice of that intention at least 120 days before the expiration of the current agreement.

B. A notice provided to satisfy §A of this regulation shall include:

  (1) The provider's reasons for ending its participation in the Program;

  (2) Plans for alternate services for participants; and

  (3) An assurance that the provider shall provide congregate housing services up to the termination date in the current subsidy services agreement.

#### Regulation .29 Violations.

*COMAR 32.03.04.29*

A. If the Department determines that a provider violated or is violating a regulation of this chapter, the Department shall prepare a written notice of violation.

B. A notice of violation shall include:

  (1) A description of each condition, action, or inaction that constitutes a violation;

  (2) A citation to each regulation violated;

  (3) The date by which an ongoing violation shall be corrected; and

  (4) The sanctions that may be imposed against the provider for failure to correct the violations.

C. If the Department intends to impose a civil money penalty pursuant to Regulation .32A of this chapter, the notice of violation shall also comply with the requirements of Regulation .32B of this chapter.

#### Regulation .30 Suspension of Certificate.

*COMAR 32.03.04.30*

A. The Department may suspend a provider's certificate if the provider has violated a regulation of this chapter, and the violation has not been corrected within the time specified in the notice of violation.

B. The Department may immediately suspend a provider's certificate if a violation of a regulation of this chapter results in conditions that pose an imminent danger to the health or safety of a participant.

C. The Department shall notify a provider in writing of a decision to suspend the provider's certificate.

D. A notice of certification suspension shall include:

  (1) The reasons for suspension;

  (2) A citation to the regulation on which the suspension is based;

  (3) The period of suspension;

  (4) Notification that the violation may lead to revocation of the certificate if the violation is not corrected within the number of days specified in the notice;

  (5) The provider's right to appeal the suspension in accordance with Regulation .33 of this chapter; and

  (6) What a provider shall do to file an appeal, including all relevant time requirements.

E. The Department shall notify the participants and the owner of the facility, or the management agent for the owner, of a decision to suspend a certificate under this regulation. The contents of the notice shall comply with §D of this regulation.

F. Upon notification of a suspension and until the suspension has been lifted, a provider may not enter into a provider-participant agreement with an individual who was not a participant at the time of the suspension.

G. A provider aggrieved by a notice of certification suspension may appeal the Department's action by filing a request for an appeal in accordance with Regulation .33 of this chapter.

#### Regulation .31 Revocation or Denial of a Certificate.

*COMAR 32.03.04.31*

A. The Department may revoke, deny, or refuse to renew a certificate for cause. Cause for revocation of a certificate, denial of a certificate, or refusal to renew a certificate includes, but is not limited to, the following:

  (1) Conditions that present an imminent danger to the life, safety, health, or welfare of the participants;

  (2) Failure to meet the initial certification or renewal requirements of this chapter;

  (3) Failure to correct cited violations within the time specified by the Department;

  (4) Fraud or misrepresentation in obtaining or attempting to obtain or retain a certificate;

  (5) Submission of false information to the Department;

  (6) Request by the provider that the certificate be revoked; and

  (7) Failure to abide by the terms of the purchase of services agreement.

B. The Department shall notify a provider in writing of a decision to deny, revoke, or deny the renewal of a certificate.

C. A notice provided under §B of this regulation shall include the following information:

  (1) The reason for the denial, revocation, or refusal to renew the certificate;

  (2) A citation to the regulations on which the decision is based;

  (3) The provider's right to appeal the decision in accordance with Regulation .33 of this chapter;

  (4) What a provider shall do to file an appeal, including all relevant time requirements; and

  (5) Notification that the provider may not enroll an individual or couple in the Program after the provider receives the notice.

D. A provider aggrieved by a notice to deny, revoke, or deny the renewal of a certification may appeal the Department's action by filing a request for an appeal in accordance with Regulation .33 of this chapter.

E. The Department shall notify the participants and the owner of the facility, or the management agent for the owner, in writing of a decision to revoke or deny the renewal of a certificate. The notice shall comply with §C of this regulation and shall include a list of community resources available to assist the participants.

#### Regulation .32 Civil Money Penalties.

*COMAR 32.03.04.32*

A. Violations Warranting Penalties. The Secretary, or the Secretary’s designee, may impose a civil money penalty against a provider of congregate housing services for:

  (1) A violation of this chapter or the provider’s subsidy services agreement that results in conditions presenting an imminent danger or substantial probability of death or serious physical harm to a participant;

  (2) A violation of a participant's rights specified in Regulation .10 of this chapter; or

  (3) Noncompliance with State or local fire safety regulations.

B. Notice of Violation. If the Department issues a notice of a violation under §A of this regulation, that notice shall provide:

  (1) The time by which the provider shall submit an acceptable plan of correction to the Department;

  (2) The time by which the provider shall substantially correct the identified violation, which time may not be less than 30 days; and

  (3) That failure to submit an acceptable plan of correction as required by §B(1) of this regulation or to correct the identified violation as required by §B(2) of this regulation may result in an order imposing a civil money penalty under §D of this regulation.

