EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
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*hb1122*
HOUSE BILL 1122
J3 (4lr2718)
ENROLLED BILL
— Health and Government Operations/Finance —
Introduced by Delegate Kerr Delegates Kerr, Alston, Bagnall, Bhandari, Chisholm,
Cullison, Guzzone, Hill, Hutchinson, S. Johnson, Kaiser, Kipke, R. Lewis,
Lopez, Martinez, M. Morgan, Pena–Melnyk, Reilly, Rosenberg, Szeliga,
Taveras, White Holland, and Woods
Read and Examined by Proofreaders:
_______________________________________________
Proofreader.
_______________________________________________
Proofreader.
Sealed with the Great Seal and presented to the Governor, for his approval this
_______ day of _______________ at ________________________ o’clock, ________M.
______________________________________________
Speaker.
CHAPTER ______
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
closing on an acquisition of a nursing home, to submit a request for acquisition to 4
the Maryland Health Care Commission and provide certain notice to certain 5
individuals; establishing requirements regarding the approval or denial of a request 6
for 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 2 HOUSE BILL 1122
Article – Health – General 1
Section 19–114(a) 2
Annotated Code of Maryland 3
(2023 Replacement Volume) 4
BY adding to 5
Article – Health – General 6
Section 19–114(a–1) and 19–120.2 7
Annotated Code of Maryland 8
(2023 Replacement Volume) 9
BY repealing and reenacting, with amendments, 10
Article – Health – General 11
Section 19–115, 19–120(k)(6)(ii), 19–1401.1, and 19–1401.2 12
Annotated Code of Maryland 13
(2023 Replacement Volume) 14
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 15
That the Laws of Maryland read as follows: 16
Article – Health – General 17
19–114. 18
(a) In this Part II of this subtitle the following words have the meanings 19
indicated. 20
(A–1) “ACQUISITION” MEANS: 21
(1) A TRANSFER OF STOCK OR ASSETS THAT RESULTS IN A CHANGE 22
OF THE PERSON THAT C ONTROLS A HEALTH CAR E FACILITY; OR 23
(2) THE TRANSFER OF MORE THAN 25% OF STOCK OR OWNERSHI P 24
INTEREST IN A HEALTH CARE FACILITY. 25
19–115. 26
(a) In addition to the duties set forth elsewhere in this subtitle, in this Part II of 27
this subtitle, the Commission shall: 28
(1) Act as the State agency to represent the State under Title VI of the 29
federal Public Health Service Act; AND 30
(2) Periodically participate in or perform analyses and studies that relate 31
to: 32
HOUSE BILL 1122 3
(i) Adequacy of services and financial resources to meet the needs of 1
the population; 2
(ii) Distribution of health care resources; 3
(iii) Allocation of health care resources; 4
(iv) Costs of health care in relationship to available financial 5
resources; or 6
(v) Any other appropriate matter[; and 7
(3) When evaluating a notice of acquisition or transfer of interest of a 8
nursing home in accordance with § 19–120(k)(6)(ii) of this title, provide the Commission’s 9
written findings and recommendations to the Office of Health Care Quality, including: 10
(i) Quality ratings of facilities currently or previously owned, within 11
or outside the State, by the purchaser of the health care facility, based on the most recent 12
