reglab/statecodes huggingface dataset:
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 7 - Health Maintenance Organizations › Section 19-729 - Prohibited Acts; Remedies

(a)    A health maintenance organization may not:
(1)    Violate any provision of this subtitle or any rule or regulation adopted under it;
(2)    Fail to fulfill its obligations to provide the health care services specified in its contracts with subscribers;
(3)    Make any false statement with respect to any report or statement required by this subtitle or by the Commissioner under this subtitle;
(4)    Advertise, merchandise, or attempt to merchandise its services in a way that misrepresents its services or capacity for service;
(5)    Engage in a deceptive, misleading, unfair, or unauthorized practice as to advertising or merchandising;
(6)    Prevent or attempt to prevent the Commissioner or the Department from performing any duty imposed by this subtitle;
(7)    Fraudulently obtain or fraudulently attempt to obtain any benefit under this subtitle;
(8)    Fail to fulfill the basic requirements to operate as a health maintenance organization as provided in § 19–710 of this subtitle;
(9)    Violate any applicable provision of Title 15, Subtitle 12 of the Insurance Article;
(10)    Fail to provide services to a member in a timely manner as provided in § 19–705.1(b)(1) of this subtitle;
(11)    Fail to comply with the provisions of Title 15, Subtitle 10A, 10B, 10C, or 10D or § 2–112.2 of the Insurance Article;
(12)    Violate any provision of § 19–712.5 of this subtitle; or
(13)    Violate any provision of Title 33 of the Insurance Article.
(b)    If any health maintenance organization violates this section, the Commissioner may pursue any one or more of the courses of action described in § 19-730 of this subtitle.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 7 - Health Maintenance Organizations › Section 19-730 - Penalties -- Violation of 19-729 of This Subtitle

(a)    If any person violates any provision of § 19-729 of this subtitle, the Commissioner may:
(1)    Issue an administrative order that requires the health maintenance organization to:
(i)    Cease inappropriate conduct or practices by it or any of the personnel employed or associated with it;
(ii)    Fulfill its contractual obligations;
(iii)    Provide a service that has been denied improperly;
(iv)    Take appropriate steps to restore its ability to provide a service that is provided under a contract;
(v)    Cease the enrollment of any additional enrollees except newborn children or other newly acquired dependents of existing enrollees; or
(vi)    Cease any advertising or solicitation;
(2)    In addition to suspending or revoking a certificate of authority:
(i)    Impose a penalty of not less than $100, but not more than $125,000 for each violation; and
(ii)    Order the health maintenance organization to pay restitution to any person who has suffered financial injury because of the violation;
(3)    Suspend, revoke, or refuse to renew the certificate of authority to do business as a health maintenance organization;
(4)    Suspend, revoke, or refuse to renew the certificate of a medical director of a health maintenance organization; or
(5)    Apply to any court for legal or equitable relief considered appropriate by the Commissioner or the Department, in accordance with the joint internal procedures.
(b)    If the Commissioner issues an order or imposes any penalty under this section, the Commissioner immediately shall provide written notice of the order or penalty to the Secretary.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 7 - Health Maintenance Organizations › Section 19-731 - Penalties -- Violation of 19-705 and 19-705.1 of This Subtitle

(a)    If a person violates any provision of §§ 19-705 and 19-705.1 of this subtitle, the Secretary may:
(1)    Issue an administrative order that requires the health maintenance organization to:
(i)    Cease inappropriate conduct or practices by it or any of the personnel employed by or associated with it and comply with the standards established by the Department; or
(ii)    Provide any service required by §§ 19-705 and 19-705.1 of this subtitle that has been denied improperly;
(2)    Impose a penalty of not less than $100 and not more than $125,000 for each violation; or
(3)    Apply to any court for legal or equitable relief considered appropriate by the Secretary.
(b)    If the Secretary issues an order or imposes any penalty under this section, the Secretary immediately shall provide written notice of the order or penalty to the Commissioner.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 7 - Health Maintenance Organizations › Section 19-732 - Appeal

(a)    Except as otherwise provided in Title 15, Subtitle 10A of the Insurance Article, a party aggrieved by a final action of the Commissioner under this subtitle has the right to a hearing and the right to appeal from the action of the Commissioner under §§ 2–210 through 2–215 of the Insurance Article.
(b)    A party aggrieved by an order of the Secretary under this subtitle may petition for judicial review as provided by the Administrative Procedure Act.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 7 - Health Maintenance Organizations › Section 19-735 - Foreign Health Maintenance Organization Transferring Domicile to This State

