Text of MD HB 25 (2023)
Public Health - Healthy Maryland Program - Establishment
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As introduced
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EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
*hb0025*
HOUSE BILL 25
J1
3lr0969
HB 534/21 – HGO
(PRE–FILED)
By: Delegate Acevero
Requested: November 18, 2022
Introduced and read first time: January 11, 2023
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning
1
Public Health – Healthy Maryland Program – Establishment
2
FOR the purpose of establishing the Healthy Maryland Program as a public corporation
3
and a unit of State government to provide comprehensive universal single–payer
4
health care services for residents of the State; establishing requirements and
5
prohibitions related to Healthy Maryland, including provisions regarding eligibility,
6
participation by and payments to health care providers, benefits, payroll premiums,
7
funding, and collective negotiations with health care providers; establishing the
8
Healthy Maryland Board and the Healthy Maryland Public Advisory Committee;
9
establishing certain requirements and prohibitions for Board and Committee
10
members regarding conflicts of interest and personal liability; requiring the
11
Secretary of Budget and Management to perform certain functions relating to the
12
employment and contracting of staff for Healthy Maryland; establishing the Healthy
13
Maryland Trust Fund as a special, nonlapsing fund; requiring interest earnings of
14
the Fund to be credited to the Fund; repealing the Board of Trustees of the Maryland
15
Health Benefit Exchange; requiring the Healthy Maryland Board to oversee the
16
administration of the Maryland Health Benefit Exchange under certain
17
circumstances; requiring the Executive Director of Healthy Maryland to serve as the
18
Executive Director of the Maryland Health Benefit Exchange under certain
19
circumstances; and generally relating to the Healthy Maryland Program.
20
BY adding to
21
Article – Health – General
22
Section 25–101 through 25–1204 to be under the new title “Title 25. Healthy
23
Maryland”
24
Annotated Code of Maryland
25
(2019 Replacement Volume and 2022 Supplement)
26
BY repealing and reenacting, without amendments,
27
Article – Insurance
28
2
HOUSE BILL 25
Section 31–101(a)
1
Annotated Code of Maryland
2
(2017 Replacement Volume and 2022 Supplement)
3
BY repealing and reenacting, with amendments,
4
Article – Insurance
5
Section 31–101(b)
6
Annotated Code of Maryland
7
(2017 Replacement Volume and 2022 Supplement)
8
BY repealing
9
Article – Insurance
10
Section 31–104 and 31–105(a)
11
Annotated Code of Maryland
12
(2017 Replacement Volume and 2022 Supplement)
13
BY adding to
14
Article – Insurance
15
Section 31–104 and 31–105(a)
16
Annotated Code of Maryland
17
(2017 Replacement Volume and 2022 Supplement)
18
BY repealing and reenacting, without amendments,
19
Article – State Finance and Procurement
20
Section 6–226(a)(2)(i)
21
Annotated Code of Maryland
22
(2021 Replacement Volume and 2022 Supplement)
23
BY repealing and reenacting, with amendments,
24
Article – State Finance and Procurement
25
Section 6–226(a)(2)(ii)170. and 171.
26
Annotated Code of Maryland
27
(2021 Replacement Volume and 2022 Supplement)
28
BY adding to
29
Article – State Finance and Procurement
30
Section 6–226(a)(2)(ii)172.
31
Annotated Code of Maryland
32
(2021 Replacement Volume and 2022 Supplement)
33
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
34
That the Laws of Maryland read as follows:
35
Article – Health – General
36
TITLE 25. HEALTHY MARYLAND.
37
HOUSE BILL 25
3
SUBTITLE 1. DEFINITIONS; GENERAL PROVISIONS.
1
25–101.
2
(A)
IN THIS TITLE THE FOLLOWING WORDS HAVE THE MEANINGS
3
INDICATED.
4
(B)
(1)
“ACTIVITIES
OF
DAILY
LIVING”
MEANS
BASIC
EVERYDAY
5
SELF–CARE ACTIVITIES.
6
(2)
“ACTIVITIES OF DAILY LIVING” INCLUDES EATING, TOILETING,
7
GROOMING, DRESSING, BATHING, AND TRANSFERRING.
8
(C)
“AFFORDABLE
CARE
ACT”
MEANS
THE
FEDERAL
PATIENT
9
PROTECTION AND AFFORDABLE CARE ACT AND ANY REGULATIONS OR GUIDANCE
10
ISSUED UNDER THE ACT.
11
(D)
(1)
“ALLIED
HEALTH
PRACTITIONER”
MEANS
A
HEALTH
12
PROFESSIONAL WHO:
13
(I)
APPLIES THE HEALTH PROFESSIONAL’S EXPERTISE TO:
14
1.
PREVENT DISEASE TRANSMISSION; AND
15
2.
DIAGNOSE, TREAT, AND REHABILITATE INDIVIDUALS
16
OF ALL AGES; AND
17
(II)
WITH A RANGE OF TECHNICAL AND SUPPORT STAFF, MAY
18
DELIVER DIRECT PATIENT CARE, REHABILITATION, TREATMENT, DIAGNOSTICS, AND
19
HEALTH IMPROVEMENT INTERVENTIONS TO RESTORE AND MAINTAIN OPTIMAL
20
PHYSICAL, SENSORY, PSYCHOLOGICAL, COGNITIVE, OR SOCIAL FUNCTIONS.
21
(2)
“ALLIED HEALTH PRACTITIONER” INCLUDES AN AUDIOLOGIST,
22
AN OCCUPATIONAL THERAPIST, A SOCIAL WORKER, AND A RADIOGRAPHER.
23
(E)
“BOARD” MEANS THE HEALTHY MARYLAND BOARD.
24
(F)
“CARRIER” HAS THE MEANING STATED IN § 15–112(A)(5) OF THE
25
INSURANCE ARTICLE.
26
(G)
“COMMITTEE” MEANS THE HEALTHY MARYLAND PUBLIC ADVISORY
27
COMMITTEE.
28
4
HOUSE BILL 25
(H)
(1)
“ESSENTIAL COMMUNITY PROVIDER” HAS THE MEANING STATED
1
IN 45 C.F.R. § 156.235(C).
2
(2)
“ESSENTIAL COMMUNITY PROVIDER” INCLUDES A PERSON
3
ACTING AS:
4
(I)
A SAFETY NET CLINIC;
5
(II)
A SAFETY NET HEALTH CARE PROVIDER; OR
6
(III) A RURAL HOSPITAL.
7
(I)
“FEDERALLY MATCHED PUBLIC HEALTH PROGRAM” MEANS:
8
(1)
THE MARYLAND MEDICAL ASSISTANCE PROGRAM UNDER TITLE
9
XIX OF THE FEDERAL SOCIAL SECURITY ACT; OR
10
(2)
THE MARYLAND CHILDREN’S HEALTH INSURANCE PROGRAM
11
UNDER TITLE XXI OF THE SOCIAL SECURITY ACT.
12
(J)
“FUND” MEANS THE HEALTHY MARYLAND TRUST FUND.
13
(K)
“HEALTH CARE PROVIDER” MEANS:
14
(1)
AN ACUPUNCTURIST;
15
(2)
AN AUDIOLOGIST;
16
(3)
A CHIROPRACTOR;
17
(4)
A DIETITIAN;
18
(5)
A DENTIST;
19
(6)
AN ELECTROLOGIST;
20
(7)
A HEALTH CARE FACILITY THAT IS:
21
(I)
A
FREESTANDING
AMBULATORY
CARE
FACILITY
AS
22
DEFINED IN § 19–3B–01 OF THIS ARTICLE;
23
(II)
A FREESTANDING MEDICAL FACILITY AS DEFINED IN §
24
19–3A–01 OF THIS ARTICLE;
25
HOUSE BILL 25
5
(III) A FACILITY AS DEFINED IN § 10–101 OF THIS ARTICLE;
1
(IV) A HOSPITAL AS DEFINED IN § 19–301 OF THIS ARTICLE;
2
(V)
A LIMITED SERVICE HOSPITAL AS DEFINED IN § 19–301 OF
3
THIS ARTICLE;
4
(VI) A RELATED INSTITUTION AS DEFINED IN § 19–301 OF THIS
5
ARTICLE; OR
6
(VII) A RESIDENTIAL TREATMENT CENTER AS DEFINED IN §
7
19–301 OF THIS ARTICLE;
8
(8)
A MASSAGE THERAPIST;
9
(9)
A REGISTERED NURSE;
10
(10) A NUTRITIONIST;
11
(11) AN OCCUPATIONAL THERAPIST;
12
(12) AN OPTOMETRIST;
13
(13) A PHYSICAL THERAPIST;
14
(14) A PHYSICIAN;
15
(15) A PODIATRIST;
16
(16) A PROFESSIONAL COUNSELOR;
17
(17) A PSYCHOLOGIST;
18
(18) A SOCIAL WORKER; OR
19
(19) A SPEECH–LANGUAGE PATHOLOGIST.
20
(L)
“HEALTH CARE SERVICE” MEANS ANY HEALTH CARE SERVICE THAT IS
21
INCLUDED AS A BENEFIT UNDER HEALTHY MARYLAND.
22
(M)
“HEALTHY MARYLAND” MEANS THE HEALTHY MARYLAND PROGRAM.
23
6
HOUSE BILL 25
(N)
“HEALTHY MARYLAND MEMBER” MEANS AN INDIVIDUAL WHO IS
1
ENROLLED IN HEALTHY MARYLAND.
2
(O)
“HOME– AND COMMUNITY–BASED SERVICES” MEANS THE HOME– AND
3
COMMUNITY–BASED SERVICES ESTABLISHED UNDER § 1915(C), (D), (I), AND (K) OF
4
THE SOCIAL SECURITY ACT
AND
AS
DESCRIBED
IN
THE
HOME–
AND
5
COMMUNITY–BASED SERVICES SETTINGS RULE UNDER 42 C.F.R. § 441.530 AND 42
6
C.F.R. § 441.710.
7
(P)
“IMPLEMENTATION PERIOD” MEANS THE PERIOD SPECIFIED UNDER §
8
25–304 OF THIS TITLE DURING WHICH HEALTHY MARYLAND IS SUBJECT TO
9
SPECIAL
ELIGIBILITY
AND
FINANCING
PROVISIONS
UNTIL
IT
IS
FULLY
10
IMPLEMENTED UNDER THAT SECTION.
11
(Q)
(1)
“INSTRUMENTAL
ACTIVITIES
OF
DAILY
LIVING”
MEANS
12
ACTIVITIES RELATED TO LIVING INDEPENDENTLY IN THE COMMUNITY.
13
(2)
“INSTRUMENTAL ACTIVITIES OF DAILY LIVING” INCLUDES MEAL
14
PLANNING AND PREPARATION, PERSONAL FINANCIAL MANAGEMENT, SHOPPING,
15
HOUSEKEEPING,
COMMUNICATING
BY
PHONE
OR
OTHER
MEDIA,
AND
16
TRANSPORTATION.
17
(R)
(1)
“LONG–TERM SERVICES AND SUPPORTS” MEANS LONG–TERM
18
CARE, TREATMENT, MAINTENANCE, OR SERVICES NEEDED TO SUPPORT THE
19
ACTIVITIES OF DAILY LIVING AND THE INSTRUMENTAL ACTIVITIES OF DAILY LIVING
20
FOR AN INDIVIDUAL WITH A DISABILITY, INCLUDING:
21
(I)
ANY LONG–TERM SERVICES AND SUPPORTS AVAILABLE
22
UNDER § 1915 OF THE SOCIAL SECURITY ACT;
23
(II)
HOME– AND COMMUNITY–BASED SERVICES; AND
24
(III) ANY ADDITIONAL SERVICES AND SUPPORTS IDENTIFIED BY
25
THE SECRETARY TO SUPPORT INDIVIDUALS WITH DISABILITIES TO LIVE, WORK, AND
26
PARTICIPATE IN THEIR COMMUNITIES.
27
(2)
“LONG–TERM SERVICES AND SUPPORTS” DOES NOT INCLUDE
28
SHORT–TERM REHABILITATION SERVICES, AS DEFINED BY THE BOARD.
29
(S)
“MEDICAID” MEANS A PROGRAM THAT IS ONE OF THE FOLLOWING:
30
(1)
THE MARYLAND MEDICAL ASSISTANCE PROGRAM UNDER TITLE
31
XIX OF THE SOCIAL SECURITY ACT; OR
32
HOUSE BILL 25
7
(2)
THE MARYLAND CHILDREN’S HEALTH INSURANCE PROGRAM
1
UNDER TITLE XXI OF THE SOCIAL SECURITY ACT.
2
(T)
“MEDICALLY NECESSARY” MEANS THE HEALTH CARE ITEMS OR
3
SERVICES:
4
(1)
NEEDED TO PREVENT, DIAGNOSE, OR TREAT AN ILLNESS, AN
5
INJURY, A CONDITION, A DISEASE, OR ITS SYMPTOMS; AND
6
(2)
THAT MEET ACCEPTED STANDARDS OF CARE AS DETERMINED BY
7
A PATIENT’S TREATING PHYSICIAN OR OTHER INDIVIDUAL HEALTH CARE PROVIDER
8
WHO, ACCORDING TO THAT HEALTH CARE PROVIDER’S SCOPE OF PRACTICE AND
9
LICENSURE IN THE STATE, IS AUTHORIZED TO ESTABLISH A MEDICAL DIAGNOSIS
10
AND HAS MADE A MEDICAL ASSESSMENT OF THE PATIENT’S CONDITION.
11
(U)
“MEDICARE” MEANS TITLE XVIII OF THE SOCIAL SECURITY ACT AND
12
THE PROGRAMS THEREUNDER.
13
(V)
“OUT–OF–STATE HEALTH CARE SERVICE” MEANS A HEALTH CARE
14
SERVICE PROVIDED IN PERSON TO A HEALTHY MARYLAND MEMBER WHILE THE
15
HEALTHY MARYLAND MEMBER IS TEMPORARILY AND PHYSICALLY LOCATED
16
OUTSIDE THE STATE BECAUSE:
17
(1)
IT IS MEDICALLY NECESSARY THAT THE HEALTH CARE SERVICE
18
BE PROVIDED WHILE THE HEALTHY MARYLAND MEMBER IS PHYSICALLY OUTSIDE
19
THE STATE; OR
20
(2)
THE HEALTH CARE SERVICE:
21
(I)
IS CLINICALLY APPROPRIATE AND NECESSARY; AND
22
(II)
CAN BE PROVIDED ONLY BY A PARTICULAR HEALTH CARE
23
PROVIDER PHYSICALLY LOCATED OUTSIDE THE STATE.
24
(W)
“PARTICIPATING PROVIDER” MEANS ANY INDIVIDUAL OR ENTITY THAT
25
IS A HEALTH CARE PROVIDER QUALIFIED UNDER § 25–701 OF THIS TITLE THAT
26
PROVIDES HEALTH CARE SERVICES TO HEALTHY MARYLAND MEMBERS.
27
(X)
“PRESCRIPTION DRUGS” HAS THE MEANING STATED IN § 21–201 OF
28
THIS ARTICLE.
29
(Y)
“PROVIDER OF SERVICES” HAS THE MEANING STATED IN § 1861(U) OF
30
8
HOUSE BILL 25
THE SOCIAL SECURITY ACT.
1
(Z)
“RESIDENT” MEANS AN INDIVIDUAL WITHOUT REGARD TO THE
2
INDIVIDUAL’S IMMIGRATION STATUS:
3
(1)
WHOSE PRIMARY PLACE OF ABODE IS IN THE STATE; AND
4
(2)
WHO MEETS THE STATE RESIDENCE REQUIREMENTS ADOPTED BY
5
THE BOARD UNDER § 25–304(B) OF THIS TITLE.
6
(AA) “TEMPORARILY” MEANS FOR A PERIOD OF TIME THAT IS NOT MORE
7
THAN 90 DAYS.
8
25–102.
9
(A)
THE GENERAL ASSEMBLY FINDS THAT:
10
(1)
ALL RESIDENTS OF THE STATE HAVE THE RIGHT TO HEALTH
11
CARE;
12
(2)
RESIDENTS OF THE STATE, AS INDIVIDUALS, EMPLOYERS, AND
13
TAXPAYERS, HAVE EXPERIENCED:
14
(I)
A RISE IN THE COST OF HEALTH CARE AND HEALTH CARE
15
COVERAGE IN RECENT YEARS, INCLUDING RISING PREMIUMS, DEDUCTIBLES, AND
16
COPAYS; AND
17
(II)
RESTRICTED
PROVIDER
NETWORKS
AND
HIGH
18
OUT–OF–NETWORK CHARGES;
19
(3)
BUSINESSES HAVE EXPERIENCED INCREASES IN THE COSTS OF
20
HEALTH CARE BENEFITS FOR EMPLOYEES, AND MANY EMPLOYERS ARE SHIFTING A
21
LARGER SHARE OF THE COST OF COVERAGE TO EMPLOYEES OR DROPPING
22
COVERAGE ENTIRELY;
23
(4)
INDIVIDUALS OFTEN ARE DEPRIVED OF AFFORDABLE CARE AND
24
CHOICE BECAUSE OF DECISIONS BY HEALTH BENEFIT PLANS GUIDED BY THE PLANS’
25
ECONOMIC NEEDS RATHER THAN INDIVIDUALS’ HEALTH CARE NEEDS;
26
(5)
TO ADDRESS THE FISCAL CRISIS FACING THE STATE AND ENSURE
27
THAT RESIDENTS OF THE STATE MAY EXERCISE THE RESIDENTS’ RIGHT TO HEALTH
28
CARE, COMPREHENSIVE HEALTH CARE COVERAGE NEEDS TO BE PROVIDED;
29
HOUSE BILL 25
9
(6)
PROFIT–MAKING HEALTH CARE PROVIDERS HAVE INCREASINGLY
1
DEVASTATED THE LIVES OF THOUSANDS OF MARYLAND RESIDENTS; AND
2
(7)
MILLIONS OF DOLLARS THAT COULD BE SPENT ON CARE TO
3
MARYLAND
RESIDENTS
ARE
DIVERTED
TO
PROFIT
OR
ARE
WASTED
ON
4
ADMINISTRATIVE COSTS NECESSARY IN A MULTIPAYER HEALTH CARE SYSTEM.
5
(B)
IT IS THE INTENT OF THE GENERAL ASSEMBLY THAT:
6
(1)
THERE
BE
A
COMPREHENSIVE
UNIVERSAL
SINGLE–PAYER
7
HEALTH CARE COVERAGE PROGRAM AND A HEALTH CARE COST CONTROL SYSTEM
8
FOR THE BENEFIT OF ALL RESIDENTS OF THE STATE;
9
(2)
HEALTHY
MARYLAND
BE
ESTABLISHED
TO
PROVIDE
10
COMPREHENSIVE
UNIVERSAL
HEALTH
COVERAGE
FOR
EVERY MARYLAND
11
RESIDENT AND BE FUNDED BY BROAD–BASED REVENUE;
12
(3)
THE STATE SEEK TO OBTAIN WAIVERS AND OTHER APPROVALS
13
RELATING TO MEDICAID, MEDICARE, THE AFFORDABLE CARE ACT, AND ANY
14
OTHER FEDERAL PROGRAMS RELATED TO THE PROVISION OF HEALTH CARE SO
15
THAT ANY FEDERAL FUNDS AND OTHER SUBSIDIES THAT WOULD OTHERWISE BE
16
PAID TO THE STATE, STATE RESIDENTS, AND HEALTH CARE PROVIDERS ARE PAID
17
BY THE FEDERAL GOVERNMENT TO THE STATE AND DEPOSITED IN THE HEALTHY
18
MARYLAND TRUST FUND;
19
(4)
THE STATE WORK TO INCORPORATE HEALTH CARE COVERAGE OF
20
STATE RESIDENTS WHO ARE EMPLOYED IN OTHER JURISDICTIONS INTO WAIVERS
21
AND OTHER APPROVALS RELATING TO MEDICAID, MEDICARE, THE AFFORDABLE
22
CARE ACT, AND ANY OTHER FEDERAL PROGRAMS RELATED TO THE PROVISION OF
23
HEALTH CARE;
24
(5)
ANY FUNDS OBTAINED UNDER WAIVERS AND APPROVALS
25
RELATING TO MEDICAID, MEDICARE, THE AFFORDABLE CARE ACT, AND ANY
26
OTHER FEDERAL PROGRAMS RELATED TO THE PROVISION OF HEALTH CARE BE
27
USED:
28
(I)
FOR
HEALTH
COVERAGE
THAT
PROVIDES
HEALTH
29
BENEFITS EQUAL TO OR EXCEEDING THOSE PROGRAMS; AND
30
(II)
TO
ELIMINATE
ANY
COST–SHARING
OR
INSURANCE
31
PREMIUM OBLIGATIONS OF RESIDENTS OF THE STATE;
32
(6)
(I)
HEALTHY MARYLAND REPLACE MEDICAID, MEDICARE,
33
10
HOUSE BILL 25
THE AFFORDABLE CARE ACT, AND ANY OTHER FEDERAL PROGRAMS RELATED TO
1
THE PROVISION OF HEALTH CARE; AND
2
(II)
THOSE PROGRAMS BE MERGED INTO HEALTHY MARYLAND,
3
WHICH WILL OPERATE AS A TRUE SINGLE–PAYER PROGRAM;
4
(7)
IF ANY NECESSARY WAIVERS OR APPROVALS ARE NOT OBTAINED,
5
THE STATE USE STATE PLAN AMENDMENTS AND SEEK WAIVERS AND APPROVALS TO
6
MAXIMIZE, AND MAKE AS SEAMLESS AS POSSIBLE, THE USE OF FUNDING FROM
7
FEDERALLY MATCHED PUBLIC HEALTH PROGRAMS AND OTHER FEDERAL HEALTH
8
PROGRAMS IN HEALTHY MARYLAND;
9
(8)
IF PROGRAMS SUCH AS MEDICAID OR MEDICARE CONTRIBUTE TO
10
PAYING FOR HEALTH CARE SERVICES:
11
(I)
HEALTH CARE COVERAGE BE DELIVERED BY HEALTHY
12
MARYLAND; AND
13
(II)
TO THE GREATEST EXTENT POSSIBLE, THE MULTIPLE
14
SOURCES OF FUNDING:
15
1.
BE POOLED WITH OTHER HEALTHY MARYLAND
16
FUNDS; AND
17
2.
NOT
BE
APPARENT
TO
HEALTHY
MARYLAND
18
MEMBERS OR PARTICIPATING PROVIDERS;
19
(9)
THIS TITLE ADDRESS THE HIGH COST OF PRESCRIPTION DRUGS
20
AND ENSURE THAT PRESCRIPTION DRUGS ARE AFFORDABLE FOR PATIENTS;
21
(10) NEITHER HEALTH INFORMATION TECHNOLOGY NOR CLINICAL
22
PRACTICE GUIDELINES LIMIT THE EFFECTIVE EXERCISE OF THE PROFESSIONAL
23
JUDGMENT OF PHYSICIANS, REGISTERED NURSES, AND OTHER LICENSED HEALTH
24
CARE PROVIDERS;
25
(11) PHYSICIANS, REGISTERED NURSES, AND OTHER LICENSED
26
HEALTH CARE PROVIDERS MAY OVERRIDE HEALTH INFORMATION TECHNOLOGY
27
AND CLINICAL PRACTICE GUIDELINES IF THE OVERRIDE:
28
(I)
IS
CONSISTENT
WITH
THE
TREATING
PHYSICIAN’S
29
DETERMINATION OF MEDICAL NECESSITY; AND
30
(II)
IN THE PROFESSIONAL JUDGMENT OF THE PHYSICIAN OR
31
HOUSE BILL 25
11
REGISTERED NURSE, IS IN THE BEST INTEREST OF THE PATIENT AND CONSISTENT
1
WITH THE PATIENT’S WISHES;
2
(12) (I)
LEGISLATION BE ENACTED TO DEVELOP A REVENUE PLAN
3
FOR HEALTHY MARYLAND, TAKING INTO CONSIDERATION ANTICIPATED FEDERAL
4
REVENUE AVAILABLE FOR HEALTHY MARYLAND; AND
5
(II)
IN DEVELOPING THE REVENUE PLAN, THE GOVERNOR AND
6
THE GENERAL ASSEMBLY
CONSULT
WITH
APPROPRIATE
OFFICIALS
AND
7
STAKEHOLDERS; AND
8
(13) LEGISLATION
BE
ENACTED
REQUIRING
THAT
ALL STATE
9
REVENUES FROM HEALTHY MARYLAND BE DEPOSITED IN AN ACCOUNT WITHIN THE
10
HEALTHY MARYLAND TRUST FUND TO BE KNOWN AS THE HEALTHY MARYLAND
11
TRUST FUND ACCOUNT.
12
25–103.
13
(A)
THIS TITLE MAY NOT BE CONSTRUED TO CREATE ANY EMPLOYMENT
14
BENEFIT, OR TO REQUIRE, PROHIBIT, OR LIMIT THE PROVISION OF ANY
15
EMPLOYMENT BENEFIT.
16
(B)
THIS TITLE DOES NOT CHANGE OR IMPACT IN ANY WAY THE ROLE OR
17
AUTHORITY OF ANY LICENSING BOARD OR STATE AGENCY THAT REGULATES THE
18
STANDARDS FOR OR PROVISION OF HEALTH CARE AND THE STANDARDS FOR
19
HEALTH CARE PROVIDERS AS ESTABLISHED UNDER STATE LAW AS OF JANUARY 1,
20
2023, INCLUDING:
21
(1)
THE HEALTH OCCUPATIONS ARTICLE; AND
22
(2)
TITLE 19 OF THIS ARTICLE.
23
(C)
THIS TITLE DOES NOT AUTHORIZE HEALTHY MARYLAND, THE BOARD,
24
OR THE SECRETARY TO ESTABLISH OR REVISE LICENSURE STANDARDS FOR HEALTH
25
CARE PROVIDERS.
26
(D)
THIS TITLE DOES NOT AUTHORIZE HEALTHY MARYLAND TO CARRY OUT
27
ANY FUNCTION NOT AUTHORIZED BY WAIVERS.
28
(E)
THIS TITLE MAY NOT BE CONSTRUED TO PREEMPT OR PREVAIL OVER
29
ANY CITY, COUNTY, OR OTHER LOCAL GOVERNMENT ORDINANCE, RESOLUTION,
30
LAW, OR RULE THAT PROVIDES MORE PROTECTIONS AND BENEFITS TO RESIDENTS
31
OF THE STATE THAN PROVIDED UNDER THIS TITLE.
32
12
HOUSE BILL 25
25–104.
1
(A)
HEALTHY MARYLAND OR ANY STATE AGENCY, LOCAL AGENCY, OR
2
PUBLIC EMPLOYEE ACTING ON BEHALF OF HEALTHY MARYLAND MAY NOT PROVIDE
3
OR DISCLOSE TO ANYONE, INCLUDING THE FEDERAL GOVERNMENT, FOR LAW
4
ENFORCEMENT
PURPOSES
ANY
PERSONALLY
IDENTIFIABLE
INFORMATION
5
OBTAINED ABOUT AN INDIVIDUAL, INCLUDING AN INDIVIDUAL’S RELIGIOUS
6
BELIEFS, PRACTICES, OR AFFILIATION, NATIONAL ORIGIN, ETHNICITY, OR
7
IMMIGRATION STATUS.
8
(B)
A LAW ENFORCEMENT AGENCY IN THE STATE MAY NOT USE HEALTHY
9
MARYLAND FUNDS, FACILITIES, PROPERTY, EQUIPMENT, OR PERSONNEL TO
10
INVESTIGATE, ENFORCE, OR ASSIST IN THE INVESTIGATION OR ENFORCEMENT OF
11
ANY CRIMINAL, CIVIL, OR ADMINISTRATIVE VIOLATION OR WARRANT FOR A
12
VIOLATION OF ANY REQUIREMENT THAT INDIVIDUALS REGISTER WITH THE
13
FEDERAL GOVERNMENT OR ANY FEDERAL AGENCY BASED ON RELIGION, NATIONAL
14
ORIGIN, ETHNICITY, IMMIGRATION STATUS, OR OTHER PROTECTED CATEGORY
15
UNDER § 20–304 OF THE STATE GOVERNMENT ARTICLE.
