DEPARTMENT OF HEALTH & MENTAL HYGIENE

OFFICE OF SECRETARY

With Senate advice and consent, the Governor appoints the Secretary of Health and Mental Hygiene. The Secretary is responsible for the functions of the Department and also directs and coordinates numerous boards, commissions, and citizen advisory groups.

201 West Preston St., Baltimore, Maryland, December 2000. Photo by Diane F. Evartt.

Reporting to the Secretary, two deputy secretaries each have a specific area of responsibility: Health Care Financing, and Public Health Services. The Office of Secretary oversees the Chief Financial Officer, the Inspector General, the Office of Minority Health and Health Disparities, Operations Administrative Support, Public Relations and Government Affairs, and Regulatory Programs. The Office of Secretary also is aided by the State Child Fatality Review Team and the Panel to Review Off-Label Uses of Drugs.

STATE CHILD FATALITY REVIEW TEAM
The State Child Fatality Review Team formed within the Department of Health and Mental Hygiene in September 1999 (Chapter 356, Acts of 1999). The purpose of the Team is to prevent child deaths by analyzing their causes and incidence; devising plans for change within those government agencies represented on the Team; and recommending changes in law, policy, and practice. Among other duties, the Team (in cooperation with local teams) will develop a protocol for child fatality investigations, including procedures for local departments of health, law enforcement, medical examiners, and social services (Code Health-General Article, secs. 5-701 through 5-709).

PANEL TO REVIEW OFF-LABEL USES OF DRUGS
Appointed by the Secretary of Health and Mental Hygiene, the Panel to Review Off-Label Uses of Drugs was authorized in 1994 (Chapter 647, Acts of 1994). Particular cases in which there is a dispute about medical insurance payments for off-label use of drugs are reviewed by the Panel. The Panel also investigates drugs prescribed for treatments other than those approved by the federal Food and Drug Administration and advises the Secretary of Health and Mental Hygiene whether a particular off-label use is medically appropriate. The Secretary forwards Panel recommendations to the Maryland Insurance Commissioner who may direct insurers to pay for the drug (Code 1957, Art. 48A, sec. 490AA).

OFFICE OF PUBLIC RELATIONS
Formerly under Operations, the Office of Public Relations transferred to the Office of Secretary in 1999. In August 2005, it moved under the Office of Public Relations and Governmental Affairs. The Office of Public Relations directs public affairs of the Department and coordinates them with Departmental officials, local health officers, and the Governor's Office. The Office of Public Relations also arranges special events and disseminates employee information.

CHIEF FINANCIAL OFFICER

BUDGET MANAGEMENT OFFICE

The Budget Management Office began as the Financial Planning Administration and received its present name in 1997. In March 2004, it moved from Operations to the Chief Financial Officer within the Office of Secretary. The Budget Management Office monitors and controls all Department financial affairs, including liaison with the Department of Budget and Management and the General Assembly. The Office oversees budget preparation and review, expenditure management, funding enhancement, rate setting, cost analysis, and fiscal policy.

Office functions are carried out by two divisions: Budget Analysis; and Program Costs and Analysis.

FISCAL SERVICES ADMINISTRATION

By 1923, functions of the Fiscal Services Administration were organized under the Bureau of Personnel and Accounts, which was responsible for fiscal administration of the Department of Health. Formerly under Operations, the Fiscal Services Administration moved under the Chief Financial Officer within the Office of Secretary in March 2004. The Administration analyzes and provides fiscal, accounting and contracting services for the statewide operation of major Department programs and health care facilities. The Administration develops systems, policies, and procedures for the Department's fiscal management in coordination with regulatory or control agencies, the General Assembly, and the federal government.

Under the Administration are three divisions: Auditing; General Accounting; and Reimbursements.

OFFICE OF INSPECTOR GENERAL

INSTITUTIONAL REVIEW BOARD
The Institutional Review Board was created by the Department in 1977. Formerly under the Community Health Administration, the Board transferred to the Office of Inspector General in January 2004.

The Board reviews research that uses human subjects to ensure that the rights, safety, and dignity of those involved are protected. The review process is mandated as a condition of federal funding.

CORPORATE COMPLIANCE DIVISION
The Corporate Compliance Division investigates allegations of fraud, waste, and abuse in Medicaid, Medicare, and other departmental programs, as well as violations of the Department's Code of Conduct. Training in corporate compliance policies also is provided by the Division.

ETHICS DIVISION
To prevent conflict of interest and maintain ethical conduct, the Ethics Division ensures that those employees who are required by law do so file statements of financial disclosure, disclosure of compensation, and secondary employment.

OFFICE OF MINORITY HEALTH & HEALTH DISPARITIES

In October 2004, the Office of Minority Health and Health Disparities was established within the Office of Secretary (Chapters 319 & 443, Acts of 2004; Code Health-General Article, Subtitle 10). The Office advocates for improvements in minority health care. Also, the Office oversees the Cigarette Restitution Fund Program.

For the Secretary of Health and Mental Hygiene, the Office assists in developing priorities for State health programs, services, and resources to address disparities. It also recommends changes in State laws and regulations to expedite delivery of health services to minorities.

With public and private organizations and institutions, the Office works to find funding, administer grants, establish programs, and conduct research to reduce and eliminate racial or ethnic health care disparities in Maryland. Emphasizing habits of health care and preventive health measures, the Office also works to educate the public and reach underserved minorities.

CIGARETTE RESTITUTION FUND PROGRAM

The Program conducts baseline and annual studies of cancer incidences and mortality. The findings are evaluated and monitored to determine the Program's effectiveness in controlling cancer and ending smoking.

To stop smoking, the Cigarette Restitution Fund Program works to establish local health coalitions that help health officers identify, support, and initiate smoking cessation programs. Media campaigns are developed to counteract tobacco industry advertising and promote healthy behavior.

With Maryland's top research institutions, the Program instigates cancer research and encourages clinical trials. The Program also supports community-based services for those who are uninsured or underinsured.

REGULATORY PROGRAMS

OFFICE OF HEALTH CARE QUALITY

The Office of Health Care Quality originated in 1971 as the Division of Licensing and Certification under the Office of General Administration and reorganized in 1986 as the Office of Licensing and Certification Programs. In 1987, the Office reformed as the Licensing and Certification Administration. As the Office of Quality Assurance, it transferred from Health Care Policy, Finance, and Regulation and was placed under the Office of Secretary in March 1999. It received its present name in September 1999. In August 2005, it moved under Regulatory Programs.

All hospitals and health-related institutions in Maryland must be licensed by the Office. The quality of care and compliance with both State and federal regulations in 8,000 health-care facilities and health-related services and programs is monitored by the Office. These include: adult daycare centers; ambulatory surgical facilities; assisted-living programs; birthing centers; developmental disabilities programs; dialysis centers; group homes; health maintenance organizations (HMOs); home health agencies; hospice programs, hospitals; independent physical therapists; major medical equipment; medical laboratories; mental health programs; nursing homes and rehabilitation centers; prison hospitals; residential service agencies; residential treatment centers; substance abuse programs; and other miscellaneous programs. To regulate these institutions and programs, the Office conducts more than 10,000 inspections yearly.

For all health facilities participating in the Medical Assistance Program (Medicaid) and Medicare, the Office is responsible for inspection and certification recommendations. Administrative actions against facilities that violate State rules and regulations are initiated by the Office.

The Office consists of Administration and two divisions: Federal Programs; and State Programs.

ADMINISTRATION
For the Office of Health Care Quality, Administration develops policy, operational procedures, regulations, budgets, and legislation. Administration also oversees the Health Maintenance Organization (HMO) and Hospital Licensure Program.

HMO & HOSPITAL LICENSURE PROGRAM
The HMO and Hospital Licensure Program evaluates all hospitals, and investigates and responds to consumer complaints. The Program licenses and certifies hospitals that participate in Medicare.

QUALITY ASSURANCE UNIT
Established in 1999, the Quality Assurance Unit investigates quality-of-care complaints referred by the Maryland Insurance Commissioner, and enforces statutory and regulatory requirements relating to the quality of care provided by health maintenance organizations (Chapter 697, Acts of 1999).

NURSING HOME TECHNICAL ASSISTANCE UNIT
The Nursing Home Technical Assistance Unit within the Office of Health Care Quality was authorized in October 2000 (Chapter 217, Acts of 2000). The Unit supports compliance with quality assurance for nursing home care. The Unit also is to establish a list of approved medical automated systems (Code Health-General Article, sec. 19-1412).

