# Health - General (GHG)

## Title 19. Health Care Facilities

### Subtitle 14. Nursing Homes

#### Section 19-1401

(a) In this subtitle the following words have the meanings indicated.

(b) "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.

(c) "Concurrent review" means daily rounds by a licensed nurse which include:

  (1) Appraisal and observation of each resident by the licensed nurse to determine any change in the resident's physical or mental status; and

  (2) If there is a change in the resident's physical or mental status, an evaluation by the licensed nurse of:

    (i) The resident's medications;

    (ii) Laboratory values relating to the resident;

    (iii) Clinical data relating to the resident, including the resident's:

      (1) Hydration and nutritional need;

      (2) Skin integrity;

      (3) Noted weight changes; and

      (4) Appetite;

    (iv) Injuries sustained by the resident that result from accident or incidents involving the resident; and

    (v) Any other relevant parameters affecting or reflecting the resident's physical and mental status.

(d) "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.

(e)

  (1) "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.

  (2) "Nursing home" does not mean a facility offering domiciliary care or personal care as those terms are defined in Sec. 19-301 of this title.

(f) "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.

(g) "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.

(h) "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.

(i) "Sustained compliance" means a period of 30 days following the date of notice of corrective action with no deficiencies.

#### Section 19-1401.1

(a)

  (1) 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:

    (i) Any person with an ownership interest in the nursing home; and

    (ii) Any management company, landlord, or other business entity that will operate or contract with the applicant to manage the nursing home.

  (2)

    (i) 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 Sec. 19-120.2 of this title is filed with the Maryland Health Care Commission.

    (ii) 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.

(b) An applicant for licensure shall submit to the Secretary or the Secretary's designee evidence:

  (1) That affirmatively demonstrates the ability of the applicant to comply with minimum standards of:

    (i) Medical care;

    (ii) Nursing care;

    (iii) Financial condition; and

    (iv) Other applicable State or federal laws and regulations;

  (2) Regarding the regulatory compliance history and financial condition of any health care facility owned or operated by the applicant in other jurisdictions; and

  (3) That a request for acquisition for the nursing home was approved in accordance with Sec. 19-120.2 of this title.

#### Section 19-1401.2

(a) On review of the information required under Sec. 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:

  (1) Approve an application for a license;

  (2) Deny an application for a license;

  (3) Approve an application for a license subject to conditions; or

  (4) Revoke a license.

(b) 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 Sec. 19-120.2 of this title.

#### Section 19-1401.3

(a) 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.

(b) 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.

(c) The provisions of subsection (b) of this section do not apply to:

  (1) The holder of a license that has been suspended or revoked; or

  (2) The use of information in:

    (i) An administrative proceeding initiated by the Department; or

    (ii) A judicial proceeding.

#### Section 19-1402

(a) If a deficiency exists, the Secretary may impose sanctions that include:

  (1) A directed plan of correction with corrective measures necessary to protect residents;

  (2) Imposing adequate staffing levels in a nursing home;

  (3) Appointing a State monitor subject to Sec. 19-1405 of this subtitle; and

  (4) Imposing a civil money penalty.

(b) A civil money penalty may be imposed when a deficiency exists or an ongoing pattern of deficiencies exists in a nursing home.

(c) 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:

  (1) The number, nature, and seriousness of the deficiencies;

  (2) The extent to which the deficiency or deficiencies are part of an ongoing pattern during the preceding 24 months;

  (3) The degree of risk to the health, life, or safety of the residents of the nursing home caused by the deficiency or deficiencies;

  (4) The efforts made by, and the ability of, the nursing home to correct the deficiency or deficiencies; and

  (5) A nursing home's prior history of compliance.

(d) Upon determination by the Department that a deficiency or deficiencies exist, the Department shall notify the nursing home that:

  (1) Unless corrective action taken pursuant to this section is substantially completed, a civil money penalty will be imposed; or

  (2) An order imposing a civil money penalty will be issued, pursuant to Sec. 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.

#### Section 19-1403

(a) 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.

(b) 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.

#### Section 19-1404

(a) A civil money penalty imposed under this section for potential for more than minimal harm deficiencies:

  (1) May not exceed $10,000 per instance; or

  (2) May not exceed $1,000 per day for an ongoing pattern of deficiencies until the nursing home is in compliance.