(a)    Any foreign health maintenance organization with a certificate of authority to operate a health maintenance organization in this State may become a domestic health maintenance organization of this State by complying with all of the requirements of the law relating to the formation and organization of a domestic health maintenance organization and by designating its principal place of business at a place in this State. On becoming a domestic health maintenance organization, the health maintenance organization shall be entitled to certificates and licenses to transact business in this State issued to domestic health maintenance organizations, and shall be given recognition in all respects as a health maintenance organization formed under the laws of this State as of the date of authorization as a health maintenance organization in its original domiciliary state, district, territory, commonwealth, or possession of the United States of America, and shall be subject to the authority and jurisdiction of this State.
(b)    (1)    The certificate of authority, insurance producers’ appointments, rates, and other forms which the Commissioner allows which are in existence at the time any foreign health maintenance organization with a certificate of authority to operate a health maintenance organization in this State transfers its corporate domicile to this State or to any other state by merger, consolidation, or any other lawful method shall continue in full force and effect on transfer if the health maintenance organization at all times retains a certificate of authority in this State.
(2)    All outstanding subscriber contracts of a transferring health maintenance organization shall remain in full force and effect and need not be endorsed as to the new name of the health maintenance organization or its new domiciliary and location unless so ordered by the Commissioner.
(3)    A transferring health maintenance organization may file new contract forms with the Commissioner on or before the effective date of the transfer, or may use any existing contract form previously filed with the Commissioner with appropriate endorsements if allowed by and under such conditions as approved by the Commissioner.
(4)    A foreign health maintenance organization transferring its domicile to another state shall notify the Commissioner of the details of the proposed transfer, and shall file promptly any resulting amendments to corporate documents and other items on file with the Commissioner.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 7A - Provider-Sponsored Organizations › Section 19-7A-01 - Definitions

(a)    In this subtitle the following words have the meanings indicated.
(b)    “Commissioner” means the Maryland Insurance Commissioner.
(c)    “Health care services” means a health or medical care procedure or service rendered by a health care provider that:
(1)    Provides testing, diagnosis, or treatment of a human disease or dysfunction; or
(2)    Dispenses drugs, medical devices, medical appliances, or medical goods for the treatment of a human disease or dysfunction.
(d)    “License” includes a certificate of authority, as defined in § 1-101 of the Insurance Article.
(e)    “Provider” means any person, including a physician or hospital, that is licensed or otherwise authorized in this State to provide health care services.
(f)    “Provider-sponsored organization” means an entity that:
(1)    Is a legal aggregation of providers operating collectively for the purpose of providing health care services to Medicare beneficiaries under the federal Medicare+Choice Program;
(2)    Acts through a licensed entity, such as a partnership, corporation, limited liability company, limited liability partnership, or sole proprietorship, that has authority over the entity’s activities and responsibility for satisfying the requirements of § 19-7A-02 of this subtitle; and
(3)    Provides a substantial proportion of the health care services required to be provided under the federal Medicare+Choice Program directly through providers or affiliated groups of providers.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 7A - Provider-Sponsored Organizations › Section 19-7A-02 - Recipients and Providers of Services

(a)    A license issued to a provider-sponsored organization under this subtitle authorizes the licensee to provide health care services only to Medicare beneficiaries under the federal Medicare+Choice Program.
(b)    Nothing in this subtitle may be construed to limit a provider-sponsored organization from participating in the Medicaid program as a managed care organization.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 7A - Provider-Sponsored Organizations › Section 19-7A-03 - Licenses and Requirements for Providing Services

(a)    (1)    Before an entity may operate as a provider-sponsored organization under the federal Medicare+Choice Program, the entity must obtain a license from the Commissioner.
(2)    The Commissioner shall issue a license under paragraph (1) of this subsection to any entity to operate as a provider-sponsored organization that meets the requirements of subsection (b) of this section.
(b)    To operate as a provider-sponsored organization under the federal Medicare+Choice Program in this State, an entity shall:
(1)    Meet the definition of a provider-sponsored organization under § 19-7A-01 of this subtitle; and
(2)    Meet the requirements applicable to a health maintenance organization under Subtitle 7 of this title to the extent those requirements are not preempted by federal law.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 7A - Provider-Sponsored Organizations › Section 19-7A-04 - Regulations