16
SUBTITLE 2. HEALTHY MARYLAND PROGRAM.
17
25–201.
18
(A)
THERE IS A HEALTHY MARYLAND PROGRAM.
19
(B)
(1)
HEALTHY MARYLAND IS A BODY POLITIC AND CORPORATE AND IS
20
AN INSTRUMENTALITY OF THE STATE.
21
(2)
HEALTHY MARYLAND IS A PUBLIC CORPORATION AND A UNIT OF
22
STATE GOVERNMENT.
23
(3)
THE EXERCISE BY HEALTHY MARYLAND OF ITS AUTHORITY
24
UNDER THIS TITLE IS AN ESSENTIAL GOVERNMENTAL FUNCTION.
25
(C)
ON OR BEFORE JANUARY 1, 2025, HEALTHY MARYLAND SHALL:
26
(1)
PROVIDE:
27
(I)
COMPREHENSIVE
UNIVERSAL
SINGLE–PAYER
HEALTH
28
CARE SERVICES FOR ALL RESIDENTS OF THE STATE;
29
(II)
A HEALTH CARE COST CONTROL SYSTEM FOR THE BENEFIT
30
HOUSE BILL 25
13
OF ALL RESIDENTS OF THE STATE;
1
(III) CHOICE AND ACCESS TO HEALTH CARE COORDINATORS
2
AND HEALTH CARE PROVIDERS TO ALL RESIDENTS OF THE STATE; AND
3
(IV) BROAD–BASED PUBLIC FINANCING OF HEALTH CARE
4
SERVICES FOR ALL RESIDENTS OF THE STATE; AND
5
(2)
ESTABLISH MECHANISMS TO:
6
(I)
ENABLE HEALTH CARE PROVIDERS TO COLLECTIVELY
7
NEGOTIATE WITH HEALTHY MARYLAND REGARDING ANY MATTER RELATING TO
8
HEALTHY MARYLAND, INCLUDING:
9
1.
RATES OF PAYMENT FOR HEALTH CARE SERVICES;
10
2.
RATES
OF
PAYMENT
FOR
PRESCRIPTION
AND
11
NONPRESCRIPTION DRUGS; AND
12
3.
PAYMENT METHODOLOGIES;
13
(II)
ENSURE TRANSPARENCY AND ACCOUNTABILITY TO THE
14
PUBLIC; AND
15
(III) PROVIDE FOR THE COLLECTION OF DATA TO:
16
1.
PROMOTE TRANSPARENCY;
17
2.
ASSESS ADHERENCE TO PATIENT CARE STANDARDS
18
ESTABLISHED UNDER SUBTITLE 9 OF THIS TITLE; AND
19
3.
COMPARE
PATIENT
OUTCOMES
AND
REVIEW
20
UTILIZATION OF HEALTH CARE SERVICES PAID FOR BY HEALTHY MARYLAND.
21
(D)
HEALTHY MARYLAND IS SUBJECT TO:
22
(1)
TITLES 3, 4, AND 5 OF THE GENERAL PROVISIONS ARTICLE;
23
(2)
THE FOLLOWING PROVISIONS OF THE STATE FINANCE AND
24
PROCUREMENT ARTICLE:
25
(I)
TITLE 3.5, SUBTITLE 3, TO THE EXTENT THAT THE
26
SECRETARY OF INFORMATION TECHNOLOGY DETERMINES THAT AN INFORMATION
27
14
HOUSE BILL 25
TECHNOLOGY PROJECT OF HEALTHY MARYLAND IS A MAJOR INFORMATION
1
TECHNOLOGY DEVELOPMENT PROJECT;
2
(II)
TITLE 12, SUBTITLE 4; AND
3
(III) TITLE 14, SUBTITLE 3;
4
(3)
THE FOLLOWING PROVISIONS OF THE STATE GOVERNMENT
5
ARTICLE:
6
(I)
TITLE 10, SUBTITLE 1; AND
7
(II)
TITLE 12; AND
8
(4)
TITLE 5, SUBTITLE 3 OF THE STATE PERSONNEL AND PENSIONS
9
ARTICLE.
10
SUBTITLE 3. HEALTHY MARYLAND BOARD.
11
25–301.
12
(A)
THERE IS A HEALTHY MARYLAND BOARD.
13
(B)
THE BOARD CONSISTS OF THE FOLLOWING MEMBERS:
14
(1)
THE SECRETARY, OR THE SECRETARY’S DESIGNEE, AS AN EX
15
OFFICIO MEMBER OF THE BOARD;
16
(2)
FOUR MEMBERS APPOINTED BY THE GOVERNOR, WITH THE
17
ADVICE AND CONSENT OF THE SENATE;
18
(3)
TWO MEMBERS APPOINTED BY THE PRESIDENT OF THE SENATE;
19
AND
20
(4)
TWO MEMBERS APPOINTED BY THE SPEAKER OF THE HOUSE.
21
(C)
(1)
THE TERM OF AN APPOINTED MEMBER IS 4 YEARS.
22
(2)
THE TERMS OF APPOINTED MEMBERS ARE STAGGERED AS
23
REQUIRED BY THE TERMS PROVIDED FOR MEMBERS OF THE BOARD ON JULY 1,
24
2023.
25
(3)
AT THE END OF A TERM, A MEMBER CONTINUES TO SERVE UNTIL
26
HOUSE BILL 25
15
A SUCCESSOR IS APPOINTED AND QUALIFIES.
1
(4)
A MEMBER WHO IS APPOINTED AFTER A TERM HAS BEGUN SERVES
2
ONLY FOR THE REST OF THE TERM AND UNTIL A SUCCESSOR IS APPOINTED AND
3
QUALIFIES.
4
(5)
(I)
IF A VACANCY OCCURS AMONG THE MEMBERS APPOINTED
5
BY THE GOVERNOR, THE GOVERNOR SHALL PROMPTLY APPOINT A SUCCESSOR WHO
6
SHALL SERVE UNTIL THE TERM EXPIRES.
7
(II)
A MEMBER APPOINTED UNDER SUBPARAGRAPH (I) OF THIS
8
PARAGRAPH MAY BE REAPPOINTED FOR A FULL TERM.
9
(6)
A MEMBER MAY NOT SERVE FOR MORE THAN TWO CONSECUTIVE
10
TERMS.
11
(7)
FROM AMONG ITS MEMBERS, THE BOARD SHALL ELECT A CHAIR
12
AND VICE CHAIR EACH YEAR.
13
(D)
IN APPOINTING MEMBERS UNDER SUBSECTION (B) OF THIS SECTION,
14
THE APPOINTING AUTHORITY SHALL:
15
(1)
ENSURE THAT THE APPOINTEE HAS DEMONSTRATED AND
16
ACKNOWLEDGED EXPERTISE IN HEALTH CARE;
17
(2)
CONSIDER THE EXPERTISE OF THE OTHER MEMBERS OF THE
18
BOARD AND ATTEMPT TO MAKE APPOINTMENTS SO THAT THE BOARD’S
19
COMPOSITION REFLECTS A DIVERSITY OF EXPERTISE IN VARIOUS ASPECTS OF
20
HEALTH CARE;
21
(3)
CONSIDER
THE
CULTURAL,
ETHNIC,
AND
GEOGRAPHICAL
22
DIVERSITY OF THE STATE SO THAT THE BOARD’S COMPOSITION REFLECTS THE
23
COMMUNITIES OF THE STATE; AND
24
(4)
ENSURE THAT THE BOARD’S COMPOSITION INCLUDES:
25
(I)
AT
LEAST
ONE
REPRESENTATIVE
OF
A
LABOR
26
ORGANIZATION REPRESENTING REGISTERED NURSES;
27
(II)
AT LEAST ONE REPRESENTATIVE OF THE GENERAL PUBLIC;
28
(III) AT
LEAST
ONE
REPRESENTATIVE
OF
A
LABOR
29
ORGANIZATION; AND
30
16
HOUSE BILL 25
(IV) AT
LEAST
ONE
REPRESENTATIVE
OF
THE
MEDICAL
1
PROVIDER COMMUNITY.
2
(E)
(1)
(I)
IN THIS SUBSECTION THE FOLLOWING WORDS HAVE THE
3
MEANINGS INDICATED.
4
(II)
“AFFILIATION” MEANS:
5
1.
A FINANCIAL INTEREST;
6
2.
A
POSITION
OF
GOVERNANCE,
INCLUDING
7
MEMBERSHIP ON A BOARD OF DIRECTORS, REGARDLESS OF COMPENSATION;
8
3.
A RELATIONSHIP THROUGH WHICH COMPENSATION
9
IS RECEIVED; OR
10
4.
A RELATIONSHIP FOR THE PROVISION OF SERVICES
11
AS A REGULATED LOBBYIST.
12
(III) “COMPENSATION” HAS THE MEANING STATED IN § 5–101 OF
13
THE GENERAL PROVISIONS ARTICLE.
14
(IV) “FINANCIAL INTEREST” HAS THE MEANING STATED IN §
15
5–101 OF THE GENERAL PROVISIONS ARTICLE.
16
(V)
“REGULATED LOBBYIST” HAS THE MEANING STATED IN §
17
5–101 OF THE GENERAL PROVISIONS ARTICLE.
18
(2)
A MEMBER OF THE BOARD OR STAFF MEMBER FOR THE BOARD,
19
WITHIN
THE 2–YEAR
PERIOD
IMMEDIATELY
PRECEDING
THE
MEMBER’S
20
APPOINTMENT OR THE STAFF MEMBER HAVING BEEN HIRED, AND WHILE SERVING
21
ON OR WORKING FOR THE BOARD, MAY NOT BE EMPLOYED, OR HAVE BEEN
22
EMPLOYED, IN ANY CAPACITY BY A CONSULTANT TO A MEMBER OF THE BOARD OF
23
DIRECTORS OF, HAVE AN AFFILIATION WITH, OR OTHERWISE BE A REPRESENTATIVE
24
OF:
25
(I)
A HEALTH CARE PROVIDER;
26
(II)
A HEALTH CARE FACILITY;
27
(III) A HEALTH CLINIC;
28
HOUSE BILL 25
17
(IV) A PHARMACEUTICAL COMPANY;
1
(V)
A MEDICAL EQUIPMENT COMPANY; OR
2
(VI) A CARRIER, AN INSURANCE PRODUCER, A THIRD–PARTY
3
ADMINISTRATOR, A MANAGED CARE ORGANIZATION, OR ANY OTHER PERSON
4
CONTRACTING DIRECTLY WITH THOSE PERSONS.
5
(3)
A MEMBER OF THE BOARD MAY NOT ACCEPT EMPLOYMENT WITH
6
OR RECEIVE COMPENSATION FROM A PERSON LISTED IN PARAGRAPH (2) OF THIS
7
SUBSECTION FOR 2 YEARS IMMEDIATELY FOLLOWING THE END OF THE MEMBER’S
8
TERM.
9
(4)
A MEMBER OF THE BOARD OR A STAFF MEMBER OF THE BOARD
10
MAY NOT BE A MEMBER, A BOARD MEMBER, OR AN EMPLOYEE OF A TRADE
11
ASSOCIATION OF HEALTH FACILITIES, HEALTH CLINICS, HEALTH CARE PROVIDERS,
12
CARRIERS, INSURANCE PRODUCERS, THIRD–PARTY ADMINISTRATORS, MANAGED
13
CARE ORGANIZATIONS, OR ANY OTHER ASSOCIATION OF ENTITIES IN A POSITION TO
14
CONTRACT DIRECTLY WITH HEALTHY MARYLAND UNLESS THE MEMBER OR STAFF
15
MEMBER OF THE BOARD:
16
(I)
RECEIVES NO COMPENSATION FOR RENDERING SERVICES
17
AS A HEALTH CARE PROVIDER; AND
18
(II)
DOES NOT HAVE AN OWNERSHIP INTEREST IN A HEALTH
19
CARE PRACTICE.
20
(F)
A MEMBER OF THE BOARD SHALL:
21
(1)
MEET THE REQUIREMENTS OF THIS TITLE AND ALL APPLICABLE
22
STATE AND FEDERAL LAWS AND REGULATIONS;
23
(2)
SERVE THE PUBLIC INTEREST OF THE INDIVIDUALS, EMPLOYERS,
24
AND
TAXPAYERS
SEEKING
HEALTH
CARE
COVERAGE
THROUGH HEALTHY
25
MARYLAND; AND
26
(3)
ENSURE THE SOUND OPERATION AND FISCAL SOLVENCY OF
27
HEALTHY MARYLAND.
28
(G)
(1)
THE BOARD SHALL DETERMINE THE TIMES, PLACES, AND
29
FREQUENCY OF ITS MEETINGS.
30
(2)
FIVE MEMBERS OF THE BOARD CONSTITUTE A QUORUM.
31
18
HOUSE BILL 25
(3)
ACTION BY THE BOARD REQUIRES THE AFFIRMATIVE VOTE OF AT
1
LEAST FIVE MEMBERS.
2
(H)
A MEMBER OF THE BOARD:
3
(1)
MAY NOT RECEIVE COMPENSATION AS A MEMBER OF THE BOARD;
4
BUT
5
(2)
IS ENTITLED TO:
6
(I)
A PER DIEM RATE AS PROVIDED IN THE STATE BUDGET FOR
7
ATTENDING SCHEDULED MEETINGS OF HEALTHY MARYLAND; AND
8
(II)
REIMBURSEMENT FOR EXPENSES UNDER THE STANDARD
9
STATE TRAVEL REGULATIONS, AS PROVIDED IN THE STATE BUDGET.
10
(I)
A MEMBER OF THE BOARD SHALL PERFORM THE MEMBER’S DUTIES:
11
(1)
IN GOOD FAITH;
12
(2)
IN THE MANNER THE MEMBER REASONABLY BELIEVES TO BE IN
13
THE BEST INTEREST OF HEALTHY MARYLAND, HEALTHY MARYLAND MEMBERS,
14
AND RESIDENTS OF THE STATE; AND
15
(3)
WITHOUT INTENTIONAL OR RECKLESS DISREGARD OF THE CARE
16
AN ORDINARILY PRUDENT PERSON IN A LIKE POSITION WOULD USE UNDER SIMILAR
17
CIRCUMSTANCES.
18
(J)
(1)
(I)
A MEMBER OF THE BOARD SHALL BE SUBJECT TO TITLE 5,
19
SUBTITLES 1 THROUGH 7 OF THE GENERAL PROVISIONS ARTICLE.
20
(II)
IN ADDITION TO THE DISCLOSURE REQUIRED UNDER TITLE
21
5, SUBTITLE 6 OF THE GENERAL PROVISIONS ARTICLE, A MEMBER OF THE BOARD
22
SHALL DISCLOSE TO THE BOARD AND TO THE PUBLIC ANY RELATIONSHIP NOT
23
ADDRESSED IN THE REQUIRED FINANCIAL DISCLOSURE THAT THE MEMBER HAS
24
WITH A HEALTH CARE PROVIDER, A HEALTH CLINIC, A PHARMACEUTICAL COMPANY,
25
A MEDICAL EQUIPMENT COMPANY, A CARRIER, AN INSURANCE PRODUCER, A
26
THIRD–PARTY ADMINISTRATOR, A MANAGED CARE ORGANIZATION, OR ANY OTHER
27
ENTITY IN AN INDUSTRY INVOLVED IN MATTERS LIKELY TO COME BEFORE THE
28
BOARD.
29
(2)
ON ALL MATTERS THAT COME BEFORE THE BOARD, THE MEMBER
30
HOUSE BILL 25
19
SHALL:
1
(I)
ADHERE STRICTLY TO THE CONFLICT OF INTEREST
2
PROVISIONS UNDER TITLE 5, SUBTITLE 5 OF THE GENERAL PROVISIONS ARTICLE
3
RELATING TO RESTRICTIONS ON PARTICIPATION, EMPLOYMENT, AND FINANCIAL
4
INTERESTS; AND
5
(II)
PROVIDE FULL DISCLOSURE TO THE BOARD AND THE
6
PUBLIC ON:
7
1.
ANY MATTER THAT GIVES RISE TO A POTENTIAL
8
CONFLICT OF INTEREST; AND
9
2.
THE MANNER IN WHICH THE MEMBER WILL COMPLY
10
WITH THE PROVISIONS OF TITLE 5, SUBTITLE 5 OF THE GENERAL PROVISIONS
11
ARTICLE TO AVOID ANY CONFLICT OF INTEREST OR APPEARANCE OF A CONFLICT
12
OF INTEREST.
13
(K)
A MEMBER OF THE BOARD WHO PERFORMS THE MEMBER’S DUTIES IN
14
ACCORDANCE WITH THE STANDARD ESTABLISHED UNDER SUBSECTION (I) OF THIS
15
SECTION MAY NOT BE LIABLE PERSONALLY FOR ACTIONS TAKEN AS A MEMBER
16
WHEN DONE IN GOOD FAITH, WITHOUT INTENT TO DEFRAUD, AND IN CONNECTION
17
WITH THE ADMINISTRATION, MANAGEMENT, OR CONDUCT OF THIS TITLE OR
18
ACTIONS RELATED TO THIS TITLE.
19
(L)
A MEMBER OF THE BOARD MAY BE REMOVED FOR INCOMPETENCE,
20
MISCONDUCT, OR FAILURE TO PERFORM THE DUTIES OF THE POSITION.
21
25–302.
22
(A)
(1)
THE BOARD SHALL APPOINT AN EXECUTIVE DIRECTOR OF
23
HEALTHY MARYLAND.
24
(2)
THE EXECUTIVE DIRECTOR SHALL SERVE AT THE PLEASURE OF
25
THE BOARD.
26
(3)
THE
BOARD
SHALL
DETERMINE
THE
APPROPRIATE
27
COMPENSATION FOR THE EXECUTIVE DIRECTOR.
28
(B)
UNDER THE DIRECTION OF THE BOARD, THE EXECUTIVE DIRECTOR
29
SHALL:
30
(1)
BE
THE
CHIEF
ADMINISTRATIVE
OFFICER
OF HEALTHY
31
20
HOUSE BILL 25
MARYLAND, INCLUDING THE HEALTHY MARYLAND TRUST FUND;
1
(2)
DIRECT, ORGANIZE, ADMINISTER, AND MANAGE THE OPERATIONS
2
OF HEALTHY MARYLAND AND THE BOARD; AND
3
(3)
PERFORM ALL DUTIES NECESSARY TO COMPLY WITH AND CARRY
4
OUT THE PROVISIONS OF THIS TITLE, OTHER APPLICABLE STATE LAWS AND
5
REGULATIONS, AND THE AFFORDABLE CARE ACT.
6
(C)
(1)
IN ACCORDANCE WITH THE STATE BUDGET, THE EXECUTIVE
7
DIRECTOR, OR THE EXECUTIVE DIRECTOR’S DESIGNEE, MAY EMPLOY AND RETAIN
8
A STAFF FOR HEALTHY MARYLAND TO IMPLEMENT THE PURPOSES AND INTENT OF
9
THIS TITLE.
10
(2)
(I)
THE EXECUTIVE DIRECTOR MAY SET THE COMPENSATION
11
OF A HEALTHY MARYLAND EMPLOYEE OR AN INDEPENDENT CONTRACTOR OF
12
HEALTHY MARYLAND WHO IS IN A POSITION THAT:
13
1.
IS UNIQUE TO HEALTHY MARYLAND;
14
2.
REQUIRES SPECIFIC SKILLS OR EXPERIENCE TO
15
PERFORM THE DUTIES OF THE POSITION; AND
16
3.
DOES NOT REQUIRE THE EMPLOYEE TO PERFORM
17
FUNCTIONS THAT ARE COMPARABLE TO FUNCTIONS PERFORMED IN OTHER UNITS
18
OF THE EXECUTIVE BRANCH OF STATE GOVERNMENT.
19
(II)
THE SECRETARY OF BUDGET AND MANAGEMENT, IN
20
CONSULTATION WITH THE EXECUTIVE DIRECTOR, SHALL DETERMINE THE
21
POSITIONS AND TYPES OF INDEPENDENT CONTRACTORS FOR WHICH THE
22
EXECUTIVE DIRECTOR MAY SET COMPENSATION UNDER SUBPARAGRAPH (I) OF
23
THIS PARAGRAPH.
24
(3)
IN HIRING STAFF FOR FUNCTIONS THAT MUST BE PERFORMED BY
25
STATE PERSONNEL UNDER THE AFFORDABLE CARE ACT OR OTHER APPLICABLE
26
FEDERAL
OR STATE
LAWS,
THE EXECUTIVE DIRECTOR’S
APPOINTMENT,
27
RETENTION, AND REMOVAL OF STAFF SHALL BE IN ACCORDANCE WITH DIVISION I
28
OF THE STATE PERSONNEL AND PENSIONS ARTICLE.
29
(4)
IN HIRING STAFF FOR FUNCTIONS THAT HAVE BEEN AND
30
CURRENTLY ARE PERFORMED BY STATE PERSONNEL, THE EXECUTIVE DIRECTOR’S
31
APPOINTMENT, RETENTION, AND REMOVAL OF STAFF SHALL BE IN ACCORDANCE
32
WITH DIVISION I OF THE STATE PERSONNEL AND PENSIONS ARTICLE.
33
HOUSE BILL 25
21
(5)
EXCEPT AS PROVIDED IN PARAGRAPH (6) OF THIS SUBSECTION,
1
STAFF FOR ALL OTHER POSITIONS NECESSARY TO CARRY OUT THE PURPOSES OF
2
THIS TITLE SHALL BE POSITIONS IN THE EXECUTIVE SERVICE OR MANAGEMENT
3
SERVICE, OR SPECIAL APPOINTMENTS OF THE SKILLED SERVICE OR THE
4
PROFESSIONAL SERVICE IN THE STATE PERSONNEL MANAGEMENT SYSTEM.
5
(6)
THE EXECUTIVE DIRECTOR MAY RETAIN AS INDEPENDENT
6
CONTRACTORS
ATTORNEYS,
FINANCIAL
CONSULTANTS,
AND
ANY
OTHER
7
PROFESSIONALS OR CONSULTANTS NECESSARY TO CARRY OUT THE PLANNING,
8
DEVELOPMENT, AND OPERATIONS OF HEALTHY MARYLAND, AND THE PROVISIONS
9
OF THIS TITLE.
10
(7)
THE EXECUTIVE DIRECTOR, OR THE EXECUTIVE DIRECTOR’S
11
DESIGNEE, SHALL GIVE PREFERENCE IN HIRING UNDER THIS SUBSECTION TO ALL
12
INDIVIDUALS DISPLACED OR UNEMPLOYED AS A DIRECT RESULT OF THE
13
IMPLEMENTATION OF HEALTHY MARYLAND.
14
(D)
THE EXECUTIVE DIRECTOR SHALL DETERMINE THE CLASSIFICATION,
15
GRADE, AND COMPENSATION OF THE POSITIONS DESIGNATED UNDER SUBSECTION
16
(C)(2) OF THIS SECTION:
17
(1)
IN CONSULTATION WITH THE SECRETARY OF BUDGET AND
18
MANAGEMENT;
19
(2)
WITH THE APPROVAL OF THE BOARD; AND
20
(3)
WHEN POSSIBLE, IN ACCORDANCE WITH THE STATE PAY PLAN.
21
(E)
(1)
THE EXECUTIVE DIRECTOR SHALL SUBMIT TO THE SECRETARY
22
OF BUDGET AND MANAGEMENT, AT LEAST 45 DAYS BEFORE THE EFFECTIVE DATE
23
OF THE CHANGE, EACH CHANGE TO HEALTHY MARYLAND’S SALARY PLANS THAT
24
INVOLVES INCREASES OR DECREASES IN SALARY RANGES OTHER THAN THOSE
25
ASSOCIATED WITH ROUTINE RECLASSIFICATIONS AND PROMOTIONS OR GENERAL
26
SALARY INCREASES APPROVED BY THE GENERAL ASSEMBLY.
27
(2)
CHANGES REQUIRED TO BE REPORTED UNDER PARAGRAPH (1) OF
28
THIS SUBSECTION INCLUDE:
29
(I)
THE CREATION OR ABOLITION OF CLASSES;
30
(II)
THE REGRADING OF CLASSES FROM ONE ESTABLISHED
31
RANGE TO ANOTHER; AND
32
22
HOUSE BILL 25
(III) THE CREATION OF NEW PAY SCHEDULES OR RANGES.
1
(3)
THE SECRETARY OF BUDGET AND MANAGEMENT SHALL:
2
(I)
REVIEW THE PROPOSED CHANGE; AND
3
(II)
AT LEAST 15 DAYS BEFORE THE EFFECTIVE DATE OF THE
4
PROPOSED CHANGE:
5
1.
ADVISE THE EXECUTIVE DIRECTOR WHETHER THE
6
CHANGE WOULD HAVE AN ADVERSE EFFECT ON COMPARABLE STATE JOBS; AND
7
2.
IF
THERE
WOULD
BE
AN
ADVERSE
EFFECT,
8
RECOMMEND AN ALTERNATIVE CHANGE THAT WOULD NOT HAVE AN ADVERSE
9
EFFECT ON COMPARABLE STATE JOBS.
10
(4)
FAILURE OF THE SECRETARY OF BUDGET AND MANAGEMENT TO
11
RESPOND TO THE PROPOSED CHANGE IN A TIMELY MANNER SHALL BE CONSIDERED
12
TO BE AGREEMENT WITH THE CHANGE AS SUBMITTED.
13
(F)
EXCEPT AS OTHERWISE PROVIDED IN THIS TITLE, AN EMPLOYEE OR
14
INDEPENDENT CONTRACTOR OF HEALTHY MARYLAND IS NOT SUBJECT TO ANY LAW,
15
REGULATION,
OR
EXECUTIVE
ORDER
GOVERNING STATE
COMPENSATION,
16
INCLUDING:
17
(1)
FURLOUGHS;
18
(2)
PAY CUTS; AND
19
(3)
ANY OTHER GENERAL FUND COST–SAVINGS MEASURE.
20
25–303.
21
(A)
SUBJECT TO ANY LIMITATIONS UNDER THIS TITLE OR OTHER
22
APPLICABLE LAW, THE BOARD SHALL HAVE ALL POWERS NECESSARY OR
23
CONVENIENT TO CARRY OUT THE FUNCTIONS AUTHORIZED BY THE AFFORDABLE
24
CARE ACT AND CONSISTENT WITH THE PURPOSES OF HEALTHY MARYLAND.
25
(B)
THE ENUMERATION OF SPECIFIC POWERS IN THIS TITLE IS NOT
26
INTENDED TO RESTRICT THE BOARD’S POWER TO TAKE ANY LAWFUL ACTION THAT
27
THE BOARD DETERMINES IS NECESSARY OR CONVENIENT TO CARRY OUT THE
28
FUNCTIONS AUTHORIZED BY THE AFFORDABLE CARE ACT AND CONSISTENT WITH
29
HOUSE BILL 25
23
THE PURPOSES OF HEALTHY MARYLAND.
