<section article="ghg" article_name="Health - General" number="19-101" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <text>In this subtitle, “Commission” means the Maryland Health Care Commission.</text> </section> <section article="ghg" article_name="Health - General" number="19-102" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>The General Assembly finds that the health care regulatory system in this State is a highly complex structure that needs to be constantly reevaluated and modified in order to better reflect and be more responsive to the ever changing health care environment and the needs of the citizens of this State.</text> </level> <level label="b"> <text>The purpose of this subtitle is to establish a streamlined health care regulatory system in this State in a manner such that a single State health policy can be better articulated, coordinated, and implemented in order to better serve the citizens of this State.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-103" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>There is a Maryland Health Care Commission.</text> </level> <level label="b"> <text>The Commission is an independent commission that functions in the Department.</text> </level> <level label="c"> <text>The purpose of the Commission is to:</text> <level label="1"> <text>Develop health care cost containment strategies to help provide access to appropriate quality health care services for all Marylanders, after consulting with the Health Services Cost Review Commission;</text> </level> <level label="2"> <text>Promote the development of a health regulatory system that provides, for all Marylanders, financial and geographic access to quality health care services at a reasonable cost by:</text> <level label="i"> <text>Advocating policies and systems to promote the efficient delivery of and improved access to health care services; and</text> </level> <level label="ii"> <text>Enhancing the strengths of the current health care service delivery and regulatory system;</text> </level> </level> <level label="3"> <text>Facilitate the public disclosure of medical claims data for the development of public policy;</text> </level> <level label="4"> <text>Establish and develop a medical care database on health care services rendered by health care practitioners;</text> </level> <level label="5"> <text>Encourage the development of clinical resource management systems to permit the comparison of costs between various treatment settings and the availability of information to consumers, providers, and purchasers of health care services;</text> </level> <level label="6"> <text>In accordance with Title 15, Subtitle 12 of the Insurance Article, develop a uniform set of effective benefits to be included in the Comprehensive Standard Health Benefit Plan;</text> </level> <level label="7"> <text>Analyze the medical care database and provide, in aggregate form, an annual report on the variations in costs associated with health care practitioners;</text> </level> <level label="8"> <text>Ensure utilization of the medical care database as a primary means to compile data and information and annually report on trends and variances regarding fees for service, cost of care, regional and national comparisons, and indications of malpractice situations;</text> </level> <level label="9"> <text>Establish standards for the operation and licensing of medical care electronic claims clearinghouses in Maryland;</text> </level> <level label="10"> <text>Reduce the costs of claims submission and the administration of claims for health care practitioners and payors;</text> </level> <level label="11"> <text>Determine the cost of mandated health insurance services in the State in accordance with Title 15, Subtitle 15 of the Insurance Article;</text> </level> <level label="12"> <text>Promote the availability of information to consumers on charges by practitioners and reimbursements from payors;</text> </level> <level label="13"> <text>Oversee and administer the Maryland Trauma Physician Services Fund in conjunction with the Health Services Cost Review Commission; and</text> </level> <level label="14"> <text>Establish policies and standards to protect the confidentiality of patient and health care practitioner information related to legally protected health care as defined in § 4–301 of this article.</text> </level> </level> <level label="d"> <text>The Commission shall coordinate the exercise of its functions with the Department and the Health Services Cost Review Commission to ensure an integrated, effective health care policy for the State.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-104" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>The Commission shall consist of 15 members appointed by the Governor with the advice and consent of the Senate.</text> </level> <level label="2"> <text>Of the 15 members:</text> <level label="i"> <text>Eight shall be individuals who do not have any connection with the management or policy of a health care provider or payor; and</text> </level> <level label="ii"> <text>Of the remaining seven members:</text> <level label="1"> <text>Two shall be physicians;</text> </level> <level label="2"> <text>Two shall be payors, as defined in § 19–132 of this subtitle;</text> </level> <level label="3"> <text>One shall be an administrator of a hospital, as defined in § 19–301 of this title;</text> </level> <level label="4"> <text>One shall be a nursing home administrator in the State; and</text> </level> <level label="5"> <text>One shall be a nonphysician health care practitioner.</text> </level> </level> </level> </level> <level label="b"> <level label="1"> <text>The term of a member is 4 years.</text> </level> <level label="2"> <text>The terms of members are staggered as required by the terms provided for members of the Commission on October 1, 1999.</text> </level> <level label="3"> <text>At the end of a term, a member continues to serve until a successor is appointed and qualifies.</text> </level> <level label="4"> <text>A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies.</text> </level> <level label="5"> <text>The Governor may remove a member for neglect of duty, incompetence, or misconduct.</text> </level> <level label="6"> <text>A member may not serve more than two consecutive terms.</text> </level> </level> <level label="c"> <text>When appointing members to the Commission, the Governor shall:</text> <level label="1"> <text>Assure that:</text> <level label="i"> <text>At least four members are residents of different counties with a population of 300,000 or more; and</text> </level> <level label="ii"> <text>At least three members are residents of different counties with a population of less than 300,000, of which at least:</text> <level label="1"> <text>One shall be a resident of the Eastern Shore;</text> </level> <level label="2"> <text>One shall be a resident of Allegany County, Garrett County, Washington County, Carroll County, or Frederick County; and</text> </level> <level label="3"> <text>One shall be a resident of Southern Maryland; and</text> </level> </level> </level> <level label="2"> <text>To the extent practicable, assure geographic balance and promote racial, ethnic, and gender diversity in the Commission’s membership.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-105" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>The Governor shall appoint the chairman of the Commission.</text> </level> <level label="b"> <text>The chairman may appoint a vice chairman for the Commission.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-106" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>With the approval of the Governor, the Commission shall appoint an executive director who shall be the chief administrative officer of the Commission.</text> </level> <level label="b"> <text>The executive director, the deputy directors, and the principal section chiefs serve at the pleasure of the Commission.</text> </level> <level label="c"> <level label="1"> <text>The executive director, the deputy directors, and the principal section chiefs shall be executive service or management service employees.</text> </level> <level label="2"> <text>The Commission, in consultation with the Secretary, shall determine the appropriate job classification and, subject to the State budget, the compensation for the executive director, the deputy directors, and the principal section chiefs.</text> </level> </level> <level label="d"> <text>Under the direction of the Commission, the executive director shall perform any duty or function that the Commission requires.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-107" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>A majority of the full authorized membership of the Commission is a quorum.</text> </level> <level label="2"> <text>The decision of the Commission shall be by a majority of the quorum present and voting.</text> </level> </level> <level label="b"> <text>The Commission shall meet at least six times each year, at the times and places that it determines.</text> </level> <level label="c"> <text>Each member of the Commission is entitled to:</text> <level label="1"> <text>Compensation in accordance with the State budget; and</text> </level> <level label="2"> <text>Reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget.</text> </level> </level> <level label="d"> <level label="1"> <text>The Commission may employ a staff in accordance with the State budget.</text> </level> <level label="2"> <text>The Commission, in consultation with the Secretary, may set the compensation of a Commission employee in a position that:</text> <level label="i"> <text>Is unique to the Commission;</text> </level> <level label="ii"> <text>Requires specific skills or experience to perform the duties of the position; and</text> </level> <level label="iii"> <text>Does not require the employee to perform functions that are comparable to functions performed in other units of the Executive Branch of State government.</text> </level> </level> <level label="3"> <text>The Secretary of Budget and Management, in consultation with the Secretary, shall determine the positions for which the Commission may set compensation under paragraph (2) of this subsection.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-108" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>In addition to the duties set forth elsewhere in this subtitle, the Commission:</text> <level label="1"> <text>Shall adopt regulations specifying the Comprehensive Standard Health Benefit Plan to apply under Title 15, Subtitle 12 of the Insurance Article; and</text> </level> <level label="2"> <text>On or before March 1, 2008, in consultation with the Department, shall propose regulations to:</text> <level label="i"> <text>Specify the components of wellness benefits, offered under Title 15, Subtitle 12 of the Insurance Article, that include incentives or differential cost–sharing for employees based on their participation in wellness activities; and</text> </level> <level label="ii"> <text>Require small employers receiving a subsidy of small employer health benefit plan premium contributions under Title 15, Subtitle 12A of the Insurance Article to agree to purchase a wellness benefit.</text> </level> </level> </level> <level label="b"> <text>In carrying out its duties under this section, the Commission shall comply with the provisions of § 15–1207 and Title 15, Subtitle 12A of the Insurance Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-108.1" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>In addition to the duties set forth elsewhere in this subtitle, the Commission shall maintain on its website an application that a small business may use to compare premiums of health benefit plans offered by health insurance carriers under Title 15, Subtitle 12 of the Insurance Article.</text> </level> <level label="b"> <text>The application required under this section shall provide information on:</text> <level label="1"> <text>Premiums for health benefit plans sold under Title 15, Subtitle 12 of the Insurance Article, categorized by age bands; and</text> </level> <level label="2"> <text>Premiums for health benefit plans sold under Title 15, Subtitle 12 of the Insurance Article that include riders typically purchased by small employers in the State.</text> </level> </level> <level label="c"> <text>The Commission shall update the information required under this section at least quarterly.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-108.2" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>‘‘Health care service” has the meaning stated in § 15–10A–01 of the Insurance Article.</text> </level> <level label="3"> <text>“Payor” means:</text> <level label="i"> <text>An insurer or nonprofit health service plan that provides hospital, medical, or surgical benefits to individuals or groups on an expense–incurred basis under health insurance policies or contracts that are issued or delivered in the State;</text> </level> <level label="ii"> <text>A health maintenance organization that provides hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State; or</text> </level> <level label="iii"> <text>A pharmacy benefits manager that is registered with the Maryland Insurance Commissioner.</text> </level> </level> <level label="4"> <text>“Provider” has the meaning stated in § 19–7A–01 of this title.</text> </level> <level label="5"> <text>“Step therapy or fail–first protocol” has the meaning stated in § 15–142 of the Insurance Article.</text> </level> </level> <level label="b"> <text>In addition to the duties stated elsewhere in this subtitle, the Commission shall work with payors and providers to attain benchmarks for:</text> <level label="1"> <text>Standardizing and automating the process required by payors for preauthorizing health care services; and</text> </level> <level label="2"> <text>Overriding a payor’s step therapy or fail–first protocol.</text> </level> </level> <level label="c"> <text>The benchmarks described in subsection (b) of this section shall include:</text> <level label="1"> <text>On or before October 1, 2012 (“Phase 1”), establishment of online access for providers to each payor’s:</text> <level label="i"> <text>List of health care services that require preauthorization; and</text> </level> <level label="ii"> <text>Key criteria for making a determination on a preauthorization request;</text> </level> </level> <level label="2"> <text>On or before March 1, 2013 (“Phase 2”), establishment by each payor of an online process for:</text> <level label="i"> <text>Accepting electronically a preauthorization request from a provider; and</text> </level> <level label="ii"> <text>Assigning to a preauthorization request a unique electronic identification number that a provider may use to track the request during the preauthorization process, whether or not the request is tracked electronically, through a call center, or by fax;</text> </level> </level> <level label="3"> <text>On or before July 1, 2013 (“Phase 3”), establishment by each payor of an online preauthorization system to approve:</text> <level label="i"> <text>In real time, electronic preauthorization requests for pharmaceutical services:</text> <level label="1"> <text>For which no additional information is needed by the payor to process the preauthorization request; and</text> </level> <level label="2"> <text>That meet the payor’s criteria for approval;</text> </level> </level> <level label="ii"> <text>Within 1 business day after receiving all pertinent information on requests not approved in real time, electronic preauthorization requests for pharmaceutical services that:</text> <level label="1"> <text>Are not urgent; and</text> </level> <level label="2"> <text>Do not meet the standards for real–time approval under item (i) of this item; and</text> </level> </level> <level label="iii"> <text>Within 2 business days after receiving all pertinent information, electronic preauthorization requests for health care services, except pharmaceutical services, that are not urgent;</text> </level> </level> <level label="4"> <text>On or before July 1, 2015, establishment, by each payor that requires a step therapy or fail–first protocol, of a process for a provider to override the step therapy or fail–first protocol of the payor; and</text> </level> <level label="5"> <text>On or before July 1, 2015, utilization by providers of:</text> <level label="i"> <text>The online preauthorization system established by payors; or</text> </level> <level label="ii"> <text>If a national transaction standard has been established and adopted by the health care industry, as determined by the Commission, the provider’s practice management, electronic health record, or e–prescribing system.</text> </level> </level> </level> <level label="d"> <text>The benchmarks described in subsections (b) and (c) of this section do not apply to preauthorizations of health care services requested by providers employed by a group model health maintenance organization as defined in § 19–713.6 of this title.</text> </level> <level label="e"> <text>The online preauthorization system described in subsection (c)(3) of this section shall:</text> <level label="1"> <text>Provide real–time notice to providers about preauthorization requests approved in real time; and</text> </level> <level label="2"> <text>Provide notice to providers, within the time frames specified in subsection (c)(3)(ii) and (iii) of this section and in a manner that is able to be tracked by providers, about preauthorization requests not approved in real time.</text> </level> </level> <level label="f"> <level label="1"> <text>The Commission shall establish by regulation a process through which a payor or provider may be waived from attaining the benchmarks described in subsections (b) and (c) of this section for extenuating circumstances.</text> </level> <level label="2"> <text>For a provider, the extenuating circumstances may include:</text> <level label="i"> <text>The lack of broadband Internet access;</text> </level> <level label="ii"> <text>Low patient volume; or</text> </level> <level label="iii"> <text>Not making medical referrals or prescribing pharmaceuticals.</text> </level> </level> <level label="3"> <text>For a payor, the extenuating circumstances may include:</text> <level label="i"> <text>Low premium volume; or</text> </level> <level label="ii"> <text>For a group model health maintenance organization, as defined in § 19–713.6 of this title, preauthorizations of health care services requested by providers not employed by the group model health maintenance organization.</text> </level> </level> </level> <level label="g"> <level label="1"> <text>On or before October 1, 2012, the Commission shall reconvene the multistakeholder workgroup whose collaboration resulted in the 2011 report “Recommendations for Implementing Electronic Prior Authorizations”.</text> </level> <level label="2"> <text>The workgroup shall:</text> <level label="i"> <text>Review the progress to date in attaining the benchmarks described in subsections (b) and (c) of this section; and</text> </level> <level label="ii"> <text>Make recommendations to the Commission for adjustments to the benchmark dates.</text> </level> </level> </level> <level label="h"> <text>If necessary to attain the benchmarks, the Commission may adopt regulations to:</text> <level label="1"> <text>Adjust the Phase 2 or Phase 3 benchmark dates;</text> </level> <level label="2"> <text>Require payors and providers to comply with the benchmarks; and</text> </level> <level label="3"> <text>Establish penalties for noncompliance.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-108.3" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Carrier” includes insurers, nonprofit health service plans, health maintenance organizations, third–party administrators, and pharmacy benefits managers.</text> </level> <level label="3"> <text>“Health care provider” includes hospitals, physicians, nurse practitioners, pharmacists, and other persons entitled to reimbursement under § 15–701(a) of the Insurance Article.</text> </level> <level label="4"> <text>“Workgroup” means the Health Care Provider–Carrier Workgroup.</text> </level> </level> <level label="b"> <text>The Commission shall establish a Health Care Provider–Carrier Workgroup.</text> </level> <level label="c"> <text>The purpose of the Workgroup is to provide a mechanism for health care providers and carriers to resolve disputes on issues over which no State agency has statutory or regulatory authority.</text> </level> <level label="d"> <text>The Workgroup shall be composed of representatives of:</text> <level label="1"> <text>Professional organizations or associations of health care providers who bill and receive reimbursement for health care services from carriers;</text> </level> <level label="2"> <text>Carriers or organizations or trade associations representing carriers that reimburse health care providers for health care services provided under health benefit plans; and</text> </level> <level label="3"> <text>Subject to subsection (e)(1)(iii) of this section, consumer organizations.</text> </level> </level> <level label="e"> <level label="1"> <text>The Commission shall invite the following to appoint members to the Workgroup:</text> <level label="i"> <text>Professional organizations or associations of health care providers;</text> </level> <level label="ii"> <text>Carriers or organizations or trade associations representing carriers; and</text> </level> <level label="iii"> <text>When appropriate to the issue under discussion, consumer organizations.</text> </level> </level> <level label="2"> <text>Membership in the Workgroup may change depending on the issues before the Workgroup.</text> </level> <level label="3"> <text>The size of the Workgroup shall be at the discretion of the Commission but large enough to represent the appropriate range of stakeholders.</text> </level> </level> <level label="f"> <text>Workgroup members may not receive compensation or reimbursement for serving on the Workgroup.</text> </level> <level label="g"> <text>The Workgroup shall meet at least quarterly.</text> </level> <level label="h"> <text>Commission staff shall facilitate Workgroup meetings and provide research and other support to the Workgroup.</text> </level> <level label="i"> <level label="1"> <text>At least annually, Commission staff shall solicit issues for consideration by the Workgroup.</text> </level> <level label="2"> <text>Issues shall be solicited from:</text> <level label="i"> <text>Members of the General Assembly;</text> </level> <level label="ii"> <text>Professional organizations or associations of health care providers and carriers or organizations or trade associations representing carriers;</text> </level> <level label="iii"> <text>State agencies, including the Department, health occupations boards, the Maryland Insurance Administration, and the Commission; and</text> </level> <level label="iv"> <text>Consumer organizations.</text> </level> </level> </level> <level label="j"> <text>After soliciting issues under subsection (i) of this section, Commission staff shall select the issues to be considered by the Workgroup.</text> </level> <level label="k"> <text>Commission staff shall:</text> <level label="1"> <text>Research each issue before the issue is considered by the Workgroup;</text> </level> <level label="2"> <text>Use the results of the research to inform Workgroup meetings;</text> </level> <level label="3"> <text>Facilitate Workgroup meetings in a way that promotes resolution of disputes on issues and is satisfactory to the members of the Workgroup; and</text> </level> <level label="4"> <text>On or before January 1, 2016, and each year thereafter, submit a report to the Commission and, in accordance with § 2–1257 of the State Government Article, the Senate Finance Committee and the House Health and Government Operations Committee regarding the issues considered by the Workgroup during the preceding year and the outcome of the Workgroup’s consideration of each issue.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-108.4" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>In this section, “primary care” means health care provided in the following fields’ outpatient settings:</text> <level label="1"> <text>Family medicine;</text> </level> <level label="2"> <text>General pediatrics;</text> </level> <level label="3"> <text>Primary care internal medicine;</text> </level> <level label="4"> <text>Primary care obstetrics and gynecology;</text> </level> <level label="5"> <text>Primary care nurse practitioner services; and</text> </level> <level label="6"> <text>Primary care midwifery.</text> </level> </level> <level label="b"> <text>On or before December 1 each year, beginning in 2024, the Commission shall provide a report to the Governor and, in accordance with § 2–1257 of the State Government Article, the General Assembly that includes:</text> <level label="1"> <text>An analysis of primary care investment over the immediately preceding year, including data stratified by zip code and county, in relation to total health care spending over the previous year;</text> </level> <level label="2"> <text>Ways to improve the quality of and access to primary care services, with special attention to increasing health care equity, reducing health care disparities, and avoiding increased costs to patients and the health care system; and</text> </level> <level label="3"> <text>Any findings and recommendations of the Commission.</text> </level> </level> <level label="c"> <level label="1"> <text>The Commission shall form a workgroup to develop the report required under subsection (b) of this section, including by interpreting the results of the required analysis and making the recommendations.</text> </level> <level label="2"> <text>The workgroup required under this subsection shall include representatives of:</text> <level label="i"> <text>The Maryland Primary Care Program;</text> </level> <level label="ii"> <text>The Health Services Cost Review Commission;</text> </level> <level label="iii"> <text>The Maryland Insurance Administration;</text> </level> <level label="iv"> <text>The Health Care Financing Division of the Maryland Department of Health;</text> </level> <level label="v"> <text>The primary care community, including from the Maryland Academy of Family Physicians, the Maryland Chapter of the American Academy of Pediatrics, the Maryland Section of the American College of Obstetricians and Gynecologists, the Maryland Nurses Association, the Maryland Affiliate – American College of Nurse Midwives, the Maryland Community Health System, and the MidAtlantic Association of Community Health Centers;</text> </level> <level label="vi"> <text>Payors of primary care services, including carriers and managed care organizations;</text> </level> <level label="vii"> <text>Health services researchers with expertise in primary care; and</text> </level> <level label="viii"> <text>Other interested stakeholders.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-108.5" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Carrier” has the meaning stated in § 15–1301 of the Insurance Article.</text> </level> <level label="3"> <text>“Health care provider” has the meaning stated in § 19–108.3 of this subtitle.</text> </level> </level> <level label="b"> <level label="1"> <text>On or before July 1, 2026, a carrier shall establish and maintain an online process that:</text> <level label="i"> <text>Links directly to all e–prescribing systems and electronic health record systems that use the National Council for Prescription Drug Programs SCRIPT standard and the National Council for Prescription Drug Programs Real Time Benefit Standard;</text> </level> <level label="ii"> <text>Can accept electronic prior authorization requests from a health care provider;</text> </level> <level label="iii"> <text>Can approve electronic prior authorization requests:</text> <level label="1"> <text>For which no additional information is needed by the carrier to process the prior authorization request;</text> </level> <level label="2"> <text>For which no clinical review is required; and</text> </level> <level label="3"> <text>That meet the carrier’s criteria for approval; and</text> </level> </level> <level label="iv"> <text>Links directly to real–time patient out–of–pocket costs, including copayment, deductible, and coinsurance costs, and more affordable medication alternatives made available by the carrier.</text> </level> </level> <level label="2"> <text>A carrier may not:</text> <level label="i"> <text>Impose a fee or charge on a person for accessing the online process required under paragraph (1) of this subsection; or</text> </level> <level label="ii"> <text>Access, without health care provider consent, health care provider data via the online process other than for the insured or enrollee.</text> </level> </level> </level> <level label="c"> <text>On or before July 1, 2025, a carrier shall:</text> <level label="1"> <text>On request of a health care provider, provide contact information for each third–party vendor or other entity that the carrier will use to meet the requirements of subsection (b) of this section; and</text> </level> <level label="2"> <text>Post the contact information required to be provided under item (1) of this subsection on its website.</text> </level> </level> <level label="d"> <level label="1"> <text>On or before July 1, 2026, each health care provider shall ensure that each e–prescribing system or electronic health record system owned or contracted for by the health care provider to maintain a health record of an insured or enrollee has the ability to access, at the point of prescribing:</text> <level label="i"> <text>The electronic prior authorization process established by a carrier under subsection (b) of this section; and</text> </level> <level label="ii"> <text>The real–time patient out–of–pocket cost information and available medication alternatives required under subsection (b) of this section.</text> </level> </level> <level label="2"> <text>The Commission shall establish by regulation a process through which a health care provider may request and receive a waiver of compliance from the requirements of this subsection.</text> </level> </level> <level label="e"> <level label="1"> <text>On or before July 1, 2026, each carrier, or a pharmacy benefits manager on behalf of the carrier, shall:</text> <level label="i"> <text>Provide real–time patient–specific benefit information to insureds and enrollees and contracted health care providers, including any out–of–pocket costs and more affordable medication alternatives or prior authorization requirements; and</text> </level> <level label="ii"> <text>Ensure that the information provided under item (i) of this paragraph is accurate.</text> </level> </level> <level label="2"> <text>Each carrier, or a pharmacy benefits manager on behalf of the carrier, shall make available the information required to be provided under paragraph (1) of this subsection to the health care provider at the point of prescribing in an accessible and understandable format, such as through the health care provider’s e–prescribing system or electronic health record system that the carrier, pharmacy benefits manager, or designated subcontractor has adopted that uses the National Council for Prescription Drug Programs SCRIPT standard and the National Council for Prescription Drug Programs Real Time Benefit Standard from which the health care provider makes the request.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-108.6" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <text>On or before December 1 every 4 years, beginning in 2026, the Commission shall submit a report to the Governor and, in accordance with § 2–1257 of the State Government Article, the General Assembly that includes:</text> <level label="1"> <text>Advances or developments in the area of telehealth, including:</text> <level label="i"> <text>Evolving modalities of telehealth delivery; and</text> </level> <level label="ii"> <text>Changes in the costs of delivering telehealth services; and</text> </level> </level> <level label="2"> <text>Any findings or recommendations of the Commission.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-109" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>In addition to the powers set forth elsewhere in this subtitle, the Commission may:</text> <level label="1"> <text>Adopt rules and regulations to carry out the provisions of this subtitle;</text> </level> <level label="2"> <text>Create committees from among its members;</text> </level> <level label="3"> <text>Appoint advisory committees, which shall include consumers and may include representatives of interested public or private organizations, to make recommendations to the Commission on community–based services, long–term care, acute patient services, ambulatory surgical services, specialized health care services, residential treatment centers for emotionally disturbed children and adolescents, mental health and alcohol and drug abuse services, and any other topic or issue that the Commission considers necessary;</text> </level> <level label="4"> <text>Apply for and accept any funds, property, or services from any person or government agency;</text> </level> <level label="5"> <text>Subject to subsection (d) of this section, award any funds received from any person or government agency;</text> </level> <level label="6"> <text>Make agreements with a grantor or payor or with a grantee or payee of funds, property, or services, including an agreement to make any study, plan, demonstration, or project;</text> </level> <level label="7"> <text>Publish and give out any information that relates to the financial aspects of health care and is considered desirable in the public interest; and</text> </level> <level label="8"> <text>Subject to the limitations of this subtitle, exercise any other power that is reasonably necessary to carry out the purposes of this subtitle, including adopting regulations that set reasonable deadlines for filing of information or reports required under this subtitle and impose reasonable penalties for failure to file information or reports as required.</text> </level> </level> <level label="b"> <text>In addition to the duties set forth elsewhere in this subtitle, the Commission shall:</text> <level label="1"> <text>Adopt rules and regulations that relate to its meetings, minutes, and transactions;</text> </level> <level label="2"> <text>Keep minutes of each meeting;</text> </level> <level label="3"> <text>Prepare annually a budget proposal that includes the estimated income of the Commission and proposed expenses for its administration and operation;</text> </level> <level label="4"> <text>Beginning December 1, 2000, and each December 1 thereafter, submit to the Governor, the Secretary, and, subject to § 2–1257 of the State Government Article, the General Assembly an annual report on the operations and activities of the Commission during the preceding fiscal year, including:</text> <level label="i"> <text>A copy of each summary, compilation, and supplementary report required by this subtitle; and</text> </level> <level label="ii"> <text>Any other fact, suggestion, or policy recommendation that the Commission considers necessary;</text> </level> </level> <level label="5"> <text>Except for confidential or privileged medical or patient information, make:</text> <level label="i"> <text>Each report filed and each summary, compilation, and report required under this subtitle available for public inspection at the office of the Commission during regular business hours; and</text> </level> <level label="ii"> <text>Each summary, compilation, and report available to any other State agency on request; and</text> </level> </level> <level label="6"> <text>In collaboration with the Office of Health Care Quality, develop a process to receive the following information and publish it on the Commission’s Maryland Quality Reporting website for each applicable facility:</text> <level label="i"> <text>The date of the Office’s most recent inspection; and</text> </level> <level label="ii"> <text>Any associated ratings or other quality metrics calculated.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>The Commission may contract with a qualified, independent third party for any service necessary to carry out the powers and duties of the Commission.</text> </level> <level label="2"> <text>Unless permission is granted specifically by the Commission, a third party hired by the Commission may not release, publish, or otherwise use any information to which the third party has access under its contract.</text> </level> </level> <level label="d"> <level label="1"> <text>In awarding funds under subsection (a)(5) of this section, the Commission shall:</text> <level label="i"> <text>Use a competitive process that affords interested persons an opportunity to submit a proposal for funding; and</text> </level> <level label="ii"> <text>Evaluate proposals for funding using a panel that consists of internal and external evaluators.</text> </level> </level> <level label="2"> <text>The Commission shall:</text> <level label="i"> <text>Provide on its website information that is easily accessible to the general public about funds to be awarded under subsection (a)(5) of this section and how to submit a proposal; and</text> </level> <level label="ii"> <text>Submit, in accordance with § 2–1257 of the State Government Article, an annual report to the General Assembly listing all funds awarded under subsection (a)(5) of this section.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-110" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>Except as expressly provided in this subtitle, the power of the Secretary over plans, proposals, and projects of units in the Department does not include the power to disapprove or modify any regulation, decision, or determination that the Commission makes under authority specifically delegated by law to the Commission.</text> </level> <level label="b"> <level label="1"> <text>The power of the Secretary to transfer, by rule, regulation, or written directive, any staff, functions, or funds of units in the Department does not apply to any staff, function, or funds of the Commission.</text> </level> <level label="2"> <text>The Secretary may assess an administrative charge, consistent with the indirect cost charge assessed to federal grants, to fund services provided to the Commission by the Executive Branch.</text> </level> </level> <level label="c"> <level label="1"> <text>The power of the Secretary over the procurement procedure for units in the Department does not apply to the procurement procedure for the Commission.</text> </level> <level label="2"> <text>Subject to the provisions of paragraph (1) of this subsection, any procurement for services to be performed or for supplies to be delivered to the Commission is subject to the purposes and requirements of the State Finance and Procurement Article.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-111" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Fund” means the Maryland Health Care Commission Fund.</text> </level> <level label="3"> <text>“Health benefit plan” has the meaning stated in § 15–1201 of the Insurance Article.</text> </level> <level label="4"> <text>“Health care practitioner” means any individual who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care services.</text> </level> <level label="5"> <text>“Nursing home” means a related institution that is classified as a nursing home.</text> </level> <level label="6"> <text>“Payor” means:</text> <level label="i"> <text>A health insurer or nonprofit health service plan that holds a certificate of authority and provides health insurance policies or contracts in the State in accordance with this article or the Insurance Article; or</text> </level> <level label="ii"> <text>A health maintenance organization that holds a certificate of authority in the State.</text> </level> </level> </level> <level label="b"> <text>Subject to the provisions of subsection (d) of this section, the Commission shall assess a fee on:</text> <level label="1"> <text>All hospitals;</text> </level> <level label="2"> <text>All nursing homes;</text> </level> <level label="3"> <text>All payors; and</text> </level> <level label="4"> <text>All health care practitioners.</text> </level> </level> <level label="c"> <level label="1"> <text>The total fees assessed by the Commission may not exceed $20,000,000.</text> </level> <level label="2"> <level label="i"> <text>The fees assessed by the Commission shall be used exclusively to cover the actual documented direct costs of fulfilling the statutory and regulatory duties of the Commission in accordance with the provisions of this subtitle.</text> </level> <level label="ii"> <text>The costs of the Commission include the administrative costs incurred by the Department on behalf of the Commission.</text> </level> <level label="iii"> <text>The amount to be paid by the Commission to the Department for administrative costs, not to exceed 30.5% of the salaries of the Commission, shall be based on indirect costs or services benefiting the Commission, less overhead costs paid directly by the Commission.</text> </level> </level> <level label="3"> <text>The Commission shall pay all funds collected from the fees assessed in accordance with this section into the Fund.</text> </level> <level label="4"> <text>The fees assessed may be expended only for purposes authorized by the provisions of this subtitle.</text> </level> <level label="5"> <text>The amount in paragraph (1) of this subsection limits only the total fees the Commission may assess in a fiscal year.</text> </level> </level> <level label="d"> <text>In determining assessments of the total fees, the Commission shall:</text> <level label="1"> <text>Use a methodology that accounts for the portion of the Commission’s workload attributable to each industry assessed; and</text> </level> <level label="2"> <text>Recalculate workload distribution every 4 years.</text> </level> </level> <level label="e"> <level label="1"> <text>The fees assessed in accordance with this section on health care practitioners shall be:</text> <level label="i"> <text>Included in the licensing fee paid to the health care practitioner’s licensing board; and</text> </level> <level label="ii"> <text>Transferred by the health care practitioner’s licensing board to the Commission on a quarterly basis.</text> </level> </level> <level label="2"> <text>The Commission may adopt regulations that waive the fee assessed under this section for a specific class of health care practitioners.</text> </level> <level label="3"> <level label="i"> <text>Subject to subparagraph (ii) of this paragraph, the Commission shall adopt regulations to permit a waiver of the fee assessment requirements for certain health care practitioners.</text> </level> <level label="ii"> <text>In adopting regulations to permit a waiver of the fee assessment requirements for certain health care practitioners, the Commission shall:</text> <level label="1"> <text>Consider the hourly wages of the health care practitioners; and</text> </level> <level label="2"> <text>Give preference to exempting health care practitioners with an average hourly wage substantially below that of other health care practitioners.</text> </level> </level> </level> </level> <level label="f"> <level label="1"> <text>There is a Maryland Health Care Commission Fund.</text> </level> <level label="2"> <text>The Fund is a special continuing, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.</text> </level> <level label="3"> <text>The Treasurer shall separately hold, and the Comptroller shall account for, the Fund.</text> </level> <level label="4"> <text>The Fund shall be invested and reinvested in the same manner as other State funds.</text> </level> <level label="5"> <text>Any investment earnings shall be retained to the credit of the Fund.</text> </level> <level label="6"> <text>The Fund shall be subject to an audit by the Office of Legislative Audits as provided for in § 2–1220 of the State Government Article.</text> </level> <level label="7"> <text>This section may not be construed to prohibit the Fund from receiving funds from any other source.</text> </level> <level label="8"> <text>The Fund shall be used only to provide funding for the Commission and for the purposes authorized under this subtitle.</text> </level> </level> <level label="g"> <text>The Commission shall:</text> <level label="1"> <level label="i"> <text>Assess fees on payors in a manner that apportions the total amount of the fees to be assessed on payors under subsection (d)(1) of this section among each payor based on the ratio of each payor’s total premiums written in the State for health benefit plans to the total written premiums of all payors written in the State; and</text> </level> <level label="ii"> <text>On or before June 30 of each year, assess each payor a fee in accordance with item (i) of this item;</text> </level> </level> <level label="2"> <level label="i"> <text>Assess fees for each hospital equal to the sum of:</text> <level label="1"> <text>The amount equal to one–half of the total fees to be assessed on hospitals under subsection (d)(1) of this section times the ratio of admissions of the hospital to total admissions of all hospitals; and</text> </level> <level label="2"> <text>The amount equal to one–half of the total fees to be assessed on hospitals under subsection (d)(1) of this section times the ratio of gross operating revenue of each hospital to total gross operating revenues of all hospitals;</text> </level> </level> <level label="ii"> <text>Establish minimum and maximum assessments; and</text> </level> <level label="iii"> <text>On or before June 30 of each year, assess each hospital a fee in accordance with item (i) of this item; and</text> </level> </level> <level label="3"> <level label="i"> <text>Assess fees for each nursing home equal to the sum of:</text> <level label="1"> <text>The amount equal to one–half of the total fees to be assessed on nursing homes under subsection (d)(1) of this section times the ratio of admissions of the nursing home to total admissions of all nursing homes; and</text> </level> <level label="2"> <text>The amount equal to one–half of the total fees to be assessed on nursing homes under subsection (d)(1) of this section times the ratio of gross operating revenue of each nursing home to total gross operating revenues of all nursing homes;</text> </level> </level> <level label="ii"> <text>Establish minimum and maximum assessments; and</text> </level> <level label="iii"> <text>On or before June 30 of each year, assess each nursing home a fee in accordance with item (i) of this item.</text> </level> </level> </level> <level label="h"> <level label="1"> <text>On or before September 1 of each year, each payor, hospital, and nursing home assessed under this section shall make payment to the Commission.</text> </level> <level label="2"> <text>The Commission shall make provisions for partial payments.</text> </level> </level> <level label="i"> <text>Any bill not paid within 30 days of the payment due date may be subject to an interest penalty to be determined and collected by the Commission.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-112" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Center” means a Patient Safety Center designated by the Commission.</text> </level> <level label="3"> <text>“Fund” means the Maryland Patient Safety Center Fund.</text> </level> </level> <level label="b"> <level label="1"> <text>On or before December 31, 2025, the Commission shall designate a Center for the State.</text> </level> <level label="2"> <text>The Center designated under paragraph (1) of this subsection shall continue to act as the State–designated Center for the duration of the designation period, as determined by the Commission, if the Center continuously meets the standards and requirements established by the Commission.</text> </level> </level> <level label="c"> <text>The designated Center shall:</text> <level label="1"> <text>Develop, coordinate, and implement patient safety initiatives across the State;</text> </level> <level label="2"> <text>Be a model for patient safety innovation and implementation in the State;</text> </level> <level label="3"> <text>Convene health care providers, patients, and families to:</text> <level label="i"> <text>Improve the quality of health care and reduce preventable and avoidable harm; and</text> </level> <level label="ii"> <text>Provide safe and equitable health care for State citizens; and</text> </level> </level> <level label="4"> <text>Share information relating to best practices among providers and patients in the State.</text> </level> </level> <level label="d"> <level label="1"> <text>There is a Patient Safety Center Fund.</text> </level> <level label="2"> <text>The purpose of the Fund is to subsidize a portion of the costs of the Center so that the Center may perform the duties described under subsection (c) of this section.</text> </level> <level label="3"> <text>The Commission shall administer the Fund.</text> </level> <level label="4"> <level label="i"> <text>The Fund is a special, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.</text> </level> <level label="ii"> <text>The State Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund.</text> </level> </level> <level label="5"> <text>The Fund consists of:</text> <level label="i"> <text>Money appropriated in the State budget to the Fund;</text> </level> <level label="ii"> <text>Interest earnings; and</text> </level> <level label="iii"> <text>Any other money from any other source accepted for the benefit of the Fund.</text> </level> </level> <level label="6"> <text>The Fund may be used only to subsidize a portion of the costs of the Center so that the Center may perform the duties described under subsection (c) of this section.</text> </level> <level label="7"> <level label="i"> <text>The State Treasurer shall invest the money of the Fund in the same manner as other State money may be invested.</text> </level> <level label="ii"> <text>Any interest earnings of the Fund shall be credited to the Fund.</text> </level> </level> </level> <level label="e"> <level label="1"> <level label="i"> <text>For fiscal years 2023 through 2025, the Governor shall include in the annual budget bill an appropriation of $1,000,000 for the Fund.</text> </level> <level label="ii"> <text>For fiscal year 2027 and each fiscal year thereafter, the Governor shall include in the annual budget bill an appropriation of $1,000,000 for the Fund.</text> </level> </level> <level label="2"> <text>The Commission may provide an annual grant from the Fund to the Center in the amount appropriated under paragraph (1) of this subsection, plus any interest and other income distributed to the Fund.</text> </level> <level label="3"> <text>Expenditures from the Fund may be made only in accordance with the State budget.</text> </level> <level label="4"> <text>Money expended from the Fund for the Center is supplemental to, and is not intended to take the place of, funding that otherwise would be appropriated for the Center.</text> </level> </level> <level label="f"> <text>On or before October 1 each year, the Commission, in conjunction with the Center, shall report to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with § 2–1257 of the State Government Article, on:</text> <level label="1"> <text>The Center’s statewide activities related to the development, coordination, and implementation of patient safety initiatives; and</text> </level> <level label="2"> <text>How the Center’s statewide initiatives align with State–designated priorities.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-114" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>In this Part II of this subtitle the following words have the meanings indicated.</text> </level> <level label="a–1"> <text>“Acquisition” means:</text> <level label="1"> <text>A transfer of stock or assets that results in a change of the person that controls a health care facility; or</text> </level> <level label="2"> <text>The transfer of more than 25% of stock or ownership interest in a health care facility.</text> </level> </level> <level label="b"> <text>“Ambulatory surgical facility” means any center, service, office, facility, or office of one or more health care practitioners or a group practice that:</text> <level label="1"> <text>Has three or more operating rooms;</text> </level> <level label="2"> <text>Operates primarily for the purpose of providing surgical services to patients who do not require overnight hospitalization; and</text> </level> <level label="3"> <text>Seeks reimbursement from payors as an ambulatory surgical facility.</text> </level> </level> <level label="c"> <text>“Certificate of need” means a certification of public need issued by the Commission under this Part II of this subtitle for a health care project.</text> </level> <level label="d"> <level label="1"> <text>“Health care facility” means:</text> <level label="i"> <text>A hospital, as defined in § 19–301 of this title;</text> </level> <level label="ii"> <text>A limited service hospital, as defined in § 19–301 of this title;</text> </level> <level label="iii"> <text>A related institution, as defined in § 19–301 of this title;</text> </level> <level label="iv"> <text>An ambulatory surgical facility;</text> </level> <level label="v"> <text>An inpatient facility that is organized primarily to help in the rehabilitation of disabled individuals, through an integrated program of medical and other services provided under competent professional supervision;</text> </level> <level label="vi"> <text>A home health agency, as defined in § 19–401 of this title;</text> </level> <level label="vii"> <text>A hospice, as defined in § 19–901 of this title;</text> </level> <level label="viii"> <text>A freestanding medical facility, as defined in § 19–3A–01 of this title; and</text> </level> <level label="ix"> <text>Any other health institution, service, or program for which this Part II of this subtitle requires a certificate of need.</text> </level> </level> <level label="2"> <text>“Health care facility” does not include:</text> <level label="i"> <text>A hospital or related institution that is operated, or is listed and certified, by the First Church of Christ Scientist, Boston, Massachusetts;</text> </level> <level label="ii"> <text>For the purpose of providing an exception to the requirement for a certificate of need under § 19–120 of this subtitle, a facility to provide comprehensive care constructed by a provider of continuing care, as defined in § 10–401 of the Human Services Article, if:</text> <level label="1"> <text>Except as provided under § 19–123 of this subtitle, the facility is for the exclusive use of the provider’s subscribers who have executed continuing care agreements, including continuing care at home agreements, and paid entrance fees that are at least equal to the lowest entrance fee charged for an independent living unit, an assisted living unit, or a continuing care at home agreement before entering the continuing care community, regardless of the level of care needed by the subscribers at the time of admission;</text> </level> <level label="2"> <text>The facility is located on the campus of the continuing care community; and</text> </level> <level label="3"> <text>The number of comprehensive care nursing beds in the community does not exceed:</text> </level> <level label="A"> <text>24 percent of the number of independent living units in a community having less than 300 independent living units; or</text> </level> <level label="B"> <text>20 percent of the number of independent living units in a community having 300 or more independent living units;</text> </level> </level> <level label="iii"> <text>For the purpose of providing an exception to the requirement for a certificate of need under § 19–120 of this subtitle, a facility to provide comprehensive care that:</text> <level label="1"> <text>Is owned and operated by the Maryland Department of Veterans and Military Families; and</text> </level> <level label="2"> <text>Restricts admissions to individuals who meet the residency requirements established by the Maryland Department of Veterans and Military Families and are:</text> </level> <level label="A"> <text>Veterans who were discharged or released from the uniformed services under honorable conditions;</text> </level> <level label="B"> <text>Former members of a reserve component, as defined in § 9–901 of the State Government Article; or</text> </level> <level label="C"> <text>Nonveteran spouses of eligible veterans;</text> </level> </level> <level label="iv"> <text>Except for a facility to provide kidney transplant services or programs, a kidney disease treatment facility, as defined by rule or regulation of the United States Department of Health and Human Services;</text> </level> <level label="v"> <text>Except for kidney transplant services or programs, the kidney disease treatment stations and services provided by or on behalf of a hospital or related institution; or</text> </level> <level label="vi"> <text>The office of one or more individuals licensed to practice dentistry under Title 4 of the Health Occupations Article, for the purposes of practicing dentistry.</text> </level> </level> </level> <level label="e"> <text>“Health care practitioner” means any individual who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care services.</text> </level> <level label="f"> <text>“Health service area” means an area of this State that the Governor designates as appropriate for planning and developing of health services.</text> </level> <level label="g"> <text>“Local health planning agency” means the health department of a jurisdiction or a body designated by the local health department to perform health planning functions.</text> </level> <level label="h"> <text>“State health plan” means the State health plan for facilities and services.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-115" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>In addition to the duties set forth elsewhere in this subtitle, in this Part II of this subtitle, the Commission shall:</text> <level label="1"> <text>Act as the State agency to represent the State under Title VI of the federal Public Health Service Act; and</text> </level> <level label="2"> <text>Periodically participate in or perform analyses and studies that relate to:</text> <level label="i"> <text>Adequacy of services and financial resources to meet the needs of the population;</text> </level> <level label="ii"> <text>Distribution of health care resources;</text> </level> <level label="iii"> <text>Allocation of health care resources;</text> </level> <level label="iv"> <text>Costs of health care in relationship to available financial resources; or</text> </level> <level label="v"> <text>Any other appropriate matter.</text> </level> </level> </level> <level label="b"> <text>In addition to the duties set forth elsewhere in this Part II of this subtitle, the Governor shall direct, as necessary, a State officer or agency to cooperate in carrying out the functions of the Commission.</text> </level> <level label="c"> <text>This State recognizes the federal act and any amendment to the federal act that does not require State legislation to be effective. However, if the federal act is repealed or expires, this Part II of this subtitle remains in effect.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-116" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>The Secretary shall provide for a study of systems capacity in health services.</text> </level> <level label="2"> <text>The study shall:</text> <level label="i"> <text>Determine for all health delivery facilities and settings where capacity should be increased or decreased to better meet the needs of the population;</text> </level> <level label="ii"> <text>Examine and describe the implementation methods and tools by which capacity should be altered to better meet the needs; and</text> </level> <level label="iii"> <text>Assess the impact of those methods and tools on the communities and health care delivery system.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>In addition to information that an applicant for a certificate of need must provide, the Commission may request, collect, and report any statistical or other information that:</text> <level label="i"> <text>Is needed by the Commission to perform its duties described in this Part II of this subtitle; and</text> </level> <level label="ii"> <text>Is described in regulations of the Commission.</text> </level> </level> <level label="2"> <text>If a health care facility fails to provide information as required in this subsection, the Commission may:</text> <level label="i"> <text>Impose a penalty of not more than $100 per day for each day the violation continues after consideration of the willfulness and seriousness of the withholding, as well as any past history of withholding of information;</text> </level> <level label="ii"> <text>Issue an administrative order that requires the applicant to provide the information; or</text> </level> <level label="iii"> <text>Apply to the circuit court in the county in which the facility is located for legal relief considered appropriate by the Commission.</text> </level> </level> <level label="3"> <text>The Commission may send to the Department or a local health planning agency any statistical or other information the Commission is authorized to collect under paragraph (1) of this subsection.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-117" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>In accordance with criteria that the Commission sets, the Governor shall designate health service areas in this State.</text> </level> <level label="b"> <text>After a 1-year period, the Governor may review or revise the boundaries of a health service area or increase the number of health service areas, on the Governor’s initiative, at the request of the Commission, at the request of a local government, or at the request of a local health planning agency. Revisions to boundaries of health service areas shall be done in accordance with the criteria established by the Commission and with the approval of the legislature.</text> </level> <level label="c"> <text>Within 45 days of receipt of the State health plan or a change in the State health plan, the plan becomes effective unless the Governor notifies the Commission of the Governor’s intent to modify or revise the State health plan adopted by the Commission.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-118" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>On or before October 1 each year, the Commission shall adopt a State health plan.</text> </level> <level label="2"> <text>The plan shall:</text> <level label="i"> <text>Be consistent with the Maryland All Payer Model Contract;</text> </level> <level label="ii"> <text>Include methodologies, standards, and criteria for certificate of need review; and</text> </level> <level label="iii"> <text>Prioritize conversion of acute capacity to alternative uses where appropriate.</text> </level> </level> </level> <level label="b"> <text>Annually or on petition by any person, the Commission shall:</text> <level label="1"> <text>Assess each State health plan chapter;</text> </level> <level label="2"> <text>Determine the chapter or chapters of the State health plan that should be reviewed and revised;</text> </level> <level label="3"> <text>Establish, at a public meeting, the priority order and timeline of the State health plan chapter review and revision; and</text> </level> <level label="4"> <text>Publish any changes in the State health plan that the Commission considers necessary, subject to the review and approval granted to the Governor under this subtitle.</text> </level> </level> <level label="c"> <text>The Commission shall adopt rules and regulations that ensure broad public input, public hearings, and consideration of local health plans in development of the State health plan.</text> </level> <level label="d"> <level label="1"> <text>The Commission shall develop standards and policies consistent with the State health plan that relate to the certificate of need program.</text> </level> <level label="2"> <text>The standards:</text> <level label="i"> <text>Shall address the availability, accessibility, cost, and quality of health care; and</text> </level> <level label="ii"> <text>Are to be reviewed and revised periodically to reflect new developments in health planning, delivery, and technology.</text> </level> </level> <level label="3"> <text>In adopting standards regarding cost, efficiency, cost–effectiveness, or financial feasibility, the Commission shall take into account the relevant methodologies of the Health Services Cost Review Commission.</text> </level> </level> <level label="e"> <text>Annually, the Secretary shall make recommendations to the Commission on the plan. The Secretary may review and comment on State specifications to be used in the development of the State health plan.</text> </level> <level label="f"> <text>All State agencies and departments, directly or indirectly involved with or responsible for any aspect of regulating, funding, or planning for the health care industry or persons involved in it, shall carry out their responsibilities in a manner consistent with the State health plan and available fiscal resources.</text> </level> <level label="g"> <text>In carrying out their responsibilities under this Part II of this subtitle for hospitals, the Commission and the Secretary shall recognize, but may not apply, develop, or duplicate standards or requirements related to quality which have been adopted and enforced by national or State licensing or accrediting authorities.</text> </level> <level label="h"> <text>The Commission shall transfer to the Maryland Department of Health health planning functions and necessary staff resources for licensed entities in the State health plan that are not required to obtain a certificate of need or an exemption from the certificate of need program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-119" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>The Commission shall develop and adopt an institution-specific plan to guide possible capacity reduction.</text> </level> <level label="b"> <text>The institution-specific plan shall address:</text> <level label="1"> <text>Accurate bed count data for licensed beds and staffed and operated beds;</text> </level> <level label="2"> <text>Cost data associated with all hospital beds and associated services on a hospital-specific basis;</text> </level> <level label="3"> <text>Migration patterns and current and future projected population data;</text> </level> <level label="4"> <text>Accessibility and availability of beds;</text> </level> <level label="5"> <text>Quality of care;</text> </level> <level label="6"> <text>Current health care needs, as well as growth trends for such needs, for the area served by each hospital;</text> </level> <level label="7"> <text>Hospitals in high growth areas; and</text> </level> <level label="8"> <text>Utilization.</text> </level> </level> <level label="c"> <text>In the development of the institution-specific plan the Commission shall give priority to the conversion of acute capacity to alternative uses where appropriate.</text> </level> <level label="d"> <level label="1"> <text>The Commission shall use the institution-specific plan in reviewing certificate of need applications for conversion, expansion, consolidation, or introduction of hospital services in conjunction with the State health plan.</text> </level> <level label="2"> <text>If there is a conflict between the State health plan and any rule or regulation adopted by the Commission in accordance with Title 10, Subtitle 1 of the State Government Article to implement an institution-specific plan that is developed for identifying any excess capacity in beds and services, the provisions of whichever plan that is most recently adopted shall control.</text> </level> <level label="3"> <text>Immediately upon adoption of the institution-specific plan the Commission shall begin the process of incorporating the institution-specific plan into the State health plan and shall complete the incorporation within 12 months.</text> </level> <level label="4"> <text>A State health plan developed or adopted after the incorporation of the institution-specific plan into the State health plan shall include the criteria in subsection (b) of this section in addition to the criteria in § 19-118 of this subtitle.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-120" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Consolidation” and “merger” include increases and decreases in bed capacity or services among the components of an organization that:</text> <level label="i"> <text>Operates more than one health care facility; or</text> </level> <level label="ii"> <text>Operates one or more health care facilities and holds an outstanding certificate of need to construct a health care facility.</text> </level> </level> <level label="3"> <level label="i"> <text>“Health care service” means any clinically related patient service.</text> </level> <level label="ii"> <text>“Health care service” includes a medical service.</text> </level> </level> <level label="4"> <text>“Hospital capital threshold” means the lesser of:</text> <level label="i"> <text>25% of the hospital’s gross regulated charges for the immediately preceding year; or</text> </level> <level label="ii"> <text>$50,000,000.</text> </level> </level> <level label="5"> <text>“Limited service hospital” means a health care facility that:</text> <level label="i"> <text>Is licensed as a hospital on or after January 1, 1999;</text> </level> <level label="ii"> <text>Changes the type or scope of health care services offered by eliminating the facility’s capability to admit or retain patients for overnight hospitalization;</text> </level> <level label="iii"> <text>Retains an emergency or urgent care center; and</text> </level> <level label="iv"> <text>Complies with the regulations adopted by the Secretary under § 19–307.1 of this title.</text> </level> </level> <level label="6"> <text>“Medical service” means:</text> <level label="i"> <text>Any of the following categories of health care services:</text> <level label="1"> <text>Medicine, surgery, gynecology, addictions;</text> </level> <level label="2"> <text>Obstetrics;</text> </level> <level label="3"> <text>Pediatrics;</text> </level> <level label="4"> <text>Psychiatry;</text> </level> <level label="5"> <text>Rehabilitation;</text> </level> <level label="6"> <text>Chronic care;</text> </level> <level label="7"> <text>Comprehensive care;</text> </level> <level label="8"> <text>Extended care;</text> </level> <level label="9"> <text>Intermediate care; or</text> </level> <level label="10"> <text>Residential treatment; or</text> </level> </level> <level label="ii"> <text>Any subcategory of the rehabilitation, psychiatry, comprehensive care, or intermediate care categories of health care services for which need is projected in the State health plan.</text> </level> </level> </level> <level label="b"> <text>The Commission may set an application fee for a certificate of need for health care facilities not assessed a user fee under this subtitle.</text> </level> <level label="c"> <text>The Commission shall adopt rules and regulations for applying for and issuing certificates of need.</text> </level> <level label="d"> <text>The Commission may adopt, after October 1, 1983, new thresholds or methods for determining the circumstances or minimum cost requirements under which a certificate of need application must be filed.</text> </level> <level label="e"> <level label="1"> <text>A person shall have a certificate of need issued by the Commission before the person develops, operates, or participates in any of the health care projects for which a certificate of need is required under this section.</text> </level> <level label="2"> <text>A certificate of need issued before January 13, 1987, may not be rendered wholly or partially invalid solely because certain conditions have been imposed, if an appeal concerning the certificate of need, challenging the power of the Commission to impose certain conditions on a certificate of need, has not been noted by an aggrieved party before January 13, 1987.</text> </level> </level> <level label="f"> <text>Except as provided in subsections (g)(2)(iii) and (p) of this section, a certificate of need is required before a new health care facility is built, developed, or established.</text> </level> <level label="g"> <level label="1"> <text>A certificate of need is required before an existing or previously approved, but unbuilt, health care facility is moved to another site.</text> </level> <level label="2"> <text>This subsection does not apply if:</text> <level label="i"> <text>The Commission adopts limits for relocations and the proposed relocation does not exceed those limits;</text> </level> <level label="ii"> <text>The relocation is the result of a partial or complete replacement of an existing hospital or related institution, as defined in § 19–301 of this title, and the relocation is to another part of the site or immediately adjacent to the site of the existing hospital or related institution;</text> </level> <level label="iii"> <text>Subject to the provisions of subsections (i) and (j) of this section, the relocation is of an existing health care facility owned or controlled by a merged asset system and is to:</text> <level label="1"> <text>A site within the primary service area of the health care facility to be relocated if:</text> </level> <level label="A"> <text>The proposed relocation is not across county boundaries; and</text> </level> <level label="B"> <text>At least 45 days prior to the proposed relocation, notice is filed with the Commission;</text> </level> <level label="2"> <text>A site outside the primary service area of the health care facility to be relocated but within the primary service area of the merged asset system if:</text> </level> <level label="A"> <text>At least 45 days prior to the proposed relocation, notice is filed with the Commission; and</text> </level> <level label="B"> <text>The Commission in its sole discretion, and in accordance with the criteria adopted by regulation, finds that the relocation is in the public interest, is not inconsistent with the State health plan, and will result in the more efficient and effective delivery of health care services; or</text> </level> <level label="3"> <text>For a limited service hospital, a site within the immediate area as defined in regulation by the Commission; or</text> </level> </level> <level label="iv"> <text>The relocation involves moving a portion of a complement of comprehensive care beds previously approved by the Commission after January 1, 1995, for use in a proposed new related institution, as defined in § 19–301 of this title, but unbuilt on October 1, 1998, if:</text> <level label="1"> <text>The comprehensive care beds that were originally approved by the Commission in a prior certificate of need review were approved for use in a proposed new related institution to be located in a municipal corporation within Carroll County in which a related institution is not located;</text> </level> <level label="2"> <text>The comprehensive care beds being relocated will be used to establish an additional new related institution that is located in another municipal corporation within Carroll County in which a related institution is not located;</text> </level> <level label="3"> <text>The comprehensive care beds not being relocated are intended to be used to establish a related institution on the original site; and</text> </level> <level label="4"> <text>Both the previously approved comprehensive care beds for use on the original site and the relocated comprehensive care beds for use on the new site will be used as components of single buildings on each site that also offer independent or assisted living residential units.</text> </level> </level> </level> <level label="3"> <text>Notwithstanding any other provision of this subtitle, a certificate of need is not required for a relocation described under paragraph (2)(iv) of this subsection.</text> </level> </level> <level label="h"> <level label="1"> <text>A certificate of need is required before the bed capacity of a health care facility is changed.</text> </level> <level label="2"> <text>This subsection does not apply to any increase or decrease in bed capacity if:</text> <level label="i"> <text>For a health care facility that is not a hospital, during a 2–year period the increase or decrease would not exceed the lesser of 10 percent of the total bed capacity or 10 beds;</text> </level> <level label="ii"> <level label="1"> <text>The increase or decrease would change the bed capacity for an existing medical service; and</text> </level> <level label="2"> <level label="A"> <text>The change would not increase total bed capacity;</text> </level> </level> <level label="B"> <text>The change is maintained for at least a 1–year period; and</text> </level> <level label="C"> <text>At least 45 days prior to the change, the hospital provides written notice to the Commission describing the change and providing an updated inventory of the hospital’s licensed bed complement;</text> </level> </level> <level label="iii"> <level label="1"> <text>At least 45 days before increasing or decreasing bed capacity, written notice of intent to change bed capacity is filed with the Commission;</text> </level> <level label="2"> <text>The Commission in its sole discretion finds that the proposed change:</text> </level> <level label="A"> <text>Is pursuant to the consolidation or merger of two or more health care facilities, conversion of a health care facility or part of a facility to a nonhealth–related use, or a change in bed capacity at an intermediate care facility that offers medically managed residential substance use disorder treatment services and has a current license issued by the Secretary;</text> </level> <level label="B"> <text>Is not inconsistent with the State health plan or the institution–specific plan developed by the Commission;</text> </level> <level label="C"> <text>Will result in the delivery of more efficient and effective health care services; and</text> </level> <level label="D"> <text>Is in the public interest; and</text> </level> <level label="3"> <text>Within 45 days of receiving notice, the Commission notifies the health care facility of its finding;</text> </level> </level> <level label="iv"> <text>The increase or decrease in bed capacity is the result of the annual licensed bed recalculation provided under § 19–307.2 of this title; or</text> </level> <level label="v"> <level label="1"> <text>The increase or decrease in bed capacity will occur in an existing general hospice program that has a current license issued by the Secretary; and</text> </level> <level label="2"> <text>At least 45 days before increasing or decreasing bed capacity, written notice of the intent to change bed capacity is filed with the Commission.</text> </level> </level> </level> </level> <level label="i"> <level label="1"> <text>Except as provided in paragraph (2) of this subsection, for a hospital located in a county with three or more hospitals, a certificate of need is not required before the bed capacity is increased or decreased if the change:</text> <level label="i"> <text>Occurs on or after July 1, 2000;</text> </level> <level label="ii"> <text>Is between hospitals in a merged asset system located within the same health service area;</text> </level> <level label="iii"> <text>Does not involve comprehensive or extended care beds; and</text> </level> <level label="iv"> <text>Does not occur earlier than 45 days after a notice of intent to reallocate bed capacity is filed with the Commission.</text> </level> </level> <level label="2"> <text>A hospital may not create a new health care service through the relocation of beds from one county to another county pursuant to this subsection.</text> </level> </level> <level label="j"> <level label="1"> <text>A certificate of need is required before the type or scope of any health care service is changed if the health care service:</text> <level label="i"> <text>Is offered:</text> <level label="1"> <text>By a health care facility;</text> </level> <level label="2"> <text>In space that is leased from a health care facility; or</text> </level> <level label="3"> <text>In space that is on land leased from a health care facility; or</text> </level> </level> <level label="ii"> <text>Results in a change in operating room capacity in a hospital, a freestanding medical facility, or an ambulatory surgical facility.</text> </level> </level> <level label="2"> <text>This subsection does not apply if:</text> <level label="i"> <text>The Commission adopts limits for changes in health care services and the proposed change would not exceed those limits;</text> </level> <level label="ii"> <text>The proposed change and the annual operating revenue that would result from the addition is entirely associated with the use of medical equipment;</text> </level> <level label="iii"> <text>The proposed change would establish, increase, or decrease a health care service and the change would not result in the:</text> <level label="1"> <text>Establishment of a new medical service or elimination of an existing medical service;</text> </level> <level label="2"> <text>Establishment of a cardiac surgery, organ transplant surgery, or burn or neonatal intensive health care service;</text> </level> <level label="3"> <text>Except as provided in § 19–120.1 of this subtitle, establishment of percutaneous coronary intervention services;</text> </level> <level label="4"> <text>Establishment of a home health program, hospice program, or freestanding ambulatory surgical center or facility; or</text> </level> <level label="5"> <text>Expansion of a comprehensive care, extended care, intermediate care, residential treatment, psychiatry, or rehabilitation medical service, except for an expansion related to an increase in total bed capacity in accordance with subsection (h)(2)(i) of this section; or</text> </level> </level> <level label="iv"> <level label="1"> <text>At least 45 days before increasing or decreasing the volume of one or more health care services, written notice of intent to change the volume of health care services is filed with the Commission;</text> </level> <level label="2"> <text>The Commission in its sole discretion finds that the proposed change:</text> </level> <level label="A"> <text>Is pursuant to:</text> </level> <level label="I"> <text>The consolidation or merger of two or more health care facilities;</text> <text>II. The conversion of a health care facility or part of a facility to a nonhealth–related use;</text> <text>III. The conversion of a hospital to a limited service hospital; or</text> <text>IV. The conversion of a licensed general hospital to a freestanding medical facility in accordance with subsection (o)(3) of this section;</text> </level> <level label="B"> <text>Is not inconsistent with the State health plan or the institution–specific plan developed and adopted by the Commission;</text> </level> <level label="C"> <text>Will result in the delivery of more efficient and effective health care services; and</text> </level> <level label="D"> <text>Is in the public interest; and</text> </level> <level label="3"> <text>Within 45 days of receiving notice under item 1 of this item, the Commission notifies the health care facility of its finding.</text> </level> </level> </level> <level label="3"> <text>Notwithstanding the provisions of paragraph (2) of this subsection, a certificate of need is required:</text> <level label="i"> <text>Before an additional home health agency, branch office, or home health care service is established by an existing health care agency or facility;</text> </level> <level label="ii"> <text>Before an existing home health agency or health care facility establishes a home health agency or home health care service at a location in the service area not included under a previous certificate of need or license;</text> </level> <level label="iii"> <text>Before a transfer of ownership of any branch office of a home health agency or home health care service of an existing health care facility that separates the ownership of the branch office from the home health agency or home health care service of an existing health care facility which established the branch office; or</text> </level> <level label="iv"> <text>Before the expansion of a home health service or program by a health care facility that:</text> <level label="1"> <text>Established the home health service or program without a certificate of need between January 1, 1984, and July 1, 1984; and</text> </level> <level label="2"> <text>During a 1–year period, the annual operating revenue of the home health service or program would be greater than $333,000 after an annual adjustment for inflation, based on an appropriate index specified by the Commission.</text> </level> </level> </level> </level> <level label="k"> <level label="1"> <text>A certificate of need is required before any of the following capital expenditures are made by or on behalf of a hospital:</text> <level label="i"> <text>Any expenditure that, under generally accepted accounting principles, is not properly chargeable as an operating or maintenance expense, if:</text> <level label="1"> <text>The expenditure is made as part of an acquisition, improvement, or expansion, and, after adjustment for inflation as provided in the regulations of the Commission, the total expenditure, including the cost of each study, survey, design, plan, working drawing, specification, and other essential activity, is more than the hospital capital threshold;</text> </level> <level label="2"> <text>The expenditure is made as part of a replacement of any plant and equipment of the hospital and is more than the hospital capital threshold after adjustment for inflation as provided in the regulations of the Commission;</text> </level> <level label="3"> <text>The expenditure results in a substantial change in the bed capacity of the hospital; or</text> </level> <level label="4"> <text>The expenditure results in the establishment of a new medical service in a hospital that would require a certificate of need under subsection (i) of this section; or</text> </level> </level> <level label="ii"> <text>Any expenditure that is made to lease or, by comparable arrangement, obtain any plant or equipment for the hospital, if:</text> <level label="1"> <text>The expenditure is made as part of an acquisition, improvement, or expansion, and the total expenditure, including the cost of each study, survey, design, plan, working drawing, specification, and other essential activity, is more than the hospital capital threshold;</text> </level> <level label="2"> <text>The expenditure is made as part of a replacement of any plant and equipment and is more than the hospital capital threshold after adjustment for inflation as provided in the regulations of the Commission;</text> </level> <level label="3"> <text>The expenditure results in a substantial change in the bed capacity of the hospital; or</text> </level> <level label="4"> <text>The expenditure results in the establishment of a new medical service in a hospital that would require a certificate of need under subsection (i) of this section.</text> </level> </level> </level> <level label="2"> <text>A certificate of need is required before any of the following capital expenditures are made by or on behalf of a health care facility other than a hospital:</text> <level label="i"> <text>Any expenditure that, under generally accepted accounting principles, is not properly chargeable as an operating or maintenance expense, if:</text> <level label="1"> <text>The expenditure results in a substantial change in the bed capacity of the health care facility other than a hospital; or</text> </level> <level label="2"> <text>The expenditure results in the establishment of a new medical service in a health care facility other than a hospital that would require a certificate of need under subsection (i) of this section; or</text> </level> </level> <level label="ii"> <text>Any expenditure that is made to lease or, by comparable arrangement, obtain any plant or equipment for the health care facility other than a hospital, if:</text> <level label="1"> <text>The expenditure results in a substantial change in the bed capacity of the health care facility other than a hospital; or</text> </level> <level label="2"> <text>The expenditure results in the establishment of a new medical service in a health care facility other than a hospital that would require a certificate of need under subsection (i) of this section.</text> </level> </level> </level> <level label="3"> <text>A certificate of need is required before any equipment or plant is donated to a health care facility, if a certificate of need would be required under paragraph (1) or (2) of this subsection for an expenditure by the health care facility to acquire the equipment or plant directly.</text> </level> <level label="4"> <text>A certificate of need is required before any equipment or plant is transferred to a health care facility at less than fair market value if a certificate of need would be required under paragraph (1) or (2) of this subsection for the transfer at fair market value.</text> </level> <level label="5"> <text>A certificate of need is required before a person acquires a health care facility if a certificate of need would be required under paragraph (1) or (2) of this subsection for the acquisition by or on behalf of the health care facility.</text> </level> <level label="6"> <text>This subsection does not apply to:</text> <level label="i"> <text>Site acquisition;</text> </level> <level label="ii"> <text>An acquisition of a health care facility if:</text> <level label="1"> <text>At least 30 days before making the contractual arrangement to acquire the facility, written notice of the intent to make the arrangement is filed with the Commission and the Commission does not find, within 30 days after the Commission receives notice, that the health services or bed capacity of the facility will be changed, provided that, for a merger with or acquisition of an existing general hospice, the purchaser of the general hospice may only acquire the authority to provide home–based hospice services in jurisdictions in which the seller of the general hospice is licensed to provide home–based hospice services; and</text> </level> <level label="2"> <text>For an acquisition of a nursing home, the acquisition has been approved in accordance with § 19–120.2 of this subtitle;</text> </level> </level> <level label="iii"> <text>Acquisition of business or office equipment that is not directly related to patient care;</text> </level> <level label="iv"> <text>Capital expenditures to the extent that they are directly related to the acquisition and installation of major medical equipment;</text> </level> <level label="v"> <text>A capital expenditure made as part of a consolidation or merger of two or more health care facilities, or conversion of a health care facility or part of a facility to a nonhealth–related use if:</text> <level label="1"> <text>At least 45 days before an expenditure is made, written notice of intent is filed with the Commission;</text> </level> <level label="2"> <text>Within 45 days of receiving notice, the Commission in its sole discretion finds that the proposed consolidation, merger, or conversion:</text> </level> <level label="A"> <text>Is not inconsistent with the State health plan or the institution–specific plan developed by the Commission as appropriate;</text> </level> <level label="B"> <text>Will result in the delivery of more efficient and effective health care services; and</text> </level> <level label="C"> <text>Is in the public interest; and</text> </level> <level label="3"> <text>Within 45 days of receiving notice, the Commission notifies the health care facility of its finding;</text> </level> </level> <level label="vi"> <text>A capital expenditure by a nursing home for equipment, construction, or renovation that:</text> <level label="1"> <text>Is not directly related to patient care; and</text> </level> <level label="2"> <text>Is not directly related to any change in patient charges or other rates;</text> </level> </level> <level label="vii"> <text>A capital expenditure by a hospital, as defined in § 19–301 of this title, for equipment, construction, or renovation that:</text> <level label="1"> <text>Is not directly related to patient care; and</text> </level> <level label="2"> <text>Does not increase patient charges or hospital rates;</text> </level> </level> <level label="viii"> <text>A capital expenditure by a hospital, as defined in § 19–301 of this title, for a project in excess of the hospital capital threshold and is for construction or renovation that:</text> <level label="1"> <text>May be related to patient care;</text> </level> <level label="2"> <text>Does not require, over the entire period or schedule of debt service associated with the project, a total cumulative increase in patient charges or hospital rates of more than $1,500,000 for the capital costs associated with the project as determined by the Commission, after consultation with the Health Services Cost Review Commission;</text> </level> <level label="3"> <text>At least 45 days before the proposed expenditure is made, the hospital notifies the Commission;</text> </level> <level label="4"> <level label="A"> <text>Within 45 days of receipt of the relevant financial information, the Commission makes the financial determination required under item 2 of this item; or</text> </level> </level> <level label="B"> <text>The Commission has not made the financial determination required under item 2 of this item within 60 days of the receipt of the relevant financial information; and</text> </level> <level label="5"> <text>The relevant financial information to be submitted by the hospital is defined in regulations adopted by the Commission, after consultation with the Health Services Cost Review Commission;</text> </level> </level> <level label="ix"> <text>A plant donated to a hospital, as defined in § 19–301 of this title, that does not require a cumulative increase in patient charges or hospital rates of more than $1,500,000 for capital costs associated with the donated plant as determined by the Commission, after consultation with the Health Services Cost Review Commission, if:</text> <level label="1"> <text>At least 45 days before the proposed donation is made, the hospital notifies the Commission;</text> </level> <level label="2"> <level label="A"> <text>Within 45 days of receipt of the relevant financial information, the Commission makes the financial determination required under this item (ix) of this paragraph; or</text> </level> </level> <level label="B"> <text>The Commission has not made the financial determination required under this item (ix) of this paragraph within 60 days of the receipt of the relevant financial information; and</text> </level> <level label="3"> <text>The relevant financial information to be submitted by the hospital is defined in regulations adopted by the Commission after consultation with the Health Services Cost Review Commission; or</text> </level> </level> <level label="x"> <text>A capital expenditure made as part of a conversion of a licensed general hospital to a freestanding medical facility in accordance with subsection (o)(3) of this section.</text> </level> </level> <level label="7"> <text>Paragraph (6)(vi), (vii), (viii), (ix), and (x) of this subsection may not be construed to permit a facility to offer a new health care service for which a certificate of need is otherwise required.</text> </level> </level> <level label="l"> <level label="1"> <text>A certificate of need is not required to close any health care facility or part of a health care facility if at least 90 days before the closing or if at least 45 days before the partial closing of the health care facility, including a State hospital, a person proposing to close all or part of the health care facility files notice of the proposed closing or partial closing with the Commission.</text> </level> <level label="2"> <text>A hospital shall hold a public informational hearing in the county where the hospital is located if the hospital:</text> <level label="i"> <text>Files a notice of the proposed closing of the hospital with the Commission;</text> </level> <level label="ii"> <text>Requests an exemption from the Commission under subsection (o)(3) of this section to convert to a freestanding medical facility; or</text> </level> <level label="iii"> <text>Is located in a county with fewer than three hospitals and files a notice of the partial closing of the hospital with the Commission.</text> </level> </level> <level label="3"> <text>The Commission may require a health care facility other than a hospital described in paragraph (2) of this subsection that files notice of its proposed closing or partial closing to hold a public informational hearing in the county where the health care facility is located.</text> </level> <level label="4"> <text>A public informational hearing required under paragraph (2) or (3) of this subsection shall be held by the health care facility, in consultation with the Commission, within 30 days after:</text> <level label="i"> <text>The health care facility files with the Commission a notice of its proposed closing or partial closing; or</text> </level> <level label="ii"> <text>The hospital files with the Commission a notice of intent to convert to a freestanding medical facility.</text> </level> </level> <level label="5"> <level label="i"> <text>The Commission shall establish by regulation requirements for a public informational hearing required under paragraph (2) or (3) of this subsection.</text> </level> <level label="ii"> <text>For a hospital proposing to close, partially close, or convert to a freestanding medical facility, the regulations shall require the hospital to address:</text> <level label="1"> <text>The reasons for the closure, partial closure, or conversion;</text> </level> <level label="2"> <text>The plan for transitioning acute care services previously provided by the hospital to residents of the hospital service area;</text> </level> <level label="3"> <text>The plan for addressing the health care needs of the residents of the hospital service area;</text> </level> <level label="4"> <text>The plan for retraining and placing displaced employees;</text> </level> <level label="5"> <text>The plan for the hospital’s physical plant and site; and</text> </level> <level label="6"> <text>The proposed timeline for the closure, partial closure, or conversion to a freestanding medical facility.</text> </level> </level> </level> <level label="6"> <text>Within 10 working days after a public informational hearing held by a hospital under this subsection, the hospital shall provide a written summary of the hearing to:</text> <level label="i"> <text>The Governor;</text> </level> <level label="ii"> <text>The Secretary;</text> </level> <level label="iii"> <text>The governing body of the county in which the hospital is located;</text> </level> <level label="iv"> <text>The local health department and the local board of health or similar body for the county in which the hospital is located;</text> </level> <level label="v"> <text>The Commission; and</text> </level> <level label="vi"> <text>Subject to § 2–1257 of the State Government Article, the Senate Finance Committee, the House Health and Government Operations Committee, and the members of the General Assembly who represent the district in which the hospital is located.</text> </level> </level> </level> <level label="m"> <level label="1"> <text>Notwithstanding any other provision of this section, the Commission shall consider the special needs and circumstances of a county where a medical service, as defined in this section, does not exist; and</text> </level> <level label="2"> <text>The Commission shall consider and may approve under this subsection a certificate of need application to establish, build, operate, or participate in a health care project to provide a new medical service in a county if the Commission, in its sole discretion, finds that:</text> <level label="i"> <text>The proposed medical service does not exist in the county that the project would be located;</text> </level> <level label="ii"> <text>The proposed medical service is necessary to meet the health care needs of the residents of that county;</text> </level> <level label="iii"> <text>The proposed medical service would have a positive impact on the existing health care system;</text> </level> <level label="iv"> <text>The proposed medical service would result in the delivery of more efficient and effective health care services to the residents of that county; and</text> </level> <level label="v"> <text>The application meets any other standards or regulations established by the Commission to approve applications under this subsection.</text> </level> </level> </level> <level label="n"> <text>The Commission may not issue a certificate of need or a determination with respect to an acquisition that authorizes a general hospice to provide home–based hospice services on a statewide basis.</text> </level> <level label="o"> <level label="1"> <text>Except as provided in paragraphs (2) and (3) of this subsection, a person shall have a certificate of need issued by the Commission before a person establishes or operates a freestanding medical facility.</text> </level> <level label="2"> <text>A certificate of need is not required for the establishment or operation of a freestanding medical facility pilot project established under § 19–3A–07 of this title.</text> </level> <level label="3"> <level label="i"> <text>A certificate of need is not required to establish or operate a freestanding medical facility if:</text> <level label="1"> <text>The freestanding medical facility is established as the result of the conversion of a licensed general hospital;</text> </level> <level label="2"> <text>Through the conversion, the licensed general hospital will eliminate the capability of the hospital to admit or retain patients for overnight hospitalization, except for observation stays;</text> </level> <level label="3"> <text>Except as provided in subparagraph (ii) of this paragraph, the freestanding medical facility will remain on the site of, or on a site adjacent to, the licensed general hospital;</text> </level> <level label="4"> <text>At least 60 days before the conversion, written notice of intent to convert the licensed general hospital to a freestanding medical facility is filed with the Commission;</text> </level> <level label="5"> <text>The Commission in its sole discretion finds that the conversion:</text> </level> <level label="A"> <text>Is consistent with the State health plan;</text> </level> <level label="B"> <text>Will result in the delivery of more efficient and effective health care services;</text> </level> <level label="C"> <text>Will maintain adequate and appropriate delivery of emergency care within the statewide emergency medical services system as determined by the State Emergency Medical Services Board; and</text> </level> <level label="D"> <text>Is in the public interest; and</text> </level> <level label="6"> <text>Within 60 days after receiving notice under item 4 of this subparagraph, the Commission notifies the licensed general hospital of the Commission’s findings.</text> </level> </level> <level label="ii"> <text>The Commission may approve a site for a freestanding medical facility that is not on the site of, or on a site adjacent to, the licensed general hospital if:</text> <level label="1"> <text>The licensed general hospital is:</text> </level> <level label="A"> <text>The only hospital in the county; or</text> </level> <level label="B"> <text>One of two hospitals in the county that are part of the same merged asset system, and are the only two hospitals in the county; and</text> </level> <level label="2"> <text>The site is within a 5–mile radius and in the primary service area of the licensed general hospital.</text> </level> </level> <level label="iii"> <text>Notwithstanding subparagraph (i) of this paragraph, a licensed general hospital located in Kent County may not convert to a freestanding medical facility in accordance with subparagraph (i) of this paragraph before July 1, 2020.</text> </level> </level> </level> <level label="p"> <text>A certificate of need is not required for the establishment or operation of an intermediate care facility that offers medically managed residential substance use disorder treatment services if:</text> <level label="1"> <text>Written notice of the intent to establish or operate the intermediate care facility is filed with the Commission at least 45 days before establishment; and</text> </level> <level label="2"> <text>The Commission in its sole discretion finds that the proposed intermediate care facility:</text> <level label="i"> <text>Is not inconsistent with the State health plan;</text> </level> <level label="ii"> <text>Will result in the delivery of more efficient and effective health care services; and</text> </level> <level label="iii"> <text>Is in the public interest.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-120.1" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Certificate of conformance” means an approval issued by the Commission that allows an acute general hospital to establish emergency PCI services or elective PCI services without a certificate of need.</text> </level> <level label="3"> <text>“Certificate of ongoing performance” means an approval issued by the Commission that the cardiac surgery services, emergency PCI services, or elective PCI services provided by an acute general hospital meet standards evidencing continued quality.</text> </level> <level label="4"> <text>“Elective PCI” (also known as “nonprimary PCI”) includes PCI provided to a patient who is not suffering from an acute coronary syndrome, but whose condition is appropriately treated with PCI based on regulations established by the Commission.</text> </level> <level label="5"> <text>“Emergency PCI” (also known as “primary PCI”) includes PCI capable of relieving coronary vessel narrowing associated with STEMI or, as defined by the Commission in regulations, STEMI equivalent.</text> </level> <level label="6"> <text>“PCI” means percutaneous coronary intervention.</text> </level> <level label="7"> <level label="i"> <text>“Percutaneous coronary intervention” means a procedure in which a catheter is inserted into a blood vessel and guided to the site of the narrowing of a coronary artery to relieve coronary narrowing.</text> </level> <level label="ii"> <text>“Percutaneous coronary intervention” includes a variety of catheter–based techniques, including balloon angioplasty.</text> </level> </level> <level label="8"> <text>“STEMI” (ST–segment–elevation myocardial infarction) means a type of heart attack or myocardial infarction that is caused by a prolonged period of blocked blood supply, which affects a large area of the heart muscle and causes changes on an electrocardiogram and in the blood levels of key chemical markers.</text> </level> </level> <level label="b"> <level label="1"> <text>Beginning July 1, 2012, before an acute general hospital may establish emergency PCI services or elective PCI services, the hospital shall obtain a certificate of conformance from the Commission.</text> </level> <level label="2"> <text>The Commission may not issue a certificate of conformance unless the Commission finds that the proposed emergency PCI services or proposed elective PCI services:</text> <level label="i"> <text>Are consistent with the State Health Plan for Facilities and Services;</text> </level> <level label="ii"> <text>Will result in the delivery of more efficient and effective health care services; and</text> </level> <level label="iii"> <text>Are in the public interest.</text> </level> </level> </level> <level label="c"> <text>Notwithstanding subsection (b) of this section, a certificate of conformance is not required for an acute general hospital to establish emergency PCI services if:</text> <level label="1"> <text>The acute general hospital was providing emergency PCI services on January 1, 2012; and</text> </level> <level label="2"> <text>The Commission determines that the emergency PCI services are consistent with the State Health Plan for Facilities and Services.</text> </level> </level> <level label="d"> <text>Notwithstanding subsection (b) of this section, a certificate of conformance is not required for an acute general hospital to establish elective PCI services if:</text> <level label="1"> <text>On January 1, 2012, the acute general hospital was providing elective PCI services through the C–PORT E registry under authority of a research waiver issued by the Commission;</text> </level> <level label="2"> <text>The Commission finds that the C–PORT E study produced results that should guide public policy; and</text> </level> <level label="3"> <text>The Commission determines that the elective PCI services provided by the acute general hospital continue to be consistent with:</text> <level label="i"> <text>The requirements of the C–PORT E registry; and</text> </level> <level label="ii"> <text>Except for the requirements under COMAR 10.24.05.05, the requirements for maintaining a research waiver under COMAR 10.24.05 and 10.24.17, Table A–1.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>This subsection applies to an acute general hospital that provides cardiac surgery or PCI services under:</text> <level label="i"> <text>A certificate of need issued under § 19–120 of this subtitle;</text> </level> <level label="ii"> <text>A certificate of conformance issued under this section; or</text> </level> <level label="iii"> <text>An exception from the certificate of conformance requirements under subsection (c) or (d) of this section.</text> </level> </level> <level label="2"> <text>An acute general hospital shall obtain and maintain a certificate of ongoing performance to continue to provide:</text> <level label="i"> <text>Cardiac surgery services;</text> </level> <level label="ii"> <text>Emergency PCI services; or</text> </level> <level label="iii"> <text>Elective PCI services.</text> </level> </level> </level> <level label="f"> <text>An acute general hospital that is providing elective PCI services under a research waiver issued by the Commission and does not meet the requirements of subsection (d) of this section shall obtain a certificate of conformance for its elective PCI services before the acute general hospital may obtain a certificate of ongoing performance to provide the elective PCI services.</text> </level> <level label="g"> <level label="1"> <text>The Commission shall adopt regulations through an update to the State Health Plan for Facilities and Services to implement this section.</text> </level> <level label="2"> <text>The regulations shall:</text> <level label="i"> <text>Address quality, access, and cost;</text> </level> <level label="ii"> <text>Establish a process and minimum standards for obtaining a certificate of conformance;</text> </level> <level label="iii"> <text>Establish a process and minimum standards for obtaining and maintaining a certificate of ongoing performance;</text> </level> <level label="iv"> <text>Set an appropriate time period for the expiration of a certificate of ongoing performance;</text> </level> <level label="v"> <text>Require, as a condition of the issuance of a certificate of conformance or a certificate of ongoing performance, that an acute general hospital agree to voluntarily relinquish its authority to provide cardiac surgery services, emergency PCI services, or elective PCI services if the hospital fails to meet the applicable standards established by the Commission;</text> </level> <level label="vi"> <text>Establish a process for an acute general hospital that is out of compliance with minimum standards for a certificate of ongoing performance to return to good standing;</text> </level> <level label="vii"> <text>Require that an acute general hospital, except for an acute general hospital located in a part of the State that does not have sufficient access to emergency PCI services, have provided emergency PCI services in accordance with established standards before seeking a certificate of conformance for elective PCI services;</text> </level> <level label="viii"> <text>Prohibit an acute general hospital from providing elective PCI services unless the acute general hospital also provides emergency PCI services;</text> </level> <level label="ix"> <text>Incorporate, to the extent appropriate, the standards for cardiac surgery services, emergency PCI services, and elective PCI services recommended by the clinical advisory group established under paragraph (3) of this subsection;</text> </level> <level label="x"> <text>Include requirements for peer or independent review, consistent with the ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions), of difficult or complicated cases and for randomly selected cases; and</text> </level> <level label="xi"> <text>For a certificate of conformance for elective PCI services, give weight to the experience, performance, investment, and scope of interventional capabilities of an applicant hospital that was providing emergency PCI services on January 1, 2012.</text> </level> </level> <level label="3"> <level label="i"> <text>The Commission shall establish a clinical advisory group to advise the Commission and recommend standards for cardiac surgery services, emergency PCI services, and elective PCI services for inclusion in regulations adopted under this subsection.</text> </level> <level label="ii"> <text>The clinical advisory group shall be composed of experts in cardiac surgery services and PCI services, including:</text> <level label="1"> <text>Clinicians and representatives from hospitals in the State with and without on–site cardiac surgery services and with and without PCI services;</text> </level> <level label="2"> <text>At least one representative of an acute general hospital that is not part of a merged asset system and provides only emergency PCI services; and</text> </level> <level label="3"> <text>Other persons with needed expertise from inside and outside the State.</text> </level> </level> </level> <level label="4"> <level label="i"> <text>On or before September 30, 2013, after obtaining advice from the clinical advisory group and other appropriate stakeholders, the Commission shall:</text> <level label="1"> <text>Develop recommended regulations under this subsection;</text> </level> <level label="2"> <text>Post the recommended regulations on its website for public comment; and</text> </level> <level label="3"> <text>Submit the recommended regulations to the Governor and, in accordance with § 2–1257 of the State Government Article, the Senate Finance Committee and the House Health and Government Operations Committee.</text> </level> </level> <level label="ii"> <text>The Senate Finance Committee and the House Health and Government Operations Committee shall have 60 days from receipt of the recommended regulations for review and comment.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-120.2" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Executive Director” means the Executive Director of the Commission.</text> </level> <level label="3"> <text>“Nursing home” has the meaning stated in § 19–1401 of this title.</text> </level> <level label="4"> <text>“Request for acquisition” means a request for the Commission to approve the acquisition of a nursing home.</text> </level> </level> <level label="b"> <text>A person shall provide notice to the Commission at least 30 days before the closing of a change of ownership of a nursing home that:</text> <level label="1"> <text>Involves at least a 5% transfer in ownership interest; and</text> </level> <level label="2"> <text>Is not an acquisition that requires approval under subsection (c) of this section.</text> </level> </level> <level label="c"> <level label="1"> <text>This subsection does not apply to an acquisition that involves only changes of ownership interests among existing owners of a nursing home.</text> </level> <level label="2"> <text>At least 60 days before the closing date of the acquisition of a nursing home, a person shall:</text> <level label="i"> <text>Submit to the Commission a request for acquisition; and</text> </level> <level label="ii"> <text>Provide notice to the residents, resident representatives, and employees of the nursing home that:</text> <level label="1"> <text>The request for acquisition was submitted to the Commission; and</text> </level> <level label="2"> <text>There will be an opportunity to submit comments in accordance with subsection (f) of this section.</text> </level> </level> </level> </level> <level label="d"> <level label="1"> <text>The Executive Director shall review a completed request for acquisition within 45 days after receiving the completed request from the applicant.</text> </level> <level label="2"> <text>The Executive Director, in consultation with the Secretary or the Secretary’s designee, may:</text> <level label="i"> <text>Approve the acquisition;</text> </level> <level label="ii"> <text>Approve the acquisition with conditions;</text> </level> <level label="iii"> <text>Deny the acquisition; or</text> </level> <level label="iv"> <text>Refer the request for acquisition to the Commission for a final decision.</text> </level> </level> </level> <level label="e"> <text>To approve a request submitted under subsection (c) of this section, the Executive Director must find that the acquisition:</text> <level label="1"> <text>Is consistent with the State Health Plan; and</text> </level> <level label="2"> <text>Subject to subsection (f) of this section, is in the public interest.</text> </level> </level> <level label="f"> <text>In determining whether an acquisition of a nursing home is in the public interest, the Executive Director shall:</text> <level label="1"> <text>Solicit and accept comments from individuals who:</text> <level label="i"> <text>Reside in the nursing home;</text> </level> <level label="ii"> <text>Have family members who reside in the nursing home; or</text> </level> <level label="iii"> <text>Are employees of the nursing home; and</text> </level> </level> <level label="2"> <text>Consult with the Attorney General on whether the acquisition raises public interest concerns.</text> </level> </level> <level label="g"> <text>If the Executive Director refers a request for acquisition to the Commission under subsection (d)(2)(iv) of this section, the Commission shall use the criteria specified in subsections (e) and (f) of this section and regulations adopted by the Commission to make a final decision within 60 days after receiving the completed request from the applicant.</text> </level> <level label="h"> <text>If the Executive Director denies a request for acquisition or imposes a condition on the approval of the acquisition, a person that is a party to the acquisition may submit a written request for the Commission to review the decision in accordance with regulations adopted by the Commission.</text> </level> <level label="i"> <level label="1"> <text>A decision of the Commission under subsection (g) or (h) of this section shall be a final decision for the purpose of judicial review.</text> </level> <level label="2"> <text>A person that is a party to the acquisition may take a direct judicial appeal within 30 days after the Commission makes the final decision.</text> </level> <level label="3"> <text>The Commission shall send each final decision to the Secretary, the Secretary of Aging, the Office of Health Care Quality, the Office of the Attorney General, and the State Long–Term Care Ombudsman.</text> </level> </level> <level label="j"> <level label="1"> <text>On or before July 1 immediately following the acquisition of a nursing home and each year for 3 years thereafter, the person that acquired the nursing home shall submit a report to the Commission in accordance with regulations adopted by the Commission.</text> </level> <level label="2"> <text>The Commission shall provide the report required under paragraph (1) of this subsection to the Secretary, the Secretary of Aging, the Office of Health Care Quality, the Office of the Attorney General, and the State Long–Term Care Ombudsman.</text> </level> </level> <level label="k"> <level label="1"> <text>The Commission shall adopt regulations through an update to the State Health Plan for Facilities and Services to carry out the provisions of this section.</text> </level> <level label="2"> <text>The regulations adopted under this subsection shall:</text> <level label="i"> <text>Require the person that acquired ownership of a nursing home to:</text> <level label="1"> <text>Reduce the number of resident rooms in the nursing home that contain more than two beds in accordance with standards established by the Commission; or</text> </level> <level label="2"> <text>Receive a waiver from the requirement established under item 1 of this item from the Executive Director in accordance with standards established by the Commission;</text> </level> </level> <level label="ii"> <level label="1"> <text>If necessary, allow the person that acquired ownership of a nursing home to temporarily delicense beds for at least 3 years immediately following the acquisition to reduce the number of resident rooms that contain more than two beds; and</text> </level> <level label="2"> <text>Authorize the Commission to extend the period the beds are temporarily delicensed beyond 3 years for good cause shown, including demonstrated progress toward eliminating multibedded rooms by expanding the existing facility or transferring the beds to another facility within a merged asset system in the same jurisdiction;</text> </level> </level> <level label="iii"> <text>Establish standards for the evaluation of the quality of the nursing homes currently or previously owned, whether in the State or outside the State, by the person that submitted a request for acquisition; and</text> </level> <level label="iv"> <text>Subject to paragraph (3) of this subsection, establish criteria for the Executive Director and the Commission to consider when making a decision regarding a request for acquisition.</text> </level> </level> <level label="3"> <text>The criteria established by the Commission under paragraph (2)(iv) of this subsection shall require that the Commission take into consideration whether any nursing home currently or previously owned, within or outside the State, by the person submitting the request, for the period of 3 years immediately preceding the submission of the request:</text> <level label="i"> <text>Maintained a quality assessment and assurance committee that met at least quarterly;</text> </level> <level label="ii"> <text>Was the subject of an enforcement action, a special focus facility designation, or a deficiency involving serious or immediate threat, actual harm, or immediate jeopardy to a resident; or</text> </level> <level label="iii"> <text>Was the subject of a lawsuit judgment, or an arbitration finding, following a complaint filed by a resident, resident representative, or a government agency.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-121" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>In this section, “health maintenance organization” means a health maintenance organization under Subtitle 7 of this title.</text> </level> <level label="b"> <level label="1"> <text>A health maintenance organization or a health care facility that either controls, directly or indirectly, or is controlled by a health maintenance organization shall have a certificate of need before the health maintenance organization or health care facility builds, develops, operates, purchases, or participates in building, developing, operating, or establishing:</text> <level label="i"> <text>A hospital, as defined in § 19–301 of this title; and</text> </level> <level label="ii"> <text>Any other health care project for which a certificate of need is required under § 19–120 of this subtitle unless at least 90% of the patients who will receive health care services from the project will be individuals enrolled in that health maintenance organization.</text> </level> </level> <level label="2"> <text>Notwithstanding paragraph (1)(ii) of this subsection, a health maintenance organization or a health care facility that either controls, directly or indirectly, or is controlled by a health maintenance organization is not required to obtain a certificate of need before purchasing an existing ambulatory surgical facility or center, as defined in § 19–114(b) of this subtitle.</text> </level> </level> <level label="c"> <text>An application for a certificate of need by a health maintenance organization or by a health care facility that either controls, directly or indirectly, or is controlled by, a health maintenance organization shall be approved if the Commission finds that the application:</text> <level label="1"> <text>Documents that the project is necessary to meet the needs of enrolled members and reasonably anticipated new members for the services proposed to be provided by the applicant; and</text> </level> <level label="2"> <text>Is not inconsistent with those sections of the State health plan or those sections of the institution–specific plan that govern hospitals, as defined in § 19–301 of this title, and ambulatory surgical facilities or centers, as defined in § 19–114(b) of this subtitle, or health care projects for which a certificate of need is required under subsection (b)(1)(ii) of this section.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-122" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <text>A certificate of need is not required to delete, expand, develop, operate, or participate in a health care project for domiciliary care.</text> </section> <section article="ghg" article_name="Health - General" number="19-123" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <text>Notwithstanding the provisions of § 19-114(d)(2)(ii) of this subtitle, a continuing care community does not lose its exemption from certificate of need requirements when the continuing care community admits an individual directly to a nursing facility within the continuing care community if:</text> <level label="1"> <text>The admittee’s spouse or relative is admitted at the same time under a joint contract to an independent living unit or assisted living unit within the continuing care community; or</text> </level> <level label="2"> <text>An individual having a long-term significant relationship with the admittee is admitted at the same time under a joint contract to an independent living unit or assisted living unit within the continuing care community.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-124" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>Notwithstanding the provisions of § 19-114(d)(2)(ii) of this part, a continuing care community that qualifies for an exemption from a certificate of need under § 19-114(d)(2)(ii) of this part may admit a subscriber directly into a comprehensive care nursing bed only if, at the time of admission, the subscriber has the potential for an eventual transfer to an independent living unit or an assisted living unit, as determined by the subscriber’s personal physician who is not an owner or employee of the continuing care retirement community.</text> </level> <level label="b"> <text>Notwithstanding the provisions of subsection (a) of this section and § 19-114(d)(2)(ii) of this part, the total number of comprehensive care nursing beds occupied by subscribers who have been directly admitted to a comprehensive care nursing bed may not exceed 20 percent of the total number of comprehensive care nursing beds that are available in the continuing care nursing facility.</text> </level> <level label="c"> <text>Notwithstanding the provisions of subsections (a) and (b) of this section and § 19-114(d)(2)(ii) of this part, a continuing care retirement community that qualifies for an exemption from a certificate of need under § 19-114(d)(2)(ii) of this part may not admit a subscriber directly into a comprehensive care nursing bed if the direct admission would cause the occupancy of the comprehensive care nursing beds in the continuing care community to exceed 95 percent of full capacity.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-125" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <text>A certificate of need is required before an ambulatory care facility:</text> <level label="1"> <text>Offers any health service:</text> <level label="i"> <text>Through a health care facility;</text> </level> <level label="ii"> <text>In space leased from a health care facility; or</text> </level> <level label="iii"> <text>In space on land leased from a health care facility;</text> </level> </level> <level label="2"> <text>To provide those services, makes an expenditure, if a certificate of need would be required under § 19-120(k) of this subtitle for the expenditure by or on behalf of a health care facility; or</text> </level> <level label="3"> <text>Does anything else for which the federal act requires a certificate of need and that the Commission has not exempted from that requirement.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-126" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>If the Commission receives an application for a certificate of need for a change in the bed capacity of a health care facility, as required under § 19–120 of this subtitle, or for a health care project that would create a new health care service or abolish an existing health care service, the Commission shall give notice of the filing by publication in the Maryland Register and give the following notice to:</text> <level label="1"> <text>Each member of the General Assembly in whose district the action is planned;</text> </level> <level label="2"> <text>Each member of the governing body for the county where the action is planned;</text> </level> <level label="3"> <text>The county executive, mayor, or chief executive officer, if any, in whose county or city the action is planned; and</text> </level> <level label="4"> <text>Any health care provider, third party payor, local planning agency, or any other person the Commission knows has an interest in the application.</text> </level> </level> <level label="b"> <text>Failure to give notice shall not adversely affect the application.</text> </level> <level label="c"> <level label="1"> <text>All decisions of the Commission on an application for a certificate of need, except in emergency circumstances posing a threat to public health, shall be consistent with the State health plan and the standards for review established by the Commission.</text> </level> <level label="2"> <text>The mere failure of the State health plan to address any particular project or health care service shall not alone be deemed to render the project inconsistent with the State health plan.</text> </level> <level label="3"> <text>Unless the Commission finds that the facility or service for which the proposed expenditure is to be made is not needed or is not consistent with the State health plan, the Commission shall approve an application for a certificate of need required under § 19–120(k) of this subtitle to the extent that the expenditure is to be made to:</text> <level label="i"> <text>Eliminate or prevent an imminent safety hazard, as defined by federal, State, or local fire, building, or life safety codes or regulations;</text> </level> <level label="ii"> <text>Comply with State licensing standards; or</text> </level> <level label="iii"> <text>Comply with accreditation standards for reimbursement under Title XVIII of the Social Security Act or under the State Medical Assistance Program approved under Title XIX of the Social Security Act.</text> </level> </level> </level> <level label="d"> <level label="1"> <text>The Commission alone shall have final nondelegable authority to act upon an application for a certificate of need, except as provided in this subsection.</text> </level> <level label="2"> <text>A majority of the full authorized membership of the Commission shall be a quorum to act on an application for a certificate of need.</text> </level> <level label="3"> <text>After an application is filed, the staff of the Commission:</text> <level label="i"> <text>Shall review the application for completeness within 10 working days of the filing of the application; and</text> </level> <level label="ii"> <text>May request further information from the applicant.</text> </level> </level> <level label="4"> <text>The Commission may delegate to a reviewer the responsibility for review of an application for a certificate of need, including:</text> <level label="i"> <text>The holding of an evidentiary hearing if the Commission, in accordance with criteria it has adopted by regulation, considers an evidentiary hearing appropriate due to the magnitude of the impact the proposed project may have on the health care delivery system; and</text> </level> <level label="ii"> <text>Preparation of a recommended decision for consideration by the full Commission.</text> </level> </level> <level label="5"> <text>The Commission shall designate a single Commissioner to act as a reviewer for the application and any competing applications.</text> </level> <level label="6"> <text>The Commission shall delegate to its staff the responsibility for an initial review of an application, including, in the event that no written comments on an application are submitted by any interested party other than the staff of the Commission, the preparation of a recommended decision for consideration by the full Commission.</text> </level> <level label="7"> <text>Any “interested party” may submit written comments on the application in accordance with procedural regulations adopted by the Commission.</text> </level> <level label="8"> <text>The Commission shall define the term “interested party” to include, at a minimum:</text> <level label="i"> <text>The staff of the Commission;</text> </level> <level label="ii"> <text>Any applicant who has submitted a competing application;</text> </level> <level label="iii"> <text>Any other person who can demonstrate that the person would be adversely affected by the decision of the Commission on the application;</text> </level> <level label="iv"> <text>A local health planning agency for a jurisdiction or region in which the proposed facility or service will be located; and</text> </level> <level label="v"> <text>In the review of a replacement acute general hospital project proposed by or on behalf of a regional health system that serves multiple contiguous jurisdictions, a jurisdiction within the region served by the regional health system that does not contain the proposed replacement acute general hospital project.