Five–Star Quality Rating System established by the Centers for Medicare and Medicaid 13
Services; 14
(ii) For the immediately preceding 3–year period: 15
1. Evidence that facilities currently or previously owned, 16
within or outside the State, by the purchaser of the health care facility maintained quality 17
assessment and assurance committees that met at least quarterly; 18
2. Inspection of care reports and corrective action plans of 19
facilities currently or previously owned, within or outside the State, by the purchaser of the 20
health care facility; 21
3. Licensing and certification surveys and corrective action 22
plans of facilities currently or previously owned, within or outside the State, by the 23
purchaser of the health care facility; and 24
4. Lawsuits or arbitration filings by any patient or patient 25
representative against facilities currently or previously owned, within or outside the State, 26
by the purchaser of the health care facility; 27
(iii) The Tax Identification Number of each purchaser; and 28
(iv) The personal Centers for Medicare and Medicaid Services 29
Certification Number of each purchaser]. 30
4 HOUSE BILL 1122
[(b) The findings and recommendations required to be provided to the Office of 1
Health Care Quality under subsection (a)(3) of this section shall include a summary of the 2
findings and the basis for the recommendations.] 3
[(c)] (B) In addition to the duties set forth elsewhere in this Part II of this 4
subtitle, the Governor shall direct, as necessary, a State officer or agency to cooperate in 5
carrying out the functions of the Commission. 6
[(d)] (C) This State recognizes the federal act and any amendment to the federal 7
act that does not require State legislation to be effective. However, if the federal act is 8
repealed or expires, this Part II of this subtitle remains in effect. 9
19–120. 10
(k) (6) This subsection does not apply to: 11
(ii) Acquisition AN ACQUISITION of a health care facility if[, at]: 12
1. AT least 30 days before making the contractual 13
arrangement to acquire the facility, written notice of the intent to make the arrangement 14
is filed with the Commission and the Commission does not find, within 30 days after the 15
Commission receives notice, that the health services or bed capacity of the facility will be 16
changed, provided that, for a merger with or acquisition of an existing general hospice, the 17
purchaser of the general hospice may only acquire the authority to provide home–based 18
hospice services in jurisdictions in which the seller of the general hospice is licensed to 19
provide home–based hospice services; AND OR AND 20
2. THE FACILITY IS A NUR SING HOME AND FOR AN 21
ACQUISITION OF A NUR SING HOME, THE ACQUISITION HAS BEEN APPROVED IN 22
ACCORDANCE WITH § 19–120.2 OF THIS SUBTITLE; 23
19–120.2. 24
(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANI NGS 25
INDICATED. 26
(2) “EXECUTIVE DIRECTOR” MEANS THE EXECUTIVE DIRECTOR OF 27
THE COMMISSION. 28
(3) “NURSING HOME ” HAS THE MEANING STAT ED IN § 19–1401 OF 29
THIS TITLE. 30
(4) “REQUEST FOR ACQUISITI ON” MEANS A REQUEST FOR THE 31
COMMISSION TO APPROVE THE ACQUISIT ION OF A NURSING HOM E. 32
