The COMAR 10.63 Overhaul: What Maryland Behavioral Health Providers Need to Know Right Now

On July 10, 2026, the Maryland Department of Health submitted its proposed COMAR 10.63 Community-Based Behavioral Health Programs and Services regulations to the Joint Committee for Administrative, Executive, and Legislative Review. BHA expects the regulations to be published in the Maryland Register in August or September 2026, which will open a formal public comment period.

This is not a minor update. COMAR 10.63 is the regulatory foundation for every community behavioral health program in Maryland -- PRP, OMHC, TCM, PHP, IOP, and more. What BHA is proposing is a comprehensive overhaul that rewrites the entire subtitle, expanding it from roughly 9 chapters to 38. If you operate any of these program types, understanding what is changing -- and when -- is not optional.

How We Got Here

The overhaul has been building since 2024, driven by three converging pressures: the rapid and largely uncontrolled growth of the PRP sector (more than doubling in licensed locations from 2019 to 2024), rising concerns about fraud, waste, and abuse in the Public Behavioral Health System, and a broader state effort to modernize a regulatory framework that had not kept pace with how community behavioral health actually operates.

BHA structured the overhaul in phases:

Phase 1 (finalized April 2025): Established civil monetary penalties for behavioral health providers with serious legal or regulatory violations. This was the enforcement teeth -- giving BHA meaningful consequences to impose on non-compliant providers, not just license suspension.

Phase 2 (proposed May 2025, revised multiple times through 2026): The comprehensive rewrite of COMAR 10.63 itself -- clearer compliance standards, staffing requirements, documentation requirements, and licensure processes. This is the phase now moving toward formal promulgation.

Phase 3 (program-specific chapters, incorporated into Phase 2): Detailed requirements tailored to each specific behavioral health program type -- PRP, OMHC, residential programs, PHP, IOP, and others. Rather than separating this into a distinct phase, BHA has incorporated program-specific chapters directly into the comprehensive COMAR 10.63 rewrite.

What the New Structure Looks Like

The proposed regulations expand COMAR 10.63 from 9 chapters to 38, organized as follows:

Chapters .01-.06: Universal requirements that apply to all licensed organizations, regardless of program type. These cover compliance and reporting, accreditation requirements, licensure processes, staffing standards, documentation requirements, and site requirements. Every provider -- no matter which program you operate -- will be governed by these chapters.

Chapter .07: Absent. This chapter previously addressed Outpatient Civil Commitment, which BHA is repealing and replacing with Assisted Outpatient Treatment.

Chapters .08-.37: Program-specific chapters. Each program type gets its own chapter covering definitions, program description, staffing requirements, services, licensure requirements, and site and documentation requirements specific to that program. This is where the most substantive new requirements for PRP, OMHC, and case management programs will live.

Chapters .38-.39: Corrective actions and civil monetary penalties -- the enforcement framework.

Each program-specific chapter follows a consistent format: definitions, program description, staffing requirements, services, licensure requirements, and site/documentation requirements. This standardization is intentional -- it makes compliance requirements predictable and auditable across program types.

Key Changes Worth Flagging Now

While the full regulatory text is lengthy and program-specific details are still being finalized, several changes stand out as immediately relevant for most providers:

Clearer documentation standards. The previous COMAR 10.63 was criticized for vagueness that allowed inconsistent interpretation across programs and surveyors. The new framework includes more explicit documentation requirements -- what must be in an assessment, what triggers a care plan update, what a compliant progress note must contain. This is good news for providers who have always done things right; it is a significant compliance shift for those who relied on ambiguity.

Staffing requirements with more specificity. The new regulations include program-specific staffing ratios and credential requirements. One notable addition: Psychiatric Rehabilitation Association (PRA) certification is now recognized as a valid credential for rehabilitation specialists, alongside the existing CPRP certification. This expands the pool of credentialed staff for PRP programs.

Audio-only telehealth is no longer prohibited. A blanket prohibition on audio-only telehealth has been removed, bringing COMAR 10.63 into alignment with the Preserve Telehealth Access Act of 2025 (SB 372), which made permanent audio-only coverage and behavioral health telehealth protections. This is a meaningful operational change for programs serving clients with transportation or technology barriers.

Dietary services clarification. A definition of "dietary services" has been added that distinguishes commercial kitchen operations (a dietary service the regulations govern) from communal food preparation by participants or food preparation done as a rehabilitative activity (not a dietary service). This addresses a recurring source of confusion during surveys.

Accreditation requirements strengthened. The relationship between BHA licensure and accreditation is clarified and strengthened. Programs with accreditation-based licenses must comply with both their accreditation organization's standards and BHA's regulatory requirements, and BHA can enforce accreditation standards directly.

Civil monetary penalties are real now. Phase 1 established the penalty framework. The new regulations integrate it directly -- non-compliance with COMAR 10.63 can result in civil monetary penalties, not just license action. This changes the calculus for providers who previously treated compliance as a licensing concern.

What Happens Next

The proposed regulations were submitted to the Joint Committee on July 10, 2026. BHA expects publication in the Maryland Register in August or September 2026. Once published, there will be a formal public comment period -- typically 30 days -- during which any provider or stakeholder can submit written comments.

After the comment period closes, BHA will review comments, make any final revisions, and the regulations will be finalized. The effective date will be specified in the final regulation text; for a rulemaking of this scope, implementation timelines are typically six months to one year after finalization to allow providers time to come into compliance.

This means the final regulations are likely to be effective sometime in 2027 -- but the comment period is your last formal opportunity to influence the specific requirements before they become law. If any of the proposed requirements would create operational hardship for your program, the formal comment period is the time to say so in writing.

What You Should Do Right Now

Read the proposed regulation text. BHA has made the full draft available at health.maryland.gov/bha. It is dense, but the program-specific chapter relevant to your program type is where you need to focus. Identify requirements that differ from your current practices.

Submit comments during the formal comment period. When the regulations are published in the Maryland Register (expected August or September 2026), you will have a defined window to submit formal comments. BHA has repeatedly revised the draft in response to stakeholder feedback -- the process is responsive. If something in the proposed regulations does not work for your program, write it up and submit it.

Begin a gap analysis now. Compare the proposed requirements against your current documentation practices, staffing credentials, and operational workflows. Identify gaps and estimate what remediation would require. Doing this now -- before the regulations are finalized -- gives you maximum runway to adapt.

Stay current on BHA's website. BHA posts all updates, revised drafts, and stakeholder meeting announcements at health.maryland.gov/bha/Pages/COMAR-10-63-Proposed-Regulations-Announcement.aspx. Subscribe to MDH communications and check this page regularly through the fall.