Maryland Makes Federal COVID-19 Nursing Home Guidance Mandatory — With Criminal Penalties

The governor of Maryland this week mandated that nursing homes follow several preventative measures included in recent federal guidance aimed at curbing the COVID-19 pandemic, raising the potential for misdemeanor charges against those who violate the order.

Gov. Larry Hogan on Sunday ordered the state’s nursing homes to provide separate accommodations and care teams for residents with confirmed and suspected COVID-19 cases, while requiring the use of personal protective equipment (PPE) for “all personnel who are in close contact with residents of nursing homes,” according to a summary released by Hogan’s office.

Facilities must also maintain a specific observation unit or floor “where newly admitted and readmitted residents are kept for 14 days on contact and droplet precautions while being observed every shift for signs and symptoms of COVID-19.”


The executive order also seeks to increase COVID-19 testing among nursing homes, a vital step when working to separate the infected from the general population; nursing home residents will receive priority at the state’s laboratory, alongside hospital patients and frontline caregivers.

“All facilities must use the most expeditious means available for testing,” according to Hogan’s office. “This includes using either a COVID-19 test kit provided by the state laboratory or another lab to send specimens to the state laboratory for expedited COVID-19 testing of residents and staff.”

Nursing homes must re-admit residents after hospital stays “as long as the facility can follow the approved CDC recommendations for transmission-based precautions.”


In addition to that clause, known as “right of return” for residents, Hogan’s directive requires nursing homes and hospitals to work with the state’s Office of Health Care Quality to facilitate the placement of patients discharged from the acute care setting.

Though the most recent guidance from the Centers for Medicare & Medicaid Services (CMS) included many of the same requirements, such as the segregation of residents by COVID-19 status and expanded use of PPE, Hogan’s order comes with the threat of criminal charges for noncompliance.

“Anyone who knowingly and willfully violates this order is guilty of a misdemeanor and upon conviction is subject to imprisonment not exceeding one year, or a fine not exceeding $5,000 — or both,” according to Hogan’s office.

Like the federal government, Hogan framed the drastic measures as necessary for public safety.

“Of major concern is that we currently have cases or clusters of cases at 81 nursing homes and long-term care facilities across the state,” the governor, a Republican, said in a statement. “Our highest priority is keeping Marylanders safe, and we will use every tool at our disposal to protect the most vulnerable among us.”

Appearing on the Fox News program “America’s Newsroom” on Monday, American Health Care Association CEO Mark Parkinson praised Hogan’s actions, particularly the prioritization of testing at nursing homes.

“I think those are very helpful, what Gov. Hogan has introduced,” Parkinson, himself the former governor of Kansas, said. “If there’s an outbreak in a building, we need to make the workers and the residents top-tier priorities for testing. That’s exactly what we need every governor in the country to do.”