Title 19. Health Care Facilities — Subtitle 3. Hospitals and Related Institutions

Storage space for food and utensils;

A refrigerator;

A cook top; and

Adequate electrical capacity and outlets for small appliances.

Shelter;

Housekeeping services;

Board;

Facilities and resources for daily living; and

Personal surveillance or direction in the activities of daily living.

Help in walking;

Help in getting in and out of bed;

Help in bathing;

Help in dressing;

Help in feeding; and

General supervision and help in daily living.

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

Admits or retains the individuals for overnight care.

“Community benefit” means a planned, organized, and measured activity that is intended to meet identified community health needs within a service area.

“Community benefit” may include:

The mission statement of the hospital;

A list of the activities that were undertaken by the hospital to address the identified community health needs within the hospital’s community;

The cost to the hospital of each community benefit activity;

A description of how each of the listed activities addresses the community health needs of the hospital’s community;

A description of efforts taken to evaluate the effectiveness of each community benefit activity;

A description of gaps in the availability of providers to serve the community;

A description of the hospital’s efforts to track and reduce health disparities in the community that the hospital serves;

A list of the unmet community health needs identified in the most recent community health needs assessment; and

A list of tax exemptions the hospital claimed during the immediately preceding taxable year, in accordance with State law.

The program design;

Goals for patient health outcomes;

Implementation procedures;

Criteria for evaluation and impact measurement;

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

An agreement between the nonprofit hospital and the community–based organization identifying which party will be responsible for:

Is related to a resident’s medical or behavioral treatment; and

Is not related to the natural course of the resident’s illness or underlying disease condition.

Life-threatening conditions;

Clinical complications including significant somatic symptoms that require the assessment of or treatment by qualified medical personnel;

The need to discontinue a medication or treatment because of:

Evaluation at or admission to a hospital;

Injuries that require the assessment of or treatment by qualified medical personnel;

The use of restraint or seclusion; and

Suicide attempts.

A change in condition;

An adverse event; and

Corrective action, if appropriate.

The individual waives the notification required under paragraph (1) of this subsection; or

The individual requires notification only in the circumstances specified in writing by the individual.

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;

As a special hospital if the hospital:

As a special rehabilitation hospital if the hospital meets the requirements of this subtitle and Subtitle 12 of this title; or

As a limited service hospital if the health care facility:

Provides nursing care for chronically ill or convalescent patients; or

Offers to provide 24-hour a day nursing care of patients in a home-type facility such as:

The number of days in the month the hospital exceeded its licensed bed capacity; and

The number of beds that were in excess on each of those days.

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

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.

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.

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.

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;

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;

The provision of appropriate personnel and equipment that a reasonable and prudent physician exercising ordinary care would use for the transfer; and

The transfer of all necessary records for continuing the care for the patient.

All newborns born in the hospital are screened for hearing loss before discharge; and

The results are reported as required under § 13–605 of this article; and

Locations for subsequent testing; and

Resources on language and communication mode options for communicating with their child.

Ask the infant’s parent or legal guardian to describe the sleep environment that the parent or legal guardian will provide at home;

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

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.

Oral and written educational resources as required under subsection (b) of this section; and

The information described under subsection (c)(1)(ii) of this section;

Occurs as recommended by the treating health care practitioner; and

Is voluntarily agreed to by the patient.

Treating opioid use disorders; and

Assisting patients to voluntarily access ongoing community–based treatment at discharge.

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.

The contact and its disposition shall be noted in the patient’s medical record.

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.

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.

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.

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.

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.

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.

To the circumstances of the family of the decedent;

To the religious beliefs of the decedent; and

To the nonsuitability for organ or tissue donation of the decedent.

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.

Hospital personnel shall note the request and its disposition in the decedent’s medical record or death certificate.

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;

Requiring that each hospital designate a person to make the contact; and

Identifying the information that the person designated by the hospital shall have available before making the contact.