FEDERAL PROGRAMS
Within the Licensing and Certification Administration, Federal Programs originated as the Long-Term Care Program before it reformed in 1992 as Long-Term Care, Community Mental Health and Substance Abuse Programs. In 1995, it became the Long-Term Care Program, which evaluates and surveys nursing homes, adult day-care centers, and licensed and registered domiciliary-care homes. In 2001, it was renamed Federal Programs. Federal Programs includes licensure of adult medical daycare, ambulatory care facilities, laboratories, and nursing homes.

Ambulatory Care Program. This program started as the Hospitals and Ambulatory Care Program. It reorganized in 1995 as the Developmental Disabilities and Ambulatory Care Program and adopted its present name in 1997. The Program reviews State and federal programs involving home health agencies, hospices, health maintenance organizations, major medical equipment, ambulatory care facilities, residential service agencies, and dialysis centers.

Laboratory Program. Within the Office of Health Care Quality, the Program evaluates and surveys some 2,000 laboratories, including physician office laboratories, to determine compliance with State and federal laws and regulations. The Program also coordinates and manages the State and federal Cytology Proficiency Testing Program for individuals who interpret pap smears.

STATE PROGRAMS
Functions of State Programs began in 1992 as Long-Term Care, Community Mental Health and Substance Abuse Programs. The work of these units was reorganized in 1995 into two units and the Substance Abuse and Community Mental Health Program formed. In 1995, the Developmental Disabilities and Ambulatory Care Program also was created. Its ambulatory care functions were reassigned in 1997. That program reorganized as the Developmental Disabilities, Substance Abuse and Community Mental Health Program in 1997, and became State Programs in 2001.

State Programs oversees licensure of assisted-living facilities, developmental disabilities facilities, and mental health programs. This office also certifies substance abuse programs. It evaluates community residential and day programs for the developmentally disabled. It also evaluates all residential and nonresidential health-related services and programs for the mentally impaired and the alcohol and drug addicted. The Program also manages the licensure of private review agents doing business in Maryland. Private review agents are third parties (often employed by insurance companies) who (in advance) approve or disapprove medical procedures to be covered by insurance.

HEALTH PROFESSIONALS BOARDS & COMMISSIONS

Health Professionals Boards and Commissions began as the Division of Boards and Commissions. The Division reorganized in 1986 as the Office of Boards and Commission Programs and, in 1993, received its present name. This office is responsible for the examination, licensing, regulation, and surveillance of health professionals in Maryland.

Under Health Professionals Boards and Commissions are the State Commission on Kidney Disease and seventeen licensing and regulatory boards:

State Acupuncture Board
State Board of Examiners for Audiologists, Hearing Aid Dispensers, & Speech-Language Pathologists
State Board for Certification of Residential Child-Care Program Administrators
State Board of Chiropractic Examiners
State Board of Professional Counselors & Therapists
State Board of Dental Examiners
State Board of Dietetic Practice
State Board of Morticians
State Board of Nursing
State Board of Examiners of Nursing Home Administrators
State Board of Occupational Therapy Practice
State Board of Examiners in Optometry
State Board of Pharmacy
State Board of Physical Therapy Examiners
State Board of Physicians
State Board of Podiatric Medical Examiners
State Board of Examiners of Psychologists
State Board of Social Work Examiners

STATE ACUPUNCTURE BOARD

The State Acupuncture Board was created in 1994 (Chapter 620, Acts of 1994). To protect consumers, the Board licenses persons wishing to practice acupuncture in Maryland. The Board provides information about the licensure procedure, fees, continuing education requirements, and new trends in acupuncture and Oriental medicine to both applicants for licenses and the public. Consumers may make inquiries to the Board regarding licensed acupuncturists and also file complaints.

Seven members constitute the Board. They are appointed to four-year terms by the Governor (Code Health Occupations Article, secs. 1A-101 through 1A-502).

STATE BOARD OF EXAMINERS FOR AUDIOLOGISTS, HEARING AID DISPENSERS, & SPEECH-LANGUAGE PATHOLOGISTS

The State Board of Examiners for Audiologists, Hearing Aid Dispensers, and Speech-Language Pathologists originated from three separate boards. The first was the Board of Examiners for Hearing Aid Dealers, formed in 1969 and placed within the Department of Licensing and Regulation in 1970 (Chapter 634, Acts of 1969; Chapter 402, Acts of 1970). The other two boards - the State Board of Examiners for Audiologists, and the Board of Examiners for Speech Pathologists - both started in 1972 within the Department of Health and Mental Hygiene (Chapter 547, Acts of 1972). In 1987, the speech pathologists' board was renamed the State Board of Examiners for Speech-Language Pathologists (Chapter 478, Acts of 1987). All three boards merged in 1992 to become the State Board of Examiners for Audiologists, Hearing Aid Dealers, and Speech-Language Pathologists within the Department of Health and Mental Hygiene (Chapter 326, Acts of 1992). In 1993, the Board received its present name (Chapter 448, Acts of 1993). The Board licenses audiologists, hearing aid dispensers, and speech-language pathologists.

The Board is composed of thirteen members appointed to four-year terms by the Governor on recommendation of the Secretary of Health and Mental Hygiene. Authorization for the Board continues until July 1, 2016 (Code Health Occupations Article, secs. 2-101 through 2-502).

STATE BOARD FOR CERTIFICATION OF RESIDENTIAL CHILD-CARE PROGRAM ADMINISTRATORS

In October 2004, the State Board for Certification of Residential Child-Care Program Administrators was established (Chapter 438, Acts of 2004). By October 2007, administrators of residential child-care programs must be certified by the Board. Residential child-care programs provide 24-hour per day care within a structured set of services and activities designed to achieve specific objectives for the children, including provision of food, clothing, shelter, education, social services, health, mental health, recreation, or any combination of these.

The Board's eleven members are appointed to four-year terms. The Governor appoints five members with Senate advice and consent, and the Secretary of Health and Mental Hygiene appoints two. One each is appointed by the Secretary of Human Resources, the Secretary of Juvenile Services, the State Superintendent of Schools, and the Subcabinet for Children, Youth, and Families.

Authorization for the Board extends to July 1, 2014 (Code Health Occupations Article, sec. 20-501).

STATE BOARD OF CHIROPRACTIC EXAMINERS

In 1920, the State Board of Chiropractic Examiners formed (Chapter 666, Acts of 1920). The Board examines applicants for licenses, investigates complaints, and (in consultation with the Office of the Attorney General) conducts disciplinary proceedings as necessary. Each person holding a chiropractic license in Maryland must renew it every two years with the Board. The Board holds three examinations per year. It also ascertains whether schools of chiropractic meet the requirements of the law.

The Board consists of seven members appointed by the Governor with the advice of the Secretary of Health and Mental Hygiene and Senate advice and consent. Members serve four-year terms. Authorization for the Board continues until July 1, 2012 (Code Health Occupations Article, secs. 3-201 through 3-602).

MASSAGE THERAPY ADVISORY COMMITTEE
Within the State Board of Chiropractic Examiners, the Massage Therapy Advisory Committee was created in 1999 (Chapter 397, Acts of 1999). The Committee advises the Board on certification, and regulatory and disciplinary matters relating to the practice of massage therapy. Appointed by the Board, the Committee consists of six members (Code Health Occupations Article, sec. 3-5A-04).

STATE BOARD OF PROFESSIONAL COUNSELORS & THERAPISTS

The State Board of Professional Counselors & Therapists originated in 1985 as the State Board of Examiners of Professional Counselors (Chapter 734, Acts of 1985). The Board adopted its present name in October 2000 (Chapter 358, Acts of 2000). The Board certifies professional counselors and therapists, and regulates their services within the State.

In 1998, the General Assembly provided for licensure of three categories of counselors offering clinical counseling: licensed clinical professional counselor; licensed clinical marriage and family therapist; and licensed clinical alcohol and drug counselor (Chapter 132, Acts of 1998).

With the advice of the Secretary of Health and Mental Hygiene, the Governor appoints the Board's nine members to four-year terms. Authorization for the Board continues until July 1, 2009 (Code Health Occupations Article, secs. 17-101 through 17-502). Since 1997, the Governor has been authorized to appoint an advisor to the Board (Chapter 461, Acts of 1997).

