Text of MD HB 534 (2021)

EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW. [Brackets] indicate matter deleted from existing law. *hb0534* HOUSE BILL 534 J1 1lr1779 HB 1648/20 – HRU By: Delegate Acevero Introduced and read first time: January 15, 2021 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; providing that the exercise by Healthy Maryland of 4 its authority under this Act is an essential governmental function; stating the 5 findings and intent of the General Assembly; providing for the construction and 6 effect of this Act; prohibiting Healthy Maryland and certain agencies and employees 7 from providing or disclosing certain information for certain purposes; prohibiting 8 certain law enforcement agencies from using certain funds, facilities, property, 9 equipment, and personnel to investigate, enforce, or assist in the investigation or 10 enforcement of certain violations and warrants; providing for the duties of Healthy 11 Maryland; establishing that Healthy Maryland is subject to certain provisions of law; 12 establishing the Healthy Maryland Board; providing for the duties of Board 13 members; establishing certain requirements and prohibitions for Board members 14 regarding conflicts of interest; prohibiting a member of the Board from being held 15 personally liable for certain actions taken as a member; establishing the powers and 16 duties of the Board; requiring the Board to appoint an Executive Director of Healthy 17 Maryland; establishing the powers and duties of the Executive Director; requiring 18 the Secretary of Budget and Management to perform certain functions relating to 19 the employment and contracting of staff for Healthy Maryland; providing that an 20 employee or independent contractor of Healthy Maryland is not subject to certain 21 laws, regulations, or executive orders; providing for the implementation of Healthy 22 Maryland; requiring the Board to provide a certain percentage of the annual budget 23 of Healthy Maryland to provide certain assistance to certain programs for a certain 24 time period; prohibiting a carrier from offering certain benefits and certain services; 25 authorizing certain carriers to offer certain benefits; requiring that certain data be 26 reported to the Health Services Cost Review Commission; providing that a certain 27 provision of law does not impact certain provider reporting requirements; 28 establishing the Healthy Maryland Public Advisory Committee; establishing certain 29 requirements and prohibitions for Advisory Committee members regarding conflicts 30 of interest; establishing the powers and duties of the Advisory Committee; 31 2 HOUSE BILL 534 prohibiting a member of the Advisory Committee from being held personally liable 1 for certain actions taken as a member; establishing certain eligibility standards for 2 enrollment in Healthy Maryland; prohibiting certain participating providers from 3 engaging in certain conduct; authorizing certain institutions of higher education to 4 purchase certain coverage for certain individuals; establishing certain requirements 5 for certain employers and certain employees relating to the payment of certain 6 premiums; authorizing certain residents of the State to receive certain benefits 7 through certain employers and to opt out of participation in Healthy Maryland; 8 providing that certain contributions made by employers on behalf of certain 9 employees may not be abridged by this Act; authorizing certain persons to take 10 certain credits