HB 983
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
House Bill 983 (Delegate Lehman)
Health and Government Operations Finance
Nursing Homes - COVID-19 and Other Catastrophic Health Emergencies -
Visitation (The Gloria Daytz Lewis Act)
This emergency bill requires the Maryland Department of Health (MDH), consistent with
federal requirements, to develop specified guidelines relating to restrictions on visitation
that a nursing home may impose to reduce the spread of COVID-19 or another disease that
constitutes a “catastrophic health emergency.” The bill expresses the intent of the
General Assembly that, during a catastrophic health emergency issued by the Governor,
visitation in nursing homes be prioritized to balance the physical needs of residents with
the mental and spiritual needs of the residents and family members from isolation and
separation during the emergency.
Fiscal Summary
State Effect: The bill’s requirements can be handled with existing budgeted resources.
Revenues are not affected.
Local Effect: None.
Small Business Effect: None.
Analysis
Bill Summary: “Catastrophic health emergency” means a health emergency with regard
to which the Governor issues a specified proclamation.
“Compassionate care visitor” means a family member or legal guardian of a resident or
any individual who is important to the mental, physical, or social well-being of the resident
during critical situations, including the end of the resident’s life, the significant mental or
physical decline of the resident, or when exigent circumstances exist regarding the resident.
“Personal care visitor” means a family member or legal guardian of a resident who is
important to the mental, physical, or social well-being of the resident.
The guidelines MDH must develop regarding restrictions on visitation must:
describe the circumstances under which visitation may be restricted to only
compassionate care visitors and personal care visitors;
limit the movement of visitors within the nursing home, which may include
restricting visitors to the resident’s room or another designated room;
require each visitor to follow safety protocols to limit the spread of COVID-19 or
another disease that constitutes a catastrophic health emergency, as specified;
require, as practicable and when available, alternative means of communication
with visitors if a nursing home determines that an in-person visit would endanger
the health and safety of a patient, resident, or member of the staff; and
provide additional guidance necessary to promote access to residents by
compassionate care visitors.
Additionally, the guidelines regarding personal care visitation must:
establish procedures for the designation of a personal care visitor by a resident or a
legal representative of the resident, as specified;
provide that a resident may not designate more than one personal care visitor;
establish procedures for changing the designation of a personal care visitor;
require a personal care visitor to waive a nursing home from liability for exposure
to COVID-19 or another disease that constitutes a catastrophic health emergency;
establish the circumstances under which visitation may be limited, suspended, or
terminated;
establish standards for the frequency and duration of personal care visits; and
establish the total number of personal care visitors authorized to visit a nursing
home facility at any one time.
Current Law: The Public Safety Article authorizes the Governor to issue a proclamation
declaring the existence of a catastrophic health emergency. “Catastrophic health
emergency” means a situation in which extensive loss of life or serious disability is
threatened imminently because of exposure to a deadly agent, including a viral agent
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capable of causing extensive loss of life or serious disability. The Governor must rescind
the proclamation whenever the Governor determines that the catastrophic health
emergency no longer exists.
A nursing home is a facility that offers non-acute care to patients suffering from a disease,
chronic illness, condition, disability of advanced age, or terminal disease requiring
maximal nursing care without continuous hospital services. Under the Code of Maryland
Regulations, at the time of admission, a resident of a nursing facility must be informed of
the nursing facility’s visitation rules.
For information on COVID-19 in Maryland, please see the Appendix – COVID-19.
Additional Comments: On March 10, 2021, the Centers for Medicare and Medicaid
Services, in collaboration with the Centers for Disease Control and Prevention, issued
updated guidelines regarding visitation during the COVID-19 public health emergency.
Additional Information
Prior Introductions: None.
Designated Cross File: None.
Information Source(s): Maryland Department of Health; Department of Legislative
Services
Fiscal Note History: First Reader - February 16, 2021
rh/jc Third Reader - March 19, 2021
Revised - Amendment(s) - March 19, 2021
Analysis by: Amberly Holcomb Direct Inquiries to:
(410) 946-5510
(301) 970-5510
HB 983/ Page 3
Appendix – COVID-19
In December 2019, a novel strain of coronavirus known as severe acute respiratory
syndrome coronavirus 2 emerged in Wuhan, China. Coronavirus disease (COVID-19) is
an infectious disease caused by this virus. As the number of cases spread globally by
March 2020, the World Health Organization declared COVID-19 a pandemic.
