# COMAR Title 10 — Maryland Department of Health

## Subtitle 01 — Procedures

### Chapter 20 — Nursing Facility Quality Assessment

**Authority:** Health-General Article, §19-310.1, Annotated Code of Maryland

**Administrative History:** Effective date: October 6, 2008 (35:20 Md. R. 1774)

**Administrative History:** Regulation .03E amended effective December 27, 2010 (37:26 Md. R. 1786); November 28, 2011 (38:24 Md. R. 1501); February 18, 2013 (40:3 Md. R. 217)

#### Regulation .01 Scope.

*COMAR 10.01.20.01*

A. This chapter applies to the collection by the Maryland Department of Health of a quality assessment, pursuant to Health-General Article, §19-310.1, Annotated Code of Maryland, to be paid on a quarterly basis by nursing facilities subject to the assessment.

B. All amounts collected under this chapter shall be distributed to a special fund to be used by the Department only to fund reimbursements to nursing facilities under the Medicaid program.

#### Regulation .02 Definitions.

*COMAR 10.01.20.02*

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) “Assessment” means the quality assessment paid on a quarterly basis by each nursing facility subject to this chapter, determined by the Department for each facility based upon an amount per non-Medicare day of service for the previous quarter of the State fiscal year.

  (2) “Department” means the Maryland Department of Health.

  (3) “Medicaid” means the Medical Assistance Program in the Maryland Department of Health.

  (4) Nursing Facility.

    (a) “Nursing facility”, for purposes of this chapter, means a nursing facility, as defined in Health-General Article, §19-301, Annotated Code of Maryland, that has 45 or more beds, and operates in the State.

    (b) “Nursing facility” does not include a continuing care retirement community that has obtained a certificate of registration to provide continuing care under Human Services Article, Title 10, Subtitle 4, Annotated Code of Maryland.

#### Regulation .03 Collection of Nursing Facility Quality Assessment.

*COMAR 10.01.20.03*

A. On or before the 60th day after each quarter of the State fiscal year, each nursing facility subject to the quality assessment shall pay the specified amount into a bank account established under the authority of the State Treasurer.

B. Late Charge.

  (1) Payments not postmarked on or before the 60th day after each quarter are subject to an interest amount equal to the State of Maryland General Fund investment portfolio interest rate in effect at the time the payment is due.

  (2) The late charge is a one-time imposition for each quarterly delinquent payment and shall equal the applicable interest rate multiplied by the quality assessment amount that is unpaid on the payment due date.

C. The amount of each facility's quarterly quality assessment shall equal the product of:

  (1) The per diem assessment amount, as annually calculated by and provided to the facility by the Department; and

  (2) The number of non-Medicare days of care provided by the facility during the previous quarter of the State fiscal year.

D. With each quarterly quality assessment payment, each nursing facility paying the quality assessment shall report, on a form provided by the Department, the nursing facility's total number of patient days and non-Medicare patient days for that quarter.

E. Effective July 1, 2012, the aggregated annual assessment collected under this chapter may not exceed 6 percent of the operating revenue for all nursing facilities subject to this assessment.

F. The Department shall pursue collection and referral of unpaid quality assessments in accordance with the timetables and agency collection standards set forth in COMAR 17.01.01.04.