(a)    The Commissioner shall adopt regulations to implement the provisions of this subtitle.
(b)    Except as provided in subsection (c) of this section, regulations relating to the solvency of a provider-sponsored organization adopted under subsection (a) of this section shall impose solvency requirements the same as required under federal law.
(c)    Upon the expiration, repeal, or termination of solvency requirements under federal law for provider-sponsored organizations, the requirements of § 19-710(d) of this title shall apply.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 8 - Problem Gamblers › Section 19-801 - "Problem Gambler" Defined

In this subtitle, “problem gambler” means an individual:
(1)    Who is preoccupied chronically and progressively with gambling and the urge to gamble; and
(2)    Whose gambling behavior compromises, disrupts, or damages the individual’s personal, family, or vocational pursuits.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 8 - Problem Gamblers › Section 19-802 - Findings

The General Assembly finds that:
(1)    Problem gambling is a serious social problem;
(2)    There is evidence that the availability of gambling increases the risk of becoming a problem gambler; and
(3)    This State, with its extensive legalized gambling, has an obligation to provide a program of treatment for problem gamblers.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 8 - Problem Gamblers › Section 19-804 - Grants and Aid; Prevalence Studies

(a)    (1)    The Secretary shall make grants from or agreements for the use of State funds, including the funds provided under § 9–1A–33 of the State Government Article, and federal funds to help public agencies or nonprofit organizations operate the network of clinically appropriate services for problem gamblers who reside in the State to provide the following:
(i)    Inpatient and residential services;
(ii)    Outpatient services;
(iii)    Intensive outpatient services;
(iv)    Continuing care services;
(v)    Educational services;
(vi)    Services for victims of domestic violence; and
(vii)    Other preventive or rehabilitative services or treatment.
(2)    Research and training that are designed to improve or extend these services are proper items of expense.
(b)    The Secretary shall conduct a prevalence study and replication prevalence studies to measure the rate of problem and pathological gambling in the State.
(c)    (1)    Subject to paragraph (2) of this subsection, the Secretary shall contract with an independent researcher to conduct the prevalence studies.
(2)    The Secretary shall utilize the most current psychiatric or diagnostic criteria for problem and pathological gambling as the basis for the prevalence studies.
(d)    The initial prevalence study shall be completed on or before July 1, 2009.
(e)    Replication prevalence studies shall be conducted no less than every 5 years with measures taken to permit comparisons between the initial prevalence study and subsequent replication prevalence studies.
(f)    Services under this subtitle shall be provided by public agencies or, under contract, by nonprofit organizations.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 9 - Hospice Care Facilities › Section 19-901 - Definitions

(a)    In this subtitle the following words have the meanings indicated.
(b)    “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:
(1)    To individuals who have no reasonable prospect of cure as estimated by a physician; and
(2)    To the families of those individuals.
(c)    “General license” means a license issued by the Secretary to operate a general hospice care program.
(d)    “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.
(e)    “Hospice facility” means a facility that:
(1)    Provides a hospice care program;
(2)    Is separate from any other facility; and
(3)    Admits at least 2 individuals who:
(i)    Are unrelated; and
(ii)    Have no reasonable prospect of a cure.
(f)    “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:
(1)    To individuals who have no reasonable prospect of cure as estimated by a physician; and
(2)    To the families of those individuals.
(g)    “Limited license” means a license issued by the Secretary to operate a limited hospice care program.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 9 - Hospice Care Facilities › Section 19-902 - Statement of Purpose

The purposes of this subtitle are:
(1)    To simplify and clarify the laws that govern the use of a hospice care program by individuals who want a supportive environment;
(2)    To encourage the establishment of hospice care programs; and
(3)    To ensure the quality of these hospice care programs.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 9 - Hospice Care Facilities › Section 19-903 - Regulations