HOUSE BILL 1122 5
(B) A PERSON SHALL PROVIDE NOTICE TO THE COMMISSION AT LEAST 30 1
DAYS BEFORE THE CLOS ING OF A CHANGE OF O WNERSHIP OF A NURSIN G HOME 2
THAT: 3
(1) INVOLVES AT LEAST A 5% TRANSFER IN OWNERSHI P INTEREST; 4
AND 5
(2) IS NOT AN ACQUISITION THAT REQUIRES APPROV AL UNDER 6
SUBSECTION (C) OF THIS SECTION. 7
(B) (C) (1) THIS SUBSECTION DOES NOT APPLY TO AN ACQU ISITION 8
THAT INVOLVES ONLY C HANGES OF OWNERSHIP INTERESTS AMONG EXIS TING 9
OWNERS OF A NURSING HOME. 10
(2) AT LEAST 120 60 DAYS BEFORE MAKING A CONTRACTUAL 11
ARRANGEMENT FOR THE CLOSING DATE OF THE ACQUISITION OF A NURSING HOME , 12
A PERSON SHALL : 13
(1) (I) SUBMIT TO THE COMMISSION A REQUEST FOR 14
ACQUISITION; AND 15
(2) (II) PROVIDE NOTICE TO THE RESIDENTS, RESIDENT 16
REPRESENTATIVES , AND STAFF EMPLOYEES OF THE NURSING HOME THAT: 17
(I) 1. THE REQUEST FOR ACQUI SITION WAS SUBMITTED TO 18
THE COMMISSION; AND 19
(II) 2. THERE WILL BE AN OPPO RTUNITY TO SUBMIT 20
COMMENTS IN ACCORDAN CE WITH SUBSECTION (E) (F) OF THIS SECTION. 21
(C) (D) (1) THE EXECUTIVE DIRECTOR SHALL REVIEW A COMPLETED 22
REQUEST FOR ACQUISIT ION WITHIN 60 45 DAYS AFTER RECEIVING THE COMPLETED 23
REQUEST FROM THE APPLICANT . 24
(2) THE EXECUTIVE DIRECTOR, IN CONSULTATION WITH THE 25
SECRETARY OR THE SECRETARY’S DESIGNEE, MAY: 26
(I) APPROVE THE ACQUISITI ON; 27
(II) APPROVE THE ACQUISITI ON WITH CONDITIONS ; 28
(III) DENY THE ACQUISITION ; OR 29
6 HOUSE BILL 1122
(IV) REFER THE REQUEST FOR ACQUISITION TO THE 1
COMMISSION FOR A FINA L DECISION. 2
(D) (E) TO APPROVE A REQUEST SUBMITTED UNDER SUBS ECTION (B) (C) 3
OF THIS SECTION, THE EXECUTIVE DIRECTOR MUST FIND TH AT THE ACQUISITION : 4
(1) IS CONSISTENT WITH TH E STATE HEALTH PLAN; AND 5
(2) WILL RESULT IN THE DE LIVERY OF MORE EFFIC IENT AND 6
EFFECTIVE HEALTH CARE SERVICES ; AND 7
(3) SUBJECT TO SUBSECTION (E) (F) OF THIS SECTION , IS IN THE 8
PUBLIC INTEREST . 9
(E) (F) IN DETERMINING WHETHE R AN ACQUISITION OF A NURSING HOME 10
IS IN THE PUBLIC INT EREST, THE EXECUTIVE DIRECTOR SHALL : 11
(1) SOLICIT AND ACCEPT CO MMENTS FROM INDIVIDUALS W HO: 12
(I) RESIDE IN THE NURSING HOME; 13
(II) HAVE FAMILY MEMBERS W HO RESIDE IN THE NUR SING 14
HOME; OR 15
(III) ARE EMPLOYED AT EMPLOYEES OF THE NURSING HOME ; 16
AND 17
(2) CONSULT WITH THE ATTORNEY GENERAL ON WHETHER TH E 18
ACQUISITION RAISES PUBLIC INTERE ST CONCERNS. 19
(F) (G) IF THE EXECUTIVE DIRECTOR REFERS A REQ UEST FOR 20
ACQUISITION TO THE COMMISSION UNDER SUBS ECTION (C)(2)(IV) (D)(2)(IV) OF 21
THIS SECTION , THE COMMISSION SHALL USE THE CRITERIA SPECIFI ED IN 22
SUBSECTION (D) SUBSECTIONS (E) AND (F) OF THIS SECTION OR AND REGULATIONS 23
ADOPTED BY THE COMMISSION TO MAKE A FINAL DECISION WITHIN 60 DAYS AFTER 24
RECEIVING THE COMPLE TED REQUEST FROM THE APPLICANT. 25
(G) (H) IF THE EXECUTIVE DIRECTOR DENIES A REQ UEST FOR 26
ACQUISITION OR IMPOSES A CONDITION ON THE APP ROVAL OF THE ACQUISI TION, A 27
PERSON THAT IS AN INTERESTED A PARTY TO THE ACQUISI TION MAY SUBMIT A 28
WRITTEN REQUEST FOR THE COMMISSION TO REVIEW THE DECISION IN 29
ACCORDANCE WITH REGU LATIONS ADOPTED BY T HE COMMISSION. 30
HOUSE BILL 1122 7
(H) (I) (1) A DECISION OF THE COMMISSION UNDER SUBS ECTION (F) 1