Has 45 or more beds; and

Operates in the State.

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

Prescribing opioid overdose reversal drugs approved by the federal Food and Drug Administration for the patient; and

Develop the process for hospitals in the State to submit requests for funding in the annual budget;

Establish eligibility criteria for a hospital to submit a request for funding under the Program;

Establish criteria for projects eligible to receive funding under the Program;

Establish deadlines for the submission of requests for funding and the determination of projects recommended for funding;

Develop project scoring and selection criteria guidelines;

Review eligible requests for funding; and

Make final recommendations for projects to be funded in the annual State budget.

Establishing the project funding request process under paragraph (1) of this subsection; and

Making recommendations for funding requests.

Review each application and the information submitted under Part II of this subtitle; and

Investigate the proposed new hospital or related institution or proposed conversion, alteration, or addition.

Notice of approval or disapproval; and

In case of disapproval, each reason for the disapproval.

May be conducted by an independent, nonhospital-affiliated review agent;

Shall be performed by registered nurses, medical records technicians, or similar qualified personnel supported and supervised by physicians as may be required;

Shall be certified by the Secretary if the program meets the minimum standards established under paragraph (4) of this subsection; and

Shall be recertified by the Secretary if the hospital makes any changes to the program after the initial certification.

Delicensure of hospital; or

$500 per day for each day the violation continues.

Preadmission review of elective admissions;

Postadmission review of emergency admissions;

Concurrent or retrospective review of all admissions as appropriate;

Preauthorization of certain selected procedures if proposed to be performed on an inpatient basis;

Continued stay review based on recognized objective criteria;

Discharge planning review; and

Readmission review.

After the hospital has notified the patient in writing of the potential disallowance; or

As a direct result of the noncompliance by the patient to treatment or hospital regulations.

The patient is a subscriber or member of a health maintenance organization as defined in § 19-701 of this title.

To evaluate the effectiveness of hospitals’ utilization review programs; and

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.

In this subsection the following words have the meanings indicated.

“Uniform standard credentialing form” means:

Establish a credentialing process for the physicians who are employed by or who have staff privileges at the hospital; and

Use the uniform standard credentialing form as the initial application of a physician seeking to be credentialed.

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:

The reappointment process established under subparagraph (i)3 of this paragraph shall document the physician’s pattern of performance by analyzing:

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

The credentialing and privileging decisions with respect to the physician who provides medical services through telemedicine are:

Delicensure of the hospital; or

$500 per day for each day the violation continues.

A board policy statement indicating commitment to the risk management program;

A requirement that one person be assigned the responsibility for coordinating the program;

An internal staff committee structure to conduct ongoing review and evaluation of risk management activities;

A formal written program for addressing patient complaints;

A documented facility-wide risk reporting system;

Ongoing risk management education programs for all staff; and

Documentation that the risk management and quality assurance programs share relevant information.

Delicensure of the hospital; or

$500 per day for each day the violation continues.

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

Display the notice developed under § 1-207 of the Health Occupations Article at the entrance to the hospital or related institution.

Be undertaken for cases chosen at random and for cases with unexpected adverse outcomes;

Be based on objective review standards;

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

Be conducted by members of the medical staff or, at the discretion of the hospital, external reviewers, who:

May expand the rights provided in §§ 10-701 through 10-709 of this article;

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;

Shall provide a system for investigating suspected violations; and

Shall ensure that there is a timely appropriate response to any suspected violation.

Delicensure of the specialty psychiatric hospital;

Delicensure of the separately identified psychiatric service of the acute general care hospital; or

A fine not to exceed $500 per day for each day the violation continues.

If the application is made for an individual, by the individual; or

If the application is made for a corporation, association, or government agency, by 2 officers of the organization; and

The name of the applicant;

A statement that the applicant meets the requirements of this subtitle;

The class of the proposed hospital or related institution;

The location of the proposed hospital or related institution;

The name of the individual who is to be the administrative head of the proposed hospital or related institution; and

Any other information that the Secretary requires.

