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EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW.
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amendment.
*sb0493*
SENATE BILL 493
J3 6lr1957
CF HB 1002
By: Senator Beidle
Introduced and read first time: February 2, 2026
Assigned to: Finance
Committee Report: Favorable with amendments
Senate action: Adopted
Read second time: March 3, 2026
CHAPTER ______
AN ACT concerning 1
Nursing Facilities – Involuntary Discharge or Transfer 2
FOR the purpose of prohibiting certain facilities from involuntarily transferring or 3
discharging a resident to certain housing or before receiving certain confirmations; 4
altering the information required to be included in a certain notice or updated new 5
notice; requiring that a certain notice or updated new notice be provided to certain 6
residents at least a certain period of time before an involuntary discharge or transfer; 7
establishing time requirements that apply to the discharge or transfer of a resident 8
if a new notice of involuntary discharge or transfer of the resident is provided; 9
requiring that a post discharge plan contain certain information; and generally 10
relating to nursing facilities and involuntary discharges and transfers. 11
BY repealing and reenacting, with amendments, 12
Article – Health – General 13
Section 19–345 and 19–345.1 14
Annotated Code of Maryland 15
(2023 Replacement Volume and 2025 Supplement) 16
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 17
That the Laws of Maryland read as follows: 18
Article – Health – General 19
19–345. 20
2 SENATE BILL 493
(a) A resident of a facility may not be transferred or discharged from the facility 1
involuntarily except for the following reasons: 2
(1) The transfer or discharge is necessary for the resident’s welfare and the 3
resident’s needs cannot be met in the facility; 4
(2) The transfer or discharge is appropriate because the resident’s health 5
has improved sufficiently so that the resident no longer needs the services provided by the 6
facility; 7
(3) The health or safety of an individual in a facility is endangered; 8
(4) The resident has failed, after reasonable and appropriate notice, to pay 9
for, or under Medicare or Medicaid or otherwise, to have paid for a stay at the facility; or 10
(5) The facility ceases to operate. 11
(b) A RESIDENT OF A FACILI TY THAT IS TRANSFERR ED OR DISCHARGED 12
FROM THE FACILITY INVOLUNTARILY MAY NOT BE TRANSFERRED OR DISCHARGED: 13
(1) TO A LOCATION OTHER T HAN THE LOCATION IDENTIFIED IN THE 14
NOTICE REQUIRED UNDER § 19–345.1(B)(3) OF THIS S UBTITLE, SUCH AS A HOTEL , 15
SHELTER, OR OTHER TEMPORARY HOUSING; 16
(2) BEFORE THE FACILITY T O WHICH THE RESIDENT IS TO BE 17
TRANSFERRED HAS CONFIRMED THAT: 18
(I) THE RESIDENT MAY BE T RANSFERRED TO THE FA CILITY; 19
AND 20
(II) THE FACILITY IS PREPARED TO ACCEPT THE RESIDENT. 21
(C) (1) A Medicaid certified facility may not: 22
(i) Include in the admission contract of a resident any requirement 23
that, to stay at the facility, the resident will be required to pay for any period of time or 24
amount of money as a private pay resident for any period when the resident is eligible for 25
Medicaid benefits; or 26
(ii) Transfer or discharge a resident involuntarily because the 27
resident is a Medicaid benefits recipient. 28
(2) (i) Except as provided in subparagraph (ii) of this paragraph, a 29
Medicaid certified facility is presumed to be transferring or discharging a resident in 30
violation of this subsection, if the resident is or becomes eligible for Medicaid benefits. 31
