Maryland Department of Health 10.63.08 Recovery Residence Certification (COMMUNITY-BASED BEHAVIORAL HEALTH PROGRAMS AND SERVICES)

PROPOSAL

Maryland Register

Issue Date: November 13, 2017

Volume 44• Issue 23 • Pages 1108—1114

Title 10
MARYLAND DEPARTMENT OF HEALTH

Subtitle 63 COMMUNITY-BASED BEHAVIORAL HEALTH PROGRAMS AND SERVICES

10.63.08 Recovery Residence Certification

Authority: Health-General Article, §§7.5-205 and 19-2501—19-2504, Annotated Code of Maryland

Notice of Proposed Action

[17-281-P]

The Secretary of Health proposes to adopt new Regulations .01—.14 under a new chapter, COMAR 10.63.08 Recovery Residence Certification.

Statement of Purpose

The purpose of this action is to establish criteria for the Maryland Department of Health to approve a credentialing entity to develop and administer a certification process for recovery residences.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. To certify all recovery residences (not just those funded by the Behavioral Health Administration), general fund expenditures will increase by $251,472 in fiscal year 2018 and by at least $271,534 annually thereafter.

	Revenue (R+/R-)
II. Types of Economic Impact.	Expenditure (E+/E-)	Magnitude


A. On issuing agency:	(E+)	$251,472
B. On other State agencies:	NONE
C. On local governments:	NONE

	Benefit (+) Cost (-)	Magnitude


D. On regulated industries or trade groups:	NONE
E. On other industries or trade groups:	NONE
F. Direct and indirect effects on public:	NONE
III. Assumptions. (Identified by Impact Letter and Number from Section II.)
A. In order to complete the inspections of the recovery residences throughout the state, five additional staff would be required to do field assessments. The total cost of the five field assessors, inclusive of a computerized system in fiscal year 2018 would be $251,472 in general funds and at least $271,534 in fiscal years thereafter. In order to process and track the applications for certification of new and existing recovery residences, a computerized system is needed. The cost of a computerized system will initially cost $12,500 and then $1,500 per year in general funds to maintain and host the system

Economic Impact on Small Businesses

The proposed action has minimal or no economic impact on small businesses.

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through December 13, 2017. A public hearing has not been scheduled.

.01 Scope.

This chapter sets forth the requirements and processes for certification that govern recovery residences in order for an individual, partnership, corporation, or other entity to operate a certified recovery residence or to advertise, represent, or imply that a certain residence is a certified recovery residence.

.02 Definitions.

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

B. Terms Defined.

(1) “Certificate of compliance” means a certificate that is issued to a recovery residence by a credentialing entity.

(2) “Certified recovery residence” means a recovery residence that holds a certificate of compliance.

(3) “Credentialing entity” means a nonprofit organization that develops and administers professional certification programs according to nationally recognized certification standards.

(4) “Critical incident” means:

(a) The death of a resident;

(b) A life-threatening injury to a resident;

(c) Nonconsensual sexual activity as prohibited in COMAR 10.01.18;

(d) Pursuant to COMAR 10.01.18.03, any sexual activity between a resident and any one of the following:

(i) A staff member;

(ii) An employee;

(iii) A peer; or

(iv) A volunteer; and

(e) Unexpected evacuation of a recovery residence under circumstances that threaten the life, health, or safety of the residents.

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

(6) “Designated credentialing entity” means the credentialing entity approved by the Department to develop and administer a certification process for recovery residences.

(7) “Good standing” means the status assigned to a member of the Maryland State Association of Recovery Residences (MSARR) that:

(a) Has remained current in the payment of all membership dues and fees; and

(b) Has undergone a housing inspection within 1 year before the date of receipt by the Department’s designated credentialing entity of the application for certification of a recovery residence.

(8) “Grandfathering certification” means a one-time only certificate of compliance that:

(a) Is issued to a recovery residence certificate applicant in good standing; and

(b) Expires 1 year from its date of issuance.

(9) “Health professional” means an individual who:

(a) Is licensed under Health Occupations Article, Annotated Code of Maryland; and

(b) Is providing mental health or substance-related disorder services according to the requirements of the appropriate professional board.

(10) “Initial certification” means a certificate of compliance issued to an applicant for a new recovery residence certificate, pursuant to Regulation .06C(1) of this chapter.

