The Department of Health and Mental Hygiene

These regulations constitute and shall be known as the regulations of the Board of Examiners of Nursing Home Administrators, and are promulgated pursuant to the authority granted to, and imposed upon, the Board under the provisions of Health Occupations Article, § 9-101--9-502, Annotated Code of Maryland.

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

B. Terms Defined.

(1) "Administrator-in-training (AIT)" means an individual approved by the Board pursuant to law and these regulations.

(2) "Administrator-in-training (AIT) program" means the Board-approved program of a minimum of 1 year full-time or 18 months part-time of practical training and experience in nursing home administration.

(3) "Board" means the Board of Examiners of Nursing Home Administrators of Maryland created by Health Occupations Article, §9-201, Annotated Code of Maryland.

(4) "Examination" means the tests consisting of:

(a) Written questions on general nursing facility administration compiled by the National Association of Long Term Care Administrator Boards (NAB examination); and

(b) Written questions on nursing facility licensure State standards of the Office of Health Care Quality (State Standards examination).

(5) "Family-owned or family-operated nursing facility" means a nursing facility owned or operated by any one or more of the following relatives of the trainee:

(a) Spouse;

(b) Father;

(c) Mother;

(d) Son;

(e) Daughter;

(f) Sister;

(g) Brother;

(h) Grandfather;

(i) Grandmother;

(j) Grandchild;

(k) Stepfather;

(l) Stepmother;

(m) Stepchild;

(n) Uncle;

(o) Aunt;

(p) Cousin;

(q) Nephew;

(r) Niece;

(s) Father-in-law;

(t) Mother-in-law;

(u) Brother-in-law;

(v) Sister-in-law;

(w) Son-in-law; or

(x) Daughter-in-law.

(6) "Nursing facility" means a facility, other than a facility offering domiciliary care, as defined in Health Occupations Article, §9-101(e), Annotated Code of Maryland, which offers nonacute inpatient care to patients:

(a) Suffering from a disease, condition, disability, or advanced age, or terminal disease requiring maximal nursing care without continuous hospital services; and

(b) Who require medical services and nursing services rendered by or under the supervision of a licensed nurse together with convalescent services, restorative services, or rehabilitative services.

(7) "Nursing home administrator" means an individual licensed by the Board, who:

(a) Administers, directs, manages, supervises, or is in general administrative charge of a nursing facility, whether or not the individual has an ownership interest in the facility, and whether or not the individual's functions and duties are shared with one or more individuals; or

(b) Is in supervisory control over one or more nursing home administrators of one or more nursing facilities and has authority to substitute the supervisor's judgment for that of the administrator of record in the day-to-day operation of the facility.

(8) "Person" means any individual, company, corporation, or association.

(9) "Practice of nursing home administration" means the exercise of final authority of any act or the making of any decision involved in the planning, organizing, directing, or controlling of the day-to-day operation of a nursing facility.

(10) "Preceptor" means an individual certified to serve as an instructor in an AIT program, pursuant to the law and these regulations.

A. The Board shall hold at least eight regular meetings each year.

B. The Chairman, or other presiding officer of the Board, may call special meetings of the Board, when, in the Chairman's judgment, circumstances or functioning of the Board require it. Special meetings shall be called upon written request of three or more members of the Board.

C. At any meeting a majority of the full authorized membership of the Board shall constitute a quorum.

A. The Board shall exercise the powers provided by the laws of this State pertaining to the licensing and license renewal of nursing home administrators.

B. Board members or designees may enter any nursing facility in the State in order to carry out its functions under Health Occupations Article, §9-205, Annotated Code of Maryland.

C. The Board shall have access to the licensing file of any nursing facility in order to carry out its functions under Health Occupations Article, §9-205, Annotated Code of Maryland.

D. The State agency responsible for licensing nursing facilities may be requested by the Board to assist in carrying out Health Occupations Article, §9-205, Annotated Code of Maryland.

E. The Board shall have the authority to utilize consultant experts, as needed, in areas of its concern.

F. From time to time, the Board shall make and publish regulations for the execution and enforcement of the laws governing the licensing and license renewal of nursing home administrators.

