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Maryland Health-General Code
Title 19 – Health Care Facilities
Miscellaneous Sections
(MD Lexis-Nexis Website)

  • §19-304.Reporting unexpected occurrences or incidents; analysis. (Md Gen'l Assembly website)
    • (a)  A hospital or related institution shall:
      • (1)  Report an unexpected occurrence related to an individual's medical treatment that results in death or serious disability that is not related to the natural course of the individual's illness or underlying disease condition; and
      • (2)  Submit the report to the Department within 5 days of the hospital's or related institution's knowledge of the occurrence.
    • (b)  A hospital or related institution may report to the Department an unexpected occurrence or other incident related to an individual's medical treatment that does not result in death or serious disability.
    • (c)  A hospital or related institution shall:
      • (1)  Conduct a root cause analysis of an occurrence required to be reported under subsection (a) of this section; and
      • (2)  Unless the Department approves a longer time period, submit the root cause analysis to the Department within 60 days of the hospital's or related institution's knowledge of the occurrence.
    • (d)  If a hospital or related institution fails to comply with subsection (a) or (c) of this section, the Secretary may impose a fine of $500 per day for each day the violation continues.
    • (e)  The Secretary shall adopt regulations to implement this section.

    [2004 Sp. Sess., ch. 5, § 1.]

  • §19-307.Classifications of hospitals and related institutions. (Md Gen'l Assembly website)
    • (a)  Hospitals
      • (1)  A hospital shall be classified:
        • (i)  As a general hospital if the hospital at least has the facilities and provides the services that are necessary for the general medical and surgical care of patients;
        • (ii)  As a special hospital if the hospital:
          • 1.  Defines a program of specialized services, such as obstetrics, mental health, tuberculosis, orthopedy, chronic disease, or communicable disease;
          • 2.  Admits only patients with medical or surgical needs within the program; and
          • 3.  Has the facilities for and provides those specialized services;
        • (iii)  As a special rehabilitation hospital if the hospital meets the requirements of this subtitle and Subtitle 12 of this title; or
        • (iv)  As a limited service hospital if the health care facility:
        • 1.  Is licensed as a hospital on or after January 1, 1999;
        • 2.  Changes the type or scope of services offered by eliminating the capability to admit or retain individuals for overnight hospitalization;
        • 3.  Retains an emergency or urgent care center; and
        • 4.  Complies with the regulations adopted by the Secretary under §19-307.1 of this subtitle.
    • (2)  The Secretary may set, by rule or regulation, other reasonable classifications for hospitals.
  • (b)  Related institutions. – A related institution shall be classified:
    • (1)  As a care home if the related institution provides care to individuals who, because of advanced age or physical or mental disability, require domiciliary care or personal care in a protective environment; or
    • (2)  As a nursing home if the related institution:
      • (i)  Provides nursing care for chronically ill or convalescent patients; or
      • (ii)  Offers to provide 24-hour a day nursing care of patients in a home-type facility such as:
        • 1.  A convalescent home;
        • 2.  A nursing unit of a home for the aged;
        • 3.  A psychiatric nursing home;
        • 4.  A nursing facility for individuals with disabilities;
        • 5.  A home for alcoholics; or
        • 6.  A halfway house.

[An. Code 1957, art. 43, §§556, 562; 1982, ch. 21, §2; 1986, ch. 733; 1990, ch. 545; 1996, ch. 147; 1999, ch. 678; 2001, ch. 255; 2002, ch. 19, §4; 2004, ch. 25, §6.]

  • §19-307.1.Regulations for limited service hospitals. (Md Gen'l Assembly website)

    The Department shall adopt regulations for a limited service hospital that include the following standards:Regulations for limited service hospitals.

    • (1)  The limited service hospital shall be open 24 hours a day, 7 days a week;
    • (2)  There shall be at least one physician credentialed in emergency medicine at the limited service hospital at all times;
    • (3)  A sufficient number of registered nurses and other health professionals shall be available at the limited service hospital to provide advanced life support;
    • (4)  Basic X-ray and laboratory facilities shall be available at the limited service hospital and operable at all times by one radiology technician and one laboratory technician;
    • (5)  Resuscitation equipment, including monitor, defibrillator, cardiac medications, intubation equipment, and intravenous line equipment shall be available at the limited service hospital and operable at all times;
    • (6)  Standard procedures in accordance with the State Emergency Medical Services Plan shall exist for the immediate transport of individuals in need of hospitalization or other more definitive care;
    • (7)  A specific defined role in the Emergency Medical Services System with appropriate telephone communication shall exist;
    • (8)  Emergency services shall be available to all persons regardless of ability to pay;
    • (9)  Adoption, implementation, and enforcement of a policy shall exist that requires, except in an emergency life-threatening situation where it is not feasible or practicable, compliance by all employees and medical staff involved in patient care services with the Centers for Disease Control's guidelines on universal precautions; and
    • (10)  Any other standard that the Secretary deems necessary to ensure the quality of the services provided by a limited service hospital.

