Nursing Homes - Cost Reports
HB933 requires Maryland nursing homes to devote at least 75% of their total nursing and residential care revenue to direct care wages and benefits. For purposes of the bill, direct care wages and benefits include compensation for nursing, dietary, restorative therapy, and social worker staff. The measure is aimed at ensuring that a larger share of nursing home revenue is used for frontline resident care rather than other operating costs or profit.
The bill also creates a new annual cost-reporting requirement beginning in 2026. Each nursing home must submit a cost report to the Maryland Department of Health by September 1 each year, including wage-disbursement documentation and any other information the Department requires. The report must be signed under penalty of perjury by an authorized representative of the facility. The Department is directed to review these reports, along with other data from nursing homes participating in the Maryland Medical Assistance Program, and to report its findings to the Governor and legislative committees each year from 2025 through 2029.
HB933 gives the Department enforcement authority if a nursing home fails to file a report, files an inaccurate or incomplete report, or does not meet the wage requirement. Available enforcement tools include recoupment of funding tied to the reimbursement-rate increase under existing law, a corrective plan, or suspension or termination from the program. In practical terms, the bill adds a new compliance and oversight framework to the regulation of nursing homes and ties financial consequences to staffing and reporting practices.
The bill appears to have been generally supported by the legislature, passing the House 98-38 and the Senate 34-13. Those vote margins suggest broad approval, though not unanimity, likely reflecting a policy preference for stronger staffing and transparency requirements in nursing homes. No committee transcript was provided, so there is no recorded discussion to identify specific arguments made during committee review.
The main point of contention is the mandate itself: nursing homes may view the 75% revenue requirement and annual reporting obligations as burdensome or difficult to meet, especially if labor costs, contracting practices, or resident-care needs vary by facility. Supporters are likely focused on improving direct-care staffing, accountability, and the use of Medicaid-related funds, while opponents may be concerned about administrative costs, enforcement risk, and the possibility that the requirement could reduce flexibility in how facilities manage their finances and workforce.
HB933 adds new sections to the Maryland Health-General Article governing nursing homes. It establishes a statutory minimum spending requirement for direct care wages and benefits, imposes annual cost-reporting duties on nursing homes beginning in 2026, and authorizes the Maryland Department of Health to review reports and take enforcement action for noncompliance. The bill also affects nursing homes participating in the Maryland Medical Assistance Program by linking compliance to reimbursement-related funding and possible program sanctions.
The overall sentiment around HB933 appears favorable, as reflected in its passage in both chambers by comfortable margins. The vote totals indicate substantial bipartisan or cross-party support for increased nursing home staffing accountability and financial transparency, although the opposition votes show that a meaningful minority had reservations. With no committee transcript available, the record does not show detailed debate, but the final action suggests the bill was viewed as a significant but acceptable regulatory reform.
The likely areas of contention are the 75% revenue allocation mandate, the scope of the annual cost-reporting requirements, and the Department of Health’s enforcement powers. Nursing home operators may argue that the bill limits financial flexibility, increases administrative burden, and could be difficult to implement uniformly across facilities with different cost structures. Supporters, by contrast, are likely to emphasize that the bill protects resident care by ensuring more revenue goes directly to frontline staff and by giving the state better oversight of Medicaid-participating facilities.