COMAR 10.21.04

Chapter 04 Community Mental Health Programs — Group Homes for Adults with Mental Illness

This chapter establishes the licensing requirements for group homes for adults with mental illness in Maryland. Operators must obtain a license from the Department, submit a detailed application including financial documentation, fire safety inspections, and program compliance materials, and meet ongoing standards under related COMAR chapters. The Department may conduct announced and unannounced inspections, and may suspend, revoke, or impose other disciplinary actions on licenses for noncompliance or safety concerns.

Code of Maryland Regulations

Chapter 04 Community Mental Health Programs — Group Homes for Adults with Mental Illness

Administrative History

Effective date: July 25, 1980 (7:15 Md. R. 1424)

Recodified from 
COMAR 10.21.05
 to 
10.21.04

Chapter revised effective October 14, 1991 (18:20 Md. R. 2199)

——————

Chapter, Group Homes for the Mentally Disabled, repealed and new Chapter, Community Mental Health Programs — Group Homes for Adults with Mental Illness, adopted effective October 5, 1998 (25:20 Md. R. 1529)

Authority

Health-General Article, §§10-514 — 10-524 and 10-604, Annotated Code of Maryland

.01 Scope.

This chapter establishes the licensing procedure for group homes for adults with mental disorders.

.02 Definitions.

A.
 In this chapter, terms have the meanings stated in 
COMAR 10.21.17
.

B.
 Definition of Group Home.

(1)
 “Group home” means a community-based residential program that provides services:

(a)
 For individuals who have been or are under treatment for a mental disorder;

(b)
 When possible, in the individual's community of origin; and

(c)
 In a home-like environment.

(2)
 “Group home” means a private group home as defined in Health-General Article, §§10-514(b), (d) — (e) and 10-518(b), Annotated Code of Maryland, as either a:

(a)
 Small private group home, which:

(i)
 Admits at least four but not more than eight individuals; and

(ii)
 Is deemed conclusively a single-family residence and is permitted in all residential zones; or

(b)
 Large private group home, which:

(i)
 Admits at least nine but not more than 16 individuals; and

(ii)
 Is deemed conclusively a multifamily residence and is permitted in zones of similar density.

(3)
 “Group home” does not include a:

(a)
 Foster home that is the domicile of the foster parent; or

(b)
 Facility that is:

(i)
 Owned by or leased to the State or any public agency;

(ii)
 Regulated by the Department of Juvenile Services or Developmental Disabilities Administration; or

(iii)
 Organized wholly or partly to make a profit.

Cross References

10.21.04.04B

.03 Admission Standards.

A.
 A group home may admit an individual if the individual:

(1)
 Has a mental disorder;

(2)
 Because of the mental disorder, requires residential services for assistance and support in community living;

(3)
 Has the ability to understand and states, in writing, willingness to comply with the rules and regulations of the group home; and

(4)
 Is able to take appropriate action, under emergency conditions, for self-preservation.

B.
 A group home may not admit an individual if the individual:

(1)
 Has a primary diagnosis of alcoholism, drug addition, or severe brain damage; or

(2)
 Shows current violent or antisocial behavior.

C.
 If an individual is a Medicaid recipient or an individual for whom, because of the severity of the illness and financial need, the cost of care is subsidized through the public mental health system, the individual may be admitted to a group home only if the services are preauthorized by the Administration's administrative services organization (ASO), according to the provisions of COMAR 10.09.70.07.

Cross References

10.21.22.07B

.04 License Required.

A.
 A person shall obtain a license from the Department before operating a group home.

B.
 The Secretary shall grant a license to an applicant to operate a group home, as described in 
Regulation .02 of this chapter
, if the applicant fulfills the requirements for:

(1)
 Licensure under this chapter;

(2)
 Administrative requirements under 
COMAR 10.21.17
;

(3)
 Psychiatric rehabilitation programs under 
COMAR 10.21.21
; and

(4)
 Residential rehabilitation programs under 
COMAR 10.21.22
.

.05 Application Process.