SENATE BILL 493 3
(ii) A Medicaid certified facility is not presumed to be transferring or 1
discharging a resident in violation of this subsection for transferring or discharging a 2
resident for nonpayment for services while the resident was ineligible for assistance under 3
the medical assistance program. 4
19–345.1. 5
(a) (1) A facility shall provide the resident with written notice of: 6
[(1)] (I) Any proposed discharge or transfer; and 7
[(2)] (II) The opportunity for a hearing in accordance with the provisions 8
of this section before the discharge or transfer. 9
(2) THE NOTI CE REQUIRED UNDER PA RAGRAPH (1) OF THIS 10
SUBSECTION SHALL INC LUDE, AT A MINIMUM , THE INFORMATION LIST ED UNDER 11
SUBSECTION (B) OF THIS SECTION. 12
(b) The Department shall prepare and provide each facility with a standardized 13
form that provides, in clear and simple language, at least the following information: 14
(1) Notice of the intended discharge or transfer of the resident, including 15
the proposed date of the intended discharge or transfer, which may change as a result of 16
an appeal or the discharge planning process; 17
(2) Each reason for the discharge or transfer; 18
(3) The location to which the resident will be discharged or transferred, 19
which may change as a result of an appeal or the discharge planning process; 20
(4) The name of the social worker or oth er professionally qualified staff, 21
which may change during the discharge planning process, who: 22
(i) Is designated to provide social services and discharge planning 23
services to the resident in connection with the discharge or transfer; and 24
(ii) Will be responsible for the development of the post discharge 25
plan of care under subsection (g) of this section; 26
(5) A proposed date within 10 days after the date of the notice for a meeting 27
between the resident, the resident’s representative, and facility staff to develop the post 28
discharge plan of care under subsection (g) of this section; 29
(6) (I) The right of the resident to request a hearing; 30
4 SENATE BILL 493
(II) THE NAME , MAILING ADDRESS , E–MAIL ADDRESS , AND 1
TELEPHONE NUMBER OF THE ENTITY TO WHICH THE RESIDENT M UST SUBMIT A 2
REQUEST FOR A HEARING; AND 3
(III) INSTRUCTIONS FOR OBTA INING, COMPLETING, AND 4
SUBMITTING A REQUEST FOR A HEARING; 5
(7) The right of the resident to consult with any lawyer the resident 6
chooses; 7
(8) The availability of the services of the Legal Aid Bureau MARYLAND 8
LEGAL AID, the Older American Act Senior Legal Assistance Programs, and other 9
agencies that may provide assistance to individuals who need legal counsel; 10
(9) (I) The availability of the Long–Term Care Ombudsman Program to 11
assist the resident; AND 12
(II) THE MAILING ADDRESS, E–MAIL ADDRESS, AND TELEPHONE 13
NUMBER OF THE LONG–TERM CARE OMBUDSMAN PROGRAM; 14
(10) (I) THE AVAILABILITY OF DISABILITY RIGHTS MARYLAND TO 15
ASSIST RESIDENTS WIT H INTELLECTUAL OR DE VELOPMENTAL DISABILI TIES, 16
MENTAL DISORDERS, AND RELATED DISORDERS; AND 17
(II) THE MAILING ADDRESS, E–MAIL ADDRESS, AND TELEPHONE 18
NUMBER OF DISABILITY RIGHTS MARYLAND; and 19
[(10)] (11) The provisions of this section. 20
(c) Except as otherwise provided in this section, at least 30 days before the facility 21
involuntarily transfers or discharges a resident, the facility shall: 22
(1) Provide to the resident the written notice required under subsection (a) 23
of this section; and 24
(2) Provide the written notice required under subsection (a) of this section 25
to: 26
(i) The resident; 27