Continue to restrict admissions for not more than 3 consecutive 30-day periods; or

Revoke the license of the related institution and move its residents to an appropriate, licensed facility.

At least 5 days before the hearing; or

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:

By service of the notice, within 24 hours after the appointment; or

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:

May not exceed the value of the nursing home or community program and its assets; and

Shall run to this State for benefit of all persons interested in the faithful performance of the receiver including the individuals.

Correct each condition on which the appointment of the receiver was based;

Ensure adequate care for each individual in the nursing home or community program; and

Preserve the property of the owner of the nursing home or community program.

Explain to the individual or guardian of the individual the alternative placements that are available;

Help the individual or guardian of the individual to find an alternative placement;

Give information about the alternative placement chosen;

Transport the individual to the alternative placement; and

Transfer all property of and records on the individual, including all necessary medical information, to the individual or the alternative placement.

Allow the receiver to avoid a lease, mortgage, secured transaction, or other contract that the owner or operating entity made if:

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.

By the receiver, at least 10 days before the hearing; or

By publication, if the receiver files with the court a statement that:

Affect the property under the contract to be avoided; and

Cannot be avoided under this subsection.

The amount of the lien;

The name of the community program to which the lien attaches; and

A description of the assets of the community program that are affected by the lien.

The land and chattel records of the county where the sites operated by the community program are located; and

The Department of Assessments and Taxation.

Extends to the property of the community program that is described in the notice of lien; and

Has priority over any lien or other interest that attaches after the date of the completion of the filings required under this subsection.

The grounds for appointment of the receiver under Part V of this subtitle no longer exist; or

The nursing home or community program is ready to be closed because all residents have been moved.

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

Complies with subsection (d) of this section;

Sign and foreign language interpreters;

Alternative formats, including large print, braille, audio recordings, and computer files; and

Vision, speech, hearing, and other temporary aids as needed, without charge;

Placing the health of the patient in serious jeopardy;

Serious impairment to bodily functions; or

Serious dysfunction of any bodily organ or body part.

A patient or the patient’s representative refuses to consent to further examination and treatment; or

A patient or the patient’s representative refuses to consent to a transfer to another medical facility.

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.

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.

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 State and federal laws, rules, and regulations;

The right to privacy;

The right to be free from mental and physical abuse;

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 expect and receive appropriate assessment, management, and treatment of pain as an integral component of the patient’s care;

The right to be free from physical and chemical restraints, except for restraints that a physician authorizes for a clearly indicated medical need;

The right to receive respect and privacy in a medical care program; and

The right to manage personal financial affairs.

On admission, to the resident;

To the guardian, next of kin, or sponsoring agency of the resident; and

To a representative payee of the resident;

The applicant is adjudicated disabled under Title 13, Subtitle 7 of the Estates and Trusts Article; or

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.

A facility may not require the execution of a durable power of attorney as a condition or requirement of admission to the facility.

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.

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.

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.

If a request for a determination is made under subparagraph (iii) of this paragraph, the medical assistance program shall make the determination.

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.

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.

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.

The facility shall cooperate with and assist the agent in seeking assistance from the medical assistance program on behalf of the applicant or resident.

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.

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.

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.

The Attorney General is responsible for the enforcement and prosecution of violations of the provisions of paragraphs (4) and (5) of this subsection.

The services of the facility, including each service that is required to be offered on an as-needed basis; and

Related charges, including any charges for services that are not covered by Medicare, Medicaid, or the basic rate of the facility; and

Shall participate in the planning of the medical treatment;

May refuse medication or treatment; and

May know the medical consequences of these actions.

Have the informed consent of a resident before the resident participates in any experimental research; and

Keep the resident’s written acknowledgment of that consent.

Is confidential;

Is to be done discreetly; and

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.

Is not associated with the facility; or

Is associated with the facility, but does not have a demonstrated need for the information.