Subject to paragraphs (2) and (3) of this subsection, on or before January 1, 2025, each hospital and urgent care center in the State shall implement an evidence–based protocol for the early recognition and treatment of a patient with sepsis, severe sepsis, or septic shock that is based on generally acceptable standards of care. The evidence–based protocol implemented for hospitals under paragraph (1) of this subsection shall comply with the Centers for Disease Control and Prevention sepsis guidelines. A hospital that is a specialty psychiatric hospital shall establish a process for the screening and early recognition of a patient with sepsis, severe sepsis, or septic shock, and procedures to transfer the patient to the appropriate setting. A hospital that submits sepsis data to the Centers for Medicare and Medicaid Services Hospital Inpatient Quality Reporting Program is presumed to meet the requirements of subsection (a) of this section. Each hospital and urgent care center shall: Require periodic training in the implementation of the sepsis protocol required under subsection (a) of this section for professional staff with direct patient care responsibilities and, as appropriate, for staff with indirect patient care responsibilities, including laboratory and pharmacy staff; and Ensure that the staff receive updated training if the hospital or urgent care center makes a substantive change to the sepsis protocol.

In this section, “health system” has the meaning stated in § 15–112(y) of the Insurance Article. A health system shall comply with § 15–112(y) of the Insurance Article.

A person shall have the approval of the Secretary before the person may: Build a hospital or related institution; or Make any conversion, alteration, or addition to the plant or building that will affect the functional structure or normal bed capacity of a hospital or related institution.

To qualify for approval under Part II of this subtitle, the applicant shall satisfy the Secretary that the hospital or related institution will meet the requirements that the Secretary adopts under this subtitle.

An applicant for approval under Part II of this subtitle shall submit to the Secretary: A written application on the form that the Secretary requires; and The documents, drawings, and other information that the Secretary requires.

The Secretary promptly shall: 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. Within 30 days after the application is submitted, the Secretary shall give the applicant: Notice of approval or disapproval; and In case of disapproval, each reason for the disapproval. The Secretary shall grant approval under Part II of this subtitle if the hospital or related institution will meet the requirements of this subtitle.

The Maryland Health and Higher Educational Facilities Authority Act provides means to enlarge and establish hospitals and related health care facilities.

A person shall be licensed by the Secretary before the person may operate a hospital or related institution in this State. A hospital shall be classified as a special rehabilitation hospital before the hospital may provide or hold itself out as providing comprehensive physical rehabilitation services, as defined in § 19-1201 of this title.

To qualify for a license, an applicant and the hospital or related institution to be operated shall meet the requirements of this section. An applicant who is an individual, and any individual who is applying on behalf of a corporation, association, or government agency shall be: At least 18 years old; and Of reputable and responsible character. The applicant shall have a certificate of need, as required under Subtitle 1 of this title, for the hospital, residential treatment center, or related institution to be operated. The hospital, residential treatment center, or related institution to be operated shall meet the requirements that the Secretary adopts under this subtitle and Subtitle 12 of this title. As a condition of licensure, each hospital shall establish a utilization review program for all patients admitted to the hospital. The utilization review program: 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. Any change made to a certified utilization review program shall be reported to the Secretary by the hospital within 30 days of the date the change was made. If a hospital fails to provide the utilization review program required under this subsection, the Secretary may impose the following penalties: Delicensure of hospital; or $500 per day for each day the violation continues. The Secretary shall, by regulation and in consultation with health care providers and payors, establish minimum standards for a utilization review program, directed at appropriateness and quality of inpatient care, as enumerated in the following items: 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. A patient may not be charged for any days disallowed as a result of retrospective review under paragraph (4) of this subsection unless the patient refuses to leave the hospital when it is medically appropriate to do so and the disallowed days occur: 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. A hospital shall be exempt from requiring a utilization review program for a patient if: The patient is insured by a third-party payor; and The third-party payor has a utilization review program for its subscribers or beneficiaries which meets the minimum standards as adopted in paragraph (4) of this subsection; or The patient is a subscriber or member of a health maintenance organization as defined in § 19-701 of this title. Where federal regulations or guidelines for a federally mandated utilization review program for federally insured patients differ from standards established under paragraph (4) of this subsection, the Secretary may waive a specific standard if the program achieves the same objectives as the standards established by the Secretary. The Secretary may establish record keeping and reporting requirements: 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. “Telemedicine” means the use of interactive audio, video, or other telecommunications or electronic technology by a physician in the practice of medicine outside the physical presence of the patient. “Telemedicine” does not include: An audio–only telephone conversation between a physician and a patient; An electronic mail message between a physician and a patient; or A facsimile transmission between a physician and a patient. “Uniform standard credentialing form” means: The form designated by the Secretary through regulation for credentialing physicians who seek to be employed by or have staff privileges at a hospital; or The uniform credentialing form that the Insurance Commissioner designates under § 15–112.1 of the Insurance Article. As a condition of licensure, each hospital shall: 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. Use of the uniform standard credentialing form does not preclude a hospital from requiring supplemental or additional information as part of the hospital’s credentialing process. 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: A formal written appointment process documenting the physician’s education, clinical expertise, licensure history, insurance history, medical history, claims history, and professional experience; A requirement that an initial appointment to staff not be complete until the physician has successfully completed a probationary period; and Subject to subparagraph (ii) of this paragraph, a formal, written reappointment process to be conducted in accordance with standards of the accreditiation body that accredits a hospital. The reappointment process established under subparagraph (i)3 of this paragraph shall document the physician’s pattern of performance by analyzing: Claims filed against the physician; Data dealing with utilization, quality, and risk; Clinical skills; Adherence to hospital bylaws, policies, and procedures; Compliance with continuing education requirements; Mental and physical status; and The results of the practitioner performance evaluation process under subsection (i) of this section. If requested by the Department, a hospital shall provide documentation that, prior to employing or granting privileges to a physician, the hospital has complied with the requirements of this subsection and that, prior to renewing employment or privileges, the hospital has complied with the requirements of this subsection. Notwithstanding any other provision of this subsection, in its credentialing and privileging process for a physician who provides medical services to patients at the hospital only through telemedicine from a distant–site hospital or distant–site telemedicine entity, a hospital may rely on the credentialing and privileging decisions made for the physician by the distant–site hospital or distant–site telemedicine entity, as authorized under 42 C.F.R. Part 482, if: 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: Approved by the medical staff of the hospital; and Recommended by the medical staff of the hospital to the hospital’s governing body. If a hospital fails to establish or maintain a credentialing process required under this subsection, the Secretary may impose the following penalties: Delicensure of the hospital; or $500 per day for each day the violation continues. As a condition of licensure, each accredited and nonaccredited hospital shall develop a protocol for the procurement of organs and tissues. As a condition of licensure, each hospital shall establish a risk management program. The Secretary shall, by regulation and in consultation with hospitals, physicians, interested community and advocacy groups, and representatives of the Maryland Defense Bar and Plaintiffs’ Bar establish minimum standards for a risk management program which shall include: 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. If a hospital fails to establish or maintain a risk management program required under this subsection, the Secretary may impose the following penalties: Delicensure of the hospital; or $500 per day for each day the violation continues. As a condition of licensure, each hospital and related institution shall: 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. If a hospital or related institution fails to comply with the requirements of this subsection, the Secretary may impose a fine of up to $500 per day per violation for each day a violation continues. As a condition of licensure, each hospital shall establish a practitioner performance evaluation process that objectively evaluates the performance of each member of the medical staff at the hospital. The practitioner performance evaluation process shall include a review of care provided to patients at the hospital by the members of the medical staff. The review of care shall: 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: Are of the same specialty as the member of the medical staff under review; Have been trained to perform practitioner performance evaluation; and Are not otherwise associated with the case under review. A hospital shall take into account the results of the practitioner performance evaluation process for a member of the medical staff in the reappointment process established under subsection (e) of this section. If a hospital fails to comply with the requirements of this subsection, the Secretary may impose a fine of up to $500 per day per violation for each day a violation continues. The Department, in coordination with the Maryland Institute for Emergency Medical Services Systems, shall adopt regulations establishing minimum perinatal care standards that meet or exceed the Maryland Perinatal System Standards for each hospital that provides obstetrical services. Each hospital that provides obstetrical services shall comply with the perinatal care standards established by the regulations adopted under paragraph (1) of this subsection as a condition of licensure.

As a prerequisite to the licensing of related institutions and each year after the license is issued, the Department shall require each related institution that provides long–term care and programs for patients with Alzheimer’s disease and related disorders to have an in–service education program that includes instruction on dementia and the techniques necessary to manage dementia patients with regard to their physical, intellectual, and behavioral manifestations.

In this section, “facility” means a special psychiatric hospital or an acute general care hospital with separately identified inpatient psychiatric service. As a condition of licensure, each facility shall adopt written policies and procedures to implement the requirements of §§ 10-701 through 10-709 of this article. The policies and procedures: 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. The Secretary may inspect any document necessary to ensure compliance with this subsection and §§ 10-701 through 10-709 of this article. If a hospital that is a facility fails to adopt and implement the policies and procedures required by this subsection or maintains a continuing pattern of conditions or practices in knowing violation of §§ 10-701 through 10-709 of this article, the Secretary may impose the following penalties, but only after the Secretary has satisfied the conditions in § 19-360 of this subtitle: 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.

An applicant for a license shall submit an application to the Secretary. The application: Shall be on the form that the Secretary requires; Shall be signed and verified as follows: 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 Shall include: 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.

The Secretary shall issue a license to any applicant if the applicant and the hospital or related institution to be operated meet the requirements of this subtitle. The Secretary shall include on each license that the Secretary issues: The name of the hospital or related institution; and The classification of the hospital or related institution.

While it is effective, a license authorizes the licensee to operate the hospital or related institution named in the license under the classification set forth in the license.

A license issued under this subtitle is not transferable.

If voluntary efforts to reduce excess capacity prove insufficient, as a last resort the Maryland Health Care Commission and the Health Services Cost Review Commission may petition the Secretary to delicense any hospital or part of a hospital or hospital service based on a finding after a public hearing that the delicensure is consistent with the State health plan or institution–specific plan. The petition shall specify in detail all efforts made by the petitioner to encourage the hospital: To reduce its underutilized capacity; To merge or consolidate; To become more efficient and effective; and To convert from acute capacity to alternative uses, where appropriate. On petition by the Maryland Health Care Commission and the Health Services Cost Review Commission, the Secretary may order that a hospital or part of a hospital or hospital service be delicensed if: The Secretary determines that delicensure is the last resort and a hospital or hospital services are excessive or inefficient, which determination is based on and is not inconsistent with the State health plan or institution–specific plan; An opportunity for notice and hearing in accordance with the Administrative Procedure Act has been given to the affected hospital, and in the affected political subdivision notice shall be given to the elected public officials and for at least 2 consecutive weeks in a newspaper of general circulation; and The hospital is not the sole provider of hospital services in a county for which the Commission and Health Services Cost Review Commission have petitioned for all of the beds of the hospital to be delicensed. The Maryland Health Care Commission and the Health Services Cost Review Commission are necessary parties to any proceeding in accordance with this section. Any person who is aggrieved by a final decision of the Secretary under this section may take a direct judicial appeal. The appeal shall be made as provided for judicial review of final decisions in the Administrative Procedure Act. The Secretary may participate in any appeal of a decision made in accordance with this section. In the event of an adverse decision that affects its final decision, the Secretary may apply within 30 days by writ of certiorari to the Court of Appeals for review where: Review is necessary to secure uniformity of decision, as where the same statute has been construed differently by 2 or more judges; or There are other special circumstances that render it desirable and in the public interest that the decision be reviewed.

