In this subtitle the following words have the meanings indicated. “General hospice care program” means a coordinated, interdisciplinary program of hospice care services for meeting the special physical, psychological, spiritual, and social needs of dying individuals and their families, by providing palliative and supportive medical, nursing, and other health services through home or inpatient care during the illness and bereavement: To individuals who have no reasonable prospect of cure as estimated by a physician; and To the families of those individuals. “General license” means a license issued by the Secretary to operate a general hospice care program. “Home–based hospice care program” means a program that directly or through a contractual arrangement provides a hospice care program in the residence of the patient. “Hospice facility” means a facility that: Provides a hospice care program; Is separate from any other facility; and Admits at least 2 individuals who: Are unrelated; and Have no reasonable prospect of a cure. “Limited hospice care program” means a coordinated, interdisciplinary program of hospice care services for meeting the special physical, psychological, spiritual, and social needs of dying individuals and their families, by providing palliative and supportive nonskilled services through a home–based hospice care program during illness and bereavement: To individuals who have no reasonable prospect of cure as estimated by a physician; and To the families of those individuals. “Limited license” means a license issued by the Secretary to operate a limited hospice care program.

The purposes of this subtitle are: To simplify and clarify the laws that govern the use of a hospice care program by individuals who want a supportive environment; To encourage the establishment of hospice care programs; and To ensure the quality of these hospice care programs.

The Secretary shall adopt regulations to carry out the provisions of this subtitle. The regulations for general hospice care programs shall set standards for general hospice care programs that are comparable to the standards established by the National Hospice Organization. The Secretary, by regulation, after consultation with interested groups, including The Hospice Network of Maryland, Inc., shall establish standards for the operation of a hospice care program. The regulations shall set qualifications for medical directors of hospices. A medical director of a hospice care program need not be an employee or a contractee of a hospice care program. The regulations for a hospice facility shall require: The medical director to be a physician licensed to practice medicine in this State; The dietary, nursing, pastoral care, pharmaceutical, and social worker services to be adequate; and A physician other than an attending physician to be on call and available at all times. The regulations for a home-based hospice care program shall require: The medical director to be a physician licensed to practice medicine in this State; The provision of bereavement services; The provision of services to meet the spiritual or social needs of dying individuals and their families; The provision of palliative and supportive medical, nursing, and other health services: Directly or by contract for a general licensee; or By referral only for a limited licensee; Submission of an annual report which includes service utilization statistics in the format prescribed; Written transfer agreements to provide acute inpatient care as needed; and Minimum standards concerning the training and role of volunteers in a hospice care program.

A building that contains a hospice facility shall: Be constructed soundly; and Meet the standards for construction and safety that the county or municipality imposes on a single-family residence. A building that contains a hospice facility may not be required to comply with health and safety standards for an institution.

A person shall be licensed by the Secretary before a person may operate a hospice care program. A home health agency, hospital, related institution, or other licensed facility that operates a hospice care program that is distinct from the other services that the home health agency or facility offers shall be licensed by the Secretary as a hospice care program before the home health agency or facility may operate that hospice care program.

To qualify for a license, an applicant and the hospice care program and its medical director 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. Except for a limited licensee, the applicant shall have a certificate of need, as required under Subtitle 1 of this title, for the hospice care program to be operated. The Secretary, in consultation with the Maryland Health Care Commission, shall specify those jurisdictions in which a general hospice is authorized to provide home-based hospice services. A general hospice may not be licensed to provide home-based hospice services in a jurisdiction unless the general hospice or an entity acquired by the general hospice provided home-based hospice services to a patient in the jurisdiction during the 12-month period ending December 31, 2001. Notwithstanding paragraph (3) of this subsection: A general hospice may provide home-based hospice services to a specific patient outside of the jurisdictions in which the hospice is licensed if the Maryland Health Care Commission approves the service provision; and A general hospice that is a hospital-based hospice or that had an affiliation agreement before April 5, 2003 with a health care facility or health care system may serve patients immediately upon discharge from the hospital, health care facility, or health care system, regardless of the jurisdiction in which the patient resides. Upon the notification by the Maryland Health Care Commission of the issuance of a certificate of need to a general hospice, the Secretary shall append to the general hospice license any additional jurisdictions in which the general hospice may provide home-based hospice services. The hospice care program to be operated and its medical director shall meet the requirements that the Secretary adopts under this subtitle.

