EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*hb1194*
HOUSE BILL 1194
J1, J3 4lr2175
CF SB 1020
By: Delegates White Holland, Acevero, Bagnall, Charkoudian, Guzzone, Hill,
S. Johnson, R. Lewis, Martinez, McCaskill, Taveras, Turner, and Vogel
Introduced and read first time: February 8, 2024
Assigned to: Health and Government Operations
Committee Report: Favorable with amendments
House action: Adopted
Read second time: March 7, 2024
CHAPTER ______
AN ACT concerning 1
Hospitals – Patient’s Bill of Rights Training and Clinical Staffing Committees 2
and Plans – Establishment 3
(Safe Staffing Act of 2024) 4
FOR the purpose of requiring each hospital certain hospitals licensed in the State to 5
establish and maintain a clinical staffing committee and to implement a clinical 6
staffing plan; requiring each clinical staffing committee to develop a clinical staffing 7
plan; requiring that an administrator of a hospital, under certain circumstances, 8
provide certain training regarding the patient’s bill of rights by contracting with a 9
third party; requiring the Health Services Cost Review Commission to conduct 10
investigations regarding alleged violations of certain provisions of this Act; 11
authorizing the Health Services Cost Review Commission to take certain actions if 12
the Commission determines a violation has occurred; and generally relating to 13
hospitals and clinical staffing committees and plans. 14
BY adding to 15
Article – Health – General 16
Section 19–388 through 19–398 to be under the new part “Part XII. Clinical Staffing 17
Committees and Plans” 19–310.4 18
Annotated Code of Maryland 19
(2023 Replacement Volume) 20
BY repealing and reenacting, with amendments, 21
Article – Health – General 22 2 HOUSE BILL 1194
Section 19–342(c)(4) 1
Annotated Code of Maryland 2
(2023 Replacement Volume) 3
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 4
That the Laws of Maryland read as follows: 5
Article – Health – General 6
19–310.4. 7
(A) (1) IN THIS SECTION THE FOLLOWING WORDS HAVE THE MEANINGS 8
INDICATED. 9
(2) “CLINICAL STAFFING COM MITTEE” MEANS A COMMITTEE 10
ESTABLISHED BY A HOS PITAL IN ACCORDANCE WITH SUBSECTION (C) OF THIS 11
SECTION. 12
(3) “CLINICAL STAFFING PLA N” MEANS A PLAN DEVELOP ED UNDER 13
SUBSECTION (D) OF THIS SECTION. 14
(B) THIS SECTION DOES NOT APPLY TO STATE HOSPITALS . 15
(C) EACH HOSPITAL LICENSE D UNDER THIS TITLE S HALL ESTABLISH AND 16
MAINTAIN A CLINICAL STAFFING COMMITTEE T HAT HAS EQUAL MEMBER SHIP FROM 17
MANAGEMENT AND EMPLO YEES. 18
(D) EACH CLINICAL STAFFI NG COMMITTEE SHALL D EVELOP A CLINICAL 19
STAFFING PLAN FOR TH E HOSPITAL THAT ESTA BLISHES THE APPROPRI ATE NUMBER 20