against certain premiums; providing for the distribution, application, 11 and amount of the credits; establishing the benefits covered under Healthy 12 Maryland; establishing that a certain physician or health care provider has a certain 13 approval under certain provisions of this Act and is authorized to establish a certain 14 diagnosis and assessment; requiring the Board to perform a certain evaluation in a 15 certain manner; authorizing health care providers and members of Healthy 16 Maryland to petition the Board for a certain purpose; providing for the manner in 17 which long–term services and supports are to be provided under Healthy Maryland; 18 establishing certain qualifications and requirements that must be met for health 19 care providers to participate in Healthy Maryland; authorizing and requiring 20 participating providers to provide certain services and take certain actions under 21 Healthy Maryland; authorizing a member of Healthy Maryland to receive certain 22 services from certain health care providers under certain circumstances; providing 23 for the enrollment with and withdrawal from certain health care delivery systems, 24 medical practices, and community providers for certain individuals and members of 25 Healthy Maryland; prohibiting certain entities from furnishing certain items and 26 services under certain circumstances; prohibiting participating providers from 27 taking certain actions; requiring that a certain contract contain certain provisions; 28 providing that a certain contract is null and void; prohibiting certain payments 29 under certain circumstances; prohibiting the Board from terminating a certain 30 participation agreement or from certain discrimination against certain individuals 31 under certain circumstances; authorizing a certain provider or authorized 32 representative of a provider to seek certain relief; prohibiting a certain employer 33 from terminating or otherwise discriminating against a certain employee under 34 certain circumstances; authorizing a certain employee to file a certain civil action; 35 providing that certain rights, privileges, and remedies may not be waived under 36 certain circumstances; establishing certain requirements for the payment of certain 37 services under Healthy Maryland; prohibiting participating providers from charging 38 certain rates and soliciting or accepting certain payment from certain persons for 39 certain health care services; establishing certain requirements for payment of 40 certain capital–related expenses; requiring the Board to pay a certain global budget 41 payment to a certain provider within a certain time period; prohibiting certain 42 payment amounts from taking into account certain factors; allowing certain 43 operating expenses of a certain provider to include certain costs; requiring Healthy 44 Maryland to engage in certain negotiations with certain representatives; requiring 45 the Board to establish a certain formulary; requiring the Board to establish certain 46 rates; prohibiting certain payments from taking into account, allowing, or including 47 HOUSE BILL 534 3 any process for the provision of certain funding; requiring Healthy Maryland to have 1 a certain standard of health care for residents of the State; prohibiting certain 2 payments under Healthy Maryland from being calculated in a certain manner; 3 establishing certain requirements and duties for health care providers who 4 participate in Healthy Maryland; requiring the Board, on or before a