(11) “Level I recovery residence” means a peer-run recovery residence that:

(a) Provides a shared living environment;

(b) Does not employ staff; and

(c) Offers self-help, drug screening, and house meetings as recovery supports.

(12) “Level II recovery residence” means a staff-monitored recovery residence that:

(a) Has a house manager to provide oversight of the residence;

(b) Provides a structured, shared living environment; and

(c) Offers self-help, drug screening, house meetings, peer run groups, and referral to community resources as recovery supports.

(13) “Level III recovery residence” means a staff-supervised recovery residence that:

(a) Has an organizational hierarchy that provides administrative oversight of the residence, staff, and operations;

(b) Provides a highly structured environment for residential support and stability;

(c) Employs a facility manager and at least one case manager; and

(d) Offers a life skills development curriculum and recovery supports on-site.

(14) “Level IV recovery residence” means a recovery residence operated by a provider that is certified or licensed by the Department to deliver behavioral health services and that:

(a) Has an organizational hierarchy that provides administrative and clinical oversight of the residence, staff, operations, and services;

(b) Provides a highly structured and supervised environment for clinical stability and residential support;

(c) Employs licensed or certified staff who are located on-site at the residence; and

(d) Offers clinical treatment and recovery support services on-site at the residence or in conjunction with the certified or licensed provider operating the residence.

(15) “Local addiction authority (LAA)” means the designated county or multicounty authority that is responsible for planning, managing, and monitoring publicly funded substance-related and addictive disorder services.

(16) “Local behavioral health authority (LBHA)” means the designated county or multicounty authority that is responsible for planning, managing, and monitoring publicly funded mental health, substance-related and addictive disorder services.

(17) “Maryland State Association of Recovery Residences (MSARR)” means the Statewide membership organization that, before the effective date of this regulation, collected annual membership dues and fees, performed annual and ad hoc housing inspections, and granted membership to recovery residences that met certain quality standards.

(18) “National Alliance for Recovery Residences (NARR)” means the nonprofit recovery community organization that establishes and promulgates national quality standards for recovery residences.

(19) “Oxford House” means a Level I recovery house that:

(a) Has been granted a charter by Oxford House, Inc.; and

(b) Is organized and operates in accordance with the Oxford House model and system of operations.

(20) “Provisional certification” means a certificate of compliance effective for a specific length of time not to exceed 6 months, issued to an applicant for a recovery residence certificate, pursuant to Regulation .06C(2), D(2), or E(3)(b) of this chapter.

(21) “Recovery residence” means a service that provides alcohol-free and illicit-drug-free housing to individuals with substance-related disorders or addictive disorders, or co-occurring mental health, substance-related, or addictive disorders.

(22) “Renewal certification” means a certificate of compliance issued to an applicant for an existing certified recovery residence, pursuant to Regulation.06D(1) or E(3)(a) of this chapter.

.03 Certification Required or Exempted.

A. Except as provided in §C of this regulation, a recovery residence shall be certified by the credentialing entity designated by the Department in order to operate in Maryland, if the residence:

(1) Receives State funds;

(2) Operates as a certified recovery residence;

(3) Is advertised by any individual, partnership, corporation, or other entity as being a certified recovery residence;

(4) Is represented by any individual, partnership, corporation, or other entity as being a certified recovery residence; or

(5) Has been implied to the public to be a certified recovery residence.

B. A separate certificate is required for each residence that is subject to certification pursuant to §A of this regulation.

C. A chartered Oxford House, operating in accordance with its charter, is exempt from the requirements of and is not required to be certified under this chapter in order to operate in Maryland, as stipulated in §A in this regulation.

.04 Application Process for Certification of Recovery Residences.

A. An applicant for a specified certificate of compliance for a recovery residence shall submit an application to the credentialing entity designated by the Department that:

(1) Is on the written or electronic form approved by the Department;

(2) Contains full, complete, and accurate information;

(3) Is specific to each residence that is subject to certification pursuant to Regulation .03A of this chapter;

(4) Includes, as applicable, the following documentation, verification, or attestation:

(a) That the residence is or will be owned or leased by the applicant;

(b) Of written permission from the property owner of record, if other than the applicant, to operate a recovery residence on the owner’s property;

(c) Of fire, liability, and hazard insurance coverage on the building in which the residence is located;

(d) Of compliance with relevant federal, State, or local ordinances, laws, regulations, and orders, including but not limited to:

(i) Health and safety;

(ii) Building and occupancy;

(iii) Fire codes; and

(iv) Zoning requirements;

(e) Of the type of legal business entity that has been established by the applicant; and

(f) For a renewal certificate of compliance, of completion by the owner or operator, staff, volunteers, and peers of trainings mandated by the Department; and

(5) Includes a copy of all applicable program materials, including the following:

(a) A manual containing, at a minimum, policies and procedures as specified by the Department and consistent with the NARR 2015 quality standards or their successor;

(b) A written mission statement that is congruent with the NARR 2015 quality standards or their successor;

(c) A written vision statement that is congruent with the NARR 2015 quality standards or their successor;

(d) An affidavit that attests to the compliance of the recovery residence with nondiscriminatory State and federal requirements as set forth in Regulation .08L of this chapter;

(e) A detailed and specific description of the level of services and recovery supports provided;

(f) Marketing and promotional materials;

(g) Detailed staff, employee, volunteer, and peer job descriptions and a sample weekly schedule;

(h) A resident orientation handbook containing elements as specified by the Department and consistent with the NARR 2015 quality standards or their successor;

(i) A sample resident service agreement that, at a minimum, specifies:

(i) Terms of occupancy;

(ii) Financial obligations, including any fees, charges, or rents that may accrue to the resident and the process, time frame, and requirements for the collection of such obligations;

(iii) Financial deposits that may be collected, if any, and the time frame, process, and requirements for the return of such deposits; and

(iv) Any circumstances under which the resident may be entitled to a refund of any amount for financial obligations collected by the recovery residence, if applicable;

(j) A safety self-assessment checklist;

(k) An emergency preparedness plan that, at a minimum, includes:

(i) Emergency contact numbers;

(ii) An evacuation plan and map;

(iii) An emergency relocation plan that specifies where residents may live temporarily; and

(iv) A continuity of operations plan; and

(l) If applicable, any forms, documents, and guides used to mentor each resident or monitor each resident’s participation in the development of the resident’s recovery plan.

B. In addition to meeting the requirements set forth in §A of this regulation, any applicant that is not licensed or certified by the Department or one of its Administrations or registered with or otherwise accredited by or affiliated with an authority that is approved by the Department at the time of application shall disclose the following with the application:

(1) Any revocation or surrender of a prior license, certificate, or approval issued within the previous 5 years from any in-State or out-of-State provider previously or currently associated with the applicant, along with any associated deficiency reports and compliance records;

(2) Whether the applicant, or a program, corporation, or provider previously or currently associated with the applicant, has surrendered or defaulted on its license, certificate, or approval, within the previous 5 years, for reasons related to disciplinary action and the nature of the disciplinary action;

(3) The identity of any individual employee, staff member, peer, or volunteer currently associated with the applicant who has had a professional license or certification revoked or suspended or has surrendered a professional license or certification for reasons related to disciplinary action or misconduct, within the previous 10 years, and the nature of the disciplinary action or misconduct; and

(4) The identity of any staff member, employee, peer, or volunteer currently associated with the applicant that has been convicted of a felony, within the previous 10 years, and the nature of the felony.

C. If the application submitted under §A of this regulation is incomplete or missing any of the information or documentation required by this regulation, the Department shall:

(1) Promptly returned the application to the applicant for the applicant to provide the missing information or documentation; and

(2) Stop processing the application until the information or documentation is received.

D. For an applicant with a current certificate of compliance, the applicant shall submit an application to the credentialing entity designated by the Department not later than 90 calendar days before the expiration of the current certificate of compliance.

.05 Application Review and Inspection.

A. Review of a Recovery Residence Application.

(1) On receipt of an application for a specified certificate of compliance for a recovery residence, the credentialing entity shall review the application for completeness and accuracy.

(2) If an application is complete and accurate:

(a) The credentialing entity shall arrange for inspection of the residence; or

(b) The credentialing entity shall accept the inspection conducted by MSARR for applications for grandfathering certificates.

(3) If an application is incomplete or inaccurate, the credentialing entity:

(a) Shall promptly return it to the applicant with written instructions regarding proper completion and resubmission of the application within a specified time frame; and

(b) May conduct, or delegate a designee to conduct, a pre-inspection site visit.