(b) A civil money penalty imposed under this subtitle for actual harm deficiencies:

  (1) May not exceed $10,000 per instance; or

  (2) May not exceed $5,000 per day for an ongoing pattern of deficiencies until the nursing home is in compliance.

(c) A civil money penalty imposed under this section for a serious and immediate threat:

  (1) May not exceed $10,000 per instance; or

  (2) May not exceed $10,000 per day for an ongoing pattern of deficiencies until the nursing home is in compliance.

(d) 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:

  (1) The number, nature, and seriousness of the deficiencies;

  (2) The degree of risk to the health, life, or safety of the residents of the nursing home caused by the deficiency or deficiencies;

  (3) The efforts made by the nursing home to correct the deficiency or deficiencies;

  (4) Current federal guidelines for money penalties;

  (5) 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

  (6) Such other factors as justice may require.

#### Section 19-1405

(a) 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.

(b) The appointment of a State monitor is an intermediate sanction that may be in addition to or in lieu of other sanctions.

(c) The State monitor's duties may include:

  (1) Periodic inspections of a nursing home for the purpose of assessing the nursing home's compliance with State and federal regulations; and

  (2) Reporting to the Department and the nursing home its findings.

(d) The State monitor may not be an employee of the Department.

(e) A nursing home shall be responsible for the costs associated with the appointment of a State monitor to the nursing home.

#### Section 19-1406

(a) 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.

(b) When the Secretary issues the final decision of the Department:

  (1) 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;

  (2) 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

  (3) 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.

(c)

  (1) 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.

  (2) The Secretary shall have the burden of proof with respect to the imposition of civil money penalties under Sec. 19-1404 or Sec. 19-1413.1 of this subtitle.

  (3) A decision shall be rendered by the Office of Administrative Hearings within 10 working days of the hearing.

(d) 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.

#### Section 19-1407

(a)

  (1) There is a Health Care Quality Account established in the Department.

  (2) 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.

  (3) The Department shall pay all penalties collected under this title to the Comptroller of the State.

  (4) The Comptroller shall distribute the funds collected under this title to the Health Care Quality Account.

  (5) The Health Care Quality Account is a continuing, nonlapsing fund, not subject to Sec. 7-302 of the State Finance and Procurement Article.

  (6) 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.

(b) The Health Care Quality Account shall be used for training, grant awards, demonstration projects, or other purposes designed to improve the quality of care.

(c) The Department shall adopt regulations for the distribution of funds from the Health Care Quality Account.

#### Section 19-1408

(a)

  (1) 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.

  (2) Unless otherwise required by federal law, all surveys shall be unannounced.

(b)

  (1) 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.

  (2) If the Department receives a complaint against a nursing home alleging immediate jeopardy to a resident, the Department:

    (i) Shall make every effort to investigate the complaint within 24 hours after receiving the complaint; and

    (ii) Shall investigate the complaint not later than 48 hours after receiving the complaint.

  (3)

    (i) If the Department initiates an investigation of a nursing home complaint under this subsection, the Department shall:

      (1) Notify the local health department for the county in which the nursing home is located within 24 hours after initiating the investigation; and

      (2) To the extent practicable and as permitted by federal law, consult and coordinate with the local health department on the complaint investigation and response.

    (ii) 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.

(c) 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:

  (1) 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

  (2) 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.

(d)

  (1) 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 Sec. 2-1257 of the State Government Article, the number of surveys conducted in each county, disaggregated by the following types of surveys:

    (i) Standard survey;

    (ii) Complain survey;

    (iii) Follow-up survey;

    (iv) Revisit survey;

    (v) Special focus facility survey;

    (vi) Abbreviated survey; and

    (vii) Life safety code survey.

  (2) 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.

#### Section 19-1408.1

(a) The Department shall develop a clear and easy-to-understand graphic data dashboard that includes:

  (1) The number of staff hired by the agency in each unit in the fiscal year to date;

  (2) The number of surveyors employed by the agency in each unit in the fiscal year to date; and

  (3) The number of vacancies within the agency in each unit in the fiscal year to date.

(b) The Department shall:

  (1) Update the data dashboard developed under subsection (a) of this section at least every 2 weeks; and

  (2) Post the most recent updated data dashboard prominently on its website.

#### Section 19-1409

(a) There is an Oversight Committee on Quality of Care in Nursing Homes and Assisted Living Facilities.