If a hospital voluntarily closes, merges, or is delicensed under § 19–325 of this subtitle, the Department of Commerce, in cooperation with the Maryland Health Care Commission, shall assist the hospital and local community in identifying alternative uses for the hospital buildings or sites.

If a hospital voluntarily closes, merges, or is delicensed under § 19–325 of this subtitle and workers are displaced: Each hospital shall pay a fee directly to the Maryland Department of Labor. The fee shall not exceed 0.01 percent of the gross operating revenue for the fiscal year immediately preceding the closure or delicensing of the hospital. A fee shall only be assessed once for each voluntary closure, merger, or delicensure. The Secretary of Labor shall pay the fees received under this section into the Hospital Employees Training Fund established under § 11–201 of the Labor and Employment Article.

The Secretary shall deny a license to any applicant or revoke a license if the applicant or licensee has been convicted of a felony that relates to Medicaid or to a nursing home. The Secretary may deny a license to an applicant or revoke a license if the applicant or licensee does not meet the requirements of this subtitle or any rule or regulation that the Secretary adopts under this subtitle. The Secretary may deny a license to an applicant or revoke a license if the applicant or licensee violates Title 6.5 of the State Government Article. Before any action is taken under this section, the Secretary shall give the applicant or licensee an opportunity for a hearing. The hearing notice to be given to the applicant or licensee shall be sent at least 10 days before the hearing. The applicant or licensee is entitled to be represented by counsel at the hearing.

If the Secretary determines that a life-threatening, health or fire safety deficiency exists in a related institution, the Secretary immediately may restrict new admissions to the related institution for not more than a 30-day period. Within 7 days after a request by an aggrieved party, a hearing shall be held to determine the appropriateness of the admissions restriction. Within 21 days after admissions are restricted, the related institution shall take steps to correct the deficiency. Unless the Secretary lifts the admissions restriction, within 30 days after admissions are restricted, a hearing shall be held to determine whether the related institution has taken enough steps to correct the deficiency. If the Secretary finds that the deficiency still exists, the Secretary may: 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. An aggrieved party is entitled to a hearing on each continuation of the admissions restriction. Within 7 days after a request by an aggrieved party, a hearing shall be held to determine the appropriateness of the admissions restriction.

If, under a Montgomery or Prince George’s county ordinance for licensing related institutions, the county licensing authority proposes to suspend or revoke the county license of a related institution, that authority shall give the Secretary notice of the proposed suspension or revocation and the reasons for it before the authority notifies the related institution. If, within 14 days after the Secretary receives the notice, the Secretary disapproves the proposed suspension or revocation, the county licensing authority may not proceed with the action. Otherwise the county licensing authority may proceed with the action. If the Secretary disapproves the proposed suspension or revocation, the Secretary shall state, in writing, the reasons for the disapproval. If the Montgomery or Prince George’s county licensing authority proposes to restrict new admissions to a related institution, that authority shall give the Secretary as much prior notice of the proposed restriction as possible, so that State and county action may be coordinated. The Secretary may become a party to any county administrative or judicial proceeding on the restriction.

Except as provided in this section for an action under § 19–329(a) of this subtitle, any person aggrieved by a final decision of the Secretary in a contested case, as defined in the Administrative Procedure Act, may petition for judicial review as allowed by the Administrative Procedure Act. A person aggrieved by a final decision of the Secretary under § 19–329(a) of this subtitle may not appeal.

In Part V of this subtitle the following words have the meanings indicated. “Affiliate” means: Each partner of a partnership; Each officer, director, and stockholder who has direct or indirect ownership or control of 10 percent or more of the stock of a corporation; or Each individual who has direct or indirect ownership of 10 percent or more of a nursing home or community program. “Community program” means: A program which provides residential services and is an alcohol abuse and drug abuse treatment program as defined in § 8-403(a) of this article; A program which provides residential services for individuals with a developmental disability as defined in § 7-101(d) and (h) of this article; A private group home required to be licensed by the Secretary under § 10-517 of this article; A private therapeutic group home for children and adolescents as defined under § 10-920 of this article; A private residential treatment center for children and adolescents licensed under § 19-307 of this subtitle; A private facility operating living units that house less than 4 persons per unit under § 10-902 of this article; A program which provides day habilitation, vocational, or community supported living arrangements services required to be licensed under § 7-903 of this article; or A private program that provides outpatient services as set forth in § 10-902 of this article. “Individual” means a person who is a resident of a nursing home or a community residential program or a person enrolled in a day habilitation or vocational program. “Nursing home” means a related institution that is classified as a nursing home.

In addition to any other power set forth in this article or the Health Occupations Article, the Secretary may file a petition for appointment of a receiver for a nursing home or community program defined in this subtitle if, after investigation of the Secretary or after investigation at the request of the Secretary of Aging, the Secretary reasonably believes that: A person is operating the nursing home or community program without a license for it; The nursing home or community program will be closed within 30 days and arrangements to relocate its residents have not been approved by the Secretary; The nursing home or community program or its residents have been abandoned; or A situation, physical condition, practice, or method of operation presents an imminent danger of death or serious mental or physical harm to the individuals. A petition under this section shall be filed with the circuit court for the county where the nursing home or community program is located.

Except as otherwise provided in subsection (b) of this section, the court shall hold a hearing on a petition under Part V of this subtitle within 10 days after the petition is filed. The owner of the nursing home or entity operating the community program shall be given notice of the hearing: 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: Is signed and verified by the Secretary; States that the owner or operating entity cannot be found; and Sets forth a substantial account of reasonable, good faith efforts to find the owner or operating entity and serve process. The owner of the nursing home or operating entity of a community service is entitled to offer evidence at the hearing. A court may appoint a receiver for a nursing home or community program if, from the petition, affidavits, and any evidence offered ex parte, the court finds probable cause to believe that a situation, physical condition, practice, or method of operation presents an imminent danger of death or serious mental or physical harm to the residents and must be remedied immediately to insure their health, safety, and welfare. The owner or person then in charge of the nursing home or community program shall be given notice of the appointment of a receiver: 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: Is signed and verified by the Secretary; States that the owner and the person in charge of the nursing home or community program cannot be found; and Sets forth a substantial account of reasonable, good faith efforts to find the owner and the person in charge and serve process. Unless the owner of the nursing home or entity operating the community program consents to a later date, the court shall hold a hearing on the appointment of the receiver within 5 days after service of process.

After the hearing under § 19-335 of this subtitle, the court may appoint a receiver for the nursing home or community program or continue the appointment of the receiver made ex parte, if the court finds: A person is operating the nursing home or community program without a license for it; The nursing home or community program will be closed within 30 days and arrangements to relocate its residents have not been approved by the Secretary; The nursing home or community program or its residents have been abandoned; or A situation, physical condition, practice, or method of operation presents an imminent danger of death or serious mental or physical harm to the individuals. The court may appoint as receiver any responsible individual other than: A State employee; An employee of a local government; or The owner or administrator of or other individual with a financial interest in the nursing home or community program or agent of any of those individuals. Before the receiver takes charge of the nursing home or community program, the receiver shall file a bond with the court. The bond: 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. Unless the court directs otherwise, the receiver may pay the premium of the bond from the income of the nursing home or community program. The Secretary may petition the court to appoint a substitute for a receiver who: Dies; Has a disability; Has an adverse interest; or Does not make reasonable progress in carrying out the receivership.

Except as expressly provided otherwise in this section, each receiver who is appointed under Part V of this subtitle has all of the powers of a receiver who is appointed under § 3-414 of the Corporations and Associations Article. The receiver shall perform all acts that are necessary and exercise the powers of the receiver to: 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. The receiver shall report to the court as the court requires. The receiver of a nursing home or community program shall: Give each individual and interested parties with respect to each individual notice of the receivership; Preserve all property of and records that relate to an individual and are in the custody of the receiver or the owner or operating entity; If an individual is to be discharged or transferred: 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. The receiver may use: Any private or third-party reimbursements to the nursing home, including any Medicaid or Medicare payments; and With the approval of the court, money from the fund established under § 19-338 of this subtitle. If the structure or furnishings of a nursing home or site of the community program violate State or federal law, the receiver may correct the violation: Without the consent of the court, if the cost of the correction does not exceed $3,000; or On petition to and with the consent of the court, if the cost of the correction is more than $3,000. The receiver shall pay the principal of and interest on a mortgage or secured transaction unless the holder of the mortgage or the secured party is the owner or an affiliate of the owner. On petition of a receiver, the court may: Allow the receiver to avoid a lease, mortgage, secured transaction, or other contract that the owner or operating entity made if: The person seeking payment under the contract is, or at the time the contract was made was, the owner or an affiliate of the owner; and The contract provides for a rent or interest rate substantially exceeding the rent or interest rate that was reasonable when the contract was made; and 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. The court shall hold a hearing on a petition under this subsection within 15 days after the petition is filed. Notice of the petition shall be given to all known owners of property that the petition affects: By the receiver, at least 10 days before the hearing; or By publication, if the receiver files with the court a statement that: Is signed and verified by the receiver; States that the owner of the property cannot be found; and Sets forth a substantial account of reasonable, good faith efforts to find the owner and serve process. The court shall set a rent under this subsection in an amount that is not less than the total current payments of principal and interest required on all mortgages and secured transactions that: Affect the property under the contract to be avoided; and Cannot be avoided under this subsection. Payment of the rent or interest rate that a court sets under this subsection is a defense in any action against the receiver for payment or for possession of the property. However, the payment does not relieve the owner or operating entity of any liability for the difference between the amount that the receiver pays and the amount that is due under the contract. A receiver is not liable for an injury to person or property that results from the condition of the nursing home or site of the community program. A receiver only is liable for any act or omission that constitutes negligence in the fulfillment of the duties as receiver. A receiver is entitled to the fee that the court finds reasonable.

The Secretary shall determine whether the receivership can be funded by State funds previously designated for the community program. In the event that previously designated funds are available, these funds shall be used for the operation of the receivership. In the event that there are insufficient funds to operate the receivership, the Secretary may petition the Board of Public Works for sufficient funds to operate the receivership. State funds used to operate a receivership under this section shall be a lien on the community program and its assets if the receiver files a notice of the lien that contains: 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 receiver shall file the notice of lien with: 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. A lien under this subsection: 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 owner or operating entity or receiver of a nursing home or community program may petition the court to terminate the receivership. The court shall terminate the receivership, if the court finds: 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. A receivership ends automatically 1 year after the court appoints the receiver, unless the court: Terminates the receivership sooner; or On petition of the Secretary, extends the receivership for an additional 1-year period because the court finds that the grounds for appointment of a receiver under Part V of this subtitle still exist. The sale of a nursing home or site for a community program or any of its assets does not terminate a receivership of the nursing home or community program.