STATE BOARD OF DENTAL EXAMINERS

Established in 1884, the State Board of Dental Examiners regulates the practice of dentistry by testing the qualifications of candidates for licenses in dentistry and in dental hygiene (Chapter 150, Acts of 1884).

All applicants for license to practice dentistry must be graduates of accredited dental colleges authorized to grant degrees in dental surgery by the laws of one of the United States or a province of Canada. For a license to practice dental hygiene, all applicants must be graduates of a school for dental hygienists that requires at least two years of study and is approved by the State Board of Dental Examiners. Examinations, held twice a year, are both written and practical. Every two years, dentists and dental hygienists must renew their licenses to practice.

Dental radiation technologists also are certified by the Board. An individual may not practice dental radiation technology in Maryland unless certified by the Board.

The Governor appoints the Board's fifteen members for four-year terms with the advice of the Secretary of Health and Mental Hygiene. Three consumer members are appointed with the advice of the Secretary and Senate advice and consent. Authorization for the Board continues until July 1, 2005 (Code Health Occupations Article, secs. 4-101 through 4-702).

STATE BOARD OF DIETETIC PRACTICE

The State Board of Dietetic Practice was authorized in 1985 to protect the public by setting standards for the practice of dietetics in Maryland (Chapter 773, Acts of 1985). The Board licenses dietitians and nutritionists in Maryland. Licenses to practice dietetics must be renewed with the Board every two years.

The Board has nine members appointed to four-year terms by the Governor. Authorization for the Board continues until July 1, 2015 (Code Health Occupations Article, secs. 5-101 through 5-502).

STATE COMMISSION ON KIDNEY DISEASE

In 1971, the State Commission on Kidney Disease was authorized (Chapter 492, Acts of 1971). The Commission oversees a program of State assistance throughout Maryland for persons with chronic renal disease.

Information on the treatment of chronic renal disease in the State is gathered and disseminated by the Commission. It also sets physical and medical standards for the operation of dialysis and renal transplantation centers and sets standards for the acceptance of a patient into the treatment phase of such programs. Patients accepted for treatment are eligible for State medical assistance. For the public and providers of health services, the Commission also institutes and supervises educational programs on kidney disease and its treatment and prevention.

The Governor appoints the Commission's twelve members to four-year terms. The Commission selects the executive director (Code Health - General Article, secs. 13-301 through 13-307).

STATE BOARD OF MORTICIANS

The State Board of Morticians was established as the State Board of Undertakers of Maryland in 1902 (Chapter 160, Acts of 1902). Renamed the State Board of Funeral Directors and Embalmers in 1937, the Board received its current name in 1981 (Chapter 8, Acts of 1981).

Every funeral director and mortician in the State must register with and procure a license from the Board. The Board sets the standards for the practice of mortuary science in the State and examines applicants for licensure. The Board renews licenses every two years and has the power to suspend or revoke any license. The Board makes regulations for the enforcement of laws regarding funeral directing and mortuary science.

Upon recommendation of the Secretary of Health and Mental Hygiene and with Senate consent, the Governor appoints the Board's twelve members to four-year terms. Authorization for the Board continues until July 1, 2008 (Code Health Occupations Article, secs. 7-101 through 7-602).

STATE BOARD OF NURSING

The State Board of Nursing began as the State Board of Examiners of Nurses in 1904 (Chapter 172, Acts of 1904). It adopted its present name in 1987 (Chapter 109, Acts of 1987).

To assure safe, competent nursing care for the public, the State Board of Nursing regulates the practice of registered nurses, licensed practical nurses, nurse practitioners, nurse midwives, nurse anesthetists, nurse psychotherapists, and nursing assistants. The Board administers licensure examinations and issues licenses to those who successfully complete requirements and examinations. The Board evaluates, monitors, and approves nursing education programs; enforces the standards and defines the scope of nursing; approves refresher programs; and assesses and evaluates trends in nursing. Through its investigative unit, the Board also investigates any complaint alleging violation of the Nurse Practice Act by a nurse, conducts hearings, and takes disciplinary action as required. Such action may include emergency suspension, revocation of license, denial of licensure, probation, or fine.

With the National Council of State Boards of Nursing, the Board cooperates in the preparation of the examination used for licensure. The Board also works with health care facilities, educational institutions, professional organizations, the Maryland Higher Education Commission, the State Board of Education, the Department of Aging, county health departments, local school systems, and Department agencies.

Upon recommendation of the Secretary of Health and Mental Hygiene, the Governor appoints the Board's eleven members for four-year terms. Two members are consumers appointed with Senate advice and consent. Authorization for the Board continues until July 1, 2013 (Code Health Occupations Article, secs. 8-101 through 8-802).

ELECTROLOGY PRACTICE COMMITTEE
The Electrology Practice Committee began as the State Board of Electrologists in 1978 (Chapter 851, Acts of 1978). On July 1, 2003, it moved under the State Board of Nursing and assumed its current name (Chapter 422, Acts of 2003). The Committee adopts and revises standards of electrology practice for registered electrologists and prescribes standards for educational programs leading to licensure. It examines and licenses qualified applicants. The Committee also conducts hearings on charges calling for discipline of a licensed electrologist by penalty, denial, revocation, or suspension of a license, and causes the prosecution of all persons in violation of the Electrology Practice Act.

The Committee consists of five members appointed to four-year terms by the State Board of Nursing. Authorization for the Board continues until July 1, 2012 (Code Health Occupations Article, secs. 8-6B-01 through 8-6B-29).

NURSE ANESTHETIST PEER REVIEW ADVISORY COMMITTEE
The Nurse Anesthetist Peer Review Advisory Committee started as the Anesthetist Advisory Committee in 1981 and received its present name in 1994. The Committee advises the State Board of Nursing concerning the practice of anesthesia by nurses. The Committee also oversees the use of health insurance and medical assistance benefits by certified nurse anesthetists.

Appointed by the State Board of Nursing, the Committee's five members serve three-year terms (Code Health Occupations Article, sec. 8-503).

NURSING ASSISTANT ADVISORY COMMITTEE
Since 1999, the Nursing Assistant Advisory Committee has advised the State Board of Nursing on applications for nursing assistant certification, approval of training programs for nursing assistants, and discipline of nursing assistants.

NURSE-MIDWIFE PEER REVIEW ADVISORY COMMITEE
Appointed by the State Board of Nursing, the Nurse-Midwife Peer Review Advisory Committee organized in 1983 as the Certified Nurse-Midwives Advisory Council. It adopted its current name in 1997. The Committee advises the Board on the practice of nurse-midwifery.

The Committee consists of at least three certified nurse-midwives who serve three-year terms (Code Health Occupations Article, sec. 8-503).

JOINT COMMITTEE ON NURSE-MIDWIFERY
Established in 1983, the Joint Committee on Nurse-Midwifery reviews and makes recommendations on all written agreements between nurse-midwives and physicians.

The Committee is composed of three nurse-midwives, appointed by the State Board of Nursing; and three physicians, appointed by the State Board of Physicians. Members serve three-year terms (Code Health Occupations Article, sec. 8-503).

NURSE PRACTITIONER JOINT COMMITTEE
The Nurse Practitioner Joint Committee was created in 1981. The Committee reviews written agreements between nurse practitioners and physicians. The Committee then makes recommendations to the State Board of Physicians and the State Board of Nursing.

Six members constitute the Committee. Three are appointed by the State Board of Physicians and three by the State Board of Nursing.

NURSE PRACTITIONER PEER REVIEW COMMITTEE
In 1981, the Nurse Practitioner Peer Review Committee was organized. It oversees the use of health insurance and medical assistance benefits by certified nurse practitioners.

Appointed by the State Board of Nursing, the Committee has ten nurse practitioners representing all nurse practitioner specialties (Code Health Occupations Article, sec. 8-503).

NURSE PSYCHOTHERAPIST PEER REVIEW ADVISORY COMMITTEE
The Nurse Psychotherapist Peer Review Advisory Committee formed in 1991. It advises the State Board of Nursing on the practice of psychotherapy by clinical specialists in psychiatric and mental health nursing. The Committee also oversees the use of health insurance and medical assistance benefits by clinical specialists-psychiatry.

PRACTICE ISSUES COMMITTEE
Established in 1985, the Practice Issues Committee meets monthly to study specific practice issues referred to it by the State Board of Nursing. The Committee's twelve members are assisted by consultants as needed.