certain date, to 5 apply for certain waivers of certain requirements and make certain arrangements 6 under certain programs for a certain purpose; authorizing the Board to take certain 7 actions relating to certain implementation for Healthy Maryland and certain 8 administration of Medicare in the State; establishing certain requirements for 9 Healthy Maryland regarding certain supplemental insurance coverage and certain 10 drug coverage; authorizing the Board to waive or modify the applicability of certain 11 provisions of this Act under certain circumstances; authorizing the Board to apply 12 for coverage for certain members of Healthy Maryland and enroll those members in 13 certain programs; requiring certain members of Healthy Maryland to enroll in 14 certain coverage as a condition of certain eligibility for certain health care services; 15 requiring members of Healthy Maryland to provide and authorize Healthy Maryland 16 to obtain certain information; authorizing the termination of coverage under Healthy 17 Maryland under certain circumstances; requiring Healthy Maryland to assume 18 responsibility for providing certain benefits and certain health care services in a 19 certain manner; establishing the Healthy Maryland Trust Fund as a special, 20 nonlapsing fund; requiring interest earnings of the Fund to be credited to the Fund; 21 exempting the Fund from a certain provision of law requiring interest earning on 22 State money to accrue to the General Fund of the State; authorizing certain health 23 care providers to meet and communicate for the purpose of collectively negotiating 24 with Healthy Maryland on certain matters; establishing certain rights and 25 requirements relating to certain negotiations with Healthy Maryland; requiring a 26 certain representative to pay a certain fee to the Board for a certain purpose; 27 requiring the Board to set the fee at a certain amount; prohibiting certain concerted 28 action and the negotiation of certain agreements by certain representatives; 29 repealing the Board of Trustees of the Maryland Health Benefit Exchange; requiring 30 the Healthy Maryland Board to oversee the administration of the Maryland Health 31 Benefit Exchange under certain circumstances; repealing a requirement that the 32 Board of Trustees of the Maryland Health Benefit Exchange appoint an Executive 33 Director of the Exchange, with the approval of the Governor, and determine certain 34 compensation for the Executive Director; requiring the Executive Director of Healthy 35 Maryland to serve as the Executive Director of the Maryland Health Benefit 36 Exchange under certain circumstances; making the provisions of this Act severable; 37 defining certain terms; and generally relating to Healthy Maryland. 38 BY adding to 39 Article – Health – General 40 Section 25–101 through 25–1204 to be under the new title “Title 25. Healthy 41 Maryland” 42 Annotated Code of Maryland 43 (2019 Replacement Volume and 2020 Supplement) 44 BY repealing and reenacting, without amendments, 45 4 HOUSE BILL 534 Article – Insurance 1 Section 31–101(a) 2 Annotated Code of Maryland 3 (2017 Replacement Volume and 2020 Supplement) 4 BY repealing and reenacting, with amendments, 5 Article – Insurance 6 Section 31–101(b) 7 Annotated Code of Maryland 8 (2017 Replacement Volume and 2020 Supplement) 9 BY repealing 10 Article – Insurance 11 Section 31–104 and 31–105(a) 12 Annotated Code of Maryland 13 (2017 Replacement Volume and 2020 Supplement) 14 BY adding to 15 Article – Insurance 16 Section 31–104 and 31–105(a) 17 Annotated Code of Maryland 18 (2017 Replacement Volume and 2020 Supplement) 19 BY repealing and reenacting, without amendments, 20 Article – State Finance and Procurement 21 Section 6–226(a)(2)(i) 22 Annotated Code of Maryland 23 (2015 Replacement Volume and 2020 Supplement) 24 BY repealing and reenacting, with amendments, 25 Article – State Finance and Procurement 26 Section 6–226(a)(2)(ii)122. and 123. 