</text> </level> </level> <level label="9"> <text>The reviewer shall review the application, any written comments on the application, and any other materials permitted by this section or by the Commission’s regulations, and present a recommended decision on the application to the full Commission.</text> </level> <level label="10"> <level label="i"> <text>An applicant and any interested party may request the opportunity to present oral argument to the reviewer, in accordance with regulations adopted by the Commission, before the reviewer prepares a recommended decision on the application for consideration by the full Commission.</text> </level> <level label="ii"> <text>The reviewer may grant, deny, or impose limitations on an interested party’s request to present oral argument to the reviewer.</text> </level> </level> <level label="11"> <text>Any interested party who has submitted written comments under paragraph (7) of this subsection may submit written exceptions to the proposed decision and make oral argument to the Commission, in accordance with regulations adopted by the Commission, before the Commission takes final action on the application.</text> </level> <level label="12"> <text>The Commission shall, after determining that the recommended decision is complete, vote to approve, approve with conditions, or deny the application on the basis of the recommended decision, the record before the staff or the reviewer, and exceptions and arguments, if any, before the Commission.</text> </level> <level label="13"> <text>The decision of the Commission shall be by a majority of the quorum present and voting.</text> </level> </level> <level label="e"> <text>Where the State health plan identifies a need for additional hospital bed capacity in a region or subregion, in a comparative review of 2 or more applicants for hospital bed expansion projects, a certificate of need shall be granted to 1 or more applicants in that region or subregion that:</text> <level label="1"> <text>Have satisfactorily met all applicable standards;</text> </level> <level label="2"> <level label="i"> <text>Have within the preceding 10 years voluntarily delicensed the greater of 10 beds or 10 percent of total licensed bed capacity to the extent of the beds that are voluntarily delicensed; or</text> </level> <level label="ii"> <text>Have been previously granted a certificate of need which was not recertified by the Commission within the preceding 10 years; and</text> </level> </level> <level label="3"> <text>The Commission finds at least comparable to all other applicants.</text> </level> </level> <level label="f"> <level label="1"> <text>If any party or interested person requests an evidentiary hearing with respect to a certificate of need application for any health care facility other than an ambulatory surgical facility and the Commission, in accordance with criteria it has adopted by regulation, considers an evidentiary hearing appropriate due to the magnitude of the impact that the proposed project may have on the health care delivery system, the Commission or a committee of the Commission shall hold the hearing in accordance with the contested case procedures of the Administrative Procedure Act.</text> </level> <level label="2"> <text>Except as provided in this section or in regulations adopted by the Commission to implement the provisions of this section, the review of an application for a certificate of need for an ambulatory surgical facility is not subject to the contested case procedures of Title 10, Subtitle 2 of the State Government Article.</text> </level> </level> <level label="g"> <level label="1"> <text>An application for a certificate of need shall be acted upon by the Commission no later than 150 days after the application was docketed.</text> </level> <level label="2"> <text>If an evidentiary hearing is not requested, the Commission’s decision on an application shall be made no later than 90 days after the application was docketed.</text> </level> </level> <level label="h"> <level label="1"> <text>The applicant or any aggrieved party, as defined in § 19–128(a) of this subtitle, may petition the Commission within 15 days for a reconsideration.</text> </level> <level label="2"> <text>The Commission shall decide whether or not it will reconsider its decision within 30 days of receipt of the petition for reconsideration.</text> </level> <level label="3"> <text>The Commission shall issue its reconsideration decision within 30 days of its decision on the petition.</text> </level> </level> <level label="i"> <level label="1"> <text>Except as provided in paragraph (2) of this subsection, if the Commission does not act on an application within the required period, the applicant may file with a court of competent jurisdiction within 60 days after expiration of the period a petition to require the Commission to act on the application.</text> </level> <level label="2"> <level label="i"> <text>This paragraph does not apply to an application for a certificate of need involving:</text> <level label="1"> <text>The establishment of a health care facility;</text> </level> <level label="2"> <text>The relocation of a health care facility; or</text> </level> <level label="3"> <text>The introduction by a hospital of cardiac surgery or organ transplantation.</text> </level> </level> <level label="ii"> <text>A certificate of need filed after October 1, 2019, shall be deemed approved if:</text> <level label="1"> <text>The certificate of need is uncontested; and</text> </level> <level label="2"> <text>Final action by the Commission does not occur within 120 days after the application for the certificate of need was docketed.</text> </level> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-127" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <text>The circuit court for the county where a health care project is being developed or operated in violation of this Part II of this subtitle may enjoin further development or operation.</text> </section> <section article="ghg" article_name="Health - General" number="19-128" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>In this section, “aggrieved party” means:</text> <level label="i"> <text>An interested party who presented written comments on the application to the Commission and who would be adversely affected by the decision of the Commission on the project; or</text> </level> <level label="ii"> <text>The Secretary.</text> </level> </level> <level label="2"> <text>The grounds for appeal by the Secretary shall be that the decision is inconsistent with the State health plan or adopted standards.</text> </level> </level> <level label="b"> <level label="1"> <text>A decision of the Commission shall be the final decision for purposes of judicial review.</text> </level> <level label="2"> <text>A request for a reconsideration will stay the final decision of the Commission for purposes of judicial review until a decision is made on the reconsideration.</text> </level> </level> <level label="c"> <text>An aggrieved party may take a direct judicial appeal within 30 days of the final decision of the Commission.</text> </level> <level label="d"> <text>The Commission is a necessary party to an appeal at all levels of the appeal.</text> </level> <level label="e"> <text>In the event of an adverse decision that affects its final decision, the Commission may apply within 30 days by writ of certiorari to the Court of Appeals for review where:</text> <level label="1"> <text>Review is necessary to secure uniformity of decision, as where the same statute has been construed differently by 2 or more judges; or</text> </level> <level label="2"> <text>There are other special circumstances that render it desirable and in the public interest that the decision be reviewed.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-129" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>Notwithstanding the fact that a merger or consolidation may limit free economic competition, the Commission may approve the merger or consolidation of 2 or more hospitals if the merger or consolidation:</text> <level label="1"> <text>Is not inconsistent with the State health plan or any institution-specific plan;</text> </level> <level label="2"> <text>Will result in the delivery of more efficient and effective hospital services; and</text> </level> <level label="3"> <text>Is in the public interest.</text> </level> </level> <level label="b"> <text>Notwithstanding the fact that a merger or consolidation or the joint ownership and operation of major medical equipment may limit free economic competition, a hospital may engage in a merger or consolidation or the joint ownership of major medical equipment that has been approved by the Commission under this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-130" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Fund” means the Maryland Trauma Physician Services Fund.</text> </level> <level label="3"> <text>“Maryland Trauma Specialty Referral Centers” means:</text> <level label="i"> <text>The Johns Hopkins Health System Burn Program;</text> </level> <level label="ii"> <text>The Eye Trauma Center at the Wilmer Eye Institute at The Johns Hopkins Hospital; and</text> </level> <level label="iii"> <text>The Curtis National Hand Center at Union Memorial Hospital.</text> </level> </level> <level label="4"> <text>“Reasonable compensation equivalent” means the limitation on the cost established by the Centers for Medicare and Medicaid Services that a provider may claim for compensation of services.</text> </level> <level label="5"> <text>“Rehabilitation hospital” means a facility classified as a special rehabilitation hospital as described in § 19–307 of this title that is affiliated with a trauma center by common ownership.</text> </level> <level label="6"> <level label="i"> <text>“Trauma center” means a facility designated by the Maryland Institute for Emergency Medical Services Systems as:</text> <level label="1"> <text>The State primary adult resource center;</text> </level> <level label="2"> <text>A Level I trauma center;</text> </level> <level label="3"> <text>A Level II trauma center;</text> </level> <level label="4"> <text>A Level III trauma center;</text> </level> <level label="5"> <text>A pediatric trauma center; or</text> </level> <level label="6"> <text>The Maryland Trauma Specialty Referral Centers.</text> </level> </level> <level label="ii"> <text>“Trauma center” includes an out–of–state pediatric trauma center that has entered into an agreement with the Maryland Institute for Emergency Medical Services Systems.</text> </level> </level> <level label="7"> <text>“Trauma health care practitioner” means a health care practitioner licensed under the Health Occupations Article who provides care in a trauma center or in a rehabilitation hospital to trauma patients on the State trauma registry as defined by the Maryland Institute for Emergency Medical Services Systems.</text> </level> <level label="8"> <text>“Trauma physician” means a physician who provides care in a trauma center or in a rehabilitation hospital to trauma patients on the State trauma registry as defined by the Maryland Institute for Emergency Medical Services Systems.</text> </level> <level label="9"> <text>“Uncompensated care” means care provided by a trauma physician or a trauma health care practitioner to a trauma patient on the State trauma registry who:</text> <level label="i"> <text>Has no health insurance, including Medicare Part B coverage;</text> </level> <level label="ii"> <text>Is not eligible for medical assistance coverage; and</text> </level> <level label="iii"> <text>Has not paid the trauma physician or trauma health care practitioner for care provided by the trauma physician or trauma health care practitioner, after documented attempts by the trauma physician or trauma health care practitioner to collect payment.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>There is a Maryland Trauma Physician Services Fund.</text> </level> <level label="2"> <text>The purpose of the Fund is to subsidize the documented costs:</text> <level label="i"> <text>Of uncompensated care incurred by a trauma physician or trauma health care practitioner in providing trauma care to a trauma patient on the State trauma registry;</text> </level> <level label="ii"> <text>Of undercompensated care incurred by a trauma physician or trauma health care practitioner in providing trauma care to an enrollee of the Maryland Medical Assistance Program who is a trauma patient on the State trauma registry;</text> </level> <level label="iii"> <text>Incurred by a trauma center to maintain trauma physicians on–call as required by the Maryland Institute for Emergency Medical Services Systems;</text> </level> <level label="iv"> <text>Incurred by the State primary adult resource center to maintain trauma surgeons, orthopedic surgeons, neurosurgeons, and anesthesiologists on–call and on standby as required by the Maryland Institute for Emergency Medical Services Systems; and</text> </level> <level label="v"> <text>Incurred by the Commission and the Health Services Cost Review Commission to administer the Fund and audit reimbursement requests to assure appropriate payments are made from the Fund.</text> </level> </level> <level label="3"> <text>The Commission and the Health Services Cost Review Commission shall administer the Fund.</text> </level> <level label="4"> <text>The Fund is a special, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.</text> </level> <level label="5"> <text>Interest on and other income from the Fund shall be separately accounted for and credited to the Fund, and are not subject to § 6–226(a) of the State Finance and Procurement Article.</text> </level> </level> <level label="c"> <text>The Fund consists of:</text> <level label="1"> <text>Motor vehicle registration surcharges paid into the Fund in accordance with § 13–954(b)(2) of the Transportation Article;</text> </level> <level label="2"> <text>At least 20% of the fines collected under § 21–902(a)(1), (b)(2), (c)(2), and (d)(1) of the Transportation Article; and</text> </level> <level label="3"> <text>Any other money transferred from the General Fund of the State.</text> </level> </level> <level label="d"> <level label="1"> <text>Disbursements from the Fund shall be made in accordance with a methodology established jointly by the Commission and the Health Services Cost Review Commission to calculate costs incurred by trauma physicians and trauma centers that are eligible to receive reimbursement under subsection (b) of this section.</text> </level> <level label="2"> <text>The Fund shall transfer to the Maryland Department of Health an amount sufficient to fully cover the State’s share of expenditures for the costs of undercompensated care incurred by a trauma physician in providing trauma care to an enrollee of the Maryland Medical Assistance Program who is a trauma patient on the State trauma registry.</text> </level> <level label="3"> <text>The methodology developed under paragraph (1) of this subsection shall:</text> <level label="i"> <text>Take into account:</text> <level label="1"> <text>The amount of uncompensated care provided by trauma physicians;</text> </level> <level label="2"> <text>The amount of undercompensated care attributable to the treatment of Medicaid enrollees in trauma centers;</text> </level> <level label="3"> <text>The cost of maintaining trauma physicians on–call;</text> </level> <level label="4"> <text>The number of patients served by trauma physicians in trauma centers;</text> </level> <level label="5"> <text>The number of Maryland residents served by trauma physicians in trauma centers; and</text> </level> <level label="6"> <text>The extent to which trauma–related costs are otherwise subsidized by hospitals, the federal government, and other sources; and</text> </level> </level> <level label="ii"> <text>Include an incentive to encourage hospitals to continue to subsidize trauma–related costs not otherwise included in hospital rates.</text> </level> </level> <level label="4"> <text>The methodology developed under paragraph (1) of this subsection shall use the following parameters to determine the amount of reimbursement made to trauma physicians and trauma centers from the Fund:</text> <level label="i"> <level label="1"> <text>The cost incurred by a Level II trauma center to maintain trauma surgeons, orthopedic surgeons, and neurosurgeons on–call shall be reimbursed:</text> </level> <level label="A"> <text>At a rate of up to 60% of the reasonable compensation equivalent hourly rate for the specialty, inflated to the current year by the physician compensation component of the Medicare economic index as designated by the Centers for Medicare and Medicaid Services; and</text> </level> <level label="B"> <text>For the minimum number of trauma physicians required to be on–call, as specified by the Maryland Institute for Emergency Medical Services Systems in its criteria for Level II trauma centers;</text> </level> <level label="2"> <text>The cost incurred by a Level III trauma center to maintain trauma surgeons, orthopedic surgeons, neurosurgeons, and anesthesiologists on–call shall be reimbursed:</text> </level> <level label="A"> <text>At a rate of up to 60% of the reasonable compensation equivalent hourly rate for the specialty, inflated to the current year by the physician compensation component of the Medicare economic index as designated by the Centers for Medicare and Medicaid Services; and</text> </level> <level label="B"> <text>For the minimum number of trauma physicians required to be on–call, as specified by the Maryland Institute for Emergency Medical Services Systems in its criteria for Level III trauma centers;</text> </level> <level label="3"> <text>The cost incurred by a Level I trauma center or pediatric trauma center to maintain trauma surgeons, orthopedic surgeons, and neurosurgeons on–call when a post–graduate resident is attending in the trauma center shall be reimbursed:</text> </level> <level label="A"> <text>At a rate of up to 60% of the reasonable compensation equivalent hourly rate for the specialty, inflated to the current year by the physician compensation component of the Medicare economic index as designated by the Centers for Medicare and Medicaid Services; and</text> </level> <level label="B"> <text>When a post–graduate resident is authorized to be in the trauma center, as specified by the Maryland Institute for Emergency Medical Services Systems in its criteria for Level I trauma centers or pediatric trauma centers;</text> </level> <level label="4"> <text>The cost incurred by a Maryland Trauma Specialty Referral Center to maintain trauma surgeons on–call in the specialty of the Center when a post–graduate resident is attending in the Center shall be reimbursed:</text> </level> <level label="A"> <text>At a rate of up to 60% of the reasonable compensation equivalent hourly rate for the specialty, inflated to the current year by the physician compensation component of the Medicare economic index as designated by the Centers for Medicare and Medicaid Services; and</text> </level> <level label="B"> <text>When a post–graduate resident is authorized to be in the Center, as specified by the Maryland Institute for Emergency Medical Services Systems in its criteria for a Maryland Trauma Specialty Referral Center; and</text> </level> <level label="5"> <level label="A"> <text>A Level II trauma center is eligible for a maximum of 26,280 hours of trauma on–call per year;</text> </level> </level> <level label="B"> <text>A Level III trauma center is eligible for a maximum of 35,040 hours of trauma on–call per year;</text> </level> <level label="C"> <text>A Level I trauma center shall be eligible for a maximum of 4,380 hours of trauma on–call per year;</text> </level> <level label="D"> <text>A pediatric trauma center shall be eligible for a maximum of 4,380 hours of trauma on–call per year; and</text> </level> <level label="E"> <text>A Maryland Trauma Specialty Referral Center shall be eligible for a maximum of 2,190 hours of trauma on–call per year;</text> </level> </level> <level label="ii"> <text>The cost of undercompensated care incurred by a trauma physician in providing trauma care to enrollees of the Maryland Medical Assistance Program who are trauma patients on the State trauma registry shall be reimbursed at a rate of up to 100% of the Medicare payment for the service, minus any amount paid by the Maryland Medical Assistance Program;</text> </level> <level label="iii"> <text>The cost of uncompensated care incurred by a trauma physician in providing trauma care to trauma patients on the State trauma registry shall be reimbursed at a rate of 100% of the Medicare payment for the service, minus any recoveries made by the trauma physician for the care;</text> </level> <level label="iv"> <text>The Commission, in consultation with the Health Services Cost Review Commission, may establish a payment rate for uncompensated care incurred by a trauma physician in providing trauma care to trauma patients on the State trauma registry that is above 100% of the Medicare payment for the service if:</text> <level label="1"> <text>The Commission determines that increasing the payment rate above 100% of the Medicare payment for the service will address an unmet need in the State trauma system; and</text> </level> <level label="2"> <text>The Commission reports on its intention to increase the payment rate to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with § 2–1257 of the State Government Article, at least 60 days before any adjustment to the rate;</text> </level> </level> <level label="v"> <text>The Commission shall develop guidelines for the reimbursement of the documented costs of the State primary adult resource center under subsection (b)(2)(iv) of this section;</text> </level> <level label="vi"> <text>The Commission, in consultation with the Health Services Cost Review Commission, may change the percentage of the reasonable compensation equivalent paid to trauma hospitals if:</text> <level label="1"> <text>The Commission determines that the projected revenue to be collected in the Fund is adequate to support the proposed increase in the percentage of reasonable compensation equivalent inflated to the current year by the physician compensation component of the Medicare economic index; and</text> </level> <level label="2"> <text>The Commission reports on its intention to change the percentage of reasonable compensation equivalent to be paid for on–call costs to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with § 2–1257 of the State Government Article, at least 60 days before any adjustment to the allowable hours;</text> </level> </level> <level label="vii"> <text>The Commission, in consultation with the Health Services Cost Review Commission, may change the number of allowable hours of trauma on–call each year if the Commission reports on its intention to change the number of allowable hours to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with § 2–1257 of the State Government Article, at least 60 days before any adjustment to the allowable hours;</text> </level> <level label="viii"> <text>The Commission may modify the percentage paid of the reasonable compensation equivalent for on–call hours not more than once each year; and</text> </level> <level label="ix"> <text>The total reimbursement to emergency physicians from the Fund may not exceed $300,000 annually.</text> </level> </level> <level label="5"> <text>In order to receive reimbursement, a trauma physician or trauma health care practitioner in the case of costs of uncompensated care under subsection (b)(2)(i) of this section, or a trauma center in the case of on–call costs under subsection (b)(2)(iii) of this section, shall apply to the Fund on a form and in a manner approved by the Commission and the Health Services Cost Review Commission.</text> </level> <level label="6"> <level label="i"> <text>The Commission and the Health Services Cost Review Commission shall adopt regulations that specify the information that trauma physicians, trauma health care practitioners, and trauma centers must submit to receive money from the Fund.</text> </level> <level label="ii"> <text>The information required shall include:</text> <level label="1"> <text>The name and federal tax identification number of the trauma physician rendering the service;</text> </level> <level label="2"> <text>The date of the service;</text> </level> <level label="3"> <text>Appropriate codes describing the service;</text> </level> <level label="4"> <text>Any amount recovered for the service rendered;</text> </level> <level label="5"> <text>The name of the trauma patient;</text> </level> <level label="6"> <text>The patient’s trauma registry number; and</text> </level> <level label="7"> <text>Any other information the Commission and the Health Services Cost Review Commission consider necessary to disburse money from the Fund.</text> </level> </level> <level label="iii"> <text>It is the intent of the General Assembly that trauma physicians and trauma centers shall cooperate with the Commission and the Health Services Cost Review Commission by providing information required under this paragraph in a timely and complete manner.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>Except as provided in paragraph (2) of this subsection and notwithstanding any other provision of law, expenditures from the Fund for costs incurred in any fiscal year may not exceed revenues of the Fund.</text> </level> <level label="2"> <level label="i"> <text>The Commission, in consultation with the Health Services Cost Review Commission and the Maryland Institute for Emergency Medical Services Systems, shall develop a process for the award of grants to Level I, Level II, and Level III trauma centers in the delivery of trauma care.</text> </level> <level label="ii"> <level label="1"> <text>The Commission shall issue grants under this paragraph from any balance carried over to the Fund from prior fiscal years.</text> </level> <level label="2"> <text>The total amount of grants awarded under this paragraph in a fiscal year may not reduce the balance remaining in the Fund at the end of the fiscal year to less than 15% of the revenue collected in that fiscal year.</text> </level> </level> <level label="iii"> <text>The process developed by the Commission for the award of grants under this paragraph shall include:</text> <level label="1"> <text>Grant applications and review and selection criteria for the award of grants;</text> </level> <level label="2"> <text>Review by the Commission, if necessary, for any project that exceeds certificate of need thresholds; and</text> </level> <level label="3"> <text>Any other procedure determined necessary by the Commission.</text> </level> </level> <level label="iv"> <text>Before awarding grants under this subsection in a fiscal year, the Commission shall report to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with § 2–1257 of the State Government Article, on the process that the Commission has developed for awarding grants in that fiscal year.</text> </level> </level> </level> <level label="f"> <text>On or before November 1 of each year, the Commission and the Health Services Cost Review Commission shall report to the General Assembly, in accordance with § 2–1257 of the State Government Article, on:</text> <level label="1"> <text>The amount of money in the Fund on the last day of the previous fiscal year;</text> </level> <level label="2"> <text>The amount of money applied for by trauma physicians, trauma health care practitioners, and trauma centers during the previous fiscal year;</text> </level> <level label="3"> <text>The amount of money distributed in the form of trauma physician, trauma health care practitioner, and trauma center reimbursements during the previous fiscal year;</text> </level> <level label="4"> <text>Any recommendations for altering the manner in which trauma physicians, trauma health care practitioners, and trauma centers are reimbursed from the Fund;</text> </level> <level label="5"> <text>The costs incurred in administering the Fund during the previous fiscal year;</text> </level> <level label="6"> <text>The amount that each hospital that participates in the Maryland trauma system and that has a trauma center contributes toward the subsidization of trauma–related costs for its trauma center;</text> </level> <level label="7"> <text>The costs that hospitals reported to the Health Services Cost Review Commission and are accounted for in the global budgets of the hospitals for each of the following:</text> <level label="i"> <text>Trauma standby;</text> </level> <level label="ii"> <text>Allowable trauma center costs for reimbursing the trauma director and trauma staff;</text> </level> <level label="iii"> <text>Maintaining Maryland Institute for Emergency Medical Services Systems trauma protocols;</text> </level> <level label="iv"> <text>Maintaining specialized trauma staff;</text> </level> <level label="v"> <text>Procuring specialized trauma equipment; and</text> </level> <level label="vi"> <text>Providing trauma education and training; and</text> </level> </level> <level label="8"> <text>Any improvements made by trauma centers as a result of an increase in funding.</text> </level> </level> <level label="g"> <text>The Commission shall award an annual grant from the Fund in the amount up to $1,800,000 to Level I pediatric trauma centers as follows:</text> <level label="1"> <text>Up to $900,000 to Johns Hopkins Children’s Center; and</text> </level> <level label="2"> <text>Up to $900,000 to Children’s National Medical Center.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-132" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>In this Part III of this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Ambulatory surgical facility” has the meaning stated in § 19–3B–01 of this title.</text> </level> <level label="c"> <text>“Carrier” means:</text> <level label="1"> <text>An insurer or nonprofit health service plan that holds a certificate of authority and provides health insurance policies or contracts in the State in accordance with the Insurance Article; or</text> </level> <level label="2"> <text>A health maintenance organization that holds a certificate of authority in the State.</text> </level> </level> <level label="d"> <text>“Comprehensive standard health benefit plan” means the comprehensive standard health benefit plan adopted in accordance with § 15–1207 of the Insurance Article.</text> </level> <level label="e"> <level label="1"> <text>“Health benefit plan” means a hospital or medical policy, contract, or certificate issued by a carrier.</text> </level> <level label="2"> <text>“Health benefit plan” does not include:</text> <level label="i"> <text>Coverage for accident or disability income insurance;</text> </level> <level label="ii"> <text>Coverage issued as a supplement to liability insurance;</text> </level> <level label="iii"> <text>Liability insurance, including general liability insurance and automobile liability insurance;</text> </level> <level label="iv"> <text>Workers’ compensation or similar insurance;</text> </level> <level label="v"> <text>Automobile or property medical payment insurance;</text> </level> <level label="vi"> <text>Credit–only insurance;</text> </level> <level label="vii"> <text>Coverage for on–site medical clinics;</text> </level> <level label="viii"> <text>Dental or vision insurance;</text> </level> <level label="ix"> <text>Long–term care insurance or benefits for nursing home care, home health care, community–based care, or any combination of these;</text> </level> <level label="x"> <text>Coverage only for a specified disease or illness;</text> </level> <level label="xi"> <text>Hospital indemnity or other fixed indemnity insurance; or</text> </level> <level label="xii"> <text>The following benefits if offered as a separate insurance policy:</text> <level label="1"> <text>Medicare supplemental health insurance, as defined in § 1882(g)(1) of the Social Security Act;</text> </level> <level label="2"> <text>Coverage supplemental to the coverage provided under Chapter 55 of Title 10 of the United States Code; or</text> </level> <level label="3"> <text>Similar supplemental coverage provided to coverage under an employer sponsored plan.</text> </level> </level> </level> </level> <level label="f"> <text>“Health care practitioner” means any individual who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care services.</text> </level> <level label="g"> <level label="1"> <text>“Health care provider” means:</text> <level label="i"> <text>A person who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care in the ordinary course of business or practice of a profession or in an approved education or training program; or</text> </level> <level label="ii"> <text>A facility where health care is provided to patients or recipients, including:</text> <level label="1"> <text>A facility, as defined in § 10–101(g) of this article;</text> </level> <level label="2"> <text>A hospital, as defined in § 19–301 of this title;</text> </level> <level label="3"> <text>A related institution, as defined in § 19–301 of this title;</text> </level> <level label="4"> <text>A health maintenance organization, as defined in § 19–701(g) of this title;</text> </level> <level label="5"> <text>An outpatient clinic; and</text> </level> <level label="6"> <text>A medical laboratory.</text> </level> </level> </level> <level label="2"> <text>“Health care provider” includes the agents and employees of a facility who are licensed or otherwise authorized to provide health care, the officers and directors of a facility, and the agents and employees of a health care provider who are licensed or otherwise authorized to provide health care.</text> </level> </level> <level label="h"> <text>“Health care service” means any health or medical care procedure or service rendered by a health care practitioner that:</text> <level label="1"> <text>Provides testing, diagnosis, or treatment of human disease or dysfunction; or</text> </level> <level label="2"> <text>Dispenses drugs, medical devices, medical appliances, or medical goods for the treatment of human disease or dysfunction.</text> </level> </level> <level label="i"> <text>“Hospital” has the meaning stated in § 19–301 of this title.</text> </level> <level label="j"> <level label="1"> <text>“Mandated health insurance service” means a legislative proposal or statute that would require a particular health care service to be provided or offered in a health benefit plan, by a carrier or other organization authorized to provide health benefit plans in the State.</text> </level> <level label="2"> <text>“Mandated health insurance service”, as applicable to all carriers, does not include services enumerated to describe a health maintenance organization under § 19–701(g)(2) of this title.</text> </level> </level> <level label="k"> <text>“Nursing facility” has the meaning stated in § 19–1401 of this title.</text> </level> <level label="l"> <level label="1"> <text>“Office facility” means the office of one or more health care practitioners in which health care services are provided to individuals.</text> </level> <level label="2"> <text>“Office facility” includes a facility that provides:</text> <level label="i"> <text>Ambulatory surgery;</text> </level> <level label="ii"> <text>Radiological or diagnostic imagery; or</text> </level> <level label="iii"> <text>Laboratory services.</text> </level> </level> <level label="3"> <text>“Office facility” does not include any office, facility, or service operated by a hospital and regulated under Part II of this subtitle.</text> </level> </level> <level label="m"> <text>“Payor” means:</text> <level label="1"> <text>A health insurer or nonprofit health service plan that holds a certificate of authority and provides health insurance policies or contracts in the State in accordance with this article or the Insurance Article;</text> </level> <level label="2"> <text>A health maintenance organization that holds a certificate of authority in the State; or</text> </level> <level label="3"> <text>For the purposes of this Part III of this subtitle only, a person that is registered as an administrator under Title 8, Subtitle 3 of the Insurance Article.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-133" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>In this section, “code” means:</text> <level label="1"> <text>The applicable Current Procedural Terminology (CPT) code as adopted by the American Medical Association; or</text> </level> <level label="2"> <text>If a CPT code is not available, the applicable code under an appropriate uniform coding scheme approved by the Commission.</text> </level> </level> <level label="b"> <text>The Commission shall establish a Maryland medical care data base to compile statewide data on health services rendered by health care practitioners and facilities selected by the Commission.</text> </level> <level label="c"> <text>In addition to any other information the Commission may require by regulation, the medical care data base shall:</text> <level label="1"> <text>Collect for each type of patient encounter with a health care practitioner or facility designated by the Commission:</text> <level label="i"> <text>The demographic characteristics of the patient;</text> </level> <level label="ii"> <text>The principal diagnosis;</text> </level> <level label="iii"> <text>The procedure performed;</text> </level> <level label="iv"> <text>The date and location of where the procedure was performed;</text> </level> <level label="v"> <text>The charge for the procedure;</text> </level> <level label="vi"> <text>If the bill for the procedure was submitted on an assigned or nonassigned basis;</text> </level> <level label="vii"> <text>If applicable, a health care practitioner’s universal identification number; and</text> </level> <level label="viii"> <text>If the health care practitioner rendering the service is a certified registered nurse anesthetist or certified nurse midwife, identification modifiers for the certified registered nurse anesthetist or certified nurse midwife;</text> </level> </level> <level label="2"> <text>Collect appropriate information relating to prescription drugs for each type of patient encounter with a pharmacist designated by the Commission; and</text> </level> <level label="3"> <text>Collect appropriate information relating to health care costs, utilization, or resources from payors and governmental agencies.</text> </level> </level> <level label="d"> <level label="1"> <text>The Commission shall adopt regulations governing the access and retrieval of all medical claims data and other information collected and stored in the medical care data base and any claims clearinghouse licensed by the Commission and may set reasonable fees covering the costs of accessing and retrieving the stored data.</text> </level> <level label="2"> <text>These regulations shall ensure that confidential or privileged patient information is kept confidential.</text> </level> <level label="3"> <text>Records or information protected by the privilege between a health care practitioner and a patient, or otherwise required by law to be held confidential, shall be filed in a manner that does not disclose the identity of the person protected.</text> </level> </level> <level label="e"> <level label="1"> <text>To the extent practicable, when collecting the data required under subsection (c) of this section, the Commission shall utilize any standardized claim form or electronic transfer system being used by health care practitioners, facilities, and payors.</text> </level> <level label="2"> <text>The Commission shall develop appropriate methods for collecting the data required under subsection (c) of this section on subscribers or enrollees of health maintenance organizations.</text> </level> </level> <level label="f"> <text>Until the provisions of § 19–134 of this subtitle are fully implemented, where appropriate, the Commission may limit the data collection under this section.</text> </level> <level label="g"> <level label="1"> <text>By October 1, 1995 and each year thereafter, the Commission shall publish an annual report on those health care services selected by the Commission that:</text> <level label="i"> <text>Describes the variation in fees charged by health care practitioners and facilities on a statewide basis and in each health service area for those health care services; and</text> </level> <level label="ii"> <text>Describes the geographic variation in the utilization of those health care services.</text> </level> </level> <level label="2"> <level label="i"> <text>On an annual basis, the Commission shall publish:</text> <level label="1"> <text>The total reimbursement for all health care services over a 12–month period;</text> </level> <level label="2"> <text>The total reimbursement for each health care specialty over a 12–month period;</text> </level> <level label="3"> <text>The total reimbursement for each code over a 12–month period; and</text> </level> <level label="4"> <text>The annual rate of change in reimbursement for health services by health care specialties and by code.</text> </level> </level> <level label="ii"> <text>In addition to the information required under subparagraph (i) of this paragraph, the Commission may publish any other information that the Commission deems appropriate, including information on capitated health care services.</text> </level> </level> </level> <level label="h"> <text>In developing the medical care data base, the Commission shall consult with representatives of the Health Services Cost Review Commission, health care practitioners, payors, and hospitals to ensure that the medical care data base is compatible with information collected by the Health Services Cost Review Commission.</text> </level> <level label="i"> <text>The Commission, in consultation with the Insurance Commissioner, payors, health care practitioners, and hospitals, may adopt by regulation standards for the electronic submission of data and submission and transfer of the uniform claims forms established under § 15–1003 of the Insurance Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-134" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>In order to more efficiently establish a medical care data base under § 19–133 of this subtitle, the Commission shall establish standards for the operation of one or more medical care electronic claims clearinghouses in Maryland and may license those clearinghouses meeting those standards.</text> </level> <level label="2"> <text>In adopting regulations under this subsection, the Commission shall consider appropriate national standards.</text> </level> <level label="3"> <text>The Commission may limit the number of licensed claims clearinghouses to assure maximum efficiency and cost effectiveness.</text> </level> <level label="4"> <text>The Commission, by regulation, may charge a reasonable licensing fee to operate a licensed claims clearinghouse.</text> </level> <level label="5"> <text>Health care practitioners in Maryland, as designated by the Commission, shall submit, and payors of health care services in Maryland as designated by the Commission shall receive claims for payment and any other information reasonably related to the medical care data base electronically in a standard format as required by the Commission whether by means of a claims clearinghouse or other method approved by the Commission.</text> </level> <level label="6"> <text>The Commission shall establish reasonable deadlines for the phasing in of electronic transmittal of claims from those health care practitioners designated under paragraph (5) of this subsection.</text> </level> <level label="7"> <text>As designated by the Commission, payors of health care services in Maryland and Medicaid and Medicare shall transmit explanations of benefits and any other information reasonably related to the medical care data base electronically in a standard format as required by the Commission whether by means of a claims clearinghouse or other method approved by the Commission.</text> </level> </level> <level label="b"> <text>The Commission may collect the medical care claims information submitted to any licensed claims clearinghouse for use in the data base established under § 19–133 of this subtitle.</text> </level> <level label="c"> <level label="1"> <text>The Commission shall:</text> <level label="i"> <text>Establish and implement a system to comparatively evaluate the quality of care and performance of categories of health benefit plans as determined by the Commission on an objective basis; and</text> </level> <level label="ii"> <text>Annually publish the summary findings of the evaluation.</text> </level> </level> <level label="2"> <text>The purpose of the evaluation system established under this subsection is to assist carriers to improve care by establishing a common set of quality and performance measurements and disseminating the findings to carriers and other interested parties.</text> </level> <level label="3"> <text>The system, where appropriate, shall:</text> <level label="i"> <text>Solicit performance information from enrollees of health benefit plans;</text> </level> <level label="ii"> <text>Establish and incorporate a standard set of measures regarding racial and ethnic variations in quality and outcomes; and</text> </level> <level label="iii"> <text>Include information on the actions taken by carriers to track and reduce health disparities, including whether the health benefit plan provides culturally appropriate educational materials for its members.</text> </level> </level> <level label="4"> <level label="i"> <text>The Commission shall adopt regulations to establish the system of evaluation provided under this subsection.</text> </level> <level label="ii"> <text>Before adopting regulations to implement an evaluation system under this subsection, the Commission shall consider recommendations of nationally recognized organizations that are involved in quality of care and performance measurement.</text> </level> <level label="iii"> <text>In implementing paragraph (3)(ii) and (iii) of this subsection, the Commission shall consult with appropriate stakeholders, including at least one representative of a carrier that does business predominantly in the State and a carrier that does business in the State and nationally, to determine national standards for evaluating the effectiveness of carriers in addressing health disparities and to fulfill the purposes of paragraph (3)(ii) and (iii) of this subsection in a manner that can be easily replicated in other states.</text> </level> </level> <level label="5"> <text>The Commission may contract with a private, nonprofit entity to implement the system required under this subsection provided that the entity is not an insurer.</text> </level> <level label="6"> <text>The annual evaluation summary required under paragraph (1) of this subsection shall include to the extent feasible information on racial and ethnic variations.</text> </level> </level> <level label="d"> <level label="1"> <text>The Commission, in consultation with the Maryland Department of Health and the Department of Aging, shall:</text> <level label="i"> <text>On or before July 1, 2001, develop and implement a system to comparatively evaluate the quality of care and performance of nursing facilities on an objective basis; and</text> </level> <level label="ii"> <text>Annually publish the summary findings of the evaluation.</text> </level> </level> <level label="2"> <level label="i"> <text>The purpose of the comparative evaluation system established under this subsection is to improve the quality of care provided by nursing facilities by establishing a common set of performance measures and disseminating the findings of the comparative evaluation to nursing facilities, consumers, and other interested parties.</text> </level> <level label="ii"> <text>In developing the comparative evaluation system, the Commission shall consider the health status of the population served.</text> </level> </level> <level label="3"> <level label="i"> <text>The system, as appropriate, shall solicit performance information from consumers and their families.</text> </level> <level label="ii"> <text>On or before October 1, 2007, to the extent feasible, the system shall incorporate racial and ethnic variations.</text> </level> </level> <level label="4"> <text>The Commission may adopt regulations to establish the comparative evaluation system provided under this subsection.</text> </level> </level> <level label="e"> <level label="1"> <text>The Commission may:</text> <level label="i"> <text>On or before July 1, 2001, develop and implement a system to comparatively evaluate the quality of care outcomes and performance measurements of hospitals and ambulatory surgical facilities on an objective basis; and</text> </level> <level label="ii"> <text>Annually publish the summary findings of the evaluation.</text> </level> </level> <level label="2"> <level label="i"> <text>The purpose of a comparable performance measurement system established under this subsection is to improve the quality of care provided by hospitals and ambulatory surgical facilities by establishing a common set of performance measurements and disseminating the findings of the performance measurements to hospitals, ambulatory surgical facilities, consumers, and interested parties.</text> </level> <level label="ii"> <text>In developing the performance measurement system, the Commission shall consider the geographic location, urban or rural orientation, and teaching or nonteaching status of the hospital and the ambulatory surgical facilities, and the health status of the population served.</text> </level> </level> <level label="3"> <level label="i"> <text>The system, where appropriate, shall solicit performance information from consumers.</text> </level> <level label="ii"> <text>On or before October 1, 2007, to the extent feasible, the system shall incorporate racial and ethnic variations.</text> </level> </level> <level label="4"> <level label="i"> <text>The Commission may adopt regulations to establish the system of evaluation provided under this subsection.</text> </level> <level label="ii"> <text>Before adopting regulations to implement an evaluation system under this subsection, the Commission shall:</text> <level label="1"> <text>Consider the performance measurements of appropriate accreditation organizations, State licensure regulations, Medicare certification regulations, the quality indicator project of the Association of Maryland Hospitals and Health Systems, and any other relevant performance measurements; and</text> </level> <level label="2"> <text>Evaluate the desirability and feasibility of developing a consumer clearinghouse on health care information using existing available data.</text> </level> </level> </level> <level label="5"> <text>The Commission may contract with a private entity to implement the system required under this subsection provided that the entity is not a hospital or an ambulatory surgical facility.</text> </level> <level label="6"> <level label="i"> <text>The comparable evaluation system established under this subsection shall include health care–associated infection information from hospitals.</text> </level> <level label="ii"> <text>The comparable evaluation system shall adhere, to the extent possible, to the current recommendations of the federal Centers for Disease Control and Prevention (CDC) and the CDC Healthcare Infection Control Practices Advisory Committee regarding public reporting of health care–associated infections.</text> </level> </level> </level> <level label="f"> <level label="1"> <text>The Commission shall compile data on:</text> <level label="i"> <text>Racial and ethnic disparities in insurance coverage for low–income, nonelderly individuals;</text> </level> <level label="ii"> <text>The racial and ethnic composition of the physician population compared to the racial and ethnic composition of the State’s population; and</text> </level> <level label="iii"> <text>Morbidity and mortality rates based on race and ethnicity for cardiovascular disease, cancer, diabetes, HIV/AIDS, infant mortality, asthma, and other diseases the Commission identifies.</text> </level> </level> <level label="2"> <text>The Commission shall:</text> <level label="i"> <text>Provide the racial and ethnic information compiled under this subsection to the Office of Minority Health and Health Disparities; and</text> </level> <level label="ii"> <text>Analyze the information jointly with the Office of Minority Health and Health Disparities for publication in the “Health Care Disparities Policy Report Card” required under § 20–1006(b)(2) of this article.</text> </level> </level> <level label="3"> <level label="i"> <text>The Commission shall evaluate the feasibility of obtaining information from urban and rural populations in order to identify geographic disparities.</text> </level> <level label="ii"> <text>If the Commission is able to obtain the information described in subparagraph (i) of this paragraph, the Commission shall provide the information to the Office of Minority Health and Health Disparities.</text> </level> </level> </level> <level label="g"> <text>For purposes of this section, the Commission shall collect racial and ethnic information and data that is reasonably collectable from any national, State, or county source that is reasonably available.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-135" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>The Commission may implement a system to encourage health care practitioners to voluntarily control the costs of health care services.</text> </level> <level label="b"> <text>The Commission may require health care practitioners of selected health care specialties to cooperate with licensed operators of clinical resource management systems that allow health care practitioners to critically analyze their charges and utilization of services in comparison to their peers.</text> </level> <level label="c"> <text>If the Commission determines that clinical resource management systems are not available in the private sector, the Commission, in consultation with interested parties including payors, health care practitioners, and the Association of Maryland Hospitals and Health Systems, may develop a clinical resource management system.</text> </level> <level label="d"> <text>The Commission may adopt regulations to govern the licensing of clinical resource management systems to ensure the accuracy and confidentiality of information provided by the system.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-136" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <text>In any matter that relates to the utilization or cost of health care services rendered by health care practitioners or office facilities, the Commission may:</text> <level label="1"> <text>Hold a public hearing;</text> </level> <level label="2"> <text>Conduct an investigation; or</text> </level> <level label="3"> <text>Require the filing of any reasonable information.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-137" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <text>If the Commission considers a further investigation necessary or desirable to authenticate information in a report that a health care practitioner or office facility files under this subtitle, the Commission may make necessary further examination of the records or accounts of the health care practitioner or office facility, in accordance with the regulations of the Commission.</text> </section> <section article="ghg" article_name="Health - General" number="19-142" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>In this Part IV of this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Carrier” means:</text> <level label="1"> <text>An insurer;</text> </level> <level label="2"> <text>A nonprofit health service plan;</text> </level> <level label="3"> <text>A health maintenance organization; or</text> </level> <level label="4"> <text>Any other person that provides health benefit plans subject to regulation by the State.</text> </level> </level> <level label="c"> <text>“Electronic health record” means an electronic record of health–related information on an individual that:</text> <level label="1"> <text>Includes patient demographic and clinical health information; and</text> </level> <level label="2"> <text>Has the capacity to:</text> <level label="i"> <text>Provide clinical decision support;</text> </level> <level label="ii"> <text>Support physician order entry;</text> </level> <level label="iii"> <text>Capture and query information relevant to health care quality; and</text> </level> <level label="iv"> <text>Exchange electronic health information with and integrate the information from other sources.</text> </level> </level> </level> <level label="d"> <level label="1"> <text>“Health benefit plan” means a hospital or medical policy, contract, or certificate issued by a carrier.</text> </level> <level label="2"> <text>“Health benefit plan” does not include:</text> <level label="i"> <text>Coverage for accident or disability income insurance;</text> </level> <level label="ii"> <text>Coverage issued as a supplement to liability insurance;</text> </level> <level label="iii"> <text>Liability insurance, including general liability insurance and automobile liability insurance;</text> </level> <level label="iv"> <text>Workers’ compensation or similar insurance;</text> </level> <level label="v"> <text>Automobile or property medical payment insurance;</text> </level> <level label="vi"> <text>Credit–only insurance;</text> </level> <level label="vii"> <text>Coverage for on–site medical clinics;</text> </level> <level label="viii"> <text>Dental or vision insurance;</text> </level> <level label="ix"> <text>Long–term care insurance or benefits for nursing home care, home health care, community–based care, or any combination of these;</text> </level> <level label="x"> <text>Coverage only for a specified disease or illness;</text> </level> <level label="xi"> <text>Hospital indemnity or other fixed indemnity insurance; or</text> </level> <level label="xii"> <text>The following benefits if offered as a separate insurance policy:</text> <level label="1"> <text>Medicare supplemental health insurance, as defined in § 1882(g)(1) of the Social Security Act;</text> </level> <level label="2"> <text>Coverage supplemental to the coverage provided under Chapter 55 of Title 10, U.S.C.; or</text> </level> <level label="3"> <text>Similar supplemental coverage provided to coverage under an employer–sponsored plan.</text> </level> </level> </level> </level> <level label="e"> <level label="1"> <text>“Health care provider” means:</text> <level label="i"> <text>A person who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care in the ordinary course of business or practice of a profession or in an approved education or training program; or</text> </level> <level label="ii"> <text>A facility where health care is provided to patients or recipients, including:</text> <level label="1"> <text>A facility, as defined in § 10–101(g) of this article;</text> </level> <level label="2"> <text>A hospital, as defined in § 19–301 of this title;</text> </level> <level label="3"> <text>A related institution, as defined in § 19–301 of this title;</text> </level> <level label="4"> <text>An outpatient clinic;</text> </level> <level label="5"> <text>A freestanding medical facility, as defined in § 19–3A–01 of this title;</text> </level> <level label="6"> <text>An ambulatory surgical facility, as defined in § 19–3B–01 of this title; and</text> </level> <level label="7"> <text>A nursing home, as defined in § 19–1401 of this title.</text> </level> </level> </level> <level label="2"> <text>“Health care provider” does not include a health maintenance organization as defined in § 19–701 of this title.</text> </level> </level> <level label="f"> <text>“Health information exchange” has the meaning stated in § 4–301 of this article.</text> </level> <level label="g"> <text>“Management service organization” means an organization that offers one or more hosted electronic health record solutions and other management services to multiple health care providers.</text> </level> <level label="h"> <text>“State–designated health information exchange” means the health information exchange designated by the Maryland Health Care Commission and the Health Services Cost Review Commission under § 19–143 of this subtitle.</text> </level> <level label="i"> <level label="1"> <text>“State–regulated payor” means a carrier issuing or delivering health benefit plans in the State.</text> </level> <level label="2"> <text>“State–regulated payor” does not include a managed care organization as defined in Title 15, Subtitle 1 of this article.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-143" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>On or before October 1, 2009, the Commission and the Health Services Cost Review Commission shall designate a health information exchange for the State.</text> </level> <level label="2"> <text>The Secretary, to align funding opportunities with the purposes of this section and the development and effective operation of the State–designated health information exchange, may provide grants to the State–designated health information exchange.</text> </level> </level> <level label="b"> <level label="1"> <text>On or before September 1, 2011, the Commission, in consultation with the Department, payors, and health care providers, shall adopt regulations that require State–regulated payors to provide incentives to health care providers to promote the adoption and meaningful use of electronic health records.</text> </level> <level label="2"> <text>Incentives required under the regulations:</text> <level label="i"> <text>Shall have monetary value;</text> </level> <level label="ii"> <text>Shall facilitate the use of electronic health records by health care providers in the State;</text> </level> <level label="iii"> <text>To the extent feasible, shall recognize and be consistent with existing payor incentives that promote the adoption and meaningful use of electronic health records;</text> </level> <level label="iv"> <text>Shall take into account:</text> <level label="1"> <text>Incentives provided to health care providers under Medicare and Medicaid; and</text> </level> <level label="2"> <text>Any grants or loans that are available to health care providers from the federal government;</text> </level> </level> <level label="v"> <text>May include:</text> <level label="1"> <text>Increased reimbursement for specific services;</text> </level> <level label="2"> <text>Lump sum payments;</text> </level> <level label="3"> <text>Gain–sharing arrangements;</text> </level> <level label="4"> <text>Rewards for quality and efficiency;</text> </level> <level label="5"> <text>In–kind payments; and</text> </level> <level label="6"> <text>Other items or services to which a specific monetary value can be assigned; and</text> </level> </level> <level label="vi"> <text>Shall be paid in cash, unless the State–regulated payor and the health care provider agree on an incentive of equivalent value.</text> </level> </level> <level label="3"> <text>The regulations need not require incentives for the adoption and meaningful use of electronic health records for each type of health care provider listed in § 19–142(e) of this subtitle.</text> </level> <level label="4"> <text>If federal law is amended to allow the State to regulate payments made by entities that self–insure their health benefit plans, regulations adopted under this section shall apply to those entities to the same extent to which they apply to State–regulated payors.</text> </level> <level label="5"> <text>Regulations adopted under this subsection:</text> <level label="i"> <text>May not require a group model health maintenance organization, as defined in § 19–713.6 of this title, to provide an incentive to a health care provider who is employed by the multispecialty group of physicians under contract with the group model health maintenance organization; and</text> </level> <level label="ii"> <text>Shall allow a State–regulated payor to:</text> <level label="1"> <text>Request information from a health care provider to validate the health care provider’s incentive claim; and</text> </level> <level label="2"> <text>If the State–regulated payor determines that a duplicate incentive payment or an overpayment has been made, reduce the incentive amount.</text> </level> </level> </level> <level label="6"> <text>The Commission may:</text> <level label="i"> <text>Audit the State–regulated payor or the health care provider for compliance with the regulations adopted under this subsection; and</text> </level> <level label="ii"> <text>If it finds noncompliance, request corrective action.</text> </level> </level> <level label="7"> <text>It is the intent of the General Assembly that the State Employee and Retiree Health and Welfare Benefits Program support the incentives provided under this subsection through contracts between the Program and the third party administrators arranging for the delivery of health care services to members covered under the Program.</text> </level> </level> <level label="c"> <text>The Health Services Cost Review Commission, in consultation with hospitals, payors, and the federal Centers for Medicare and Medicaid Services, shall take the actions necessary to:</text> <level label="1"> <text>Assure that hospitals in the State receive the payments provided under § 4102 of the federal American Recovery and Reinvestment Act of 2009 and any subsequent federal rules and regulations; and</text> </level> <level label="2"> <text>Implement any changes in hospital rates required by the federal Centers for Medicare and Medicaid Services to ensure compliance with § 4102 of the federal American Recovery and Reinvestment Act of 2009 and any subsequent federal rules and regulations.</text> </level> </level> <level label="d"> <text>The Department, in consultation with the Commission, shall develop a mechanism to assure that health care providers that participate in the Maryland Medical Assistance Program receive the payments provided for adoption and use of electronic health records technology under § 4201 of the federal American Recovery and Reinvestment Act of 2009 and any subsequent federal rules and regulations.</text> </level> <level label="e"> <level label="1"> <text>On or before October 1, 2012, the Commission shall designate one or more management service organizations to offer services throughout the State.</text> </level> <level label="2"> <text>The Commission may use federal grants and loans to help subsidize the use of the designated management service organizations by health care providers.</text> </level> </level> <level label="f"> <text>On and after the later of January 1, 2015, or the date established for the imposition of penalties under § 4102 of the federal American Recovery and Reinvestment Act of 2009:</text> <level label="1"> <text>Each health care provider using an electronic health record that seeks payment from a State–regulated payor shall use electronic health records that are:</text> <level label="i"> <text>Certified by a national certification organization designated by the Commission; and</text> </level> <level label="ii"> <text>Capable of connecting to and exchanging data with the State–designated health information exchange; and</text> </level> </level> <level label="2"> <text>The incentives required under subsection (b) of this section may include reductions in payments to a health care provider that does not use electronic health records that meet the requirements of paragraph (1) of this subsection.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-144" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>To facilitate the use of Web–based technology for electronic advance directives, the Maryland Health Care Commission shall develop criteria for recognizing electronic advance directives services that are authorized to connect to the State–designated health information exchange.</text> </level> <level label="b"> <text>To be authorized to connect to the State–designated health information exchange, an electronic advance directives service shall:</text> <level label="1"> <text>Be recognized by the Maryland Health Care Commission;</text> </level> <level label="2"> <text>Be responsible for all costs associated with connecting to the State–designated health information exchange; and</text> </level> <level label="3"> <text>Store electronic advance directives that are received by facsimile or other electronic means.</text> </level> </level> <level label="c"> <text>The State–designated health information exchange may charge electronic advance directives services recognized by the Maryland Health Care Commission a fee for connecting to the State–designated health information exchange.</text> </level> <level label="d"> <text>The State–designated health information exchange shall ensure that electronic advance directives services do not have access to information stored on the State–designated health information exchange.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-145" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Dispenser” means a person authorized by law to dispense, as defined in § 12–101 of the Health Occupations Article, a prescription drug to a patient or the patient’s agent in the State.</text> </level> <level label="3"> <text>“Noncontrolled prescription drug” means a prescription drug, as defined in § 21–201 of this article, that is not a controlled dangerous substance designated under Title 5, Subtitle 4 of the Criminal Law Article.</text> </level> <level label="4"> <text>“State–designated health information exchange” has the meaning stated in § 4–301 of this article.</text> </level> </level> <level label="b"> <text>The State–designated health information exchange shall operate as a health data utility for the State.</text> </level> <level label="c"> <text>The purposes of the health data utility include:</text> <level label="1"> <text>The collection, aggregation, and analysis of clinical information, public health data, and health administrative and operations data to assist the Department, local health departments, the Commission, and the Health Services Cost Review Commission in the evaluation of public health interventions and health equity;</text> </level> <level label="2"> <text>The communication of data between public health officials and health care providers to advance disease control and health equity; and</text> </level> <level label="3"> <text>The enhancement and acceleration of the interoperability of health information throughout the State.</text> </level> </level> <level label="d"> <text>Dispensers shall provide data to the State–designated health information exchange.</text> </level> <level label="e"> <level label="1"> <text>The purpose of this subsection is to:</text> <level label="i"> <text>Authorize individuals and organizations involved in the treatment and care coordination of patients to access, as legally authorized, a patient’s medication history, including medications prescribed for the patient; and</text> </level> <level label="ii"> <text>Assist health care providers, care managers, the Department, and local health departments to understand and promote matters of health equity and treatment efficacy.</text> </level> </level> <level label="2"> <text>After dispensing a noncontrolled prescription drug, a dispenser shall submit prescription information to the State–designated health information exchange.</text> </level> <level label="3"> <text>The prescription information shall be submitted:</text> <level label="i"> <text>By electronic means;</text> </level> <level label="ii"> <text>Without unduly increasing the workload and expense on a dispenser;</text> </level> <level label="iii"> <text>In a manner that minimizes burden and duplication by being as compatible as possible with existing federal standards for data submission practices, including technology software of dispensers; and</text> </level> <level label="iv"> <text>As otherwise required by regulations adopted by the Commission.</text> </level> </level> <level label="4"> <text>The State–designated health information exchange may not impose any fees or other assessments on dispensers to support the operation of the exchange.</text> </level> <level label="5"> <text>The State–designated health information exchange shall make prescription information submitted under this subsection available for purposes of treatment and care coordination of a patient.</text> </level> </level> <level label="f"> <text>The State–designated health information exchange may provide data, as allowed by law, for public health purposes that may include:</text> <level label="1"> <text>Improving health equity through access to prescription medications, including for the treatment of infectious disease;</text> </level> <level label="2"> <text>Assisting programs led by health care providers and the Department, local health departments, the Commission, and the Health Services Cost Review Commission to identify opportunities for quality improvement, including for stewardship of antibiotic medications; and</text> </level> <level label="3"> <text>Conducting case investigations and related activities.</text> </level> </level> <level label="g"> <text>Information submitted to the State–designated health information exchange or provided by the State–designated health information exchange under this section shall be submitted or provided, to the extent practicable, in as near to real time as possible.</text> </level> <level label="h"> <level label="1"> <text>The Commission, in consultation with appropriate stakeholders, shall adopt regulations to carry out this section.</text> </level> <level label="2"> <text>The regulations shall take into account consumer perspective and include:</text> <level label="i"> <text>The specific data required to be provided under subsection (d) of this section;</text> </level> <level label="ii"> <text>The specific prescription information required to be submitted under subsection (e) of this section;</text> </level> <level label="iii"> <text>The time frame for submitting prescription information under subsection (e) of this section;</text> </level> <level label="iv"> <text>The electronic means and manner by which prescription information is to be submitted under subsection (e) of this section;</text> </level> <level label="v"> <text>Prescription information submission requirements that align with the data submission requirements on dispensers of monitored prescription drugs under Title 21, Subtitle 2A of this article; and</text> </level> <level label="vi"> <text>Identification and necessary suppression of information related to providers or medications that are determined to have significant potential to cause harm.</text> </level> </level> </level> <level label="i"> <level label="1"> <text>The State–designated health information exchange shall establish a consumer advisory council to bring the perspectives of individuals and organizations with an interest in protecting consumers into the delivery of services provided by the State–designated health information exchange.</text> </level> <level label="2"> <text>In selecting members, the State–designated health information exchange shall consider diversity of experience.</text> </level> <level label="3"> <text>The consumer advisory council established under paragraph (1) of this subsection shall:</text> <level label="i"> <text>Consist of a minimum of six members, including at least four consumer representatives and two staff representatives, and maintain a ratio of consumer representatives to nonconsumer representatives of at least two to one;</text> </level> <level label="ii"> <text>Identify and report consumer privacy concerns to senior leadership of the State–designated health information exchange;</text> </level> <level label="iii"> <text>Advise on efforts to educate consumers on data exchange policies, including options for consumers to opt out of disclosure of protected health information;</text> </level> <level label="iv"> <text>Meet at least 3 times each year; and</text> </level> <level label="v"> <text>Adopt and maintain a charter to be posted online that includes the purpose, members, and meeting schedule of the consumer advisory council.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-145.1" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <level label="i"> <text>“Advance care planning document” means a document that indicates an individual’s preferences for the receipt of health care.</text> </level> <level label="ii"> <text>“Advance care planning document” includes:</text> <level label="1"> <text>An advance directive; and</text> </level> <level label="2"> <text>A Medical Orders for Life–Sustaining Treatment form.</text> </level> </level> </level> <level label="3"> <text>“Carrier” means:</text> <level label="i"> <text>An insurer;</text> </level> <level label="ii"> <text>A nonprofit health service plan; and</text> </level> <level label="iii"> <text>A health maintenance organization.</text> </level> </level> <level label="4"> <text>“Electronic advance care planning document” means an electronic version of an advance care planning document that is able to be uploaded or saved to the electronic platform developed under subsection (b)(2)(i) of this section.</text> </level> <level label="5"> <text>“Health care provider” means:</text> <level label="i"> <text>A health care practitioner who is licensed or certified under the Health Occupations Article to provide health care in the ordinary course of business;</text> </level> <level label="ii"> <text>A set of health care practitioners, as defined in § 15–113 of this article;</text> </level> <level label="iii"> <text>A health care facility as defined in § 19–114 of this subtitle;</text> </level> <level label="iv"> <text>A nursing facility, as defined in § 19–301 of this title; or</text> </level> <level label="v"> <text>An assisted living program, as defined in § 19–1801 of this title.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>The Commission shall coordinate the accessibility of electronic advance care planning documents in the State.</text> </level> <level label="2"> <text>The coordination provided by the Commission under this subsection shall include:</text> <level label="i"> <text>Collaboration with the State–designated health information exchange to develop an electronic platform through which:</text> <level label="1"> <text>Individuals can upload or save advance care planning documents;</text> </level> <level label="2"> <text>Individuals can update electronic advance care planning documents; and</text> </level> <level label="3"> <text>Health care providers can access electronic advance care planning documents as appropriate;</text> </level> </level> <level label="ii"> <text>Identification of options meeting federal, State, and industry cybersecurity standards that may be taken by carriers, managed care organizations, and health care providers to:</text> <level label="1"> <text>Encourage members, enrollees, and patients to create, upload or save, and update advance care planning documents; and</text> </level> <level label="2"> <text>Make tools, which may include electronic advance directives services recognized by the Commission under § 19–144 of this subtitle, accessible to members, enrollees, and patients that allow them to create, upload or save, and update electronic advance care planning documents;</text> </level> </level> <level label="iii"> <text>Development and implementation of quality measures endorsed or designated for testing by a national quality measurement organization to measure the effectiveness of the options identified under item (ii) of this paragraph; and</text> </level> <level label="iv"> <text>Inclusion of a distinct tab on the State–designated health information exchange website that provides:</text> <level label="1"> <text>Access to the advance directive information sheet developed under § 5–615 of this article;</text> </level> <level label="2"> <text>The electronic means to create, execute, and store an advance directive or health care designation; and</text> </level> <level label="3"> <text>The capability to upload or save an advance care planning document to the electronic platform developed in accordance with item (i) of this paragraph and update existing electronic advance care planning documents.</text> </level> </level> </level> <level label="3"> <text>As the Commission identifies options under paragraph (2)(ii) of this subsection, the Commission may explore whether carriers, managed care organizations, and health care providers with secure member authentication websites can link between the website of the carrier, managed care organization, or health care provider and the State–designated health information exchange website.</text> </level> <level label="4"> <text>In developing the electronic platform in accordance with paragraph (2)(i) of this subsection, the Commission and the State–designated health information exchange:</text> <level label="i"> <text>Shall consult with other State agencies and stakeholders, as appropriate; and</text> </level> <level label="ii"> <text>Subject to available funds, may contract with a third–party vendor, as appropriate.</text> </level> </level> <level label="5"> <text>The electronic platform developed in accordance with paragraph (2)(i) of this subsection shall:</text> <level label="i"> <text>Provide an individual with disabilities with nonvisual access in a way that is fully and equally accessible to and independently usable by the individual with disabilities so that the individual is able to acquire the same information, engage in the same interactions, and enjoy the same services as users without disabilities, with substantially equivalent ease of use; and</text> </level> <level label="ii"> <text>Be consistent with the standards of § 508 of the federal Rehabilitation Act of 1973.</text> </level> </level> </level> <level label="c"> <text>As an option under subsection (b)(2)(ii) of this section, a carrier, managed care organization, or health care provider may contract with an electronic advance directives service if the service:</text> <level label="1"> <text>Is approved by the Maryland Health Care Commission under § 19–144 of this subtitle; and</text> </level> <level label="2"> <text>Meets the technology, security, and privacy standards set by the Commission.</text> </level> </level> <level label="d"> <text>The Commission may adopt regulations to carry out this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-146" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>In this Part V of this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Carrier” has the meaning stated in § 15–1301 of the Insurance Article.</text> </level> <level label="c"> <text>“Enrollee” means an individual entitled to health benefits from a carrier.</text> </level> <level label="d"> <text>“Physician rating system” has the meaning stated in § 15–1701 of the Insurance Article.</text> </level> <level label="e"> <text>“Ratings examiner” means an independent entity that is approved by the Commission to review physician rating systems.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-147" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation"> <level label="a"> <text>The Commission shall approve an entity that meets the requirements of this section to be a ratings examiner.</text> </level> <level label="b"> <text>To be approved by the Commission as a ratings examiner, an entity examining a physician rating system shall require a physician rating system to:</text> <level label="1"> <text>Use only quality of performance and cost efficiency as measurement categories;</text> </level> <level label="2"> <text>Calculate and disclose separately measures of cost efficiency and quality of performance;</text> </level> <level label="3"> <text>Disclose clearly to physicians and enrollees the proportion of the component score for cost efficiency and quality of performance in each combined score;</text> </level> <level label="4"> <text>In determining quality of performance, use measures:</text> <level label="i"> <text>That are based on nationally recognized, evidence–based or consensus–based clinical recommendations or guidelines; or</text> </level> <level label="ii"> <text>When available, that are endorsed by entities whose work in physician quality of performance is generally accepted in the health care system;</text> </level> </level> <level label="5"> <text>Disclose to physicians who are subject to the physician rating system:</text> <level label="i"> <text>The measurements for each criterion and the relative weight of each criterion and measurement in the overall rating of the physician;</text> </level> <level label="ii"> <level label="1"> <text>The basis for the carrier’s quality of performance ratings;</text> </level> <level label="2"> <text>The data used to determine the quality of performance ratings; and</text> </level> <level label="3"> <text>The relative weight or relevance of quality of performance to the overall rating of a physician in the physician rating system;</text> </level> </level> <level label="iii"> <text>The basis for determining whether there is a sufficient number of patients and episodes of care for a given disease state and specialty to generate reliable ratings for a physician; and</text> </level> <level label="iv"> <text>The methodology used to determine how data is attributed to a physician;</text> </level> </level> <level label="6"> <text>Use appropriate risk adjustments to account for the characteristics of the patient population seen by a physician in determining the quality of performance and cost efficiency of the physician;</text> </level> <level label="7"> <text>In measuring the cost efficiency of the performance of a physician:</text> <level label="i"> <text>Compare physicians within the same specialty within the appropriate geographical market; and</text> </level> <level label="ii"> <text>Use appropriate and comprehensive episode of care computer software to evaluate the cost efficiency of the performance of a physician;</text> </level> </level> <level label="8"> <level label="i"> <text>Include an appeals process that a physician subject to the physician rating system may use to appeal the rating received under the physician rating system; and</text> </level> <level label="ii"> <text>Based on the outcome of an appeal, make any necessary corrections to the data used to rate the physician in the physician rating system; and</text> </level> </level> <level label="9"> <text>Disclose to physicians and enrollees how the perspectives of enrollees, consumer advocates, employers, labor unions, and physicians were incorporated into the development of the physician rating system.</text> </level> </level> <level label="c"> <text>Notwithstanding subsection (b) of this section, an entity that has a physician performance rating certification program approved after August 1, 2008, by a national consortium of employer, consumer, and labor organizations working toward a common goal to ensure that all Americans have access to publicly reported health care performance information:</text> <level label="1"> <text>Is deemed to be a ratings examiner under this part; and</text> </level> <level label="2"> <text>Is deemed to meet the requirements of subsection (b) of this section.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1B-01" title_number="19" title_name="Health Care Facilities" subtitle_number="1B" subtitle_name="Community Integrated Medical Home Program"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Advisory body” means the Community Integrated Medical Home Program advisory body.</text> </level> <level label="c"> <text>“Carrier” has the meaning stated in § 15–1801 of the Insurance Article.</text> </level> <level label="d"> <text>“Commission” means the Maryland Health Care Commission.</text> </level> <level label="e"> <text>“Community integrated medical home” means a certified participating patient centered medical home integrated with community–based services and supports provided by certified entities to address social as well as medical determinants of health.</text> </level> <level label="f"> <text>“Managed care organization” has the meaning stated in § 15–101 of this article.</text> </level> <level label="g"> <text>“Patient centered medical home” means a primary care practice organized to provide a first, coordinated, ongoing, and comprehensive source of care to patients to:</text> <level label="1"> <text>Foster a partnership with a qualifying individual;</text> </level> <level label="2"> <text>Coordinate health care services for a qualifying individual; and</text> </level> <level label="3"> <text>Exchange medical information with carriers, other providers, and qualifying individuals.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1B-02" title_number="19" title_name="Health Care Facilities" subtitle_number="1B" subtitle_name="Community Integrated Medical Home Program"> <level label="a"> <text>There is a Community Integrated Medical Home Program.</text> </level> <level label="b"> <text>The mission of the Community Integrated Medical Home Program is to:</text> <level label="1"> <text>Keep Maryland families healthy through the use of innovative mapping tools that allow better targeting of resources to those in need;</text> </level> <level label="2"> <text>Coordinate comprehensive services provided by a participating patient centered medical home with public health resources in local communities across the State; and</text> </level> <level label="3"> <text>Provide complementary support for qualified individuals between office visits.</text> </level> </level> <level label="c"> <text>The Community Integrated Medical Home Program shall be administered jointly by the Commission and the Department.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1B-03" title_number="19" title_name="Health Care Facilities" subtitle_number="1B" subtitle_name="Community Integrated Medical Home Program"> <level label="a"> <text>There is a Community Integrated Medical Home Program advisory body.</text> </level> <level label="b"> <text>The advisory body shall make recommendations concerning:</text> <level label="1"> <text>The model, standards, and scope of services for the Community Integrated Medical Home Program;</text> </level> <level label="2"> <text>The essential elements for implementing the Community Integrated Medical Home Program, including those necessary to attract patient centered medical homes, carriers, managed care organizations, and other payors to participate in the Program;</text> </level> <level label="3"> <text>The extent and nature of the relationship between the Community Integrated Medical Home Program and patient centered medical homes, carriers, managed care organizations, and other payors; and</text> </level> <level label="4"> <text>How the Community Integrated Medical Home Program can be financially self–sustaining.</text> </level> </level> <level label="c"> <text>The advisory body shall include interested stakeholders representing health care provider organizations, consumer advocacy organizations, health professional associations, health occupations boards, carriers, and managed care organizations.</text> </level> <level label="d"> <text>The Commission and the Secretary, in consultation, shall:</text> <level label="1"> <text>Appoint the members of the advisory body; and</text> </level> <level label="2"> <text>Determine the frequency and location of meetings of the advisory body.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1C-01" title_number="19" title_name="Health Care Facilities" subtitle_number="1C" subtitle_name="Safety and Community Relations Plans"> <level label="a"> <text>Before the Department approves the operation of a facility under this title, including by granting a license to the facility, the Department shall require the facility to establish and implement:</text> <level label="1"> <text>A safety plan for the safety of the individuals served by the facility; and</text> </level> <level label="2"> <text>A community relations plan, if the facility is:</text> <level label="i"> <text>Accredited by an accreditation organization, as defined in § 19–2301 of this title; and</text> </level> <level label="ii"> <text>Required by the accreditation organization to establish and implement a community relations plan.</text> </level> </level> </level> <level label="b"> <text>The Department may authorize a facility to satisfy the requirement under:</text> <level label="1"> <text>Subsection (a)(1) of this section by implementing a safety plan established for the facility for another purpose, including an emergency plan; and</text> </level> <level label="2"> <text>Subsection (a)(2) of this section by implementing the community relations plan required by the accreditation organization.</text> </level> </level> <level label="c"> <text>A facility in operation on or before September 30, 2021, shall submit a safety plan on or before October 1, 2023, in accordance with this section.</text> </level> <level label="d"> <text>Each facility shall revise its safety plan not less than every 5 years.</text> </level> <level label="e"> <text>A facility may satisfy the requirement under subsection (c) of this section by implementing a safety or emergency plan established for the facility for another purpose.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-201" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“All–payer model contract” means the payment model demonstration agreement authorized under § 1115A of the Social Security Act, including any amendments to the agreement, between the State and the federal Center for Medicare and Medicaid Innovation.</text> </level> <level label="c"> <text>“Commission” means the State Health Services Cost Review Commission.</text> </level> <level label="d"> <text>“Facility” means, whether operated for a profit or not:</text> <level label="1"> <text>Any hospital; or</text> </level> <level label="2"> <text>Any related institution.</text> </level> </level> <level label="e"> <level label="1"> <text>“Hospital services” means:</text> <level label="i"> <text>Inpatient hospital services as enumerated in Medicare Regulation 42 C.F.R. § 409.10, as amended;</text> </level> <level label="ii"> <text>Emergency services, including services provided at a freestanding medical facility licensed under Subtitle 3A of this title;</text> </level> <level label="iii"> <text>Outpatient services provided at a hospital;</text> </level> <level label="iv"> <text>Outpatient services, as specified by the Commission in regulation, provided at a freestanding medical facility licensed under Subtitle 3A of this title that has received:</text> <level label="1"> <text>A certificate of need under § 19–120(o)(1) of this title; or</text> </level> <level label="2"> <text>An exemption from obtaining a certificate of need under § 19–120(o)(3) of this title; and</text> </level> </level> <level label="v"> <text>Identified physician services for which a facility has Commission–approved rates on June 30, 1985.</text> </level> </level> <level label="2"> <text>“Hospital services” includes a hospital outpatient service:</text> <level label="i"> <text>Of a hospital that, on or before June 1, 2015, is under a merged asset hospital system;</text> </level> <level label="ii"> <text>That is designated as a part of another hospital under the same merged asset hospital system to make it possible for the hospital outpatient service to participate in the 340B Program under the federal Public Health Service Act; and</text> </level> <level label="iii"> <text>That complies with all federal requirements for the 340B Program and applicable provisions of 42 C.F.R. § 413.65.</text> </level> </level> <level label="3"> <text>“Hospital services” does not include:</text> <level label="i"> <text>Outpatient renal dialysis services; or</text> </level> <level label="ii"> <text>Outpatient services provided at a limited service hospital as defined in § 19–301 of this title, except for emergency services.</text> </level> </level> </level> <level label="f"> <level label="1"> <text>“Related institution” means an institution that is licensed by the Department as:</text> <level label="i"> <text>A comprehensive care facility that is currently regulated by the Commission; or</text> </level> <level label="ii"> <text>An intermediate care facility–intellectual disability.</text> </level> </level> <level label="2"> <text>“Related institution” includes any institution in paragraph (1) of this subsection, as reclassified from time to time by law.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-202" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <text>There is a State Health Services Cost Review Commission. The Commission is an independent commission that functions in the Department.</text> </section> <section article="ghg" article_name="Health - General" number="19-203" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <level label="1"> <text>The Commission consists of 7 members appointed by the Governor with the advice and consent of the Senate.</text> </level> <level label="2"> <text>Of the 7 members, 4 shall be individuals who do not have any connection with the management or policy of any facility.</text> </level> </level> <level label="b"> <text>Each member shall be interested in problems of health care.</text> </level> <level label="c"> <level label="1"> <text>The term of a member is 4 years.</text> </level> <level label="2"> <text>The terms of members are staggered as required by the terms provided for members of the Commission on July 1, 1982. The terms of those members end as follows:</text> <level label="i"> <text>2 in 1983;</text> </level> <level label="ii"> <text>1 in 1984;</text> </level> <level label="iii"> <text>2 in 1985; and</text> </level> <level label="iv"> <text>2 in 1986.</text> </level> </level> <level label="3"> <text>At the end of a term, a member continues to serve until a successor is appointed and qualifies.</text> </level> <level label="4"> <text>A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies.</text> </level> <level label="5"> <text>A member who serves 2 consecutive full 4-year terms may not be reappointed for 4 years after completion of those terms.</text> </level> <level label="6"> <text>When appointing a member to fill a vacancy due to the expiration of a member’s term, the Governor shall give consideration to, and make appointments when appropriate, that would promote the racial, gender, and geographic diversity of the Commission.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-204" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <text>Annually, from among the members of the Commission:</text> <level label="1"> <text>The Governor shall appoint a chairman; and</text> </level> <level label="2"> <text>The chairman shall appoint a vice chairman.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-205" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>With the approval of the Governor, the Commission shall appoint an Executive Director, who is the chief administrative officer of the Commission.</text> </level> <level label="b"> <text>The Executive Director serves at the pleasure of the Commission.</text> </level> <level label="c"> <text>Under the direction of the Commission, the Executive Director shall perform any duty or function that the Commission requires.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-206" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>A majority of the full authorized membership of the Commission is a quorum. However, the Commission may not act on any matter unless at least 4 members in attendance concur.</text> </level> <level label="b"> <text>The Commission shall meet at least 6 times a year, at the times and places that it determines.</text> </level> <level label="c"> <text>Each member of the Commission is entitled to:</text> <level label="1"> <text>Compensation in accordance with the State budget; and</text> </level> <level label="2"> <text>Reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget.</text> </level> </level> <level label="d"> <level label="1"> <text>The Commission may employ a staff in accordance with the State budget.</text> </level> <level label="2"> <text>The Commission, in consultation with the Secretary, may set the compensation of a Commission employee in a position that:</text> <level label="i"> <text>Is unique to the Commission;</text> </level> <level label="ii"> <text>Requires specific skills or experience to perform the duties of the position; and</text> </level> <level label="iii"> <text>Does not require the employee to perform functions that are comparable to functions performed in other units of the Executive Branch of State government.</text> </level> </level> <level label="3"> <text>The Secretary of Budget and Management, in consultation with the Commission, shall determine the positions for which the Commission may set compensation under paragraph (2) of this subsection.</text> </level> <level label="4"> <text>The Deputy Director and each principal section chief of the Commission serve at the pleasure of the Commission.</text> </level> <level label="5"> <text>The Commission, in consultation with the Secretary, may determine the appropriate job classifications for the Executive Director, Deputy Director, and each principal section chief of the Commission.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-207" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>In addition to the powers set forth elsewhere in this subtitle, the Commission may:</text> <level label="1"> <text>Adopt rules and regulations to carry out the provisions of this subtitle;</text> </level> <level label="2"> <text>Create committees from among its members;</text> </level> <level label="3"> <text>Appoint advisory committees, which may include individuals and representatives of interested public or private organizations;</text> </level> <level label="4"> <text>Apply for and accept any funds, property, or services from any person or government agency;</text> </level> <level label="5"> <text>Make agreements with a grantor or payor of funds, property, or services, including an agreement to make any study, plan, demonstration, or project;</text> </level> <level label="6"> <text>Publish and give out any information that relates to the financial aspects of health care and is considered desirable in the public interest; and</text> </level> <level label="7"> <text>Subject to the limitations of this subtitle, exercise any other power that is reasonably necessary to carry out the purposes of this subtitle.</text> </level> </level> <level label="b"> <text>In addition to the duties set forth elsewhere in this subtitle, the Commission shall:</text> <level label="1"> <text>Adopt rules and regulations that relate to its meetings, minutes, and transactions;</text> </level> <level label="2"> <text>Keep minutes of each meeting;</text> </level> <level label="3"> <text>Prepare annually a budget proposal that includes the estimated income of the Commission and proposed expenses for its administration and operation;</text> </level> <level label="4"> <text>Within a reasonable time after the end of each facility’s fiscal year or more often as the Commission determines, prepare from the information filed with the Commission any summary, compilation, or other supplementary report that will advance the purposes of this subtitle;</text> </level> <level label="5"> <text>Periodically participate in or do analyses and studies that relate to:</text> <level label="i"> <text>Health care costs;</text> </level> <level label="ii"> <text>The financial status of any facility; or</text> </level> <level label="iii"> <text>Any other appropriate matter;</text> </level> </level> <level label="6"> <text>On or before May 1 of each year, submit to the Governor, to the Secretary, and, subject to § 2–1257 of the State Government Article, to the General Assembly an annual report on the operations and activities of the Commission during the preceding fiscal year, including:</text> <level label="i"> <text>A copy of each summary, compilation, and supplementary report required by this subtitle;</text> </level> <level label="ii"> <text>Budget information regarding the Health Services Cost Review Commission Fund, including:</text> <level label="1"> <text>Any balance remaining in the Fund at the end of the previous fiscal year; and</text> </level> <level label="2"> <text>The percentage of the total annual costs of the Commission that is represented by the balance remaining in the Fund at the end of the previous fiscal year;</text> </level> </level> <level label="iii"> <text>A summary of the Commission’s role in hospital quality of care activities, including information about the status of any pay for performance initiatives;</text> </level> <level label="iv"> <text>An update on the status of the State’s compliance with the provisions of the all–payer model contract that includes:</text> <level label="1"> <text>Performance in limiting inpatient and outpatient hospital per capita cost growth for all payers;</text> </level> <level label="2"> <text>Annual progress toward achieving the State’s financial targets established by the all–payer model contract;</text> </level> <level label="3"> <text>A summary of the work conducted, recommendations made, including recommendations made by workgroups created to provide technical input and advice, and Commission action on activities related to the all–payer model contract;</text> </level> <level label="4"> <text>Actions approved by the Commission to promote alternative methods of rate determination and payment of an experimental nature, as authorized under § 19–219(c)(2) of this subtitle;</text> </level> <level label="5"> <text>Reports submitted to the federal Center for Medicare and Medicaid Innovation relating to the all–payer model contract;</text> </level> <level label="6"> <text>Any known adverse consequences in implementing the all–payer model contract, as reported to the federal Center for Medicare and Medicaid Innovation, that may negatively impact quality of or access to care, and the actions taken by the Commission to mitigate the consequences; and</text> </level> <level label="7"> <text>Annual progress made in the development of public and private partnerships between hospitals and other entities, including community–based physicians, community–based organizations, and other post–acute care providers, to achieve the population health goals established with the federal Center for Medicare and Medicaid Innovation; and</text> </level> </level> <level label="v"> <text>Any other fact, suggestion, or policy recommendation that the Commission considers necessary;</text> </level> </level> <level label="7"> <text>Oversee and administer the Maryland Trauma Physician Services Fund in conjunction with the Maryland Health Care Commission; and</text> </level> <level label="8"> <text>If the Centers for Medicare and Medicaid Services issues a warning notice related to a “triggering event” as described in the all–payer model contract, provide written notification to the Governor, the Secretary, and, subject to § 2–1257 of the State Government Article, the General Assembly within 15 days after the issuance of the notice.</text> </level> </level> <level label="c"> <level label="1"> <text>The Commission shall set deadlines for the filing of reports required under this subtitle.</text> </level> <level label="2"> <text>The Commission may adopt rules or regulations that impose penalties for failure to file a report as required.</text> </level> <level label="3"> <text>The amount of any penalty under paragraph (2) of this subsection may not be included in the costs of a facility in regulating its rates.</text> </level> </level> <level label="d"> <text>Except for privileged medical information, the Commission shall make:</text> <level label="1"> <text>Each report filed and each summary, compilation, and report required under this subtitle available for public inspection at the office of the Commission during regular business hours; and</text> </level> <level label="2"> <text>Each summary, compilation, and report available to any agency on request.</text> </level> </level> <level label="e"> <level label="1"> <text>The Commission may contract with a qualified, independent third party for any service necessary to carry out the powers and duties of the Commission.</text> </level> <level label="2"> <text>Unless permission is granted specifically by the Commission, a third party hired by the Commission may not release, publish, or otherwise use any information to which the third party has access under its contract.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-208" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>The power of the Secretary over plans, proposals, and projects of units in the Department does not include the power to disapprove or modify any decision or determination that the Commission makes under authority specifically delegated by law to the Commission.</text> </level> <level label="b"> <level label="1"> <text>The power of the Secretary to transfer by rule, regulation, or written directive, any staff, functions, or funds of units in the Department does not apply to any staff, function, or funds of the Commission.</text> </level> <level label="2"> <text>The Secretary may assess an administrative charge on the Commission to fund services provided to the Commission by the Department.</text> </level> <level label="3"> <text>The amount to be paid by the Commission to the Department for administrative costs, not to exceed 30.5% of the salaries of the Commission, shall be based on indirect costs or services benefiting the Commission, less overhead costs paid directly by the Commission.</text> </level> </level> <level label="c"> <level label="1"> <text>The power of the Secretary over the procurement procedure for units in the Department does not apply to the procurement procedure for the Commission.</text> </level> <level label="2"> <text>Subject to the provisions of paragraph (1) of this subsection, any procurement for services to be performed or for supplies to be delivered to the Commission is subject to the purposes and requirements of the State Finance and Procurement Article.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-210" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>In this section, “Fund” means the Maternal and Child Health Population Health Improvement Fund.</text> </level> <level label="b"> <text>There is a Maternal and Child Health Population Health Improvement Fund.</text> </level> <level label="c"> <text>The purpose of the Fund is to invest in maternal and child population health improvements through the Medical Care Programs Administration and the Prevention and Health Promotion Administration.</text> </level> <level label="d"> <text>The Department and the Commission shall administer the Fund.</text> </level> <level label="e"> <level label="1"> <text>The Fund is a special, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.</text> </level> <level label="2"> <text>The State Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund.</text> </level> </level> <level label="f"> <text>The Fund consists of:</text> <level label="1"> <text>A uniform, broad–based assessment of a reasonable amount in hospital rates in order to invest in maternal and child population health improvements under § 19–207 of this subtitle;</text> </level> <level label="2"> <text>Interest earnings; and</text> </level> <level label="3"> <text>Any other money from any other source accepted for the benefit of the Fund.</text> </level> </level> <level label="g"> <text>The Fund may be used only for expenses associated with maternal and child health population health improvements through December 31, 2027.</text> </level> <level label="h"> <level label="1"> <text>The State Treasurer shall invest the money of the Fund in the same manner as other State money may be invested.</text> </level> <level label="2"> <text>Any interest earnings of the Fund shall be credited to the Fund.</text> </level> </level> <level label="i"> <text>Expenditures from the Fund may be made only:</text> <level label="1"> <text>In accordance with the State budget; and</text> </level> <level label="2"> <text>After the approval of a majority of the members of the Commission.</text> </level> </level> <level label="j"> <text>Money expended from the Fund is supplemental to and is not intended to take the place of funding that would otherwise be appropriated for the Maryland Medical Assistance Program.</text> </level> <level label="k"> <text>The Fund is subject to audit by the Office of Legislative Audits as provided in § 2–1220 of the State Government Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-211" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <level label="1"> <text>Except for a facility that is operated or is listed and certified by the First Church of Christ Scientist, Boston, Massachusetts, the Commission has jurisdiction over hospital services offered by or through all facilities.</text> </level> <level label="2"> <text>The jurisdiction of the Commission over any identified physician service shall terminate for a facility on the request of the facility.</text> </level> <level label="3"> <text>The rate approved for an identified physician service may not exceed the rate on June 30, 1985, adjusted by an appropriate index of inflation.</text> </level> </level> <level label="b"> <text>The Commission may not set rates for related institutions until:</text> <level label="1"> <text>State law authorizes the State Medical Assistance Program to reimburse related institutions at Commission rates; and</text> </level> <level label="2"> <text>The United States Department of Health and Human Services agrees to accept Commission rates as a method of providing federal financial participation in the State Medical Assistance Program.</text> </level> </level> <level label="c"> <text>The Commission shall set rates for hospital services provided at:</text> <level label="1"> <text>A freestanding medical facility pilot project authorized under Subtitle 3A of this title prior to January 1, 2008; and</text> </level> <level label="2"> <text>A freestanding medical facility licensed under Subtitle 3A of this title.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-212" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <text>The Commission shall:</text> <level label="1"> <text>Require each facility to disclose publicly:</text> <level label="i"> <text>Its financial position; and</text> </level> <level label="ii"> <text>As computed by methods that the Commission determines, the verified total costs incurred and revenue generated by the facility in providing health services;</text> </level> </level> <level label="2"> <text>Review for reasonableness and certify the rates and revenue of each facility;</text> </level> <level label="3"> <text>Keep informed as to whether a facility has enough resources to meet its financial requirements;</text> </level> <level label="4"> <text>Concern itself with solutions if a facility does not have enough resources;</text> </level> <level label="5"> <text>Assure each purchaser of health care facility services that:</text> <level label="i"> <text>The total costs of all hospital services offered by or through a facility are reasonable;</text> </level> <level label="ii"> <text>The aggregate rates of the facility are related reasonably to the aggregate costs of the facility; and</text> </level> <level label="iii"> <text>Rates are set equitably among all purchasers of services without undue discrimination;</text> </level> </level> <level label="6"> <text>Develop guidelines for the establishment of global budgets for each facility under Maryland’s all–payer model contract, including guidelines to prevent facilities from taking actions to meet a budget that the Commission determines would have adverse consequences for recipients or purchasers of services;</text> </level> <level label="7"> <text>Receive confirmation from Commission staff that facility global budget agreements, as they are developed, are consistent with the guidelines; and</text> </level> <level label="8"> <text>After review by the Commission for compliance with the guidelines, post each executed global budget agreement on the Commission’s website.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-213" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>In this section, “facilities” means hospitals and related institutions whose rates have been approved by the Commission.</text> </level> <level label="b"> <text>The Commission shall assess and collect user fees on facilities as defined in this section.</text> </level> <level label="c"> <level label="1"> <text>The total fees assessed by the Commission may not exceed the greater of:</text> <level label="i"> <level label="0"> <text>1% of the immediately preceding fiscal year’s budgeted, regulated, gross hospital revenue; or</text> </level> </level> <level label="ii"> <text>The largest amount determined under this paragraph for a fiscal year during the immediately preceding 5 fiscal years.</text> </level> </level> <level label="2"> <text>The total user fees assessed by the Commission may not exceed the Special Fund appropriation for the Commission by more than 20%.</text> </level> <level label="3"> <text>The user fees assessed by the Commission shall be used exclusively to cover the actual documented direct costs of fulfilling the statutory and regulatory duties of the Commission in accordance with the provisions of this subtitle and any administrative costs for services to the Commission provided by the Department.</text> </level> <level label="4"> <text>The Commission shall pay all funds collected from fees assessed in accordance with this section into the Health Services Cost Review Commission Fund.</text> </level> <level label="5"> <text>The user fees assessed by the Commission may be expended only for purposes authorized by the provisions of this subtitle.</text> </level> <level label="6"> <text>The amount specified in paragraph (1) of this subsection limits only the total user fees the Commission may assess in a fiscal year.</text> </level> </level> <level label="d"> <level label="1"> <text>There is a Health Services Cost Review Commission Fund.</text> </level> <level label="2"> <text>The Fund is a special continuing, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.</text> </level> <level label="3"> <text>The Treasurer shall separately hold, and the Comptroller shall account for, the Fund.</text> </level> <level label="4"> <text>The Fund shall be invested and reinvested in the same manner as other State funds.</text> </level> <level label="5"> <text>Any investment earnings shall be retained to the credit of the Fund.</text> </level> <level label="6"> <text>The Fund shall be subject to an audit by the Office of Legislative Audits as provided for in § 2–1220 of the State Government Article.</text> </level> <level label="7"> <text>This section may not be construed to prohibit the Fund from receiving funds from any other source.</text> </level> <level label="8"> <level label="i"> <text>The Fund shall be used only to provide funding for the Commission and for the purposes authorized under this subtitle.</text> </level> <level label="ii"> <text>The costs of the Commission include the administrative costs incurred by the Department on behalf of the Commission.</text> </level> </level> </level> <level label="e"> <text>The Commission shall:</text> <level label="1"> <text>Assess user fees for each facility equal to the sum of:</text> <level label="i"> <text>The amount equal to one half of the total user fees times the ratio of admissions of the facility to total admissions of all facilities; and</text> </level> <level label="ii"> <text>The amount equal to one half of the total user fees times the ratio of gross operating revenue of each facility to total gross operating revenues of all facilities;</text> </level> </level> <level label="2"> <text>Establish minimum and maximum assessments; and</text> </level> <level label="3"> <text>Assess each facility on or before June 30 of each year.</text> </level> </level> <level label="f"> <level label="1"> <text>On or before September 1 of each year, each facility assessed under this section shall make payment to the Commission.</text> </level> <level label="2"> <text>The Commission shall make provision for partial payments.</text> </level> </level> <level label="g"> <text>Any bill not paid within 30 days of an agreed payment date may be subject to an interest penalty to be determined by the Commission.</text> </level> <level label="h"> <level label="1"> <text>This section shall terminate and be of no effect on the first day of July following the cessation of a waiver by law or agreement for Medicare and Medicaid between the State of Maryland and the federal government.</text> </level> <level label="2"> <level label="i"> <text>If notice of intent to terminate is made by the federal government to this State before the first day of an intervening session of the Maryland General Assembly, this section shall expire June 30 of the following calendar year.</text> </level> <level label="ii"> <text>Under no circumstances shall less than 7 calendar months occur between notice of termination and expiration of this section.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-214" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>The Commission shall assess the underlying causes of hospital uncompensated care and make recommendations to the General Assembly on the most appropriate alternatives to:</text> <level label="1"> <text>Reduce uncompensated care; and</text> </level> <level label="2"> <text>Assure the integrity of the payment system.</text> </level> </level> <level label="b"> <text>The Commission may adopt regulations establishing alternative methods for financing the reasonable total costs of hospital uncompensated care and the disproportionate share hospital payment provided that the alternative methods:</text> <level label="1"> <text>Are in the public interest;</text> </level> <level label="2"> <text>Will equitably distribute the reasonable costs of uncompensated care and the disproportionate share hospital payment;</text> </level> <level label="3"> <text>Will fairly determine the cost of reasonable uncompensated care and the disproportionate share hospital payment included in hospital rates;</text> </level> <level label="4"> <text>Will continue incentives for hospitals to adopt fair, efficient, and effective credit and collection policies; and</text> </level> <level label="5"> <text>Will not result in significantly increasing costs to Medicare or termination of the all–payer model contract.</text> </level> </level> <level label="c"> <text>Any funds generated through hospital rates under an alternative method adopted by the Commission in accordance with subsection (b) of this section may only be used to finance the delivery of hospital uncompensated care and the disproportionate share hospital payment.</text> </level> <level label="d"> <level label="1"> <text>Each year, the Commission shall assess a uniform, broad–based, and reasonable amount in hospital rates to reflect the aggregate reduction in hospital uncompensated care realized from the expansion of health care coverage under Chapter 7 of the Acts of the 2007 Special Session of the General Assembly.</text> </level> <level label="2"> <level label="i"> <level label="1"> <text>The Commission shall ensure that the assessment amount equals 1.25% of projected regulated net patient revenue.</text> </level> <level label="2"> <text>Each hospital shall remit its assessment amount to the Health Care Coverage Fund established under § 15–701 of this article.</text> </level> </level> <level label="ii"> <text>Any savings realized in averted uncompensated care as a result of the expansion of health care coverage under Chapter 7 of the Acts of the 2007 Special Session of the General Assembly that are not subject to the assessment under paragraph (1) of this subsection shall be shared among purchasers of hospital services in a manner that the Commission determines is most equitable.</text> </level> </level> <level label="3"> <level label="i"> <text>Funds generated from the assessment under this subsection may be used only to supplement coverage under the Medical Assistance Program beyond the eligibility requirements in existence on January 1, 2008.</text> </level> <level label="ii"> <text>Any funds remaining after the expenditure of funds under subparagraph (i) of this paragraph has been made may be used for the general operations of the Medicaid program.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-214.1" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Financial hardship” means medical debt, incurred by a family over a 12–month period, that exceeds 25% of family income.</text> </level> <level label="3"> <text>“Medical debt” means out–of–pocket expenses, including co–payments, coinsurance, and deductibles, for medical costs.</text> </level> <level label="4"> <text>“Medically necessary care” means care that is:</text> <level label="i"> <text>Directly related to diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;</text> </level> <level label="ii"> <text>Consistent with accepted standards of good medical practice; and</text> </level> <level label="iii"> <text>Not primarily for the convenience of the patient, the patient’s family, or the provider.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>The Commission shall require each acute care hospital and each chronic care hospital in the State under the jurisdiction of the Commission to develop a financial assistance policy for providing free and reduced–cost care to patients who lack health care coverage or whose health care coverage does not pay the full cost of the hospital bill.</text> </level> <level label="2"> <text>The financial assistance policy shall provide, at a minimum:</text> <level label="i"> <text>Free medically necessary care to patients with family income at or below 200% of the federal poverty level, calculated at the time of service or updated, as appropriate, to account for any change in financial circumstances of the patient that occurs within 240 days after the initial hospital bill is provided;</text> </level> <level label="ii"> <text>Reduced–cost medically necessary care to low–income patients with family income above 200% of the federal poverty level, calculated at the time of service or updated, as appropriate, to account for any change in financial circumstances of the patient that occurs within 240 days after the initial hospital bill is provided;</text> </level> <level label="iii"> <text>A description of the availability of the payment plan required under § 19–214.2(d) of this subtitle; and</text> </level> <level label="iv"> <text>A mechanism for a patient to request the hospital to reconsider the denial of free or reduced–cost care that includes in the request:</text> <level label="1"> <text>The Health Education and Advocacy Unit is available to assist the patient or the patient’s authorized representative in filing and mediating a reconsideration request; and</text> </level> <level label="2"> <text>The address, phone number, facsimile number, e–mail address, mailing address, and website of the Health Education and Advocacy Unit.</text> </level> </level> </level> <level label="3"> <level label="i"> <text>The Commission by regulation may establish income thresholds higher than those under paragraphs (2) and (4) of this subsection.</text> </level> <level label="ii"> <text>In establishing income thresholds that are higher than those under paragraph (2) of this subsection for a hospital, the Commission shall take into account:</text> <level label="1"> <text>The patient mix of the hospital;</text> </level> <level label="2"> <text>The financial condition of the hospital;</text> </level> <level label="3"> <text>The level of bad debt experienced by the hospital; and</text> </level> <level label="4"> <text>The amount of charity care provided by the hospital.</text> </level> </level> </level> <level label="4"> <text>Subject to income thresholds set under paragraph (3) of this subsection, the financial assistance policy required under this subsection shall provide reduced–cost medically necessary care to patients with family income below 500% of the federal poverty level who have a financial hardship.</text> </level> <level label="5"> <level label="i"> <text>If a patient is eligible for reduced–cost medically necessary care under paragraph (2)(ii) of this subsection, the hospital shall, at a minimum, reduce the patient’s out–of–pocket expenses for the regulated hospital service:</text> <level label="1"> <text>For a patient with family income of at least 201% but not more than 250% of the federal poverty level, by 75%; and</text> </level> <level label="2"> <text>For a patient with family income of more than 250% but not more than 300% of the federal poverty level, by 60%.</text> </level> </level> <level label="ii"> <text>If a patient is eligible for reduced–cost medically necessary care under paragraph (4) of this subsection, the hospital shall, at a minimum, reduce the patient’s out–of–pocket expenses for the regulated hospital service:</text> <level label="1"> <text>For a patient with family income of at least 201% but not more than 250% of the federal poverty level, by 75%;</text> </level> <level label="2"> <text>For a patient with family income of more than 250% but not more than 300% of the federal poverty level, by 60%;</text> </level> <level label="3"> <text>For a patient with family income of more than 300% but not more than 350% of the federal poverty level, by 50%;</text> </level> <level label="4"> <text>For a patient with family income of more than 350% but not more than 400% of the federal poverty level, by 45%;</text> </level> <level label="5"> <text>For a patient with family income of more than 400% but not more than 450% of the federal poverty level, by 40%; and</text> </level> <level label="6"> <text>For a patient with family income of more than 450% but not more than 500% of the federal poverty level, by 35%.</text> </level> </level> </level> <level label="6"> <text>If a patient has received reduced–cost medically necessary care due to a financial hardship, the patient or any immediate family member of the patient living in the same household:</text> <level label="i"> <text>Shall remain eligible for reduced–cost medically necessary care when seeking subsequent care at the same hospital during the 12–month period beginning on the date on which the reduced–cost medically necessary care was initially received; and</text> </level> <level label="ii"> <text>To avoid an unnecessary duplication of the hospital’s determination of eligibility for free and reduced–cost care, shall inform the hospital of the patient’s or family member’s eligibility for the reduced–cost medically necessary care.</text> </level> </level> <level label="7"> <text>The financial assistance policy required under this subsection shall provide presumptive eligibility for free medically necessary care to a patient who is not eligible for the Maryland Medical Assistance Program or Maryland Children’s Health Program and:</text> <level label="i"> <text>Lives in a household with a child who is enrolled in the free and reduced–cost meal program and is eligible for the program based on the household’s income;</text> </level> <level label="ii"> <text>Receives benefits through the federal Supplemental Nutrition Assistance Program;</text> </level> <level label="iii"> <text>Receives benefits through the State’s Energy Assistance Program;</text> </level> <level label="iv"> <text>Receives benefits through the federal Special Supplemental Food Program for Women, Infants, and Children; or</text> </level> <level label="v"> <text>Receives benefits from any other social service program as determined by the Department and the Commission.</text> </level> </level> <level label="8"> <level label="i"> <text>A hospital may consider only household monetary assets in excess of $100,000 when determining eligibility for free and reduced–cost care under the hospital’s financial assistance policy.</text> </level> <level label="ii"> <text>If a hospital considers household monetary assets under subparagraph (i) of this paragraph, retirement assets that the Internal Revenue Service has granted preferential tax treatment as a retirement account, including deferred–compensation plans qualified under the Internal Revenue Code or nonqualified deferred–compensation plans shall be excluded.</text> </level> </level> <level label="9"> <level label="i"> <text>In determining the family income of a patient, a hospital shall apply a definition of household size that consists of the patient and, at a minimum, the following individuals:</text> <level label="1"> <text>A spouse, regardless of whether the patient and spouse expect to file a joint federal or State tax return;</text> </level> <level label="2"> <text>Biological children, adopted children, or stepchildren; and</text> </level> <level label="3"> <text>Anyone for whom the patient claims a personal exemption in a federal or State tax return.</text> </level> </level> <level label="ii"> <text>For a patient who is a child, the household size shall consist of the child and the following individuals:</text> <level label="1"> <text>Biological parents, adopted parents, or stepparents or guardians;</text> </level> <level label="2"> <text>Biological siblings, adopted siblings, or stepsiblings; and</text> </level> <level label="3"> <text>Anyone for whom the patient’s parents or guardians claim a personal exemption in a federal or State tax return.</text> </level> </level> </level> <level label="10"> <level label="i"> <text>A hospital shall provide notice of the hospital’s financial assistance policy to the patient, the patient’s family, or the patient’s authorized representative before discharging the patient and in each communication to the patient regarding collection of the hospital bill.</text> </level> <level label="ii"> <text>The notice required under subparagraph (i) of this paragraph shall state that the patient has up to 240 days after the day the patient receives the initial hospital bill to apply for financial assistance from the hospital.