Notice of Transfers of Ownership. A person shall provide notice to the Commission at least 30 days before the change of ownership of a nursing home, including changes in ownership of real property and improvements, bed rights, or operatorship, that: Involves at least a 5 percent transfer in ownership interest; and Is not an acquisition that requires approval under §B of this regulation. The notice required by §A(1) of this regulation shall be in a form required by the Commission and include: A description of the change in ownership interest; Complete organizational charts for all persons holding at least a 5 percent ownership interest in the nursing home prior to and following the proposed transfer; An attestation that the change does not require approval under §B of this regulation; and Any other information requested by the Commission. Request for Acquisition Approval. Applicability. This section does not apply to an acquisition that: Involves only changes of ownership interests among existing owners of a nursing home; or The Commission has exempted from these requirements in accordance with COMAR 10.24.20.06A(3). This section applies to: Transfers of stock or assets of the owner of the real property and improvements, bed rights, or operation of the nursing home, or any combination thereof; An affiliation agreement between non-profit entities that changes the person who controls a nursing home’s operation or assets; and A lease agreement that changes the person who controls a nursing home’s operation or assets. At least 60 days before closing on an acquisition of a nursing home, a person shall: Submit to the Commission a request for acquisition approval in a form prescribed by the Commission; and Provide notice, in the form prescribed by the Commission, to the residents, resident representatives, and employees of the nursing home that: The request for acquisition approval was submitted to the Commission; and They have the right to submit comments. Notice by the Commission to the Public, and Other State Agencies. Within 5 days after it receives a complete request for acquisition approval, the Commission shall: Submit notice of its receipt and the deadline for residents, resident representatives and employees of the nursing home to submit comments on the proposed acquisition: To at least one newspaper of general circulation in the affected area; To be published in the next available issue of the Maryland Register; and On the Commission’s website; and Provide notice of the request to: The Secretary or the Secretary’s designee; The Office of the Attorney General; The Secretary of Aging; and The State Long-Term Care Ombudsman Program. Executive Director Action. The Executive Director shall review a request for acquisition approval within 45 days after receiving the completed request from the applicant. The Executive Director, in consultation with the Secretary or the Secretary’s designee, may: Approve the acquisition; Approve the acquisition with conditions; Deny the acquisition; or Refer the request for acquisition approval to the Commission for a final decision. To approve a request for acquisition approval, the Executive Director must find that the acquisition: Is consistent with COMAR 10.24.20, the State Health Plan chapter for Comprehensive Care Facility (Nursing Home) Services; and Is in the public interest. In determining whether an acquisition of a nursing home is in the public interest, the Executive Director shall: Consider comments from individuals who: Reside in the nursing home; Have family members who reside in the nursing home; or Are employed as employees of the nursing home; Consult with the Attorney General on whether the acquisition raises public interest concerns. Commission Action. If the Executive Director refers a request for acquisition approval to the Commission under §C(2)(d) of this regulation , the Commission shall use the criteria specified in §C(3) and (4) of this regulation to make a final decision within 60 days after receiving the completed request from the applicant. The Commission shall promptly send a copy of the decision of the Executive Director or Commission on a request for acquisition approval to the Secretary, the Secretary of Aging, the Office of Health Care Quality, the Office of the Attorney General, and the State Long–Term Care Ombudsman. Appeal. Commission Review of Executive Director Decision. A person who is a party to the acquisition may seek Commission review of an Executive Director’s decision denying the request or imposing a condition on approval. A request for review of an Executive Director’s decision: Shall be filed within 15 days after the issuance of a decision; Shall specifically identify each finding and conclusion to which review is requested; and May include a request for oral argument. The Commission shall review the Executive Director’s decision within 45 days of the request for review. Judicial Review. A decision of the Commission under §D or §F(1) of this regulation shall be a final decision for the purpose of judicial review. A person that is a party to the acquisition may take a direct judicial appeal within 30 days after the Commission makes the final decision. Annual Reports. On or before July 1 immediately following the acquisition of a nursing home and each year for 3 years thereafter, the person that acquired the nursing home shall submit a report to the Commission in accordance with COMAR 10.24.20. The Commission shall provide a copy of the report required under §G(1) of this regulation to the Secretary, the Secretary of Aging, the Office of Health Care Quality, the Office of the Attorney General, and the State Long–Term Care Ombudsman.