(a)    (1)    The Secretary shall adopt regulations to carry out the provisions of this subtitle.
(2)    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.
(3)    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.
(b)    (1)    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.
(2)    The regulations for a hospice facility shall require:
(i)    The medical director to be a physician licensed to practice medicine in this State;
(ii)    The dietary, nursing, pastoral care, pharmaceutical, and social worker services to be adequate; and
(iii)    A physician other than an attending physician to be on call and available at all times.
(3)    The regulations for a home-based hospice care program shall require:
(i)    The medical director to be a physician licensed to practice medicine in this State;
(ii)    The provision of bereavement services;
(iii)    The provision of services to meet the spiritual or social needs of dying individuals and their families;
(iv)    The provision of palliative and supportive medical, nursing, and other health services:
1.    Directly or by contract for a general licensee; or
2.    By referral only for a limited licensee;
(v)    Submission of an annual report which includes service utilization statistics in the format prescribed;
(vi)    Written transfer agreements to provide acute inpatient care as needed; and
(vii)    Minimum standards concerning the training and role of volunteers in a hospice care program.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 9 - Hospice Care Facilities › Section 19-904 - Standards for Construction and Safety

(a)    A building that contains a hospice facility shall:
(1)    Be constructed soundly; and
(2)    Meet the standards for construction and safety that the county or municipality imposes on a single-family residence.
(b)    A building that contains a hospice facility may not be required to comply with health and safety standards for an institution.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 9 - Hospice Care Facilities › Section 19-905 - License Required

(a)    A person shall be licensed by the Secretary before a person may operate a hospice care program.
(b)    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.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 9 - Hospice Care Facilities › Section 19-906 - Qualifications for License

(a)    To qualify for a license, an applicant and the hospice care program and its medical director shall meet the requirements of this section.
(b)    An applicant who is an individual, and any individual who is applying on behalf of a corporation, association, or government agency shall be:
(1)    At least 18 years old; and
(2)    Of reputable and responsible character.
(c)    (1)    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.
(2)    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.
(3)    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.
(4)    Notwithstanding paragraph (3) of this subsection:
(i)    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
(ii)    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.
(5)    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.
(6)    The hospice care program to be operated and its medical director shall meet the requirements that the Secretary adopts under this subtitle.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 9 - Hospice Care Facilities › Section 19-907 - Applications for Licenses

(a)    An applicant for a license shall submit an application to the Secretary.
(b)    The application:
(1)    Shall be on the form that the Secretary requires;
(2)    Shall be signed and verified by the individual; and
(3)    Shall include:
(i)    The name of the applicant;
(ii)    A statement that the applicant meets the requirements of this subtitle;
(iii)    The location of the proposed hospice;
(iv)    The name of the individual who is to be the medical director of the hospice care program; and
(v)    Any other information that the Secretary requires.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 9 - Hospice Care Facilities › Section 19-909 - Scope of Licenses

(a)    While it is effective, a general license authorizes the general licensee to operate a general hospice care program.
(b)    (1)    While it is effective, a limited license authorizes the limited licensee to operate a limited hospice care program.
(2)    A limited licensee may not provide any medical, nursing, or other health services directly or through a contractual arrangement.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 9 - Hospice Care Facilities › Section 19-911 - Denials and Revocation

(a)    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.
(b)    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.
(c)    (1)    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:
(i)    $500 for a first violation; and
(ii)    $1,000 for a subsequent, repeated violation.
(2)    The Secretary shall adopt regulations to provide standards for the imposition of an administrative penalty under paragraph (1) of this subsection.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 12 - Comprehensive Physical Rehabilitation Facilities › Section 19-1201 - Definitions

(a)    In this subtitle the following words have the meanings indicated.
(b)    “Comprehensive physical rehabilitation services” means:
(1)    A program of coordinated, integrated, interdisciplinary, physician-directed services provided by or under the supervision of physicians qualified or experienced in rehabilitation that:
(i)    Includes evaluation and treatment of individuals with physical disabilities;
(ii)    Emphasizes education and training of individuals with disabilities; and
(iii)    Incorporates:
1.    At least 4 of the following core disciplines:
A.    Physical therapy;
B.    Occupational therapy;
C.    Speech and language therapy;
D.    Psychotherapy;
E.    Rehabilitation nursing; and
F.    Social work; and
2.    At least 2 of the following disciplines:
A.    Psychology;
B.    Audiology;
C.    Respiratory therapy;
D.    Therapeutic recreation;
E.    Orthotics;
F.    Prosthetics;
G.    Special education or instruction; and
H.    Vocational rehabilitation; and
(2)    Any other service that the Secretary may designate by regulation.
(c)    “Comprehensive rehabilitation facility” means:
(1)    Any person that provides or holds himself out as providing comprehensive physical rehabilitation services on an out-patient basis; or
(2)    A hospital that is licensed as a special rehabilitation hospital under Subtitle 3 of this title.
(d)    (1)    “Health care facility” includes any facility defined in § 19-114(d) of this title.
(2)    “Health care facility” does not include a home health agency that is licensed under Subtitle 4 of this title.
(e)    “Specialized rehabilitation program” means any of the specialty programs that the Commission on Accreditation of Rehabilitation Facilities accredits, including:
(1)    Spinal cord injury programs;
(2)    Head injury programs; and
(3)    Infant and early childhood developmental programs.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 12 - Comprehensive Physical Rehabilitation Facilities › Section 19-1203 - Comprehensive Rehabilitation Licenses