1
(C)
IN ADDITION TO THE POWERS SET FORTH ELSEWHERE IN THIS TITLE,
2
THE BOARD MAY:
3
(1)
ADOPT AND ALTER AN OFFICIAL SEAL;
4
(2)
ORGANIZE, ADMINISTER, AND MARKET HEALTHY MARYLAND AND
5
HEALTHY MARYLAND SERVICES AS A SINGLE–PAYER PROGRAM UNDER THE NAME
6
“HEALTHY MARYLAND” OR ANY OTHER NAME AS THE BOARD DETERMINES;
7
(3)
SUE, BE SUED, PLEAD, AND BE IMPLEADED;
8
(4)
ADOPT BYLAWS, RULES, AND POLICIES;
9
(5)
ADOPT REGULATIONS TO CARRY OUT THIS TITLE:
10
(I)
IN ACCORDANCE WITH TITLE 10, SUBTITLE 1 OF THE STATE
11
GOVERNMENT ARTICLE; AND
12
(II)
THAT
DO
NOT
CONFLICT
WITH
OR
PREVENT
THE
13
APPLICATION OF REGULATIONS ADOPTED BY THE U.S. SECRETARY OF HEALTH AND
14
HUMAN SERVICES UNDER TITLE 1, SUBTITLE D OF THE AFFORDABLE CARE ACT;
15
(6)
MAINTAIN AN OFFICE AT THE PLACE DESIGNATED BY THE BOARD;
16
(7)
CREATE COMMITTEES FROM AMONG ITS MEMBERS;
17
(8)
MAKE AGREEMENTS WITH A GRANTOR OR PAYOR OF FUNDS,
18
PROPERTY, OR SERVICES;
19
(9)
ENTER INTO ANY AGREEMENTS OR CONTRACTS AND EXECUTE
20
THE INSTRUMENTS NECESSARY OR CONVENIENT TO MANAGE ITS OWN AFFAIRS AND
21
CARRY OUT THE PURPOSES OF THIS TITLE, INCLUDING CONTRACTS WITH HEALTH
22
CARE PROVIDERS;
23
(10) APPLY
FOR
AND
RECEIVE
GIFTS,
GRANTS,
DONATIONS,
24
CONTRACTS, OR OTHER FUNDING FROM ANY AGENCY OF THE FEDERAL
25
GOVERNMENT, ANY AGENCY OF THE STATE, AND ANY MUNICIPALITY, COUNTY, OR
26
OTHER POLITICAL SUBDIVISION OF THE STATE;
27
(11) APPLY
FOR
AND
RECEIVE
GIFTS,
GRANTS,
DONATIONS,
28
CONTRACTS, OR OTHER PRIVATE OR PUBLIC FUNDING FROM INDIVIDUALS,
29
24
HOUSE BILL 25
ASSOCIATIONS, PRIVATE FOUNDATIONS, AND CORPORATIONS, IN COMPLIANCE
1
WITH TITLE 5, SUBTITLES 1 THROUGH 7 OF THE GENERAL PROVISIONS ARTICLE;
2
(12) SHARE
INFORMATION
WITH
RELEVANT
STATE
ENTITIES,
3
CONSISTENT WITH THE CONFIDENTIALITY PROVISIONS IN THIS TITLE AND AS
4
NECESSARY FOR THE ADMINISTRATION OF HEALTHY MARYLAND; AND
5
(13) SUBJECT TO THE LIMITATIONS OF THIS TITLE, EXERCISE ANY
6
OTHER POWER THAT IS REASONABLY NECESSARY OR CONVENIENT TO CARRY OUT
7
THE PURPOSES OF THIS TITLE.
8
(D)
(1)
TO CARRY OUT THE PURPOSES OF THIS TITLE OR PERFORM ANY
9
OF ITS FUNCTIONS UNDER THIS TITLE, THE BOARD MAY CONTRACT OR ENTER INTO
10
MEMORANDA OF UNDERSTANDING WITH ELIGIBLE ENTITIES.
11
(2)
THE OPERATIONS OF HEALTHY MARYLAND ARE SUBJECT TO THE
12
PROVISIONS OF THIS TITLE WHETHER THE OPERATIONS ARE PERFORMED DIRECTLY
13
BY HEALTHY MARYLAND OR THROUGH AN ENTITY UNDER A CONTRACT WITH
14
HEALTHY MARYLAND.
15
(3)
THE BOARD SHALL ENSURE THAT ANY ENTITY UNDER A
16
CONTRACT WITH HEALTHY MARYLAND COMPLIES WITH THE PROVISIONS OF THIS
17
TITLE WHEN PERFORMING SERVICES THAT ARE SUBJECT TO THIS TITLE ON BEHALF
18
OF HEALTHY MARYLAND.
19
(E)
(1)
IN ACCORDANCE WITH TITLE 12, SUBTITLE 4 OF THE STATE
20
FINANCE AND PROCUREMENT ARTICLE, THE BOARD SHALL ADOPT WRITTEN
21
POLICIES AND PROCEDURES GOVERNING ALL PROCUREMENTS OF HEALTHY
22
MARYLAND.
23
(2)
TO THE FULLEST EXTENT PRACTICABLE AND IN A MANNER THAT
24
DOES NOT IMPAIR HEALTHY MARYLAND’S ABILITY TO CARRY OUT THE PURPOSES
25
OF THIS TITLE, THE BOARD’S PROCUREMENT POLICIES AND PROCEDURES SHALL
26
ESTABLISH AN OPEN AND TRANSPARENT PROCESS THAT:
27
(I)
PROMOTES PUBLIC CONFIDENCE IN THE PROCUREMENTS
28
OF HEALTHY MARYLAND;
29
(II)
ENSURES FAIR AND EQUITABLE TREATMENT OF ALL
30
PERSONS AND ENTITIES THAT PARTICIPATE IN THE PROCUREMENT SYSTEM OF
31
HEALTHY MARYLAND;
32
(III) FOSTERS APPROPRIATE COMPETITION AND PROVIDES
33
HOUSE BILL 25
25
SAFEGUARDS FOR MAINTAINING A PROCUREMENT SYSTEM OF QUALITY AND
1
INTEGRITY;
2
(IV) PROMOTES
INCREASED
ECONOMIC
EFFICIENCY
AND
3
RESPONSIBILITY ON THE PART OF HEALTHY MARYLAND;
4
(V)
ACHIEVES THE MAXIMUM BENEFIT FROM THE PURCHASING
5
POWER OF HEALTHY MARYLAND; AND
6
(VI) PROVIDES CLARITY AND SIMPLICITY IN THE RULES AND
7
PROCEDURES GOVERNING THE PROCUREMENTS OF HEALTHY MARYLAND.
8
(F)
TO CARRY OUT THE PURPOSES OF THIS TITLE, THE BOARD SHALL:
9
(1)
CONSULT WITH AND SOLICIT INPUT FROM THE COMMITTEE AND
10
ANY OTHER PERSON AS THE BOARD DETERMINES IS APPROPRIATE;
11
(2)
PROMOTE THE PUBLIC UNDERSTANDING AND AWARENESS OF
12
AVAILABLE BENEFITS AND PROGRAMS OF HEALTHY MARYLAND;
13
(3)
AVOID JEOPARDIZING FEDERAL FINANCIAL PARTICIPATION IN
14
THE PROGRAMS THAT ARE INCORPORATED INTO HEALTHY MARYLAND;
15
(4)
ENSURE THAT THERE IS ADEQUATE FUNDING TO MEET THE
16
HEALTH CARE NEEDS OF RESIDENTS AND TO COMPENSATE HEALTH CARE
17
PROVIDERS THAT PARTICIPATE IN HEALTHY MARYLAND;
18
(5)
EVALUATE REQUESTS FOR CAPITAL EXPENSES REQUIRED TO
19
MEET THE HEALTH CARE NEEDS OF RESIDENTS;
20
(6)
APPROVE THE BENEFITS PROVIDED BY HEALTHY MARYLAND;
21
(7)
EVALUATE THE PERFORMANCE OF HEALTHY MARYLAND;
22
(8)
EVALUATE AND MAKE RECOMMENDATIONS TO THE GENERAL
23
ASSEMBLY ON ANY LEGISLATION RELATED TO HEALTHY MARYLAND;
24
(9)
GUARANTEE THAT MECHANISMS FOR PUBLIC FEEDBACK ARE
25
ACCESSIBLE AND NONDISCRIMINATORY; AND
26
(10) DEVELOP A PLAN TO COORDINATE THE ACTIVITIES OF HEALTHY
27
MARYLAND WITH THE ACTIVITIES OF THE MARYLAND HEALTH CARE COMMISSION,
28
THE HEALTH SERVICES COST REVIEW COMMISSION, AND THE DEPARTMENT TO
29
26
HOUSE BILL 25
ENSURE APPROPRIATE PLANNING FOR THE EFFECTIVE DELIVERY AND EQUITABLE
1
DISTRIBUTION OF HEALTH CARE SERVICES THROUGHOUT THE STATE.
2
(G)
THE BOARD SHALL PROVIDE GRANTS FROM FUNDS IN THE HEALTHY
3
MARYLAND TRUST FUND OR FUNDS OTHERWISE APPROPRIATED FOR HEALTH
4
PLANNING TO THE HEALTH PLANNING PROGRAMS ESTABLISHED BY THE MARYLAND
5
HEALTH CARE COMMISSION TO SUPPORT THE OPERATION OF THOSE PROGRAMS.
6
(H)
THE BOARD SHALL PROVIDE FUNDS FROM THE FUND OR FUNDS
7
OTHERWISE APPROPRIATED FOR THE PURPOSE OF WORKER RETRAINING AND JOB
8
TRANSITION ASSISTANCE TO THE MARYLAND DEPARTMENT OF LABOR FOR:
9
(1)
A PROGRAM FOR RETRAINING AND ASSISTING WITH JOB
10
TRANSITION FOR INDIVIDUALS EMPLOYED OR PREVIOUSLY EMPLOYED IN THE
11
FIELDS OF HEALTH INSURANCE, HEALTH CARE SERVICE PLANS, AND OTHER
12
THIRD–PARTY PAYMENTS FOR HEALTH CARE; AND
13
(2)
A PROGRAM FOR RETRAINING AND ASSISTING WITH JOB
14
TRANSITION FOR THOSE INDIVIDUALS EMPLOYED OR PREVIOUSLY EMPLOYED IN
15
FIELDS PROVIDING SERVICES TO HEALTH CARE PROVIDERS TO DEAL WITH
16
THIRD–PARTY PAYORS FOR HEALTH CARE, WHOSE JOBS MAY BE OR HAVE BEEN
17
ENDED AS A RESULT OF THE IMPLEMENTATION OF HEALTHY MARYLAND.
18
(I)
(1)
FOR UP TO 5 YEARS FOLLOWING THE DATE ON WHICH BENEFITS
19
FIRST BECOME AVAILABLE UNDER HEALTHY MARYLAND, THE BOARD SHALL
20
PROVIDE AT LEAST 1% OF THE ANNUAL BUDGET OF HEALTHY MARYLAND TO
21
PROGRAMS PROVIDING ASSISTANCE TO WORKERS WHO PERFORM FUNCTIONS IN
22
THE ADMINISTRATION OF HEALTH INSURANCE OR OTHERS WHO MAY BE AFFECTED
23
BY THE IMPLEMENTATION OF HEALTHY MARYLAND AND WHO MAY EXPERIENCE
24
ECONOMIC DISLOCATION AS A RESULT OF THE IMPLEMENTATION OF THIS TITLE.
25
(2)
THE ASSISTANCE DESCRIBED IN PARAGRAPH (1) OF THIS
26
SUBSECTION SHALL INCLUDE WAGE REPLACEMENT, RETIREMENT BENEFITS, JOB
27
TRAINING, AND EDUCATION BENEFITS.
28
(J)
THE BOARD SHALL CARRY OUT THE FUNCTIONS REQUIRED OF THE
29
BOARD UNDER TITLE 31 OF THE INSURANCE ARTICLE UNTIL THE MARYLAND
30
HEALTH BENEFIT EXCHANGE CEASES TO OPERATE IN THE STATE.
31
(K)
THE BOARD MAY CONTRACT WITH NONPROFIT ORGANIZATIONS TO
32
PROVIDE:
33
(1)
ASSISTANCE TO CONSUMERS IN ENROLLING, OBTAINING HEALTH
34
HOUSE BILL 25
27
CARE SERVICES, DISENROLLING, AND OTHER MATTERS RELATING TO HEALTHY
1
MARYLAND; AND
2
(2)
ASSISTANCE TO HEALTH CARE PROVIDERS PROVIDING, SEEKING,
3
OR CONSIDERING WHETHER TO PROVIDE HEALTH CARE SERVICES UNDER HEALTHY
4
MARYLAND.
5
(L)
THE BOARD MAY DELEGATE TO THE EXECUTIVE DIRECTOR ANY OF ITS
6
DUTIES UNDER THIS SECTION.
7
25–304.
8
(A)
(1)
SUBJECT TO § 25–201(C) OF THIS TITLE, THE BOARD SHALL
9
DETERMINE WHEN INDIVIDUALS MAY BEGIN ENROLLING IN HEALTHY MARYLAND.
10
(2)
HEALTHY MARYLAND SHALL HAVE AN IMPLEMENTATION PERIOD
11
THAT SHALL:
12
(I)
BEGIN ON THE DATE THAT INDIVIDUALS MAY BEGIN
13
ENROLLING IN HEALTHY MARYLAND UNDER PARAGRAPH (1) OF THIS SUBSECTION;
14
AND
15
(II)
END ON A DATE DETERMINED BY THE BOARD.
16
(B)
(1)
THE BOARD SHALL ADOPT RULES OR REGULATIONS ON STATE
17
RESIDENCY REQUIREMENTS UNDER HEALTHY MARYLAND.
18
(2)
IN ADOPTING RULES OR REGULATIONS UNDER PARAGRAPH (1) OF
19
THIS SUBSECTION, THE BOARD SHALL BE GUIDED BY THE STATE RESIDENCY
20
REQUIREMENTS FOR THE MARYLAND MEDICAL ASSISTANCE PROGRAM AND THE
21
MARYLAND CHILDREN’S HEALTH INSURANCE PROGRAM.
22
(C)
A CARRIER MAY NOT OFFER BENEFITS OR COVER ANY SERVICES FOR
23
WHICH COVERAGE IS OFFERED TO INDIVIDUALS UNDER HEALTHY MARYLAND.
24
(D)
A CARRIER THAT IS ISSUED A CERTIFICATE OF AUTHORITY BY THE
25
MARYLAND INSURANCE COMMISSIONER MAY OFFER:
26
(1)
BENEFITS THAT DO NOT DUPLICATE THE HEALTH CARE SERVICES
27
COVERED BY HEALTHY MARYLAND;
28
(2)
BENEFITS
TO
OR
FOR
INDIVIDUALS,
INCLUDING
THE
29
INDIVIDUALS’ FAMILIES, WHO ARE EMPLOYED OR SELF–EMPLOYED IN THE STATE
30
28
HOUSE BILL 25
BUT WHO ARE NOT RESIDENTS OF THE STATE; AND
1
(3)
BENEFITS
DURING
THE
IMPLEMENTATION
PERIOD
TO
2
INDIVIDUALS WHO ENROLLED OR MAY ENROLL AS HEALTHY MARYLAND MEMBERS.
3
(E)
THIS TITLE DOES NOT PROHIBIT A RESIDENT WHO IS EMPLOYED
4
OUTSIDE THE STATE FROM CHOOSING TO RECEIVE HEALTH INSURANCE BENEFITS
5
THROUGH THE RESIDENT’S EMPLOYER AND OPTING OUT OF PARTICIPATION IN
6
HEALTHY MARYLAND.
7
(F)
AFTER THE END OF THE IMPLEMENTATION PERIOD, EACH BOARD
8
MEMBER SHALL ENROLL AS A HEALTHY MARYLAND MEMBER.
9
(G)
(1)
ON OR BEFORE DECEMBER 1, 2023, THE BOARD SHALL SUBMIT
10
TO THE GOVERNOR AND, IN ACCORDANCE WITH § 2–1257 OF THE STATE
11
GOVERNMENT ARTICLE, THE GENERAL ASSEMBLY A REPORT ON ANY CHANGES TO
12
THE LAWS OF THE STATE AND UNITS OF STATE GOVERNMENT NECESSARY TO
13
EFFECTIVELY CARRY OUT THE PROVISIONS OF THIS TITLE.
14
(2)
THE REPORT REQUIRED UNDER PARAGRAPH (1) OF THIS
15
SUBSECTION SHALL INCLUDE RECOMMENDATIONS ON THE REPEAL OR AMENDMENT
16
OF ANY LAWS OF THE STATE THAT ARE INCONSISTENT WITH THE PROVISIONS OF
17
THIS TITLE.
18
(H)
ON OR BEFORE DECEMBER 1, 2023, THE BOARD SHALL APPLY FOR ALL
19
WAIVERS FROM THE PROVISIONS OF THE EMPLOYMENT RETIREMENT INCOME
20
SECURITY ACT THAT ARE NECESSARY TO ENSURE THE PARTICIPATION OF ALL
21
RESIDENTS OF THE STATE IN HEALTHY MARYLAND.
22
(I)
THE BOARD SHALL DEVELOP PROPOSALS FOR ACCOMMODATING
23
EMPLOYER RETIREE HEALTH BENEFITS FOR:
24
(1)
INDIVIDUALS WHO HAVE BEEN HEALTHY MARYLAND MEMBERS
25
BUT LIVE AS RETIREES OUTSIDE THE STATE; AND
26
(2)
INDIVIDUALS WHO EARNED OR ACCRUED THOSE BENEFITS WHILE
27
RESIDING IN THE STATE BEFORE THE IMPLEMENTATION OF HEALTHY MARYLAND
28
AND LIVE AS RETIREES OUTSIDE THE STATE.
29
(J)
THE BOARD SHALL DEVELOP A PROPOSAL FOR HEALTHY MARYLAND
30
COVERAGE OF HEALTH CARE SERVICES CURRENTLY COVERED UNDER THE STATE
31
WORKERS’ COMPENSATION SYSTEM, INCLUDING WHETHER AND HOW TO:
32
HOUSE BILL 25
29
(1)
CONTINUE FUNDING FOR THOSE SERVICES UNDER THE WORKERS’
1
COMPENSATION SYSTEM; AND
2
(2)
INCORPORATE AN ELEMENT OF EXPERIENCE RATING.
3
25–305.
4
(A)
THE BOARD SHALL REQUIRE AND ENFORCE THE COLLECTION AND
5
AVAILABILITY OF ALL THE FOLLOWING DATA TO PROMOTE TRANSPARENCY, ASSESS
6
QUALITY OF PATIENT CARE, COMPARE PATIENT OUTCOMES, AND REVIEW
7
UTILIZATION OF HEALTH CARE SERVICES PAID FOR BY HEALTHY MARYLAND:
8
(1)
HOSPITAL INPATIENT DISCHARGE DATA FOR EACH DISCHARGE,
9
INCLUDING SEVERITY OF ILLNESS, RISK OF MORTALITY, COST DATA, CHARGE DATA,
10
LENGTH OF STAY DATA, AND PATIENT CARE UNIT DATA;
11
(2)
EMERGENCY DEPARTMENT, AMBULATORY SURGERY CENTER,
12
AND OTHER OUTPATIENT FACILITY DATA FOR EACH HEALTHY MARYLAND MEMBER
13
RECEIVING ITEMS AND SERVICES, INCLUDING COST DATA, CHARGE DATA, LENGTH
14
OF STAY DATA, AND PATIENT CARE UNIT DATA;
15
(3)
ANNUAL FINANCIAL DATA FOR ALL PROVIDERS OF SERVICES
16
RECEIVING PAYMENT UNDER § 25–802 OF THIS TITLE, INCLUDING:
17
(I)
THE DOLLAR VALUE AT COST OF COMMUNITY BENEFITS
18
ACTIVITIES, INCLUDING CHARITY CARE, PROVIDED BY THE PROVIDER OF SERVICES;
19
(II)
NUMBER OF EMPLOYEES BY JOB CLASSIFICATION FOR
20
EACH HOSPITAL AND OUTPATIENT UNIT;
21
(III) NUMBER OF HOURS WORKED BY JOB CLASSIFICATION FOR
22
EACH HOSPITAL AND OUTPATIENT UNIT;
23
(IV) EMPLOYEE WAGE INFORMATION BY JOB CLASSIFICATION
24
FOR EACH HOSPITAL AND OUTPATIENT UNIT;
25
(V)
NUMBER OF REGISTERED NURSES PER STAFFED BED BY
26
HOSPITAL UNIT;
27
(VI) TYPE AND DOLLAR VALUE OF HEALTH INFORMATION
28
TECHNOLOGY; AND
29
(VII) ANNUAL
SPENDING
ON
HEALTH
INFORMATION
30
30
HOUSE BILL 25
TECHNOLOGY, INCLUDING PURCHASES, UPGRADES, AND MAINTENANCE;
1
(4)
RISK–ADJUSTED AND RAW DATA ON PATIENT OUTCOMES,
2
INCLUDING DATA ON MEDICAL, SURGICAL, OBSTETRIC, AND OTHER PROCEDURES;
3
(5)
PHYSICIAN SERVICES AND OFFICE VISITS, INCLUDING COST DATA
4
AND CHARGE DATA;
5
(6)
PRESCRIPTION DRUG COST DATA AND CHARGE DATA FOR
6
PRESCRIPTION DRUGS PRESCRIBED AND DISPENSED THROUGH HOSPITALS,
7
EMERGENCY DEPARTMENTS, AMBULATORY SURGERY CENTERS AND OTHER
8
OUTPATIENT FACILITIES, OR A PHYSICIAN’S OFFICE; AND
9
(7)
ANY OTHER DATA THAT THE PROVIDER REPORTS TO ANY OTHER
10
STATE, LOCAL, OR FEDERAL AGENCY.
11
(B)
DATA COLLECTED UNDER SUBSECTION (A) OF THIS SECTION SHALL BE
12
REPORTED TO THE HEALTH SERVICES COST REVIEW COMMISSION.
13
(C)
THIS SECTION DOES NOT CHANGE OR IMPACT IN ANY WAY PROVIDER
14
REPORTING REQUIREMENTS TO ANY STATE, LOCAL, OR FEDERAL AGENCY AS
15
ESTABLISHED UNDER STATE LAW.
16
(D)
THE BOARD SHALL ESTABLISH REPORTING REQUIREMENTS AND
17
STANDARDS NECESSARY TO EVALUATE AND ELIMINATE HEALTH CARE DISPARITIES,
18
INCLUDING GEOGRAPHIC, RACIAL, INCOME–BASED, GENDER–BASED, SEX–BASED,
19
AND OTHER DISPARITIES.
20
(E)
THE BOARD SHALL MAKE ALL DISCLOSED DATA COLLECTED UNDER
21
SUBSECTION (A) OF THIS SECTION PUBLICLY AVAILABLE THROUGH:
22
(1)
A SEARCHABLE WEBSITE; AND
23
(2)
THE HEALTH SERVICES COST REVIEW COMMISSION.
24
(F)
THE BOARD SHALL, DIRECTLY AND THROUGH GRANTS TO NONPROFIT
25
ORGANIZATIONS, CONDUCT PROGRAMS USING DATA COLLECTED THROUGH
26
HEALTHY MARYLAND TO PROMOTE AND PROTECT PUBLIC, ENVIRONMENTAL, AND
27
OCCUPATIONAL HEALTH, INCLUDING THROUGH COOPERATION WITH OTHER DATA
28
COLLECTION AND RESEARCH PROGRAMS OF THE MARYLAND HEALTH CARE
29
COMMISSION, THE HEALTH SERVICES COST REVIEW COMMISSION, AND THE
30
DEPARTMENT CONSISTENT WITH THIS TITLE AND OTHERWISE APPLICABLE LAW.
31
HOUSE BILL 25
31
(G)
BEFORE FULL IMPLEMENTATION OF HEALTHY MARYLAND, THE BOARD
1
SHALL PROVIDE FOR THE COLLECTION AND AVAILABILITY OF THE FOLLOWING DATA
2
FROM HOSPITALS AND OTHER PROVIDERS THAT SEEK TO PARTICIPATE IN HEALTHY
3
MARYLAND:
4
(1)
FINANCIAL DATA;
5
(2)
THE NUMBER OF PATIENTS SERVED; AND
6
(3)
THE ACTUAL EXPENDITURES AND DOLLAR VALUE OF THE CARE
7
PROVIDED, AT COST, FOR THE FOLLOWING CATEGORIES OF DATA ITEMS:
8
(I)
PATIENTS RECEIVING CHARITY CARE;
9
(II)
CONTRACTUAL ADJUSTMENTS OF COUNTY AND INDIGENT
10
PROGRAMS, INCLUDING TRADITIONAL AND MANAGED CARE; AND
11
(III) BAD DEBTS.
12
SUBTITLE 4. HEALTHY MARYLAND PUBLIC ADVISORY COMMITTEE.
13
25–401.
14
(A)
THERE IS A HEALTHY MARYLAND PUBLIC ADVISORY COMMITTEE.
15
(B)
THE COMMITTEE CONSISTS OF THE FOLLOWING MEMBERS:
16
(1)
FOUR
PHYSICIANS
WHO
ARE
BOARD
CERTIFIED
IN
THE
17
PHYSICIANS’ RESPECTIVE FIELDS:
18
(I)
AT LEAST ONE OF WHOM SHALL BE A PSYCHIATRIST;
19
(II)
ONE OF WHOM SHALL BE APPOINTED BY THE PRESIDENT OF
20
THE SENATE;
21
(III) ONE OF WHOM SHALL BE APPOINTED BY THE GOVERNOR;
22
AND
23
(IV) TWO OF WHOM SHALL BE:
24
1.
APPOINTED BY THE SPEAKER OF THE HOUSE; AND
25
2.
PRIMARY CARE PROVIDERS;
26
32
HOUSE BILL 25
(2)
TWO REGISTERED NURSES, APPOINTED BY THE PRESIDENT OF
1
THE SENATE;
2
(3)
ONE LICENSED ALLIED HEALTH PRACTITIONER, APPOINTED BY
3
THE SPEAKER OF THE HOUSE;
4
(4)
ONE BEHAVIORAL HEALTH CARE PROVIDER, APPOINTED BY THE
5
PRESIDENT OF THE SENATE;
6
(5)
ONE DENTIST, APPOINTED BY THE GOVERNOR;
7
(6)
ONE REPRESENTATIVE OF PRIVATE HOSPITALS, APPOINTED BY
8
THE GOVERNOR;
9
(7)
ONE REPRESENTATIVE OF PUBLIC HOSPITALS, APPOINTED BY
10
THE GOVERNOR;
11
(8)
FOUR CONSUMERS OF HEALTH CARE:
12
(I)
TWO OF WHOM SHALL BE APPOINTED BY THE GOVERNOR,
13
INCLUDING ONE WHO IS A MEMBER OF THE DISABLED COMMUNITY;
14
(II)
ONE OF WHOM SHALL BE:
15
1.
APPOINTED BY THE PRESIDENT OF THE SENATE; AND
16
2.
A HEALTHY MARYLAND MEMBER WHO IS AT LEAST 65
17
YEARS OLD; AND
18
(III) ONE OF WHOM SHALL BE APPOINTED BY THE SPEAKER OF
19
THE HOUSE;
20
(9)
TWO REPRESENTATIVES OF ORGANIZED LABOR:
21
(I)
ONE OF WHOM SHALL BE APPOINTED BY THE PRESIDENT OF
22
THE SENATE; AND
23
(II)
ONE OF WHOM SHALL BE APPOINTED BY THE SPEAKER OF
24
THE HOUSE;
25
(10) ONE REPRESENTATIVE OF ESSENTIAL COMMUNITY PROVIDERS,
26
APPOINTED BY THE PRESIDENT OF THE SENATE;
27
HOUSE BILL 25
33
(11) ONE REPRESENTATIVE OF A SMALL BUSINESS THAT EMPLOYS
1
FEWER THAN 25 EMPLOYEES, APPOINTED BY THE GOVERNOR;
2
(12) ONE REPRESENTATIVE OF A LARGE BUSINESS THAT EMPLOYS
3
MORE THAN 250 EMPLOYEES, APPOINTED BY THE SPEAKER OF THE HOUSE; AND
4
(13) ONE PHARMACIST, APPOINTED BY THE SPEAKER OF THE HOUSE.
5
(C)
EACH COMMITTEE MEMBER MUST HAVE WORKED IN THE FIELD THE
6
MEMBER REPRESENTS ON THE COMMITTEE FOR A PERIOD OF AT LEAST 2 YEARS
7
BEFORE BEING APPOINTED TO THE COMMITTEE.
8
(D)
(1)
THE TERM OF A MEMBER IS 4 YEARS.
9
(2)
THE TERMS OF MEMBERS ARE STAGGERED AS REQUIRED BY THE
10
TERMS PROVIDED FOR MEMBERS OF THE COMMITTEE ON JULY 1, 2023.
11
(3)
AT THE END OF A TERM, A MEMBER CONTINUES TO SERVE UNTIL
12
A SUCCESSOR IS APPOINTED AND QUALIFIES.
