EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb1122*
HOUSE BILL 1122
J3 4lr2718
CF SB 1000
By: Delegate Kerr
Introduced and read first time: February 7, 2024
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Maryland Health Care Commission – Nursing Homes – Acquisitions 2
FOR the purpose of requiring a person, before making a contractual agreement for the 3
acquisition of a nursing home, to submit a request for acquisition to the Maryland 4
Health Care Commission and provide certain notice to certain individuals; 5
establishing requirements regarding the approval or denial of a request for 6
acquisition; providing for judicial review of a final decision of the Commission 7
regarding a request for acquisition of a nursing home; requiring a person who 8
acquires a nursing home to submit a certain report to the Commission on a certain 9
basis; and generally relating to the acquisition of a nursing home. 10
BY repealing and reenacting, without amendments, 11
Article – Health – General 12
Section 19–114(a) 13
Annotated Code of Maryland 14
(2023 Replacement Volume) 15
BY adding to 16
Article – Health – General 17
Section 19–114(a–1) and 19–120.2 18
Annotated Code of Maryland 19
(2023 Replacement Volume) 20
BY repealing and reenacting, with amendments, 21
Article – Health – General 22
Section 19–115, 19–120(k)(6)(ii), 19–1401.1, and 19–1401.2 23
Annotated Code of Maryland 24
(2023 Replacement Volume) 25
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 26
That the Laws of Maryland read as follows: 27 2 HOUSE BILL 1122
Article – Health – General 1
19–114. 2
(a) In this Part II of this subtitle the following words have the meanings 3
indicated. 4
(A–1) “ACQUISITION” MEANS: 5
(1) A TRANSFER OF STOCK OR ASSETS THAT RESULTS IN A CHANGE 6
OF THE PERSON THAT CONTROL S A HEALTH CARE FACILI TY; OR 7
(2) THE TRANSFER OF MORE THAN 25% OF STOCK OR OWNERSHIP 8
INTEREST IN A HEALTH CARE FACILI TY. 9
19–115. 10
(a) In addition to the duties set forth elsewhere in this subtitle, in this Part II of 11
this subtitle, the Commission shall: 12
(1) Act as the State agency to represent the State under Title VI of the 13
federal Public Health Service Act; AND 14
(2) Periodically participate in or perform analyses and studies that relate 15
to: 16
(i) Adequacy of services and financial resources to meet the needs of 17
the population; 18
(ii) Distribution of health care resources; 19
(iii) Allocation of health care resources; 20
(iv) Costs of health care in relationship to available financial 21
resources; or 22
(v) Any other appropriate matter[; and 23
(3) When evaluating a notice of acquisition or transfer of interest of a 24
nursing home in accordance with § 19–120(k)(6)(ii) of this title, provide the Commission’s 25
written findings and recommendations to the Office of Health Care Quality, including: 26
(i) Quality ratings of facilities currently or previously owned, within 27
or outside the State, by the purchaser of the health care facility, based on the most recent 28 HOUSE BILL 1122 3
Five–Star Quality Rating System established by the Centers for Medicare and Medicaid 1
Services; 2
(ii) For the immediately preceding 3–year period: 3
1. Evidence that facilities currently or previously owned, 4
within or outside the State, by the purchaser of the health care facility maintained quality 5
assessment and assurance committees that met at least quarterly; 6
