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Sponsors propose letting counties perform nursing‑home surveys to address backlog; state cites oversight concerns
Summary
A bill would let counties perform annual nursing‑home surveys under a state delegation arrangement, sponsors and county officials told the committee, arguing that local capacity could close a backlog of overdue OHCQ inspections and provide more timely oversight.
Delegate Bonnie Collison and Montgomery County witnesses proposed House Bill 4-29 to permit county governments to conduct annual Medicare/Medicaid nursing‑home surveys and investigations under a delegation agreement with the Maryland Department of Health. Sponsors and county officials said delegating authority would address a documented backlog of overdue surveys and restore a previously used memorandum of understanding (MOU) arrangement that Montgomery County had operated for many years.
Supporters — including Montgomery County Commission on Aging representatives, a county executive aide, long‑time ombudsmen and advocacy groups — said the Office of Health Care Quality (OHCQ) has a large backlog of required annual surveys and complaint investigations in many counties, leaving residents and families without timely regulatory oversight. They said that when the county previously conducted delegated surveys under an MOU the results led to corrective action and improved care, and that counties stand ready to act as “force multipliers” if the state provides matching funds or a cost‑sharing arrangement.
The Department of Health opposed the bill as drafted. Deputy Secretary Nilesh Kalyanaraman told the committee that OHCQ has increased survey capacity and is making steady progress on the backlog; he objected to a statutory change that would carve out state survey functions to counties because the state must retain ultimate responsibility and oversight for federally required survey activity. The Department said carving funding out of OHCQ risks reducing statewide flexibility and complicating CMS review and quality control of survey activity; it said ongoing MOU negotiations with Montgomery County were already under way.
County representatives said they would accept a funded, collaborative approach and requested the committee enable delegation while allowing a practical agreement on cost‑sharing and oversight. Sponsor Collison said the bill is an enabling option; counties would not be required to take delegation but would have the authority if they and the Department agree on an operational MOU.
Committee members asked about the mechanics of delegation, CMS approval and fiscal impacts; witnesses said the previous Montgomery County MOU operated for nearly two decades and that county staff included nurses and surveyors with relevant experience. The committee did not vote at the hearing.