In this section, “patient” includes an inpatient, an outpatient, and an emergency services patient. The General Assembly intends to promote the health, safety, and well–being of patients and to foster better communication between patients and health care providers in hospitals through the use of a patient’s bill of rights that specifies the ethical and humane treatment the patient has a right to expect. Each administrator of a hospital shall: Provide to each patient in the hospital a written copy of the patient’s bill of rights that: 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; If a patient does not speak English or requires the patient’s bill of rights in an alternative format, provide a translator, an interpreter, or another accommodation to assist the patient in understanding and exercising the rights included in the patient’s bill of rights; Conspicuously post copies of the patient’s bill of rights on the hospital’s website and in areas that are accessible to patients and visitors, which may include admitting offices, patient floors, patient rooms, the outpatient department, and emergency services waiting areas; and Provide annual training to all patient care staff members to ensure the staff’s knowledge and understanding of the patient’s bill of rights. The patient’s bill of rights shall at a minimum include a statement, in plain language, that a patient has a right to: Receive considerate, respectful, and compassionate care; Be provided care in a safe environment free from all forms of abuse and neglect, including verbal, mental, physical, and sexual abuse; Have a medical screening exam and be provided stabilizing treatment for emergency medical conditions and labor; Be free from restraints and seclusion unless needed for safety; Be told the names and jobs of the health care team members involved in the patient’s care if staff safety is not a concern; Have respect shown for the patient’s personal values, beliefs, and wishes; Be treated without discrimination based on race, color, national origin, ethnicity, age, gender, sexual orientation, gender identity or expression, physical or mental disability, religion, language, or ability to pay; Be provided a list of protective and advocacy services when needed; Receive information about the patient’s hospital and physician charges and ask for an estimate of hospital charges before care is provided and as long as patient care is not impeded; Receive information in a manner that is understandable by the patient, which may include: 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; Receive information from the patient’s doctor or other health care practitioners about the patient’s diagnosis, prognosis, test results, possible outcomes of care, and unanticipated outcomes of care; Access the patient’s medical records in accordance with HIPAA Notice of Privacy Practices; Be involved in the patient’s plan of care; Be screened, assessed, and treated for pain; Refuse care; In accordance with hospital visitation policies, have an individual of the patient’s choice remain with the patient for emotional support during the patient’s hospital stay, choose the individuals who may visit the patient, and change the patient’s mind about the individuals who may visit; Appoint an individual of the patient’s choice to make health care decisions for the patient, if the patient is unable to do so; Make or change an advance directive; Give informed consent before any nonemergency care is provided, including the benefits and risks of the care, alternatives to the care, and the benefits and risks of the alternatives to the care; Agree or refuse to take part in medical research studies, without the agreement or refusal affecting the patient’s care; Allow or refuse to allow pictures of the patient for purposes other than the patient’s care; Expect privacy and confidentiality in care discussions and treatments; Be provided a copy of the Health Insurance Portability and Accountability Act Notice of Privacy Practices; and File a complaint about care and have the complaint reviewed without the complaint affecting the patient’s care. The Office of Health Care Quality shall monitor the compliance of each hospital with the requirements of this section.

In this section the following words have the meanings indicated. “Emergency pregnancy–related medical condition” means a medical condition that presents in a pregnant patient through acute symptoms of sufficient severity and for which the absence of immediate medical attention could be reasonably expected to result in: Placing the health of the patient in serious jeopardy; Serious impairment to bodily functions; or Serious dysfunction of any bodily organ or body part. “Stabilize” means, for an emergency pregnancy–related medical condition, to provide the medical treatment necessary to alleviate the condition or ensure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the patient from the facility. This section applies only to a hospital with an emergency department. If a hospital determines that a patient has an emergency pregnancy–related medical condition, the hospital shall: Using the staff and facilities available to the hospital, provide further examination and the treatment required to stabilize the emergency pregnancy–related medical condition, including the termination of a pregnancy when the termination is medically necessary to stabilize the patient; or Transfer the patient to another medical facility. A hospital shall allow the termination of a pregnancy at the hospital if the patient’s treating health care practitioner determines termination is medically necessary to stabilize a patient. A hospital is considered to have met the requirements of this section if, after offering further examination and treatment or transfer to the patient or the patient’s representative and informing the patient or patient’s representative of the risks and benefits of further examination and treatment or transfer: 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. A hospital shall take reasonable steps to secure written informed consent to the refusal of an examination or treatment or transfer under this subsection from the patient or the patient’s representative. If a patient has an emergency pregnancy–related medical condition that has not been stabilized, the hospital may not transfer the patient unless the transfer is done consistent with 42 U.S.C. § 1395dd. A hospital may not penalize or take other adverse action, including an action related to discharge, promotion, demotion, suspension, compensation, training opportunities, staff privileges, or admitting privileges, against: A treating health care provider if the provider refuses to authorize the transfer of a patient with an emergency pregnancy–related medical condition that has not been stabilized; A treating health care provider if the provider’s treatment of the patient is consistent with the medical standards of care that, in the provider’s clinical judgment, were necessary to stabilize the patient; or A hospital employee if the employee reports a violation of this section. A hospital that negligently violates this section is subject to a civil penalty of: For a hospital with 100 or more beds, not more than $50,000 for each violation; or For a hospital with fewer than 100 beds, not more than $25,000 for each violation. The Department shall stay a final decision on a potential violation if there is an ongoing federal investigation under 42 U.S.C. § 1395dd regarding the same incident. If a federal investigation under 42 U.S.C. § 1395dd results in a fine being imposed for the same incident, the Department shall subtract the amount of the federal fine from the maximum potential fine under this section for the same incident. 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.

In this section and §§ 19–344, 19–345, 19–345.1, 19–345.2, and 19–345.3 of this subtitle, “facility” means a related institution that, under the rules and regulations of the Department, is a comprehensive care facility or an extended care facility. The General Assembly intends to promote the interests and well–being of each resident of a facility. It is the policy of this State that, in addition to any other rights, each resident of a facility has the following basic rights: 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. Each facility shall: Post, conspicuously in a public place, the policy set forth in subsection (b) of this section and the provisions in §§ 19–344(b) through (m), 19–345, and 19–346(i)(2) of this subtitle; Give a copy of the policy and those provisions: 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; Keep a receipt for the copy that is signed by the person who received the copy; and Provide appropriate staff training to carry out the policy and those provisions.

To carry out the policy set forth in § 19-343 of this subtitle, the following procedures are required for all services provided to a resident of a facility. A facility may not require or solicit, as a condition of admission into the facility, the signature of another person, other than the applicant, on the application or contract for admission to the facility, unless: The applicant is adjudicated disabled under Title 13, Subtitle 7 of the Estates and Trusts Article; or The applicant’s physician determines that the applicant is incapable of understanding or exercising the applicant’s rights and responsibilities; and The applicant’s physician records, in the applicant’s facility record, the specific reasons for the determination. If, in addition to the signature of an applicant, a facility requires the signature of another person on the application or contract for admission to the facility in accordance with the provisions of paragraph (1) of this subsection, the facility shall provide a written statement to be included in the document of the rights, duties, and liabilities of the signer of the document. 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. In this subsection, “agent” means a person who manages, uses, or controls the funds or assets that legally may be used to pay the applicant’s or resident’s share of costs or other charges for the facility’s services. Except as provided by the Department, a facility may not charge an applicant or resident who is a medical assistance beneficiary, or the applicant’s or resident’s agent, any amount in addition to the amounts determined by the medical assistance program for services that are covered by medical assistance. Unless otherwise agreed, the financial obligation of the applicant’s or resident’s agent is limited to the amount of the applicant’s or resident’s funds that are considered available to the agent by the medical assistance program. 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. Nothing in this subsection may be construed to prohibit any person from knowingly and voluntarily agreeing to guarantee payment for the cost of an applicant’s care. Each facility shall: On or before admission of an individual, give the individual a written statement of: 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 Keep a written receipt for the statement that is signed by the individual. Unless it is medically inadvisable, the resident physician of a facility or attending physician of its resident shall give the resident information about the diagnosis, treatment, and prognosis of the resident that is complete and current and is stated in language that the resident reasonably can be expected to understand. A resident of a facility: Shall participate in the planning of the medical treatment; May refuse medication or treatment; and May know the medical consequences of these actions. The facility shall: 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. The resident shall receive information about the relationship of the facility to other health care institutions if the information relates to the care of the resident. The resident shall receive reasonable continuity of care, including information as to the availability of physicians and times for medical appointments. Any case discussion, consultation, examination, or treatment of a resident of a facility: 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. Except as necessary for the transfer of a resident from the facility to another health care institution or as required by law or a third-party payment contract, the personal and medical records of a resident are confidential and may not be released without the consent of the resident to any individual who: Is not associated with the facility; or Is associated with the facility, but does not have a demonstrated need for the information. If it is feasible to do so and not medically contraindicated, spouses or domestic partners who are both residents of the facility shall be given the opportunity to share a room. A resident of a facility alone or with other individuals is entitled to present any grievance or recommend a change in a policy or service to the staff or administrator of the facility, the Department of Aging, or any other person, without fear of reprisal, restraint, interference, coercion, or discrimination. Each facility shall place at the bedside of each resident the name, address, and telephone number of a physician who is responsible for the resident’s care. A resident shall have access at any reasonable time to a telephone where the resident may speak privately. A resident shall have access to writing instruments, stationery, and postage. The correspondence of a resident shall be sent to the addressee without delay and without being opened. Every patient and resident may associate and communicate privately and without restriction with persons and groups of his choice on his own or their initiative at any reasonable hour. Each married resident of a facility shall have privacy during a visit by the spouse. Each resident of a facility who has a domestic partner shall have privacy during a visit by the other domestic partner. To a reasonable extent, a resident of a facility shall have the right to possess and use clothing and other personal effects and to have security for those effects. A resident of a facility may not be assigned to do any work for the facility without personal consent and without written approval of the attending physician of the resident. A resident of a facility shall receive a reasonable response from an administrator or staff to a personal request of the resident. A resident of a facility shall enjoy privacy in the room of the resident. Unless the staff member knows that the resident is asleep, the member shall knock on the door before the member enters the room of the resident. The administrator of a facility is responsible for carrying out this section. A resident of a facility or the next of kin or domestic partner or guardian of the person of a resident may file a complaint about an alleged violation of this section. The complaint may be filed with the Department of Aging or the Department. The Secretary of Aging shall: Investigate the complaint; and After the investigation, report the findings to the complainant. After receipt of the report, the complainant shall be given an opportunity for a hearing before the Department in accordance with the rules and regulations that the Department adopts. The Secretary of Aging or the Secretary’s designee may request a hearing and act as a representative of the resident at the hearing under paragraph (4) of this subsection when: There is no guardian able and available or family member able, willing, and available; and The resident consents. The Secretary of Aging or the Secretary’s designee may, in any hearing under paragraph (4) of this subsection to which it is not a party under paragraph (5) of this subsection, take part as an interested party. If a resident is adjudicated a disabled person, is found to be medically incompetent by the attending physician of the resident, or is unable to communicate with others, the rights of the resident may be exercised by: The next of kin of the resident; The guardian of the person of the resident; The sponsoring agency of the resident; or Unless the facility is the representative payee, the representative payee that the Social Security Administration designates for the resident.

A resident of a facility may not be transferred or discharged from the facility involuntarily except for the following reasons: The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility; The transfer or discharge is appropriate because the resident’s health has improved sufficiently so that the resident no longer needs the services provided by the facility; The health or safety of an individual in a facility is endangered; The resident has failed, after reasonable and appropriate notice, to pay for, or under Medicare or Medicaid or otherwise, to have paid for a stay at the facility; or The facility ceases to operate. A resident of a facility that is transferred or discharged from the facility involuntarily may not be transferred or discharged: To a location other than the location identified in the notice required under § 19–345.1(b)(3) of this subtitle, such as a hotel, shelter, or other temporary housing; Before the facility to which the resident is to be transferred has confirmed that: The resident may be transferred to the facility; and The facility is prepared to accept the resident. A Medicaid certified facility may not: Include in the admission contract of a resident any requirement that, to stay at the facility, the resident will be required to pay for any period of time or amount of money as a private pay resident for any period when the resident is eligible for Medicaid benefits; or Transfer or discharge a resident involuntarily because the resident is a Medicaid benefits recipient. Except as provided in subparagraph (ii) of this paragraph, a Medicaid certified facility is presumed to be transferring or discharging a resident in violation of this subsection, if the resident is or becomes eligible for Medicaid benefits. A Medicaid certified facility is not presumed to be transferring or discharging a resident in violation of this subsection for transferring or discharging a resident for nonpayment for services while the resident was ineligible for assistance under the medical assistance program.