13
(4)
A MEMBER WHO IS APPOINTED AFTER A TERM HAS BEGUN SERVES
14
ONLY FOR THE REST OF THE TERM AND UNTIL A SUCCESSOR IS APPOINTED AND
15
QUALIFIES.
16
(5)
(I)
IF A VACANCY OCCURS, THE APPOINTING AUTHORITY
17
PROMPTLY SHALL APPOINT A SUCCESSOR WHO SHALL SERVE UNTIL THE TERM
18
EXPIRES.
19
(II)
A MEMBER APPOINTED UNDER SUBPARAGRAPH (I) OF THIS
20
PARAGRAPH MAY BE REAPPOINTED FOR A FULL TERM.
21
(6)
A MEMBER MAY NOT SERVE FOR MORE THAN TWO CONSECUTIVE
22
TERMS.
23
(7)
FROM AMONG ITS MEMBERS, THE COMMITTEE SHALL ELECT A
24
CHAIR WHO SHALL SERVE 2 YEARS AND WHO MAY BE REELECTED FOR AN
25
ADDITIONAL 2 YEARS.
26
(E)
IN MAKING APPOINTMENTS OF MEMBERS UNDER SUBSECTION (B) OF
27
THIS SECTION, THE APPOINTING AUTHORITY SHALL MAKE GOOD FAITH EFFORTS TO
28
ENSURE THAT THE APPOINTMENTS, AS A WHOLE, REFLECT, TO THE GREATEST
29
EXTENT PRACTICABLE, THE SOCIOECONOMIC AND GEOGRAPHIC DIVERSITY OF THE
30
34
HOUSE BILL 25
STATE.
1
(F)
THE COMMITTEE SHALL ADVISE THE BOARD ON ALL MATTERS OF
2
POLICY RELATED TO HEALTHY MARYLAND.
3
(G)
A COMMITTEE MEMBER OR ANY OF THE MEMBER’S ASSISTANTS,
4
CLERKS, OR DEPUTIES MAY NOT USE FOR PERSONAL BENEFIT ANY INFORMATION
5
THAT IS:
6
(1)
FILED WITH, OR OBTAINED BY, THE COMMITTEE; AND
7
(2)
NOT GENERALLY AVAILABLE TO THE PUBLIC.
8
(H)
(1)
THE COMMITTEE SHALL MEET AT LEAST SIX TIMES PER YEAR IN
9
A PLACE CONVENIENT TO THE PUBLIC SUBJECT TO TITLE 3 OF THE GENERAL
10
PROVISIONS ARTICLE.
11
(2)
ELEVEN MEMBERS OF THE COMMITTEE CONSTITUTE A QUORUM.
12
(3)
ACTION BY THE COMMITTEE REQUIRES THE AFFIRMATIVE VOTE
13
OF AT LEAST 12 MEMBERS.
14
(I)
A MEMBER OF THE COMMITTEE:
15
(1)
MAY NOT RECEIVE COMPENSATION AS A MEMBER OF THE
16
COMMITTEE; BUT
17
(2)
IS ENTITLED TO:
18
(I)
A PER DIEM RATE AS PROVIDED IN THE STATE BUDGET FOR
19
ATTENDING SCHEDULED MEETINGS OF THE COMMITTEE; AND
20
(II)
REIMBURSEMENT FOR EXPENSES UNDER THE STANDARD
21
STATE TRAVEL REGULATIONS, AS PROVIDED IN THE STATE BUDGET.
22
(J)
A MEMBER OF THE COMMITTEE SHALL PERFORM THE MEMBER’S
23
DUTIES:
24
(1)
IN GOOD FAITH;
25
(2)
IN THE MANNER THE MEMBER REASONABLY BELIEVES TO BE IN
26
THE BEST INTEREST OF HEALTHY MARYLAND; AND
27
HOUSE BILL 25
35
(3)
WITHOUT INTENTIONAL OR RECKLESS DISREGARD OF THE CARE
1
AN ORDINARILY PRUDENT PERSON IN A LIKE POSITION WOULD USE UNDER SIMILAR
2
CIRCUMSTANCES.
3
(K)
(1)
(I)
A MEMBER OF THE COMMITTEE SHALL BE SUBJECT TO
4
TITLE 5, SUBTITLES 1 THROUGH 7 OF THE GENERAL PROVISIONS ARTICLE.
5
(II)
IN ADDITION TO THE DISCLOSURE REQUIRED UNDER TITLE
6
5, SUBTITLE 6 OF THE GENERAL PROVISIONS ARTICLE, A MEMBER OF THE
7
COMMITTEE SHALL DISCLOSE TO THE COMMITTEE AND TO THE PUBLIC ANY
8
RELATIONSHIP NOT ADDRESSED IN THE REQUIRED FINANCIAL DISCLOSURE THAT
9
THE MEMBER HAS WITH:
10
1.
A HEALTH CARE PROVIDER;
11
2.
A HEALTH CLINIC;
12
3.
A PHARMACEUTICAL COMPANY;
13
4.
A MEDICAL EQUIPMENT COMPANY;
14
5.
A CARRIER;
15
6.
AN INSURANCE PRODUCER;
16
7.
A THIRD–PARTY ADMINISTRATOR;
17
8.
A MANAGED CARE ORGANIZATION; OR
18
9.
ANY OTHER ENTITY IN AN INDUSTRY INVOLVED IN
19
MATTERS LIKELY TO COME BEFORE THE COMMITTEE.
20
(2)
ON ALL MATTERS THAT COME BEFORE THE COMMITTEE, A
21
MEMBER SHALL:
22
(I)
ADHERE STRICTLY TO THE CONFLICT OF INTEREST
23
PROVISIONS UNDER TITLE 5, SUBTITLE 5 OF THE GENERAL PROVISIONS ARTICLE
24
RELATING TO RESTRICTIONS ON PARTICIPATION, EMPLOYMENT, AND FINANCIAL
25
INTERESTS; AND
26
(II)
PROVIDE FULL DISCLOSURE TO THE COMMITTEE AND THE
27
PUBLIC ON:
28
36
HOUSE BILL 25
1.
ANY MATTER THAT GIVES RISE TO A POTENTIAL
1
CONFLICT OF INTEREST; AND
2
2.
THE MANNER IN WHICH THE MEMBER WILL COMPLY
3
WITH THE PROVISIONS OF TITLE 5, SUBTITLE 5 OF THE GENERAL PROVISIONS
4
ARTICLE TO AVOID ANY CONFLICT OF INTEREST OR APPEARANCE OF A CONFLICT
5
OF INTEREST.
6
(L)
A MEMBER OF THE COMMITTEE WHO PERFORMS THE MEMBER’S DUTIES
7
IN ACCORDANCE WITH THE STANDARD ESTABLISHED UNDER SUBSECTION (J) OF
8
THIS SECTION MAY NOT BE LIABLE PERSONALLY FOR ACTIONS TAKEN AS A MEMBER
9
WHEN DONE IN GOOD FAITH, WITHOUT INTENT TO DEFRAUD, AND IN CONNECTION
10
WITH THE ADMINISTRATION, MANAGEMENT, OR CONDUCT OF THIS TITLE OR
11
ACTIONS RELATED TO THIS TITLE.
12
(M)
A MEMBER OF THE COMMITTEE MAY BE REMOVED FOR INCOMPETENCE,
13
MISCONDUCT, OR FAILURE TO PERFORM THE DUTIES OF THE POSITION.
14
SUBTITLE 5. ELIGIBILITY AND ENROLLMENT.
15
25–501.
16
(A)
EACH RESIDENT OF THE STATE IS ELIGIBLE TO:
17
(1)
ENROLL AS A HEALTHY MARYLAND MEMBER; AND
18
(2)
RECEIVE BENEFITS FOR HEALTH CARE SERVICES COVERED BY
19
HEALTHY MARYLAND.
20
(B)
HEALTHY MARYLAND MEMBERS ARE NOT REQUIRED TO PAY ANY FEE,
21
PAYMENT, OR OTHER CHARGE FOR ENROLLING IN OR BEING A HEALTHY MARYLAND
22
MEMBER.
23
(C)
A PARTICIPATING PROVIDER MAY NOT:
24
(1)
REQUIRE HEALTHY MARYLAND MEMBERS TO PAY ANY PREMIUM,
25
CO–PAYMENT, COINSURANCE, DEDUCTIBLE, OR OTHER FORM OF COST SHARING
26
FOR ANY COVERED BENEFITS;
27
(2)
USE PREEXISTING MEDICAL CONDITIONS TO DETERMINE THE
28
ELIGIBILITY OF A HEALTHY MARYLAND MEMBER TO RECEIVE BENEFITS FOR
29
HEALTH CARE SERVICES COVERED BY HEALTHY MARYLAND; OR
30
HOUSE BILL 25
37
(3)
REFUSE TO PROVIDE HEALTH CARE SERVICES TO A HEALTHY
1
MARYLAND MEMBER ON THE BASIS OF:
2
(I)
RACE;
3
(II)
COLOR;
4
(III) RELIGION OR CREED;
5
(IV) SEX;
6
(V)
AGE;
7
(VI) ANCESTRY OR NATIONAL ORIGIN;
8
(VII) MARITAL STATUS;
9
(VIII) MENTAL OR PHYSICAL DISABILITY;
10
(IX) SEXUAL ORIENTATION;
11
(X)
GENDER IDENTITY OR EXPRESSION;
12
(XI) CITIZENSHIP;
13
(XII) IMMIGRATION STATUS;
14
(XIII) PRIMARY LANGUAGE;
15
(XIV) MEDICAL CONDITION;
16
(XV) GENETIC INFORMATION;
17
(XVI) FAMILIAL STATUS;
18
(XVII)
MILITARY OR VETERAN STATUS;
19
(XVIII)
GEOGRAPHY; OR
20
(XIX) SOURCE OF INCOME.
21
(D)
A COLLEGE, A UNIVERSITY, OR ANY OTHER INSTITUTION OF HIGHER
22
EDUCATION IN THE STATE MAY PURCHASE COVERAGE UNDER HEALTHY MARYLAND
23
38
HOUSE BILL 25
FOR A STUDENT, OR A STUDENT’S DEPENDENT, WHO IS NOT A RESIDENT OF THE
1
STATE.
2
25–502.
3
(A)
IF A STATE RESIDENT IS EMPLOYED OUTSIDE THE STATE BY AN
4
EMPLOYER THAT IS SUBJECT TO STATE LAW, THE EMPLOYER AND EMPLOYEE SHALL
5
PAY ANY PAYROLL PREMIUM ADOPTED UNDER THIS TITLE AS TO THAT EMPLOYEE
6
AS IF THE EMPLOYMENT WERE IN THE STATE.
7
(B)
IF A STATE RESIDENT IS EMPLOYED OUTSIDE THE STATE BY AN
8
EMPLOYER THAT IS NOT SUBJECT TO STATE LAW, EITHER:
9
(1)
THE EMPLOYER AND EMPLOYEE SHALL VOLUNTARILY PAY ANY
10
PAYROLL PREMIUM ADOPTED UNDER THIS TITLE AS TO THAT EMPLOYEE AS IF THE
11
EMPLOYMENT WERE IN THE STATE; OR
12
(2)
THE EMPLOYEE SHALL PAY THE PAYROLL PREMIUM ADOPTED
13
UNDER THIS TITLE AS IF THE EMPLOYEE WERE SELF–EMPLOYED.
14
(C)
ANY PAYROLL PREMIUM ADOPTED UNDER THIS TITLE APPLIES TO:
15
(1)
AN OUT–OF–STATE RESIDENT EMPLOYED IN THE STATE; AND
16
(2)
AN OUT–OF–STATE RESIDENT SELF–EMPLOYED IN THE STATE.
17
(D)
(1)
A STATE RESIDENT WHO IS EMPLOYED OUTSIDE THE STATE MAY
18
CHOOSE TO RECEIVE HEALTH INSURANCE BENEFITS THROUGH THE RESIDENT’S
19
EMPLOYER AND OPT OUT OF PARTICIPATION IN HEALTHY MARYLAND.
20
(2)
THE
BOARD
SHALL
DEVELOP
AND
IMPLEMENT
RULES
21
ESTABLISHING PROCEDURES FOR STATE RESIDENTS EMPLOYED OUTSIDE THE
22
STATE TO OPT OUT OF PARTICIPATION IN HEALTHY MARYLAND.
23
(E)
NEGOTIATED
HEALTH
INSURANCE
CONTRIBUTIONS
MADE
BY
24
EMPLOYERS ON BEHALF OF EMPLOYEES WHO ARE WORKING IN THE STATE BUT
25
RESIDING OUTSIDE THE STATE MAY NOT BE ABRIDGED BY THIS TITLE.
26
25–503.
27
(A)
(1)
IF AN OUT–OF–STATE RESIDENT IS EMPLOYED IN THE STATE, THE
28
OUT–OF–STATE RESIDENT AND THE OUT–OF–STATE RESIDENT’S EMPLOYER MAY
29
TAKE A CREDIT AGAINST ANY PAYROLL PREMIUM ADOPTED UNDER THIS TITLE THAT
30
HOUSE BILL 25
39
THE INDIVIDUAL OR THE INDIVIDUAL’S EMPLOYER WOULD OTHERWISE PAY AS TO
1
THAT INDIVIDUAL.
2
(2)
THE CREDIT TAKEN UNDER THIS SUBSECTION IS FOR AMOUNTS
3
SPENT ON HEALTH BENEFITS FOR THE INDIVIDUAL THAT WOULD OTHERWISE BE
4
COVERED BY HEALTHY MARYLAND IF THAT INDIVIDUAL WERE A HEALTHY
5
MARYLAND MEMBER.
6
(3)
THE CREDIT TAKEN UNDER THIS SUBSECTION SHALL BE
7
DISTRIBUTED
BETWEEN
THE
INDIVIDUAL
AND
EMPLOYER
IN
THE
SAME
8
PROPORTION AS THE SPENDING BY EACH FOR THE HEALTH BENEFITS.
9
(4)
AN EMPLOYER AND EMPLOYEE MAY APPLY THEIR RESPECTIVE
10
PORTIONS OF THE CREDIT AVAILABLE UNDER THIS SUBSECTION TO THEIR
11
RESPECTIVE PORTIONS OF THE PAYROLL PREMIUM ADOPTED UNDER THIS TITLE.
12
(B)
(1)
IF AN OUT–OF–STATE RESIDENT IS SELF–EMPLOYED IN THE
13
STATE, THE INDIVIDUAL MAY TAKE A CREDIT AGAINST ANY PAYROLL PREMIUM
14
ADOPTED UNDER THIS TITLE THAT THE INDIVIDUAL WOULD OTHERWISE PAY.
15
(2)
A CREDIT TAKEN UNDER PARAGRAPH (1) OF THIS SUBSECTION IS
16
FOR AMOUNTS THE INDIVIDUAL SPENDS ON HEALTH BENEFITS THAT WOULD
17
OTHERWISE BE COVERED BY HEALTHY MARYLAND IF THE INDIVIDUAL WERE A
18
HEALTHY MARYLAND MEMBER.
19
(C)
(1)
A CREDIT TAKEN BY INDIVIDUALS UNDER SUBSECTION (B) OF
20
THIS SECTION IS LIMITED TO SPENDING FOR HEALTH BENEFITS.
21
(2)
AN INDIVIDUAL MAY NOT TAKE A CREDIT UNDER SUBSECTION (B)
22
OF THIS SECTION FOR OUT–OF–POCKET HEALTH CARE SPENDING.
23
(D)
A CREDIT UNDER THIS SECTION IS AVAILABLE REGARDLESS OF:
24
(1)
THE COST OR COMPREHENSIVENESS OF THE HEALTH BENEFIT;
25
OR
26
(2)
THE FORM OF THE HEALTH BENEFIT.
27
(E)
(1)
AN EMPLOYER OR INDIVIDUAL MAY TAKE A CREDIT UNDER THIS
28
SECTION ONLY AGAINST PAYROLL PREMIUMS ADOPTED UNDER THIS TITLE.
29
(2)
AN EMPLOYER OR INDIVIDUAL MAY NOT APPLY ANY HEALTH
30
BENEFIT SPENDING IN EXCESS OF THE PAYROLL PREMIUM TO OTHER TAX LIABILITY.
31
40
HOUSE BILL 25
SUBTITLE 6. BENEFITS.
1
25–601.
2
(A)
(1)
COVERED HEALTH CARE BENEFITS UNDER HEALTHY MARYLAND
3
SHALL INCLUDE ALL MEDICAL CARE PROVIDED TO A HEALTHY MARYLAND MEMBER
4
THAT IS:
5
(I)
MEDICALLY NECESSARY OR APPROPRIATE AS DETERMINED
6
BY THE HEALTHY MARYLAND MEMBER’S:
7
1.
TREATING PHYSICIAN; OR
8
2.
HEALTH CARE PROVIDER WHO, IN ACCORDANCE
9
WITH THE PROVIDER’S SCOPE OF PRACTICE AND LICENSURE, IS AUTHORIZED TO
10
ESTABLISH A MEDICAL DIAGNOSIS AND HAS MADE A MEDICAL ASSESSMENT OF THE
11
HEALTHY MARYLAND MEMBER’S CONDITION; AND
12
(II)
IN
ACCORDANCE
WITH
THE
HEALTHY
MARYLAND
13
STANDARDS ESTABLISHED IN SUBTITLE 9 OF THIS TITLE AND BY THE BOARD.
14
(2)
A HEALTHY MARYLAND MEMBER’S TREATING PHYSICIAN OR ANY
15
OTHER HEALTH CARE PROVIDER TREATING THE HEALTHY MARYLAND MEMBER IS:
16
(I)
AN APPROVED HEALTH CARE PROVIDER UNDER § 25–701
17
OF THIS TITLE; AND
18
(II)
IN
ACCORDANCE
WITH
THE
PROVIDER’S
SCOPE
OF
19
PRACTICE AND LICENSURE, AUTHORIZED TO ESTABLISH A MEDICAL DIAGNOSIS AND
20
MAKE A MEDICAL ASSESSMENT OF THE HEALTHY MARYLAND MEMBER’S
21
CONDITION.
22
(B)
COVERED
HEALTH
CARE
BENEFITS
FOR HEALTHY MARYLAND
23
MEMBERS INCLUDE:
24
(1)
INPATIENT AND OUTPATIENT MEDICAL AND HEALTH CARE
25
FACILITY SERVICES;
26
(2)
INPATIENT AND OUTPATIENT PROFESSIONAL HEALTH CARE
27
PROVIDER MEDICAL SERVICES;
28
(3)
DIAGNOSTIC IMAGING, LABORATORY SERVICES, AND OTHER
29
HOUSE BILL 25
41
DIAGNOSTIC AND EVALUATIVE SERVICES;
1
(4)
(I)
MEDICAL
EQUIPMENT,
APPLIANCES,
AND
ASSISTIVE
2
TECHNOLOGY, INCLUDING:
3
1.
PROSTHETICS;
4
2.
EYEGLASSES; AND
5
3.
HEARING AIDS; AND
6
(II)
THE REPAIR, TECHNICAL SUPPORT, AND CUSTOMIZATION
7
NEEDED FOR INDIVIDUAL USE OF MEDICAL EQUIPMENT, APPLIANCES, AND
8
ASSISTIVE TECHNOLOGY;
9
(5)
INPATIENT AND OUTPATIENT REHABILITATIVE CARE;
10
(6)
EMERGENCY CARE SERVICES;
11
(7)
EMERGENCY TRANSPORTATION;
12
(8)
NECESSARY TRANSPORTATION FOR HEALTH CARE SERVICES FOR
13
PERSONS WITH DISABILITIES OR WHO MAY QUALIFY AS LOW–INCOME;
14
(9)
CHILD AND ADULT IMMUNIZATIONS AND PREVENTIVE CARE;
15
(10) HEALTH AND WELLNESS EDUCATION;
16
(11) HOSPICE CARE;
17
(12) CARE IN A SKILLED NURSING FACILITY;
18
(13) HOME HEALTH CARE, INCLUDING HEALTH CARE PROVIDED IN AN
19
ASSISTED LIVING FACILITY;
20
(14) MENTAL HEALTH SERVICES;
21
(15) SUBSTANCE ABUSE TREATMENT;
22
(16) DENTAL CARE;
23
(17) VISION CARE;
24
42
HOUSE BILL 25
(18) PRESCRIPTION DRUGS;
1
(19) PEDIATRIC CARE;
2
(20) PRENATAL AND POSTNATAL CARE;
3
(21) PODIATRIC CARE;
4
(22) EARLY
AND
PERIODIC
SCREENING,
DIAGNOSTIC,
AND
5
TREATMENT SERVICES AS DEFINED IN § 1905(R) OF THE SOCIAL SECURITY ACT;
6
(23) DIETARY AND NUTRITIONAL THERAPIES APPROVED BY THE
7
BOARD UNDER § 25–602 OF THIS SUBTITLE;
8
(24) ACUPUNCTURE;
9
(25) THERAPIES THAT ARE SHOWN BY THE NATIONAL INSTITUTES OF
10
HEALTH, NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH
11
TO BE SAFE AND EFFECTIVE;
12
(26) BLOOD AND BLOOD PRODUCTS;
13
(27) DIALYSIS;
14
(28) ADULT DAY CARE;
15
(29) HABILITATIVE AND REHABILITATIVE SERVICES;
16
(30) ANCILLARY HEALTH CARE OR SOCIAL SERVICES PREVIOUSLY
17
COVERED BY THE COMMUNITY INTEGRATED MEDICAL HOME PROGRAM UNDER §
18
19–1B–02 OF THIS ARTICLE;
19
(31) CASE MANAGEMENT AND CARE COORDINATION;
20
(32) LANGUAGE INTERPRETATION AND TRANSLATION FOR HEALTH
21
CARE SERVICES, INCLUDING SIGN LANGUAGE, BRAILLE, AND ANY OTHER SERVICES
22
NEEDED FOR INDIVIDUALS WITH COMMUNICATION BARRIERS;
23
(33) HEALTH CARE AND LONG–TERM SERVICES AND SUPPORTS THAT
24
ARE:
25
(I)
COVERED
UNDER
MEDICAID
OR
THE
MARYLAND
26
CHILDREN’S HEALTH INSURANCE PROGRAM ON JANUARY 1, 2023; AND
27
HOUSE BILL 25
43
(II)
DESCRIBED IN § 25–603 OF THIS SUBTITLE;
1
(34) ALL
HEALTH
CARE
SERVICES
FOR
WHICH
COVERAGE
IS
2
REQUIRED BY OR UNDER ANY OF THE FOLLOWING PROGRAMS OR ENTITIES,
3
WITHOUT REGARD TO WHETHER THE HEALTHY MARYLAND MEMBER WOULD
4
OTHERWISE BE ELIGIBLE FOR OR COVERED BY THE PROGRAM OR SOURCE
5
REFERRED TO:
6
(I)
MEDICAID; AND
7
(II)
MEDICARE;
8
(35) ANY HEALTH CARE SERVICES ADDED TO HEALTHY MARYLAND
9
BENEFITS BY THE BOARD, AS AUTHORIZED UNDER THIS TITLE; AND
10
(36) ALL
ESSENTIAL
HEALTH
BENEFITS
MANDATED
BY
THE
11
AFFORDABLE CARE ACT AS OF JANUARY 1, 2017.
12
25–602.
13
(A)
ON A REGULAR BASIS, THE BOARD SHALL EVALUATE WHETHER
14
COVERED BENEFITS UNDER HEALTHY MARYLAND SHOULD BE IMPROVED OR
15
ADJUSTED:
16
(1)
TO PROMOTE THE HEALTH OF BENEFICIARIES;
17
(2)
TO ACCOUNT FOR CHANGES IN MEDICAL PRACTICE OR NEW
18
INFORMATION FROM MEDICAL RESEARCH; OR
19
(3)
TO RESPOND TO OTHER RELEVANT DEVELOPMENTS IN HEALTH
20
SCIENCE.
21
(B)
IN CARRYING OUT SUBSECTION (A) OF THIS SECTION, THE BOARD
22
SHALL CONSULT WITH THE PERSONS DESCRIBED IN SUBSECTION (C) OF THIS
23
SECTION ON:
24
(1)
IDENTIFYING SPECIFIC COMPLEMENTARY AND INTEGRATIVE
25
MEDICINE PRACTICES THAT, ON THE BASIS OF RESEARCH FINDINGS OR PROMISING
26
CLINICAL INTERVENTIONS, ARE APPROPRIATE TO INCLUDE IN THE BENEFITS
27
PACKAGE; AND
28
(2)
IDENTIFYING:
29
44
HOUSE BILL 25
(I)
BARRIERS
TO
THE
EFFECTIVE
PROVISION
AND
1
INTEGRATION OF SUCH PRACTICES INTO THE DELIVERY OF HEALTH CARE; AND
2
(II)
MECHANISMS FOR OVERCOMING SUCH BARRIERS.
3
(C)
IN ACCORDANCE WITH SUBSECTION (B) OF THIS SECTION, THE BOARD
4
SHALL CONSULT WITH:
5
(1)
INSTITUTIONS OF HIGHER EDUCATION, PRIVATE RESEARCH
6
INSTITUTES, AND INDIVIDUAL RESEARCHERS WITH EXTENSIVE EXPERIENCE IN
7
COMPLEMENTARY AND ALTERNATIVE MEDICINE AND THE INTEGRATION OF SUCH
8
PRACTICES INTO THE DELIVERY OF HEALTH CARE;
9
(2)
NATIONALLY RECOGNIZED PROVIDERS OF COMPLEMENTARY AND
10
INTEGRATIVE MEDICINE; AND
11
(3)
OTHER OFFICIALS, ENTITIES, AND INDIVIDUALS WITH EXPERTISE
12
ON COMPLEMENTARY AND INTEGRATIVE MEDICINE AS THE BOARD DETERMINES
13
APPROPRIATE.
14
(D)
(1)
HEALTH CARE PROVIDERS AND HEALTHY MARYLAND MEMBERS
15
MAY PETITION THE BOARD TO IMPROVE OR ADJUST COVERED BENEFITS UNDER
16
HEALTHY MARYLAND.
17
(2)
THE BOARD SHALL DEVELOP AND IMPLEMENT PROCEDURES FOR
18
HEALTHY MARYLAND MEMBERS TO PETITION THE BOARD TO IMPROVE OR ADJUST
19
COVERED BENEFITS UNDER HEALTHY MARYLAND.
20
25–603.
21
(A)
SUBJECT TO THE OTHER PROVISIONS OF THIS TITLE, A MEMBER IS
22
ENTITLED TO PAYMENT BY HEALTHY MARYLAND TO AN ELIGIBLE HEALTH CARE
23
PROVIDER FOR LONG–TERM SERVICES AND SUPPORTS, FOR MAINTENANCE OF
24
HEALTH, OR FOR CARE, SERVICES, DIAGNOSIS, TREATMENT, OR REHABILITATION
25
THAT IS RELATED TO A MEDICALLY DETERMINABLE CONDITION, WHETHER
26
PHYSICAL OR MENTAL, OF HEALTH, INJURY, OR AGE THAT:
27
(1)
CAUSES A FUNCTIONAL LIMITATION IN PERFORMING ONE OR
28
MORE ACTIVITIES OF DAILY LIVING OR INSTRUMENTAL ACTIVITIES OF DAILY
29
LIVING; AND
30
(2)
SUBSTANTIALLY LIMITS ONE OR MORE OF THE ENROLLEE’S
31
HOUSE BILL 25
45
MAJOR LIFE ACTIVITIES.
1
(B)
AN INDIVIDUAL WHO QUALIFIES FOR DISABILITY BENEFITS UNDER
2
TITLE II OR TITLE XVI OF THE SOCIAL SECURITY ACT IS ENTITLED TO LONG–TERM
3
SERVICES AND SUPPORTS UNDER HEALTHY MARYLAND.
4
(C)
ANY HEALTHY MARYLAND MEMBER WHO RECEIVES OR IS APPROVED
5
TO RECEIVE BENEFITS UNDER TITLE II OR TITLE XVI OF THE SOCIAL SECURITY
6
ACT IS ENTITLED TO PAYMENT BY HEALTHY MARYLAND FOR LONG–TERM SERVICES
7
AND SUPPORTS.