A. The Chairman shall preside at all meetings of the Board, and shall sign or designate who shall sign all official documents of the Board. In the absence of the Chairman, the Vice-Chairman shall preside at meetings, and perform all duties usually performed by the Chairman.

B. In addition to the duties imposed by law, the executive director shall:

(1) Attend all meetings of the Board;

(2) Keep a full and complete record of the minutes of the meetings;

(3) Notify the members of the Board of the time and place fixed for meetings of the Board;

(4) Maintain all records pertinent to the operation of the Board;

(5) Countersign all licenses and renewal cards;

(6) Conduct all routine correspondence for the Board;

(7) Issue all notices of meetings and hearings;

(8) Have custody of all books, records, and property of the Board; and

(9) Perform all duties pertaining to the office of executive director.

C. The executive director of the Board shall receive all monies payable to the Board and shall pay the same to general funds of the State.

D. The Board shall provide all nursing facilities with a current list of Board members and its appointed representatives and consultants.

E. The Board may provide consultation to administrators upon request through the executive director.

F. Board members may not make public statements or visitations to nursing facilities as official representatives of the Board unless authorized by the Board.

The applicant shall:

A. Be at least 21 years old.

B. At the time of submitting the application, have successfully completed a baccalaureate degree. Applicants from out-of-State will be processed for licensure in accordance with Health Occupations Article, §9-302, Annotated Code of Maryland.

C. In the absence of a baccalaureate or master's degree in health care administration from an accredited college or university, present evidence of satisfactory completion within the last 5 years of a minimum of 100 hours in a course of study in health care administration approved by the Board. This is the course of study referred to in Regulation .11A of this chapter.

D. Obtain a passing grade on the examination administered by the Board, or meet the criteria outlined in Regulation .18 of this chapter for waiver of examination.

E. Successfully complete:

(1) The AIT program, or its equivalent, as outlined in Regulation .13 of this chapter; or

(2) 1 year as the full-time nursing home administrator of record in a nursing facility within the last 5 years.

F. Be of good moral character.

G. Not have committed any act that would constitute grounds for licensure denial, reprimand, suspension, or revocation, as specified in Health Occupations Article, §9-314(b), Annotated Code of Maryland, or in Regulation .15 of this chapter, unless the Board is satisfied that the applicant has subsequently removed the disability that would be grounds for license denial, reprimand, suspension, or revocation.

A. An applicant for a license as a nursing home administrator shall make application, in writing, on forms provided by the Board, and shall furnish evidence satisfactory to the Board that the applicant has met the requirements as provided for in the Maryland Nursing Home Administrators Licensing Act and Regulations .06 and .13 of this chapter.

B. An applicant for license shall submit with the application two letters from individuals engaged in either business or professional work, who shall attest to the good moral character of the applicant. These character references may not be those from current employers or members of the applicant's family.

C. An applicant who has been convicted of, or pleads guilty or nolo contendere to, a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside, shall submit with the application evidence satisfactory to the Board that the applicant has complied with all of the terms of the applicant's sentence imposed by the court and, if applicable, probation authority.

D. An applicant shall submit with the application on the form supplied by the Board, a certificate of health, signed by a licensed physician, describing the current health status of the individual, and reflecting the date of the examination.

D-1. An applicant shall submit with the application a finished, unmounted, photograph of himself or herself, which shall have been taken within 3 months prior to the date of application.

E. After an applicant has completed a minimum of 8 months of the full-time administrator-in-training program or its equivalent, or 12 months of the part-time administrator-in-training program or its equivalent, and has completed the other requirements for licensure as specified in Regulation .06 of this chapter, the applicant may sit for the written portions of the examination.

F. An application shall be void if an applicant fails to meet all the requirements for licensure within 2 years of receipt of the application by the Board. To pursue licensure after that time, the applicant shall submit a new application, and shall meet the requirements for licensure that are in force at the time of reapplication.

A. The fee for a license shall be established by the Board.

B. The fee shall be payable on notification by the Board that the applicant has successfully completed the requirements for licensure or renewal.

C. The license fee or license renewal fee does not include costs for participating in educational courses or for the examination.

D. Fee Schedule.

(1) Initial application ... $100.

(2) Original license ... $100.

(3) Biennial license renewal ... $200.

(4) Reinstatement fee ... $200.