A facility shall provide the resident with written notice of: Any proposed discharge or transfer; and The opportunity for a hearing in accordance with the provisions of this section before the discharge or transfer. The notice required under paragraph (1) of this subsection shall include, at a minimum, the information listed under subsection (b) of this section. The Department shall prepare and provide each facility with a standardized form that provides, in clear and simple language, at least the following information: Notice of the intended discharge or transfer of the resident, including the proposed date of the intended discharge or transfer, which may change as a result of an appeal or the discharge planning process; Each reason for the discharge or transfer; The location to which the resident will be discharged or transferred, which may change as a result of an appeal or the discharge planning process; The name of the social worker or other professionally qualified staff, which may change during the discharge planning process, who: Is designated to provide social services and discharge planning services to the resident in connection with the discharge or transfer; and Will be responsible for the development of the post discharge plan of care under subsection (g) of this section; A proposed date within 10 days after the date of the notice for a meeting between the resident, the resident’s representative, and facility staff to develop the post discharge plan of care under subsection (g) of this section; The right of the resident to request a hearing; The name, mailing address, e–mail address, and telephone number of the entity to which the resident must submit a request for a hearing; and Instructions for obtaining, completing, and submitting a request for a hearing; The right of the resident to consult with any lawyer the resident chooses; The availability of the services of Maryland Legal Aid, the Older American Act Senior Legal Assistance Programs, and other agencies that may provide assistance to individuals who need legal counsel; The availability of the Long–Term Care Ombudsman Program to assist the resident; and The mailing address, e–mail address, and telephone number of the Long–Term Care Ombudsman Program; The mailing address, e–mail address, and telephone number of Disability Rights Maryland; and The provisions of this section. Except as otherwise provided in this section, at least 30 days before the facility involuntarily transfers or discharges a resident, the facility shall: Provide to the resident the written notice required under subsection (a) of this section; and Provide the written notice required under subsection (a) of this section to: The resident; The next of kin, guardian, or any other individual known to have acted as the resident’s representative, if any; The Long–Term Care Ombudsman; and The Department. In accordance with regulations adopted by the Secretary, the facility shall provide the resident with an opportunity for a hearing on the proposed transfer or discharge. The regulations adopted by the Secretary may provide for the establishment of an escrow account when: The basis for the discharge is nonpayment; and The resident continues to reside in the facility while the appeal is pending. Except as otherwise provided in this subsection, hearings on proposed transfers or discharges shall be conducted in accordance with the provisions of Title 10, Subtitle 2 of the State Government Article and the Medicaid Fair Hearing Procedures. Any hearing on a proposed discharge or transfer of a resident: Is not a contested case as defined in § 10–202 of the State Government Article; and May not include the Secretary as a party. A decision by an administrative law judge on a proposed discharge or transfer of a resident: Is not a decision of the Secretary; Unless appealed, is final and binding on the parties; and May be appealed in accordance with § 10–222 of the State Government Article as if it were a contested case but the appeal does not automatically stay the decision of the administrative law judge. The facility shall provide the written notice required in subsection (a) of this section as soon as practicable before discharge or transfer if an emergency exists and health or safety of the resident or other residents would be placed in imminent and serious jeopardy if the resident were not transferred or discharged from the facility as soon as possible. If the information in the notice provided under subsection (c) of this section changes before the discharge or transfer, the facility shall provide the changes to the recipients of the notice as soon as practicable after the new information becomes available. If a new notice is provided under paragraph (1) of this subsection, the following time requirements apply to the discharge or transfer of the resident: The resident may not be discharged or transferred for at least 30 days after the new notice has been provided to the resident if the new notice is provided before: The expiration of the time period required under subsection (c) of this section; or The date of an order of discharge issued by an administrative law judge under subsection (d) of this section; and If the new notice is provided after a date described under item (i) of this paragraph: If the original notice indicated a discharge location that was a licensed skilled nursing facility and the new notice changes the date of discharge or transfer only, the resident may be discharged on the earliest date that a bed is available at the facility; If the new notice changes the location of discharge or transfer from a licensed skilled nursing facility to a different licensed skilled nursing facility, the resident may not be discharged or transferred for at least 7 days after the new notice has been provided to the resident; and If the new notice changes the location of discharge or transfer from a licensed skilled nursing facility to a location that is not a licensed skilled nursing facility but is otherwise determined to be a safe discharge location under an appropriate clinical evaluation and as set forth in the post discharge plan of care, the resident may not be discharged or transferred for at least 30 days after the new notice has been provided to the resident. A new notice provided under this subsection shall: Indicate any differences between the prior notice and the new notice; and Include a notice of the right to appeal the new notice: For any discharge or transfer described under paragraph (2)(i) of this subsection; or For a discharge or transfer described under paragraph (2)(ii)3 of this subsection, if the underlying basis of the original notice has changed. For a discharge or transfer described under paragraph (2)(ii)1 or 2 of this subsection, a new notice is not required to include a notice of the right to appeal the new notice. Before any discharge or transfer and subject to paragraphs (4) and (5) of this subsection, a facility shall develop a post discharge plan of care for the resident to assist the resident with adjusting to the resident’s new living environment and that: Addresses the resident’s post discharge goals of care and treatment preferences; Identifies each of the resident’s reasonably anticipated medical and basic needs after discharge or transfer and establishes a plan for meeting those needs; Identifies the address at which the resident will reside post discharge; and In accordance with regulations adopted by the Secretary, provides a safe, secure, and sustainable environment for the resident. The facility shall designate a social worker or other professionally qualified staff member to coordinate the development of the resident’s post discharge plan of care. The facility shall, if possible, meet with the resident and, with the resident’s consent, the resident’s representative within 10 days after providing the notice required under subsection (a) of this section to discuss the post discharge plan of care for the resident. The resident’s post discharge plan of care shall be developed with the participation of the resident and, with the resident’s consent, the resident’s representative. If the post discharge plan of care was developed without the participation of the resident or the resident’s representative, the facility shall include in the resident’s medical record an explanation of why the resident or the resident’s representative did not participate. The resident’s post discharge plan of care shall be developed in consultation with: The resident’s attending physician; A registered nurse responsible for the care of the resident; and Any other appropriate staff or professional involved with meeting the resident’s medical needs.

In addition to the provisions of §§ 19–345 and 19–345.1 of this subtitle, a facility may not involuntarily discharge or transfer a resident unless, within 48 hours before the discharge or transfer, the facility has: Provided or obtained: A comprehensive medical assessment and evaluation of the resident, including a physical examination, that is documented in the resident’s medical record; A post discharge plan of care for the resident that is developed, if possible, with the participation of the resident’s next of kin, guardian, or legal representative in accordance with § 19–345.1 of this subtitle; and Written documentation from the resident’s attending physician indicating that the transfer or discharge is in accordance with the post discharge plan of care and is not contraindicated by the resident’s medical condition; and Provided information to the resident concerning the resident’s rights to make decisions concerning health care, including: The right to accept or refuse medical treatment; The right to make an advance directive, including the right to make a living will and the right to appoint an agent to make health care decisions; and The right to revoke an advance directive. Except as provided in subsection (d)(3) of this section, and at least 24 hours before discharge or transfer, the facility shall provide the resident and the resident’s next of kin, guardian, or legal representative with: The written statement of the medical assessment and evaluation and written documentation from the resident’s attending physician required under subsection (a) of this section; The post discharge plan of care developed under § 19–345.1 of this subtitle; The information necessary to assist the resident and the resident’s next of kin, guardian, or legal representative in obtaining additional prescriptions for necessary medication through consultation with the resident’s treating physician; and A written statement containing the date, time, method, mode, and destination of discharge. To the extent authorized under State and federal law, a facility shall provide at least a 3–day supply of medications currently being taken by the resident at the time of discharge or transfer. Except as provided in paragraphs (2) and (3) of this subsection, a facility may not discharge or transfer a resident unless the resident is capable of and has consented in writing to the discharge or transfer. A facility may discharge or transfer a resident without obtaining the written consent of the resident for one of the reasons listed in § 19–345(a) of this subtitle if the discharge or transfer: Is in accordance with a post discharge plan of care developed under § 19–345.1 of this subtitle; Is to the community in which the resident resided before becoming a resident of the facility unless the facility documents why it is in the best interest of the resident to be discharged to another location; Is to another licensed provider, unless: The resident is being discharged or transferred because the resident’s health has improved sufficiently and the resident no longer needs the services provided by the facility; The resident has no pending application to the medical assistance program or is ineligible for the medical assistance program and is being discharged or transferred for nonpayment under § 19–345(a)(4) of this subtitle; or If the resident is or may be eligible for the medical assistance program: The facility has fulfilled its obligation under § 19–344(c) of this subtitle to cooperate with and assist the resident or the resident’s representative in seeking assistance from the medical assistance program and has documented the cooperation and assistance; The resident or resident’s representative has refused to apply for or seek assistance from the medical assistance program or has repeatedly failed, despite the facility’s documented assistance, to make good–faith efforts to supply information or materials necessary for the medical assistance program to enroll the resident; and The resident is being discharged for nonpayment under § 19–345(a)(4) of this subtitle; and Is to a safe and secure environment. A facility that is certified as a continuing care provider under Title 10, Subtitle 4 of the Human Services Article is not subject to the provisions of subsection (b) of this section if: The facility transfers a resident to a lesser level of care within the same facility in accordance with a contractual agreement between the facility and the resident; and The transfer is approved by the attending physician. If the requirements of §§ 19–345 and 19–345.1 of this subtitle and subsections (a) and (b) of this section have been met, the resident’s next of kin or legal representative shall cooperate and assist in the discharge planning process, including: Contacting, cooperating with, and assisting other facilities considering admitting the resident; and Cooperating with governmental agencies, including meeting the requirements of § 19–344(c) of this subtitle to seek and pursue with due diligence assistance from the medical assistance program. A facility may, without requesting the appointment of a guardian, petition the appropriate circuit court for an order or injunction directed at the resident or agent of the resident for appropriate relief to enforce this subsection. If requested by any person during the process of transferring or discharging a resident or on its own initiative, the Office of the Attorney General may investigate whether an abuse of funds under § 19–346 of this subtitle contributed to the decision to transfer or discharge the resident and may make appropriate referrals of the matter to other government agencies.

The Secretary may impose a civil money penalty not to exceed $10,000 for: Each violation by a facility of § 19–345, § 19–345.1, or § 19–345.2 of this subtitle; or Each willful or grossly negligent violation by a resident’s agent or legal representative of § 19–345, § 19–345.1, or § 19–345.2 of this subtitle. If a civil money penalty is imposed under this section, the facility or agent or legal representative of the resident shall have the right to appeal from an order imposing the civil money penalty in accordance with Title 10, Subtitle 2 of the State Government Article. A resident, resident’s agent, or resident’s attorney, or the Attorney General on behalf of the resident, who believes that an involuntary discharge or transfer that violates the requirements of § 19–345, § 19–345.1, or § 19–345.2 of this subtitle is imminent or has taken place may request injunctive relief from a circuit court. To prevent irreparable harm to residents in a facility, the Attorney General may seek injunctive relief on behalf of the State on the basis of an imminent or ongoing violation of a basic right of residents of facilities provided under § 19–343(b)(2)(ii), (iv), (v), (viii), or (x) of this subtitle. In an action brought by the Attorney General under this subsection, the Attorney General may request that the court impose a civil penalty not to exceed $100,000 for each violation by a facility of § 19–345, § 19–345.1, or § 19–345.2 of this subtitle. In exercising the authority granted under paragraphs (2) and (3) of this subsection, the Attorney General may not duplicate any corrective action imposed by the Department for the same violation.