REHABILITATION COMMITTEE no. 1
REHABILITATION COMMITTEE no. 2
As a nonpunitive alternative to the disciplinary process of the State Board of Nursing, the Rehabilitation Committee was authorized in 1988 (Chapter 508, Acts of 1988). Nurses whose job performance is impaired by drugs, alcohol, or mental illness may participate in the Rehabilitation Program upon recommendation of the Committee. To handle the volume of nurses referred to the Program, a second committee was established in 1992.

The State Board of Nursing selects each committee's six members. Three are licensed registered nurses with expertise in the field of chemical dependency or psychiatric nursing. One member is a registered nurse, who has demonstrated expertise in pain management; one is a licensed practical nurse; and one, a consumer knowledgeable in the field of chemical dependency (Code Health Occupations Article, sec. 8-208).

STATE BOARD OF EXAMINERS OF NURSING HOME ADMINISTRATORS

Established in 1970, the State Board of Examiners of Nursing Home Administrators examines, licenses, and regulates nursing home administrators (Chapter 262, Acts of 1970). Licenses must be renewed with the Board every two years. They may be revoked or suspended for cause. The Board also studies nursing homes and their administrators to improve licensing standards and enforcement procedures.

Eleven members constitute the Board. They are appointed to four-year terms by the Governor upon recommendation of the Secretary of Health and Mental Hygiene. The Governor names the chair and vice-chair. The Board appoints the executive director. Authorization for the Board continues until July 1, 2013 (Code Health Occupations Article, secs. 9-101 through 9-502).

STATE BOARD OF OCCUPATIONAL THERAPY PRACTICE

The State Board of Occupational Therapy Practice was created in 1978 (Chapter 909, Acts of 1978). The Board administers, coordinates, and enforces the provisions of the Maryland Occupational Therapy Practice Act. The Board evaluates the qualifications of applicants for licensure and supervises the examination of applicants. It keeps a current list of licensed occupational therapists and occupational therapy assistants. Licenses must be renewed every two years and may be revoked or suspended for cause.

The Board's seven members are appointed for four-year terms by the Governor with the advice of the Secretary of Health and Mental Hygiene. The Board selects the Executive Director. Authorization for the Board continues until July 1, 2015 (Code Health Occupations Article, secs. 10-201 through 10-502).

STATE BOARD OF EXAMINERS IN OPTOMETRY

Formed in 1914, the State Board of Examiners in Optometry administers the optometry laws of the State and regulates the practice of optometry (Chapter 652, Acts of 1914). It examines, licenses, and registers applicants, and may revoke any certificate of registration or examination for just cause.

The Board consists of seven persons appointed to four-year terms by the Governor upon the recommendation of the Secretary of Health and Mental Hygiene from nominees of the Maryland Optometric Association. Two members are consumers appointed by the Governor on recommendation of the Secretary with Senate advice and consent. Authorization for the Board continues until July 1, 2013 (Code Health Occupations Article, secs. 11-101 through 11-602).

STATE BOARD OF PHARMACY

Created in 1902, the State Board of Pharmacy licenses pharmacists by examination and reciprocity (Chapter 179, Acts of 1902). It also conducts a biennial re-registration program for pharmacists. The Board issues permits for the operation of retail pharmacies and for the manufacture of drugs, medicines, toilet articles, dentifrices, and cosmetics. The Board also licenses jobbers, distributors, and wholesalers or manufacturers of prescription drugs. In cooperation with the Department of Health and Mental Hygiene, the Board enforces the pharmacy and drug laws of the State.

All pharmacies or other places where prescriptions, medicines, drugs, drug products, or domestic remedies are compounded or sold are inspected by Board members and duly authorized agents of the Department of Health and Mental Hygiene. They also inspect prescriptions, medicines, drugs, drug products, or domestic products offered for sale. Pharmacists are required to keep in their places of business, for a period of not less than five years, a file of every prescription compounded or dispensed.

The Board's twelve members include ten licensed pharmacists and two consumers. All are appointed by the Governor with the advice of the Secretary of Health and Mental Hygiene for four-year terms. The Board may designate an executive director. Authorization for the Board continues until July 1, 2013 (Code Health Occupations Article, secs. 12-101 through 12-802).

PHARMACY REVIEW COMMITTEE
In 1997, the State Board of Pharmacy was authorized to appoint a Pharmacy Review Committee (Chapter 615, Acts of 1997).

STATE BOARD OF PHYSICAL THERAPY EXAMINERS

Authorized in 1947, the State Board of Physical Therapy Examiners examines and licenses physical therapists and physical therapist assistants to practice in Maryland (Chapter 606, Acts of 1947). The Board also makes rules and regulations governing the denial, suspension, and revocation of licenses.

The Board's eight members are appointed to four-year terms by the Governor with the advice of the Secretary of Health and Mental Hygiene. Two consumer members are named with Senate advice and consent. Authorization for the Board continues until July 1, 2012 (Code Health Occupations Article, secs. 13-101 through 13-502).

STATE BOARD OF PHYSICIANS

In Maryland, authority to license physicians was granted first to the Medical and Chirurgical Faculty of the State of Maryland in their charter of 1798 (Chapter 105, Acts of 1798). From 1798 to 1838, the Faculty examined candidates, issued licenses upon payment of a fee, and prosecuted unlicensed doctors. The petitions of botanic medical practitioners influenced the legislature to pass a law in 1838 allowing any person to collect fees for medical services performed, which effectively ended the licensing of doctors for fifty years in Maryland (Chapter 281, Acts of 1838).

In 1888, the State Board of Health began to license all physicians (Chapter 429, Acts of 1888). By 1892, two boards of medical examiners carried on this function. One represented the Medical and Chirurgical Faculty and the other the State Homeopathic Society (Chapter 296, Acts of 1892). The General Assembly in 1957 abolished the Homeopathic Board and set up the State Board of Medical Examiners to regulate the practice of medicine. In 1968, responsibility for disciplining licensed physicians was assigned to the Commission on Medical Discipline of Maryland (Chapter 469, Acts of 1968). Functions of both the State Board of Medical Examiners and the Commission on Medical Discipline of Maryland combined in 1988 under the State Board of Physician Quality Assurance (Chapter 109, Acts of 1988). The Board reformed in 2003 as the State Board of Physicians (Chapter 252, Acts of 2003).

The State Board of Physicians tests and licenses physicians to practice medicine in Maryland. The Board determines the eligibility of physicians to represent themselves as specialists. For certain causes, the Board may revoke the license of any physician. The Board also registers residents and x-ray assistants. In addition, the Board certifies seven categories of allied health practitioners, including physician assistants, psychiatrists' assistants, respiratory care practitioners, medical radiation technologists, nuclear medical technologists, cardiac rescue technicians, and emergency medical technicians-paramedics. With the State Board of Nursing, the Board reviews written agreements between physicians and nurse practitioners and nurse midwives.

To determine eligibility for initial medical licensure, the Board administers the United States Medical Licensing Examination. The Board also administers the Special Purpose Examination of the Federation of State Medical Boards to some applicants and licensees to determine if they have remained competent practitioners after an absence from practicing medicine.

For certain cases, the Board may take disciplinary action, including revocation, suspension, reprimand, or probation, and may fine a licensee. Where there is an imminent threat to the public, the Board may issue an emergency suspension of a license. In an effort to prevent misconduct, the Board operates a speaker's bureau, and conducts educational programs and training sessions on certain high-risk behavioral areas. Quarterly, the Board issues a newsletter with a lead article of topical interest to the medical community as well as information about Board acts or sanctions.

The Board works closely with state and local law-enforcement agencies, as well as federal agencies, such as the Federal Bureau of Investigation and the U.S. Office of Inspector General. Since 1977, the Board has participated in the network of state disciplinary information bank of the Federation of State Medical Boards. Since 1990, the Board has served as a conduit of disciplinary information between Maryland hospitals and the National Practitioners Data Bank.

Composed of fifteen members, the Board is appointed by the Governor. One consumer member is appointed to an initial term of three years with Senate advice and consent. Other members serve four-year terms. The Governor selects a physician member as chair. Authorization for the Board continues until July 1, 2013 (Code Health Occupations Article, secs. 14-101 through 15-502).