(ii) The next of kin, guardian, or any other individual known to have 28
acted as the resident’s representative, if any; 29
(iii) The Long–Term Care Ombudsman; and 30
SENATE BILL 493 5
(iv) The Department. 1
(d) (1) (i) In accordance with regulations adopted by the Secretary, the 2
facility shall provide the resident with an opportunity for a hearing on the proposed 3
transfer or discharge. 4
(ii) The regulations adopted by the Secretary may provide for the 5
establishment of an escrow account when: 6
1. The basis for the discharge is nonpayment; and 7
2. The resident continues to reside in the facility while the 8
appeal is pending. 9
(2) Except as otherwise provided in this subsection, hearings on proposed 10
transfers or discharges shall be conducted in accordance with the provisions of Title 10, 11
Subtitle 2 of the State Government Article and the Medicaid Fair Hearing Procedures. 12
(3) Any hearing on a proposed discharge or transfer of a resident: 13
(i) Is not a c ontested case as defined in § 10 –202 of the State 14
Government Article; and 15
(ii) May not include the Secretary as a party. 16
(4) A decision by an administrative law judge on a proposed discharge or 17
transfer of a resident: 18
(i) Is not a decision of the Secretary; 19
(ii) Unless appealed, is final and binding on the parties; and 20
(iii) May be appealed in accordance with § 10 –222 of the State 21
Government Article as if it were a contested case but the appeal does not automatically 22
stay the decision of the administrative law judge. 23
(e) The facility shall provide the written notice required in subsection (a) of this 24
section as soon as practicable before discharge or transfer if[: 25
(1) An] AN emergency exists and health or safety of the resident or o ther 26
residents would be placed in imminent and serious jeopardy if the resident were not 27
transferred or discharged from the facility as soon as possible[; or 28
(2) The resident has not resided in the facility for 30 days]. 29
(f) (1) If the information in the notice provided under subsection (c) of this 30
section changes before the discharge or transfer, the facility shall provide the changes to 31
6 SENATE BILL 493
the recipients of the notice as soon as practicable after the new information becomes 1
available. 2
(2) IF AN UPDATED NOTICE IS PR OVIDED UNDER THIS SU BSECTION, 3
THE RESIDENT MAY NOT BE DISCHARGED OR TRANSFERRED FOR AT LEAST 30 DAYS 4
AFTER THE UPDATED NOTICE HAS BEEN PROVIDED TO THE RESIDENT. 5
(2) IF A NEW NOTICE IS PR OVIDED UNDER PARAGRA PH (1) OF THIS 6
SUBSECTION, THE FOLLOWING TIME REQUIREMENTS APPLY TO THE DISCHARGE OR 7
TRANSFER OF THE RESIDENT: 8
(I) THE RESIDENT MAY NOT BE DISCHARGED OR 9
TRANSFERRED FOR AT LEAST 30 DAYS AFTER THE NEW NOTICE HAS BEEN PROVIDED 10
TO THE RESIDENT IF THE NEW NOTICE IS PROVIDED BEFORE: 11
1. THE EXPIRATION OF THE TIME PERIOD REQUIRED 12
UNDER SUBSECTION (C) OF THIS SECTION; OR 13
2. THE DATE OF AN ORDER OF DISCHARGE ISSUED BY AN 14
ADMINISTRATIVE LAW JUDGE UNDER SUBSECTION (D) OF THIS SECTION; AND 15
(II) IF THE NEW NOTICE IS PROVIDED AFTER A DATE DESCRIBED 16
UNDER ITEM (I) OF THIS PARAGRAPH: 17
1. IF THE ORIGINAL NOTIC E INDICATED A DISCHA RGE 18
LOCATION THAT WAS A LICENSED SKILLED NURSING FACILITY AND THE NEW NOTICE 19
CHANGES THE DATE OF DISCHARGE OR TRANSFE R ONLY , THE RESIDENT MAY BE 20
DISCHARGED ON THE EARLIEST DATE THAT A BED IS AVAILABLE AT THE FACILITY; 21
2. IF THE NEW NOTICE CHA NGES THE LOCATION OF 22
DISCHARGE OR TRANSFE R FROM A LICENSED SK ILLED NURSING FACILI TY TO A 23
DIFFERENT LICENSED S KILLED NURSING FACIL ITY, THE RESIDENT MAY NOT BE 24