8
(D)
LONG–TERM SERVICES AND SUPPORTS SHALL:
9
(1)
INCLUDE ANY LONG–TERM NURSING OR MEDICAL SERVICES FOR
10
THE HEALTHY MARYLAND MEMBER, WHETHER PROVIDED IN AN INSTITUTION OR A
11
HOME– AND COMMUNITY–BASED SETTING;
12
(2)
PROVIDE COVERAGE FOR A BROAD SPECTRUM OF LONG–TERM
13
SERVICES AND SUPPORTS, INCLUDING FOR HOME– AND COMMUNITY–BASED
14
SERVICES AND OTHER CARE PROVIDED THROUGH NONINSTITUTIONAL SETTINGS;
15
(3)
PROVIDE COVERAGE THAT MEETS THE PHYSICAL, MENTAL, AND
16
SOCIAL NEEDS OF RECIPIENTS WHILE ALLOWING RECIPIENTS THEIR MAXIMUM
17
POSSIBLE AUTONOMY AND THEIR MAXIMUM POSSIBLE CIVIC, SOCIAL, AND
18
ECONOMIC PARTICIPATION;
19
(4)
PRIORITIZE HOME– AND COMMUNITY–BASED SERVICES OVER
20
INSTITUTIONALIZATION;
21
(5)
BE PROVIDED WITH A PRESUMPTION THAT RECIPIENTS OF ALL
22
AGES AND DISABILITIES WILL RECEIVE LONG–TERM SERVICES AND SUPPORTS
23
THROUGH HOME– AND COMMUNITY–BASED SERVICES UNLESS THE INDIVIDUAL
24
CHOOSES OTHERWISE;
25
(6)
BE PROVIDED WITH THE GOAL OF ENABLING INDIVIDUALS WITH
26
DISABILITIES TO RECEIVE SERVICES IN THE LEAST RESTRICTIVE AND MOST
27
INTEGRATED SETTING APPROPRIATE TO THE INDIVIDUAL’S NEEDS;
28
(7)
BE PROVIDED IN A MANNER THAT ALLOWS INDIVIDUALS WITH
29
DISABILITIES TO MAINTAIN THEIR INDEPENDENCE, SELF–DETERMINATION, AND
30
DIGNITY;
31
(8)
PROVIDE LONG–TERM SERVICES AND SUPPORTS THAT ARE OF
32
46
HOUSE BILL 25
EQUAL QUALITY AND EQUALLY ACCESSIBLE ACROSS GEOGRAPHIC REGIONS;
1
(9)
ENSURE THAT LONG–TERM SERVICES AND SUPPORTS PROVIDE
2
HEALTHY MARYLAND MEMBERS THE OPTION OF SELF–DIRECTION OF SERVICES;
3
AND
4
(10) PROVIDE SERVICES TO SUPPORT ACTIVITIES OF DAILY LIVING
5
AND INSTRUMENTAL ACTIVITIES OF DAILY LIVING FOR INDIVIDUALS WITH
6
FUNCTION LIMITATIONS, WHETHER PHYSICAL OR COGNITIVE.
7
(E)
IN DEVELOPING REGULATIONS TO IMPLEMENT THIS SECTION, THE
8
BOARD SHALL CONSULT WITH RELEVANT STAKEHOLDERS, INCLUDING:
9
(1)
INDIVIDUALS WITH DISABILITIES AND OLDER ADULTS WHO USE
10
LONG–TERM SERVICES AND SUPPORTS;
11
(2)
REPRESENTATIVES OF INDIVIDUALS WITH DISABILITIES OR OF
12
OLDER ADULTS;
13
(3)
GROUPS THAT REPRESENT THE DIVERSITY OF THE POPULATION
14
OF INDIVIDUALS LIVING WITH DISABILITIES, INCLUDING GENDER, RACIAL, AND
15
ECONOMIC DIVERSITY;
16
(4)
PROVIDERS
OF
LONG–TERM
SERVICES
AND
SUPPORTS,
17
INCLUDING FAMILY ATTENDANTS AND FAMILY CAREGIVERS;
18
(5)
DISABILITY RIGHTS ORGANIZATIONS;
19
(6)
MEMBERS OF ORGANIZED LABOR;
20
(7)
SENIOR GROUPS; AND
21
(8)
RELEVANT ACADEMIC INSTITUTIONS AND RESEARCHERS.
22
SUBTITLE 7. DELIVERY OF CARE.
23
25–701.
24
(A)
(1)
ANY HEALTH CARE PROVIDER IS QUALIFIED TO PARTICIPATE IN
25
HEALTHY MARYLAND IF:
26
(I)
THE HEALTH CARE PROVIDER IS LICENSED TO PRACTICE IN
27
THE STATE AND IS IN GOOD STANDING;
28
HOUSE BILL 25
47
(II)
THE HEALTH CARE PROVIDER’S SERVICES ARE PERFORMED
1
WHILE PHYSICALLY PRESENT WITHIN THE STATE;
2
(III) THE
HEALTH
CARE
PROVIDER
AGREES
TO
ACCEPT
3
HEALTHY MARYLAND RATES AS PAYMENT IN FULL FOR ALL COVERED SERVICES;
4
AND
5
(IV) THE HEALTH CARE PROVIDER HAS FILED WITH THE BOARD
6
A PARTICIPATION AGREEMENT DESCRIBED IN § 25–702 OF THIS SUBTITLE.
7
(2)
THE BOARD SHALL ESTABLISH AND MAINTAIN PROCEDURES AND
8
STANDARDS FOR RECOGNIZING HEALTH CARE PROVIDERS LOCATED OUTSIDE THE
9
STATE FOR PURPOSES OF PROVIDING COVERAGE UNDER HEALTHY MARYLAND FOR
10
HEALTHY MARYLAND MEMBERS WHO REQUIRE OUT–OF–STATE HEALTH CARE
11
SERVICES WHILE TEMPORARILY LOCATED OUTSIDE THE STATE.
12
(B)
ANY HEALTH CARE PROVIDER QUALIFIED TO PARTICIPATE UNDER THIS
13
SECTION MAY PROVIDE COVERED HEALTH CARE SERVICES UNDER HEALTHY
14
MARYLAND IF THE HEALTH CARE PROVIDER IS LEGALLY AUTHORIZED TO PERFORM
15
THE HEALTH CARE SERVICE FOR THE INDIVIDUAL UNDER THE CIRCUMSTANCES
16
INVOLVED.
17
(C)
A HEALTHY MARYLAND MEMBER MAY RECEIVE HEALTH CARE
18
SERVICES UNDER HEALTHY MARYLAND FROM ANY PARTICIPATING HEALTH CARE
19
PROVIDER IF THE RECEIPT OF THE HEALTH CARE SERVICES IS CONSISTENT WITH:
20
(1)
THE REQUIREMENTS OF THIS SECTION AND ANY PROCEDURES OR
21
STANDARDS ESTABLISHED BY THE BOARD UNDER THIS SECTION;
22
(2)
THE WILLINGNESS OR AVAILABILITY OF THE PROVIDER TO
23
PROVIDE THE HEALTH CARE SERVICES TO THE HEALTHY MARYLAND MEMBER;
24
(3)
PROVISIONS OF THIS TITLE RELATING TO DISCRIMINATION; AND
25
(4)
THE APPROPRIATE CLINICALLY RELEVANT CIRCUMSTANCES AND
26
STANDARDS.
27
(D)
(1)
A HEALTH CARE PROVIDER MAY NOT USE HEALTH INFORMATION
28
TECHNOLOGY OR CLINICAL PRACTICE GUIDELINES THAT LIMIT THE EFFECTIVE
29
EXERCISE OF THE PROFESSIONAL JUDGMENT OF PHYSICIANS, REGISTERED
30
NURSES, OR OTHER HEALTH CARE PROVIDERS OPERATING WITHIN THE SCOPE OF
31
PRACTICE OF THE PROVIDER UNDER THE HEALTH OCCUPATIONS ARTICLE.
32
48
HOUSE BILL 25
(2)
A PHYSICIAN, A REGISTERED NURSE, OR ANY OTHER HEALTH
1
CARE PROVIDER MAY OVERRIDE HEALTH INFORMATION TECHNOLOGY AND
2
CLINICAL PRACTICE GUIDELINES USED BY A HEALTH CARE PROVIDER IF THE
3
OVERRIDE:
4
(I)
IS CONSISTENT WITH THE HEALTH CARE PROVIDER’S
5
DETERMINATION OF MEDICAL NECESSITY; AND
6
(II)
IN THE PROFESSIONAL JUDGMENT OF THE HEALTH CARE
7
PROVIDER, IS IN THE BEST INTEREST OF THE PATIENT AND CONSISTENT WITH THE
8
PATIENT’S WISHES.
9
(E)
AN ENTITY MAY NOT FURNISH COVERED ITEMS AND SERVICES UNDER
10
THIS TITLE IF THE ENTITY PROVIDES NO ITEMS AND SERVICES DIRECTLY TO
11
HEALTHY MARYLAND MEMBERS, INCLUDING:
12
(1)
ENTITIES THAT ENTER INTO CONTRACTS WITH OTHER ENTITIES
13
OR HEALTH CARE PROVIDERS TO PROVIDE ALL ITEMS AND SERVICES; AND
14
(2)
ENTITIES THAT ARE APPROVED TO COORDINATE CARE PLANS
15
UNDER PART C OF TITLE XVIII OF THE SOCIAL SECURITY ACT BUT DO NOT
16
DIRECTLY PROVIDE THE ITEMS AND SERVICES AUTHORIZED BY THE CARE PLANS.
17
25–702.
18
(A)
A HEALTH CARE PROVIDER SHALL ENTER INTO A PARTICIPATION
19
AGREEMENT WITH THE BOARD IN ORDER TO QUALIFY AS A PARTICIPATING
20
PROVIDER UNDER HEALTHY MARYLAND.
21
(B)
A PARTICIPATION AGREEMENT BETWEEN THE BOARD AND A HEALTH
22
CARE PROVIDER SHALL:
23
(1)
REQUIRE THE HEALTH CARE PROVIDER TO PROVIDE SERVICES TO
24
ELIGIBLE INDIVIDUALS WITHOUT DISCRIMINATION, IN ACCORDANCE WITH §
25
25–901(C)(4) OF THIS TITLE;
26
(2)
PROHIBIT THE HEALTH CARE PROVIDER FROM CHARGING A
27
HEALTHY MARYLAND MEMBER FOR ANY COVERED SERVICES OTHER THAN FOR
28
PAYMENT AUTHORIZED BY THIS TITLE;
29
(3)
REQUIRE
THE
HEALTH
CARE
PROVIDER
TO
PROVIDE
30
INFORMATION REQUESTED BY THE BOARD, IN ACCORDANCE WITH § 25–305 OF THIS
31
HOUSE BILL 25
49
TITLE, FOR:
1
(I)
QUALITY REVIEW BY DESIGNATED ENTITIES;
2
(II)
MAKING PAYMENTS UNDER THIS TITLE, INCLUDING THE
3
EXAMINATION OF RECORDS AS MAY BE NECESSARY FOR THE VERIFICATION OF
4
INFORMATION ON WHICH THE PAYMENTS ARE BASED;
5
(III) STATISTICAL OR OTHER STUDIES REQUIRED FOR THE
6
IMPLEMENTATION OF THIS TITLE; AND
7
(IV) ANY OTHER PURPOSES REQUIRED BY THE BOARD;
8
(4)
FOR A PROVIDER OF SERVICES, PROHIBIT THE PROVIDER OF
9
SERVICES FROM EMPLOYING OR USING FOR THE PROVISION OF HEALTH SERVICES
10
ANY INDIVIDUAL HEALTH CARE PROVIDER THAT HAS HAD A PARTICIPATION
11
AGREEMENT UNDER THIS SUBSECTION TERMINATED FOR CAUSE;
12
(5)
FOR A HEALTH CARE PROVIDER PAID ON A FEE–FOR–SERVICE
13
BASIS FOR ITEMS AND SERVICES PROVIDED UNDER THIS TITLE, REQUIRE THE
14
PROVIDER TO SUBMIT BILLS AND ANY REQUIRED SUPPORTING DOCUMENTATION
15
RELATING TO THE PROVISION OF COVERED SERVICES WITHIN 30 DAYS AFTER THE
16
DATE OF PROVIDING SUCH SERVICES;
17
(6)
FOR PROVIDER OF SERVICES PAID IN ACCORDANCE WITH §
18
25–802 OF THIS TITLE, REQUIRE THE I PROVIDER OF SERVICES TO SUBMIT, IN
19
ACCORDANCE WITH § 25–305 OF THIS TITLE, INFORMATION ON A QUARTERLY BASIS
20
THAT:
21
(I)
RELATES TO THE PROVISION OF COVERED SERVICES; AND
22
(II)
DESCRIBES SERVICES PROVIDED AT A PATIENT LEVEL;
23
(7)
FOR A PROVIDER RECEIVING PAYMENT UNDER THIS TITLE BASED
24
ON DIAGNOSIS–RELATED CODING, PROCEDURE–RELATED CODING, OR ANY OTHER
25
CODING SYSTEM OR DATA:
26
(I)
REQUIRE THE PROVIDER TO DISCLOSE TO THE BOARD:
27
1.
ANY
CASE
MIX
INDEXES,
DIAGNOSIS
CODING
28
SOFTWARE, PROCEDURE CODING SOFTWARE, OR OTHER CODING SYSTEM USED BY
29
THE PROVIDER FOR THE PURPOSES OF MEETING PAYMENT, GLOBAL BUDGETING, OR
30
DISCLOSURE REQUIREMENTS UNDER THIS TITLE; AND
31
50
HOUSE BILL 25
2.
ANY CASE MIX, DIAGNOSIS CODING GUIDELINES,
1
PROCEDURE CODING GUIDELINES, OR CODING TIP SHEETS USED BY THE PROVIDER
2
FOR THE PURPOSES OF MEETING PAYMENT, GLOBAL BUDGETING, OR DISCLOSURE
3
REQUIREMENTS UNDER THIS TITLE; AND
4
(II)
PROHIBIT THE PROVIDER FROM:
5
1.
USING PROPRIETARY CASE MIX INDEXES, DIAGNOSIS
6
CODING
SOFTWARE,
PROCEDURE
CODING
SOFTWARE,
OR
OTHER
CODING
7
SOFTWARE FOR THE PURPOSES OF MEETING PAYMENT, GLOBAL BUDGETING, OR
8
DISCLOSURE REQUIREMENTS UNDER THIS TITLE;
9
2.
REQUIRING ANY HEALTH CARE PROVIDER TO APPLY
10
CASE MIX INDEXES, DIAGNOSIS CODING, PROCEDURE CODING, OR OTHER CODING
11
SYSTEMS IN A MANNER THAT LIMITS THE MEDICAL OR NURSING PROCESS OR LIMITS
12
A TREATING PHYSICIAN’S OR ASSIGNED REGISTERED NURSE’S PROFESSIONAL
13
JUDGMENT IN DETERMINING A DIAGNOSIS, INCLUDING THE USE OF LEADING
14
QUERIES OR PROHIBITIONS ON USING CERTAIN CODES;
15
3.
PROVIDING FINANCIAL INCENTIVES TO PHYSICIANS,
16
REGISTERED NURSES, OR OTHER HEALTH CARE PROVIDERS FOR PARTICULAR
17
CODING RESULTS OR FOR SELECTING CODES WITH HIGHER PAYMENTS;
18
4.
IMPOSING
FINANCIAL
DISINCENTIVES
TO
19
PHYSICIANS, REGISTERED NURSES, OR OTHER HEALTH CARE PROVIDERS FOR
20
PARTICULAR CODING RESULTS OR FOR SELECTING DIAGNOSTIC CODES WITH
21
LOWER PAYMENTS; AND
22
5.
USING CASE MIX INDEXES OR DIAGNOSIS CODING
23
SOFTWARE THAT MAKE SUGGESTIONS FOR HIGHER–SEVERITY DIAGNOSES OR
24
CODING FOR HIGHER–COST PROCEDURES;
25
(8)
REQUIRE THE PROVIDER TO COMPLY WITH THE DUTY OF PATIENT
26
ADVOCACY DESCRIBED IN § 25–902 OF THIS TITLE;
27
(9)
REQUIRE THE PROVIDER TO COMPLY WITH THE PROHIBITIONS
28
AND REQUIREMENTS DESCRIBED IN § 25–703 OF THIS SUBTITLE; AND
29
(10) FOR A PROVIDER OF SERVICES, REQUIRE THE PROVIDER OF
30
SERVICES TO AGREE THAT NO BOARD MEMBER, EXECUTIVE, OR ADMINISTRATOR OF
31
THE PROVIDER OF SERVICES WILL RECEIVE COMPENSATION FROM, OWN STOCK OR
32
HAVE OTHER FINANCIAL INVESTMENTS IN, OR SERVE AS A BOARD MEMBER OF ANY
33
HOUSE BILL 25
51
ENTITY THAT CONTRACTS WITH OR PROVIDES ITEMS OR SERVICES, INCLUDING
1
PHARMACEUTICAL PRODUCTS AND MEDICAL DEVICES OR EQUIPMENT, TO THE
2
PROVIDER.
3
(C)
THIS SECTION MAY NOT BE CONSTRUED TO REQUIRE A HEALTH CARE
4
PROVIDER TO PROVIDE A TYPE OR CLASS OF SERVICES THAT IS OUTSIDE THE SCOPE
5
OF THE PROVIDER’S NORMAL PRACTICE.
6
25–703.
7
(A)
A PARTICIPATING PROVIDER:
8
(1)
MAY NOT BILL OR ENTER INTO A PRIVATE CONTRACT WITH AN
9
INDIVIDUAL ELIGIBLE FOR BENEFITS UNDER HEALTHY MARYLAND FOR ANY ITEM
10
OR SERVICE THAT IS A BENEFIT DESCRIBED IN SUBTITLE 6 OF THIS TITLE;
11
(2)
MAY BILL OR ENTER INTO A PRIVATE CONTRACT WITH AN
12
INDIVIDUAL ELIGIBLE FOR BENEFITS UNDER HEALTHY MARYLAND FOR ANY ITEM
13
OR SERVICE THAT IS NOT A BENEFIT DESCRIBED IN SUBTITLE 6 OF THIS TITLE IF:
14
(I)
THE CONTRACT AND PARTICIPATING PROVIDER MEET THE
15
REQUIREMENTS OF SUBSECTIONS (B) AND (C) OF THIS SECTION;
16
(II)
THE ITEM OR SERVICE IS NOT PAYABLE OR AVAILABLE
17
UNDER HEALTHY MARYLAND; AND
18
(III) THE PARTICIPATING PROVIDER DOES NOT RECEIVE:
19
1.
REIMBURSEMENT
UNDER HEALTHY MARYLAND
20
DIRECTLY OR INDIRECTLY FOR THE ITEM OR SERVICE; AND
21
2.
ANY AMOUNT FOR THE ITEM OR SERVICE FROM AN
22
ORGANIZATION THAT RECEIVES REIMBURSEMENT FOR THE ITEM OR SERVICE
23
UNDER HEALTHY MARYLAND DIRECTLY OR INDIRECTLY; AND
24
(3)
MAY BILL OR ENTER INTO A PRIVATE CONTRACT WITH ANY
25
INDIVIDUAL INELIGIBLE FOR BENEFITS UNDER HEALTHY MARYLAND FOR ANY ITEM
26
OR SERVICE.
27
(B)
A CONTRACT TO PROVIDE ITEMS AND SERVICES DESCRIBED IN
28
SUBSECTION (A)(2) OF THIS SECTION:
29
(1)
SHALL BE IN WRITING AND SIGNED BY THE INDIVIDUAL OR
30
52
HOUSE BILL 25
AUTHORIZED REPRESENTATIVE OF THE INDIVIDUAL RECEIVING THE ITEM OR
1
SERVICE BEFORE THE ITEM OR SERVICE IS FURNISHED;
2
(2)
MAY NOT BE ENTERED INTO AT A TIME WHEN THE INDIVIDUAL IS
3
FACING AN EMERGENCY HEALTH CARE SITUATION; AND
4
(3)
SHALL CLEARLY INDICATE TO THE INDIVIDUAL RECEIVING THE
5
ITEMS AND SERVICES THAT BY SIGNING THE CONTRACT THE INDIVIDUAL:
6
(I)
AGREES NOT TO SUBMIT A CLAIM UNDER HEALTHY
7
MARYLAND FOR THE ITEMS OR SERVICES;
8
(II)
ACCEPTS RESPONSIBILITY FOR PAYMENT FOR THE ITEMS
9
OR SERVICES AND UNDERSTANDS THAT NO REIMBURSEMENT WILL BE PROVIDED
10
UNDER HEALTHY MARYLAND FOR THE ITEMS OR SERVICES;
11
(III) ACKNOWLEDGES
THAT
NO
LIMITS
UNDER HEALTHY
12
MARYLAND APPLY TO AMOUNTS THAT MAY BE CHARGED FOR THE ITEMS OR
13
SERVICES; AND
14
(IV) ACKNOWLEDGES THAT THE PARTICIPATING PROVIDER IS
15
PROVIDING SERVICES OUTSIDE THE SCOPE OF HEALTHY MARYLAND.
16
(C)
A PARTICIPATING PROVIDER THAT ENTERS INTO A CONTRACT
17
DESCRIBED IN SUBSECTION (A)(2) OF THIS SECTION SHALL HAVE IN EFFECT DURING
18
THE PERIOD AN ITEM OR A SERVICE IS TO BE PROVIDED AN AFFIDAVIT THAT:
19
(1)
IDENTIFIES THE PARTICIPATING PROVIDER THAT IS TO FURNISH
20
THE ITEM OR SERVICE;
21
(2)
STATES THAT THE PARTICIPATING PROVIDER WILL NOT SUBMIT
22
ANY CLAIM UNDER HEALTHY MARYLAND FOR ANY ITEM OR SERVICE PROVIDED TO
23
ANY INDIVIDUAL ENROLLED UNDER HEALTHY MARYLAND;
24
(3)
IS SIGNED BY THE PARTICIPATING PROVIDER; AND
25
(4)
IS FILED WITH THE BOARD NOT LATER THAN 10 DAYS AFTER THE
26
PROVIDER ENTERS INTO THE FIRST CONTRACT TO WHICH THE AFFIDAVIT APPLIES.
27
(D)
IF A PROVIDER THAT SIGNS AN AFFIDAVIT DESCRIBED IN SUBSECTION
28
(C) OF THIS SECTION KNOWINGLY AND WILLFULLY SUBMITS A CLAIM UNDER THIS
29
TITLE FOR ANY ITEM OR SERVICE PROVIDED OR RECEIVES ANY REIMBURSEMENT OR
30
AMOUNT FOR AN ITEM OR A SERVICE PROVIDED UNDER A CONTRACT DESCRIBED IN
31
HOUSE BILL 25
53
SUBSECTION (A)(2) OF THIS SECTION:
1
(1)
THE CONTRACT SHALL BE NULL AND VOID; AND
2
(2)
NO PAYMENT SHALL BE MADE UNDER THIS TITLE FOR ANY ITEM
3
OR SERVICE FURNISHED BY THE PROVIDER DURING THE 1–YEAR PERIOD
4
BEGINNING ON THE DATE THE AFFIDAVIT WAS SIGNED.
5
25–704.
6
(A)
A PROVIDER OF SERVICES OR AN INDIVIDUAL PROVIDER WHO IS NOT A
7
PARTICIPATING PROVIDER:
8
(1)
IF THE CONTRACT MEETS THE REQUIREMENTS OF § 25–703(B) OF
9
THIS SUBTITLE AND THE PROVIDER MEETS THE REQUIREMENTS OF § 25–703(C) OF
10
THIS SUBTITLE, MAY BILL OR ENTER INTO ANY PRIVATE CONTRACT WITH ANY
11
INDIVIDUAL ELIGIBLE FOR BENEFITS UNDER HEALTHY MARYLAND FOR ANY ITEM
12
OR SERVICE THAT IS A BENEFIT DESCRIBED IN SUBTITLE 6 OF THIS TITLE; AND
13
(2)
MAY BILL OR ENTER INTO A PRIVATE CONTRACT WITH ANY
14
INDIVIDUAL FOR AN ITEM OR A SERVICE THAT IS NOT A BENEFIT UNDER SUBTITLE
15
6 OF THIS TITLE.
16
(B)
A CONTRACT TO PROVIDE ITEMS AND SERVICES DESCRIBED IN
17
SUBSECTION (A) OF THIS SECTION:
18
(1)
SHALL BE IN WRITING AND SIGNED BY THE INDIVIDUAL OR
19
AUTHORIZED REPRESENTATIVE OF THE INDIVIDUAL RECEIVING THE ITEM OR
20
SERVICE BEFORE THE ITEM OR SERVICE IS FURNISHED;
21
(2)
MAY NOT BE ENTERED INTO AT A TIME WHEN THE INDIVIDUAL IS
22
FACING AN EMERGENCY HEALTH CARE SITUATION; AND
23
(3)
SHALL CLEARLY INDICATE TO THE INDIVIDUAL RECEIVING THE
24
ITEMS AND SERVICES THAT BY SIGNING THE CONTRACT THE INDIVIDUAL:
25
(I)
ACKNOWLEDGES THAT THE INDIVIDUAL HAS THE RIGHT TO
26
HAVE SUCH ITEMS OR SERVICES PROVIDED UNDER HEALTHY MARYLAND;
27
(II)
AGREES NOT TO SUBMIT A CLAIM UNDER THIS TITLE FOR
28
THE ITEMS OR SERVICES EVEN IF SUCH ITEMS OR SERVICES ARE OTHERWISE
29
COVERED BY THIS TITLE;
30
54
HOUSE BILL 25
(III) AGREES TO BE RESPONSIBLE FOR PAYMENT OF THE ITEMS
1
OR SERVICES AND UNDERSTANDS THAT NO REIMBURSEMENT WILL BE PROVIDED
2
UNDER HEALTHY MARYLAND FOR SUCH ITEMS OR SERVICES;
3
(IV) ACKNOWLEDGES
THAT
NO
LIMITS
UNDER HEALTHY
4
MARYLAND APPLY TO AMOUNTS THAT MAY BE CHARGED FOR THE ITEMS OR
5
SERVICES; AND
6
(V)
ACKNOWLEDGES THAT THE PROVIDER IS PROVIDING
7
SERVICES OUTSIDE HEALTHY MARYLAND.
8
(C)
AFTER THE PROVIDER ENTERS INTO A CONTRACT DESCRIBED IN
9
SUBSECTION (A) OF THIS SECTION SHALL HAVE IN EFFECT DURING THE PERIOD ANY
10
ITEM OR SERVICE IS TO BE PROVIDED AN AFFIDAVIT THAT:
11
(1)
IDENTIFIES THE PROVIDER THAT IS TO FURNISH THE COVERED
12
ITEM OR SERVICE;
13
(2)
STATES THAT THE PROVIDER WILL NOT SUBMIT ANY CLAIM
14
UNDER HEALTHY MARYLAND FOR ANY COVERED ITEM OR SERVICE PROVIDED TO
15
ANY INDIVIDUAL ENROLLED UNDER HEALTHY MARYLAND DURING THE 1–YEAR
16
PERIOD BEGINNING ON THE DATE THE AFFIDAVIT IS SIGNED;
17
(3)
IS SIGNED BY THE PROVIDER; AND
18
(4)
IS FILED WITH THE BOARD NOT LATER THAN 10 DAYS AFTER
19
ENTERING INTO THE FIRST CONTRACT TO WHICH THE AFFIDAVIT APPLIES.
20
(D)
IF A PROVIDER THAT SIGNS AN AFFIDAVIT DESCRIBED IN SUBSECTION
21
(C) OF THIS SECTION KNOWINGLY AND WILLFULLY SUBMITS A CLAIM UNDER THIS
22
TITLE FOR ANY ITEM OR SERVICE PROVIDED OR RECEIVES ANY REIMBURSEMENT OR
23
AMOUNT FOR AN ITEM OR A SERVICE PROVIDED UNDER A PRIVATE CONTRACT
24
DESCRIBED IN SUBSECTION (A) OF THIS SECTION:
25
(1)
ANY CONTRACT DESCRIBED IN SUBSECTION (A) OF THIS SECTION
26
SHALL BE NULL AND VOID; AND
27
(2)
NO PAYMENT SHALL BE MADE UNDER THIS TITLE FOR ANY ITEM
28
OR SERVICE FURNISHED BY THE PROVIDER DURING THE 1–YEAR PERIOD
29
BEGINNING ON THE DATE THE AFFIDAVIT WAS SIGNED.