2. Inspection of care reports and corrective action plans of 7
facilities currently or previously owned, within or outside the State, by the purchaser of the 8
health care facility; 9
3. Licensing and certification surveys and corrective action 10
plans of facilities currently or previously owned, within or outside the State, by the 11
purchaser of the health care facility; and 12
4. Lawsuits or arbitration filings by any patient or patient 13
representative against facilities currently or previously owned, within or outside the State, 14
by the purchaser of the health care facility; 15
(iii) The Tax Identification Number of each purchaser; and 16
(iv) The personal Centers for Medicare and Medicaid Services 17
Certification Number of each purchaser]. 18
[(b) The findings and recommendations required to be provided to the Office of 19
Health Care Quality under subsection (a)(3) of this section shall include a summary of the 20
findings and the basis for the recommendations.] 21
[(c)] (B) In addition to the duties set forth elsewhere in this Part II of this 22
subtitle, the Governor shall direct, as necessary, a State officer or agency to cooperate in 23
carrying out the functions of the Commission. 24
[(d)] (C) This State recognizes the federal act and any amendment to the federal 25
act that does not require State legislation to be effective. However, if the federal act is 26
repealed or expires, this Part II of this subtitle remains in effect. 27
19–120. 28
(k) (6) This subsection does not apply to: 29
(ii) Acquisition of a health care facility if[, at]: 30
1. AT least 30 days before making the contractual 31
arrangement to acquire the facility, written notice of the intent to make the arrangement 32 4 HOUSE BILL 1122
is filed with the Commission and the Commission does not find, within 30 days after the 1
Commission receives notice, that the health services or bed capacity of the facility will be 2
changed, provided that, for a merger with or acquisition of an existing general hospice, the 3
purchaser of the general hospice may only acquire the authority to provide home–based 4
hospice services in jurisdictions in which the seller of the general hospice is licensed to 5
provide home–based hospice services; AND 6
2. THE FACILITY IS A NURSING HOME AND THE 7
ACQUISITION HAS BEEN APPROVED IN ACCORDAN CE WITH § 19–120.2 OF THIS 8
SUBTITLE; 9
19–120.2. 10
(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 11
INDICATED. 12
(2) “EXECUTIVE DIRECTOR” MEANS THE EXECUTIVE DIRECTOR OF 13
THE COMMISSION. 14
(3) “NURSING HOME ” HAS THE MEANING STAT ED IN § 19–1401 OF 15
THIS TITLE. 16
(4) “REQUEST FOR ACQUISITI ON” MEANS A REQUEST FOR THE 17
COMMISSION TO APPROVE THE ACQUISITION OF A NURSING HOME . 18
(B) AT LEAST 120 DAYS BEFORE MAKING A CONTRACTUAL ARRANGEM ENT 19
FOR THE ACQUISITION OF A NURSING HOME , A PERSON SHALL : 20
(1) SUBMIT TO THE COMMISSION A REQUEST FOR ACQUISITION; AND 21
(2) PROVIDE NOTICE TO THE RESIDE NTS AND STAFF OF THE NURSING 22
HOME THAT: 23
(I) THE REQUEST FOR ACQUISITION WAS SUBMITTED TO THE 24
COMMISSION; AND 25
(II) THERE WILL BE AN OPPORTUNITY TO SUBMI T COMMENTS IN 26
ACCORDANCE WITH SUBS ECTION (E) OF THIS SECTION. 27
(C) (1) THE EXECUTIVE DIRECTOR SHALL REVIEW A COMPLETED 28
REQUEST FOR ACQUISITION WITHIN 60 DAYS AFTER RECEIVING THE COMPLETE D 29
REQUEST. 30
HOUSE BILL 1122 5
(2) THE EXECUTIVE DIRECTOR, IN CONSULTATION WITH THE 1
SECRETARY, MAY: 2
(I) APPROVE THE ACQUISITION; 3