C. Action if Violation Not Timely Corrected.

  (1) After the expiration of the time set forth in §B(2) of this regulation the Department shall inspect the facility to determine whether the violation or violations have been corrected.

  (2) If the violation or violations have not been corrected, the Secretary, or the Secretary's designee, may:

    (a) Extend the time frame during which the violation shall be corrected; or

    (b) Impose a civil money penalty under §D of this regulation.

D. Amount and Limitation of Civil Money Penalty.

  (1) The Secretary, or the Secretary's designee, may impose a civil money penalty in the amount of $20 per violation per participant for each day that a violation remains uncorrected beyond the expiration of the time set forth in §B(2) of this regulation. A civil money penalty imposed under this regulation may not exceed $1,000 per violation or $5,000 in total.

  (2) In setting the amount of a civil money penalty under §D(1) of this regulation, the following factors shall be considered:

    (a) The number, nature, and seriousness of the violations;

    (b) The degree of risk to the health, life, or physical safety of the participants caused by the violations;

    (c) The efforts made by the provider to correct the violations;

    (d) Whether the amount of the proposed civil money penalty will jeopardize the financial ability of the provider to continue operating; and

    (e) Other factors as justice may require.

E. Notice. If a civil money penalty is imposed under this regulation, the Secretary, or the Secretary's designee, shall provide written notice to a provider of the imposition of the civil money penalty. The notice shall be served on the provider by certified mail and shall include:

  (1) The basis on which the order is made;

  (2) Each regulation or statute violated;

  (3) Each penalty imposed and the total amount of the civil money penalty imposed;

  (4) The manner in which the amount of the civil money penalty was calculated;

  (5) A statement of the provider's right to request a reduction; and

  (6) A statement on how to file an administrative appeal, including all relevant time requirements.

F. Appeal. If a civil money penalty is imposed under this regulation, the provider shall have the right to appeal from the order in accordance with Regulation .33 of this chapter.

G. Payment of Penalty; Civil Action; Deposit in General Fund.

  (1) A provider shall pay all penalties to the Department within 10 days after the provider receives a final order imposing a civil money penalty.

  (2) An order imposing a civil money penalty is final when the provider has exhausted all opportunities to contest the penalty in accordance with the Administrative Procedure Act, State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.

  (3) If a provider does not comply with §G of this regulation, the Department may file a civil action to recover the penalty.

  (4) The Department shall deposit all penalties collected under §G of this regulation into the General Fund.

H. Enhanced Penalties. The Secretary, or Secretary's designee, may impose a penalty three times the amount set forth in §D of this regulation if a sanction has been imposed on the provider for the same violation within 2 years before issuance of the notice of violation.

I. Requests for Penalty Reduction.

  (1) A provider of congregate housing services may request a reduction of a civil money penalty imposed. The request shall:

    (a) Be in writing;

    (b) State the reasons for the request; and

    (c) Be made within 10 days of the provider's receipt of the notice of the imposition of the civil money penalty.

  (2) A request for reduction of a civil money penalty does not interrupt the accrual of the penalties under §D of this regulation.

  (3) If a provider properly requests a reduction of a penalty under §I(1) of this regulation, the Department shall confer informally with the provider about whether to reduce the civil money penalty. The Department shall schedule the conference within 14 days of receipt of a request for reduction.

  (4) The Secretary, or the Secretary's designee, shall consider, for the purpose of reducing the civil money penalty, such factors as:

    (a) The provider's history of violations;

    (b) The provider's current and past diligence in correcting violations;

    (c) The number and severity of the violations; and

    (d) Other factors which the Secretary, or Secretary's designee, considers appropriate in the particular circumstances.

  (5) If the Secretary, or Secretary's designee, grants a provider's request for reduction of a civil money penalty, the Secretary, or Secretary's designee, shall impose as a condition on the reduction of the penalty the correction of all violations.

  (6) The Secretary, or Secretary's designee, shall issue a written determination either granting or denying a request for reduction of a civil money penalty and shall state the reasons for the determination.

#### Regulation .33 Appeals.

*COMAR 32.03.04.33*

A. A person aggrieved by a denial of a certificate, a revocation of a certificate, a suspension of a certificate, a refusal to renew a certificate, or by any other action of the Department or the Secretary under this chapter may file a written appeal.

B. An appeal of any action taken by the Department or the Secretary under this chapter shall be conducted in accordance with COMAR 32.01.01 and the Administrative Procedure Act, State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.

C. Unless the Secretary states in writing that a provider may enroll new participants while the provider's appeal of a suspension or revocation of its certificate is pending, the provider may not enroll new participants while the appeal is pending.