February 23, 2026
McKnight's Long-Term Care News
Lawmakers in Maryland are considering legislation this week to impose new qualifications for nursing home medical directors and limit them to covering two facilities each.
The House Health Committee is scheduled to hear testimony Thursday on new statewide standards for nursing homes’ top docs, limits on their appointments and the establishment of a public directory listing their credentials.
House Bill 931 would require medical directors, a group already under increasing federal scrutiny, to hold an approved medical director certification or be actively pursuing one. Acceptable certification would include one provided by professional specialty society PALTmed or an equivalent approved by the Department of Health.
The new rules would go into effect starting Oct. 1, but directors without a certification who were appointed prior to September 2026 would have two years to come into compliance.
While PALTmed has generally supported increasing standards for medical directors, the organization said its Mid-Atlantic chapter had flagged another change in the bill that would allow directors to oversee just two nursing homes each.
LeadingAge Maryland told McKnight’s Long-Term Care News Monday that its position aligns with that of MMDA—The Mid-Atlantic Society for Post-Acute and Long-Term Care Medicine. State law there already requires medical directors to successfully complete a curriculum in physician management or administration from PALTmed or a curriculum approved by the Department, but the bill would strengthen that requirement, said LeadingAge Maryland President and CEO Allison Ciborowski.
“We support medical director certification, including credentials such as the Certified Medical Director (CMD), which promote ongoing education, clinical excellence and consistent standards for medical leadership,” Ciborowski said “LeadingAge Maryland also agrees that medical directors should be appropriately engaged in the communities and facilities they serve to help elevate standards of care across Maryland.”
But, she added, a strict numerical cap would be detrimental because it does not account for significant variations in nursing home size or other factors.
“A flat limit treats all facilities as identical, without regard to scale, staffing infrastructure or clinical intensity,” she noted.
Concerns about coverage
LifeSpan Network became the Maryland affiliate of the American Health Care Association last year. It, too, is supporting the bill with an amendment to address coverage limits.
“Workforce challenges already make it very difficult for nursing homes to recruit and retain medical directors, and the two facility limit per director would exacerbate these challenges,” President and CEO Kevin Heffner told McKnight’s.
A 2024 study found that 35% of US nursing homes reported zero medical director presence in the first quarter of 2023. Using Payroll Based Journal data, the researchers found medical director presence fluctuated between 2017 and 2023 with a decline over the last four years of that period. Nursing homes that reported having a required medical director showed that person was on the payroll for an average of 36 minutes per day, or just over four hours a week.
The Health and Human Services Office of Inspector General this year also announced that it is investigating whether medical director PBJ data is accurate or useful for oversight, and the extent to which medical directors performed their required duties.
If it moves forward with its own requirements, Maryland would join Florida and California, which have both acted in advance of any coming federal certification standards.
The Maryland bill also directs the health department to create a public, online directory of nursing home medical directors that lists their credentials and certification status. That provision is in line with national standards proposed by PALTmed at least as far back as 2022 and later backed by the American Medical Association, members of Congress and the Biden administration.
Fatima Naqvi, MD, MMDA president, agreed the directory could promote transparency and accountability.
“Public access to this information will improve excellence in clinical leadership and trust in the system,” she told McKnight’s.