B. Inspection of a Recovery Residence. Upon receipt of an application that is determined to be complete and accurate, the Department’s designated credentialing entity or its designee, in collaboration with a representative of the applicant, shall inspect the recovery residence for compliance with the NARR 2015 quality standards or their successor.

C. The Department’s designated credentialing entity or its designee may conduct an inspection of the residence at any time without prior notice, including inspecting and copying financial and resident records.

.06 Approval or Denial of the Application for a Specified Certificate of Compliance.

A. Based on a review of the application and documentation submitted pursuant to Regulation .04A and B of this chapter and the inspection conducted under Regulation .05 of this chapter, the Department’s designated credentialing entity shall grant or deny approval of the application for a specified certificate of compliance for a recovery residence.

B. Grandfathering Certification. Pursuant to §A of this regulation, the Department’s designated credentialing entity shall:

(1) Grant approval of the application for grandfathering certification of a recovery residence if the applicant is a MSARR member in good standing; or

(2) Deny approval of the application for grandfathering certification if the applicant:

(a) Is not a MSARR member; or

(b) Is a MSARR member that is not in good standing.

C. Initial Certification. Pursuant to §A of this regulation, the Department’s designated credentialing entity shall:

(1) Grant approval of the application for initial certification of a recovery residence in the following circumstances:

(a) The applicant does not hold a current certificate of compliance; and

(b) The applicant is in substantial compliance with the NARR 2015 quality standards or their successor;

(2) Grant provisional approval of the application for initial certification of a recovery residence in the following circumstances:

(a) The credentialing entity has identified deficiencies with respect to specific NARR 2015 quality standards or their successor; and

(b) The identified deficiencies do not pose an imminent risk to the health, safety, or welfare of a resident; or

(3) Deny approval of the application for an initial certification of a recovery residence in the following circumstances:

(a) The applicant is in substantial noncompliance with the NARR 2015 quality standards or their successor;

(b) One or more deficiencies have been identified that pose an imminent risk to the health, safety, or welfare of the residents;

(c) An individualized assessment of the nature and gravity of the facts disclosed under Regulation .04B of this chapter reveals that there would be an unreasonable risk of harm to the residents if the certificate were granted; or

(d) The applicant has previously discontinued operations of a recovery residence without complying with the provisions of Regulation .10 of this chapter.

D. Renewal Certification. Pursuant to §A of this regulation, the Department’s designated credentialing entity shall:

(1) Grant approval of the application for renewal certification of a recovery residence in the following circumstances:

(a) The applicant holds a current certificate of compliance and is in substantial compliance with the NARR 2015 quality standards or their successor; or

(b) Subsequent to the issuance of a provisional certificate of compliance, the identified deficiencies on the basis of which the provisional certificate was granted have been fully and satisfactorily remediated;

(2) Grant provisional approval of the application for renewal certification of a recovery residence if:

(a) The credentialing entity has identified deficiencies with respect to specific NARR 2015 quality standards or their successor; and

(b) The identified deficiencies do not pose an imminent risk to the health, safety, or welfare of a resident; or

(3) Deny approval for an application for a renewal certification of a recovery residence in the following circumstances:

(a) The applicant is in substantial noncompliance with the NARR 2015 quality standards or their successor;

(b) One or more deficiencies have been identified that pose an imminent risk to the health, safety, or welfare of the residents;

(d) The applicant has discontinued operations of a recovery residence without complying with the provisions of Regulation .10 of this chapter; or

(e) The identified deficiencies on the basis of which a second, consecutive provisional certificate has been issued have not been fully and satisfactorily remediated.

E. Considerations for Provisional Approval.

(1) If the Department’s designated credentialing entity has issued two consecutive provisional certificates of compliance, the second provisional certificate shall expire at the end of the duration of the certificate and the recovery residence may not be eligible for a third consecutive provisional certificate of compliance.

(2) If the Department’s designated credentialing entity has issued a provisional certificate of compliance under Regulation .07B of this chapter, except as provided in §E(1) of this regulation, before the expiration of the provisional certificate, the owner or operator of the recovery residence shall:

(a) Provide documentation to the credentialing entity that demonstrates that the identified deficiencies have been eliminated; and

(b) At the discretion of the credentialing entity, submit to a re-inspection of the residence.