In this section the following words have the meanings indicated. “Abuse of funds” means using the assets or income of a resident: Against the express wish of the resident, if the expenditure was not necessary for the direct and immediate benefit and welfare of the resident; or For the use or benefit of a person other than the resident if the expenditure is not also for the direct and immediate benefit of the resident or consistent with an express wish and past behavior of the resident. “Bank” means a bank, trust company, savings bank, or savings and loan association that: Is authorized to do business in this State; and Is insured by the Federal Deposit Insurance Corporation, Federal Savings and Loan Insurance Corporation, or the State of Maryland Deposit Insurance Fund Corporation. “Facility” means: A hospital that is classified as a special hospital; or A related institution. This section provides rights and remedies in addition to, and not in derogation of, any right or remedy that a resident of a facility has under any other law. Each resident of a facility may: Keep control over personal financial transactions unless: A court adjudicates the resident as a disabled person, in accordance with Title 13 of the Estates and Trusts Article; or The Social Security Administration designates a representative payee to receive the Social Security funds for the use and benefit of the resident; and Choose any person, including the administrator of the facility or a designee of the administrator, to handle the financial transactions. Each facility shall have adequate safeguards for property of a resident that is entrusted to the facility. A facility to which money is entrusted shall deposit the money in an account if the facility cannot keep the money safely. If the facility is operated by a State, county, or municipal agency and one resident entrusts more than $300 to the facility, the facility shall deposit the amount in excess of $300. If the facility is operated by a person other than a State, county, or municipal agency and one resident entrusts more than $100 to the facility, the facility shall deposit the amount in excess of $100. If the total amount of money that is entrusted to the facility by its residents exceeds $50 per resident, the facility shall deposit the amount in excess of $50 per resident or $1,000, whichever is less. A facility that is a related institution caring for individuals and whose administrator or bookkeeper has control over or access to the funds of a resident of the facility shall provide, as determined by the Department, either: A bond in an amount the Department requires; A letter of credit equal to 3 times the average yearly balance of funds of all residents of the facility; or Self–insurance if the net worth of the facility is at least 3 times the average yearly balance of funds of all residents of the facility. A facility shall keep the accounts of its residents separate from the accounts of the facility. A facility that is operated by a person other than a State, county, or municipal agency shall: Establish a separate account with a bank in the name of each resident who entrusts more than $100 to the facility; and Deposit other money that the facility is required to deposit, in either: A separate account in the name of the resident; or An account that is designated “General Fund of the Participating Residents of the (name of facility)”. If the facility is operated by a State, county, or municipal agency, the facility may establish any required accounts with a bank or with the State, county, or municipal treasurer. The accounts established by facilities shall be interest bearing accounts. All interest on money of a resident shall be credited to the resident. The State Treasurer or a county or municipal treasurer shall: Credit interest to the total account at a rate that equals the average interest rate on short term investments of the government; and Allocate the interest among each resident participating in the account in proportion to the resident’s participation in the total account. A resident may get money as follows: If the facility has the money in possession, during the business hours of the facility; or If a bank or the State or a county or municipal treasurer holds the money, within 3 banking days. A resident may give a licensed employee of the facility a limited power of attorney for the account of the resident. The Department shall prescribe the form to be used for this limited power of attorney. A facility may: Include in its operating costs the cost of establishing and servicing accounts for private, State, and federally funded residents; and Recover the cost through a daily or monthly charge for care or as provided in rules or regulations that the Secretary of Health and Human Services adopts under the Social Security Act. A facility: Shall make an accounting of money of a resident to the resident or personal representative of the resident; and In accordance with Department rules and regulations: Shall keep, at the facility, records of all transactions with money of residents; and Shall be subject to audit. Each facility that, under the rules and regulations of the Department, is a comprehensive care facility or an extended care facility shall: Have a monthly accounting available for inspection; and Provide a quarterly statement on money of a resident: To the resident; or To a person exercising the right of the resident under § 19–344(r) of this subtitle. If a facility discharges a resident, the facility shall: Return, on demand, the money of the resident that the facility has in possession to the resident or a designee of the resident if the resident or designee signs a receipt; and Make the money of the resident in an account with a bank or the State, county, or municipal treasurer available to the resident or designee within 3 banking days. This paragraph does not apply to a resident who is transferred temporarily to an acute care facility. If a facility discharges a resident and the facility is the representative payee of the resident, the facility shall: Promptly seek designation of a new representative payee; and Transfer all money of the resident to the new representative payee. If a resident has been absent from a facility for 1 year, the facility shall make reasonable attempts to find the resident or the personal representative or heirs of the resident to turn over the property of the resident unless the resident or the attending physician of the resident gives the facility written notice that the resident: Is expected to be readmitted to the facility; and Wants the facility to continue to hold the property. All property and any income from property that a facility holds for a discharged or deceased resident are presumed abandoned in accordance with Title 17 of the Commercial Law Article, if the property and income are not claimed by the resident, personal representative, or heir within 1 year. If the ownership of a facility changes, the transferor shall give the transferee a certified written audit of all funds that residents have entrusted to the facility. The transferee shall give to the transferor a signed receipt acknowledging the receipt of the accounts. A resident is not liable for any act or omission of the facility concerning the finances of the facility or the resident. A person, including the legal representative of the resident, may not use the assets or income of a resident for any purpose that is not authorized by the resident, a designee, or a legal representative, including a representative payee of the resident. A person may make a written or oral complaint if the person believes that there has been an abuse of funds. The complaint shall set forth each reason for the belief that there has been an abuse of funds and any facts that the complainant has to support the complaint. The complaint shall be made: To the local department of social services for the county where the facility is located; or If the patient is 65 years old or older, to the Secretary of Aging. The recipient of the complaint shall: Immediately give the administrator of the facility written notice of the complaint, unless the administrator is the alleged abuser and the recipient believes that the notice would affect an investigation adversely; Investigate the complaint, as appropriate; and Give the alleged abuser specific notice of the alleged abuse and an opportunity to reply to the charges stated in the complaint. On request of the Secretary of Aging or the local department of social services, a State’s Attorney shall help in the investigation. If, after the completion of an investigation, there is probable cause to believe that there has been an abuse of funds, the Secretary of Aging or the local department of social services may: Refer the matter to the State’s Attorney for appropriate action; and On behalf of the resident, bring suit to recover the misused money, costs, and attorney’s fees. A person who acts in good faith is not civilly or criminally liable for: Making a complaint under this subsection; Participating in an investigation arising out of a complaint under this subsection; or Participating in a judicial proceeding arising out of a report under this subsection. If there is an abuse of funds, a person who misused the money is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $10,000. Any person who violates another provision of this section is subject to a fine of $10,000.

In this section the following words have the meanings indicated. “Abuse” means the non–therapeutic infliction of physical pain or injury, or any persistent course of conduct intended to produce or resulting in mental or emotional distress. “Abuse” does not include the performance of an accepted medical procedure that a physician orders. “Law enforcement agency” means the Department of State Police or a police agency of a county or municipal corporation. A person who believes that a resident of a related institution has been abused shall report promptly the alleged abuse to an appropriate law enforcement agency and the Office of Health Care Quality in the Department. A report: May be oral or written; and Shall contain as much information as the reporter is able to provide. Unless the administrator is the alleged abuser, a recipient of a report promptly shall notify, to the extent allowed by federal and State law, the administrator of the related institution. If the Office of Health Care Quality receives a report under paragraph (1) of this subsection, the Office promptly shall notify the Long–Term Care Ombudsman Program established under § 10–902 of the Human Services Article. Any employee of a related institution who is required to report alleged abuse under subsection (b) of this section, and who fails to report the alleged abuse within 3 days after learning of the alleged abuse, is liable for a civil penalty of not more than $1,000. Unless otherwise provided, the law enforcement agency, with the assistance of the Secretary, shall: Investigate thoroughly each report of an alleged abuse; and Attempt to ensure the protection of the alleged victim. The investigation shall include: A determination of the nature, extent, and cause of the abuse; The identity of the alleged abuser; and Any other pertinent fact or matter. Within 10 working days after the completion of the investigation, the law enforcement agency shall submit a written report of its findings to: The State’s Attorney; The Secretary; The local long–term care ombudsman entity, as defined in § 10–901 of the Human Services Article; Unless the administrator is the alleged abuser, the administrator of the related institution; and The Office of Health Care Quality of the Maryland Department of Health. The law enforcement agency: Shall refer to the Secretary for investigation reported instances of abuse involving any persistent course of conduct intended to produce or resulting in mental or emotional distress; and May refer to the Secretary for investigation reported instances of patient–to–patient abuse. Within 10 working days after the completion of an investigation under subsection (d) of this section, the Secretary shall submit a written report of its findings to: The State’s Attorney; The local long–term care ombudsman entity, as defined in § 10–901 of the Human Services Article; and Unless the administrator is the alleged abuser, the administrator of the related institution. A person shall have the immunity from liability described under § 5–631 of the Courts and Judicial Proceedings Article for: Making a report under this section; Participating in an investigation arising out of a report under this section; Participating in a judicial proceeding arising out of a report under this section; or Participating in transferring, suspending, or terminating the employment of any individual who is believed to have abused or aided in abusing a resident under this section. The Department shall provide each related institution with signs that set forth the reporting requirements under this section. The related institution shall post the signs conspicuously in the employee and public areas of the related institution.

In this section, “inappropriate sexual behavior” has the meaning stated in COMAR 10.01.18.02. A privately owned and operated residential treatment center shall be subject to the reporting requirements established by the Department under COMAR 10.01.18.05 that apply when a staff member observes, receives a complaint regarding, or otherwise has reason to believe that an individual has been subjected to inappropriate sexual behavior.

Each hospital shall offer to each adult female inpatient of the hospital a Papanicolaou smear for detection of cervical cancer unless: The attending physician orders otherwise; or The patient has had the examination within the preceding year. A patient may refuse the examination. Each hospital shall offer mammography educational materials to each female patient when medically appropriate for the patient. The Department, in collaboration with the Maryland Hospital Association, the Medical and Chirurgical Faculty of Maryland, and appropriate advocacy groups, shall select and approve, or develop and print, and update as necessary, mammography educational materials for the purposes of paragraph (1) of this subsection.

At least 45 days before a related institution increases any fee or charge for a service of the related institution, the related institution shall give each resident or the authorized representative of the resident written notice of the amount of the increase.

A hospital shall provide oral and written notice to a patient of the patient’s outpatient status, the billing implications of the outpatient status, and the impact of the outpatient status on the patient’s eligibility for Medicare rehabilitation services if: The patient receives on–site services from the hospital for more than 23 consecutive hours; The on–site services received by the patient include a hospital bed and meals that have been provided in an area of the hospital other than the emergency room; and The patient is classified as an outpatient at the hospital for observation rather than an admitted inpatient. The Department, in consultation with hospitals in the State, shall adopt by regulation standardized elements to be included in the written notice required under subsection (a) of this section.