(5) Duplicate of original license or license renewal ... $50.

(6) Inactive fee ... $100.

(7) Biennial inactive renewal ... $100.

(8) Reactivation application fee ... $100.

(9) Reactivation fee ... $100.

(10) Repealed.

(11) Repealed.

(12) Fine for failure to notify Board of change in either name or home address of the licensee, or change in name or address of the employer or business connection of the licensee within 30 days of the change ... $100.

(13) NAB Examination. The administration fee is $100. The National Association of Long Term Care Administrator Boards, Inc., determine the fees for the National Licensure Examination for nursing home administrators. A fee is charged each time a candidate takes the examination.

(14) State's Standards Examination. The fee is $125. A fee is charged each time a candidate takes the examination.

E. All fees are nonrefundable.

The examination may include, but is not limited to, the following subjects:

A. Applicable standards of environmental health and safety;

B. Local health and safety regulations: Guidelines vary according to local provisions and may be obtained from local health subdivisions;

C. General administration;

D. Psychology of patient care;

E. Principles of medical care;

F. Personal and social care;

G. Therapeutic and supportive care and services in long-term care;

H. Departmental organization and management; or

I. Community interrelationships.

A. The passing grade for the examination for the license shall be determined by the Board.

B. The Board shall determine a method of grading each part of the examination separately, and shall apply that method uniformly to all candidates taking the examination.

C. Minimum Passing Grades. The following apply:

(1) Written questions on general nursing facility administration (NAB examination)—scale score of 113;

(2) Written questions on nursing facility licensure (State's Standards examination)—75 percent correct answers.

A. Courses taken for credit for the purpose of original licensure shall first be approved by the Board. This is the course of study referred to in Regulation .06C of this chapter.

B. The courses shall contain the subject matter listed in Regulation .09 of this chapter.

A. Before relicensure, an individual shall submit satisfactory evidence of having completed a minimum of 40 hours, unless otherwise specified by State or federal law, of continuing education, approved by the Board, within the 2-year period before the relicensure date. A maximum of 10 hours of Board-approved continuing education may be carried over into the next renewal period. The approval of the continuing education shall be at the discretion of the Board.

B. In order for the Board to approve a program of study for continuing education, the program of study shall:

(1) Relate to health care administration; and

(2) Be approved by the National Association of Long Term Care Administrator Boards.

C. The Board shall award 10 clock hours of continuing education for each completed accredited college credit that falls within the core of knowledge.

A. An Administrator-in-training (AIT) is a supervised 12-month full-time or 18-month part-time internship during which the AIT works under the guidance and supervision of a preceptor, a licensed administrator meeting the qualifications set forth in Regulation .14 of this chapter. The AIT program is a required phase of education consisting of both the supervised practice of nursing home administration in the environment of the nursing facility, performing and participating in the day-to-day duties of each position, when legally permissible, in each of the following service areas:

(1) Administration;

(2) Business office;

(3) Nursing;

(4) Resident activities;

(5) Social services;

(6) Medical records;

(7) Dietary;

(8) Maintenance; and

(9) Environmental, including housekeeping and laundry.

B. An AIT may not, during the normal working hours of the program, fill a specific, specialized position in the nursing facility.

C. If the AIT is a department head, notice shall be conspicuously posted in the nursing facility stating who the acting department head will be while the AIT is performing training duties.

D. If a candidate does not meet all of the requirements for licensure after having completed 12 months in the full-time or 18 months in the part-time AIT program, preceptor and candidate have the option to work out a plan satisfactory to the Board to continue studying in the AIT program beyond the 12 or 18 months until all the requirements are met.

E. The Board shall interview each applicant and proposed preceptor, or preceptors, before the approval of an AIT program. The Board shall satisfy itself that the background and circumstances of the applicant and preceptor, or preceptors, qualify them for the AIT program.

F. Application Requirements.

(1) The Board may approve an application for a nursing facility AIT program only if it determines that the application contains satisfactory evidence that:

(a) The applicant is at least 21 years old;

(b) The applicant is of good moral character;

(c) The applicant's training will be supervised by a preceptor approved by the Board; and

(d) The AIT program meets the other requirements of this section.

(2) The training shall be satisfactory to the Board.