A.
 Consultation. Before submitting an application, an applicant for licensure to operate a group home may request assistance from the Department's designated licensure unit or the appropriate core service agency (CSA) regarding the proper compilation of application materials and completion of the application.

B.
 Application for Licensure. An applicant for licensure for a group home shall:

(1)
 Submit, to the Department's designated licensure unit, a signed, notarized application on the form approved by the Department with the requirement that all questions be answered and all required documents be attached;

(2)
 Include in the application:

(a)
 The applicant's:

(i)
 Name;

(ii)
 Agency affiliation, if any; and

(iii)
 Address;

(b)
 Documentation:

(i)
 Of the applicant's not-for-profit status;

(ii)
 That the applicant has sufficient financial resources or that sufficient resources are available to the applicant for the establishment and operation of the residence;

(c)
 The following information about the property:

(i)
 The street address of the property or, if it has no street address, a description that adequately identifies the location; and

(ii)
 If the applicant does not own the property, the name and address of the owner;

(d)
 The satisfactory reports, not more than 1 year old, of the group home that are required by the local jurisdiction, including, at a minimum:

(i)
 A fire safety inspection report; and

(ii)
 In addition, for a large group home, a health inspection report;

(e)
 Written material that describes how the applicant intends the program to comply with the:

(i)
 Requirements outlined in this chapter;

(ii)
 Administrative requirements outlined in 
COMAR 10.21.17
; and

(iii)
 Programmatic and staffing requirements outlined in 
COMAR 10.21.21
 and 
10.21.22
;

(f)
 When applicable, a letter of intent that explains how the proposed services meet a need identified in the Administration-approved CSA plan; and

(g)
 When applicable, documentation that the program will collaborate with the CSA, as required under 
COMAR 10.21.17.04
;

(h)
 Documentation that the group home:

(i)
 Is compatible with the nature and character of the area involved;

(ii)
 Is near transportation facilities; and

(iii)
 Meets or, on completion, will meet general zoning requirements regarding size, density, land use, and architectural guidelines that apply to the location;

(3)
 Submit with the application a copy of the residential specialist's certificate of approval of the residence, as granted under the provisions of 
COMAR 10.21.22
; and

(4)
 Forward a copy of the:

(a)
 Application cover letter to the Administration; and

(b)
 Application to the:

(i)
 CSA, if the jurisdiction in which the program is to be located is served by a CSA; or

(ii)
 Health officer, if the jurisdiction in which the program is to be located is not served by a CSA.

Cross References

10.21.04.06A(1)

10.21.04.07A(3)(a)

.06 Licensure.

A.
 Initial License.

(1)
 Within 90 days of receipt of an application completed according to 
Regulation .05B of this chapter
, the Department's designated licensure unit:

(a)
 Shall:

(i)
 Evaluate the application;

(ii)
 Meet with the applicant; and

(iii)
 Conduct an on-site review to inspect the physical plant and evaluate the proposed group home; and

(b)
 May ask the group home program director to submit a program improvement plan regarding deficiencies cited by the licensure unit.

(2)
 Based on the evaluation conducted under §A(1)(a) and the results of the plan under 
§A(1)(b) of this regulation
, the Secretary shall either:

(a)
 Issue a license for a period of 2 years, if the group home:

(i)
 Has no deficiencies that constitute a threat to the health, safety, or welfare of the individuals served; and

(ii)
 Complies with the requirements outlined in this chapter and 
COMAR 10.21.17
, 
10.21.21
, and 
10.21.22
; or

(b)
 Propose to deny a license.

(3)
 If the Secretary takes the action in 
§A(2)(b) of this regulation
, the Secretary shall advise the applicant of hearing rights, as described in 
Regulation .12 of this chapter
.

B.
 Renewal License.

(1)
 If a group home licensee proposes to continue to operate, the licensee shall file an application for renewal:

(a)
 At least 60 days before the expiration of the current license;

(b)
 With the Department's designated licensure unit, with copies to the CSA and the Administration; and

(c)
 On the form approved by the Department with the requirement that all questions be answered and all required documents be attached.