In this section the following words have the meanings indicated. “Electronically” means a secure digital or electronic transmission in compliance with federal and State law, including by: Patient Internet portal; Encrypted e–mail; or Text message with a link to an encrypted notice. “Outpatient facility fee” means a hospital outpatient charge approved by the Commission for an outpatient clinic service, supply, or equipment, including the service of a nonphysician clinician. “Outpatient facility fee” does not include: A charge billed for services delivered in an emergency department; or A physician fee billed for professional services provided at the hospital. “Patient” means an individual who receives health care. “Patient” includes: A person authorized to consent to health care for an individual consistent with the authority granted, including a guardian, surrogate, or person with a medical power of attorney; An individual who is a minor, if the minor seeks treatment to which the minor has the right to consent and has consented under Title 20, Subtitle 1 of this article; A parent, guardian, custodian, or representative of an individual who is a minor; and A person authorized to consent to health care for an individual who is a minor consistent with the authority granted. Subject to subsections (c), (d), (e), and (f) of this section, if a hospital charges an outpatient facility fee, the hospital shall provide the patient with a written notice, separate from any other forms or notices, in the following form or a substantially similar form: IMPORTANT FINANCIAL INFORMATION (Patient Name)________________ Appointment Date:___________________ Notice Of Hospital Outpatient Facility Fee And Billing Disclosure a. Your appointment with (provider, practice, or outpatient facility name) will take place in an outpatient department of (hospital name). b. (Hospital name) will charge an outpatient facility fee that is separate from and in addition to the bill you will receive from (provider). c. You will receive two charges for your visit: a provider services bill from (provider); and a hospital facility bill from (hospital name). Expected Fee (if known) The amount of the facility fee that will be charged by (hospital name) for your appointment is $ ____________. or (if unknown) (Hospital name’s) facility fee is likely to range from $___________ to $_____________. and (if unknown) Based on appointments like the one you are scheduled for, we estimate the facility fee to be $____________. and (if unknown) We are providing you with a range of fees and an estimate because the actual amount of the facility fee will depend on the hospital services that are actually provided. The fee could be higher if you require services during your appointment that we cannot reasonably predict today. Financial help for your portion of the outpatient facility fee bill may be available. If you need financial help with the outpatient facility bill, please contact (hospital financial assistance office, with telephone number and direct website address). Receiving services here may result in greater financial liability than receiving services at a location where a facility fee may not be charged. (if applicable) No Facility Fee Location You can see (provider) at another location that does not charge a facility fee. (address and contact information) Contact your insurance carrier to see if (provider) is a participating provider and in–network at the (address of alternative location) location. Insurance Information The amount of the facility fee that you will be responsible for paying will depend on your insurance coverage. Insurance companies could impose deductibles or higher copayment or coinsurance amounts for services provided in hospital outpatient departments. If you have insurance, you should contact your carrier to determine your insurance coverage and your estimated financial responsibility for the facility fee, including copayments, coinsurance, and deductible amounts for the outpatient facility fee. Facility Fee Complaints If you have a complaint about an outpatient facility fee charge, please first contact the hospital, (hospital billing office contact information). If the complaint is unresolved, you may then file the complaint with the Health Services Cost Review Commission, (contact information). If you need additional information regarding your facility fee charges or if you need assistance mediating a facility fee complaint against a hospital, contact the Health Education and Advocacy Unit of the Office of the Attorney General, 1–877–261–8807 | Heau@oag.state.md.us | www.MarylandCares.org. Acknowledgment I understand that I will be billed a hospital facility fee and a provider fee. (Hospital name) provided me with information on the facility fees that will be billed for my appointment. I understand that the fee could vary based on conditions and services provided to me that the hospital cannot reasonably predict today. I understand that my out–of–pocket costs will depend on my insurance coverage. ________(initial here) – by initialing here, I confirm that I received the facility fee information at the time I made my appointment with (provider). By signing this form, I acknowledge that I have received this information before receiving services today. _____________________________ _______________________________ Signature Date To request this notice in an alternative format, please call (contact information) or e–mail (contact information). (Same sentence in Spanish). If a patient does not speak English or requires the notice required under subsection (b) of this section to be in an alternative format, the hospital shall, to the extent practicable, provide the notice in a language or format that is understood by the patient. A hospital shall determine the range of hospital outpatient facility fees and fee estimates, based on typical or average facility fees for the same or similar appointments, to be provided in the notice required under this section, consistent with the hospital’s most recent rate order as approved by the Commission. Each hospital that charges an outpatient facility fee shall use the range of hospital outpatient facility fees and fee estimates determined under paragraph (1) of this subsection. For an appointment made in person or by telephone: Oral notice of all the information that would be provided in the form required under subsection (b) of this section shall be given at the time the appointment is made; and Except as provided in paragraph (3) of this subsection, the written notice required under subsection (b) of this section shall be sent to the patient electronically at the time the appointment is made. For an appointment made electronically or using a website, the written notice required under subsection (b) of this section shall be: Provided at the time the appointment is made; and Sent to the patient electronically at the time the appointment is made. If the patient refuses electronic communication under paragraph (1)(ii) of this subsection, the written notice shall be sent to the patient by first–class mail at the time the appointment is made. Before professional medical services are provided on the date of the appointment, the patient shall acknowledge in writing that the notice required under this section was provided at the time the appointment was made. A hospital may not charge, bill, or attempt to collect an outpatient facility fee unless the patient was given notice in accordance with this section. On or before January 31 each year, beginning in 2022, each hospital shall report to the Health Services Cost Review Commission a list of the hospital–based, rate–regulated outpatient services provided by the hospital. On or before February 28 each year, beginning in 2022, the Health Services Cost Review Commission annually shall: Post on its website the list of the hospital–based, rate–regulated outpatient services reported by each hospital under paragraph (1) of this subsection; and Provide the list of the hospital–based, rate–regulated outpatient services reported by each hospital to the Maryland Insurance Administration and the Health Education and Advocacy Unit in the Office of the Attorney General. When lack of notice in accordance with this section is alleged in a consumer complaint, the Commission shall give consideration in its investigatory and audit procedures as to whether notice was not feasible due to circumstances beyond the hospital’s control.

This section applies only to: Related institutions as defined in § 19–301 of this subtitle; and Hospitals as defined in § 19–301 of this subtitle. Nothing in this section shall apply to charges for services that are set pursuant to § 16–201 of this article. On request of a patient made before or during treatment, a hospital shall provide to the patient a written estimate of the total charges for the hospital services, procedures, and supplies that reasonably are expected to be provided and billed to the patient by the hospital. The written estimate shall state clearly that it is only an estimate and actual charges could vary. A hospital may restrict the availability of a written estimate to normal business office hours. This paragraph does not apply to emergency services. Within 30 days after discharge of an individual from a hospital, the hospital shall give the individual a summary financial statement that clearly describes: The total charges incurred; If readily ascertainable, a summary of the total charges under the major services categories, including: Room and board; Diagnostic services; Therapeutic services; Emergency room services; Drugs and IV solutions; and Miscellaneous other supplies and services; If applicable, the name of the primary and secondary insurer to which a claim has been or will be filed on the individual’s behalf; That charges for services provided by a physician are not included in the total hospital charges and are billed separately; and The individual’s right to request an itemized statement of the account within 1 year of receipt of the summary statement. Within 30 days after an individual’s request as provided under paragraph (2)(v) of this subsection, the hospital shall provide the individual a statement of the account that: Is itemized; and Describes briefly but clearly each item and the amount charged for it. Unless a related institution contracts with its residents to provide care for an all–inclusive preestablished fee, on demand made within 90 days after service is provided to a resident, the related institution shall give the resident or representative of the resident a financial statement that: Is itemized; Describes briefly but clearly each item and the amount charged for it; and Identifies the payor to whom a claim has been forwarded. A related institution may not be required to give a resident more than 1 itemized statement in any 90–day period. On demand made within 30 days after payment of any charge for an individual, a hospital or related institution shall give the individual or representative of the individual a financial statement that: Is itemized; and Describes briefly but clearly each item and the amount charged for it. A hospital or related institution is subject to a fine of $300 if it fails to: Comply with this subsection; or Give the individual or representative a reasonable written explanation for any delay in complying with this subsection. A hospital or related institution may not demand or accept final payment or recover for money unless the hospital or related institution has given the financial statements required under this section.

In this section the following words have the meanings indicated. “Third party payor” means any person that administers or provides reimbursement for hospital benefits on an expense incurred basis including: A health maintenance organization issued a certificate of authority in accordance with Subtitle 7 of this title; A health insurer or nonprofit health service plan authorized to offer health insurance policies or contracts in this State in accordance with the Insurance Article; or A third party administrator registered under the Insurance Article. “Uniform claims form” means the claim or billing form for reimbursement of hospital services adopted by the Insurance Commissioner under § 15-1003 of the Insurance Article. When submitting a claim or bill for reimbursement to a third party payor, a hospital shall use the uniform claims form. The uniform claims form submitted under this section: Shall be properly completed; and May be submitted by electronic transfer. The Secretary may impose a penalty not to exceed $500 on any hospital that violates the provisions of this section.

Except as provided in subsections (b) and (d) of this section, this subtitle does not affect the right of a hospital or related institution to employ or appoint staff. A hospital or related institution that provides services that licensed podiatrists are authorized to perform under Title 16 of the Health Occupations Article, other than incidental care, shall include, in its bylaws, rules, or regulations, provisions for use of facilities by and staff privileges for qualified podiatrists. The hospital or related institution may restrict use of facilities and staff privileges by podiatrists to those podiatrists who meet the qualifications that the hospital or related institution sets for granting those privileges. The qualifications that the hospital or related institution sets for granting privileges for services that licensed podiatrists are authorized to perform under Title 16 of the Health Occupations Article shall include consideration of the training, education, and experience of the podiatrist. A hospital or related institution shall include in its bylaws, rules, or regulations provisions for use of facilities by and staff privileges for qualified dentists. The hospital or related institution may restrict use of facilities and staff privileges by dentists to those dentists who meet the qualifications that the hospital or related institution sets for granting those privileges. A hospital or related institution that provides services of the type that licensed psychologists are permitted to perform under Title 18 of the Health Occupations Article shall include in its bylaws, rules, or regulations, provisions for use of facilities by and staff privileges for qualified psychologists. The hospital or related institution may restrict use of facilities and staff privileges by psychologists to those psychologists who meet the qualifications that the hospital or related institution sets for granting those privileges. Nothing in this subsection shall be construed to require a hospital to: Grant admitting privileges to a psychologist; or Permit the exercise of those privileges granted by the hospital board of trustees to psychologists without appropriate collaboration with the physician who has privileges to admit and attend patients in the unit of the facility where the patient is being treated and who has ongoing responsibility for the patient. In the event of a disagreement between the psychologist and the physician concerning the patient’s treatment, the decision of the physician who has ongoing responsibility for the patient shall govern.

In this section, “nursing home” means a related institution that is classified as a nursing home. A nursing home may not assess an interest penalty on charges for services provided to a resident until, whichever is later in time: 45 days after the nursing home mails an itemized statement of the charges to the person responsible for payment of the charges; or 30 days after the end of the period for which the itemized statement of the charges covers. The nursing home shall include on the itemized statement of charges a statement in bold and conspicuous print as to when interest may be assessed consistent with the provisions of subsection (b) of this section.

A health care facility that is not covered under § 19-342 or § 19-343 of this subtitle shall include in a patient’s bill of rights or similar document that is provided to the patient or resident a statement that a patient or resident has the right to expect and receive appropriate assessment, management, and treatment of pain as an integral component of that patient’s or resident’s care.

