§19-1417. Maryland Nursing Home Quality Assurance Act |

This subtitle may be cited as the “Maryland Nursing Home Quality Assurance Act”.

(a) In this subtitle the following words have the meanings indicated.
(b) “Final report” means the third party liability audit report issued to a nursing home stating the total amount due to the Department as a result of the completed audit.
(c) “Nursing home” has the meaning stated in § 19-1401(e) of this title.
(d) (1) “Third party” means any individual, entity, or program that is or may be liable to pay all or part of the medical cost of any medical assistance furnished to a recipient under the Medical Assistance Program.
- (2) “Third party” includes private health insurance, employment-related health insurance, medical support from absent parents, automobile insurance, court judgments or settlements from a liability insurer, State workers’ compensation, first party probate-estate recoveries, or any federal programs.
(e) “Third party liability audit” means a financial review of Medical Assistance payments to a provider to ascertain the legal liability of third parties to pay for care and services available under the Medical Assistance Program.
(f) “Third party liability review” means a financial review of the credit balances of a nursing home to ascertain the legal liability of third parties to pay for care and services available under the Medical Assistance Program.

(a) A nursing home that receives payment from the Medical Assistance Program shall provide a report of the credit balances of the nursing home to the Department on a quarterly basis.
(b) The Department shall conduct a third party liability review of the report of the credit balances provided under subsection (a) of this section.
(c) The Department may conduct a third party liability audit of a random sample of the reports of credit balances reviewed under subsection (b) of this section.
(d) (1) Subject to paragraph(2) of this subsection, the Department may conduct a third party liability audit of a nursing home that is found to be noncompliant as a result of the audit conducted under subsection (c) of this section.
- (2) In conducting the third party liability audit authorized under paragraph (1) of this subsection, the Department may only review the financial information of the nursing home for the 2-year period immediately prior to the date of the audit period in which the nursing home was found to be noncompliant.

(a) A nursing home may appeal the results of a final report of a third party liability audit by filing written notice with the Department within 30 days after the nursing home receives the final report from the Department.
(b) An individual at the Department who did not participate in the final report shall:
- (1) Review the appeal authorized under subsection (a) of this section; and
- (2) Issue a report that either revises or concurs with the final report of the third party liability audit.
(c) A nursing home may appeal the results of the report issued by the Department under subsection (b) of this section by filing written notice with the Nursing Home Appeal Board within 30 days of receipt of the report.

The Department may adopt rules and regulations to carry out the provisions of this subtitle.