OF CLINICIANS NEEDED TO ADMINISTER QUALIT Y HEALTH CARE BY SET TING. 21
(E) (1) WHEN DEVELOPING A CLI NICAL STAFFING PLAN , THE CLINICAL 22
STAFFING COMMIT TEE SHALL ESTABLISH , BASED ON THE PATIENT POPULATION OF 23
THE HOSPITAL: 24
(I) SUGGESTED GUIDELINES OR RATIOS, MATRICES, OR GRIDS 25
INDICATING HOW MANY PATIENTS SHOULD BE A SSIGNED TO EACH REGI STERED 26
NURSE BY UNIT OR SET TING; AND 27
(II) THE NUMBER OF REGISTERED NURSES , LICENSED 28
PRACTICAL NURSES , CERTIFIED NURSING AS SISTANTS, CERTIFIED MEDICINE 29
TECHNICIANS, ENVIRONMENTAL SERVIC E WORKERS, AND ANCILLARY MEMBER S OF 30
THE DIRECT CARE TEAM THAT SHOULD BE PRESE NT ON EACH UNIT DURI NG EACH 31
SHIFT. 32
HOUSE BILL 1194 3
(2) TO THE EXTENT PRACTICABLE , THE GUIDELINES ESTAB LISHED 1
UNDER PARAGRAPH (1)(I) OF THIS SUBSECTION S HALL BE BASED ON NAT IONAL 2
EVIDENCE–BASED STANDARDS . 3
(F) ON OR BEFORE JULY 1 EACH YEAR, EACH HOSPITAL , THROUGH THE 4
CLINICAL STAFFING CO MMITTEE, SHALL CONDUCT A REVI EW OF THE CLINICAL 5
STAFFING PLAN TO : 6
(1) EVALUATE THE EFFECTIV ENESS OF THE CLINICA L STAFFING 7
PLAN DURING THE IMME DIATELY PRECEDING YE AR; AND 8
(2) UPDATE THE CLINICAL S TAFFING PLAN TO ENSU RE THAT THE 9
CLINICAL STAFFING PL AN CONTINUES TO BE A PPROPRIATE A ND EFFECTIVE. 10
(G) A HOSPITAL SHALL PROVI DE ITS CLINICAL STAF FING PLAN ON 11
REQUEST. 12
19–342. 13
(c) Each administrator of a hospital shall: 14
(4) Provide annual training to all patient care staff members to ensure the 15
staff’s knowledge and understanding of the patient’s bill of rights THROUGH TRAINING 16
PROVIDED BY STAFF ME MBERS OR, IF THE HOSPITAL IS U NABLE TO PROVIDE THE 17
TRAINING THROUGH STA FF MEMBERS, BY CONTRACTING WITH A THIRD PARTY. 18
19–386. RESERVED. 19
19–387. RESERVED. 20
PART XII. CLINICAL STAFFING COMMITTEES AND PLANS. 21
19–388. 22
(A) IN THIS PART THE FOLL OWING WORDS HAVE THE MEANINGS 23
INDICATED. 24
(B) (1) “ANCILLARY MEMBER OF T HE FRONTLINE TEAM ” MEANS AN 25
INDIVIDUAL WHOSE PRI MARY DUTIES INCLUDE SUPPORTING INDIVIDUA LS WHO 26
PROVIDE DIRECT PATIE NT CARE. 27
(2) “ANCILLARY MEMBER OF T HE FRONTLINE TEAM ” INCLUDES: 28
(I) DIETARY WORKERS ; 29
4 HOUSE BILL 1194
(II) PATIENT CARE TECHNICI ANS; AND 1
(III) OTHER NONLICENSED STA FF ASSISTING WITH PA TIENT 2
CARE. 3
(C) “CLINICAL STAFFING COM MITTEE” MEANS THE COMMITTEE 4
ESTABLISHED BY A H OSPITAL IN ACCORDANC E WITH § 19–390 OF THIS SUBTITLE. 5
(D) “CLINICAL STAFFING PLA N” MEANS THE PLAN REQUI RED TO BE 6
DEVELOPED UNDER § 19–391 OF THIS SUBTITLE. 7
(E) “COMMISSION” MEANS THE HEALTH SERVICES COST REVIEW 8
COMMISSION ESTABLISHE D UNDER SUBTITLE 2 OF THIS TITLE. 9
(F) “UNFORESEEABLE EMERGEN CY CIRCUMSTANCE ” MEANS: 10