LICENSURE & PRACTICE OF MEDICINE ADVISORY COMMITTEE
The Licensure Advisory Committee was formed originally by the State Board of Physician Quality Assurance. In 2003, it was combined with the Practice of Medicine Advisory Committee, which was organized in 1992 by the State Board of Physician Quality Assurance. As the Licensure and Practice of Medicine Advisory Committee, it advises the State Board of Physicians on licensure issues, such as postgraduate training, examinations, and renewal and reinstatement requirements, as well as on issues affecting medical licensure, such as telemedicine and delegation of medical acts.

MEDICAL RADIATION & NUCLEAR MEDICAL TECHNOLOGY ADVISORY COMMITTEE
In 1990, the Medical Radiation and Nuclear Medical Technology Advisory Committee began. The Committee reviews and makes recommendations to the State Board of Physicians on all applications for certification of nuclear medical technologists and medical radiation technologists. The Committee recommends to the Board the approval, modification, or disapproval of an application for certification. The Committee also recommends to the Board regulations governing nuclear medical technologists and medical radiation technologists and their practice.

PHYSICIAN ASSISTANT ADVISORY COMMITTEE
Within the State Board of Medical Examiners, the Physician Assistant Advisory Committee was created in 1986 (Chapter 759, Acts of 1986). The Committee became part of the State Board of Physician Quality Assurance (now the State Board of Physicians) in 1988 (Chapter 109, Acts of 1988).

The Committee recommends to the State Board of Physicians, regulations for the certification of physician assistants. To the Board, it also recommends the approval, modification, or disapproval of an application for certification. The Committee may report to the Board any alleged unauthorized practice of a physician assistant, or any conduct of a supervising physician or a physician assistant that may be cause for disciplinary action.

To perform delegated medical acts, a physician assistant must obtain an approved delegation agreement from the State Board of Physicians. The Committee evaluates the qualifications of the physician assistant for delegated medical acts to be performed under that agreement and recommends that the Board approve, modify, or reject the application for a delegation agreement. The Board, on review of the Committee's recommendation, may approve, modify, or disapprove a delegation agreement for good cause.

The Committee's seven members are appointed to three-year terms by the State Board of Physicians. Authorization for the Committee expires July 1, 2013 (Code Health Occupations Article, secs. 15-101 through 15-502).

RESPIRATORY-CARE PROFESSIONAL STANDARDS COMMITTEE
Authorized in 1988, the Respiratory-Care Professional Standards Committee formed in 1990 (Chapter 127, Acts of 1988). The Committee advises the State Board of Physicians on regulations governing the practice of respiratory care, and the approval, modification, or disapproval of an application for certification. The Committee refers to the Board any allegation of unauthorized practice by a respiratory care practitioner or conduct by a supervising physician or respiratory care practitioner that may be cause for disciplinary action.

Authorization for the Committee extends to July 1, 2013 (Code Health Occupations Article, secs. 14-5A-01 through 14-5A-24).

STATE BOARD OF PODIATRIC MEDICAL EXAMINERS

The State Board of Podiatric Medical Examiners commenced in 1916 as the State Board of Chiropody Examiners (Chapter 173, Acts of 1916). In 1965, it became the State Board of Podiatry Examiners (Chapter 416, Acts of 1965). The Board was renamed the State Board of Podiatric Medical Examiners in 1986 (Chapter 243, Acts of 1986).

In Maryland, the practice of podiatry is regulated by the Board. The Board evaluates credentials, gives licensure examinations, issues licenses, renews licenses biennially, approves continuing education programs, monitors compliance of licensees with continuing education requirements, and investigates allegations of professional misconduct. After a hearing, the Board may revoke the license of any podiatrist charged with malpractice or unethical conduct.

The Governor appoints the Board's seven members to four-year terms with the advice of the Secretary of Health and Mental Hygiene. Two are consumers appointed with Senate advice and consent. Authorization for the Board continues until July 1, 2012 (Code Health Occupations Article, secs. 16-101 through 16-602).

STATE BOARD OF EXAMINERS OF PSYCHOLOGISTS

The practice of psychology in Maryland is regulated by the State Board of Examiners of Psychologists. Established in 1957, the Board evaluates the qualifications of psychologists in the State and issues licenses to those who fulfill the requirements (Chapter 748, Acts of 1957). Licenses must be renewed biennially. The Board administers examinations to qualified applicants for licensing twice each year.

Nine members compose the Board. They are appointed by the Governor with the advice of the Secretary of Health and Mental Hygiene and Senate advice and consent. Members serve four-year terms. Authorization for the Board continues until July 1, 2013 (Code Health Occupations Article, secs.18-101 through 18-502).

STATE BOARD OF SOCIAL WORK EXAMINERS

In 1975, the State Board of Social Work Examiners formed (Chapter 453, Acts of 1975). The Board issues licenses to social work associates, graduate social workers, certified social workers, and certified social workers-clinical. Under certain conditions the Board may take disciplinary measures to reprimand, suspend, revoke, or refuse to renew the license of a licensee.

The Board's eleven members are appointed by the Governor to four-year terms. Two are consumers appointed on recommendation of the Secretary of Health and Mental Hygiene with Senate advice and consent. The Board appoints the Executive Director. Authorization for the Board continues until July 1, 2014 (Code Health Occupations Article, secs. 19-201 through 19-502).

MARYLAND COMMUNITY HEALTH RESOURCES COMMISSION

The Maryland Community Health Resources Commission was established in July 2005 (Chapter 280, Acts of 2005). To improve access to health-care for those who are under insured and those without any insurance, the Commission will award operating and information technology grants to community clinics which meet Commission-determined criteria as community health resources. Using such clinics as the basis for community health care, the Commission will help communities establish integrated health services.

The Commission's eleven members are appointed by the Governor with Senate advice and consent. The Governor designates the chair. With the Governor's approval, the Commission appoints an executive director.

Authorization for the Commission extends through June 30, 2010 (Code Health-General Article, secs. 19-2101 through 19-2111).

MARYLAND HEALTH CARE COMMISSION

The Maryland Health Care Commission originated in 1993 as the Maryland Health Care Access and Cost Commission, an independent body within the Department of Health and Mental Hygiene (Chapter 9, Acts of 1993). Assuming functions of the former State Health Resources Planning Commission, it reorganized in 1999 as the Maryland Health Care Commission (Chapter 702, Acts of 1999).

The Commission promotes a health regulatory system to provide all Marylanders with financial and geographic access to quality health care at a reasonable cost. Strategies to limit health care costs and extend health care access for all Marylanders are developed by the Commission. The Commission also formulates a uniform set of benefits for the comprehensive standard health benefit plan; devises a payment system for health care services; and fosters development of practice parameters. Moreover, the Commission facilitates public disclosure of medical claims data for the development of public policy; maintains and analyzes a medical care database on health care provided by health care practitioners; and ensures the use of that database as a primary means to compile data and annually report on trends, variances, and comparisons regarding fees for service, cost of care, and malpractice. Additionally, the Commission encourages the development of clinical resource management systems that permit cost comparisons between various treatment settings and the availability of information to consumers, providers, and purchasers of health care; sets standards for the operation and licensing of medical care electronic claims clearinghouses; and reduces the costs of submitting and administering claims for health care practitioners and payors.

To evaluate the quality and performance of health maintenance organizations (HMOs) operating in Maryland, the Commission has developed a system based on clinical standards and a consumer survey. Each fall since October 1997, an annual report is issued enabling employers and employees to compare the quality of care and services provided by Maryland HMOs and make informed choices about health care plans.

With Senate advice and consent, the Governor appoints the Commission's fifteen members to four-year terms. The Governor also names the chair. The Executive Director is appointed by the Commission with the Governor's approval (Code Health - General Article, secs. 19-101 through 19-227).

HOSPITAL & AMBULATORY SURGICAL-FACILITY REPORT-CARD STEERING COMMITTEE
In January 2000, the Hospital and Ambulatory Surgical-Facility Report-Card Steering Committee was created by the Maryland Health Care Commission. The Committee is devising a system by which to evaluate the performance of hospital and ambulatory surgical facilities. The system is to be implemented by July 2001 (Chapter 657, Acts of 1999).

NURSING HOME REPORT-CARD STEERING COMMITTEE
In September 1999, the Maryland Health Care Commission formed the Nursing Home Report-Card Steering Committee. The Committee is developing a system to comparatively evaluate the quality of care in nursing homes. The system is to be implemented by July 2001 (Chapter 382, Acts of 1999).

