<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".09" citation="COMAR 10.07.09.09" title_num="10" subtitle_num="07" chapter_num="09" heading="Implementation of Residents' Bill of Rights.">
  <text>A nursing facility shall:</text>
  <paragraph num="A.">
    <text>Ensure that:</text>
    <paragraph num="(1)">
      <text>The rights of residents as set forth in the Residents' Bill of Rights are protected, including but not limited to informing each resident of the resident's right to select a physician and pharmacy of the resident's choice;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Employees of the nursing facility are trained to:</text>
      <paragraph num="(a)">
        <text>Respect and enforce the Residents' Bill of Rights and the nursing facility's policies and procedures that implement the Residents' Bill of Rights; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Protect the rights of residents;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The nursing facility's policies and procedures implement all rights of the residents as set forth in:</text>
      <paragraph num="(a)">
        <text>Health-General Article, §§19-343—19-347 and 19-349—19-352, Annotated Code of Maryland;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Title XIX of the Social Security Act;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>42 CFR §483.10 et seq.; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The regulations of this chapter; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>The nursing facility's policies comply with the requirements of federal and State law concerning advance directives, including but not limited to:</text>
      <paragraph num="(a)">
        <text>If an applicant is incapacitated or is incapable of informing the nursing facility whether the applicant has executed an advance directive, the facility may provide advance directive information to the resident's health care representative; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Once the resident is no longer incapacitated, the facility shall provide the advance directive information to the resident directly at the appropriate time;</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Post conspicuously in a public place accessible to residents:</text>
    <paragraph num="(1)">
      <text>The Residents' Bill of Rights in large, clearly readable type;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The nursing facility's complaint procedures in large, clearly readable type;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The nursing facility's statement of deficiencies for the most recent survey and any subsequent complaint investigations conducted by federal or State surveyors and any plans of correction in effect with respect to the survey or complaint investigation findings; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Signs provided by the Department to notify the visiting public and residents:</text>
      <paragraph num="(a)">
        <text>That complaints may be made to the Department or to the Office;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>How to report an instance of abuse of a resident to the Department, the Office, or law enforcement agencies; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>How to file a complaint with State agencies and client advocacy agencies, such as the Licensing and Certification Administration, the Office on Aging, the Older Americans Act Legal Services providers, the Maryland Disabilities Law Center, State Medicaid Fraud Unit, and the Legal Aid Bureau, Inc.;</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services under the State plan for all individuals, regardless of source of payment;</text>
  </paragraph>
  <paragraph num="D.">
    <text>Provide each resident and, if applicable, the resident's appropriate representative or interested family member, with a written description of the resident's legal rights, including a:</text>
    <paragraph num="(1)">
      <text>Description of the manner of protecting resident funds; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Statement that the resident may file a complaint with the Department or the Office concerning resident abuse, neglect, misappropriation of resident property in the nursing facility, and noncompliance with advance directive requirements;</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Place the name, address, and telephone number of the physician who is responsible for the resident's care within easy access of the resident;</text>
  </paragraph>
  <paragraph num="F.">
    <text>Inform the resident and the appropriate legal representative, or interested family member, and promptly consult with the resident's physician if any of the following incidents occur:</text>
    <paragraph num="(1)">
      <text>An accident involving the resident which results in injury;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A significant change in the resident's physical, mental, or psychosocial status;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>A need to alter treatment significantly; or</text>
    </paragraph>
    <paragraph num="(4)">
      <text>A decision to transfer or discharge the resident from the nursing facility;</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Consistent with State and federal confidentiality laws and, in a timely manner, notify a resident and, if applicable, the resident's representative or interested family member, of any:</text>
    <paragraph num="(1)">
      <text>Change in condition;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Adverse event that may result in a change in condition;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Outcome of care that results in an unanticipated consequence; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Corrective action, if any;</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Notify the resident and, when applicable, the appropriate representative, or interested family member, when there is a change in:</text>
    <paragraph num="(1)">
      <text>Room or roommate assignment;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The Residents' Bill of Rights; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Federal or State law and regulations relating to residents' rights;</text>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>Record and update the address and phone number of the resident's representatives and interested family members;</text>
  </paragraph>
  <paragraph num="J.">
    <text>Permit representatives of the State Long-Term Care Ombudsman Program to accomplish their responsibilities, as set forth in 42 U.S.C. §3058g, the State Long-Term Care Ombudsman Program;</text>
  </paragraph>
  <paragraph num="K.">
    <text>Encourage the activities of resident and family groups by:</text>
    <paragraph num="(1)">
      <text>Providing the residents and their families with private space for meetings;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Designating a staff person to provide assistance and respond to written requests from residents and their families;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Listening to the views of residents and their families;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Acting upon the grievances and recommendations of residents and their families concerning proposed policy and operational decisions affecting resident care and life in the nursing facility; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Advising resident and family groups of the disposition of their grievances and recommendations;</text>
    </paragraph>
  </paragraph>
  <paragraph num="L.">
    <text>Educate staff, residents, representatives, and interested family members on advance directives;</text>
  </paragraph>
  <paragraph num="M.">
    <text>When applicable, promptly provide the Medical Assistance Program with all required information in its possession; and</text>
  </paragraph>
  <paragraph num="N.">
    <text>Provide copies of clinical records upon request, based on the following charges:</text>
    <paragraph num="(1)">
      <text>A fee for copying and mailing not exceeding 50 cents per page;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A discretionary fee not to exceed $15 for record retrieval and preparation;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The actual cost of postage and handling of the copies; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>A discretionary annual adjustment in the fees described in §M(1)—(3) of this regulation based on the current Consumer Price Index.</text>
    </paragraph>
  </paragraph>
</regulation>