OR (G) (G) OR (H) OF THIS SECTION SHAL L BE A FINAL DECISIO N FOR THE PURPOSE 2
OF JUDICIAL REVIEW . 3
(2) A PERSON THAT IS AN INTERESTED A PARTY TO THE ACQUISI TION 4
MAY TAKE A DIRECT JU DICIAL APPEAL WITHIN 30 DAYS AFTER THE COMMISSION 5
MAKES THE FINAL DECI SION. 6
(3) THE COMMISSION SHALL SEND EACH FINAL DECISION TO THE 7
SECRETARY, THE SECRETARY OF AGING, THE OFFICE OF HEALTH CARE QUALITY, 8
AND THE OFFICE OF THE ATTORNEY GENERAL, AND THE STATE LONG–TERM CARE 9
OMBUDSMAN . 10
(I) (J) (1) ON OR BEFORE JULY 1 IMMEDIATELY FOLLOWIN G THE 11
ACQUISITION OF A NUR SING HOME AND EVERY EACH YEAR FOR 3 YEARS 12
THEREAFTER , THE PERSON THAT ACQU IRED THE NURSING HOM E SHALL SUBMIT A 13
REPORT TO THE COMMISSION IN ACCORDA NCE WITH REGULATIONS ADOPTED BY 14
THE COMMISSION. 15
(2) THE COMMISSION SHALL PROV IDE THE REPORT REQUI RED 16
UNDER PARAGRAPH (1) OF THIS SUBSECTION T O THE SECRETARY, THE SECRETARY 17
OF AGING, THE OFFICE OF HEALTH CARE QUALITY, AND THE OFFICE OF THE 18
ATTORNEY GENERAL, AND THE STATE LONG–TERM CARE OMBUDSMAN . 19
(J) (K) (1) THE COMMISSION SHALL ADOP T REGULATIONS THROUGH 20
AN UPDATE TO THE STATE HEALTH PLAN FOR FACILITIES AND SERVICES TO CARRY 21
OUT THE PROVISIONS O F THIS SECTION. 22
(2) THE REGULATIONS ADOPT ED UNDER THIS SUBSEC TION SHALL: 23
(I) REQUIRE THE PERSON THAT ACQU IRED OWNERSHIP OF A 24
NURSING HOME TO : 25
1. REDUCE THE NUMBER OF RESIDENT ROOMS IN TH E 26
NURSING HOME THAT CO NTAIN MORE THAN TWO BEDS IN ACCORDANCE W ITH 27
STANDARDS ESTABLISHE D BY THE COMMISSION; OR 28
2. RECEIVE A WAIVER FROM THE REQUIR EMENT 29
ESTABLISHED UNDER IT EM 1 OF THIS ITEM FROM TH E EXECUTIVE DIRECTOR IN 30
ACCORDANCE WITH STAN DARDS ESTABLISHED BY THE COMMISSION; 31
(II) 1. IF NECESSARY, ALLOW THE PERSON THA T ACQUIRED 32
OWNERSHIP OF A NURSI NG HOME TO TEMPORARI LY DELICENSE BEDS FO R AT LEAST 33 8 HOUSE BILL 1122
3 YEARS IMMEDIATELY FO LLOWING THE ACQUISIT ION TO REDUCE THE NU MBER OF 1
RESIDENT ROOMS THAT CONTAIN MORE THAN TW O BEDS; AND 2
2. AUTHORIZE THE COMMISSION TO EXTEND THE 3
PERIOD THE BEDS ARE TEMPORARILY DELICENS ED BEYOND 3 YEARS FOR GOOD 4
CAUSE SHOWN , INCLUDING DEMONSTRATE D PROGRESS TOWARD EL IMINATING 5
MULTIBEDDED ROOMS BY EXPANDING THE EXISTI NG FACILITY OR TRANS FERRING 6
THE BEDS TO ANOTHER FACILITY WITHIN A ME RGED ASSET SYSTEM IN THE SAME 7
JURISDICTION; 8
(II) (III) ESTABLISH STANDARDS F OR THE EVALUATION OF 9
THE QUALITY OF THE FACILITIES NURSING HOMES CURRENTLY OR PREVIOU SLY 10
OWNED, WHETHER IN THE STATE OR OUTSIDE THE STATE, BY THE PERSON THAT 11
SUBMITTED A REQUEST FOR ACQUISITION ; AND 12
(III) (IV) SUBJECT TO PARAGRAPH (3) OF THIS SUBSECTION , 13
ESTABLISH CRITERIA F OR THE EXECUTIVE DIRECTOR AND THE COMMISSION TO 14
CONSIDER WHEN MAKING A DECISION REGARDING A REQUEST FOR ACQUIS ITION. 15
(3) THE CRITERIA ESTABLIS HED BY THE COMMISSION UNDER 16
PARAGRAPH (2)(III) (2)(IV) OF THIS SUBS ECTION SHALL REQUIRE THAT THE 17
COMMISSION TAKE INTO CONSIDERATION WHETHE R ANY FACILITY NURSING HOME 18
CURRENTLY OR PREVIOU SLY OWNED, WITHIN OR OUTSIDE TH E STATE, BY THE 19
PERSON SUBMITTING TH E REQUEST, FOR THE PERIOD OF 3 YEARS IMMEDIATELY 20
PRECEDING THE SUBMIS SION OF THE REQUEST : 21
(I) MAINTAINED A QUALITY ASSESSMENT AND ASSUR ANCE 22