</text> </level> <level label="iii"> <level label="1"> <text>The hospital shall obtain documentation ensuring that the patient or the patient’s authorized representative acknowledges the patient’s receipt of the notice before discharging the patient.</text> </level> <level label="2"> <text>If a patient chooses not to apply for financial assistance, the patient’s documented acknowledgment shall indicate that the patient is not applying on the day of the acknowledgment but may apply within 240 days immediately following the patient’s receipt of the initial hospital bill.</text> </level> </level> </level> <level label="11"> <text>The hospital shall consider any change in the patient’s financial circumstance that occurs during the 240–day period following the patient’s receipt of the initial hospital bill if the patient informs the hospital of the change in financial circumstance on or before the conclusion of the 240–day period.</text> </level> </level> <level label="c"> <level label="1"> <text>A hospital shall post a notice in conspicuous places throughout the hospital, including the billing office, informing patients of their right to apply for financial assistance and who to contact at the hospital for additional information.</text> </level> <level label="2"> <text>The notice required under paragraph (1) of this subsection shall:</text> <level label="i"> <text>Be in simplified language in at least 10 point type; and</text> </level> <level label="ii"> <text>Be provided in the patient’s preferred language or, if no preferred language is specified, each language spoken by a limited English proficient population that constitutes at least 5% of the overall population within the city or county in which the hospital is located as measured by the most recent census.</text> </level> </level> </level> <level label="d"> <text>The Commission shall:</text> <level label="1"> <text>Develop a uniform financial assistance application; and</text> </level> <level label="2"> <text>Require each hospital to use the uniform financial assistance application to determine eligibility for free and reduced–cost care under the hospital’s financial assistance policy.</text> </level> </level> <level label="e"> <text>The uniform financial assistance application:</text> <level label="1"> <text>Shall be written in simplified language; and</text> </level> <level label="2"> <text>May not require documentation that presents an undue barrier to a patient’s receipt of financial assistance.</text> </level> </level> <level label="f"> <level label="1"> <text>Each hospital shall develop an information sheet that:</text> <level label="i"> <text>Describes the hospital’s financial assistance policy and includes a section that allows for a patient to initial that the patient has been made aware of the financial assistance policy;</text> </level> <level label="ii"> <text>Describes a patient’s rights and obligations with regard to hospital billing and collection under the law;</text> </level> <level label="iii"> <text>Provides contact information for the individual or office at the hospital that is available to assist the patient, the patient’s family, or the patient’s authorized representative in order to understand:</text> <level label="1"> <text>The patient’s hospital bill;</text> </level> <level label="2"> <text>The patient’s rights and obligations with regard to the hospital bill;</text> </level> <level label="3"> <text>How to apply for free and reduced–cost care; and</text> </level> <level label="4"> <text>How to apply for the Maryland Medical Assistance Program and any other programs that may help pay the bill;</text> </level> </level> <level label="iv"> <text>Provides contact information for the Maryland Medical Assistance Program;</text> </level> <level label="v"> <text>Includes a statement that physician charges are not included in the hospital bill and are billed separately; and</text> </level> <level label="vi"> <text>Informs patients of the right to request and receive a written estimate of the total charges for hospital nonemergency services, procedures, and supplies that reasonably are expected to be provided for professional services by the hospital.</text> </level> </level> <level label="2"> <text>The information sheet shall:</text> <level label="i"> <text>Be in simplified language in at least 10 point type; and</text> </level> <level label="ii"> <text>Be in the patient’s preferred language or, if no preferred language is specified, each language spoken by a limited English proficient population that constitutes at least 5% of the overall population within the city or county in which the hospital is located as measured by the most recent census.</text> </level> </level> <level label="3"> <text>The information sheet shall be provided to the patient, the patient’s family, or the patient’s authorized representative:</text> <level label="i"> <text>Before discharge;</text> </level> <level label="ii"> <text>With the hospital bill;</text> </level> <level label="iii"> <text>On request; and</text> </level> <level label="iv"> <text>In each written communication to the patient regarding collection of the hospital bill.</text> </level> </level> <level label="4"> <text>The hospital bill shall include a reference to the information sheet.</text> </level> <level label="5"> <text>The Commission shall:</text> <level label="i"> <text>Establish uniform requirements for the information sheet; and</text> </level> <level label="ii"> <text>Review each hospital’s implementation of and compliance with the requirements of this subsection.</text> </level> </level> </level> <level label="g"> <text>Each hospital shall ensure the availability of staff who are trained to work with the patient, the patient’s family, and the patient’s authorized representative in order to understand:</text> <level label="1"> <text>The patient’s hospital bill;</text> </level> <level label="2"> <text>The patient’s rights and obligations with regard to the hospital bill, including the patient’s rights and obligations with regard to reduced–cost medically necessary care due to a financial hardship;</text> </level> <level label="3"> <text>How to apply for the Maryland Medical Assistance Program and any other programs that may help pay the hospital bill; and</text> </level> <level label="4"> <text>How to contact the hospital for additional assistance.</text> </level> </level> <level label="h"> <text>Each hospital shall develop a procedure to determine a patient’s eligibility under the hospital’s financial assistance policy in which the hospital:</text> <level label="1"> <text>Determines whether the patient has health insurance;</text> </level> <level label="2"> <text>Determines whether the patient is presumptively eligible for free or reduced–cost care under subsection (b)(7) of this section;</text> </level> <level label="3"> <text>Determines whether uninsured patients are eligible for public or private health insurance;</text> </level> <level label="4"> <text>To the extent practicable, offers assistance to uninsured patients if the patient chooses to apply for public or private health insurance;</text> </level> <level label="5"> <text>To the extent practicable, determines whether the patient is eligible for other public programs that may assist with health care costs;</text> </level> <level label="6"> <text>Uses information in the possession of the hospital, if available, to determine whether the patient is qualified for free or reduced–cost care under the hospital’s financial assistance policy; and</text> </level> <level label="7"> <text>When a patient submits a completed application for financial assistance, determines the patient’s eligibility under the hospital’s financial assistance policy within 14 days after the patient applies for financial assistance and suspends any billing or collections actions while eligibility is being determined.</text> </level> </level> <level label="i"> <text>A hospital may not:</text> <level label="1"> <text>Use a patient’s citizenship or immigration status as an eligibility requirement for financial assistance; or</text> </level> <level label="2"> <text>Withhold financial assistance or deny a patient’s application for financial assistance on the basis of race, color, religion, ancestry or national origin, sex, age, marital status, sexual orientation, gender identity, genetic information, or on the basis of disability.</text> </level> </level> <level label="j"> <text>Each hospital shall submit to the Commission annually at times prescribed by the Commission:</text> <level label="1"> <text>The hospital’s financial assistance policy developed under this section; and</text> </level> <level label="2"> <text>An annual report on the hospital’s financial assistance policy that includes:</text> <level label="i"> <text>The total number of patients who completed or partially completed an application for financial assistance during the prior year;</text> </level> <level label="ii"> <text>The total number of inpatients and outpatients who received:</text> <level label="1"> <text>Free care during the immediately preceding year; and</text> </level> <level label="2"> <text>Reduced–cost care for the prior year;</text> </level> </level> <level label="iii"> <text>The total number of patients who received financial assistance during the immediately preceding year by race or ethnicity and gender;</text> </level> <level label="iv"> <text>The total number of patients who were denied financial assistance during the immediately preceding year by race or ethnicity and gender;</text> </level> <level label="v"> <text>The total amount of the costs of hospital services provided to patients who received free care; and</text> </level> <level label="vi"> <text>The total amount of the costs of hospital services provided to patients who received reduced–cost care that was either covered by the hospital as financial assistance or that the hospital charged to the patient.</text> </level> </level> </level> <level label="k"> <level label="1"> <text>The Commission shall post on its website each hospital’s financial assistance policy and annual report.</text> </level> <level label="2"> <text>The Commission shall compile the reports required under subsection (j) of this section and issue a hospital financial assistance report.</text> </level> <level label="3"> <text>The hospital financial assistance report required under paragraph (2) of this subsection shall be made available to the public free of charge.</text> </level> <level label="4"> <text>On or before December 1 each year, the Commission shall submit a copy of the annual hospital financial assistance report issued under paragraph (2) of this subsection, in accordance with § 2–1257 of the State Government Article, to the Senate Finance Committee and the House Health and Government Operations Committee.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-214.2" future_version_removed="true" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <level label="1"> <text>Each hospital annually shall submit to the Commission:</text> <level label="i"> <text>At times prescribed by the Commission, the hospital’s policy on the collection of debts owed by patients; and</text> </level> <level label="ii"> <text>A report including:</text> <level label="1"> <text>The total number of patients by race or ethnicity, gender, and zip code of residence against whom the hospital, or a debt collector used by the hospital, filed an action to collect a debt owed on a hospital bill;</text> </level> <level label="2"> <text>The total number of patients by race or ethnicity, gender, and zip code of residence with respect to whom the hospital has and has not reported or classified a bad debt;</text> </level> <level label="3"> <text>The total dollar amount of the charges for hospital services provided to patients but not collected by the hospital for patients covered by insurance, including the out–of–pocket costs for patients covered by insurance, and patients without insurance; and</text> </level> <level label="4"> <text>For hospital debts owed by patients of the hospital that the hospital sold to a governmental unit, contractor, or nonprofit organization under subsection (l) of this section:</text> </level> <level label="A"> <text>The total dollar amount of the debt sold by the hospital for the reporting year;</text> </level> <level label="B"> <text>The total dollar amount paid to the hospital by the unit, contractor, or nonprofit organization who purchased the debt; and</text> </level> <level label="C"> <text>The total number of patients whose debt was sold, in full or in part, to the unit, contractor, or nonprofit organization who purchased the debt.</text> </level> </level> </level> <level label="2"> <text>The Commission shall post the information submitted under paragraph (1) of this subsection on its website.</text> </level> </level> <level label="b"> <text>The policy submitted under subsection (a)(1) of this section shall:</text> <level label="1"> <text>Provide for active oversight by the hospital of any contract for collection of debts on behalf of the hospital;</text> </level> <level label="2"> <text>Except as provided in subsection (l) of this section, prohibit the hospital from selling any debt;</text> </level> <level label="3"> <text>Describe in detail the consideration by the hospital of patient income, assets, and other criteria;</text> </level> <level label="4"> <text>Prohibit the hospital from reporting adverse information to a consumer reporting agency;</text> </level> <level label="5"> <text>Prohibit the hospital from filing a civil action to collect a debt within 240 days after the initial bill is provided;</text> </level> <level label="6"> <text>Prohibit the hospital from filing a civil action to collect a debt against a patient whose outstanding debt is at or below $500;</text> </level> <level label="7"> <text>Describe the hospital’s procedures for collecting a debt;</text> </level> <level label="8"> <text>Describe the circumstances in which the hospital will seek a judgment against a patient;</text> </level> <level label="9"> <text>In accordance with subsection (c) of this section, provide for a refund of amounts collected from a patient or the guarantor of a patient who was later found to be eligible for free care within 240 days after the initial bill was provided;</text> </level> <level label="10"> <text>If the hospital has obtained a judgment against or reported adverse information to a consumer reporting agency about a patient who later was found to be eligible for free care within 240 days after the initial bill was provided for which the judgment was awarded or the adverse information was reported, require the hospital to seek to vacate the judgment or strike the adverse information;</text> </level> <level label="11"> <text>Provide a mechanism for a patient to:</text> <level label="i"> <text>Request the hospital to reconsider the denial of free or reduced–cost care;</text> </level> <level label="ii"> <text>File with the hospital a complaint against the hospital or a debt collector used by the hospital regarding the handling of the patient’s bill; and</text> </level> <level label="iii"> <text>Allow the patient and the hospital to mutually agree to modify the terms of a payment plan offered under subsection (d) of this section or entered into with the patient;</text> </level> </level> <level label="12"> <text>For a patient who is eligible for free or reduced–cost care under the hospital’s financial assistance policy, prohibit the hospital from:</text> <level label="i"> <text>Charging interest on the debt owed on a bill for the patient before a court judgment is obtained; or</text> </level> <level label="ii"> <text>Collecting fees or any other amount that exceeds the approved charge for the hospital service as established by the Commission;</text> </level> </level> <level label="13"> <text>Require the hospital to dismiss actions pending against a patient for collection of debt that was sold under subsection (l) of this section;</text> </level> <level label="14"> <text>Prohibit the hospital from:</text> <level label="i"> <text>Engaging in collection activities on 100% of the outstanding amount of the Commission–set charge for debt sold under subsection (l) of this section; and</text> </level> <level label="ii"> <text>Collecting on judgments entered into on patient debt that was sold under subsection (l) of this section; and</text> </level> </level> <level label="15"> <text>Comply with § 24–2502 of this article.</text> </level> </level> <level label="c"> <level label="1"> <level label="i"> <text>A hospital shall provide for a refund of amounts exceeding $25 collected from a patient or the guarantor of a patient who was found to be eligible for free care within 240 days after the initial bill is provided to the patient.</text> </level> <level label="ii"> <text>The hospital shall provide the refund to the patient not later than 30 days after determining that the patient was eligible for free care.</text> </level> </level> <level label="2"> <text>If a patient is enrolled in a means–tested government health care plan that requires the patient to pay out–of–pocket for hospital services, a hospital’s refund policy shall provide for a refund that complies with the terms of the patient’s plan.</text> </level> </level> <level label="d"> <level label="1"> <text>Subject to paragraph (2) of this subsection, a hospital shall provide in writing to each patient who incurs medical debt information about the availability of an installment payment plan for the debt.</text> </level> <level label="2"> <text>A hospital shall provide the information under paragraph (1) of this subsection to the patient, the patient’s family, the patient’s authorized representative, or the patient’s legal guardian:</text> <level label="i"> <text>Before the patient is discharged;</text> </level> <level label="ii"> <text>With the hospital bill;</text> </level> <level label="iii"> <text>On request; and</text> </level> <level label="iv"> <text>In each written communication to the patient regarding collection of hospital debt.</text> </level> </level> <level label="3"> <level label="i"> <text>The Commission shall develop guidelines, with input from stakeholders, for an income–based payment plan offered under this subsection that includes:</text> <level label="1"> <text>The amount of medical debt owed to the hospital;</text> </level> <level label="2"> <text>The duration of the payment plan based on a patient’s annual gross income;</text> </level> <level label="3"> <text>Guidelines for requiring appropriate documentation of income level;</text> </level> <level label="4"> <text>Guidelines for the payment amount that:</text> </level> <level label="A"> <text>May not exceed 5% of the patient’s federal or State adjusted gross monthly household income that takes into consideration all individuals on the same federal or State tax return; and</text> </level> <level label="B"> <text>Shall consider financial hardship, as defined in § 19–214.1(a) of this subtitle;</text> </level> <level label="5"> <text>Guidelines for:</text> </level> <level label="A"> <text>The determination of possible interest payments for patients who do not qualify for free or reduced–cost care, which may not begin before 240 days after the initial bill is provided; and</text> </level> <level label="B"> <text>A prohibition on interest payments for patients who qualify for free or reduced–cost care as required under subsection (b)(12) of this section;</text> </level> <level label="6"> <text>Guidelines for modification of a payment plan that does not create a greater financial burden on the patient; and</text> </level> <level label="7"> <text>A prohibition on penalties or fees for prepayment or early payment.</text> </level> </level> <level label="ii"> <text>A hospital may not seek legal action against a patient on a debt owed until the hospital has established and implemented a payment plan policy that complies with the guidelines developed under subparagraph (i) of this paragraph.</text> </level> </level> <level label="4"> <level label="i"> <text>A patient shall be deemed to be compliant with a payment plan if the patient makes at least 11 scheduled monthly payments within a 12–month period.</text> </level> <level label="ii"> <text>If a patient misses a scheduled monthly payment, the patient shall contact the health care facility and identify a plan to make up the missed payment within 1 year after the date of the missed payment.</text> </level> <level label="iii"> <text>The health care facility may, but may not be required to, waive any additional missed payments that occur within a 12–month period and allow the patient to continue to participate in the income–based payment plan and not refer the outstanding balance owed to a collection agency or for legal action.</text> </level> </level> <level label="5"> <level label="i"> <text>A hospital shall demonstrate that it attempted in good faith to meet the requirements of this subsection and the guidelines developed by the Commission under paragraph (3) of this subsection before the hospital:</text> <level label="1"> <text>Files an action to collect a debt owed on a hospital bill by a patient; or</text> </level> <level label="2"> <text>Delegates collection activity to a debt collector for a debt owed on a hospital bill by a patient.</text> </level> </level> <level label="ii"> <text>Subparagraph (i) of this paragraph does not prohibit a hospital from using an eligibility vendor to provide outreach to a patient for purposes of assisting the patient in qualifying for financial assistance.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>A hospital shall comply with § 24–2502 of this article.</text> </level> <level label="2"> <text>For at least 240 days after the initial patient bill was provided, a hospital may not report adverse information about a patient to a consumer reporting agency or commence civil action against a patient for nonpayment.</text> </level> <level label="3"> <text>A hospital shall report the fulfillment of a patient’s payment obligation within 60 days after the obligation is fulfilled to any consumer reporting agency to which the hospital had reported adverse information about the patient, including if the debt was sold under subsection (l) of this section.</text> </level> <level label="4"> <text>A hospital may not commence a civil action against a patient for nonpayment, or delegate collection activity to a debt collector:</text> <level label="i"> <text>If the hospital was notified in accordance with federal law by the patient or the insurance carrier that an appeal or a review of a health insurance decision is pending within the immediately preceding 60 days;</text> </level> <level label="ii"> <text>If the hospital is processing a requested reconsideration of the denial of free or reduced–cost care that was appropriately completed by the patient or has completed the reconsideration within the immediately preceding 60 days; or</text> </level> <level label="iii"> <text>If the hospital sold the debt under subsection (l) of this section.</text> </level> </level> <level label="5"> <text>By November 1, 2025, a hospital that had reported adverse information about a patient to a consumer reporting agency shall instruct the consumer reporting agency to delete the adverse information about the patient.</text> </level> </level> <level label="f"> <level label="1"> <text>A hospital may not force the sale or foreclosure of a patient’s primary residence to collect a debt owed on a hospital bill.</text> </level> <level label="2"> <text>A hospital may not request a lien against a patient’s primary residence in an action to collect debt owed on a hospital bill.</text> </level> <level label="3"> <level label="i"> <text>A hospital may not give notice to a patient under subsection (h) of this section until after 240 days after the initial bill was provided.</text> </level> <level label="ii"> <text>If a hospital files an action to collect the debt owed on a hospital bill, the hospital may not request the issuance of or otherwise knowingly take action that would cause a court to issue:</text> <level label="1"> <text>A body attachment against a patient; or</text> </level> <level label="2"> <text>An arrest warrant against a patient.</text> </level> </level> </level> <level label="4"> <text>A hospital may not request a writ of garnishment of wages or file an action that would result in an attachment of wages against a patient to collect debt owed on a hospital bill if the patient is eligible for free or reduced–cost care under § 19–214.1 of this subtitle.</text> </level> <level label="5"> <level label="i"> <text>A hospital may not make a claim against the estate of a deceased patient to collect a debt owed on a hospital bill if the deceased patient was known by the hospital to be eligible for free care under § 19–214.1 of this subtitle or if the value of the estate after tax obligations are fulfilled is less than half of the debt owed.</text> </level> <level label="ii"> <text>A hospital may offer the family of the deceased patient the ability to apply for financial assistance.</text> </level> </level> <level label="6"> <text>A hospital may not file an action to collect a debt owed on a hospital bill by a patient until the hospital determines whether the patient is eligible for free or reduced–cost care under § 19–214.1 of this subtitle.</text> </level> </level> <level label="g"> <level label="1"> <text>Except as provided in paragraph (2) of this subsection, a spouse or another individual may not be held liable for the debt owed on a hospital bill of an individual who is at least 18 years old.</text> </level> <level label="2"> <text>An individual may voluntarily consent to assume liability for the debt owed on a hospital bill of any other individual if the consent is:</text> <level label="i"> <text>Made on a separate document signed by the individual;</text> </level> <level label="ii"> <text>Not solicited in an emergency room or during an emergency situation; and</text> </level> <level label="iii"> <text>Not required as a condition of providing any emergency or nonemergency health care services.</text> </level> </level> </level> <level label="h"> <level label="1"> <text>Subject to paragraph (2) of this subsection, at least 45 days before filing an action against a patient to collect on the debt owed on a hospital bill, a hospital shall send written notice of the intent to file an action to the patient.</text> </level> <level label="2"> <text>The notice required under paragraph (1) of this subsection shall:</text> <level label="i"> <text>Be sent to the patient by certified mail and first–class mail;</text> </level> <level label="ii"> <text>Be in simplified language and in at least 10 point type;</text> </level> <level label="iii"> <text>Include:</text> <level label="1"> <text>The name and telephone number of:</text> </level> <level label="A"> <text>The hospital;</text> </level> <level label="B"> <text>If applicable, the debt collector; and</text> </level> <level label="C"> <text>An agent of the hospital authorized to modify the terms of the payment plan, if any;</text> </level> <level label="2"> <text>The amount required to cure the nonpayment of debt, including past due payments, interest, penalties, and fees;</text> </level> <level label="3"> <text>A statement recommending that the patient seek debt counseling services;</text> </level> <level label="4"> <text>Telephone numbers and Internet addresses of the Health Education Advocacy Unit in the Office of the Attorney General, available to assist patients experiencing medical debt;</text> </level> <level label="5"> <text>An explanation of the hospital’s financial assistance policy; and</text> </level> <level label="6"> <text>Any other relevant information prescribed by the Commission; and</text> </level> </level> <level label="iv"> <text>Be provided in the patient’s preferred language or, if no preferred language is specified, each language spoken by a limited English proficient population that constitutes at least 5% of the population within the jurisdiction in which the hospital is located as measured by the most recent federal census.</text> </level> </level> <level label="3"> <text>The notice required under this subsection shall be accompanied by:</text> <level label="i"> <text>An application for financial assistance under the hospital’s financial assistance policy, along with instructions for completing the application for financial assistance, and the telephone number to call to confirm receipt of the application;</text> </level> <level label="ii"> <text>The availability of an income–based payment plan to satisfy the medical debt that is the subject of the hospital debt collection action; and</text> </level> <level label="iii"> <text>The information sheet required under § 19–214.1(f) of this subtitle.</text> </level> </level> </level> <level label="i"> <text>A complaint by a hospital in an action to collect a debt owed on a hospital bill by a patient shall:</text> <level label="1"> <text>Include an affidavit stating:</text> <level label="i"> <text>The date on which the 240–day period required under subsection (f)(3) of this section elapsed and the nature of the nonpayment;</text> </level> <level label="ii"> <text>That a notice of intent to file an action under subsection (h) of this section:</text> <level label="1"> <text>Was sent to the patient and the date on which the notice was sent; and</text> </level> <level label="2"> <text>Accurately reflected the contents required to be included in the notice;</text> </level> </level> <level label="iii"> <text>That the hospital provided:</text> <level label="1"> <text>The patient with a copy of the information sheet on the financial assistance policy in accordance with subsection (h)(3)(ii) of this section; and</text> </level> <level label="2"> <text>Notice of the financial assistance policy as documented under § 19–214.1(f) of this subtitle;</text> </level> </level> <level label="iv"> <text>That the hospital made a determination regarding whether the patient is eligible for the hospital’s financial assistance policy in accordance with § 19–214.1 of this subtitle; and</text> </level> <level label="v"> <text>That the hospital made a good–faith effort to meet the requirements of subsection (d) of this section; and</text> </level> </level> <level label="2"> <text>Be accompanied by:</text> <level label="i"> <text>The original or a certified copy of the hospital bill;</text> </level> <level label="ii"> <text>A statement of the remaining due and payable debt supported by an affidavit of the plaintiff, the hospital, or the agent or attorney of the plaintiff or hospital;</text> </level> <level label="iii"> <text>A copy of the most recent hospital bill sent to the patient;</text> </level> <level label="iv"> <text>If the defendant is eligible for federal Service Members Civil Relief Act benefits, an affidavit that the hospital is in compliance with the Act;</text> </level> <level label="v"> <text>A copy of the notice of intent to file an action on a hospital bill; and</text> </level> <level label="vi"> <text>A copy of the patient’s signed certified mail acknowledgment of receipt of the written notice of intent to file an action, if received by the hospital.</text> </level> </level> </level> <level label="j"> <text>If a hospital delegates collection activity to a debt collector, the hospital shall:</text> <level label="1"> <text>Specify the collection activity to be performed by the debt collector through an explicit authorization or contract;</text> </level> <level label="2"> <text>Require the debt collector to abide by the hospital’s credit and collection policy;</text> </level> <level label="3"> <text>Specify procedures the debt collector must follow if a patient appears to qualify for financial assistance; and</text> </level> <level label="4"> <text>Require the debt collector to:</text> <level label="i"> <text>In accordance with the hospital’s policy, provide a mechanism for a patient to file with the hospital a complaint against the hospital or the debt collector regarding the handling of the patient’s bill;</text> </level> <level label="ii"> <text>Forward the complaint to the hospital if a patient files a complaint with the debt collector; and</text> </level> <level label="iii"> <text>Along with the hospital, be jointly and severally responsible for meeting the requirements of this section.</text> </level> </level> </level> <level label="k"> <level label="1"> <text>The board of directors of each hospital shall review and approve the hospital’s financial assistance policy required under § 19–214.1 of this subtitle and debt collection policy required under this section at least every 2 years.</text> </level> <level label="2"> <text>A hospital may not alter its financial assistance or debt collection policies without approval by the board of directors.</text> </level> </level> <level label="l"> <level label="1"> <level label="i"> <text>Subject to paragraph (2) of this subsection, a hospital may sell debt owed to the hospital by a patient for hospital services to a governmental unit or an entity that is under contract with the unit or to a nonprofit organization that is exempt from taxation under § 501(c)(3) of the Internal Revenue Code for the sole purpose of canceling the debt.</text> </level> <level label="ii"> <text>The contract between the hospital and the governmental unit, contractor, or nonprofit organization purchasing the debt under this subsection shall state that the sole purpose of the sale of the debt is to cancel the debt.</text> </level> <level label="iii"> <text>The patient is not responsible to the hospital, the governmental unit, the contractor, or the nonprofit organization for any amount of the debt that is sold under this subsection or any interest, fees, or costs associated with the debt or the sale.</text> </level> </level> <level label="2"> <text>Debt sold under this subsection:</text> <level label="i"> <text>Must be for hospital services provided at least 2 years before the date of the sale;</text> </level> <level label="ii"> <text>May not be expected to yield additional reimbursements from a third–party payor;</text> </level> <level label="iii"> <text>May not be subject to an open appeal with an insurance company; and</text> </level> <level label="iv"> <text>Must be for an individual whose family income is at or below 500% of the federal poverty level or who has medical debt exceeding 5% of the individual’s family income, as determined by the governmental unit, contractor, or nonprofit organization purchasing the debt.</text> </level> </level> <level label="3"> <text>Debt sold under this subsection may be sold with a reduction of Commission charges.</text> </level> <level label="4"> <text>The Commission shall treat the amount of payments to hospitals under this subsection as an offset to uncompensated care amounts reported by hospitals.</text> </level> <level label="5"> <text>The purchaser of the debt shall:</text> <level label="i"> <text>Notify the patient that the debt has been canceled; and</text> </level> <level label="ii"> <text>If the hospital obtained a judgment against the patient or reported adverse information to a consumer reporting agency about the patient, seek to vacate the judgment or strike the adverse information.</text> </level> </level> </level> <level label="m"> <text>The Commission shall review each hospital’s implementation of and compliance with the hospital’s policies and the requirements of this section.</text> </level> <level label="n"> <level label="1"> <text>On or before February 1 each year, beginning in 2023, the Commission shall compile the information required under subsection (a) of this section and prepare a medical debt collection report based on the compiled information.</text> </level> <level label="2"> <text>The report required under paragraph (1) of this subsection shall be:</text> <level label="i"> <text>Made available to the public free of charge; and</text> </level> <level label="ii"> <text>Submitted to the Senate Finance Committee and the House Health and Government Operations Committee in accordance with § 2–1257 of the State Government Article.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-214.3" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <level label="1"> <level label="i"> <text>The Commission shall establish a process for a patient or a patient’s authorized representative to file with the Commission a complaint against a hospital for an alleged violation of § 19–214.1 or § 19–214.2 of this subtitle.</text> </level> <level label="ii"> <text>The process established under subparagraph (i) of this paragraph shall:</text> <level label="1"> <text>Include the option for a patient or a patient’s authorized representative to file the complaint jointly with the Commission and the Health Education and Advocacy Unit; and</text> </level> <level label="2"> <text>Provide the patient or the patient’s authorized representative with the following information:</text> </level> <level label="A"> <text>The Health Education and Advocacy Unit is available to assist the patient or the patient’s authorized representative in filing and mediating a reconsideration request; and</text> </level> <level label="B"> <text>The address, phone number, facsimile number, e–mail address, mailing address, and website of the Health Education and Advocacy Unit.</text> </level> </level> </level> <level label="2"> <level label="i"> <text>Subject to subparagraph (ii) of this paragraph, a complaint filed with the Commission is a public record and is subject to reasonable inspection.</text> </level> <level label="ii"> <text>The Commission shall deny inspection of the complainant’s name, address, or any other personal identifying information.</text> </level> </level> <level label="3"> <text>The filing of a complaint under this subsection does not prevent an individual from:</text> <level label="i"> <text>Exercising any right or seeking any remedy to which the individual may otherwise be entitled; or</text> </level> <level label="ii"> <text>Filing a complaint with any other agency or a court.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>The remedies authorized under this section are in addition to any other statutory, legal, or equitable remedies that may be available and are not intended to be a prerequisite to, or exclusive of, any other remedy.</text> </level> <level label="2"> <text>An individual or a governmental unit is not required to exhaust the administrative remedy authorized under this subtitle before filing suit.</text> </level> </level> <level label="c"> <level label="1"> <text>A waiver by any patient or other individual of any protection provided by § 19–214.1, § 19–214.2, or § 19–214.4 of this subtitle or any regulation adopted under this subtitle is null and void as being against the public policy of the State.</text> </level> <level label="2"> <text>Except as prohibited by federal law, a provision in a hospital’s financial assistance policy or agreement between the patient and a hospital that waives any substantive or procedural right or remedy related to conduct prohibited by § 19–214.1, § 19–214.2, or § 19–214.4 of this subtitle or any regulation adopted under this subtitle is null and void as being against the public policy of the State.</text> </level> </level> <level label="d"> <level label="1"> <text>If a hospital knowingly violates any provision of § 19–214.1 or § 19–214.2 of this subtitle or any regulation adopted under this subtitle, the Commission may impose a fine not to exceed $50,000 per violation.</text> </level> <level label="2"> <text>Before imposing a fine, the Commission shall consider the appropriateness of the fine in relation to the severity of the violation.</text> </level> <level label="3"> <text>A violation by a hospital or an outside collection agency of § 19–214.1 or § 19–214.2 of this subtitle or any regulation adopted under this subtitle is an unfair, abusive, and deceptive trade practice under the Maryland Consumer Protection Act.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-214.4" effective_note="EFFECTIVE UNTIL JUNE 30, 2025 PER CHAPTER 683 OF 2022" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>The Commission, in coordination with the Department, the Department of Human Services, the Office of the Comptroller, the State Department of Education, the Health Education and Advocacy Unit, and the Maryland Hospital Association, shall develop a process that:</text> <level label="1"> <text>Identifies the patients who paid more than $25 for hospital services who may have qualified for free care under § 19–214.1 of this subtitle on the date the hospital service was provided during calendar years 2017 through 2021;</text> </level> <level label="2"> <text>Provides reimbursement to the patients identified under item (1) of this subsection, which may be applied incrementally;</text> </level> <level label="3"> <text>Ensures that a patient’s alternate address is used if the patient requested an alternate address for safety reasons; and</text> </level> <level label="4"> <text>Determines how the Commission, the Department, the Department of Human Services, the Office of the Comptroller, and the State Department of Education should share with or disclose relevant information, including tax information, to the minimum extent necessary, to the hospital and in accordance with federal and State confidentiality laws for the purpose of carrying out the process developed under this subsection.</text> </level> </level> <level label="b"> <text>The Health Education Advocacy Unit in the Office of the Attorney General shall assist patients identified under subsection (a) of this section in obtaining reimbursement under this section.</text> </level> <level label="c"> <level label="1"> <text>The process developed under subsection (a) of this section:</text> <level label="i"> <text>Shall require each hospital to consider:</text> <level label="1"> <text>Tax data from the Office of the Comptroller as de facto evidence of a patient’s income; and</text> </level> <level label="2"> <text>Data from the Department, the Department of Human Services, and the State Department of Education as de facto evidence of a patient’s presumptive eligibility for free care;</text> </level> </level> <level label="ii"> <text>Shall require each hospital to provide refunds to patients who qualify under subsection (g)(2) of this section; and</text> </level> <level label="iii"> <text>May not require a hospital to provide a patient with a refund if the patient previously was denied free care because of a failed asset test for the identified date of service.</text> </level> </level> <level label="2"> <text>Each hospital shall create a webpage that includes:</text> <level label="i"> <text>Information about the reimbursement provided in accordance with this section, including the process to be followed by a patient and relevant timelines; and</text> </level> <level label="ii"> <text>A telephone number and e–mail address that a patient may use to submit questions about the reimbursement process developed under this section.</text> </level> </level> <level label="3"> <text>If a patient is entitled to a single refund per year under subsection (a) of this section in an amount of $25 or less, the hospital may but is not required to provide the reimbursement.</text> </level> </level> <level label="d"> <level label="1"> <text>The Commission may modify the process developed under subsection (a) of this section as necessary.</text> </level> <level label="2"> <text>If reimbursements are provided incrementally and less than 5% of the estimated reimbursements are made each year during the first increment, the Commission is not required to implement additional increments of the process.</text> </level> </level> <level label="e"> <text>The Department, the Department of Human Services, the Office of the Comptroller, the State Department of Education, and each hospital shall report information on the process developed under this section to the Commission, in the time and manner determined by the Commission.</text> </level> <level label="f"> <level label="1"> <text>Notwithstanding any other provision of law, the Commission, the Department, the Department of Human Services, the Office of the Comptroller, the State Department of Education, and each hospital shall disclose to:</text> <level label="i"> <text>Each other, to the minimum extent necessary, relevant information, including tax information, necessary for implementation of the process developed under subsection (a) of this section; and</text> </level> <level label="ii"> <text>The Health Education and Advocacy Unit relevant information necessary for the Health Education and Advocacy Unit to assist patients in obtaining reimbursement under subsection (a) of this section, on receipt of the patient’s executed authorization for release of medical information form provided by the Health Education and Advocacy Unit or other authorization form required by the Department of Human Services, the Office of the Comptroller, or the State Department of Education.</text> </level> </level> <level label="2"> <text>If the Health Education and Advocacy Unit requests information from the Commission, the Department, the Department of Human Services, the Office of the Comptroller, the State Department of Education, or a hospital to assist a patient in obtaining reimbursement under subsection (a) of this section, the Commission, the Department, the Department of Human Services, the Office of the Comptroller, the State Department of Education, or the hospital shall provide the information to the Health Education and Advocacy Unit within 10 business days after the date of the receipt of the request.</text> </level> <level label="3"> <text>This section may not be construed to make a hospital responsible for the confidentiality of the information in possession of each State entity listed in paragraph (1) of this subsection.</text> </level> </level> <level label="g"> <level label="1"> <level label="i"> <text>On or before January 1, 2023, and October 1, 2024, the Commission shall report to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with § 2–1257 of the State Government Article, on the development and implementation by hospitals of the process required under subsection (a) of this section.</text> </level> <level label="ii"> <text>If the process developed under subsection (a) of this section requires legislation for implementation, the Commission shall include the legislative recommendations in the report required on or before January 1, 2023, under subparagraph (i) of this paragraph.</text> </level> <level label="iii"> <text>If the process established under subsection (a) of this section does not require legislation, each hospital shall implement the process developed under subsection (a) of this section on or before January 1, 2023.</text> </level> </level> <level label="2"> <level label="i"> <text>Subject to subparagraph (ii) of this paragraph, each hospital the Commission, the Office of the Comptroller, the Department, the Department of Human Services, and the State Department of Education shall implement Option 3 from the “Free Hospital Care Refund Process” report submitted by the Commission in December 2022 as required under paragraph (1)(i) of this subsection and in accordance with this section and § 13–203(c) of the Tax – General Article.</text> </level> <level label="ii"> <text>Under the process required under subparagraph (i) of this paragraph, a patient shall qualify for refunds who paid an out–of–pocket expense for services based on the following:</text> <level label="1"> <text>The Office of the Comptroller determining that the patient’s family income was at or below 200% of the federal poverty level during the year of service date or dates; or</text> </level> <level label="2"> <text>The Department of Human Services, the Department, or the State Department of Education determining that during the year of service date or dates, the patient:</text> </level> <level label="A"> <text>Received benefits through the federal Supplemental Nutrition Assistance Program;</text> </level> <level label="B"> <text>Received benefits through the State’s Energy Assistance Program;</text> </level> <level label="C"> <text>Received benefits through the federal Special Supplemental Food Program for Women, Infants, and Children; or</text> </level> <level label="D"> <text>Lived in a household with children enrolled in the free and reduced–cost meal program.</text> </level> </level> </level> <level label="3"> <text>The Office of the Comptroller, the Department of Human Services, the Department, the State Department of Education, the Commission, and each hospital may not implement the alternative approach included with Option 3 in the report identified under paragraph (2)(i) of this subsection.</text> </level> </level> <level label="h"> <level label="1"> <text>Each hospital shall reimburse the Commission, the Office of the Comptroller, the Department, the Department of Human Services, the State Department of Education, and the Health Education Advocacy Unit in the Office of the Attorney General for the costs incurred by each State entity in complying with this section.</text> </level> <level label="2"> <level label="i"> <text>Reimbursement required under paragraph (1) of this subsection shall be based on the hospital’s proportion of the total number of patients who were identified by the State entity as potentially eligible for reimbursement in a designated year, as determined by the Commission.</text> </level> <level label="ii"> <text>For the purpose of determining the reimbursement due under subparagraph (i) of this paragraph, the State entities identified under paragraph (1) of this subsection shall provide quarterly cost information to the Commission.</text> </level> </level> <level label="3"> <text>The Commission shall provide each hospital with the reimbursement amount due to the appropriate State entity based on the costs incurred by the entity in complying with this section.</text> </level> </level> <level label="i"> <level label="1"> <level label="i"> <text>If a hospital fails to provide refunds to patients who qualify under subsection (g)(2) of this section as required, the Commission may impose a fine not exceeding $50,000 per violation.</text> </level> <level label="ii"> <text>In determining the amount of a fine to be imposed under subparagraph (i) of this paragraph, the Commission shall consider the appropriateness of the fine in relation to the severity of the violation.</text> </level> </level> <level label="2"> <text>A violation of this section by a hospital is:</text> <level label="i"> <text>An unfair, abusive, or deceptive trade practice, as defined under Title 13 of the Commercial Law Article; and</text> </level> <level label="ii"> <text>Subject to enforcement and penalty provisions of Title 13 of the Commercial Law Article.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-215" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <level label="1"> <text>After public hearings and consultation with any appropriate advisory committee, the Commission shall adopt, by rule or regulation, a uniform accounting and financial reporting system that:</text> <level label="i"> <text>Includes any cost allocation method that the Commission determines; and</text> </level> <level label="ii"> <text>Requires each facility to record its income, revenues, assets, expenses, outlays, liabilities, and units of service.</text> </level> </level> <level label="2"> <text>Each facility shall adopt the uniform accounting and financial reporting system.</text> </level> </level> <level label="b"> <text>In conformity with this subtitle, the Commission may allow and provide for modifications in the uniform accounting and financial reporting system to reflect correctly any differences among facilities in their type, size, financial structure, or scope or type of service.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-216" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>At the end of the fiscal year for a facility, at least 120 days following a merger or a consolidation, and at any other interval that the Commission sets, the facility shall file:</text> <level label="1"> <text>A balance sheet that details its assets, liabilities, and net worth;</text> </level> <level label="2"> <text>A statement of income and expenses;</text> </level> <level label="3"> <text>The most recent Form 990 that the facility filed with the Internal Revenue Service; and</text> </level> <level label="4"> <text>Any other report that the Commission requires about costs incurred in providing services.</text> </level> </level> <level label="b"> <level label="1"> <text>A report under this section shall:</text> <level label="i"> <text>Be in the form that the Commission requires;</text> </level> <level label="ii"> <text>Conform to the uniform accounting and financial reporting system adopted under this subtitle; and</text> </level> <level label="iii"> <text>Be certified by the facility’s certified public accountant.</text> </level> </level> <level label="2"> <text>If the Commission requires, responsible officials of a facility also shall attest that, to the best of their knowledge and belief, the report has been prepared in conformity with the uniform accounting and financial reporting system adopted under § 19–211 of this subtitle.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-217" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>Except as provided in subsection (c) of this section, a facility shall notify the Commission at least 30 days prior to executing any financial transaction, contract, or other agreement that would:</text> <level label="1"> <text>Pledge more than 50% of the operating assets of the facility as collateral for a loan or other obligation;</text> </level> <level label="2"> <text>Result in more than 50% of the operating assets of the facility being sold, leased, or transferred to another person or entity; or</text> </level> <level label="3"> <text>Result in more than 50% of all corporate voting rights or governance reserve powers being transferred to or assumed by another person or entity.</text> </level> </level> <level label="b"> <text>Except as provided in subsection (c) of this section, the Commission shall publish a notice of the proposed financial transaction, contract, or other agreement reported by a facility in accordance with subsection (a) of this section in a newspaper of general circulation in the area where the facility is located.</text> </level> <level label="c"> <text>The provisions of this section do not apply to any financial transaction, contract, or other agreement made by a facility with any issuer of tax–exempt bonds, including the Maryland Health and Higher Education Facilities Authority, the State, or any county or municipal corporation of the State, if a notice of the proposed issuance of revenue bonds that meets the requirements of § 147(f) of the Internal Revenue Code has been published.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-218" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>The Commission shall require each facility to give the Commission information that:</text> <level label="1"> <text>Concerns the total financial needs of the facility;</text> </level> <level label="2"> <text>Concerns its current and expected resources to meet its total financial needs;</text> </level> <level label="3"> <text>Includes the effect of any proposal made, under Subtitle 1 of this title, on comprehensive health planning; and</text> </level> <level label="4"> <text>Includes physician information sufficient to identify practice patterns of individual physicians across all facilities.</text> </level> </level> <level label="b"> <text>The identities of individual physicians are confidential and are not discoverable or admissible in evidence in a civil or criminal proceeding, and may only be disclosed to the following:</text> <level label="1"> <text>The utilization review committee of a Maryland hospital;</text> </level> <level label="2"> <text>The Medical and Chirurgical Faculty of the State of Maryland;</text> </level> <level label="3"> <text>The State Board of Physicians;</text> </level> <level label="4"> <text>The Office of Health Care Quality in the Department;</text> </level> <level label="5"> <text>The Maryland Health Care Commission; or</text> </level> <level label="6"> <text>An investigatory body under the State or federal government.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-219" future_version_removed="true" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>The Commission may review the costs, and rates, quality, and efficiency of facility services, and make any investigation that the Commission considers necessary to assure each purchaser of health care facility services that:</text> <level label="1"> <text>The total costs of all hospital services offered by or through a facility are reasonable;</text> </level> <level label="2"> <text>The aggregate rates of the facility are related reasonably to the aggregate costs of the facility; and</text> </level> <level label="3"> <text>Except as provided in § 19–214.2(l) of this subtitle, the rates are set equitably among all purchasers or classes of purchasers without undue discrimination or preference.</text> </level> </level> <level label="b"> <level label="1"> <text>To carry out its powers under subsection (a) of this section, the Commission may review and approve or disapprove the reasonableness of any rate or amount of revenue that a facility sets or requests.</text> </level> <level label="2"> <text>A facility shall:</text> <level label="i"> <text>Charge for services only at a rate set in accordance with this subtitle; and</text> </level> <level label="ii"> <text>Comply with the applicable terms and conditions of the all–payer model contract.</text> </level> </level> <level label="3"> <text>Consistent with the all–payer model contract, in determining the reasonableness of rates, the Commission may take into account objective standards of efficiency and effectiveness.</text> </level> </level> <level label="c"> <text>Consistent with the all–payer model contract, and notwithstanding any other provision of this subtitle, the Commission may:</text> <level label="1"> <text>Establish hospital rate levels and rate increases in the aggregate or on a hospital–specific basis;</text> </level> <level label="2"> <text>Promote and approve alternative methods of rate determination and payment of an experimental nature for the duration of the all–payer model contract; and</text> </level> <level label="3"> <text>On request of the Secretary, assist in the implementation of federally approved model programs.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-220" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <level label="1"> <text>To have the statistical information needed for rate review and approval, the Commission shall compile all relevant financial and accounting information.</text> </level> <level label="2"> <text>The information shall include:</text> <level label="i"> <text>Necessary operating expenses;</text> </level> <level label="ii"> <text>Appropriate expenses that are incurred in providing services to patients who cannot or do not pay;</text> </level> <level label="iii"> <text>Incurred interest charges; and</text> </level> <level label="iv"> <text>Reasonable depreciation expenses that are based on the expected useful life of property or equipment.</text> </level> </level> </level> <level label="b"> <text>The Commission shall define, by regulation, the types and classes of charges that may not be changed, except as specified in § 19-222 of this subtitle.</text> </level> <level label="c"> <text>The Commission shall obtain from each facility its current rate schedule and each later change in the schedule that the Commission requires.</text> </level> <level label="d"> <text>Consistent with the all–payer model contract approved by the federal Center for Medicare and Medicaid Innovation, the Commission shall:</text> <level label="1"> <text>Permit a nonprofit facility to charge reasonable rates that will permit the facility to provide, on a solvent basis, effective and efficient service that is in the public interest; and</text> </level> <level label="2"> <text>Permit a proprietary profit–making facility to charge reasonable rates that:</text> <level label="i"> <text>Will permit the facility to provide effective and efficient service that is in the public interest; and</text> </level> <level label="ii"> <text>Based on the fair value of the property and investments that are related directly to the facility, include enough allowance for and provide a fair return to the owner of the facility.</text> </level> </level> </level> <level label="e"> <text>In the determination of reasonable rates for each facility, as specified in this section, the Commission shall take into account all of the cost of complying with recommendations made, under Subtitle 1 of this title, on comprehensive health planning.</text> </level> <level label="f"> <text>In reviewing rates or charges or considering a request for change in rates or charges, the Commission shall permit a facility to charge rates that, in the aggregate, will produce enough total revenue to enable the facility to meet reasonably each requirement specified in this section.</text> </level> <level label="g"> <text>Except as otherwise provided by law, in reviewing rates or charges or considering a request for changes in rates or charges, the Commission may not hold executive sessions.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-221" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <text>The Commission shall use any reasonable, relevant, or generally accepted accounting principles to determine reasonable rates for each facility.</text> </section> <section article="ghg" article_name="Health - General" number="19-222" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <level label="1"> <text>A facility may not change any rate schedule or charge of any type or class defined under § 19-220(b) of this subtitle, unless the facility files with the Commission a written notice of the proposed change that is supported by any information that the facility considers appropriate.</text> </level> <level label="2"> <text>Unless the Commission orders otherwise in conformity to this section, a change in the rate schedule or charge is effective on the date that the notice specifies. That effective date shall be at least 30 days after the date on which the notice is filed.</text> </level> </level> <level label="b"> <level label="1"> <text>Commission review of a proposed change may not exceed 150 days after the notice is filed.</text> </level> <level label="2"> <text>The Commission may hold a public hearing to consider the notice.</text> </level> <level label="3"> <text>If the Commission decides to hold a public hearing, the Commission:</text> <level label="i"> <text>Within 65 days after the filing of the notice, shall set a place and date for the hearing; and</text> </level> <level label="ii"> <text>May suspend the effective date of any proposed change until 30 days after conclusion of the hearing.</text> </level> </level> <level label="4"> <text>If the Commission suspends the effective date of a proposed change, the Commission shall give the facility a written statement of the reasons for the suspension.</text> </level> <level label="5"> <text>The Commission:</text> <level label="i"> <text>May conduct the public hearing without complying with formal rules of evidence; and</text> </level> <level label="ii"> <text>Shall allow any interested party to introduce evidence that relates to the proposed change, including testimony by witnesses.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>The Commission may permit a facility to change any rate or charge temporarily, if the Commission considers it to be in the public interest.</text> </level> <level label="2"> <text>An approved temporary change becomes effective immediately on filing.</text> </level> <level label="3"> <text>Under the review procedures of this section, the Commission promptly shall consider the reasonableness of the temporary change.</text> </level> </level> <level label="d"> <text>If the Commission modifies a proposed change or approves only part of a proposed change, a facility, without losing its right to appeal the part of the Commission order that denies full approval of the proposed change, may:</text> <level label="1"> <text>Charge its patients according to the decision of the Commission; and</text> </level> <level label="2"> <text>Accept any benefits under that decision.</text> </level> </level> <level label="e"> <text>If a change in any rate or charge increase becomes effective because a final determination is delayed because of an appeal or otherwise, the Commission may order the facility:</text> <level label="1"> <text>To keep a detailed and accurate account of:</text> <level label="i"> <text>Funds received because of the change; and</text> </level> <level label="ii"> <text>The persons from whom these funds were collected; and</text> </level> </level> <level label="2"> <text>As to any funds received because of a change that later is held excessive or unreasonable:</text> <level label="i"> <text>To refund the funds with interest; or</text> </level> <level label="ii"> <text>If a refund of the funds is impracticable, to charge over and amortize the funds through a temporary decrease in charges or rates.</text> </level> </level> </level> <level label="f"> <text>A decision by the Commission on any contested change under this section shall comply with the Administrative Procedure Act and shall be only prospective in effect.</text> </level> <level label="g"> <level label="1"> <text>The State Health Services Cost Review Commission shall provide incentives for merger, consolidation, and conversion and for the implementation of the institution–specific plan developed in accordance with § 19–119 of this title.</text> </level> <level label="2"> <text>Notwithstanding any of the provisions in this section, on notification of a merger or consolidation by 2 or more hospitals, the Commission shall review the rates of those hospitals that are directly involved in the merger or consolidation in accordance with the rate review and approval procedures provided in § 19–220 of this subtitle and the regulations of the Commission.</text> </level> <level label="3"> <text>The Commission may provide, as appropriate, for temporary adjustment of the rates of those hospitals that are directly involved in the merger or consolidation, closure, or delicensure in order to provide sufficient funds for an orderly transition. These funds may include:</text> <level label="i"> <text>Allowances for those employees who are or would be displaced;</text> </level> <level label="ii"> <text>Allowances to permit a surviving institution in a merger to generate capital to convert a closed facility to an alternate use;</text> </level> <level label="iii"> <text>Any other closure costs as defined in § 10–340 of the Economic Development Article; or</text> </level> <level label="iv"> <text>Agreements to allow retention of a portion of the savings that result for a designated period of time.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-223" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <text>The Commission shall assess a fee on all hospitals whose rates have been approved by the Commission to pay for:</text> <level label="1"> <text>To the extent provided for in Title 10, Subtitle 3, Part IV of the Economic Development Article, the amounts required by § 10–350 of the Economic Development Article with respect to public obligations or closure costs of a closed or delicensed hospital; and</text> </level> <level label="2"> <text>Funding the Hospital Employees Retraining Fund.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-224" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>This section applies to each person that is concurrently:</text> <level label="1"> <text>A trustee, director, or officer of any nonprofit facility in this State; and</text> </level> <level label="2"> <text>An employee, partner, director, officer, or beneficial owner of 3 percent or more of the capital account or stock of:</text> <level label="i"> <text>A partnership;</text> </level> <level label="ii"> <text>A firm;</text> </level> <level label="iii"> <text>A corporation; or</text> </level> <level label="iv"> <text>Any other business entity.</text> </level> </level> </level> <level label="b"> <text>Each person specified in subsection (a) of this section shall file with the Commission an annual report that discloses, in detail, each business transaction between any business entity specified in subsection (a)(2) of this section and any facility that the person serves as specified in subsection (a)(1) of this section, if any of the following is $10,000 or more a year:</text> <level label="1"> <text>The actual or imputed value or worth to the business entity of any transaction between it and the facility; or</text> </level> <level label="2"> <text>The amount of the contract price, consideration, or other advances by the facility as part of the transaction.</text> </level> </level> <level label="c"> <text>A report under this section shall be:</text> <level label="1"> <text>Signed and verified; and</text> </level> <level label="2"> <text>Filed in accordance with the procedures and on the form that the Commission requires.</text> </level> </level> <level label="d"> <text>A person that willfully fails to file any report required by this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $500.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-225" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>In any matter that relates to a facility’s cost of services and consistent with the all–payer model contract, the Commission may:</text> <level label="1"> <text>Hold a public hearing;</text> </level> <level label="2"> <text>Conduct an investigation;</text> </level> <level label="3"> <text>Require the filing of any information; or</text> </level> <level label="4"> <text>Subpoena any witness or evidence.</text> </level> </level> <level label="b"> <text>The Executive Director of the Commission may administer oaths in connection with any hearing or investigation under this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-226" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <text>If the Commission considers a further investigation necessary or desirable to authenticate information in a report that a facility files under this subtitle, consistent with the all–payer model contract, the Commission may make any necessary further examination of the records or accounts of the facility, in accordance with the rules or regulations of the Commission.</text> </level> <level label="b"> <text>The examination under this section may include a full or partial audit of the records or accounts of the facility that is:</text> <level label="1"> <text>Provided by the facility; or</text> </level> <level label="2"> <text>Performed by:</text> <level label="i"> <text>The staff of the Commission;</text> </level> <level label="ii"> <text>A third party for the Commission; or</text> </level> <level label="iii"> <text>The Legislative Auditor.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-227" title_number="19" title_name="Health Care Facilities" subtitle_number="2" subtitle_name="Health Services Cost Review Commission"> <level label="a"> <level label="1"> <text>Any person aggrieved by a final decision of the Commission under this subtitle may take a direct judicial appeal.</text> </level> <level label="2"> <text>The appeal shall be made as provided for judicial review of final decisions in the Administrative Procedure Act.</text> </level> </level> <level label="b"> <level label="1"> <text>An appeal from a final decision of the Commission under this section shall be taken in the name of the person aggrieved as appellant and against the Commission as appellee.</text> </level> <level label="2"> <text>The Commission is a necessary party to an appeal at all levels of the appeal.</text> </level> <level label="3"> <text>The Commission may appeal any decision that affects any of its final decisions to a higher level for further review.</text> </level> <level label="4"> <text>On grant of leave by the appropriate court, any aggrieved party or interested person may intervene or participate in an appeal at any level.</text> </level> </level> <level label="c"> <text>Any person, government agency, or nonprofit health service plan that contracts with or pays a facility for health care services has standing to participate in Commission hearings and shall be allowed to appeal final decisions of the Commission.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-301" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Accredited hospital” means a hospital accredited by the Joint Commission on Accreditation of Healthcare Organizations.</text> </level> <level label="c"> <text>“Accredited residential treatment center” means a residential treatment center that is accredited by:</text> <level label="1"> <text>The Joint Commission on Accreditation of Healthcare Organizations;</text> </level> <level label="2"> <text>The Commission on Accreditation of Rehabilitation Facilities; or</text> </level> <level label="3"> <text>The Council on Accreditation.</text> </level> </level> <level label="d"> <text>“Apartment unit” means any space, in a residential building, that is enclosed and self-contained and has a sanitary environment, if the space includes:</text> <level label="1"> <text>2 or more rooms;</text> </level> <level label="2"> <text>A direct exit to a thoroughfare or to a common element leading to a thoroughfare;</text> </level> <level label="3"> <text>Facilities for living, sleeping, and eating; and</text> </level> <level label="4"> <text>At least the following facilities for cooking:</text> <level label="i"> <text>Storage space for food and utensils;</text> </level> <level label="ii"> <text>A refrigerator;</text> </level> <level label="iii"> <text>A cook top; and</text> </level> <level label="iv"> <text>Adequate electrical capacity and outlets for small appliances.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>“Domiciliary care” means services that are provided to aged or disabled individuals in a protective, institutional or home-type environment.</text> </level> <level label="2"> <text>“Domiciliary care” includes:</text> <level label="i"> <text>Shelter;</text> </level> <level label="ii"> <text>Housekeeping services;</text> </level> <level label="iii"> <text>Board;</text> </level> <level label="iv"> <text>Facilities and resources for daily living; and</text> </level> <level label="v"> <text>Personal surveillance or direction in the activities of daily living.</text> </level> </level> </level> <level label="f"> <text>“Hospital” means an institution that:</text> <level label="1"> <text>Has a group of at least 5 physicians who are organized as a medical staff for the institution;</text> </level> <level label="2"> <text>Maintains facilities to provide, under the supervision of the medical staff, diagnostic and treatment services for 2 or more unrelated individuals; and</text> </level> <level label="3"> <text>Admits or retains the individuals for overnight care.</text> </level> </level> <level label="g"> <text>“License” means a license issued by the Secretary:</text> <level label="1"> <text>To operate a hospital in this State;</text> </level> <level label="2"> <text>To operate a related institution in this State; or</text> </level> <level label="3"> <text>To operate a residential treatment center in this State.</text> </level> </level> <level label="h"> <text>“Limited service hospital” means a health care facility that:</text> <level label="1"> <text>Is licensed as a hospital on or after January 1, 1999;</text> </level> <level label="2"> <text>Changes the type or scope of health care services offered by eliminating the facility’s capability to admit or retain patients for overnight hospitalization;</text> </level> <level label="3"> <text>Retains an emergency or urgent care center; and</text> </level> <level label="4"> <text>Complies with the regulations adopted by the Secretary under § 19-307.1 of this subtitle.</text> </level> </level> <level label="i"> <text>“Nonaccredited hospital” means a hospital not accredited by the Joint Commission on Accreditation of Healthcare Organizations.</text> </level> <level label="j"> <text>“Nonaccredited residential treatment center” means a residential treatment center that is not accredited by:</text> <level label="1"> <text>The Joint Commission on Accreditation of Healthcare Organizations;</text> </level> <level label="2"> <text>The Commission on Accreditation of Rehabilitation Facilities; or</text> </level> <level label="3"> <text>The Council on Accreditation.</text> </level> </level> <level label="k"> <text>“Nursing care” means service for a patient that is:</text> <level label="1"> <text>Ordered by a physician; and</text> </level> <level label="2"> <text>Provided or supervised by a registered or practical nurse who is licensed to practice in this State.</text> </level> </level> <level label="l"> <text>“Nursing facility” means a related institution that provides nursing care for 2 or more unrelated individuals.</text> </level> <level label="m"> <text>“Person” includes this State or a county or municipal corporation.</text> </level> <level label="n"> <level label="1"> <text>“Personal care” means a service that an individual normally would perform personally, but for which the individual needs help from another because of advanced age, infirmity, or physical or mental limitation.</text> </level> <level label="2"> <text>“Personal care” includes:</text> <level label="i"> <text>Help in walking;</text> </level> <level label="ii"> <text>Help in getting in and out of bed;</text> </level> <level label="iii"> <text>Help in bathing;</text> </level> <level label="iv"> <text>Help in dressing;</text> </level> <level label="v"> <text>Help in feeding; and</text> </level> <level label="vi"> <text>General supervision and help in daily living.</text> </level> </level> </level> <level label="o"> <level label="1"> <text>“Related institution” means an organized institution, environment, or home that:</text> <level label="i"> <text>Maintains conditions or facilities and equipment to provide domiciliary, personal, or nursing care for 2 or more unrelated individuals who are dependent on the administrator, operator, or proprietor for nursing care or the subsistence of daily living in a safe, sanitary, and healthful environment; and</text> </level> <level label="ii"> <text>Admits or retains the individuals for overnight care.</text> </level> </level> <level label="2"> <text>“Related institution” does not include a nursing facility or visiting nurse service that is conducted only by or for adherents of a bona fide church or religious organization, in accordance with tenets and practices that include reliance on treatment by spiritual means alone for healing.</text> </level> </level> <level label="p"> <text>“Residential treatment center” means a psychiatric institution that provides campus-based intensive and extensive evaluation and treatment of children and adolescents with severe and chronic emotional disturbances who require a self-contained therapeutic, educational, and recreational program in a residential setting.</text> </level> <level label="q"> <text>“Unrelated individual” means anyone who is not:</text> <level label="1"> <text>A child, grandchild, parent, grandparent, sibling, stepparent, stepchild, or spouse of the proprietor; or</text> </level> <level label="2"> <text>An in-law of any of these individuals.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-302" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>This subtitle does not apply to a dispensary or first aid treatment facility that is maintained only to provide services for:</text> <level label="1"> <text>Employees of a commercial or industrial plant;</text> </level> <level label="2"> <text>Employees or students of an educational institution; or</text> </level> <level label="3"> <text>Individuals in a convent, county home, motel, hotel, apartment, or facility, if the individuals are able to live independently.</text> </level> </level> <level label="b"> <text>This subtitle applies to the provision of home health care services by a hospital or related institution to 2 or more unrelated individuals, whether the services are provided directly or under contract with a home health agency.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-303" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Commission” means the Health Services Cost Review Commission.</text> </level> <level label="3"> <level label="i"> <text>“Community benefit” means a planned, organized, and measured activity that is intended to meet identified community health needs within a service area.</text> </level> <level label="ii"> <text>“Community benefit” may include:</text> <level label="1"> <text>A community health service;</text> </level> <level label="2"> <text>Health professional education;</text> </level> <level label="3"> <text>Research;</text> </level> <level label="4"> <text>A financial contribution;</text> </level> <level label="5"> <text>A community–building activity, including partnerships with community–based organizations;</text> </level> <level label="6"> <text>Charity care;</text> </level> <level label="7"> <text>An activity described under subparagraph (i) of this paragraph that is funded by a foundation;</text> </level> <level label="8"> <text>A mission–driven health service;</text> </level> <level label="9"> <text>An operation related to an activity described under subparagraph (i) of this paragraph;</text> </level> <level label="10"> <text>Financial or in–kind support of the Maryland Behavioral Health Crisis Response System; and</text> </level> <level label="11"> <text>A community health worker workforce program established in accordance with § 19–303.1 of this subtitle.</text> </level> </level> </level> <level label="4"> <text>“Community Benefit Reporting Workgroup” means the Community Benefit Reporting Workgroup established in accordance with subsection (b) of this section.</text> </level> <level label="5"> <text>“Community health needs assessment” means the process required by the Affordable Care Act by which unmet community health care needs and priorities are identified by a nonprofit hospital in accordance with § 501(r)(3) of the Internal Revenue Code.</text> </level> </level> <level label="b"> <level label="1"> <text>The Commission shall establish a Community Benefit Reporting Workgroup.</text> </level> <level label="2"> <text>The Community Benefit Reporting Workgroup shall be composed of individuals and stakeholder groups that have knowledge of and are impacted by hospital community benefit spending.</text> </level> </level> <level label="c"> <text>The Commission shall adopt regulations to implement the recommendations of the Community Benefit Reporting Workgroup, that:</text> <level label="1"> <text>Establish a standard format for reporting the information required under this subsection;</text> </level> <level label="2"> <text>Specify the date by which each nonprofit hospital is required to submit the annual community benefit report;</text> </level> <level label="3"> <text>Require each nonprofit hospital to solicit and take into account input received from individuals who represent the broad interests of that community, including individuals with special knowledge of or expertise in public and behavioral health in accordance with § 501(r)(3) of the Internal Revenue Code;</text> </level> <level label="4"> <text>Require each nonprofit hospital to conduct its community health needs assessment in consultation with community members as recommended by the Community Benefit Reporting Workgroup and to submit an annual community benefits report to the Commission detailing the community benefits provided by the hospital during the preceding year that includes:</text> <level label="i"> <text>The mission statement of the hospital;</text> </level> <level label="ii"> <text>A list of the activities that were undertaken by the hospital to address the identified community health needs within the hospital’s community;</text> </level> <level label="iii"> <text>The cost to the hospital of each community benefit activity;</text> </level> <level label="iv"> <text>A description of how each of the listed activities addresses the community health needs of the hospital’s community;</text> </level> <level label="v"> <text>A description of efforts taken to evaluate the effectiveness of each community benefit activity;</text> </level> <level label="vi"> <text>A description of gaps in the availability of providers to serve the community;</text> </level> <level label="vii"> <text>A description of the hospital’s efforts to track and reduce health disparities in the community that the hospital serves;</text> </level> <level label="viii"> <text>A list of the unmet community health needs identified in the most recent community health needs assessment; and</text> </level> <level label="ix"> <text>A list of tax exemptions the hospital claimed during the immediately preceding taxable year, in accordance with State law.</text> </level> </level> </level> <level label="d"> <text>The Commission shall establish a method through which State and local governing bodies are made aware of the meetings of the Community Benefit Reporting Workgroup.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-303.1" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this section, “community health worker” has the meaning stated in § 13–3701 of this article.</text> </level> <level label="b"> <level label="1"> <text>A community benefit under § 19–303 of this subtitle may include a partnership between a nonprofit hospital and a community–based organization to establish a community health worker workforce program.</text> </level> <level label="2"> <text>The primary purpose of a community health worker workforce program shall be to provide services to patients of a nonprofit hospital that are intended to improve health outcomes and address social determinants of health.</text> </level> </level> <level label="c"> <level label="1"> <text>A partnership established under this section may be executed through a memorandum of understanding between a nonprofit hospital and a community–based organization.</text> </level> <level label="2"> <text>The memorandum of understanding shall include:</text> <level label="i"> <text>The program design;</text> </level> <level label="ii"> <text>Goals for patient health outcomes;</text> </level> <level label="iii"> <text>Implementation procedures;</text> </level> <level label="iv"> <text>Criteria for evaluation and impact measurement;</text> </level> <level label="v"> <text>Data collection, management, and reporting standards and protocols that are in accordance with applicable federal and State laws and regulations, including the federal Health Insurance Portability and Accountability Act; and</text> </level> <level label="vi"> <text>An agreement between the nonprofit hospital and the community–based organization identifying which party will be responsible for:</text> <level label="1"> <text>Recruiting and employing the community health worker workforce;</text> </level> <level label="2"> <text>Supervising the workforce in the settings in which the community health workers will provide services to patients;</text> </level> <level label="3"> <text>Training the workforce; and</text> </level> <level label="4"> <text>Providing employer–sponsored health insurance coverage to each community health worker.</text> </level> </level> </level> </level> <level label="d"> <text>A partnership established under this section may provide health insurance coverage to each community health worker for the duration of the program if the individual does not have health insurance coverage and requests coverage.</text> </level> <level label="e"> <text>A nonprofit hospital and a community–based organization may collaborate to identify financial resources to address costs associated with increasing administrative capacity within the community–based organization necessary to participate in the partnership.</text> </level> <level label="f"> <text>Subject to other provisions of law governing community benefits and on the agreement of the parties, a nonprofit hospital may provide financial support to a community–based organization to cover the costs associated with increasing administrative capacity within the community–based organization necessary to participate in the partnership.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-304" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>A hospital or related institution shall:</text> <level label="1"> <text>Report an unexpected occurrence related to an individual’s medical treatment that results in death or serious disability that is not related to the natural course of the individual’s illness or underlying disease condition; and</text> </level> <level label="2"> <text>Submit the report to the Department within 5 days of the hospital’s or related institution’s knowledge of the occurrence.</text> </level> </level> <level label="b"> <text>A hospital or related institution may report to the Department an unexpected occurrence or other incident related to an individual’s medical treatment that does not result in death or serious disability.</text> </level> <level label="c"> <text>A hospital or related institution shall:</text> <level label="1"> <text>Conduct a root cause analysis of an occurrence required to be reported under subsection (a) of this section; and</text> </level> <level label="2"> <text>Unless the Department approves a longer time period, submit the root cause analysis to the Department within 60 days of the hospital’s or related institution’s knowledge of the occurrence.</text> </level> </level> <level label="d"> <text>If a hospital or related institution fails to comply with subsection (a) or (c) of this section, the Secretary may impose a fine of $500 per day for each day the violation continues.</text> </level> <level label="e"> <text>The Secretary shall adopt regulations to implement this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-305" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Adverse event” means an unexpected occurrence that:</text> <level label="i"> <text>Is related to a resident’s medical or behavioral treatment; and</text> </level> <level label="ii"> <text>Is not related to the natural course of the resident’s illness or underlying disease condition.</text> </level> </level> <level label="3"> <text>“Change in condition” means a significant change in a resident’s physical, mental, or psychological status including:</text> <level label="i"> <text>Life-threatening conditions;</text> </level> <level label="ii"> <text>Clinical complications including significant somatic symptoms that require the assessment of or treatment by qualified medical personnel;</text> </level> <level label="iii"> <text>The need to discontinue a medication or treatment because of:</text> <level label="1"> <text>Adverse consequences; or</text> </level> <level label="2"> <text>The need to begin a new form of treatment;</text> </level> </level> <level label="iv"> <text>Evaluation at or admission to a hospital;</text> </level> <level label="v"> <text>Injuries that require the assessment of or treatment by qualified medical personnel;</text> </level> <level label="vi"> <text>The use of restraint or seclusion; and</text> </level> <level label="vii"> <text>Suicide attempts.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>Within 24 hours, in accordance with State and federal confidentiality laws, a residential treatment center shall attempt to notify a resident and a resident’s representative, family member, legal guardian, or custodian of:</text> <level label="i"> <text>A change in condition;</text> </level> <level label="ii"> <text>An adverse event; and</text> </level> <level label="iii"> <text>Corrective action, if appropriate.</text> </level> </level> <level label="2"> <text>If a residential treatment center sends a notice to an individual under paragraph (1) of this subsection, the individual may send a written response to the residential treatment center instructing the residential treatment center that:</text> <level label="i"> <text>The individual waives the notification required under paragraph (1) of this subsection; or</text> </level> <level label="ii"> <text>The individual requires notification only in the circumstances specified in writing by the individual.</text> </level> </level> </level> <level label="c"> <text>A residential treatment center shall document the notification required under subsection (b)(1) of this section and the response of the resident and the resident’s representative, family member, legal guardian, or custodian in the resident’s medical record.</text> </level> <level label="d"> <text>If the Department determines that a residential treatment center failed to notify a resident and a resident’s representative, family member, legal guardian, or custodian under subsection (b)(1) of this section, the Department shall require the residential treatment center, as part of a plan of correction, to notify the resident and the resident’s representative, family member, legal guardian, or custodian as soon as possible.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-306" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>A hospital shall:</text> <level label="1"> <text>Adopt a policy describing the protocol of the hospital when there is an immigration enforcement action at the hospital consistent with the guidance of the Attorney General issued under § 6–111 of the State Government Article;</text> </level> <level label="2"> <text>Make the hospital’s immigration enforcement action policy available to all hospital staff members; and</text> </level> <level label="3"> <text>Provide annual training to all hospital staff members to ensure the staff’s knowledge and understanding of the immigration enforcement action policy.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-307" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>A hospital shall be classified:</text> <level label="i"> <text>As a general hospital if the hospital at least has the facilities and provides the services that are necessary for the general medical and surgical care of patients;</text> </level> <level label="ii"> <text>As a special hospital if the hospital:</text> <level label="1"> <text>Defines a program of specialized services, such as obstetrics, mental health, tuberculosis, orthopedy, chronic disease, or communicable disease;</text> </level> <level label="2"> <text>Admits only patients with medical or surgical needs within the program; and</text> </level> <level label="3"> <text>Has the facilities for and provides those specialized services;</text> </level> </level> <level label="iii"> <text>As a special rehabilitation hospital if the hospital meets the requirements of this subtitle and Subtitle 12 of this title; or</text> </level> <level label="iv"> <text>As a limited service hospital if the health care facility:</text> <level label="1"> <text>Is licensed as a hospital on or after January 1, 1999;</text> </level> <level label="2"> <text>Changes the type or scope of services offered by eliminating the capability to admit or retain individuals for overnight hospitalization;</text> </level> <level label="3"> <text>Retains an emergency or urgent care center; and</text> </level> <level label="4"> <text>Complies with the regulations adopted by the Secretary under § 19-307.1 of this subtitle.</text> </level> </level> </level> <level label="2"> <text>The Secretary may set, by rule or regulation, other reasonable classifications for hospitals.</text> </level> </level> <level label="b"> <text>A related institution shall be classified:</text> <level label="1"> <text>As a care home if the related institution provides care to individuals who, because of advanced age or physical or mental disability, require domiciliary care or personal care in a protective environment; or</text> </level> <level label="2"> <text>As a nursing home if the related institution:</text> <level label="i"> <text>Provides nursing care for chronically ill or convalescent patients; or</text> </level> <level label="ii"> <text>Offers to provide 24-hour a day nursing care of patients in a home-type facility such as:</text> <level label="1"> <text>A convalescent home;</text> </level> <level label="2"> <text>A nursing unit of a home for the aged;</text> </level> <level label="3"> <text>A psychiatric nursing home;</text> </level> <level label="4"> <text>A nursing facility for individuals with disabilities;</text> </level> <level label="5"> <text>A home for alcoholics; or</text> </level> <level label="6"> <text>A halfway house.</text> </level> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-307.1" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>The Department shall adopt regulations for a limited service hospital that include the following standards:</text> <level label="1"> <text>The limited service hospital shall be open 24 hours a day, 7 days a week;</text> </level> <level label="2"> <text>There shall be at least one physician credentialed in emergency medicine at the limited service hospital at all times;</text> </level> <level label="3"> <text>A sufficient number of registered nurses and other health professionals shall be available at the limited service hospital to provide advanced life support;</text> </level> <level label="4"> <text>Basic X–ray and laboratory facilities shall be available at the limited service hospital and operable at all times by one radiology technician and one laboratory technician;</text> </level> <level label="5"> <text>Resuscitation equipment, including monitor, defibrillator, cardiac medications, intubation equipment, and intravenous line equipment shall be available at the limited service hospital and operable at all times;</text> </level> <level label="6"> <text>Standard procedures in accordance with the State Emergency Medical Services Plan shall exist for the immediate transport of individuals in need of hospitalization or other more definitive care;</text> </level> <level label="7"> <text>A specific defined role in the Emergency Medical Services System with appropriate telephone communication shall exist;</text> </level> <level label="8"> <text>Emergency services shall be available to all persons regardless of ability to pay;</text> </level> <level label="9"> <text>Adoption, implementation, and enforcement of a policy shall exist that requires, except in an emergency life–threatening situation where it is not feasible or practicable, compliance by all employees and medical staff involved in patient care services with the Centers for Disease Control and Prevention’s guidelines on universal precautions; and</text> </level> <level label="10"> <text>Any other standard that the Secretary deems necessary to ensure the quality of the services provided by a limited service hospital.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-307.2" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>For a hospital classified as a general hospital, the Secretary shall annually calculate the hospital’s licensed bed capacity.</text> </level> <level label="b"> <text>The annual licensed bed calculation for each hospital shall equal 140 percent of the average daily census for the 12-month period immediately preceding the calculation.</text> </level> <level label="c"> <text>If necessary to adequately meet demand for services, a hospital may exceed its licensed bed capacity if:</text> <level label="1"> <text>On average for the 12-month period, the hospital does not exceed its licensed bed capacity based on the annual calculation; and</text> </level> <level label="2"> <text>The hospital includes in its monthly report to the Health Services Cost Review Commission the following information:</text> <level label="i"> <text>The number of days in the month the hospital exceeded its licensed bed capacity; and</text> </level> <level label="ii"> <text>The number of beds that were in excess on each of those days.</text> </level> </level> </level> <level label="d"> <text>Before July 1, 2000 and each July 1 thereafter, the Secretary shall delicense any licensed hospital beds determined to be excess bed capacity under subsection (b) of this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-308" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>The Secretary shall adopt reasonable rules and regulations that set standards of services for related institutions, accredited hospitals, nonaccredited hospitals, accredited residential treatment centers, and nonaccredited residential treatment centers in the following areas:</text> <level label="1"> <text>The care of patients;</text> </level> <level label="2"> <text>The medical supervision of patients;</text> </level> <level label="3"> <text>The physical environment;</text> </level> <level label="4"> <text>Disease control;</text> </level> <level label="5"> <text>Sanitation;</text> </level> <level label="6"> <text>Safety; and</text> </level> <level label="7"> <text>Dietary matters.</text> </level> </level> <level label="b"> <level label="1"> <text>To assure compliance with the standards adopted under this subtitle, the Secretary shall have an inspection made:</text> <level label="i"> <text>Of each related institution, each accredited hospital or nonaccredited hospital, and each accredited residential treatment center or nonaccredited residential treatment center for which a license is sought; and</text> </level> <level label="ii"> <text>Periodically of each related institution, each accredited hospital or nonaccredited hospital, and each accredited residential treatment center or nonaccredited residential treatment center for which a license has been issued.</text> </level> </level> <level label="2"> <text>At least 2 inspections a year of each related institution shall be unannounced.</text> </level> <level label="3"> <text>The part of a building that contains part of a hospital, residential treatment center, or related institution and any outbuilding are considered part of the facility and are subject to inspection to determine occupancy status for licensing purposes.</text> </level> <level label="4"> <text>Subject to § 2–1257 of the State Government Article, during each regular session of the General Assembly, the Department shall submit to the General Assembly a report on the inspections.</text> </level> <level label="5"> <level label="i"> <text>An employee of the Department may not inform a hospital, residential treatment center, or related institution of any proposed inspection activity, unless the chief of the employee’s division directs the employee to do so.</text> </level> <level label="ii"> <text>An employee who violates any provision of this paragraph is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 or imprisonment not exceeding 1 year or both.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-308.1" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>In this section, “patient care personnel” means an individual whom a related institution employs to provide health related or personal care services.</text> </level> <level label="2"> <text>“Patient care personnel” does not include an individual who provides general administrative, nonmedical supervisory, or record keeping services in a related institution.</text> </level> </level> <level label="b"> <text>The Secretary may adopt reasonable rules and regulations that set minimum qualifications for patient care personnel who are not licensed under the Health Occupations Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-308.2" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>Subsection (b)(1) of this section is not intended to preempt the requirements of § 10-625 of this article.</text> </level> <level label="2"> <text>The Department shall adopt guidelines, after consultation with the Maryland Hospital Association, Inc., governing the transfer of patients between hospitals to ensure that transfers of patients between hospitals are accomplished in a medically appropriate manner and in accordance with the health care policies of the State that, at a minimum, require:</text> <level label="i"> <text>Notification to the receiving hospital before the transfer and confirmation by that hospital that the patient meets that hospital’s admissions criteria relating to appropriate bed, physician, and other services necessary to treat the patient;</text> </level> <level label="ii"> <text>The use of medically appropriate life-support measures that a reasonable and prudent physician exercising ordinary care would use to stabilize the patient before transfer and to sustain the patient during the transfer;</text> </level> <level label="iii"> <text>The provision of appropriate personnel and equipment that a reasonable and prudent physician exercising ordinary care would use for the transfer; and</text> </level> <level label="iv"> <text>The transfer of all necessary records for continuing the care for the patient.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>The Department shall adopt regulations providing for penalties for hospitals that violate provisions of subsection (a) of this section.</text> </level> <level label="2"> <text>A penalty not exceeding $1,000 may be imposed per violation.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-308.3" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this section “facility” means a related institution that, under the regulations of the Department, is a comprehensive care facility or an extended care facility.</text> </level> <level label="b"> <text>Before a facility may use an application or contract for admission the administrator of the facility shall submit the application or contract for admission to the Department.</text> </level> <level label="c"> <text>Before a facility may make any substantive change in an application or contract for admission that has been submitted under subsection (b) of this section, the administrator of the facility shall submit the proposed change to the Department.</text> </level> <level label="d"> <text>The Department, after consulting with the Department of Aging, shall review the applications and contracts to assure:</text> <level label="1"> <text>That the rights, responsibilities, and duties of the parties are set forth clearly and legibly;</text> </level> <level label="2"> <text>That they comply with applicable federal and State laws, including the patient’s bill of rights; and</text> </level> <level label="3"> <text>That they do not contain provisions which are unenforceable because of public policy.</text> </level> </level> <level label="e"> <level label="1"> <text>Any application or contract for admission submitted by a facility to the Department for review and approval in accordance with the provisions of this section shall be deemed approved if the Department fails to make a decision on the proposed application or contract for admission within 30 days of its submission.</text> </level> <level label="2"> <text>Any substantive change in an application or contract for admission submitted by a facility to the Department for review and approval in accordance with the provisions of this section shall be deemed approved if the Department fails to make a decision on the proposed substantive change within 15 days of its submission.</text> </level> <level label="3"> <text>Any decision disapproving any provision of any application or contract shall clearly and with particularity state the grounds for such disapproval.</text> </level> </level> <level label="f"> <text>The Department shall adopt regulations to implement the provisions of this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-308.4" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>Each hospital or nursing facility in the State shall ensure that its employees and any other individuals who provide a health care service within or on the premises of the hospital or nursing facility wear a personal identification tag, except where inappropriate for medical reasons, that indicates in readable text:</text> <level label="1"> <text>The first name, nickname, last name, or full name of the individual that is commonly used in the hospital or nursing facility; and</text> </level> <level label="2"> <text>The professional or other title of the individual.</text> </level> </level> <level label="b"> <text>The Secretary may impose a fine not to exceed $25 per violation of this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-308.5" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>Each hospital that provides obstetrical services shall establish a universal newborn hearing screening program to ensure that:</text> <level label="1"> <level label="i"> <text>All newborns born in the hospital are screened for hearing loss before discharge; and</text> </level> <level label="ii"> <text>The results are reported as required under § 13–605 of this article; and</text> </level> </level> <level label="2"> <text>Before discharge and to the extent practicable, the hospital provides to the parent or legal guardian of a newborn identified as having a hearing loss under item (1)(i) of this subsection a list of resources available for parents of children with hearing loss, including:</text> <level label="i"> <text>Locations for subsequent testing; and</text> </level> <level label="ii"> <text>Resources on language and communication mode options for communicating with their child.</text> </level> </level> </level> <level label="b"> <text>The universal newborn hearing screening program established under this section shall consist of at least one of the following screening tests:</text> <level label="1"> <text>Auditory brain stem response;</text> </level> <level label="2"> <text>Otoacoustic emissions; or</text> </level> <level label="3"> <text>Another appropriate screening test recommended by the Advisory Council and approved by the Secretary.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-308.6" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>The Secretary, in consultation with the Association of Maryland Hospitals and Health Systems and the Maryland Association of Hospital Security and Safety Directors, shall develop a uniform set of emergency security codes for hospitals.</text> </level> <level label="b"> <text>The Secretary shall adopt regulations to implement the uniform set of emergency security codes.</text> </level> <level label="c"> <text>Each hospital in Maryland shall implement the provisions of the uniform set of emergency security codes for hospitals within 2 years of the adoption of the regulations by the Secretary.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-308.7" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>Unless it is medically inadvisable, each hospital shall allow a pregnant patient to arrange for the donation of the blood extracted from the umbilical cord of the patient’s newborn child to a certified public cord blood bank.</text> </level> <level label="b"> <text>A patient who agrees to donate cord blood to a public cord blood bank may not be charged for the costs of collecting, storing, or transporting the cord blood.</text> </level> <level label="c"> <text>A hospital is not required to collect cord blood if in the professional judgment of a licensed physician the collection of the cord blood would threaten the health of the mother or newborn child.</text> </level> <level label="d"> <text>A hospital or hospital employee, including a physician, nurse, or other medical staff, may not be required to collect cord blood if the collection of cord blood conflicts with the bona fide religious practices and beliefs of the hospital or hospital employee.</text> </level> <level label="e"> <text>This section may not be construed to require a hospital to arrange for the donation of blood extracted from umbilical cords.</text> </level> <level label="f"> <level label="1"> <text>The Department, in consultation with obstetricians, the Maryland Hospital Association, and interested groups, shall develop educational materials concerning the values, uses, and donation of umbilical cord blood for the purposes of paragraph (2) of this subsection.</text> </level> <level label="2"> <text>Each obstetrician and hospital that provides obstetrical services shall distribute the educational materials described in paragraph (1) of this subsection to pregnant patients.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-308.8" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>A hospital may discharge a patient:</text> <level label="1"> <text>Entirely;</text> </level> <level label="2"> <text>To another level of care, treatment, or services;</text> </level> <level label="3"> <text>To different health professionals; or</text> </level> <level label="4"> <text>To settings for continued services.</text> </level> </level> <level label="b"> <text>A hospital’s process for transfer or discharge shall be based on a patient’s assessed needs.</text> </level> <level label="c"> <text>To facilitate discharge or transfer, the hospital shall:</text> <level label="1"> <text>Assess a patient’s needs;</text> </level> <level label="2"> <text>Plan for discharge or transfer;</text> </level> <level label="3"> <text>Facilitate the discharge or transfer process;</text> </level> <level label="4"> <text>Give the patient or person responsible for providing continuing care to the patient written discharge instructions in a form the patient can understand; and</text> </level> <level label="5"> <text>Help to ensure that continuity of care, treatment, and services is maintained.</text> </level> </level> <level label="d"> <text>If a hospital fails to comply with the requirements of this section, the Secretary may impose a civil money penalty not to exceed $10,000 for each failure to comply.</text> </level> <level label="e"> <text>A hospital may appeal a civil money penalty imposed under subsection (c) of this section in accordance with Title 10, Subtitle 2 of the State Government Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-308.9" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>Except as provided in subsection (c) of this section, if an individual is treated at a hospital and the hospital conducts a urine drug screening to assist in diagnosing the individual’s condition, the hospital shall include testing for fentanyl in the individual’s urine drug screening.</text> </level> <level label="b"> <text>If the urine drug screening conducted in accordance with subsection (a) of this section detects fentanyl, the hospital shall report the test results, which shall be deidentified, to the Department through the State–designated health information exchange.</text> </level> <level label="c"> <text>This section does not apply to a hospital that does not have chemical analyzer equipment.</text> </level> <level label="d"> <text>This section does not affect any State law providing civil or criminal immunity to an individual who is in need of medical assistance after ingesting or using alcohol or drugs, or to an individual who in good faith assists another individual who is in need of medical assistance after ingesting or using alcohol or drugs.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-308.10" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this section, “safe sleep environment” means, as described in the most recent American Academy of Pediatrics policy statements, an environment in which a newborn may sleep that reduces the risk of sleep–related infant deaths, including through:</text> <level label="1"> <text>The use of supine positioning;</text> </level> <level label="2"> <text>The use of a firm, flat sleep surface;</text> </level> <level label="3"> <text>The use of room sharing without bed sharing;</text> </level> <level label="4"> <text>The avoidance of soft bedding and overheating; and</text> </level> <level label="5"> <text>The avoidance of exposure to smoke.</text> </level> </level> <level label="b"> <level label="1"> <text>As soon as practicable before a hospital discharges an infant after the birth of the infant, the hospital shall provide oral and written educational resources to the parent or legal guardian on how to provide a safe sleep environment.</text> </level> <level label="2"> <text>The oral and written educational resources required under paragraph (1) of this subsection may be supplemented by an educational video.</text> </level> </level> <level label="c"> <level label="1"> <text>As soon as practicable before discharging an infant after the birth of the infant, a hospital shall:</text> <level label="i"> <text>Ask the infant’s parent or legal guardian to describe the sleep environment that the parent or legal guardian will provide at home;</text> </level> <level label="ii"> <text>Inform the parent or legal guardian of the importance of ensuring that the infant has a safe sleep environment and the risks of suffocation and sudden infant death in unsafe sleep environments; and</text> </level> <level label="iii"> <text>Document that the educational resources described under subsection (b) of this section and the information described under item (ii) of this paragraph were provided to the parent or legal guardian.</text> </level> </level> <level label="2"> <text>The hospital shall provide a list of resources available for the parent or legal guardian to obtain the items necessary to provide a safe sleep environment for the infant.</text> </level> </level> <level label="d"> <text>On or before January 1, 2025, each hospital shall establish a process for:</text> <level label="1"> <text>Providing each parent or legal guardian with:</text> <level label="i"> <text>Oral and written educational resources as required under subsection (b) of this section; and</text> </level> <level label="ii"> <text>The information described under subsection (c)(1)(ii) of this section;</text> </level> </level> <level label="2"> <text>A parent or legal guardian to confirm the receipt of the educational resources provided under subsection (b) of this section; and</text> </level> <level label="3"> <text>Maintaining records of confirmations made under item (2) of this subsection.</text> </level> </level> <level label="e"> <level label="1"> <text>On or before January 1, 2025, the Department, in consultation with local health officers, shall develop for distribution to birthing parents and legal guardians a list of resources available by county to obtain the items necessary to provide a safe sleep environment for an infant.</text> </level> <level label="2"> <text>Each local health department shall provide an updated list of resources to the Department each year to assist the Department in developing the list of resources required under paragraph (1) of this subsection.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-308.11" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this section, “medication for opioid use disorder”:</text> <level label="1"> <text>Means a drug approved by the U.S. Food and Drug Administration for the treatment of opioid use disorder; and</text> </level> <level label="2"> <text>Does not include a drug administered to mitigate opioid–related overdose symptoms.</text> </level> </level> <level label="b"> <text>Each hospital shall establish and maintain, as part of its emergency services, protocols and capacity to:</text> <level label="1"> <text>Provide to a patient before discharging the patient appropriate, evidence–based interventions that reduce the risk of subsequent harm and fatality following an opioid–related overdose or a visit for an opioid–related emergency medical condition;</text> </level> <level label="2"> <text>Possess at least one formulation of each U.S. Food and Drug Administration–approved full opioid agonist and partial opioid agonist used for the treatment of opioid use disorder; and</text> </level> <level label="3"> <text>Treat a patient who presents in a hospital emergency department for care and treatment of an opioid–related overdose or opioid–related emergency medical condition with a medication for opioid use disorder if the treatment:</text> <level label="i"> <text>Occurs as recommended by the treating health care practitioner; and</text> </level> <level label="ii"> <text>Is voluntarily agreed to by the patient.</text> </level> </level> </level> <level label="c"> <text>A protocol established by a hospital under this section shall include:</text> <level label="1"> <text>Any requirement by the Department regarding prescribing opioid agonist treatment;</text> </level> <level label="2"> <text>Uniform practices for screening and diagnosing individuals who present with an opioid–related overdose or opioid–related emergency medical condition for an opioid use disorder based on the criteria in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders;</text> </level> <level label="3"> <text>Uniform practices for offering and administering opioid agonist medication to treat an opioid–related overdose or opioid use disorder; and</text> </level> <level label="4"> <text>Uniform practices to identify community–based treatment services that are appropriate for:</text> <level label="i"> <text>Treating opioid use disorders; and</text> </level> <level label="ii"> <text>Assisting patients to voluntarily access ongoing community–based treatment at discharge.</text> </level> </level> </level> <level label="d"> <text>Before discharging a patient who is diagnosed with an opioid use disorder or administered or prescribed medication for opioid use disorder, a hospital shall:</text> <level label="1"> <text>Make a referral of the patient to an appropriate provider or facility for a timely appointment, when possible, to voluntarily continue treatment in the community; and</text> </level> <level label="2"> <text>Work with peer support professionals, as available, or other resources to assist the patient in accessing the identified treatment services.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-309" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>Notwithstanding any other provisions of this subtitle, each hospital or residential treatment center shall be open to inspections by the Department to investigate and resolve any complaint concerning patient care, safety, medical and nursing supervision, physical environment, sanitation or dietary matters.</text> </level> <level label="b"> <level label="1"> <text>To resolve expeditiously a complaint that alleges the existence of any nonlife-threatening deficiency, the Department may refer the complaint directly to the hospital or residential treatment center.</text> </level> <level label="2"> <text>If appropriate, issues relating to the practice of medicine or the licensure or conduct of a health professional shall be referred to the hospital or the residential treatment center and may be referred to the appropriate licensure board for resolution.</text> </level> <level label="3"> <text>If the Department determines that the hospital or residential treatment center has not satisfactorily addressed the referred complaint or where the complaint alleges the existence of a life-threatening deficiency, the Department shall conduct an independent investigation.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-310" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>In this subsection, “designated requestor” means a hospital employee who has completed a course offered by an organ, tissue, or eye recovery agency on how to approach potential donor families and request organ or tissue donation.</text> </level> <level label="2"> <level label="i"> <text>On or before the occurrence of each death in a hospital, the hospital shall contact an appropriate organ, tissue, or eye recovery agency in order to determine the patient’s suitability for organ, tissue, or eye donation.</text> </level> <level label="ii"> <text>The contact and its disposition shall be noted in the patient’s medical record.</text> </level> </level> <level label="3"> <level label="i"> <text>The appropriate organ, tissue, or eye recovery agency, in consultation with the patient’s attending physician or the physician’s designee, shall determine the patient’s suitability for organ, tissue, or eye donation.</text> </level> <level label="ii"> <text>If the organ, tissue, or eye recovery agency, in consultation with the patient’s attending physician or the physician’s designee, determines that donation is not appropriate based on established medical criteria, this determination shall be noted by hospital personnel in the patient’s medical record and no further action is necessary.</text> </level> <level label="iii"> <text>If the organ, tissue, or eye recovery agency, in consultation with the patient’s attending physician or the physician’s designee, determines that the patient is a suitable candidate for organ, tissue, or eye donation, a representative of the appropriate organ, tissue, or eye recovery agency or a designated requestor shall initiate a request under paragraph (4) of this subsection, if applicable.</text> </level> </level> <level label="4"> <level label="i"> <text>Except as provided in the Maryland Revised Uniform Anatomical Gift Act, when an individual dies in a hospital in accordance with § 5–202 of this article, a representative of the appropriate organ, tissue, or eye recovery agency or a designated requestor shall request, with sensitivity and in compliance with § 4–507 of the Estates and Trusts Article, that the individual’s representative consent to the donation of all or any of the decedent’s organs or tissues as an anatomical donation if suitable.</text> </level> <level label="ii"> <text>Directions given by a person authorized under § 4–503 of the Estates and Trusts Article to make, amend, revoke, or refuse to make an anatomical gift of a decedent’s body or parts shall be recorded in the decedent’s medical record.</text> </level> <level label="iii"> <text>The representative of the appropriate organ, tissue, or eye recovery agency or the designated requestor and the representative of the deceased patient are entitled to protection from civil and criminal liability as provided in § 4–514 of the Estates and Trusts Article.</text> </level> </level> <level label="5"> <text>In all discussions concerning donations of organs and tissues, the representative of the appropriate organ, tissue, or eye recovery agency or the designated requestor shall show reasonable discretion and sensitivity:</text> <level label="i"> <text>To the circumstances of the family of the decedent;</text> </level> <level label="ii"> <text>To the religious beliefs of the decedent; and</text> </level> <level label="iii"> <text>To the nonsuitability for organ or tissue donation of the decedent.</text> </level> </level> <level label="6"> <level label="i"> <text>When a representative of the appropriate organ, tissue, or eye recovery agency or a designated requestor makes a request under paragraph (4)(i) of this subsection, the representative or designated requestor shall document the request and its disposition as required by § 4–508 of the Estates and Trusts Article.</text> </level> <level label="ii"> <text>Hospital personnel shall note the request and its disposition in the decedent’s medical record or death certificate.</text> </level> </level> <level label="7"> <text>A hospital may not bill the estate of the decedent, a surviving spouse or domestic partner of the decedent, any heirs of the decedent, or an insurer of the decedent for the costs associated with the removal of all or any of the decedent’s organs or tissues for the purpose of an anatomical donation.</text> </level> <level label="8"> <text>After consultation with the Maryland Hospital Association, Inc., the Medical and Chirurgical Faculty of the State of Maryland, Living Legacy Foundation, the Washington Regional Transplant Community, the Medical Eye Bank of Maryland, the Health Facilities Association of Maryland, and Tissue Banks International, the Secretary shall publish guidelines designed to implement this subsection, including guidelines:</text> <level label="i"> <text>Requiring that, at or near the time of each individual death in a hospital, the hospital contact by telephone an appropriate organ, tissue, or eye recovery agency to determine the suitability of the individual for organ, tissue, and eye donation;</text> </level> <level label="ii"> <text>Requiring that each hospital designate a person to make the contact; and</text> </level> <level label="iii"> <text>Identifying the information that the person designated by the hospital shall have available before making the contact.</text> </level> </level> <level label="9"> <text>The provisions of this subsection shall in no way interfere with the duties of the office of the Chief Medical Examiner. In sudden deaths under the jurisdiction of the office of the Chief Medical Examiner as provided in § 5–309 of this article, notification will be made to the office of the Chief Medical Examiner prior to organ removal.</text> </level> <level label="10"> <text>The consent of the decedent’s representative is not necessary and the provisions of paragraph (4) of this subsection do not apply if § 4–506 of the Estates and Trusts Article precludes the decedent’s representative from making an anatomical gift.</text> </level> <level label="11"> <text>A person who acts in good faith to recover organs or tissues in accordance with a notation on the decedent’s driver’s license or identification card that the decedent is an organ donor, a gift made in accordance with § 5–604.1 of this article or Title 4, Subtitle 5 of the Estates and Trusts Article, or a gift made in accordance with the anatomical gift laws of another state or country is immune from criminal prosecution and liability for damages in any cause of action related to the recovery and donation of the decedent’s organs or tissues.</text> </level> <level label="12"> <text>The Department shall conduct annual death record reviews at each hospital to determine the hospital’s compliance with the provisions of this subsection. The Department may delegate its duty to conduct annual death record reviews to the appropriate organ, tissue, or eye recovery agency serving the region in which a particular hospital is located.</text> </level> </level> <level label="b"> <level label="1"> <text>Subject to paragraph (2) of this subsection and notwithstanding any other provision of law, a hospital offering bone marrow transplant services shall allow an individual to donate bone marrow to any individual.</text> </level> <level label="2"> <text>An individual may donate bone marrow to another individual if a licensed physician determines, based on the physician’s medical judgment, that the donation of the bone marrow is in the best interests of the donee and there is no substantial risk of medical injury to the donor.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-310.1" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>This section applies to a nursing facility, as defined in § 19–301 of this subtitle, that:</text> <level label="i"> <text>Has 45 or more beds; and</text> </level> <level label="ii"> <text>Operates in the State.</text> </level> </level> <level label="2"> <text>This section does not apply to a nursing home bed in a continuing care retirement community that has obtained a certificate of registration to provide continuing care under Title 10, Subtitle 4 of the Human Services Article.</text> </level> </level> <level label="b"> <level label="1"> <text>The Department may impose a quality assessment on each freestanding nursing facility subject to this section.</text> </level> <level label="2"> <text>The amount assessed in the aggregate on all nursing facilities may not exceed 6.0% of the operating revenue for all nursing facilities subject to this section for the previous fiscal quarter.</text> </level> <level label="3"> <text>The assessment authorized by this section shall be paid by each nursing facility in accordance with this section.</text> </level> </level> <level label="c"> <level label="1"> <text>On or before the 60th day after each quarter of the State fiscal year, each nursing facility subject to this section shall pay to the Comptroller an amount determined by the Department based on an amount per non–Medicare day of service for the previous fiscal quarter.</text> </level> <level label="2"> <text>The assessment shall be based on an amount per patient day, not including Medicare days.</text> </level> </level> <level label="d"> <level label="1"> <text>All amounts collected by the State Comptroller under this section shall be distributed to a special fund, to be used by the Department only to fund reimbursements to nursing facilities under the Medicaid program.</text> </level> <level label="2"> <text>At least 65% of the funds allocated by the Department as reimbursements to nursing facilities under this section shall be in addition to and may not supplant funds already appropriated for this purpose.</text> </level> </level> <level label="e"> <text>The Department shall adopt regulations to implement this section.</text> </level> <level label="f"> <text>On or before September 1, 2015, and each year thereafter, the Department shall report to the General Assembly, in accordance with § 2–1257 of the State Government Article, on the implementation of this section, including:</text> <level label="1"> <text>The percentage and amount of the assessment charged to each nursing facility subject to this section;</text> </level> <level label="2"> <text>The number of nursing facilities subject to this section with a net loss; and</text> </level> <level label="3"> <text>A comparison of the total amount provided in the Medicaid budget for nursing home reimbursement in the current fiscal year to the actual amount received in the immediately prior fiscal year.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-310.2" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>On or before July 1, 2014, each hospital that provides emergency medical services shall have a protocol to provide timely access to a sexual assault medical forensic examination by a forensic nurse examiner or a physician to a victim of an alleged rape or sexual offense who arrives at the hospital for treatment.</text> </section> <section article="ghg" article_name="Health - General" number="19-310.3" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>On or before January 1, 2018, each hospital shall have a protocol for discharging a patient who was treated by the hospital for a drug overdose or was identified as having a substance use disorder.