(3) The applicant shall participate in training provided in a nursing facility licensed in Maryland, as defined in Regulation .02B of this chapter, with at least 60 beds.

(4) If there are subject areas as specified in the list of subjects provided in Regulation .09 of this chapter that are not available in the nursing facility approved by the Board for training, the Board may require training in other facilities.

(5) The applicant shall participate in training provided in not more than two duly Maryland licensed nursing facilities approved by the Board for training. One of the licensed nursing facilities shall have at least 60 beds.

(6) The preceptor is currently certified by the Board.

(7) The preceptor may not be responsible for more than two AITs at any one time. The preceptor shall devote a minimum of 16 hours per week of direct, on-site supervision for each AIT, which may be on an individual or combined basis in the case of two trainees.

(8) The preceptor may or may not be the administrator of record of the facility in which the training is to take place, but the preceptor may not be the administrator of record of a facility other than the one designated for training.

(9) A minimum of 80 percent of the training shall occur during 8 consecutive hours for full-time programs or 6 consecutive hours for part-time programs each day (except for regular days off) between the hours of 7 a.m. and 7 p.m. A minimum of 40 hours per week for full-time or 30 hours per week for part-time shall be devoted to continuous, bona fide training activities which include observing and performing the day-to-day duties of each position, when legally permissible, in the service areas referred to in §A of this regulation. The trainee shall be exposed to all shifts during the AIT program.

(10) The applicant may spend a maximum of 50 percent of the training in a family-owned or family-operated nursing facility, and the remainder of the time shall be spent in another Board-approved facility, under a Board-approved preceptor.

(11) An employee may not be a preceptor for his employer.

G. Required AIT Reports.

(1) The AIT and preceptor shall maintain a progress report for the training program on forms prescribed by the Board for every 3 months of the training program.

(2) The report shall:

(a) Be submitted to the Board's office on the dates specified by the Board; and

(b) Include the following:

(i) A brief description of activity or area covered, or both, and dates of rotation;

(ii) A brief analysis of any problems observed, new experiences, insights gained, and the AIT's role in problem solutions; and

(iii) A checklist including signatures from preceptor, AIT, and department managers to verify that the AIT trained in those departments.

(3) At the conclusion of the training program, the AIT shall complete a brief survey and return it to the Board's office providing feedback with suggestions for continuing improvements.

(4) If the reports are not submitted to the Board's office on the date specified by the Board, the AIT shall be considered to have violated the terms of the AIT contract.

H. Credit for Prior Experience.

(1) The AIT program is a minimum of 12 months for full-time programs or 18 months for part-time programs unless the Board awards credit for prior experience within the last 5 years. The amount of credit awarded is at the discretion of the Board, based on exposure to the core of knowledge set forth in Regulation .09 of this chapter, but may not exceed;

(a) 6 months for a hospital assistant administrator;

(b) 8 months for a hospital administrator;

(c) 6 months for a nursing facility assistant administrator;

(d) 6 months for a department head;

(e) 3 months for an executive director of a continuing care retirement community;

(f) 3 months for an assisted living manager;

(g) 3 months for a health-care-related senior management official;

(h) 3 months for a non-health-care-related senior management official.

(2) Qualifying Experience for Healthcare Related Professions in §H(1)(a)—(f) of this regulation. The following requirements set the minimum experience required for receiving credit:

(a) Minimum of 18 months as a full-time employee, with line responsibility for hiring, firing, budget, and supervision of at least one department comprised of ten or more employees;

(b) Reporting directly to the facility administrator or chief executive officer;

(3) Qualifying Experience for Healthcare Related or Non-Healthcare Related Senior Management Official in §H(1)(g) and (h) of this regulation. The following requirements set the minimum experience required for receiving credit:

(a) Minimum of 18 months as a full-time senior management official of a single facility or entity; and

(b) Administrative responsibility for the total operation of the facility or entity and its multiple departments, as applicable.

(4) Experience credit can be awarded on a month-to-month basis totaling 12 months for:

(a) An individual who has worked as a licensed nursing home administrator in another state;

(b) A resident or intern in a program offered by an accredited college or university for the purpose of satisfying the requirements for a baccalaureate or master's degree in health care administration; or

(c) An individual who has successfully completed an AIT program in another state, if the program is substantially comparable to the AIT program in Maryland, as determined by the Board.