(b) The Oversight Committee shall consist of the following members:

  (1) One member of the Senate Finance Committee, appointed by the President of the Senate;

  (2) One member of the House Health Committee, appointed by the Speaker of the House;

  (3) The Secretary of Aging, or the Secretary's designee;

  (4) The Director of the Office of Health Care Quality, or the Director's designee;

  (5) The Deputy Secretary for Behavioral Health, or the Deputy Secretary's designee;

  (6) The Secretary of Human Services, or the Secretary's designee;

  (7) The Secretary of Disabilities, or the Secretary's designee;

  (8) The State Long-Term Care Ombudsman;

  (9) 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;

  (10) One representative of a local long-term care ombudsman entity, selected by the State Long-Term Care Ombudsman;

  (11) 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;

  (12) The following representatives, selected by the organizations the individual represents:

    (i) One representative from the Mid-Atlantic LifeSpan;

    (ii) One representative of the Hospice Network of Maryland;

    (iii) One representative of the Maryland Hospital Association;

    (iv) One representative of 1199SEIU United Health Workers East;

    (v) One representative of the Maryland Chapter of AARP;

    (vi) One representative of United Seniors of Maryland;

    (vii) One representative of the Mental Health Association of Maryland knowledgeable in issues of aging;

    (viii) One representative of the Greater Maryland Chapter of the Alzheimer's Association;

    (ix) One representative of the Maryland Association for Medical Adult Day Services; and

    (x) One representative of LeadingAge Maryland; and

  (13) 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.

(c) The Secretary of Aging, or the Secretary's designee, shall chair the Oversight Committee.

(d) The Oversight Committee shall evaluate the progress in improving nursing home care quality and assisted living facility quality statewide, which may include consideration of:

  (1) Quality of care standards for nursing homes and assisted living facilities;

  (2) Standards for the identification of the onset of dementia and Alzheimer's disease;

  (3) Standards for the identification of conditions appropriate for hospice services;

  (4) Staffing patterns and staffing standards;

  (5) Policies and procedures for inspecting nursing homes and assisted living facilities, and responding to quality of care complaints;

  (6) A comparison of Maryland standards, policies, and procedures to those in other states;

  (7) The labor pool available to fill nursing and nursing aide jobs;

  (8) 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;

  (9) 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;

  (10) Staff training and development;

  (11) The rights of residents;

  (12) Data on resident satisfaction;

  (13) Resident assessments;

  (14) Resident care planning;

  (15) The monitoring of residents; and

  (16) The change of resident status.

(e) 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.

(f) 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:

  (1) Elements of the existing methodology that are no longer relevant;

  (2) Elements of the existing methodology that can be revised;

  (3) The appropriateness of redesigning the system given changing demographics of the target population; and

  (4) General Fund and federal fund savings from a system redesign that may be redirected to nursing home staff development in the nursing cost center.

(g) 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.

(h) The Oversight Committee may:

  (1) Review legislation introduced in the General Assembly that may affect nursing home and assisted living facility care; and

  (2) Make recommendations about the legislation to the General Assembly.

(i) The Oversight Committee may:

  (1) Review proposed regulations that may affect nursing home and assisted living facility care; and

  (2) Make recommendations about the regulations to the departments proposing the regulations and to the Joint Committee on Administrative, Executive, and Legislative Review.

(j) The Oversight Committee shall report its findings and recommendations to the Governor and, subject to Sec. 2-1257 of the State Government Article, to the General Assembly on or before December 1 of each year.

(k) 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.

#### Section 19-1410

(a) Each nursing home shall develop and implement a quality assurance program.

(b)

  (1) Each nursing home shall designate a qualified individual to coordinate and manage the nursing home's quality assurance program.

  (2) Each nursing home shall establish a quality assurance committee and shall include at least the following members:

    (i) The nursing home administrator;

    (ii) The director of nursing;

    (iii) The medical director;

    (iv) A social worker;

    (v) A licensed dietitian; and

    (vi) A geriatric nursing assistant.

  (3) The quality assurance committee shall:

    (i) Meet at least monthly;

    (ii) Maintain records of all quality assurance activities;

    (iii) Keep records of committee meetings that shall be available to the Department during any on-site visit; and

    (iv) Prepare monthly reports that shall be presented to the ombudsman, the resident's council, and the family council.

  (4) The quality assurance committee for a nursing home shall review and approve annually the quality assurance plan for the nursing home.