</text> </level> <level label="b"> <text>The protocol:</text> <level label="1"> <text>May include:</text> <level label="i"> <text>Coordination with peer recovery counselors who can conduct a screening, a brief intervention, and referral to treatment and connection of the patient with community services; and</text> </level> <level label="ii"> <text>Prescribing opioid overdose reversal drugs approved by the federal Food and Drug Administration for the patient; and</text> </level> </level> <level label="2"> <text>On or before June 30, 2023, shall require offering opioid overdose reversal drugs approved by the federal Food and Drug Administration, free of charge, to a patient who received treatment for a substance use disorder, opioid use disorder, or nonfatal drug overdose event.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-310.4" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Committee” means the review committee established in accordance with subsection (e) of this section.</text> </level> <level label="3"> <text>“Program” means the Private Hospital Grant Program.</text> </level> </level> <level label="b"> <text>Except as provided in subsection (f) of this section, this section may not be construed to prohibit an organization from receiving funds from a government source other than the Private Hospital Grant Program.</text> </level> <level label="c"> <text>There is a Private Hospital Grant Program.</text> </level> <level label="d"> <text>The purpose of the Program is to make recommendations to the Governor for funding in the annual State budget for capital projects at private hospitals in the State.</text> </level> <level label="e"> <level label="1"> <text>The Maryland Hospital Association shall establish a review committee to:</text> <level label="i"> <text>Develop the process for hospitals in the State to submit requests for funding in the annual budget;</text> </level> <level label="ii"> <text>Establish eligibility criteria for a hospital to submit a request for funding under the Program;</text> </level> <level label="iii"> <text>Establish criteria for projects eligible to receive funding under the Program;</text> </level> <level label="iv"> <text>Establish deadlines for the submission of requests for funding and the determination of projects recommended for funding;</text> </level> <level label="v"> <text>Develop project scoring and selection criteria guidelines;</text> </level> <level label="vi"> <text>Review eligible requests for funding; and</text> </level> <level label="vii"> <text>Make final recommendations for projects to be funded in the annual State budget.</text> </level> </level> <level label="2"> <text>To the extent practicable, the membership of the committee established under paragraph (1) of this subsection shall reflect the geographic diversity of hospitals in the State.</text> </level> <level label="3"> <text>The committee shall consult with the Department of Budget and Management and the Department of Legislative Services in:</text> <level label="i"> <text>Establishing the project funding request process under paragraph (1) of this subsection; and</text> </level> <level label="ii"> <text>Making recommendations for funding requests.</text> </level> </level> </level> <level label="f"> <text>In consultation with the Department of Budget and Management, the committee may establish conditions under which a request for funding may be rejected for consideration.</text> </level> <level label="g"> <text>The Maryland Hospital Association shall submit the recommendations of the committee to the Governor and the Secretary of Budget and Management.</text> </level> <level label="h"> <text>For fiscal year 2026 and each fiscal year thereafter, the Governor may include in the capital or operating budget bill an appropriation of $20,000,000 for the Private Hospital Grant Program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-310.5" future_version_removed="true" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions" /> <section article="ghg" article_name="Health - General" number="19-310.6" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>Subject to paragraphs (2) and (3) of this subsection, on or before January 1, 2025, each hospital and urgent care center in the State shall implement an evidence–based protocol for the early recognition and treatment of a patient with sepsis, severe sepsis, or septic shock that is based on generally acceptable standards of care.</text> </level> <level label="2"> <text>The evidence–based protocol implemented for hospitals under paragraph (1) of this subsection shall comply with the Centers for Disease Control and Prevention sepsis guidelines.</text> </level> <level label="3"> <text>A hospital that is a specialty psychiatric hospital shall establish a process for the screening and early recognition of a patient with sepsis, severe sepsis, or septic shock, and procedures to transfer the patient to the appropriate setting.</text> </level> </level> <level label="b"> <text>A hospital that submits sepsis data to the Centers for Medicare and Medicaid Services Hospital Inpatient Quality Reporting Program is presumed to meet the requirements of subsection (a) of this section.</text> </level> <level label="c"> <text>Each hospital and urgent care center shall:</text> <level label="1"> <text>Require periodic training in the implementation of the sepsis protocol required under subsection (a) of this section for professional staff with direct patient care responsibilities and, as appropriate, for staff with indirect patient care responsibilities, including laboratory and pharmacy staff; and</text> </level> <level label="2"> <text>Ensure that the staff receive updated training if the hospital or urgent care center makes a substantive change to the sepsis protocol.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-310.7" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this section, “health system” has the meaning stated in § 15–112(y) of the Insurance Article.</text> </level> <level label="b"> <text>A health system shall comply with § 15–112(y) of the Insurance Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-311" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>A person shall have the approval of the Secretary before the person may:</text> <level label="1"> <text>Build a hospital or related institution; or</text> </level> <level label="2"> <text>Make any conversion, alteration, or addition to the plant or building that will affect the functional structure or normal bed capacity of a hospital or related institution.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-312" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>To qualify for approval under Part II of this subtitle, the applicant shall satisfy the Secretary that the hospital or related institution will meet the requirements that the Secretary adopts under this subtitle.</text> </section> <section article="ghg" article_name="Health - General" number="19-313" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>An applicant for approval under Part II of this subtitle shall submit to the Secretary:</text> <level label="1"> <text>A written application on the form that the Secretary requires; and</text> </level> <level label="2"> <text>The documents, drawings, and other information that the Secretary requires.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-314" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>The Secretary promptly shall:</text> <level label="i"> <text>Review each application and the information submitted under Part II of this subtitle; and</text> </level> <level label="ii"> <text>Investigate the proposed new hospital or related institution or proposed conversion, alteration, or addition.</text> </level> </level> <level label="2"> <text>Within 30 days after the application is submitted, the Secretary shall give the applicant:</text> <level label="i"> <text>Notice of approval or disapproval; and</text> </level> <level label="ii"> <text>In case of disapproval, each reason for the disapproval.</text> </level> </level> </level> <level label="b"> <text>The Secretary shall grant approval under Part II of this subtitle if the hospital or related institution will meet the requirements of this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-315" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>The Maryland Health and Higher Educational Facilities Authority Act provides means to enlarge and establish hospitals and related health care facilities.</text> </section> <section article="ghg" article_name="Health - General" number="19-318" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>A person shall be licensed by the Secretary before the person may operate a hospital or related institution in this State.</text> </level> <level label="b"> <text>A hospital shall be classified as a special rehabilitation hospital before the hospital may provide or hold itself out as providing comprehensive physical rehabilitation services, as defined in § 19-1201 of this title.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-319" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>To qualify for a license, an applicant and the hospital or related institution to be operated shall meet the requirements of this section.</text> </level> <level label="b"> <text>An applicant who is an individual, and any individual who is applying on behalf of a corporation, association, or government agency shall be:</text> <level label="1"> <text>At least 18 years old; and</text> </level> <level label="2"> <text>Of reputable and responsible character.</text> </level> </level> <level label="c"> <level label="1"> <text>The applicant shall have a certificate of need, as required under Subtitle 1 of this title, for the hospital, residential treatment center, or related institution to be operated.</text> </level> <level label="2"> <text>The hospital, residential treatment center, or related institution to be operated shall meet the requirements that the Secretary adopts under this subtitle and Subtitle 12 of this title.</text> </level> </level> <level label="d"> <level label="1"> <text>As a condition of licensure, each hospital shall establish a utilization review program for all patients admitted to the hospital. The utilization review program:</text> <level label="i"> <text>May be conducted by an independent, nonhospital-affiliated review agent;</text> </level> <level label="ii"> <text>Shall be performed by registered nurses, medical records technicians, or similar qualified personnel supported and supervised by physicians as may be required;</text> </level> <level label="iii"> <text>Shall be certified by the Secretary if the program meets the minimum standards established under paragraph (4) of this subsection; and</text> </level> <level label="iv"> <text>Shall be recertified by the Secretary if the hospital makes any changes to the program after the initial certification.</text> </level> </level> <level label="2"> <text>Any change made to a certified utilization review program shall be reported to the Secretary by the hospital within 30 days of the date the change was made.</text> </level> <level label="3"> <text>If a hospital fails to provide the utilization review program required under this subsection, the Secretary may impose the following penalties:</text> <level label="i"> <text>Delicensure of hospital; or</text> </level> <level label="ii"> <text>$500 per day for each day the violation continues.</text> </level> </level> <level label="4"> <text>The Secretary shall, by regulation and in consultation with health care providers and payors, establish minimum standards for a utilization review program, directed at appropriateness and quality of inpatient care, as enumerated in the following items:</text> <level label="i"> <text>Preadmission review of elective admissions;</text> </level> <level label="ii"> <text>Postadmission review of emergency admissions;</text> </level> <level label="iii"> <text>Concurrent or retrospective review of all admissions as appropriate;</text> </level> <level label="iv"> <text>Preauthorization of certain selected procedures if proposed to be performed on an inpatient basis;</text> </level> <level label="v"> <text>Continued stay review based on recognized objective criteria;</text> </level> <level label="vi"> <text>Discharge planning review; and</text> </level> <level label="vii"> <text>Readmission review.</text> </level> </level> <level label="5"> <text>A patient may not be charged for any days disallowed as a result of retrospective review under paragraph (4) of this subsection unless the patient refuses to leave the hospital when it is medically appropriate to do so and the disallowed days occur:</text> <level label="i"> <text>After the hospital has notified the patient in writing of the potential disallowance; or</text> </level> <level label="ii"> <text>As a direct result of the noncompliance by the patient to treatment or hospital regulations.</text> </level> </level> <level label="6"> <text>A hospital shall be exempt from requiring a utilization review program for a patient if:</text> <level label="i"> <level label="1"> <text>The patient is insured by a third-party payor; and</text> </level> <level label="2"> <text>The third-party payor has a utilization review program for its subscribers or beneficiaries which meets the minimum standards as adopted in paragraph (4) of this subsection; or</text> </level> </level> <level label="ii"> <text>The patient is a subscriber or member of a health maintenance organization as defined in § 19-701 of this title.</text> </level> </level> <level label="7"> <text>Where federal regulations or guidelines for a federally mandated utilization review program for federally insured patients differ from standards established under paragraph (4) of this subsection, the Secretary may waive a specific standard if the program achieves the same objectives as the standards established by the Secretary.</text> </level> <level label="8"> <text>The Secretary may establish record keeping and reporting requirements:</text> <level label="i"> <text>To evaluate the effectiveness of hospitals’ utilization review programs; and</text> </level> <level label="ii"> <text>To determine if the utilization review programs are in compliance with the provisions of this section and regulations adopted by the Secretary to administer this section.</text> </level> </level> </level> <level label="e"> <level label="1"> <level label="i"> <text>In this subsection the following words have the meanings indicated.</text> </level> <level label="ii"> <level label="1"> <text>“Telemedicine” means the use of interactive audio, video, or other telecommunications or electronic technology by a physician in the practice of medicine outside the physical presence of the patient.</text> </level> <level label="2"> <text>“Telemedicine” does not include:</text> </level> <level label="A"> <text>An audio–only telephone conversation between a physician and a patient;</text> </level> <level label="B"> <text>An electronic mail message between a physician and a patient; or</text> </level> <level label="C"> <text>A facsimile transmission between a physician and a patient.</text> </level> </level> <level label="iii"> <text>“Uniform standard credentialing form” means:</text> <level label="1"> <text>The form designated by the Secretary through regulation for credentialing physicians who seek to be employed by or have staff privileges at a hospital; or</text> </level> <level label="2"> <text>The uniform credentialing form that the Insurance Commissioner designates under § 15–112.1 of the Insurance Article.</text> </level> </level> </level> <level label="2"> <text>As a condition of licensure, each hospital shall:</text> <level label="i"> <text>Establish a credentialing process for the physicians who are employed by or who have staff privileges at the hospital; and</text> </level> <level label="ii"> <text>Use the uniform standard credentialing form as the initial application of a physician seeking to be credentialed.</text> </level> </level> <level label="3"> <text>Use of the uniform standard credentialing form does not preclude a hospital from requiring supplemental or additional information as part of the hospital’s credentialing process.</text> </level> <level label="4"> <level label="i"> <text>The Secretary shall, by regulation and in consultation with hospitals, physicians, interested community and advocacy groups, and representatives of the Maryland Defense Bar and Plaintiffs’ Bar, establish minimum standards for a credentialing process which shall include:</text> <level label="1"> <text>A formal written appointment process documenting the physician’s education, clinical expertise, licensure history, insurance history, medical history, claims history, and professional experience;</text> </level> <level label="2"> <text>A requirement that an initial appointment to staff not be complete until the physician has successfully completed a probationary period; and</text> </level> <level label="3"> <text>Subject to subparagraph (ii) of this paragraph, a formal, written reappointment process to be conducted in accordance with standards of the accreditiation body that accredits a hospital.</text> </level> </level> <level label="ii"> <text>The reappointment process established under subparagraph (i)3 of this paragraph shall document the physician’s pattern of performance by analyzing:</text> <level label="1"> <text>Claims filed against the physician;</text> </level> <level label="2"> <text>Data dealing with utilization, quality, and risk;</text> </level> <level label="3"> <text>Clinical skills;</text> </level> <level label="4"> <text>Adherence to hospital bylaws, policies, and procedures;</text> </level> <level label="5"> <text>Compliance with continuing education requirements;</text> </level> <level label="6"> <text>Mental and physical status; and</text> </level> <level label="7"> <text>The results of the practitioner performance evaluation process under subsection (i) of this section.</text> </level> </level> </level> <level label="5"> <text>If requested by the Department, a hospital shall provide documentation that, prior to employing or granting privileges to a physician, the hospital has complied with the requirements of this subsection and that, prior to renewing employment or privileges, the hospital has complied with the requirements of this subsection.</text> </level> <level label="6"> <text>Notwithstanding any other provision of this subsection, in its credentialing and privileging process for a physician who provides medical services to patients at the hospital only through telemedicine from a distant–site hospital or distant–site telemedicine entity, a hospital may rely on the credentialing and privileging decisions made for the physician by the distant–site hospital or distant–site telemedicine entity, as authorized under 42 C.F.R. Part 482, if:</text> <level label="i"> <text>The physician who provides medical services through telemedicine holds a license to practice medicine in the State issued under Title 14 of the Health Occupations Article; and</text> </level> <level label="ii"> <text>The credentialing and privileging decisions with respect to the physician who provides medical services through telemedicine are:</text> <level label="1"> <text>Approved by the medical staff of the hospital; and</text> </level> <level label="2"> <text>Recommended by the medical staff of the hospital to the hospital’s governing body.</text> </level> </level> </level> <level label="7"> <text>If a hospital fails to establish or maintain a credentialing process required under this subsection, the Secretary may impose the following penalties:</text> <level label="i"> <text>Delicensure of the hospital; or</text> </level> <level label="ii"> <text>$500 per day for each day the violation continues.</text> </level> </level> </level> <level label="f"> <text>As a condition of licensure, each accredited and nonaccredited hospital shall develop a protocol for the procurement of organs and tissues.</text> </level> <level label="g"> <level label="1"> <text>As a condition of licensure, each hospital shall establish a risk management program.</text> </level> <level label="2"> <text>The Secretary shall, by regulation and in consultation with hospitals, physicians, interested community and advocacy groups, and representatives of the Maryland Defense Bar and Plaintiffs’ Bar establish minimum standards for a risk management program which shall include:</text> <level label="i"> <text>A board policy statement indicating commitment to the risk management program;</text> </level> <level label="ii"> <text>A requirement that one person be assigned the responsibility for coordinating the program;</text> </level> <level label="iii"> <text>An internal staff committee structure to conduct ongoing review and evaluation of risk management activities;</text> </level> <level label="iv"> <text>A formal written program for addressing patient complaints;</text> </level> <level label="v"> <text>A documented facility-wide risk reporting system;</text> </level> <level label="vi"> <text>Ongoing risk management education programs for all staff; and</text> </level> <level label="vii"> <text>Documentation that the risk management and quality assurance programs share relevant information.</text> </level> </level> <level label="3"> <text>If a hospital fails to establish or maintain a risk management program required under this subsection, the Secretary may impose the following penalties:</text> <level label="i"> <text>Delicensure of the hospital; or</text> </level> <level label="ii"> <text>$500 per day for each day the violation continues.</text> </level> </level> </level> <level label="h"> <level label="1"> <text>As a condition of licensure, each hospital and related institution shall:</text> <level label="i"> <text>Adopt, implement, and enforce a policy that requires, except in an emergency life-threatening situation where it is not feasible or practicable, all employees and medical staff involved in patient care services to comply with the Centers for Disease Control and Prevention guidelines on universal precautions; and</text> </level> <level label="ii"> <text>Display the notice developed under § 1-207 of the Health Occupations Article at the entrance to the hospital or related institution.</text> </level> </level> <level label="2"> <text>If a hospital or related institution fails to comply with the requirements of this subsection, the Secretary may impose a fine of up to $500 per day per violation for each day a violation continues.</text> </level> </level> <level label="i"> <level label="1"> <text>As a condition of licensure, each hospital shall establish a practitioner performance evaluation process that objectively evaluates the performance of each member of the medical staff at the hospital.</text> </level> <level label="2"> <text>The practitioner performance evaluation process shall include a review of care provided to patients at the hospital by the members of the medical staff.</text> </level> <level label="3"> <text>The review of care shall:</text> <level label="i"> <text>Be undertaken for cases chosen at random and for cases with unexpected adverse outcomes;</text> </level> <level label="ii"> <text>Be based on objective review standards;</text> </level> <level label="iii"> <text>Include a review of the appropriateness of the plan of care for the patient, particularly any medical procedures performed on the patient, in relation to the patient’s condition; and</text> </level> <level label="iv"> <text>Be conducted by members of the medical staff or, at the discretion of the hospital, external reviewers, who:</text> <level label="1"> <text>Are of the same specialty as the member of the medical staff under review;</text> </level> <level label="2"> <text>Have been trained to perform practitioner performance evaluation; and</text> </level> <level label="3"> <text>Are not otherwise associated with the case under review.</text> </level> </level> </level> <level label="4"> <text>A hospital shall take into account the results of the practitioner performance evaluation process for a member of the medical staff in the reappointment process established under subsection (e) of this section.</text> </level> <level label="5"> <text>If a hospital fails to comply with the requirements of this subsection, the Secretary may impose a fine of up to $500 per day per violation for each day a violation continues.</text> </level> </level> <level label="j"> <level label="1"> <text>The Department, in coordination with the Maryland Institute for Emergency Medical Services Systems, shall adopt regulations establishing minimum perinatal care standards that meet or exceed the Maryland Perinatal System Standards for each hospital that provides obstetrical services.</text> </level> <level label="2"> <text>Each hospital that provides obstetrical services shall comply with the perinatal care standards established by the regulations adopted under paragraph (1) of this subsection as a condition of licensure.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-319.1" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>As a prerequisite to the licensing of related institutions and each year after the license is issued, the Department shall require each related institution that provides long–term care and programs for patients with Alzheimer’s disease and related disorders to have an in–service education program that includes instruction on dementia and the techniques necessary to manage dementia patients with regard to their physical, intellectual, and behavioral manifestations.</text> </section> <section article="ghg" article_name="Health - General" number="19-319.2" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this section, “facility” means a special psychiatric hospital or an acute general care hospital with separately identified inpatient psychiatric service.</text> </level> <level label="b"> <level label="1"> <text>As a condition of licensure, each facility shall adopt written policies and procedures to implement the requirements of §§ 10-701 through 10-709 of this article. The policies and procedures:</text> <level label="i"> <text>May expand the rights provided in §§ 10-701 through 10-709 of this article;</text> </level> <level label="ii"> <text>Shall provide for a mechanism for patients and others to report suspected violations of §§ 10-701 through 10-709 of this article to a designated official of the hospital;</text> </level> <level label="iii"> <text>Shall provide a system for investigating suspected violations; and</text> </level> <level label="iv"> <text>Shall ensure that there is a timely appropriate response to any suspected violation.</text> </level> </level> <level label="2"> <text>The Secretary may inspect any document necessary to ensure compliance with this subsection and §§ 10-701 through 10-709 of this article.</text> </level> <level label="3"> <text>If a hospital that is a facility fails to adopt and implement the policies and procedures required by this subsection or maintains a continuing pattern of conditions or practices in knowing violation of §§ 10-701 through 10-709 of this article, the Secretary may impose the following penalties, but only after the Secretary has satisfied the conditions in § 19-360 of this subtitle:</text> <level label="i"> <text>Delicensure of the specialty psychiatric hospital;</text> </level> <level label="ii"> <text>Delicensure of the separately identified psychiatric service of the acute general care hospital; or</text> </level> <level label="iii"> <text>A fine not to exceed $500 per day for each day the violation continues.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-320" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>An applicant for a license shall submit an application to the Secretary.</text> </level> <level label="b"> <text>The application:</text> <level label="1"> <text>Shall be on the form that the Secretary requires;</text> </level> <level label="2"> <text>Shall be signed and verified as follows:</text> <level label="i"> <text>If the application is made for an individual, by the individual; or</text> </level> <level label="ii"> <text>If the application is made for a corporation, association, or government agency, by 2 officers of the organization; and</text> </level> </level> <level label="3"> <text>Shall include:</text> <level label="i"> <text>The name of the applicant;</text> </level> <level label="ii"> <text>A statement that the applicant meets the requirements of this subtitle;</text> </level> <level label="iii"> <text>The class of the proposed hospital or related institution;</text> </level> <level label="iv"> <text>The location of the proposed hospital or related institution;</text> </level> <level label="v"> <text>The name of the individual who is to be the administrative head of the proposed hospital or related institution; and</text> </level> <level label="vi"> <text>Any other information that the Secretary requires.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-321" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>The Secretary shall issue a license to any applicant if the applicant and the hospital or related institution to be operated meet the requirements of this subtitle.</text> </level> <level label="b"> <text>The Secretary shall include on each license that the Secretary issues:</text> <level label="1"> <text>The name of the hospital or related institution; and</text> </level> <level label="2"> <text>The classification of the hospital or related institution.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-322" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>While it is effective, a license authorizes the licensee to operate the hospital or related institution named in the license under the classification set forth in the license.</text> </section> <section article="ghg" article_name="Health - General" number="19-324" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>A license issued under this subtitle is not transferable.</text> </section> <section article="ghg" article_name="Health - General" number="19-325" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>If voluntary efforts to reduce excess capacity prove insufficient, as a last resort the Maryland Health Care Commission and the Health Services Cost Review Commission may petition the Secretary to delicense any hospital or part of a hospital or hospital service based on a finding after a public hearing that the delicensure is consistent with the State health plan or institution–specific plan. The petition shall specify in detail all efforts made by the petitioner to encourage the hospital:</text> <level label="1"> <text>To reduce its underutilized capacity;</text> </level> <level label="2"> <text>To merge or consolidate;</text> </level> <level label="3"> <text>To become more efficient and effective; and</text> </level> <level label="4"> <text>To convert from acute capacity to alternative uses, where appropriate.</text> </level> </level> <level label="b"> <text>On petition by the Maryland Health Care Commission and the Health Services Cost Review Commission, the Secretary may order that a hospital or part of a hospital or hospital service be delicensed if:</text> <level label="1"> <text>The Secretary determines that delicensure is the last resort and a hospital or hospital services are excessive or inefficient, which determination is based on and is not inconsistent with the State health plan or institution–specific plan;</text> </level> <level label="2"> <text>An opportunity for notice and hearing in accordance with the Administrative Procedure Act has been given to the affected hospital, and in the affected political subdivision notice shall be given to the elected public officials and for at least 2 consecutive weeks in a newspaper of general circulation; and</text> </level> <level label="3"> <text>The hospital is not the sole provider of hospital services in a county for which the Commission and Health Services Cost Review Commission have petitioned for all of the beds of the hospital to be delicensed.</text> </level> </level> <level label="c"> <text>The Maryland Health Care Commission and the Health Services Cost Review Commission are necessary parties to any proceeding in accordance with this section.</text> </level> <level label="d"> <text>Any person who is aggrieved by a final decision of the Secretary under this section may take a direct judicial appeal.</text> </level> <level label="e"> <text>The appeal shall be made as provided for judicial review of final decisions in the Administrative Procedure Act.</text> </level> <level label="f"> <text>The Secretary may participate in any appeal of a decision made in accordance with this section.</text> </level> <level label="g"> <text>In the event of an adverse decision that affects its final decision, the Secretary may apply within 30 days by writ of certiorari to the Court of Appeals for review where:</text> <level label="1"> <text>Review is necessary to secure uniformity of decision, as where the same statute has been construed differently by 2 or more judges; or</text> </level> <level label="2"> <text>There are other special circumstances that render it desirable and in the public interest that the decision be reviewed.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-326" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>If a hospital voluntarily closes, merges, or is delicensed under § 19–325 of this subtitle, the Department of Commerce, in cooperation with the Maryland Health Care Commission, shall assist the hospital and local community in identifying alternative uses for the hospital buildings or sites.</text> </section> <section article="ghg" article_name="Health - General" number="19-326.1" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>If a hospital voluntarily closes, merges, or is delicensed under § 19–325 of this subtitle and workers are displaced:</text> <level label="1"> <text>Each hospital shall pay a fee directly to the Maryland Department of Labor. The fee shall not exceed 0.01 percent of the gross operating revenue for the fiscal year immediately preceding the closure or delicensing of the hospital. A fee shall only be assessed once for each voluntary closure, merger, or delicensure.</text> </level> <level label="2"> <text>The Secretary of Labor shall pay the fees received under this section into the Hospital Employees Training Fund established under § 11–201 of the Labor and Employment Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-327" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>The Secretary shall deny a license to any applicant or revoke a license if the applicant or licensee has been convicted of a felony that relates to Medicaid or to a nursing home.</text> </level> <level label="2"> <text>The Secretary may deny a license to an applicant or revoke a license if the applicant or licensee does not meet the requirements of this subtitle or any rule or regulation that the Secretary adopts under this subtitle.</text> </level> </level> <level label="b"> <text>The Secretary may deny a license to an applicant or revoke a license if the applicant or licensee violates Title 6.5 of the State Government Article.</text> </level> <level label="c"> <level label="1"> <text>Before any action is taken under this section, the Secretary shall give the applicant or licensee an opportunity for a hearing.</text> </level> <level label="2"> <text>The hearing notice to be given to the applicant or licensee shall be sent at least 10 days before the hearing.</text> </level> <level label="3"> <text>The applicant or licensee is entitled to be represented by counsel at the hearing.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-328" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>If the Secretary determines that a life-threatening, health or fire safety deficiency exists in a related institution, the Secretary immediately may restrict new admissions to the related institution for not more than a 30-day period.</text> </level> <level label="2"> <text>Within 7 days after a request by an aggrieved party, a hearing shall be held to determine the appropriateness of the admissions restriction.</text> </level> <level label="3"> <text>Within 21 days after admissions are restricted, the related institution shall take steps to correct the deficiency.</text> </level> </level> <level label="b"> <level label="1"> <text>Unless the Secretary lifts the admissions restriction, within 30 days after admissions are restricted, a hearing shall be held to determine whether the related institution has taken enough steps to correct the deficiency.</text> </level> <level label="2"> <text>If the Secretary finds that the deficiency still exists, the Secretary may:</text> <level label="i"> <text>Continue to restrict admissions for not more than 3 consecutive 30-day periods; or</text> </level> <level label="ii"> <text>Revoke the license of the related institution and move its residents to an appropriate, licensed facility.</text> </level> </level> <level label="3"> <text>An aggrieved party is entitled to a hearing on each continuation of the admissions restriction. Within 7 days after a request by an aggrieved party, a hearing shall be held to determine the appropriateness of the admissions restriction.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-329" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>If, under a Montgomery or Prince George’s county ordinance for licensing related institutions, the county licensing authority proposes to suspend or revoke the county license of a related institution, that authority shall give the Secretary notice of the proposed suspension or revocation and the reasons for it before the authority notifies the related institution.</text> </level> <level label="2"> <text>If, within 14 days after the Secretary receives the notice, the Secretary disapproves the proposed suspension or revocation, the county licensing authority may not proceed with the action. Otherwise the county licensing authority may proceed with the action.</text> </level> <level label="3"> <text>If the Secretary disapproves the proposed suspension or revocation, the Secretary shall state, in writing, the reasons for the disapproval.</text> </level> </level> <level label="b"> <level label="1"> <text>If the Montgomery or Prince George’s county licensing authority proposes to restrict new admissions to a related institution, that authority shall give the Secretary as much prior notice of the proposed restriction as possible, so that State and county action may be coordinated.</text> </level> <level label="2"> <text>The Secretary may become a party to any county administrative or judicial proceeding on the restriction.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-330" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>Except as provided in this section for an action under § 19–329(a) of this subtitle, any person aggrieved by a final decision of the Secretary in a contested case, as defined in the Administrative Procedure Act, may petition for judicial review as allowed by the Administrative Procedure Act.</text> </level> <level label="b"> <text>A person aggrieved by a final decision of the Secretary under § 19–329(a) of this subtitle may not appeal.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-333" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In Part V of this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Affiliate” means:</text> <level label="1"> <text>Each partner of a partnership;</text> </level> <level label="2"> <text>Each officer, director, and stockholder who has direct or indirect ownership or control of 10 percent or more of the stock of a corporation; or</text> </level> <level label="3"> <text>Each individual who has direct or indirect ownership of 10 percent or more of a nursing home or community program.</text> </level> </level> <level label="c"> <text>“Community program” means:</text> <level label="1"> <text>A program which provides residential services and is an alcohol abuse and drug abuse treatment program as defined in § 8-403(a) of this article;</text> </level> <level label="2"> <text>A program which provides residential services for individuals with a developmental disability as defined in § 7-101(d) and (h) of this article;</text> </level> <level label="3"> <text>A private group home required to be licensed by the Secretary under § 10-517 of this article;</text> </level> <level label="4"> <text>A private therapeutic group home for children and adolescents as defined under § 10-920 of this article;</text> </level> <level label="5"> <text>A private residential treatment center for children and adolescents licensed under § 19-307 of this subtitle;</text> </level> <level label="6"> <text>A private facility operating living units that house less than 4 persons per unit under § 10-902 of this article;</text> </level> <level label="7"> <text>A program which provides day habilitation, vocational, or community supported living arrangements services required to be licensed under § 7-903 of this article; or</text> </level> <level label="8"> <text>A private program that provides outpatient services as set forth in § 10-902 of this article.</text> </level> </level> <level label="d"> <text>“Individual” means a person who is a resident of a nursing home or a community residential program or a person enrolled in a day habilitation or vocational program.</text> </level> <level label="e"> <text>“Nursing home” means a related institution that is classified as a nursing home.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-334" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In addition to any other power set forth in this article or the Health Occupations Article, the Secretary may file a petition for appointment of a receiver for a nursing home or community program defined in this subtitle if, after investigation of the Secretary or after investigation at the request of the Secretary of Aging, the Secretary reasonably believes that:</text> <level label="1"> <text>A person is operating the nursing home or community program without a license for it;</text> </level> <level label="2"> <text>The nursing home or community program will be closed within 30 days and arrangements to relocate its residents have not been approved by the Secretary;</text> </level> <level label="3"> <text>The nursing home or community program or its residents have been abandoned; or</text> </level> <level label="4"> <text>A situation, physical condition, practice, or method of operation presents an imminent danger of death or serious mental or physical harm to the individuals.</text> </level> </level> <level label="b"> <text>A petition under this section shall be filed with the circuit court for the county where the nursing home or community program is located.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-335" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>Except as otherwise provided in subsection (b) of this section, the court shall hold a hearing on a petition under Part V of this subtitle within 10 days after the petition is filed.</text> </level> <level label="2"> <text>The owner of the nursing home or entity operating the community program shall be given notice of the hearing:</text> <level label="i"> <text>At least 5 days before the hearing; or</text> </level> <level label="ii"> <text>At least 3 days before the hearing, by a notice posted conspicuously inside or on the front door of the nursing home or site of the community program, if the Secretary files a statement that:</text> <level label="1"> <text>Is signed and verified by the Secretary;</text> </level> <level label="2"> <text>States that the owner or operating entity cannot be found; and</text> </level> <level label="3"> <text>Sets forth a substantial account of reasonable, good faith efforts to find the owner or operating entity and serve process.</text> </level> </level> </level> <level label="3"> <text>The owner of the nursing home or operating entity of a community service is entitled to offer evidence at the hearing.</text> </level> </level> <level label="b"> <level label="1"> <text>A court may appoint a receiver for a nursing home or community program if, from the petition, affidavits, and any evidence offered ex parte, the court finds probable cause to believe that a situation, physical condition, practice, or method of operation presents an imminent danger of death or serious mental or physical harm to the residents and must be remedied immediately to insure their health, safety, and welfare.</text> </level> <level label="2"> <text>The owner or person then in charge of the nursing home or community program shall be given notice of the appointment of a receiver:</text> <level label="i"> <text>By service of the notice, within 24 hours after the appointment; or</text> </level> <level label="ii"> <text>By posting the notice conspicuously inside or on the front door of the nursing home or site of the community program, if the Secretary files a statement that:</text> <level label="1"> <text>Is signed and verified by the Secretary;</text> </level> <level label="2"> <text>States that the owner and the person in charge of the nursing home or community program cannot be found; and</text> </level> <level label="3"> <text>Sets forth a substantial account of reasonable, good faith efforts to find the owner and the person in charge and serve process.</text> </level> </level> </level> <level label="3"> <text>Unless the owner of the nursing home or entity operating the community program consents to a later date, the court shall hold a hearing on the appointment of the receiver within 5 days after service of process.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-336" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>After the hearing under § 19-335 of this subtitle, the court may appoint a receiver for the nursing home or community program or continue the appointment of the receiver made ex parte, if the court finds:</text> <level label="1"> <text>A person is operating the nursing home or community program without a license for it;</text> </level> <level label="2"> <text>The nursing home or community program will be closed within 30 days and arrangements to relocate its residents have not been approved by the Secretary;</text> </level> <level label="3"> <text>The nursing home or community program or its residents have been abandoned; or</text> </level> <level label="4"> <text>A situation, physical condition, practice, or method of operation presents an imminent danger of death or serious mental or physical harm to the individuals.</text> </level> </level> <level label="b"> <text>The court may appoint as receiver any responsible individual other than:</text> <level label="1"> <text>A State employee;</text> </level> <level label="2"> <text>An employee of a local government; or</text> </level> <level label="3"> <text>The owner or administrator of or other individual with a financial interest in the nursing home or community program or agent of any of those individuals.</text> </level> </level> <level label="c"> <level label="1"> <text>Before the receiver takes charge of the nursing home or community program, the receiver shall file a bond with the court.</text> </level> <level label="2"> <text>The bond:</text> <level label="i"> <text>May not exceed the value of the nursing home or community program and its assets; and</text> </level> <level label="ii"> <text>Shall run to this State for benefit of all persons interested in the faithful performance of the receiver including the individuals.</text> </level> </level> <level label="3"> <text>Unless the court directs otherwise, the receiver may pay the premium of the bond from the income of the nursing home or community program.</text> </level> </level> <level label="d"> <text>The Secretary may petition the court to appoint a substitute for a receiver who:</text> <level label="1"> <text>Dies;</text> </level> <level label="2"> <text>Has a disability;</text> </level> <level label="3"> <text>Has an adverse interest; or</text> </level> <level label="4"> <text>Does not make reasonable progress in carrying out the receivership.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-337" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>Except as expressly provided otherwise in this section, each receiver who is appointed under Part V of this subtitle has all of the powers of a receiver who is appointed under § 3-414 of the Corporations and Associations Article.</text> </level> <level label="2"> <text>The receiver shall perform all acts that are necessary and exercise the powers of the receiver to:</text> <level label="i"> <text>Correct each condition on which the appointment of the receiver was based;</text> </level> <level label="ii"> <text>Ensure adequate care for each individual in the nursing home or community program; and</text> </level> <level label="iii"> <text>Preserve the property of the owner of the nursing home or community program.</text> </level> </level> </level> <level label="b"> <text>The receiver shall report to the court as the court requires.</text> </level> <level label="c"> <text>The receiver of a nursing home or community program shall:</text> <level label="1"> <text>Give each individual and interested parties with respect to each individual notice of the receivership;</text> </level> <level label="2"> <text>Preserve all property of and records that relate to an individual and are in the custody of the receiver or the owner or operating entity;</text> </level> <level label="3"> <text>If an individual is to be discharged or transferred:</text> <level label="i"> <text>Explain to the individual or guardian of the individual the alternative placements that are available;</text> </level> <level label="ii"> <text>Help the individual or guardian of the individual to find an alternative placement;</text> </level> <level label="iii"> <text>Give information about the alternative placement chosen;</text> </level> <level label="iv"> <text>Transport the individual to the alternative placement; and</text> </level> <level label="v"> <text>Transfer all property of and records on the individual, including all necessary medical information, to the individual or the alternative placement.</text> </level> </level> </level> <level label="d"> <text>The receiver may use:</text> <level label="1"> <text>Any private or third-party reimbursements to the nursing home, including any Medicaid or Medicare payments; and</text> </level> <level label="2"> <text>With the approval of the court, money from the fund established under § 19-338 of this subtitle.</text> </level> </level> <level label="e"> <text>If the structure or furnishings of a nursing home or site of the community program violate State or federal law, the receiver may correct the violation:</text> <level label="1"> <text>Without the consent of the court, if the cost of the correction does not exceed $3,000; or</text> </level> <level label="2"> <text>On petition to and with the consent of the court, if the cost of the correction is more than $3,000.</text> </level> </level> <level label="f"> <level label="1"> <text>The receiver shall pay the principal of and interest on a mortgage or secured transaction unless the holder of the mortgage or the secured party is the owner or an affiliate of the owner.</text> </level> <level label="2"> <text>On petition of a receiver, the court may:</text> <level label="i"> <text>Allow the receiver to avoid a lease, mortgage, secured transaction, or other contract that the owner or operating entity made if:</text> <level label="1"> <text>The person seeking payment under the contract is, or at the time the contract was made was, the owner or an affiliate of the owner; and</text> </level> <level label="2"> <text>The contract provides for a rent or interest rate substantially exceeding the rent or interest rate that was reasonable when the contract was made; and</text> </level> </level> <level label="ii"> <text>If the receiver is allowed to avoid the contract, set a reasonable rent or interest rate to be paid on any property that is subject to the contract and is needed to continue operation of the nursing home or community program.</text> </level> </level> <level label="3"> <text>The court shall hold a hearing on a petition under this subsection within 15 days after the petition is filed.</text> </level> <level label="4"> <text>Notice of the petition shall be given to all known owners of property that the petition affects:</text> <level label="i"> <text>By the receiver, at least 10 days before the hearing; or</text> </level> <level label="ii"> <text>By publication, if the receiver files with the court a statement that:</text> <level label="1"> <text>Is signed and verified by the receiver;</text> </level> <level label="2"> <text>States that the owner of the property cannot be found; and</text> </level> <level label="3"> <text>Sets forth a substantial account of reasonable, good faith efforts to find the owner and serve process.</text> </level> </level> </level> <level label="5"> <text>The court shall set a rent under this subsection in an amount that is not less than the total current payments of principal and interest required on all mortgages and secured transactions that:</text> <level label="i"> <text>Affect the property under the contract to be avoided; and</text> </level> <level label="ii"> <text>Cannot be avoided under this subsection.</text> </level> </level> <level label="6"> <text>Payment of the rent or interest rate that a court sets under this subsection is a defense in any action against the receiver for payment or for possession of the property. However, the payment does not relieve the owner or operating entity of any liability for the difference between the amount that the receiver pays and the amount that is due under the contract.</text> </level> </level> <level label="g"> <level label="1"> <text>A receiver is not liable for an injury to person or property that results from the condition of the nursing home or site of the community program.</text> </level> <level label="2"> <text>A receiver only is liable for any act or omission that constitutes negligence in the fulfillment of the duties as receiver.</text> </level> </level> <level label="h"> <text>A receiver is entitled to the fee that the court finds reasonable.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-338" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>The Secretary shall determine whether the receivership can be funded by State funds previously designated for the community program. In the event that previously designated funds are available, these funds shall be used for the operation of the receivership.</text> </level> <level label="b"> <text>In the event that there are insufficient funds to operate the receivership, the Secretary may petition the Board of Public Works for sufficient funds to operate the receivership.</text> </level> <level label="c"> <level label="1"> <text>State funds used to operate a receivership under this section shall be a lien on the community program and its assets if the receiver files a notice of the lien that contains:</text> <level label="i"> <text>The amount of the lien;</text> </level> <level label="ii"> <text>The name of the community program to which the lien attaches; and</text> </level> <level label="iii"> <text>A description of the assets of the community program that are affected by the lien.</text> </level> </level> <level label="2"> <text>The receiver shall file the notice of lien with:</text> <level label="i"> <text>The land and chattel records of the county where the sites operated by the community program are located; and</text> </level> <level label="ii"> <text>The Department of Assessments and Taxation.</text> </level> </level> <level label="3"> <text>A lien under this subsection:</text> <level label="i"> <text>Extends to the property of the community program that is described in the notice of lien; and</text> </level> <level label="ii"> <text>Has priority over any lien or other interest that attaches after the date of the completion of the filings required under this subsection.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-339" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>The owner or operating entity or receiver of a nursing home or community program may petition the court to terminate the receivership.</text> </level> <level label="2"> <text>The court shall terminate the receivership, if the court finds:</text> <level label="i"> <text>The grounds for appointment of the receiver under Part V of this subtitle no longer exist; or</text> </level> <level label="ii"> <text>The nursing home or community program is ready to be closed because all residents have been moved.</text> </level> </level> </level> <level label="b"> <text>A receivership ends automatically 1 year after the court appoints the receiver, unless the court:</text> <level label="1"> <text>Terminates the receivership sooner; or</text> </level> <level label="2"> <text>On petition of the Secretary, extends the receivership for an additional 1-year period because the court finds that the grounds for appointment of a receiver under Part V of this subtitle still exist.</text> </level> </level> <level label="c"> <text>The sale of a nursing home or site for a community program or any of its assets does not terminate a receivership of the nursing home or community program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-342" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this section, “patient” includes an inpatient, an outpatient, and an emergency services patient.</text> </level> <level label="b"> <text>The General Assembly intends to promote the health, safety, and well–being of patients and to foster better communication between patients and health care providers in hospitals through the use of a patient’s bill of rights that specifies the ethical and humane treatment the patient has a right to expect.</text> </level> <level label="c"> <text>Each administrator of a hospital shall:</text> <level label="1"> <text>Provide to each patient in the hospital a written copy of the patient’s bill of rights that:</text> <level label="i"> <text>The hospital adopts under Joint Commission guidelines or guidelines issued by a nationally recognized hospital accreditation organization approved by the Centers for Medicare and Medicaid Services conditions of participation; and</text> </level> <level label="ii"> <text>Complies with subsection (d) of this section;</text> </level> </level> <level label="2"> <text>If a patient does not speak English or requires the patient’s bill of rights in an alternative format, provide a translator, an interpreter, or another accommodation to assist the patient in understanding and exercising the rights included in the patient’s bill of rights;</text> </level> <level label="3"> <text>Conspicuously post copies of the patient’s bill of rights on the hospital’s website and in areas that are accessible to patients and visitors, which may include admitting offices, patient floors, patient rooms, the outpatient department, and emergency services waiting areas; and</text> </level> <level label="4"> <text>Provide annual training to all patient care staff members to ensure the staff’s knowledge and understanding of the patient’s bill of rights.</text> </level> </level> <level label="d"> <text>The patient’s bill of rights shall at a minimum include a statement, in plain language, that a patient has a right to:</text> <level label="1"> <text>Receive considerate, respectful, and compassionate care;</text> </level> <level label="2"> <text>Be provided care in a safe environment free from all forms of abuse and neglect, including verbal, mental, physical, and sexual abuse;</text> </level> <level label="3"> <text>Have a medical screening exam and be provided stabilizing treatment for emergency medical conditions and labor;</text> </level> <level label="4"> <text>Be free from restraints and seclusion unless needed for safety;</text> </level> <level label="5"> <text>Be told the names and jobs of the health care team members involved in the patient’s care if staff safety is not a concern;</text> </level> <level label="6"> <text>Have respect shown for the patient’s personal values, beliefs, and wishes;</text> </level> <level label="7"> <text>Be treated without discrimination based on race, color, national origin, ethnicity, age, gender, sexual orientation, gender identity or expression, physical or mental disability, religion, language, or ability to pay;</text> </level> <level label="8"> <text>Be provided a list of protective and advocacy services when needed;</text> </level> <level label="9"> <text>Receive information about the patient’s hospital and physician charges and ask for an estimate of hospital charges before care is provided and as long as patient care is not impeded;</text> </level> <level label="10"> <text>Receive information in a manner that is understandable by the patient, which may include:</text> <level label="i"> <text>Sign and foreign language interpreters;</text> </level> <level label="ii"> <text>Alternative formats, including large print, braille, audio recordings, and computer files; and</text> </level> <level label="iii"> <text>Vision, speech, hearing, and other temporary aids as needed, without charge;</text> </level> </level> <level label="11"> <text>Receive information from the patient’s doctor or other health care practitioners about the patient’s diagnosis, prognosis, test results, possible outcomes of care, and unanticipated outcomes of care;</text> </level> <level label="12"> <text>Access the patient’s medical records in accordance with HIPAA Notice of Privacy Practices;</text> </level> <level label="13"> <text>Be involved in the patient’s plan of care;</text> </level> <level label="14"> <text>Be screened, assessed, and treated for pain;</text> </level> <level label="15"> <text>Refuse care;</text> </level> <level label="16"> <text>In accordance with hospital visitation policies, have an individual of the patient’s choice remain with the patient for emotional support during the patient’s hospital stay, choose the individuals who may visit the patient, and change the patient’s mind about the individuals who may visit;</text> </level> <level label="17"> <text>Appoint an individual of the patient’s choice to make health care decisions for the patient, if the patient is unable to do so;</text> </level> <level label="18"> <text>Make or change an advance directive;</text> </level> <level label="19"> <text>Give informed consent before any nonemergency care is provided, including the benefits and risks of the care, alternatives to the care, and the benefits and risks of the alternatives to the care;</text> </level> <level label="20"> <text>Agree or refuse to take part in medical research studies, without the agreement or refusal affecting the patient’s care;</text> </level> <level label="21"> <text>Allow or refuse to allow pictures of the patient for purposes other than the patient’s care;</text> </level> <level label="22"> <text>Expect privacy and confidentiality in care discussions and treatments;</text> </level> <level label="23"> <text>Be provided a copy of the Health Insurance Portability and Accountability Act Notice of Privacy Practices; and</text> </level> <level label="24"> <text>File a complaint about care and have the complaint reviewed without the complaint affecting the patient’s care.</text> </level> </level> <level label="e"> <text>The Office of Health Care Quality shall monitor the compliance of each hospital with the requirements of this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-342.1" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Emergency pregnancy–related medical condition” means a medical condition that presents in a pregnant patient through acute symptoms of sufficient severity and for which the absence of immediate medical attention could be reasonably expected to result in:</text> <level label="i"> <text>Placing the health of the patient in serious jeopardy;</text> </level> <level label="ii"> <text>Serious impairment to bodily functions; or</text> </level> <level label="iii"> <text>Serious dysfunction of any bodily organ or body part.</text> </level> </level> <level label="3"> <text>“Stabilize” means, for an emergency pregnancy–related medical condition, to provide the medical treatment necessary to alleviate the condition or ensure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the patient from the facility.</text> </level> </level> <level label="b"> <text>This section applies only to a hospital with an emergency department.</text> </level> <level label="c"> <text>If a hospital determines that a patient has an emergency pregnancy–related medical condition, the hospital shall:</text> <level label="1"> <text>Using the staff and facilities available to the hospital, provide further examination and the treatment required to stabilize the emergency pregnancy–related medical condition, including the termination of a pregnancy when the termination is medically necessary to stabilize the patient; or</text> </level> <level label="2"> <text>Transfer the patient to another medical facility.</text> </level> </level> <level label="d"> <text>A hospital shall allow the termination of a pregnancy at the hospital if the patient’s treating health care practitioner determines termination is medically necessary to stabilize a patient.</text> </level> <level label="e"> <level label="1"> <text>A hospital is considered to have met the requirements of this section if, after offering further examination and treatment or transfer to the patient or the patient’s representative and informing the patient or patient’s representative of the risks and benefits of further examination and treatment or transfer:</text> <level label="i"> <text>A patient or the patient’s representative refuses to consent to further examination and treatment; or</text> </level> <level label="ii"> <text>A patient or the patient’s representative refuses to consent to a transfer to another medical facility.</text> </level> </level> <level label="2"> <text>A hospital shall take reasonable steps to secure written informed consent to the refusal of an examination or treatment or transfer under this subsection from the patient or the patient’s representative.</text> </level> </level> <level label="f"> <text>If a patient has an emergency pregnancy–related medical condition that has not been stabilized, the hospital may not transfer the patient unless the transfer is done consistent with 42 U.S.C. § 1395dd.</text> </level> <level label="g"> <text>A hospital may not penalize or take other adverse action, including an action related to discharge, promotion, demotion, suspension, compensation, training opportunities, staff privileges, or admitting privileges, against:</text> <level label="1"> <text>A treating health care provider if the provider refuses to authorize the transfer of a patient with an emergency pregnancy–related medical condition that has not been stabilized;</text> </level> <level label="2"> <text>A treating health care provider if the provider’s treatment of the patient is consistent with the medical standards of care that, in the provider’s clinical judgment, were necessary to stabilize the patient; or</text> </level> <level label="3"> <text>A hospital employee if the employee reports a violation of this section.</text> </level> </level> <level label="h"> <text>A hospital that negligently violates this section is subject to a civil penalty of:</text> <level label="1"> <text>For a hospital with 100 or more beds, not more than $50,000 for each violation; or</text> </level> <level label="2"> <text>For a hospital with fewer than 100 beds, not more than $25,000 for each violation.</text> </level> </level> <level label="i"> <level label="1"> <text>The Department shall stay a final decision on a potential violation if there is an ongoing federal investigation under 42 U.S.C. § 1395dd regarding the same incident.</text> </level> <level label="2"> <text>If a federal investigation under 42 U.S.C. § 1395dd results in a fine being imposed for the same incident, the Department shall subtract the amount of the federal fine from the maximum potential fine under this section for the same incident.</text> </level> <level label="3"> <level label="i"> <text>Subject to subparagraph (ii) of this paragraph, if a federal investigation under 42 U.S.C. § 1395dd results in a fine being imposed for the same incident within 2 years after the Department imposes a fine under this section, the Department shall refund the hospital an amount equal to the amount of the federal fine.</text> </level> <level label="ii"> <text>The amount refunded under subparagraph (i) of this paragraph may not exceed the amount of the fine imposed by the Department for the same incident.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-343" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this section and §§ 19–344, 19–345, 19–345.1, 19–345.2, and 19–345.3 of this subtitle, “facility” means a related institution that, under the rules and regulations of the Department, is a comprehensive care facility or an extended care facility.</text> </level> <level label="b"> <level label="1"> <text>The General Assembly intends to promote the interests and well–being of each resident of a facility.</text> </level> <level label="2"> <text>It is the policy of this State that, in addition to any other rights, each resident of a facility has the following basic rights:</text> <level label="i"> <text>The right to be treated with consideration, respect, and full recognition of human dignity and individuality;</text> </level> <level label="ii"> <text>The right to receive treatment, care, and services that are adequate, appropriate, and in compliance with relevant State and federal laws, rules, and regulations;</text> </level> <level label="iii"> <text>The right to privacy;</text> </level> <level label="iv"> <text>The right to be free from mental and physical abuse;</text> </level> <level label="v"> <text>The right to notice, procedural fairness, and humane treatment when being transferred or discharged from a facility;</text> </level> <level label="vi"> <text>The right to participate in decision making regarding transitions in care, including a transfer or discharge from a facility;</text> </level> <level label="vii"> <text>The right to expect and receive appropriate assessment, management, and treatment of pain as an integral component of the patient’s care;</text> </level> <level label="viii"> <text>The right to be free from physical and chemical restraints, except for restraints that a physician authorizes for a clearly indicated medical need;</text> </level> <level label="ix"> <text>The right to receive respect and privacy in a medical care program; and</text> </level> <level label="x"> <text>The right to manage personal financial affairs.</text> </level> </level> </level> <level label="c"> <text>Each facility shall:</text> <level label="1"> <text>Post, conspicuously in a public place, the policy set forth in subsection (b) of this section and the provisions in §§ 19–344(b) through (m), 19–345, and 19–346(i)(2) of this subtitle;</text> </level> <level label="2"> <text>Give a copy of the policy and those provisions:</text> <level label="i"> <text>On admission, to the resident;</text> </level> <level label="ii"> <text>To the guardian, next of kin, or sponsoring agency of the resident; and</text> </level> <level label="iii"> <text>To a representative payee of the resident;</text> </level> </level> <level label="3"> <text>Keep a receipt for the copy that is signed by the person who received the copy; and</text> </level> <level label="4"> <text>Provide appropriate staff training to carry out the policy and those provisions.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-344" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>To carry out the policy set forth in § 19-343 of this subtitle, the following procedures are required for all services provided to a resident of a facility.</text> </level> <level label="b"> <level label="1"> <text>A facility may not require or solicit, as a condition of admission into the facility, the signature of another person, other than the applicant, on the application or contract for admission to the facility, unless:</text> <level label="i"> <text>The applicant is adjudicated disabled under Title 13, Subtitle 7 of the Estates and Trusts Article; or</text> </level> <level label="ii"> <level label="1"> <text>The applicant’s physician determines that the applicant is incapable of understanding or exercising the applicant’s rights and responsibilities; and</text> </level> <level label="2"> <text>The applicant’s physician records, in the applicant’s facility record, the specific reasons for the determination.</text> </level> </level> </level> <level label="2"> <text>If, in addition to the signature of an applicant, a facility requires the signature of another person on the application or contract for admission to the facility in accordance with the provisions of paragraph (1) of this subsection, the facility shall provide a written statement to be included in the document of the rights, duties, and liabilities of the signer of the document.</text> </level> <level label="3"> <level label="i"> <text>A facility may request an applicant for whom a second signature cannot be required or solicited under paragraph (1) of this subsection to execute valid durable powers of attorney designating an attorney in fact to make financial, medical, funeral, and burial decisions in the event of the applicant’s disability.</text> </level> <level label="ii"> <text>A facility may not require the execution of a durable power of attorney as a condition or requirement of admission to the facility.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>In this subsection, “agent” means a person who manages, uses, or controls the funds or assets that legally may be used to pay the applicant’s or resident’s share of costs or other charges for the facility’s services.</text> </level> <level label="2"> <text>Except as provided by the Department, a facility may not charge an applicant or resident who is a medical assistance beneficiary, or the applicant’s or resident’s agent, any amount in addition to the amounts determined by the medical assistance program for services that are covered by medical assistance.</text> </level> <level label="3"> <text>Unless otherwise agreed, the financial obligation of the applicant’s or resident’s agent is limited to the amount of the applicant’s or resident’s funds that are considered available to the agent by the medical assistance program.</text> </level> <level label="4"> <level label="i"> <text>A facility may require an applicant, a resident, or the agent of an applicant or resident to agree to distribute any funds, including income or assets of the applicant or resident, which the medical assistance program has determined to be available to pay for the cost of the applicant’s or resident’s care, to the facility, promptly when due, for the cost of the applicant’s or resident’s care.</text> </level> <level label="ii"> <text>For the purpose of this section, funds of the applicant or resident include funds of the applicant or resident that are under the use, ownership, management, or control of the agent.</text> </level> <level label="iii"> <text>A resident or agent of the resident who has not paid a current obligation for the resident’s care may apply to the medical assistance program for a determination of the funds available to pay for the cost of the resident’s care.</text> </level> <level label="iv"> <text>If a request for a determination is made under subparagraph (iii) of this paragraph, the medical assistance program shall make the determination.</text> </level> <level label="v"> <text>If a resident or agent of a resident who has not paid a current obligation for the resident’s care fails to request a determination under subparagraph (iii) of this paragraph, the facility may, without requesting the appointment of a guardian, petition the appropriate circuit court for an order or injunction directing the resident or agent of the resident to request and pursue the determination with due diligence or granting other appropriate relief to enforce the obligations under this section.</text> </level> <level label="vi"> <text>If a resident or agent of the resident fails to pay for the cost of the resident’s care from funds that the medical assistance program has determined to be available to pay for that care, the facility may, without requesting the appointment of a guardian, petition the appropriate circuit court for an order directing the resident or agent of the resident to pay the facility from the funds determined by the medical assistance program to be available.</text> </level> </level> <level label="5"> <level label="i"> <text>An applicant, a resident, or the agent of an applicant or resident shall seek and pursue with due diligence, on behalf of the applicant or resident, all assistance from the medical assistance program which may be available to the applicant or resident.</text> </level> <level label="ii"> <text>The facility shall cooperate with and assist the agent in seeking assistance from the medical assistance program on behalf of the applicant or resident.</text> </level> <level label="iii"> <text>If a resident or the agent of a resident fails to seek assistance from the medical assistance program or to cooperate fully in the eligibility determination process, a facility providing care to the resident may, without requesting the appointment of a guardian, petition the appropriate circuit court for an order or injunction requiring the resident or agent of the resident to seek assistance from the medical assistance program or to cooperate in the eligibility determination process with due diligence or granting other appropriate relief to enforce the obligations under this section.</text> </level> </level> <level label="6"> <level label="i"> <text>Any agent who willfully or with gross negligence violates the requirements of paragraph (4) of this subsection regarding the distribution of the applicant’s or resident’s funds is subject to a civil penalty not less than the amount of funds subject to the violation.</text> </level> <level label="ii"> <text>Any agent who willfully or with gross negligence violates the requirements of paragraph (5) of this subsection regarding an application for medical assistance by or on behalf of an applicant or resident is subject to a civil penalty not exceeding $10,000.</text> </level> <level label="iii"> <text>The Attorney General is responsible for the enforcement and prosecution of violations of the provisions of paragraphs (4) and (5) of this subsection.</text> </level> </level> <level label="7"> <text>Nothing in this subsection may be construed to prohibit any person from knowingly and voluntarily agreeing to guarantee payment for the cost of an applicant’s care.</text> </level> </level> <level label="d"> <text>Each facility shall:</text> <level label="1"> <text>On or before admission of an individual, give the individual a written statement of:</text> <level label="i"> <text>The services of the facility, including each service that is required to be offered on an as-needed basis; and</text> </level> <level label="ii"> <text>Related charges, including any charges for services that are not covered by Medicare, Medicaid, or the basic rate of the facility; and</text> </level> </level> <level label="2"> <text>Keep a written receipt for the statement that is signed by the individual.</text> </level> </level> <level label="e"> <text>Unless it is medically inadvisable, the resident physician of a facility or attending physician of its resident shall give the resident information about the diagnosis, treatment, and prognosis of the resident that is complete and current and is stated in language that the resident reasonably can be expected to understand.</text> </level> <level label="f"> <level label="1"> <text>A resident of a facility:</text> <level label="i"> <text>Shall participate in the planning of the medical treatment;</text> </level> <level label="ii"> <text>May refuse medication or treatment; and</text> </level> <level label="iii"> <text>May know the medical consequences of these actions.</text> </level> </level> <level label="2"> <text>The facility shall:</text> <level label="i"> <text>Have the informed consent of a resident before the resident participates in any experimental research; and</text> </level> <level label="ii"> <text>Keep the resident’s written acknowledgment of that consent.</text> </level> </level> <level label="3"> <text>The resident shall receive information about the relationship of the facility to other health care institutions if the information relates to the care of the resident.</text> </level> <level label="4"> <text>The resident shall receive reasonable continuity of care, including information as to the availability of physicians and times for medical appointments.</text> </level> </level> <level label="g"> <level label="1"> <text>Any case discussion, consultation, examination, or treatment of a resident of a facility:</text> <level label="i"> <text>Is confidential;</text> </level> <level label="ii"> <text>Is to be done discreetly; and</text> </level> <level label="iii"> <text>Is not open to an individual who is not involved directly in the care of the resident unless the resident permits the individual to be present.</text> </level> </level> <level label="2"> <text>Except as necessary for the transfer of a resident from the facility to another health care institution or as required by law or a third-party payment contract, the personal and medical records of a resident are confidential and may not be released without the consent of the resident to any individual who:</text> <level label="i"> <text>Is not associated with the facility; or</text> </level> <level label="ii"> <text>Is associated with the facility, but does not have a demonstrated need for the information.</text> </level> </level> </level> <level label="h"> <text>If it is feasible to do so and not medically contraindicated, spouses or domestic partners who are both residents of the facility shall be given the opportunity to share a room.</text> </level> <level label="i"> <text>A resident of a facility alone or with other individuals is entitled to present any grievance or recommend a change in a policy or service to the staff or administrator of the facility, the Department of Aging, or any other person, without fear of reprisal, restraint, interference, coercion, or discrimination.</text> </level> <level label="j"> <level label="1"> <text>Each facility shall place at the bedside of each resident the name, address, and telephone number of a physician who is responsible for the resident’s care.</text> </level> <level label="2"> <text>A resident shall have access at any reasonable time to a telephone where the resident may speak privately.</text> </level> <level label="3"> <text>A resident shall have access to writing instruments, stationery, and postage.</text> </level> <level label="4"> <text>The correspondence of a resident shall be sent to the addressee without delay and without being opened.</text> </level> <level label="5"> <text>Every patient and resident may associate and communicate privately and without restriction with persons and groups of his choice on his own or their initiative at any reasonable hour.</text> </level> </level> <level label="k"> <level label="1"> <text>Each married resident of a facility shall have privacy during a visit by the spouse.</text> </level> <level label="2"> <text>Each resident of a facility who has a domestic partner shall have privacy during a visit by the other domestic partner.</text> </level> </level> <level label="l"> <text>To a reasonable extent, a resident of a facility shall have the right to possess and use clothing and other personal effects and to have security for those effects.</text> </level> <level label="m"> <text>A resident of a facility may not be assigned to do any work for the facility without personal consent and without written approval of the attending physician of the resident.</text> </level> <level label="n"> <text>A resident of a facility shall receive a reasonable response from an administrator or staff to a personal request of the resident.</text> </level> <level label="o"> <level label="1"> <text>A resident of a facility shall enjoy privacy in the room of the resident.</text> </level> <level label="2"> <text>Unless the staff member knows that the resident is asleep, the member shall knock on the door before the member enters the room of the resident.</text> </level> </level> <level label="p"> <text>The administrator of a facility is responsible for carrying out this section.</text> </level> <level label="q"> <level label="1"> <text>A resident of a facility or the next of kin or domestic partner or guardian of the person of a resident may file a complaint about an alleged violation of this section.</text> </level> <level label="2"> <text>The complaint may be filed with the Department of Aging or the Department.</text> </level> <level label="3"> <text>The Secretary of Aging shall:</text> <level label="i"> <text>Investigate the complaint; and</text> </level> <level label="ii"> <text>After the investigation, report the findings to the complainant.</text> </level> </level> <level label="4"> <text>After receipt of the report, the complainant shall be given an opportunity for a hearing before the Department in accordance with the rules and regulations that the Department adopts.</text> </level> <level label="5"> <text>The Secretary of Aging or the Secretary’s designee may request a hearing and act as a representative of the resident at the hearing under paragraph (4) of this subsection when:</text> <level label="i"> <text>There is no guardian able and available or family member able, willing, and available; and</text> </level> <level label="ii"> <text>The resident consents.</text> </level> </level> <level label="6"> <text>The Secretary of Aging or the Secretary’s designee may, in any hearing under paragraph (4) of this subsection to which it is not a party under paragraph (5) of this subsection, take part as an interested party.</text> </level> </level> <level label="r"> <text>If a resident is adjudicated a disabled person, is found to be medically incompetent by the attending physician of the resident, or is unable to communicate with others, the rights of the resident may be exercised by:</text> <level label="1"> <text>The next of kin of the resident;</text> </level> <level label="2"> <text>The guardian of the person of the resident;</text> </level> <level label="3"> <text>The sponsoring agency of the resident; or</text> </level> <level label="4"> <text>Unless the facility is the representative payee, the representative payee that the Social Security Administration designates for the resident.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-345" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>A resident of a facility may not be transferred or discharged from the facility involuntarily except for the following reasons:</text> <level label="1"> <text>The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility;</text> </level> <level label="2"> <text>The transfer or discharge is appropriate because the resident’s health has improved sufficiently so that the resident no longer needs the services provided by the facility;</text> </level> <level label="3"> <text>The health or safety of an individual in a facility is endangered;</text> </level> <level label="4"> <text>The resident has failed, after reasonable and appropriate notice, to pay for, or under Medicare or Medicaid or otherwise, to have paid for a stay at the facility; or</text> </level> <level label="5"> <text>The facility ceases to operate.</text> </level> </level> <level label="b"> <text>A resident of a facility that is transferred or discharged from the facility involuntarily may not be transferred or discharged:</text> <level label="1"> <text>To a location other than the location identified in the notice required under § 19–345.1(b)(3) of this subtitle, such as a hotel, shelter, or other temporary housing;</text> </level> <level label="2"> <text>Before the facility to which the resident is to be transferred has confirmed that:</text> <level label="i"> <text>The resident may be transferred to the facility; and</text> </level> <level label="ii"> <text>The facility is prepared to accept the resident.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>A Medicaid certified facility may not:</text> <level label="i"> <text>Include in the admission contract of a resident any requirement that, to stay at the facility, the resident will be required to pay for any period of time or amount of money as a private pay resident for any period when the resident is eligible for Medicaid benefits; or</text> </level> <level label="ii"> <text>Transfer or discharge a resident involuntarily because the resident is a Medicaid benefits recipient.</text> </level> </level> <level label="2"> <level label="i"> <text>Except as provided in subparagraph (ii) of this paragraph, a Medicaid certified facility is presumed to be transferring or discharging a resident in violation of this subsection, if the resident is or becomes eligible for Medicaid benefits.</text> </level> <level label="ii"> <text>A Medicaid certified facility is not presumed to be transferring or discharging a resident in violation of this subsection for transferring or discharging a resident for nonpayment for services while the resident was ineligible for assistance under the medical assistance program.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-345.1" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>A facility shall provide the resident with written notice of:</text> <level label="i"> <text>Any proposed discharge or transfer; and</text> </level> <level label="ii"> <text>The opportunity for a hearing in accordance with the provisions of this section before the discharge or transfer.</text> </level> </level> <level label="2"> <text>The notice required under paragraph (1) of this subsection shall include, at a minimum, the information listed under subsection (b) of this section.</text> </level> </level> <level label="b"> <text>The Department shall prepare and provide each facility with a standardized form that provides, in clear and simple language, at least the following information:</text> <level label="1"> <text>Notice of the intended discharge or transfer of the resident, including the proposed date of the intended discharge or transfer, which may change as a result of an appeal or the discharge planning process;</text> </level> <level label="2"> <text>Each reason for the discharge or transfer;</text> </level> <level label="3"> <text>The location to which the resident will be discharged or transferred, which may change as a result of an appeal or the discharge planning process;</text> </level> <level label="4"> <text>The name of the social worker or other professionally qualified staff, which may change during the discharge planning process, who:</text> <level label="i"> <text>Is designated to provide social services and discharge planning services to the resident in connection with the discharge or transfer; and</text> </level> <level label="ii"> <text>Will be responsible for the development of the post discharge plan of care under subsection (g) of this section;</text> </level> </level> <level label="5"> <text>A proposed date within 10 days after the date of the notice for a meeting between the resident, the resident’s representative, and facility staff to develop the post discharge plan of care under subsection (g) of this section;</text> </level> <level label="6"> <level label="i"> <text>The right of the resident to request a hearing;</text> </level> <level label="ii"> <text>The name, mailing address, e–mail address, and telephone number of the entity to which the resident must submit a request for a hearing; and</text> </level> <level label="iii"> <text>Instructions for obtaining, completing, and submitting a request for a hearing;</text> </level> </level> <level label="7"> <text>The right of the resident to consult with any lawyer the resident chooses;</text> </level> <level label="8"> <text>The availability of the services of Maryland Legal Aid, the Older American Act Senior Legal Assistance Programs, and other agencies that may provide assistance to individuals who need legal counsel;</text> </level> <level label="9"> <level label="i"> <text>The availability of the Long–Term Care Ombudsman Program to assist the resident; and</text> </level> <level label="ii"> <text>The mailing address, e–mail address, and telephone number of the Long–Term Care Ombudsman Program;</text> </level> </level> <level label="10"> <text>The mailing address, e–mail address, and telephone number of Disability Rights Maryland; and</text> </level> <level label="11"> <text>The provisions of this section.</text> </level> </level> <level label="c"> <text>Except as otherwise provided in this section, at least 30 days before the facility involuntarily transfers or discharges a resident, the facility shall:</text> <level label="1"> <text>Provide to the resident the written notice required under subsection (a) of this section; and</text> </level> <level label="2"> <text>Provide the written notice required under subsection (a) of this section to:</text> <level label="i"> <text>The resident;</text> </level> <level label="ii"> <text>The next of kin, guardian, or any other individual known to have acted as the resident’s representative, if any;</text> </level> <level label="iii"> <text>The Long–Term Care Ombudsman; and</text> </level> <level label="iv"> <text>The Department.</text> </level> </level> </level> <level label="d"> <level label="1"> <level label="i"> <text>In accordance with regulations adopted by the Secretary, the facility shall provide the resident with an opportunity for a hearing on the proposed transfer or discharge.</text> </level> <level label="ii"> <text>The regulations adopted by the Secretary may provide for the establishment of an escrow account when:</text> <level label="1"> <text>The basis for the discharge is nonpayment; and</text> </level> <level label="2"> <text>The resident continues to reside in the facility while the appeal is pending.</text> </level> </level> </level> <level label="2"> <text>Except as otherwise provided in this subsection, hearings on proposed transfers or discharges shall be conducted in accordance with the provisions of Title 10, Subtitle 2 of the State Government Article and the Medicaid Fair Hearing Procedures.</text> </level> <level label="3"> <text>Any hearing on a proposed discharge or transfer of a resident:</text> <level label="i"> <text>Is not a contested case as defined in § 10–202 of the State Government Article; and</text> </level> <level label="ii"> <text>May not include the Secretary as a party.</text> </level> </level> <level label="4"> <text>A decision by an administrative law judge on a proposed discharge or transfer of a resident:</text> <level label="i"> <text>Is not a decision of the Secretary;</text> </level> <level label="ii"> <text>Unless appealed, is final and binding on the parties; and</text> </level> <level label="iii"> <text>May be appealed in accordance with § 10–222 of the State Government Article as if it were a contested case but the appeal does not automatically stay the decision of the administrative law judge.</text> </level> </level> </level> <level label="e"> <text>The facility shall provide the written notice required in subsection (a) of this section as soon as practicable before discharge or transfer if an emergency exists and health or safety of the resident or other residents would be placed in imminent and serious jeopardy if the resident were not transferred or discharged from the facility as soon as possible.</text> </level> <level label="f"> <level label="1"> <text>If the information in the notice provided under subsection (c) of this section changes before the discharge or transfer, the facility shall provide the changes to the recipients of the notice as soon as practicable after the new information becomes available.</text> </level> <level label="2"> <text>If a new notice is provided under paragraph (1) of this subsection, the following time requirements apply to the discharge or transfer of the resident:</text> <level label="i"> <text>The resident may not be discharged or transferred for at least 30 days after the new notice has been provided to the resident if the new notice is provided before:</text> <level label="1"> <text>The expiration of the time period required under subsection (c) of this section; or</text> </level> <level label="2"> <text>The date of an order of discharge issued by an administrative law judge under subsection (d) of this section; and</text> </level> </level> <level label="ii"> <text>If the new notice is provided after a date described under item (i) of this paragraph:</text> <level label="1"> <text>If the original notice indicated a discharge location that was a licensed skilled nursing facility and the new notice changes the date of discharge or transfer only, the resident may be discharged on the earliest date that a bed is available at the facility;</text> </level> <level label="2"> <text>If the new notice changes the location of discharge or transfer from a licensed skilled nursing facility to a different licensed skilled nursing facility, the resident may not be discharged or transferred for at least 7 days after the new notice has been provided to the resident; and</text> </level> <level label="3"> <text>If the new notice changes the location of discharge or transfer from a licensed skilled nursing facility to a location that is not a licensed skilled nursing facility but is otherwise determined to be a safe discharge location under an appropriate clinical evaluation and as set forth in the post discharge plan of care, the resident may not be discharged or transferred for at least 30 days after the new notice has been provided to the resident.</text> </level> </level> </level> <level label="3"> <text>A new notice provided under this subsection shall:</text> <level label="i"> <text>Indicate any differences between the prior notice and the new notice; and</text> </level> <level label="ii"> <text>Include a notice of the right to appeal the new notice:</text> <level label="1"> <text>For any discharge or transfer described under paragraph (2)(i) of this subsection; or</text> </level> <level label="2"> <text>For a discharge or transfer described under paragraph (2)(ii)3 of this subsection, if the underlying basis of the original notice has changed.</text> </level> </level> </level> <level label="4"> <text>For a discharge or transfer described under paragraph (2)(ii)1 or 2 of this subsection, a new notice is not required to include a notice of the right to appeal the new notice.</text> </level> </level> <level label="g"> <level label="1"> <text>Before any discharge or transfer and subject to paragraphs (4) and (5) of this subsection, a facility shall develop a post discharge plan of care for the resident to assist the resident with adjusting to the resident’s new living environment and that:</text> <level label="i"> <text>Addresses the resident’s post discharge goals of care and treatment preferences;</text> </level> <level label="ii"> <text>Identifies each of the resident’s reasonably anticipated medical and basic needs after discharge or transfer and establishes a plan for meeting those needs;</text> </level> <level label="iii"> <text>Identifies the address at which the resident will reside post discharge; and</text> </level> <level label="iv"> <text>In accordance with regulations adopted by the Secretary, provides a safe, secure, and sustainable environment for the resident.</text> </level> </level> <level label="2"> <text>The facility shall designate a social worker or other professionally qualified staff member to coordinate the development of the resident’s post discharge plan of care.</text> </level> <level label="3"> <text>The facility shall, if possible, meet with the resident and, with the resident’s consent, the resident’s representative within 10 days after providing the notice required under subsection (a) of this section to discuss the post discharge plan of care for the resident.</text> </level> <level label="4"> <level label="i"> <text>The resident’s post discharge plan of care shall be developed with the participation of the resident and, with the resident’s consent, the resident’s representative.</text> </level> <level label="ii"> <text>If the post discharge plan of care was developed without the participation of the resident or the resident’s representative, the facility shall include in the resident’s medical record an explanation of why the resident or the resident’s representative did not participate.</text> </level> </level> <level label="5"> <text>The resident’s post discharge plan of care shall be developed in consultation with:</text> <level label="i"> <text>The resident’s attending physician;</text> </level> <level label="ii"> <text>A registered nurse responsible for the care of the resident; and</text> </level> <level label="iii"> <text>Any other appropriate staff or professional involved with meeting the resident’s medical needs.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-345.2" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In addition to the provisions of §§ 19–345 and 19–345.1 of this subtitle, a facility may not involuntarily discharge or transfer a resident unless, within 48 hours before the discharge or transfer, the facility has:</text> <level label="1"> <text>Provided or obtained:</text> <level label="i"> <text>A comprehensive medical assessment and evaluation of the resident, including a physical examination, that is documented in the resident’s medical record;</text> </level> <level label="ii"> <text>A post discharge plan of care for the resident that is developed, if possible, with the participation of the resident’s next of kin, guardian, or legal representative in accordance with § 19–345.1 of this subtitle; and</text> </level> <level label="iii"> <text>Written documentation from the resident’s attending physician indicating that the transfer or discharge is in accordance with the post discharge plan of care and is not contraindicated by the resident’s medical condition; and</text> </level> </level> <level label="2"> <text>Provided information to the resident concerning the resident’s rights to make decisions concerning health care, including:</text> <level label="i"> <text>The right to accept or refuse medical treatment;</text> </level> <level label="ii"> <text>The right to make an advance directive, including the right to make a living will and the right to appoint an agent to make health care decisions; and</text> </level> <level label="iii"> <text>The right to revoke an advance directive.</text> </level> </level> </level> <level label="b"> <text>Except as provided in subsection (d)(3) of this section, and at least 24 hours before discharge or transfer, the facility shall provide the resident and the resident’s next of kin, guardian, or legal representative with:</text> <level label="1"> <text>The written statement of the medical assessment and evaluation and written documentation from the resident’s attending physician required under subsection (a) of this section;</text> </level> <level label="2"> <text>The post discharge plan of care developed under § 19–345.1 of this subtitle;</text> </level> <level label="3"> <text>The information necessary to assist the resident and the resident’s next of kin, guardian, or legal representative in obtaining additional prescriptions for necessary medication through consultation with the resident’s treating physician; and</text> </level> <level label="4"> <text>A written statement containing the date, time, method, mode, and destination of discharge.</text> </level> </level> <level label="c"> <text>To the extent authorized under State and federal law, a facility shall provide at least a 3–day supply of medications currently being taken by the resident at the time of discharge or transfer.</text> </level> <level label="d"> <level label="1"> <text>Except as provided in paragraphs (2) and (3) of this subsection, a facility may not discharge or transfer a resident unless the resident is capable of and has consented in writing to the discharge or transfer.</text> </level> <level label="2"> <text>A facility may discharge or transfer a resident without obtaining the written consent of the resident for one of the reasons listed in § 19–345(a) of this subtitle if the discharge or transfer:</text> <level label="i"> <text>Is in accordance with a post discharge plan of care developed under § 19–345.1 of this subtitle;</text> </level> <level label="ii"> <text>Is to the community in which the resident resided before becoming a resident of the facility unless the facility documents why it is in the best interest of the resident to be discharged to another location;</text> </level> <level label="iii"> <text>Is to another licensed provider, unless:</text> <level label="1"> <text>The resident is being discharged or transferred because the resident’s health has improved sufficiently and the resident no longer needs the services provided by the facility;</text> </level> <level label="2"> <text>The resident has no pending application to the medical assistance program or is ineligible for the medical assistance program and is being discharged or transferred for nonpayment under § 19–345(a)(4) of this subtitle; or</text> </level> <level label="3"> <text>If the resident is or may be eligible for the medical assistance program:</text> </level> <level label="A"> <text>The facility has fulfilled its obligation under § 19–344(c) of this subtitle to cooperate with and assist the resident or the resident’s representative in seeking assistance from the medical assistance program and has documented the cooperation and assistance;</text> </level> <level label="B"> <text>The resident or resident’s representative has refused to apply for or seek assistance from the medical assistance program or has repeatedly failed, despite the facility’s documented assistance, to make good–faith efforts to supply information or materials necessary for the medical assistance program to enroll the resident; and</text> </level> <level label="C"> <text>The resident is being discharged for nonpayment under § 19–345(a)(4) of this subtitle; and</text> </level> </level> <level label="iv"> <text>Is to a safe and secure environment.</text> </level> </level> <level label="3"> <text>A facility that is certified as a continuing care provider under Title 10, Subtitle 4 of the Human Services Article is not subject to the provisions of subsection (b) of this section if:</text> <level label="i"> <text>The facility transfers a resident to a lesser level of care within the same facility in accordance with a contractual agreement between the facility and the resident; and</text> </level> <level label="ii"> <text>The transfer is approved by the attending physician.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>If the requirements of §§ 19–345 and 19–345.1 of this subtitle and subsections (a) and (b) of this section have been met, the resident’s next of kin or legal representative shall cooperate and assist in the discharge planning process, including:</text> <level label="i"> <text>Contacting, cooperating with, and assisting other facilities considering admitting the resident; and</text> </level> <level label="ii"> <text>Cooperating with governmental agencies, including meeting the requirements of § 19–344(c) of this subtitle to seek and pursue with due diligence assistance from the medical assistance program.</text> </level> </level> <level label="2"> <text>A facility may, without requesting the appointment of a guardian, petition the appropriate circuit court for an order or injunction directed at the resident or agent of the resident for appropriate relief to enforce this subsection.</text> </level> </level> <level label="f"> <text>If requested by any person during the process of transferring or discharging a resident or on its own initiative, the Office of the Attorney General may investigate whether an abuse of funds under § 19–346 of this subtitle contributed to the decision to transfer or discharge the resident and may make appropriate referrals of the matter to other government agencies.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-345.3" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>The Secretary may impose a civil money penalty not to exceed $10,000 for:</text> <level label="1"> <text>Each violation by a facility of § 19–345, § 19–345.1, or § 19–345.2 of this subtitle; or</text> </level> <level label="2"> <text>Each willful or grossly negligent violation by a resident’s agent or legal representative of § 19–345, § 19–345.1, or § 19–345.2 of this subtitle.</text> </level> </level> <level label="b"> <text>If a civil money penalty is imposed under this section, the facility or agent or legal representative of the resident shall have the right to appeal from an order imposing the civil money penalty in accordance with Title 10, Subtitle 2 of the State Government Article.</text> </level> <level label="c"> <level label="1"> <text>A resident, resident’s agent, or resident’s attorney, or the Attorney General on behalf of the resident, who believes that an involuntary discharge or transfer that violates the requirements of § 19–345, § 19–345.1, or § 19–345.2 of this subtitle is imminent or has taken place may request injunctive relief from a circuit court.</text> </level> <level label="2"> <text>To prevent irreparable harm to residents in a facility, the Attorney General may seek injunctive relief on behalf of the State on the basis of an imminent or ongoing violation of a basic right of residents of facilities provided under § 19–343(b)(2)(ii), (iv), (v), (viii), or (x) of this subtitle.</text> </level> <level label="3"> <text>In an action brought by the Attorney General under this subsection, the Attorney General may request that the court impose a civil penalty not to exceed $100,000 for each violation by a facility of § 19–345, § 19–345.1, or § 19–345.2 of this subtitle.</text> </level> <level label="4"> <text>In exercising the authority granted under paragraphs (2) and (3) of this subsection, the Attorney General may not duplicate any corrective action imposed by the Department for the same violation.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-346" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Abuse of funds” means using the assets or income of a resident:</text> <level label="i"> <text>Against the express wish of the resident, if the expenditure was not necessary for the direct and immediate benefit and welfare of the resident; or</text> </level> <level label="ii"> <text>For the use or benefit of a person other than the resident if the expenditure is not also for the direct and immediate benefit of the resident or consistent with an express wish and past behavior of the resident.</text> </level> </level> <level label="3"> <text>“Bank” means a bank, trust company, savings bank, or savings and loan association that:</text> <level label="i"> <text>Is authorized to do business in this State; and</text> </level> <level label="ii"> <text>Is insured by the Federal Deposit Insurance Corporation, Federal Savings and Loan Insurance Corporation, or the State of Maryland Deposit Insurance Fund Corporation.</text> </level> </level> <level label="4"> <text>“Facility” means:</text> <level label="i"> <text>A hospital that is classified as a special hospital; or</text> </level> <level label="ii"> <text>A related institution.</text> </level> </level> </level> <level label="b"> <text>This section provides rights and remedies in addition to, and not in derogation of, any right or remedy that a resident of a facility has under any other law.</text> </level> <level label="c"> <text>Each resident of a facility may:</text> <level label="1"> <text>Keep control over personal financial transactions unless:</text> <level label="i"> <text>A court adjudicates the resident as a disabled person, in accordance with Title 13 of the Estates and Trusts Article; or</text> </level> <level label="ii"> <text>The Social Security Administration designates a representative payee to receive the Social Security funds for the use and benefit of the resident; and</text> </level> </level> <level label="2"> <text>Choose any person, including the administrator of the facility or a designee of the administrator, to handle the financial transactions.</text> </level> </level> <level label="d"> <level label="1"> <text>Each facility shall have adequate safeguards for property of a resident that is entrusted to the facility.</text> </level> <level label="2"> <level label="i"> <text>A facility to which money is entrusted shall deposit the money in an account if the facility cannot keep the money safely.</text> </level> <level label="ii"> <text>If the facility is operated by a State, county, or municipal agency and one resident entrusts more than $300 to the facility, the facility shall deposit the amount in excess of $300.</text> </level> <level label="iii"> <text>If the facility is operated by a person other than a State, county, or municipal agency and one resident entrusts more than $100 to the facility, the facility shall deposit the amount in excess of $100.</text> </level> <level label="iv"> <text>If the total amount of money that is entrusted to the facility by its residents exceeds $50 per resident, the facility shall deposit the amount in excess of $50 per resident or $1,000, whichever is less.</text> </level> </level> <level label="3"> <text>A facility that is a related institution caring for individuals and whose administrator or bookkeeper has control over or access to the funds of a resident of the facility shall provide, as determined by the Department, either:</text> <level label="i"> <text>A bond in an amount the Department requires;</text> </level> <level label="ii"> <text>A letter of credit equal to 3 times the average yearly balance of funds of all residents of the facility; or</text> </level> <level label="iii"> <text>Self–insurance if the net worth of the facility is at least 3 times the average yearly balance of funds of all residents of the facility.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>A facility shall keep the accounts of its residents separate from the accounts of the facility.</text> </level> <level label="2"> <text>A facility that is operated by a person other than a State, county, or municipal agency shall:</text> <level label="i"> <text>Establish a separate account with a bank in the name of each resident who entrusts more than $100 to the facility; and</text> </level> <level label="ii"> <text>Deposit other money that the facility is required to deposit, in either:</text> <level label="1"> <text>A separate account in the name of the resident; or</text> </level> <level label="2"> <text>An account that is designated “General Fund of the Participating Residents of the (name of facility)”.</text> </level> </level> </level> <level label="3"> <text>If the facility is operated by a State, county, or municipal agency, the facility may establish any required accounts with a bank or with the State, county, or municipal treasurer.</text> </level> </level> <level label="f"> <level label="1"> <text>The accounts established by facilities shall be interest bearing accounts.</text> </level> <level label="2"> <text>All interest on money of a resident shall be credited to the resident.</text> </level> <level label="3"> <text>The State Treasurer or a county or municipal treasurer shall:</text> <level label="i"> <text>Credit interest to the total account at a rate that equals the average interest rate on short term investments of the government; and</text> </level> <level label="ii"> <text>Allocate the interest among each resident participating in the account in proportion to the resident’s participation in the total account.</text> </level> </level> </level> <level label="g"> <level label="1"> <text>A resident may get money as follows:</text> <level label="i"> <text>If the facility has the money in possession, during the business hours of the facility; or</text> </level> <level label="ii"> <text>If a bank or the State or a county or municipal treasurer holds the money, within 3 banking days.</text> </level> </level> <level label="2"> <text>A resident may give a licensed employee of the facility a limited power of attorney for the account of the resident. The Department shall prescribe the form to be used for this limited power of attorney.</text> </level> </level> <level label="h"> <text>A facility may:</text> <level label="1"> <text>Include in its operating costs the cost of establishing and servicing accounts for private, State, and federally funded residents; and</text> </level> <level label="2"> <text>Recover the cost through a daily or monthly charge for care or as provided in rules or regulations that the Secretary of Health and Human Services adopts under the Social Security Act.</text> </level> </level> <level label="i"> <level label="1"> <text>A facility:</text> <level label="i"> <text>Shall make an accounting of money of a resident to the resident or personal representative of the resident; and</text> </level> <level label="ii"> <text>In accordance with Department rules and regulations:</text> <level label="1"> <text>Shall keep, at the facility, records of all transactions with money of residents; and</text> </level> <level label="2"> <text>Shall be subject to audit.</text> </level> </level> </level> <level label="2"> <text>Each facility that, under the rules and regulations of the Department, is a comprehensive care facility or an extended care facility shall:</text> <level label="i"> <text>Have a monthly accounting available for inspection; and</text> </level> <level label="ii"> <text>Provide a quarterly statement on money of a resident:</text> <level label="1"> <text>To the resident; or</text> </level> <level label="2"> <text>To a person exercising the right of the resident under § 19–344(r) of this subtitle.</text> </level> </level> </level> </level> <level label="j"> <level label="1"> <text>If a facility discharges a resident, the facility shall:</text> <level label="i"> <text>Return, on demand, the money of the resident that the facility has in possession to the resident or a designee of the resident if the resident or designee signs a receipt; and</text> </level> <level label="ii"> <text>Make the money of the resident in an account with a bank or the State, county, or municipal treasurer available to the resident or designee within 3 banking days.</text> </level> </level> <level label="2"> <level label="i"> <text>This paragraph does not apply to a resident who is transferred temporarily to an acute care facility.</text> </level> <level label="ii"> <text>If a facility discharges a resident and the facility is the representative payee of the resident, the facility shall:</text> <level label="1"> <text>Promptly seek designation of a new representative payee; and</text> </level> <level label="2"> <text>Transfer all money of the resident to the new representative payee.</text> </level> </level> </level> </level> <level label="k"> <level label="1"> <text>If a resident has been absent from a facility for 1 year, the facility shall make reasonable attempts to find the resident or the personal representative or heirs of the resident to turn over the property of the resident unless the resident or the attending physician of the resident gives the facility written notice that the resident:</text> <level label="i"> <text>Is expected to be readmitted to the facility; and</text> </level> <level label="ii"> <text>Wants the facility to continue to hold the property.</text> </level> </level> <level label="2"> <text>All property and any income from property that a facility holds for a discharged or deceased resident are presumed abandoned in accordance with Title 17 of the Commercial Law Article, if the property and income are not claimed by the resident, personal representative, or heir within 1 year.</text> </level> </level> <level label="l"> <level label="1"> <text>If the ownership of a facility changes, the transferor shall give the transferee a certified written audit of all funds that residents have entrusted to the facility.</text> </level> <level label="2"> <text>The transferee shall give to the transferor a signed receipt acknowledging the receipt of the accounts.</text> </level> </level> <level label="m"> <text>A resident is not liable for any act or omission of the facility concerning the finances of the facility or the resident.</text> </level> <level label="n"> <level label="1"> <text>A person, including the legal representative of the resident, may not use the assets or income of a resident for any purpose that is not authorized by the resident, a designee, or a legal representative, including a representative payee of the resident.</text> </level> <level label="2"> <level label="i"> <text>A person may make a written or oral complaint if the person believes that there has been an abuse of funds.</text> </level> <level label="ii"> <text>The complaint shall set forth each reason for the belief that there has been an abuse of funds and any facts that the complainant has to support the complaint.</text> </level> <level label="iii"> <text>The complaint shall be made:</text> <level label="1"> <text>To the local department of social services for the county where the facility is located; or</text> </level> <level label="2"> <text>If the patient is 65 years old or older, to the Secretary of Aging.</text> </level> </level> </level> <level label="3"> <text>The recipient of the complaint shall:</text> <level label="i"> <text>Immediately give the administrator of the facility written notice of the complaint, unless the administrator is the alleged abuser and the recipient believes that the notice would affect an investigation adversely;</text> </level> <level label="ii"> <text>Investigate the complaint, as appropriate; and</text> </level> <level label="iii"> <text>Give the alleged abuser specific notice of the alleged abuse and an opportunity to reply to the charges stated in the complaint.</text> </level> </level> <level label="4"> <text>On request of the Secretary of Aging or the local department of social services, a State’s Attorney shall help in the investigation.</text> </level> <level label="5"> <text>If, after the completion of an investigation, there is probable cause to believe that there has been an abuse of funds, the Secretary of Aging or the local department of social services may:</text> <level label="i"> <text>Refer the matter to the State’s Attorney for appropriate action; and</text> </level> <level label="ii"> <text>On behalf of the resident, bring suit to recover the misused money, costs, and attorney’s fees.</text> </level> </level> <level label="6"> <text>A person who acts in good faith is not civilly or criminally liable for:</text> <level label="i"> <text>Making a complaint under this subsection;</text> </level> <level label="ii"> <text>Participating in an investigation arising out of a complaint under this subsection; or</text> </level> <level label="iii"> <text>Participating in a judicial proceeding arising out of a report under this subsection.</text> </level> </level> </level> <level label="o"> <level label="1"> <text>If there is an abuse of funds, a person who misused the money is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $10,000.</text> </level> <level label="2"> <text>Any person who violates another provision of this section is subject to a fine of $10,000.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-347" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <level label="i"> <text>“Abuse” means the non–therapeutic infliction of physical pain or injury, or any persistent course of conduct intended to produce or resulting in mental or emotional distress.</text> </level> <level label="ii"> <text>“Abuse” does not include the performance of an accepted medical procedure that a physician orders.</text> </level> </level> <level label="3"> <text>“Law enforcement agency” means the Department of State Police or a police agency of a county or municipal corporation.</text> </level> </level> <level label="b"> <level label="1"> <text>A person who believes that a resident of a related institution has been abused shall report promptly the alleged abuse to an appropriate law enforcement agency and the Office of Health Care Quality in the Department.</text> </level> <level label="2"> <text>A report:</text> <level label="i"> <text>May be oral or written; and</text> </level> <level label="ii"> <text>Shall contain as much information as the reporter is able to provide.</text> </level> </level> <level label="3"> <level label="i"> <text>Unless the administrator is the alleged abuser, a recipient of a report promptly shall notify, to the extent allowed by federal and State law, the administrator of the related institution.</text> </level> <level label="ii"> <text>If the Office of Health Care Quality receives a report under paragraph (1) of this subsection, the Office promptly shall notify the Long–Term Care Ombudsman Program established under § 10–902 of the Human Services Article.</text> </level> </level> </level> <level label="c"> <text>Any employee of a related institution who is required to report alleged abuse under subsection (b) of this section, and who fails to report the alleged abuse within 3 days after learning of the alleged abuse, is liable for a civil penalty of not more than $1,000.</text> </level> <level label="d"> <level label="1"> <text>Unless otherwise provided, the law enforcement agency, with the assistance of the Secretary, shall:</text> <level label="i"> <text>Investigate thoroughly each report of an alleged abuse; and</text> </level> <level label="ii"> <text>Attempt to ensure the protection of the alleged victim.</text> </level> </level> <level label="2"> <text>The investigation shall include:</text> <level label="i"> <text>A determination of the nature, extent, and cause of the abuse;</text> </level> <level label="ii"> <text>The identity of the alleged abuser; and</text> </level> <level label="iii"> <text>Any other pertinent fact or matter.</text> </level> </level> <level label="3"> <text>Within 10 working days after the completion of the investigation, the law enforcement agency shall submit a written report of its findings to:</text> <level label="i"> <text>The State’s Attorney;</text> </level> <level label="ii"> <text>The Secretary;</text> </level> <level label="iii"> <text>The local long–term care ombudsman entity, as defined in § 10–901 of the Human Services Article;</text> </level> <level label="iv"> <text>Unless the administrator is the alleged abuser, the administrator of the related institution; and</text> </level> <level label="v"> <text>The Office of Health Care Quality of the Maryland Department of Health.</text> </level> </level> </level> <level label="e"> <text>The law enforcement agency:</text> <level label="1"> <text>Shall refer to the Secretary for investigation reported instances of abuse involving any persistent course of conduct intended to produce or resulting in mental or emotional distress; and</text> </level> <level label="2"> <text>May refer to the Secretary for investigation reported instances of patient–to–patient abuse.</text> </level> </level> <level label="f"> <text>Within 10 working days after the completion of an investigation under subsection (d) of this section, the Secretary shall submit a written report of its findings to:</text> <level label="1"> <text>The State’s Attorney;</text> </level> <level label="2"> <text>The local long–term care ombudsman entity, as defined in § 10–901 of the Human Services Article; and</text> </level> <level label="3"> <text>Unless the administrator is the alleged abuser, the administrator of the related institution.</text> </level> </level> <level label="g"> <text>A person shall have the immunity from liability described under § 5–631 of the Courts and Judicial Proceedings Article for:</text> <level label="1"> <text>Making a report under this section;</text> </level> <level label="2"> <text>Participating in an investigation arising out of a report under this section;</text> </level> <level label="3"> <text>Participating in a judicial proceeding arising out of a report under this section; or</text> </level> <level label="4"> <text>Participating in transferring, suspending, or terminating the employment of any individual who is believed to have abused or aided in abusing a resident under this section.</text> </level> </level> <level label="h"> <level label="1"> <text>The Department shall provide each related institution with signs that set forth the reporting requirements under this section.</text> </level> <level label="2"> <text>The related institution shall post the signs conspicuously in the employee and public areas of the related institution.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-347.1" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this section, “inappropriate sexual behavior” has the meaning stated in COMAR 10.01.18.02.</text> </level> <level label="b"> <text>A privately owned and operated residential treatment center shall be subject to the reporting requirements established by the Department under COMAR 10.01.18.05 that apply when a staff member observes, receives a complaint regarding, or otherwise has reason to believe that an individual has been subjected to inappropriate sexual behavior.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-348" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>Each hospital shall offer to each adult female inpatient of the hospital a Papanicolaou smear for detection of cervical cancer unless:</text> <level label="i"> <text>The attending physician orders otherwise; or</text> </level> <level label="ii"> <text>The patient has had the examination within the preceding year.</text> </level> </level> <level label="2"> <text>A patient may refuse the examination.</text> </level> </level> <level label="b"> <level label="1"> <text>Each hospital shall offer mammography educational materials to each female patient when medically appropriate for the patient.</text> </level> <level label="2"> <text>The Department, in collaboration with the Maryland Hospital Association, the Medical and Chirurgical Faculty of Maryland, and appropriate advocacy groups, shall select and approve, or develop and print, and update as necessary, mammography educational materials for the purposes of paragraph (1) of this subsection.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-349" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>At least 45 days before a related institution increases any fee or charge for a service of the related institution, the related institution shall give each resident or the authorized representative of the resident written notice of the amount of the increase.</text> </section> <section article="ghg" article_name="Health - General" number="19-349.1" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>A hospital shall provide oral and written notice to a patient of the patient’s outpatient status, the billing implications of the outpatient status, and the impact of the outpatient status on the patient’s eligibility for Medicare rehabilitation services if:</text> <level label="1"> <text>The patient receives on–site services from the hospital for more than 23 consecutive hours;</text> </level> <level label="2"> <text>The on–site services received by the patient include a hospital bed and meals that have been provided in an area of the hospital other than the emergency room; and</text> </level> <level label="3"> <text>The patient is classified as an outpatient at the hospital for observation rather than an admitted inpatient.</text> </level> </level> <level label="b"> <text>The Department, in consultation with hospitals in the State, shall adopt by regulation standardized elements to be included in the written notice required under subsection (a) of this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-349.2" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Electronically” means a secure digital or electronic transmission in compliance with federal and State law, including by:</text> <level label="i"> <text>Patient Internet portal;</text> </level> <level label="ii"> <text>Encrypted e–mail; or</text> </level> <level label="iii"> <text>Text message with a link to an encrypted notice.</text> </level> </level> <level label="3"> <level label="i"> <text>“Outpatient facility fee” means a hospital outpatient charge approved by the Commission for an outpatient clinic service, supply, or equipment, including the service of a nonphysician clinician.</text> </level> <level label="ii"> <text>“Outpatient facility fee” does not include:</text> <level label="1"> <text>A charge billed for services delivered in an emergency department; or</text> </level> <level label="2"> <text>A physician fee billed for professional services provided at the hospital.</text> </level> </level> </level> <level label="4"> <level label="i"> <text>“Patient” means an individual who receives health care.</text> </level> <level label="ii"> <text>“Patient” includes:</text> <level label="1"> <text>A person authorized to consent to health care for an individual consistent with the authority granted, including a guardian, surrogate, or person with a medical power of attorney;</text> </level> <level label="2"> <text>An individual who is a minor, if the minor seeks treatment to which the minor has the right to consent and has consented under Title 20, Subtitle 1 of this article;</text> </level> <level label="3"> <text>A parent, guardian, custodian, or representative of an individual who is a minor; and</text> </level> <level label="4"> <text>A person authorized to consent to health care for an individual who is a minor consistent with the authority granted.</text> </level> </level> </level> </level> <level label="b"> <text>Subject to subsections (c), (d), (e), and (f) of this section, if a hospital charges an outpatient facility fee, the hospital shall provide the patient with a written notice, separate from any other forms or notices, in the following form or a substantially similar form:</text> <text>IMPORTANT FINANCIAL INFORMATION</text> <text>(Patient Name)________________ Appointment Date:___________________</text> <text>Notice Of Hospital Outpatient Facility Fee And Billing Disclosure</text> <text>a. Your appointment with (provider, practice, or outpatient facility name) will take place in an outpatient department of (hospital name).