COMMITTEE THAT MET A T LEAST QUARTERLY ; 23
(II) WAS THE SUBJECT OF AN ENFORCEMENT ACTION , A 24
SPECIAL FOCUS FACILI TY DESIGNATION , SURVEY, OR PLAN OF CORRECTIO N OR A 25
DEFICIENCY INVOLVING SERIOUS OR IMMEDIATE THREAT , ACTUAL HARM , OR 26
IMMEDIATE JEOPARDY T O A RESIDENT; OR 27
(III) WAS THE SUBJECT OF A LAWSUIT, A JUDGMENT, OR AN 28
ARBITRATION FINDING , FOLLOWING A COMPLAIN T FILED BY A RESIDENT OR, 29
RESIDENT REPRESENTATIVE , OR A GOVERNMEN T AGENCY. 30
19–1401.1. 31
(a) (1) In addition to the requirements for licensure of a related institution as 32
provided in this title, an applicant for licensure of a nursing home shall include in the 33
application the identity of: 34
HOUSE BILL 1122 9
(i) Any person with an ownership interest in the nursing home; and 1
(ii) Any management company, landlord, or other business entity 2
that will operate or contract with the applicant to manage the nursing home. 3
(2) (i) The person acquiring a nursing home shall provide the 4
Department with written notice of the acquisition or change in operator at the same time 5
as the notice required under [§ 19–120(k)(6)(ii)] § 19–120.2 of this title is filed with the 6
Maryland Health Care Commission. 7
(ii) For other changes to the information required under paragraph 8
(1) of this subsection, the nursing home shall notify the Department within 30 days after 9
the effective date of the change. 10
(b) An applicant for licensure shall submit to the Secretary or the Secretary’s 11
designee evidence: 12
(1) That affirmatively demonstrates the ability of the applicant to comply 13
with minimum standards of: 14
(i) Medical care; 15
(ii) Nursing care; 16
(iii) Financial condition; and 17
(iv) Other applicable State or federal laws and regulations; [and] 18
(2) Regarding the regulatory compliance history and financial condition of 19
any health care facility owned or operated by the applicant in other jurisdictions; AND 20
(3) THAT A REQUEST FOR AC QUISITION FOR THE NU RSING HOME WAS 21
APPROVED IN ACCORDAN CE WITH § 19–120.2 OF THIS TITLE. 22
19–1401.2. 23
[(a)] On review of the information required under § 19–1401.1 of this subtitle and 24
any other information that is relevant to the ability of the applicant to operate a nursing 25
home, the Secretary may: 26
(1) Approve an application for a license; 27
(2) Deny an application for a license; 28
(3) Approve an application for a license subject to conditions; or 29
10 HOUSE BILL 1122
(4) Revoke a license. 1
[(b) Before taking action on a license under subsection (a) of this section, the 2
Secretary shall consider any findings and recommendations DECISIONS of the Maryland 3
Health Care Commission provided to the Office of Health Care Quality under § 19–115 § 4
19–120.2 of this title.] 5
SECTION 2. AND BE IT FURTHER ENACTED, That the Maryland Health Care 6
Commission shall adopt the regulations required under § 19–120.2(j) of the Health – 7
General Article, as enacted by Section 1 of this Act, on or before January 1, 2025 to be 8
applicable to acquisitions executed after the adoption of the regulations. 9
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 10
October 1, 2024. 11
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.