30
25–705.
31
HOUSE BILL 25
55
(A)
A PARTICIPATION AGREEMENT IN EFFECT UNDER § 25–702 OF THIS
1
SUBTITLE MAY BE TERMINATED WITH APPROPRIATE NOTICE:
2
(1)
BY THE BOARD, FOR FAILURE TO MEET THE REQUIREMENTS OF
3
THIS TITLE; OR
4
(2)
BY THE PARTICIPATING PROVIDER.
5
(B)
THE BOARD MAY NOT TERMINATE A PARTICIPATION AGREEMENT OR IN
6
ANY OTHER WAY DISCRIMINATE AGAINST, OR CAUSE TO BE DISCRIMINATED
7
AGAINST, A PARTICIPATING PROVIDER OR AN AUTHORIZED REPRESENTATIVE OF
8
THE PARTICIPATING PROVIDER FOR:
9
(1)
PROVIDING, OR CAUSING TO BE PROVIDED, TO THE FEDERAL
10
GOVERNMENT, OR THE ATTORNEY GENERAL OF A STATE, INFORMATION RELATING
11
TO A VIOLATION OF, OR AN ACT OR OMISSION THAT THE PARTICIPATING PROVIDER
12
OR AUTHORIZED REPRESENTATIVE REASONABLY BELIEVES TO BE A VIOLATION OF,
13
ANY PROVISION OF THIS TITLE;
14
(2)
TESTIFYING IN A PROCEEDING ABOUT A VIOLATION DESCRIBED
15
IN ITEM (1) OF THIS SUBSECTION;
16
(3)
ASSISTING OR PARTICIPATING IN A PROCEEDING DESCRIBED IN
17
ITEM (2) OF THIS SUBSECTION; OR
18
(4)
OBJECTING TO, OR REFUSING TO PARTICIPATE IN, ANY ACTIVITY,
19
POLICY, PRACTICE, OR ASSIGNED TASK THAT THE PARTICIPATING PROVIDER OR
20
AUTHORIZED REPRESENTATIVE REASONABLY BELIEVES TO BE IN VIOLATION OF
21
ANY PROVISION OF THIS TITLE.
22
(C)
A PARTICIPATING PROVIDER OR AN AUTHORIZED REPRESENTATIVE OF
23
THE PARTICIPATING PROVIDER THAT BELIEVES THAT THE PARTICIPATING
24
PROVIDER OR AUTHORIZED REPRESENTATIVE HAS BEEN DISCRIMINATED AGAINST
25
IN VIOLATION OF THIS SECTION MAY SEEK RELIEF IN ACCORDANCE WITH TITLE 11,
26
SUBTITLE 3 OF THE STATE FINANCE AND PROCUREMENT ARTICLE.
27
25–706.
28
(A)
(1)
IN THIS SECTION THE FOLLOWING WORDS HAVE THE MEANINGS
29
INDICATED.
30
(2)
“EMPLOYEE” MEANS ANY INDIVIDUAL PERFORMING ACTIVITIES
31
UNDER THIS TITLE ON BEHALF OF AN EMPLOYER.
32
56
HOUSE BILL 25
(3)
“EMPLOYER” MEANS ANY PERSON ENGAGED IN A FOR–PROFIT OR
1
NONPROFIT BUSINESS OR INDUSTRY, INCLUDING ONE OR MORE INDIVIDUALS,
2
PARTNERSHIPS,
ASSOCIATIONS,
CORPORATIONS,
TRUSTS,
PROFESSIONAL
3
MEMBERSHIP
ORGANIZATIONS,
UNINCORPORATED
ORGANIZATIONS,
4
NONGOVERNMENTAL ORGANIZATIONS, OR TRUSTEES, AND SUBJECT TO LIABILITY
5
FOR VIOLATING THE PROVISIONS OF THIS TITLE.
6
(B)
AN EMPLOYER MAY NOT TERMINATE OR OTHERWISE DISCRIMINATE
7
AGAINST AN EMPLOYEE BECAUSE THE EMPLOYEE OR A PERSON ACTING AT THE
8
REQUEST OF THE EMPLOYEE:
9
(1)
NOTIFIED THE BOARD OR THE EMPLOYEE’S EMPLOYER OF ANY
10
ALLEGED VIOLATION OF THIS TITLE;
11
(2)
REFUSED TO ENGAGE IN A PRACTICE MADE UNLAWFUL BY THIS
12
TITLE, IF THE EMPLOYEE HAS IDENTIFIED THE ALLEGED UNLAWFUL PRACTICE TO
13
THE EMPLOYER;
14
(3)
COMMENCED OR CAUSED TO BE COMMENCED, OR PLANS TO
15
COMMENCE OR CAUSE TO BE COMMENCED, A PROCEEDING UNDER THIS TITLE;
16
(4)
TESTIFIED IN A PROCEEDING ABOUT A VIOLATION OF THIS TITLE;
17
OR
18
(5)
ASSISTED OR PARTICIPATED, IN ANY MANNER, OR PLANS TO
19
ASSIST OR PARTICIPATE IN ANY MANNER, IN A PROCEEDING OR IN ANY OTHER
20
ACTION TO CARRY OUT THE PURPOSES OF THIS TITLE.
21
(C)
AN EMPLOYEE WHO ALLEGES THAT AN EMPLOYER ENGAGED IN
22
DISCRIMINATION IN VIOLATION OF SUBSECTION (A) OF THIS SECTION MAY FILE A
23
CIVIL ACTION IN ACCORDANCE WITH TITLE 8 OF THE GENERAL PROVISIONS
24
ARTICLE.
25
(D)
(1)
THE RIGHTS, PRIVILEGES, AND REMEDIES IN THIS SECTION MAY
26
NOT BE WAIVED BY AGREEMENT, POLICY, FORM, OR CONDITION OF EMPLOYMENT.
27
(2)
THIS SECTION MAY NOT BE CONSTRUED TO:
28
(I)
DIMINISH THE RIGHTS, PRIVILEGES, OR REMEDIES OF ANY
29
EMPLOYEE UNDER ANY OTHER LAW OR REGULATION, OR UNDER ANY COLLECTIVE
30
BARGAINING AGREEMENT; OR
31
HOUSE BILL 25
57
(II)
PREEMPT OR DIMINISH ANY OTHER LAW OR REGULATION
1
AGAINST
DEMOTION,
DISCHARGE,
SUSPENSION,
THREATS,
HARASSMENT,
2
REPRIMAND, RETALIATION, OR ANY OTHER MANNER OF DISCRIMINATION.
3
SUBTITLE 8. PAYMENT FOR HEALTH CARE SERVICES.
4
25–801.
5
(A)
THE BOARD SHALL ADOPT REGULATIONS REGARDING CONTRACTING
6
AND ESTABLISHING PAYMENT METHODOLOGIES FOR COVERED HEALTH CARE
7
SERVICES PROVIDED TO HEALTHY MARYLAND MEMBERS BY PARTICIPATING
8
PROVIDERS.
9
(B)
PAYMENT RATES UNDER HEALTHY MARYLAND SHALL BE REASONABLE
10
AND REASONABLY RELATED TO:
11
(1)
THE COST OF EFFICIENTLY PROVIDING THE HEALTH CARE
12
SERVICE; AND
13
(2)
ENSURING AN ADEQUATE AND ACCESSIBLE SUPPLY OF HEALTH
14
CARE SERVICES.
15
(C)
(1)
THE BOARD SHALL PAY A PARTICIPATING PROVIDER THAT IS A
16
PROVIDER OF SERVICES A QUARTERLY GLOBAL BUDGET PAYMENT IN ACCORDANCE
17
WITH § 25–802 OF THIS SUBTITLE.
18
(2)
A PARTICIPATING PROVIDER THAT RECEIVES A GLOBAL BUDGET
19
PAYMENT UNDER PARAGRAPH (1) OF THIS SUBSECTION SHALL ACCEPT THE
20
PAYMENT AS PAYMENT IN FULL FOR ALL COVERED ITEMS AND SERVICES UNDER
21
HEALTHY MARYLAND, INCLUDING OUTPATIENT OR OTHER CARE PROVIDED BY THE
22
PARTICIPATING PROVIDER.
23
(3)
PAYMENT TO INDIVIDUAL PROVIDERS UNDER THIS SECTION MAY
24
NOT INCLUDE PAYMENTS TO INDIVIDUAL PROVIDERS IN SALARIED POSITIONS OF
25
PARTICIPATING PROVIDERS RECEIVING GLOBAL BUDGET PAYMENTS UNDER
26
PARAGRAPH (1) OF THIS SUBSECTION.
27
(D)
(1)
HEALTH CARE SERVICES PROVIDED TO HEALTHY MARYLAND
28
MEMBERS BY PARTICIPATING PROVIDERS WHO ARE INDIVIDUAL PROVIDERS SHALL
29
BE PAID FOR ON A FEE–FOR–SERVICE BASIS UNDER § 25–803 OF THIS SUBTITLE
30
UNLESS AND UNTIL THE BOARD ESTABLISHES ANOTHER PAYMENT METHODOLOGY.
31
(2)
THERE IS A REBUTTABLE PRESUMPTION THAT THE MEDICARE
32
58
HOUSE BILL 25
RATE OF REIMBURSEMENT CONSTITUTES A REASONABLE FEE–FOR–SERVICE
1
PAYMENT RATE.
2
(E)
(1)
PAYMENT FOR HEALTH CARE SERVICES ESTABLISHED UNDER
3
THIS SUBTITLE SHALL BE CONSIDERED PAYMENT IN FULL.
4
(2)
A PARTICIPATING HEALTH CARE PROVIDER MAY NOT:
5
(I)
CHARGE
ANY
RATE
IN
EXCESS
OF
THE
PAYMENT
6
ESTABLISHED UNDER THIS SUBTITLE FOR ANY HEALTH CARE SERVICE PROVIDED
7
TO A HEALTHY MARYLAND MEMBER; OR
8
(II)
EXCEPT AS PROVIDED UNDER A FEDERAL PROGRAM,
9
SOLICIT OR ACCEPT PAYMENT FROM ANY HEALTHY MARYLAND MEMBER OR THIRD
10
PARTY FOR ANY HEALTH CARE SERVICE.
11
(3)
THIS SECTION DOES NOT PRECLUDE HEALTHY MARYLAND FROM
12
ACTING AS A PRIMARY OR SECONDARY PAYOR IN CONJUNCTION WITH ANOTHER
13
THIRD–PARTY PAYOR WHEN ALLOWED BY A FEDERAL PROGRAM.
14
(F)
(1)
HEALTHY MARYLAND MAY ADOPT, BY REGULATION, PAYMENT
15
METHODOLOGIES FOR THE PAYMENT OF CAPITAL–RELATED EXPENSES FOR
16
SPECIFICALLY
IDENTIFIED
CAPITAL
EXPENDITURES
INCURRED
BY
A
17
PARTICIPATING PROVIDER THAT IS A HEALTH CARE FACILITY AS DEFINED IN §
18
19–114 OF THIS ARTICLE.
19
(2)
ANY CAPITAL–RELATED EXPENSE GENERATED BY A CAPITAL
20
EXPENDITURE THAT REQUIRES PRIOR APPROVAL BY HEALTHY MARYLAND MUST
21
HAVE RECEIVED APPROVAL TO BE PAID BY HEALTHY MARYLAND.
22
(3)
A PARTICIPATING PROVIDER SEEKING FUNDS FOR CAPITAL
23
EXPENDITURES SHALL PRESENT A BUDGET FOR REVIEW TO THE BOARD.
24
(4)
PRIORITY FOR CAPITAL EXPENDITURES SHALL BE GIVEN TO
25
PROJECTS THAT ADDRESS A MEDICALLY UNDERSERVED AREA OR POPULATION, OR
26
SEEK TO ADDRESS HEALTH DISPARITIES DUE TO RACE, ETHNICITY, INCOME, OR
27
GEOGRAPHIC REGION.
28
(5)
THE BOARD
MAY
NOT
PROVIDE
FUNDING
FOR
CAPITAL
29
EXPENDITURES UNDER THIS SECTION THAT ARE FINANCED DIRECTLY OR
30
INDIRECTLY THROUGH THE DIVERSION OF HEALTHY MARYLAND FUNDS THAT
31
RESULTS IN REDUCTIONS IN DIRECT CARE TO PATIENTS, INCLUDING REDUCTIONS
32
IN REGISTERED NURSING STAFFING PATTERNS AND CHANGES IN EMERGENCY ROOM
33
HOUSE BILL 25
59
OR PRIMARY CARE SERVICES OR AVAILABILITY.
1
(G)
(1)
A PARTICIPATING PROVIDER THAT IS A PROVIDER OF SERVICES
2
SHALL MAINTAIN SEPARATE ACCOUNTS FOR PAYMENTS MADE UNDER THIS
3
SUBTITLE FOR OPERATIONS AND CAPITAL EXPENDITURES.
4
(2)
A PROVIDER OF SERVICES MAY NOT:
5
(I)
USE PAYMENTS MADE FOR OPERATIONS FOR CAPITAL
6
EXPENDITURES OR FOR PROFIT; OR
7
(II)
USE PAYMENTS MADE FOR CAPITAL EXPENDITURES FOR
8
OPERATIONS.
9
(H)
THE BOARD SHALL ESTABLISH PAYMENT METHODOLOGIES AND AN
10
ANNUAL BUDGET FOR SPECIAL PROJECTS TO BE USED FOR THE CONSTRUCTION OF
11
NEW FACILITIES, MAJOR EQUIPMENT PURCHASES, AND STAFFING IN RURAL OR
12
MEDICALLY UNDERSERVED AREAS, AS DEFINED IN § 330(B)(3) OF THE FEDERAL
13
PUBLIC HEALTH SERVICE ACT, INCLUDING AREAS DESIGNATED AS HEALTH
14
PROFESSIONAL SHORTAGE AREAS, AS DEFINED IN § 332(A) OF THE FEDERAL
15
PUBLIC HEALTH SERVICE ACT.
16
(I)
THE PAYMENT METHODOLOGIES AND RATES ESTABLISHED BY THE
17
BOARD UNDER THIS SECTION SHALL INCLUDE A DISTINCT COMPONENT OF
18
REIMBURSEMENT FOR DIRECT AND INDIRECT GRADUATE MEDICAL EDUCATION.
19
(J)
(1)
SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION, THE BOARD
20
SHALL ADOPT, BY REGULATION, PAYMENT METHODOLOGIES AND PROCEDURES FOR
21
PAYING FOR HEALTH CARE SERVICES PROVIDED TO A HEALTHY MARYLAND
22
MEMBER WHILE THE HEALTHY MARYLAND MEMBER IS TEMPORARILY LOCATED
23
OUTSIDE THE STATE.
24
(2)
THE
PAYMENT
METHODOLOGIES
AND
PROCEDURES
25
ESTABLISHED BY THE BOARD UNDER THIS SUBSECTION SHALL:
26
(I)
PROVIDE FOR THE PAYMENT OF HEALTH CARE SERVICES
27
THAT ARE:
28
1.
MEDICALLY NECESSARY AS DETERMINED BY THE
29
HEALTHY MARYLAND MEMBER’S TREATING PHYSICIAN; AND
30
2.
IN ACCORDANCE WITH THE HEALTHY MARYLAND
31
PROGRAM STANDARDS ESTABLISHED UNDER SUBTITLE 9 OF THIS TITLE AND BY
32
60
HOUSE BILL 25
THE BOARD; AND
1
(II)
PROVIDE FOR THE PAYMENT OF HEALTH CARE SERVICES
2
PROVIDED BY A HEALTHY MARYLAND MEMBER’S TREATING PHYSICIAN AS AN
3
APPROVED HEALTH CARE PROVIDER UNDER § 25–701 OF THIS TITLE.
4
25–802.
5
(A)
THIS SECTION APPLIES ONLY WITH RESPECT TO A PARTICIPATING
6
PROVIDER THAT IS A PROVIDER OF SERVICES.
7
(B)
(1)
NOT LATER THAN THE BEGINNING OF EACH FISCAL QUARTER
8
DURING WHICH A PARTICIPATING PROVIDER IS TO FURNISH ITEMS AND SERVICES
9
UNDER HEALTHY MARYLAND, THE BOARD SHALL PAY TO THE PROVIDER OF
10
SERVICES A GLOBAL BUDGET PAYMENT IN ACCORDANCE WITH THIS SECTION.
11
(2)
A GLOBAL BUDGET PAYMENT UNDER THIS SECTION IS PAYMENT
12
IN FULL FOR ALL OPERATING EXPENSES OF A PROVIDER OF SERVICES FOR THE
13
QUARTER.
14
(3)
THE BOARD, ON A QUARTERLY BASIS, SHALL:
15
(I)
REVIEW
WHETHER
THE
REQUIREMENTS
OF
THE
16
PARTICIPATING PROVIDER’S PARTICIPATION AGREEMENT AND GLOBAL BUDGET
17
NEGOTIATED UNDER THIS SECTION HAVE BEEN PERFORMED; AND
18
(II)
DETERMINE
WHETHER
ADJUSTMENTS
TO
THE
19
PARTICIPATING PROVIDER’S PAYMENT ARE WARRANTED.
20
(4)
THE BOARD MAY AUTHORIZE A PARTICIPATING PROVIDER WHO IS
21
AN
INDIVIDUAL
PROVIDER
WHO
PROVIDES
ITEMS
AND
SERVICES
AS
A
22
PARTICIPATING PROVIDER THAT IS A PROVIDER OF SERVICES TO BE PAID THROUGH
23
A GLOBAL BUDGET NEGOTIATED UNDER THIS SECTION INSTEAD OF PAYMENT
24
UNDER § 25–803 OF THIS SUBTITLE.
25
(5)
A PARTICIPATING PROVIDER WHO IS AN INDIVIDUAL PROVIDER
26
WHO RECEIVES PAYMENT UNDER PARAGRAPH (4) OF THIS SUBSECTION:
27
(I)
SHALL BE PAID A SALARY THAT IS COMPARABLE TO THE
28
SALARY FOR A PROVIDER WHO IS AN EMPLOYEE OF THE PROVIDER OF SERVICES;
29
AND
30
(II)
IS SUBJECT TO THE SAME REPORTING AND DISCLOSURE
31
HOUSE BILL 25
61
REQUIREMENTS AS THE PROVIDER OF SERVICES.
1
(C)
(1)
BEFORE THE START OF A FISCAL YEAR, THE BOARD AND A
2
PARTICIPATING PROVIDER SHALL NEGOTIATE THE AMOUNT OF EACH GLOBAL
3
BUDGET PAYMENT FOR THAT FISCAL YEAR.
4
(2)
THE AMOUNT NEGOTIATED UNDER PARAGRAPH (1) OF THIS
5
SUBSECTION SHALL TAKE INTO ACCOUNT, FOR EACH PARTICIPATING PROVIDER:
6
(I)
THE VOLUME OF SERVICES PROVIDED IN THE IMMEDIATELY
7
PRECEDING 3–YEAR PERIOD;
8
(II)
THE ACTUAL EXPENDITURES OF THE PROVIDER OF
9
SERVICES FOR EACH ITEM AND SERVICE, AS COMPARED TO:
10
1.
OTHER
PROVIDERS
OF
SERVICES
WITHIN
THE
11
MARKET OF THE PROVIDER OF SERVICES; OR
12
2.
COMPARATIVE PAYMENT RATE SYSTEMS DESCRIBED
13
UNDER SUBSECTION (F) OF THIS SECTION FOR THE ITEMS AND SERVICES
14
FURNISHED BY THE PROVIDER;
15
(III) EXPENDITURES OF SIMILARLY SITUATED PROVIDERS OF
16
SERVICES;
17
(IV) PROJECTED CHANGES IN THE VOLUME AND TYPE OF ITEMS
18
AND SERVICES TO BE FURNISHED;
19
(V)
WAGES
FOR
EMPLOYEES,
INCLUDING
NECESSARY
20
INCREASES TO ENSURE MINIMUM SAFE REGISTERED NURSE–TO–PATIENT STAFFING
21
RATIOS AND OPTIMAL STAFFING LEVELS FOR PHYSICIANS AND OTHER HEALTH
22
CARE WORKERS;
23
(VI) THE PROVIDER’S MAXIMUM CAPACITY TO PROVIDE ITEMS
24
AND SERVICES;
25
(VII) EDUCATION AND PREVENTION PROGRAMS;
26
(VIII) PERMISSIBLE ADJUSTMENTS TO THE OPERATING BUDGET
27
DUE TO FACTORS, INCLUDING:
28
1.
INCREASING PRIMARY AND SPECIALTY CARE ACCESS;
29
62
HOUSE BILL 25
2.
DECREASING DISPARITIES IN RURAL OR MEDICALLY
1
UNDERSERVED AREAS;
2
3.
RESPONDING TO EMERGENT EPIDEMIC CONCERNS;
3
AND
4
4.
PROPOSED NEW AND INNOVATIVE PATIENT CARE
5
PROGRAMS AT THE INSTITUTIONAL LEVEL; AND
6
(IX) ANY OTHER FACTOR DETERMINED APPROPRIATE BY THE
7
BOARD.
8
(D)
IN ADDITION TO THE LIMITATIONS AND REQUIREMENTS DESCRIBED IN
9
§ 25–804 OF THIS SUBTITLE, PAYMENT AMOUNTS NEGOTIATED UNDER THIS
10
SECTION MAY NOT:
11
(1)
TAKE INTO ACCOUNT CAPITAL EXPENDITURES OR ANY OTHER
12
EXPENDITURE NOT DIRECTLY ASSOCIATED WITH THE PROVISION OF ITEMS AND
13
SERVICES BY THE PARTICIPATING PROVIDER TO AN INDIVIDUAL;
14
(2)
BE
USED
BY
A
PARTICIPATING
PROVIDER
FOR
CAPITAL
15
EXPENDITURES;
16
(3)
EXCEED THE PARTICIPATING PROVIDER’S CAPACITY TO PROVIDE
17
CARE; AND
18
(4)
BE USED TO PAY OR OTHERWISE COMPENSATE ANY BOARD
19
MEMBER, EXECUTIVE, OR ADMINISTRATOR OF THE PARTICIPATING PROVIDER WHO
20
HAS AN INTEREST OR RELATIONSHIP THAT IS PROHIBITED UNDER THIS TITLE.
21
(E)
OPERATING EXPENSES OF A PARTICIPATING PROVIDER MAY INCLUDE:
22
(1)
THE COST OF ALL SERVICES ASSOCIATED WITH THE PROVISION
23
OF INPATIENT CARE AND OUTPATIENT CARE, INCLUDING:
24
(I)
WAGES AND SALARY COSTS FOR PHYSICIANS, NURSES, AND
25
OTHER HEALTH CARE PROVIDERS EMPLOYED BY A PARTICIPATING PROVIDER;
26
(II)
WAGES AND SALARY COSTS FOR ALL OTHER STAFF AND
27
SERVICES;
28
(III) COSTS
OF
ALL
PHARMACEUTICAL
PRODUCTS
29
ADMINISTERED BY HEALTH CARE PROVIDERS AT THE PARTICIPATING PROVIDER’S
30
HOUSE BILL 25
63
FACILITIES OR THROUGH SERVICES PROVIDED IN ACCORDANCE WITH STATE
1
LICENSING LAWS OR REGULATIONS UNDER WHICH THE PARTICIPATING PROVIDER
2
OPERATES;
3
(IV) PURCHASING AND MAINTENANCE OF MEDICAL DEVICES,
4
SUPPLIES, AND OTHER HEALTH CARE TECHNOLOGIES, INCLUDING DIAGNOSTIC
5
TESTING EQUIPMENT;
6
(V)
COSTS OF ALL INCIDENTAL SERVICES NECESSARY FOR SAFE
7
PATIENT CARE; AND
8
(VI) COSTS
OF
PATIENT
CARE
PROGRAMS,
EDUCATION
9
PROGRAMS, AND PREVENTION PROGRAMS, INCLUDING OCCUPATIONAL HEALTH
10
AND SAFETY PROGRAMS AND PUBLIC HEALTH PROGRAMS, FOR THE CONTINUED
11
EDUCATION AND HEALTH AND SAFETY OF HEALTH CARE PROVIDERS AND OTHER
12
INDIVIDUALS EMPLOYED BY THE PROVIDER OF SERVICES; AND
13
(2)
ADMINISTRATIVE COSTS FOR THE PROVIDER OF SERVICES.
14
(F)
(1)
THE BOARD SHALL USE THE EXISTING MEDICARE PROSPECTIVE
15
PAYMENT SYSTEMS ESTABLISHED UNDER TITLE XVIII OF THE SOCIAL SECURITY
16
ACT TO SERVE AS THE COMPARATIVE PAYMENT RATE SYSTEM IN GLOBAL BUDGET
17
NEGOTIATIONS DESCRIBED IN THIS SECTION.
18
(2)
THE BOARD SHALL UPDATE THE COMPARATIVE PAYMENT RATE
19
SYSTEM ANNUALLY.
20
(3)
IN DEVELOPING THE COMPARATIVE PAYMENT RATE SYSTEM, THE
21
BOARD SHALL USE ONLY THE OPERATING BASE PAYMENT RATES UNDER EACH
22
MEDICARE PROSPECTIVE PAYMENT SYSTEM WITH APPLICABLE ADJUSTMENTS.
23
(4)
THE COMPARATIVE PAYMENT RATE SYSTEM ESTABLISHED UNDER
24
THIS SUBSECTION MAY NOT INCLUDE THE VALUE–BASED PAYMENT ADJUSTMENTS
25
AND THE CAPITAL EXPENSES BASE PAYMENT RATES THAT MAY BE INCLUDED IN A
26
MEDICARE PROSPECTIVE PAYMENT SYSTEM.
27
(5)
IN THE FIRST YEAR THAT GLOBAL BUDGET PAYMENTS UNDER
28
HEALTHY MARYLAND ARE AVAILABLE TO PARTICIPATING PROVIDERS AND FOR THE
29
PURPOSES OF SELECTING A COMPARATIVE PAYMENT RATE SYSTEM USED DURING
30
INITIAL GLOBAL BUDGET NEGOTIATIONS FOR EACH PARTICIPATING PROVIDER, THE
31
BOARD SHALL:
32
(I)
TAKE INTO ACCOUNT THE APPROPRIATE PROSPECTIVE
33
64
HOUSE BILL 25
PAYMENT SYSTEM FROM THE MOST RECENT YEAR UNDER TITLE XVIII OF THE
1
SOCIAL SECURITY ACT;
2
(II)
USE THE PROSPECTIVE PAYMENT SYSTEM IDENTIFIED IN
3
ITEM (I) OF THIS PARAGRAPH TO DETERMINE THE OPERATING BASE PAYMENT THAT
4
THE PARTICIPATING PROVIDER WOULD HAVE BEEN PAID FOR COVERED ITEMS AND
5
SERVICES FURNISHED BY THE PARTICIPATING PROVIDER DURING THE PRECEDING
6
YEAR; AND
7
(III) APPLY
APPLICABLE
ADJUSTMENTS
BASED
ON
THE
8
PROSPECTIVE PAYMENT SYSTEM IDENTIFIED IN ITEM (I) OF THIS PARAGRAPH,
9
EXCLUDING VALUE–BASED PAYMENT ADJUSTMENTS.
10
25–803.
11
(A)
HEALTHY MARYLAND SHALL ENGAGE IN GOOD FAITH NEGOTIATIONS
12
WITH HEALTH CARE PROVIDER REPRESENTATIVES UNDER SUBTITLE 12 OF THIS
13
TITLE ON:
14
(1)
FEE–FOR–SERVICE RATES OF PAYMENT FOR HEALTH CARE
15
SERVICES;
16
(2)
RATES OF PAYMENT FOR PRESCRIPTION AND NONPRESCRIPTION
17
DRUGS; AND
18
(3)
PAYMENT METHODOLOGIES.