  (5) Each nursing home shall establish a written quality assurance plan that:

    (i) Includes procedures for concurrent review for all residents;

    (ii) 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;

    (iii) Includes methods to identify and correct problems; and

    (iv) Is readily available to nursing home residents and their families, guardians, or surrogate decision makers.

  (6) The quality assurance plan shall be submitted to the Department every 2 years.

  (7) The nursing home administrator shall take appropriate remedial actions based on the recommendations of the nursing home's quality assurance committee.

  (8) 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.

  (9) 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.

(c)

  (1) 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.

  (2) The notice shall be:

    (i) Posted in a location that is visible and accessible to residents and their family or guardians and any potential consumers; and

    (ii) On a form provided by the Department.

#### Section 19-1410.1

(a) On or before December 1, 2008, each nursing home shall establish a safe patient lifting workgroup with equal membership from management and employees.

(b)

  (1) On or before July 1, 2009, the safe patient lifting workgroup shall develop a safe patient lifting policy for the nursing home.

  (2) The goal of the policy shall be to reduce employee injuries associated with patient lifting.

(c) 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:

  (1) Developing or enhancing patient handling hazard assessment processes;

  (2) Enhanced use of mechanical lifting devices;

  (3) Developing specialized lift teams;

  (4) Training programs for safe patient lifting required for all patient care personnel at the nursing home;

  (5) Incorporating physical space and construction design for mechanical lifting devices in any architectural plans for nursing home construction and renovation; and

  (6) Developing an evaluation process to determine the effectiveness of the policy.

#### Section 19-1410.2

(a) In this section, "workplace safety" means the prevention of any physical assault or threatening behavior against an employee in a nursing home.

(b) This section applies to nursing homes that are licensed for 45 beds or more.

(c) Each nursing home shall assign to an appropriate committee the task of:

  (1) Conducting an annual assessment of workplace safety issues; and

  (2) Making recommendations to the nursing home for reducing workplace injuries.

(d) 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.

#### Section 19-1410.3

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "Catastrophic health emergency" means a health emergency with regard to which the Governor issues a proclamation under Sec. 14-3A-02 of the Public Safety Article.

  (3) "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.

  (4) "COVID-19" means, interchangeably and collectively, the coronavirus known as COVID-19 or 2019-nCoV and the SARS-CoV-2 virus.

  (5) "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.

(b)

  (1) 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.

  (2) The guidelines shall:

    (i) Describe the circumstances under which visitation may be restricted to only compassionate care visitors and personal care visitors;

    (ii) Limit the movement of visitors within the nursing home, which may include restricting visitors to the resident's room or another designated room;

    (iii) 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:

      (1) Testing for COVID-19 or another disease that constitutes a catastrophic health emergency;

      (2) Checking body temperature;

      (3) Health screenings;

      (4) The use of personal protective equipment;

      (5) Social distancing; and

      (6) 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;

    (iv) 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

    (v) Provide additional guidance necessary to promote access to residents by compassionate care visitors.

  (3) In addition to the requirements in paragraph (2) of this subsection, the guidelines regarding personal care visitation shall:

    (i) Establish procedures for the designation of a personal care visitor by a resident or a legal representative of the resident that:

      (1) 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

      (2) If a determination is required, authorize the determination to be made by a health care professional who is not affiliated with the nursing home;

    (ii) Provide that a resident may designate not more than one personal care visitor;

    (iii) Establish procedures for changing the designation of a resident's personal care visitor;

    (iv) 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;

    (v) 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;

    (vi) Establish standards for the frequency and duration of personal care visits; and

    (vii) Establish the total number of personal care visitors authorized to visit a nursing home facility at any one time.

#### Section 19-1411

(a)

  (1) Each nursing home shall designate a physician to serve as medical director.

  (2) The medical director is responsible for monitoring physician services at the nursing home.

  (3) The medical director shall report monthly to the quality assurance committee on the quality of medical care at the nursing home.

(b) The Secretary, in consultation with the Medical and Chirurgical Faculty of Maryland, and representatives of the nursing home industry, shall:

  (1) Establish qualifications for the medical director of a nursing home or anyone acting for the medical director in his or her absence;

  (2) Define the duties of the medical director; and

  (3) Adopt regulations for the attending physicians who treat residents of nursing homes that will provide for physician accountability.