(a)    This section does not apply to a special rehabilitation hospital that is licensed under Subtitle 3 of this title.
(b)    Any person that provides or holds himself out as providing comprehensive physical rehabilitation services on an out–patient basis shall obtain a comprehensive rehabilitation license before the person may provide comprehensive physical rehabilitation services in the State.
(c)    The Department shall issue a comprehensive rehabilitation license to any person for whom a comprehensive rehabilitation license is required if the person submits an application on the form established and provided for the Secretary.
(d)    While it is effective, a comprehensive rehabilitation license authorizes the licensed person to provide comprehensive physical rehabilitation services.
(e)    A person may not provide or hold himself out as providing comprehensive physical rehabilitation services on an out–patient basis unless the person has been issued a comprehensive rehabilitation license under this section.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 12 - Comprehensive Physical Rehabilitation Facilities › Section 19-1207 - Health Care Facilities

(a)    A person may not hold himself out as providing a complete array of rehabilitation services unless the person provides comprehensive physical rehabilitation services.
(b)    A health care facility may not provide or hold itself out as providing any specialized rehabilitation program unless the facility is licensed by the Department.
(c)    A person may not provide comprehensive physical rehabilitation services unless the person meets the requirements of this subtitle.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 14 - Nursing Homes › Section 19-1401 - Definitions

(a)    In this subtitle the following words have the meanings indicated.
(b)    “Actual harm deficiency” means a condition existing in a nursing home or an action or inaction by the nursing home staff that has caused physical or emotional injury or impairment to a resident.
(c)    “Concurrent review” means daily rounds by a licensed nurse which include:
(1)    Appraisal and observation of each resident by the licensed nurse to determine any change in the resident’s physical or mental status; and
(2)    If there is a change in the resident’s physical or mental status, an evaluation by the licensed nurse of:
(i)    The resident’s medications;
(ii)    Laboratory values relating to the resident;
(iii)    Clinical data relating to the resident, including the resident’s:
1.    Hydration and nutritional need;
2.    Skin integrity;
3.    Noted weight changes; and
4.    Appetite;
(iv)    Injuries sustained by the resident that result from accident or incidents involving the resident; and
(v)    Any other relevant parameters affecting or reflecting the resident’s physical and mental status.
(d)    “Deficiency” means a condition existing in a nursing home or an action or inaction by the nursing home staff that results in potential for more than minimal harm, actual harm, or serious and immediate threat to one or more residents.
(e)    “Nursing home” means a facility (other than a facility offering domiciliary or personal care as defined in Subtitle 3 of this title) which offers nonacute inpatient care to patients suffering from a disease, chronic illness, condition, disability of advanced age, or terminal disease requiring maximal nursing care without continuous hospital services and who require medical services and nursing services rendered by or under the supervision of a licensed nurse together with convalescent, restorative, or rehabilitative services.
(f)    “Ongoing pattern” means the occurrence of any potential for more than minimal harm or greater deficiency on two consecutive on-site visits as a result of annual surveys, follow-up visits, any unscheduled visits, or complaint investigations.
(g)    “Potential for more than minimal harm deficiency” means a condition existing in a nursing home or an action or inaction by the nursing home staff that has the potential to cause actual harm to a resident.
(h)    “Serious and immediate threat” means a situation in which immediate corrective action is necessary because a nursing home’s noncompliance with one or more State regulations has caused or is likely to cause serious injury, harm, impairment to, or death of a resident receiving care in the nursing home.
(i)    “Sustained compliance” means a period of 30 days following the date of notice of corrective action with no deficiencies.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 14 - Nursing Homes › Section 19-1401.1 - Application