(3) Following review of documentation submitted under §E(2)(a) of this regulation and, as applicable, the inspection conducted under §E(2)(b) of this regulation, the Department’s designated credentialing entity shall:

(a) Grant approval of the recovery residence, if the identified deficiencies on the basis of which the provisional certification was granted have been fully and satisfactorily remediated;

(b) Except as provided in §E(1) of this regulation, grant provisional approval of the recovery residence, if, despite the good faith effort of the owner or operator of the recovery residence, the identified deficiencies on the basis of which the provisional certification was granted have been only partially but not fully remediated or have been unsatisfactorily remediated; or

(c) Deny approval of the recovery residence, if the owner or operator has not demonstrated a good faith effort to remediate the identified deficiencies on the basis of which the provisional certification was granted.

.07 Issuance of Approval or Denial of a Certificate of Compliance.

A. If the applicant was granted approval pursuant to Regulation .06B(1), C(1), D(1), or E(3)(a) of this chapter, the Department’s designated credentialing entity shall issue to the applicant the applicable certificate of compliance for a specified recovery residence for the specified duration of time set forth in §F of this regulation.

B. If the applicant was granted provisional approval pursuant to Regulation .06C(2), D(2),or E(3)(b) of this chapter, the Department’s designated credentialing entity shall issue to the applicant a provisional certificate of compliance for a specified recovery residence for the specified duration of time set forth in §F of this regulation.

C. If the applicant was denied approval pursuant to Regulation .06B(2), C(3), D(3), or E(3)(c) of this regulation, the Department’s designated credentialing entity shall issue to the applicant a written notification that the application has been denied and that includes the elements specified in §D of this regulation.

D. A notification to an applicant that its application for a certificate has been denied or that the applicant will receive a provisional certificate shall:

(1) Identify each deficiency, the applicable standard, the facts demonstrating the failure to comply with the standard, and the specific basis for the finding of failure to comply;

(2) Notify the applicant of the appeal rights provided in Regulation .13 of this chapter; and

(3) Solely for a notification of denial, notify the applicant of the obligation of the owner or operator to facilitate the move-out contingency plan, as required by Regulation .08C(3) of this chapter.

E. A certificate of compliance issued by the Department’s designated credentialing entity shall specify the following:

(1) Name of the recovery residence;

(2) Business name of the organization or entity that owns and operates the recovery residence;

(3) Number of beds permitted under the certificate;

(4) Gender designation of the beds;

(5) Address of the recovery residence;

(6) Type of certification:

(a) Initial;

(b) Grandfathering;

(c) Renewal; or

(d) Provisional;

(7) Level of recovery support provided:

(a) Level I Recovery Residence: Peer-run;

(b) Level II Recovery Residence: Monitored;

(c)Level III Recovery Residence: Supervised; or

(d) Level IV Recovery Residence: Service Provider;

(8) Duration of the certificate of compliance;

(9) Date of issue; and

(10) Certificate number.

F. Duration of the certificate of compliance:

(1) For initial certificates of compliance, shall equal 1 year from the date of issue;

(2) For grandfathering certificates, shall equal 1 year from the date of expiration of the MSARR approval;

(3) For renewal certificates, shall equal 1 year from the date of expiration of the current certificate of compliance; and

(4) For provisional certificates, shall equal not longer than 6 months from the date of:

(a) Issue for new applicants; or

(b) Expiration of the current certificate of compliance for continuing applicants.

G. Expiration of the Certificate of Compliance. If the owner or operator of the recovery residence fails to comply with the requirements of Regulation .04D of this chapter, the current certificate of compliance:

(1) Shall expire at the end of the duration of the certificate as specified in §E(8) of this regulation; and

(2) May not be subject to extension pursuant to §H of this regulation.

H. Extension of Certificate of Compliance of a Recovery Residence. If the credentialing entity does not complete a site inspection before the expiration of the certificate of compliance, the designated credentialing entity shall issue a written notification to the owner or operator of the recovery residence of an extension of the certificate of compliance until the designated credentialing entity is able to conduct a site inspection of the recovery residence.

I. Notification and Dissemination. The Department’s designated credentialing entity shall:

(1) Notify the LAA or LBHA of any recovery residence:

(a) Issued or denied a valid certificate pursuant to §A or C of this regulation; or

(b) For which a valid certificate of compliance has been revoked pursuant to Regulation .11 of this chapter; and

(2) Publish on the Department’s website a list:

(a) Of each recovery residence operating in each county in the State, or Baltimore City, that holds a valid certificate of compliance pursuant to §A or B of this regulation; and

(b) Including the following information:

(i) The name of the certified recovery residence;

(ii) The name of the owner and operator of the certified recovery residence; and

(iii) The contact information of the owner and operator.