(2)
 Upon receipt of an application for renewal, the Department's designated licensure unit:

(a)
 Shall conduct an on-site evaluation of the group home; and

(b)
 May ask the group home program director to submit a program improvement plan regarding deficiencies cited by the licensure unit.

(3)
 Based on the evaluation under §B(2)(a) and the results of the plan under 
§B(2)(b) of this regulation
, the Secretary shall either:

(a)
 Issue a license for a period of 2 years, if the group home:

(i)
 Has operated satisfactorily under the current license; and

(ii)
 Complies with the requirements outlined in this chapter and 
COMAR 10.21.17
, 
10.21.21
, and 
10.21.22
; or

(b)
 Propose to deny a license.

(4)
 If the Secretary takes the action in 
§B(3)(b) of this regulation
, the Secretary shall advise the applicant of hearing rights, as described in 
Regulation .12 of this chapter
.

C.
 Waivers and Variances.

(1)
 Waivers. The Secretary may not waive the requirements of any regulation adopted under this chapter.

(2)
 Variances.

(a)
 The Secretary may grant a variance to a regulation if the Secretary:

(i)
 Receives a written request from a program; and

(ii)
 Finds that the intent of the regulation to which a variance is sought is met by the alternative proposed by the program.

(b)
 The Secretary may not grant a variance that would endanger the health or safety of the individuals served.

(c)
 The Secretary may grant a variance that:

(i)
 Remains in effect for as long as the program continues to comply with the conditions under which the variance is granted; or

(ii)
 Is time limited.

(d)
 The Secretary shall issue a written decision, including the reason or reasons for granting or not granting the variance, and shall:

(i)
 Send the decision to the program for inclusion in the program's official file; and

(ii)
 Enter the decision in the records of the Department.

.07 Deemed Status.

A.
 Request for Deemed Status. If a group home is licensed by the Department and is accredited by the Joint Commission on the Accreditation of Health Care Organizations (JCAHO) or the Rehabilitation Accreditation Commission (CARF), the governing body of the group home may request that the Secretary grant the group home deemed status by submitting a written request:

(1)
 At least 90 days before the expiration of the group home's license;

(2)
 To the:

(a)
 Administration;

(b)
 CSA, if the jurisdiction in which the program is to be located is served by a CSA; and

(c)
 Health officer, if the jurisdiction in which the program is to be located is not served by a CSA; and

(3)
 That includes the:

(a)
 Application required under 
Regulation .05B of this chapter
; and

(b)
 Accreditation body's full report including the group home's status and any conditions placed on the group home.

B.
 Evaluation of Request for Deemed Status. Within 30 calendar days of receipt of the request under 
§A of this regulation
:

(1)
 The Administration, in consultation with the CSA:

(a)
 Shall evaluate the:

(i)
 Application;

(ii)
 Report of the accreditation body; and

(iii)
 Most recent report by the Department's designated licensure unit;

(b)
 May meet with the applicant; and

(c)
 May arrange for an on-site evaluation; and

(2)
 The Director shall recommend to the Secretary a decision regarding deemed status, based on:

(a)
 Comparison of the standards used by the accreditation body with the requirements outlined in 
COMAR 10.21.17
, 
10.21.21
, 
10.21.22
, and this chapter; and

(b)
 The results of an on-site evaluation, if any.

C.
 Decision Regarding Deemed Status. Based on the evaluation of the request for deemed status conducted under 
§B of this regulation
, within 45 calendar days of completion of the evaluation, the Secretary shall:

(1)
 Decide, whether to:

(a)
 Grant deemed status;

(b)
 Grant deemed status with conditions, which may include evaluation by the Department's designated licensure unit; or

(c)
 Propose to deny deemed status; and

(2)
 Send notice of the proposed decision to the:

(a)
 Department's designated licensure unit;

(b)
 Governing body;

(c)
 Group home director;

(d)
 Administration; and

(e)
 As applicable, either the CSA director or health officer.