(a)    (1)    In addition to the requirements for licensure of a related institution as provided in this title, an applicant for licensure of a nursing home shall include in the application the identity of:
(i)    Any person with an ownership interest in the nursing home; and
(ii)    Any management company, landlord, or other business entity that will operate or contract with the applicant to manage the nursing home.
(2)    (i)    The person acquiring a nursing home shall provide the Department with written notice of the acquisition or change in operator at the same time as the notice required under § 19–120(k)(6)(ii) of this title is filed with the Maryland Health Care Commission.
(ii)    For other changes to the information required under paragraph (1) of this subsection, the nursing home shall notify the Department within 30 days after the effective date of the change.
(b)    An applicant for licensure shall submit to the Secretary or the Secretary’s designee evidence:
(1)    That affirmatively demonstrates the ability of the applicant to comply with minimum standards of:
(i)    Medical care;
(ii)    Nursing care;
(iii)    Financial condition; and
(iv)    Other applicable State or federal laws and regulations; and
(2)    Regarding the regulatory compliance history and financial condition of any health care facility owned or operated by the applicant in other jurisdictions.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 14 - Nursing Homes › Section 19-1401.2 - Approval or Denial of Application

On review of the information required under § 19–1401.1 of this subtitle and any other information that is relevant to the ability of the applicant to operate a nursing home, the Secretary may:
(1)    Approve an application for a license;
(2)    Deny an application for a license;
(3)    Approve an application for a license subject to conditions; or
(4)    Revoke a license.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 14 - Nursing Homes › Section 19-1401.3 - Change in Financial Condition of Nursing Home

(a)    A licensee shall report to the Secretary or the Secretary’s designee any significant change in the financial condition of the nursing home, including cash flow or any other circumstances that could adversely affect the nursing home’s delivery of essential services to patients, including nursing services, dietary services, and utilities.
(b)    Except as provided by subsection (c) of this section, any information obtained by the Secretary under this section is confidential and may not be disclosed without the consent of the licensee.
(c)    The provisions of subsection (b) of this section do not apply to:
(1)    The holder of a license that has been suspended or revoked; or
(2)    The use of information in:
(i)    An administrative proceeding initiated by the Department; or
(ii)    A judicial proceeding.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 14 - Nursing Homes › Section 19-1402 - Imposition of Penalties Generally

(a)    If a deficiency exists, the Secretary may impose sanctions that include:
(1)    A directed plan of correction with corrective measures necessary to protect residents;
(2)    Imposing adequate staffing levels in a nursing home;
(3)    Appointing a State monitor subject to § 19-1405 of this subtitle; and
(4)    Imposing a civil money penalty.
(b)    A civil money penalty may be imposed when a deficiency exists or an ongoing pattern of deficiencies exists in a nursing home.
(c)    In determining whether a civil money penalty is to be imposed, the Secretary shall consider, pursuant to guidelines set forth in regulations promulgated by the Secretary, the following factors:
(1)    The number, nature, and seriousness of the deficiencies;
(2)    The extent to which the deficiency or deficiencies are part of an ongoing pattern during the preceding 24 months;
(3)    The degree of risk to the health, life, or safety of the residents of the nursing home caused by the deficiency or deficiencies;
(4)    The efforts made by, and the ability of, the nursing home to correct the deficiency or deficiencies; and
(5)    A nursing home’s prior history of compliance.
(d)    Upon determination by the Department that a deficiency or deficiencies exist, the Department shall notify the nursing home that:
(1)    Unless corrective action taken pursuant to this section is substantially completed, a civil money penalty will be imposed; or
(2)    An order imposing a civil money penalty will be issued, pursuant to § 19-1403 of this subtitle which shall include a list of all deficiencies and notice that a civil money penalty may be imposed until the time that the cited deficiencies have been rectified.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 14 - Nursing Homes › Section 19-1403 - Order Proposing Penalty

(a)    If a civil money penalty is proposed, the Secretary shall issue an order which shall state the basis on which the order is made, the deficiency or deficiencies on which the order is based, the amount of civil money penalties to be imposed, and the manner in which the amount of civil money penalties imposed was calculated.
(b)    An order issued pursuant to subsection (a) of this section shall be void unless issued within 60 days of the inspection or reinspection at which the deficiency is identified.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 14 - Nursing Homes › Section 19-1404 - Amount of Penalty