.08 Recovery Residence Operations.

A. Intake. Within 10 working days of receipt of an accurate and complete referral for a recovery residence, the owner or operator or designee of the owner or operator shall:

(1) Conduct an intake to determine whether the individual who has been referred is appropriate for the recovery residence; and

(2) Either:

(a) If the owner or operator determines that the individual who has been referred is appropriate for the recovery residence, inform the individual in writing of admission into the recovery residence and the date by which the recovery residence may be occupied; or

(b) If the owner or operator determines that the individual who has been referred is not appropriate for the recovery residence, in writing:

(i) Inform the individual of the determination and the reason;

(ii) Provide the individual with recommendations for alternative housing or treatment services, as warranted; and

(iii) With proper consent, notify the referral source, the family, or others designated by the individual of the determination and of any recommendations for alternative housing or treatment services.

B. Orientation. On or before the date that an individual occupies the residence, the owner or operator shall:

(1) Ensure that the individual receives verbally and in writing, at a minimum, the following information:

(a) A description of services and recovery supports provided;

(b) A statement of resident rights, responsibilities, and house rules;

(c) A description of the complaint and grievance procedures as set forth in §J of this regulation;

(d) A copy of the resident service agreement that, at a minimum, contains the elements specified in Regulation .04A(5)(i) of this chapter;

(e) Policy and protocols for the disposition of resident possessions left at the residence following resident move-out;

(f) Policy and protocols for protecting the privacy and confidentiality of personally identifiable information;

(g) Policy and protocols for addressing resident alcohol and prohibited drug use or seeking behaviors;

(h) Resident drug screening and toxicology policy and protocols;

(i) Prescription and nonprescription medication usage and storage policy and protocols;

(j) Policy and protocols regarding the possession of hazardous and prohibited items and the associated circumstances under which an individual or property may be searched;

(k) Policy and protocols specifying the circumstances under which a resident may be asked to involuntarily vacate the residence; and

(l) Emergency contact numbers, procedures, and evacuation map;

(2) Document the resident’s signed receipt of the information contained in §B(1) of this regulation; and

(3) Exercise reasonable prudence to ensure that the prospective resident understands the information in §B(1) of this regulation before the resident’s signing the resident service agreement.

C. Recovery Plan. Within 10 working days of the resident’s occupancy of the residence, the owner or operator or designee of the owner or operator shall mentor each resident or monitor each resident’s participation in the development of an individualized recovery plan that, at a minimum, contains the following elements:

(1) Goals and objectives;

(2) Services and supports to be provided; and

(3) An individualized move-out contingency plan that specifies where the resident may safely live if the resident is no longer able to live in the recovery residence.

D. Recovery Residence Record Requirements: The Recovery Residence owner or operator shall:

(1) Develop, organize, and maintain original copies of applicable program materials as specified in Regulation .04A(5) of this chapter;

(2) Implement a manual or electronic accounting system that records all resident financial transactions with the owner or operator of the recovery residence; and

(3) Produce account statements within 5 working days of the request of the resident.

E. Resident Record Requirements.

(1) The recovery residence owner or operator shall, either manually or electronically, establish a record for each resident.

(2) The owner or operator shall ensure that individuals’ records are:

(a) Maintained in a manner that protects confidentiality of resident information;

(b) Located so that the records are convenient and available to designated staff or reviewers;

(c) Appropriately stored, secured, and indexed; and

(d) Subject to the requirements of confidentiality laws and regulations, made available to carry out required activities of the:

(i) Department;

(ii) The Department’s designated credentialing entity; and

(iii) The LAA or LBHA.