</text> <text>b. (Hospital name) will charge an outpatient facility fee that is separate from and in addition to the bill you will receive from (provider).</text> <text>c. You will receive two charges for your visit:</text> <level label="1"> <text>a provider services bill from (provider); and</text> </level> <level label="2"> <text>a hospital facility bill from (hospital name).</text> <text>Expected Fee</text> <text>(if known) The amount of the facility fee that will be charged by (hospital name) for your appointment is $ ____________. or</text> <text>(if unknown) (Hospital name’s) facility fee is likely to range from $___________ to $_____________. and</text> <text>(if unknown) Based on appointments like the one you are scheduled for, we estimate the facility fee to be $____________. and</text> <text>(if unknown) We are providing you with a range of fees and an estimate because the actual amount of the facility fee will depend on the hospital services that are actually provided. The fee could be higher if you require services during your appointment that we cannot reasonably predict today.</text> <text>Financial help for your portion of the outpatient facility fee bill may be available. If you need financial help with the outpatient facility bill, please contact (hospital financial assistance office, with telephone number and direct website address).</text> <text>Receiving services here may result in greater financial liability than receiving services at a location where a facility fee may not be charged.</text> <text>(if applicable) No Facility Fee Location</text> <text>You can see (provider) at another location that does not charge a facility fee.</text> <text>(address and contact information)</text> <text>Contact your insurance carrier to see if (provider) is a participating provider and in–network at the (address of alternative location) location.</text> <text>Insurance Information</text> </level> <level label="1"> <text>The amount of the facility fee that you will be responsible for paying will depend on your insurance coverage.</text> </level> <level label="2"> <text>Insurance companies could impose deductibles or higher copayment or coinsurance amounts for services provided in hospital outpatient departments.</text> </level> <level label="3"> <text>If you have insurance, you should contact your carrier to determine your insurance coverage and your estimated financial responsibility for the facility fee, including copayments, coinsurance, and deductible amounts for the outpatient facility fee.</text> <text>Facility Fee Complaints</text> <text>If you have a complaint about an outpatient facility fee charge, please first contact the hospital, (hospital billing office contact information).</text> <text>If the complaint is unresolved, you may then file the complaint with the Health Services Cost Review Commission, (contact information).</text> <text>If you need additional information regarding your facility fee charges or if you need assistance mediating a facility fee complaint against a hospital, contact the Health Education and Advocacy Unit of the Office of the Attorney General, 1–877–261–8807 | Heau@oag.state.md.us | www.MarylandCares.org.</text> <text>Acknowledgment</text> </level> <level label="1"> <text>I understand that I will be billed a hospital facility fee and a provider fee.</text> </level> <level label="2"> <text>(Hospital name) provided me with information on the facility fees that will be billed for my appointment.</text> </level> <level label="3"> <text>I understand that the fee could vary based on conditions and services provided to me that the hospital cannot reasonably predict today.</text> </level> <level label="4"> <text>I understand that my out–of–pocket costs will depend on my insurance coverage.</text> <text>________(initial here) – by initialing here, I confirm that I received the facility fee information at the time I made my appointment with (provider).</text> <text>By signing this form, I acknowledge that I have received this information before receiving services today.</text> <text>_____________________________ _______________________________</text> <text>Signature Date</text> <text>To request this notice in an alternative format, please call (contact information) or e–mail (contact information).</text> <text>(Same sentence in Spanish).</text> </level> </level> <level label="c"> <text>If a patient does not speak English or requires the notice required under subsection (b) of this section to be in an alternative format, the hospital shall, to the extent practicable, provide the notice in a language or format that is understood by the patient.</text> </level> <level label="d"> <level label="1"> <text>A hospital shall determine the range of hospital outpatient facility fees and fee estimates, based on typical or average facility fees for the same or similar appointments, to be provided in the notice required under this section, consistent with the hospital’s most recent rate order as approved by the Commission.</text> </level> <level label="2"> <text>Each hospital that charges an outpatient facility fee shall use the range of hospital outpatient facility fees and fee estimates determined under paragraph (1) of this subsection.</text> </level> </level> <level label="e"> <level label="1"> <text>For an appointment made in person or by telephone:</text> <level label="i"> <text>Oral notice of all the information that would be provided in the form required under subsection (b) of this section shall be given at the time the appointment is made; and</text> </level> <level label="ii"> <text>Except as provided in paragraph (3) of this subsection, the written notice required under subsection (b) of this section shall be sent to the patient electronically at the time the appointment is made.</text> </level> </level> <level label="2"> <text>For an appointment made electronically or using a website, the written notice required under subsection (b) of this section shall be:</text> <level label="i"> <text>Provided at the time the appointment is made; and</text> </level> <level label="ii"> <text>Sent to the patient electronically at the time the appointment is made.</text> </level> </level> <level label="3"> <text>If the patient refuses electronic communication under paragraph (1)(ii) of this subsection, the written notice shall be sent to the patient by first–class mail at the time the appointment is made.</text> </level> </level> <level label="f"> <text>Before professional medical services are provided on the date of the appointment, the patient shall acknowledge in writing that the notice required under this section was provided at the time the appointment was made.</text> </level> <level label="g"> <text>A hospital may not charge, bill, or attempt to collect an outpatient facility fee unless the patient was given notice in accordance with this section.</text> </level> <level label="h"> <level label="1"> <text>On or before January 31 each year, beginning in 2022, each hospital shall report to the Health Services Cost Review Commission a list of the hospital–based, rate–regulated outpatient services provided by the hospital.</text> </level> <level label="2"> <text>On or before February 28 each year, beginning in 2022, the Health Services Cost Review Commission annually shall:</text> <level label="i"> <text>Post on its website the list of the hospital–based, rate–regulated outpatient services reported by each hospital under paragraph (1) of this subsection; and</text> </level> <level label="ii"> <text>Provide the list of the hospital–based, rate–regulated outpatient services reported by each hospital to the Maryland Insurance Administration and the Health Education and Advocacy Unit in the Office of the Attorney General.</text> </level> </level> <level label="3"> <text>When lack of notice in accordance with this section is alleged in a consumer complaint, the Commission shall give consideration in its investigatory and audit procedures as to whether notice was not feasible due to circumstances beyond the hospital’s control.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-350" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>This section applies only to:</text> <level label="i"> <text>Related institutions as defined in § 19–301 of this subtitle; and</text> </level> <level label="ii"> <text>Hospitals as defined in § 19–301 of this subtitle.</text> </level> </level> <level label="2"> <text>Nothing in this section shall apply to charges for services that are set pursuant to § 16–201 of this article.</text> </level> </level> <level label="b"> <level label="1"> <level label="i"> <text>On request of a patient made before or during treatment, a hospital shall provide to the patient a written estimate of the total charges for the hospital services, procedures, and supplies that reasonably are expected to be provided and billed to the patient by the hospital.</text> </level> <level label="ii"> <text>The written estimate shall state clearly that it is only an estimate and actual charges could vary.</text> </level> <level label="iii"> <text>A hospital may restrict the availability of a written estimate to normal business office hours.</text> </level> <level label="iv"> <text>This paragraph does not apply to emergency services.</text> </level> </level> <level label="2"> <text>Within 30 days after discharge of an individual from a hospital, the hospital shall give the individual a summary financial statement that clearly describes:</text> <level label="i"> <text>The total charges incurred;</text> </level> <level label="ii"> <text>If readily ascertainable, a summary of the total charges under the major services categories, including:</text> <level label="1"> <text>Room and board;</text> </level> <level label="2"> <text>Diagnostic services;</text> </level> <level label="3"> <text>Therapeutic services;</text> </level> <level label="4"> <text>Emergency room services;</text> </level> <level label="5"> <text>Drugs and IV solutions; and</text> </level> <level label="6"> <text>Miscellaneous other supplies and services;</text> </level> </level> <level label="iii"> <text>If applicable, the name of the primary and secondary insurer to which a claim has been or will be filed on the individual’s behalf;</text> </level> <level label="iv"> <text>That charges for services provided by a physician are not included in the total hospital charges and are billed separately; and</text> </level> <level label="v"> <text>The individual’s right to request an itemized statement of the account within 1 year of receipt of the summary statement.</text> </level> </level> <level label="3"> <text>Within 30 days after an individual’s request as provided under paragraph (2)(v) of this subsection, the hospital shall provide the individual a statement of the account that:</text> <level label="i"> <text>Is itemized; and</text> </level> <level label="ii"> <text>Describes briefly but clearly each item and the amount charged for it.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>Unless a related institution contracts with its residents to provide care for an all–inclusive preestablished fee, on demand made within 90 days after service is provided to a resident, the related institution shall give the resident or representative of the resident a financial statement that:</text> <level label="i"> <text>Is itemized;</text> </level> <level label="ii"> <text>Describes briefly but clearly each item and the amount charged for it; and</text> </level> <level label="iii"> <text>Identifies the payor to whom a claim has been forwarded.</text> </level> </level> <level label="2"> <text>A related institution may not be required to give a resident more than 1 itemized statement in any 90–day period.</text> </level> </level> <level label="d"> <level label="1"> <text>On demand made within 30 days after payment of any charge for an individual, a hospital or related institution shall give the individual or representative of the individual a financial statement that:</text> <level label="i"> <text>Is itemized; and</text> </level> <level label="ii"> <text>Describes briefly but clearly each item and the amount charged for it.</text> </level> </level> <level label="2"> <text>A hospital or related institution is subject to a fine of $300 if it fails to:</text> <level label="i"> <text>Comply with this subsection; or</text> </level> <level label="ii"> <text>Give the individual or representative a reasonable written explanation for any delay in complying with this subsection.</text> </level> </level> </level> <level label="e"> <text>A hospital or related institution may not demand or accept final payment or recover for money unless the hospital or related institution has given the financial statements required under this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-350.1" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Third party payor” means any person that administers or provides reimbursement for hospital benefits on an expense incurred basis including:</text> <level label="i"> <text>A health maintenance organization issued a certificate of authority in accordance with Subtitle 7 of this title;</text> </level> <level label="ii"> <text>A health insurer or nonprofit health service plan authorized to offer health insurance policies or contracts in this State in accordance with the Insurance Article; or</text> </level> <level label="iii"> <text>A third party administrator registered under the Insurance Article.</text> </level> </level> <level label="3"> <text>“Uniform claims form” means the claim or billing form for reimbursement of hospital services adopted by the Insurance Commissioner under § 15-1003 of the Insurance Article.</text> </level> </level> <level label="b"> <text>When submitting a claim or bill for reimbursement to a third party payor, a hospital shall use the uniform claims form.</text> </level> <level label="c"> <text>The uniform claims form submitted under this section:</text> <level label="1"> <text>Shall be properly completed; and</text> </level> <level label="2"> <text>May be submitted by electronic transfer.</text> </level> </level> <level label="d"> <text>The Secretary may impose a penalty not to exceed $500 on any hospital that violates the provisions of this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-351" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>Except as provided in subsections (b) and (d) of this section, this subtitle does not affect the right of a hospital or related institution to employ or appoint staff.</text> </level> <level label="b"> <level label="1"> <text>A hospital or related institution that provides services that licensed podiatrists are authorized to perform under Title 16 of the Health Occupations Article, other than incidental care, shall include, in its bylaws, rules, or regulations, provisions for use of facilities by and staff privileges for qualified podiatrists.</text> </level> <level label="2"> <text>The hospital or related institution may restrict use of facilities and staff privileges by podiatrists to those podiatrists who meet the qualifications that the hospital or related institution sets for granting those privileges.</text> </level> <level label="3"> <text>The qualifications that the hospital or related institution sets for granting privileges for services that licensed podiatrists are authorized to perform under Title 16 of the Health Occupations Article shall include consideration of the training, education, and experience of the podiatrist.</text> </level> </level> <level label="c"> <level label="1"> <text>A hospital or related institution shall include in its bylaws, rules, or regulations provisions for use of facilities by and staff privileges for qualified dentists.</text> </level> <level label="2"> <text>The hospital or related institution may restrict use of facilities and staff privileges by dentists to those dentists who meet the qualifications that the hospital or related institution sets for granting those privileges.</text> </level> </level> <level label="d"> <level label="1"> <text>A hospital or related institution that provides services of the type that licensed psychologists are permitted to perform under Title 18 of the Health Occupations Article shall include in its bylaws, rules, or regulations, provisions for use of facilities by and staff privileges for qualified psychologists.</text> </level> <level label="2"> <text>The hospital or related institution may restrict use of facilities and staff privileges by psychologists to those psychologists who meet the qualifications that the hospital or related institution sets for granting those privileges.</text> </level> <level label="3"> <level label="i"> <text>Nothing in this subsection shall be construed to require a hospital to:</text> <level label="1"> <text>Grant admitting privileges to a psychologist; or</text> </level> <level label="2"> <text>Permit the exercise of those privileges granted by the hospital board of trustees to psychologists without appropriate collaboration with the physician who has privileges to admit and attend patients in the unit of the facility where the patient is being treated and who has ongoing responsibility for the patient.</text> </level> </level> <level label="ii"> <text>In the event of a disagreement between the psychologist and the physician concerning the patient’s treatment, the decision of the physician who has ongoing responsibility for the patient shall govern.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-352" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this section, “nursing home” means a related institution that is classified as a nursing home.</text> </level> <level label="b"> <text>A nursing home may not assess an interest penalty on charges for services provided to a resident until, whichever is later in time:</text> <level label="1"> <text>45 days after the nursing home mails an itemized statement of the charges to the person responsible for payment of the charges; or</text> </level> <level label="2"> <text>30 days after the end of the period for which the itemized statement of the charges covers.</text> </level> </level> <level label="c"> <text>The nursing home shall include on the itemized statement of charges a statement in bold and conspicuous print as to when interest may be assessed consistent with the provisions of subsection (b) of this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-353" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>A health care facility that is not covered under § 19-342 or § 19-343 of this subtitle shall include in a patient’s bill of rights or similar document that is provided to the patient or resident a statement that a patient or resident has the right to expect and receive appropriate assessment, management, and treatment of pain as an integral component of that patient’s or resident’s care.</text> </section> <section article="ghg" article_name="Health - General" number="19-354" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>A hospital or related institution that is a charitable institution shall have the immunity from liability described under § 5-632 of the Courts and Judicial Proceedings Article.</text> </section> <section article="ghg" article_name="Health - General" number="19-355" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this section, “gender identity” and “sexual orientation” have the meanings stated in § 20–101 of the State Government Article.</text> </level> <level label="b"> <text>This section does not prohibit a hospital or related institution that is licensed or otherwise regulated by the Department or a unit of the Department from refusing, withholding from, or denying any person services for failure to conform to the usual and regular requirements, standards, and regulations imposed by the licensed or regulated hospital or related institution, unless the refusal, withholding, or denial is based on discrimination on the grounds of race, color, religion, sex, age, national origin, marital status, sexual orientation, gender identity, or disability.</text> </level> <level label="c"> <text>A hospital or related institution may not discriminate against any individual with respect to the individual’s medical care because of the race, color, religion, sex, age, national origin, marital status, sexual orientation, gender identity, or disability of the individual.</text> </level> <level label="d"> <text>The Commission on Civil Rights shall enforce this section as provided in Title 20 of the State Government Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-356" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>A hospital or related institution may not grant a discount to or receive a discount from any medical referral service or in any manner split fees with a medical referral service.</text> </level> <level label="b"> <text>A person who violates any provision of this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $100 for the first offense and not exceeding $500 for each subsequent conviction for a violation of the same provision.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-357" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>A person who operates a hospital or related institution may not ask for or receive any rebate, commission, or other consideration from a pharmacy or other provider of drugs, prescriptions, or pharmaceutical services.</text> </level> <level label="b"> <text>A person who violates this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $500 and is subject to suspension or revocation of the license.</text> </level> <level label="c"> <text>In addition to the penalties provided in subsection (b) of this section, the Department may declare a person who violates this section to be ineligible to participate in the Maryland Medical Assistance Program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-358" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>A person may not operate a hospital or related institution unless issued a registration permit or licensed by the Secretary.</text> </level> <level label="b"> <text>A hospital may not provide or hold itself out as providing comprehensive physical rehabilitation services, as defined in § 19-1201 of this title, or operate as a special rehabilitation hospital unless the hospital is classified as a special rehabilitation hospital by the Secretary.</text> </level> <level label="c"> <text>Unless a health care facility is classified as a special rehabilitation hospital by the Secretary, a health care facility may only offer those physical rehabilitation services which are appropriate and necessary to the care, treatment, or support of the acute, chronic disease, or long-term care patient.</text> </level> <level label="d"> <level label="1"> <text>A person who violates any provision of this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 for the first offense and not exceeding $10,000 for each subsequent conviction for a violation of the same provision. Each day a violation is continued after the first conviction is a subsequent offense.</text> </level> <level label="2"> <text>The Secretary may impose a civil money penalty not to exceed $10,000 for each offense under this section.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-359" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>A person who operates a related institution in violation of the rules and regulations that the Secretary adopts for related institutions is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000. Each day a violation is continued after the first conviction is a separate offense.</text> </level> <level label="b"> <text>The Secretary may impose a civil money penalty not to exceed $10,000 for each offense under this section.</text> </level> <level label="c"> <level label="1"> <text>If a civil money penalty is imposed under this section or under § 19-358 of this subtitle, the Secretary shall issue an order which shall state the basis on which the order is made, the amount of the civil money penalty imposed, and the manner in which the amount of the civil money penalty was calculated.</text> </level> <level label="2"> <text>The operator of an unlicensed hospital or an unlicensed or unregistered related institution shall have the right to appeal from the order imposing the civil money penalty in accordance with Title 10, Subtitle 2 of the State Government Article (Administrative Procedure Act - Contested Cases).</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-360" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>This section applies to:</text> <level label="1"> <text>Nonaccredited hospitals found in violation of the standards adopted under this subtitle;</text> </level> <level label="2"> <text>Accredited hospitals:</text> <level label="i"> <text>Found deficient as a result of the complaint review process; or</text> </level> <level label="ii"> <text>Subject to inspection by the Department under § 19–2302(e) of this title as a result of a serious or life–threatening patient care deficiency identified by the Joint Commission on Accreditation of Healthcare Organizations, the Centers for Medicare and Medicaid Services, or the Department;</text> </level> </level> <level label="3"> <text>Accredited residential treatment centers subject to inspection by the Department under § 19–2302(e) of this title as a result of a serious or life–threatening patient care deficiency identified by the Joint Commission on Accreditation of Healthcare Organizations, the Commission on Accreditation of Rehabilitation Facilities, the Council on Accreditation, the Centers for Medicare and Medicaid Services, or the Department; and</text> </level> <level label="4"> <text>Health care facilities that fail to achieve substantial compliance with the standards of an approved accreditation organization under § 19–2302(c)(2) of this title.</text> </level> </level> <level label="b"> <level label="1"> <text>If conditions are found to be detrimental to patient health, safety, or welfare, the Department shall allow the hospital, residential treatment center, or health care facility 30 days to address the deficiencies in other than serious or life-threatening situations.</text> </level> <level label="2"> <text>If corrections cannot be completed within the 30-day period, the Department may accept a plan of correction from the hospital, residential treatment center, or health care facility based upon evidence that corrective action has been undertaken by the hospital or residential treatment center.</text> </level> <level label="3"> <text>Periodic updates of the plan of correction from the hospital, residential treatment center, or health care facility may be requested by the Department.</text> </level> </level> <level label="c"> <text>If a serious or life-threatening condition is found to exist, the Department may order the hospital, residential treatment center, or health care facility to initiate immediate corrective action, and the hospital or residential treatment center shall be subject to inspection by the Department under § 19-308 of this subtitle.</text> </level> <level label="d"> <text>If the Secretary determines that a serious or life-threatening patient care deficiency exists and the hospital, residential treatment center, or health care facility fails to correct the deficiency through implementation of immediate corrective action, the Secretary may:</text> <level label="1"> <text>For an accredited hospital or accredited residential treatment center:</text> <level label="i"> <text>Revoke or restrict the licensure entitlement of § 19-319(c)(2) of this subtitle;</text> </level> <level label="ii"> <text>Impose a civil monetary penalty of not more than $10,000 per instance or per day;</text> </level> <level label="iii"> <text>Impose a directed plan of correction; and</text> </level> <level label="iv"> <text>Impose appropriate operating conditions.</text> </level> </level> <level label="2"> <text>For an unaccredited hospital or health care facility:</text> <level label="i"> <text>Revoke or restrict the license to operate;</text> </level> <level label="ii"> <text>Impose a civil monetary penalty of not more than $10,000 per instance or per day;</text> </level> <level label="iii"> <text>Impose a directed plan of correction; and</text> </level> <level label="iv"> <text>Impose appropriate operating conditions.</text> </level> </level> </level> <level label="e"> <text>In determining the action to be taken under subsection (d) of this section, the Secretary shall consider the following factors:</text> <level label="1"> <text>The number, nature, and seriousness of the patient care deficiencies;</text> </level> <level label="2"> <text>The extent to which the patient care deficiency or deficiencies are part of an ongoing pattern during the preceding 24 months;</text> </level> <level label="3"> <text>The degree of risk to the health, life, or safety of the patients of the hospital, residential treatment center, or health care facility caused by the patient care deficiency or deficiencies;</text> </level> <level label="4"> <text>The efforts made by, and the ability of, the hospital, residential treatment center, or health care facility to correct the patient care deficiency or deficiencies through implementation of immediate corrective action; and</text> </level> <level label="5"> <text>The hospital’s, residential treatment center’s, or health care facility’s history of compliance.</text> </level> </level> <level label="f"> <text>The remedies provided by this section are in addition to any other remedies available to the Department at law or equity.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-361" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this part the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Hazardous condition” means a condition existing in a related institution that does not constitute a life-threatening, health, or fire safety deficiency, as described in § 19-328 of this subtitle, but which is a violation of departmental regulations which is likely to endanger the health, life, or safety of patients.</text> </level> <level label="c"> <text>“Intermediate sanction” means the establishment of an escrow account by a related institution.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-362" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>An intermediate sanction may be imposed consistent with this section when a hazardous condition exists in a related institution and that condition is not remedied pursuant to the following sections.</text> </level> <level label="2"> <text>In determining whether a hazardous condition exists, the following factors shall be considered:</text> <level label="i"> <text>The potential impact of the condition on the health, life, or safety of patients;</text> </level> <level label="ii"> <text>The period of time during which the condition has existed;</text> </level> <level label="iii"> <text>The frequency of occurrence of the condition; and</text> </level> <level label="iv"> <text>The efforts made by the related institution to correct the condition.</text> </level> </level> <level label="3"> <text>Upon determination by the Department that a hazardous condition exists, the Department will notify the facility that a hazardous condition exists which may subject the facility to a sanction.</text> </level> </level> <level label="b"> <level label="1"> <text>The Department shall order that a plan of correction which is acceptable to the Department be submitted within 10 working days.</text> </level> <level label="2"> <text>The Department shall notify the related institution within 3 working days of receipt of the plan of correction as to whether it is or is not acceptable.</text> </level> <level label="3"> <text>If the Department determines that the plan is not acceptable, the related institution will resubmit a revised plan within 5 working days of such notification.</text> </level> <level label="4"> <text>The Department will schedule reinspections of the facility based on time frames established in the plan of correction.</text> </level> </level> <level label="c"> <level label="1"> <text>If the Department determines that an acceptable plan of correction has not been submitted, that the hazardous condition has not been corrected, or that progress satisfactory to the Department has not been accomplished, the Department shall order the facility ownership and appropriate administrative personnel to appear before a representative of the Department.</text> </level> <level label="2"> <text>Following the appearance, or if the facility ownership fails to appear, a decision may be issued which:</text> <level label="i"> <text>Extends the time frame in which the hazardous condition must be corrected; or</text> </level> <level label="ii"> <text>Proposes the imposition of the sanction.</text> </level> </level> </level> <level label="d"> <level label="1"> <text>If a sanction is proposed, or if at the end of the extended time frame the hazardous condition has not been corrected, the Secretary may issue a sanction order.</text> </level> <level label="2"> <text>The sanction order shall state the number of days within which the hazardous condition must be corrected and shall require the related institution to establish an escrow account in accordance with § 19-363 of this subtitle.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-363" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>The funds in the escrow account shall be used only for the purposes of remedying the hazardous condition.</text> </level> <level label="b"> <text>The amount of the escrow account shall be the estimated cost of correcting the hazardous condition or $5,000 whichever is greater.</text> </level> <level label="c"> <text>The escrow account is to be established by the related institution at an authorized financial institution selected by the related institution.</text> </level> <level label="d"> <text>Current operating funds may not be used to establish the escrow account.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-364" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>The related institution shall have the right to appeal from the order within 5 working days from the receipt of the order.</text> </level> <level label="b"> <text>The appeal shall be heard by the hearings office of the Department, which shall render the final agency decision for purposes of judicial review.</text> </level> <level label="c"> <text>Imposition of the sanction shall be stayed until the final decision is issued pursuant to subsection (m) of this section.</text> </level> <level label="d"> <text>A hearing on the sanction shall be held within 10 working days of the request for hearing.</text> </level> <level label="e"> <text>The parties to the hearing shall be the aggrieved related institution and the Secretary.</text> </level> <level label="f"> <text>The parties are entitled to be represented by counsel.</text> </level> <level label="g"> <text>The hearings office may permit, modify, or deny a timely request by the related institution for prehearing discovery.</text> </level> <level label="h"> <text>The hearings office, upon its own motion or upon motion of either party, may subpoena any person or evidence, administer oaths, and take depositions and other testimony.</text> </level> <level label="i"> <text>The hearing shall inquire fully into all of the matters at issue and shall receive into evidence the testimony of witnesses and any documents which are relevant and material to such matters.</text> </level> <level label="j"> <text>The parties shall have the right to present evidence and testimony and to cross-examine that presented by the opposing party.</text> </level> <level label="k"> <text>The purpose of the hearing is to consider and render a decision on the following matters:</text> <level label="1"> <text>The existence of a hazardous condition;</text> </level> <level label="2"> <text>If a hazardous condition exists, the amount of money to be placed into the escrow account; and</text> </level> <level label="3"> <text>The length of time in which the hazardous condition must be corrected.</text> </level> </level> <level label="l"> <text>The burdens of proof are as follows:</text> <level label="1"> <text>The related institution has the burden of proof with respect to establishing the lack of the cited deficiency or deficiencies; and</text> </level> <level label="2"> <text>The Secretary has the burden of proof with respect to the establishment of a deficiency or deficiencies as constituting a hazardous condition.</text> </level> </level> <level label="m"> <text>A decision shall be rendered by the hearings office within 7 days of the hearing. The decision shall be the final agency decision of the Department, subject to appeal pursuant to § 19-367 of this part.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-365" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>Escrowed funds may be released by the escrow agent:</text> <level label="1"> <text>If the related institution can present specific bills (vouchers) for correcting the hazardous condition which have been certified by the Secretary as appropriate; and</text> </level> <level label="2"> <text>In the absence of bills or vouchers, the related institution has received written approval from the Secretary that the expenditure is appropriate for correcting the hazardous condition.</text> </level> </level> <level label="b"> <text>The escrow is terminated and the balance, if any, in the account is returned to the related institution when:</text> <level label="1"> <text>The Secretary certifies that the hazardous condition is corrected;</text> </level> <level label="2"> <text>After the time period set by the Secretary, the Secretary certifies that adequate progress has been made toward correcting the hazardous condition; or</text> </level> <level label="3"> <text>The related institution changes ownership.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-366" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>If the related institution fails to establish the escrow account as ordered, the Secretary may petition the appropriate circuit court to require compliance with the sanction order.</text> </level> <level label="b"> <text>If the hazardous condition is not corrected or progress acceptable to the Secretary is not made within the time frame set by the sanction order, the Secretary may:</text> <level label="1"> <text>Petition the appropriate circuit court to require the related institution to comply with the sanction order; or</text> </level> <level label="2"> <text>Order the forfeiture of the escrowed funds and/or remove all patients and initiate procedures to revoke the related institution’s licensure in accordance with § 19–327 of this subtitle.</text> </level> </level> <level label="c"> <text>Upon petition to the circuit court under subsection (b)(1) of this section, and following notification to the Secretary by the circuit court that the related institution has failed to comply with a court order, the Secretary may impose further sanctions in accordance with subsection (b)(2) of this section. This sanction is in addition to all remedies otherwise available to the circuit court for enforcement of a court order.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-367" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>Either party aggrieved by the decision of the hearings office shall have the right to appeal that decision.</text> </level> <level label="b"> <text>A related institution subject to a sanction shall have the right to appeal a decision by the Secretary that the hazardous condition has not been corrected or that inadequate progress has been made toward correcting the hazardous condition.</text> </level> <level label="c"> <text>Such appeal shall be filed within 30 days of the action to be appealed.</text> </level> <level label="d"> <text>The appeal shall be taken directly to the circuit court of the jurisdiction in which the related institution is located.</text> </level> <level label="e"> <text>Appeal to the circuit court does not stay the imposition of the sanction.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-370" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this Part IX of this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Advice” means the recommendations of the advisory committee.</text> </level> <level label="c"> <text>“Advisory committee” means a patient care advisory committee.</text> </level> <level label="d"> <text>“Petitioner” means one of the following individuals who is responsible for making a decision with a medical consequence for a patient:</text> <level label="1"> <text>A patient;</text> </level> <level label="2"> <text>A physician;</text> </level> <level label="3"> <text>A registered nurse;</text> </level> <level label="4"> <text>A social worker;</text> </level> <level label="5"> <text>A family member;</text> </level> <level label="6"> <text>A guardian;</text> </level> <level label="7"> <text>An individual with a power of attorney to make a decision with a medical consequence for a patient; or</text> </level> <level label="8"> <text>Any other health care practitioner directly involved in the care of the patient.</text> </level> </level> <level label="e"> <text>“Related institution” does not include a domiciliary care home that is operated independent of any other related institution.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-371" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>Each hospital and each related institution shall establish:</text> <level label="1"> <text>An advisory committee as provided in this Part IX of this subtitle; and</text> </level> <level label="2"> <text>A written procedure by which the advisory committee shall be convened.</text> </level> </level> <level label="b"> <text>An advisory committee at a related institution may function:</text> <level label="1"> <text>Solely at that related institution;</text> </level> <level label="2"> <text>Jointly with a hospital advisory committee; or</text> </level> <level label="3"> <text>Jointly with an advisory committee representing no more than 30 other related institutions.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-372" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>Each advisory committee shall consist of at least 4 members, including:</text> <level label="i"> <text>A physician not directly involved with the care of the patient in question;</text> </level> <level label="ii"> <text>A registered nurse not directly involved with the care of the patient in question;</text> </level> <level label="iii"> <text>A social worker; and</text> </level> <level label="iv"> <text>The chief executive officer or a designee from each hospital and each related institution represented on that advisory committee.</text> </level> </level> <level label="2"> <text>The advisory committee may consist of as many other individuals as each represented hospital and related institution may choose, including:</text> <level label="i"> <text>Representatives of the community; and</text> </level> <level label="ii"> <text>Ethical advisors or clergy.</text> </level> </level> <level label="3"> <text>As part of the advisory committee’s deliberations, the advisory committee, in appropriate cases, shall consult:</text> <level label="i"> <text>All members of the patient’s treatment team;</text> </level> <level label="ii"> <text>The patient;</text> </level> <level label="iii"> <text>The patient’s family; and</text> </level> <level label="iv"> <text>In a case involving the options for medical care and treatment of a child with a life-threatening condition, a medical professional familiar with pediatric end-of-life care, if a medical professional with this expertise is not already a member of the committee.</text> </level> </level> </level> <level label="b"> <text>The petitioner may be accompanied by any persons the petitioner desires.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-373" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In addition to any other duties or responsibilities, and on the request of a petitioner, the advisory committee shall offer advice in cases involving individuals with life-threatening conditions.</text> </level> <level label="b"> <text>In addition to any other duties or responsibilities, the advisory committee may:</text> <level label="1"> <text>Educate represented hospital and related institution personnel, patients, and patients’ families concerning medical decision-making; and</text> </level> <level label="2"> <text>Review and recommend institutional policies and guidelines concerning the withholding of medical treatment.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-374" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>On the request of a petitioner, an advisory committee shall give advice concerning the options for medical care and treatment of an individual with a life-threatening condition.</text> </level> <level label="b"> <level label="1"> <text>The advisory committee shall make a good faith effort to notify a patient, a patient’s immediate family members, a patient’s guardians, and an individual with a power of attorney to make a decision with a medical consequence for a patient, of the individual’s right:</text> <level label="i"> <text>To be a petitioner;</text> </level> <level label="ii"> <text>To meet with the advisory committee concerning the options for medical care and treatment; and</text> </level> <level label="iii"> <text>To receive an explanation of the basis of the advisory committee’s advice.</text> </level> </level> <level label="2"> <text>Any information or document that indicates the wishes of the patient shall take precedence in the deliberations of the advisory committee.</text> </level> </level> <level label="c"> <text>An advisory committee or a member of an advisory committee who gives advice in good faith may not be held liable in court for the advice given.</text> </level> <level label="d"> <text>A person that assists one or more hospitals or related institutions in the establishment of an advisory committee may not be held liable in court for any advice given in good faith by that person, the related institution, the advisory committee, or any member of the advisory committee and the committee and its members may not be held liable for any advice given in good faith.</text> </level> <level label="e"> <level label="1"> <text>The proceedings and deliberations of an advisory committee are confidential as provided in § 1-401 of the Health Occupations Article.</text> </level> <level label="2"> <text>The advice of an advisory committee concerning a patient’s medical care and treatment shall become part of the patient’s medical record and is confidential under §§ 4-301 and 4-302 of this article.</text> </level> </level> <level label="f"> <text>A hospital or related institution may not be held liable in a civil action for failing to carry out the advice of an advisory committee concerning a patient’s medical care if the advice given is inconsistent with the written policies of the hospital or related institution.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-377" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this section, “safe patient lifting” means the use of mechanical lifting devices by hospital employees, instead of manual lifting, to lift, transfer, and reposition patients.</text> </level> <level label="b"> <text>On or before December 1, 2007, each hospital shall establish a safe patient lifting committee with equal membership from management and employees.</text> </level> <level label="c"> <level label="1"> <text>On or before July 1, 2008, the safe patient lifting committee shall develop a safe patient lifting policy for the hospital.</text> </level> <level label="2"> <text>The goal of the policy shall be to reduce employee injuries associated with patient lifting.</text> </level> </level> <level label="d"> <text>While developing a safe patient lifting policy, the committee shall consider, based on the patient population of that hospital, the appropriateness and effectiveness of:</text> <level label="1"> <text>Developing or enhancing patient handling hazard assessment processes;</text> </level> <level label="2"> <text>Enhanced use of mechanical lifting devices;</text> </level> <level label="3"> <text>Developing specialized lift teams;</text> </level> <level label="4"> <text>Training programs for safe patient lifting required for all patient care personnel at the hospital;</text> </level> <level label="5"> <text>Incorporating physical space and construction design for mechanical lifting devices in any architectural plans for hospital construction or renovation; and</text> </level> <level label="6"> <text>Developing an evaluation process to determine the effectiveness of the policy.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-380" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this part the following words have the meanings indicated.</text> </level> <level label="b"> <level label="1"> <text>“Aftercare” means any assistance provided by a lay caregiver to a patient after discharge of the patient.</text> </level> <level label="2"> <text>“Aftercare” includes tasks that are limited to the patient’s condition at the time of discharge that do not require a licensed professional.</text> </level> </level> <level label="c"> <text>“Discharge” means the exit or release of a patient from inpatient care in a hospital to the residence of the patient.</text> </level> <level label="d"> <text>“Lay caregiver” means an individual who:</text> <level label="1"> <text>Is an adult;</text> </level> <level label="2"> <text>Is designated as a lay caregiver by a patient or the legal guardian of a patient under this part; and</text> </level> <level label="3"> <text>Performs aftercare for the patient at the residence of the patient.</text> </level> </level> <level label="e"> <level label="1"> <text>“Residence” means a dwelling that a patient considers to be home.</text> </level> <level label="2"> <text>“Residence” does not include:</text> <level label="i"> <text>A rehabilitation facility;</text> </level> <level label="ii"> <text>A hospital;</text> </level> <level label="iii"> <text>A nursing home;</text> </level> <level label="iv"> <text>An assisted living facility; or</text> </level> <level label="v"> <text>A group home licensed by the State.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-381" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>A hospital shall provide a patient or the legal guardian of a patient with an opportunity to designate one lay caregiver before discharge of the patient.</text> </level> <level label="b"> <text>If a patient or the legal guardian of a patient declines to designate a lay caregiver:</text> <level label="1"> <text>The hospital shall document the decision in the patient’s medical record; and</text> </level> <level label="2"> <text>The hospital shall be deemed to be in compliance with the provisions of this part.</text> </level> </level> <level label="c"> <text>If a patient or the legal guardian of a patient designates a lay caregiver, the hospital shall:</text> <level label="1"> <text>Record in the patient’s medical record:</text> <level label="i"> <text>The designation of the lay caregiver;</text> </level> <level label="ii"> <text>The relationship of the lay caregiver to the patient; and</text> </level> <level label="iii"> <text>The name, telephone number, and address of the lay caregiver; and</text> </level> </level> <level label="2"> <text>Request the written consent of the patient or the legal guardian of the patient to release medical information to the lay caregiver in accordance with:</text> <level label="i"> <text>The procedures of the hospital for releasing personal health information; and</text> </level> <level label="ii"> <text>All applicable federal and State laws.</text> </level> </level> </level> <level label="d"> <text>If a patient or the legal guardian of a patient declines to consent to the release of medical information to the lay caregiver, the hospital is not required to:</text> <level label="1"> <text>Provide to the lay caregiver the notice required under § 19–382 of this part; or</text> </level> <level label="2"> <text>Consult with the lay caregiver or provide to the lay caregiver information contained in the discharge plan issued under § 19–383 of this part.</text> </level> </level> <level label="e"> <text>A patient or the legal guardian of a patient may change the designation of a lay caregiver in the event the lay caregiver becomes incapacitated.</text> </level> <level label="f"> <text>A designation of a lay caregiver by a patient or the legal guardian of a patient under this section does not obligate an individual to perform any aftercare for the patient.</text> </level> <level label="g"> <text>This section may not be construed to require a patient or the legal guardian of a patient to designate a lay caregiver.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-382" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>If a patient or the legal guardian of a patient has designated a lay caregiver under § 19–381 of this part, the hospital shall notify the lay caregiver of the discharge of the patient or the transfer of the patient to another hospital or facility licensed by the State as soon as practicable.</text> </section> <section article="ghg" article_name="Health - General" number="19-383" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>As soon as practicable before discharge of a patient, a hospital shall attempt to:</text> <level label="1"> <text>Consult with the patient’s lay caregiver to prepare the lay caregiver for aftercare; and</text> </level> <level label="2"> <text>Issue a discharge plan that describes the aftercare needs of the patient.</text> </level> </level> <level label="b"> <text>The inability of a hospital to consult with a patient’s designated lay caregiver may not interfere with, delay, or otherwise affect the medical care provided to the patient or the patient’s discharge.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-384" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>A hospital’s discharge process may incorporate established evidence–based practices, including those described in:</text> <level label="1"> <text>Standards for accreditation adopted by The Joint Commission or another nationally recognized hospital accreditation organization; and</text> </level> <level label="2"> <text>The Conditions of Participation for hospitals adopted by the Centers for Medicare and Medicaid Services.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-385" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>This part may not be construed to:</text> <level label="1"> <text>Affect the rights of an agent to make health care decisions under Title 5, Subtitle 6 of this article; or</text> </level> <level label="2"> <text>Create a private right of action against a hospital, a hospital employee, or a duly authorized agent of a hospital, or otherwise supersede or replace existing rights or remedies under any other State or federal law.</text> </level> </level> <level label="b"> <text>No federal or State:</text> <level label="1"> <text>Funds may be used for payment of a lay caregiver; and</text> </level> <level label="2"> <text>Program funding may be impacted by this part.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-388" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this part the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Coordinators” means the pediatric overstay coordinator in the Department and the pediatric overstay coordinator in the Department of Human Services.</text> </level> <level label="c"> <text>“Pediatric hospital overstay patient” means a patient under the age of 22 years who remains in an inpatient unit or emergency department of a hospital for more than 48 hours after being medically cleared for discharge or transfer.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-389" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <level label="1"> <text>Except as provided in paragraph (2) of this subsection, the Department shall ensure that a pediatric hospital overstay patient is transferred to and treated in the least restrictive setting when clinically indicated and when possible.</text> </level> <level label="2"> <text>The Department of Human Services, in coordination with the Department, shall ensure that a pediatric hospital overstay patient who is a child committed to the care and custody of the Department of Human Services is transferred to and treated in the least restrictive setting when clinically indicated and when possible.</text> </level> </level> <level label="b"> <text>If a pediatric hospital overstay patient remains in the hospital for more than 48 hours and the registry established under § 7.5–802 of this article indicates that an appropriate inpatient bed is available, the hospital shall seek the transfer to maintain the clinical stability of the patient.</text> </level> <level label="c"> <text>Notwithstanding any other provision of law, to ensure that a pediatric hospital overstay patient is treated in the least restrictive setting, a hospital may concurrently explore in–State and out–of–state placement options.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-390" future_version_removed="true" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>The Department and the Department of Human Services shall establish a pediatric hospital overstay coordinator within each department.</text> </level> <level label="b"> <text>The coordinators shall act in the best interest of a pediatric overstay patient by coordinating between hospitals, relevant State agencies and programs, and providers of mental health and substance use disorder services.</text> </level> <level label="c"> <text>The coordinators shall:</text> <level label="1"> <text>Advocate on behalf of pediatric hospital overstay patients while maintaining appropriate patient confidentiality;</text> </level> <level label="2"> <text>Review policies and procedures of relevant State agencies and make recommendations for necessary changes to the policies and procedures to better serve pediatric hospital overstay patients;</text> </level> <level label="3"> <text>Maintain data on each pediatric hospital overstay patient, including:</text> <level label="i"> <text>Patient’s length of stay;</text> </level> <level label="ii"> <text>The responsible State agency, if applicable;</text> </level> <level label="iii"> <text>Services needed;</text> </level> <level label="iv"> <text>Placement options being sought by the patient;</text> </level> <level label="v"> <text>Information regarding previous hospital admissions for a behavioral health diagnosis;</text> </level> <level label="vi"> <text>Information regarding whether the admission was based on an emergency petition and, if so, whether the emergency petition was executed in a school; and</text> </level> <level label="vii"> <text>Any other relevant data; and</text> </level> </level> <level label="4"> <text>Provide monthly reports on the data collected under this subsection to the Secretary, the Secretary of Human Services, and the Child and Youth Placement Review Panel in the Governor’s Office for Children.</text> </level> <level label="5"> <text>A hospital immediately shall notify the coordinators, through a system designated by the Department, about a pediatric hospital overstay patient.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-393" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>In this part the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Clinical staffing committee” means a committee established by a hospital in accordance with § 19–394(c) of this subtitle.</text> </level> <level label="c"> <text>“Clinical staffing plan” means a plan developed under § 19–394(d) of this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-394" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <level label="a"> <text>This part does not apply to State hospitals.</text> </level> <level label="b"> <level label="1"> <text>Each hospital licensed under this title shall comply with the staffing standards of:</text> <level label="i"> <text>The accreditation body that accredits the hospital; and</text> </level> <level label="ii"> <text>The federal Centers for Medicare and Medicaid Services conditions of participation.</text> </level> </level> <level label="2"> <text>A clinical staffing plan developed under this part shall comply with this subsection.</text> </level> </level> <level label="c"> <level label="1"> <text>Each hospital licensed under this title shall establish and maintain a clinical staffing committee that:</text> <level label="i"> <text>If the hospital has 150 or fewer licensed beds, has 3 managers and 2 employees; or</text> </level> <level label="ii"> <text>If the hospital has 151 or more licensed beds, has 5 managers and 4 employees.</text> </level> </level> <level label="2"> <text>Each clinical staffing committee established under this part may include:</text> <level label="i"> <text>A certified nursing assistant;</text> </level> <level label="ii"> <text>A dietary aide;</text> </level> <level label="iii"> <text>A licensed nurse;</text> </level> <level label="iv"> <text>An environmental service worker;</text> </level> <level label="v"> <text>A medical resident, if the committee is in a teaching hospital;</text> </level> <level label="vi"> <text>A staff physician who is not a hospital employee or administrator;</text> </level> <level label="vii"> <text>A technician; or</text> </level> <level label="viii"> <text>An employee whose duties include patient advocacy.</text> </level> </level> </level> <level label="d"> <level label="1"> <text>The chief nurse executive of each hospital shall produce a draft clinical staffing plan and submit it to the clinical staffing committee of the hospital.</text> </level> <level label="2"> <text>Each clinical staffing committee shall finalize a clinical staffing plan that meets patient needs using the plan submitted under paragraph (1) of this subsection.</text> </level> </level> <level label="e"> <text>When finalizing a clinical staffing plan, the clinical staffing committee shall consider:</text> <level label="1"> <text>Existing staffing levels;</text> </level> <level label="2"> <text>Methods to secure coverage needs as necessary;</text> </level> <level label="3"> <text>Existing gaps in staffing and how to address the gaps;</text> </level> <level label="4"> <text>Any available evidence–based staffing standards;</text> </level> <level label="5"> <text>A schedule for periodic review of the staffing plan;</text> </level> <level label="6"> <text>Appropriate skill mix and competency of staff;</text> </level> <level label="7"> <text>Standards required by:</text> <level label="i"> <text>The Centers for Medicare and Medicaid Services conditions of participation; and</text> </level> <level label="ii"> <text>The accreditation body that accredits the hospital;</text> </level> </level> <level label="8"> <text>The average number of patients of the hospital during the immediately preceding year and relevant information regarding patient discharges, potential admissions, and transfers;</text> </level> <level label="9"> <text>The average level of acuity for patients of the hospital during the immediately preceding year and the corresponding level of nursing care required; and</text> </level> <level label="10"> <text>An estimate of the appropriate combination of skill, experience level, and specialty certification or training of staff that is required to adequately provide care to patients of the hospital.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-395" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>On or before July 1 each year, beginning in 2028, each hospital shall:</text> <level label="1"> <text>Implement the clinical staffing plan finalized under § 19–394 of this subtitle; and</text> </level> <level label="2"> <text>Assign personnel to each patient care unit in accordance with the clinical staffing plan.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-396" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>Each hospital shall provide the clinical staffing plan to staff on request.</text> </section> <section article="ghg" article_name="Health - General" number="19-397" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions"> <text>This part may not be construed to require a hospital to take actions that are inconsistent with the Centers for Medicare and Medicaid Services conditions of participation or the accreditation standards of the accreditation body that accredits the hospital.</text> </section> <section article="ghg" article_name="Health - General" number="19-3A-01" title_number="19" title_name="Health Care Facilities" subtitle_number="3A" subtitle_name="Freestanding Medical Facilities"> <text>In this subtitle, “freestanding medical facility” means a facility:</text> <level label="1"> <text>In which medical and health services are provided;</text> </level> <level label="2"> <text>That, except for a freestanding medical facility established as a result of a conversion of a licensed general hospital under § 19–120(o)(3) of this title, is physically separate from a hospital or hospital grounds;</text> </level> <level label="3"> <text>That is an administrative part of a hospital, as defined in § 19–301 of this title; and</text> </level> <level label="4"> <text>That meets the requirements for provider–based status under the certification for an affiliated hospital as set forth by the Centers for Medicare and Medicaid Services in 42 C.F.R. § 413.65.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-3A-02" title_number="19" title_name="Health Care Facilities" subtitle_number="3A" subtitle_name="Freestanding Medical Facilities"> <level label="a"> <text>On or before January 1, 2006, the Department shall adopt regulations for licensing a freestanding medical facility that uses in its title or advertising the word “emergency” or other language indicating to the public that medical treatment for immediately life-threatening medical conditions is available at that freestanding medical facility.</text> </level> <level label="b"> <text>The regulations shall require the freestanding medical facility to:</text> <level label="1"> <text>Be open 24 hours a day, 7 days a week;</text> </level> <level label="2"> <text>Have available at all times:</text> <level label="i"> <text>At least 1 physician who is credentialed in emergency medicine by the hospital of which the freestanding medical facility is an administrative part;</text> </level> <level label="ii"> <text>A sufficient number of registered nurses and other health care professionals to provide advanced life support;</text> </level> <level label="iii"> <text>Basic diagnostic and laboratory facilities and technicians;</text> </level> <level label="iv"> <text>Resuscitation supplies and equipment, including monitors, defibrillators, cardiac medications, intubation equipment, and intravenous line equipment;</text> </level> <level label="v"> <text>A commercial ambulance for transport of individuals in need of hospitalization or other emergency care; and</text> </level> <level label="vi"> <text>Emergency services to all individuals, regardless of ability to pay;</text> </level> </level> <level label="3"> <text>Comply with all Maryland Institute for Emergency Medical Services Systems emergency transport protocols established for the freestanding medical facility;</text> </level> <level label="4"> <level label="i"> <text>Comply, except in a life–threatening emergency in which compliance is not feasible or practicable, with the federal Centers for Disease Control and Prevention guidelines on universal precautions; and</text> </level> <level label="ii"> <text>Display the notice developed under § 1–207 of the Health Occupations Article that explains the federal Centers for Disease Control and Prevention’s guidelines on universal precautions at the entrance to the freestanding medical facility;</text> </level> </level> <level label="5"> <text>Refrain from use of the words “emergency department”, “emergency room”, or “hospital”; and</text> </level> <level label="6"> <text>Meet any other standard that the Secretary deems necessary to ensure the quality and safety of services provided by a freestanding medical facility.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-3A-03" title_number="19" title_name="Health Care Facilities" subtitle_number="3A" subtitle_name="Freestanding Medical Facilities"> <level label="a"> <text>The Department shall issue a license to a freestanding medical facility that:</text> <level label="1"> <text>Meets the licensure requirements under this subtitle; and</text> </level> <level label="2"> <text>Receives a certificate of need or an exemption from obtaining a certificate of need from the Maryland Health Care Commission under § 19–120 of this title.</text> </level> </level> <level label="b"> <text>A freestanding medical facility that uses in its title or advertising the word “emergency” or other language indicating to the public that medical treatment for immediately life–threatening medical conditions exist at that facility shall be licensed by the Department before it may operate in this State.</text> </level> <level label="c"> <text>Notwithstanding subsection (a)(2) of this section, the Department may not require a freestanding medical facility pilot project to be approved by the Maryland Health Care Commission as a condition of licensure.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-3A-04" title_number="19" title_name="Health Care Facilities" subtitle_number="3A" subtitle_name="Freestanding Medical Facilities"> <text>The governing body of any county may adopt rules and regulations governing freestanding medical facilities more restrictive than the regulations adopted by the Department.</text> </section> <section article="ghg" article_name="Health - General" number="19-3A-05" title_number="19" title_name="Health Care Facilities" subtitle_number="3A" subtitle_name="Freestanding Medical Facilities"> <level label="a"> <text>Except as provided in subsection (b) of this section, a person who violates any provision of this subtitle is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $5,000 or imprisonment not exceeding 1 year or both.</text> </level> <level label="b"> <level label="1"> <text>In addition to other penalties available under law, the Department may impose sanctions against a freestanding medical facility that fails to comply with this subtitle or regulations adopted under this subtitle.</text> </level> <level label="2"> <text>The sanctions imposed by the Department under paragraph (1) of this subsection include:</text> <level label="i"> <text>A civil penalty not to exceed $10,000;</text> </level> <level label="ii"> <text>Restrictions on the operation of the freestanding medical facility;</text> </level> <level label="iii"> <text>A directed plan of correction; and</text> </level> <level label="iv"> <text>Suspension or revocation of the freestanding medical facility’s license.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>Except as otherwise provided under the Administrative Procedure Act, before the Department may impose sanctions under subsection (b)(2)(i), (ii), or (iv) of this section, the Department shall give the freestanding medical facility notice and the opportunity for a hearing and judicial review under the Administrative Procedure Act, as provided in Title 10, Subtitle 2 of the State Government Article.</text> </level> <level label="2"> <text>Before the Department may impose a directed plan of correction, the Department shall give the freestanding medical facility notice and the opportunity for a prompt informal hearing with the Director of the Office of Health Care Quality.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-3A-06" title_number="19" title_name="Health Care Facilities" subtitle_number="3A" subtitle_name="Freestanding Medical Facilities"> <text>The circuit court for a county in which a person is operating a freestanding medical facility in violation of a provision of this subtitle may enjoin further operation of the freestanding medical facility that violates this subtitle.</text> </section> <section article="ghg" article_name="Health - General" number="19-3A-07" title_number="19" title_name="Health Care Facilities" subtitle_number="3A" subtitle_name="Freestanding Medical Facilities"> <level label="a"> <text>There are two freestanding medical facility pilot projects that shall operate in two jurisdictions in the State.</text> </level> <level label="b"> <text>The Department shall issue a freestanding medical facility license to:</text> <level label="1"> <text>One freestanding medical facility pilot project if:</text> <level label="i"> <text>The freestanding medical facility pilot project is established by, and will operate administratively as part of, an acute care general hospital;</text> </level> <level label="ii"> <text>The acute care general hospital is part of a merged asset system with all of its existing Maryland acute care general hospitals located in a single jurisdiction;</text> </level> <level label="iii"> <text>There are not more than 5 acute care general hospitals in the jurisdiction;</text> </level> <level label="iv"> <text>One or more of the existing acute care general hospitals in the merged asset system has an emergency department volume of 75,000 or more visits for the 12 months ending June 30, 2004;</text> </level> <level label="v"> <text>The freestanding medical facility pilot project will operate in Montgomery County;</text> </level> <level label="vi"> <text>The capital expenditure to implement the freestanding medical facility pilot project otherwise meets the requirements of § 19–120(k)(6)(viii) of this title; and</text> </level> <level label="vii"> <text>The freestanding medical facility pilot project meets the requirements under § 19–3A–02(b) of this subtitle; and</text> </level> </level> <level label="2"> <text>One freestanding medical facility pilot project if:</text> <level label="i"> <text>The freestanding medical facility pilot project is established by, and will operate administratively as part of, an acute care general hospital located in Talbot County;</text> </level> <level label="ii"> <text>The freestanding medical facility pilot project will operate in Queen Anne’s County;</text> </level> <level label="iii"> <text>The capital expenditure to implement the freestanding medical facility pilot project otherwise meets the requirements of § 19–120(k)(6)(viii) of this title; and</text> </level> <level label="iv"> <text>The freestanding medical facility pilot project meets the requirements under § 19–3A–02(b) of this subtitle.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>A freestanding medical facility pilot project shall provide to the Maryland Health Care Commission information, as specified by the Commission, on the configuration, location, operation, and utilization, including patient–level utilization, of the pilot project.</text> </level> <level label="2"> <text>A certificate of need is not required for a freestanding medical facility pilot project.</text> </level> </level> <level label="d"> <text>The provisions of §§ 19–3A–01 through 19–3A–06 of this subtitle shall apply to a freestanding medical facility pilot project.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-3A-08" title_number="19" title_name="Health Care Facilities" subtitle_number="3A" subtitle_name="Freestanding Medical Facilities"> <level label="a"> <text>This section applies to all payors subject to the rate–setting authority of the Health Services Cost Review Commission, including:</text> <level label="1"> <text>Insurers, nonprofit health service plans, and health maintenance organizations that deliver or issue for delivery individual, group, or blanket health insurance policies and contracts in the State;</text> </level> <level label="2"> <text>Managed care organizations, as defined in § 15–101 of this article; and</text> </level> <level label="3"> <text>The Maryland Medical Assistance Program established under Title 15, Subtitle 1 of this article.</text> </level> </level> <level label="b"> <text>A payor subject to this section shall pay rates set by the Health Services Cost Review Commission under Subtitle 2 of this title for hospital services provided at:</text> <level label="1"> <text>A freestanding medical facility pilot project authorized under this subtitle prior to January 1, 2008; and</text> </level> <level label="2"> <text>A freestanding medical facility licensed under § 19–3A–03 of this subtitle.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-3B-01" title_number="19" title_name="Health Care Facilities" subtitle_number="3B" subtitle_name="Freestanding Ambulatory Care Facilities"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <level label="1"> <text>“Ambulatory surgical facility” means any center, service, office facility, or other entity that:</text> <level label="i"> <text>Operates exclusively for the purpose of providing surgical services to patients requiring a period of postoperative observation but not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following admission; and</text> </level> <level label="ii"> <text>Seeks reimbursement from payors as an ambulatory surgery center.</text> </level> </level> <level label="2"> <text>“Ambulatory surgical facility” does not include:</text> <level label="i"> <text>The office of one or more health care practitioners seeking only professional reimbursement for the provisions of medical services, unless:</text> <level label="1"> <text>The office operates under contract or other agreement with a payor as an ambulatory surgical facility regardless of whether it is paid a technical or facility fee; or</text> </level> <level label="2"> <text>The office is designated to receive ambulatory surgical referrals in accordance with utilization review or other policies adopted by a payor;</text> </level> </level> <level label="ii"> <text>Any facility or service owned or operated by a hospital and regulated under Subtitle 2 of this title;</text> </level> <level label="iii"> <text>The office of a health care practitioner with not more than one operating room if:</text> <level label="1"> <text>The office does not receive a technical or facility fee; and</text> </level> <level label="2"> <text>The operating room is used exclusively by the health care practitioner for patients of the health care practitioner;</text> </level> </level> <level label="iv"> <text>The office of a group of health care practitioners with not more than one operating room if:</text> <level label="1"> <text>The office does not receive a technical or facility fee; and</text> </level> <level label="2"> <text>The operating room is used exclusively by members of the group practice for patients of the group practice; or</text> </level> </level> <level label="v"> <text>An office owned or operated by one or more dentists licensed under the Health Occupations Article.</text> </level> </level> </level> <level label="c"> <text>“Freestanding ambulatory care facility” means:</text> <level label="1"> <text>An ambulatory surgical facility;</text> </level> <level label="2"> <text>A freestanding endoscopy facility;</text> </level> <level label="3"> <text>A freestanding facility utilizing major medical equipment;</text> </level> <level label="4"> <text>A kidney dialysis center; or</text> </level> <level label="5"> <text>A freestanding birthing center.</text> </level> </level> <level label="d"> <level label="1"> <text>“Freestanding birthing center” means a facility that provides nurse midwife services under Title 8, Subtitle 6 of the Health Occupations Article.</text> </level> <level label="2"> <text>“Freestanding birthing center” does not include:</text> <level label="i"> <text>A hospital regulated under Subtitle 2 of this title; or</text> </level> <level label="ii"> <text>The private residence of the mother.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>“Freestanding endoscopy facility” means a facility:</text> <level label="i"> <text>For the testing, diagnosis, or treatment of a medical disorder in conjunction with the use of microscopic, endoscopic, or laparoscopic equipment that is inserted in a naturally occurring orifice of the body; and</text> </level> <level label="ii"> <text>That seeks reimbursement as a freestanding endoscopy facility from payors or Medicare.</text> </level> </level> <level label="2"> <text>“Freestanding endoscopy facility” does not include:</text> <level label="i"> <text>The office of one or more health care practitioners unless:</text> <level label="1"> <text>The office operates under a contract or other agreement with a payor as a freestanding endoscopy facility regardless of whether it is paid a technical or facility fee; or</text> </level> <level label="2"> <text>The office is designated to receive endoscopic referrals in accordance with utilization review or other policies adopted by a payor; or</text> </level> </level> <level label="ii"> <text>Any facility or service operated by a hospital and regulated under Subtitle 2 of this title.</text> </level> </level> </level> <level label="f"> <level label="1"> <text>“Freestanding facility operating major medical equipment” means a facility using major medical equipment.</text> </level> <level label="2"> <text>“Freestanding facility operating major medical equipment” does not include any facility or service owned or operated by a hospital and regulated under Subtitle 2 of this title.</text> </level> </level> <level label="g"> <text>“Health care practitioner” means a person who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide medical services in the ordinary course of business or practice of a profession.</text> </level> <level label="h"> <level label="1"> <text>“Kidney dialysis center” means a facility that provides hemodialysis or chronic peritoneal dialysis.</text> </level> <level label="2"> <text>“Kidney dialysis center” does not include any facility or service owned or operated by a hospital and regulated under Subtitle 2 of this title.</text> </level> </level> <level label="i"> <text>“License” means a license issued by the Secretary under this subtitle.</text> </level> <level label="j"> <text>“Major medical equipment” means:</text> <level label="1"> <text>Cardiac catheterization equipment;</text> </level> <level label="2"> <text>A computer tomography (CT) scanner;</text> </level> <level label="3"> <text>A lithotripter;</text> </level> <level label="4"> <text>Radiation therapy equipment, including a linear accelerator; or</text> </level> <level label="5"> <text>A magnetic resonance imager (MRI).</text> </level> </level> <level label="k"> <text>“Nonsterile procedure room” means a room:</text> <level label="1"> <text>In which minor surgical procedures are performed, including endoscopy and endoscopic procedures requiring deep sedation;</text> </level> <level label="2"> <text>That can only be accessed from a semi–restricted corridor or an unrestricted corridor;</text> </level> <level label="3"> <text>That is not used for open surgical procedures that:</text> <level label="i"> <text>Enter the thorax, abdomen, pelvis, cranium, or spine; or</text> </level> <level label="ii"> <text>Routinely require induction of deep sedation or general anesthesia for the entirety of the surgical procedure; and</text> </level> </level> <level label="4"> <text>In which deep sedation or general anesthesia may be induced if:</text> <level label="i"> <text>Warranted by the clinical situation; and</text> </level> <level label="ii"> <text>The room is equipped to safely conduct the required level of anesthesia.</text> </level> </level> </level> <level label="l"> <text>“Payor” means:</text> <level label="1"> <text>A health insurer, nonprofit health service plan, or health maintenance organization that holds a certificate of authority to offer health insurance policies or contracts in the State in accordance with this article or the Insurance Article;</text> </level> <level label="2"> <text>A third party administrator or any other entity under contract with a Maryland business to administer health benefits; or</text> </level> <level label="3"> <text>A self–insured group.</text> </level> </level> <level label="m"> <text>“Sterile operating room” means a room in a surgical suite that meets the requirements of a restricted area and is designated and equipped for performing surgical operations or other invasive procedures that may require an aseptic field.</text> </level> <level label="n"> <text>“Surgical services” has the meaning incorporated in the Centers for Medicare and Medicaid Services State Operations Manual – Guidance for Surveyors: Ambulatory Surgical Centers.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-3B-02" title_number="19" title_name="Health Care Facilities" subtitle_number="3B" subtitle_name="Freestanding Ambulatory Care Facilities"> <level label="a"> <text>A freestanding ambulatory care facility may not operate in the State unless the Secretary has granted the facility a license.</text> </level> <level label="b"> <text>The Secretary shall issue a license to an applicant that meets the requirements of this subtitle and all applicable regulations adopted by the Secretary.</text> </level> <level label="c"> <text>A license issued under this subtitle is not transferable.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-3B-03" title_number="19" title_name="Health Care Facilities" subtitle_number="3B" subtitle_name="Freestanding Ambulatory Care Facilities"> <level label="a"> <level label="1"> <text>After consultation with representatives of payors, health care practitioners, and freestanding ambulatory care facilities, the Secretary shall by regulation establish:</text> <level label="i"> <text>Procedures to implement the provisions of this subtitle; and</text> </level> <level label="ii"> <text>Standards to ensure quality of care and patient safety that shall include:</text> <level label="1"> <text>Procedures for credentialing and practitioner performance evaluation;</text> </level> <level label="2"> <text>Qualifications of health care practitioners and support personnel;</text> </level> <level label="3"> <text>Procedures to be followed in the event of an emergency, including a requirement that in the event of an emergency the patient be transported to the nearest appropriate emergency care facility;</text> </level> <level label="4"> <text>Procedures for quality control of any biomedical equipment;</text> </level> <level label="5"> <text>Procedures for postoperative recovery;</text> </level> <level label="6"> <text>Procedures for discharge;</text> </level> <level label="7"> <text>Procedures for ensuring that an anesthesia practitioner is not precluded from providing the highest level of anesthesia support that may be required to safely treat patients undergoing procedures in a freestanding ambulatory surgical facility performed in a nonsterile procedure room or a sterile operating room;</text> </level> <level label="8"> <text>The use of ultrasound imaging in a freestanding birthing center;</text> </level> <level label="9"> <text>Minimum perinatal care standards for a freestanding birthing center that meet or exceed the Maryland Perinatal System Standards that a freestanding birthing center shall meet as a condition of licensure; and</text> </level> <level label="10"> <text>Any other procedures that the Secretary considers necessary for quality of care and patient safety.</text> </level> </level> </level> <level label="2"> <text>The procedures for practitioner performance evaluation required under paragraph (1)(ii)1 of this subsection shall include a review of care provided to patients at the freestanding ambulatory care facility by members of the medical staff.</text> </level> <level label="3"> <text>The review of care shall:</text> <level label="i"> <text>Be undertaken for cases chosen at random and for cases with unexpected adverse outcomes;</text> </level> <level label="ii"> <text>Be based on objective review standards;</text> </level> <level label="iii"> <text>Include a review of the appropriateness of the plan of care for the patient, particularly any medical procedures performed on the patient, in relation to the patient’s condition; and</text> </level> <level label="iv"> <text>Except as provided in paragraph (4) of this subsection, be conducted by at least two members of the medical staff who:</text> <level label="1"> <text>As appropriate, are of the same specialty as the member of the medical staff under review; and</text> </level> <level label="2"> <text>Have been trained in the freestanding ambulatory care facility’s policies and procedures regarding practitioner performance evaluation.</text> </level> </level> </level> <level label="4"> <text>A review of the care provided by a member of the medical staff who is a solo practitioner shall be conducted by an external reviewer.</text> </level> <level label="5"> <text>A freestanding ambulatory care facility shall take into account the results of the practitioner performance evaluation process for a member of the medical staff in the reappointment process.</text> </level> </level> <level label="b"> <text>If appropriate certification by Medicare is available, obtaining the certification shall be a condition of licensure for:</text> <level label="1"> <text>An ambulatory surgical facility; and</text> </level> <level label="2"> <text>A kidney dialysis center.</text> </level> </level> <level label="c"> <text>Each freestanding ambulatory care facility shall provide assurances satisfactory to the Secretary that the freestanding ambulatory care facility does not discriminate against patients, including discrimination based on ability to pay for nonelective procedures.</text> </level> <level label="d"> <text>The Secretary may delegate to the Kidney Disease Commission the Secretary’s authority under § 19–3B–07 of this subtitle to inspect kidney dialysis centers.</text> </level> <level label="e"> <level label="1"> <text>Except as provided in paragraph (2) of this subsection, the Department shall survey freestanding ambulatory care facilities in accordance with federal regulations.</text> </level> <level label="2"> <text>The Department shall survey each freestanding birthing center at least once per calendar year.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-3B-03.1" title_number="19" title_name="Health Care Facilities" subtitle_number="3B" subtitle_name="Freestanding Ambulatory Care Facilities"> <level label="a"> <text>If a newborn is delivered in a freestanding birthing center following a high–risk pregnancy, the freestanding birthing center shall:</text> <level label="1"> <text>Complete a postpartum infant and maternal referral form and submit the form to the local health department for the county in which the birthing parent resides;</text> </level> <level label="2"> <text>Provide to the birthing parent resources and information specific to the circumstances of the birthing parent, including information regarding the risks, signs, preventive measures, and treatment needs for postpartum complications, including cardiovascular conditions, chronic disease, substance misuse, and mental health conditions; and</text> </level> <level label="3"> <text>Call the birthing parent at least 24, but not later than 48, hours after discharging the parent to evaluate the parent’s status and, as necessary, provide information about postpartum complications.</text> </level> </level> <level label="b"> <text>On or before October 1 each year, each local health department shall submit to the Department a report that includes the number and type of referrals made based on the referral forms submitted to the local health department in accordance with subsection (a)(1) of this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-3B-04" title_number="19" title_name="Health Care Facilities" subtitle_number="3B" subtitle_name="Freestanding Ambulatory Care Facilities"> <level label="a"> <text>An applicant for a license shall submit an application to the Secretary.</text> </level> <level label="b"> <text>The application shall:</text> <level label="1"> <text>Be on a form and accompanied by any supporting information that the Secretary requires, including documentation that the Maryland Health Care Commission has determined that the freestanding ambulatory care facility either received a certificate of need or is exempt from certificate of need requirements; and</text> </level> <level label="2"> <text>Be signed and verified by the applicant.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-3B-05" title_number="19" title_name="Health Care Facilities" subtitle_number="3B" subtitle_name="Freestanding Ambulatory Care Facilities"> <text>A license does not entitle the licensee to an exemption from other provisions of law relating to:</text> <level label="1"> <text>The review and approval of hospital rates and charges by the Health Services Cost Review Commission; or</text> </level> <level label="2"> <text>The review and approval of new services or facilities by the Maryland Health Care Commission.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-3B-06" title_number="19" title_name="Health Care Facilities" subtitle_number="3B" subtitle_name="Freestanding Ambulatory Care Facilities"> <text>The Secretary, by regulation, may encourage the joint acquisition, purchase, or operation of major medical equipment by two or more health care practitioners, despite the fact that such joint acquisition, purchase, or operation may limit free economic competition.</text> </section> <section article="ghg" article_name="Health - General" number="19-3B-07" title_number="19" title_name="Health Care Facilities" subtitle_number="3B" subtitle_name="Freestanding Ambulatory Care Facilities"> <level label="a"> <text>The Secretary may investigate complaints concerning the conformance of a freestanding ambulatory care facility to the requirements of this subtitle or to the regulations adopted under this subtitle.</text> </level> <level label="b"> <text>If the complaint concerns health care practitioner performance or standards of medical practice, the complaint shall be referred to the board that licenses, certifies, or otherwise authorizes the health care practitioner under the Health Occupations Article to provide medical services.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-3B-08" title_number="19" title_name="Health Care Facilities" subtitle_number="3B" subtitle_name="Freestanding Ambulatory Care Facilities"> <level label="a"> <level label="1"> <text>The Secretary may deny a license to any applicant, or suspend, restrict, or revoke a license if the applicant has been convicted of:</text> <level label="i"> <text>A felony that relates to Medicaid; or</text> </level> <level label="ii"> <text>A crime involving moral turpitude.</text> </level> </level> <level label="2"> <text>The Secretary may deny a license to any applicant or may restrict, suspend, or revoke any license if the applicant does not meet the requirements of this subtitle or any regulation that the Secretary adopts under this subtitle.</text> </level> </level> <level label="b"> <level label="1"> <text>Before denying, suspending, restricting, or revoking a license or a provisional license under this section, the Secretary shall provide the applicant an opportunity for a hearing.</text> </level> <level label="2"> <text>The Secretary shall send a hearing notice to any applicant by certified mail, return receipt requested, at least 30 days before the hearing.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-3B-09" title_number="19" title_name="Health Care Facilities" subtitle_number="3B" subtitle_name="Freestanding Ambulatory Care Facilities"> <level label="a"> <text>A person who violates any provision of this subtitle or any regulation adopted under this subtitle is guilty of a misdemeanor and on conviction is subject to a penalty not exceeding $1,000 or imprisonment not exceeding 1 year or both. Each day a violation is continued after the first conviction is a separate offense.</text> </level> <level label="b"> <level label="1"> <text>In addition to the provisions of subsection (a) of this section, the Secretary may impose an administrative penalty of up to $1,000 for a violation of any provision of this subtitle or any regulations adopted under this subtitle.</text> </level> <level label="2"> <text>The Secretary shall adopt regulations to provide standards for the imposition of an administrative penalty under paragraph (1) of this subsection.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-3C-01" title_number="19" title_name="Health Care Facilities" subtitle_number="3C" subtitle_name="Cosmetic Surgical Facilities"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <level label="1"> <text>“Cosmetic surgical facility” means an office or a facility in which a cosmetic surgical procedure is performed.</text> </level> <level label="2"> <text>“Cosmetic surgical facility” does not include:</text> <level label="i"> <text>An ambulatory surgical facility regulated under Subtitle 3B of this title;</text> </level> <level label="ii"> <text>A hospital regulated under Subtitle 3 of this title; or</text> </level> <level label="iii"> <text>An office owned or operated by one or more dentists providing services within the scope of practice of dentistry under Title 4 of the Health Occupations Article.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>“Cosmetic surgical procedure” means the use of surgical services to reshape the structure of a human body to change the appearance of an individual.</text> </level> <level label="2"> <text>Except as provided in paragraph (3) of this subsection, “cosmetic surgical procedure” does not include:</text> <level label="i"> <text>A procedure done under local anesthesia or mild sedation; or</text> </level> <level label="ii"> <text>Liposuction that removes less than 1,000 cubic centimeters of aspirate.</text> </level> </level> <level label="3"> <text>“Cosmetic surgical procedure” includes any procedure under paragraph (2) of this subsection that, under the circumstances established by the Secretary in regulations adopted under § 19–3C–02(d) of this subtitle, is a cosmetic surgical procedure.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-3C-02" title_number="19" title_name="Health Care Facilities" subtitle_number="3C" subtitle_name="Cosmetic Surgical Facilities"> <level label="a"> <text>The Secretary may adopt regulations for cosmetic surgical facilities in the State.</text> </level> <level label="b"> <text>Regulations adopted by the Secretary under this section shall include deeming a cosmetic surgical facility to meet specified requirements, if the cosmetic surgical facility is accredited by:</text> <level label="1"> <text>The American Association for Accreditation of Ambulatory Surgical Facilities;</text> </level> <level label="2"> <text>The Accreditation Association for Ambulatory Health Care;</text> </level> <level label="3"> <text>The Joint Commission; or</text> </level> <level label="4"> <text>Any other accreditation organization, as determined by the Secretary.</text> </level> </level> <level label="c"> <text>Regulations adopted under this section may not require higher standards for cosmetic surgical facilities than the standards required for ambulatory surgical facilities under Subtitle 3B of this title.</text> </level> <level label="d"> <level label="1"> <text>The Secretary may adopt regulations that establish the circumstances under which a procedure is a “cosmetic surgical procedure” under § 19–3C–01(c)(3) of this subtitle.</text> </level> <level label="2"> <text>The regulations adopted under paragraph (1) of this subsection shall be based on a finding by the Secretary that the procedure raises substantial health and safety concerns that warrant regulation of the procedure under this subtitle.</text> </level> <level label="3"> <text>In adopting regulations under paragraph (1) of this subsection, the Secretary shall consider available studies, reports, and other literature related to:</text> <level label="i"> <text>The safety or risks of the procedure;</text> </level> <level label="ii"> <text>The education and training of the health care practitioners administering anesthesia for the procedure;</text> </level> <level label="iii"> <text>The education and training of the health care practitioners performing the procedure; and</text> </level> <level label="iv"> <text>The setting in which the procedure is performed.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-3C-03" title_number="19" title_name="Health Care Facilities" subtitle_number="3C" subtitle_name="Cosmetic Surgical Facilities"> <level label="a"> <text>The Secretary may investigate complaints concerning the conformance of a cosmetic surgical facility to the requirements of regulations adopted under § 19–3C–02 of this subtitle.</text> </level> <level label="b"> <text>If the complaint concerns health care practitioner performance or standards of medical practice, the complaint shall be referred to the appropriate health occupations board that licenses, certifies, or otherwise regulates the health care practitioner under the Health Occupations Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-401" title_number="19" title_name="Health Care Facilities" subtitle_number="4" subtitle_name="Home Health Agencies"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Home health agency” means a health-related institution, organization, or a part of an institution that:</text> <level label="1"> <text>Is owned or operated by 1 or more persons, whether or not for profit and whether as a public or private enterprise; and</text> </level> <level label="2"> <text>Directly or through a contractual arrangement, provides to a sick or disabled individual in the residence of that individual skilled nursing services, home health aid services, and at least one other home health care service that are centrally administered.</text> </level> </level> <level label="c"> <level label="1"> <text>“Home health care” means any of the following services that are provided under the general direction of a licensed health professional practicing within the scope of their practice:</text> <level label="i"> <text>Audiology and speech pathology;</text> </level> <level label="ii"> <text>Dietary and nutritional services;</text> </level> <level label="iii"> <text>Drug services;</text> </level> <level label="iv"> <text>Home health aid;</text> </level> <level label="v"> <text>Laboratory;</text> </level> <level label="vi"> <text>Medical social services;</text> </level> <level label="vii"> <text>Nursing;</text> </level> <level label="viii"> <text>Occupational therapy;</text> </level> <level label="ix"> <text>Physical therapy; or</text> </level> <level label="x"> <text>Provision of medically necessary sickroom equipment and supplies.</text> </level> </level> <level label="2"> <text>However, the provisions of this subsection do not apply to:</text> <level label="i"> <text>A nursing referral service agency that is licensed as a nursing referral service agency under the provisions of Subtitle 4B of this title; or</text> </level> <level label="ii"> <text>A home-based hospice care program that is licensed as a home-based hospice care program under the provisions of Subtitle 9 of this title.</text> </level> </level> <level label="3"> <text>A home health agency shall also be licensed as a hospice care program if the home health agency operates a hospice care program that is distinct from its other services.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-402" title_number="19" title_name="Health Care Facilities" subtitle_number="4" subtitle_name="Home Health Agencies"> <text>The purpose of home health care is:</text> <level label="1"> <text>To avoid institutionalization;</text> </level> <level label="2"> <text>To shorten hospital stays;</text> </level> <level label="3"> <text>To speed recovery; and</text> </level> <level label="4"> <text>To bridge the gap in community health services for patients who otherwise could not get adequate health care.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-403" title_number="19" title_name="Health Care Facilities" subtitle_number="4" subtitle_name="Home Health Agencies"> <text>This subtitle does not:</text> <level label="1"> <text>Limit the right of any person to practice a health occupation that the individual is authorized to practice under the Health Occupations Article;</text> </level> <level label="2"> <text>Limit the right of any person who holds a license under this article to act as authorized by that license; or</text> </level> <level label="3"> <text>Prohibit the care of an individual who relies on treatment in accordance with the tenets and practices of a recognized church or religious denomination and, with or without compensation, is cared for in accordance with those tenets and practices.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-404" title_number="19" title_name="Health Care Facilities" subtitle_number="4" subtitle_name="Home Health Agencies"> <level label="a"> <text>The Department shall adopt rules and regulations that set standards for the care, treatment, health, safety, welfare, and comfort of patients of home health agencies.</text> </level> <level label="b"> <text>The rules and regulations shall provide for the licensing of home health agencies and shall establish standards that require as a minimum, that all home health agencies:</text> <level label="1"> <text>Within 10 days of acceptance of a patient for skilled care, make and record all reasonable efforts to contact a physician to obtain the signed order required under item (2) of this subsection;</text> </level> <level label="2"> <text>That accept patients for skilled care do so only on the signed order of a physician obtained within 28 days after acceptance;</text> </level> <level label="3"> <text>Adopt procedures for the administration of drugs and biologicals;</text> </level> <level label="4"> <text>Maintain clinical records on all patients accepted for skilled care;</text> </level> <level label="5"> <text>Establish patient care policies and personnel policies;</text> </level> <level label="6"> <text>Have services available at least 8 hours a day, 5 days a week, and available on an emergency basis 24 hours a day, 7 days a week;</text> </level> <level label="7"> <text>Make service available to an individual in need within 24 hours of a referral when stipulated by a physician’s order;</text> </level> <level label="8"> <text>Have a designated supervisor of patient care who is a full–time employee of the agency and is available at all times during operating hours and additionally as needed; and</text> </level> <level label="9"> <text>Have as the administrator of the agency a person who has at least 1 year of supervisory experience in hospital management, home health management, or public health program management and who is:</text> <level label="i"> <text>A licensed physician;</text> </level> <level label="ii"> <text>A registered nurse; or</text> </level> <level label="iii"> <text>A college graduate with a bachelor’s degree in a health–related field.</text> </level> </level> </level> <level label="c"> <text>The rules and regulations may include provisions that:</text> <level label="1"> <text>Deal with the establishment of home health agencies;</text> </level> <level label="2"> <text>Require each home health agency to have its policies established by a professional group that includes at least:</text> <level label="i"> <text>1 physician;</text> </level> <level label="ii"> <text>1 registered nurse;</text> </level> <level label="iii"> <text>1 representative of another offered service; and</text> </level> <level label="iv"> <text>1 public member;</text> </level> </level> <level label="3"> <text>Govern the services provided by the home health agencies;</text> </level> <level label="4"> <text>Require keeping clinical records of each patient, including the plan of treatment to be provided;</text> </level> <level label="5"> <text>Govern supervision of the services, as appropriate, by:</text> <level label="i"> <text>A physician;</text> </level> <level label="ii"> <text>A registered nurse; or</text> </level> <level label="iii"> <text>Another health professional who is qualified sufficiently by advanced training to supervise the same kind of services in a hospital; and</text> </level> </level> <level label="6"> <text>Require submission of an annual report which includes service utilization statistics.</text> </level> </level> <level label="d"> <text>The provisions of this section do not waive the requirement for a home health agency to obtain a certificate of need.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-405" title_number="19" title_name="Health Care Facilities" subtitle_number="4" subtitle_name="Home Health Agencies"> <text>Except as otherwise provided in this subtitle, a person shall be licensed by the Department before the person may operate a home health agency.</text> </section> <section article="ghg" article_name="Health - General" number="19-406" title_number="19" title_name="Health Care Facilities" subtitle_number="4" subtitle_name="Home Health Agencies"> <text>To qualify for a license, an applicant shall:</text> <level label="1"> <text>Show that the home health agency will provide:</text> <level label="i"> <text>Appropriate home health care to patients who may be cared for at a prescribed level of care, in their residence instead of in a hospital; and</text> </level> <level label="ii"> <text>Skilled nursing, home health aid, and at least one other home health care service that is approved by the Secretary; and</text> </level> </level> <level label="2"> <text>Meet the requirements of Subtitle 1 of this title for certification of need.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-407" title_number="19" title_name="Health Care Facilities" subtitle_number="4" subtitle_name="Home Health Agencies"> <text>The Department shall:</text> <level label="1"> <text>Inspect the operations of each home health agency at least every 3 years to determine whether it is meeting the requirements of this subtitle and the rules and regulations adopted under it; and</text> </level> <level label="2"> <text>Issue, deny, suspend, or revoke a home health agency license in accordance with the rules and regulations adopted under this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-408" title_number="19" title_name="Health Care Facilities" subtitle_number="4" subtitle_name="Home Health Agencies"> <level label="a"> <text>A person may not operate, attempt to operate, or hold one’s self out as operating a home health agency unless licensed under this subtitle.</text> </level> <level label="b"> <text>A home health agency may not withhold any home health care services from an individual because of the individual’s age, sex, sexual orientation, gender identity, disability, race, color, creed, national origin, source of payment, or ability to pay.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-409" title_number="19" title_name="Health Care Facilities" subtitle_number="4" subtitle_name="Home Health Agencies"> <text>A person who operates a home health agency without a license is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 for the first offense and not exceeding $10,000 for each subsequent offense.</text> </section> <section article="ghg" article_name="Health - General" number="19-410" title_number="19" title_name="Health Care Facilities" subtitle_number="4" subtitle_name="Home Health Agencies"> <text>A home health agency may not hold itself out as providing a complete array of physical rehabilitation services unless the home health agency:</text> <level label="1"> <text>Provides a program of coordinated interdisciplinary rehabilitative care, including at a minimum, physical and occupational therapy, speech and language therapy, audiology therapy, psychotherapy, and social work services;</text> </level> <level label="2"> <text>Holds interdisciplinary meetings with the involvement of a physician to plan and monitor patient care; and</text> </level> <level label="3"> <text>Meets any other standard that the Secretary may adopt by regulation.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-411" effective_note="EFFECTIVE UNTIL DECEMBER 31, 2022 PER CHAPTERS 29 AND 31 OF THE 2021 SPECIAL SESSION" title_number="19" title_name="Health Care Facilities" subtitle_number="4" subtitle_name="Home Health Agencies"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“COVID–19” means, interchangeably and collectively, the coronavirus known as COVID–19 or 2019–nCoV and the SARS–CoV–2 virus.</text> </level> <level label="3"> <text>“COVID–19 test” means an in vitro diagnostic test for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, as described in § 3201 of the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act.</text> </level> </level> <level label="b"> <text>For calendar years 2021 and 2022, a home health agency shall adopt and implement a COVID–19 infection control and prevention plan for patients and staff who provide home health care services to patients of the home health agency.</text> </level> <level label="c"> <level label="1"> <text>The plan required under subsection (b) of this section shall:</text> <level label="i"> <text>Be adopted and implemented in accordance with any applicable federal orders and guidance; and</text> </level> <level label="ii"> <text>Ensure that patients and staff who provide home health care services to patients of the home health agency are screened for COVID–19 on a regular basis and tested or referred for testing for COVID–19, if required or recommended under applicable federal orders or guidance, to control and prevent the spread of COVID–19 among staff and patients of the home health agency.</text> </level> </level> <level label="2"> <text>The screening required under paragraph (1) of this subsection shall include reporting to the home health agency of any:</text> <level label="i"> <text>Symptoms related to COVID–19 experienced by patients and staff; and</text> </level> <level label="ii"> <text>Known exposures of patients and staff to individuals who have been diagnosed with COVID–19.</text> </level> </level> </level> <level label="d"> <text>A home health agency shall provide the plan required under subsection (b) of this section to:</text> <level label="1"> <text>Patients and staff; and</text> </level> <level label="2"> <text>Members of the public on request.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-4A-01" title_number="19" title_name="Health Care Facilities" subtitle_number="4A" subtitle_name="Residential Service Agencies"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Home health care” includes any of the following services:</text> <level label="1"> <text>Audiology and speech pathology;</text> </level> <level label="2"> <text>Dietary and nutritional services;</text> </level> <level label="3"> <text>Drug services;</text> </level> <level label="4"> <text>Home health aide;</text> </level> <level label="5"> <text>Laboratory;</text> </level> <level label="6"> <text>Medical social services;</text> </level> <level label="7"> <text>Nursing;</text> </level> <level label="8"> <text>Occupational therapy;</text> </level> <level label="9"> <text>Physical therapy;</text> </level> <level label="10"> <text>Provision of invasive medical equipment; and</text> </level> <level label="11"> <text>Home medical equipment services.</text> </level> </level> <level label="c"> <text>“Home medical equipment services” means the delivery, installation, maintenance, or replacement of, or instruction in the use of, medical equipment used by a sick or disabled individual to allow the individual to be maintained in a noninstitutional environment.</text> </level> <level label="d"> <text>“Medical equipment” means technologically sophisticated medical devices including:</text> <level label="1"> <text>Oxygen and oxygen delivery systems;</text> </level> <level label="2"> <text>Ventilators;</text> </level> <level label="3"> <text>Respiratory disease management devices;</text> </level> <level label="4"> <text>Electronic and computer driven wheelchairs and seating systems;</text> </level> <level label="5"> <text>Apnea monitors;</text> </level> <level label="6"> <text>Transcutaneous electrical nerve stimulator (T.E.N.S.) units;</text> </level> <level label="7"> <text>Low air loss cutaneous pressure management devices;</text> </level> <level label="8"> <text>Sequential compression devices;</text> </level> <level label="9"> <text>Neonatal home phototherapy devices;</text> </level> <level label="10"> <text>Feeding pumps; and</text> </level> <level label="11"> <text>Other similar equipment as defined in regulations established by the Secretary.</text> </level> </level> <level label="e"> <text>“Personal care aide” means an individual who provides personal care as defined in § 19–301 of this title.</text> </level> <level label="f"> <level label="1"> <text>“Residential service agency” means any person that is engaged in a nongovernmental business of employing or contracting with individuals to provide home health care for compensation to an unrelated sick or disabled individual in the residence of that individual.</text> </level> <level label="2"> <text>“Residential service agency” includes any agency that employs or contracts with individuals directly for hire as home health care providers.</text> </level> <level label="3"> <text>“Residential service agency” does not include:</text> <level label="i"> <text>A home health agency that is licensed under the provisions of Subtitle 4 of this title;</text> </level> <level label="ii"> <text>A person required to be licensed as a home health agency under the provisions of Subtitle 4 of this title;</text> </level> <level label="iii"> <text>A home–based hospice care program that is licensed under the provisions of Subtitle 9 of this title;</text> </level> <level label="iv"> <text>A hospital that is licensed under the provisions of Subtitle 3 of this title;</text> </level> <level label="v"> <text>A related institution that is licensed under the provisions of Subtitle 3 of this title;</text> </level> <level label="vi"> <text>Personal care providers under the Medical Assistance Personal Care Program;</text> </level> <level label="vii"> <text>Any person practicing a health occupation that the person is authorized to practice under the Health Occupations Article;</text> </level> <level label="viii"> <text>A nursing referral service agency that is licensed under Subtitle 4B of this title;</text> </level> <level label="ix"> <text>A group of persons licensed under the same title of the Health Occupations Article practicing as a business; or</text> </level> <level label="x"> <text>Residential rehabilitation services providers approved under regulations adopted by the State mental health authority.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-4A-02" title_number="19" title_name="Health Care Facilities" subtitle_number="4A" subtitle_name="Residential Service Agencies"> <text>This subtitle does not:</text> <level label="1"> <text>Limit the right of any person who holds a license under this article to act as authorized by that license; or</text> </level> <level label="2"> <text>Prohibit the care of an individual who relies on treatment in accordance with the tenets and practices of a recognized church or religious denomination and, with or without compensation, is provided care in accordance with those tenets and practices.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-4A-03" title_number="19" title_name="Health Care Facilities" subtitle_number="4A" subtitle_name="Residential Service Agencies"> <level label="a"> <text>The Department shall adopt regulations that set standards for the care, treatment, health, safety, welfare, and comfort of individuals who receive home health care services through a residential service agency.</text> </level> <level label="b"> <text>The regulations shall provide for the licensing of residential service agencies.</text> </level> <level label="c"> <text>The regulations shall include provisions that:</text> <level label="1"> <text>Provide for the establishment of residential service agencies;</text> </level> <level label="2"> <text>Establish qualifications for licensure;</text> </level> <level label="3"> <text>Set minimum standards for individuals who provide home health care services through a residential service agency;</text> </level> <level label="4"> <text>Require the residential service agency to screen and verify the character references of all home health care providers that are employed by the residential service agency; and</text> </level> <level label="5"> <text>Authorize a residential service agency to provide training to a licensed nurse after hire in accordance with § 19–4A–03.2 of this subtitle.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-4A-03.1" title_number="19" title_name="Health Care Facilities" subtitle_number="4A" subtitle_name="Residential Service Agencies"> <level label="a"> <text>In this section, “supervisory staff” means an individual who supervises direct care staff in the individual’s clinical role.</text> </level> <level label="b"> <text>This section does not apply to a residential service agency that only provides durable medical equipment.</text> </level> <level label="c"> <level label="1"> <text>Except as provided in subsection (d) of this section, beginning July 1, 2022, each residential service agency shall ensure that:</text> <level label="i"> <text>Within 45 days after an individual’s start of employment as part of the residential service agency’s direct care or supervisory staff, the individual is trained to provide the care required by the clients of the residential service agency by, at a minimum, providing 3 hours of online or in–person training regarding dementia, including training regarding:</text> <level label="1"> <text>An overview of Alzheimer’s disease and dementia;</text> </level> <level label="2"> <text>Person–centered care;</text> </level> <level label="3"> <text>An understanding of the assessment and care planning process;</text> </level> <level label="4"> <text>Activities of daily living; and</text> </level> <level label="5"> <text>Alzheimer’s disease and dementia–related behaviors and communication; and</text> </level> </level> <level label="ii"> <text>Each member of the residential service agency’s direct care or supervisory staff receives 2 hours of online or in–person continuing education training regarding Alzheimer’s disease and dementia each calendar year.</text> </level> </level> <level label="2"> <text>The training required under paragraph (1) of this subsection may be provided by a supervisory staff member who is responsible for developing an individual’s plan of care and assigning appropriate personnel.</text> </level> </level> <level label="d"> <text>A residential service agency is not required to provide the training:</text> <level label="1"> <text>Described under subsection (c)(1)(i) of this section if the individual has:</text> <level label="i"> <text>Provided Alzheimer’s disease or dementia–related direct care or supervisory services for at least 24 consecutive months before beginning employment with the residential service agency; and</text> </level> <level label="ii"> <text>Received from a residential service agency or other entity a certificate of completion issued under subsection (e) of this section; or</text> </level> </level> <level label="2"> <text>Described under subsection (c)(1)(ii) of this section if the individual has completed the training described under subsection (c)(1)(ii) of this section in the immediately preceding 12 months.</text> </level> </level> <level label="e"> <text>A person providing the training described under subsection (c) of this section shall issue a certificate of completion to each individual who completes the training.</text> </level> <level label="f"> <text>Each residential service agency shall maintain records that indicate the type of training received by each individual who has received a certificate of completion issued under subsection (e) of this section while employed by the residential service agency.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-4A-03.2" title_number="19" title_name="Health Care Facilities" subtitle_number="4A" subtitle_name="Residential Service Agencies"> <level label="a"> <text>A residential service agency that provides private duty nursing services may employ a licensed nurse who does not meet the clinical experience requirements established by the Department if the residential service agency provides training and a competency evaluation in accordance with this section.</text> </level> <level label="b"> <text>A residential service agency that seeks to employ a nurse described under subsection (a) of this section shall:</text> <level label="1"> <text>Establish and implement a training program designed to ensure safe and competent care based on patient needs;</text> </level> <level label="2"> <text>Ensure the nurse receives clinical supervision by a registered nurse qualified in private duty nursing services;</text> </level> <level label="3"> <text>Assign the nurse to a qualified preceptor or clinical supervisor until competency is demonstrated;</text> </level> <level label="4"> <text>Document satisfactory completion of required competency standards in the nurse’s personnel file; and</text> </level> <level label="5"> <text>Conduct competency evaluations of the nurse:</text> <level label="i"> <text>Annually; or</text> </level> <level label="ii"> <text>For disciplinary purposes, on a more frequent schedule as required by the Department.</text> </level> </level> </level> <level label="c"> <text>A training program and competency evaluation required under this section are subject to approval by the Department.</text> </level> <level label="d"> <text>This section may not be construed to affect requirements relating to occupational licensure, scope of practice, or standards of care.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-4A-04" title_number="19" title_name="Health Care Facilities" subtitle_number="4A" subtitle_name="Residential Service Agencies"> <text>Except as otherwise provided in this subtitle, a person shall be licensed by the Department before the person may operate a residential service agency.</text> </section> <section article="ghg" article_name="Health - General" number="19-4A-05" title_number="19" title_name="Health Care Facilities" subtitle_number="4A" subtitle_name="Residential Service Agencies"> <text>To qualify for a license, an applicant:</text> <level label="1"> <text>Shall show that the residential service agency will provide appropriate home health care providers to sick or disabled individuals who may be provided care in the individual’s residence, instead of in a hospital;</text> </level> <level label="2"> <text>Shall meet any additional requirements that the Department adopts; and</text> </level> <level label="3"> <text>May not be required to meet the requirements of Subtitle 1 of this title for certificate of need.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-4A-06" title_number="19" title_name="Health Care Facilities" subtitle_number="4A" subtitle_name="Residential Service Agencies"> <text>The Department shall:</text> <level label="1"> <text>Inspect the operations of each residential service agency to determine whether the agency is meeting the requirements of this subtitle and the regulations adopted under this subtitle; and</text> </level> <level label="2"> <text>Issue, deny, suspend, or revoke a residential service agency license in accordance with the regulations adopted under this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-4A-07" title_number="19" title_name="Health Care Facilities" subtitle_number="4A" subtitle_name="Residential Service Agencies"> <text>A person may not operate, attempt to operate, or hold one’s self out as operating a residential service agency, unless the person is licensed under this subtitle.</text> </section> <section article="ghg" article_name="Health - General" number="19-4A-08" title_number="19" title_name="Health Care Facilities" subtitle_number="4A" subtitle_name="Residential Service Agencies"> <text>A person who operates a residential service agency without a license is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 for the first offense and not exceeding $10,000 for each subsequent offense.</text> </section> <section article="ghg" article_name="Health - General" number="19-4A-09" title_number="19" title_name="Health Care Facilities" subtitle_number="4A" subtitle_name="Residential Service Agencies"> <text>A person who operates a residential service agency in violation of the regulations adopted under this subtitle is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000. Each day a violation is continued after the first conviction is a separate offense.</text> </section> <section article="ghg" article_name="Health - General" number="19-4A-10" title_number="19" title_name="Health Care Facilities" subtitle_number="4A" subtitle_name="Residential Service Agencies"> <level label="a"> <text>Except as provided by federal law, licensure under this subtitle does not entitle a residential service agency to reimbursement by a third party payor.</text> </level> <level label="b"> <text>The Department may reimburse a residential service agency for personal assistance services only if the personal assistance services are provided by an individual classified as an employee.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-4A-11" title_number="19" title_name="Health Care Facilities" subtitle_number="4A" subtitle_name="Residential Service Agencies"> <level label="a"> <level label="1"> <text>On or before December 30, 2021, the Office of the Attorney General, in consultation with the Department and the Maryland Department of Labor, shall produce a guidance document concerning the application of employee protection laws in the Labor and Employment Article, to the use of personal care aides by residential service agencies.</text> </level> <level label="2"> <text>The guidance document required under paragraph (1) of this subsection shall:</text> <level label="i"> <text>Describe with specific reference to the residential service care industry:</text> <level label="1"> <text>Relevant definitions of “employ”, “employee”, “employer”, and “independent contractor”;</text> </level> <level label="2"> <text>The concept of independent contractor misclassification and the potential for legal liability including monetary damages for employees; and</text> </level> <level label="3"> <text>Steps a residential service agency may take to ensure compliance with the Labor and Employment Article;</text> </level> </level> <level label="ii"> <text>Be three pages or fewer and, to the extent feasible, written in plain language; and</text> </level> <level label="iii"> <text>Be revised and updated on an annual basis.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>As a condition of obtaining an initial license from the Department to operate as a residential service agency and every 3 years thereafter, a residential service agency shall certify to the Department, on a form developed by the Department and through the signature of an individual with authority over the residential service agency’s pay or employment practices, that:</text> <level label="i"> <text>The individual has read and understood the guidance document produced under subsection (a) of this section; and</text> </level> <level label="ii"> <text>The residential service agency will comply with the relevant requirements of the Labor and Employment Article.</text> </level> </level> <level label="2"> <text>On an annual basis, the Secretary shall provide the most current version of the guidance document to each licensed residential service agency.</text> </level> <level label="3"> <text>A form developed by the Department for use under paragraph (1) of this subsection shall include a checkbox by which a residential service agency that receives Medicaid reimbursement for the provision of home care or similar services by a personal care aide shall indicate whether the residential service agency uses personal care aides designated as independent contractors.</text> </level> </level> <level label="c"> <text>On or before October 1 each year, each residential service agency receiving Medicaid reimbursement for the provision of home care or similar services by a personal care aide shall report to the Department, on a form or in an electronic manner developed by the Department, the number of personal care aides classified by the residential service agency as:</text> <level label="1"> <text>Employees; and</text> </level> <level label="2"> <text>Independent contractors.</text> </level> </level> <level label="d"> <level label="1"> <text>On or before July 1 each year, the Department shall use the information reported under subsection (c) of this section to create a report concerning:</text> <level label="i"> <text>Medicaid reimbursement rates;</text> </level> <level label="ii"> <text>The cost of delivering services; and</text> </level> <level label="iii"> <text>Aggregated employment classifications of individuals who provide personal care.</text> </level> </level> <level label="2"> <text>Data included in the report under this subsection:</text> <level label="i"> <text>May only be in aggregate; and</text> </level> <level label="ii"> <text>May not identify a specific residential service agency.</text> </level> </level> <level label="3"> <text>The Department shall submit each report created under paragraph (1) of this subsection to the Senate Finance Committee and the House Health and Government Operations Committee in accordance with § 2–1257 of the State Government Article.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-4B-01" title_number="19" title_name="Health Care Facilities" subtitle_number="4B" subtitle_name="Nursing Referral Service Agencies"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Background check” has the meaning stated in § 19-1901 of this title.</text> </level> <level label="c"> <text>“Care provider” means an individual who provides health care services and assistance to a client in the activities of daily living, including:</text> <level label="1"> <text>Bathing, toileting, and personal hygiene;</text> </level> <level label="2"> <text>Dressing;</text> </level> <level label="3"> <text>Meal preparation and eating;</text> </level> <level label="4"> <text>Companionship; and</text> </level> <level label="5"> <text>Assistance in physical transfer and ambulation.</text> </level> </level> <level label="d"> <text>“Central Repository” means the Criminal Justice Information System Central Repository of the Department of Public Safety and Correctional Services.