D.
 Proposal to Deny Deemed Status.

(1)
 If the Secretary proposes to deny approval of deemed status, the Secretary shall give written notice of the proposed denial to those listed in 
§C(2) of this regulation
.

(2)
 In the notice under 
§D(1) of this regulation
, the Secretary shall include:

(a)
 The date that the Secretary proposes to deny approval of deemed status;

(b)
 Location, including street address, to which the proposed denial applies;

(c)
 The facts that warrant the proposed denial; and

(d)
 Notification that, before the denial, the program has a right to a hearing.

(3)
 Upon receipt of the notice under 
§D(2) of this regulation
, the chairman of the governing body may:

(a)
 Withdraw the request for deemed status; and

(b)
 Request an on-site review for approval by the Department's designated licensure unit.

(4)
 If the governing body does not take the action under 
§D(3) of this regulation
 and if, after notice and opportunity to be heard, the Secretary denies approval of deemed status, the Director shall notify the governing body that, unless the program elects not to seek approval, the Department's designated approval unit shall conduct an on-site review for the purpose of granting or denying a license.

.08 Program Inspection and Investigation by the Department.

A.
 The Department may make announced and unannounced visits to a group home.

B.
 If the Department receives information that the safety or welfare of an individual served is in jeopardy, the Department shall promptly:

(1)
 Conduct and document an investigation; and

(2)
 Based on the investigation under 
§B(1) of this regulation
, take appropriate action, including:

(a)
 Outlining the requirements for the group home to correct the problems identified; or

(b)
 Initiating any of the following:

(i)
 Emergency suspension, under the provisions of 
Regulation .09B of this chapter
;

(ii)
 Disciplinary action, including suspension, revocation, probation, or banning new admissions under the provisions of 
Regulation .09C of this chapter
; or

(iii)
 Receivership, under the provisions of 
Regulation .11 of this chapter
.

.09 Denial and Emergency Suspension of Licensure and Disciplinary Action.

A.
 Denial of License.

(1)
 If the Secretary proposes to deny a license to an applicant under the provisions of this chapter, the Secretary shall give written notice of the proposed denial to the:

(a)
 Chairman of the governing body;

(b)
 Program director;

(c)
 Administration; and

(d)
 As applicable, either the CSA director or the health officer.

(2)
 In the notice under 
§A(1) of this regulation
, the Secretary shall include:

(a)
 The date on which the Secretary proposes to deny the license;

(b)
 Location, including street address, to which the proposed denial applies;

(c)
 The facts that warrant the proposed denial of the license;

(d)
 Citation of the regulation or regulations upon which the proposed denial is based; and

(e)
 Notification that, before the deprivation of a license, the group home may request a hearing under the provisions of 
Regulation .12 of this chapter
.

(3)
 If, after notice and opportunity to be heard, the Secretary denies a license to a group home, the governing body shall assure that, within 10 working days, the program director:

(a)
 Notifies the residents in the group home of the denial;

(b)
 When appropriate, notifies the CSA or the Administration of the denial and cooperates with the CSA or the Administration in accessing appropriate alternate housing for individuals in the group home; and

(c)
 Ceases operations of the group home.

B.
 Emergency Suspension of License.

(1)
 Pursuant to 
State Government Article, §10-226, Annotated Code of Maryland
, upon findings of conditions that pose an imminent risk to the health, safety, or welfare of an individual served by a group home, the Secretary may order the immediate suspension of the license of the group home and the cessation of operations.

(2)
 If the Secretary takes the action under 
§B(1) of this regulation
, the Secretary shall promptly give written notice of the proposed emergency suspension to the:

(a)
 Chairman of the governing body;

(b)
 Program director;

(c)
 Administration; and

(d)
 As applicable, either the CSA director or the health officer.