F. Contents of Resident Record. For each resident, the recovery residence shall maintain a record that contains, at a minimum:

(1) Identifying information, including but not limited to:

(a) Name, sex, race, marital status, and date of birth of the individual;

(b) Address and telephone number; and

(c) As permitted by law, Social Security number;

(2) If available, the names, addresses, and telephone numbers of at least two individuals to be contacted in case of emergency;

(3) Documentation of any current medical conditions or allergies;

(4) Documentation of any prescribed or over the counter medications that the resident is taking, the dosage of each medication, and the frequency with each medication is being taken;

(5) If applicable, names and either addresses or telephone numbers of the individual’s:

(a) Treatment provider;

(b) Care coordinator;

(c) Primary care provider;

(d) Managed care organization; and

(e) Insurance carrier;

(6) The referrals to the recovery residence, including but not limited to:

(a) Source of the referral;

(b) Documentation as to whether the individual has been referred from a behavioral health program or health professional; and

(c) Date of receipt of the referral;

(7) The intake conducted under §A(1) of this regulation and the date of the intake;

(8) The date of admission and resident occupancy as specified in §A(2) of this regulation;

(9) For Level III and Level IV recovery residences, a copy of any referrals from the recovery residence to applicable treatment and service providers, as warranted;

(10) An individualized recovery plan as developed under §C of this regulation;

(11) Documentation that substantiates that the requirements under §B(2) and (3) of this regulation have been met;

(12) A signed resident agreement for the payment and collection of fees, charges, or rents associated with the recovery residence;

(13) An itemized record of resident payment of fees, charges, or rents;

(14) If applicable, critical incident reports pursuant to §G of this chapter; and

(15) Any written notifications to the resident.

G. Critical Incidents. The owner or operator of the recovery residence shall report all critical incidents to the Department or its designee within 5 calendar days following receipt of knowledge of the incident, on the form required by the Department.

H. Criminal Background Investigation.

(1) The owner or operator of the recovery residence shall have and follow a written policy that complies with §F(2) of this regulation regarding the criminal history of any staff member, employee, peer, or volunteer who serves in a staff capacity with the recovery residence and, in that capacity, has direct and regular interaction with residents.

(2) At a minimum, the policy specified in §H(1) of this regulation shall require that, when deciding whether the criminal history of a potential staff member, employee, peer, or volunteer disqualifies the individual from being selected to serve in a staff capacity at the recovery residence, the owner or operator of the recovery residence shall consider:

(a) The age at which the individual committed the crime;

(b) The circumstances surrounding the crime;

(c) Any punishment imposed for the crime, including any subsequent court actions regarding that punishment;

(d) The length of time that has passed since the crime;

(e) Subsequent work history;

(f) Employment and character references; and

(g) Any other evidence that demonstrates whether the staff member, employee, volunteer, or peer poses a threat to the health, safety, or welfare of a resident or a member of the public.

(3) The owner or operator of a recovery residence may not hire or permit to serve in a staff capacity an individual, peer, or volunteer if the owner or operator does not receive and consider the criminal history information required under this regulation.

(4) An individual may not be hired or serve in a staff capacity as an employee, volunteer, or peer:

(a) For a recovery residence with residents younger than 18 years old, if the individual has been convicted at any time of child abuse or child sexual abuse; and

(b) For a recovery residence with residents 18 years old or older, if the individual has been convicted at any time of abuse or neglect of a vulnerable adult.

(5) The criminal background policy may be stricter than required by this regulation, as appropriate, to protect the residents or the public.

(6) The owner or operator shall document and retain in an individual staff record the following:

(a) The review of criminal history records of a potential staff member, employee, peer, or volunteer;

(b) The decision regarding the impact of the criminal history on the fitness or suitability of each individual to serve in a staff capacity at the residence; and

(c) Implementation of the policy required by §H(1) of this regulation.

I. Posting of Information Within the Residence. The owner or operator of the recovery residence shall ensure that the following information is posted in a conspicuous location within the common area of the residence:

(1) A statement of resident rights, responsibilities, and house rules;

(2) A description of the complaint and grievance procedures as set forth in §J of this regulation; and

(3) Emergency contact numbers, procedures, and evacuation map.

J. Complaint Grievance Procedures. The owner or operator shall ensure that:

(1) The description of the complaint and grievance procedures in §§B(1)(c) and I(2) of this regulation contains the following elements:

(a) Steps of the grievance process;

(b) Levels to which the grievance may be taken; and

(c) The right to take unresolved grievances to the oversight authority;

(2) No retaliation against a resident who presents a grievance is taken; and

(3) Each resident is informed of any changes to the resident grievance policy and the nature and extent of the revisions.