(1) AN OFFICIALLY DECLARE D NATIONAL , STATE, OR LOCAL 11
EMERGENCY ; 12
(2) AN EVENT THAT CAUSES A HOSPITAL TO ACTIVA TE THE 13
HOSPITAL’S DISASTER PLAN; OR 14
(3) A NATURAL OR MANMADE D ISASTER OR CATASTROPHIC EVENT 15
THAT IMMEDIATELY AFF ECTS OR INCREASES TH E NEED FOR HEALTH CA RE 16
SERVICES. 17
19–389. 18
THIS PART MAY NOT BE CONSTRUED TO : 19
(1) REPLACE OR SUPPLANT A NY COMPLAINT MECHANI SM 20
ESTABLISHED BY A HOS PITAL, INCLUDING ANY COMPLA INT MECHANISM DESIGNED 21
TO COMPLY WITH ANY E XISTING FEDERAL , STATE, OR LOCAL LAWS ; 22
(2) LIMIT OR SUPPLANT THE RIGHTS OF EMPLOYEES OR THEIR 23
EXCLUSIVE REPRESENTA TIVES TO ENFORCE RIG HTS CONFERRED UNDER THE 24
TERMS OF A COLLECTIV E BARGAINING AGREEME NT; OR 25
(3) AFFECT MORE STRINGENT STANDARDS IN FEDERAL OR STATE 26
LAW OR REGULATION OR THE TERMS OF AN APPL ICABLE COLLECTIVE BA RGAINING 27
AGREEMENT . 28
19–390. 29
HOUSE BILL 1194 5
(A) (1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION , ON OR 1
BEFORE JANUARY 1, 2025, EACH HOSPITAL LICENS ED UNDER THIS TITLE SHALL 2
ESTABLISH AND MAINTA IN A CLINICAL STAFFI NG COMMITTEE . 3
(2) A HOSPITAL MAY COMPLY WITH THE REQUIREMENT UNDER 4
PARAGRAPH (1) OF THIS SUBSECTION B Y ASSIGNING THE DUTI ES OF A CLINICAL 5
STAFFING COMMITTEE T O AN EXISTING COMMIT TEE IN THE HOSPITAL THAT MEETS 6
THE REQUIREMENTS OF SUBSECTION (B) OF THIS SECTION. 7
(B) (1) (I) AT LEAST 50% OF THE MEMBERSHIP OF A CLINICAL 8
STAFFING COMMITTEE M UST BE COMPOSED OF R EGISTERED NURSES , LICENSED 9
PRACTICAL NURSES , CERTIFIED NURSING AS SISTANTS, AND ANCILLARY MEMBER S 10
OF THE FRONTLINE TEAM IN TH E HOSPITAL. 11
(II) THE MEMBERSHIP DESCRI BED IN SUBPARAGRAPH (I) OF 12
THIS PARAGRAPH SHALL BE SELECTED: 13
1. IF THERE IS AN APPLIC ABLE COLLECTIVE 14
BARGAINING AGREEMENT , IN ACCORDANCE WITH T HE COLLECTIVE BARGAI NING 15
AGREEMENT ; OR 16
2. BY THE REGISTERED NUR SES, LICENSED PRACTICAL 17
NURSES, CERTIFIED NURSING AS SISTANTS, AND ANCILLARY MEMBER S OF THE 18
FRONTLINE TEAM WORKI NG IN THE HOSPITAL . 19
(2) THE REMAINDER OF THE MEMBERSHIP OF A CLIN ICAL STAFFING 20
COMMITTEE MUST BE CO MPOSED OF INDIVIDUAL S EMPLOYED IN THE 21
ADMINISTRATION OF TH E HOSPITAL AND MAY I NCLUDE: 22
(I) A CHIEF FINANCIAL OFFI CER; 23
(II) A CHIEF NURSING OFFICE R; AND 24
(III) PATIENT CARE UNIT DIR ECTORS OR MANAGERS O R THEIR 25
DESIGNEES. 26
(C) (1) A HOSPITAL MAY NOT : 27
(I) REQUIRE A MEMBER OF THE CLINIC AL STAFFING 28
COMMITTEE TO PARTICI PATE ON THE CLINICAL STAFFING COMMITTEE O UTSIDE 29
SCHEDULED WORK TIME ; OR 30
6 HOUSE BILL 1194
(II) ADD WORK DUTIES TO OR REASSIGN A MEMBER OF THE 1
CLINICAL STAFFING CO MMITTEE AS A RESULT OF THE MEMBER ’S PARTICIPATION 2
ON THE CLINICAL STAFFING CO MMITTEE. 3
