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SB 679

Nursing Homes - Cost Reports (Nursing Home Care Crisis Transparency Act)

2025 Regular Session Introduced by Jim Rosapepe

Requires MDH to audit Medicaid nursing home cost reports to ensure 75% direct-care wages/benefits, with annual findings and penalties.

Referred Rules and Executive Nominations
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Bill Summary · SB 679

SB 679 — Nursing Home Care Crisis Transparency Act (Nursing Homes — Cost Reports)

Status: Referred to Rules and Executive Nominations
Introduced: 2025 (multiple readings/committee actions referenced)
Primary sponsor (Maryland version): Senator Rosapepe
Related/companion bills: HB 933, HB 357

Main purpose

To increase transparency and accountability in how nursing homes that participate in the Maryland Medical Assistance Program (Medicaid) allocate revenues — especially toward direct care wages and benefits — and to enable state oversight through standardized cost-reporting and annual reviews.

Key provisions

  • MDH review requirement
    • The Maryland Department of Health (MDH) must review cost reports and other data submitted by each nursing home participating in the Maryland Medical Assistance Program.
    • Review must specifically examine revenues allocated to:
    • Contracted nursing care services; and
    • Salaries and wages for direct care non‑administrative staff (examples listed: certified nurse aides, directors of nurses, licensed practical nurses, resident care aides, registered nurses, housekeepers, dietary workers, and in‑house clerical staff who regularly interact with residents).
  • Annual findings reports
    • MDH must report findings to the Governor, the Senate Finance Committee, and the House Health and Government Operations Committee by October 1, 2025, and annually through 2029.
  • Direct‑care spending floor (as included in amended versions)
    • A nursing home must expend at least 75% of its total nursing and residential care revenue on direct care wages and benefits (defined to include wages/benefits for nursing, dietary, restorative therapy, and social worker staff).
  • Annual cost reporting by facilities (as included in amended versions)
    • Beginning in 2026, each nursing home must submit an annual cost report in the form required by MDH (includes documentation of wage disbursement and other department‑specified information), signed under penalty of perjury.
  • Enforcement tools (as included in amended versions)
    • MDH may take enforcement actions against facilities that fail to submit reports, submit inaccurate/incomplete reports, or fail to pay required wages.
    • Possible actions include recoupment of state funding (including amounts tied to reimbursement rate increases), imposition of corrective plans, and suspension or termination from the Medicaid program.

Who is affected

  • Primary: Nursing homes participating in Maryland’s Medical Assistance (Medicaid) program.
  • Secondary: Direct care workforce (CNAs, RNs, LPNs, dietary/housekeeping/clerical staff), residents and their families, MDH (administration and oversight), and state appropriations tied to Medicaid reimbursements.

Timeline / effective dates

  • Effective date in the Maryland text: June 1, 2025.
  • MDH reporting deadlines: initial findings due October 1, 2025; annually through 2029.
  • Facility cost reports (in amended drafts): annual submissions beginning September 1, 2026; MDH enforcement thereafter.

Fiscal impact

  • According to the fiscal note, MDH can perform the required reviews and produce reports with existing budgeted resources. No identified impact on revenues; minimal local or small‑business effects anticipated.

Additional notes

  • The bill appears in multiple draft forms. Some versions focus solely on MDH review and reporting through 2029; other amended versions add a mandatory 75% direct‑care spending requirement, annual facility cost reporting, and explicit enforcement mechanisms.
  • The Maryland bill is titled the “Nursing Home Care Crisis Transparency Act” and is intended to improve transparency about how Medicaid dollars are used in nursing homes and to ensure funding reaches direct care staff.

Compiled from official sources — confirm details with the bill’s official record.

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