    [1999, ch. 678.]

  • §19-309.Complaints. (Md Gen'l Assembly website)
    • (a)  Inspection to investigate complaints. – Notwithstanding any other provisions of this subtitle, each hospital or residential treatment center shall be open to inspections by the Department to investigate and resolve any complaint concerning patient care, safety, medical and nursing supervision, physical environment, sanitation or dietary matters.
    • (b)  Complaints concerning nonlife-threatening deficiency.
      • (1)  To resolve expeditiously a complaint that alleges the existence of any nonlife-threatening deficiency, the Department may refer the complaint directly to the hospital or residential treatment center.
      • (2)  If appropriate, issues relating to the practice of medicine or the licensure or conduct of a health professional shall be referred to the hospital or the residential treatment center and may be referred to the appropriate licensure board for resolution.
      • (3)  If the Department determines that the hospital or residential treatment center has not satisfactorily addressed the referred complaint or where the complaint alleges the existence of a life-threatening deficiency, the Department shall conduct an independent investigation. When conducting its independent investigation, the Department shall use:
        • (i) For an accredited hospital or accredited residential treatment center, the current applicable standards of review of the Joint Commission on Accreditation of Healthcare Organizations;
        • (ii) For a nonaccredited hospital or nonaccredited residential treatment center, the standards adopted by the Secretary under this subtitle;
        • (iii) For an accredited or nonaccredited hospital that is a facility as defined under §19-319.2 of this subtitle, the requirements of §§10-701 through 10-709 of this article; and
        • (iv) For an accredited or nonaccredited residential treatment center, the requirements of §§10-701 through 10-709 of this article.

    [1982, ch. 107, §1; 1991, ch. 500; 1994, ch. 368; 1997, ch. 130.]

  • §19-318.License required; special rehabilitation hospitals. (Md Gen'l Assembly website)
    • (a)  Licensed required. – A person shall be licensed by the Secretary before the person may operate a hospital or related institution in this State.
    • (b)  Classification of hospitals as special rehabilitation hospital. – A hospital shall be classified as a special rehabilitation hospital before the hospital may provide or hold itself out as providing comprehensive physical rehabilitation services, as defined in §19-1201 of this title.

    [An. Code 1957, art. 43, §557; 1982, ch. 21, §2; 1986, ch. 733.]