A hospital or related institution that is a charitable institution shall have the immunity from liability described under § 5-632 of the Courts and Judicial Proceedings Article.

In this section, “gender identity” and “sexual orientation” have the meanings stated in § 20–101 of the State Government Article. This section does not prohibit a hospital or related institution that is licensed or otherwise regulated by the Department or a unit of the Department from refusing, withholding from, or denying any person services for failure to conform to the usual and regular requirements, standards, and regulations imposed by the licensed or regulated hospital or related institution, unless the refusal, withholding, or denial is based on discrimination on the grounds of race, color, religion, sex, age, national origin, marital status, sexual orientation, gender identity, or disability. A hospital or related institution may not discriminate against any individual with respect to the individual’s medical care because of the race, color, religion, sex, age, national origin, marital status, sexual orientation, gender identity, or disability of the individual. The Commission on Civil Rights shall enforce this section as provided in Title 20 of the State Government Article.

A hospital or related institution may not grant a discount to or receive a discount from any medical referral service or in any manner split fees with a medical referral service. A person who violates any provision of this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $100 for the first offense and not exceeding $500 for each subsequent conviction for a violation of the same provision.

A person who operates a hospital or related institution may not ask for or receive any rebate, commission, or other consideration from a pharmacy or other provider of drugs, prescriptions, or pharmaceutical services. A person who violates this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $500 and is subject to suspension or revocation of the license. In addition to the penalties provided in subsection (b) of this section, the Department may declare a person who violates this section to be ineligible to participate in the Maryland Medical Assistance Program.

A person may not operate a hospital or related institution unless issued a registration permit or licensed by the Secretary. A hospital may not provide or hold itself out as providing comprehensive physical rehabilitation services, as defined in § 19-1201 of this title, or operate as a special rehabilitation hospital unless the hospital is classified as a special rehabilitation hospital by the Secretary. Unless a health care facility is classified as a special rehabilitation hospital by the Secretary, a health care facility may only offer those physical rehabilitation services which are appropriate and necessary to the care, treatment, or support of the acute, chronic disease, or long-term care patient. A person who violates any provision of this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 for the first offense and not exceeding $10,000 for each subsequent conviction for a violation of the same provision. Each day a violation is continued after the first conviction is a subsequent offense. The Secretary may impose a civil money penalty not to exceed $10,000 for each offense under this section.

A person who operates a related institution in violation of the rules and regulations that the Secretary adopts for related institutions is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000. Each day a violation is continued after the first conviction is a separate offense. The Secretary may impose a civil money penalty not to exceed $10,000 for each offense under this section. If a civil money penalty is imposed under this section or under § 19-358 of this subtitle, the Secretary shall issue an order which shall state the basis on which the order is made, the amount of the civil money penalty imposed, and the manner in which the amount of the civil money penalty was calculated. The operator of an unlicensed hospital or an unlicensed or unregistered related institution shall have the right to appeal from the order imposing the civil money penalty in accordance with Title 10, Subtitle 2 of the State Government Article (Administrative Procedure Act - Contested Cases).

This section applies to: Nonaccredited hospitals found in violation of the standards adopted under this subtitle; Accredited hospitals: Found deficient as a result of the complaint review process; or Subject to inspection by the Department under § 19–2302(e) of this title as a result of a serious or life–threatening patient care deficiency identified by the Joint Commission on Accreditation of Healthcare Organizations, the Centers for Medicare and Medicaid Services, or the Department; Accredited residential treatment centers subject to inspection by the Department under § 19–2302(e) of this title as a result of a serious or life–threatening patient care deficiency identified by the Joint Commission on Accreditation of Healthcare Organizations, the Commission on Accreditation of Rehabilitation Facilities, the Council on Accreditation, the Centers for Medicare and Medicaid Services, or the Department; and Health care facilities that fail to achieve substantial compliance with the standards of an approved accreditation organization under § 19–2302(c)(2) of this title. If conditions are found to be detrimental to patient health, safety, or welfare, the Department shall allow the hospital, residential treatment center, or health care facility 30 days to address the deficiencies in other than serious or life-threatening situations. If corrections cannot be completed within the 30-day period, the Department may accept a plan of correction from the hospital, residential treatment center, or health care facility based upon evidence that corrective action has been undertaken by the hospital or residential treatment center. Periodic updates of the plan of correction from the hospital, residential treatment center, or health care facility may be requested by the Department. If a serious or life-threatening condition is found to exist, the Department may order the hospital, residential treatment center, or health care facility to initiate immediate corrective action, and the hospital or residential treatment center shall be subject to inspection by the Department under § 19-308 of this subtitle. If the Secretary determines that a serious or life-threatening patient care deficiency exists and the hospital, residential treatment center, or health care facility fails to correct the deficiency through implementation of immediate corrective action, the Secretary may: For an accredited hospital or accredited residential treatment center: Revoke or restrict the licensure entitlement of § 19-319(c)(2) of this subtitle; Impose a civil monetary penalty of not more than $10,000 per instance or per day; Impose a directed plan of correction; and Impose appropriate operating conditions. For an unaccredited hospital or health care facility: Revoke or restrict the license to operate; Impose a civil monetary penalty of not more than $10,000 per instance or per day; Impose a directed plan of correction; and Impose appropriate operating conditions. In determining the action to be taken under subsection (d) of this section, the Secretary shall consider the following factors: The number, nature, and seriousness of the patient care deficiencies; The extent to which the patient care deficiency or deficiencies are part of an ongoing pattern during the preceding 24 months; The degree of risk to the health, life, or safety of the patients of the hospital, residential treatment center, or health care facility caused by the patient care deficiency or deficiencies; The efforts made by, and the ability of, the hospital, residential treatment center, or health care facility to correct the patient care deficiency or deficiencies through implementation of immediate corrective action; and The hospital’s, residential treatment center’s, or health care facility’s history of compliance. The remedies provided by this section are in addition to any other remedies available to the Department at law or equity.

In this part the following words have the meanings indicated. “Hazardous condition” means a condition existing in a related institution that does not constitute a life-threatening, health, or fire safety deficiency, as described in § 19-328 of this subtitle, but which is a violation of departmental regulations which is likely to endanger the health, life, or safety of patients. “Intermediate sanction” means the establishment of an escrow account by a related institution.

An intermediate sanction may be imposed consistent with this section when a hazardous condition exists in a related institution and that condition is not remedied pursuant to the following sections. In determining whether a hazardous condition exists, the following factors shall be considered: The potential impact of the condition on the health, life, or safety of patients; The period of time during which the condition has existed; The frequency of occurrence of the condition; and The efforts made by the related institution to correct the condition. Upon determination by the Department that a hazardous condition exists, the Department will notify the facility that a hazardous condition exists which may subject the facility to a sanction. The Department shall order that a plan of correction which is acceptable to the Department be submitted within 10 working days. The Department shall notify the related institution within 3 working days of receipt of the plan of correction as to whether it is or is not acceptable. If the Department determines that the plan is not acceptable, the related institution will resubmit a revised plan within 5 working days of such notification. The Department will schedule reinspections of the facility based on time frames established in the plan of correction. If the Department determines that an acceptable plan of correction has not been submitted, that the hazardous condition has not been corrected, or that progress satisfactory to the Department has not been accomplished, the Department shall order the facility ownership and appropriate administrative personnel to appear before a representative of the Department. Following the appearance, or if the facility ownership fails to appear, a decision may be issued which: Extends the time frame in which the hazardous condition must be corrected; or Proposes the imposition of the sanction. If a sanction is proposed, or if at the end of the extended time frame the hazardous condition has not been corrected, the Secretary may issue a sanction order. The sanction order shall state the number of days within which the hazardous condition must be corrected and shall require the related institution to establish an escrow account in accordance with § 19-363 of this subtitle.

The funds in the escrow account shall be used only for the purposes of remedying the hazardous condition. The amount of the escrow account shall be the estimated cost of correcting the hazardous condition or $5,000 whichever is greater. The escrow account is to be established by the related institution at an authorized financial institution selected by the related institution. Current operating funds may not be used to establish the escrow account.

The related institution shall have the right to appeal from the order within 5 working days from the receipt of the order. The appeal shall be heard by the hearings office of the Department, which shall render the final agency decision for purposes of judicial review. Imposition of the sanction shall be stayed until the final decision is issued pursuant to subsection (m) of this section. A hearing on the sanction shall be held within 10 working days of the request for hearing. The parties to the hearing shall be the aggrieved related institution and the Secretary. The parties are entitled to be represented by counsel. The hearings office may permit, modify, or deny a timely request by the related institution for prehearing discovery. The hearings office, upon its own motion or upon motion of either party, may subpoena any person or evidence, administer oaths, and take depositions and other testimony. The hearing shall inquire fully into all of the matters at issue and shall receive into evidence the testimony of witnesses and any documents which are relevant and material to such matters. The parties shall have the right to present evidence and testimony and to cross-examine that presented by the opposing party. The purpose of the hearing is to consider and render a decision on the following matters: The existence of a hazardous condition; If a hazardous condition exists, the amount of money to be placed into the escrow account; and The length of time in which the hazardous condition must be corrected. The burdens of proof are as follows: The related institution has the burden of proof with respect to establishing the lack of the cited deficiency or deficiencies; and The Secretary has the burden of proof with respect to the establishment of a deficiency or deficiencies as constituting a hazardous condition. A decision shall be rendered by the hearings office within 7 days of the hearing. The decision shall be the final agency decision of the Department, subject to appeal pursuant to § 19-367 of this part.

Escrowed funds may be released by the escrow agent: If the related institution can present specific bills (vouchers) for correcting the hazardous condition which have been certified by the Secretary as appropriate; and In the absence of bills or vouchers, the related institution has received written approval from the Secretary that the expenditure is appropriate for correcting the hazardous condition. The escrow is terminated and the balance, if any, in the account is returned to the related institution when: The Secretary certifies that the hazardous condition is corrected; After the time period set by the Secretary, the Secretary certifies that adequate progress has been made toward correcting the hazardous condition; or The related institution changes ownership.

If the related institution fails to establish the escrow account as ordered, the Secretary may petition the appropriate circuit court to require compliance with the sanction order. If the hazardous condition is not corrected or progress acceptable to the Secretary is not made within the time frame set by the sanction order, the Secretary may: Petition the appropriate circuit court to require the related institution to comply with the sanction order; or Order the forfeiture of the escrowed funds and/or remove all patients and initiate procedures to revoke the related institution’s licensure in accordance with § 19–327 of this subtitle. Upon petition to the circuit court under subsection (b)(1) of this section, and following notification to the Secretary by the circuit court that the related institution has failed to comply with a court order, the Secretary may impose further sanctions in accordance with subsection (b)(2) of this section. This sanction is in addition to all remedies otherwise available to the circuit court for enforcement of a court order.

Either party aggrieved by the decision of the hearings office shall have the right to appeal that decision. A related institution subject to a sanction shall have the right to appeal a decision by the Secretary that the hazardous condition has not been corrected or that inadequate progress has been made toward correcting the hazardous condition. Such appeal shall be filed within 30 days of the action to be appealed. The appeal shall be taken directly to the circuit court of the jurisdiction in which the related institution is located. Appeal to the circuit court does not stay the imposition of the sanction.

In this Part IX of this subtitle the following words have the meanings indicated. “Advice” means the recommendations of the advisory committee. “Advisory committee” means a patient care advisory committee. “Petitioner” means one of the following individuals who is responsible for making a decision with a medical consequence for a patient: A patient; A physician; A registered nurse; A social worker; A family member; A guardian; An individual with a power of attorney to make a decision with a medical consequence for a patient; or Any other health care practitioner directly involved in the care of the patient. “Related institution” does not include a domiciliary care home that is operated independent of any other related institution.

