In this subtitle: “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. “Assisted living program” does not include: A nursing home, as defined under § 19–1401 of this title; A State facility, as defined under § 10–101 of this article; A program licensed by the Department under Title 7 or Title 10 of this article; A hospice care program regulated by the Department under Subtitle 9 of this title; Services provided by family members; Services provided in an individual’s own home; or 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.

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.

The Department shall encourage, but may not require, providers of assisted living program services to offer a continuum of care. Providers of assisted living program services may provide services at a variety of levels and in a variety of settings.

The Department shall: Serve as the point of entry for persons desiring information on assisted living programs; 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 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.

A person shall be licensed by the Department to conduct, operate, or maintain an assisted living program in the State. 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. The Secretary shall develop the application for licensure required under paragraph (1) of this subsection. 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. In addition to the application, an applicant for initial licensure shall submit to the Secretary: 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; Information demonstrating the financial and administrative ability of the applicant to operate an assisted living program in compliance with this subtitle; The policies and procedures to be implemented by the assisted living program; Identification of the personnel and relief personnel to be employed by the assisted living program; and Any other information that is relevant to the ability of the applicant to care for the residents of the assisted living program. The Secretary shall: Review the application and information received under subsection (b) of this section; and Conduct an independent investigation of the assisted living program applying for initial licensure. Based on the review and investigation conducted under paragraph (1) of this subsection, the Secretary shall: Authorize the unconditional approval of the application; Authorize the conditional approval of the application; or Deny the application. 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.

The Department shall: Define different levels of assisted living according to the level of care provided; Require all assisted living programs to be licensed to operate according to the level of the program; 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; Promote affordable and accessible assisted living programs throughout the State; Establish and enforce quality standards for assisted living programs; Require periodic inspections of assisted living program facilities, including at least an annual unannounced on–site inspection; Establish requirements for the qualifications or training or both of assisted living program employees; Establish a “resident bill of rights” for residents of assisted living program facilities that includes, at a minimum: The right to be treated with consideration, respect, and full recognition of human dignity and individuality; The right to receive treatment, care, and services that are adequate, appropriate, and in compliance with relevant federal and State laws, rules, and regulations; The right to be free from mental and physical abuse; The right to be free from mental, verbal, sexual, and physical abuse, neglect, or involuntary seclusion or exploitation; The right to notice, procedural fairness, and humane treatment when being transferred or discharged from a facility; The right to participate in decision making regarding transitions in care, including a transfer or discharge from a facility; The right to be free from physical and chemical restraints, except for restraints that a physician authorizes for a clearly indicated medical need; and The right to manage personal financial affairs; Define which, if any, assisted living programs may be exempt from the requirements of § 19–311 of this title; and For Alzheimer’s special care units: Establish the number of dementia–specific training hours to be completed for those staff working in Alzheimer’s special care units; Determine the topic content for dementia–specific training required for those staff working in Alzheimer’s special care units; and Require staff sufficient to meet the needs of residents in Alzheimer’s special care units. 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. The regulations adopted under paragraph (1) of this subsection shall: Provide for the licensing of assisted living programs; 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 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: Its statement of deficiencies for the most recent survey; Any subsequent complaint investigations conducted by federal, State, or local surveyors; and Any plans of correction in effect with respect to the survey or complaint investigation; or A notice of the location, within the facility, of the items listed in item 1 of this item.

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. 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.

In this section the following words have the meanings indicated. “Continuing care” has the meaning stated in § 10–401 of the Human Services Article. “Continuing care agreement” has the meaning stated in § 10–401 of the Human Services Article. 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. 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. 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. 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. 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. 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. 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.

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. The manager training course shall: Consist of at least 80 hours; and Provide the training through in–person courses, virtual training methods, or a combination of both. An assisted living manager employed by a program shall be required to complete 20 hours of Department–approved continuing education every 2 years. 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. The requirements of subsection (a) of this section do not apply to an individual who: 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; 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 Subject to paragraph (2) of this subsection: Has been employed as an assisted living manager in the State for 1 year prior to January 1, 2006; or Is licensed as a nursing home administrator in the State. 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. 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.

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. 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. 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. 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. 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. An assisted living program shall provide a copy of the services disclosure statement to individuals as part of the program’s marketing materials.

Each assisted living program in the State shall notify a resident or prospective resident in writing or by written electronic communication if: The assisted living program does not maintain professional liability insurance coverage; or The assisted living program’s professional liability insurance coverage has lapsed for any period of time and has not been renewed. The notification under subsection (a) of this section shall be: Provided to a prospective resident: At the first visit by the prospective resident during any period in which an assisted living program does not maintain professional liability insurance; and 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 If the professional liability coverage lapses, provided to each resident within 30 days after the date the coverage lapsed; Signed by: The prospective resident at the time of application for admission; or The resident at the time the notification of the lapse in coverage is provided under item (1)(ii) of this subsection; and Retained by the assisted living program as part of the assisted living program’s records. 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.