</text> </level> <level label="e"> <text>“Home health aid services” means personal and health care services delivered to a client by a care provider.</text> </level> <level label="f"> <text>“License” means a nursing referral service agency license.</text> </level> <level label="g"> <text>“Licensed health professional” means an individual who is licensed or certified under the Health Occupations Article to provide health care services.</text> </level> <level label="h"> <text>“Nursing referral service agency” means one or more individuals engaged in the business of screening and referring, directly or in accordance with contractual arrangements that may include independent contractors, licensed health professionals or care providers to clients for the provision of nursing services, home health aid services, or other home health care services at the request of the client.</text> </level> <level label="i"> <text>“Private agency” has the meaning stated in § 19-1901 of this title.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-4B-02" title_number="19" title_name="Health Care Facilities" subtitle_number="4B" subtitle_name="Nursing Referral Service Agencies"> <text>This subtitle does not limit the right of any person who holds a license under this article to act as authorized by that license.</text> </section> <section article="ghg" article_name="Health - General" number="19-4B-03" title_number="19" title_name="Health Care Facilities" subtitle_number="4B" subtitle_name="Nursing Referral Service Agencies"> <level label="a"> <level label="1"> <text>A nursing referral service agency may receive a fee or other compensation for providing its services.</text> </level> <level label="2"> <text>A contractual arrangement may provide that a nursing referral service agency is not responsible for paying any part of the compensation to the licensed health care professionals or care providers that the nursing referral service agency screens or refers to clients.</text> </level> <level label="3"> <text>A nursing referral service agency may provide administrative assistance.</text> </level> </level> <level label="b"> <text>A nursing referral service agency shall:</text> <level label="1"> <text>Obtain a license from the Department prior to operating as a nursing referral service agency;</text> </level> <level label="2"> <text>Develop and implement a procedure to screen licensed health professionals and care providers that includes the following:</text> <level label="i"> <text>In accordance with subsection (c) of this section:</text> <level label="1"> <text>A State criminal history records check; or</text> </level> <level label="2"> <text>A private agency background check;</text> </level> </level> <level label="ii"> <text>Verification of current licensure or certification under the Health Occupations Article;</text> </level> <level label="iii"> <text>A basic health screening, including a tuberculosis screening;</text> </level> <level label="iv"> <text>Verification of references;</text> </level> <level label="v"> <text>Verification of employment history;</text> </level> <level label="vi"> <text>Completion of I-9 forms; and</text> </level> <level label="vii"> <text>An in-person interview of a licensed health professional and care provider before any referral of the individual is made to a client;</text> </level> </level> <level label="3"> <text>Institute an internal client complaint investigation process that includes:</text> <level label="i"> <text>Notice to the client or client’s representative of the complaint process; and</text> </level> <level label="ii"> <text>Protocols to investigate complaints;</text> </level> </level> <level label="4"> <text>Provide notice to clients of the Department’s complaint hotline number for complaints about the services provided by an individual referred by the nursing referral service agency; and</text> </level> <level label="5"> <text>Allow clients to accept or reject, at their discretion, any licensed health professional or care provider referred by the nursing referral service agency.</text> </level> </level> <level label="c"> <level label="1"> <text>For each licensed health professional and care provider, a nursing referral service agency shall:</text> <level label="i"> <text>Apply to the Central Repository for a State criminal history records check; or</text> </level> <level label="ii"> <text>Request a private agency to conduct a background check.</text> </level> </level> <level label="2"> <level label="i"> <text>As part of the application for a criminal history records check, the nursing referral service agency shall submit to the Central Repository:</text> <level label="1"> <text>Two complete sets of legible fingerprints of the licensed health professional or care provider taken on forms approved by the Director of the Central Repository; and</text> </level> <level label="2"> <text>The fee authorized under § 10-221(b)(7) of the Criminal Procedure Article for access to Maryland criminal history records.</text> </level> </level> <level label="ii"> <text>In accordance with §§ 10-201 through 10-228 of the Criminal Procedure Article, the Central Repository shall forward to the licensed health professional or care provider and the nursing referral service agency a printed statement listing the criminal convictions of the licensed health professional or care provider.</text> </level> <level label="iii"> <text>Information obtained from the Central Repository under this subsection:</text> <level label="1"> <text>Is confidential and may not be redisseminated; and</text> </level> <level label="2"> <text>May be used only for the screening purpose authorized by this subsection.</text> </level> </level> <level label="iv"> <text>The subject of a criminal history records check under this subsection may contest the contents of the printed statement issued by the Central Repository as provided in § 10-223 of the Criminal Procedure Article.</text> </level> </level> <level label="3"> <text>If a nursing referral service agency requests a private agency to conduct a background check:</text> <level label="i"> <text>The private agency shall:</text> <level label="1"> <text>Conduct a background check in each state in which the nursing referral service agency knows or has reason to know the licensed health professional or care provider worked or resided during the past 7 years; and</text> </level> <level label="2"> <text>Issue a statement of its findings to:</text> </level> <level label="A"> <text>On request, the licensed health professional or care provider; and</text> </level> <level label="B"> <text>The nursing referral service agency; and</text> </level> </level> <level label="ii"> <text>The licensed health professional or care provider shall have an opportunity to contest the findings.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-4B-04" title_number="19" title_name="Health Care Facilities" subtitle_number="4B" subtitle_name="Nursing Referral Service Agencies"> <level label="a"> <level label="1"> <text>The Department shall adopt regulations to implement the requirements of this subtitle.</text> </level> <level label="2"> <text>The regulations may not preclude a nursing referral service agency from operating with independent contractors.</text> </level> </level> <level label="b"> <text>The Department shall issue a license to a nursing referral service agency after the nursing referral service agency completes an application for licensure.</text> </level> <level label="c"> <text>The Department may suspend or revoke a license issued under this section if the nursing referral service agency is operating in violation of the requirements of this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-4B-05" title_number="19" title_name="Health Care Facilities" subtitle_number="4B" subtitle_name="Nursing Referral Service Agencies"> <level label="a"> <text>An individual may not operate or engage in, or attempt to operate or engage in, or hold one’s self out as operating or engaging in the business of a nursing referral service agency unless the individual is licensed under this subtitle.</text> </level> <level label="b"> <level label="1"> <text>An individual who violates this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 for the first offense and not exceeding $10,000 for any subsequent offense.</text> </level> <level label="2"> <text>Each day a violation is continued after the first conviction is a separate offense.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-4B-06" title_number="19" title_name="Health Care Facilities" subtitle_number="4B" subtitle_name="Nursing Referral Service Agencies"> <text>For the purposes of any other provision of law, the granting of a license under this subtitle does not constitute a finding of any fact on which the granting of the license was based and may not give rise to any presumption regarding the existence of any fact on which the granting of the license was based.</text> </section> <section article="ghg" article_name="Health - General" number="19-501" title_number="19" title_name="Health Care Facilities" subtitle_number="5" subtitle_name="Chronic Disease Centers"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Board” means a citizens’ advisory board for a center.</text> </level> <level label="c"> <text>“Center” means a chronic disease center.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-502" title_number="19" title_name="Health Care Facilities" subtitle_number="5" subtitle_name="Chronic Disease Centers"> <level label="a"> <text>There are chronic disease centers in the State for individuals who:</text> <level label="1"> <text>Need constant medical and nursing care by reason of chronic illness or infirmity; or</text> </level> <level label="2"> <text>Have a chronic disability amenable to rehabilitation.</text> </level> </level> <level label="b"> <text>One center shall be located in each of the following places:</text> <level label="1"> <text>The Eastern Shore; and</text> </level> <level label="2"> <text>The western part of this State.</text> </level> </level> <level label="c"> <text>The Secretary also shall operate any other centers established by law and placed under the jurisdiction of the Secretary for the care of individuals who have chronic diseases.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-503" title_number="19" title_name="Health Care Facilities" subtitle_number="5" subtitle_name="Chronic Disease Centers"> <text>The Secretary shall adopt rules and regulations that set:</text> <level label="1"> <text>The services to be provided by centers; and</text> </level> <level label="2"> <text>The qualifications and standards for admission to and discharge from the centers.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-504" title_number="19" title_name="Health Care Facilities" subtitle_number="5" subtitle_name="Chronic Disease Centers"> <text>Each center may:</text> <level label="1"> <text>Establish any outpatient clinic for preadmission evaluation, aftercare, or other home health care service;</text> </level> <level label="2"> <text>Further medical knowledge by having a facility to explore new ways of treating problems peculiar to chronically ill and disabled individuals;</text> </level> <level label="3"> <text>Conduct any educational and training program to improve the knowledge and skills of physicians and ancillary professional, scientific, and other staff of the center and other treatment facilities and, thus, to improve a high standard of patient care; and</text> </level> <level label="4"> <text>Add a unit to treat chronic diseases of children.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-505" title_number="19" title_name="Health Care Facilities" subtitle_number="5" subtitle_name="Chronic Disease Centers"> <level label="a"> <text>Admission of an individual to a center shall be based on:</text> <level label="1"> <text>The statement of a physician who, after an examination of the individual, finds that the individual needs care at a center; and</text> </level> <level label="2"> <text>The review and approval of an application for admission of the individual by the center.</text> </level> </level> <level label="b"> <text>If an individual cannot be placed in a special facility in this State that can treat the condition of the individual, the individual may be admitted to a center.</text> </level> <level label="c"> <text>A center may not admit an individual who has:</text> <level label="1"> <text>A mental disorder of the type that requires care in a mental health facility; or</text> </level> <level label="2"> <text>An orthopedic disease for which medical treatment is available in a special orthopedic hospital.</text> </level> </level> <level label="d"> <level label="1"> <text>The centers shall be operated primarily for residents of this State.</text> </level> <level label="2"> <text>A center may admit an individual who is not a resident of this State if:</text> <level label="i"> <text>The individual is admitted and discharged in accordance with a specific regional health program or specific demonstration or study project approved by the Department; and</text> </level> <level label="ii"> <text>This State is reimbursed for the full cost of services to the individual.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-506" title_number="19" title_name="Health Care Facilities" subtitle_number="5" subtitle_name="Chronic Disease Centers"> <level label="a"> <text>If the medical staff of a center determines that an individual cannot receive any further benefit at the center, the individual shall be discharged on the written order of a medical staff member.</text> </level> <level label="b"> <text>If, after a competent authority directs a discharged individual to leave the center, the individual fails to do so, the administrative head of the center may take any legal step needed to remove the individual from the center, under an adequate plan for treatment and care.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-507" title_number="19" title_name="Health Care Facilities" subtitle_number="5" subtitle_name="Chronic Disease Centers"> <level label="a"> <text>If this State is paying any of the costs of an individual at a center, the individual may be transferred to another facility that is approved under a federal program.</text> </level> <level label="b"> <text>If the individual refuses to apply for assistance from any applicable State, federal, or local program, the administrative head of the center or the designee of the administrative head may apply for the assistance and transfer the individual to another facility.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-508" title_number="19" title_name="Health Care Facilities" subtitle_number="5" subtitle_name="Chronic Disease Centers"> <text>There is a citizens’ advisory board for each center.</text> </section> <section article="ghg" article_name="Health - General" number="19-509" title_number="19" title_name="Health Care Facilities" subtitle_number="5" subtitle_name="Chronic Disease Centers"> <level label="a"> <level label="1"> <text>Each board consists of 7 members appointed by the Governor.</text> </level> <level label="2"> <text>The Governor shall appoint the members from a list of qualified individuals submitted to the Governor by the Secretary.</text> </level> </level> <level label="b"> <text>Each member of the board for a center:</text> <level label="1"> <text>Shall be a citizen of this State;</text> </level> <level label="2"> <text>Shall be a resident of a county that the center serves;</text> </level> <level label="3"> <text>Shall be representative of the community; and</text> </level> <level label="4"> <text>Shall be known for an interest in civic and public affairs and for concern about the care of chronically ill individuals.</text> </level> </level> <level label="c"> <level label="1"> <text>The term of a member is 4 years.</text> </level> <level label="2"> <text>The terms of members are staggered as required by the terms provided for members of each board on July 1, 1982. The terms of those members end as follows:</text> <level label="i"> <text>1 in 1983.</text> </level> <level label="ii"> <text>4 in 1984.</text> </level> <level label="iii"> <text>1 in 1985.</text> </level> <level label="iv"> <text>1 in 1986.</text> </level> </level> <level label="3"> <text>At the end of a term, a member continues to serve until a successor is appointed and qualifies.</text> </level> <level label="4"> <text>A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies.</text> </level> <level label="5"> <text>A member who serves 2 consecutive full 4-year terms may not be reappointed for 4 years after completion of those terms.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-510" title_number="19" title_name="Health Care Facilities" subtitle_number="5" subtitle_name="Chronic Disease Centers"> <level label="a"> <text>From among its members, each board shall elect a chairman and other officers that the board considers necessary.</text> </level> <level label="b"> <text>The manner of election of officers and their terms of office shall be as the board determines.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-511" title_number="19" title_name="Health Care Facilities" subtitle_number="5" subtitle_name="Chronic Disease Centers"> <level label="a"> <text>Each board shall meet at least 4 times a year, at the times and places that the board determines.</text> </level> <level label="b"> <text>A member of a board may not receive compensation.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-512" title_number="19" title_name="Health Care Facilities" subtitle_number="5" subtitle_name="Chronic Disease Centers"> <level label="a"> <text>Each board may adopt rules and regulations for the conduct of its meetings.</text> </level> <level label="b"> <level label="1"> <text>Each board serves in an advisory capacity.</text> </level> <level label="2"> <text>Each board shall:</text> <level label="i"> <text>Submit to the Secretary an annual report on:</text> <level label="1"> <text>The needs of chronically ill individuals; and</text> </level> <level label="2"> <text>The extent to which its center meets these needs;</text> </level> </level> <level label="ii"> <text>Advise the administrative head of the center on its facilities, goals, programs, and policies;</text> </level> <level label="iii"> <text>Help in evaluating the degree to which these goals are achieved;</text> </level> <level label="iv"> <text>Review and make recommendations about the annual budget of the center;</text> </level> <level label="v"> <text>Assume leadership in developing community understanding of the needs of chronically ill individuals; and</text> </level> <level label="vi"> <text>Carry out any other responsibility that the administrative head of the center requests.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-513" title_number="19" title_name="Health Care Facilities" subtitle_number="5" subtitle_name="Chronic Disease Centers"> <level label="a"> <text>Except with the approval of the administrative head of a center, a person other than an employee of the center may not bring any alcoholic beverage into any area of the center that is used by individuals under treatment in the center.</text> </level> <level label="b"> <text>An employee of the center may not:</text> <level label="1"> <text>Drink any alcoholic beverage while on duty; or</text> </level> <level label="2"> <text>Give any alcoholic beverage to an individual who is under treatment in the center.</text> </level> </level> <level label="c"> <text>A person who violates any provision of this section is guilty of a misdemeanor and on conviction is subject to a penalty not exceeding $100 or imprisonment not exceeding 60 days or both.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-701" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Benefit package” means a set of health care services to be provided to a member of a health maintenance organization under a contract that entitles the member to the health care services, whether the services are provided:</text> <level label="1"> <text>Directly by a health maintenance organization; or</text> </level> <level label="2"> <text>Through a contract or arrangement with another person.</text> </level> </level> <level label="c"> <text>“Commissioner” means the State Insurance Commissioner.</text> </level> <level label="d"> <text>“Covered service” means a health care service included in the benefit package of the health maintenance organization and rendered to a member or subscriber of the health maintenance organization by:</text> <level label="1"> <text>A provider under contract with the health maintenance organization, when the service is obtained in accordance with the terms of the benefit contract of the member or subscriber; or</text> </level> <level label="2"> <text>A noncontracting provider under § 19–710.1 of this subtitle, when the service is:</text> <level label="i"> <text>Obtained in accordance with the terms of the benefit contract of the member or subscriber;</text> </level> <level label="ii"> <text>Obtained pursuant to a verbal or written referral by:</text> <level label="1"> <text>The health maintenance organization of the member or subscriber; or</text> </level> <level label="2"> <text>A provider under written contract with the health maintenance organization of the member or subscriber; or</text> </level> </level> <level label="iii"> <text>Preauthorized or otherwise approved either verbally or in writing by:</text> <level label="1"> <text>The health maintenance organization of the member or subscriber; or</text> </level> <level label="2"> <text>A provider under written contract with the health maintenance organization of the member or subscriber.</text> </level> </level> </level> </level> <level label="e"> <text>“Emergency medical condition” means a medical condition, including a mental health condition or substance use disorder, that manifests itself by acute symptoms of such severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent layperson, who possesses an average knowledge of health and medicine, to result in a condition described in § 1867(e)(1) of the Social Security Act.</text> </level> <level label="e–1"> <level label="1"> <text>“Emergency services” means, with respect to an emergency medical condition:</text> <level label="i"> <text>A medical screening examination that is within the capability of the emergency department of a hospital or freestanding medical facility, including ancillary services routinely available to the emergency department to evaluate an emergency medical condition;</text> </level> <level label="ii"> <text>Any other examination or treatment within the capabilities of the staff and facilities available at the hospital or freestanding medical facility that is necessary to stabilize the patient, regardless of the department of the hospital in which the examination or treatment is furnished; or</text> </level> <level label="iii"> <text>Except as provided in paragraph (3) of this subsection, additional covered items and services furnished by a health care provider of emergency services that does not have a contractual relationship with the carrier after the patient is stabilized and as part of outpatient observation or an inpatient or outpatient stay with respect to the visit in which the services described in items (i) and (ii) of this paragraph are furnished.</text> </level> </level> <level label="2"> <text>“Emergency services” includes services described in paragraph (1) of this subsection that are provided in specialized facilities that are staffed by behavioral health providers trained to provide crisis services.</text> </level> <level label="3"> <text>Subject to § 19–710(p) of this subtitle and § 14–205.2 of the Insurance Article, “emergency services” does not include items and services described in paragraph (1)(iii) of this subsection if all of the conditions in 45 C.F.R. § 149.410(b) are met.</text> </level> </level> <level label="f"> <level label="1"> <text>“Health care services” means services, medical equipment, and supplies that are provided by a provider.</text> </level> <level label="2"> <text>“Health care services” includes:</text> <level label="i"> <text>Ambulance services;</text> </level> <level label="ii"> <text>Appliances, drugs, medicines, and supplies;</text> </level> <level label="iii"> <text>Chiropractic care and services;</text> </level> <level label="iv"> <text>Convalescent institutional care;</text> </level> <level label="v"> <text>Dental care and services;</text> </level> <level label="vi"> <text>Extended care;</text> </level> <level label="vii"> <text>Family planning or infertility services;</text> </level> <level label="viii"> <text>Health education services;</text> </level> <level label="ix"> <text>Home health care or medical social services;</text> </level> <level label="x"> <text>Inpatient hospital services;</text> </level> <level label="xi"> <text>Laboratory, radiological, or other diagnostic services;</text> </level> <level label="xii"> <text>Medical care and services;</text> </level> <level label="xiii"> <text>Mental health services;</text> </level> <level label="xiv"> <text>Nursing care and services;</text> </level> <level label="xv"> <text>Nursing home care;</text> </level> <level label="xvi"> <text>Optical care and services;</text> </level> <level label="xvii"> <text>Optometric care and services;</text> </level> <level label="xviii"> <text>Osteopathic care and services;</text> </level> <level label="xix"> <text>Outpatient services;</text> </level> <level label="xx"> <text>Pharmaceutical services;</text> </level> <level label="xxi"> <text>Physical therapy care and services;</text> </level> <level label="xxii"> <text>Podiatric care and services;</text> </level> <level label="xxiii"> <text>Preventive medical services;</text> </level> <level label="xxiv"> <text>Psychological care and services;</text> </level> <level label="xxv"> <text>Rehabilitative services;</text> </level> <level label="xxvi"> <text>Surgical care and services;</text> </level> <level label="xxvii"> <text>Treatment for alcoholism or drug abuse; and</text> </level> <level label="xxviii"> <text>Any other care, service, or treatment of disease or injury, the correction of defects, or the maintenance of the physical and mental well–being of human beings.</text> </level> </level> </level> <level label="g"> <text>“Health maintenance organization” means any person, including a profit or nonprofit corporation organized under the laws of any state or country, that:</text> <level label="1"> <text>Operates or proposes to operate in this State;</text> </level> <level label="2"> <text>Except as provided in § 19–703(b) and (e) of this subtitle, provides or otherwise makes available to its members health care services that include at least physician, hospitalization, laboratory, X–ray, emergency, and preventive services, out–of–area coverage, and any other health care services that the Commissioner determines to be available generally on an insured or prepaid basis in the area serviced by the health maintenance organization, and, at the option of the health maintenance organization, may provide additional coverage;</text> </level> <level label="3"> <text>Except for any copayment or deductible arrangement, is compensated only on a predetermined periodic rate basis for providing to members the minimum services that are specified in item (2) of this subsection;</text> </level> <level label="4"> <text>Assures its subscribers and members, the Commissioner, and the Department that one clearly specified legal and administrative focal point or element of the health maintenance organization has the responsibility of providing the availability, accessibility, quality, and effective use of comprehensive health care services; and</text> </level> <level label="5"> <text>Primarily provides services of physicians:</text> <level label="i"> <text>Directly through physicians who are either employees or partners of the health maintenance organization; or</text> </level> <level label="ii"> <text>Under arrangements with one or more groups of physicians, who are organized on a group practice or individual practice basis, under which each group:</text> <level label="1"> <text>Is compensated for its services primarily on the basis of an aggregate fixed sum or on a per capita basis; and</text> </level> <level label="2"> <text>Is provided with an effective incentive to avoid unnecessary inpatient use, whether the individual physician members of the group are paid on a fee–for–service or other basis.</text> </level> </level> </level> </level> <level label="h"> <text>“Member” means a person who makes a contract or on whose behalf a contract is made with a health maintenance organization for health care services.</text> </level> <level label="i"> <text>“Provider” means any person, including a physician or hospital, who is licensed or otherwise authorized in this State to provide health care services.</text> </level> <level label="j"> <text>“Subscriber” means a person who makes a contract with a health maintenance organization, either directly or through an insurer or marketing organization, under which the person or other designated persons are entitled to the health care services.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-702" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>In adopting this subtitle, the General Assembly intends to:</text> <level label="1"> <text>Provide alternative methods for the delivery of health care services to residents of this State, with a view toward achieving greater efficiency and economy in providing these services;</text> </level> <level label="2"> <text>Encourage the formation of health maintenance organizations that provide health care services to subscribers or groups of subscribers who contract for these services under a system of prepayments; and</text> </level> <level label="3"> <text>Encourage the formation of health maintenance organizations by such diverse groups as:</text> <level label="i"> <text>Nonprofit health service plans;</text> </level> <level label="ii"> <text>Medical health service plans;</text> </level> <level label="iii"> <text>Medical care foundations;</text> </level> <level label="iv"> <text>Groups of professionals, either in the form of partnerships or professional corporations;</text> </level> <level label="v"> <text>Consumer sponsored organizations; or</text> </level> <level label="vi"> <text>Business or legal entities.</text> </level> </level> </level> <level label="b"> <text>To carry out the intent of subsection (a) of this section, the policy of this State is to:</text> <level label="1"> <text>Provide one overall State law that:</text> <level label="i"> <text>Regulates health maintenance organizations;</text> </level> <level label="ii"> <text>Allows flexibility for the many forms these health maintenance organizations may take; and</text> </level> <level label="iii"> <text>Facilitates public understanding and uniform administration of the rules and regulations that are adopted under this subtitle;</text> </level> </level> <level label="2"> <text>Eliminate legal barriers to the organization, promotion, and expansion of health maintenance organizations;</text> </level> <level label="3"> <text>Provide for regulation of:</text> <level label="i"> <text>The quality of health care, by the Department and by professional standards review organizations where appropriate; and</text> </level> <level label="ii"> <text>All other matters covered under this subtitle, by the Commissioner; and</text> </level> </level> <level label="4"> <text>Exempt health maintenance organizations from the insurance laws of this State, except as set forth in this subtitle.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-703" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>This subtitle does not:</text> <level label="1"> <text>Authorize any person to engage directly or indirectly in the practice of any health occupation except as otherwise authorized by law;</text> </level> <level label="2"> <text>Authorize any person to regulate, interfere, or intervene in the relationship between any provider of health care services and the patients of the provider; or</text> </level> <level label="3"> <text>Prohibit any health maintenance organization from meeting the requirements of any federal law that authorizes the health maintenance organization to:</text> <level label="i"> <text>Receive federal financial assistance; or</text> </level> <level label="ii"> <text>Enroll beneficiaries assisted by federal funds.</text> </level> </level> </level> <level label="b"> <text>A health maintenance organization or a part of it that is also a community health center organized under the federal Public Health Service Act and receives federal funds under 42 U.S.C. § 254c is not required to provide hospitalization for individuals for whom services are provided by those funds.</text> </level> <level label="c"> <text>Health maintenance organizations shall offer as an option to all of their members or subscribers benefits for hospice services provided by a hospice care program, as defined in § 19–901(c) of this title.</text> </level> <level label="d"> <text>Health maintenance organizations shall provide continuation coverage required under §§ 15–407 through 15–409 of the Insurance Article.</text> </level> <level label="e"> <text>Notwithstanding any other provision of this subtitle, a health maintenance organization may provide a limited set of health benefits if the limited set of health benefits is for subscribers or members who are enrolled in a county program to provide health care services for low–income individuals.</text> </level> <level label="f"> <level label="1"> <text>In addition to the requirements of § 15–10B–09 of the Insurance Article, whenever a mother is required to remain hospitalized after childbirth for medical reasons and the mother requests that the newborn remain in the hospital, a health maintenance organization shall provide as part of its hospitalization services provided to members and subscribers payment for the cost of additional hospitalization for the newborn for up to 4 days.</text> </level> <level label="2"> <text>The attending physician or certified nurse midwife of the mother, or the designee of the attending physician or certified nurse midwife, shall provide notice to the mother of the provisions of paragraph (1) of this subsection.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-704" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <text>A health maintenance organization may operate as authorized by this subtitle notwithstanding any prohibition against the corporate practice of medicine.</text> </section> <section article="ghg" article_name="Health - General" number="19-705" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <level label="1"> <text>The Secretary may adopt rules, regulations, and standards for the quality of health care services provided by a health maintenance organization through its benefit packages.</text> </level> <level label="2"> <text>With the advice of the Department, the Commissioner shall adopt reasonable rules and regulations as necessary to carry out any other provisions of this subtitle.</text> </level> </level> <level label="b"> <level label="1"> <text>The Commissioner and the Department shall adopt joint internal procedures to help them work together to carry out their duties under this subtitle.</text> </level> <level label="2"> <text>The joint internal procedures shall establish means by which the Commissioner and the Department may inform each other promptly on matters that affect any health maintenance organization, including:</text> <level label="i"> <text>Any important action, change, or rearrangement that a health maintenance organization may undertake; and</text> </level> <level label="ii"> <text>Any regulatory problem.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-705.1" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>The Secretary shall adopt regulations that set out reasonable standards of quality of care that a health maintenance organization shall provide to its members.</text> </level> <level label="b"> <level label="1"> <text>The standards of quality of care shall include:</text> <level label="i"> <text>A requirement that a health maintenance organization shall provide for regular hours during which a member may receive services, including providing for services to a member in a timely manner that takes into account the immediacy of need for services;</text> </level> <level label="ii"> <text>A requirement that a health maintenance organization shall have a system for providing a member with 24–hour access to a physician in cases where there is an immediate need for medical services, and for promoting timely access to and continuity of health care services for members, including:</text> <level label="1"> <text>Providing 24–hour access by telephone to a person who is able to appropriately respond to calls from members and providers concerning after–hours care; and</text> </level> <level label="2"> <text>Providing a 24–hour toll free telephone access system for use in hospital emergency departments in accordance with § 19–705.7 of this subtitle;</text> </level> </level> <level label="iii"> <text>A requirement that any nonparticipating provider shall submit to the health maintenance organization the appropriate documentation of the medical complaint of the member and the services rendered;</text> </level> <level label="iv"> <text>A requirement that a health maintenance organization shall have a physician available at all times to provide diagnostic and treatment services;</text> </level> <level label="v"> <text>A requirement that a health maintenance organization shall ensure that:</text> <level label="1"> <text>Each member who is seen for a medical complaint is evaluated under the direction of a physician; and</text> </level> <level label="2"> <text>Each member who receives diagnostic evaluation or treatment is under the medical management of a health maintenance organization physician who provides continuing medical management;</text> </level> </level> <level label="vi"> <text>A requirement that each member shall have an opportunity to select a primary physician, a physician assistant, a certified nurse–midwife, a licensed certified midwife, or a certified nurse practitioner from among those available to the health maintenance organization; and</text> </level> <level label="vii"> <text>A requirement that a health maintenance organization print, in any directory of participating providers or hospitals, in a conspicuous manner, the address, telephone number, and facsimile number of the State agency that members, enrollees, and insureds may call to discuss quality of care issues, life and health insurance complaints, and assistance in resolving billing and payment disputes with the health plan or health care provider, as follows:</text> <level label="1"> <text>For quality of care issues and life and health care insurance complaints, the Maryland Insurance Administration; and</text> </level> <level label="2"> <text>For assistance in resolving a billing or payment dispute with the health plan or a health care provider, the Health Education and Advocacy Unit of the Consumer Protection Division of the Office of the Attorney General.</text> </level> </level> </level> <level label="2"> <text>This subsection may not be construed to require that a health maintenance organization include certified nurse practitioners on the health maintenance organization’s provider panel as primary care providers.</text> </level> </level> <level label="c"> <level label="1"> <text>The health maintenance organization shall make available and encourage appropriate history and baseline examinations for each member within a reasonable time of enrollment set by it.</text> </level> <level label="2"> <text>Medical problems that are a potential hazard to the person’s health shall be identified and a course of action to alleviate these problems outlined.</text> </level> <level label="3"> <text>Progress notes indicating success or failure of the course of action shall be recorded.</text> </level> <level label="4"> <text>The health maintenance organization shall:</text> <level label="i"> <text>Offer or arrange for preventive services that include health education and counseling, early disease detection, immunization, and hearing loss screening of newborns provided by a hospital before discharge;</text> </level> <level label="ii"> <text>Develop or arrange for periodic health education on subjects which impact on the health status of a member population; and</text> </level> <level label="iii"> <text>Notify every member in writing of the availability of these and other preventive services.</text> </level> </level> <level label="5"> <text>The health maintenance organization shall offer services to prevent a disease if:</text> <level label="i"> <text>The disease produces death or disability and exists in the member population;</text> </level> <level label="ii"> <text>The etiology of the disease is known or the disease can be detected at an early stage; and</text> </level> <level label="iii"> <text>Any elimination of factors leading to the disease or immunization has been proven to prevent its occurrence, or early disease detection followed by behavior modification, environmental modification, or medical intervention has been proven to prevent death or disability.</text> </level> </level> </level> <level label="d"> <level label="1"> <text>To implement these standards of quality of care, a health maintenance organization shall have a written plan that is updated and reviewed at least every 3 years.</text> </level> <level label="2"> <text>The plan shall include the following information:</text> <level label="i"> <text>Statistics on age, sex, and other general demographic data used to determine the health care needs of its population;</text> </level> <level label="ii"> <text>Identification of the major health problems in the member population;</text> </level> <level label="iii"> <text>Identification of any special groups of members that have unique health problems, such as the poor, the elderly, the mentally ill, and educationally disadvantaged; and</text> </level> <level label="iv"> <text>A description of community health resources and how they will be used.</text> </level> </level> <level label="3"> <text>The health maintenance organization shall state its priorities and objectives in writing, describing how the priorities and objectives relating to the health problems and needs of the member population will be provided for.</text> </level> <level label="4"> <level label="i"> <text>The health maintenance organization shall provide at the time membership is solicited a general description of the benefits and services available to its members, including benefit limitations and exclusions, location of facilities or providers, and procedures to obtain medical services.</text> </level> <level label="ii"> <text>The health maintenance organization shall place the following statement, in bold print, on every enrollment card or application: “If you have any questions concerning the benefits and services that are provided by or excluded under this agreement, please contact a membership services representative before signing this application or card”.</text> </level> </level> <level label="5"> <text>The plan shall contain evidence that:</text> <level label="i"> <text>The programs and services offered are based on the health problems of and the community health services available to its member population;</text> </level> <level label="ii"> <text>There is an active program for preventing illness, disability, and hospitalization among its members; and</text> </level> <level label="iii"> <text>The services designed to prevent the major health problems identified among child and adult members and to improve their general health are provided by the health maintenance organization.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>The health maintenance organization shall have an internal peer review system that will evaluate the utilizational services and the quality of health care provided to its members.</text> </level> <level label="2"> <text>The review system shall:</text> <level label="i"> <text>Provide for review by appropriate health professionals of the process followed in the provision of health services;</text> </level> <level label="ii"> <text>Use systematic data collection of performances and patient results;</text> </level> <level label="iii"> <text>Provide interpretation of this data to the practitioners;</text> </level> <level label="iv"> <text>Review and update continuing education programs for health professionals providing services to its members;</text> </level> <level label="v"> <text>Identify needed change and proposed modifications to implement the change; and</text> </level> <level label="vi"> <text>Maintain written records of the internal peer review process.</text> </level> </level> </level> <level label="f"> <level label="1"> <text>Except as provided in paragraph (5) of this subsection, the Department shall conduct an annual external review of the quality of the health services of the health maintenance organization in a manner that the Department considers to be appropriate.</text> </level> <level label="2"> <text>The external review shall be conducted by:</text> <level label="i"> <text>A panel of physicians and other health professionals that consists of persons who:</text> <level label="1"> <text>Have been approved by the Department;</text> </level> <level label="2"> <text>Have substantial experience in the delivery of health care in a health maintenance organization setting, but who are not members of the health maintenance organization staff or performing professional services for the health maintenance organization; and</text> </level> <level label="3"> <text>Reside outside the area serviced by the health maintenance organization; or</text> </level> </level> <level label="ii"> <text>The Department.</text> </level> </level> <level label="3"> <text>The final decision on the type of external review that is to be employed rests solely with the Secretary.</text> </level> <level label="4"> <text>The external review shall consist of a review and evaluation of:</text> <level label="i"> <text>An internal peer review system and reports;</text> </level> <level label="ii"> <text>The program plan of the health maintenance organization to determine if it is adequate and being followed;</text> </level> <level label="iii"> <text>The professional standards and practices of the health maintenance organization in every area of services provided;</text> </level> <level label="iv"> <text>The grievances relating specifically to the delivery of medical care, including their final disposition;</text> </level> <level label="v"> <text>The physical facilities and equipment; and</text> </level> <level label="vi"> <text>A statistically representative sample of member records.</text> </level> </level> <level label="5"> <text>A health maintenance organization accredited by an accreditation organization approved by the Secretary in accordance with § 19–2302 of this title shall be exempt from the external review.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-705.2" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>With the advice of the Secretary, the Commissioner shall adopt regulations to establish a system for the receipt and timely investigation of complaints of members and subscribers of health maintenance organizations concerning the operation of any health maintenance organization in this State.</text> </level> <level label="b"> <text>The complaint system shall include:</text> <level label="1"> <text>A procedure for the timely acknowledgment of receipt of a complaint;</text> </level> <level label="2"> <text>Criteria that the Secretary shall adopt by regulation for determining the appropriate level of investigation for a complaint concerning quality of care, including:</text> <level label="i"> <text>A determination as to whether the member or subscriber with the complaint previously attempted to have the complaint resolved; and</text> </level> <level label="ii"> <text>A determination as to whether a complaint should be sent to the member’s or subscriber’s health maintenance organization for resolution prior to investigation under the provisions of this section; and</text> </level> </level> <level label="3"> <text>A procedure for the referral of quality of care complaints to the Secretary for an appropriate investigation.</text> </level> </level> <level label="c"> <text>If a determination is made to investigate a complaint under the provisions of this section prior to the member or subscriber attempting to otherwise resolve the complaint, the reasons for that determination shall be documented.</text> </level> <level label="d"> <text>Notice of the complaint system established under the provisions of this section shall be included in all contracts between a health maintenance organization and a member or subscriber of a health maintenance organization.</text> </level> <level label="e"> <text>For quality of care complaints referred to the Secretary for investigation under subsection (b)(3) of this section, the Secretary shall report to the Commissioner in a timely manner on the results and findings of each investigation.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-705.3" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>In this section, “health maintenance organization” means a health maintenance organization where health care services are delivered by health care providers to subscribers at a central facility or centralized system of facilities operated by the health maintenance organization.</text> </level> <level label="b"> <text>The Department shall adopt regulations to require health maintenance organizations to:</text> <level label="1"> <text>Adopt, implement, and enforce a policy that requires, except in an emergency life–threatening situation where it is not feasible or practicable, all employees and medical staff involved in patient care services to comply with the Centers for Disease Control and Prevention’s guidelines on universal precautions; and</text> </level> <level label="2"> <text>Display the notice developed under § 1–207 of the Health Occupations Article at the entrance to the health maintenance organization.</text> </level> </level> <level label="c"> <text>If the health maintenance organization fails to comply with the requirements of this section the Secretary may impose a penalty of up to $500 per day per violation for each day a violation continues.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-705.4" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>Any limitation imposed by a health maintenance organization on the receipt of covered services provided to a member or subscriber by a physical therapist licensed under Title 13 of the Health Occupations Article may only be imposed per incident or per injury within a contract period.</text> </level> <level label="b"> <text>This subsection may not be construed to prohibit a health maintenance organization from imposing any limitations on the number of visits permitted for a member or subscriber.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-705.5" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <level label="i"> <text>“Inherited metabolic disease” means a disease caused by an inherited abnormality of body chemistry.</text> </level> <level label="ii"> <text>“Inherited metabolic disease” includes a disease for which the State screens newborn babies.</text> </level> </level> <level label="3"> <level label="i"> <text>“Low protein modified food product” means a food product that is:</text> <level label="1"> <text>Specially formulated to have less than 1 gram of protein per serving; and</text> </level> <level label="2"> <text>Intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease.</text> </level> </level> <level label="ii"> <text>“Low protein modified food product” does not include a natural food that is naturally low in protein.</text> </level> </level> <level label="4"> <text>“Medical food” means a food that is:</text> <level label="i"> <text>Intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation; and</text> </level> <level label="ii"> <text>Formulated to be consumed or administered enterally under the direction of a physician.</text> </level> </level> </level> <level label="b"> <text>A health maintenance organization shall include as part of its benefit package of health care services to be provided to members and subscribers coverage for medical foods and low protein modified food products for the treatment of inherited metabolic diseases if the medical foods and low protein modified food products are:</text> <level label="1"> <text>Prescribed as medically necessary for the therapeutic treatment of inherited metabolic diseases; and</text> </level> <level label="2"> <text>Administered under the direction of a physician.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-705.6" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>If it is necessary to provide emergency services, authorization shall be presumed for utilizing the medical or surgical provider on call for unassigned patients or the appropriate specialist on call for the hospital on that date if:</text> <level label="1"> <text>A telephone access system is not operational at the time of the call; or</text> </level> <level label="2"> <text>A member’s primary care provider or the specialist needed by a member cannot be determined within a reasonable time, as determined by the treating emergency physician but not to exceed 30 minutes after the initial documented call to the telephone access system.</text> </level> </level> <level label="b"> <text>This section may not be construed to require a health maintenance organization to have contracted specialist providers at hospitals outside of the service area of the health maintenance organization.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-705.7" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <text>The 24-hour toll free telephone access system provided by each health maintenance organization shall:</text> <level label="1"> <text>Enable members and providers to determine, with one telephone call, the primary care provider assigned to a member; and</text> </level> <level label="2"> <text>Enable providers to determine, with one telephone call, the names of three contracted specialist providers for the health maintenance organization who also have staff privileges at a particular hospital in the State.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-705.8" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“HMO Quality Assurance Unit” means the Health Maintenance Organization (HMO) Quality Assurance Unit in the Department.</text> </level> <level label="3"> <text>“Quality Assurance Medical Director” means the Medical Director of the HMO Quality Assurance Unit.</text> </level> </level> <level label="b"> <text>There is a Health Maintenance Organization (HMO) Quality Assurance Unit in the Department.</text> </level> <level label="c"> <level label="1"> <text>The Secretary shall appoint the Quality Assurance Medical Director.</text> </level> <level label="2"> <text>The Quality Assurance Medical Director shall:</text> <level label="i"> <text>Be a physician who is licensed in the State;</text> </level> <level label="ii"> <text>Be board certified in at least one specialty;</text> </level> <level label="iii"> <text>Have experience in primary care and administrative medicine; and</text> </level> <level label="iv"> <text>Have broad knowledge of health maintenance organizations and managed care organizations.</text> </level> </level> <level label="3"> <text>The Quality Assurance Medical Director is entitled to the compensation provided in the State budget.</text> </level> <level label="4"> <text>Subject to the authority vested in the Secretary by law, the Quality Assurance Medical Director is in charge of and responsible for the clinical operations of the HMO Quality Assurance Unit.</text> </level> <level label="5"> <text>In accordance with the State budget the Secretary may employ staff for the HMO Quality Assurance Unit.</text> </level> </level> <level label="d"> <text>The HMO Quality Assurance Unit shall:</text> <level label="1"> <text>Enforce all requirements established under §§ 19-705 and 19-705.1 of this subtitle and the regulations adopted under these provisions regarding the quality of health care provided by a health maintenance organization; and</text> </level> <level label="2"> <text>Investigate quality of care complaints referred to the Secretary under § 19-705.2(b)(3) of this subtitle.</text> </level> </level> <level label="e"> <text>The Quality Assurance Medical Director shall:</text> <level label="1"> <text>Determine whether a health maintenance organization meets the requirements established under §§ 19-705 and 19-705.1 of this subtitle and the regulations adopted under these provisions regarding the quality of health care provided by a health maintenance organization; and</text> </level> <level label="2"> <text>Make recommendations to the Secretary for corrective action necessary to meet these requirements.</text> </level> </level> <level label="f"> <text>If the Secretary agrees with a determination made by the Quality Assurance Medical Director that a health maintenance organization does not meet the requirements established under §§ 19-705 and 19-705.1 of this subtitle or the regulations adopted under these provisions regarding the quality of health care provided by a health maintenance organization, the Secretary may issue an order under § 19-731 of this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-706" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>Each health maintenance organization that is issued a certificate of authority by the Commissioner shall be regulated under this subtitle.</text> </level> <level label="b"> <level label="1"> <text>Any health maintenance organization that is regulated by Title 14, Subtitle 1 of the Insurance Article is subject also to this subtitle.</text> </level> <level label="2"> <text>This subsection applies to a corporation described in Title 14, Subtitle 1 of the Insurance Article, but only if it is a health maintenance organization.</text> </level> </level> <level label="c"> <text>Except as otherwise provided in this subtitle or expressly provided in the Insurance Article, a health maintenance organization is not subject to the insurance laws of this State.</text> </level> <level label="d"> <text>Only the Commissioner may issue, suspend, or revoke a certificate of authority of a health maintenance organization.</text> </level> <level label="e"> <text>The provisions of Title 27, Subtitle 8 of the Insurance Article shall apply to health maintenance organizations.</text> </level> <level label="f"> <text>The provisions of Title 15, Subtitle 10B of the Insurance Article shall apply to health maintenance organizations.</text> </level> <level label="g"> <text>The provisions of Title 6.5 of the State Government Article shall apply to the acquisition of a health maintenance organization owned by a nonprofit entity.</text> </level> <level label="h"> <text>The provisions of § 27–210 of the Insurance Article apply to health maintenance organizations.</text> </level> <level label="i"> <text>The provisions of § 15–145 of this article apply to health maintenance organizations.</text> </level> <level label="j"> <text>The provisions of Title 15, Subtitle 16 of the Insurance Article apply to health maintenance organizations.</text> </level> <level label="k"> <text>The provisions of § 2–517 of the State Personnel and Pensions Article apply to health maintenance organizations.</text> </level> <level label="l"> <text>The provisions of § 15–134 of the Insurance Article apply to health maintenance organizations.</text> </level> <level label="m"> <text>The provisions of Title 4, Subtitle 5 of the Insurance Article apply to health maintenance organizations.</text> </level> <level label="n"> <text>The provisions of Title 9, Subtitle 4 of the Insurance Article apply to health maintenance organizations.</text> </level> <level label="o"> <text>The provisions of Title 33 of the Insurance Article apply to health maintenance organizations.</text> </level> <level label="p"> <text>The provisions of § 12–211 of the Insurance Article apply to health maintenance organizations.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-706.1" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>Subject to this section, the provisions of Title 9, Subtitle 2 of the Insurance Article regarding the rehabilitation and liquidation of insurers are applicable to health maintenance organizations.</text> </level> <level label="b"> <level label="1"> <text>Subject to paragraph (2) of this subsection, any rehabilitation or liquidation of a health maintenance organization shall be deemed to be the rehabilitation or liquidation of an insurer and shall be conducted under the supervision of the Commissioner under the law governing the rehabilitation or liquidation of insurers.</text> </level> <level label="2"> <text>The provisions of §§ 9-224 and 9-225 of the Insurance Article do not apply to the rehabilitation or liquidation of a health maintenance organization.</text> </level> </level> <level label="c"> <text>The Commissioner may apply for an order directing the Commissioner to rehabilitate or liquidate a health maintenance organization:</text> <level label="1"> <text>Upon any one or more grounds set out in Title 9, Subtitle 2 of the Insurance Article; or</text> </level> <level label="2"> <text>When in the Commissioner’s opinion the continued operation of the health maintenance organization would be hazardous either to its members or to the people of this State.</text> </level> </level> <level label="d"> <level label="1"> <text>In addition to the Commissioner’s authority under Title 9, Subtitle 2 of the Insurance Article, the Commissioner as a rehabilitator of a health maintenance organization may, subject to approval by a court:</text> <level label="i"> <text>Change premium rates and other terms of an individual or group contract;</text> </level> <level label="ii"> <text>Terminate or change the terms of:</text> <level label="1"> <text>Provider contracts; or</text> </level> <level label="2"> <text>Contracts with participating entities for the provision of administrative, financial, or management services; and</text> </level> </level> <level label="iii"> <text>Negotiate and, if the assuming health maintenance organization agrees:</text> <level label="1"> <text>Transfer the coverage obligations of the impaired health maintenance organization to an assuming health maintenance organization; and</text> </level> <level label="2"> <text>Assign the provider contracts of the impaired health maintenance organization to an assuming health maintenance organization.</text> </level> </level> </level> <level label="2"> <text>Before taking any action under paragraph (1)(ii) of this subsection, the Commissioner shall consider:</text> <level label="i"> <text>The interests of providers and other participating entities under contract with the impaired health maintenance organizations; and</text> </level> <level label="ii"> <text>The viability of continuing the health plan.</text> </level> </level> <level label="3"> <text>If a court under paragraph (1)(ii) of this subsection approves a change to the terms of a contract that diminishes the compensation of a provider or a participating entity providing administrative, financial, or management services, the change may not:</text> <level label="i"> <text>Be effective for more than 60 days; and</text> </level> <level label="ii"> <text>Except by mutual consent, be renewed or extended.</text> </level> </level> </level> <level label="e"> <text>In addition to the Commissioner’s authority under Title 9, Subtitle 2 of the Insurance Article, the Commissioner as a liquidator may, subject to approval by a court:</text> <level label="1"> <text>Contract with a solvent health maintenance organization or other appropriate entity to operate the insolvent health maintenance organization, including the provision of medical care, on a short-term basis;</text> </level> <level label="2"> <text>Operate the insolvent health maintenance organization, which may include compensating health care providers in accordance with the terms of the health care provider’s contract with the insolvent health maintenance organization;</text> </level> <level label="3"> <level label="i"> <text>Direct all other health maintenance organizations that participated in an open enrollment process with the insolvent health maintenance organization at a group’s last regular open enrollment period to offer enrollees or subscribers of the insolvent health maintenance organization a 30-day open enrollment period to begin on the date of the insolvency; and</text> </level> <level label="ii"> <text>Require each health maintenance organization directed to offer enrollees or subscribers of the insolvent health maintenance organization a 30-day open enrollment period to offer the enrollees of the insolvent health maintenance organization the same coverage and rates that it offered the enrollees at the last regular open enrollment period;</text> </level> </level> <level label="4"> <level label="i"> <text>Equitably allocate the insolvent health maintenance organization’s group contracts of those groups not offered other coverage under item (3) of this subsection, among all health maintenance organizations operating within a portion of the insolvent health maintenance organization’s service area, except that before allocating the group contracts under this item, the Commissioner shall consider the health care delivery system and financial resources of all possible successor health maintenance organizations;</text> </level> <level label="ii"> <text>Require each health maintenance organization allocated a group or groups under item (i) of this item to offer the group or groups the health maintenance organization’s existing coverage which is most similar to each group’s coverage with the insolvent health maintenance organization at rates determined in accordance with the successor health maintenance organization’s existing rate methodology; and</text> </level> <level label="iii"> <text>Ensure that any enrollee or subscriber whose group coverage had terminated prior to the date of the insolvency and who converted their group coverage into individual conversion coverage is offered the same conversion coverage that is offered by the successor health maintenance organization to persons converting from the group of which the enrollee or subscriber had been a former member;</text> </level> </level> <level label="5"> <level label="i"> <text>Equitably allocate the insolvent health maintenance organization’s nongroup individual contracts of those nongroup individuals not offered other coverage under item (3) of this subsection, among all health maintenance organizations operating within a portion of the insolvent health maintenance organization’s service area, except that before allocating the nongroup individual contract or contracts under this item, the Commissioner shall consider the health care delivery system and financial resources of all possible successor health maintenance organizations; and</text> </level> <level label="ii"> <text>Require each health maintenance organization allocated a nongroup individual or individuals under item (i) of this item to offer the nongroup individual or individuals the health maintenance organization’s existing coverage which is most similar to the nongroup individual’s coverage with the insolvent health maintenance organization at rates determined in accordance with the successor health maintenance organization’s existing rate methodology; and</text> </level> </level> <level label="6"> <text>Take any other action deemed necessary by the Commissioner.</text> </level> </level> <level label="f"> <text>The claims and expenses of health care providers incurred by the Commissioner, as a receiver, in continuing plan benefits as provided in the insolvent health maintenance organization’s plan of insolvency adopted under § 19-710(q) of this subtitle shall:</text> <level label="1"> <text>Be considered expenses for the administration of the receivership; and</text> </level> <level label="2"> <text>Have priority over all other expenses.</text> </level> </level> <level label="g"> <text>In the event of the liquidation or rehabilitation of a health maintenance organization under this section:</text> <level label="1"> <text>Members of the health maintenance organization shall have the same priority of claims as provided in § 9-227(c) of the Insurance Article; and</text> </level> <level label="2"> <text>For claims for health care services rendered to members before an order of receivership has been entered, the following health care providers shall immediately follow in priority claims of the members of the health maintenance organization:</text> <level label="i"> <text>Health care providers under contract with the health maintenance organization;</text> </level> <level label="ii"> <text>Health care providers that rendered health care services to members of the health maintenance organization upon referral from a health care provider under contract with the health maintenance organization; and</text> </level> <level label="iii"> <text>A hospital.</text> </level> </level> </level> <level label="h"> <level label="1"> <text>A health care provider may not assert a claim of subrogation against:</text> <level label="i"> <text>A member of an insolvent health maintenance organization; or</text> </level> <level label="ii"> <text>Any individual, organization, or government agency which has made payments to the health maintenance organization on behalf of a member.</text> </level> </level> <level label="2"> <text>Notwithstanding paragraph (1) of this subsection, a health care provider may assert any claim it may have against the receiver of the insolvent health maintenance organization.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-707" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>A health maintenance organization shall obtain from the Commissioner a certificate of authority to operate as a health maintenance organization before it may issue any contract or certificate to a member, provide any health care services to a member, or otherwise operate in this State.</text> </level> <level label="b"> <text>Except as permitted by the Commissioner and subject to the rules and regulations adopted under this subtitle, a health maintenance organization that does not have a certificate of authority may not contact potential members to discuss the health care services the health maintenance organization proposes to offer if a certificate of authority is granted.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-708" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>An applicant for a certificate to operate as a health maintenance organization shall submit an application to the Commissioner on the form that the Commissioner requires.</text> </level> <level label="b"> <text>The application shall include or be accompanied by:</text> <level label="1"> <text>A copy of the basic health maintenance organizational document and any amendments to it that, where applicable, are certified by the Department of Assessments and Taxation;</text> </level> <level label="2"> <text>A copy of the bylaws of the health maintenance organization, if any, that are certified by the appropriate officer;</text> </level> <level label="3"> <text>A list of the individuals who are to be responsible for the conduct of the affairs of the health maintenance organization, including all members of the governing body, the officers and directors if it is a corporation, and the partners or associates if it is a partnership or association;</text> </level> <level label="4"> <text>The addresses of those individuals and their official capacity with the health maintenance organization;</text> </level> <level label="5"> <text>A statement by each individual referred to in item (3) of this subsection that fully discloses the extent and nature of any contract or arrangement between the individual and the health maintenance organization and any possible conflict of interest;</text> </level> <level label="6"> <text>A resume of the qualifications of:</text> <level label="i"> <text>The administrator;</text> </level> <level label="ii"> <text>The medical director, who shall be a physician licensed in this State and certified under Title 15, Subtitle 10C of the Insurance Article;</text> </level> <level label="iii"> <text>The enrollment director; and</text> </level> <level label="iv"> <text>Any other individual who is associated with the health maintenance organization that the Commissioner and the Secretary request under their joint internal procedures;</text> </level> </level> <level label="7"> <text>A statement that describes generally:</text> <level label="i"> <text>The health maintenance organization, including:</text> <level label="1"> <text>Its operations;</text> </level> <level label="2"> <text>Its enrollment process;</text> </level> <level label="3"> <text>Its quality assurance mechanism; and</text> </level> <level label="4"> <text>Its internal grievance procedures;</text> </level> </level> <level label="ii"> <text>The methods the health maintenance organization proposes to use to offer its members and public representatives an opportunity to participate in matters of policy and operation;</text> </level> <level label="iii"> <text>The location of the facilities where health care services will be available regularly to members;</text> </level> <level label="iv"> <text>The type and specialty of physicians and health care personnel who are engaged to provide health care services;</text> </level> <level label="v"> <text>The number of physicians and personnel in each category; and</text> </level> <level label="vi"> <text>The health and medical records system to provide documentation of use by members;</text> </level> </level> <level label="8"> <text>The form of each contract that the health maintenance organization proposes to offer to subscribers showing the benefits to which they are entitled and a table of the rates charged or proposed to be charged for each form of contract;</text> </level> <level label="9"> <text>A statement that describes with reasonable certainty each geographic area to be served by the health maintenance organization;</text> </level> <level label="10"> <text>A statement of the financial condition of the health maintenance organization, including:</text> <level label="i"> <text>Sources of financial support;</text> </level> <level label="ii"> <text>A balance sheet showing assets, liabilities, and minimum tangible net worth; and</text> </level> <level label="iii"> <text>Any other financial information the Commissioner requires for adequate financial evaluation;</text> </level> </level> <level label="11"> <text>Copies of any proposed advertising and proposed techniques and methods of selling the services of the health maintenance organization;</text> </level> <level label="12"> <text>A power of attorney that is executed by the health maintenance organization appointing the Commissioner as agent of the organization in this State to accept service of process in any action, proceeding, or cause of action arising in this State against the health maintenance organization; and</text> </level> <level label="13"> <text>Copies of the agreements proposed to be made between the health maintenance organizations and providers of health care services.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-709" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>When a health maintenance organization files its initial application for a certificate of authority to operate, it shall pay to the Commissioner a fee of $300.</text> </level> <level label="b"> <text>In addition to the fee required under subsection (a) of this section, each health maintenance organization shall pay a reasonable sum that the Commissioner finds to be the cost of the investigations made by the Commissioner and the Department as required under this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-710" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>To qualify for a certificate of authority to operate as a health maintenance organization, an applicant shall satisfy the Commissioner that the applicant will meet the requirements of this section.</text> </level> <level label="b"> <text>The applicant shall conform to the definition of a health maintenance organization.</text> </level> <level label="c"> <text>The applicant shall establish and operate a bona fide health maintenance organization that can provide health care services in the proposed geographic area.</text> </level> <level label="d"> <level label="1"> <text>The health maintenance organization shall be actuarially sound.</text> </level> <level label="2"> <level label="i"> <text>Except as otherwise provided in this paragraph, the surplus that the health maintenance organization is required to have shall be paid in full.</text> </level> <level label="ii"> <text>The health maintenance organization licensed on or after July 1, 1989 shall have an initial surplus that exceeds the liabilities of the health maintenance organization by at least $1,500,000.</text> </level> <level label="iii"> <text>All health maintenance organizations shall maintain a surplus that exceeds the liabilities of the health maintenance organization in the amount that is at least equal to the greater of $750,000 or 5 percent of the subscription charges earned during the prior calendar year as recorded in the annual report filed by the health maintenance organization with the Commissioner.</text> </level> <level label="iv"> <text>No health maintenance organization shall be required to maintain a surplus in excess of a value of $3,000,000.</text> </level> </level> <level label="3"> <level label="i"> <text>For the protection of the health maintenance organization’s members and creditors, the applicant shall deposit and maintain in trust with the State Treasurer $100,000 in cash or government securities of the type described in § 5–701(b) of the Insurance Article.</text> </level> <level label="ii"> <level label="1"> <text>The deposits shall be accepted and held in trust by the State Treasurer in accordance with Title 5, Subtitle 7 of the Insurance Article.</text> </level> <level label="2"> <text>For the purpose of applying this subparagraph, a health maintenance organization shall be treated as an insurer.</text> </level> </level> </level> <level label="4"> <text>The Commissioner may waive the surplus and deposit requirements contained in this subsection if the Commissioner is satisfied that:</text> <level label="i"> <text>The health maintenance organization has sufficient net worth and an adequate history of generating net income to assure financial viability for the next year;</text> </level> <level label="ii"> <text>The health maintenance organization’s performance and obligations are guaranteed by another person with sufficient net worth and an adequate history of generating net income; or</text> </level> <level label="iii"> <text>The assets of the health maintenance organization or contracts with insurers, governments, providers, or other persons are sufficient to reasonably assure the performance of the health maintenance organization’s obligations.</text> </level> </level> </level> <level label="e"> <text>The provisions of Title 4, Subtitle 3 (Risk Based Capital Standards for Insurers) and § 15–604 (Rates for Payments to Hospitals) of the Insurance Article apply to health maintenance organizations in the same manner as they apply to insurers.</text> </level> <level label="f"> <text>The terms of contracts, including any medical assistance program contracts under Title XVIII or Title XIX of the Social Security Act or Title III of the Public Health Service Act, proposed to be made or made with government or private agencies that cover all or part of the cost of subscriptions to provide health care services, facilities, appliances, medicines, or supplies shall be financially sound, based on reasonable actuarial assumptions that the health maintenance organization can meet its obligations to the agencies and their beneficiaries by reason of the health maintenance organization’s net worth position, stop loss, reinsurance arrangements with authorized insurers, or other arrangements that are satisfactory to the Commissioner.</text> </level> <level label="g"> <level label="1"> <text>The terms of the contracts to be offered to subscribers shall provide that the health care services provided to members of the health maintenance organization will meet reasonable standards of quality of care that are applicable to the geographic area to be served, as approved by the Department.</text> </level> <level label="2"> <text>If a health maintenance organization offers services that are within the scope of practice of a physician and another health care practitioner who is licensed under the Health Occupations Article, the health maintenance organization shall offer those services through other licensed health care practitioners, where appropriate, as determined by the health maintenance organization.</text> </level> </level> <level label="h"> <level label="1"> <text>The procedures for offering health care services and offering and terminating contracts to subscribers may not discriminate unfairly on the basis of age, sex, sexual orientation, gender identity, religious beliefs, disability, race, health, or economic status.</text> </level> <level label="2"> <text>The requirement under paragraph (1) of this subsection does not prohibit:</text> <level label="i"> <text>Reasonable underwriting classifications for establishing contract rates; or</text> </level> <level label="ii"> <text>Experience rating.</text> </level> </level> </level> <level label="i"> <level label="1"> <text>The terms of the agreements between a health maintenance organization and providers of health services shall contain a “hold harmless” clause.</text> </level> <level label="2"> <text>The hold harmless clause shall provide that the provider may not, under any circumstances, including nonpayment of money due the providers by the health maintenance organization, insolvency of the health maintenance organization, or breach of the provider contract, bill, charge, collect a deposit, seek compensation, remuneration, or reimbursement from, or have any recourse against the subscriber, member, enrollee, patient, or any persons other than the health maintenance organization acting on their behalf, for services provided in accordance with the provider contract.</text> </level> <level label="3"> <text>Collection from the subscriber or member of copayments or supplemental charges in accordance with the terms of the subscriber’s contract with the health maintenance organization, or charges for services not covered under the subscriber’s contract, may be excluded from the hold harmless clause.</text> </level> <level label="4"> <text>Each provider contract shall state that the hold harmless clause will survive the termination of the provider contract, regardless of the cause of termination.</text> </level> </level> <level label="j"> <text>The health maintenance organization shall provide evidence of adequate insurance coverage or an adequate plan for self–insurance to satisfy claims for injuries that may occur from providing health care.</text> </level> <level label="k"> <text>The health maintenance organization shall provide for having its health and medical facilities and services audited and reviewed periodically:</text> <level label="1"> <text>By personnel outside the health maintenance organization who:</text> <level label="i"> <text>Act in a manner that is approved by the Department; and</text> </level> <level label="ii"> <text>Use methods that will assure objective evaluation and keep the identity of patients as confidential as possible;</text> </level> </level> <level label="2"> <text>By the health maintenance organization’s own internal quality of care committee audit procedures, if the Department approves the procedures; or</text> </level> <level label="3"> <text>By a professional standards review organization, as described in Title XI of the Social Security Act, that is certified by the Department of Health and Human Services as capable of serving individuals in the area where the health maintenance organization operates who are receiving benefits under Title XVIII or Title XIX of the Social Security Act or Title III of the Public Health Service Act, if the professional standards review organization is acting consistently with its certification.</text> </level> </level> <level label="l"> <level label="1"> <text>With the approval of the Department, the health maintenance organization shall provide continuous internal peer review for monitoring and evaluating patient records for:</text> <level label="i"> <text>Quality of care; and</text> </level> <level label="ii"> <text>Overuse and underuse of provider care; and</text> </level> </level> <level label="2"> <text>The health maintenance organization shall meet the requirements of Subtitle 13 of this title and all regulations for the performance of utilization review.</text> </level> </level> <level label="m"> <text>The health maintenance organization shall provide an internal grievance system to resolve adequately any grievances initiated by any of its members, in a manner approved by the Department on matters concerning quality of care and by the Commissioner on all other matters covered by this subtitle, under rules and regulations adopted under this subtitle.</text> </level> <level label="n"> <text>The health maintenance organization shall establish procedures to offer each member an opportunity to participate in matters of policy and operation.</text> </level> <level label="o"> <text>The health maintenance organization shall maintain a health and medical records system that:</text> <level label="1"> <text>Under procedures assuring maximum confidentiality, is readily accessible to authorized persons;</text> </level> <level label="2"> <text>Can accurately document use by each member; and</text> </level> <level label="3"> <text>At a minimum:</text> <level label="i"> <text>Identifies clearly each patient by:</text> <level label="1"> <text>Name;</text> </level> <level label="2"> <text>Number;</text> </level> <level label="3"> <text>Age; and</text> </level> <level label="4"> <text>Sex; and</text> </level> </level> <level label="ii"> <text>Shows clearly:</text> <level label="1"> <text>The services provided;</text> </level> <level label="2"> <text>When the services are provided;</text> </level> <level label="3"> <text>Where the services are provided;</text> </level> <level label="4"> <text>By whom the services are provided;</text> </level> <level label="5"> <text>The diagnosis and prognosis, if appropriate;</text> </level> <level label="6"> <text>The treatment;</text> </level> <level label="7"> <text>Any drug therapy; and</text> </level> <level label="8"> <text>The health status of the patient, if appropriate.</text> </level> </level> </level> </level> <level label="p"> <level label="1"> <text>Except as provided in paragraph (3) of this subsection, individual enrollees and subscribers of health maintenance organizations issued certificates of authority to operate in this State may not be liable to any health care provider for any covered services provided to the enrollee or subscriber.</text> </level> <level label="2"> <level label="i"> <text>A health care provider or any representative of a health care provider may not collect or attempt to collect from any subscriber or enrollee any money owed to the health care provider by a health maintenance organization issued a certificate of authority to operate in this State.</text> </level> <level label="ii"> <text>A health care provider or any representative of a health care provider may not maintain any action against any subscriber or enrollee to collect or attempt to collect any money owed to the health care provider by a health maintenance organization issued a certificate of authority to operate in this State.</text> </level> </level> <level label="3"> <text>Notwithstanding any other provision of this subsection, a health care provider or representative of a health care provider may collect or attempt to collect from a subscriber or enrollee:</text> <level label="i"> <text>Any copayment or coinsurance sums owed by the subscriber or enrollee to a health maintenance organization issued a certificate of authority to operate in this State for covered services provided by the health care provider;</text> </level> <level label="ii"> <text>If Medicare is the primary insurer and a health maintenance organization is the secondary insurer, any amount up to the Medicare approved or limiting amount, as specified under the Social Security Act, that is not owed to the health care provider by Medicare or the health maintenance organization after coordination of benefits has been completed, for Medicare covered services provided to the subscriber or enrollee by the health care provider; or</text> </level> <level label="iii"> <text>Any payment or charges for services that are not covered services.</text> </level> </level> </level> <level label="q"> <level label="1"> <text>The Commissioner shall require each health maintenance organization to have an insolvency plan by January 1, 1990 which provides for:</text> <level label="i"> <text>Continuation of benefits to subscribers and enrollees for the duration of the contract period for which premiums have been paid; and</text> </level> <level label="ii"> <text>Continuation of benefits to subscribers or enrollees who are admitted to an inpatient health care facility on the date of insolvency until, the earlier of:</text> <level label="1"> <text>The subscriber or enrollee is discharged from the inpatient health care facility; or</text> </level> <level label="2"> <text>365 days.</text> </level> </level> </level> <level label="2"> <text>In determining the adequacy of any insolvency plan, the Commissioner may consider:</text> <level label="i"> <text>The existence of insurance to cover expenses incurred in continuing benefits after an insolvency;</text> </level> <level label="ii"> <text>Provisions in provider contracts obligating providers to continue to provide services to enrollees or subscribers:</text> <level label="1"> <text>For the duration of the contract period for which premiums have been made; and</text> </level> <level label="2"> <text>If admitted to an inpatient health care facility, until the enrollee or subscriber is discharged or 365 days, whichever occurs first;</text> </level> </level> <level label="iii"> <text>Reserves;</text> </level> <level label="iv"> <text>Letters of credit;</text> </level> <level label="v"> <text>Guarantees; or</text> </level> <level label="vi"> <text>Any other arrangement to assure that benefits are continued in accordance with the provisions of paragraph (1) of this subsection.</text> </level> </level> </level> <level label="r"> <text>Repealed.</text> </level> <level label="s"> <level label="1"> <text>In this subsection, “practice profile” means a profile, summary, economic analysis, or other analysis of data concerning services rendered or utilized by a provider under contract with or employed by a health maintenance organization for the provision of health care services by the provider to enrollees or subscribers of the health maintenance organization.</text> </level> <level label="2"> <text>If a health maintenance organization uses a practice profile as a factor in its contract review to evaluate a provider’s status on a provider panel, the health maintenance organization shall disclose at the commencement and renewal of the contract and, not more often than annually, upon the request of the provider:</text> <level label="i"> <text>A description of the criteria used to compile the practice profile concerning the provider; and</text> </level> <level label="ii"> <text>The manner in which the practice profile is used to evaluate the provider.</text> </level> </level> <level label="3"> <text>The information provided under this subsection may not be used to create a cause of action.</text> </level> <level label="4"> <text>A health maintenance organization may not terminate a provider contract or provider’s employment with the health maintenance organization on the basis of a practice profile without first informing the provider of the findings of the practice profile and the provider specific data underlying those findings.</text> </level> </level> <level label="t"> <text>A health maintenance organization may not by contract, or in any other manner, require a provider to indemnify the health maintenance organization or hold the health maintenance organization harmless from a coverage decision or negligent act of the health maintenance organization.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-710.1" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Adjunct claims documentation” means an abstract of an enrollee’s medical record which describes and summarizes the diagnosis and treatment of, and services rendered to, the enrollee, including, in the case of trauma rendered in a trauma center, an operative report, a discharge summary, a Maryland Ambulance Information Systems form, or a medical record.</text> </level> <level label="3"> <text>“Berenson–Eggers Type of Service Code” means a code in a classification system developed by the Centers for Medicare and Medicaid Services that groups Current Procedural Terminology codes together based on clinical consistency.</text> </level> <level label="4"> <text>“Enrollee” means a subscriber or member of a health maintenance organization.</text> </level> <level label="5"> <text>“Evaluation and management service” means any service with a Berenson–Eggers Type of Service Code in the category of evaluation and management.</text> </level> <level label="6"> <text>“Institute” means the Maryland Institute for Emergency Medical Services Systems.</text> </level> <level label="7"> <text>“Medicare Economic Index” means the fixed–weight input price index that:</text> <level label="i"> <text>Measures the weighted average annual price change for various inputs needed to produce physician services; and</text> </level> <level label="ii"> <text>Is used by the Centers for Medicare and Medicaid Services in the calculation of reimbursement of physician services under Title XVIII of the federal Social Security Act.</text> </level> </level> <level label="8"> <text>“Similarly licensed provider” means:</text> <level label="i"> <text>For a physician:</text> <level label="1"> <text>A physician who is board certified or eligible in the same practice specialty; or</text> </level> <level label="2"> <text>A group physician practice that contains board certified or eligible physicians in the same practice specialty;</text> </level> </level> <level label="ii"> <text>For a health care provider that is not a physician, a health care provider that holds the same type of license.</text> </level> </level> <level label="9"> <level label="i"> <text>“Trauma center” means a primary adult resource center, level I trauma center, level II trauma center, level III trauma center, or pediatric trauma center that has been designated by the institute to provide care to trauma patients.</text> </level> <level label="ii"> <text>“Trauma center” includes an out–of–state pediatric facility that has entered into an agreement with the institute to provide care to trauma patients.</text> </level> </level> <level label="10"> <text>“Trauma patient” means a patient that is evaluated or treated in a trauma center and is entered into the State trauma registry as a trauma patient.</text> </level> <level label="11"> <text>“Trauma physician” means a licensed physician who has been credentialed or designated by a trauma center to provide care to a trauma patient at a trauma center.</text> </level> </level> <level label="b"> <text>In addition to any other provisions of this subtitle, for a covered service rendered to an enrollee of a health maintenance organization by a health care provider not under written contract with the health maintenance organization, the health maintenance organization or its agent:</text> <level label="1"> <text>Shall pay the health care provider within 30 days after the receipt of a claim in accordance with the applicable provisions of this subtitle; and</text> </level> <level label="2"> <text>Shall pay the claim submitted by:</text> <level label="i"> <text>A hospital at the rate approved by the Health Services Cost Review Commission;</text> </level> <level label="ii"> <text>A trauma physician for trauma care rendered to a trauma patient in a trauma center, at the greater of:</text> <level label="1"> <text>140% of the rate paid by the Medicare program, as published by the Centers for Medicare and Medicaid Services, for the same covered service, to a similarly licensed provider; or</text> </level> <level label="2"> <text>The rate as of January 1, 2001 that the health maintenance organization paid in the same geographic area, as published by the Centers for Medicare and Medicaid Services, for the same covered service, to a similarly licensed provider; and</text> </level> </level> <level label="iii"> <text>Any other health care provider:</text> <level label="1"> <text>For an evaluation and management service, no less than the greater of:</text> </level> <level label="A"> <text>125% of the average rate the health maintenance organization paid as of January 1 of the previous calendar year in the same geographic area, as defined by the Centers for Medicare and Medicaid Services, for the same covered service, to similarly licensed providers under written contract with the health maintenance organization; or</text> </level> <level label="B"> <text>140% of the rate paid by Medicare, as published by the Centers for Medicare and Medicaid Services, for the same covered service to a similarly licensed provider in the same geographic area as of August 1, 2008, inflated by the change in the Medicare Economic Index from 2008 to the current year; and</text> </level> <level label="2"> <text>For a service that is not an evaluation and management service, no less than 125% of the average rate the health maintenance organization paid as of January 1 of the previous calendar year in the same geographic area, as defined by the Centers for Medicare and Medicaid Services, to a similarly licensed provider under written contract with the health maintenance organization for the same covered service.</text> </level> </level> </level> </level> <level label="c"> <text>For the purposes of subsection (b)(2)(iii) of this section, a health maintenance organization shall calculate the average rate paid to similarly licensed providers under written contract with the health maintenance organization for the same covered service by summing the contracted rate for all occurrences of the Current Procedural Terminology Code for that service and then dividing by the total number of occurrences of the Current Procedural Terminology Code.</text> </level> <level label="d"> <text>A health maintenance organization shall disclose, on request of a health care provider not under written contract with the health maintenance organization, the reimbursement rate required under subsection (b)(2)(ii) and (iii) of this section.</text> </level> <level label="e"> <level label="1"> <text>Subject to paragraph (2) of this subsection, a health maintenance organization may require a trauma physician not under contract with the health maintenance organization to submit appropriate adjunct claims documentation and to include on the uniform claim form a provider number assigned to the trauma physician by the health maintenance organization.</text> </level> <level label="2"> <text>If a health maintenance organization requires a trauma physician to include a provider number on the uniform claim form in accordance with paragraph (1) of this subsection, the health maintenance organization shall assign a provider number to a trauma physician not under contract with the health maintenance organization at the request of the physician.</text> </level> <level label="3"> <text>A trauma center, on request from a health maintenance organization, shall verify that a licensed physician is credentialed or otherwise designated by the trauma center to provide trauma care.</text> </level> <level label="4"> <text>Notwithstanding the provisions of § 19–701(d) of this subtitle, for trauma care rendered to a trauma patient in a trauma center by a trauma physician, a health maintenance organization may not require a referral or preauthorization for a service to be covered.</text> </level> </level> <level label="f"> <level label="1"> <text>A health maintenance organization may seek reimbursement from an enrollee for any payment under subsection (b) of this section for a claim or portion of a claim submitted by a health care provider and paid by the health maintenance organization that the health maintenance organization determines is the responsibility of the enrollee.</text> </level> <level label="2"> <text>The health maintenance organization may request and the health care provider shall provide adjunct claims documentation to assist in making the determination under paragraph (1) of this subsection or under subsection (b) of this section.</text> </level> </level> <level label="g"> <level label="1"> <text>A health care provider may enforce the provisions of this section by filing a complaint against a health maintenance organization with the Maryland Insurance Administration or by filing a civil action in a court of competent jurisdiction under § 1–501 or § 4–201 of the Courts Article.</text> </level> <level label="2"> <text>The Maryland Insurance Administration or a court shall award reasonable attorney fees if the complaint of the health care provider is sustained.</text> </level> </level> <level label="h"> <text>The Maryland Health Care Commission annually shall review payments to health care providers to determine the compliance of health maintenance organizations with the requirements of this section and report its findings to the Maryland Insurance Administration.</text> </level> <level label="i"> <text>The Maryland Insurance Administration may take any action authorized under this subtitle or the Insurance Article, including conducting an examination under Title 2, Subtitle 2 of the Insurance Article, to investigate and enforce a violation of the provisions of this section.</text> </level> <level label="j"> <text>In addition to any other penalties under this subtitle, the Commissioner may impose a penalty not to exceed $5,000 on any health maintenance organization which violates the provisions of this section if the violation is committed with such frequency as to indicate a general business practice of the health maintenance organization.</text> </level> <level label="k"> <text>The Maryland Insurance Administration, in consultation with the Maryland Health Care Commission, shall adopt regulations to implement this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-710.2" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Carrier” means:</text> <level label="i"> <text>An insurer;</text> </level> <level label="ii"> <text>A nonprofit health service plan;</text> </level> <level label="iii"> <text>A health maintenance organization;</text> </level> <level label="iv"> <text>A dental plan organization; or</text> </level> <level label="v"> <text>Any other person or organization that provides health benefit plans subject to State regulation.</text> </level> </level> <level label="3"> <text>“Point-of-service option” means a health benefit plan that permits a member or subscriber of a health maintenance organization to receive any health care service outside the provider panel of the health maintenance organization that is covered under the member’s or subscriber’s contract with the health maintenance organization.</text> </level> <level label="4"> <text>“Provider panel” means those providers with which a health maintenance organization contracts to provide services to the health maintenance organization’s members or subscribers under the health maintenance organization’s health benefit plan.</text> </level> </level> <level label="b"> <level label="1"> <text>If an employer, association, or other private group arrangement offers health benefit plan coverage to employees or individuals only through a health maintenance organization, the health maintenance organization with which the employer, association, or other private group arrangement is contracting for the coverage shall offer, or contract with another carrier to offer, a point-of-service option to the employer, association, or other private group arrangement in conjunction with the health maintenance organization as an additional benefit for an employee or individual, at the employee’s or individual’s option, to accept or reject.</text> </level> <level label="2"> <text>When a health maintenance organization is the sole delivery system offered to employees by an employer, the health maintenance organization:</text> <level label="i"> <text>Shall offer the employer a point-of-service option for the individual employee to accept or reject;</text> </level> <level label="ii"> <text>May not impose a minimum participation level on the point-of-service option; and</text> </level> <level label="iii"> <text>As part of the group enrollment application, shall provide to each employer a disclosure statement for each point-of-service option offered that conforms to regulations, for the point-of-service option required under paragraph (1) of this subsection, adopted by:</text> <level label="1"> <text>The Maryland Health Care Commission for the small group market; and</text> </level> <level label="2"> <text>The Maryland Insurance Administration for the non-small group market.</text> </level> </level> </level> </level> <level label="c"> <level label="1"> <text>An employer, association, or other private group arrangement may require an employee or individual that accepts the additional coverage under a point-of-service option under subsection (b) of this section to be responsible for the payment of a premium over the amount of the premium for the coverage offered by the health maintenance organization.</text> </level> <level label="2"> <text>A carrier may impose different cost-sharing provisions for the point-of-service option based on whether the service is provided through the provider panel of the health maintenance organization or outside the provider panel of the health maintenance organization.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-711" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>Within 90 days after the filing of an application for a certificate of authority to operate as a health maintenance organization, the Commissioner shall issue the certificate of authority to the applicant if:</text> <level label="1"> <text>The application conforms with § 19-708 of this subtitle;</text> </level> <level label="2"> <text>The applicant has paid the fees required by § 19-709 of this subtitle;</text> </level> <level label="3"> <text>The Department has advised in writing that the health maintenance organization’s proposed health-related services, operations, and functions that fall under the regulatory jurisdiction of the Department appear to meet its requirements or are approved by the Department; and</text> </level> <level label="4"> <text>The Commissioner is satisfied that the requirements of § 19-710 of this subtitle are met.</text> </level> </level> <level label="b"> <level label="1"> <text>Subject to paragraph (2) of this subsection, the provisions of Title 7 of the Insurance Article apply to health maintenance organizations.</text> </level> <level label="2"> <text>Before approving a transaction under § 7-306 of the Insurance Article, the Insurance Commissioner shall consult with the Secretary.</text> </level> </level> <level label="c"> <text>Subsection (b) of this section may not apply to any transaction preempted by federal law.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-711.3" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <text>In any case where a health maintenance organization is being merged or consolidated with or acquired by another person, any current financing money provided by the health maintenance organization to a hospital, in accordance with regulations adopted by the Health Services Cost Review Commission, in return for a discount in rates charged by the hospital shall be deemed to be security for the amount of outstanding charges owed by the health maintenance organization to the hospital for bills or claims for services provided by the hospital prior to the merger, consolidation, or acquisition.</text> </section> <section article="ghg" article_name="Health - General" number="19-712" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>Subject to the provisions of subsection (b) of this section, a person who holds a certificate of authority to operate a health maintenance organization under this subtitle may:</text> <level label="1"> <text>Exercise the power that professional and other corporations, partnerships, associations, or other business entities have under their organizational documents and any laws of this State that do not conflict with this subtitle;</text> </level> <level label="2"> <text>Provide health care services to nonmembers who present themselves on other than a prepaid basis;</text> </level> <level label="3"> <text>Provide health care services on a prepaid basis through licensed providers of these services who are under contract with or employed by the health maintenance organization;</text> </level> <level label="4"> <text>Contract with any person to perform, on behalf of the health maintenance organization, functions such as marketing, enrollment, and administration;</text> </level> <level label="5"> <text>Contract for insurance, reinsurance, or indemnity or reimbursement against the cost of health care services provided by the health maintenance organization with:</text> <level label="i"> <text>Any insurance company licensed to do health business in this State; or</text> </level> <level label="ii"> <text>Any hospital, nonprofit health service plan, medical health service, nursing service, optometric service, podiatry service, dental service, pharmaceutical service plan corporation, or similar entity authorized to do business in this State;</text> </level> </level> <level label="6"> <text>Accept from government or private agencies payments that cover all or part of the cost of subscriptions to provide health care services, facilities, appliances, medicines, and supplies;</text> </level> <level label="7"> <text>Buy, lease, construct, renovate, operate, or maintain:</text> <level label="i"> <text>A hospital, medical facility, and ancillary equipment; and</text> </level> <level label="ii"> <text>Property that is reasonably required for its principal office or for any other purpose necessary in the business of the health maintenance organization; and</text> </level> </level> <level label="8"> <text>Offer indemnity benefits that cover out-of-area and emergency services.</text> </level> </level> <level label="b"> <level label="1"> <text>A person who holds a certificate of authority to operate a health maintenance organization under this subtitle and who enters into any administrative service provider contract, as defined in § 19-713.2 of this subtitle, with a person or entity for the provision of health care services to subscribers shall be responsible for all claims or payments for health care services:</text> <level label="i"> <text>Covered under the subscriber’s contract; and</text> </level> <level label="ii"> <text>Rendered by a provider, who is not the person or entity which entered into the administrative service provider contract with the health maintenance organization, pursuant to a referral by a person or entity which entered into the administrative service provider contract with the health maintenance organization.</text> </level> </level> <level label="2"> <text>Responsibility for claims and payments under this subsection is subject to the provisions of § 15-1005 of the Insurance Article.</text> </level> </level> <level label="c"> <text>The responsibility of a health maintenance organization for claims or payments for health care services in accordance with subsection (b) of this section under an administrative service provider contract:</text> <level label="1"> <text>Is not limited by the amount in a segregated fund established under § 19-713.2 of this subtitle;</text> </level> <level label="2"> <text>Exists irrespective of the insolvency or other inability or failure of a contracting provider, as defined in § 19-713.2 of this subtitle, to pay;</text> </level> <level label="3"> <text>Exists irrespective of the delegation or further subcontracting of health care services by a contracting provider to an external provider, as defined in § 19-713.2 of this subtitle;</text> </level> <level label="4"> <text>May not be altered by contract; and</text> </level> <level label="5"> <text>Applies to all health care services, including those provided under State and federal programs, unless preempted by federal law.</text> </level> </level> <level label="d"> <text>Subsections (b) and (c) of this section apply to a contract between a health maintenance organization and any company affiliated with the health maintenance organization through common ownership within an insurance holding company system, that meets the definition of a contracting provider under § 19-713.2 of this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-712.2" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>A health maintenance organization that provides pharmaceutical benefits shall notify all pharmacies under contract with the health maintenance organization in writing of changes in the pharmaceutical benefit program rules or requirements at least 30 days before the change is effective.</text> </level> <level label="b"> <text>Changes that require 30 days’ advance written notice under subsection (a) of this section are:</text> <level label="1"> <text>Exclusion of coverage for classes of drugs as specified by contract;</text> </level> <level label="2"> <text>Changes in prior or preauthorization procedures; and</text> </level> <level label="3"> <text>Selection of new prescription claims processors.</text> </level> </level> <level label="c"> <text>A health maintenance organization that fails to provide advance notice as required under subsection (a) of this section shall honor and pay in full any claim under the program rules or requirements that existed before the change for 30 days after the postmarked date of the notice.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-712.4" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>In this section the terms “health care practitioner”, “health care entity”, and “health care service” have the same meanings as provided in § 1–301 of the Health Occupations Article.</text> </level> <level label="b"> <text>A health maintenance organization may seek repayment from a health care practitioner of any money paid for any claim, bill, or other demand or request for payment for the health care services that were determined by the appropriate regulatory licensing board to be furnished as a result of a referral prohibited by § 1–302 of the Health Occupations Article.</text> </level> <level label="c"> <text>Every contract between a health maintenance organization and its subscribers or a group of subscribers for the provision of health care services shall include a provision excluding payment of any claim, bill, or other demand or request for payment for health care services determined to be furnished as a result of a referral prohibited by § 1–302 of the Health Occupations Article.</text> </level> <level label="d"> <text>A health maintenance organization subject to the provisions of this section shall report to the Commissioner and the appropriate regulatory board any pattern of claims, bills or other demands or requests for payment submitted for a health care service provided as a result of a referral prohibited by § 1–302 of the Health Occupations Article within 30 days after that health maintenance organization has knowledge of that pattern.</text> </level> <level label="e"> <level label="1"> <text>Notwithstanding the provisions of this section, a health maintenance organization reimbursing for health care services is not required to audit or investigate any claim, bill, or other demand or request for payment for the purpose of determining whether those services were the result of a prohibited referral.</text> </level> <level label="2"> <text>Any audit or investigation of any claim, bill, or other demand or request for payment for the purpose of determining whether those services were the result of the prohibited referral are not grounds to delay payment or waive the provisions of § 15–1005 of the Insurance Article.</text> </level> </level> <level label="f"> <text>For any claim, bill, or request for payment that is paid and is subsequently determined to be the result of a prohibited referral, a health maintenance organization may seek a refund of that payment in accordance with the provisions of § 1–305 of the Health Occupations Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-712.5" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>A health maintenance organization shall reimburse a hospital emergency facility and provider, less any applicable co–payments, for medically necessary services provided to a member or subscriber of the health maintenance organization if the health maintenance organization authorized, directed, referred, or otherwise allowed the member or subscriber to use the emergency facility and the medically necessary services are related to the condition for which the member was allowed to use the emergency facility.</text> </level> <level label="b"> <text>A health maintenance organization shall reimburse a hospital emergency facility and provider, less any applicable co–payments, for medically necessary services that relate to the condition presented and that are provided by the provider in the emergency facility to a member or subscriber of the health maintenance organization if the health maintenance organization fails to provide 24–hour access in accordance with the standards of quality of care required under § 19–705.1(b)(1)(ii) of this subtitle.</text> </level> <level label="c"> <text>A health maintenance organization shall reimburse a hospital emergency facility and provider, less any applicable co–payments, for medical screening, assessment, and stabilization services rendered to meet the requirements of the federal Emergency Medical Treatment and Active Labor Act.</text> </level> <level label="d"> <text>Notwithstanding any other provision of this subtitle, a provider may not be required to obtain prior authorization or approval for payment from a health maintenance organization in order to obtain reimbursement under subsection (a), (b), or (c) of this section.</text> </level> <level label="e"> <text>Notwithstanding any other provision of this article, a hospital emergency facility or provider or a health maintenance organization that has reimbursed a provider may collect or attempt to collect payment from a member or subscriber for health care services provided for a medical condition that is determined not to be an emergency as defined in § 19–701(e) of this subtitle.</text> </level> <level label="f"> <text>If a health maintenance organization authorizes, directs, refers, or otherwise allows a member or subscriber to access a hospital emergency facility or other urgent care facility for a medical condition that requires emergency surgery, the health maintenance organization:</text> <level label="1"> <text>Shall reimburse the physician, oral surgeon, periodontist, or podiatrist, who performed the surgical procedure, for follow–up care that is:</text> <level label="i"> <text>Medically necessary;</text> </level> <level label="ii"> <text>Directly related to the condition for which the surgical procedure was performed; and</text> </level> <level label="iii"> <text>Provided in consultation with the member’s or subscriber’s primary care physician; and</text> </level> </level> <level label="2"> <text>May not impose on the member or subscriber any co–payment or other cost–sharing requirement for any follow–up care that exceeds what a member or subscriber is required to pay for services rendered by a physician, oral surgeon, periodontist, or podiatrist who is a member of the provider panel of the health maintenance organization.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-712.6" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>Whenever a subscriber or an enrollee of a health maintenance organization is a resident of a continuing care facility that is regulated under Title 10, Subtitle 4 of the Human Services Article and received health care services in an acute care health care facility, the resident’s primary care physician shall refer, if medically appropriate, the resident to the skilled nursing unit at the resident’s continuing care facility for the provision of health care services included in the resident’s health maintenance organization Medicare contract if:</text> <level label="1"> <text>The primary care physician and the resident or the designated representative of the resident do not choose an alternative course of treatment;</text> </level> <level label="2"> <text>The continuing care facility becomes a contracting provider in accordance with the health maintenance organization’s standard terms and conditions for its participating providers and meets the credentialing criteria for becoming a participating provider;</text> </level> <level label="3"> <text>The continuing care facility meets all the guidelines established by the Division of Licensing and Certification of the Department, including Medicare certification; and</text> </level> <level label="4"> <text>The continuing care facility’s skilled nursing unit is certified as a Medicare skilled nursing facility.</text> </level> </level> <level label="b"> <level label="1"> <text>The continuing care facility is not obligated to accept for the provision of health care services anyone other than a resident of the continuing care facility.</text> </level> <level label="2"> <text>The health maintenance organization and the continuing care facility are not obligated to advertise in any manner that the continuing care facility is a participating provider with respect to coverage offered by the health maintenance organization for Medicare benefits or other treatment in the skilled nursing unit for anyone other than residents of the continuing care facility.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-712.7" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <text>To the extent required under federal law, a health maintenance organization shall reimburse a community health resource, as defined in § 19-2101 of this title, for covered services provided to a member or subscriber of the health maintenance organization.</text> </section> <section article="ghg" article_name="Health - General" number="19-713" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <level label="1"> <text>Each health maintenance organization shall file with the Commissioner and pay the applicable filing fee as provided in § 2–112 of the Insurance Article, before they become effective:</text> <level label="i"> <text>All rates that the health maintenance organization charges subscribers or groups of subscribers; and</text> </level> <level label="ii"> <text>The form and content of each contract between the health maintenance organization and its subscribers or groups of subscribers.</text> </level> </level> <level label="2"> <level label="i"> <text>A health maintenance organization that offers a health benefit plan, as defined in § 11–601 of the Insurance Article, is subject to Title 11, Subtitle 6 of the Insurance Article for the health benefit plan.</text> </level> <level label="ii"> <text>If the provisions of Title 11, Subtitle 6 of the Insurance Article conflict with the provisions of this section, the provisions of Title 11, Subtitle 6 of the Insurance Article shall prevail.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>Rates of a health maintenance organization may not be excessive, inadequate, or unfairly discriminatory in relation to the services offered.</text> </level> <level label="2"> <text>A health maintenance organization that includes a subrogation provision in its contract as authorized under § 19-713.1(d) of this subtitle shall:</text> <level label="i"> <text>Use in its rating methodology an adjustment that reflects the subrogation; and</text> </level> <level label="ii"> <text>Identify in its rate filing with the Maryland Insurance Administration, and annually in a form approved by the Insurance Commissioner, all amounts recovered through subrogation.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>If, at any time, a health maintenance organization wishes to amend any contract with its subscribers or change any rate charged, the health maintenance organization shall file with the Commissioner the number of copies of the amendment or rate change that the Commissioner requires.</text> </level> <level label="2"> <text>The Commissioner shall provide the Department with the number of copies it requires.</text> </level> </level> <level label="d"> <text>The Commissioner shall coordinate the contract and related rate filing review under this section.</text> </level> <level label="e"> <level label="1"> <text>If within 60 days after a filing made pursuant to this section, the Commissioner finds the filing does not meet the requirements of subsection (f) of this section, the filer shall be sent notice of disapproval specifying in what respects the Commissioner finds that the filing fails to meet the requirements of this section and stating that the filing shall not become effective.</text> </level> <level label="2"> <text>The Commissioner may extend the initial review period described in paragraph (1) of this subsection for up to an additional 30 days if the Commissioner gives notice to the health maintenance organization of the extension before the initial review period ends.</text> </level> <level label="3"> <text>The Commissioner may not issue a notice of disapproval of a filing under subsection (f) of this section without a statutory or regulatory basis for the disapproval and an explanation of the application of the statutory or regulatory basis which resulted in the disapproval.</text> </level> </level> <level label="f"> <text>The Commissioner shall disapprove any form filed, or withdraw any previous approval, if the form:</text> <level label="1"> <text>Is in any respect in violation or does not comply with this article or applicable regulations;</text> </level> <level label="2"> <text>Contains, or incorporates by reference, any inconsistent or inapplicable clauses, exceptions, or conditions which affect the risk purported to be assumed in the general coverage of the contract;</text> </level> <level label="3"> <text>Has any title, heading, or other indication of its provisions which is likely to mislead the subscriber or member;</text> </level> <level label="4"> <text>Includes provisions that are inequitable, or provisions that lack any substantial benefit to the subscriber or member;</text> </level> <level label="5"> <text>Is printed or otherwise reproduced in a manner as to render any provision of the form substantially illegible; or</text> </level> <level label="6"> <text>Provides benefits that are unreasonable in relation to the premium charged.</text> </level> </level> <level label="g"> <level label="1"> <text>Except as provided in paragraph (2) of this subsection, unless the Commissioner disapproves a filing under this section, the filing becomes effective:</text> <level label="i"> <text>60 days after the office of the Commissioner receives the filing;</text> </level> <level label="ii"> <text>If the Commissioner extends the review period under subsection (e)(2) of this section, on the date specified in the notice required under subsection (e)(2) of this section; or</text> </level> <level label="iii"> <text>On any other date that the Commissioner sets.</text> </level> </level> <level label="2"> <text>The Commissioner may adopt regulations to allow a type or kind of form to be effective upon receipt of the filing by the Commissioner.</text> </level> <level label="3"> <text>If a health maintenance organization uses a form which becomes effective in accordance with the provisions of paragraph (2) of this subsection and the form would be subject to disapproval under subsection (f) of this section, the Commissioner may:</text> <level label="i"> <text>Subsequently disapprove the form; and</text> </level> <level label="ii"> <text>Find the health maintenance organization to be in violation of § 19–729 of this subtitle and impose a penalty as provided in § 19–730 of this subtitle.</text> </level> </level> <level label="4"> <text>If a health maintenance organization files a form with the Commissioner which becomes effective in accordance with the provisions of paragraph (2) of this subsection, the health maintenance organization shall pay the applicable filing fee provided in § 2–112 of the Insurance Article.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-713.1" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>A contract between a health maintenance organization and its subscribers or a group of subscribers may contain nonduplication provisions or provisions to coordinate the coverage with subscriber contracts of other health maintenance organizations, health insurance policies, including those of nonprofit health service plans, and with other established programs under which the subscriber or member may make a claim.</text> </level> <level label="b"> <text>Notwithstanding the provisions of subsection (a) of this section, a contract between a health maintenance organization and its subscribers or a group of subscribers may not contain nonduplication provisions or provisions to coordinate coverage with any individually underwritten and issued, guaranteed renewable, specified disease policy, as defined in § 15-109 of the Insurance Article, or intensive care policy, which does not provide benefits on an expense incurred basis.</text> </level> <level label="c"> <text>For purposes of this section, “intensive care policy” means a health insurance policy that provides benefits only when treatment is received in that specifically designated facility of a hospital that provides the highest level of care and which is restricted to those patients who are physically, critically ill or injured.</text> </level> <level label="d"> <text>Notwithstanding § 19-701(g)(3) of this subtitle, a contract between a health maintenance organization and its subscribers or a group of subscribers may contain a provision allowing the health maintenance organization to be subrogated to a cause of action that a subscriber has against another person:</text> <level label="1"> <text>To the extent that any actual payments made by the health maintenance organization result from the occurrence that gave rise to the cause of action; or</text> </level> <level label="2"> <text>For a nonprofit health maintenance organization that exclusively contracts with a group of physicians to provide or to arrange for the provision of health care services for its enrollees, for any service provided by the health maintenance organization as a result of the occurrence that gave rise to the cause of action, per the fee schedule established by the nonprofit health maintenance organization.</text> </level> </level> <level label="e"> <level label="1"> <text>Subsection (d) of this section does not allow a contract between a health maintenance organization and its subscribers or a group of subscribers to contain a provision allowing the health maintenance organization to recover any payments made to a subscriber under the personal injury protection coverage of a motor vehicle liability insurance policy.</text> </level> <level label="2"> <text>A contract between a health maintenance organization and its subscribers or a group of subscribers may not contain a provision that requires personal injury protection benefits under a motor vehicle liability insurance policy to be paid before benefits under the contract.</text> </level> </level> <level label="f"> <text>Subsection (d) of this section does not allow a health maintenance organization to recover medical expenses from a subscriber under a subrogation provision unless the subscriber recovers for medical expenses in a cause of action.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-713.2" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Administrative service provider contract” means a contract or capitation agreement between a health maintenance organization and a contracting provider which includes requirements that:</text> <level label="i"> <text>The contracting provider accept payments from a health maintenance organization for health care services to be provided to members of the health maintenance organization that the contracting provider arranges to be provided by external providers; and</text> </level> <level label="ii"> <text>The contracting provider administer payments pursuant to the contract with the health maintenance organization for the health care services to the external providers.</text> </level> </level> <level label="3"> <level label="i"> <text>“Contracting provider” means a person who enters into an administrative service provider contract with a health maintenance organization.</text> </level> <level label="ii"> <text>“Contracting provider” does not include a medical laboratory as defined in § 17–201 of this article.</text> </level> </level> <level label="4"> <text>“External provider” means a health care provider, including a physician or hospital, who is not:</text> <level label="i"> <text>A contracting provider; or</text> </level> <level label="ii"> <text>An employee, shareholder, or partner of a contracting provider.