K. Involuntary Vacation of the Residence. If a resident poses a risk to the health, safety, and welfare of the individual or others, the owner or operator may ask the individual to vacate the residence, as follows:

(1) If the resident is involuntarily asked to vacate the residence, the owner or operator shall, in writing:

(a) Inform the resident of the determination and the reason for such determination; and

(b) Provide information on alternative housing and treatment options; or

(2) If the owner or operator is unable to provide written notification to the resident due to the nature of the risk, the owner or operator shall document the determination and the reason for the determination in the resident record.

L. Nondiscrimination. A recovery residence may not discriminate on the basis of race, creed, color, gender, sexual orientation, gender identity, national origin, marital status, disabilities, and any other classification prohibited under state or federal law, including:

(1) Americans with Disabilities Act, 42 U.S.C. §12101 et seq.; and

(2) Fair Housing Act, 42 U.S.C. §3804.

.09 Sale or Transfer of a Certificate of Compliance.

A. The certificate of compliance for a recovery residence shall be valid only for the residence and address for which the certificate is issued.

B. If the sale or transfer of a recovery residence causes a change in ownership, the owner or operator may not sell, assign, or transfer its certificate of compliance.

C. The new owner or operator shall apply for an initial certificate of compliance to operate a certified recovery residence pursuant to Regulation .04 of this chapter.

.10 Discontinuation of Operations of a Recovery Residence.

A. If a certified recovery residence intends to discontinue operations, the owner or operator shall submit, not earlier than 60 calendar days before the residence intends to cease operations, to the Department’s credentialing entity, a written plan for:

(1) Cessation of operations, including relevant dates;

(2) Informing residents of the planned discontinuation of operations and of other certified recovery residences and housing options; and

(3) Notifying employees, volunteers, staff, and peers of the cessation of operations.

B. Once the recovery residence is no longer in operation, the owner or operator shall surrender the certificate of compliance to the Department’s designated credentialing entity.

C. If the owner of a recovery residence does not comply with §§A and B of this regulation, the Department may deny any future application for a certificate of compliance that the owner, operator, or principals of the recovery residence may submit.

.11 Revocation of a Certificate of Compliance.

A. If the Department determines that a recovery residence certified under this chapter has violated a requirement of this chapter, the Department may revoke the certificate of compliance.

B. If the Department revokes a recovery residence’s certificate of compliance under this regulation, the Department or its designee shall notify the residents of the recovery residence of the revocation and of other certified recovery residences and housing options.

.12 Civil Money Penalties.

A. The Department may impose on a person a civil money penalty not to exceed $1,000 for each offense for advertising, representing, or implying to the public that a recovery residence that does not possess a current certificate of compliance issued by the Department’s designated credentialing entity is a certified recovery residence.

B. In determining the amount of the civil money penalty to be imposed, the Department shall consider the following factors:

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

(2) The ability of the recovery residence to pay the penalty; and

(3) Any other factors the Department determines are relevant.

.13 Recovery Residence’s Right to a Hearing on Proposed Sanctions.

A recovery residence may submit a request for an administrative hearing in accordance with Regulation .14 of this chapter to appeal any of the following decisions proposed by the Department’s designated credentialing entities:

A. The denial of an application for a certificate of compliance or for a renewal of a certificate of compliance;

B. A revocation of a certificate of compliance under Regulation .11 of this chapter.

C. An issuance of a provisional certificate rather than a certificate of compliance under Regulation .06 of this chapter; or

D. Notice of the imposition of a civil money penalty under Regulation .12 of this chapter.

.14 Hearing Procedures.

A. If the Department’s designated credentialing entity proposes to take an action listed in Regulation .13 of this chapter, the Department shall deliver a written notice of the proposed action to the recovery residence, in accordance with the provisions of COMAR 10.01.03.

B. Within 10 working days after receipt of the notice of proposed action, the recovery residence may submit to the Department, at the address indicated in the notice, a written request for a hearing with copies to the:

(1) Behavioral Health Administration;

(2) LAA or LBHA, as appropriate; and

(3) The Director of the Department’s designated credentialing entity.

C. If the recovery residence does not submit to the Department a hearing request that is postmarked within 10 working days after the date on the notice:

(1) The right of the recovery residence to a hearing is waived; and

(2) The Department’s designated credentialing entity may implement the proposed action.

D. When possible, the Department may offer the recovery residence the opportunity for an informal case resolution conference to attempt to resolve all or some of the deficiencies listed in the notice.

E. Any hearing permitted by this chapter shall follow the procedures set out in COMAR 10.01.03.

DENNIS SCHRADER
Secretary of Health