A person may not knowingly and willfully operate, maintain, or own an assisted living program without a license. A person who violates paragraph (1) of this subsection is guilty of a felony and on conviction is subject to: For a first offense, a fine not exceeding $10,000 or imprisonment not exceeding 5 years or both; or For a subsequent offense, a fine not exceeding $20,000 or imprisonment not exceeding 5 years or both. 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. 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. 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. 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: 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 The person operating the program may not be subject to prosecution under paragraph (2) of this subsection if the person has: Promptly and in good faith submitted a complete application to the Department for an assisted living program license; Is awaiting a decision from the Department regarding the application; and Has not been denied an assisted living program license on a prior occasion. 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. 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. A violation of paragraph (1) of this subsection shall be a violation of the Consumer Protection Act. 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. A person may not advertise an assisted living program in a misleading or fraudulent manner. 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. 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. A person may not willfully and knowingly refer another person to an assisted living program that is operating without a license. A person who violates paragraph (1) of this subsection is subject to the following civil penalties: For a first offense, a civil penalty not exceeding $1,000; For a second offense, a civil penalty not exceeding $2,000; or For a third or subsequent offense, a civil penalty not exceeding $3,000. 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. The Department may adopt regulations to carry out this section.

An assisted living program may request an appeal of a civil money penalty imposed under this subtitle. 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; and Regulations adopted by the Secretary.

There is a Health Care Quality Account for Assisted Living Programs established in the Department. 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. The Department shall pay all penalties collected under this title to the Comptroller. The Comptroller shall distribute funds collected under this title to the Health Care Quality Account for Assisted Living Programs. The Account is a continuing, nonlapsing fund, not subject to § 7–302 of the State Finance and Procurement Article. 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. 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. The Department shall adopt regulations for the distribution of funds from the Health Care Quality Account for Assisted Living Programs.

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. The Department shall require that each facility provide emergency electrical power as provided in this section. The emergency power source shall be a generating set and prime mover located on the facility premises with automatic transfer. An emergency power system shall meet the following requirements: In the event of failure of the normal electric service, the emergency electrical power shall be activated immediately; The emergency generator set shall come to full speed and load acceptance within 10 seconds; and The emergency generator shall have the capability of 48 hours of operation from fuel stored on–site. The emergency power system shall be tested one time each month. The emergency power system test shall require that the generator be exercised for a minimum of 30 minutes under normal emergency facility connected load. The test shall be recorded in a permanent log book maintained for that purpose. The emergency power system shall provide lighting in the following areas of the facility: 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; Nurses’ station; Drug distribution station or unit dose station; An area for emergency telephone use; Boiler or mechanical room; Kitchen; Emergency generator location and switch gear location; Elevator, if operable on emergency power; Areas where life support equipment is used; If applicable, common areas or areas of refuge; and If applicable, toilet rooms of common areas or areas of refuge. Emergency electrical power shall be provided for the following: Nurses’ call system; At least one telephone in order to make and receive calls; Fire pump; Sewerage pump and sump pump; If required for evacuation purposes, an elevator; 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; Life support equipment; and Nonflammable medical gas systems. 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. The Department shall adopt regulations regarding the requirements for designating parts of the facility as common areas or areas of refuge. 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. The Department may grant a facility a waiver from the requirements of this section if the facility: 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 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. Subject to paragraph (3) of this subsection, a waiver granted under paragraph (1) of this subsection may not exceed a period of 3 years. 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.

In this section, “assisted living referrer” means an individual or agency that: Makes referrals to assisted living programs without cost to the person receiving the referral; and Is compensated by an assisted living program or other third party for referring individuals to a licensed assisted living program. Each assisted living referrer: Shall register with the Office of Health Care Quality; 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; If referring a client or potential client to an assisted living program, shall affirm that the assisted living program is licensed; 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; Shall maintain general liability insurance; Shall require employees to obtain a criminal history records check; Shall provide to the client or the client’s representative a description of the services that will be provided by the referrer; 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 Shall notify the Office of Health Care Quality immediately on learning that the assisted living program is operating without a license. An assisted living referrer may not: Receive funding from the Department if the assisted living referrer is in violation of this subtitle; 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 Request payment of a referral fee from an assisted living program more than 2 years after the assisted living referrer provided the referral. 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. The Office of Health Care Quality shall maintain a user–friendly database of licensed assisted living programs. On or before September 30, 2025, an assisted living referrer: 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 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. On or after October 1, 2025, an assisted living referrer shall comply with all applicable data privacy laws.

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.

In this section the following words have the meanings indicated. “COVID–19” means, interchangeably and collectively, the coronavirus known as COVID–19 or 2019–nCoV and the SARS–CoV–2 virus. “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. 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. 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. The Department shall adopt regulations that set standards for a COVID–19 testing plan required under this section. The standards set by the Department under this subsection shall: Be guided by applicable federal orders and policies; and 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.