(II) APPROVE THE ACQUISITI ON WITH CONDITIONS ; 4
(III) DENY THE ACQUISITION ; OR 5
(IV) REFER THE REQUEST FOR ACQUISITION TO THE 6
COMMISSION FOR A FINAL DECISION. 7
(D) TO APPROVE A REQUEST SUBMITTED UNDER SUBS ECTION (B) OF THIS 8
SECTION, THE EXECUTIVE DIRECTOR MUST FIND THAT THE ACQUIS ITION: 9
(1) IS CONSISTENT WITH TH E STATE HEALTH PLAN; 10
(2) WILL RESULT IN THE DE LIVERY OF MORE EFFIC IENT AND 11
EFFECTIVE HEALTH CAR E SERVICES; AND 12
(3) SUBJECT TO SUBSECTION (E) OF THIS SECTION, IS IN THE PUBLIC 13
INTEREST. 14
(E) IN DETERMINING WHETHER AN ACQUISITION OF A NUR SING HOME IS IN 15
THE PUBLIC INTEREST , THE EXECUTIVE DIRECTOR SHALL: 16
(1) SOLICIT AND ACCEPT COMMENTS FROM INDIVIDUALS WHO : 17
(I) RESIDE IN THE NURSING HOME; 18
(II) HAVE FAMILY MEMBER S WHO RESIDE IN THE NU RSING 19
HOME; OR 20
(III) ARE EMPLOYED AT THE NURSING HOME ; AND 21
(2) CONSULT WITH THE ATTORNEY GENERAL ON WHETHER THE 22
ACQUISITION RAISES P UBLIC INTEREST CONCE RNS. 23
(F) IF THE EXECUTIVE DIRECTOR REFERS A REQUEST FOR ACQUISITION TO 24
THE COMMISSION UNDER SUBSECTION (C)(2)(IV) OF THIS SECTION , THE 25
COMMISSION SHALL USE THE CRITERIA SPECIFIED IN SUBSECTION (D) OF THIS 26
SECTION OR REGULATIONS ADOPT ED BY THE COMMISSION TO MAKE A FINAL 27
DECISION. 28 6 HOUSE BILL 1122
(G) IF THE EXECUTIVE DIRECTOR DENIES A REQUEST FOR ACQUISITION , A 1
PERSON THAT IS AN INTERESTE D PARTY TO THE ACQUI SITION MAY SUBMIT A 2
WRITTEN REQUEST FOR THE COMMISSION TO REVIEW THE DECISION IN 3
ACCORDANCE WITH REGU LATIONS ADOPTED BY T HE COMMISSION. 4
(H) (1) A DECISION OF THE COMMISSION UNDER SUBSECTION (F) OR (G) 5
OF THIS SECTION SHAL L BE A FINAL DECISIO N FOR THE PURPOSE OF JUDICIAL 6
REVIEW. 7
(2) A PERSON THAT IS AN INTERESTE D PARTY TO THE ACQUI SITION 8
MAY TAKE A DIRECT JUDICIAL AP PEAL WITHIN 30 DAYS AFTER THE COMMISSION 9
MAKES THE FINAL DECISION. 10
(3) THE COMMISSION SHALL SEND EACH FINAL DECISION TO TH E 11
SECRETARY, THE SECRETARY OF AGING, THE OFFICE OF HEALTH CARE QUALITY, 12
AND THE OFFICE OF THE ATTORNEY GENERAL. 13
(I) (1) ON OR BEFORE JULY 1 IMMEDIATELY FOLLOWING THE 14
ACQUISITION OF A NU RSING HOME AND EVERY 3 YEARS THEREAFTER , THE PERSON 15
THAT ACQUIRED THE NURSING HOME SHALL SUBMIT A REPORT TO THE 16
COMMISSION IN ACCORDANCE WITH R EGULATIONS ADOPTED B Y THE COMMISSION. 17
(2) THE COMMISSION SHALL PROVIDE THE REPORT REQUIRED 18
UNDER PARAGRAPH (1) OF THIS SUBSECTION T O THE SECRETARY, THE SECRETARY 19
OF AGING, THE OFFICE OF HEALTH CARE QUALITY, AND THE OFFICE OF THE 20
ATTORNEY GENERAL. 21
(J) (1) THE COMMISSION SHALL ADOP T REGULATIONS TO CAR RY OUT 22
THE PROVISIONS OF TH IS SECTION. 23
(2) THE REGULATIONS ADOPTED UNDER THIS SUBSECTIO N SHALL: 24
(I) REQUIRE THE PERSON THAT ACQUIRED OWNERSHIP OF A 25
NURSING HOME TO : 26
1. REDUCE THE NUMBER OF RESIDENT ROOMS IN TH E 27
NURSING HOME THAT CONTAIN MORE TH AN TWO BEDS IN ACCOR DANCE WITH 28
STANDARDS ESTABLISH ED BY THE COMMISSION; OR 29
2. RECEIVE A WAIVER FROM THE REQUIREMENT 30
ESTABLISHED UNDER IT EM 1 OF THIS ITEM FROM THE EXECUTIVE DIRECTOR IN 31
ACCORDANCE WITH STAN DARDS ESTABLISHED BY THE COMMISSION; 32 HOUSE BILL 1122 7
(II) ESTABLISH STANDARDS FOR THE EVALUATION OF THE 1
QUALITY OF THE FACIL ITIES CURRENTLY OR P REVIOUSLY OWNED , WHETHER IN THE 2
STATE OR OUTSIDE THE STATE, BY THE PERSON THAT SUBMITTED A REQUEST FOR 3
ACQUISITION; AND 4
(III) SUBJECT TO PARAGRAPH (3) OF THIS SUBSECTION , 5
