Update of Maryland’s Health Care Facility Licensing Regulations Under Way

2011: Issue 2 – Focus on Long Term Care

Maryland’s Department of Health and Mental Hygiene (DHMH) recently announced an internal “Task Force on Regulatory Efficiency” to conduct a review of facilities to promote greater transparency, efficiency and effectiveness. The Task Force will review and recommend adjustments to regulations applicable to a broad array of facilities. Details of the initiative, launched April 4, 2011, are available here.

The Task Force’s review will cover the regulations that set quality of care standards for a broad array of facilities holding DHMH licenses, as listed on the Office of Health Care Quality website. Each health care facility holding a DHMH OHCQ license should check the list to determine whether its licensing regulations will be affected.

At a minimum, the affected facilities include: skilled nursing facilities, assisted living facilities, community programs for individuals with mental health, substance use concerns, hospice, hospitals, programs for individuals with developmental disabilities, laboratories, adult day care and in-home services. Just as examples, chapters of the regulations under review govern health care facilities from hospitals to tissue banks, from nursing homes to food service facilities, or from developmental disabilities services providers to entities regulated by the alcohol and drug abuse administration — and others beyond these.

According to the DHMH website: “The Task Force will focus on adjustments to these regulations to promote efficiency and effectiveness, such as:

Ways to facilitate communication, such as electronic signature
Ways to encourage smart technology adoption, such as wireless call bell systems
Flexibility for furnishings or physical plant requirements
Better support for independence of residents in long-term care and other settings
Simplification or electronic systems for documentation without losing value

The Task Force will not consider wholesale changes to the regulatory structure. Such ideas, if compelling, may be referred for more in-depth consideration.”

Timeline

April 4, 2011:	A 45-day comment period was launched.
May 19, 2011:	Comment period ends.
June 27, 2011:	Task force issues interim report and a second 45-day comment period to be initiated.
August 11, 2011:	Second comment period ends
September 8, 2011:	Final report to Dr. Sharfstein, the DHMH Secretary, along with specific recommendations for changes to the regulations and legislative proposals for the 2012 session.

The Task Force is chaired by Wendy Kronmiller, DHMH’s Assistant Secretary for Regulatory Affairs, and Mark Luchner, Executive Director of the Community Health Resources Commission. Six DHMH operating divisions are represented on the Task Force.

Ober|Kaler's Comments

This is a unique opportunity for health care providers to take a comprehensive look at the way in which they now or need to deliver care into the future and to determine the extent to which current licensing regulations constrain those efforts and plans. For example, health information technology needs and uses may not be fully reflected in current regulations. Moreover, facility-type licensing regulations may be constraining on a nursing environment initiative to create settings that are more “home-like.” The review of the regulations may entail consulting with internal staff and external staff who are subject matter experts in particular areas such as physical plant, food service, and health information systems. Also, changes to these regulations may entail review of other state and federal laws that go beyond health care, such as in considering the use of electronic signatures. Moreover, payer requirements, including Medicare or otherwise, should be considered so the licensing regulations align with available choices and incentives.