Testing, Cases, and Deaths in Maryland
Maryland’s first three confirmed cases of COVID-19 were recorded on March 6, 2020,
with the first two deaths occurring March 16, 2020. As of January 27, 2021, Maryland
reported a total of 346,559 confirmed cases, 31,468 individuals ever hospitalized, and
6,821 confirmed deaths. The jurisdictions with the highest number of cases have been
Prince George’s, Montgomery, and Baltimore counties and Baltimore City. Statewide,
8.4% of cases (28,954) and 45.9% of COVID-19 deaths (3,130) occurred in congregate
living settings (i.e., nursing homes, assisted living, and group homes). Updated data on
COVID-19 in Maryland is available on the Maryland Department of Health (MDH)
dashboard: https://coronavirus.maryland.gov.
Vaccines
In December 2020, the U.S. Food and Drug Administration approved both
Pfizer-BioNTech and Moderna’s COVID-19 vaccines for emergency use. Due to limited
quantities, distribution began with priority groups as determined by states. Maryland began
distribution in January 2021 with Phase 1A, which includes health care workers, residents
and staff of nursing homes, first responders, public safety, corrections staff, and front-line
Judiciary staff. Phase 1B began January 18, 2021, and includes residents of assisted living
facilities and other congregate settings, adults age 75 and older, staff of K-12 schools and
child care facilities, high-risk incarcerated individuals, and those involved in continuity of
government. As of January 27, 2020, the State is in Phase 1C, which includes adults
aged 65 and older, additional public safety and public health workers, and essential workers
in food/agriculture, manufacturing, public transit, and the postal service. Phase 2 will
include individuals aged 16 to 64 at increased risk of severe illness, incarcerated adults,
and remaining essential workers. Phase 3 will include the general public. As of
January 27, 2021, 852,625 doses of the vaccine have been distributed, and 419,579 doses
have been administered (363,282 first doses and 56,297 second doses). Updated data is
available on the MDH dashboard: coronavirus.maryland.gov/#Vaccine.
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Declaration of a State of Emergency and Initial Executive Orders
On March 5, 2020, Governor Lawrence J. Hogan, Jr. declared a state of emergency and the
existence of a catastrophic health emergency to deploy resources and implement the
emergency powers of the Governor to control and prevent the spread of COVID-19. The
declaration, which has been renewed several times (most recently January 21, 2021),
initiated a series of executive actions, including moving the Maryland Emergency
Management Agency to its highest activation level, activating the National Guard, and
closing all public schools. The Governor then ordered the closure of in-house dining at bars
and restaurants and banned mass gatherings of more than 50 people. This action was
followed by a more extensive stay-at-home order on March 30, 2020, requiring closure of
all nonessential businesses. This order remained in effect until May 15, 2020.
Emergency Legislation
Chapters 13 and 14 of 2020 (the COVID-19 Public Health Emergency Protection Act of
2020) authorized the Governor, for the duration of the emergency, to take actions relating
to health insurance, Medicaid, retailer profits, employer actions, and personnel at State
health care facilities as a result of the state of emergency and catastrophic health
emergency. The Acts also authorize the Secretary of Labor to determine certain individuals
eligible for unemployment insurance (UI) benefits due to COVID-19. The Acts terminate
April 30, 2021.
Subsequent Executive Orders and Advisories
Since March 2020, the Governor has issued numerous executive orders relating to
COVID-19, including (1) closing Maryland ports and harbors to passenger vessels;
(2) expanding child care access; (3) expanding the scope of practice for health care
practitioners, activating the Maryland Responds Medical Reserve Corps, controlling and
restricting elective medical procedures, closing adult day care centers, and providing
additional health care regulatory flexibility; (4) augmenting emergency medical services;
(5) prohibiting price gouging; (6) fast tracking lab testing processes; (7) authorizing
expanded telehealth services; (8) delegating authority to local health officials to control
and close unsafe facilities; (9) extending certain licenses, permits, and registrations;
(10) authorizing remote notarizations; (11) prohibiting evictions of tenants suffering
substantial loss of income due to COVID-19, additionally prohibiting certain
repossessions, restricting initiation of residential mortgage foreclosures, and prohibiting
commercial evictions; (12) regulating certain businesses and facilities and generally
requiring the use of face coverings; (13) establishing alternate health care sites and
authorizing regulation of patient care space in health care facilities; and (14) implementing
alterative correctional detention and supervision.
