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Office of Healthcare Quality budget review: survey backlog shrinking, contractors used while training new surveyors
Summary
DLS and OHCQ told the subcommittee the office has reduced vacancies and accelerated survey activity, but still uses nurse subcontractors to clear a complaint-investigation backlog; contracts total $5.6 million while hiring and certification of state nurse surveyors continues.
The subcommittee reviewed the Maryland Department of Health Office of Healthcare Quality (OHCQ) budget Feb. 13 and heard that OHCQ has made recent gains in survey activity and complaint investigations but continues to rely on contracts for nurse surveyors while new hires complete federal certification.
Victoria Martinez of the Department of Legislative Services presented the OHCQ analysis, noting the fiscal 2026 allowance increases by $2.2 million to $41.9 million. DLS noted about 83% of the office’s spending supports personnel and spelled out a $4.4 million contract line for nursing home subcontractors and grants. Exhibit figures showed a marked improvement in vacancy rates (from 17% to 5%) and in the percentage of completed investigations and annual surveys across several units.
OHCQ Executive Director Tia Witherspoon told the committee OHCQ regulates more than 22,000 providers across 47 industries and has accelerated survey activity: the full survey completion rate rose to 60% in FY25 and OHCQ completed 77 annual surveys in the first six to seven months of the fiscal year. She said OHCQ had filled 12 long-term-care nurse surveyor positions and expects newly hired state surveyors to complete the CMS 12-month training and then carry out survey work, reducing the need for subcontracted surveyors.
Backlog and contracts: DLS noted two contracts awarded to provide 5–13 nurse surveyors per week, totaling $5.6 million, primarily funded with $3.9 million in general funds and $1.5 million in special funds. DLS asked OHCQ to clarify the source of the special funds because the fiscal 2025–26 budgets include less than $600,000 in available special funds. Martinez also asked the agency to comment on cost-effectiveness of subcontractors versus hiring full-time staff: DLS compared the contract cost to an estimated $6.8 million in annual salaries for 72 state nurse surveyor positions.
Federal funding and staffing rule: DLS and OHCQ discussed federal funding for survey activity; OHCQ said it received approximately $10 million in federal funding in each of the prior two years for surveys tied to Medicare/Medicaid facilities but that the federal contribution does not fully cover state survey costs. The presentation also updated the committee on CMS’s final staffing rule for nursing homes; the agency will monitor compliance as facilities implement the new requirement.
Timeframe and outcomes: DLS estimates the backlog of long-term-care complaint investigations will be resolved in two years using the contracts while state hires complete training. OHCQ said the average interval between surveys decreased by 21% in FY25 and noted system disruptions during prior years — COVID-era infection-control mandates and a cybersecurity incident that paused work for several months — that contributed to earlier survey delays.
Why it matters: OHCQ’s ability to complete annual surveys and timely complaint investigations affects oversight of long-term care and other licensed health facilities, which regulators prioritize according to immediate risk to patient health and safety. The committee pressed OHCQ on funding sources for contracts, the cost-effectiveness of contractors versus staff, and plans to eliminate reliance on subcontractors as state surveyors become certified.
Provenance: DLS presentation began at the OHCQ section and OHCQ responses followed; DLS recommended the Governor's allowance concur.
