In this section the following words have the meanings indicated. “Executive Director” means the Executive Director of the Commission. “Nursing home” has the meaning stated in § 19–1401 of this title. “Request for acquisition” means a request for the Commission to approve the acquisition of a nursing home. 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: Involves at least a 5% transfer in ownership interest; and Is not an acquisition that requires approval under subsection (c) of this section. This subsection does not apply to an acquisition that involves only changes of ownership interests among existing owners of a nursing home. At least 60 days before the closing date of the acquisition of a nursing home, a person shall: Submit to the Commission a request for acquisition; and Provide notice to the residents, resident representatives, and employees of the nursing home that: The request for acquisition was submitted to the Commission; and There will be an opportunity to submit comments in accordance with subsection (f) of this section. The Executive Director shall review a completed request for acquisition within 45 days after receiving the completed request from the applicant. The Executive Director, in consultation with the Secretary or the Secretary’s designee, may: Approve the acquisition; Approve the acquisition with conditions; Deny the acquisition; or Refer the request for acquisition to the Commission for a final decision. To approve a request submitted under subsection (c) of this section, the Executive Director must find that the acquisition: Is consistent with the State Health Plan; and Subject to subsection (f) of this section, is in the public interest. In determining whether an acquisition of a nursing home is in the public interest, the Executive Director shall: Solicit and accept comments from individuals who: Reside in the nursing home; Have family members who reside in the nursing home; or Are employees of the nursing home; and Consult with the Attorney General on whether the acquisition raises public interest concerns. 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. 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. A decision of the Commission under subsection (g) or (h) of this section shall be a final decision for the purpose of judicial review. 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. 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. 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. 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. 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. The regulations adopted under this subsection shall: Require the person that acquired ownership of a nursing home to: 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 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; 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 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; 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 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. 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: Maintained a quality assessment and assurance committee that met at least quarterly; 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 Was the subject of a lawsuit judgment, or an arbitration finding, following a complaint filed by a resident, resident representative, or a government agency.