</text> </level> </level> </level> <level label="b"> <text>This section does not apply to a contract between a health maintenance organization and a contracting provider that is affiliated with the health maintenance organization through common ownership within an insurance holding company system, if the health maintenance organization:</text> <level label="1"> <text>Files with the Commissioner consolidated financial statements that include the contracting provider; and</text> </level> <level label="2"> <text>Records a reserve for the liabilities of the contracting provider in accordance with § 5-201 of the Insurance Article.</text> </level> </level> <level label="c"> <text>A health maintenance organization may not enter into an administrative service provider contract unless:</text> <level label="1"> <text>The health maintenance organization files with the Insurance Commissioner a plan that satisfies the requirements of subsection (d) of this section; and</text> </level> <level label="2"> <text>The Insurance Commissioner does not disapprove the filing within 30 days after the plan is filed.</text> </level> </level> <level label="d"> <text>The plan required under subsection (c) of this section shall:</text> <level label="1"> <text>Require the contracting provider to provide the health maintenance organization with monthly reports, within 30 days of the end of the month reported, that identify payments made or owed to external providers in sufficient detail to determine if the payments are being made in compliance with law;</text> </level> <level label="2"> <text>Require the contracting provider to provide to the health maintenance organization a current annual financial statement of the contracting provider each year, within 90 days of the end of the year reported;</text> </level> <level label="3"> <text>Require the health maintenance organization to establish and maintain a segregated fund, in a form and an amount approved by the Commissioner, which may include withheld funds, escrow accounts, letters of credit, or similar arrangements, or require the availability of other resources that are sufficient to satisfy the contracting provider’s obligations to external providers for services rendered to members of the health maintenance organization;</text> </level> <level label="4"> <text>Require the contracting provider to submit to the health maintenance organization information demonstrating that the fund established under item (3) of this subsection is sufficient to satisfy the contracting provider’s obligations to external providers for services rendered to members of the health maintenance organization; and</text> </level> <level label="5"> <text>Require the health maintenance organization, at least quarterly, to review and inspect the contracting provider’s books, records, and operations relevant to the provider’s contract for the purpose of determining the contracting provider’s compliance with the plan.</text> </level> </level> <level label="e"> <text>In determining the sufficiency of a segregated fund, the Commissioner may consider whether external providers are owned or controlled by the contracting provider.</text> </level> <level label="f"> <text>The segregated fund or other resources established as a result of an administrative service provider contract:</text> <level label="1"> <text>Shall be held in trust for payment to external providers; and</text> </level> <level label="2"> <text>May not be considered an asset or an account of the contracting provider for the purpose of determining the assets or accounts of a bankrupt contracting provider.</text> </level> </level> <level label="g"> <text>The health maintenance organization and the contracting provider shall comply with the plan.</text> </level> <level label="h"> <level label="1"> <text>The health maintenance organization shall monitor the contracting provider to assure compliance with the plan, and the health maintenance organization shall notify the contracting provider whenever a failure to comply with the plan occurs.</text> </level> <level label="2"> <text>Upon the failure of the contracting provider to comply with the plan following notice of noncompliance, or upon termination of the administrative service provider contract for any reason, the health maintenance organization shall notify the Commissioner and shall assume the administration of any payments due from the contracting provider to external providers on behalf of the contracting provider, as required under § 19-712 of this subtitle.</text> </level> </level> <level label="i"> <text>The health maintenance organization shall file with the Commissioner, the results of each quarterly review required under subsection (d)(5) of this section.</text> </level> <level label="j"> <text>The plan and all supporting documentation submitted in connection with the plan shall be treated as confidential and proprietary, and may not be disclosed except as otherwise required by law.</text> </level> <level label="k"> <text>A health maintenance organization and a contracting provider shall comply with the terms of an administrative service provider contract as required under this section and § 19-712 of this subtitle.</text> </level> <level label="l"> <text>If a contracting provider fails to comply with the plan or the administrative service provider contract, as required under subsections (g) and (k) of this section, the Commissioner may impose a fine not exceeding $125,000 or suspend or revoke the registration of the contracting provider under § 19-713.3 of this subtitle, or both.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-713.3" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Administrative service provider contract” has the meaning stated in § 19-713.2 of this subtitle.</text> </level> <level label="3"> <text>“Contracting provider” has the meaning stated in § 19-713.2 of this subtitle.</text> </level> </level> <level label="b"> <level label="1"> <text>A person must register with the Commissioner before the person acts as a contracting provider in this State.</text> </level> <level label="2"> <text>A health maintenance organization may not enter into an administrative service provider contract with a contracting provider that has not registered with the Commissioner.</text> </level> </level> <level label="c"> <level label="1"> <text>An applicant for registration shall submit an application to the Commissioner in a form approved by the Commissioner and include any information required under subsection (e) of this section.</text> </level> <level label="2"> <text>A registration under this section expires 2 years from the date the application is approved.</text> </level> </level> <level label="d"> <text>The Commissioner may charge a registration fee sufficient to cover the cost of implementing this section.</text> </level> <level label="e"> <text>The Commissioner may adopt regulations to carry out the provisions of this section and § 19-713.2 of this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-713.4" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>In this section, “health maintenance organization” or “HMO” includes any agent of a health maintenance organization.</text> </level> <level label="b"> <level label="1"> <text>A health maintenance organization that issues a request for proposal, including changes in terms to an existing contract to provide pharmaceutical services, shall notify the Maryland Pharmacists Association of the request for proposal to provide pharmaceutical services within 10 days after issuing that request.</text> </level> <level label="2"> <text>The Maryland Pharmacists Association may inform licensed pharmacists of the request.</text> </level> </level> <level label="c"> <text>A health maintenance organization may not charge a fee for processing or accepting an application to provide pharmaceutical services.</text> </level> <level label="d"> <text>This section does not apply to a health maintenance organization if the health maintenance organization provides pharmaceutical services from a pharmacy that is:</text> <level label="1"> <text>Located on the site of the health maintenance organization; and</text> </level> <level label="2"> <text>Wholly owned and operated by the health maintenance organization.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-713.5" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>If a health maintenance organization requires its subscribers to have a referral to receive consultation services in writing, the health maintenance organization shall use the uniform consultation referral form adopted by the Commissioner under § 15-120 of the Insurance Article as the sole instrument for referrals for consultation services.</text> </level> <level label="b"> <text>A health maintenance organization may not impose as a condition of coverage any requirement to:</text> <level label="1"> <text>Modify the uniform consultation referral form; or</text> </level> <level label="2"> <text>Submit additional consultation referral forms.</text> </level> </level> <level label="c"> <text>The uniform consultation referral form shall be properly completed by the health care provider referring the subscriber for consultation services.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-713.6" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Documented informed consent” means:</text> <level label="i"> <text>A written consent form signed by a patient; or</text> </level> <level label="ii"> <text>Verbal or otherwise communicated consent signified by a notation in a patient’s electronic medical record maintained by a group model health maintenance organization.</text> </level> </level> <level label="3"> <text>“Drug therapy management” means treatment of a patient using drug therapy, laboratory tests, or medical devices under conditions or limitations set forth in a protocol specified in a physician–pharmacist agreement for the purpose of improving patient outcome.</text> </level> <level label="4"> <text>“Group model health maintenance organization” means a health maintenance organization that:</text> <level label="i"> <text>Contracts with one multispecialty group of physicians who are employed by and shareholders of the multispecialty group; and</text> </level> <level label="ii"> <text>Provides and arranges for the provision of physician services to patients at medical facilities operated by the health maintenance organization.</text> </level> </level> <level label="5"> <text>“Licensed pharmacist” means an individual who is licensed to practice pharmacy under Title 12 of the Health Occupations Article.</text> </level> <level label="6"> <text>“Licensed physician” means an individual who is licensed to practice medicine under Title 14 of the Health Occupations Article.</text> </level> <level label="7"> <text>“Patient” means:</text> <level label="i"> <text>A patient who is a member of a group model health maintenance organization; or</text> </level> <level label="ii"> <text>An individual to whom the group model health maintenance organization is contractually or legally obligated to provide, or arrange to provide, health care services.</text> </level> </level> <level label="8"> <text>“Physician–pharmacist agreement” means an agreement between a licensed physician and a licensed pharmacist that is disease–state specific and specifies the protocols that may be used.</text> </level> <level label="9"> <text>“Protocol” means a course of treatment predetermined by the licensed physician and licensed pharmacist according to generally accepted medical practice for the proper completion of a particular therapeutic or diagnostic intervention.</text> </level> </level> <level label="b"> <level label="1"> <text>In a group model health maintenance organization, a licensed physician and a licensed pharmacist who wish to provide drug therapy management to patients shall have a physician–pharmacist agreement.</text> </level> <level label="2"> <text>Drug therapy management shall be provided under this section only:</text> <level label="i"> <text>In accordance with a physician–pharmacist agreement; and</text> </level> <level label="ii"> <text>Through the internal pharmacy operations of the group model health maintenance organization.</text> </level> </level> <level label="3"> <text>A licensed physician who has entered into a physician–pharmacist agreement shall submit to the State Board of Physicians a copy of the physician–pharmacist agreement and any subsequent modifications made to the physician–pharmacist agreement or the protocols specified in the physician–pharmacist agreement.</text> </level> <level label="4"> <text>A licensed pharmacist who has entered into a physician–pharmacist agreement shall submit to the State Board of Pharmacy a copy of the physician–pharmacist agreement and any subsequent modifications made to the physician–pharmacist agreement or the protocols specified in the physician–pharmacist agreement.</text> </level> </level> <level label="c"> <text>A licensed pharmacist is authorized to enter into a physician–pharmacist agreement if the licensed pharmacist:</text> <level label="1"> <text>Has a Doctor of Pharmacy degree or equivalent training as established in regulations adopted by the State Board of Pharmacy;</text> </level> <level label="2"> <text>Is approved by the State Board of Pharmacy to enter into a physician–pharmacist agreement with a licensed physician; and</text> </level> <level label="3"> <text>Meets any other requirements established by regulation by the State Board of Pharmacy.</text> </level> </level> <level label="d"> <text>A physician–pharmacist agreement shall prohibit the substitution of a chemically dissimilar drug product by the pharmacist for the product prescribed by the physician, unless permitted in the protocol specified in the physician–pharmacist agreement.</text> </level> <level label="e"> <text>A patient may decline to participate or withdraw from participating in drug therapy management in a group model health maintenance organization at any time.</text> </level> <level label="f"> <text>A licensed physician or licensed pharmacist or both shall inform a patient:</text> <level label="1"> <text>Regarding the procedures that will be utilized for drug therapy management under the associated protocols;</text> </level> <level label="2"> <text>That the patient may decline to participate or withdraw from participating in the drug therapy management at any time; and</text> </level> <level label="3"> <text>That neither the physician nor the pharmacist has been coerced, given economic incentives, excluding normal reimbursement for services rendered, or involuntarily required to participate.</text> </level> </level> <level label="g"> <text>A licensed physician or a licensed pharmacist or both shall obtain documented informed consent from a patient after disclosing the information required to be disclosed under subsection (f) of this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-714" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <text>Each marketing document that sets forth the health care services of a health maintenance organization shall describe fully and clearly:</text> <level label="1"> <text>The health care services under each benefit package and every other benefit to which a member is entitled;</text> </level> <level label="2"> <text>Where and how services may be obtained;</text> </level> <level label="3"> <text>Each exclusion or limitation on any service or other benefit that it provides;</text> </level> <level label="4"> <text>Each deductible feature;</text> </level> <level label="5"> <text>Each copayment provision; and</text> </level> <level label="6"> <text>All information required by § 15-1206 of the Insurance Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-715" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <text>Each health maintenance organization application or offer of enrollment shall contain or be accompanied by, and each form of health maintenance organization subscriber contract shall contain, a full and clear statement of:</text> <level label="1"> <text>The items specified in § 19-714 of this subtitle;</text> </level> <level label="2"> <text>The rate of periodic payment;</text> </level> <level label="3"> <text>When the coverage is effective and what restrictions, if any, apply to preexisting conditions;</text> </level> <level label="4"> <text>All standards for cancellation of enrollment or denial of reenrollment; and</text> </level> <level label="5"> <text>Service priorities, if any, in epidemic or other emergency or catastrophic conditions that may cause an unusually high demand for medical services.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-716" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <text>Annually, each health maintenance organization shall provide to its members and make available to the general public, in clear, readable, and concise form:</text> <level label="1"> <text>A summary of the most recent financial report that the health maintenance organization submits to the Commissioner under § 19-717 of this subtitle;</text> </level> <level label="2"> <text>A description of the benefit packages available and the nongroup rates required by the Commissioner;</text> </level> <level label="3"> <text>A description of the accessibility and availability of services, including where and how to obtain them;</text> </level> <level label="4"> <text>A statement of the potential responsibility of a member for payment for services the member seeks to obtain from a provider, including a physician or hospital, that does not have a written contract with the health maintenance organization;</text> </level> <level label="5"> <text>A description of procedures to be followed for emergency services, including:</text> <level label="i"> <text>The appropriate use of hospital emergency facilities;</text> </level> <level label="ii"> <text>The appropriate use, location, and hours of operation of any urgent care facilities operated by the health maintenance organization; and</text> </level> <level label="iii"> <text>The potential responsibility of subscribers and enrollees for payment for emergency services or nonemergency services rendered in a hospital emergency facility;</text> </level> </level> <level label="6"> <text>A statement that shows, by category, the percentage of members assisted by public funds;</text> </level> <level label="7"> <text>The information required to be disclosed by § 15-1206 of the Insurance Article; and</text> </level> <level label="8"> <text>Any other information that the Commissioner or the Department requires by rule or regulation.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-717" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>Except as provided in subsections (b) and (c) of this section and unless, for good cause shown, the Commissioner extends the time for a reasonable period:</text> <level label="1"> <text>On or before March 1 of each year, each health maintenance organization shall file with the Commissioner a report that shows the financial condition of the health maintenance organization on the last day of the preceding calendar year and any other information that the Commissioner requires by rule or regulation; and</text> </level> <level label="2"> <text>On or before June 1 of each year, each health maintenance organization shall file with the Commissioner an audited financial report for the preceding calendar year.</text> </level> </level> <level label="b"> <text>A health maintenance organization that has a fiscal year other than the calendar year may request permission to file both the annual report required under subsection (a)(1) of this section and the audited financial report required under subsection (a)(2) of this section at the end of its fiscal year rather than the preceding calendar year. If the Commissioner grants this permission, the health maintenance organization shall file the annual report with the Commissioner within 60 days after the end of its fiscal year, and the health maintenance organization shall file the audited financial report with the Commissioner within 150 days after the end of its fiscal year.</text> </level> <level label="c"> <text>With 90 days’ advance notice, the Commissioner may require a health maintenance organization to file an audited financial report earlier than the date specified in subsection (a) of this section.</text> </level> <level label="d"> <text>The annual report shall:</text> <level label="1"> <text>Be on the forms that the Commissioner requires; and</text> </level> <level label="2"> <text>Include a description of any changes in the information submitted under § 19–708 of this subtitle.</text> </level> </level> <level label="e"> <text>The audited financial report shall:</text> <level label="1"> <text>Be on the forms that the Commissioner requires; and</text> </level> <level label="2"> <text>Be certified by an audit of a certified public accounting firm.</text> </level> </level> <level label="f"> <text>Each financial report filed under this section is a public record.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-719" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <text>Under rules, regulations, and procedures that the Secretary approves and using methods that keep the identity of patients as confidential as possible, assure objective evaluation, and are consistent with § 19-710 of this subtitle, the Department may do periodic examinations to:</text> <level label="1"> <text>Determine the quality of health care services being provided by health maintenance organizations; and</text> </level> <level label="2"> <text>Develop statistical information.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-720" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>The State Health Services Cost Review Commission promptly shall give the Commissioner and the Secretary any financial information that the Commission acquires about each facility that is:</text> <level label="1"> <text>Under the jurisdiction of the Commission; and</text> </level> <level label="2"> <text>Subject to this subtitle.</text> </level> </level> <level label="b"> <text>If requested by the Commissioner or the Secretary, the State Health Services Cost Review Commission shall provide any other information that the Commission is authorized to acquire about health maintenance organizations regulated under this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-721" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>Unless previously suspended or revoked, each original and renewal certificate of authority issued under this subtitle to a health maintenance organization expires at midnight on the November 30 after its effective date.</text> </level> <level label="b"> <text>On payment of an annual renewal fee of $25 by the health maintenance organization before the expiration date of its certificate of authority, its certificate remains in effect until a new certificate of authority is issued or specifically refused.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-722" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>The Commissioner may refuse to renew a certificate of authority for any reason for which the Commissioner may:</text> <level label="1"> <text>Refuse to issue an original certificate; or</text> </level> <level label="2"> <text>Suspend or revoke an existing certificate.</text> </level> </level> <level label="b"> <text>If the Commissioner refuses to renew a certificate of authority, the applicant has the same administrative and legal remedies as those provided under this subtitle for the suspension or revocation of a certificate of authority.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-723" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>At all times, each health maintenance organization is subject to the supervision of the Commissioner and the Department as provided in this subtitle.</text> </level> <level label="b"> <text>Any health maintenance organization that contracts with the Department and is subject to this subtitle shall act in concert with the Department or with the written consent of the Department concerning all information that the Commissioner requires.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-724" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>Except as provided in subsection (b) of this section, a health maintenance organization may solicit members through advertising its services, charges, or nonprofessional aspects of its operation.</text> </level> <level label="b"> <text>A health maintenance organization may not use any advertising that makes any qualitative judgment about any person who provides services for a health maintenance organization.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-725" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>A health maintenance organization may not cancel the enrollment of a member or refuse to transfer a member from a group to an individual basis because of age, sex, sexual orientation, gender identity, religious beliefs, disability, race, or health status.</text> </level> <level label="b"> <text>A health maintenance organization may cancel a contract with a member who violates any published policy of the health maintenance organization that has been approved by the Commissioner and the Department under their joint internal procedures.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-726" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <level label="1"> <text>A health maintenance organization may not include in its name:</text> <level label="i"> <text>The words “insurer”, “casualty”, “surety”, or “health and accident”; or</text> </level> <level label="ii"> <text>Any other words generally regarded as descriptive of the insurance industry.</text> </level> </level> <level label="2"> <text>This subsection does not apply to an insurer or health service corporation that is licensed and regulated under the laws of this State, except as to its health maintenance organization activities that are authorized and regulated under this subtitle.</text> </level> </level> <level label="b"> <text>Except as authorized by the Commissioner under this subtitle, a person other than a health maintenance organization regulated under this subtitle may not designate its services, operations, or functions as a “health maintenance organization” or use any other title or designation if the arrangement of services, operations, or functions substantially fall under the definition of a health maintenance organization in § 19-701 of this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-727" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>Except as provided in subsection (b) of this section, a health maintenance organization is not exempted from any State, county, or local taxes solely because of this subtitle.</text> </level> <level label="b"> <level label="1"> <text>A nonprofit health maintenance organization that is exempt from taxation under § 501(c)(3) of the Internal Revenue Code is not subject to the insurance premium tax under Title 6, Subtitle 1 of the Insurance Article.</text> </level> <level label="2"> <text>Premiums received by an insurer under policies that provide health maintenance organization benefits are not subject to the premium tax imposed under Title 6, Subtitle 1 of the Insurance Article to the extent:</text> <level label="i"> <text>Of the amounts actually paid by the insurer to a nonprofit health maintenance organization that operates only as a health maintenance organization; or</text> </level> <level label="ii"> <text>The premiums have been paid by that nonprofit health maintenance organization.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-728" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>The Commissioner is responsible for:</text> <level label="1"> <text>Determining whether each health maintenance organization is or will be able to provide a fiscally sound operation and adequate provision against risk of insolvency and may adopt reasonable rules and regulations designed to achieve this goal; and</text> </level> <level label="2"> <text>Actuarial and financial evaluations and determinations of each health maintenance organization.</text> </level> </level> <level label="b"> <level label="1"> <text>If the Commissioner determines that a health maintenance organization is not operating in a fiscally sound manner, the Commissioner shall notify the Department of the determination.</text> </level> <level label="2"> <text>After notifying the Department in accordance with the provisions of paragraph (1) of this subsection, the Commissioner shall monitor the health maintenance organization on a continuous basis until the Commissioner determines that the health maintenance organization is operating in a fiscally sound manner.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-729" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>A health maintenance organization may not:</text> <level label="1"> <text>Violate any provision of this subtitle or any rule or regulation adopted under it;</text> </level> <level label="2"> <text>Fail to fulfill its obligations to provide the health care services specified in its contracts with subscribers;</text> </level> <level label="3"> <text>Make any false statement with respect to any report or statement required by this subtitle or by the Commissioner under this subtitle;</text> </level> <level label="4"> <text>Advertise, merchandise, or attempt to merchandise its services in a way that misrepresents its services or capacity for service;</text> </level> <level label="5"> <text>Engage in a deceptive, misleading, unfair, or unauthorized practice as to advertising or merchandising;</text> </level> <level label="6"> <text>Prevent or attempt to prevent the Commissioner or the Department from performing any duty imposed by this subtitle;</text> </level> <level label="7"> <text>Fraudulently obtain or fraudulently attempt to obtain any benefit under this subtitle;</text> </level> <level label="8"> <text>Fail to fulfill the basic requirements to operate as a health maintenance organization as provided in § 19–710 of this subtitle;</text> </level> <level label="9"> <text>Violate any applicable provision of Title 15, Subtitle 12 of the Insurance Article;</text> </level> <level label="10"> <text>Fail to provide services to a member in a timely manner as provided in § 19–705.1(b)(1) of this subtitle;</text> </level> <level label="11"> <text>Fail to comply with the provisions of Title 15, Subtitle 10A, 10B, 10C, or 10D or § 2–112.2 of the Insurance Article;</text> </level> <level label="12"> <text>Violate any provision of § 19–712.5 of this subtitle; or</text> </level> <level label="13"> <text>Violate any provision of Title 33 of the Insurance Article.</text> </level> </level> <level label="b"> <text>If any health maintenance organization violates this section, the Commissioner may pursue any one or more of the courses of action described in § 19-730 of this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-730" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>If any person violates any provision of § 19-729 of this subtitle, the Commissioner may:</text> <level label="1"> <text>Issue an administrative order that requires the health maintenance organization to:</text> <level label="i"> <text>Cease inappropriate conduct or practices by it or any of the personnel employed or associated with it;</text> </level> <level label="ii"> <text>Fulfill its contractual obligations;</text> </level> <level label="iii"> <text>Provide a service that has been denied improperly;</text> </level> <level label="iv"> <text>Take appropriate steps to restore its ability to provide a service that is provided under a contract;</text> </level> <level label="v"> <text>Cease the enrollment of any additional enrollees except newborn children or other newly acquired dependents of existing enrollees; or</text> </level> <level label="vi"> <text>Cease any advertising or solicitation;</text> </level> </level> <level label="2"> <text>In addition to suspending or revoking a certificate of authority:</text> <level label="i"> <text>Impose a penalty of not less than $100, but not more than $125,000 for each violation; and</text> </level> <level label="ii"> <text>Order the health maintenance organization to pay restitution to any person who has suffered financial injury because of the violation;</text> </level> </level> <level label="3"> <text>Suspend, revoke, or refuse to renew the certificate of authority to do business as a health maintenance organization;</text> </level> <level label="4"> <text>Suspend, revoke, or refuse to renew the certificate of a medical director of a health maintenance organization; or</text> </level> <level label="5"> <text>Apply to any court for legal or equitable relief considered appropriate by the Commissioner or the Department, in accordance with the joint internal procedures.</text> </level> </level> <level label="b"> <text>If the Commissioner issues an order or imposes any penalty under this section, the Commissioner immediately shall provide written notice of the order or penalty to the Secretary.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-731" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>If a person violates any provision of §§ 19-705 and 19-705.1 of this subtitle, the Secretary may:</text> <level label="1"> <text>Issue an administrative order that requires the health maintenance organization to:</text> <level label="i"> <text>Cease inappropriate conduct or practices by it or any of the personnel employed by or associated with it and comply with the standards established by the Department; or</text> </level> <level label="ii"> <text>Provide any service required by §§ 19-705 and 19-705.1 of this subtitle that has been denied improperly;</text> </level> </level> <level label="2"> <text>Impose a penalty of not less than $100 and not more than $125,000 for each violation; or</text> </level> <level label="3"> <text>Apply to any court for legal or equitable relief considered appropriate by the Secretary.</text> </level> </level> <level label="b"> <text>If the Secretary issues an order or imposes any penalty under this section, the Secretary immediately shall provide written notice of the order or penalty to the Commissioner.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-732" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>Except as otherwise provided in Title 15, Subtitle 10A of the Insurance Article, a party aggrieved by a final action of the Commissioner under this subtitle has the right to a hearing and the right to appeal from the action of the Commissioner under §§ 2–210 through 2–215 of the Insurance Article.</text> </level> <level label="b"> <text>A party aggrieved by an order of the Secretary under this subtitle may petition for judicial review as provided by the Administrative Procedure Act.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-734" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <text>This subtitle may be cited as the “Maryland Health Maintenance Organization Act”.</text> </section> <section article="ghg" article_name="Health - General" number="19-735" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations"> <level label="a"> <text>Any foreign health maintenance organization with a certificate of authority to operate a health maintenance organization in this State may become a domestic health maintenance organization of this State by complying with all of the requirements of the law relating to the formation and organization of a domestic health maintenance organization and by designating its principal place of business at a place in this State. On becoming a domestic health maintenance organization, the health maintenance organization shall be entitled to certificates and licenses to transact business in this State issued to domestic health maintenance organizations, and shall be given recognition in all respects as a health maintenance organization formed under the laws of this State as of the date of authorization as a health maintenance organization in its original domiciliary state, district, territory, commonwealth, or possession of the United States of America, and shall be subject to the authority and jurisdiction of this State.</text> </level> <level label="b"> <level label="1"> <text>The certificate of authority, insurance producers’ appointments, rates, and other forms which the Commissioner allows which are in existence at the time any foreign health maintenance organization with a certificate of authority to operate a health maintenance organization in this State transfers its corporate domicile to this State or to any other state by merger, consolidation, or any other lawful method shall continue in full force and effect on transfer if the health maintenance organization at all times retains a certificate of authority in this State.</text> </level> <level label="2"> <text>All outstanding subscriber contracts of a transferring health maintenance organization shall remain in full force and effect and need not be endorsed as to the new name of the health maintenance organization or its new domiciliary and location unless so ordered by the Commissioner.</text> </level> <level label="3"> <text>A transferring health maintenance organization may file new contract forms with the Commissioner on or before the effective date of the transfer, or may use any existing contract form previously filed with the Commissioner with appropriate endorsements if allowed by and under such conditions as approved by the Commissioner.</text> </level> <level label="4"> <text>A foreign health maintenance organization transferring its domicile to another state shall notify the Commissioner of the details of the proposed transfer, and shall file promptly any resulting amendments to corporate documents and other items on file with the Commissioner.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-7A-01" title_number="19" title_name="Health Care Facilities" subtitle_number="7A" subtitle_name="Provider-Sponsored Organizations"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Commissioner” means the Maryland Insurance Commissioner.</text> </level> <level label="c"> <text>“Health care services” means a health or medical care procedure or service rendered by a health care provider that:</text> <level label="1"> <text>Provides testing, diagnosis, or treatment of a human disease or dysfunction; or</text> </level> <level label="2"> <text>Dispenses drugs, medical devices, medical appliances, or medical goods for the treatment of a human disease or dysfunction.</text> </level> </level> <level label="d"> <text>“License” includes a certificate of authority, as defined in § 1-101 of the Insurance Article.</text> </level> <level label="e"> <text>“Provider” means any person, including a physician or hospital, that is licensed or otherwise authorized in this State to provide health care services.</text> </level> <level label="f"> <text>“Provider-sponsored organization” means an entity that:</text> <level label="1"> <text>Is a legal aggregation of providers operating collectively for the purpose of providing health care services to Medicare beneficiaries under the federal Medicare+Choice Program;</text> </level> <level label="2"> <text>Acts through a licensed entity, such as a partnership, corporation, limited liability company, limited liability partnership, or sole proprietorship, that has authority over the entity’s activities and responsibility for satisfying the requirements of § 19-7A-02 of this subtitle; and</text> </level> <level label="3"> <text>Provides a substantial proportion of the health care services required to be provided under the federal Medicare+Choice Program directly through providers or affiliated groups of providers.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-7A-02" title_number="19" title_name="Health Care Facilities" subtitle_number="7A" subtitle_name="Provider-Sponsored Organizations"> <level label="a"> <text>A license issued to a provider-sponsored organization under this subtitle authorizes the licensee to provide health care services only to Medicare beneficiaries under the federal Medicare+Choice Program.</text> </level> <level label="b"> <text>Nothing in this subtitle may be construed to limit a provider-sponsored organization from participating in the Medicaid program as a managed care organization.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-7A-03" title_number="19" title_name="Health Care Facilities" subtitle_number="7A" subtitle_name="Provider-Sponsored Organizations"> <level label="a"> <level label="1"> <text>Before an entity may operate as a provider-sponsored organization under the federal Medicare+Choice Program, the entity must obtain a license from the Commissioner.</text> </level> <level label="2"> <text>The Commissioner shall issue a license under paragraph (1) of this subsection to any entity to operate as a provider-sponsored organization that meets the requirements of subsection (b) of this section.</text> </level> </level> <level label="b"> <text>To operate as a provider-sponsored organization under the federal Medicare+Choice Program in this State, an entity shall:</text> <level label="1"> <text>Meet the definition of a provider-sponsored organization under § 19-7A-01 of this subtitle; and</text> </level> <level label="2"> <text>Meet the requirements applicable to a health maintenance organization under Subtitle 7 of this title to the extent those requirements are not preempted by federal law.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-7A-04" title_number="19" title_name="Health Care Facilities" subtitle_number="7A" subtitle_name="Provider-Sponsored Organizations"> <level label="a"> <text>The Commissioner shall adopt regulations to implement the provisions of this subtitle.</text> </level> <level label="b"> <text>Except as provided in subsection (c) of this section, regulations relating to the solvency of a provider-sponsored organization adopted under subsection (a) of this section shall impose solvency requirements the same as required under federal law.</text> </level> <level label="c"> <text>Upon the expiration, repeal, or termination of solvency requirements under federal law for provider-sponsored organizations, the requirements of § 19-710(d) of this title shall apply.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-801" title_number="19" title_name="Health Care Facilities" subtitle_number="8" subtitle_name="Problem Gamblers"> <text>In this subtitle, “problem gambler” means an individual:</text> <level label="1"> <text>Who is preoccupied chronically and progressively with gambling and the urge to gamble; and</text> </level> <level label="2"> <text>Whose gambling behavior compromises, disrupts, or damages the individual’s personal, family, or vocational pursuits.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-802" title_number="19" title_name="Health Care Facilities" subtitle_number="8" subtitle_name="Problem Gamblers"> <text>The General Assembly finds that:</text> <level label="1"> <text>Problem gambling is a serious social problem;</text> </level> <level label="2"> <text>There is evidence that the availability of gambling increases the risk of becoming a problem gambler; and</text> </level> <level label="3"> <text>This State, with its extensive legalized gambling, has an obligation to provide a program of treatment for problem gamblers.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-803" title_number="19" title_name="Health Care Facilities" subtitle_number="8" subtitle_name="Problem Gamblers"> <text>The Secretary shall establish a network of clinically appropriate services to problem gamblers throughout the State.</text> </section> <section article="ghg" article_name="Health - General" number="19-804" title_number="19" title_name="Health Care Facilities" subtitle_number="8" subtitle_name="Problem Gamblers"> <level label="a"> <level label="1"> <text>The Secretary shall make grants from or agreements for the use of State funds, including the funds provided under § 9–1A–33 of the State Government Article, and federal funds to help public agencies or nonprofit organizations operate the network of clinically appropriate services for problem gamblers who reside in the State to provide the following:</text> <level label="i"> <text>Inpatient and residential services;</text> </level> <level label="ii"> <text>Outpatient services;</text> </level> <level label="iii"> <text>Intensive outpatient services;</text> </level> <level label="iv"> <text>Continuing care services;</text> </level> <level label="v"> <text>Educational services;</text> </level> <level label="vi"> <text>Services for victims of domestic violence; and</text> </level> <level label="vii"> <text>Other preventive or rehabilitative services or treatment.</text> </level> </level> <level label="2"> <text>Research and training that are designed to improve or extend these services are proper items of expense.</text> </level> </level> <level label="b"> <text>The Secretary shall conduct a prevalence study and replication prevalence studies to measure the rate of problem and pathological gambling in the State.</text> </level> <level label="c"> <level label="1"> <text>Subject to paragraph (2) of this subsection, the Secretary shall contract with an independent researcher to conduct the prevalence studies.</text> </level> <level label="2"> <text>The Secretary shall utilize the most current psychiatric or diagnostic criteria for problem and pathological gambling as the basis for the prevalence studies.</text> </level> </level> <level label="d"> <text>The initial prevalence study shall be completed on or before July 1, 2009.</text> </level> <level label="e"> <text>Replication prevalence studies shall be conducted no less than every 5 years with measures taken to permit comparisons between the initial prevalence study and subsequent replication prevalence studies.</text> </level> <level label="f"> <text>Services under this subtitle shall be provided by public agencies or, under contract, by nonprofit organizations.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-901" title_number="19" title_name="Health Care Facilities" subtitle_number="9" subtitle_name="Hospice Care Facilities"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“General hospice care program” means a coordinated, interdisciplinary program of hospice care services for meeting the special physical, psychological, spiritual, and social needs of dying individuals and their families, by providing palliative and supportive medical, nursing, and other health services through home or inpatient care during the illness and bereavement:</text> <level label="1"> <text>To individuals who have no reasonable prospect of cure as estimated by a physician; and</text> </level> <level label="2"> <text>To the families of those individuals.</text> </level> </level> <level label="c"> <text>“General license” means a license issued by the Secretary to operate a general hospice care program.</text> </level> <level label="d"> <text>“Home–based hospice care program” means a program that directly or through a contractual arrangement provides a hospice care program in the residence of the patient.</text> </level> <level label="e"> <text>“Hospice facility” means a facility that:</text> <level label="1"> <text>Provides a hospice care program;</text> </level> <level label="2"> <text>Is separate from any other facility; and</text> </level> <level label="3"> <text>Admits at least 2 individuals who:</text> <level label="i"> <text>Are unrelated; and</text> </level> <level label="ii"> <text>Have no reasonable prospect of a cure.</text> </level> </level> </level> <level label="f"> <text>“Limited hospice care program” means a coordinated, interdisciplinary program of hospice care services for meeting the special physical, psychological, spiritual, and social needs of dying individuals and their families, by providing palliative and supportive nonskilled services through a home–based hospice care program during illness and bereavement:</text> <level label="1"> <text>To individuals who have no reasonable prospect of cure as estimated by a physician; and</text> </level> <level label="2"> <text>To the families of those individuals.</text> </level> </level> <level label="g"> <text>“Limited license” means a license issued by the Secretary to operate a limited hospice care program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-902" title_number="19" title_name="Health Care Facilities" subtitle_number="9" subtitle_name="Hospice Care Facilities"> <text>The purposes of this subtitle are:</text> <level label="1"> <text>To simplify and clarify the laws that govern the use of a hospice care program by individuals who want a supportive environment;</text> </level> <level label="2"> <text>To encourage the establishment of hospice care programs; and</text> </level> <level label="3"> <text>To ensure the quality of these hospice care programs.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-903" title_number="19" title_name="Health Care Facilities" subtitle_number="9" subtitle_name="Hospice Care Facilities"> <level label="a"> <level label="1"> <text>The Secretary shall adopt regulations to carry out the provisions of this subtitle.</text> </level> <level label="2"> <text>The regulations for general hospice care programs shall set standards for general hospice care programs that are comparable to the standards established by the National Hospice Organization.</text> </level> <level label="3"> <text>The Secretary, by regulation, after consultation with interested groups, including The Hospice Network of Maryland, Inc., shall establish standards for the operation of a hospice care program.</text> </level> </level> <level label="b"> <level label="1"> <text>The regulations shall set qualifications for medical directors of hospices. A medical director of a hospice care program need not be an employee or a contractee of a hospice care program.</text> </level> <level label="2"> <text>The regulations for a hospice facility shall require:</text> <level label="i"> <text>The medical director to be a physician licensed to practice medicine in this State;</text> </level> <level label="ii"> <text>The dietary, nursing, pastoral care, pharmaceutical, and social worker services to be adequate; and</text> </level> <level label="iii"> <text>A physician other than an attending physician to be on call and available at all times.</text> </level> </level> <level label="3"> <text>The regulations for a home-based hospice care program shall require:</text> <level label="i"> <text>The medical director to be a physician licensed to practice medicine in this State;</text> </level> <level label="ii"> <text>The provision of bereavement services;</text> </level> <level label="iii"> <text>The provision of services to meet the spiritual or social needs of dying individuals and their families;</text> </level> <level label="iv"> <text>The provision of palliative and supportive medical, nursing, and other health services:</text> <level label="1"> <text>Directly or by contract for a general licensee; or</text> </level> <level label="2"> <text>By referral only for a limited licensee;</text> </level> </level> <level label="v"> <text>Submission of an annual report which includes service utilization statistics in the format prescribed;</text> </level> <level label="vi"> <text>Written transfer agreements to provide acute inpatient care as needed; and</text> </level> <level label="vii"> <text>Minimum standards concerning the training and role of volunteers in a hospice care program.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-904" title_number="19" title_name="Health Care Facilities" subtitle_number="9" subtitle_name="Hospice Care Facilities"> <level label="a"> <text>A building that contains a hospice facility shall:</text> <level label="1"> <text>Be constructed soundly; and</text> </level> <level label="2"> <text>Meet the standards for construction and safety that the county or municipality imposes on a single-family residence.</text> </level> </level> <level label="b"> <text>A building that contains a hospice facility may not be required to comply with health and safety standards for an institution.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-905" title_number="19" title_name="Health Care Facilities" subtitle_number="9" subtitle_name="Hospice Care Facilities"> <level label="a"> <text>A person shall be licensed by the Secretary before a person may operate a hospice care program.</text> </level> <level label="b"> <text>A home health agency, hospital, related institution, or other licensed facility that operates a hospice care program that is distinct from the other services that the home health agency or facility offers shall be licensed by the Secretary as a hospice care program before the home health agency or facility may operate that hospice care program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-906" title_number="19" title_name="Health Care Facilities" subtitle_number="9" subtitle_name="Hospice Care Facilities"> <level label="a"> <text>To qualify for a license, an applicant and the hospice care program and its medical director shall meet the requirements of this section.</text> </level> <level label="b"> <text>An applicant who is an individual, and any individual who is applying on behalf of a corporation, association, or government agency shall be:</text> <level label="1"> <text>At least 18 years old; and</text> </level> <level label="2"> <text>Of reputable and responsible character.</text> </level> </level> <level label="c"> <level label="1"> <text>Except for a limited licensee, the applicant shall have a certificate of need, as required under Subtitle 1 of this title, for the hospice care program to be operated.</text> </level> <level label="2"> <text>The Secretary, in consultation with the Maryland Health Care Commission, shall specify those jurisdictions in which a general hospice is authorized to provide home-based hospice services.</text> </level> <level label="3"> <text>A general hospice may not be licensed to provide home-based hospice services in a jurisdiction unless the general hospice or an entity acquired by the general hospice provided home-based hospice services to a patient in the jurisdiction during the 12-month period ending December 31, 2001.</text> </level> <level label="4"> <text>Notwithstanding paragraph (3) of this subsection:</text> <level label="i"> <text>A general hospice may provide home-based hospice services to a specific patient outside of the jurisdictions in which the hospice is licensed if the Maryland Health Care Commission approves the service provision; and</text> </level> <level label="ii"> <text>A general hospice that is a hospital-based hospice or that had an affiliation agreement before April 5, 2003 with a health care facility or health care system may serve patients immediately upon discharge from the hospital, health care facility, or health care system, regardless of the jurisdiction in which the patient resides.</text> </level> </level> <level label="5"> <text>Upon the notification by the Maryland Health Care Commission of the issuance of a certificate of need to a general hospice, the Secretary shall append to the general hospice license any additional jurisdictions in which the general hospice may provide home-based hospice services.</text> </level> <level label="6"> <text>The hospice care program to be operated and its medical director shall meet the requirements that the Secretary adopts under this subtitle.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-907" title_number="19" title_name="Health Care Facilities" subtitle_number="9" subtitle_name="Hospice Care Facilities"> <level label="a"> <text>An applicant for a license shall submit an application to the Secretary.</text> </level> <level label="b"> <text>The application:</text> <level label="1"> <text>Shall be on the form that the Secretary requires;</text> </level> <level label="2"> <text>Shall be signed and verified by the individual; and</text> </level> <level label="3"> <text>Shall include:</text> <level label="i"> <text>The name of the applicant;</text> </level> <level label="ii"> <text>A statement that the applicant meets the requirements of this subtitle;</text> </level> <level label="iii"> <text>The location of the proposed hospice;</text> </level> <level label="iv"> <text>The name of the individual who is to be the medical director of the hospice care program; and</text> </level> <level label="v"> <text>Any other information that the Secretary requires.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-908" title_number="19" title_name="Health Care Facilities" subtitle_number="9" subtitle_name="Hospice Care Facilities"> <text>The Secretary shall issue a license to any applicant if the applicant and the hospice care program and its medical director meet the requirements of this subtitle.</text> </section> <section article="ghg" article_name="Health - General" number="19-909" title_number="19" title_name="Health Care Facilities" subtitle_number="9" subtitle_name="Hospice Care Facilities"> <level label="a"> <text>While it is effective, a general license authorizes the general licensee to operate a general hospice care program.</text> </level> <level label="b"> <level label="1"> <text>While it is effective, a limited license authorizes the limited licensee to operate a limited hospice care program.</text> </level> <level label="2"> <text>A limited licensee may not provide any medical, nursing, or other health services directly or through a contractual arrangement.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-911" title_number="19" title_name="Health Care Facilities" subtitle_number="9" subtitle_name="Hospice Care Facilities"> <level label="a"> <text>The Secretary shall deny a license to any applicant or revoke a license if the applicant or licensee has been convicted of a felony that relates to Medicaid or to a nursing home.</text> </level> <level label="b"> <text>The Secretary may deny a license to an applicant or revoke a license if the applicant or licensee does not meet the requirements of this subtitle or any rule or regulation that the Secretary adopts under this subtitle.</text> </level> <level label="c"> <level label="1"> <text>In addition to the provisions of subsections (a) and (b) of this section, the Secretary may, for a violation of any provision of this subtitle or any regulation adopted under this subtitle, impose an administrative penalty of up to:</text> <level label="i"> <text>$500 for a first violation; and</text> </level> <level label="ii"> <text>$1,000 for a subsequent, repeated violation.</text> </level> </level> <level label="2"> <text>The Secretary shall adopt regulations to provide standards for the imposition of an administrative penalty under paragraph (1) of this subsection.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-912" title_number="19" title_name="Health Care Facilities" subtitle_number="9" subtitle_name="Hospice Care Facilities"> <text>A person may not operate a hospice care program unless licensed by the Secretary.</text> </section> <section article="ghg" article_name="Health - General" number="19-913" title_number="19" title_name="Health Care Facilities" subtitle_number="9" subtitle_name="Hospice Care Facilities"> <text>A hospice facility may not admit an individual unless a physician estimates that the individual has no reasonable prospect of cure.</text> </section> <section article="ghg" article_name="Health - General" number="19-914" title_number="19" title_name="Health Care Facilities" subtitle_number="9" subtitle_name="Hospice Care Facilities"> <level label="a"> <level label="1"> <text>This section applies to a general hospice care program only when providing hospice services in an in–home setting.</text> </level> <level label="2"> <text>This section does not apply to a general hospice care program when providing hospice services in a nursing home, assisted living facility, or a general hospice care program facility.</text> </level> </level> <level label="b"> <text>A general hospice care program shall establish a written policy that outlines the procedures for the collection and disposal of a patient’s unused prescription medication, including a procedure that requires a general hospice care employee, at the time that a patient is enrolled in the general hospice care program, to:</text> <level label="1"> <text>Discuss with the patient and the patient’s family member or personal representative the requirements under subsection (c) of this section; and</text> </level> <level label="2"> <text>Provide a written copy of the unused prescription medication collection and disposal policy to the patient and the patient’s family member or personal representative.</text> </level> </level> <level label="c"> <level label="1"> <text>In accordance with a general hospice care program’s policy and subject to paragraphs (2) and (3) of this subsection, a general hospice care program employee shall, as soon as practicable, collect and dispose of a patient’s unused prescription medication on:</text> <level label="i"> <text>The death of the patient; or</text> </level> <level label="ii"> <text>The termination of a prescription medication by the patient’s prescriber.</text> </level> </level> <level label="2"> <text>Before a general hospice care program employee collects or disposes of a patient’s unused prescription medication under paragraph (1) of this subsection, the employee shall provide to the patient or the patient’s family member or personal representative a written request for authorization to collect and dispose of the patient’s unused prescription medication in accordance with the patient’s care plan.</text> </level> <level label="3"> <text>A general hospice care program employee may not collect or dispose of a patient’s unused prescription medication unless the patient or the patient’s family member or representative provides written authorization to the general hospice care program.</text> </level> <level label="4"> <text>If a patient or the patient’s family member or personal representative refuses to authorize the collection or disposal of the patient’s unused prescription medication, the general hospice care program employee shall urge that the patient or the patient’s family member or personal representative dispose of any unused prescription medication in a safe and legal manner in accordance with federal Environmental Protection Agency and federal Drug Enforcement Administration guidelines for the safe disposal of prescription drugs.</text> </level> </level> <level label="d"> <text>If authorized, a general hospice care program employee shall, as soon as practicable, dispose of a patient’s unused prescription medication at the site where hospice care was provided:</text> <level label="1"> <text>In accordance with federal Environmental Protection Agency and federal Drug Enforcement Administration guidelines for the safe disposal of prescription drugs; and</text> </level> <level label="2"> <text>Under the witness of:</text> <level label="i"> <text>The patient or the patient’s family member or personal representative;</text> </level> <level label="ii"> <text>Another general hospice care program employee; or</text> </level> <level label="iii"> <text>If none of the individuals under items (i) or (ii) of this item are available, a local law enforcement officer.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>The collection and disposal of a patient’s unused prescription medication by the general hospice care program shall be documented in the patient’s medical record by the general hospice care program employee who conducted the collection and disposal.</text> </level> <level label="2"> <text>The medical record shall include the following information:</text> <level label="i"> <text>The name and quantity of each unused prescription medication;</text> </level> <level label="ii"> <text>The name of the individual who authorized the collection and disposal of the unused prescription medication and the individual’s relationship to the patient;</text> </level> <level label="iii"> <text>The date of disposal for each unused prescription medication;</text> </level> <level label="iv"> <text>The name of the individual who conducted the collection and disposal; and</text> </level> <level label="v"> <text>The name of the individual who witnessed the disposal of unused prescription medication by the employee as required under subsection (d)(2) of this section.</text> </level> </level> <level label="3"> <text>If a patient or the patient’s family member or personal representative refuses to authorize the collection and disposal of the patient’s unused prescription medication by the general hospice care program, the general hospice care program employee shall document in the patient’s medical record:</text> <level label="i"> <text>The refusal to authorize the collection and disposal of the patient’s unused prescription medication; and</text> </level> <level label="ii"> <text>The name and quantity of each unused prescription medication not surrendered.</text> </level> </level> </level> <level label="f"> <text>A general hospice care program may not be held liable in a civil or criminal action for any good faith act or omission taken in accordance with the requirements of this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1001" title_number="19" title_name="Health Care Facilities" subtitle_number="10"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Health care facility” means:</text> <level label="1"> <text>A hospital, as defined in § 19–301 of this title;</text> </level> <level label="2"> <text>A limited service hospital, as defined in § 19–301 of this title;</text> </level> <level label="3"> <text>A related institution, as defined in § 19–301 of this title;</text> </level> <level label="4"> <text>An ambulatory surgical facility; or</text> </level> <level label="5"> <text>A freestanding medical facility, as defined in § 19–3A–01 of this title.</text> </level> </level> <level label="c"> <text>“Smoke evacuation system” means equipment that effectively captures and filters surgical smoke at the site of origin before the surgical smoke makes contact with the eyes or respiratory tract of occupants in the room.</text> </level> <level label="d"> <text>“Surgical smoke” means the gaseous by–product produced by energy–generating devices, including surgical plume, smoke plume, bio–aerosols, laser–generated airborne contaminants, or lung–damaging dust.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1002" title_number="19" title_name="Health Care Facilities" subtitle_number="10"> <text>By January 1, 2028, each health care facility that performs surgical procedures shall adopt and implement policies that require the use of a smoke evacuation system during a surgical procedure that may generate surgical smoke.</text> </section> <section article="ghg" article_name="Health - General" number="19-1201" title_number="19" title_name="Health Care Facilities" subtitle_number="12" subtitle_name="Comprehensive Physical Rehabilitation Facilities"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Comprehensive physical rehabilitation services” means:</text> <level label="1"> <text>A program of coordinated, integrated, interdisciplinary, physician-directed services provided by or under the supervision of physicians qualified or experienced in rehabilitation that:</text> <level label="i"> <text>Includes evaluation and treatment of individuals with physical disabilities;</text> </level> <level label="ii"> <text>Emphasizes education and training of individuals with disabilities; and</text> </level> <level label="iii"> <text>Incorporates:</text> <level label="1"> <text>At least 4 of the following core disciplines:</text> </level> <level label="A"> <text>Physical therapy;</text> </level> <level label="B"> <text>Occupational therapy;</text> </level> <level label="C"> <text>Speech and language therapy;</text> </level> <level label="D"> <text>Psychotherapy;</text> </level> <level label="E"> <text>Rehabilitation nursing; and</text> </level> <level label="F"> <text>Social work; and</text> </level> <level label="2"> <text>At least 2 of the following disciplines:</text> </level> <level label="A"> <text>Psychology;</text> </level> <level label="B"> <text>Audiology;</text> </level> <level label="C"> <text>Respiratory therapy;</text> </level> <level label="D"> <text>Therapeutic recreation;</text> </level> <level label="E"> <text>Orthotics;</text> </level> <level label="F"> <text>Prosthetics;</text> </level> <level label="G"> <text>Special education or instruction; and</text> </level> <level label="H"> <text>Vocational rehabilitation; and</text> </level> </level> </level> <level label="2"> <text>Any other service that the Secretary may designate by regulation.</text> </level> </level> <level label="c"> <text>“Comprehensive rehabilitation facility” means:</text> <level label="1"> <text>Any person that provides or holds himself out as providing comprehensive physical rehabilitation services on an out-patient basis; or</text> </level> <level label="2"> <text>A hospital that is licensed as a special rehabilitation hospital under Subtitle 3 of this title.</text> </level> </level> <level label="d"> <level label="1"> <text>“Health care facility” includes any facility defined in § 19-114(d) of this title.</text> </level> <level label="2"> <text>“Health care facility” does not include a home health agency that is licensed under Subtitle 4 of this title.</text> </level> </level> <level label="e"> <text>“Specialized rehabilitation program” means any of the specialty programs that the Commission on Accreditation of Rehabilitation Facilities accredits, including:</text> <level label="1"> <text>Spinal cord injury programs;</text> </level> <level label="2"> <text>Head injury programs; and</text> </level> <level label="3"> <text>Infant and early childhood developmental programs.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1202" title_number="19" title_name="Health Care Facilities" subtitle_number="12" subtitle_name="Comprehensive Physical Rehabilitation Facilities"> <text>A comprehensive rehabilitation facility shall meet the requirements of this subtitle before the facility may provide:</text> <level label="1"> <text>Comprehensive physical rehabilitation services; or</text> </level> <level label="2"> <text>Any specialized rehabilitation program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1203" title_number="19" title_name="Health Care Facilities" subtitle_number="12" subtitle_name="Comprehensive Physical Rehabilitation Facilities"> <level label="a"> <text>This section does not apply to a special rehabilitation hospital that is licensed under Subtitle 3 of this title.</text> </level> <level label="b"> <text>Any person that provides or holds himself out as providing comprehensive physical rehabilitation services on an out–patient basis shall obtain a comprehensive rehabilitation license before the person may provide comprehensive physical rehabilitation services in the State.</text> </level> <level label="c"> <text>The Department shall issue a comprehensive rehabilitation license to any person for whom a comprehensive rehabilitation license is required if the person submits an application on the form established and provided for the Secretary.</text> </level> <level label="d"> <text>While it is effective, a comprehensive rehabilitation license authorizes the licensed person to provide comprehensive physical rehabilitation services.</text> </level> <level label="e"> <text>A person may not provide or hold himself out as providing comprehensive physical rehabilitation services on an out–patient basis unless the person has been issued a comprehensive rehabilitation license under this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1204" title_number="19" title_name="Health Care Facilities" subtitle_number="12" subtitle_name="Comprehensive Physical Rehabilitation Facilities"> <text>A comprehensive rehabilitation facility shall meet any standard that the Secretary adopts by regulation.</text> </section> <section article="ghg" article_name="Health - General" number="19-1205" title_number="19" title_name="Health Care Facilities" subtitle_number="12" subtitle_name="Comprehensive Physical Rehabilitation Facilities"> <text>The Secretary may inspect a comprehensive rehabilitation facility to assure that the facility meets the requirements of this subtitle.</text> </section> <section article="ghg" article_name="Health - General" number="19-1206" title_number="19" title_name="Health Care Facilities" subtitle_number="12" subtitle_name="Comprehensive Physical Rehabilitation Facilities"> <text>The Secretary may revoke a license issued under this subtitle or may revoke the authority to provide comprehensive physical rehabilitation services for any health care facility or person that does not meet each requirement of this subtitle or any regulation adopted by the Secretary under this subtitle.</text> </section> <section article="ghg" article_name="Health - General" number="19-1207" title_number="19" title_name="Health Care Facilities" subtitle_number="12" subtitle_name="Comprehensive Physical Rehabilitation Facilities"> <level label="a"> <text>A person may not hold himself out as providing a complete array of rehabilitation services unless the person provides comprehensive physical rehabilitation services.</text> </level> <level label="b"> <text>A health care facility may not provide or hold itself out as providing any specialized rehabilitation program unless the facility is licensed by the Department.</text> </level> <level label="c"> <text>A person may not provide comprehensive physical rehabilitation services unless the person meets the requirements of this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1208" title_number="19" title_name="Health Care Facilities" subtitle_number="12" subtitle_name="Comprehensive Physical Rehabilitation Facilities"> <text>A person who violates any provision of this subtitle is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $5,000, or imprisonment not exceeding 1 year, or both.</text> </section> <section article="ghg" article_name="Health - General" number="19-1401" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Actual harm deficiency” means a condition existing in a nursing home or an action or inaction by the nursing home staff that has caused physical or emotional injury or impairment to a resident.</text> </level> <level label="c"> <text>“Concurrent review” means daily rounds by a licensed nurse which include:</text> <level label="1"> <text>Appraisal and observation of each resident by the licensed nurse to determine any change in the resident’s physical or mental status; and</text> </level> <level label="2"> <text>If there is a change in the resident’s physical or mental status, an evaluation by the licensed nurse of:</text> <level label="i"> <text>The resident’s medications;</text> </level> <level label="ii"> <text>Laboratory values relating to the resident;</text> </level> <level label="iii"> <text>Clinical data relating to the resident, including the resident’s:</text> <level label="1"> <text>Hydration and nutritional need;</text> </level> <level label="2"> <text>Skin integrity;</text> </level> <level label="3"> <text>Noted weight changes; and</text> </level> <level label="4"> <text>Appetite;</text> </level> </level> <level label="iv"> <text>Injuries sustained by the resident that result from accident or incidents involving the resident; and</text> </level> <level label="v"> <text>Any other relevant parameters affecting or reflecting the resident’s physical and mental status.</text> </level> </level> </level> <level label="d"> <text>“Deficiency” means a condition existing in a nursing home or an action or inaction by the nursing home staff that results in potential for more than minimal harm, actual harm, or serious and immediate threat to one or more residents.</text> </level> <level label="e"> <level label="1"> <text>“Nursing home” means a facility that offers nonacute inpatient care to patients suffering from a disease, chronic illness, condition, disability of advanced age, or terminal disease requiring maximal nursing care without continuous hospital services and who require medical services and nursing services rendered by or under the supervision of a licensed nurse together with convalescent, restorative, or rehabilitative services.</text> </level> <level label="2"> <text>“Nursing home” does not mean a facility offering domiciliary care or personal care as those terms are defined in § 19–301 of this title.</text> </level> </level> <level label="f"> <text>“Ongoing pattern” means the occurrence of any potential for more than minimal harm or greater deficiency on two consecutive on-site visits as a result of annual surveys, follow-up visits, any unscheduled visits, or complaint investigations.</text> </level> <level label="g"> <text>“Potential for more than minimal harm deficiency” means a condition existing in a nursing home or an action or inaction by the nursing home staff that has the potential to cause actual harm to a resident.</text> </level> <level label="h"> <text>“Serious and immediate threat” means a situation in which immediate corrective action is necessary because a nursing home’s noncompliance with one or more State regulations has caused or is likely to cause serious injury, harm, impairment to, or death of a resident receiving care in the nursing home.</text> </level> <level label="i"> <text>“Sustained compliance” means a period of 30 days following the date of notice of corrective action with no deficiencies.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1401.1" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <level label="1"> <text>In addition to the requirements for licensure of a related institution as provided in this title, an applicant for licensure of a nursing home shall include in the application the identity of:</text> <level label="i"> <text>Any person with an ownership interest in the nursing home; and</text> </level> <level label="ii"> <text>Any management company, landlord, or other business entity that will operate or contract with the applicant to manage the nursing home.</text> </level> </level> <level label="2"> <level label="i"> <text>The person acquiring a nursing home shall provide the Department with written notice of the acquisition or change in operator at the same time as the notice required under § 19–120.2 of this title is filed with the Maryland Health Care Commission.</text> </level> <level label="ii"> <text>For other changes to the information required under paragraph (1) of this subsection, the nursing home shall notify the Department within 30 days after the effective date of the change.</text> </level> </level> </level> <level label="b"> <text>An applicant for licensure shall submit to the Secretary or the Secretary’s designee evidence:</text> <level label="1"> <text>That affirmatively demonstrates the ability of the applicant to comply with minimum standards of:</text> <level label="i"> <text>Medical care;</text> </level> <level label="ii"> <text>Nursing care;</text> </level> <level label="iii"> <text>Financial condition; and</text> </level> <level label="iv"> <text>Other applicable State or federal laws and regulations;</text> </level> </level> <level label="2"> <text>Regarding the regulatory compliance history and financial condition of any health care facility owned or operated by the applicant in other jurisdictions; and</text> </level> <level label="3"> <text>That a request for acquisition for the nursing home was approved in accordance with § 19–120.2 of this title.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1401.2" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>On review of the information required under § 19–1401.1 of this subtitle and any other information that is relevant to the ability of the applicant to operate a nursing home, the Secretary may:</text> <level label="1"> <text>Approve an application for a license;</text> </level> <level label="2"> <text>Deny an application for a license;</text> </level> <level label="3"> <text>Approve an application for a license subject to conditions; or</text> </level> <level label="4"> <text>Revoke a license.</text> </level> </level> <level label="b"> <text>Before taking action on a license under subsection (a) of this section, the Secretary shall consider any findings and decisions of the Maryland Health Care Commission provided to the Office of Health Care Quality under § 19–120.2 of this title.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1401.3" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>A licensee shall report to the Secretary or the Secretary’s designee any significant change in the financial condition of the nursing home, including cash flow or any other circumstances that could adversely affect the nursing home’s delivery of essential services to patients, including nursing services, dietary services, and utilities.</text> </level> <level label="b"> <text>Except as provided by subsection (c) of this section, any information obtained by the Secretary under this section is confidential and may not be disclosed without the consent of the licensee.</text> </level> <level label="c"> <text>The provisions of subsection (b) of this section do not apply to:</text> <level label="1"> <text>The holder of a license that has been suspended or revoked; or</text> </level> <level label="2"> <text>The use of information in:</text> <level label="i"> <text>An administrative proceeding initiated by the Department; or</text> </level> <level label="ii"> <text>A judicial proceeding.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1402" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>If a deficiency exists, the Secretary may impose sanctions that include:</text> <level label="1"> <text>A directed plan of correction with corrective measures necessary to protect residents;</text> </level> <level label="2"> <text>Imposing adequate staffing levels in a nursing home;</text> </level> <level label="3"> <text>Appointing a State monitor subject to § 19-1405 of this subtitle; and</text> </level> <level label="4"> <text>Imposing a civil money penalty.</text> </level> </level> <level label="b"> <text>A civil money penalty may be imposed when a deficiency exists or an ongoing pattern of deficiencies exists in a nursing home.</text> </level> <level label="c"> <text>In determining whether a civil money penalty is to be imposed, the Secretary shall consider, pursuant to guidelines set forth in regulations promulgated by the Secretary, the following factors:</text> <level label="1"> <text>The number, nature, and seriousness of the deficiencies;</text> </level> <level label="2"> <text>The extent to which the deficiency or deficiencies are part of an ongoing pattern during the preceding 24 months;</text> </level> <level label="3"> <text>The degree of risk to the health, life, or safety of the residents of the nursing home caused by the deficiency or deficiencies;</text> </level> <level label="4"> <text>The efforts made by, and the ability of, the nursing home to correct the deficiency or deficiencies; and</text> </level> <level label="5"> <text>A nursing home’s prior history of compliance.</text> </level> </level> <level label="d"> <text>Upon determination by the Department that a deficiency or deficiencies exist, the Department shall notify the nursing home that:</text> <level label="1"> <text>Unless corrective action taken pursuant to this section is substantially completed, a civil money penalty will be imposed; or</text> </level> <level label="2"> <text>An order imposing a civil money penalty will be issued, pursuant to § 19-1403 of this subtitle which shall include a list of all deficiencies and notice that a civil money penalty may be imposed until the time that the cited deficiencies have been rectified.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1403" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>If a civil money penalty is proposed, the Secretary shall issue an order which shall state the basis on which the order is made, the deficiency or deficiencies on which the order is based, the amount of civil money penalties to be imposed, and the manner in which the amount of civil money penalties imposed was calculated.</text> </level> <level label="b"> <text>An order issued pursuant to subsection (a) of this section shall be void unless issued within 60 days of the inspection or reinspection at which the deficiency is identified.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1404" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>A civil money penalty imposed under this section for potential for more than minimal harm deficiencies:</text> <level label="1"> <text>May not exceed $10,000 per instance; or</text> </level> <level label="2"> <text>May not exceed $1,000 per day for an ongoing pattern of deficiencies until the nursing home is in compliance.</text> </level> </level> <level label="b"> <text>A civil money penalty imposed under this subtitle for actual harm deficiencies:</text> <level label="1"> <text>May not exceed $10,000 per instance; or</text> </level> <level label="2"> <text>May not exceed $5,000 per day for an ongoing pattern of deficiencies until the nursing home is in compliance.</text> </level> </level> <level label="c"> <text>A civil money penalty imposed under this section for a serious and immediate threat:</text> <level label="1"> <text>May not exceed $10,000 per instance; or</text> </level> <level label="2"> <text>May not exceed $10,000 per day for an ongoing pattern of deficiencies until the nursing home is in compliance.</text> </level> </level> <level label="d"> <text>In setting the amount of a civil money penalty under this section, the Secretary shall consider, pursuant to guidelines set forth in regulations promulgated by the Secretary, the following factors:</text> <level label="1"> <text>The number, nature, and seriousness of the deficiencies;</text> </level> <level label="2"> <text>The degree of risk to the health, life, or safety of the residents of the nursing home caused by the deficiency or deficiencies;</text> </level> <level label="3"> <text>The efforts made by the nursing home to correct the deficiency or deficiencies;</text> </level> <level label="4"> <text>Current federal guidelines for money penalties;</text> </level> <level label="5"> <text>Whether the amount of the proposed civil money penalty will jeopardize the financial ability of the nursing home to continue operating as a nursing home; and</text> </level> <level label="6"> <text>Such other factors as justice may require.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1405" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>When the Department determines that there is a deficiency in a nursing home, the Department may appoint an independent monitor to oversee efforts made by the nursing home to achieve compliance with State and federal regulations governing nursing homes that participate in the Medicare and Medicaid programs.</text> </level> <level label="b"> <text>The appointment of a State monitor is an intermediate sanction that may be in addition to or in lieu of other sanctions.</text> </level> <level label="c"> <text>The State monitor’s duties may include:</text> <level label="1"> <text>Periodic inspections of a nursing home for the purpose of assessing the nursing home’s compliance with State and federal regulations; and</text> </level> <level label="2"> <text>Reporting to the Department and the nursing home its findings.</text> </level> </level> <level label="d"> <text>The State monitor may not be an employee of the Department.</text> </level> <level label="e"> <text>A nursing home shall be responsible for the costs associated with the appointment of a State monitor to the nursing home.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1406" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>Within 15 days of the request for an appeal by a nursing home, the nursing home shall deposit the amount of the civil money penalty in an interest bearing escrow account, the nursing home shall bear any cost associated with establishing the escrow account, and the account shall be titled in the name of the nursing home and the Maryland Department of Health as joint owners.</text> </level> <level label="b"> <text>When the Secretary issues the final decision of the Department:</text> <level label="1"> <text>If the decision upholds the imposition of the full civil money penalty, the escrow funds will be released to the Department within 15 days from the date of the decision;</text> </level> <level label="2"> <text>If the decision upholds the imposition of a civil penalty, but reduces the amount of the civil penalty, the amount due the Department will be released to the Department with accrued interest within 15 days of the date of the decision and the balance will be released to the nursing home within 15 days of the date of the decision; or</text> </level> <level label="3"> <text>If the decision reverses the imposition of the civil penalty, the escrow funds will be released to the nursing home within 15 days of the decision.</text> </level> </level> <level label="c"> <level label="1"> <text>A hearing on the appeal shall be held in accordance with the Administrative Procedure Act, under Title 10, Subtitle 2 of the State Government Article.</text> </level> <level label="2"> <text>The Secretary shall have the burden of proof with respect to the imposition of civil money penalties under § 19–1404 or § 19–1413.1 of this subtitle.</text> </level> <level label="3"> <text>A decision shall be rendered by the Office of Administrative Hearings within 10 working days of the hearing.</text> </level> </level> <level label="d"> <text>A nursing home is entitled to a 40% reduction in the amount of the civil money penalty if it waives its right to a hearing within 30 days of the Department’s order.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1407" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <level label="1"> <text>There is a Health Care Quality Account established in the Department.</text> </level> <level label="2"> <text>The Health Care Quality Account shall be funded by civil money penalties paid by nursing homes and other penalties that the Office of Health Care Quality may assess.</text> </level> <level label="3"> <text>The Department shall pay all penalties collected under this title to the Comptroller of the State.</text> </level> <level label="4"> <text>The Comptroller shall distribute the funds collected under this title to the Health Care Quality Account.</text> </level> <level label="5"> <text>The Health Care Quality Account is a continuing, nonlapsing fund, not subject to § 7–302 of the State Finance and Procurement Article.</text> </level> <level label="6"> <text>Any unspent portions of the Health Care Quality Account may not be transferred or reverted to the General Fund of the State, but shall remain in the Health Care Quality Account to be used for the purposes specified in this section.</text> </level> </level> <level label="b"> <text>The Health Care Quality Account shall be used for training, grant awards, demonstration projects, or other purposes designed to improve the quality of care.</text> </level> <level label="c"> <text>The Department shall adopt regulations for the distribution of funds from the Health Care Quality Account.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1408" future_version_removed="true" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <level label="1"> <text>Subject to subsection (c) of this section, the Department shall make a site visit and conduct a full survey of each licensed nursing home at least once per calendar year.</text> </level> <level label="2"> <text>Unless otherwise required by federal law, all surveys shall be unannounced.</text> </level> </level> <level label="b"> <level label="1"> <text>Subject to paragraphs (2) and (3) of this subsection, the Department shall initiate an investigation of a nursing home complaint alleging actual harm within 10 business days after receiving the complaint.</text> </level> <level label="2"> <text>If the Department receives a complaint against a nursing home alleging immediate jeopardy to a resident, the Department:</text> <level label="i"> <text>Shall make every effort to investigate the complaint within 24 hours after receiving the complaint; and</text> </level> <level label="ii"> <text>Shall investigate the complaint not later than 48 hours after receiving the complaint.</text> </level> </level> <level label="3"> <level label="i"> <text>If the Department initiates an investigation of a nursing home complaint under this subsection, the Department shall:</text> <level label="1"> <text>Notify the local health department for the county in which the nursing home is located within 24 hours after initiating the investigation; and</text> </level> <level label="2"> <text>To the extent practicable and as permitted by federal law, consult and coordinate with the local health department on the complaint investigation and response.</text> </level> </level> <level label="ii"> <text>This paragraph may not be construed to require a local health department to assist with or otherwise assume the nursing home oversight responsibilities of the Department as required by federal or State law.</text> </level> </level> </level> <level label="c"> <text>If ownership of a licensed nursing home is transferred to a person that does not own or operate another nursing home in the State at the time of the transfer, the Department shall conduct:</text> <level label="1"> <text>The first full survey of the licensed nursing home as required under subsection (a) of this section within 3 months after the date of transfer; and</text> </level> <level label="2"> <text>An unannounced, on–site follow–up survey of the licensed nursing home that covers any deficiencies noted in the full survey within 120 days after the full survey was completed.</text> </level> </level> <level label="d"> <level label="1"> <text>Beginning July 1, 2025, and every 3 months thereafter, the Department shall report to the Senate Finance Committee and the House Health Committee, in accordance with § 2–1257 of the State Government Article, the number of surveys conducted in each county, disaggregated by the following types of surveys:</text> <level label="i"> <text>Standard survey;</text> </level> <level label="ii"> <text>Complain survey;</text> </level> <level label="iii"> <text>Follow–up survey;</text> </level> <level label="iv"> <text>Revisit survey;</text> </level> <level label="v"> <text>Special focus facility survey;</text> </level> <level label="vi"> <text>Abbreviated survey; and</text> </level> <level label="vii"> <text>Life safety code survey.</text> </level> </level> <level label="2"> <text>Beginning July 1, 2025, and every 6 months thereafter, the Office of Health Care Quality shall report to the local area agency on aging for each county the name of each nursing home in the county that was surveyed in the immediately preceding 6 months and the date each survey was conducted.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1408.1" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>The Department shall develop a clear and easy–to–understand graphic data dashboard that includes:</text> <level label="1"> <text>The number of staff hired by the agency in each unit in the fiscal year to date;</text> </level> <level label="2"> <text>The number of surveyors employed by the agency in each unit in the fiscal year to date; and</text> </level> <level label="3"> <text>The number of vacancies within the agency in each unit in the fiscal year to date.</text> </level> </level> <level label="b"> <text>The Department shall:</text> <level label="1"> <text>Update the data dashboard developed under subsection (a) of this section at least every 2 weeks; and</text> </level> <level label="2"> <text>Post the most recent updated data dashboard prominently on its website.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1409" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>There is an Oversight Committee on Quality of Care in Nursing Homes and Assisted Living Facilities.</text> </level> <level label="b"> <text>The Oversight Committee shall consist of the following members:</text> <level label="1"> <text>One member of the Senate Finance Committee, appointed by the President of the Senate;</text> </level> <level label="2"> <text>One member of the House Health Committee, appointed by the Speaker of the House;</text> </level> <level label="3"> <text>The Secretary of Aging, or the Secretary’s designee;</text> </level> <level label="4"> <text>The Director of the Office of Health Care Quality, or the Director’s designee;</text> </level> <level label="5"> <text>The Deputy Secretary for Behavioral Health, or the Deputy Secretary’s designee;</text> </level> <level label="6"> <text>The Secretary of Human Services, or the Secretary’s designee;</text> </level> <level label="7"> <text>The Secretary of Disabilities, or the Secretary’s designee;</text> </level> <level label="8"> <text>The State Long–Term Care Ombudsman;</text> </level> <level label="9"> <text>Two representatives of area agencies on aging, one of which shall be a member of a local long–term care ombudsman program established under Title 10, Subtitle 9 of the Human Services Article, selected by the President of the Maryland Association of Area Agencies on Aging;</text> </level> <level label="10"> <text>One representative of a local long–term care ombudsman entity, selected by the State Long–Term Care Ombudsman;</text> </level> <level label="11"> <text>Three consumer members, selected by the State Long–Term Care Ombudsman, all of whom shall be consumers living in an assisted living facility or a nursing home or have a family member living in an assisted living facility or a nursing home;</text> </level> <level label="12"> <text>The following representatives, selected by the organizations the individual represents:</text> <level label="i"> <text>One representative from the Mid–Atlantic LifeSpan;</text> </level> <level label="ii"> <text>One representative of the Hospice Network of Maryland;</text> </level> <level label="iii"> <text>One representative of the Maryland Hospital Association;</text> </level> <level label="iv"> <text>One representative of 1199SEIU United Health Workers East;</text> </level> <level label="v"> <text>One representative of the Maryland Chapter of AARP;</text> </level> <level label="vi"> <text>One representative of United Seniors of Maryland;</text> </level> <level label="vii"> <text>One representative of the Mental Health Association of Maryland knowledgeable in issues of aging;</text> </level> <level label="viii"> <text>One representative of the Greater Maryland Chapter of the Alzheimer’s Association;</text> </level> <level label="ix"> <text>One representative of the Maryland Association for Medical Adult Day Services; and</text> </level> <level label="x"> <text>One representative of LeadingAge Maryland; and</text> </level> </level> <level label="13"> <text>Three representatives from the assisted living industry, of which, to the extent practicable, one shall represent a program that cares for one to four residents, one shall represent a program that cares for five to nine residents, and one shall represent a program that cares for more than 10 residents.</text> </level> </level> <level label="c"> <text>The Secretary of Aging, or the Secretary’s designee, shall chair the Oversight Committee.</text> </level> <level label="d"> <text>The Oversight Committee shall evaluate the progress in improving nursing home care quality and assisted living facility quality statewide, which may include consideration of:</text> <level label="1"> <text>Quality of care standards for nursing homes and assisted living facilities;</text> </level> <level label="2"> <text>Standards for the identification of the onset of dementia and Alzheimer’s disease;</text> </level> <level label="3"> <text>Standards for the identification of conditions appropriate for hospice services;</text> </level> <level label="4"> <text>Staffing patterns and staffing standards;</text> </level> <level label="5"> <text>Policies and procedures for inspecting nursing homes and assisted living facilities, and responding to quality of care complaints;</text> </level> <level label="6"> <text>A comparison of Maryland standards, policies, and procedures to those in other states;</text> </level> <level label="7"> <text>The labor pool available to fill nursing and nursing aide jobs;</text> </level> <level label="8"> <text>State funding mechanisms for nursing homes and assisted living facilities, including the Medicaid Nursing Home Reimbursement System, potential barriers to eligibility in the Maryland Medical Assistance Program, potential barriers to the timely payment of claims submitted to the Maryland Medical Assistance Program, and regulation of nursing homes;</text> </level> <level label="9"> <text>The provision and quality of dementia care and behavioral health supports and services to meet the needs of nursing home and assisted living facility residents;</text> </level> <level label="10"> <text>Staff training and development;</text> </level> <level label="11"> <text>The rights of residents;</text> </level> <level label="12"> <text>Data on resident satisfaction;</text> </level> <level label="13"> <text>Resident assessments;</text> </level> <level label="14"> <text>Resident care planning;</text> </level> <level label="15"> <text>The monitoring of residents; and</text> </level> <level label="16"> <text>The change of resident status.</text> </level> </level> <level label="e"> <text>The Office of Health Care Quality in the Maryland Department of Health shall submit a report to the Oversight Committee annually on the status of quality of care in nursing homes and assisted living facilities.</text> </level> <level label="f"> <text>The Deputy Secretary of Health Care Financing, or the Deputy Secretary’s designee, shall report annually to the Oversight Committee on the status of the Medicaid Nursing Home Reimbursement System, which shall include but not be limited to:</text> <level label="1"> <text>Elements of the existing methodology that are no longer relevant;</text> </level> <level label="2"> <text>Elements of the existing methodology that can be revised;</text> </level> <level label="3"> <text>The appropriateness of redesigning the system given changing demographics of the target population; and</text> </level> <level label="4"> <text>General Fund and federal fund savings from a system redesign that may be redirected to nursing home staff development in the nursing cost center.</text> </level> </level> <level label="g"> <text>The Oversight Committee shall review the reports of the Office of Health Care Quality and the Deputy Secretary of Health Care Financing and develop recommendations to continue improvement in nursing home and assisted living facility care.</text> </level> <level label="h"> <text>The Oversight Committee may:</text> <level label="1"> <text>Review legislation introduced in the General Assembly that may affect nursing home and assisted living facility care; and</text> </level> <level label="2"> <text>Make recommendations about the legislation to the General Assembly.</text> </level> </level> <level label="i"> <text>The Oversight Committee may:</text> <level label="1"> <text>Review proposed regulations that may affect nursing home and assisted living facility care; and</text> </level> <level label="2"> <text>Make recommendations about the regulations to the departments proposing the regulations and to the Joint Committee on Administrative, Executive, and Legislative Review.</text> </level> </level> <level label="j"> <text>The Oversight Committee shall report its findings and recommendations to the Governor and, subject to § 2–1257 of the State Government Article, to the General Assembly on or before December 1 of each year.</text> </level> <level label="k"> <text>The Department of Aging, with assistance from the Maryland Department of Health, the Department of Human Services, and the Department of Legislative Services, shall provide staff support for the Oversight Committee.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1410" future_version_removed="true" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>Each nursing home shall develop and implement a quality assurance program.</text> </level> <level label="b"> <level label="1"> <text>Each nursing home shall designate a qualified individual to coordinate and manage the nursing home’s quality assurance program.</text> </level> <level label="2"> <text>Each nursing home shall establish a quality assurance committee and shall include at least the following members:</text> <level label="i"> <text>The nursing home administrator;</text> </level> <level label="ii"> <text>The director of nursing;</text> </level> <level label="iii"> <text>The medical director;</text> </level> <level label="iv"> <text>A social worker;</text> </level> <level label="v"> <text>A licensed dietitian; and</text> </level> <level label="vi"> <text>A geriatric nursing assistant.</text> </level> </level> <level label="3"> <text>The quality assurance committee shall:</text> <level label="i"> <text>Meet at least monthly;</text> </level> <level label="ii"> <text>Maintain records of all quality assurance activities;</text> </level> <level label="iii"> <text>Keep records of committee meetings that shall be available to the Department during any on–site visit; and</text> </level> <level label="iv"> <text>Prepare monthly reports that shall be presented to the ombudsman, the resident’s council, and the family council.</text> </level> </level> <level label="4"> <text>The quality assurance committee for a nursing home shall review and approve annually the quality assurance plan for the nursing home.</text> </level> <level label="5"> <text>Each nursing home shall establish a written quality assurance plan that:</text> <level label="i"> <text>Includes procedures for concurrent review for all residents;</text> </level> <level label="ii"> <text>Provides criteria that routinely monitors nursing care including medication administration, prevention of decubitus ulcers, dehydration and malnutrition, nutritional status and weight loss or gain, accidents and injuries, unexpected deaths, changes in mental or psychological status, and any other data necessary to monitor quality of care;</text> </level> <level label="iii"> <text>Includes methods to identify and correct problems; and</text> </level> <level label="iv"> <text>Is readily available to nursing home residents and their families, guardians, or surrogate decision makers.</text> </level> </level> <level label="6"> <text>The quality assurance plan shall be submitted to the Department every 2 years.</text> </level> <level label="7"> <text>The nursing home administrator shall take appropriate remedial actions based on the recommendations of the nursing home’s quality assurance committee.</text> </level> <level label="8"> <text>The Secretary may not require the quality assurance committee to disclose the records and the reports prepared by the committee except as necessary to assure compliance with the requirements of this section.</text> </level> <level label="9"> <text>If the Department determines that a nursing home is not implementing its quality assurance program effectively and that quality assurance activities are inadequate, the Department may impose appropriate sanctions on the nursing home to improve quality assurance including mandated employment of specified quality assurance personnel.</text> </level> </level> <level label="c"> <level label="1"> <text>Each nursing home shall display on each floor of the nursing home a notice that explains the current ratio of licensed personnel to residents and unlicensed personnel to residents.</text> </level> <level label="2"> <text>The notice shall be:</text> <level label="i"> <text>Posted in a location that is visible and accessible to residents and their family or guardians and any potential consumers; and</text> </level> <level label="ii"> <text>On a form provided by the Department.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1410.1" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>On or before December 1, 2008, each nursing home shall establish a safe patient lifting workgroup with equal membership from management and employees.</text> </level> <level label="b"> <level label="1"> <text>On or before July 1, 2009, the safe patient lifting workgroup shall develop a safe patient lifting policy for the nursing home.</text> </level> <level label="2"> <text>The goal of the policy shall be to reduce employee injuries associated with patient lifting.</text> </level> </level> <level label="c"> <text>While developing a safe patient lifting policy, the workgroup shall consider, based on the patient population of that nursing home, the appropriateness and effectiveness of:</text> <level label="1"> <text>Developing or enhancing patient handling hazard assessment processes;</text> </level> <level label="2"> <text>Enhanced use of mechanical lifting devices;</text> </level> <level label="3"> <text>Developing specialized lift teams;</text> </level> <level label="4"> <text>Training programs for safe patient lifting required for all patient care personnel at the nursing home;</text> </level> <level label="5"> <text>Incorporating physical space and construction design for mechanical lifting devices in any architectural plans for nursing home construction and renovation; and</text> </level> <level label="6"> <text>Developing an evaluation process to determine the effectiveness of the policy.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1410.2" future_version_removed="true" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>In this section, “workplace safety” means the prevention of any physical assault or threatening behavior against an employee in a nursing home.</text> </level> <level label="b"> <text>This section applies to nursing homes that are licensed for 45 beds or more.</text> </level> <level label="c"> <text>Each nursing home shall assign to an appropriate committee the task of:</text> <level label="1"> <text>Conducting an annual assessment of workplace safety issues; and</text> </level> <level label="2"> <text>Making recommendations to the nursing home for reducing workplace injuries.</text> </level> </level> <level label="d"> <text>In conducting an annual assessment of workplace safety issues, the committee assigned to conduct the assessment under subsection (c)(1) of this section shall consult with geriatric nursing assistants and other employees of the nursing home who are involved in assisting residents with activities of daily living.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1410.3" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Catastrophic health emergency” means a health emergency with regard to which the Governor issues a proclamation under § 14–3A–02 of the Public Safety Article.</text> </level> <level label="3"> <text>“Compassionate care visitor” means a family member or legal guardian of a resident or any individual who is important to the mental, physical, or social well–being of the resident during critical situations including the end of the resident’s life, the significant mental or physical decline of the resident, or when exigent circumstances exist regarding the resident.</text> </level> <level label="4"> <text>“COVID–19” means, interchangeably and collectively, the coronavirus known as COVID–19 or 2019–nCoV and the SARS–CoV–2 virus.</text> </level> <level label="5"> <text>“Personal care visitor” means a family member or legal guardian of a resident who is important to the mental, physical, or social well–being of the resident.</text> </level> </level> <level label="b"> <level label="1"> <text>Consistent with federal requirements, the Department shall develop guidelines relating to the restrictions on visitation that a nursing home may impose to reduce the spread of COVID–19 or another disease that constitutes a catastrophic health emergency.</text> </level> <level label="2"> <text>The guidelines shall:</text> <level label="i"> <text>Describe the circumstances under which visitation may be restricted to only compassionate care visitors and personal care visitors;</text> </level> <level label="ii"> <text>Limit the movement of visitors within the nursing home, which may include restricting visitors to the resident’s room or another designated room;</text> </level> <level label="iii"> <text>Require each visitor to follow safety protocols to limit the spread of COVID–19 or another disease that constitutes a catastrophic health emergency, which may include:</text> <level label="1"> <text>Testing for COVID–19 or another disease that constitutes a catastrophic health emergency;</text> </level> <level label="2"> <text>Checking body temperature;</text> </level> <level label="3"> <text>Health screenings;</text> </level> <level label="4"> <text>The use of personal protective equipment;</text> </level> <level label="5"> <text>Social distancing; and</text> </level> <level label="6"> <text>Any other safety protocol that the Department considers appropriate to limit the spread of COVID–19 or another disease that constitutes a catastrophic health emergency in a nursing home;</text> </level> </level> <level label="iv"> <text>Require, as practicable and when available, alternative means of communication with visitors if a nursing home determines that an in–person visit would endanger the health and safety of a patient, resident, or member of the staff; and</text> </level> <level label="v"> <text>Provide additional guidance necessary to promote access to residents by compassionate care visitors.</text> </level> </level> <level label="3"> <text>In addition to the requirements in paragraph (2) of this subsection, the guidelines regarding personal care visitation shall:</text> <level label="i"> <text>Establish procedures for the designation of a personal care visitor by a resident or a legal representative of the resident that:</text> <level label="1"> <text>May include requiring a health care professional to determine whether a personal care visitor is necessary for the mental, physical, or social well–being of the resident; and</text> </level> <level label="2"> <text>If a determination is required, authorize the determination to be made by a health care professional who is not affiliated with the nursing home;</text> </level> </level> <level label="ii"> <text>Provide that a resident may designate not more than one personal care visitor;</text> </level> <level label="iii"> <text>Establish procedures for changing the designation of a resident’s personal care visitor;</text> </level> <level label="iv"> <text>Require a personal care visitor to waive a nursing home from liability for exposure to COVID–19 or another disease that constitutes a catastrophic health emergency;</text> </level> <level label="v"> <text>Establish the circumstances under which visitation by a personal care visitor may be limited, suspended, or terminated, including increased local infection rates and health care capacity;</text> </level> <level label="vi"> <text>Establish standards for the frequency and duration of personal care visits; and</text> </level> <level label="vii"> <text>Establish the total number of personal care visitors authorized to visit a nursing home facility at any one time.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1411" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <level label="1"> <text>Each nursing home shall designate a physician to serve as medical director.</text> </level> <level label="2"> <text>The medical director is responsible for monitoring physician services at the nursing home.</text> </level> <level label="3"> <text>The medical director shall report monthly to the quality assurance committee on the quality of medical care at the nursing home.</text> </level> </level> <level label="b"> <text>The Secretary, in consultation with the Medical and Chirurgical Faculty of Maryland, and representatives of the nursing home industry, shall:</text> <level label="1"> <text>Establish qualifications for the medical director of a nursing home or anyone acting for the medical director in his or her absence;</text> </level> <level label="2"> <text>Define the duties of the medical director; and</text> </level> <level label="3"> <text>Adopt regulations for the attending physicians who treat residents of nursing homes that will provide for physician accountability.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1412" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>The Secretary shall:</text> <level label="1"> <text>Establish a technical assistance unit within the Department to support compliance efforts and best practices; and</text> </level> <level label="2"> <text>Establish a list of approved medical automated systems.</text> </level> </level> <level label="b"> <text>The Secretary may:</text> <level label="1"> <text>Partially reimburse a nursing home for installation of automated systems that have been approved by the Department;</text> </level> <level label="2"> <text>Develop guidelines for reimbursement; and</text> </level> <level label="3"> <text>Adopt regulations for the implementation of this subtitle.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1413" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <text>Each nursing home shall:</text> <level label="1"> <text>Establish a procedure to provide for the smooth and orderly transfer of residents in the event of closure;</text> </level> <level label="2"> <text>Provide a 30-day notice to residents and their families or guardians prior to closure of the nursing home unless the Department waives the notice requirement;</text> </level> <level label="3"> <text>Provide a 15-day notice to residents and their families or guardians prior to termination of public funding unless the Department waives the notice requirement; and</text> </level> <level label="4"> <text>Immediately notify, if known, a resident’s family or guardian of:</text> <level label="i"> <text>An accident involving the resident which results in injury and has the potential for requiring physician intervention;</text> </level> <level label="ii"> <text>A significant change in the resident’s physical, mental, or psychosocial status; or</text> </level> <level label="iii"> <text>A need to alter the resident’s treatment significantly.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1413.1" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>A nursing home that violates § 19-1413(2) of this subtitle is subject to a civil money penalty not exceeding expenses incurred by the Office of Health Care Quality in ensuring a smooth and orderly transition of residents, including payroll expenses.</text> </level> <level label="b"> <text>If a civil money penalty is imposed on a nursing home under subsection (a) of this section, the nursing home is subject to § 19-1406 of this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1414" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <text>The Department may review financial and performance records of an applicant for a license or management firm under contract with an applicant for a license to determine ability of the applicant or management firm to comply with appropriate laws and regulations.</text> </section> <section article="ghg" article_name="Health - General" number="19-1415" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>In this section, “change in condition” means a significant change in the resident’s physical, mental, or psychological status including:</text> <level label="1"> <text>Life-threatening conditions such as heart attack or stroke;</text> </level> <level label="2"> <text>Clinical complications such as:</text> <level label="i"> <text>Development of a pressure sore;</text> </level> <level label="ii"> <text>Onset of recurrent periods of delirium;</text> </level> <level label="iii"> <text>Onset of recurrent urinary tract infection;</text> </level> <level label="iv"> <text>Onset of depression; or</text> </level> <level label="v"> <text>Onset of aggressive or inappropriate behavior;</text> </level> </level> <level label="3"> <text>The need to discontinue a medication or treatment because of:</text> <level label="i"> <text>Adverse consequences; or</text> </level> <level label="ii"> <text>The need to begin a new form of treatment;</text> </level> </level> <level label="4"> <text>Evaluation at or admission to a hospital; and</text> </level> <level label="5"> <text>Accidents that result in injury having the potential for requiring a physician’s intervention.</text> </level> </level> <level label="b"> <text>Consistent with State and federal confidentiality laws and in a timely manner, a nursing home shall notify a resident and, if applicable, the resident’s representative or interested family member of any:</text> <level label="1"> <text>Change in condition;</text> </level> <level label="2"> <text>Adverse event that may result in a change in condition;</text> </level> <level label="3"> <text>Outcome or care that results in an unanticipated consequence; or</text> </level> <level label="4"> <text>Corrective action, if appropriate.</text> </level> </level> <level label="c"> <text>If the Department determines that a nursing home failed to notify a resident, resident’s representative, or interested family member under subsection (b) of this section, the Department shall require as part of a plan of correction that the nursing home notify the resident, the resident’s representative, or interested family member as soon as possible.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1416" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>In this section, “family council” means a group of individuals who work together to protect the rights of and improve the quality of life of residents of a nursing home.</text> </level> <level label="b"> <level label="1"> <text>A family council for a nursing home may consist of the following members:</text> <level label="i"> <text>Members of a resident’s family; or</text> </level> <level label="ii"> <text>An individual appointed by the resident, or if the resident is incapable of appointing an individual, an individual appointed by the resident’s family.</text> </level> </level> <level label="2"> <level label="i"> <text>Subject to subparagraph (ii) of this paragraph, a family council may be created by the owner, operator, or staff of a nursing home.</text> </level> <level label="ii"> <text>Except as provided in paragraph (3) of this subsection, in order to facilitate the development of a family council, the owner, operator, or staff of a nursing home may lead the family council for no longer than 6 months at which time the family council shall be led by a member of the family council.</text> </level> </level> <level label="3"> <text>On the written request of a family council, the nursing home may assist the family council in the administrative functions of operating the family council in a mutually agreed upon manner.</text> </level> </level> <level label="c"> <text>A nursing home shall give each new or prospective resident the following written information about the family council:</text> <level label="1"> <text>The name, address, and phone number of a current member of the family council;</text> </level> <level label="2"> <text>A brief description of the purpose and function of the family council;</text> </level> <level label="3"> <text>Instructions on how the resident or prospective resident may review the public files described in subsection (e) of this section; and</text> </level> <level label="4"> <text>The name, address, and phone number of the State or local ombudsman.</text> </level> </level> <level label="d"> <text>A nursing home shall respond in writing to any written grievance or other written communication from the family council within 14 calendar days after receiving a communication.</text> </level> <level label="e"> <level label="1"> <text>A nursing home shall create and maintain a public correspondence file and a regulatory correspondence file for communications with a family council.</text> </level> <level label="2"> <text>The correspondence files shall include a copy of each written communication and response described in subsection (d) of this section.</text> </level> <level label="3"> <level label="i"> <text>The records in the regulatory file shall be unedited.</text> </level> <level label="ii"> <text>The records in the public file shall delete any information that identifies an individual resident.</text> </level> </level> <level label="4"> <text>The public file may be reviewed by a resident, prospective resident, or the representative of either a resident or prospective resident during normal business hours and at any other time the nursing home agrees to make the public file available.</text> </level> <level label="5"> <text>The nursing home shall promptly comply with a request by a licensing authority to review the records in either the public or regulatory files.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1417" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <level label="a"> <text>Each nursing home in the State shall notify each resident and prospective resident in writing or by written electronic communication if:</text> <level label="1"> <text>The nursing home does not maintain professional liability insurance coverage; or</text> </level> <level label="2"> <text>The nursing home’s professional liability insurance coverage has lapsed for any period of time and has not been renewed.</text> </level> </level> <level label="b"> <text>The notification under subsection (a) of this section shall be:</text> <level label="1"> <level label="i"> <text>Provided to a prospective resident:</text> <level label="1"> <text>At the first visit by the prospective resident during any period during which the nursing home does not maintain professional liability coverage; and</text> </level> <level label="2"> <text>If the nursing home does not maintain professional liability insurance at the time the prospective resident applies for admission, at the time of application; and</text> </level> </level> <level label="ii"> <text>If the professional liability insurance lapses, provided to each resident within 30 days after the date the coverage lapsed;</text> </level> </level> <level label="2"> <text>Signed by:</text> <level label="i"> <text>The prospective resident at the time of application for admission; or</text> </level> <level label="ii"> <text>The resident at the time the notification of the lapse in coverage is provided under item (1)(ii) of this subsection; and</text> </level> </level> <level label="3"> <text>Retained by the nursing home as part of the nursing home’s records.</text> </level> </level> <level label="c"> <text>Each nursing home operating in the State that does not maintain professional liability insurance coverage shall post in a conspicuous place visible to residents and guests that the nursing home does not maintain professional liability coverage.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1418" title_number="19" title_name="Health Care Facilities" subtitle_number="14" subtitle_name="Nursing Homes"> <text>This subtitle may be cited as the “Maryland Nursing Home Quality Assurance Act”.</text> </section> <section article="ghg" article_name="Health - General" number="19-14A-01" title_number="19" title_name="Health Care Facilities" subtitle_number="14A" subtitle_name="Third Party Liability Reviews and Audits of Nursing Homes"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Final report” means the third party liability audit report issued to a nursing home stating the total amount due to the Department as a result of the completed audit.</text> </level> <level label="c"> <text>“Nursing home” has the meaning stated in § 19-1401(e) of this title.</text> </level> <level label="d"> <level label="1"> <text>“Third party” means any individual, entity, or program that is or may be liable to pay all or part of the medical cost of any medical assistance furnished to a recipient under the Medical Assistance Program.</text> </level> <level label="2"> <text>“Third party” includes private health insurance, employment-related health insurance, medical support from absent parents, automobile insurance, court judgments or settlements from a liability insurer, State workers’ compensation, first party probate-estate recoveries, or any federal programs.</text> </level> </level> <level label="e"> <text>“Third party liability audit” means a financial review of Medical Assistance payments to a provider to ascertain the legal liability of third parties to pay for care and services available under the Medical Assistance Program.</text> </level> <level label="f"> <text>“Third party liability review” means a financial review of the credit balances of a nursing home to ascertain the legal liability of third parties to pay for care and services available under the Medical Assistance Program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-14A-02" title_number="19" title_name="Health Care Facilities" subtitle_number="14A" subtitle_name="Third Party Liability Reviews and Audits of Nursing Homes"> <level label="a"> <text>A nursing home that receives payment from the Medical Assistance Program shall provide a report of the credit balances of the nursing home to the Department on a quarterly basis.</text> </level> <level label="b"> <text>The Department shall conduct a third party liability review of the report of the credit balances provided under subsection (a) of this section.</text> </level> <level label="c"> <text>The Department may conduct a third party liability audit of a random sample of the reports of credit balances reviewed under subsection (b) of this section.</text> </level> <level label="d"> <level label="1"> <text>Subject to paragraph (2) of this subsection, the Department may conduct a third party liability audit of a nursing home that is found to be noncompliant as a result of the audit conducted under subsection (c) of this section.</text> </level> <level label="2"> <text>In conducting the third party liability audit authorized under paragraph (1) of this subsection, the Department may only review the financial information of the nursing home for the 2-year period immediately prior to the date of the audit period in which the nursing home was found to be noncompliant.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-14A-03" title_number="19" title_name="Health Care Facilities" subtitle_number="14A" subtitle_name="Third Party Liability Reviews and Audits of Nursing Homes"> <level label="a"> <text>A nursing home may appeal the results of a final report of a third party liability audit by filing written notice with the Department within 30 days after the nursing home receives the final report from the Department.</text> </level> <level label="b"> <text>An individual at the Department who did not participate in the final report shall:</text> <level label="1"> <text>Review the appeal authorized under subsection (a) of this section; and</text> </level> <level label="2"> <text>Issue a report that either revises or concurs with the final report of the third party liability audit.</text> </level> </level> <level label="c"> <text>A nursing home may appeal the results of the report issued by the Department under subsection (b) of this section by filing written notice with the Nursing Home Appeal Board within 30 days of receipt of the report.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-14A-04" title_number="19" title_name="Health Care Facilities" subtitle_number="14A" subtitle_name="Third Party Liability Reviews and Audits of Nursing Homes"> <text>The Department may adopt rules and regulations to carry out the provisions of this subtitle.</text> </section> <section article="ghg" article_name="Health - General" number="19-14B-01" title_number="19" title_name="Health Care Facilities" subtitle_number="14B" subtitle_name="Pay-for-Performance Program for Nursing Homes"> <level label="a"> <level label="1"> <text>As provided in subsection (e) of this section, a portion of the revenues from the quality assessment that is assessed under § 19–310.1 of this title shall be distributed to nursing facilities subject to § 19–310.1 of this title based on accountability measures that indicate quality of care or a commitment to quality of care.</text> </level> <level label="2"> <text>In consultation with representatives of the nursing facilities and other stakeholders, the Maryland Department of Health shall develop accountability measures to use in a pay–for–performance program that take into account both performance and improvement.</text> </level> <level label="3"> <text>The accountability measures shall be objective, measurable, and when considered in combination with each other, deemed to have a correlation to residents’ quality of life and care.</text> </level> </level> <level label="b"> <level label="1"> <text>On or before December 1, 2009, and each year thereafter, the Department shall, in consultation with representatives of nursing facilities and other interested stakeholders, make necessary changes to the pay–for–performance program to determine the effect on providers and to determine if the measures satisfy the requirements of being objective, measurable, and, when considered in combination with each other, have a correlation to residents’ quality of life and care.</text> </level> <level label="2"> <text>In performing the review required under paragraph (1) of this subsection, on or before December 1, 2009, and on or before December 1, 2010, the Department shall examine and modify the pay–for–performance program to include improvement measures in the scoring criteria.</text> </level> </level> <level label="c"> <level label="1"> <text>A portion of the revenues generated by the quality assessment under § 19–310.1 of this title shall be in an incentive program to be distributed as provided in this section, to the extent federal law allows.</text> </level> <level label="2"> <text>The distribution of revenues as provided in this section shall be used as an incentive for nursing facilities to provide quality care and may not be used to directly or indirectly hold harmless any nursing facility.</text> </level> </level> <level label="d"> <text>On or before December 1, 2008, the plan required under this section shall be submitted by the Department, in accordance with § 2–1257 of the State Government Article, to the General Assembly.</text> </level> <level label="e"> <level label="1"> <text>On or before July 1, 2009, the Department shall:</text> <level label="i"> <text>Score nursing facilities based on scoring criteria developed and reported to the General Assembly in the December 1, 2008 report as required by Chapter 200 of the Acts of the General Assembly of 2008; and</text> </level> <level label="ii"> <text>Send each nursing facility a transmittal with the scoring criteria, the performance of the nursing facility relative to the scoring, and the money that would have been received by the nursing facility using the scoring criteria.