DISCHARGED OR TRANSFERRED FOR AT LEAST 7 DAYS AFTER THE NEW NOTICE HAS 25
BEEN PROVIDED TO THE RESIDENT; AND 26
3. IF THE NEW NOTICE CHA NGES THE LOCATION OF 27
DISCHARGE OR TRANSFE R FROM A LICENSED SK ILLED NURSING FACILI TY TO A 28
LOCATION THAT IS NOT A LICENSED SKILLED NURSING FACILITY BUT IS OTHERWISE 29
DETERMINED TO BE A SAFE DISCHARGE LOCAT ION UNDER AN APPROPR IATE 30
CLINICAL EVALUATION AND AS SET FORTH IN THE POST DISCHARGE PLAN OF CARE, 31
THE RESIDENT MAY NOT BE DISCHARGED OR TRANSFERRED FOR AT LEAST 30 DAYS 32
AFTER THE NEW NOTICE HAS BEEN PROVIDED TO THE RESIDENT. 33
SENATE BILL 493 7
(3) AN UPDATED A NEW NOTICE PROVIDED UNDER THIS SUBSECTION 1
SHALL INDICATE: 2
(I) INDICATE ANY DIFFERENCES BETWEEN THE PRIOR NOTICE 3
AND THE UPDATED NEW NOTICE; AND 4
(II) INCLUDE A NOTICE OF T HE RIGHT TO APPEAL T HE NEW 5
NOTICE: 6
1. FOR ANY DISCHARGE OR TRANSFER DESCRIBED 7
UNDER PARAGRAPH (2)(I) OF THIS SUBSECTION; OR 8
2. FOR A DISCHARGE OR TRANSFER DESCRIBED UNDER 9
PARAGRAPH (2)(II)3 OF THIS SUBSECTION , IF THE UNDERLYING BA SIS OF THE 10
ORIGINAL NOTICE HAS CHANGED. 11
(4) FOR A DISCHARGE OR TRANSFER DESCRIBED UNDER PARAGRAPH 12
(2)(II)1 OR 2 OF THIS SUBSECTION, A NEW NOTICE IS NOT REQUIRED TO INCLUDE A 13
NOTICE OF THE RIGHT TO APPEAL THE NEW NOTICE. 14
(g) (1) Before any discharge or transfer and subject to paragraphs (4) and (5) 15
of this subsection, a facility shall develop a post discharge plan of care for the resident to 16
assist the resident with adjusting to the resident’s new living environment and that: 17
(i) Addresses the resident’s post discharge goals of care and 18
treatment preferences; [and] 19
(ii) Identifies each of the resident’s reasonably anticipated medical 20
and basic needs after discharge or transfer and establishes a plan for meeting those needs; 21
(III) IDENTIFIES THE ADDRES S AT WHICH THE RESID ENT WILL 22
RESIDE POST DISCHARGE; AND 23
(IV) IN ACCORDANCE WITH REGU LATIONS ADOPTED BY T HE 24
SECRETARY, PROVIDES A SAFE , SECURE, AND SUSTAINABLE ENVI RONMENT FOR 25
THE RESIDENT. 26
(2) The facility shall designate a social worker or other professionally 27
qualified staff member to coordinate the development of the resident’s post discharge plan 28
of care. 29
(3) The facility shall, if possible, meet with the resident and, with the 30
resident’s consent, the resident’s representative within 10 days after providing the notice 31
required under subsection (a) of this section to discuss the post discharge plan of care for 32
the resident. 33
8 SENATE BILL 493
(4) (i) The resident’s post discharge plan of care shall be developed with 1
the participation of the resident and, with the resident’s consent, the resident’s 2
representative. 3
(ii) If the post discharge plan of care was developed without the 4
participation of the resident or the resident’s representative, the facility shall include in 5
the resident’s medical record an explanation of why the resident or the resident’s 6
representative did not participate. 7
(5) The resident’s post discharge plan of care shall be developed in 8
consultation with: 9
(i) The resident’s attending physician; 10
(ii) A registered nurse responsible for the care of the resident; and 11
(iii) Any other appropriat e staff or professional involved with 12
meeting the resident’s medical needs. 13
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 14
October 1, 2026. 15
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
President of the Senate.
________________________________________________________________________________
Speaker of the House of Delegates.