19
(B)
THE NEGOTIATIONS REQUIRED UNDER SUBSECTION (A) OF THIS
20
SECTION SHALL BE CONDUCTED ANNUALLY THROUGH A SINGLE ENTITY ON BEHALF
21
OF HEALTHY MARYLAND FOR PRESCRIPTION AND NONPRESCRIPTION DRUGS.
22
(C)
(1)
THE
BOARD
SHALL
ESTABLISH
A
PRESCRIPTION
DRUG
23
FORMULARY.
24
(2)
THE FORMULARY ESTABLISHED UNDER THIS SUBSECTION SHALL:
25
(I)
DISCOURAGE THE USE OF INEFFECTIVE, DANGEROUS, OR
26
EXCESSIVELY COSTLY MEDICATIONS WHEN BETTER ALTERNATIVES ARE AVAILABLE;
27
AND
28
(II)
PROMOTE THE USE OF GENERIC MEDICATIONS TO THE
29
GREATEST EXTENT POSSIBLE.
30
HOUSE BILL 25
65
(3)
CLINICIANS AND PATIENTS MAY PETITION THE BOARD TO ADD
1
NEW
PHARMACEUTICALS
OR
TO
REMOVE
INEFFECTIVE
OR
DANGEROUS
2
MEDICATIONS FROM THE FORMULARY.
3
(4)
THE
BOARD
SHALL
DEVELOP
AND
IMPLEMENT
RULES
4
REGARDING THE USE OF OFF–FORMULARY MEDICATIONS WHICH ALLOW FOR
5
PATIENT ACCESS BUT DO NOT COMPROMISE THE FORMULARY.
6
(D)
THE BOARD SHALL:
7
(1)
ESTABLISH FEE–FOR–SERVICE RATES OF PAYMENT THAT ARE
8
FAIR AND OPTIMAL; AND
9
(2)
UPDATE THE FEE SCHEDULE ANNUALLY.
10
(E)
IN THE FIRST YEAR THAT FEE–FOR–SERVICE PAYMENTS UNDER
11
HEALTHY MARYLAND
ARE
AVAILABLE
TO
INDIVIDUAL
PROVIDERS,
THE
12
FEE–FOR–SERVICE
REIMBURSEMENTS
AVAILABLE
UNDER
THE
MEDICARE
13
PROGRAM IN EFFECT AT THE TIME SHALL BE THE BASIS FOR NEGOTIATION OF FEES
14
FOR ALL ITEMS AND SERVICES COVERED UNDER THIS TITLE.
15
25–804.
16
PAYMENTS TO PARTICIPATING PROVIDERS UNDER THIS SUBTITLE MAY NOT
17
TAKE INTO ACCOUNT, ALLOW, OR INCLUDE ANY PROCESS FOR THE PROVISION OF
18
FUNDING FOR:
19
(1)
MARKETING OF THE PARTICIPATING PROVIDER;
20
(2)
THE
PARTICIPATING
PROVIDER’S
PROFIT,
REVENUE,
OR
21
FINANCIAL STANDING, OR INCREASING THE PARTICIPATING PROVIDER’S PROFIT,
22
REVENUE, OR FINANCIAL STANDING;
23
(3)
INCENTIVE PAYMENTS, BONUSES, OR OTHER COMPENSATION
24
BASED ON PATIENT UTILIZATION OF ITEMS OR SERVICES OR ANY OTHER FINANCIAL
25
MEASURE APPLIED WITH RESPECT TO THE PARTICIPATING PROVIDER OR ANY
26
GROUP PRACTICE, CLINICALLY INTEGRATED ORGANIZATION, OR OTHER ENTITY
27
WITH WHICH THE PARTICIPATING PROVIDER CONTRACTS OR HAS A PECUNIARY
28
INTEREST, INCLUDING ANY VALUE–BASED PAYMENT OR EMPLOYMENT–BASED
29
COMPENSATION; OR
30
(4)
ANY AGREEMENT OR ARRANGEMENT DESCRIBED IN § 203(A)(4)
31
OF THE FEDERAL LABOR–MANAGEMENT REPORTING AND DISCLOSURE ACT OF
32
66
HOUSE BILL 25
1959.
1
SUBTITLE 9. PROGRAM STANDARDS.
2
25–901.
3
(A)
HEALTHY MARYLAND SHALL HAVE A SINGLE STANDARD OF SAFE,
4
THERAPEUTIC, AND EFFECTIVE CARE FOR ALL RESIDENTS OF THE STATE.
5
(B)
THE BOARD SHALL ESTABLISH REQUIREMENTS AND STANDARDS, BY
6
REGULATION, FOR HEALTHY MARYLAND AND HEALTH CARE PROVIDERS THAT ARE
7
CONSISTENT WITH THIS TITLE AND THE APPLICABLE PROFESSIONAL PRACTICE AND
8
LICENSURE STANDARDS FOR HEALTH CARE PROVIDERS ESTABLISHED UNDER
9
TITLE 19 OF THIS ARTICLE, THE HEALTH OCCUPATIONS ARTICLE, AND THE
10
INSURANCE
ARTICLE,
INCLUDING
REQUIREMENTS
AND
STANDARDS,
AS
11
APPLICABLE, FOR:
12
(1)
THE SCOPE, QUALITY, AND ACCESSIBILITY OF HEALTH CARE
13
SERVICES; AND
14
(2)
RELATIONS BETWEEN HEALTH CARE PROVIDERS AND HEALTHY
15
MARYLAND MEMBERS.
16
(C)
THE BOARD SHALL ESTABLISH REQUIREMENTS AND STANDARDS, BY
17
REGULATION, FOR HEALTHY MARYLAND THAT INCLUDE PROVISIONS TO PROMOTE:
18
(1)
SIMPLIFICATION, TRANSPARENCY, UNIFORMITY, AND FAIRNESS
19
IN HEALTH CARE PROVIDER CREDENTIALING AND PARTICIPATION, REFERRALS,
20
PAYMENT PROCEDURES AND RATES, CLAIMS PROCESSING, AND APPROVAL OF
21
HEALTH CARE SERVICES, AS APPLICABLE;
22
(2)
IN–PERSON
PRIMARY
AND
PREVENTIVE
CARE,
CARE
23
COORDINATION, EFFICIENT AND EFFECTIVE HEALTH CARE SERVICES, QUALITY
24
ASSURANCE, AND PROMOTION OF PUBLIC, ENVIRONMENTAL, AND OCCUPATIONAL
25
HEALTH;
26
(3)
ELIMINATION
OF
HEALTH
CARE
DISPARITIES,
INCLUDING
27
GEOGRAPHIC, RACIAL, INCOME–BASED, GENDER–BASED, SEX–BASED, AND OTHER
28
DISPARITIES;
29
(4)
CONSISTENT WITH TITLE 20 OF THE STATE GOVERNMENT
30
ARTICLE, TITLE 19 OF THE STATE FINANCE AND PROCUREMENT ARTICLE, AND
31
OTHER
NONDISCRIMINATION
LAWS,
NONDISCRIMINATION,
INCLUDING
A
32
HOUSE BILL 25
67
PROHIBITION ON DISCRIMINATORY REDUCTION OF BENEFITS, WITH RESPECT TO
1
HEALTHY MARYLAND MEMBERS AND HEALTH CARE PROVIDERS ON THE BASIS OF
2
RACE, COLOR, RELIGION OR CREED, SEX, AGE, ANCESTRY OR NATIONAL ORIGIN,
3
MARITAL STATUS, MENTAL OR PHYSICAL DISABILITY, SEXUAL ORIENTATION,
4
GENDER IDENTITY OR EXPRESSION, CITIZENSHIP, IMMIGRATION STATUS, PRIMARY
5
LANGUAGE, MEDICAL CONDITION, GENETIC INFORMATION, FAMILIAL STATUS,
6
MILITARY OR VETERAN STATUS, OR SOURCE OF INCOME;
7
(5)
THE PROVISION OF HEALTH CARE SERVICES UNDER HEALTHY
8
MARYLAND THAT ARE APPROPRIATE TO THE PATIENT’S CLINICALLY RELEVANT
9
CIRCUMSTANCES;
10
(6)
ACCESSIBILITY OF PRIMARY CARE AND OTHER HEALTH CARE
11
SERVICES, INCLUDING ACCESSIBILITY FOR PEOPLE WITH DISABILITIES AND PEOPLE
12
WITH LIMITED ABILITY TO SPEAK OR UNDERSTAND ENGLISH; AND
13
(7)
THE PROVISION OF PRIMARY CARE AND OTHER HEALTH CARE
14
SERVICES IN A CULTURALLY COMPETENT MANNER.
15
(D)
THE BOARD SHALL ESTABLISH REQUIREMENTS AND STANDARDS, BY
16
REGULATION AND TO THE EXTENT AUTHORIZED BY FEDERAL LAW, FOR REPLACING
17
AND MERGING WITH HEALTHY MARYLAND ANY HEALTH CARE SERVICES AND
18
ANCILLARY SERVICES CURRENTLY PROVIDED BY OTHER PROGRAMS, INCLUDING:
19
(1)
MEDICARE;
20
(2)
THE AFFORDABLE CARE ACT; AND
21
(3)
FEDERALLY MATCHED PUBLIC HEALTH PROGRAMS.
22
(E)
(1)
ANY PARTICIPATING PROVIDER THAT IS ORGANIZED AS A
23
NONPROFIT ENTITY MAY NOT RECEIVE PAYMENTS FOR ITEMS OR SERVICES
24
FURNISHED UNDER HEALTHY MARYLAND TO ACCOMMODATE INCREASES IN NET
25
INCOME.
26
(2)
ANY PARTICIPATING PROVIDER THAT IS ORGANIZED AS A
27
FOR–PROFIT ENTITY SHALL BE REQUIRED TO MEET THE SAME REQUIREMENTS AND
28
STANDARDS AS ENTITIES ORGANIZED AS NONPROFIT ENTITIES.
29
(3)
PAYMENTS
UNDER HEALTHY MARYLAND
TO
FOR–PROFIT
30
ENTITIES MAY NOT BE CALCULATED TO ACCOMMODATE THE GENERATION OF
31
PROFIT, EXCESS REVENUE, REVENUE FOR DIVIDENDS, OR OTHER RETURN ON
32
INVESTMENT OR THE PAYMENT OF TAXES THAT WOULD NOT BE PAID BY A
33
68
HOUSE BILL 25
NONPROFIT ENTITY.
1
(F)
(1)
A HEALTH CARE PROVIDER WHO PARTICIPATES IN HEALTHY
2
MARYLAND SHALL:
3
(I)
PROVIDE INFORMATION AS REQUIRED BY:
4
1.
THE MARYLAND HEALTH CARE COMMISSION;
5
2.
THE HEALTH SERVICES COST REVIEW COMMISSION;
6
AND
7
3.
THE DEPARTMENT; AND
8
(II)
ALLOW EXAMINATION OF THE INFORMATION BY HEALTHY
9
MARYLAND AS MAY BE REASONABLY REQUIRED FOR PURPOSES OF REVIEWING
10
ACCESSIBILITY
AND
UTILIZATION
OF
HEALTH
CARE
SERVICES,
QUALITY
11
ASSURANCE, COST CONTAINMENT, THE MAKING OF PAYMENTS, AND STATISTICAL OR
12
OTHER STUDIES OF THE OPERATION OF HEALTHY MARYLAND OR FOR PROTECTION
13
AND PROMOTION OF PUBLIC, ENVIRONMENTAL, AND OCCUPATIONAL HEALTH.
14
(2)
THE BOARD
SHALL
USE
DATA
COLLECTED
UNDER
THIS
15
SUBSECTION TO ENSURE THAT CLINICAL PRACTICES MEET THE UTILIZATION,
16
QUALITY, AND ACCESS STANDARDS OF HEALTHY MARYLAND.
17
(G)
IN DEVELOPING REQUIREMENTS AND STANDARDS AND MAKING OTHER
18
POLICY DETERMINATIONS UNDER THIS TITLE, THE BOARD SHALL CONSULT WITH
19
REPRESENTATIVES OF HEALTHY MARYLAND MEMBERS, HEALTH CARE PROVIDERS,
20
LABOR ORGANIZATIONS REPRESENTING HEALTH CARE EMPLOYEES, AND OTHER
21
INTERESTED PARTIES.
22
25–902.
23
(A)
AS PART OF A HEALTH CARE PROVIDER’S DUTY TO EXERCISE A
24
PROFESSIONAL STANDARD OF CARE WHEN EVALUATING EACH INDIVIDUAL
25
PATIENT’S MEDICAL CONDITION, A HEALTH CARE PROVIDER UNDER HEALTHY
26
MARYLAND HAS A DUTY:
27
(1)
TO ADVOCATE FOR MEDICALLY NECESSARY HEALTH CARE FOR
28
EACH OF THE HEALTH CARE PROVIDER’S INDIVIDUAL PATIENTS; AND
29
(2)
TO ACT IN THE EXCLUSIVE INTEREST OF EACH OF THE HEALTH
30
CARE PROVIDER’S INDIVIDUAL PATIENTS.
31
HOUSE BILL 25
69
(B)
CONSISTENT WITH SUBSECTION (A) OF THIS SECTION AND WITH
1
PROFESSIONAL STANDARDS OF CARE UNDER THE HEALTH OCCUPATIONS ARTICLE:
2
(1)
A PATIENT’S TREATING PHYSICIAN OR OTHER HEALTH CARE
3
PROVIDER WHO, ACCORDING TO THE HEALTH CARE PROVIDER’S SCOPE OF
4
PRACTICE AND LICENSE, IS AUTHORIZED TO ESTABLISH A MEDICAL DIAGNOSIS IS
5
RESPONSIBLE FOR THE DETERMINATION OF THE HEALTH CARE SERVICES
6
MEDICALLY NECESSARY FOR THE PATIENT;
7
(2)
A HEALTH CARE PROVIDER:
8
(I)
SHALL
USE
REASONABLE
CARE
AND
DILIGENCE
IN
9
SAFEGUARDING THE HEALTH CARE PROVIDER’S PATIENT; AND
10
(II)
MAY NOT IMPAIR A HEALTH CARE PROVIDER’S DUTY UNDER
11
SUBSECTION (A) OF THIS SECTION;
12
(3)
ANY PECUNIARY INTEREST OR RELATIONSHIP OF A HEALTH CARE
13
PROVIDER, INCLUDING ANY INTEREST OR RELATIONSHIP DISCLOSED UNDER
14
SUBSECTION (C) OF THIS SECTION, THAT IMPAIRS THE HEALTH CARE PROVIDER’S
15
OWN ABILITY TO PROVIDE MEDICALLY NECESSARY HEALTH CARE TO THE HEALTH
16
CARE PROVIDER’S PATIENT VIOLATES THE HEALTH CARE PROVIDER’S DUTY TO
17
ADVOCATE FOR MEDICALLY NECESSARY HEALTH CARE FOR THE PATIENT; AND
18
(4)
A HEALTH CARE PROVIDER VIOLATES THE DUTY TO PROVIDE
19
MEDICALLY NECESSARY CARE UNDER THIS SECTION IF THE HEALTH CARE
20
PROVIDER ACCEPTS ANY BONUS, INCENTIVE PAYMENT, OR COMPENSATION BASED
21
ON:
22
(I)
A PATIENT’S UTILIZATION OF SERVICES; OR
23
(II)
THE FINANCIAL RESULTS OF ANY OTHER HEALTH CARE
24
PROVIDER OR CARE COORDINATOR WITH WHICH THE HEALTH CARE PROVIDER HAS
25
A
PECUNIARY
INTEREST
OR
CONTRACTUAL
RELATIONSHIP,
INCLUDING
26
EMPLOYMENT OR ANY OTHER COMPENSATION–BASED RELATIONSHIP.
27
(C)
TO EVALUATE AND REVIEW COMPLIANCE BY HEALTH CARE PROVIDERS
28
WITH THIS SECTION, HEALTH CARE PROVIDERS PARTICIPATING IN HEALTHY
29
MARYLAND SHALL REPORT, AT LEAST ANNUALLY, TO THE HEALTH SERVICES COST
30
REVIEW COMMISSION:
31
(1)
ANY BENEFICIAL INTEREST OR COMPENSATION ARRANGEMENT
32
70
HOUSE BILL 25
REQUIRED TO BE DISCLOSED TO A PATIENT UNDER § 1–303 OR § 1–304 OF THE
1
HEALTH OCCUPATIONS ARTICLE;
2
(2)
ANY MEMBERSHIP, PROPRIETARY INTEREST, OR CO–OWNERSHIP
3
IN ANY FORM IN OR WITH A CLINICAL OR BIOANALYTICAL LABORATORY;
4
(3)
ANY PAYMENTS TO A CLINICAL OR BIOANALYTICAL LABORATORY
5
REQUIRED TO BE DISCLOSED TO A PATIENT UNDER § 14–404(A)(16) OF THE HEALTH
6
OCCUPATIONS ARTICLE;
7
(4)
ANY PROFIT–SHARING ARRANGEMENT WITH A CLINICAL OR
8
BIOANALYTICAL LABORATORY;
9
(5)
ANY CONTRACTS OR SUBCONTRACTS ENTERED INTO:
10
(I)
THAT CONTAIN INCENTIVE PLANS;
11
(II)
THAT INVOLVE GENERAL PAYMENTS THAT ARE NOT TIED TO
12
SPECIFIC MEDICAL DECISIONS INVOLVING SPECIFIC ENROLLEES OR GROUPS OF
13
ENROLLEES WITH SIMILAR MEDICAL CONDITIONS; OR
14
(III) UNDER § 15–113 OF THE INSURANCE ARTICLE;
15
(6)
ANY BONUS, INCENTIVE AGREEMENTS, OR COMPENSATION
16
ARRANGEMENTS WITH ANY HEALTH CARE PROVIDER;
17
(7)
ANY BONUS, INCENTIVE AGREEMENTS, OR COMPENSATION
18
ARRANGEMENTS WITH A CLINICALLY INTEGRATED ORGANIZATION AS DEFINED IN §
19
15–1901 OF THE INSURANCE ARTICLE; AND
20
(8)
ANY OFFER, DELIVERY, RECEIPT, OR ACCEPTANCE OF A REBATE,
21
REFUND, COMMISSION, PREFERENCE, PATRONAGE DIVIDEND, DISCOUNT, OR OTHER
22
CONSIDERATION FOR A REFERRAL MADE UNDER § 1–302(D) OF THE HEALTH
23
OCCUPATIONS ARTICLE.
24
(D)
AS NECESSARY, THE BOARD MAY ADOPT RULES AND REGULATIONS:
25
(1)
TO IMPLEMENT AND ENFORCE THIS SECTION; AND
26
(2)
TO EXPAND REPORTING REQUIREMENTS UNDER THIS SECTION.
27
SUBTITLE 10. FUNDING.
28
HOUSE BILL 25
71
25–1001.
1
(A)
THE BOARD SHALL SEEK ALL FEDERAL WAIVERS AND OTHER FEDERAL
2
APPROVALS AND ARRANGEMENTS AND SUBMIT STATE PLAN AMENDMENTS AS
3
NECESSARY TO OPERATE HEALTHY MARYLAND CONSISTENT WITH THIS TITLE.
4
(B)
(1)
ON OR BEFORE DECEMBER 1, 2023, THE BOARD SHALL APPLY TO
5
THE U.S. SECRETARY OF HEALTH AND HUMAN SERVICES OR ANY OTHER
6
APPROPRIATE FEDERAL OFFICIAL FOR ALL WAIVERS OF REQUIREMENTS, AND MAKE
7
OTHER ARRANGEMENTS, UNDER MEDICARE, ANY FEDERALLY MATCHED PUBLIC
8
HEALTH PROGRAM, THE AFFORDABLE CARE ACT, AND ANY OTHER FEDERAL
9
PROGRAMS RELATED TO THE PROVISION OF HEALTH CARE THAT PROVIDE FEDERAL
10
FUNDS FOR PAYMENT FOR HEALTH CARE SERVICES THAT ARE NECESSARY:
11
(I)
TO ENABLE ALL HEALTHY MARYLAND MEMBERS TO
12
RECEIVE ALL BENEFITS THROUGH HEALTHY MARYLAND;
13
(II)
TO ENABLE THE STATE TO IMPLEMENT THIS TITLE;
14
(III) TO ALLOW THE STATE TO RECEIVE AND DEPOSIT ALL
15
FEDERAL PAYMENTS UNDER THOSE PROGRAMS, INCLUDING FUNDS THAT MAY BE
16
PROVIDED IN LIEU OF PREMIUM TAX CREDITS, COST–SHARING SUBSIDIES, AND
17
SMALL BUSINESS TAX CREDITS, IN THE STATE TREASURY TO THE CREDIT OF THE
18
HEALTHY MARYLAND TRUST FUND CREATED UNDER SUBTITLE 11 OF THIS TITLE;
19
AND
20
(IV) TO USE FUNDS DEPOSITED IN THE FUND FOR HEALTHY
21
MARYLAND AND OTHER PROVISIONS UNDER THIS TITLE.
22
(2)
TO THE FULLEST EXTENT POSSIBLE, THE BOARD SHALL
23
NEGOTIATE ARRANGEMENTS WITH THE FEDERAL GOVERNMENT TO ENSURE THAT
24
FEDERAL PAYMENTS ARE PAID TO HEALTHY MARYLAND IN PLACE OF FEDERAL
25
FUNDING OF, OR TAX BENEFITS FOR, FEDERALLY MATCHED PUBLIC HEALTH
26
PROGRAMS OR FEDERAL HEALTH PROGRAMS.
27
(3)
TO THE EXTENT ANY FEDERAL FUNDING IS NOT PAID DIRECTLY
28
TO HEALTHY MARYLAND, THE STATE SHALL DIRECT THE FUNDING TO HEALTHY
29
MARYLAND.
30
(4)
(I)
THE BOARD MAY REQUIRE HEALTHY MARYLAND MEMBERS
31
OR APPLICANTS TO PROVIDE INFORMATION NECESSARY FOR HEALTHY MARYLAND
32
TO COMPLY WITH ANY WAIVER OR ARRANGEMENT UNDER THIS TITLE.
33
72
HOUSE BILL 25
(II)
INFORMATION
PROVIDED
BY
HEALTHY
MARYLAND
1
MEMBERS OR APPLICANTS TO THE BOARD FOR THE PURPOSES OF THIS PARAGRAPH
2
MAY NOT BE USED FOR ANY OTHER PURPOSE.
3
(5)
THE BOARD MAY TAKE ANY ACTION NECESSARY TO EFFECTIVELY
4
IMPLEMENT HEALTHY MARYLAND TO THE MAXIMUM EXTENT POSSIBLE AS A
5
SINGLE–PAYER PROGRAM CONSISTENT WITH THIS TITLE.
6
(C)
(1)
THE BOARD MAY TAKE ANY ACTION CONSISTENT WITH THIS
7
ARTICLE TO ENABLE HEALTHY MARYLAND TO ADMINISTER MEDICARE IN THE
8
STATE.
9
(2)
HEALTHY MARYLAND SHALL:
10
(I)
PROVIDE SUPPLEMENTAL INSURANCE COVERAGE UNDER
11
MEDICARE PART B; AND
12
(II)
PROVIDE PREMIUM ASSISTANCE DRUG COVERAGE UNDER
13
MEDICARE PART D FOR ELIGIBLE BENEFICIARIES OF MEDICARE PART D.
14
(D)
THE BOARD MAY WAIVE OR MODIFY THE APPLICABILITY OF ANY
15
PROVISIONS OF THIS SUBTITLE RELATING TO ANY FEDERALLY MATCHED PUBLIC
16
HEALTH PROGRAM OR MEDICARE, AS NECESSARY:
17
(1)
TO IMPLEMENT ANY WAIVER ARRANGEMENT UNDER THIS
18
SUBTITLE; OR
19
(2)
TO MAXIMIZE THE FEDERAL BENEFITS TO HEALTHY MARYLAND
20
UNDER THIS SUBTITLE.
21
(E)
(1)
THE BOARD MAY APPLY FOR COVERAGE FOR AND ENROLL ANY
22
ELIGIBLE HEALTHY MARYLAND MEMBER UNDER ANY FEDERALLY MATCHED
23
PUBLIC HEALTH PROGRAM OR MEDICARE.
24
(2)
ENROLLMENT IN A FEDERALLY MATCHED PUBLIC HEALTH
25
PROGRAM OR MEDICARE MAY NOT:
26
(I)
CAUSE ANY HEALTHY MARYLAND MEMBER TO LOSE ANY
27
HEALTH CARE SERVICE PROVIDED BY HEALTHY MARYLAND; OR
28
(II)
DIMINISH ANY RIGHT THE HEALTHY MARYLAND MEMBER
29
WOULD OTHERWISE HAVE UNDER ANY FEDERALLY MATCHED PUBLIC HEALTH
30
PROGRAM OR MEDICARE.
31
HOUSE BILL 25
73
(F)
NOTWITHSTANDING ANY OTHER LAW, THE BOARD SHALL TAKE ACTION
1
NECESSARY TO INCORPORATE HEALTH CARE COVERAGE OF STATE RESIDENTS WHO
2
ARE EMPLOYED IN OTHER JURISDICTIONS INTO WAIVERS AND OTHER APPROVALS
3
APPLIED FOR OR OBTAINED UNDER THIS SECTION.
4
(G)
(1)
NOTWITHSTANDING ANY OTHER LAW, THE BOARD SHALL TAKE
5
NECESSARY ACTION TO REDUCE OR ELIMINATE HEALTHY MARYLAND MEMBER
6
COINSURANCE, COST–SHARING, OR PREMIUM OBLIGATIONS AND INCREASE
7
HEALTHY MARYLAND MEMBER ELIGIBILITY FOR ANY FEDERAL FINANCIAL
8
SUPPORT RELATED TO MEDICARE OR THE AFFORDABLE CARE ACT.
9
(2)
THE BOARD
MAY
ACT
UNDER
PARAGRAPH (1)
OF
THIS
10
SUBSECTION ONLY ON A FINDING APPROVED BY THE SECRETARY OF BUDGET AND
11
MANAGEMENT AND THE BOARD THAT THE ACTION:
12
(I)
WILL HELP TO INCREASE THE NUMBER OF HEALTHY
13
MARYLAND MEMBERS WHO ARE ELIGIBLE FOR AND ENROLLED IN FEDERALLY
14
MATCHED PUBLIC HEALTH PROGRAMS, OR OTHER PROGRAMS, TO REDUCE OR
15
ELIMINATE HEALTHY MARYLAND MEMBER COINSURANCE, COST–SHARING, OR
16
PREMIUM OBLIGATIONS OR INCREASE HEALTHY MARYLAND MEMBER ELIGIBILITY
17
FOR ANY FEDERAL FINANCIAL SUPPORT RELATED TO MEDICARE OR THE
18
AFFORDABLE CARE ACT;
19
(II)
WILL NOT DIMINISH ANY HEALTHY MARYLAND MEMBER’S
20
ACCESS TO ANY HEALTH CARE SERVICE OR RIGHT THE HEALTHY MARYLAND
21
MEMBER WOULD OTHERWISE HAVE UNDER ANY FEDERALLY MATCHED PUBLIC
22
HEALTH PROGRAM OR MEDICARE;
23
(III) IS IN THE INTEREST OF HEALTHY MARYLAND; AND
24
(IV) DOES NOT REQUIRE OR HAS ALREADY RECEIVED ANY
25
NECESSARY FEDERAL WAIVERS OR APPROVALS TO ENSURE FEDERAL FINANCIAL
26
PARTICIPATION.