STATE HEALTH SERVICES COST REVIEW COMMISSION

In 1971, the State Health Services Cost Review Commission was mandated to monitor all fiscal affairs of Maryland's hospitals and related institutions (Chapter 627, Acts of 1971). The Commission publicly may disclose a hospital's financial position, its verified total costs incurred in rendering health services, and the level of reasonableness of its rates as determined by Commission review and certification. The Commission also evaluates the adequacy of each institution's financial resources. When these resources are inadequate, the Commission seeks solutions.

For purchasers of hospital health care, the Commission assures that total costs are reasonable, aggregate rates are set in relation to a hospital's aggregate costs, and rates are set equitably.

The Commission consists of seven members appointed to four-year terms by the Governor, who names the chair. With the approval of the Governor, the Commission appoints the executive director (Code Health - General Article, secs. 19-201 through 19-227).

HEALTH CARE FINANCING

In 1975, Health Care Financing began as the Office of Regulatory Services. By 1981, responsibilities of the Office were assigned to the Assistant Secretary for Health Regulation and Policy Analysis and, by 1985, to the Assistant Secretary for Health Regulation. In 1987, Policy, Financing, and Regulation was created and, in 1988, renamed Health Care Policy, Finance, and Regulation. The deputy secretariat reorganized as Health Care Financing in December 1999.

Health Care Financing administers Maryland's five medical care programs: Family Planning; Kidney Disease; Maryland Children's Health Program; Maryland Pharmacy Program; and Medical Assistance (Medicaid and HealthChoice).

The principal health regulatory functions of the Department are overseen by Health Care Financing which also provides leadership and guidance for the Department's financing and regulatory programs. This entails oversight of regulatory functions of the Maryland Health Care Commission and the State Health Services Cost Review Commission.

The Deputy Secretary for Health Care Financing develops recommendations for the Secretary of Health and Mental Hygiene to modify and shape the role of the Department. The Deputy Secretary helps define health problems, evaluates Department programs, and develops data on federal and other external trends so as to advise the Secretary on program emphasis and Department direction.

Under Health Care Financing are three offices: Health Services; Operations, Eligibility, and Pharmacy; and Planning and Finance. Health Care Financing also is assisted by the CommunityChoice Advisory Group and the Maryland Medicaid Advisory Committee.

COMMUNITYCHOICE ADVISORY GROUP
The CommunityChoice Advisory Group was convened by the Secretary of Health and Mental Hygiene in December 2004. The Advisory Group assists the Department in setting up CommunityChoice, a new Medicaid program for eligible individuals who need long-term care. CommunityChoice is envisioned as a program of managed health care which provides necessary services to older adults or persons with disabilities in their homes or communities instead of in nursing homes. The Advisory Group formulates policy and regulations for CommunityChoice, and also assisted in drafting the waiver application submitted to the U.S. Department of Health and Human Services in August 2005. If the waiver is approved, the Advisory Group will continue to implement the new program.

MARYLAND MEDICAID ADVISORY COMMITTEE
The Maryland Medicaid Advisory Committee organized as the Medical Assistance Advisory Committee. It was created for the Medical Assistance Program (Medicaid) by the Secretary of Health and Mental Hygiene in accordance with the federal Social Security Act (sec. 1902A(22)). In 1996, the legislation which enabled Medicaid recipients to be enrolled in managed health-care organizations also reconstituted the Committee as the Maryland Medicaid Advisory Committee (Chapter 352, Acts of 1996).

From the Committee, the Secretary of Health and Mental Hygiene receives advice on implementation, operation, and evaluation of managed care programs for Medicaid recipients. The Committee also reviews and makes recommendations on regulations, contracts, and quality control; assesses data; sees that information is available to Medicaid recipients in language they can understand; and otherwise assists in the transition of Medicaid to managed care.

The Committee has up to twenty-five members. Seventeen are appointed to four-year terms by the Secretary of Health and Mental Hygiene. Two are appointed by the Senate President, and three by the House Speaker. Three serve ex officio (Code Health - General Article, sec. 15-101 through 15-103).

MARYLAND CHILDREN'S HEALTH PROGRAM
The Maryland Children's Health Program was created in 1998 as the Children and Families Health Care Program (Chapter 110, Acts of 1998). Effective July 1, 2001, it adopted its current name (Chapters 15 and 16, Acts of 2000). The Program provides complete health coverage for children and pregnant women who are not eligible for Medicaid, are uninsured, and whose family income is at or below 200% of the federal poverty level. Health care is provided by managed care organizations through HealthChoice.

MEDICAL ASSISTANCE PROGRAM (MEDICAID)
Health Care Financing plans, directs, and evaluates the Medical Assistance Program (Medicaid). Since 1966, the Program has provided access to health care for categorically and medically needy residents throughout Maryland. Health care includes hospital services (inpatient and outpatient), laboratory and X-ray services, nursing facility services, physician services, and home health care. Additional health care is available as indicated in the Medical Assistance State Plan. The Program is implemented by three offices: Health Services; Operations and Eligibility, Medical Care Programs; and Planning, Development, and Finance.

Health care expenses of the Medical Assistance Program (Medicaid) are federally matched on a 50/50 basis for approximately 90 percent of recipients. For the remaining 10 percent, services are funded totally by State and local funds (Code Health - General Article, secs. 15-101 through 15-128).

OFFICE OF HEALTH SERVICES

The Office of Health Services began as the Policy Administration in 1975. Renamed the Health Systems Financing Administration in 1987, and the Medical Care Policy Administration in March 1990, it became the Medical Care Services Administration in December 1999. The Office received its present name in January 2000.

Policies and regulations that establish eligibility criteria, define services, detail coverage, specify limitations, and determine reimbursement rates for the Medical Assistance Program (Medicaid) are developed and reviewed by the Office. In addition, the Office updates the State Plan for the Medical Assistance Program and secures federal approval for program changes to assure the continued availability of federal matching funds.

In October 1997, the Office reorganized into three main units: Acute and Primary Care; Long-Term Care and Community Support Services; and Long-Term Care and Waiver Services. In January 2000, it further reorganized under two administrations: HealthChoice and Acute Care; and Long-Term Care and Community Support Services.

HEALTHCHOICE & ACUTE CARE ADMINISTRATION

ACUTE CARE
Acute Care organized in November 2005. It oversees three divisions: Children's Services; Dental Clinics and Laboratory Services; and Hospital and Professional Services.

DIVISION OF CHILDREN'S SERVICES
The Division of Children's Services organized in May 1998.

DIVISION OF HOSPITAL & PROFESSIONAL SERVICES
The Division of Hospital and Professional Services was established in July 1979 as the Division of Acute Care. It became the Division of Medical Services in October 1997, the Division of Pharmacy and Clinic Services in January 2000, the Division of Hospital and Physician Services in June 2003, and received its current name in November 2005. The Division plans, prepares, and amends regulations, and interprets policy for the following parts of the Medical Assistance Program (Medicaid): Ambulatory Surgery; Free-standing Dialysis Centers; Hospitals; Medical Laboratories; Mental Health; and Residential Treatment Centers.

MANAGED CARE
Managed Care formed in January 2000 as Provider Management and adopted its present name in November 2005. It oversees four divisions: HealthChoice Customer Relations; HealthChoice Management and Quality Assurance; Healthy Kids Program; and Outreach and Care Coordination.

DIVISION OF HEALTHCHOICE MANAGEMENT & QUALITY ASSURANCE
In July 1987, the Division of HealthChoice Management and Quality Assurance began as the Division of Primary Care, became the Division of Managed Care in October 1997, and the Division of HealthChoice Management in January 2000. That division merged with the Division of Managed Care Quality Assurance in April 2002 to become the Division of HealthChoice Management and Quality Assurance. The Division establishes and articulates the State Medicaid policies and regulations pertaining to medical and professional services. These services are provided by physicians, dentists, podiatrists, vision care providers, free-standing clinics, nurse-midwives, nurse anesthestists, nurse practitioners, and health maintenance organizations.

DIVISION OF OUTREACH & CARE COORDINATION
The Division of Outreach and Care Coordination started in May 1998 as the Division of Outreach and Women's Services, became the Division of Outreach and Assistance in January 2000, and received its current name in July 2000.

LONG-TERM CARE & COMMUNITY SUPPORT SERVICES ADMINISTRATION

LONG-TERM CARE & WAIVER SERVICES
Under Long-Term Care and Waiver Services are three divisions: Evaluation and Quality Review; Living-At-Home Waiver; and Waiver Programs.