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Federal Legislation Regarding COVID-19
Five federal emergency bills have been enacted to address the COVID-19 pandemic:
the Coronavirus Preparedness and Response Supplemental Appropriations
Act, which provided $8.3 billion in emergency funds for federal agencies (including
$950 million through the U.S. Centers for Disease Control and Prevention for state
and local response);
the Families First Coronavirus Response Act, which addressed emergency family
and medical leave and paid sick leave, specified insurance coverage of COVID-19
testing, and provided additional funding for nutrition assistance programs and
unemployment benefits;
the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which
included a Coronavirus Relief Fund for state and local governments; an Education
Stabilization Fund for states, school districts, and institutions of higher education; a
Disaster Relief Fund for state and local governments; additional funding for public
health agencies to prevent, prepare for, and respond to COVID-19; funding for
transit systems; an expansion and extension of eligibility for UI benefits, and
additional temporary unemployment compensation of $600 per week; $349 billion
for the establishment of the Paycheck Protection Program (PPP); a $500 billion
lending fund for businesses, cities, and states; and Economic Impact Payments to
American households of up to $1,200 per adult and $500 per child;
the Paycheck Protection Program and Health Care Enhancement Act, which
provided an additional $310 billion to PPP, $75 billion for health care providers,
$60 billion for small business disaster loans, and $25 billion for increased testing
capacity; and
the Consolidated Appropriations Act, 2021, and Other Extensions Act, which
included $908 billion in relief, including another $284 billion for PPP, $82 billion
for schools, $45 billion for transportation, $25 billion in emergency assistance to
renters, $20 billion for vaccine distribution, $13 billion for a major expansion in
Supplemental Nutrition Assistance benefits, $13 billion for agriculture and rural
programs, $10 billion for child care assistance, extended federal unemployment
benefits of up to $300 per week, extended the federal moratorium on evictions
through January 31, 2021, and provided a second stimulus payment of up to $600
per person.
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Federal Funding for Maryland to Address COVID-19
The CARES Act and the Families First Coronavirus Response Act provided Maryland with
a significant amount of federal aid. More than $6 billion in assistance has been made
available to the State and local governments, including an enhanced federal matching rate
for Medicaid. More than $900 million was directly provided to local governments. The
largest and most flexible portion of CARES Act funding is the Coronavirus Relief Fund,
which totals $2.3 billion, $691 million of which was allocated directly to Baltimore City
and Anne Arundel, Baltimore, Montgomery, and Prince George’s counties.
CARES Act funding also included $800 million for the Disaster Recovery Fund;
$696 million for transit grants; $575 million in enhanced Medicaid matching funds
(through December 2020); $239 million in CDC grants; $108 million for airports;
$74 million for community development block grants; $50 million for homelessness
assistance; $46 million for grants for local education agencies and higher education
institutions; $46 million for child care and development block grants; $36 million for public
housing and rental assistance grants; $24 million for community health centers; $20 million
for senior nutrition; $19 million for energy assistance; $18 million for justice assistance
grants; $17 million for administration of the UI program; $14 million for community
service block grants; $13 million for emergency food assistance; $8 million for Head Start;
$8 million for the Women, Infants, and Children program; and $7 million for election
security.
The Consolidated Appropriations Act is estimated to provide Maryland with $1.2 billion
for education (including $869 million for K-12 education, $306 million for higher
education, and $57.7 million for the Governor’s Fund); $1.1 billion for transportation
(including $830.3 million for transit in the Washington, DC area, $149.3 million for
highways, $76.2 million for transit in Baltimore, $22.5 million for airports, and
$9.1 million for rural area grants); more than $475 million for health (including
$335.6 million for testing, $75.3 million for vaccines, $32.6 million for mental health
assistance, and $31.9 million for substance use assistance); $402.4 million for rental
assistance; and $140.6 million for human services (including $130.4 million for child care).
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Statutes affected: Text - First - Nursing Homes - COVID-19 - Visitation: 19-1410.3 Health General
Text - Third - Nursing Homes - COVID-19 and Other Catastrophic Health Emergencies - Visitation (The Gloria Daytz Lewis Act): 19-1410.3 Health General