I. Discontinuance of AIT Status in a Nursing Facility in Which the Trainee is Registered.

(1) The AIT and the preceptor shall report discontinuance within 10 days.

(2) Within 10 days of the date of discontinuance, the preceptor shall file a report detailing the trainee's experience and abilities.

(3) The trainee may fulfill the training requirement in not more than two licensed nursing facilities, with not more than 90 days lapse between the two periods of training.

J. A change of preceptor may be authorized by the Board upon submission of:

(1) Application by the proposed new preceptor;

(2) A report by the Credentials Committee resulting from a personal interview with the trainee and proposed preceptor;

(3) Evidence satisfactory to the Board that the proposed preceptor is certified by the Board; and

(4) A new signed contract by the trainee, preceptor, and the Board.

K. If a preceptor is found by the Board to have failed to provide adequate training, the Board may cancel the preceptor's authorization to serve as a preceptor for a period of time prescribed by the Board. If an AIT fails to live up to the terms of the contract, the Board may cancel the contract.

L. A person duly registered as an AIT whose internship is interrupted by service in the armed forces of the United States shall be permitted to resume the internship without loss of credit at any time within 1 year after the date of the AIT's separation from active service.

A. The Board shall issue a certificate of qualification to be a preceptor in the AIT program if the following conditions are met:

(1) The preceptor holds and has held a license from the Board for 1 year or longer;

(2) The proposed preceptor has been satisfactorily employed in nursing home administration for a minimum of 3 years as the nursing home administrator of record;

(3) The proposed preceptor has no disciplinary action pending nor is currently under investigation by the State Board of Examiners of Nursing Home Administrators;

(4) Persons seeking certification as preceptors in the AIT program shall submit evidence of the successful completion of a Board-approved training program for preceptors; and

(5) The proposed preceptor has been employed full time as a nursing home administrator for a minimum of 2 of the past 3 years immediately before application to precept.

B. If the proposed preceptor has not precepted an AIT program within the past 5 years, the proposed preceptor shall recertify as a preceptor by completing a Board-approved training program.

C. The Board may disapprove a preceptor for a training program:

(1) If the preceptor has failed to remain in compliance with this chapter; or

(2) At any time for good cause.

A. Pursuant to Health Occupations Article, §9-314(b)(3), Annotated Code of Maryland, the Board may deny a license or limited license to any applicant, suspend or revoke a license of a nursing home administrator, or reprimand or otherwise discipline an applicant or a licensee after due notice and an opportunity to be heard at a formal hearing, upon evidence that the applicant or licensee:

(1) Has violated any of the provisions of the law pertaining to the licensing of nursing home administrators or the regulations of the Board pertaining to it;

(2) Has violated any of the provisions of the law or regulations of the licensing or supervising authority or agency of the State or political subdivision of it having jurisdiction of the operation and licensing of nursing facilities;

(3) Is incompetent to engage in the practice of nursing home administration or to act as a nursing home administrator;

(4) Has practiced fraud, deceit, or misrepresentation in the licensee's capacity as a nursing home administrator;

(5) Has wrongfully transferred or surrendered possession, either temporarily or permanently, his license certificate, license card, or license renewal card to any other person;

(6) Has paid, given, has caused to be paid or given, or offered to pay or to give to any person a commission or other valuable consideration for the solicitation or procurement, either directly or indirectly of nursing facility patronage;

(7) Has used fraudulent, misleading, or deceptive advertising;

(8) Has falsely impersonated another licensee;

(9) Has endangered or sanctioned the endangerment of the safety, health, and life of any patient;

(10) Has failed to oversee and facilitate the nursing facilities quality improvement processes to the extent that the safety, health, or life of any patient has been endangered;

(11) Has willfully permitted unauthorized disclosure of information relating to a patient or patient's records;

(12) Has discriminated in respect to patients, employees, or staff on account of race, religion, color, national origin, sexual orientation, or disability;

(13) Has violated the terms of the AIT contract;

(14) Has engaged in sexual behavior that would be considered unethical or unprofessional according to the professional standards of conduct, including but not limited to:

(a) Sexual behavior with a client, patient, or resident in the context of a professional evaluation, treatment, procedure, or service to the client, patient, or resident, regardless of the setting in which the professional service is rendered,

(b) Sexual behavior with a client, patient, or resident under the pretext of diagnostic or therapeutic intent or benefit,

(c) Solicitation of a sexual relationship, whether consensual or nonconsensual, with a client, patient, or resident,

(d) Sexual advances requesting sexual favors,

(e) Therapeutically inappropriate or intentional touching of a sexual nature,

(f) A verbal comment of a sexual nature,

(g) Physical contact of a sexual nature with a client, patient, or resident,

(h) Discussion of unnecessary sexual matters with a client, patient, or resident,

(i) Direct or indirect observation of a client, patient, or resident while the client, patient, or resident is undressing or dressing,

(j) The taking of photographs of a client, patient, or resident for a sexual purpose,

(k) Sexual harassment of staff, students, or volunteers,

(l) An unnecessary sensual act or comment,

(m) Sexual contact with an incompetent or unconscious client, patient, or resident;

(n) Offering to provide services, such as drugs, in exchange for sexual favors; or

(15) Has practiced as a nursing home administrator without holding a license to practice nursing home administration in the State.

B. Pursuant to Health Occupations Article §§9-302(d) and 9-205, Annotated Code of Maryland, the Board may, after due notice and an opportunity to be heard, reprimand, suspend, or revoke an AIT's participation in a Board approved program, upon substantial evidence that the AIT has committed any of the actions listed in §A of this regulation.

A. Preferring of Charges.

(1) Any person, public officer, or association, or the Board may prefer charges against any licensee or AIT for due cause.

(2) The charges shall be in writing, signed by the complainant, and shall be submitted to the Board.

B. Preliminary Hearings. The Board or any person or persons appointed by it for that purpose, may hold a preliminary hearing to determine whether a formal hearing on the charges is necessary. All decisions reached at a preliminary hearing shall be ratified by the Board.

A. Scope. These regulations apply to all formal hearings before the Board of Examiners of Nursing Home Administrators. They do not apply to conferences or other informal investigations or proceedings when no formal ruling or decision is made.

B. Notice of Hearing.

(1) Written notice of hearing shall be sent by the secretary of the Board to all interested parties at least 30 days before the hearing. The notice shall state the date, time, and place of the hearing. It shall also state the basis for the charge or charges involved in the proceeding.

(2) If, by reason of the nature of the proceeding, the issues supporting the charges cannot be fully stated in advance of the hearing, or if subsequent amendment of the issues is necessary, they shall be fully stated as soon as possible.

(3) Service upon Party. The charging document and a copy of the complaint shall be delivered to the party in person. Instead of personal service, the Board may service the charging document and a copy of the complaint by registered or certified mail, restricted delivery-return receipt requested.

C. Representation of Parties. All parties appearing at formal hearings shall have the right to appear in person, or by or with counsel.

D. Prehearing Procedures.

(1) Prehearing Conferences. The Board may schedule the prehearing conferences as it deems appropriate.

(2) Filing of Motions and Response. All motions shall be accompanied by a memorandum of points and authorities, and shall be filed with the Board at least 10 working days before the hearing, and a copy served on the opposing party. A response shall be filed with the Board at least 5 working days before the hearing and a copy served on the opposing party.

(3) Discovery on Request. By written request served on the other party and filed with the Board or the Office of Administrative Hearings, as appropriate, a party may require another party to produce, within 15 days, the following:

(a) A list of witnesses to be called;

(b) Copies of documents intended to be produced at the hearing; or

(c) Both §D(3)(a) and (b) of this regulation.

(4) Mandatory Discovery.

(a) Each party shall provide to the other party not later than 15 days before the prehearing conference, if scheduled, or 45 days before the scheduled hearing date, whichever is earlier:

(i) The name and curriculum vitae of any expert witness who will testify at the hearing; and

(ii) A detailed written report summarizing the expert's testimony, which includes the opinion offered and the factual basis and reasons underlying the opinion.

(b) If the Board or the Office of Administrative Hearings, as appropriate, finds that the report is not sufficiently specific, or otherwise fails to comply with the requirements of this section, the testimony of the expert and any report of the expert shall be excluded from the hearing.