(a)    A civil money penalty imposed under this section for potential for more than minimal harm deficiencies:
(1)    May not exceed $10,000 per instance; or
(2)    May not exceed $1,000 per day for an ongoing pattern of deficiencies until the nursing home is in compliance.
(b)    A civil money penalty imposed under this subtitle for actual harm deficiencies:
(1)    May not exceed $10,000 per instance; or
(2)    May not exceed $5,000 per day for an ongoing pattern of deficiencies until the nursing home is in compliance.
(c)    A civil money penalty imposed under this section for a serious and immediate threat:
(1)    May not exceed $10,000 per instance; or
(2)    May not exceed $10,000 per day for an ongoing pattern of deficiencies until the nursing home is in compliance.
(d)    In setting the amount of a civil money penalty under this section, the Secretary shall consider, pursuant to guidelines set forth in regulations promulgated by the Secretary, the following factors:
(1)    The number, nature, and seriousness of the deficiencies;
(2)    The degree of risk to the health, life, or safety of the residents of the nursing home caused by the deficiency or deficiencies;
(3)    The efforts made by the nursing home to correct the deficiency or deficiencies;
(4)    Current federal guidelines for money penalties;
(5)    Whether the amount of the proposed civil money penalty will jeopardize the financial ability of the nursing home to continue operating as a nursing home; and
(6)    Such other factors as justice may require.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 14 - Nursing Homes › Section 19-1405 - Independent State Monitor

(a)    When the Department determines that there is a deficiency in a nursing home, the Department may appoint an independent monitor to oversee efforts made by the nursing home to achieve compliance with State and federal regulations governing nursing homes that participate in the Medicare and Medicaid programs.
(b)    The appointment of a State monitor is an intermediate sanction that may be in addition to or in lieu of other sanctions.
(c)    The State monitor’s duties may include:
(1)    Periodic inspections of a nursing home for the purpose of assessing the nursing home’s compliance with State and federal regulations; and
(2)    Reporting to the Department and the nursing home its findings.
(d)    The State monitor may not be an employee of the Department.
(e)    A nursing home shall be responsible for the costs associated with the appointment of a State monitor to the nursing home.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 14 - Nursing Homes › Section 19-1406 - Administrative Appeal

(a)    Within 15 days of the request for an appeal by a nursing home, the nursing home shall deposit the amount of the civil money penalty in an interest bearing escrow account, the nursing home shall bear any cost associated with establishing the escrow account, and the account shall be titled in the name of the nursing home and the Maryland Department of Health as joint owners.
(b)    When the Secretary issues the final decision of the Department:
(1)    If the decision upholds the imposition of the full civil money penalty, the escrow funds will be released to the Department within 15 days from the date of the decision;
(2)    If the decision upholds the imposition of a civil penalty, but reduces the amount of the civil penalty, the amount due the Department will be released to the Department with accrued interest within 15 days of the date of the decision and the balance will be released to the nursing home within 15 days of the date of the decision; or
(3)    If the decision reverses the imposition of the civil penalty, the escrow funds will be released to the nursing home within 15 days of the decision.
(c)    (1)    A hearing on the appeal shall be held in accordance with the Administrative Procedure Act, under Title 10, Subtitle 2 of the State Government Article.
(2)    The Secretary shall have the burden of proof with respect to the imposition of civil money penalties under § 19–1404 or § 19–1413.1 of this subtitle.
(3)    A decision shall be rendered by the Office of Administrative Hearings within 10 working days of the hearing.
(d)    A nursing home is entitled to a 40% reduction in the amount of the civil money penalty if it waives its right to a hearing within 30 days of the Department’s order.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 14 - Nursing Homes › Section 19-1407 - Health Care Quality Account

(a)    (1)    There is a Health Care Quality Account established in the Department.
(2)    The Health Care Quality Account shall be funded by civil money penalties paid by nursing homes and other penalties that the Office of Health Care Quality may assess.
(3)    The Department shall pay all penalties collected under this title to the Comptroller of the State.
(4)    The Comptroller shall distribute the funds collected under this title to the Health Care Quality Account.
(5)    The Health Care Quality Account is a continuing, nonlapsing fund, not subject to § 7–302 of the State Finance and Procurement Article.
(6)    Any unspent portions of the Health Care Quality Account may not be transferred or reverted to the General Fund of the State, but shall remain in the Health Care Quality Account to be used for the purposes specified in this section.
(b)    The Health Care Quality Account shall be used for training, grant awards, demonstration projects, or other purposes designed to improve the quality of care.
(c)    The Department shall adopt regulations for the distribution of funds from the Health Care Quality Account.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 14 - Nursing Homes › Section 19-1408 - Site Visit and Full Survey