27
(3)
ACTION THAT THE BOARD MAY TAKE UNDER PARAGRAPH (1) OF
28
THIS SUBSECTION MAY INCLUDE:
29
(I)
AN INCREASE TO INCOME ELIGIBILITY LEVELS RELATED TO
30
MEDICARE OR THE AFFORDABLE CARE ACT;
31
(II)
AN INCREASE TO OR AN ELIMINATION OF THE RESOURCE
32
TEST FOR ELIGIBILITY RELATED TO MEDICARE OR THE AFFORDABLE CARE ACT;
33
74
HOUSE BILL 25
(III) SIMPLIFICATION
OF
ANY
PROCEDURAL
OR
1
DOCUMENTATION REQUIREMENT FOR ENROLLMENT RELATED TO MEDICARE OR
2
THE AFFORDABLE CARE ACT; AND
3
(IV) AN INCREASE IN THE BENEFITS FOR ANY FEDERALLY
4
MATCHED PUBLIC HEALTH PROGRAM AND FOR ANY OTHER PROGRAM TO REDUCE
5
OR ELIMINATE HEALTHY MARYLAND MEMBER COINSURANCE, COST–SHARING, OR
6
PREMIUM OBLIGATIONS OR INCREASE HEALTHY MARYLAND MEMBER ELIGIBILITY
7
FOR ANY FEDERAL FINANCIAL SUPPORT RELATED TO MEDICARE OR THE
8
AFFORDABLE CARE ACT.
9
(4)
ACTIONS
UNDER
THIS
SUBSECTION
MAY
NOT
APPLY
TO
10
ELIGIBILITY FOR PAYMENT FOR LONG–TERM SERVICES AND SUPPORTS.
11
(H)
TO ENABLE THE BOARD TO APPLY FOR COVERAGE FOR, AND ENROLL,
12
ANY ELIGIBLE HEALTHY MARYLAND MEMBER UNDER ANY FEDERALLY MATCHED
13
PUBLIC HEALTH PROGRAM, MEDICARE, OR ANY PROGRAM OR BENEFIT UNDER
14
MEDICARE, THE BOARD MAY REQUIRE THAT ALL HEALTHY MARYLAND MEMBERS
15
OR APPLICANTS FOR SUCH COVERAGE OR BENEFITS UNDER THOSE PROGRAMS
16
PROVIDE THE INFORMATION NECESSARY TO ENABLE THE BOARD TO DETERMINE
17
WHETHER THE HEALTHY MARYLAND MEMBERS OR APPLICANTS ARE ELIGIBLE FOR
18
COVERAGE OR BENEFITS UNDER THOSE PROGRAMS.
19
(I)
AS A CONDITION OF CONTINUED ELIGIBILITY FOR HEALTH CARE
20
SERVICES UNDER HEALTHY MARYLAND, A HEALTHY MARYLAND MEMBER WHO IS
21
ELIGIBLE FOR BENEFITS UNDER MEDICARE SHALL ENROLL IN MEDICARE,
22
INCLUDING PARTS A, B, AND D.
23
(J)
(1)
HEALTHY MARYLAND SHALL PROVIDE PREMIUM ASSISTANCE
24
FOR ALL HEALTHY MARYLAND MEMBERS ENROLLING IN A MEDICARE PART D
25
DRUG COVERAGE PLAN UNDER TITLE XVIII, § 1860D OF THE SOCIAL SECURITY
26
ACT.
27
(2)
(I)
SUBJECT TO SUBPARAGRAPH (II) OF THIS PARAGRAPH, THE
28
PREMIUM ASSISTANCE REQUIRED UNDER PARAGRAPH (1) OF THIS SUBSECTION IS
29
LIMITED TO THE LOW–INCOME BENCHMARK PREMIUM AMOUNT ESTABLISHED BY
30
THE CENTERS FOR MEDICARE AND MEDICAID SERVICES AND ANY OTHER AMOUNT
31
THE FEDERAL AGENCY ESTABLISHES UNDER ITS DE MINIMIS PREMIUM POLICY.
32
(II)
PREMIUM
ASSISTANCE
PAYMENTS
MADE
UNDER
33
PARAGRAPH (1) OF THIS SUBSECTION ON BEHALF OF HEALTHY MARYLAND
34
MEMBERS ENROLLED IN A MEDICARE ADVANTAGE PLAN MAY EXCEED THE
35
HOUSE BILL 25
75
LOW–INCOME BENCHMARK PREMIUM AMOUNT IF DETERMINED TO BE COST
1
EFFECTIVE TO HEALTHY MARYLAND.
2
(K)
IF HEALTHY MARYLAND HAS REASONABLE GROUNDS TO BELIEVE THAT
3
A HEALTHY MARYLAND MEMBER MAY BE ELIGIBLE FOR AN INCOME–RELATED
4
SUBSIDY UNDER TITLE XVIII, § 1860D–14 OF THE SOCIAL SECURITY ACT:
5
(1)
THE HEALTHY MARYLAND MEMBER SHALL PROVIDE AND
6
AUTHORIZE
HEALTHY
MARYLAND
TO
OBTAIN
ANY
INFORMATION
OR
7
DOCUMENTATION REQUIRED TO ESTABLISH THE HEALTHY MARYLAND MEMBER’S
8
ELIGIBILITY FOR THAT SUBSIDY; AND
9
(2)
HEALTHY MARYLAND SHALL ATTEMPT TO OBTAIN AS MUCH OF
10
THE INFORMATION AND DOCUMENTATION REQUIRED TO BE PROVIDED UNDER ITEM
11
(1) OF THIS SUBSECTION AS POSSIBLE.
12
(L)
(1)
HEALTHY MARYLAND SHALL MAKE A REASONABLE EFFORT TO
13
NOTIFY EACH HEALTHY MARYLAND MEMBER OF THE HEALTHY MARYLAND
14
MEMBER’S OBLIGATIONS UNDER THIS SECTION.
15
(2)
IF A REASONABLE EFFORT HAS BEEN MADE TO CONTACT THE
16
HEALTHY MARYLAND MEMBER AND THE HEALTHY MARYLAND MEMBER HAS NOT
17
PROVIDED INFORMATION REQUIRED UNDER THIS SECTION, HEALTHY MARYLAND
18
SHALL NOTIFY THE HEALTHY MARYLAND MEMBER IN WRITING THAT THE HEALTHY
19
MARYLAND MEMBER HAS 60 DAYS TO PROVIDE THE REQUIRED INFORMATION.
20
(3)
IF THE HEALTHY MARYLAND MEMBER DOES NOT PROVIDE THE
21
REQUIRED INFORMATION WITHIN 60 DAYS AFTER RECEIPT OF THE NOTIFICATION
22
UNDER PARAGRAPH (2) OF THIS SUBSECTION, THE HEALTHY MARYLAND MEMBER’S
23
COVERAGE UNDER HEALTHY MARYLAND MAY BE TERMINATED.
24
(4)
INFORMATION PROVIDED BY MEMBERS OR APPLICANTS TO THE
25
BOARD FOR THE PURPOSES OF THIS SECTION MAY NOT BE USED FOR ANY OTHER
26
PURPOSE.
27
(M)
HEALTHY MARYLAND SHALL ASSUME RESPONSIBILITY FOR PROVIDING
28
ALL BENEFITS AND HEALTH CARE SERVICES PAID FOR BY THE FEDERAL
29
GOVERNMENT WITH THE FEDERAL FUNDS PROVIDED FOR THOSE BENEFITS AND
30
SERVICES.
31
SUBTITLE 11. HEALTHY MARYLAND TRUST FUND.
32
25–1101.
33
76
HOUSE BILL 25
(A)
THERE IS A HEALTHY MARYLAND TRUST FUND.
1
(B)
THE PURPOSE OF THE FUND IS TO IMPLEMENT THE PURPOSES OF
2
HEALTHY MARYLAND UNDER THIS TITLE.
3
(C)
THE BOARD SHALL ADMINISTER THE FUND.
4
(D)
THE FUND IS A SPECIAL, NONLAPSING FUND THAT IS NOT SUBJECT TO
5
§ 7–302 OF THE STATE FINANCE AND PROCUREMENT ARTICLE.
6
(E)
THE FUND SHALL CONSIST OF:
7
(1)
MONEY APPROPRIATED IN THE STATE BUDGET TO THE FUND;
8
(2)
MONEY FROM ANY PAYROLL PREMIUM ADOPTED UNDER THIS
9
TITLE;
10
(3)
MONEY TRANSFERRED TO THE FUND THAT IS ATTRIBUTABLE TO
11
STATE AND FEDERAL FINANCIAL PARTICIPATION IN MEDICAID, THE MARYLAND
12
CHILDREN’S HEALTH INSURANCE PROGRAM, OR MEDICARE;
13
(4)
FEDERAL PAYMENTS RECEIVED BY THE STATE AS A RESULT OF
14
ANY WAIVER OF REQUIREMENTS GRANTED OR OTHER ARRANGEMENTS AGREED TO
15
BY THE U.S. SECRETARY OF HEALTH AND HUMAN SERVICES OR ANY OTHER
16
APPROPRIATE FEDERAL OFFICIAL FOR HEALTH CARE PROGRAMS ESTABLISHED
17
UNDER MEDICARE, ANY FEDERALLY MATCHED PUBLIC HEALTH PROGRAM, OR THE
18
AFFORDABLE CARE ACT;
19
(5)
FEDERAL AND STATE FUNDS FOR PURPOSES OF THE PROVISION
20
OF SERVICES AUTHORIZED UNDER TITLE XX OF THE SOCIAL SECURITY ACT THAT
21
WOULD OTHERWISE BE COVERED UNDER HEALTHY MARYLAND;
22
(6)
MONEY FROM OTHER FEDERAL PROGRAMS THAT PROVIDE FUNDS
23
FOR THE PAYMENT OF HEALTH CARE SERVICES THAT ARE PROVIDED UNDER THIS
24
TITLE;
25
(7)
STATE AND LOCAL FUNDS APPROPRIATED FOR HEALTH CARE
26
SERVICES AND BENEFITS THAT ARE PROVIDED UNDER THIS TITLE;
27
(8)
THE AMOUNTS PAID BY THE STATE THAT ARE EQUIVALENT TO
28
THOSE AMOUNTS THAT ARE PAID ON BEHALF OF RESIDENTS OF THE STATE UNDER
29
MEDICARE, ANY FEDERALLY MATCHED PUBLIC HEALTH PROGRAM, OR THE
30
HOUSE BILL 25
77
AFFORDABLE CARE ACT FOR HEALTH BENEFITS THAT ARE EQUIVALENT TO HEALTH
1
BENEFITS COVERED UNDER HEALTHY MARYLAND; AND
2
(9)
INVESTMENT EARNINGS OF THE FUND.
3
(F)
NOTWITHSTANDING ANY OTHER LAW, MONEY IN THE FUND MAY NOT BE
4
TRANSFERRED TO:
5
(1)
THE GENERAL FUND OR A SPECIAL FUND OF THE STATE; OR
6
(2)
ANY FUND OF A COUNTY OR MUNICIPALITY.
7
(G)
THE FUND MAY BE USED ONLY FOR HEALTHY MARYLAND AS
8
ESTABLISHED BY THIS TITLE.
9
(H)
(1)
THE STATE TREASURER SHALL INVEST THE MONEY OF THE FUND
10
IN THE SAME MANNER AS OTHER STATE MONEY MAY BE INVESTED.
11
(2)
ANY INVESTMENT EARNINGS OF THE FUND SHALL BE PAID INTO
12
THE FUND.
13
(I)
THE BOARD SHALL ESTABLISH AND MAINTAIN A PRUDENT RESERVE IN
14
THE FUND.
15
(J)
THE BOARD OR STAFF OF THE BOARD MAY NOT USE ANY FUNDS
16
INTENDED FOR THE ADMINISTRATIVE AND OPERATIONAL EXPENSES OF THE BOARD
17
FOR
STAFF
RETREATS,
PROMOTIONAL
GIVEAWAYS,
EXCESSIVE
EXECUTIVE
18
COMPENSATION, OR PROMOTION OF FEDERAL OR STATE LEGISLATIVE OR
19
REGULATORY MODIFICATIONS.
20
(K)
(1)
THERE IS A HEALTHY MARYLAND FEDERAL FUNDS ACCOUNT
21
WITHIN THE FUND.
22
(2)
ALL FEDERAL MONEY SHALL BE PLACED INTO THE HEALTHY
23
MARYLAND FEDERAL FUNDS ACCOUNT.
24
SUBTITLE 12. COLLECTIVE NEGOTIATION WITH HEALTHY MARYLAND.
25
25–1201.
26
(A)
IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS
27
INDICATED.
28
78
HOUSE BILL 25
(B)
(1)
“HEALTH CARE PROVIDER” MEANS AN INDIVIDUAL OR ENTITY
1
THAT IS:
2
(I)
LICENSED, CERTIFIED, REGISTERED, OR AUTHORIZED TO
3
PRACTICE A HEALTH CARE PROFESSION IN THE STATE; AND
4
(II)
APPROVED TO PARTICIPATE IN HEALTHY MARYLAND
5
UNDER § 25–701 OF THIS TITLE.
6
(2)
“HEALTH CARE PROVIDER” INCLUDES:
7
(I)
AN
INDIVIDUAL
WHO
PRACTICES
A
HEALTH
CARE
8
PROFESSION AS AN INDEPENDENT CONTRACTOR;
9
(II)
AN
OWNER,
AN
OFFICER,
A
SHAREHOLDER,
OR
A
10
PROPRIETOR OF A HEALTH CARE PROVIDER; AND
11
(III) AN ENTITY THAT EMPLOYS OR UTILIZES HEALTH CARE
12
PROVIDERS TO PROVIDE HEALTH CARE SERVICES, INCLUDING A HEALTH CARE
13
FACILITY AS DEFINED IN § 19–114 OF THIS ARTICLE.
14
(3)
“HEALTH CARE PROVIDER” DOES NOT INCLUDE AN INDIVIDUAL
15
WHO PRACTICES A HEALTH CARE PROFESSION AS AN EMPLOYEE OF ANOTHER
16
HEALTH CARE PROVIDER.
17
(C)
“HEALTH CARE PROVIDERS’ REPRESENTATIVE” MEANS A THIRD PARTY
18
THAT IS AUTHORIZED BY HEALTH CARE PROVIDERS TO NEGOTIATE ON THE HEALTH
19
CARE PROVIDERS’ BEHALF WITH HEALTHY MARYLAND OVER TERMS AND
20
CONDITIONS AFFECTING THOSE HEALTH CARE PROVIDERS.
21
25–1202.
22
(A)
HEALTH CARE PROVIDERS MAY MEET AND COMMUNICATE FOR THE
23
PURPOSE OF COLLECTIVELY NEGOTIATING WITH HEALTHY MARYLAND ON ANY
24
MATTER RELATING TO HEALTHY MARYLAND, INCLUDING:
25
(1)
RATES OF PAYMENT FOR HEALTH CARE SERVICES;
26
(2)
RATES OF PAYMENT FOR PRESCRIPTION AND NONPRESCRIPTION
27
DRUGS; AND
28
(3)
PAYMENT METHODOLOGIES.
29
HOUSE BILL 25
79
(B)
THIS SUBTITLE MAY NOT BE CONSTRUED:
1
(1)
TO ALLOW A STRIKE OF HEALTHY MARYLAND BY HEALTH CARE
2
PROVIDERS RELATED TO THE COLLECTIVE NEGOTIATIONS; OR
3
(2)
TO ALLOW OR AUTHORIZE TERMS OR CONDITIONS THAT WOULD
4
IMPEDE THE ABILITY OF HEALTHY MARYLAND:
5
(I)
TO OBTAIN OR RETAIN ACCREDITATION BY THE NATIONAL
6
COMMITTEE FOR QUALITY ASSURANCE OR A SIMILAR BODY; OR
7
(II)
TO COMPLY WITH APPLICABLE STATE OR FEDERAL LAW.
8
25–1203.
9
(A)
A HEALTH CARE PROVIDERS’ REPRESENTATIVE IS THE ONLY PARTY
10
AUTHORIZED TO NEGOTIATE WITH HEALTHY MARYLAND ON BEHALF OF THE
11
HEALTH CARE PROVIDERS AS A GROUP.
12
(B)
A HEALTH CARE PROVIDER MAY BE BOUND BY THE TERMS AND
13
CONDITIONS NEGOTIATED BY THE HEALTH CARE PROVIDERS’ REPRESENTATIVE.
14
(C)
DURING COLLECTIVE NEGOTIATIONS, HEALTH CARE PROVIDERS MAY
15
COMMUNICATE WITH:
16
(1)
OTHER HEALTH CARE PROVIDERS REGARDING THE TERMS AND
17
CONDITIONS TO BE NEGOTIATED WITH HEALTHY MARYLAND; AND
18
(2)
THE HEALTH CARE PROVIDERS’ REPRESENTATIVES.
19
(D)
HEALTHY MARYLAND MAY:
20
(1)
COMMUNICATE AND NEGOTIATE WITH THE HEALTH CARE
21
PROVIDERS’ REPRESENTATIVE; AND
22
(2)
OFFER AND PROVIDE DIFFERENT TERMS AND CONDITIONS TO
23
INDIVIDUAL COMPETING HEALTH CARE PROVIDERS.
24
(E)
THIS SECTION DOES NOT AFFECT OR LIMIT THE RIGHT OF A HEALTH
25
CARE PROVIDER OR GROUP OF HEALTH CARE PROVIDERS TO COLLECTIVELY
26
PETITION A GOVERNMENTAL ENTITY FOR A CHANGE IN A LAW, RULE, OR
27
REGULATION.
28
80
HOUSE BILL 25
(F)
THIS SECTION DOES NOT AFFECT OR LIMIT:
1
(1)
COLLECTIVE ACTION OR COLLECTIVE BARGAINING ON THE PART
2
OF A HEALTH CARE PROVIDER WITH THE HEALTH CARE PROVIDER’S EMPLOYER; OR
3
(2)
ANY OTHER LAWFUL COLLECTIVE ACTION OR COLLECTIVE
4
BARGAINING BY HEALTH CARE PROVIDERS.
5
(G)
BEFORE ENGAGING IN COLLECTIVE NEGOTIATIONS WITH HEALTHY
6
MARYLAND ON BEHALF OF HEALTH CARE PROVIDERS, A HEALTH CARE PROVIDERS’
7
REPRESENTATIVE SHALL FILE WITH THE BOARD, IN THE MANNER PRESCRIBED BY
8
THE BOARD, INFORMATION IDENTIFYING:
9
(1)
THE REPRESENTATIVE;
10
(2)
THE REPRESENTATIVE’S PLAN OF OPERATION; AND
11
(3)
THE REPRESENTATIVE’S PROCEDURES TO ENSURE COMPLIANCE
12
WITH THIS SUBTITLE.
13
(H)
(1)
A PERSON WHO ACTS AS THE REPRESENTATIVE OF NEGOTIATING
14
PARTIES UNDER THIS SUBTITLE SHALL PAY A FEE TO THE BOARD TO ACT AS A
15
REPRESENTATIVE.
16
(2)
THE BOARD SHALL SET THE FEE REQUIRED UNDER PARAGRAPH
17
(1) OF THIS SUBSECTION IN AN AMOUNT DETERMINED TO BE REASONABLE AND
18
NECESSARY TO COVER THE COSTS INCURRED BY THE BOARD IN ADMINISTERING
19
THIS SUBTITLE.
20
25–1204.
21
(A)
EXCEPT AS AUTHORIZED BY OTHER LAW, THIS SUBTITLE DOES NOT
22
AUTHORIZE COMPETING HEALTH CARE PROVIDERS TO ACT IN CONCERT IN
23
RESPONSE TO A HEALTH CARE PROVIDERS’ REPRESENTATIVE’S DISCUSSIONS OR
24
NEGOTIATIONS WITH HEALTHY MARYLAND.
25
(B)
A HEALTH CARE PROVIDERS’ REPRESENTATIVE MAY NOT NEGOTIATE
26
ANY
AGREEMENT
THAT
EXCLUDES,
LIMITS
THE
PARTICIPATION
OR
27
REIMBURSEMENT OF, OR OTHERWISE LIMITS THE SCOPE OF SERVICES TO BE
28
PROVIDED BY ANY HEALTH CARE PROVIDER OR GROUP OF HEALTH CARE
29
PROVIDERS WITH RESPECT TO THE PERFORMANCE OF SERVICES THAT ARE WITHIN
30
THE HEALTH CARE PROVIDER’S SCOPE OF PRACTICE, LICENSE, REGISTRATION, OR
31
CERTIFICATE.
32
HOUSE BILL 25
81
Article – Insurance
1
31–101.
2
(a)
In this subtitle the following words have the meanings indicated.
3
(b)
“Board” means the [Board of Trustees of the Exchange] HEALTHY
4
MARYLAND BOARD, ESTABLISHED UNDER TITLE 25, SUBTITLE 3 OF THE HEALTH –
5
GENERAL ARTICLE.
6
[31–104.
7
(a)
There is a Board of Trustees of the Exchange.
8
(b)
The Board consists of the following members:
9
(1)
the Secretary of Health;
10
(2)
the Commissioner;
11
(3)
the Executive Director of the Maryland Health Care Commission; and
12
(4)
the following members appointed by the Governor, with the advice and
13
consent of the Senate:
14
(i)
three members who:
15
1.
represent the interests of employers and individual
16
consumers of products offered by the Exchange; and
17
2.
may have public health research expertise; and
18
(ii)
three members who have demonstrated knowledge and expertise
19
in at least two of the following areas:
20
1.
individual health care coverage;
21
2.
small employer–sponsored health care coverage;
22
3.
health benefit plan administration;
23
4.
health care finance;
24
5.
administration of public or private health care delivery
25
systems;
26
82
HOUSE BILL 25
6.
purchasing and facilitating enrollment in health plan
1
coverage, including demonstrated knowledge and expertise about the role of licensed health
2
insurance producers and third–party administrators in connecting employers and
3
individual consumers to health plan coverage; and
4
7.
public health and public health research, including
5
knowledge about the health needs and health disparities among the State’s diverse
6
communities.
7
(c)
In making appointments of members under subsection (b)(4) of this section,
8
the Governor shall assure that:
9
(1)
the Board’s composition reflects a diversity of expertise;
10
(2)
the Board’s composition reflects the gender, racial, and ethnic diversity
11
of the State; and
12
(3)
the geographic areas of the State are represented.
13
(d)
(1)
For purposes of this subsection, “affiliation” means:
14
(i)
a financial interest, as defined in § 5–101 of the General
15
Provisions Article;
16
(ii)
a position of governance, including membership on a board of
17
directors, regardless of compensation;
18
(iii)
a relationship through which compensation, as defined in §
19
5–101 of the General Provisions Article, is received; or
20
(iv)
a relationship for the provision of services as a regulated lobbyist,
21
as defined in § 5–101 of the General Provisions Article.
22
(2)
A member of the Board or of the staff of the Exchange, while serving on
23
the Board or the staff, may not have an affiliation with:
24
(i)
a carrier, an insurance producer, a third–party administrator, a
25
managed care organization, or any other person contracting directly with the Exchange;
26
(ii)
a trade association of carriers, insurance producers, third–party
27
administrators, or managed care organizations; or
28
(iii)
any other association of entities in a position to contract directly
29
with the Exchange.
30
(e)
(1)
The term of a member appointed by the Governor is 4 years.
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HOUSE BILL 25
83
(2)
The terms of members appointed by the Governor are staggered as
1
required by the terms provided for members of the Board on June 1, 2011.
2
(3)
At the end of a term, a member continues to serve until a successor is
3
appointed and qualifies.
4
(4)
A member who is appointed after a term has begun serves only for the
5
rest of the term and until a successor is appointed and qualifies.
6
(f)
An appointed member of the Board may not serve more than two consecutive
7
full terms.
8
(g)
The Governor shall designate a chair of the Board.
9
(h)
(1)
The Board shall determine the times, places, and frequency of its
10
meetings.
11
(2)
Five members of the Board constitute a quorum.
12
(3)
Action by the Board requires the affirmative vote of at least five
13
members.
14
(i)
A member of the Board is entitled to reimbursement for expenses under the
15
Standard State Travel Regulations, as provided in the State budget.
16
(j)
A member shall:
17
(1)
meet the requirements of this subtitle, the Affordable Care Act, and all
18
applicable State and federal laws and regulations;
19
(2)
serve the public interest of the individuals and qualified employers
20
seeking health care coverage through the Exchange; and
21
(3)
ensure the sound operation and fiscal solvency of the Exchange.
22
(k)
A member of the Board shall perform the member’s duties:
23
(1)
in good faith;
24
(2)
in the manner the member reasonably believes to be in the best
25
interests of the Exchange; and
26
(3)
without intentional or reckless disregard of the care an ordinarily
27
prudent person in a like position would use under similar circumstances.
28
(l)
A member of the Board who performs the member’s duties in accordance with
29
the standard provided in subsection (k) of this section may not be liable personally for
30
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HOUSE BILL 25
actions taken as a member.
1
(m)
A member of the Board may be removed for incompetence, misconduct, or
2
failure to perform the duties of the position.
3
(n)
(1)
(i)
A member of the Board shall be subject to the Maryland Public
4
Ethics Law, Title 5, Subtitles 1 through 7 of the General Provisions Article.
5
(ii)
In addition to the disclosure required under Title 5, Subtitle 6 of
6
the General Provisions Article, a member of the Board shall disclose to the Board and to
7
the public any relationship not addressed in the required financial disclosure that the
8
member has with a carrier, insurance producer, third–party administrator, managed care
9
organization, or other entity in an industry involved in matters likely to come before the
10
Board.
11
(2)
On all matters that come before the Board, the member shall:
12
(i)
adhere strictly to the conflict of interest provisions under Title 5,
13
Subtitle 5 of the General Provisions Article relating to restrictions on participation,
14
employment, and financial interests; and
15
(ii)
provide full disclosure to the Board and the public on:
16
1.
any matter that gives rise to a potential conflict of interest;
17
and
18
2.
the manner in which the member will comply with the
19
provisions of Title 5, Subtitle 5 of the General Provisions Article to avoid any conflict of
20
interest or appearance of a conflict of interest.]
21
31–104.
22
THE HEALTHY MARYLAND BOARD SHALL OVERSEE THE ADMINISTRATION OF
23
THE EXCHANGE UNTIL THE EXCHANGE CEASES TO OPERATE IN THE STATE.
24
31–105.
25
[(a)
(1)
With the approval of the Governor, the Board shall appoint an
26
Executive Director of the Exchange.
27
(2)
The Executive Director shall serve at the pleasure of the Board.
28
(3)
The Board shall determine the appropriate compensation for the
29
Executive Director.]
30
(A)
THE EXECUTIVE DIRECTOR OF HEALTHY MARYLAND, APPOINTED BY
31
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85
THE BOARD UNDER § 25–302 OF THE HEALTH – GENERAL ARTICLE, SHALL SERVE
1
AS THE EXECUTIVE DIRECTOR OF THE EXCHANGE UNTIL THE EXCHANGE CEASES
2
TO OPERATE IN THE STATE.
3
Article – State Finance and Procurement
4
6–226.
5
(a)
(2)
(i)
Notwithstanding any other provision of law, and unless
6
inconsistent with a federal law, grant agreement, or other federal requirement or with the
7
terms of a gift or settlement agreement, net interest on all State money allocated by the
8
State Treasurer under this section to special funds or accounts, and otherwise entitled to
9
receive interest earnings, as accounted for by the Comptroller, shall accrue to the General
10
Fund of the State.
11
(ii)
The provisions of subparagraph (i) of this paragraph do not apply
12
to the following funds:
13
170. the Cannabis Public Health Fund; [and]
14
171. the Community Reinvestment and Repair Fund; AND
15
172. THE HEALTHY MARYLAND TRUST FUND.
16
SECTION 2. AND BE IT FURTHER ENACTED, That the terms of the initial
17
appointed members of:
18
(1)
the Healthy Maryland Board shall expire as follows:
19
(i)
two members in 2024;
20
(ii)
two members in 2025;
21
(iii)
two members in 2026; and
22
(iv)
two members in 2027; and
23
(2)
the Healthy Maryland Public Advisory Committee shall expire as
24
follows:
25
(i)
five members in 2024;
26
(ii)
five members in 2025;
27
(iii)
five members in 2026; and
28
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HOUSE BILL 25
(iv)
six members in 2027.
1
SECTION 3. AND BE IT FURTHER ENACTED, That, if any provision of this Act or
2
the application thereof to any person or circumstance is held invalid for any reason in a
3
court of competent jurisdiction, the invalidity does not affect other provisions or any other
4
application of this Act that can be given effect without the invalid provision or application,
5
and for this purpose the provisions of this Act are declared severable.
6
SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect July
7
1, 2023.
8