(2) A HOSPITAL SHALL COMPE NSATE EACH MEMBER OF THE 4
CLINICAL STAFFING CO MMITTEE AT AN APPROP RIATE RATE FOR TIME SPENT 5
PARTICIPATING ON A C LINICAL STAFFING COM MITTEE. 6
19–391. 7
(A) A CLINICAL STAFFING CO MMITTEE SHALL : 8
(1) DEVELOP AND PROVIDE O VERSIGHT FOR THE IMP LEMENTATION 9
OF AN ANNUAL CLINICA L STAFFING PLAN THAT : 10
(I) IS BASED ON PATIENT N EEDS; 11
(II) ESTABLISHES SPECIFIC GUIDELINES OR RATIOS , 12
MATRICES, OR GRIDS INDICATING HOW MANY PATIENTS SH OULD BE ASSIGNED TO 13
EACH REGISTERED NURSE ; AND 14
(III) ESTABLISHES THE NUMBE R OF REGISTERED NURS ES, 15
LICENSED PRACTICAL N URSES, CERTIFIED NURSING AS SISTANTS, AND ANCILLARY 16
MEMBERS OF THE FRONT LINE TEAM THAT SHOUL D BE PRESENT ON EACH UNIT AND 17
DURING EACH SHIFT ; 18
(2) DEVELOP A PROCESS FOR REEVALUA TING AND AMENDING TH E 19
CLINICAL STAFFING PL AN AS NECESSARY ; 20
(3) ESTABLISH RULES AND C RITERIA TO PROVIDE F OR EMPLOYEE 21
CONFIDENTIALITY DURI NG A REVIEW OF A CLI NICAL STAFFING PLAN ; AND 22
(4) DEVELOP A PROCESS FOR RECEIVING, RESOLVING, AND 23
TRACKING COMPLAINTS REGARDING THE CLINIC AL STAFFING PLAN . 24
(B) IN DEVELOPING THE CLI NICAL STAFFING PLAN , THE CLINICAL 25
STAFFING COMMITTEE S HALL CONSIDER : 26
(1) THE AVERAGE NUMBER OF PATIENTS ON EACH UNI T ON EACH 27
SHIFT DURING THE IMM EDIATELY PRECEDING YEAR AND RELEVANT IN FORMATION 28
REGARDING PATIENT DI SCHARGES, POTENTIAL ADMISSIONS , AND TRANSFERS ; 29
HOUSE BILL 1194 7
(2) THE AVERAGE LEVEL OF ACUITY FOR PATIENTS ON EACH UNIT ON 1
EACH SHIFT DURING TH E IMMEDIATELY PRECED ING YEAR AND THE 2
CORRESPONDING LEVEL OF NURSING CARE REQUIRED; 3
(3) AN ESTIMATE OF THE AP PROPRIATE COMBINATIO N OF SKILL, 4
EXPERIENCE LEVEL , AND SPECIALTY CERTIF ICATION OR TRAINING OF STAFF FOR 5
EACH UNIT ON EACH SH IFT THAT IS REQUIRED TO ADEQUATELY PROVID E CARE; 6
(4) THE NEED FOR SPECIALI ZED INTENSIVE EQUI PMENT; 7
(5) THE ARCHITECTURE AND LAYOUT OF A PATIENT CARE UNIT, 8
INCLUDING PLACEMENT OF PATIENT ROOMS , TREATMENT AREAS , NURSING 9
STATIONS, MEDICATION PREPARATI ON AREAS, AND EQUIPMENT ; 10
(6) MECHANISMS AND PROCED URES REQUIRED TO PRO VIDE 11
ONE–TO–ONE PATIENT OBSERVATION OR CARE , AS APPROPRIATE , FOR PATIENTS ON 12
PSYCHIATRIC OR OTHER UNITS; 13
(7) MEASURES TO IMPROVE A ND ENSURE WORKER AND PATIENT 14
SAFETY; 15
(8) SPECIAL CHARACTERISTI CS OF EACH UNIT OR P ATIENT 16
COMMUNITY POPULATION , INCLUDING PATIENT AG E, CULTURAL OR LINGUISTIC 17
DIVERSITY AND NEEDS , FUNCTIONAL ABILITY , COMMUNICATION SKILLS , OR OTHER 18
RELEVANT SOCIAL OR S OCIOECONOMIC FACTORS ; 19
(9) STAFFING GUIDELINES A DOPTED OR PUBLISHED IN OTHER 20
STATES OR LOCAL JURI SDICTIONS OR BY NATI ONAL NURSING PROFESS IONAL 21