DIVISION OF WAIVER PROGRAMS
The Division of Waiver Programs was one of two agencies derived from the former Division of Program Services in December 1994. The Division of Waiver Programs is concerned with Medical Assistance waivers. These are exceptions granted by the federal Health Care Financing Administration to certain federal regulations governing Medicaid. Such waivers are authorized when it becomes cost effective to do so, but only if the quality of medical care is maintained (federal Social Security Act, sec. 1915). Typically, waivers help people who otherwise would require a hospital, or a facility providing skilled nursing or intermediate care.

The Division coordinates and manages three home- and community-based services waivers. These are the Model Waiver, Senior Assisted-Housing Waiver, and Developmental Disabilities Waiver. The Division also directs nine targeted case-management services programs, and two managed-care waivers and proposals (Maryland Access to Care and the Diabetes Care Waiver).

LONG-TERM CARE FINANCING
Formed in November 2005, Long-Term Care Financing is responsible for the Division of Long-Term Care Services.

DIVISION OF LONG-TERM CARE SERVICES
In July 1979, the Division of Long-Term Care Services formed. It became the Division of Institutional Long-Term Care Services in January 2000, and returned to its original name in 2006. The Division administers Maryland Medicaid coverage and reimbursement for nursing home services, medical day care, and personal care.

The Division develops strategies for financing and delivering services to persons with special needs who are eligible for Medicaid. These include children and adults with chronic or mental illnesses, traumatic injury, developmental disability, AIDS, or a history of drug and alcohol abuse. Services funded entirely by the State are refinanced to include federal Medicaid funds. Financial resources and services are reallocated from institutions, such as nursing homes and State psychiatric and developmental disability facilities, to community-based services.

NURSING & COMMUNITY PROGRAMS
Nursing and Community Programs began in January 2000 as Access, Quality, and Program Integrity and restructured under its present name in July 2004. It oversees three divisions: Community Long-Term Care Services; Community Support Services; and Nursing Services.

DIVISION OF COMMUNITY LONG-TERM CARE SERVICES
The Division of Community Long-Term Care Services organized as the Division of Special Populations in December 1994. It was one of two units created from the former Division of Program Services. In 1997, the Division of Special Populations reorganized as the Division of Planning and Evaluation. It received its present name in January 2000.

OFFICE OF OPERATIONS & ELIGIBILITY, MEDICAL CARE PROGRAMS

The Office of Operations and Eligibility, Medical Care Programs originated in 1975 as the Medical Care Operations Administration. It reorganized as the Program Systems and Operations Administration in November 1993, and reclaimed its original name in July 1997. In December 1999, it became the Medical Care Operations and Eligibility Administration and, in January 2000, it adopted its current name.

Systems for prompt and accurate payment to providers of health care services are developed and maintained by the Office. It also maintains files of approved providers of services and of Maryland residents certified as eligible to receive services through the Medical Assistance Program (Medicaid). In 1999, the Office became responsible for eligibility determination and policy.

The Office includes the Maryland Pharmacy Program and two administrations: Beneficiary Services; and Systems and Operations.

ADMINISTRATIVE SERVICES
Administrative Services started in March 1990. The Division conducts personnel transactions, prepares budgets, promulgates Medicaid regulations, and formulates amendments to the Medicaid State Plan.

BENEFICIARY SERVICES ADMINISTRATION

ELIGIBILITY OPERATIONS
Eligibility Operations began as Beneficiary Operations and adopted its present name in November 2006.

Under Eligibility Operations are the Kidney Disease Program and two divisions: Beneficiary Enrollment and Call Center; and Recipient Eligibility Programs.

KIDNEY DISEASE PROGRAM
Formed in 1971, the Kidney Disease Program financially assists Marylanders who are certified end-stage renal disease patients. This assistance for treatment is available only after all other medical and federal insurance coverage has been pursued.

DIVISION OF BENEFICIARY ENROLLMENT & CALL CENTER
The Division of Beneficiary Enrollment and Call Center was created in December 1999 as the Beneficiary Services Division, and reorganized under its present name in 2003. It oversees the HealthChoice Program.

HealthChoice Program. This program was initiated in December 1991 as the Maryland Access to Care (MAC) Program. It reorganized as Maryland Access to Care (MAC) Recipient Services and Medical Assistance Provider Relations in November 1993 and further reformed as HealthChoice in July 1998.

To improve the quality of health care for Medical Assistance recipients, HealthChoice maintains a roster of primary care physicians. Recipients having difficulty finding their own physician may choose a primary care provider enrolled with the Program. That provider then refers the recipient to medical specialists as needed. The Program enrolls both recipients and providers and informs Medical Assistance recipients about the Program.

DIVISION OF ELIGIBILITY WAIVER SERVICES
The Division of Eligibility Waiver Services formerly was known as the Medical Assistance Waiver Unit of the Family Investment Administration within the Department of Human Resources. Under its current name, it transferred to the Department of Health and Mental Hygiene in March 2002.

The Division administers the Home and Community-Based Waiver programs. Waivers allow persons to receive Medical Assistance benefits in a community setting, at home, or in assisted-living facilities. Waivers include: the Waiver for Older Adults; Living at Home Maryland Community Choices Waiver; Waiver for Children with Autism Spectrum Disorder; Model Waiver for Disabled Children; Waiver for Individuals with Developmental Disabilities; and the Home and Community-Based Services Model Waiver for Adults with Traumatic Brain Injury.

Also, the Division determines and maintains Medical Assistance eligibility for children in residential treatment centers and institutions providing mental health services.

DIVISION OF RECIPIENT ELIGIBILITY PROGRAMS
The Division of Recipient Eligibility Programs began as the Division of Programs and Liaison. Renamed the Division of Eligibility Services in 1989, it reorganized as Recipient Eligibility Programs in November 1993, and reformed as the Division of Recipient Eligibility Programs in November 2005.

The Division is responsible for systems and procedures that update the Recipient Eligibility Master File; produce and issue Medical Care Program identification cards; and resolve eligibility problems. It also oversees the Buy-In Programs for Medicare.

Buy-In Programs for Medicare (Parts A & B). Under the these programs, the State, through the Medical Assistance Program (Medicaid), pays federal premiums for people certified by the local department of social services as unable to cover hospital insurance (Part A) or medical insurance (Part B).

ELIGIBILITY POLICY

MARYLAND PHARMACY PROGRAM

Two divisions carry out the work of the Maryland Pharmacy Program: Eligibility Operations; and Pharmacy Services.

The Pharmacy Assistance Program helps pay for certain kinds of maintenance prescription drugs for chronic conditions; anti-infective drugs, including AZT; and insulin syringes and needles. Completely State-funded, the Program is designed for low-income families and individuals who are not eligible for Medicaid (Code Health - General Article, sec. 15-124).

The Pharmacy Discount Program allows income-eligible Medicare recipients to purchase prescription drugs priced at 65% of the Medicaid price.

SYSTEMS & OPERATIONS ADMINISTRATION

PROGRAM OPERATIONS
Program Operations is responsible for six divisions: Adjustments and Payment Auditing; Claims Processing; Long-Term Care Problem Resolution; Medical Assistance Recoveries; Provider Relations; and Provider Services.

DIVISION OF CLAIMS PROCESSING
The Division of Claims Processing was first named the Division of Invoice Processing and adopted its present name in 1989. The Division processes all claims for payment made by providers of health care services under the Medical Assistance Program (Medicaid) and the Pharmacy Assistance Program. Processing includes mail sorting, microfilming, entry of claims into the Batch and Invoice Control File of the Medicaid Management Information System, and processing of payments in excess of $2.5 billion annually for claims received, resolution of erroneous claims, and claim storage and retrieval. The Division maintains records of payments to the more than 45,000 health care providers enrolled in the Medical Assistance Program.

DIVISION OF MEDICAL ASSISTANCE RECOVERIES
In 1969, the Division of Medical Assistance Recoveries started. By 1993, it was made part of the Medical Care Finance and Compliance Administration. The Division transferred to the Medical Care Operations Administration in February 1998, and has been part of the Office of Health Services since January 2000.

The Division operates third-party liability programs. Through these, other responsible parties are pursued for payment of health care received under the Medical Assistance Program (Medicaid). Money spent on behalf of recipients is recovered from sources allowed by federal or State law.