(a)    (1)    Subject to subsection (c) of this section, the Department shall make a site visit and conduct a full survey of each licensed nursing home at least once per calendar year.
(2)    Unless otherwise required by federal law, all surveys shall be unannounced.
(b)    (1)    Subject to paragraph (2) of this subsection, the Department shall initiate an investigation of a nursing home complaint alleging actual harm within 10 business days after receiving the complaint.
(2)    If the Department receives a complaint against a nursing home alleging immediate jeopardy to a resident, the Department:
(i)    Shall make every effort to investigate the complaint within 24 hours after receiving the complaint; and
(ii)    Shall investigate the complaint not later than 48 hours after receiving the complaint.
(c)    If ownership of a licensed nursing home is transferred to a person that does not own or operate another nursing home in the State at the time of the transfer, the Department shall conduct:
(1)    The first full survey of the licensed nursing home as required under subsection (a) of this section within 3 months after the date of transfer; and
(2)    An unannounced, on–site follow–up survey of the licensed nursing home that covers any deficiencies noted in the full survey within 120 days after the full survey was completed.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 14 - Nursing Homes › Section 19-1408.1 - Graphic Data Dashboard

(a)    The Department shall develop a clear and easy–to–understand graphic data dashboard that includes:
(1)    The number of staff hired by the agency in each unit in the fiscal year to date;
(2)    The number of surveyors employed by the agency in each unit in the fiscal year to date; and
(3)    The number of vacancies within the agency in each unit in the fiscal year to date.
(b)    The Department shall:
(1)    Update the data dashboard developed under subsection (a) of this section at least every 2 weeks; and
(2)    Post the most recent updated data dashboard prominently on its website.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 14 - Nursing Homes › Section 19-1410 - Quality Assurance Program

(a)    Each nursing home shall develop and implement a quality assurance program.
(b)    (1)    Each nursing home shall designate a qualified individual to coordinate and manage the nursing home’s quality assurance program.
(2)    Each nursing home shall establish a quality assurance committee and shall include at least the following members:
(i)    The nursing home administrator;
(ii)    The director of nursing;
(iii)    The medical director;
(iv)    A social worker;
(v)    A licensed dietitian; and
(vi)    A geriatric nursing assistant.
(3)    The quality assurance committee shall:
(i)    Meet at least monthly;
(ii)    Maintain records of all quality assurance activities;
(iii)    Keep records of committee meetings that shall be available to the Department during any on–site visit; and
(iv)    Prepare monthly reports that shall be presented to the ombudsman, the resident’s council, and the family council.
(4)    The quality assurance committee for a nursing home shall review and approve annually the quality assurance plan for the nursing home.
(5)    Each nursing home shall establish a written quality assurance plan that:
(i)    Includes procedures for concurrent review for all residents;
(ii)    Provides criteria that routinely monitors nursing care including medication administration, prevention of decubitus ulcers, dehydration and malnutrition, nutritional status and weight loss or gain, accidents and injuries, unexpected deaths, changes in mental or psychological status, and any other data necessary to monitor quality of care;
(iii)    Includes methods to identify and correct problems; and
(iv)    Is readily available to nursing home residents and their families, guardians, or surrogate decision makers.
(6)    The quality assurance plan shall be submitted to the Department every 2 years.
(7)    The nursing home administrator shall take appropriate remedial actions based on the recommendations of the nursing home’s quality assurance committee.
(8)    The Secretary may not require the quality assurance committee to disclose the records and the reports prepared by the committee except as necessary to assure compliance with the requirements of this section.
(9)    If the Department determines that a nursing home is not implementing its quality assurance program effectively and that quality assurance activities are inadequate, the Department may impose appropriate sanctions on the nursing home to improve quality assurance including mandated employment of specified quality assurance personnel.
(c)    (1)    Each nursing home shall display on each floor of the nursing home a notice that explains the current ratio of licensed personnel to residents and unlicensed personnel to residents.
(2)    The notice shall be:
(i)    Posted in a location that is visible and accessible to residents and their family or guardians and any potential consumers; and
(ii)    On a form provided by the Department.