</text> </level> </level> <level label="2"> <text>Beginning July 1, 2010, the Department shall distribute 50% of the revenues generated by the quality assessment that is assessed under § 19–310.1 of this title and required for use in a pay–for–performance program to nursing facilities as provided in this section.</text> </level> <level label="3"> <text>Beginning July 1, 2011, the Department shall fully implement the pay–for–performance program as provided in this section.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-14C-01" title_number="19" title_name="Health Care Facilities" subtitle_number="14C" subtitle_name="Maryland State-Owned Nursing Homes"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Deficiency” has the meaning stated in § 19–1401 of this title.</text> </level> <level label="c"> <text>“Monitoring agency” means:</text> <level label="1"> <text>The Centers for Medicare and Medicaid Services;</text> </level> <level label="2"> <text>The Office of Health Care Quality within the Department;</text> </level> <level label="3"> <text>The Maryland Department of Labor;</text> </level> <level label="4"> <text>A local health department;</text> </level> <level label="5"> <text>The U.S. Department of Veterans Affairs; or</text> </level> <level label="6"> <text>The federal Occupational Safety and Health Administration.</text> </level> </level> <level label="d"> <text>“Nursing home” has the meaning stated in § 19–1401 of this title.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-14C-02" title_number="19" title_name="Health Care Facilities" subtitle_number="14C" subtitle_name="Maryland State-Owned Nursing Homes"> <level label="a"> <level label="1"> <text>If a State–owned nursing home that is operated by a contractor receives a deficiency from or is subject to an enforcement action by a monitoring agency, within 15 days after the final survey finding, the department charged with oversight of the nursing home shall provide notice of the deficiency or enforcement action to:</text> <level label="i"> <text>The Governor;</text> </level> <level label="ii"> <text>In accordance with § 2–1257 of the State Government Article, the Senate Finance Committee, the House Health Committee, and the members of the General Assembly who represent the district in which the nursing home is located; and</text> </level> <level label="iii"> <text>The local governing body of the county in which the nursing home is located.</text> </level> </level> <level label="2"> <text>Within 30 days after the contractor’s final acceptance of a plan of correction or completion of an informal dispute resolution, the department charged with oversight of the nursing home shall provide to the Governor and, in accordance with § 2–1257 of the State Government Article, the Senate Finance Committee, the House Health Committee, and the members of the General Assembly who represent the district in which the nursing home is located:</text> <level label="i"> <text>A statement of the deficiencies found by the monitoring agency;</text> </level> <level label="ii"> <text>The plan of correction or results of the informal dispute resolution; and</text> </level> <level label="iii"> <text>All communications from the monitoring agency regarding survey activities conducted at the nursing home.</text> </level> </level> </level> <level label="b"> <text>On or before January 1 each year, beginning in 2024, the Department shall report to the Governor and, in accordance with § 2–1257 of the State Government Article, the General Assembly on all federal and State:</text> <level label="1"> <text>Survey activities conducted during the immediately preceding 12–month period at each State–owned nursing home that is operated by a contractor; and</text> </level> <level label="2"> <text>Enforcement actions imposed during the immediately preceding 12–month period on each State–owned nursing home that is operated by a contractor.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1801" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <text>In this subtitle:</text> <level label="1"> <text>“Assisted living program” means a residential or facility–based program that provides housing and supportive services, supervision, personalized assistance, health–related services, or a combination thereof that meets the needs of individuals who are unable to perform or who need assistance in performing the activities of daily living or instrumental activities of daily living in a way that promotes optimum dignity and independence for the individuals.</text> </level> <level label="2"> <text>“Assisted living program” does not include:</text> <level label="i"> <text>A nursing home, as defined under § 19–1401 of this title;</text> </level> <level label="ii"> <text>A State facility, as defined under § 10–101 of this article;</text> </level> <level label="iii"> <text>A program licensed by the Department under Title 7 or Title 10 of this article;</text> </level> <level label="iv"> <text>A hospice care program regulated by the Department under Subtitle 9 of this title;</text> </level> <level label="v"> <text>Services provided by family members;</text> </level> <level label="vi"> <text>Services provided in an individual’s own home; or</text> </level> <level label="vii"> <text>A program certified by the Department of Human Services under Title 6, Subtitle 5, Part II of the Human Services Article as a certified Adult Residential Environment Program.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1802" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <text>The Department shall be the lead agency for supervising and monitoring a statewide interagency system for regulating the establishment and operation of assisted living programs.</text> </section> <section article="ghg" article_name="Health - General" number="19-1803" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <level label="a"> <text>The Department shall encourage, but may not require, providers of assisted living program services to offer a continuum of care.</text> </level> <level label="b"> <text>Providers of assisted living program services may provide services at a variety of levels and in a variety of settings.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1804" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <text>The Department shall:</text> <level label="1"> <text>Serve as the point of entry for persons desiring information on assisted living programs;</text> </level> <level label="2"> <text>Provide the Department of Aging and other State agencies that routinely receive inquiries from the public about assisted living with information that will enable the agencies to respond to the inquiries accurately and effectively; and</text> </level> <level label="3"> <text>Delegate various aspects of its responsibilities under this subtitle to monitor and inspect assisted living programs and facilities to the Department of Aging and the Department of Human Services, in accordance with an interagency agreement, for the purpose of ensuring compliance with the regulations adopted by the Department under this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1804.1" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <level label="a"> <text>A person shall be licensed by the Department to conduct, operate, or maintain an assisted living program in the State.</text> </level> <level label="b"> <level label="1"> <text>A person shall submit an application for licensure to conduct, operate, or maintain an assisted living program to the Secretary on a form developed by the Secretary.</text> </level> <level label="2"> <level label="i"> <text>The Secretary shall develop the application for licensure required under paragraph (1) of this subsection.</text> </level> <level label="ii"> <text>The application shall include the name and address of each officer, manager, alternate manager, and delegating nurse or case manager of the assisted living program.</text> </level> </level> <level label="3"> <text>In addition to the application, an applicant for initial licensure shall submit to the Secretary:</text> <level label="i"> <text>Information concerning any license or certification held by the applicant under the Health Occupations Article or under this article, including the prior or current operation by the applicant of a health care facility, residential facility, or similar health care program;</text> </level> <level label="ii"> <text>Information demonstrating the financial and administrative ability of the applicant to operate an assisted living program in compliance with this subtitle;</text> </level> <level label="iii"> <text>The policies and procedures to be implemented by the assisted living program;</text> </level> <level label="iv"> <text>Identification of the personnel and relief personnel to be employed by the assisted living program; and</text> </level> <level label="v"> <text>Any other information that is relevant to the ability of the applicant to care for the residents of the assisted living program.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>The Secretary shall:</text> <level label="i"> <text>Review the application and information received under subsection (b) of this section; and</text> </level> <level label="ii"> <text>Conduct an independent investigation of the assisted living program applying for initial licensure.</text> </level> </level> <level label="2"> <text>Based on the review and investigation conducted under paragraph (1) of this subsection, the Secretary shall:</text> <level label="i"> <text>Authorize the unconditional approval of the application;</text> </level> <level label="ii"> <text>Authorize the conditional approval of the application; or</text> </level> <level label="iii"> <text>Deny the application.</text> </level> </level> </level> <level label="d"> <text>The Secretary may issue a probationary license that is valid for a period of time determined by the Secretary in accordance with regulations adopted by the Secretary.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1805" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <level label="a"> <text>The Department shall:</text> <level label="1"> <text>Define different levels of assisted living according to the level of care provided;</text> </level> <level label="2"> <text>Require all assisted living programs to be licensed to operate according to the level of the program;</text> </level> <level label="3"> <text>Develop a waiver process for authorizing an assisted living program to continue to care for an individual whose medical or functional condition has changed since admission to the program to an extent that the level of care required by the individual exceeds the level of care for which the program is licensed;</text> </level> <level label="4"> <text>Promote affordable and accessible assisted living programs throughout the State;</text> </level> <level label="5"> <text>Establish and enforce quality standards for assisted living programs;</text> </level> <level label="6"> <text>Require periodic inspections of assisted living program facilities, including at least an annual unannounced on–site inspection;</text> </level> <level label="7"> <text>Establish requirements for the qualifications or training or both of assisted living program employees;</text> </level> <level label="8"> <text>Establish a “resident bill of rights” for residents of assisted living program facilities that includes, at a minimum:</text> <level label="i"> <text>The right to be treated with consideration, respect, and full recognition of human dignity and individuality;</text> </level> <level label="ii"> <text>The right to receive treatment, care, and services that are adequate, appropriate, and in compliance with relevant federal and State laws, rules, and regulations;</text> </level> <level label="iii"> <text>The right to be free from mental and physical abuse;</text> </level> <level label="iv"> <text>The right to be free from mental, verbal, sexual, and physical abuse, neglect, or involuntary seclusion or exploitation;</text> </level> <level label="v"> <text>The right to notice, procedural fairness, and humane treatment when being transferred or discharged from a facility;</text> </level> <level label="vi"> <text>The right to participate in decision making regarding transitions in care, including a transfer or discharge from a facility;</text> </level> <level label="vii"> <text>The right to be free from physical and chemical restraints, except for restraints that a physician authorizes for a clearly indicated medical need; and</text> </level> <level label="viii"> <text>The right to manage personal financial affairs;</text> </level> </level> <level label="9"> <text>Define which, if any, assisted living programs may be exempt from the requirements of § 19–311 of this title; and</text> </level> <level label="10"> <text>For Alzheimer’s special care units:</text> <level label="i"> <text>Establish the number of dementia–specific training hours to be completed for those staff working in Alzheimer’s special care units;</text> </level> <level label="ii"> <text>Determine the topic content for dementia–specific training required for those staff working in Alzheimer’s special care units; and</text> </level> <level label="iii"> <text>Require staff sufficient to meet the needs of residents in Alzheimer’s special care units.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>The Department, in consultation with representatives of the affected industry and advocates for residents of the facilities and with the approval of the Department of Aging and the Department of Human Services, shall adopt regulations to implement this subtitle.</text> </level> <level label="2"> <text>The regulations adopted under paragraph (1) of this subsection shall:</text> <level label="i"> <text>Provide for the licensing of assisted living programs;</text> </level> <level label="ii"> <text>Require the Department, during a survey or other inspection of an assisted living program, to review the number of waivers granted to the program under subsection (a)(3) of this section and determine whether a change in the program’s licensure status is warranted; and</text> </level> <level label="iii"> <text>Require an assisted living program facility to post in a conspicuous place visible to actual and potential residents of the facility and other interested parties:</text> <level label="1"> <level label="A"> <text>Its statement of deficiencies for the most recent survey;</text> </level> </level> <level label="B"> <text>Any subsequent complaint investigations conducted by federal, State, or local surveyors; and</text> </level> <level label="C"> <text>Any plans of correction in effect with respect to the survey or complaint investigation; or</text> </level> <level label="2"> <text>A notice of the location, within the facility, of the items listed in item 1 of this item.</text> </level> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1805.1" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <level label="a"> <text>To prevent irreparable harm to residents in a program, the Attorney General may seek injunctive relief on behalf of the State on the basis of an imminent or ongoing violation of a basic right of assisted living program residents provided under § 19–1805(a)(8)(i) through (viii) of this subtitle.</text> </level> <level label="b"> <text>In exercising the authority granted under this section, the Attorney General may not duplicate the corrective action imposed by the Department for the same violation.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1806" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Continuing care” has the meaning stated in § 10–401 of the Human Services Article.</text> </level> <level label="3"> <text>“Continuing care agreement” has the meaning stated in § 10–401 of the Human Services Article.</text> </level> </level> <level label="b"> <text>This section applies to assisted living programs that offer assisted living program services as part of a continuum of care in accordance with a continuing care agreement that does not require a subscriber to execute a separate assisted living agreement to receive those services.</text> </level> <level label="c"> <level label="1"> <text>An assisted living program subject to this section that meets the requirements of Title 10, Subtitle 4 of the Human Services Article with regard to assisted living is not required to execute a separate assisted living resident agreement that is in addition to the continuing care agreement.</text> </level> <level label="2"> <text>For purposes of paragraph (1) of this subsection, if a separate assisted living resident agreement is not utilized, references to a resident agreement in any regulations adopted under this subtitle shall mean the continuing care agreement.</text> </level> </level> <level label="d"> <text>A continuing care agreement that contains a provision to provide assisted living program services and does not require a subscriber to execute a separate assisted living agreement to receive those services is not required to contain general or specific contract provisions, except as required under Title 10, Subtitle 4 of the Human Services Article, that apply to assisted living programs that are not subject to this section.</text> </level> <level label="e"> <level label="1"> <text>In addition to subsection (c) of this section, an assisted living program subject to this section is not required to provide a disclosure statement relating to its assisted living program separate from any disclosure statement required by Title 10, Subtitle 4 of the Human Services Article for continuing care.</text> </level> <level label="2"> <text>Any disclosure statement required to be provided to a resident under Title 10, Subtitle 4 of the Human Services Article shall include information that is required to be disclosed by an assisted living program in accordance with this subtitle.</text> </level> </level> <level label="f"> <text>A transfer of a resident from an assisted living program subject to this section to another assisted living or continuing care arrangement governed by the same continuing care agreement may not be considered a relocation or discharge from the assisted living program for purposes of triggering any regulatory requirements adopted under this subtitle for matters relating to notice, financial accounting, or refunds.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1807" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <level label="a"> <level label="1"> <text>Except as provided in subsection (d) of this section, an assisted living manager who is employed by an assisted living program shall have completed a manager training course that is approved by the Department and includes an examination.</text> </level> <level label="2"> <text>The manager training course shall:</text> <level label="i"> <text>Consist of at least 80 hours; and</text> </level> <level label="ii"> <text>Provide the training through in–person courses, virtual training methods, or a combination of both.</text> </level> </level> </level> <level label="b"> <text>An assisted living manager employed by a program shall be required to complete 20 hours of Department–approved continuing education every 2 years.</text> </level> <level label="c"> <text>In addition to the sanctions specified in COMAR 10.07.14.48, an assisted living program that fails to employ an assisted living manager who meets the requirements of this section may be subject to a civil money penalty not to exceed $10,000.</text> </level> <level label="d"> <level label="1"> <text>The requirements of subsection (a) of this section do not apply to an individual who:</text> <level label="i"> <text>Is employed by an assisted living program and has enrolled in a Department–approved manager training course that the individual expects to complete within 6 months;</text> </level> <level label="ii"> <text>Is temporarily serving as an assisted living manager under § 9–3A–01 of the Health Occupations Article due to an assisted living manager leaving employment and prior to the hiring of a permanent assisted living manager; or</text> </level> <level label="iii"> <text>Subject to paragraph (2) of this subsection:</text> <level label="1"> <text>Has been employed as an assisted living manager in the State for 1 year prior to January 1, 2006; or</text> </level> <level label="2"> <text>Is licensed as a nursing home administrator in the State.</text> </level> </level> </level> <level label="2"> <text>The Department may require an individual who is exempt under paragraph (1)(iii) of this subsection to complete a manager training course and examination if the Department finds that the assisted living manager repeatedly has violated State law or regulations on assisted living and that those violations have caused actual physical or emotional harm to a resident.</text> </level> </level> <level label="e"> <text>The Department shall ensure that manager training courses approved by the Department are affordable and accessible to assisted living programs and to individuals seeking to enroll in the courses.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1808" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <level label="a"> <text>The Department, in consultation with the Maryland Health Care Commission and stakeholders, including advocates, consumers, and providers of assisted living services, shall develop a standard assisted living program services disclosure statement.</text> </level> <level label="b"> <text>The purpose of the assisted living program services disclosure statement is to inform potential consumers about the services provided by an assisted living program in order to assist a consumer in choosing the most appropriate assisted living program.</text> </level> <level label="c"> <level label="1"> <text>An assisted living program, as part of the application for licensure, shall file with the Office of Health Care Quality the assisted living program services disclosure statement developed by the Department.</text> </level> <level label="2"> <text>If an assisted living program changes the services reported on the assisted living program services disclosure statement, the assisted living program shall file with the Office of Health Care Quality an amended assisted living program services disclosure statement within 30 days of the change in services.</text> </level> </level> <level label="d"> <level label="1"> <text>If an individual requests a copy of an assisted living program’s services disclosure statement, the assisted living program shall provide a copy of the services disclosure statement to the individual making the request.</text> </level> <level label="2"> <text>An assisted living program shall provide a copy of the services disclosure statement to individuals as part of the program’s marketing materials.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1808.1" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <level label="a"> <text>Each assisted living program in the State shall notify a resident or prospective resident in writing or by written electronic communication if:</text> <level label="1"> <text>The assisted living program does not maintain professional liability insurance coverage; or</text> </level> <level label="2"> <text>The assisted living program’s professional liability insurance coverage has lapsed for any period of time and has not been renewed.</text> </level> </level> <level label="b"> <text>The notification under subsection (a) of this section shall be:</text> <level label="1"> <level label="i"> <text>Provided to a prospective resident:</text> <level label="1"> <text>At the first visit by the prospective resident during any period in which an assisted living program does not maintain professional liability insurance; and</text> </level> <level label="2"> <text>If the assisted living program does not maintain professional liability insurance at the time the prospective resident applies for admission, at the time of application; and</text> </level> </level> <level label="ii"> <text>If the professional liability coverage lapses, provided to each resident within 30 days after the date the coverage lapsed;</text> </level> </level> <level label="2"> <text>Signed by:</text> <level label="i"> <text>The prospective resident at the time of application for admission; or</text> </level> <level label="ii"> <text>The resident at the time the notification of the lapse in coverage is provided under item (1)(ii) of this subsection; and</text> </level> </level> <level label="3"> <text>Retained by the assisted living program as part of the assisted living program’s records.</text> </level> </level> <level label="c"> <text>Each facility–based assisted living program in the State that does not maintain professional liability insurance coverage shall post a notification in a conspicuous place visible to residents and guests that the assisted living program does not maintain professional liability insurance.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1809" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <level label="a"> <level label="1"> <text>A person may not knowingly and willfully operate, maintain, or own an assisted living program without a license.</text> </level> <level label="2"> <text>A person who violates paragraph (1) of this subsection is guilty of a felony and on conviction is subject to:</text> <level label="i"> <text>For a first offense, a fine not exceeding $10,000 or imprisonment not exceeding 5 years or both; or</text> </level> <level label="ii"> <text>For a subsequent offense, a fine not exceeding $20,000 or imprisonment not exceeding 5 years or both.</text> </level> </level> <level label="3"> <text>If the Department finds a credible allegation that an assisted living program is operating without a license, the Department, or the Office of Health Care Quality, shall investigate whether residents in the assisted living program have been subjected to neglect, exploitation, or abuse.</text> </level> <level label="4"> <level label="i"> <text>On receipt of a credible allegation, or after an investigation that results in a finding that residents in an unlicensed assisted living program have been subjected to neglect, exploitation, or abuse, the person operating the unlicensed program shall be subject to immediate prosecution under paragraph (2) of this subsection.</text> </level> <level label="ii"> <text>If the person operating an unlicensed assisted living program fails or refuses to cooperate fully in an investigation by the Department, or the Office of Health Care Quality, conducted under paragraph (3) of this subsection, the person operating the unlicensed assisted living program shall be subject to immediate prosecution under paragraph (2) of this subsection.</text> </level> </level> <level label="5"> <text>If the Department finds, after an investigation conducted under paragraph (3) of this subsection, that there is no reason to believe that residents in the assisted living program operating without a license have been subject to exploitation, neglect, or abuse:</text> <level label="i"> <text>The Department shall provide written notice to the unlicensed assisted living program that the program shall come into compliance with licensure requirements within 30 days after receipt of the written notification; and</text> </level> <level label="ii"> <text>The person operating the program may not be subject to prosecution under paragraph (2) of this subsection if the person has:</text> <level label="1"> <text>Promptly and in good faith submitted a complete application to the Department for an assisted living program license;</text> </level> <level label="2"> <text>Is awaiting a decision from the Department regarding the application; and</text> </level> <level label="3"> <text>Has not been denied an assisted living program license on a prior occasion.</text> </level> </level> </level> <level label="6"> <text>In recommending the amount of the criminal penalty under paragraph (2) of this subsection, the State shall consider factors including the nature, number, and seriousness of the violations.</text> </level> <level label="7"> <text>The Department, the Attorney General, a State’s Attorney, or a local health officer may petition a circuit court for injunctive relief against the operation of an assisted living program operating without a license.</text> </level> <level label="8"> <text>A violation of paragraph (1) of this subsection shall be a violation of the Consumer Protection Act.</text> </level> </level> <level label="b"> <level label="1"> <level label="i"> <text>A person may not advertise, represent, or imply to the public that an assisted living program is authorized to provide a service that the program is not licensed, certified, or otherwise authorized by the Department to provide when the license, certificate, or authorization is required under this subtitle.</text> </level> <level label="ii"> <text>A person may not advertise an assisted living program in a misleading or fraudulent manner.</text> </level> </level> <level label="2"> <level label="i"> <text>A person who violates paragraph (1) of this subsection is subject to a civil money penalty imposed by the Secretary not exceeding $10,000 for each offense.</text> </level> <level label="ii"> <text>In setting the amount of a civil money penalty on the program under subparagraph (i) of this paragraph, the Secretary shall consider factors including the nature, number, and seriousness of the violations and the ability of the assisted living program to pay the penalty.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>A person may not willfully and knowingly refer another person to an assisted living program that is operating without a license.</text> </level> <level label="2"> <text>A person who violates paragraph (1) of this subsection is subject to the following civil penalties:</text> <level label="i"> <text>For a first offense, a civil penalty not exceeding $1,000;</text> </level> <level label="ii"> <text>For a second offense, a civil penalty not exceeding $2,000; or</text> </level> <level label="iii"> <text>For a third or subsequent offense, a civil penalty not exceeding $3,000.</text> </level> </level> <level label="3"> <text>The Secretary shall remit all civil penalties collected under this subsection to the Office of Health Care Quality for the purposes of carrying out the provisions of § 19–1813 of this subsection.</text> </level> </level> <level label="d"> <text>The Department may adopt regulations to carry out this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1810" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <level label="a"> <text>An assisted living program may request an appeal of a civil money penalty imposed under this subtitle.</text> </level> <level label="b"> <text>A hearing on the appeal shall be held in accordance with:</text> <level label="1"> <text>The Administrative Procedure Act under Title 10, Subtitle 2 of the State Government Article; and</text> </level> <level label="2"> <text>Regulations adopted by the Secretary.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1811" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <level label="a"> <level label="1"> <text>There is a Health Care Quality Account for Assisted Living Programs established in the Department.</text> </level> <level label="2"> <text>The Account shall be funded by civil money penalties paid by assisted living programs and other penalties that the Office of Health Care Quality may assess.</text> </level> <level label="3"> <text>The Department shall pay all penalties collected under this title to the Comptroller.</text> </level> <level label="4"> <text>The Comptroller shall distribute funds collected under this title to the Health Care Quality Account for Assisted Living Programs.</text> </level> <level label="5"> <text>The Account is a continuing, nonlapsing fund, not subject to § 7–302 of the State Finance and Procurement Article.</text> </level> <level label="6"> <text>Any unspent portions of the Account may not be transferred or reverted to the General Fund of the State, but shall remain in the Account to be used for the purposes specified in this section.</text> </level> </level> <level label="b"> <text>The Health Care Quality Account for Assisted Living Programs shall be used for training, grant awards, demonstration projects, or other purposes designed to improve the quality of care.</text> </level> <level label="c"> <text>The Department shall adopt regulations for the distribution of funds from the Health Care Quality Account for Assisted Living Programs.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1812" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <level label="a"> <text>Except as provided in subsections (g) and (h) of this section, the Department shall require that each assisted living program facility that provides services to 50 or more individuals have an emergency electrical power generator on the premises.</text> </level> <level label="b"> <text>The Department shall require that each facility provide emergency electrical power as provided in this section.</text> </level> <level label="c"> <level label="1"> <text>The emergency power source shall be a generating set and prime mover located on the facility premises with automatic transfer.</text> </level> <level label="2"> <text>An emergency power system shall meet the following requirements:</text> <level label="i"> <text>In the event of failure of the normal electric service, the emergency electrical power shall be activated immediately;</text> </level> <level label="ii"> <text>The emergency generator set shall come to full speed and load acceptance within 10 seconds; and</text> </level> <level label="iii"> <text>The emergency generator shall have the capability of 48 hours of operation from fuel stored on–site.</text> </level> </level> <level label="3"> <level label="i"> <text>The emergency power system shall be tested one time each month.</text> </level> <level label="ii"> <text>The emergency power system test shall require that the generator be exercised for a minimum of 30 minutes under normal emergency facility connected load.</text> </level> <level label="iii"> <text>The test shall be recorded in a permanent log book maintained for that purpose.</text> </level> </level> </level> <level label="d"> <text>The emergency power system shall provide lighting in the following areas of the facility:</text> <level label="1"> <text>Areas of egress and protection as required by the State Fire Prevention Code and Life Safety Code 101 adopted by the State Fire Prevention Commission;</text> </level> <level label="2"> <text>Nurses’ station;</text> </level> <level label="3"> <text>Drug distribution station or unit dose station;</text> </level> <level label="4"> <text>An area for emergency telephone use;</text> </level> <level label="5"> <text>Boiler or mechanical room;</text> </level> <level label="6"> <text>Kitchen;</text> </level> <level label="7"> <text>Emergency generator location and switch gear location;</text> </level> <level label="8"> <text>Elevator, if operable on emergency power;</text> </level> <level label="9"> <text>Areas where life support equipment is used;</text> </level> <level label="10"> <text>If applicable, common areas or areas of refuge; and</text> </level> <level label="11"> <text>If applicable, toilet rooms of common areas or areas of refuge.</text> </level> </level> <level label="e"> <text>Emergency electrical power shall be provided for the following:</text> <level label="1"> <text>Nurses’ call system;</text> </level> <level label="2"> <text>At least one telephone in order to make and receive calls;</text> </level> <level label="3"> <text>Fire pump;</text> </level> <level label="4"> <text>Sewerage pump and sump pump;</text> </level> <level label="5"> <text>If required for evacuation purposes, an elevator;</text> </level> <level label="6"> <text>If necessary, heating equipment needed to maintain a minimum temperature of 70 degrees Fahrenheit (24 degrees Celsius) in all common areas or areas of refuge;</text> </level> <level label="7"> <text>Life support equipment; and</text> </level> <level label="8"> <text>Nonflammable medical gas systems.</text> </level> </level> <level label="f"> <level label="1"> <text>If the emergency power system does not provide heat to all patient rooms or toilet rooms in the event of a loss of electricity from the main source of power, the facility shall provide common areas or areas of refuge for all patients.</text> </level> <level label="2"> <text>The Department shall adopt regulations regarding the requirements for designating parts of the facility as common areas or areas of refuge.</text> </level> </level> <level label="g"> <text>An assisted living program facility shall be exempt from the requirements of this section if the facility can safely transfer residents through an enclosed corridor to a building that is equipped with an electrical power generator that satisfies the requirements of this section.</text> </level> <level label="h"> <level label="1"> <text>The Department may grant a facility a waiver from the requirements of this section if the facility:</text> <level label="i"> <text>Provides evidence to the Department that the requirements of this section will create an undue financial burden on the facility and will require the facility to cease operation; and</text> </level> <level label="ii"> <text>Discloses to the residents of the facility that the facility does not have an emergency electrical power generator that meets the requirements of this section.</text> </level> </level> <level label="2"> <text>Subject to paragraph (3) of this subsection, a waiver granted under paragraph (1) of this subsection may not exceed a period of 3 years.</text> </level> <level label="3"> <text>The Department may extend a waiver granted under paragraph (1) of this subsection for an additional period of 2 years beyond the period specified in paragraph (2) of this subsection.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1813" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <level label="a"> <text>In this section, “assisted living referrer” means an individual or agency that:</text> <level label="1"> <text>Makes referrals to assisted living programs without cost to the person receiving the referral; and</text> </level> <level label="2"> <text>Is compensated by an assisted living program or other third party for referring individuals to a licensed assisted living program.</text> </level> </level> <level label="b"> <text>Each assisted living referrer:</text> <level label="1"> <text>Shall register with the Office of Health Care Quality;</text> </level> <level label="2"> <text>Shall disclose to a client or potential client of the assisted living referrer all financial relationships the assisted living referrer has with assisted living programs;</text> </level> <level label="3"> <text>If referring a client or potential client to an assisted living program, shall affirm that the assisted living program is licensed;</text> </level> <level label="4"> <text>If referring a client or potential client to an assisted living program, may refer the client or potential client only to a licensed assisted living program;</text> </level> <level label="5"> <text>Shall maintain general liability insurance;</text> </level> <level label="6"> <text>Shall require employees to obtain a criminal history records check;</text> </level> <level label="7"> <text>Shall provide to the client or the client’s representative a description of the services that will be provided by the referrer;</text> </level> <level label="8"> <text>If the referrer has a financial agreement with the client or the client’s representative, shall provide the agreement to the client or the client’s representative in writing or by electronic means; and</text> </level> <level label="9"> <text>Shall notify the Office of Health Care Quality immediately on learning that the assisted living program is operating without a license.</text> </level> </level> <level label="c"> <text>An assisted living referrer may not:</text> <level label="1"> <text>Receive funding from the Department if the assisted living referrer is in violation of this subtitle;</text> </level> <level label="2"> <text>Make referrals only to licensed assisted living programs from which the assisted living referrer receives compensation as described in subsection (a)(2) of this section; or</text> </level> <level label="3"> <text>Request payment of a referral fee from an assisted living program more than 2 years after the assisted living referrer provided the referral.</text> </level> </level> <level label="d"> <text>If requested by any person or on its own initiative, the Office of the Attorney General may investigate whether an assisted living referrer violated this subtitle and may seek appropriate relief.</text> </level> <level label="e"> <text>The Office of Health Care Quality shall maintain a user–friendly database of licensed assisted living programs.</text> </level> <level label="f"> <level label="1"> <text>On or before September 30, 2025, an assisted living referrer:</text> <level label="i"> <text>Shall keep a client or potential client’s medical record, as defined in § 4–301 of this article, confidential and may disclose the medical record only for the purpose of making a referral if the client or potential client gives informed written, electronic, or audio recorded consent; and</text> </level> <level label="ii"> <text>May not sell the personal data of a client, potential client, or client’s representative to another person unless the client or the client’s representative gives informed written, electronic, or audio recorded consent.</text> </level> </level> <level label="2"> <text>On or after October 1, 2025, an assisted living referrer shall comply with all applicable data privacy laws.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1814" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <text>The Office of Health Care Quality within the Department shall refer an allegation of an unfair, abusive, or deceptive trade practice by an assisted living program to the Division of Consumer Protection of the Office of the Attorney General and to the Office of the Inspector General within the Department.</text> </section> <section article="ghg" article_name="Health - General" number="19-1815" effective_note="EFFECTIVE UNTIL DECEMBER 31, 2022 PER CHAPTERS 29 AND 31 OF 2021 SPECIAL SESSION" title_number="19" title_name="Health Care Facilities" subtitle_number="18" subtitle_name="Assisted Living Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“COVID–19” means, interchangeably and collectively, the coronavirus known as COVID–19 or 2019–nCoV and the SARS–CoV–2 virus.</text> </level> <level label="3"> <text>“COVID–19 test” means an in vitro diagnostic test for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, as described in § 3201 of the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act.</text> </level> </level> <level label="b"> <text>For calendar years 2021 and 2022, an assisted living program shall adopt and implement a COVID–19 testing plan for residents of the assisted living program and staff who provide services to residents of the assisted living program.</text> </level> <level label="c"> <text>The COVID–19 testing plan shall ensure that residents and staff are tested for COVID–19 on a regular basis and at a frequency that is sufficient to prevent the spread of COVID–19 among residents and staff of the assisted living program.</text> </level> <level label="d"> <level label="1"> <text>The Department shall adopt regulations that set standards for a COVID–19 testing plan required under this section.</text> </level> <level label="2"> <text>The standards set by the Department under this subsection shall:</text> <level label="i"> <text>Be guided by applicable federal orders and policies; and</text> </level> <level label="ii"> <text>Include requirements for testing frequency that are reasonably related to the COVID–19 testing positivity rate in the local jurisdiction in which an assisted living program is located.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1901" title_number="19" title_name="Health Care Facilities" subtitle_number="19" subtitle_name="Adult Dependent Care Programs -- Criminal History Records Checks and Background Checks"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Adult dependent care program” means:</text> <level label="1"> <text>An adult day care facility regulated under Title 14, Subtitle 2 of this article;</text> </level> <level label="2"> <text>An assisted living program facility regulated under Subtitle 18 of this title;</text> </level> <level label="3"> <text>A group home regulated under Title 10, Subtitle 5 or Title 7, Subtitle 6 of this article;</text> </level> <level label="4"> <text>A home health agency regulated under Subtitle 4 of this title;</text> </level> <level label="5"> <text>A congregate housing services program regulated under Title 10, Subtitle 2 of the Human Services Article;</text> </level> <level label="6"> <text>A residential service agency as defined under § 19–4A–01 of this title;</text> </level> <level label="7"> <text>An alternative living unit as defined under § 7–101 of this article;</text> </level> <level label="8"> <text>A hospice facility regulated under Subtitle 9 of this title; or</text> </level> <level label="9"> <text>A related institution regulated under Subtitle 3 of this title.</text> </level> </level> <level label="c"> <text>“Background check” means a check of court and other records by a private agency.</text> </level> <level label="d"> <text>“Conviction” means a:</text> <level label="1"> <text>Plea or verdict of guilty;</text> </level> <level label="2"> <text>Plea of nolo contendere;</text> </level> <level label="3"> <text>Disposition of probation before judgment; or</text> </level> <level label="4"> <text>Disposition of not criminally responsible.</text> </level> </level> <level label="e"> <text>“Criminal history records check” means a check of criminal history record information, as defined in § 10-201 of the Criminal Procedure Article, by the Department of Public Safety and Correctional Services.</text> </level> <level label="f"> <text>“Department” means the Department of Public Safety and Correctional Services.</text> </level> <level label="g"> <text>“Disclosure statement” means a sworn statement or affirmation of the existence of a criminal conviction or pending criminal charges without a final disposition.</text> </level> <level label="h"> <level label="1"> <text>“Eligible employee” means an individual:</text> <level label="i"> <text>Who, for compensation, works for an adult dependent care program;</text> </level> <level label="ii"> <text>Who has routine, direct access to dependent adults in the program; and</text> </level> <level label="iii"> <text>Who is not licensed or certified under the Health Occupations Article.</text> </level> </level> <level label="2"> <text>“Eligible employee” does not include an individual delivering or retrieving medical equipment.</text> </level> </level> <level label="i"> <text>“Printed statement” means a document issued by the Criminal Justice Information System Central Repository in the Department of Public Safety and Correctional Services in response to an application for a criminal history records check.</text> </level> <level label="j"> <text>“Private agency” means a person that:</text> <level label="1"> <text>Is licensed as a private detective agency under Title 13, Subtitle 3 of the Business Occupations and Professions Article;</text> </level> <level label="2"> <text>Maintains an errors and omissions insurance policy in an amount not less than $1,000,000;</text> </level> <level label="3"> <text>Offers customer assistance in the use of background checks for employment purposes; and</text> </level> <level label="4"> <text>Is capable of conducting a background check within the State within 2 working days of a request and outside the State within 5 working days of a request.</text> </level> </level> <level label="k"> <text>“Secretary” means the Secretary of Public Safety and Correctional Services.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1902" title_number="19" title_name="Health Care Facilities" subtitle_number="19" subtitle_name="Adult Dependent Care Programs -- Criminal History Records Checks and Background Checks"> <level label="a"> <text>Before an eligible employee may begin work for an adult dependent care program, each adult dependent care program shall, for each eligible employee:</text> <level label="1"> <level label="i"> <text>Apply for a State criminal history records check; or</text> </level> <level label="ii"> <text>Request a private agency to conduct a background check; and</text> </level> </level> <level label="2"> <text>Request a reference from the potential employee’s most recent employer.</text> </level> </level> <level label="b"> <text>The reference request required under subsection (a)(2) of this section shall, at a minimum, seek information about any history of physical abuse on the part of the potential employee.</text> </level> <level label="c"> <text>An adult dependent care program shall pay for each eligible employee:</text> <level label="1"> <text>A State criminal history records check; or</text> </level> <level label="2"> <text>A private agency background check.</text> </level> </level> <level label="d"> <text>If an adult dependent care program requests a private agency to conduct a background check, the private agency shall conduct a background check in each state in which the adult dependent care program knows or has reason to know the eligible employee worked or resided during the past 7 years.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1903" title_number="19" title_name="Health Care Facilities" subtitle_number="19" subtitle_name="Adult Dependent Care Programs -- Criminal History Records Checks and Background Checks"> <level label="a"> <text>In addition to the checks required under this subtitle, an adult dependent care program may require an alcohol or controlled dangerous substance test of the potential employee.</text> </level> <level label="b"> <text>An alcohol or controlled dangerous substance test conducted under this section shall comply with the provisions of § 17-214 of this article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1904" title_number="19" title_name="Health Care Facilities" subtitle_number="19" subtitle_name="Adult Dependent Care Programs -- Criminal History Records Checks and Background Checks"> <level label="a"> <text>As part of the application for a State criminal history records check to be conducted by the Department, an eligible employee shall submit to the adult dependent care program:</text> <level label="1"> <text>Except as provided in subsection (c) of this section, a complete set of legible fingerprints taken on forms specified by the Director of the Criminal Justice Information System Central Repository; and</text> </level> <level label="2"> <text>The disclosure statement required under § 19-1905 of this subtitle.</text> </level> </level> <level label="b"> <text>The adult dependent care program shall submit the fingerprints, disclosure statement, and payment for the costs of the criminal history records check.</text> </level> <level label="c"> <text>The requirement that a complete set of legible fingerprints taken on forms specified by the Director of the Criminal Justice Information System Central Repository be submitted as part of the application for a criminal history records check may be waived by the Department if:</text> <level label="1"> <text>The eligible employee has attempted to have a complete set of fingerprints taken on at least two occasions;</text> </level> <level label="2"> <text>The taking of a complete set of legible fingerprints is not possible because of a physical or medical condition of the eligible employee’s fingers or hands;</text> </level> <level label="3"> <text>The eligible employee submits documentation satisfactory to the Department of the requirements of this subsection; and</text> </level> <level label="4"> <text>The eligible employee submits the other information required for a criminal history records check to be conducted by the Department as part of the application process.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1905" title_number="19" title_name="Health Care Facilities" subtitle_number="19" subtitle_name="Adult Dependent Care Programs -- Criminal History Records Checks and Background Checks"> <level label="a"> <text>As part of the application process for a criminal history records check, an eligible employee shall complete and sign a disclosure statement.</text> </level> <level label="b"> <text>The Department or its designee shall mail an acknowledged receipt of the application with a disclosure statement from an eligible employee within 3 days after receipt of the application to:</text> <level label="1"> <text>The adult dependent care program seeking to hire the eligible employee; and</text> </level> <level label="2"> <text>The eligible employee.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1906" title_number="19" title_name="Health Care Facilities" subtitle_number="19" subtitle_name="Adult Dependent Care Programs -- Criminal History Records Checks and Background Checks"> <level label="a"> <text>If the adult dependent care program requests a private agency background check:</text> <level label="1"> <text>The private agency shall issue a statement of its findings to:</text> <level label="i"> <text>On request, the eligible employee; and</text> </level> <level label="ii"> <text>The adult dependent care program; and</text> </level> </level> <level label="2"> <text>The eligible employee shall have an opportunity to contest the findings.</text> </level> </level> <level label="b"> <text>The adult dependent care program shall comply with the federal Fair Credit Reporting Act that includes the issuance of a statement by the program of its findings to an eligible employee when adverse information is obtained that precludes the hiring of that employee.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1907" title_number="19" title_name="Health Care Facilities" subtitle_number="19" subtitle_name="Adult Dependent Care Programs -- Criminal History Records Checks and Background Checks"> <level label="a"> <level label="1"> <text>The Department shall conduct the criminal history records check and issue the printed statement provided for under this subtitle.</text> </level> <level label="2"> <text>The Department shall update an initial criminal history records check and issue a revised printed statement, listing any of the convictions or pending charges occurring in the State after the date of the initial criminal history records check.</text> </level> <level label="3"> <text>The Department shall provide an initial and a revised statement of an eligible employee’s State criminal record to the recipients of the acknowledgments specified in § 19-1905(b) of this subtitle.</text> </level> <level label="4"> <text>The Department shall adopt regulations requiring employers to verify periodically the continuing employment of an employee.</text> </level> </level> <level label="b"> <text>The Department shall provide a printed statement of the eligible employee’s State criminal record to the recipients of the acknowledgments specified in § 19-1905(b) of this subtitle.</text> </level> <level label="c"> <text>Information obtained from the Department or a private agency under this subtitle shall be confidential and may be disseminated only to the eligible employee who is the subject of the criminal history records check or private agency background check and to an adult dependent care program seeking to hire the eligible employee.</text> </level> <level label="d"> <text>Information obtained from the Department or a private agency under this subtitle may not:</text> <level label="1"> <text>Be used for any purpose other than that for which it was disseminated; or</text> </level> <level label="2"> <text>Be redisseminated.</text> </level> </level> <level label="e"> <text>Information obtained from the Department or a private agency under this subtitle shall be maintained in a manner to insure the security of the information.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1908" title_number="19" title_name="Health Care Facilities" subtitle_number="19" subtitle_name="Adult Dependent Care Programs -- Criminal History Records Checks and Background Checks"> <level label="a"> <text>An eligible employee may contest the finding of a criminal conviction or pending charge reported in a printed statement issued by the Department as provided in this section.</text> </level> <level label="b"> <level label="1"> <text>In contesting the finding of a conviction or a pending charge, the eligible employee shall contact the office of the Secretary, or a designee of the Secretary, and a hearing shall be convened within 20 workdays, unless subsequently waived by the eligible employee.</text> </level> <level label="2"> <text>The Secretary, or a designee of the Secretary, shall render a decision regarding the appeal within 5 workdays after the hearing.</text> </level> </level> <level label="c"> <level label="1"> <text>For the purposes of this subtitle, the record of a conviction for a crime or a copy of the record certified by the clerk of the court or by a judge of the court in which the conviction occurred, shall be conclusive evidence of the conviction.</text> </level> <level label="2"> <text>In a case where a pending charge is recorded, documentation provided by a court to the Secretary, or a designee of the Secretary, that a pending charge for a crime which has not been finally adjudicated shall be conclusive evidence of the pending charge.</text> </level> </level> <level label="d"> <text>Failure of the eligible employee to appear at the scheduled hearing shall be considered grounds for dismissal of the appeal.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1909" title_number="19" title_name="Health Care Facilities" subtitle_number="19" subtitle_name="Adult Dependent Care Programs -- Criminal History Records Checks and Background Checks"> <level label="a"> <text>An eligible employee who fails to disclose a conviction or the existence of pending charges for a criminal offense or attempted criminal offense as required under § 19-1905 of this subtitle shall be guilty of perjury and on conviction is subject to the penalty provided by law.</text> </level> <level label="b"> <text>Unless otherwise provided, an eligible employee who violates any provision of this subtitle is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 or imprisonment not exceeding 1 year or both.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1910" title_number="19" title_name="Health Care Facilities" subtitle_number="19" subtitle_name="Adult Dependent Care Programs -- Criminal History Records Checks and Background Checks"> <text>The following persons or agencies shall have the immunity from civil or criminal liability described under § 5-619 of the Courts and Judicial Proceedings Article in connection with a criminal history records check under this subtitle:</text> <level label="1"> <text>An adult dependent care program; and</text> </level> <level label="2"> <text>A State agency.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-1911" title_number="19" title_name="Health Care Facilities" subtitle_number="19" subtitle_name="Adult Dependent Care Programs -- Criminal History Records Checks and Background Checks"> <level label="a"> <text>An employer providing a reference for employment under this subtitle and acting in good faith may not be held liable for disclosing any information about the job performance or the reason for termination of employment of an employee or former employee of the employer.</text> </level> <level label="b"> <text>An employer providing a reference under this subtitle shall be presumed to be acting in good faith unless it is shown by clear and convincing evidence that the employer:</text> <level label="1"> <text>Acted with actual malice toward the employee or former employee; or</text> </level> <level label="2"> <text>Intentionally or recklessly disclosed false information about the employee or former employee.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-1912" title_number="19" title_name="Health Care Facilities" subtitle_number="19" subtitle_name="Adult Dependent Care Programs -- Criminal History Records Checks and Background Checks"> <text>Nothing in this subtitle may be construed to prevent an adult dependent care program from obtaining a criminal history records check or background check on any other individual applying for a job or volunteering services in the program.</text> </section> <section article="ghg" article_name="Health - General" number="19-2001" title_number="19" title_name="Health Care Facilities" subtitle_number="20" subtitle_name="Health Care Staff Agencies"> <level label="a"> <level label="1"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Client facility” means a health care facility that contracts with a health care staff agency for the referral of health care practitioners.</text> </level> <level label="3"> <text>“Health care facility” means a hospital or related institution as defined in § 19–301 of this title.</text> </level> <level label="4"> <level label="i"> <text>Except as provided in subparagraph (ii) of this paragraph, “health care practitioner” means any individual licensed or certified under the Health Occupations Article who:</text> <level label="1"> <text>Is a licensed practical nurse, registered nurse, or certified nursing assistant; or</text> </level> <level label="2"> <text>Practices in an allied health care field, as defined by the Office in regulation.</text> </level> </level> <level label="ii"> <text>“Health care practitioner” does not include:</text> <level label="1"> <text>An acupuncturist;</text> </level> <level label="2"> <text>A dentist;</text> </level> <level label="3"> <text>A nurse anesthetist;</text> </level> <level label="4"> <text>A nurse midwife;</text> </level> <level label="5"> <text>A nurse practitioner;</text> </level> <level label="6"> <text>A pharmacist;</text> </level> <level label="7"> <text>A physician;</text> </level> <level label="8"> <text>A physician assistant; or</text> </level> <level label="9"> <text>A podiatrist.</text> </level> </level> </level> <level label="5"> <level label="i"> <text>“Health care staff agency” means any person, firm, corporation, partnership, or other business entity engaged in the business of referring health care practitioners as employees or independent contractors to render temporary health care services at a health care facility in the State.</text> </level> <level label="ii"> <text>“Health care staff agency” does not include:</text> <level label="1"> <text>A health care staff agency operated by a health care facility or its affiliates solely for the purpose of procuring, furnishing, or referring temporary or permanent health care personnel for employment at that health care facility or its affiliates;</text> </level> <level label="2"> <text>A home health agency regulated under Subtitle 4 of this title; or</text> </level> <level label="3"> <text>Any health care practitioners procuring, furnishing, or referring their own services to a health care facility without the direct or indirect assistance of a health care staff agency.</text> </level> </level> </level> <level label="6"> <text>“Initially providing or referring” means the first time a health care staff agency provides or refers a particular health care practitioner to a health care facility.</text> </level> <level label="7"> <text>“Office” means the Office of Health Care Quality in the Department.</text> </level> <level label="8"> <text>“Responsible party” means the individual at a health care staff agency who controls the day to day operation of the health care staff agency.</text> </level> </level> <level label="b"> <level label="1"> <text>A health care staff agency shall be licensed by the Office before referring health care practitioners to a health care facility to render temporary health care services at a health care facility in this State.</text> </level> <level label="2"> <text>All health care staff agencies shall submit to the Office:</text> <level label="i"> <text>The health care staff agency’s:</text> <level label="1"> <text>Business name;</text> </level> <level label="2"> <text>Business address;</text> </level> <level label="3"> <text>Business telephone number; and</text> </level> <level label="4"> <text>Responsible party; and</text> </level> </level> <level label="ii"> <text>Any other information the Office requires by regulation to ensure compliance with the provisions of this subtitle.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>A health care staff agency shall notify the Office of any change in ownership, agency name, or address within 30 days of the change.</text> </level> <level label="2"> <text>Notwithstanding the provisions of subsection (g)(1) of this section, if a health care staff agency fails to notify the Office within the time required under this subsection, the Office may impose a fine of $100.</text> </level> </level> <level label="d"> <level label="1"> <text>Before initially providing or referring a health care practitioner to health care facilities to render temporary health care services, the health care staff agency shall verify the licensure or certification status of the health care practitioner.</text> </level> <level label="2"> <text>At the time a health care practitioner who is being referred to health care facilities by a health care staff agency must renew the health care practitioner’s license or certificate, the health care staff agency shall:</text> <level label="i"> <text>Submit the name and license or certificate number of the health care practitioner to the Office; and</text> </level> <level label="ii"> <text>Verify the licensure or certification status of the health care practitioner.</text> </level> </level> </level> <level label="e"> <text>A health care staff agency may not knowingly provide or refer an individual who is not licensed or certified under the Health Occupations Article to a health care facility to render health care services.</text> </level> <level label="f"> <level label="1"> <text>Except as provided in paragraph (2) of this subsection:</text> <level label="i"> <text>If a health care staff agency knows of an action or condition performed by a health care practitioner provided or referred by that health care staff agency that might be grounds for action relating to a license or certificate issued under the Health Occupations Article, the health care staff agency shall report the action or condition to the appropriate health occupation board; and</text> </level> <level label="ii"> <text>An individual shall have immunity from liability described under § 5–709 of the Courts and Judicial Proceedings Article for making a report as required under this paragraph.</text> </level> </level> <level label="2"> <text>A health care staff agency is not required under this subsection to make any report that would be in violation of any federal or State law, rule, or regulation concerning the confidentiality of alcohol and drug abuse patient records.</text> </level> </level> <level label="g"> <level label="1"> <text>Subject to the provisions of Title 10, Subtitle 2 of the State Government Article, the Office may impose a penalty for a violation of any provision of this section:</text> <level label="i"> <text>For a first offense, up to $2,500 per violation or up to $2,500 per day until the health care staff agency complies with the requirements of this subtitle;</text> </level> <level label="ii"> <text>For a second offense, up to $5,000 per violation or up to $5,000 per day until the health care staff agency complies with the requirements of this subtitle; and</text> </level> <level label="iii"> <text>For a third or subsequent offense, up to $10,000 per violation or up to $10,000 per day until the health care staff agency complies with the requirements of this subtitle.</text> </level> </level> <level label="2"> <text>Each day a violation continues is a separate violation.</text> </level> </level> <level label="h"> <text>A health care staff agency is not a health care provider.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-2002" title_number="19" title_name="Health Care Facilities" subtitle_number="20" subtitle_name="Health Care Staff Agencies"> <level label="a"> <text>In this section, “Office” means the Office of Health Care Quality in the Department.</text> </level> <level label="b"> <text>The Office may inspect a health care staff agency to verify compliance with this subtitle.</text> </level> <level label="c"> <text>When the Office conducts an inspection, the Office shall verify that the health care practitioners referred by the health care staff agency are licensed or certified by the appropriate health occupation board.</text> </level> <level label="d"> <text>When the Office conducts an inspection, the Office shall verify that the health care staff agency has developed, documented, and implemented procedures for:</text> <level label="1"> <text>Selecting and verifying the credentials of health care practitioners referred by the health care staff agency;</text> </level> <level label="2"> <text>Validating experience of health care practitioners prior to referral by the health care staff agency;</text> </level> <level label="3"> <text>Tracking and acting on serious or life–threatening complaints received by a client facility or the client facility’s agent;</text> </level> <level label="4"> <text>Reporting of an action or condition under § 19–2001(f) of this subtitle;</text> </level> <level label="5"> <text>Verifying that health care practitioners referred by the health care staff agency are of satisfactory health status and have received the necessary testing and immunization as required or requested by the client facility;</text> </level> <level label="6"> <text>Verifying I–9 status;</text> </level> <level label="7"> <text>Verifying, prior to initial referral of health care practitioners to a client facility by the health care staff agency, drug screening of health care practitioners referred by the health care staff agency if the client facility requires drug screening for facility employees;</text> </level> <level label="8"> <text>Verifying, when there is probable cause to perform a drug test or when a client facility requests a drug test, drug testing of health care practitioners referred by the health care staff agency;</text> </level> <level label="9"> <text>Verifying, prior to initial referral of health care practitioners to a client facility by the health care staff agency, criminal background checks of health care practitioners referred by the health care staff agency if the client facility requires criminal background checks for facility employees; and</text> </level> <level label="10"> <text>Verifying the references of health care practitioners referred by the health care staff agency.</text> </level> </level> <level label="e"> <text>A health care staff agency shall attest that the health care staff agency is in compliance with the:</text> <level label="1"> <text>Civil Rights Act of 1964;</text> </level> <level label="2"> <text>Rehabilitation Act of 1973;</text> </level> <level label="3"> <text>Americans with Disabilities Act of 1990; and</text> </level> <level label="4"> <text>Drug Free Workplace Act of 1988, if applicable.</text> </level> </level> <level label="f"> <text>The Office may inspect a health care staff agency upon receiving a complaint, and may give notice of the inspection to the health care staff agency.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-2101" effective_note="EFFECTIVE UNTIL JUNE 30, 2035 PER CHAPTER 386 OF 2024" title_number="19" title_name="Health Care Facilities" subtitle_number="21" subtitle_name="Maryland Community Health Resources Commission"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Affordable Care Act” means the federal Patient Protection and Affordable Care Act, as amended by the federal Health Care and Education Reconciliation Act of 2010, and any regulations adopted or guidance issued under the Acts.</text> </level> <level label="c"> <text>“Commission” means the Maryland Community Health Resources Commission.</text> </level> <level label="d"> <level label="1"> <text>“Community health resource” means a nonprofit or for profit health care center or program that offers the primary health care services required by the Commission under § 19–2109(a)(2) of this subtitle to an individual on a sliding scale fee schedule and without regard to an individual’s ability to pay.</text> </level> <level label="2"> <text>“Community health resource” includes:</text> <level label="i"> <text>A federally qualified health center;</text> </level> <level label="ii"> <text>A federally qualified health center “look–alike”;</text> </level> <level label="iii"> <text>A community health center;</text> </level> <level label="iv"> <text>A migrant health center;</text> </level> <level label="v"> <text>A health care program for the homeless;</text> </level> <level label="vi"> <text>A primary care program for a public housing project;</text> </level> <level label="vii"> <text>A local nonprofit and community–owned health care program;</text> </level> <level label="viii"> <text>A school–based health center;</text> </level> <level label="ix"> <text>A teaching clinic;</text> </level> <level label="x"> <text>A wellmobile;</text> </level> <level label="xi"> <text>A health center controlled operating network;</text> </level> <level label="xii"> <text>A historic Maryland primary care provider;</text> </level> <level label="xiii"> <text>An outpatient behavioral health program; and</text> </level> <level label="xiv"> <text>Any other center or program identified by the Commission as a community health resource.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-2102" effective_note="EFFECTIVE UNTIL JUNE 30, 2035 PER CHAPTER 386 OF 2024" title_number="19" title_name="Health Care Facilities" subtitle_number="21" subtitle_name="Maryland Community Health Resources Commission"> <level label="a"> <text>There is a Maryland Community Health Resources Commission.</text> </level> <level label="b"> <text>The Commission is an independent commission that operates within the Department.</text> </level> <level label="c"> <text>The purpose of the Commission is to increase access to health care through community health resources.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-2103" effective_note="EFFECTIVE UNTIL JUNE 30, 2035 PER CHAPTER 386 OF 2024" title_number="19" title_name="Health Care Facilities" subtitle_number="21" subtitle_name="Maryland Community Health Resources Commission"> <level label="a"> <level label="1"> <text>The Commission consists of eleven members appointed by the Governor with the advice and consent of the Senate.</text> </level> <level label="2"> <text>Of the eleven members:</text> <level label="i"> <text>One shall be a representative of a nonprofit health maintenance organization;</text> </level> <level label="ii"> <text>One shall be a representative of a nonprofit health service plan;</text> </level> <level label="iii"> <text>One shall be a representative of a Maryland hospital;</text> </level> <level label="iv"> <text>Four shall be individuals who:</text> <level label="1"> <text>Do not have any connection with the management or policy of a community health resource, nonprofit health service plan, or nonprofit health maintenance organization; and</text> </level> <level label="2"> <text>Have a background or experience in health care;</text> </level> </level> <level label="v"> <text>One shall be an individual who has a background or experience with an outpatient mental health clinic within the past 5 years; and</text> </level> <level label="vi"> <text>Three shall be individuals who have a background or experience with a community health resource within the past 5 years.</text> </level> </level> <level label="3"> <text>At least two of the eleven members shall be health care professionals licensed in the State.</text> </level> </level> <level label="b"> <text>To the extent practicable, when appointing members to the Commission, the Governor shall assure geographic balance and promote racial and gender diversity in the Commission’s membership.</text> </level> <level label="c"> <level label="1"> <text>On or after July 1, 2009, the term of a member is 4 years.</text> </level> <level label="2"> <text>The terms of members are staggered as required by the terms provided for members of the Commission on July 1, 2009.</text> </level> <level label="3"> <text>At the end of a term, a member continues to serve until a successor is appointed and qualifies.</text> </level> <level label="4"> <text>A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies.</text> </level> <level label="5"> <text>A member may not serve more than two consecutive terms, except that a member appointed before July 1, 2009, may serve one additional 4–year term when the member’s current term expires.</text> </level> <level label="6"> <text>The Governor may remove a member for neglect of duty, incompetence, or misconduct.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-2104" effective_note="EFFECTIVE UNTIL JUNE 30, 2035 PER CHAPTER 386 OF 2024" title_number="19" title_name="Health Care Facilities" subtitle_number="21" subtitle_name="Maryland Community Health Resources Commission"> <text>From among the members of the Commission:</text> <level label="1"> <text>The Governor shall appoint a chair; and</text> </level> <level label="2"> <text>The chair shall appoint a vice chair.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-2105" effective_note="EFFECTIVE UNTIL JUNE 30, 2035 PER CHAPTER 386 OF 2024" title_number="19" title_name="Health Care Facilities" subtitle_number="21" subtitle_name="Maryland Community Health Resources Commission"> <level label="a"> <text>With the approval of the Governor, the Commission shall appoint an Executive Director, who is the chief administrative officer of the Commission.</text> </level> <level label="b"> <text>The Executive Director serves at the pleasure of the Commission.</text> </level> <level label="c"> <text>Under the direction of the Commission, the Executive Director shall perform any duty or function that the Commission requires.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-2106" effective_note="EFFECTIVE UNTIL JUNE 30, 2035 PER CHAPTER 386 OF 2024" title_number="19" title_name="Health Care Facilities" subtitle_number="21" subtitle_name="Maryland Community Health Resources Commission"> <level label="a"> <level label="1"> <text>A majority of the full authorized membership of the Commission is a quorum.</text> </level> <level label="2"> <text>The decision of the Commission shall be by a majority of the quorum present and voting.</text> </level> </level> <level label="b"> <text>The Commission shall meet at least six times a year, at the times and places that it determines.</text> </level> <level label="c"> <text>A member of the Commission is entitled to:</text> <level label="1"> <text>Compensation in accordance with the State budget; and</text> </level> <level label="2"> <text>Reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget.</text> </level> </level> <level label="d"> <level label="1"> <text>The Commission may employ a staff in accordance with the State budget.</text> </level> <level label="2"> <text>The Commission, in consultation with the Secretary, shall determine the appropriate job classifications and grades for all staff.</text> </level> <level label="3"> <text>The Commission, in consultation with the Secretary, may set the compensation of a Commission employee in a position that:</text> <level label="i"> <text>Is unique to the Commission;</text> </level> <level label="ii"> <text>Requires specific skills or experience to perform the duties of the position; and</text> </level> <level label="iii"> <text>Does not require the employee to perform functions that are comparable to functions performed in other units of the Executive Branch of State government.</text> </level> </level> <level label="4"> <text>The Secretary of Budget and Management, in consultation with the Commission, shall determine the positions for which the Commission may set compensation under paragraph (3) of this subsection.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-2107" effective_note="EFFECTIVE UNTIL JUNE 30, 2035 PER CHAPTER 386 OF 2024" title_number="19" title_name="Health Care Facilities" subtitle_number="21" subtitle_name="Maryland Community Health Resources Commission"> <level label="a"> <text>In addition to the powers set forth elsewhere in this subtitle, the Commission may:</text> <level label="1"> <text>Adopt regulations to carry out the provisions of this subtitle;</text> </level> <level label="2"> <text>Create committees from among its members;</text> </level> <level label="3"> <text>Appoint advisory committees, which may include individuals and representatives of interested public or private organizations;</text> </level> <level label="4"> <text>Apply for and accept any funds, property, or services from any person or government agency;</text> </level> <level label="5"> <text>Make agreements with a grantor or payor of funds, property, or services, including an agreement to make any study, plan, demonstration, or project;</text> </level> <level label="6"> <text>Publish and give out any information that relates to expanding access to health care through community health resources that is considered desirable in the public interest;</text> </level> <level label="7"> <text>Subject to the limitations of this subtitle, exercise any other power that is reasonably necessary to carry out the purposes of this subtitle; and</text> </level> <level label="8"> <text>Assist community health resources in preparing to implement the Affordable Care Act.</text> </level> </level> <level label="b"> <text>In addition to the duties set forth elsewhere in this subtitle, the Commission shall:</text> <level label="1"> <text>Adopt rules and regulations that relate to its meetings, minutes, and transactions;</text> </level> <level label="2"> <text>Keep minutes of each meeting;</text> </level> <level label="3"> <text>Prepare annually a budget proposal that includes the estimated income of the Commission and proposed expenses for its administration and operation; and</text> </level> <level label="4"> <text>On or before October 1 of each year, submit to the Governor, to the Secretary, and, in accordance with § 2–1257 of the State Government Article, to the General Assembly an annual report on the operations and activities of the Commission during the preceding fiscal year.</text> </level> </level> <level label="c"> <level label="1"> <text>The Commission may contract with a qualified, independent third party for any service that is necessary to carry out the powers and duties of the Commission.</text> </level> <level label="2"> <text>Unless permission is granted specifically by the Commission, a third party with whom the Commission contracts under paragraph (1) of this subsection may not release, publish, or use in a manner not authorized by the contract any information to which the third party has access under the contract.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-2108" effective_note="EFFECTIVE UNTIL JUNE 30, 2035 PER CHAPTER 386 OF 2024" title_number="19" title_name="Health Care Facilities" subtitle_number="21" subtitle_name="Maryland Community Health Resources Commission"> <level label="a"> <text>The power of the Secretary over plans, proposals, and projects of units in the Department does not include the power to disapprove or modify any decision or determination that the Commission makes under authority specifically delegated by law to the Commission.</text> </level> <level label="b"> <text>The power of the Secretary to transfer by rule, regulation, or written directive any staff, functions, or funds of units in the Department does not apply to any staff, functions, or funds of the Commission.</text> </level> <level label="c"> <level label="1"> <text>The power of the Secretary over the procurement procedure for units in the Department does not apply to the procurement procedure of the Commission.</text> </level> <level label="2"> <text>Notwithstanding paragraph (1) of this subsection, when procuring services or supplies, the Commission is subject to the provisions of the State Finance and Procurement Article.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-2109" effective_note="EFFECTIVE UNTIL JUNE 30, 2035 PER CHAPTER 386 OF 2024" title_number="19" title_name="Health Care Facilities" subtitle_number="21" subtitle_name="Maryland Community Health Resources Commission"> <level label="a"> <text>In addition to the duties set forth elsewhere in this subtitle, the Commission shall, to the extent budgeted resources permit:</text> <level label="1"> <text>Establish by regulation the criteria to qualify as a community health resource under this subtitle;</text> </level> <level label="2"> <text>Establish by regulation the services that a community health resource shall provide to qualify as a community health resource under this subtitle;</text> </level> <level label="3"> <text>Require community health resources to submit a plan to the Commission on how the community health resource will provide or arrange to provide mental health services;</text> </level> <level label="4"> <text>Identify and seek federal and State funding for the expansion of community health resources;</text> </level> <level label="5"> <text>Establish by regulation the criteria for community health resources to qualify for operating grants and procedures for applying for operating grants;</text> </level> <level label="6"> <text>Administer operating grant fund programs for qualifying community health resources;</text> </level> <level label="7"> <text>Taking into consideration regional disparities in income and the cost of medical services, establish guidelines for sliding scale fee payments at community health resources that are not federally qualified health centers, for individuals whose family income is between 100% and 200% of the federal poverty guidelines;</text> </level> <level label="8"> <text>Identify and implement programs and policies to encourage specialist providers to serve individuals referred from community health resources;</text> </level> <level label="9"> <text>Identify and implement programs and policies to encourage hospitals and community health resources to partner to increase access to health care services;</text> </level> <level label="10"> <text>Establish a reverse referral pilot program under which a hospital will identify and assist patients in accessing health care services through a community health resource;</text> </level> <level label="11"> <text>Work with community health resources, hospital systems, and others to develop a unified information and data management system for use by all community health resources that is integrated with the local hospital systems to track the treatment of individual patients and that provides real–time indicators of available resources;</text> </level> <level label="12"> <text>Work in cooperation with clinical education and training programs, area health education centers, and telemedicine centers to enhance access to quality primary and specialty health care for individuals in rural and underserved areas referred by community health resources;</text> </level> <level label="13"> <text>Evaluate the feasibility of developing a capital grant program for community health resources that are not federally qualified health centers;</text> </level> <level label="14"> <text>Develop an outreach program to educate and inform individuals of the availability of community health resources and assist individuals under 200% of the federal poverty level who do not have health insurance to access health care services through community health resources;</text> </level> <level label="15"> <text>Study school–based health center funding and access issues including:</text> <level label="i"> <text>Reimbursement of school–based health centers by managed care organizations, insurers, nonprofit health service plans, and health maintenance organizations; and</text> </level> <level label="ii"> <text>Methods to expand school–based health centers to provide primary care services;</text> </level> </level> <level label="16"> <text>Study access and reimbursement issues regarding the provision of dental services;</text> </level> <level label="17"> <text>Evaluate the feasibility of extending liability protection under the Maryland Tort Claims Act to health care practitioners who contract directly with a community health resource that is also a Maryland qualified health center or a school–based health center; and</text> </level> <level label="18"> <text>Establish criteria and mechanisms to pay for office–based specialty care visits, diagnostic testing, and laboratory tests for uninsured individuals with family income that does not exceed 200% of the federal poverty guidelines who are referred through community health resources.</text> </level> </level> <level label="b"> <text>The reverse referral pilot program established under subsection (a)(10) of this section shall include at least one hospital and one community health resource from a rural, urban, and suburban area of this State.</text> </level> <level label="c"> <text>The Commission, in developing and implementing the outreach program established under subsection (a)(14) of this section, shall consult and coordinate with the Motor Vehicle Administration, workforce development boards, local departments of social services, local health departments, Medbank Inc., the Comptroller, the Maryland Health Care Commission, hospitals, community health resources, and physicians to provide outreach and consumer information.</text> </level> <level label="d"> <text>The Commission, in conducting the school–based health center study required under subsection (a)(15) of this section, shall:</text> <level label="1"> <text>Solicit input from and consult with local governments that operate school–based health centers, the State Department of Education, the Maryland Insurance Commissioner, representatives from school–based health centers, providers, and insurers; and</text> </level> <level label="2"> <text>Identify the following:</text> <level label="i"> <text>A fee schedule for individuals accessing a school–based community health center;</text> </level> <level label="ii"> <text>Reimbursement rates to be paid by managed care organizations and insurers, nonprofit health services plans, and health maintenance organizations to the school–based community health center;</text> </level> <level label="iii"> <text>Insurance payments owed to school–based community health centers and how much of the payments should be collected to offset any State subsidy;</text> </level> <level label="iv"> <text>Barriers to the reimbursement of licensed health care providers who provide services at school–based health centers, including nurse practitioners and physician assistants;</text> </level> <level label="v"> <text>A system of registering individuals who receive health care services from a school–based community health center that requires an individual to pay premiums and sliding scale fees; and</text> </level> <level label="vi"> <text>Security measures to be used by school–based community health centers.</text> </level> </level> </level> <level label="e"> <text>The Commission, in conducting the dental services study required under subsection (a)(16) of this section, shall select input from and consult with community health resources that provide dental services, managed care organizations, the University of Maryland School of Dentistry, and dental service providers.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-2111" effective_note="EFFECTIVE UNTIL JUNE 30, 2035 PER CHAPTER 386 OF 2024" title_number="19" title_name="Health Care Facilities" subtitle_number="21" subtitle_name="Maryland Community Health Resources Commission"> <level label="a"> <text>The Commission, in collaboration with community health resources and local health departments, shall develop a specialty care network for individuals:</text> <level label="1"> <text>With family income that does not exceed 200% of the federal poverty level; and</text> </level> <level label="2"> <text>Who are referred through a community health resource.</text> </level> </level> <level label="b"> <text>The specialty care network shall:</text> <level label="1"> <text>Consist of health care practitioners who agree to provide care to individuals referred through a community health resource for a discounted fee established by the Commission; and</text> </level> <level label="2"> <text>Include health care practitioners who historically have served the uninsured.</text> </level> </level> <level label="c"> <text>Individuals receiving health care through the specialty care network shall pay for specialty care according to a sliding fee scale developed by the Commission.</text> </level> <level label="d"> <text>In addition to patient fees, office–based specialty care visits, diagnostic testing, and laboratory tests shall be subsidized by funds provided from:</text> <level label="1"> <text>General funds; and</text> </level> <level label="2"> <text>Money collected from a nonprofit health maintenance organization in accordance with § 6–121(b)(3) of the Insurance Article.</text> </level> </level> <level label="e"> <text>Subject to available funding, the Commission shall provide subsidies to community health resources for office–based specialty care visits, diagnostic testing, and laboratory tests.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-2201" future_version_removed="true" title_number="19" title_name="Health Care Facilities" subtitle_number="22" subtitle_name="Community Health Resources Commission Fund"> <level label="a"> <text>In this section, “Fund” means the Community Health Resources Commission Fund.</text> </level> <level label="b"> <text>There is a Community Health Resources Commission Fund.</text> </level> <level label="c"> <level label="1"> <text>The Fund is a special, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.</text> </level> <level label="2"> <text>The Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund.</text> </level> </level> <level label="d"> <text>The Fund consists of:</text> <level label="1"> <text>Money collected from a nonprofit health service plan in accordance with § 14–106.1 of the Insurance Article;</text> </level> <level label="2"> <text>Money from the Cigarette Restitution Fund, appropriated in accordance with § 7–317 of the State Finance and Procurement Article;</text> </level> <level label="3"> <text>Interest earned on investments;</text> </level> <level label="4"> <text>Money donated to the Fund;</text> </level> <level label="5"> <text>Money awarded to the Fund through grants; and</text> </level> <level label="6"> <text>Any other money from any other source accepted for the benefit of the Fund.</text> </level> </level> <level label="e"> <level label="1"> <text>Subject to paragraph (2) of this subsection, the Fund may be used only to:</text> <level label="i"> <text>Cover the administrative costs of the Commission;</text> </level> <level label="ii"> <text>Cover the actual documented direct costs of fulfilling the statutory and regulatory duties of the Commission in accordance with the provisions of this subtitle;</text> </level> <level label="iii"> <text>Provide operating grants to qualifying community health resources; and</text> </level> <level label="iv"> <text>Provide funding for the development, support, and monitoring of a unified data information system among primary and specialty care providers, hospitals, and other providers of services to community health resource members.</text> </level> </level> <level label="2"> <level label="i"> <text>For fiscal years 2014, 2015, and 2016, the Fund may be used for any project or initiative authorized under Title 20, Subtitle 14 of this article and approved by the Commission if no less than $4,000,000 of the subsidy required under § 14–106(d)(2)(ii)2 of the Insurance Article is used in each fiscal year for the purposes under paragraph (1) of this subsection.</text> </level> <level label="ii"> <text>For fiscal year 2017, the Fund may be used for any project or initiative authorized under Title 20, Subtitle 14 of this article and approved by the Commission if no less than $8,000,000 of the subsidy required under § 14–106(d)(2)(ii)2 of the Insurance Article is used in each fiscal year for the purposes under paragraph (1) of this subsection.</text> </level> <level label="iii"> <text>For fiscal year 2018, the Fund may be used for any project or initiative authorized under Title 10, Subtitle 2 and Title 13, Subtitle 3 of this article and approved by the Commission if no less than $4,750,000 of the subsidy required under § 14–106(d)(2)(ii)2 of the Insurance Article is used in that fiscal year for the purposes under paragraph (1) of this subsection.</text> </level> <level label="iv"> <text>For fiscal years 2019 through 2021, the Fund may be used for any project or initiative authorized under Title 10, Subtitle 2 and Title 13, Subtitle 3 of this article and approved by the Commission if no less than $8,000,000 of the subsidy required under § 14–106(d)(2)(ii)2 of the Insurance Article is used in each fiscal year for the purposes under paragraph (1) of this subsection.</text> </level> <level label="v"> <text>For fiscal year 2022, the Fund may be used for any project or initiative authorized under Title 10, Subtitle 2 and Title 13, Subtitle 3 of this article and approved by the Commission if not more than $8,000,000 of the subsidy required under § 14–106(d)(2)(ii)2 of the Insurance Article is used in that fiscal year for the purposes under paragraph (1) of this subsection.</text> </level> </level> <level label="3"> <text>The funding for a unified data information system under paragraph (1)(iv) of this subsection shall be limited to:</text> <level label="i"> <text>$500,000 in fiscal year 2006; and</text> </level> <level label="ii"> <text>$1,700,000 in fiscal year 2007 and annually thereafter.</text> </level> </level> </level> <level label="f"> <text>The Commission shall adopt regulations that:</text> <level label="1"> <text>Establish the criteria for a community health resource to qualify for a grant;</text> </level> <level label="2"> <text>Establish the procedures for disbursing grants to qualifying community health resources;</text> </level> <level label="3"> <text>Develop a formula for disbursing grants to qualifying community health resources;</text> </level> <level label="4"> <text>Establish criteria and mechanisms for funding a unified data information system; and</text> </level> <level label="5"> <text>In consultation with the Secretary, implement a program to provide subsidies to community health resources for office–based specialty care visits, diagnostic testing, and laboratory tests.</text> </level> </level> <level label="g"> <text>In developing regulations under subsection (f)(1) of this section, the Commission shall:</text> <level label="1"> <text>Consider geographic balance; and</text> </level> <level label="2"> <text>Give priority to community health resources that:</text> <level label="i"> <text>In addition to normal business hours, have evening and weekend hours of operation;</text> </level> <level label="ii"> <text>Have partnered with a hospital to establish a reverse referral program at the hospital;</text> </level> <level label="iii"> <text>Reduce the use of the hospital emergency department for nonemergency services;</text> </level> <level label="iv"> <text>Assist patients in establishing a medical home with a community health resource;</text> </level> <level label="v"> <text>Coordinate and integrate the delivery of primary and specialty care services;</text> </level> <level label="vi"> <text>Promote the integration of mental and somatic health with federally qualified health centers or other somatic care providers;</text> </level> <level label="vii"> <text>Fund medication management or therapy services for uninsured individuals up to 200% of the federal poverty level who meet medical necessity criteria but who are ineligible for the public mental health system;</text> </level> <level label="viii"> <text>Provide a clinical home for individuals who access hospital emergency departments for mental health services, substance abuse services, or both; and</text> </level> <level label="ix"> <text>Support the implementation of evidence–based clinical practices.</text> </level> </level> </level> <level label="h"> <text>Grants awarded to a community health resource under this section may be used:</text> <level label="1"> <text>To provide operational assistance to a community health resource; and</text> </level> <level label="2"> <text>For any other purpose the Commission determines is appropriate to assist a community health resource.</text> </level> </level> <level label="i"> <level label="1"> <text>The Treasurer shall invest the money in the Fund in the same manner as other State money may be invested.</text> </level> <level label="2"> <text>Any investment earnings of the Fund shall be retained to the credit of the Fund.</text> </level> </level> <level label="j"> <text>The Fund shall be subject to an audit by the Office of Legislative Audits as provided for in § 2–1220 of the State Government Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-22A-01" title_number="19" title_name="Health Care Facilities" subtitle_number="22A" subtitle_name="School–based Health Centers"> <text>The Secretary, in consultation with the State Department of Education and other stakeholders, shall develop guidelines to support the expansion of school–based health centers.</text> </section> <section article="ghg" article_name="Health - General" number="19-22A-04" title_number="19" title_name="Health Care Facilities" subtitle_number="22A" subtitle_name="School–based Health Centers"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Commission” means the Maryland Community Health Resources Commission.</text> </level> <level label="c"> <text>“Council” means the Maryland Council on Advancement of School–Based Health Centers.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-22A-05" title_number="19" title_name="Health Care Facilities" subtitle_number="22A" subtitle_name="School–based Health Centers"> <level label="a"> <text>There is a Maryland Council on Advancement of School–Based Health Centers in the Department.</text> </level> <level label="b"> <text>The purpose of the Council is to improve the health and educational outcomes of students who receive services from school–based health centers by advancing the integration of school–based health centers into:</text> <level label="1"> <text>The health care system at the State and local levels; and</text> </level> <level label="2"> <text>The educational system at the State and local levels.</text> </level> </level> <level label="c"> <level label="1"> <text>Staff support for the Council shall be provided by the Commission.</text> </level> <level label="2"> <text>The Commission may seek the assistance of organizations with expertise in school–based health care or other matters within the duties of the Council provided in § 19–22A–08 of this subtitle to provide additional staffing resources to the Commission and the Council.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-22A-06" title_number="19" title_name="Health Care Facilities" subtitle_number="22A" subtitle_name="School–based Health Centers"> <level label="a"> <text>The Council consists of the following 16 voting members and 6 ex officio members:</text> <level label="1"> <text>One member of the Senate of Maryland, appointed by the President of the Senate, as an ex officio member;</text> </level> <level label="2"> <text>One member of the House of Delegates, appointed by the Speaker of the House, as an ex officio member;</text> </level> <level label="3"> <text>The Secretary of Health, or a designee of the Secretary, as an ex officio member;</text> </level> <level label="4"> <text>The State Superintendent of Schools as an ex officio member;</text> </level> <level label="5"> <text>The Executive Director of the Maryland Health Benefit Exchange as an ex officio member;</text> </level> <level label="6"> <text>The Chairman of the Commission, or a designee of the Chairman, as an ex officio member; and</text> </level> <level label="7"> <text>The following 16 members, appointed by the Governor:</text> <level label="i"> <text>The President of the Maryland Assembly on School–Based Health Care, or a designee of the President;</text> </level> <level label="ii"> <text>Three representatives of school–based health centers, nominated by the Maryland Assembly on School–Based Health Care:</text> <level label="1"> <text>From a diverse array of sponsoring organizations; and</text> </level> <level label="2"> <text>For at least one of the representatives, from a nursing background;</text> </level> </level> <level label="iii"> <text>One representative of the Public Schools Superintendents Association of Maryland;</text> </level> <level label="iv"> <text>One representative of the Maryland Association of Boards of Education;</text> </level> <level label="v"> <text>One elementary school principal of a school that has a school–based health center;</text> </level> <level label="vi"> <text>One secondary school principal of a school that has a school–based health center;</text> </level> <level label="vii"> <text>One representative of the Maryland Hospital Association;</text> </level> <level label="viii"> <text>One representative of the Maryland Association of County Health Officers;</text> </level> <level label="ix"> <text>One representative of a federally qualified health center, nominated by the Mid–Atlantic Association of Community Health Centers;</text> </level> <level label="x"> <text>One representative of a managed care organization;</text> </level> <level label="xi"> <text>One representative of a commercial health insurance carrier;</text> </level> <level label="xii"> <text>One pediatrician, nominated by the Maryland Chapter of the American Academy of Pediatrics;</text> </level> <level label="xiii"> <text>One parent or guardian of a student who utilizes services at a school–based health center; and</text> </level> <level label="xiv"> <text>One school nurse, nominated by the Maryland Association of School Health Nurses.</text> </level> </level> </level> <level label="b"> <text>In making the appointments required under this section, the Governor shall ensure that the Council is representative of:</text> <level label="1"> <text>The geographic regions of the State; and</text> </level> <level label="2"> <text>Minority populations of the State.</text> </level> </level> <level label="c"> <level label="1"> <text>The term of a member appointed under subsection (a) of this section is 3 years.</text> </level> <level label="2"> <text>The terms of voting members are staggered as required by the terms provided for members of the Council on October 1, 2015.</text> </level> <level label="3"> <text>At the end of a term, a member shall continue to serve until a successor is appointed and qualifies.</text> </level> <level label="4"> <text>A member who is appointed after a term has begun shall serve for the rest of the term or until a successor is appointed and qualifies.</text> </level> </level> <level label="d"> <text>The Governor shall appoint a successor in the event of a vacancy on the Council.</text> </level> <level label="e"> <text>From among the members of the Council, the voting members of the Council shall elect a chair for a 2–year term.</text> </level> <level label="f"> <text>A member of the Council may not receive compensation but is entitled to reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-22A-07" title_number="19" title_name="Health Care Facilities" subtitle_number="22A" subtitle_name="School–based Health Centers"> <level label="a"> <text>A majority of the members then serving on the Council is a quorum.</text> </level> <level label="b"> <text>The Council shall determine the times and places of its meetings and any other necessary operating procedures in accordance with the Open Meetings Act.</text> </level> <level label="c"> <level label="1"> <text>The Council may establish workgroups to advise the Council on specific issues, including behavioral health, oral health, and primary care.</text> </level> <level label="2"> <level label="i"> <text>The chair of the Council shall appoint the members of a workgroup established by the Council under paragraph (1) of this subsection.</text> </level> <level label="ii"> <text>The chair of the Council may appoint the following individuals to a workgroup:</text> <level label="1"> <text>Members of the Council with expertise in the issue to be studied; and</text> </level> <level label="2"> <text>Members of the public, including consumers and stakeholder group representatives, with expertise in the area to be studied.</text> </level> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-22A-08" title_number="19" title_name="Health Care Facilities" subtitle_number="22A" subtitle_name="School–based Health Centers"> <level label="a"> <text>The Council shall develop policy recommendations to improve the health and educational outcomes of students who receive services from school–based health centers by:</text> <level label="1"> <text>Supporting local community efforts to establish or expand school–based health center capacity in primary care, behavioral health, and oral health;</text> </level> <level label="2"> <text>Integrating school–based health centers into existing and emerging patient–centered models of care;</text> </level> <level label="3"> <text>Promoting the inclusion of school–based health centers in networks of managed care organizations and commercial health insurance carriers;</text> </level> <level label="4"> <text>Advancing the public health goals of State and local health officials;</text> </level> <level label="5"> <text>Promoting the inclusion of school–based health centers into networks of school health services and coordinated student service models for the range of services offered in school settings;</text> </level> <level label="6"> <text>Supporting State and local initiatives to promote student success;</text> </level> <level label="7"> <text>Reviewing and revising best practice guidelines; and</text> </level> <level label="8"> <text>Supporting the long–term sustainability of school–based health centers.</text> </level> </level> <level label="b"> <text>The Council shall review the collection and analysis of school–based health center data collected by the State Department of Education to:</text> <level label="1"> <text>Make recommendations on best practices for the collection and analysis of the data; and</text> </level> <level label="2"> <text>Provide guidance on the development of findings and recommendations based on the data.</text> </level> </level> <level label="c"> <text>The Council shall conduct other activities the Council considers appropriate to meet the purpose of the Council.</text> </level> <level label="d"> <text>On or before December 31 of each year, the Council shall report the findings and recommendations of the Council to the Maryland Department of Health, the State Department of Education, the Commission, and, in accordance with § 2–1257 of the State Government Article, the General Assembly on improving the health and educational outcomes of students who receive services from school–based health centers.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-2301" title_number="19" title_name="Health Care Facilities" subtitle_number="23" subtitle_name="Accreditation of Health Care Facilities and Health Care Staff Agencies"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Accreditation organization” means a private entity that conducts inspections and surveys of health care facilities or health care staff agencies based on nationally recognized and developed standards.</text> </level> <level label="c"> <text>“Deemed status” means a status under which a health care facility or a health care staff agency may be exempt from routine surveys conducted by the Department.</text> </level> <level label="d"> <text>“Health care facility” means:</text> <level label="1"> <text>A hospital as defined in § 19–301 of this title;</text> </level> <level label="2"> <text>A health maintenance organization as defined in § 19–701(g) of this title;</text> </level> <level label="3"> <text>A freestanding ambulatory care facility as defined in § 19–3B–01 of this title;</text> </level> <level label="4"> <text>An assisted living facility as defined in § 19–1801 of this title;</text> </level> <level label="5"> <text>A laboratory as defined in § 17–201 of this article;</text> </level> <level label="6"> <text>A home health agency as defined in § 19–401 of this title;</text> </level> <level label="7"> <text>A residential treatment center as defined in § 19–301 of this title;</text> </level> <level label="8"> <text>A comprehensive rehabilitation facility as defined in § 19–1201 of this title;</text> </level> <level label="9"> <text>A forensic laboratory as defined in § 17–2A–01 of this article;</text> </level> <level label="10"> <text>A substance–related disorder program as defined in § 7.5–101 of this article; and</text> </level> <level label="11"> <text>A mental health program as defined in § 7.5–101 of this article.</text> </level> </level> <level label="e"> <text>“Health care staff agency” has the meaning stated in § 19–2001 of this title.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-2302" title_number="19" title_name="Health Care Facilities" subtitle_number="23" subtitle_name="Accreditation of Health Care Facilities and Health Care Staff Agencies"> <level label="a"> <text>An accreditation organization shall apply to the Secretary for approval.</text> </level> <level label="b"> <text>Prior to approval of an accreditation organization, the Secretary shall:</text> <level label="1"> <text>Determine that the standards of the accreditation organization are equal to or more stringent than existing State requirements;</text> </level> <level label="2"> <text>Evaluate the survey or inspection process of the accreditation organization to ensure the integrity of the survey or inspection process; and</text> </level> <level label="3"> <text>Enter into a formal written agreement with the accreditation organization that includes requirements for:</text> <level label="i"> <text>Notice of all surveys and inspections;</text> </level> <level label="ii"> <text>Sharing of complaints and other relevant information;</text> </level> <level label="iii"> <text>Participation of the Department in accreditation organization activities; and</text> </level> <level label="iv"> <text>Any other provision necessary to ensure the integrity of the accreditation and licensure process.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>When an approved accreditation organization has issued a final report finding a health care facility or a health care staff agency to be in substantial compliance with the accreditation organization’s standards, the Department shall accept the report as evidence that the health care facility or health care staff agency has met State licensure requirements and shall grant the health care facility or health care staff agency deemed status.</text> </level> <level label="2"> <text>A health care facility or a health care staff agency that fails to achieve substantial compliance with the standards of an approved accreditation organization may be subject to the provisions of § 19–360 of this title.</text> </level> </level> <level label="d"> <level label="1"> <text>An approved accreditation organization shall send the Department any preliminary and final report of each inspection and survey at the time it is sent to the health care facility or health care staff agency.</text> </level> <level label="2"> <text>A final report of an approved accreditation organization shall be made immediately available to the public on request.</text> </level> <level label="3"> <text>A preliminary or final report of an approved accreditation organization is not admissible in evidence in any civil action or proceeding.</text> </level> </level> <level label="e"> <text>The Department may inspect an accredited health care facility or a health care staff agency to:</text> <level label="1"> <text>Determine compliance with any quality requirement;</text> </level> <level label="2"> <text>Follow up on any serious problem identified by an approved accreditation organization;</text> </level> <level label="3"> <text>Investigate a complaint; or</text> </level> <level label="4"> <text>Validate the findings of an approved accreditation organization.</text> </level> </level> <level label="f"> <text>The Department may participate in or observe a survey or inspection of a health care facility or a health care staff agency conducted by an approved accreditation organization.</text> </level> <level label="g"> <text>On a determination by the Secretary that an approved accreditation organization has failed to meet its obligations under this section, the Secretary may withdraw:</text> <level label="1"> <text>The approval from the accreditation organization; and</text> </level> <level label="2"> <text>The deemed status given to a health care facility or a health care staff agency by the accreditation organization.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-2401" title_number="19" title_name="Health Care Facilities" subtitle_number="24" subtitle_name="Prince George's County Regional Medical Center"> <level label="a"> <text>The General Assembly finds that:</text> <level label="1"> <text>In 2011, the State, Prince George’s County, and the University of Maryland Medical System came together in a historic public–private partnership to transition the last county–owned hospital system in the State to a private, nonprofit institution that is part of the State’s largest academic medical system, with the goal of transforming health care delivery in the second most populous county in the State;</text> </level> <level label="2"> <text>The goals established under the partnership include:</text> <level label="i"> <text>Growing access to high–quality clinical programs in Prince George’s County;</text> </level> <level label="ii"> <text>Establishing a delivery system that enables residents to receive care within Prince George’s County;</text> </level> <level label="iii"> <text>Addressing the disproportionate burden of chronic health conditions impacting residents of Prince George’s County, including heart disease and cancer; and</text> </level> <level label="iv"> <text>Serving as an anchor institution and engine of economic development for Prince George’s County and the southern Maryland region;</text> </level> </level> <level label="3"> <text>Key to the transformation of care in Prince George’s County are efforts to:</text> <level label="i"> <text>Build high–quality specialty clinical programs, such as cancer, cardiac, and stroke care;</text> </level> <level label="ii"> <text>Expand primary care;</text> </level> <level label="iii"> <text>Attract and retain highly qualified clinicians; and</text> </level> <level label="iv"> <text>Preserve services that address community needs;</text> </level> </level> <level label="4"> <text>Since the establishment of the University of Maryland Capital Region Health as part of the University of Maryland Medical System in 2017, the organization has succeeded in advancing the vision articulated by the historic partnership between the State, Prince George’s County, and the University of Maryland Medical System to transform care delivery in Prince George’s County and the southern Maryland region; and</text> </level> <level label="5"> <text>The University of Maryland Capital Region Health requires State support and investment to continue its mission to provide high–quality care and transform health care delivery in Prince George’s County and the southern Maryland region.</text> </level> </level> <level label="b"> <level label="1"> <text>Subject to subsection (c) of this section, for the purpose of providing an operating grant to ensure and assist in the transition of a new Prince George’s County Regional Medical System to the University of Maryland Medical System Corporation:</text> <level label="i"> <text>For fiscal year 2018, the Governor shall include in the budget bill an appropriation of $28,000,000;</text> </level> <level label="ii"> <text>For fiscal year 2019, the Governor shall include in the budget bill an appropriation of $27,000,000;</text> </level> <level label="iii"> <text>For fiscal years 2020 and 2021, the Governor shall include in the budget bill an appropriation of $15,000,000; and</text> </level> <level label="iv"> <text>For fiscal year 2022 and each fiscal year thereafter, the Governor shall include in the budget bill an appropriation of $10,000,000.</text> </level> </level> <level label="2"> <text>Subject to subsection (c) of this section, Prince George’s County shall provide a combination of matching funds and other financial assistance to the University of Maryland Medical System Corporation that constitutes total financial assistance as follows:</text> <level label="i"> <text>$15,000,000 annually for fiscal year 2017 through fiscal year 2019; and</text> </level> <level label="ii"> <text>$5,000,000 annually for fiscal years 2020 and 2021.</text> </level> </level> </level> <level label="c"> <text>The State and county funds described in subsection (b) of this section:</text> <level label="1"> <text>Shall be used to support the transition of the Prince George’s County Regional Medical Center from operation under the Dimensions Health Care System to operation as a participating institution of the University of Maryland Medical System Corporation; and</text> </level> <level label="2"> <text>May be used only for:</text> <level label="i"> <text>Providing increased access to critical health care services for the region served by the Prince George’s County Regional Medical Center and improving the quality of the services provided; and</text> </level> <level label="ii"> <text>Facilitating cost containment measures to prevent additional operating losses for the Prince George’s County Regional Medical Center and its affiliated institutions.</text> </level> </level> </level> <level label="d"> <level label="1"> <text>The Governor shall include in the capital or operating budget bill the following amounts that are equal to the capital funds committed by Prince George’s County to be used for the construction of the Prince George’s County Regional Medical Center:</text> <level label="i"> <text>$11,300,000 for fiscal year 2018;</text> </level> <level label="ii"> <text>$48,000,000 for fiscal year 2019; and</text> </level> <level label="iii"> <text>$56,200,000 for fiscal year 2020.</text> </level> </level> <level label="2"> <text>Prince George’s County shall provide matching funds of $208,000,000 for the capital construction of the Prince George’s County Regional Medical Center.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-2501" title_number="19" title_name="Health Care Facilities" subtitle_number="25" subtitle_name="Recovery Residences"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Certificate of compliance” means a certificate that is issued to a recovery residence by a credentialing entity.</text> </level> <level label="c"> <text>“Certified recovery residence” means a recovery residence that holds a certificate of compliance.</text> </level> <level label="d"> <text>“Credentialing entity” means a nonprofit organization that develops and administers professional certification programs according to nationally recognized certification standards.</text> </level> <level label="e"> <text>“Recovery residence” has the meaning stated in § 7.5–101 of this article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-2502" title_number="19" title_name="Health Care Facilities" subtitle_number="25" subtitle_name="Recovery Residences"> <level label="a"> <text>The Department shall approve a credentialing entity to develop and administer a certification process for recovery residences.</text> </level> <level label="b"> <text>The credentialing entity shall:</text> <level label="1"> <text>Subject to subsection (c) of this section, establish recovery residence certification requirements;</text> </level> <level label="2"> <text>Establish processes to administer the application, certification, and recertification process;</text> </level> <level label="3"> <text>Establish processes to monitor and inspect a recovery residence;</text> </level> <level label="4"> <text>Conduct an on–site inspection of a recovery residence:</text> <level label="i"> <text>Before issuing a certificate of compliance; and</text> </level> <level label="ii"> <text>At least once during each certification renewal period; and</text> </level> </level> <level label="5"> <text>Issue a certificate of compliance on approval of the application process and the inspection of the recovery residence.</text> </level> </level> <level label="c"> <text>The requirements established by a credentialing entity under subsection (b)(1) of this section shall prohibit a certified recovery residence from:</text> <level label="1"> <text>Refusing services to an individual based on the individual receiving medication–assisted treatment for opioid use disorder; and</text> </level> <level label="2"> <text>Requiring an individual to cease receiving or modify how the individual receives medication–assisted treatment for opioid use disorder before the individual may receive services at the recovery residence.</text> </level> </level> <level label="d"> <text>A certificate of compliance issued by the credentialing entity is valid for 1 year from the date of issuance.</text> </level> <level label="e"> <text>The credentialing entity may revoke the certificate of compliance of a certified recovery residence if the credentialing entity finds that the recovery residence is not in compliance with the requirements established by the credentialing entity.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-2503" title_number="19" title_name="Health Care Facilities" subtitle_number="25" subtitle_name="Recovery Residences"> <level label="a"> <text>On or before October 1, 2017, the credentialing entity shall submit a list to the Department of the recovery residences that have obtained a certificate of compliance.</text> </level> <level label="b"> <level label="1"> <text>On or before November 1, 2017, the Department shall publish on its website:</text> <level label="i"> <text>A list of each credentialing entity and the contact information for the credentialing entity; and</text> </level> <level label="ii"> <text>A list of each recovery residence operating in each county in the State.</text> </level> </level> <level label="2"> <text>The list published under paragraph (1)(ii) of this subsection shall indicate whether the owner of a recovery residence has received a valid certificate of compliance.</text> </level> </level> <level label="c"> <level label="1"> <text>On or before November 1, 2017, a credentialing entity shall publish on its website a list of each recovery residence that holds a valid certificate of compliance.</text> </level> <level label="2"> <text>The list published under paragraph (1) of this subsection shall include only the owner of the recovery residence and the contact information of the owner.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-2504" title_number="19" title_name="Health Care Facilities" subtitle_number="25" subtitle_name="Recovery Residences"> <level label="a"> <text>A person may not advertise, represent, or imply to the public that a recovery residence is a certified recovery residence unless the recovery residence has obtained a certificate of compliance under this subtitle.</text> </level> <level label="b"> <level label="1"> <text>A person who violates subsection (a) of this section is subject to a civil penalty imposed by the Department not exceeding $1,000 for each offense.</text> </level> <level label="2"> <text>In setting the amount of a civil penalty under paragraph (1) of this subsection, the Department shall consider the nature, number, and seriousness of the violations, the ability of the certified recovery residence to pay the penalty, and any other factors the Department determines are relevant.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-2505" title_number="19" title_name="Health Care Facilities" subtitle_number="25" subtitle_name="Recovery Residences"> <level label="a"> <text>In this section, “Program” means the Recovery Residence Grant Program.</text> </level> <level label="b"> <level label="1"> <text>There is a Recovery Residence Grant Program in the Department.</text> </level> <level label="2"> <text>The purpose of the Program is to provide grants to recovery residences in the State in accordance with this section.</text> </level> </level> <level label="c"> <text>The Department shall administer the Program.</text> </level> <level label="d"> <text>The Program shall award competitive grants to recovery residences to support operations, services, and programs.</text> </level> <level label="e"> <text>To qualify for a grant under the Program, a recovery residence must:</text> <level label="1"> <text>Be a nonprofit organization in good standing with the Internal Revenue Service;</text> </level> <level label="2"> <text>Submit a current copy of the Form 990 that the organization files with the Internal Revenue Service;</text> </level> <level label="3"> <text>Be certified by the credentialing entity as a Level I, Level II, or Level III recovery residence in accordance with the National Alliance for Recovery Residences standards;</text> </level> <level label="4"> <text>Not accept or receive reimbursement from private insurance or the Maryland Medical Assistance Program; and</text> </level> <level label="5"> <text>Meet any other requirement established by the Department in regulation.</text> </level> </level> <level label="f"> <level label="1"> <text>The Department shall establish:</text> <level label="i"> <text>Application procedures;</text> </level> <level label="ii"> <text>Criteria for prioritizing applications under the Program;</text> </level> <level label="iii"> <text>Procedures for awarding grants under the Program; and</text> </level> <level label="iv"> <text>Any other procedures or criteria necessary to carry out this section.</text> </level> </level> <level label="2"> <text>In establishing procedures and criteria under this subsection, the Department shall consult the credentialing entity.</text> </level> </level> <level label="g"> <text>For each of fiscal years 2024 through 2030, the annual budget bill shall include an appropriation of $500,000 for the Program.</text> </level> <level label="h"> <text>On or before December 1 each year, beginning in 2024, the Department shall submit to the Governor and, in accordance with § 2–1257 of the State Government Article, the General Assembly a report that includes, for the most recent closed fiscal year:</text> <level label="1"> <text>The number of grants distributed; and</text> </level> <level label="2"> <text>Information about grant recipients and programs and services provided.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="19-2601" title_number="19" title_name="Health Care Facilities" subtitle_number="26" subtitle_name="Hospital Obstetric Services Policy"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Doula” means a nonmedical professional who provides continuous physical, emotional, and informational support to the birthing parent throughout the prenatal, labor, and postpartum periods.</text> </level> <level label="c"> <text>“Hospital” means a hospital, as defined in § 19–301 of this title, that provides obstetric care.</text> </level> <level label="d"> <text>“Significant medical intervention” means a cesarean section, induction of labor, augmentation of labor, operative vaginal delivery, or episiotomy.</text> </level> </section> <section article="ghg" article_name="Health - General" number="19-2602" title_number="19" title_name="Health Care Facilities" subtitle_number="26" subtitle_name="Hospital Obstetric Services Policy"> <level label="a"> <text>A hospital shall adopt and provide evidence to the Department that the hospital has:</text> <level label="1"> <text>A doula policy that allows every birthing parent to have at least one doula present during birth in addition to authorized guests;</text> </level> <level label="2"> <text>An informed consent policy for significant medical intervention for the birthing parent; and</text> </level> <level label="3"> <text>A transfer acceptance policy that includes the hospital’s process for receiving:</text> <level label="i"> <text>A patient from a health care practitioner regulated under Title 8 of the Health Occupations Article who had provided services to a birthing parent in a home birth setting;</text> </level> <level label="ii"> <text>A birthing parent’s or newborn’s medical information from the home birth provider; and</text> </level> <level label="iii"> <text>A transfer from a licensed direct–entry midwife that is consistent with the requirements of § 8–6C–08 of the Health Occupations Article.</text> </level> </level> </level> <level label="b"> <text>A hospital shall provide evidence to the Department that the hospital has adopted a policy under subsection (a) of this section:</text> <level label="1"> <level label="i"> <text>On or before January 1, 2026; or</text> </level> <level label="ii"> <text>If the hospital is established after January 1, 2026, on the establishment of the hospital; and</text> </level> </level> <level label="2"> <text>Whenever the policy is updated.</text> </level> </level> <level label="c"> <text>The Department shall adopt regulations to carry out this section, including regulations that establish the form and manner in which a hospital may prove to the Department that the hospital has adopted a policy in compliance with this section.</text> </level> <level label="d"> <text>The Department shall make the policies provided by a hospital under this section available to the public on request and in a manner determined by the Department.</text> </level> <level label="e"> <text>This section does not prohibit a hospital from setting a policy that restricts the number of doulas or authorized guests.</text> </level> </section>