TECHNICAL SYSTEMS
Under Technical Systems are two divisions: Medicaid Information Systems; and Systems and Liaison Services.

DIVISION OF MEDICAID INFORMATION SYSTEMS
Established in 1982, the Division of Medicaid Information Systems serves as the data processing unit for Medical Care Programs. The Division performs systems analysis and programming, and maintains a teleprocessing network. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. The Division also provides data processing for Geriatric Evaluation Services; Pharmacy Assistance Program; and Statewide Evaluation and Planning Services.

OFFICE OF PLANNING & FINANCE

Priority projects are developed and implemented by the Office of Planning and Finance, which devises initiatives and conducts technical analyzes needed to address departmental, gubernatorial and legislative concerns. For policy decisions, the Office also analyzes evaluations and statistics.

Under the Office are two main units: Finance; and the Planning Administration.

OPERATIONS ADMINISTRATIVE SUPPORT

Operations Administrative Support supports the Department through expenditure control, personnel management, data processing and information technology, general services, grants administration, and capital construction.

Under Operations Administrative Support are the Board of Review; the Office of Human Resources; and the Office of Public Relations and Governmental Affairs. In addition, three administrations are overseen by Operations Administrative Support: Financial Management; Information Resources Management and Vital Statistics. Operations Administrative Support also is responsible for three offices: Community Relations; Contract Policy, Management, and Procurement; and Planning and Capital Financing.

BOARD OF REVIEW
The Board of Review of the Department of Health and Mental Hygiene was established in 1969 (Chapter 77, Acts of 1969). The Board decides appeals of departmental decisions as provided by law.

With Senate advice and consent, the Governor appoints the Board's seven members to three-year terms (Code Health - General Article, secs. 2-201 through 2-207).

OFFICE OF COMMUNITY RELATIONS
In 1994, the Office of Community Relations began under the Personnel Services Administration and later was placed under Operations. The Office monitors Department programs and health care providers to assure that they comply with civil rights laws, mandates, and regulations. For the same purpose, the Office monitors personnel management, services, and procurement procedures of the Department. The Office also develops and monitors programs for equal opportunities for employment, including affirmative action, on-site review, outreach recruitment, and complaint processing. In addition, the Office develops and monitors programs for equal access to health care and for minority business participation in State contracts.

OFFICE OF PROCUREMENT & SUPPORT SERVICES
The Office of Procurement and Support Services was established as the Office of Contract Policy, Management, and Procurement under Operations in December 2001 and adopted its present name in April 2006. The Office develops policies, procedures, and standards that govern how the Department procures and manages contracts, and ensures that those policies and procedures are disseminated and adhered to throughout the Department. Upon request, the Office serves in an advisory capacity to programs and directly delivers procurement services for programs not certified to process or approve their own procurements. The Office also provides legal advice on procurement issues and serves as the repository and clearinghouse for procurement and contract management information within the Department.

DIVISION OF CENTRAL SERVICES
Formerly under the General Services Administration, the Division of Central Services moved to the Office of Contract Policy, Management, and Procurement in January 2006. The Division of Central Services manages the Central Warehouse, building services, fleet management, forms management, inventory control, life safety, security, and telecommunications.

OFFICE OF PLANNING & CAPITAL FINANCING
The Office of Planning and Capital Financing started as the Office of Planning and Policy Management and received its present name in 1994. The Office prepares the Department's annual Executive Plan, the Five-Year Capital Improvement Plan, the Master Facilities Plan, and twenty individual facility plans. The Office also is responsible for the Department's annual capital budget, real estate transactions, and bond bill submission. Internal policies and procedures are developed and promulgated through the Office. The Office also conducts special studies requested by the Secretary of Health and Mental Hygiene or the General Assembly.

DIVISION OF ENGINEERING & MAINTENANCE
Formerly under the General Services Administration, the Division of Engineering and Maintenance moved to the Office of Planning and Capital Financing in January 2006. The Division oversees environmental, air quality and asbestos projects in Department facilities. It also reviews plans for every health care facility designed and constructed in Maryland.

OFFICE OF HUMAN RESOURCES

The Office of Human Resources was first the Office of Personnel Management and became the Personnel Services Administration in 1988. On May 1, 2004, the Administration reformed as the Office of Human Resources. For the Department, the Office provides personnel services and training.

Under the Office are Personnel Information Systems, and six divisions: Administration; Classification and Compensation; Employee Relations; Employment; Recruitment and Testing; and Training Services.

OFFICE OF PUBLIC RELATIONS & GOVERNMENTAL AFFAIRS

OFFICE OF APPOINTMENTS & EXECUTIVE NOMINATIONS
Formerly under Business and Regulatory Services, the Office of Appointments and Executive Nominations transferred to Operations in 1997. It was placed under the Office of Public Relations and Governmental Affairs in 2005. The Office recruits and screens candidates for health regulatory boards and commissions, task forces, and citizen advisory boards whose members are appointed by the Governor or the Secretary of Health and Mental Hygiene.

OFFICE OF GOVERNMENTAL AFFAIRS
Under the Office of Public Relations and Governmental Affairs, the Department's liaison with State and federal government is the Office of Governmental Affairs. The Office coordinates the preparation of legislation the Department wants introduced, and analyzes other legislation for its impact on the Department.

OFFICE OF REGULATIONS COORDINATION
A central clearinghouse for health regulations is provided by the Office of Regulations Coordination. Here, regulations are reviewed and revised. The Office provides technical assistance to administrative units of the Department.

VOLUNTEER SERVICES DIVISION
The Volunteer Services Division develops and directs the Department's thirty-two volunteer services programs statewide. These programs offer citizens and community groups the opportunity to aid and enhance the lives of residents of Department hospital centers and patients in the community. The Chief serves as liaison to the Department's Council of Auxiliaries, a private, nonprofit service organization.

INFORMATION RESOURCES MANAGEMENT ADMINISTRATION

The Administration devises information-processing strategies and implements the policy, procedures, and controls required for automation programs. The Administration also provides security, systems analysis, programming and data communications, and training and computer operation services for the Department's information systems throughout the State.

Under the Administration are four divisions: Computer Operations; Information Systems; Information Technology Support; and Policy, Planning, and Administration.

VITAL STATISTICS ADMINISTRATION

In November 1998, the Vital Statistics Administration started from divisions formerly under the General Services Administration. At that time, the Division of Health Statistics and the Division of Vital Records were placed under the Administration.

The Administration is responsible for two divisions: Health Statistics, and Vital Records.

DIVISION OF HEALTH STATISTICS

Annually, the Division of Health Statistics publishes vital statistics and population estimates for the State. To highlight significant trends and findings, the Division analyzes and reports annually on the health status of Maryland residents. It provides statistical analysis and advice to programs on studies and systems development. The Division publishes annual and special reports on these topics.

DIVISION OF VITAL RECORDS

The Division of Vital Records organized in 1910 as the Bureau of Vital Statistics under the State Department of Health (Chapter 560, Acts of 1910). In 1951, it reformed as the Division of Vital Records and Statistics and, in 1967, as the Division of Vital Records under the Bureau of Analysis and Records. In 1969, the Division was placed under the Center for Health Statistics. In 1988, the Division was separated from Health Statistics.

Copies of certified birth, death, and marriage certificates are provided by the Division. All births, deaths, marriages, and divorces that occur in the State are registered. Copies of birth, death and marriage records are issued to authorized persons for a fee of $12.00 per copy (checks to be made payable to Department of Health and Mental Hygiene).

Birth and Death Records. The Division has birth and death records for Baltimore City from January 1, 1875, and for the twenty-three counties of Maryland from August 1898. The information also is available from the State Archives.

Marriage and Divorce Records. State marriage registration began on June 1, 1951, and divorce registration began in June 1961. Copies of marriage records prior to June 1951 and of all divorce records may be obtained from the Circuit Court clerk in the county where the marriage or divorce occurred, or from the State Archives.

PUBLIC HEALTH SERVICES

AIDS ADMINISTRATION

ALCOHOL & DRUG ABUSE ADMINISTRATION

COMMUNITY & PUBLIC HEALTH ADMINISTRATION

LOCAL HEALTH DEPARTMENTS

DEVELOPMENTAL DISABILITIES ADMINISTRATION

LABORATORIES ADMINISTRATION

MENTAL HYGIENE ADMINISTRATION

OFFICE OF CHIEF MEDICAL EXAMINER

STATE ANATOMY BOARD

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