  • §19-319.Qualifications for licenses. (Md Gen'l Assembly website)
    • (a)  In general. – To qualify for a license, an applicant and the hospital or related institution to be operated shall meet the requirements of this section.
    • (b)  Applicant. – 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)  Hospital, residential treatment center, or related institution.
      • (1)  The applicant shall have a certificate of need, as required under Subtitle 1 of this title, for the hospital, residential treatment center, or related institution to be operated.
      • (2)  The hospital, residential treatment center, or related institution to be operated shall:
        • (i)  Be an accredited hospital or accredited residential treatment center; or
        • (ii)  Meet the requirements that the Secretary adopts under this subtitle and Subtitle 12 of this title.
    • (c)  Utilization review program.
      • (1)  As a condition of licensure, each hospital shall establish a utilization review program for all patients admitted to the hospital. The utilization review program:
        • (i)  May be conducted by an independent, nonhospital-affiliated review agent;
        • (ii)  Shall be performed by registered nurses, medical records technicians, or similar qualified personnel supported and supervised by physicians as may be required;
        • (iii)  Shall be certified by the Secretary if the program meets the minimum standards established under paragraph (4) of this subsection; and
        • (iv)  Shall be recertified by the Secretary if the hospital makes any changes to the program after the initial certification.
      • (2)  Any change made to a certified utilization review program shall be reported to the Secretary by the hospital within 30 days of the date the change was made.
      • (3)  If a hospital fails to provide the utilization review program required under this subsection, the Secretary may impose the following penalties:
        • (i)  Delicensure of hospital; or
        • (ii)  $500 per day for each day the violation continues.
      • (4)  The Secretary shall, by regulation and in consultation with health care providers and payors, establish minimum standards for a utilization review program, directed at appropriateness and quality of inpatient care, as enumerated in the following items:
        • (i)  Preadmission review of elective admissions;
        • (ii)  Postadmission review of emergency admissions;
        • (iii)  Concurrent or retrospective review of all admissions as appropriate;
        • (iv)  Preauthorization of certain selected procedures if proposed to be performed on an inpatient basis;
        • (v)  Continued stay review based on recognized objective criteria;
        • (vi)  Readmission review.
      • (5)  A patient may not be charged for any days disallowed as a result of retrospective review under paragraph (4) of this subsection unless the patient refuses to leave the hospital when it is medically appropriate to do so and the disallowed days occur:
        • (i)  After the hospital has notified the patient in writing of the potential disallowance; or
        • (ii)  As a direct result of the noncompliance by the patient to treatment or hospital regulations.
      • (6)  A hospital shall be exempt from requiring a utilization review program for a patient if:
        • (i) 
          • 1. The patient is insured by a third-party payor; and
          • 2. The third-party payor has a utilization review program for its subscribers or beneficiaries which meets the minimum standards as adopted in paragraph (4) of this subsection; or
        • (ii)  The patient is a subscriber or member of a health maintenance organization as defined in §19-701 of this title.
      • (7)  Where federal regulations or guidelines for a federally mandated utilization review program for federally insured patients differ from standards established under paragraph (4) of this subsection, the Secretary may waive a specific standard if the program achieves the same objectives as the standards established by the Secretary.
      • (8)  The Secretary may establish record keeping and reporting requirements:
        • (i)  To evaluate the effectiveness of hospitals' utilization review programs; and
        • (ii)  To determine if the utilization review programs are in compliance with the provisions of this section and regulations adopted by the Secretary to administer this section.
    • (e)  Credentialing process for physicians.
      • (1)  In this subsection, "uniform standard credentialing form" means the form designated by the Secretary through regulation for credentialing physicians who seek to be employed by or have staff privileges at a hospital.
      • (2)  As a condition of licensure, each hospital shall:
        • (i)  Establish a credentialing process for the physicians who are employed by or who have staff privileges at the hospital; and
        • (ii)  Use the uniform standard credentialing form as the initial application of a physician seeking to be credentialed.
      • (3)  Use of the uniform standard credentialing form does not preclude a hospital from requiring supplemental or additional information as part of the hospital's credentialing process.
      • (4)  The Secretary shall, by regulation and in consultation with hospitals, physicians, interested community and advocacy groups, and representatives of the Maryland Defense Bar and Plaintiffs' Bar, establish minimum standards for a credentialing process which shall include:
        • (i)  A formal written appointment process documenting the physician's education, clinical expertise, licensure history, insurance history, medical history, claims history, and professional experience.
        • (ii)  A requirement that an initial appointment to staff not be complete until the physician has successfully completed a probationary period.
        • (iii)  A formal, written reappointment process to be conducted at least every 2 years. The reappointment process shall document the physician's pattern of performance by analyzing claims filed against the physician, data dealing with utilization, quality, and risk, a review of clinical skills, adherence to hospital bylaws, policies and procedures, compliance with continuing education requirements, and mental and physical status.
      • (5)  If requested by the Department, a hospital shall provide documentation that, prior to employing or granting privileges to a physician, the hospital has complied with the requirements of this subsection and that, prior to renewing employment or privileges, the hospital has complied with the requirements of this subsection.
      • (6)  If a hospital fails to establish or maintain a credentialing process required under this subsection, the Secretary may impose the following penalties:
        • (i)  Delicensure of the hospital; or
        • (ii)  $500 per day for each day the violation continues.
    • (f)  Procurement of organs and tissues. – As a condition of licensure, each accredited and nonaccredited hospital shall develop a protocol for the procurement of organs and tissues.
    • (g)  Risk management program.
      • (1)  As a condition of licensure, each hospital shall establish a risk management program.
      • (2)  The Secretary shall, by regulation and in consultation with hospitals, physicians, interested community and advocacy groups, and representatives of the Maryland Defense Bar and Plaintiffs' Bar establish minimum standards for a risk management program which shall include:
        • (i)  A board policy statement indicating commitment to the risk management program;
        • (ii)  A requirement that one person be assigned the responsibility for coordinating the program;
        • (iii)  An internal staff committee structure to conduct ongoing review and evaluation of risk management activities;
        • (iv)  A formal written program for addressing patient complaints;
        • (v)  A documented facility-wide risk reporting system;
        • (vi)  Ongoing risk management education programs for all staff; and
        • (vii)  Documentation that the risk management and quality assurance programs share relevant information.
      • (3)  If a hospital fails to establish or maintain a risk management program required under this subsection, the Secretary may impose the following penalties:
        • (i)  Delicensure of the hospital; or
        • (ii)  $500 per day for each day the violation continues.
    • (h)  Compliance with and notice explaining Centers for Disease Control and Prevention's guidelines on universal precautions.
      • (1)  As a condition of licensure, each hospital and related institution shall:
        • (i)  Adopt, implement, and enforce a policy that requires, except in an emergency life-threatening situation where it is not feasible or practicable, all employees and medical staff involved in patient care services to comply with the Centers for Disease Control and Prevention guidelines on universal precautions; and
        • (ii)  Display the notice developed under §1-207 of the Health Occupations Article at the entrance to the hospital or related institution.
      • (2)  If a hospital or related institution fails to comply with the requirements of this subsection, the Secretary may impose a fine of up to $500 per day per violation for each day a violation continues.

    [An. Code 1957, art. 43, §§559, 560; 1982, ch. 21, §2; ch. 107, §1; 1985, ch. 111; 1986, ch. 5, §1; ch. 642, §3; chs. 673, 690, 733; 1990, ch. 671; 1992, ch. 154, §1; ch. 581; 1993, ch. 99; 1997, ch. 130; 2002, ch. 189; 2003, ch. 21, §1; 2004, ch. 25 §§1, 6.]

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