ESTABLISH CRITERIA FOR THE EXECUTIVE DIRECTOR AND THE COMMISSION TO 6
CONSIDER WHEN MAKING A DECISION REGARDING A REQUEST FOR ACQUISITION . 7
(3) THE CRITERIA ESTABLIS HED BY THE COMMISSION UNDER 8
PARAGRAPH (2)(III) OF THIS SUBSECTION SHALL REQUIRE THAT THE COMMISSION 9
TAKE INTO CONSIDERATION WHETHER ANY FACILITY CURRENTLY OR PREVIOU SLY 10
OWNED, WITHIN OR OUTSIDE TH E STATE, BY THE PERSON SUBMIT TING THE 11
REQUEST, FOR THE PERIOD OF 3 YEARS IMMEDIATELY PR ECEDING THE SUBMISSI ON 12
OF THE REQUEST : 13
(I) MAINTAINED A QUALITY ASSESSMENT AND ASSURANCE 14
COMMITTEE THAT MET A T LEAST QUARTERLY ; 15
(II) WAS THE SUBJECT OF ENFORCEMENT ACTION , SPECIAL 16
FOCUS FACILITY DESIG NATION, SURVEY, OR PLAN OF CORRECTIO N; OR 17
(III) WAS THE SUBJECT OF A LAWSUIT, A JUDGMENT, OR AN 18
ARBITRATION FINDING BY A RESIDENT OR RESIDENT REPR ESENTATIVE. 19
19–1401.1. 20
(a) (1) In addition to the requirements for licensure of a related institution as 21
provided in this title, an applicant for licensure of a nursing home shall include in the 22
application the identity of: 23
(i) Any person with an ownership interest in the nursing home; and 24
(ii) Any management company, landlord, or other business entity 25
that will operate or contract with the applicant to manage the nursing home. 26
(2) (i) The person acquiring a nursing home sh all provide the 27
Department with written notice of the acquisition or change in operator at the same time 28
as the notice required under [§ 19–120(k)(6)(ii)] § 19–120.2 of this title is filed with the 29
Maryland Health Care Commission. 30
(ii) For other changes to the information required under paragraph 31
(1) of this subsection, the nursing home shall notify the Department within 30 days after 32
the effective date of the change. 33 8 HOUSE BILL 1122
(b) An applicant for licensure shall submit to the Secretary or the Secretary’s 1
designee evidence: 2
(1) That affirmatively demonstrates the ability of the applicant to comply 3
with minimum standards of: 4
(i) Medical care; 5
(ii) Nursing care; 6
(iii) Financial condition; and 7
(iv) Other applicable State or federal laws and regulations; [and] 8
(2) Regarding the regulatory compliance history and financial condition of 9
any health care facility owned or operated by the applicant in other jurisdictions; AND 10
(3) THAT A REQUEST FOR ACQUISITION FOR THE NU RSING HOME WAS 11
APPROVED IN ACCORDANCE WITH § 19–120.2 OF THIS TITLE. 12
19–1401.2. 13
[(a)] On review of the information required under § 19–1401.1 of this subtitle and 14
any other information that is relevant to the ability of the applicant to operate a nursing 15
home, the Secretary may: 16
(1) Approve an application for a license; 17
(2) Deny an application for a license; 18
(3) Approve an application for a license subject to conditions; or 19
(4) Revoke a license. 20
[(b) Before taking action on a license under subsection (a) of this section, the 21
Secretary shall consider any findings and recommendations of the Maryland Health Care 22
Commission provided to the Office of Health Care Quality under § 19–115 of this title.] 23
SECTION 2. AND BE IT FURTHER ENACTED, That the Maryland Health Care 24
Commission shall adopt the regulations required under § 19–120.2(j) of the Health – 25
General Article, as enacted by Section 1 of this Act, on or before January 1, 2025. 26
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 27
October 1, 2024. 28