27 Annotated Code of Maryland 28 (2015 Replacement Volume and 2020 Supplement) 29 BY adding to 30 Article – State Finance and Procurement 31 Section 6–226(a)(2)(ii)124. 32 Annotated Code of Maryland 33 (2015 Replacement Volume and 2020 Supplement) 34 SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 35 That the Laws of Maryland read as follows: 36 Article – Health – General 37 TITLE 25. HEALTHY MARYLAND. 38 HOUSE BILL 534 5 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)(4)(I) OF THE 25 INSURANCE ARTICLE. 26 (G) “COMMITTEE” MEANS THE HEALTHY MARYLAND PUBLIC ADVISORY 27 COMMITTEE. 28 6 HOUSE BILL 534 (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 HOUSE BILL 534 7 19–3A–01 OF THIS ARTICLE; 1 (III) A HEALTH CARE FACILITY AS DEFINED IN § 10–101 OF THIS 2 ARTICLE; 3 (IV) A HOSPITAL AS DEFINED IN § 19–301 OF THIS ARTICLE; 4 (V) A LIMITED SERVICE HOSPITAL AS DEFINED IN § 19–301 OF 5 THIS ARTICLE; 6 (VI) A RELATED INSTITUTION AS DEFINED IN § 19–301 OF THIS 7 ARTICLE; OR 8 (VII) A RESIDENTIAL TREATMENT CENTER AS DEFINED IN § 9 19–301 OF THIS ARTICLE; 10 (8) A MASSAGE THERAPIST; 11 (9) A REGISTERED NURSE; 12 (10) A NUTRITIONIST; 13 (11) AN OCCUPATIONAL THERAPIST; 14 (12) AN OPTOMETRIST; 15 (13) A PHYSICAL THERAPIST; 16 (14) A PHYSICIAN; 17 (15) A PODIATRIST; 18 (16) A PROFESSIONAL COUNSELOR; 19 (17) A PSYCHOLOGIST; 20 (18) A SOCIAL WORKER; OR 21 (19) A SPEECH–LANGUAGE PATHOLOGIST. 22 (L) “HEALTH CARE SERVICE” MEANS ANY HEALTH CARE SERVICE THAT IS 23 INCLUDED AS A BENEFIT UNDER HEALTHY MARYLAND. 24 8 HOUSE BILL 534 (M) “HEALTHY MARYLAND” MEANS THE HEALTHY MARYLAND PROGRAM. 1 (N) “HOME– AND COMMUNITY–BASED SERVICES” MEANS THE HOME– AND 2 COMMUNITY–BASED SERVICES ESTABLISHED UNDER § 1915(C), (D), (I), AND (K) OF 3 THE SOCIAL SECURITY ACT AND AS DEFINED IN THE HOME– AND 4 COMMUNITY–BASED SERVICES SETTINGS RULE UNDER 42 C.F.R. § 441.530 AND 42 5 C.F.R. § 441.656. 6 (O) “IMPLEMENTATION PERIOD” MEANS THE PERIOD SPECIFIED UNDER § 7 25–304 OF THIS TITLE DURING WHICH HEALTHY MARYLAND IS SUBJECT TO 8 SPECIAL ELIGIBILITY AND FINANCING PROVISIONS UNTIL IT IS FULLY 9 IMPLEMENTED UNDER THAT SECTION. 10 (P) “INSTITUTIONAL PROVIDER” HAS THE MEANING STATED IN § 1861(U) 11 OF THE SOCIAL SECURITY ACT. 12 (Q) (1) “INSTRUMENTAL ACTIVITIES OF DAILY LIVING” MEANS 13 ACTIVITIES RELATED TO LIVING INDEPENDENTLY IN THE COMMUNITY. 14 (2) “INSTRUMENTAL ACTIVITIES OF DAILY LIVING” INCLUDES MEAL 15 PLANNING AND PREPARATION, PERSONAL FINANCIAL MANAGEMENT, SHOPPING, 16 HOUSEKEEPING, COMMUNICATING BY PHONE OR OTHER MEDIA, AND 17 TRANSPORTATION. 18 (R) (1) “LONG–TERM SERVICES AND SUPPORTS” MEANS LONG–TERM 19 CARE, TREATMENT, MAINTENANCE, OR SERVICES NEEDED TO SUPPORT THE 20 ACTIVITIES OF DAILY LIVING AND THE INSTRUMENTAL ACTIVITIES OF DAILY LIVING 21 FOR AN INDIVIDUAL WITH A DISABILITY, INCLUDING: 22 (I) ANY LONG–TERM SERVICES AND SUPPORTS AVAILABLE 23 UNDER § 1915 OF THE SOCIAL SECURITY ACT; 24 (II) HOME– AND COMMUNITY–BASED SERVICES; AND 25 (III) ANY ADDITIONAL SERVICES AND SUPPORTS IDENTIFIED BY 26 THE SECRETARY TO SUPPORT INDIVIDUALS WITH DISABILITIES TO LIVE, WORK, AND 27 PARTICIPATE IN THEIR COMMUNITIES. 