(c) The Board or the Office of Administrative Hearings, as appropriate, shall consider and decide arguments regarding the sufficiency of the report:

(i) At the prehearing conference, if scheduled; or

(ii) Immediately before the scheduled hearing.

(d) If an expert adopts a sufficiently specific charging document as the expert's report, that adoption shall satisfy the requirements set forth in this subsection.

(5) Parties are not entitled to discovery of items other than as listed in §D(3) and (4) of this regulation.

(6) Both parties have a continuing duty to supplement their disclosures of witnesses and documents.

(7) Absent unforeseen circumstances which would otherwise impose an extraordinary hardship on a party:

(a) Witnesses or documents may not be added to the list after the prehearing conference, if scheduled; or

(b) If no prehearing conference is scheduled, witnesses or documents may not be added to the list later than 15 days before the hearing.

(8) The prohibition against adding witnesses does not apply to witnesses or documents to be used for impeachment or rebuttal purposes.

(9) Construction.

(a) In hearings conducted by an administrative law judge of the Office of Administrative Hearings, this section shall, whenever possible, be construed as supplementing and in harmony with COMAR 28.02.01.

(b) In the event of a conflict between this section and COMAR 28.02.01, this section applies.

E. Conduct of the Hearing.

(1) Board Majority. Each hearing shall be held before a majority of the Board, which majority of the Board shall include not less than three nursing home administrators, unless the hearing authority is delegated pursuant to State Government Article, §10-205, Annotated Code of Maryland. Board action shall be by majority vote of those Board members present at the hearing, unless the hearing authority has been delegated, in which case the provisions of State Government Article, §10-205, Annotated Code of Maryland, apply to any decision.

(2) Duties of Presiding Officer.

(a) The chairman, or in the chairman's absence, a member designated by the chairman shall be the presiding officer or if in a delegated hearing, a hearing examiner shall be the presiding officer. The presiding officer shall:

(i) Have complete charge of the hearing;

(ii) Permit the examination of witnesses;

(iii) Admit evidence;

(iv) Rule on the admissibility of evidence;

(v) Adjourn or recess the hearing from time to time.

(b) The presiding officer, at the presiding officer's discretion, may set reasonable time limits on arguments and presentation of evidence.

(c) The presiding officer shall be responsible for decorum in a hearing and can suspend the proceedings as necessary to maintain decorum.

(3) Legal Advisor and Counsel for the Board.

(a) The Board may request the Office of the Attorney General to participate in any hearing to present the case on behalf of the Board.

(b) Counsel presenting the case on behalf of the Board shall have the same rights with regard to the submission of evidence, examination, cross-examination of witnesses, presentation of summation and argument, and filing of objections, exceptions, and motions as does counsel for any party.

(c) The Board may also request a representative of the Office of the Attorney General to act as legal advisor to the Board as to questions of evidence and law.

(4) Order of Procedure. The case on behalf of the Board shall be presented first. The respondent shall then present the respondent's case. After that, rebuttal shall be permitted.

(5) Examination of Witnesses and Introduction of Evidence.

(a) The rules of evidence in all hearings under these regulations shall be as set forth in State Government Article, §10-213, Annotated Code of Maryland.

(b) Every party has the right to:

(i) Call witnesses and present evidence;

(ii) Cross-examine every witness called on behalf of the Board or other party;

(iii) Present summation and argument and file objections, exceptions, and motions.

(c) When a party is represented by counsel, all submission of evidence, examination and cross-examination of witnesses, and filing of objections, exceptions, and motions shall be done and presented solely by counsel.

(d) Witnesses.

(i) The presiding officer, or any person designated by the presiding officer for that purpose, may examine any witness called to testify.

(ii) The presiding officer may call as a witness any person in attendance at the hearing.

(iii) Any member of the Board may examine any witness called to testify.

F. Records and Transcript.

(1) The Board or its designee shall prepare an official record which shall include all pleadings, testimony, exhibits, and other memoranda or material filed in the proceeding.

(2) A stenographic record of the proceedings shall be made at the expense of the Board. This record need not be transcribed, however, unless requested by a party or by the Board. The cost of any typewritten transcripts of any proceedings, or part of them, shall be paid by the party requesting the transcript.