ASSOCIATIONS, SPECIALTY NURSING OR GANIZATIONS, OR OTHER HEALTH 22
PROFESSIONAL ORGANIZ ATIONS; 23
(10) AVAILABILITY OF OTHER PERSONNEL SUPPORTING NURSING 24
SERVICES ON EACH UNI T; 25
(11) WAIVER OF PLAN REQUIR EMENTS IN CASE OF UN FORESEEABLE 26
EMERGENCY CIRCUMSTAN CES; 27
(12) COVERAGE TO ENABLE RE GISTERED NURSES , LICENSED 28
PRACTICAL NURSES , AND ANCILLARY MEMBER S OF THE FRONTLINE T EAM TO TAKE 29
MEAL AND REST BREAKS AND PLANNED TIME OFF , AND TO ACCOMMODATE 30
UNPLANNED ABSENCES T HAT ARE REASONABLY F ORESEEABLE ; 31
(13) GENERAL HOSPITAL FINA NCES AND RESOURCES ; AND 32
8 HOUSE BILL 1194
(14) PROVISIONS FOR LIMITE D SHORT–TERM ADJUSTMENTS MAD E BY 1
APPROPRIATE HOSPITAL PERSONNEL OVERSEEING PATIENT CARE OPERATI ONS TO 2
THE STAFFING LEVELS REQUIRED BY A CLINIC AL STAFFING PLAN NEC ESSARY TO 3
ACCOUNT FO R UNEXPECTED CHANGES IN CIRCUMSTANCES THA T ARE TO BE OF 4
LIMITED DURATION . 5
(C) (1) A CLINICAL STAFFING PL AN SHALL COMPLY WITH ALL FEDERAL 6
AND STATE LAWS AND REGULA TIONS. 7
(2) A CLINICAL STAFFING PL AN SHALL COMPLY WITH AND 8
INCORPORATE ANY MINI MUM STAFFING LEVELS PROV IDED FOR IN APPLICAB LE 9
COLLECTIVE BARGAININ G AGREEMENTS , INCLUDING: 10
(I) NURSE–TO–PATIENT RATIOS ; 11
(II) CAREGIVER–TO–PATIENT RATIOS ; 12
(III) STAFFING GRIDS; 13
(IV) STAFFING MATRICES ; AND 14
(V) ANY OTHER APPLICABLE STAFFING PROVISION. 15
(D) AT LEAST EVERY 6 MONTHS, THE CLINICAL STAFFIN G COMMITTEE 16
SHALL CONDUCT A REVI EW OF THE CLINICAL S TAFFING PLAN BY COMP ARING THE 17
CLINICAL STAFFING PL AN TO PATIENT NEEDS AND EVIDENCE –BASED STAFFING 18
INFORMATION . 19
(E) THE CLINICAL STAFFING COMMITTEE SHALL REVIEW , ASSESS, AND 20
RESOLVE COMPLAINTS R EGARDING POTENTIAL V IOLATIONS OF A CLINI CAL 21
STAFFING PLAN , STAFFING VARIATIONS , OR OTHER CONCERNS RE GARDING THE 22
IMPLEMENTATION OF TH E CLINICAL STAFFING PLAN. 23
19–392. 24
(A) ON OR BEFORE JUNE 1 EACH YEAR , THE CLINICAL STAFFIN G 25
COMMITTEE OF EACH HO SPITAL SHALL DEVELOP THE HOSPITAL ’S CLINICAL 26
STAFFING PLAN . 27
(B) EXCEPT AS PROVIDED IN SUBSECTION (C)(1) OF THIS SECTION , ON OR 28
BEFORE JUNE 15 EACH YEAR, THE CLINICAL STAFFIN G COMMITTEE SHALL AD OPT A 29
CLINICAL STAFFING PLAN BY A M AJORITY VOTE OF THE CLINICAL STAFFING 30
COMMITTEE . 31
HOUSE BILL 1194 9
(C) (1) IF A CLINICAL STAFFIN G COMMITTEE IS UNABL E TO ADOPT A 1
CLINICAL STAFFING PL AN AS REQUIRED UNDER SUBSECTION (B) OF THIS SECTION, 2
THE CHIEF EXECUTIVE OFFICER OF THE HOSPI TAL SHALL ADOPT A CLINICAL 3
STAFFING PLAN THAT M EETS THE REQUIREMENT S OF THIS SUBTITLE N OT LATER 4
THAN JUNE 30. 5
(2) IF A CHIEF EXECUTIVE OFFICER ADOPTS A CLI NICAL STAFFING 6
PLAN UNDER THIS PARA GRAPH (1) OF THIS SUBSECTION , THE CHIEF EXECUTIVE 7