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 by the individual; and Shall include: The name of the applicant; A statement that the applicant meets the requirements of this subtitle; The location of the proposed hospice; The name of the individual who is to be the medical director of the hospice care program; and Any other information that the Secretary requires.

The Secretary shall issue a license to any applicant if the applicant and the hospice care program and its medical director meet the requirements of this subtitle.

While it is effective, a general license authorizes the general licensee to operate a general hospice care program. While it is effective, a limited license authorizes the limited licensee to operate a limited hospice care program. A limited licensee may not provide any medical, nursing, or other health services directly or through a contractual arrangement.

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. In addition to the provisions of subsections (a) and (b) of this section, the Secretary may, for a violation of any provision of this subtitle or any regulation adopted under this subtitle, impose an administrative penalty of up to: $500 for a first violation; and $1,000 for a subsequent, repeated violation. The Secretary shall adopt regulations to provide standards for the imposition of an administrative penalty under paragraph (1) of this subsection.

A person may not operate a hospice care program unless licensed by the Secretary.

A hospice facility may not admit an individual unless a physician estimates that the individual has no reasonable prospect of cure.

This section applies to a general hospice care program only when providing hospice services in an in–home setting. This section does not apply to a general hospice care program when providing hospice services in a nursing home, assisted living facility, or a general hospice care program facility. A general hospice care program shall establish a written policy that outlines the procedures for the collection and disposal of a patient’s unused prescription medication, including a procedure that requires a general hospice care employee, at the time that a patient is enrolled in the general hospice care program, to: Discuss with the patient and the patient’s family member or personal representative the requirements under subsection (c) of this section; and Provide a written copy of the unused prescription medication collection and disposal policy to the patient and the patient’s family member or personal representative. In accordance with a general hospice care program’s policy and subject to paragraphs (2) and (3) of this subsection, a general hospice care program employee shall, as soon as practicable, collect and dispose of a patient’s unused prescription medication on: The death of the patient; or The termination of a prescription medication by the patient’s prescriber. Before a general hospice care program employee collects or disposes of a patient’s unused prescription medication under paragraph (1) of this subsection, the employee shall provide to the patient or the patient’s family member or personal representative a written request for authorization to collect and dispose of the patient’s unused prescription medication in accordance with the patient’s care plan. A general hospice care program employee may not collect or dispose of a patient’s unused prescription medication unless the patient or the patient’s family member or representative provides written authorization to the general hospice care program. If a patient or the patient’s family member or personal representative refuses to authorize the collection or disposal of the patient’s unused prescription medication, the general hospice care program employee shall urge that the patient or the patient’s family member or personal representative dispose of any unused prescription medication in a safe and legal manner in accordance with federal Environmental Protection Agency and federal Drug Enforcement Administration guidelines for the safe disposal of prescription drugs. If authorized, a general hospice care program employee shall, as soon as practicable, dispose of a patient’s unused prescription medication at the site where hospice care was provided: In accordance with federal Environmental Protection Agency and federal Drug Enforcement Administration guidelines for the safe disposal of prescription drugs; and Under the witness of: The patient or the patient’s family member or personal representative; Another general hospice care program employee; or If none of the individuals under items (i) or (ii) of this item are available, a local law enforcement officer. The collection and disposal of a patient’s unused prescription medication by the general hospice care program shall be documented in the patient’s medical record by the general hospice care program employee who conducted the collection and disposal. The medical record shall include the following information: The name and quantity of each unused prescription medication; The name of the individual who authorized the collection and disposal of the unused prescription medication and the individual’s relationship to the patient; The date of disposal for each unused prescription medication; The name of the individual who conducted the collection and disposal; and The name of the individual who witnessed the disposal of unused prescription medication by the employee as required under subsection (d)(2) of this section. If a patient or the patient’s family member or personal representative refuses to authorize the collection and disposal of the patient’s unused prescription medication by the general hospice care program, the general hospice care program employee shall document in the patient’s medical record: The refusal to authorize the collection and disposal of the patient’s unused prescription medication; and The name and quantity of each unused prescription medication not surrendered. A general hospice care program may not be held liable in a civil or criminal action for any good faith act or omission taken in accordance with the requirements of this section.