#### Section 19-1412

(a) The Secretary shall:

  (1) Establish a technical assistance unit within the Department to support compliance efforts and best practices; and

  (2) Establish a list of approved medical automated systems.

(b) The Secretary may:

  (1) Partially reimburse a nursing home for installation of automated systems that have been approved by the Department;

  (2) Develop guidelines for reimbursement; and

  (3) Adopt regulations for the implementation of this subtitle.

#### Section 19-1413

Each nursing home shall:

(1) Establish a procedure to provide for the smooth and orderly transfer of residents in the event of closure;

(2) 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;

(3) 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

(4) Immediately notify, if known, a resident's family or guardian of:

  (i) An accident involving the resident which results in injury and has the potential for requiring physician intervention;

  (ii) A significant change in the resident's physical, mental, or psychosocial status; or

  (iii) A need to alter the resident's treatment significantly.

#### Section 19-1413.1

(a) A nursing home that violates Sec. 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.

(b) If a civil money penalty is imposed on a nursing home under subsection (a) of this section, the nursing home is subject to Sec. 19-1406 of this subtitle.

#### Section 19-1414

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.

#### Section 19-1415

(a) In this section, "change in condition" means a significant change in the resident's physical, mental, or psychological status including:

  (1) Life-threatening conditions such as heart attack or stroke;

  (2) Clinical complications such as:

    (i) Development of a pressure sore;

    (ii) Onset of recurrent periods of delirium;

    (iii) Onset of recurrent urinary tract infection;

    (iv) Onset of depression; or

    (v) Onset of aggressive or inappropriate behavior;

  (3) The need to discontinue a medication or treatment because of:

    (i) Adverse consequences; or

    (ii) The need to begin a new form of treatment;

  (4) Evaluation at or admission to a hospital; and

  (5) Accidents that result in injury having the potential for requiring a physician's intervention.

(b) 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:

  (1) Change in condition;

  (2) Adverse event that may result in a change in condition;

  (3) Outcome or care that results in an unanticipated consequence; or

  (4) Corrective action, if appropriate.

(c) 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.

#### Section 19-1416

(a) 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.

(b)

  (1) A family council for a nursing home may consist of the following members:

    (i) Members of a resident's family; or

    (ii) An individual appointed by the resident, or if the resident is incapable of appointing an individual, an individual appointed by the resident's family.

  (2)

    (i) Subject to subparagraph (ii) of this paragraph, a family council may be created by the owner, operator, or staff of a nursing home.

    (ii) 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.

  (3) 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.

(c) A nursing home shall give each new or prospective resident the following written information about the family council:

  (1) The name, address, and phone number of a current member of the family council;

  (2) A brief description of the purpose and function of the family council;

  (3) Instructions on how the resident or prospective resident may review the public files described in subsection (e) of this section; and

  (4) The name, address, and phone number of the State or local ombudsman.

(d) 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.

(e)

  (1) A nursing home shall create and maintain a public correspondence file and a regulatory correspondence file for communications with a family council.

  (2) The correspondence files shall include a copy of each written communication and response described in subsection (d) of this section.

  (3)

    (i) The records in the regulatory file shall be unedited.

    (ii) The records in the public file shall delete any information that identifies an individual resident.

  (4) 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.

  (5) The nursing home shall promptly comply with a request by a licensing authority to review the records in either the public or regulatory files.

#### Section 19-1417

(a) Each nursing home in the State shall notify each resident and prospective resident in writing or by written electronic communication if:

  (1) The nursing home does not maintain professional liability insurance coverage; or

  (2) The nursing home's professional liability insurance coverage has lapsed for any period of time and has not been renewed.

(b) The notification under subsection (a) of this section shall be:

  (1)

    (i) Provided to a prospective resident:

      (1) At the first visit by the prospective resident during any period during which the nursing home does not maintain professional liability coverage; and

      (2) 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

    (ii) If the professional liability insurance lapses, provided to each resident within 30 days after the date the coverage lapsed;

  (2) Signed by:

    (i) The prospective resident at the time of application for admission; or

    (ii) The resident at the time the notification of the lapse in coverage is provided under item (1)(ii) of this subsection; and

  (3) Retained by the nursing home as part of the nursing home's records.

(c) 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.

#### Section 19-1418

This subtitle may be cited as the "Maryland Nursing Home Quality Assurance Act".

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Md. Code Ann., Health-Gen. (as displayed at mgaleg.maryland.gov, October 16, 2026)