OFFICER SHALL ADOPT A PLAN THAT: 8
(I) IF PRACTICABLE , IS BASED ON A CLINIC AL STAFFING PLAN 9
THAT WAS PREVIOUSLY ADOPTED BY THE CLINI CAL STAFFING COMMITT EE AS A 10
BASIS FOR THE NEW CL INICAL STAFFING PLAN ; AND 11
(II) INCORPORATES ANY STAF FING–RELATED TERMS AND 12
CONDITIONS THAT HAVE BEEN ADOPTED PR EVIOUSLY THROUGH A C OLLECTIVE 13
BARGAINING AGREEMENT . 14
(D) (1) ON OR BEFORE JULY 31 EACH YEAR, EACH HOSPITAL SHALL 15
SUBMIT TO THE COMMISSION: 16
(I) THE CLINICAL STAFFING PLAN; 17
(II) DATA FROM THE IMMEDIA TELY PRECEDING YEAR 18
REGARDING THE FREQUENCY AND DU RATION OF VARIATIONS FROM THE ADOPTED 19
CLINICAL STAFFING PL AN; AND 20
(III) THE NUMBER OF COMPLAI NTS RECEIVED DURING THE 21
IMMEDIATELY PRECEDIN G YEAR RELATING TO T HE CLINICAL STAFFING PLAN AND 22
THE DISPOSITION OF E ACH COMPLAINT . 23
(2) (I) ON OR BEFORE AUGUST 14 EACH YEAR, THE COMMISSION 24
SHALL INCLUDE ON ITS WEBSITE EACH CLINICA L STAFFING PLAN SUBM ITTED 25
UNDER PARAGRAPH (1)(I) OF THIS SUBSECTION . 26
(II) IF A HOSPITAL’S CLINICAL STAFFING PLAN IS AMENDED 27
FOR ANY REASON DURIN G THE YEAR , THE HOSPITAL SHALL SUBMI T TO THE 28
COMMISSION AN UPDATED CLINICAL STAFFING PL AN IN A TIMELY MANNE R. 29
(III) THE COMMISSION SHALL INCL UDE ON ITS WEBSITE A NY 30
CLINICAL STAFFING PL AN THAT IS UPDATED U NDER THIS PARAGRAPH IN A TIMELY 31
MANNER. 32
19–393. 33 10 HOUSE BILL 1194
(A) ON OR BEFORE JANUARY 1 EACH YEAR, BEGINNING IN 2026, EACH 1
HOSPITAL SHALL : 2
(1) IMPLEMENT THE CLINICA L STAFFING PLAN ADOP TED UNDER § 3
19–392 OF THIS SUBTITLE ; AND 4
(2) ASSIGN PERSONNEL TO E ACH PATIENT CARE UNI T IN 5
ACCORDANCE WITH THE CLINICAL STAFFING PL AN. 6
(B) A REGISTERED NURSE , A LICENSED PRACTICAL NURSE, AN ANCILLARY 7
MEMBER OF THE FRONTL INE TEAM , OR AN APPLICABLE EXC LUSIVE 8
REPRESENTATIVE MAY S UBMIT A COMPLAINT TO THE CLINICAL STAFFIN G 9
COMMITTEE REGARDING ANY VARIATION WHERE PERSONNEL ASSIGNMENT IN A 10
PATIENT CARE UNIT IS NOT IN ACCORDANCE WITH T HE ADOPTED CLINICAL 11
STAFFING PLAN . 12
(C) THE CLINICAL STAFFING COMMITTEE SHALL DETE RMINE, BY A 13
MAJORITY VOTE , WHETHER A COMPLAINT HAS BEEN ADEQUATELY RESOLVED. 14
19–394. 15
(A) ON OR BEFORE JANUARY 1 EACH YEAR, EACH HOSPITAL SHALL POST IN 16
A PUBLICLY ACCESSIBL E AND CONSPICUOUS AR EA ON EACH PATIENT U NIT THE 17
CLINICAL STAFFING PL AN FOR THE UNIT AND THE ACTUAL DAILY STA FFING FOR 18
EACH SHIFT ON THE UN IT. 19
(B) IF A CLINICAL STAFFIN G PLAN FOR A UNIT IS AMENDED AFTER IT IS 20
IMPLEMENTED, THE HOSPITAL SHALL P OST THE AMENDED CLIN ICAL STAFFING 21
PLAN FOR THE UNIT IN A TIMELY MANNER . 22
19–395. 23
A HOSPITAL MAY NOT RET ALIATE AGAINST OR EN GAGE IN ANY FORM OF 24