(3)
 In the notice under 
§B(2) of this regulation
, the Secretary shall include:

(a)
 The effective date of the emergency suspension;

(b)
 Location, including street address, to which the emergency suspension applies;

(c)
 The findings under 
§B(1) of this regulation
 and the reasons that support the findings;

(d)
 Notification that:

(i)
 Following the emergency suspension, the group home may request a hearing under the provisions of 
Regulation .12 of this chapter
; and

(ii)
 The emergency suspension may lead to revocation of the license if the violation or violations are not corrected within the time period specified by the Department.

(4)
 If the Secretary suspends the license, the governing body shall assure that the program director immediately takes the action described under 
§A(3) of this regulation
.

C.
 Disciplinary Action.

(1)
 The Secretary may propose to take any of the following disciplinary actions against the license to operate a group home:

(a)
 Revocation;

(b)
 Suspension;

(c)
 Probation, with conditions; or

(d)
 Banning new admissions.

(2)
 The Secretary may propose to take one of the actions outlined in 
§C(1) of this regulation
 if the group home:

(a)
 Is out of compliance with the requirements of this chapter; or

(b)
 Obtains or attempts to obtain licensure by fraud, misrepresentation, or the submission of false information to the Secretary.

(3)
 Within 45 calendar days in advance of the proposed action taken under this regulation, the Secretary shall send written notice of the proposed action to the:

(a)
 Chairman of the governing body;

(b)
 Program director;

(c)
 Administration; and

(d)
 As applicable, either the CSA director or the health officer.

(4)
 In the notice under 
§C(3) of this regulation
, the Secretary shall include:

(a)
 The date on which the Secretary proposes to take action against the license;

(b)
 Location, including street address, to which the proposed action applies;

(c)
 The facts that warrant the proposed action;

(d)
 Citation of the regulation or regulations upon which the proposed action is based; and

(e)
 Notification that, before the action, the group home has the right to request a hearing under the provisions of 
Regulation .12 of this chapter
.

(5)
 If, after notice and opportunity to be heard, the Secretary takes disciplinary action, the governing body shall assure that, within 10 working days, the program director takes the action described under 
§A(3) of this regulation
.

Cross References

10.21.04.08B(2)(b)(i)

10.21.04.08B(2)(b)(ii)

10.21.04.10B

.10 Group Home Request.

If a group home requests that licensure be discontinued:

A.
 The Secretary shall discontinue licensure; and

B.
 The governing body shall assure that, within 10 working days, the program director takes the action described under 
Regulation .09A(3) of this chapter
.

.11 Initiation of Receivership.

The Secretary may take action to initiate receivership under the provisions of Health-General Article, §§19-333 — 19-339, Annotated Code of Maryland.

Cross References

10.21.04.08B(2)(b)(iii)

.12 Procedures for Hearings.

A.
 Within 10 working days of receipt of notification that the Secretary proposes to deny approval or initiate disciplinary action, the chairman of the governing body may file a written request for a hearing with the Office of Administrative Hearings, with copies to the:

(1)
 Administration;

(2)
 CSA director; and

(3)
 Director of the Department's designated licensure unit.

B.
 If the chairman of the governing body does not file a request for hearing that is post-marked within 10 working days of receipt of the notification, the group home waives the right to request a hearing, and the Secretary may effect the proposed action.

C.
 If a timely request for hearing has been received, the Office of Administrative Hearings shall:

(1)
 Notify the director and the chairman of the governing body of the date, time, and location of the hearing; and

(2)
 Hold a hearing and render a proposed decision to the Secretary in accordance with 
COMAR 28.02.01
.

D.
 After giving parties the opportunity to file exceptions under the provisions of 
State Government Article, §10-216, Annotated Code of Maryland
, the Secretary shall issue a final decision according to 
State Government Article, §10-221, Annotated Code of Maryland
, and send notice of the decision to the:

(1)
 Director; and

(2)
 Chairman of the governing body.

E.
 Further Appeal. A group home may appeal any final decision by the Secretary by following the provisions of Health-General Article, §10-524, and 
State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland
.

Cross References

10.21.04.06A(3)

10.21.04.06B(4)

10.21.04.09A(2)(e)

10.21.04.09B(3)(d)(i)

10.21.04.09C(4)(e)