Long debate as committee examines bill to let counties resume nursing-home inspections amid inspection backlog

Senate Bill 376 would enable county governments to resume or perform delegated inspections of nursing homes under the federal-state inspection contract, the sponsor told the House Health and Government Operations Committee, amid testimony that Maryland has fallen far behind on federally required nursing-home surveys.

Sen. Ben Kramer, introducing the bill, said Maryland is failing to inspect its most vulnerable residents; he cited federal contract numbers showing the state received roughly $3–3.7 million per year in recent fiscal years for nursing-home survey work and argued those funds have not produced the required inspections. Kramer said Montgomery County previously performed survey work for the state for 20 years and paid roughly 60% of the cost; since the contract lapsed in 2021 he said many jurisdictions have had either one, two or no inspections in a year and that the state was ‘‘tied for second-to-last’’ among states in complying with survey obligations.

Kramer and other advocates said some counties — led by Montgomery County — are willing to resume inspections and to share costs, and he described the department's fiscal note as exaggerated. Committee members pressed the department's witnesses and the sponsor for specifics about how federal funding has been used, whether the state has been fined by CMS for failures to inspect, and the types and tiers of surveys conducted.

Dr. Nilesh Kalyanaraman, Deputy Secretary for Public Health at the Maryland Department of Health, said the department takes the issue seriously and described recent steps: hiring 13 surveyors this fiscal year (with training lasting 6 to 12 months), improving processes, using contractors to catch up, and moving from ~23% of nursing homes surveyed earlier in the year to roughly 57% "today and counting." He said survey results take months to appear in CMS datasets and said the department supports accountability amendments that were being discussed, but urged caution about language that would require the state to transfer funding to localities because doing so could reduce state staffing capacity and slow overall progress.

Committee members questioned the department's fiscal note and whether Montgomery County's prior contract required state oversight; county officials and the sponsor said Montgomery County did the work for 20 years without the current oversight requirements and with a strong record. Multiple delegates and senators said the problem is statewide; witnesses and members described complaints backlog numbers and cited examples of facilities with no inspection since 2021.

The committee heard that the department has an executive director for the Office of Health Care Quality who started roughly five months ago and that the department reports having hired surveyors and contractors to increase throughput. The hearing concluded with the committee planning further work on amendments that would add reporting, triggers for local augmentation, and safeguards to avoid fiscal impact on the state while allowing counties to augment survey capacity.

No formal vote was recorded during the hearing. Sponsors asked the committee to consider amendments to add county-reporting triggers, periodic reporting to local jurisdictions, and clarifications that would preserve tier progression for county surveyors.