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Nursing homes must adhere to federal, state and local laws and regulations. This section includes information on specific portions of the Code of Maryland Regulations that apply to nursing homes. How the Omnibus Budget Reconciliation Act of 1987 affects care provided in nursing homes is also discussed. In addition, you may wish to review information about quality indicators that may be helpful in your search to find the best nursing home for your loved one.

Code of Maryland Regulations

Nursing homes in Maryland are licensed by the Department of Health and must adhere to the regulations set forth in the Code of Maryland Regulations (COMAR) for nursing homes. The portions of the regulations of greatest interest to nursing home residents and their families are listed below:

COMAR Admission and Discharge: This regulation prohibits discrimination based on a person's race, color, national origin or physical or mental handicap and it specifies the conditions under which a facility cannot admit or must discharge an individual.

COMAR Resident's Representative: This regulation requires the nursing home to accept the authority of a resident's legal representative (guardian, power of attorney, health care agent, surrogate decision maker).

COMAR Nursing Services: This regulation specifies how nursing services must be organized. It outlines the minimum number of supervisory and other nursing staff to be on duty each day.

COMAR Special Care Units-General: This regulation outlines the requirements for establishing and operating special care units.

COMAR Pharmaceutical Services: This regulation outlines the manner in which medications must be delivered, stored, documented and administered. It also outlines the role of the consultant pharmacist and the Pharmaceutical Services Committee.

COMAR Reports and Action Required in Unusual Circumstances: This regulation prohibits nursing homes from accepting or keeping residents who are a danger to themselves or others.

COMAR Care Planning: This regulation outlines the requirements for developing an individualized care plan for each resident.

COMAR Resident's Rights and Services: This regulation defines the Nursing Home Resident's Bill Of Rights.

COMAR Resident Discharges and Transfers: This regulation provides information about resident transfers and discharges, including the reasons a patient may be discharged.

COMAR Involuntary Discharge or Transfer of a Resident: This regulation states the nursing home's responsibilities prior to issuing an involuntary discharge or transfer.

COMAR Resident Relocation and Bed hold: This regulation outlines the nursing home's responsibility to notify a resident if relocation is planned. It also explains the facility's responsibility regarding bed holds while a patient is out of the facility.

COMAR Hearings for Transfers and Discharges, and Establishment of an Escrow Account: This regulation explains the procedures to request a hearing after receiving notice of an involuntary transfer or discharge and the circumstances under which an escrow account may be established.

COMAR Physical and Chemical Restraints: This regulation outlines the specific conditions under which physical and chemical restraints may be used in a nursing home.

COMAR Abuse of Residents: The responsibility of nursing homes to implement policies and procedures prohibiting abuse and neglect of residents is specified in this regulation. The reporting requirements are also outlined here.

COMAR Personal Property of Residents: This regulation discusses the right of the resident to have personal property at the nursing home.

COMAR Protection of a Resident's Personal Funds: This regulation outlines the residents' rights and nursing homes' responsibilities regarding management of residents' personal funds.

COMAR Records of Resident Personal Funds: This regulation specifies the nursing home's responsibilities regarding maintaining records of residents' personal funds and the conditions under which the facility must make funds available to residents.

Nursing Home Reform Act of 1987 (OBRA '87 or Omnibus Budget Reconciliation Act)

AARP offers a detailed explanation of how the Nursing Home Reform Act of 1987 affects the quality of services provided to nursing home residents. This law strengthened the standards by which nursing homes must operate in order to receive Medicaid reimbursement. One of the most important provisions of the Act requires nursing homes to provide care for residents in a way that promotes dignity, choice and self-determination.