INTIMIDATION OF : 25
(1) AN EMPLOYEE FOR PERFO RMING DUTIES OR RESP ONSIBILITIES 26
IN CONNECTION WITH THE CLINICAL STAFFING CO MMITTEE; OR 27
(2) AN EMPLOYEE, A PATIENT, OR OTHER INDIVIDUAL WHO NOTIFIES 28
THE CLINICAL STAFFIN G COMMITTEE OR THE H OSPITAL ADMINISTRATI ON OF THE 29
INDIVIDUAL’S STAFFING CONCERNS . 30
19–396. 31 HOUSE BILL 1194 11
(A) ON RECEIPT OF A COMPLAINT WITH SUPPO RTING EVIDENCE , THE 1
COMMISSION SHALL INVE STIGATE AN ALLEGED F AILURE: 2
(1) OF A HOSPITAL TO ESTA BLISH A CLINICAL STA FFING COMMITTEE 3
AS REQUIRED; 4
(2) OF A HOSPITAL TO COMP LY WITH THE REQUIREM ENTS OF THIS 5
SUBTITLE IN CREATING A CLINICAL STAFFING PL AN; 6
(3) OF A HOSPITAL TO IMPL EMENT ALL OR PART OF AN ADOPTED 7
CLINICAL STAFFING PL AN; 8
(4) OF A CLINICAL STAFFIN G COMMITTEE TO CONDU CT A REVIEW OF 9
A CLINICAL STAFFING PLAN UNDER § 19–391(D) OF THIS SUBTITLE; OR 10
(5) OF A HOSPITAL TO SUBMIT TO THE COMMISSION ANY RELEVA NT 11
UPDATES TO A CLINICA L STAFFING PLAN . 12
(B) IF THE COMMISSION RECEIVES A COMPLAINT OF UNRESOL VED 13
COMPLAINTS RELATING TO A CLINICAL STAFFI NG PLAN, THE COMMISSION SHALL 14
INITIATE AN INVESTIG ATION IF THE COMPLAI NT RELATES TO: 15
(1) COMPLIANCE WITH AN AD OPTED CLINICAL STAFF ING PLAN; 16
(2) PERSONNEL ASSIGNMENTS IN A PATIENT CARE UN IT OR 17
STAFFING LEVELS ; OR 18
(3) ANY OTHER MATTER REQU IRED TO BE INCLUDED IN A CLINICAL 19
STAFFING PLAN IN ACC ORDANCE WITH THIS SU BTITLE. 20
(C) IF THE COMMISSION INITIATES AN INVESTIGATION UND ER SUBSECTION 21
(B) OF THIS SECTION , THE COMMISSION SHALL DETE RMINE WHETHER THERE IS A 22
PATTERN OF FAILURE O N THE PART OF A CLIN ICAL STAFFING COMMIT TEE OR A 23
HOSPITAL: 24
(1) TO RESOLVE COMPLAINTS SUBMITTED TO TH E CLINICAL 25
STAFFING COMMITTEE ; OR 26
(2) TO ADOPT A CLINICAL S TAFFING PLAN UNDER § 19–392 OF THIS 27
SUBTITLE. 28
(D) (1) EXCEPT AS PROVIDED IN PARAGRAPH (2) OF THIS SUBSECTION , 29
THE COMMISSION SHALL REQU IRE THE HOSPITAL TO SUBMIT A CORRECTIVE 30 12 HOUSE BILL 1194
ACTION PLAN WITHI N 45 DAYS AFTER THE COMMISSION’S NOTIFICATION OF A 1
VIOLATION IF: 2
(I) THERE HAS BEEN A DETE RMINATION OF A VIOLA TION 3
UNDER THIS SUBTITLE ; OR 4
(II) THE COMMISSION FINDS UNDE R SUBSECTION (C) OF THIS 5
SECTION THAT THE CLI NICAL STAFFING COMMI TTEE IS RESPONSIBLE FOR A 6
PATTERN OF UNRESOLVE D COMPLAINTS . 7
(2) THE COMMISSION MAY NOT RE QUIRE THE HOSPITAL T O SUBMIT A 8
CORRECTIVE PLAN OF A CTION IF THE COMMISSION FINDS THAT THE MEMBERS OF 9
THE CLINICAL STAFFIN G COMMITTEE WHO ARE ANCILLARY MEMBERS OF THE 10
FRONTLINE TEAM WERE RESPON SIBLE FOR: 11
(I) THE CLINICAL STAFFING COMMITTEE FAILING TO RESOLVE 12
COMPLAINTS ; OR 13