G. Decision and Order. Each decision and order rendered by the Board shall be in writing and shall be accompanied by finding s of fact and conclusions of law. A copy of the decision and order and accompanying findings and conclusions shall be delivered or mailed promptly to each party or his attorney of record.

H. Rehearings.

(1) Any party aggrieved by the decision and order may apply for rehearing within 10 days after service of the decision and order. Action on an application shall lie in the discretion of the Board.

(2) Unless otherwise ordered, neither the rehearing nor the application for it shall stay the enforcement of the order, or excuse the persons affected by it for failure to comply with its terms.

(3) On rehearing, the Board shall only consider facts not presented in the original hearing, including facts arising after the date of the original hearing, and may by new order abrogate, change, or modify its original order.

A. The Board may find that a compelling public purpose warrants disclosure of information in a certification, licensing, or investigative file, whether or not there has been a request for the information and may disclose the information under the following circumstances:

(1) The information concerns possible criminal activity and is disclosed to a federal, state, or local law enforcement or prosecutorial official or authority;

(2) The information concerns a possible violation of law and is disclosed to a federal, state, or local authority that has jurisdiction over the individual whose conduct may be a violation and the information disclosed is limited to information relevant to the possible violation by that individual; or

(3) The information concerns conduct by an individual which the Board reasonably believes may pose a risk to the public health, safety, or welfare and is disclosed to a law enforcement authority, administrative official, or agency that regulates the individual, or to a hospital or other health care facility where the individual has privileges.

B. Other Disclosures. This regulation does not prevent or limit the ability of the Board to disclose general licensing information as provided in State Government Article, §10-617(h), Annotated Code of Maryland, or any information which the Board may otherwise disclose by law.

The Board in its discretion, and otherwise subject to the laws pertaining to the licensing of nursing home administrators prescribing the qualification for a nursing home administrator license, may endorse, without retaking the national examination, a nursing home administrator license issued by the proper authorities of any other state, upon payment of the fee and upon submission of evidence satisfactory to the Board that the:

A. Other state maintains a system and standard of qualification and examination for a nursing home administrator license, which are substantially equivalent to those required by this State;

B. Other state gives similar recognition and endorsement to nursing home administrator licenses of this State;

C. Applicant for endorsement is familiar with State and local health and safety regulations related to nursing facilities, and has received a passing grade on the State's standards examination; and

D. Applicant for endorsement holds a valid license as a nursing home administrator which has not been revoked or suspended in each state from which the applicant has ever received a nursing home administrator license or reciprocal endorsement.

A. A license may be restored after a period of 2 years after revocation by the Board, in its discretion, upon submission of evidence satisfactory to the Board that the applicant for the restoration of the license has removed the disability causing the revocation.

B. Upon application for restoration of a license, the Board, in its discretion, may grant the applicant a formal hearing after notice.

Each person licensed as a nursing home administrator shall display a license certificate and license card, or license renewal card in a conspicuous place in the office or place of business or employment of the licensee.

Upon receipt of satisfactory evidence that the license certificate, license card, or license renewal card has been lost, mutilated, or destroyed, the Board may issue a duplicate license certificate, license card, or license renewal card upon any conditions as the Board may prescribe, and upon payment of an appropriate fee established by the Board in Regulation .08.

A. Every regulation, order, and directive adopted by the Board shall state the date upon which the Board proposes that it take effect, and a copy signed by the Chairman and the Executive Director of the Board shall be filed as a public record in the Board office and as required by the Administrative Procedure Act.

B. If any provision of these regulations is declared unconstitutional or invalid, or the application of these regulations to any person or circumstance is held invalid, the applicability of the provision to other persons and circumstances and the constitutionality or validity of every other provision of these regulations is not to be affected.

C. These regulations do not affect pending actions or proceedings, civil or criminal.

D. Amendments to these regulations of the Board may be made only at a regularly called Board meeting by a majority vote of all members. An amendment may not be acted upon unless the amendment was presented at a prior meeting and unless notice has been given to the members of the Board that the amendment is to be acted upon at a specific meeting of the Board.

E. The most recent edition of "Robert's Rules of Order, Newly Revised" shall govern all meetings of the Board