Each hospital and each related institution shall establish: An advisory committee as provided in this Part IX of this subtitle; and A written procedure by which the advisory committee shall be convened. An advisory committee at a related institution may function: Solely at that related institution; Jointly with a hospital advisory committee; or Jointly with an advisory committee representing no more than 30 other related institutions.

Each advisory committee shall consist of at least 4 members, including: A physician not directly involved with the care of the patient in question; A registered nurse not directly involved with the care of the patient in question; A social worker; and The chief executive officer or a designee from each hospital and each related institution represented on that advisory committee. The advisory committee may consist of as many other individuals as each represented hospital and related institution may choose, including: Representatives of the community; and Ethical advisors or clergy. As part of the advisory committee’s deliberations, the advisory committee, in appropriate cases, shall consult: All members of the patient’s treatment team; The patient; The patient’s family; and In a case involving the options for medical care and treatment of a child with a life-threatening condition, a medical professional familiar with pediatric end-of-life care, if a medical professional with this expertise is not already a member of the committee. The petitioner may be accompanied by any persons the petitioner desires.

In addition to any other duties or responsibilities, and on the request of a petitioner, the advisory committee shall offer advice in cases involving individuals with life-threatening conditions. In addition to any other duties or responsibilities, the advisory committee may: Educate represented hospital and related institution personnel, patients, and patients’ families concerning medical decision-making; and Review and recommend institutional policies and guidelines concerning the withholding of medical treatment.

On the request of a petitioner, an advisory committee shall give advice concerning the options for medical care and treatment of an individual with a life-threatening condition. The advisory committee shall make a good faith effort to notify a patient, a patient’s immediate family members, a patient’s guardians, and an individual with a power of attorney to make a decision with a medical consequence for a patient, of the individual’s right: To be a petitioner; To meet with the advisory committee concerning the options for medical care and treatment; and To receive an explanation of the basis of the advisory committee’s advice. Any information or document that indicates the wishes of the patient shall take precedence in the deliberations of the advisory committee. An advisory committee or a member of an advisory committee who gives advice in good faith may not be held liable in court for the advice given. A person that assists one or more hospitals or related institutions in the establishment of an advisory committee may not be held liable in court for any advice given in good faith by that person, the related institution, the advisory committee, or any member of the advisory committee and the committee and its members may not be held liable for any advice given in good faith. The proceedings and deliberations of an advisory committee are confidential as provided in § 1-401 of the Health Occupations Article. The advice of an advisory committee concerning a patient’s medical care and treatment shall become part of the patient’s medical record and is confidential under §§ 4-301 and 4-302 of this article. A hospital or related institution may not be held liable in a civil action for failing to carry out the advice of an advisory committee concerning a patient’s medical care if the advice given is inconsistent with the written policies of the hospital or related institution.

In this section, “safe patient lifting” means the use of mechanical lifting devices by hospital employees, instead of manual lifting, to lift, transfer, and reposition patients. On or before December 1, 2007, each hospital shall establish a safe patient lifting committee with equal membership from management and employees. On or before July 1, 2008, the safe patient lifting committee shall develop a safe patient lifting policy for the hospital. The goal of the policy shall be to reduce employee injuries associated with patient lifting. While developing a safe patient lifting policy, the committee shall consider, based on the patient population of that hospital, the appropriateness and effectiveness of: Developing or enhancing patient handling hazard assessment processes; Enhanced use of mechanical lifting devices; Developing specialized lift teams; Training programs for safe patient lifting required for all patient care personnel at the hospital; Incorporating physical space and construction design for mechanical lifting devices in any architectural plans for hospital construction or renovation; and Developing an evaluation process to determine the effectiveness of the policy.

In this part the following words have the meanings indicated. “Aftercare” means any assistance provided by a lay caregiver to a patient after discharge of the patient. “Aftercare” includes tasks that are limited to the patient’s condition at the time of discharge that do not require a licensed professional. “Discharge” means the exit or release of a patient from inpatient care in a hospital to the residence of the patient. “Lay caregiver” means an individual who: Is an adult; Is designated as a lay caregiver by a patient or the legal guardian of a patient under this part; and Performs aftercare for the patient at the residence of the patient. “Residence” means a dwelling that a patient considers to be home. “Residence” does not include: A rehabilitation facility; A hospital; A nursing home; An assisted living facility; or A group home licensed by the State.

A hospital shall provide a patient or the legal guardian of a patient with an opportunity to designate one lay caregiver before discharge of the patient. If a patient or the legal guardian of a patient declines to designate a lay caregiver: The hospital shall document the decision in the patient’s medical record; and The hospital shall be deemed to be in compliance with the provisions of this part. If a patient or the legal guardian of a patient designates a lay caregiver, the hospital shall: Record in the patient’s medical record: The designation of the lay caregiver; The relationship of the lay caregiver to the patient; and The name, telephone number, and address of the lay caregiver; and Request the written consent of the patient or the legal guardian of the patient to release medical information to the lay caregiver in accordance with: The procedures of the hospital for releasing personal health information; and All applicable federal and State laws. If a patient or the legal guardian of a patient declines to consent to the release of medical information to the lay caregiver, the hospital is not required to: Provide to the lay caregiver the notice required under § 19–382 of this part; or Consult with the lay caregiver or provide to the lay caregiver information contained in the discharge plan issued under § 19–383 of this part. A patient or the legal guardian of a patient may change the designation of a lay caregiver in the event the lay caregiver becomes incapacitated. A designation of a lay caregiver by a patient or the legal guardian of a patient under this section does not obligate an individual to perform any aftercare for the patient. This section may not be construed to require a patient or the legal guardian of a patient to designate a lay caregiver.

If a patient or the legal guardian of a patient has designated a lay caregiver under § 19–381 of this part, the hospital shall notify the lay caregiver of the discharge of the patient or the transfer of the patient to another hospital or facility licensed by the State as soon as practicable.

As soon as practicable before discharge of a patient, a hospital shall attempt to: Consult with the patient’s lay caregiver to prepare the lay caregiver for aftercare; and Issue a discharge plan that describes the aftercare needs of the patient. The inability of a hospital to consult with a patient’s designated lay caregiver may not interfere with, delay, or otherwise affect the medical care provided to the patient or the patient’s discharge.

A hospital’s discharge process may incorporate established evidence–based practices, including those described in: Standards for accreditation adopted by The Joint Commission or another nationally recognized hospital accreditation organization; and The Conditions of Participation for hospitals adopted by the Centers for Medicare and Medicaid Services.

This part may not be construed to: Affect the rights of an agent to make health care decisions under Title 5, Subtitle 6 of this article; or Create a private right of action against a hospital, a hospital employee, or a duly authorized agent of a hospital, or otherwise supersede or replace existing rights or remedies under any other State or federal law. No federal or State: Funds may be used for payment of a lay caregiver; and Program funding may be impacted by this part.

In this part the following words have the meanings indicated. “Coordinators” means the pediatric overstay coordinator in the Department and the pediatric overstay coordinator in the Department of Human Services. “Pediatric hospital overstay patient” means a patient under the age of 22 years who remains in an inpatient unit or emergency department of a hospital for more than 48 hours after being medically cleared for discharge or transfer.

Except as provided in paragraph (2) of this subsection, the Department shall ensure that a pediatric hospital overstay patient is transferred to and treated in the least restrictive setting when clinically indicated and when possible. The Department of Human Services, in coordination with the Department, shall ensure that a pediatric hospital overstay patient who is a child committed to the care and custody of the Department of Human Services is transferred to and treated in the least restrictive setting when clinically indicated and when possible. If a pediatric hospital overstay patient remains in the hospital for more than 48 hours and the registry established under § 7.5–802 of this article indicates that an appropriate inpatient bed is available, the hospital shall seek the transfer to maintain the clinical stability of the patient. Notwithstanding any other provision of law, to ensure that a pediatric hospital overstay patient is treated in the least restrictive setting, a hospital may concurrently explore in–State and out–of–state placement options.

The Department and the Department of Human Services shall establish a pediatric hospital overstay coordinator within each department. The coordinators shall act in the best interest of a pediatric overstay patient by coordinating between hospitals, relevant State agencies and programs, and providers of mental health and substance use disorder services. The coordinators shall: Advocate on behalf of pediatric hospital overstay patients while maintaining appropriate patient confidentiality; Review policies and procedures of relevant State agencies and make recommendations for necessary changes to the policies and procedures to better serve pediatric hospital overstay patients; Maintain data on each pediatric hospital overstay patient, including: Patient’s length of stay; The responsible State agency, if applicable; Services needed; Placement options being sought by the patient; Information regarding previous hospital admissions for a behavioral health diagnosis; Information regarding whether the admission was based on an emergency petition and, if so, whether the emergency petition was executed in a school; and Any other relevant data; and Provide monthly reports on the data collected under this subsection to the Secretary, the Secretary of Human Services, and the Child and Youth Placement Review Panel in the Governor’s Office for Children. A hospital immediately shall notify the coordinators, through a system designated by the Department, about a pediatric hospital overstay patient.

In this part the following words have the meanings indicated. “Clinical staffing committee” means a committee established by a hospital in accordance with § 19–394(c) of this subtitle. “Clinical staffing plan” means a plan developed under § 19–394(d) of this subtitle.

This part does not apply to State hospitals. Each hospital licensed under this title shall comply with the staffing standards of: The accreditation body that accredits the hospital; and The federal Centers for Medicare and Medicaid Services conditions of participation. A clinical staffing plan developed under this part shall comply with this subsection. Each hospital licensed under this title shall establish and maintain a clinical staffing committee that: If the hospital has 150 or fewer licensed beds, has 3 managers and 2 employees; or If the hospital has 151 or more licensed beds, has 5 managers and 4 employees. Each clinical staffing committee established under this part may include: A certified nursing assistant; A dietary aide; A licensed nurse; An environmental service worker; A medical resident, if the committee is in a teaching hospital; A staff physician who is not a hospital employee or administrator; A technician; or An employee whose duties include patient advocacy. The chief nurse executive of each hospital shall produce a draft clinical staffing plan and submit it to the clinical staffing committee of the hospital. Each clinical staffing committee shall finalize a clinical staffing plan that meets patient needs using the plan submitted under paragraph (1) of this subsection. When finalizing a clinical staffing plan, the clinical staffing committee shall consider: Existing staffing levels; Methods to secure coverage needs as necessary; Existing gaps in staffing and how to address the gaps; Any available evidence–based staffing standards; A schedule for periodic review of the staffing plan; Appropriate skill mix and competency of staff; Standards required by: The Centers for Medicare and Medicaid Services conditions of participation; and The accreditation body that accredits the hospital; The average number of patients of the hospital during the immediately preceding year and relevant information regarding patient discharges, potential admissions, and transfers; The average level of acuity for patients of the hospital during the immediately preceding year and the corresponding level of nursing care required; and An estimate of the appropriate combination of skill, experience level, and specialty certification or training of staff that is required to adequately provide care to patients of the hospital.

On or before July 1 each year, beginning in 2028, each hospital shall: Implement the clinical staffing plan finalized under § 19–394 of this subtitle; and Assign personnel to each patient care unit in accordance with the clinical staffing plan.

Each hospital shall provide the clinical staffing plan to staff on request.

This part may not be construed to require a hospital to take actions that are inconsistent with the Centers for Medicare and Medicaid Services conditions of participation or the accreditation standards of the accreditation body that accredits the hospital.