(II) A PATTERN OF FAILING T O ADOPT A CLINICAL S TAFFING 14
PLAN. 15
(E) IN DETERMINING WHETHE R A VIOLATION OCCURR ED, THE 16
COMMISSION SHALL CONS IDER WHETH ER AN UNFORESEEABLE EMERGENCY 17
CIRCUMSTANCE WAS A M ITIGATING FACTOR AFF ECTING THE HOSPITAL ’S ABILITY 18
TO FOLLOW AN ADOPTED CLINICAL STAFFING PL AN. 19
19–397. 20
(A) IF A HOSPITAL FAILS T O SUBMIT A CORRECTIV E ACTION PLAN IN 21
ACCORDANCE WITH § 19–396 OF THIS SUBTITLE, THE COMMISSION MAY IMPOSE A 22
CIVIL PENALTY NOT EX CEEDING $3,000 FOR EACH VIOLATION . 23
(B) THE COMMISSION SHALL MAIN TAIN FOR PUBLIC INSP ECTION AND 24
INCLUDE ON THE COMMISSION’S WEBSITE A RECORD O F ANY CIVIL PENALTY 25
IMPOSED IN ACCORDANC E WITH THIS SUB TITLE. 26
19–398. 27
(A) ON OR BEFORE DECEMBER 31 EACH YEAR, BEGINNING IN 2025, THE 28
COMMISSION SHALL SUBM IT A REPORT TO THE GOVERNOR, THE SECRETARY, AND, 29
IN ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, THE 30
GENERAL ASSEMBLY. 31
HOUSE BILL 1194 13
(B) THE REPORT REQUI RED UNDER SUBSECTION (A) OF THIS SECTION 1
SHALL INCLUDE , FOR THE IMMEDIATELY PRECEDING CALENDAR Y EAR: 2
(1) THE NUMBER OF COMPLAI NTS SUBMITTED TO THE COMMISSION 3
REGARDING A CLINICAL STAFFING COMMITTEE O R CLINICAL STAFFING PLAN; 4
(2) THE NUMBER OF INVESTI GATIONS CONDUCTED BY THE 5
COMMISSION UNDER § 19–396 OF THIS SUBTITLE; 6
(3) THE DISPOSITION OF CO MPLAINTS SUBMITTED T O THE 7
COMMISSION REGARDING A CLINICAL STAFFING COMMITTEE OR CLINICA L 8
STAFFING PLAN ; AND 9
(4) THE ASSOCIATED COSTS FOR CONDUCTING INVESTIGATIONS AND 10
RESOLVING COMPLAINTS UNDER THIS SUBTITLE . 11
(C) BEFORE SUBMITTING THE REPORT REQUIRED UNDE R SUBSECTION (A) 12
OF THIS SECTION , THE COMMISSION SHALL CONV ENE A STAKEHOLDER 13
WORKGROUP CONSISTING OF HOSPITAL ASSOCIAT IONS AND UNIONS 14
REPRESENTING NURSES OR ANCILLARY MEMBERS OF THE FRONT LINE TEAM FOR 15
THE PURPOSES OF REVI EWING THE REPORT . 16
SECTION 2. AND BE IT FURTHER ENACTED, That each hospital shall establish 17
a clinical staffing committee as required under § 19–310.4 of the Health – General Article, 18
as enacted by Section 1 of this Act, on or before January 1, 2025. 19
SECTION 3. AND BE IT FURTHER ENACTED, That each clinical staffing 20
committee shall develop a clinical staffing plan as required under § 19–310.4 of the 21
Health – General Article, as enacted by Section 1 of this Act, on or before July 1, 2025. 22
SECTION 2. 4. AND BE IT FURTHER ENACTED, That this Act shall take effect 23
October 1, 2024. 24
Approved:
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Governor.
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Speaker of the House of Delegates.
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President of the Senate.