28 (2) “LONG–TERM SERVICES AND SUPPORTS” DOES NOT INCLUDE 29 SHORT–TERM REHABILITATION SERVICES, AS DEFINED BY THE BOARD. 30 (S) “MEDICAID” OR “MEDICAL ASSISTANCE” MEANS A PROGRAM THAT IS 31 ONE OF THE FOLLOWING: 32 HOUSE BILL 534 9 (1) THE MARYLAND MEDICAL ASSISTANCE PROGRAM UNDER TITLE 1 XIX OF THE SOCIAL SECURITY ACT; OR 2 (2) THE MARYLAND CHILDREN’S HEALTH INSURANCE PROGRAM 3 UNDER TITLE XXI OF THE SOCIAL SECURITY ACT. 4 (T) “MEDICALLY NECESSARY” MEANS THE HEALTH CARE ITEMS OR 5 SERVICES: 6 (1) NEEDED TO PREVENT, DIAGNOSE, OR TREAT AN ILLNESS, AN 7 INJURY, A CONDITION, A DISEASE, OR ITS SYMPTOMS; AND 8 (2) THAT MEET ACCEPTED STANDARDS OF CARE AS DETERMINED BY 9 A PATIENT’S TREATING PHYSICIAN OR OTHER INDIVIDUAL HEALTH CARE PROVIDER 10 WHO, ACCORDING TO THAT HEALTH CARE PROVIDER’S SCOPE OF PRACTICE AND 11 LICENSURE IN THE STATE, IS AUTHORIZED TO ESTABLISH A MEDICAL DIAGNOSIS 12 AND HAS MADE A MEDICAL ASSESSMENT OF THE PATIENT’S CONDITION. 13 (U) “MEDICARE” MEANS TITLE XVIII OF THE SOCIAL SECURITY ACT AND 14 THE PROGRAMS THEREUNDER. 15 (V) “MEMBER” MEANS AN INDIVIDUAL WHO IS ENROLLED IN HEALTHY 16 MARYLAND. 17 (W) “OUT–OF–STATE HEALTH CARE SERVICE” MEANS A HEALTH CARE 18 SERVICE PROVIDED IN PERSON TO A MEMBER WHILE THE MEMBER IS TEMPORARILY 19 AND PHYSICALLY LOCATED OUTSIDE THE STATE BECAUSE: 20 (1) IT IS MEDICALLY NECESSARY THAT THE HEALTH CARE SERVICE 21 BE PROVIDED WHILE THE MEMBER PHYSICALLY IS OUTSIDE THE STATE; OR 22 (2) THE HEALTH CARE SERVICE: 23 (I) IS CLINICALLY APPROPRIATE AND NECESSARY; AND 24 (II) CAN BE PROVIDED ONLY BY A PARTICULAR HEALTH CARE 25 PROVIDER PHYSICALLY LOCATED OUTSIDE THE STATE. 26 (X) “PARTICIPATING PROVIDER” MEANS ANY INDIVIDUAL OR ENTITY THAT 27 IS A HEALTH CARE PROVIDER QUALIFIED UNDER § 25–701 OF THIS TITLE THAT 28 PROVIDES HEALTH CARE SERVICES TO MEMBERS UNDER HEALTHY MARYLAND. 29 10 HOUSE BILL 534 (Y) “PRESCRIPTION DRUGS” HAS THE MEANING STATED IN § 21–201 OF 1 THIS ARTICLE. 2 (Z) “RESIDENT” MEANS AN INDIVIDUAL WITHOUT REGARD TO THE 3 INDIVIDUAL’S IMMIGRATION STATUS: 4 (1) WHOSE PRIMARY PLACE OF ABODE IS IN THE STATE; AND 5 (2) WHO MEETS THE STATE RESIDENCE REQUIREMENTS ADOPTED BY 6 THE BOARD UNDER § 25–304(B) OF THIS TITLE. 7 (AA) “TEMPORARILY” MEANS FOR A PERIOD OF TIME THAT IS NOT MORE 8 THAN 90 DAYS. 9 25–102. 10 (A) THE GENERAL ASSEMBLY FINDS THAT: 11 (1) ALL RESIDENTS OF THE STATE HAVE THE RIGHT TO HEALTH 12 CARE; 13 (2) RESIDENTS OF THE STATE, AS INDIVIDUALS, EMPLOYERS, AND 14 TAXPAYERS, HAVE EXPERIENCED: 15 (I) A RISE IN THE COST OF HEALTH CARE AND HEALTH CARE 16 COVERAGE IN RECENT YEARS, INCLUDING RISING PREMIUMS, DEDUCTIBLES, AND 17 COPAYS; AND 18 (II) RESTRICTED PROVIDER NETWORKS AND HIGH 19 OUT–OF–NETWORK CHARGES; 20 (3) BUSINESSES HAVE EXPERIENCED INCREASES IN THE COSTS OF 21 HEALTH CARE BENEFITS FOR EMPLOYEES, AND MANY EMPLOYERS ARE SHIFTING A 22 LARGER SHARE OF THE COST OF COVERAGE TO EMPLOYEES OR DROPPING 23 COVERAGE ENTIRELY; 24 (4) INDIVIDUALS OFTEN FIND THAT THE INDIVIDUALS ARE DEPRIVED 25 OF AFFORDABLE CARE AND CHOICE BECAUSE OF DECISIONS BY HEALTH BENEFIT 26 PLANS GUIDED BY THE PLAN’S ECONOMIC NEEDS RATHER THAN INDIVIDUALS’ 27 HEALTH CARE NEEDS; 28 (5) TO ADDRESS THE FISCAL CRISIS FACING THE STATE AND ENSURE 29 THAT RESIDENTS OF THE STATE MAY EXERCISE THE RESIDENTS’ RIGHT TO HEALTH 30 HOUSE BILL 534 11 CARE, COMPREHENSIVE HEALTH CARE COVERAGE NEEDS TO BE PROVIDED; 1 (6) PROFIT–MAKING HEALTH CARE PROVIDERS HAVE INCREASINGLY 2 DEVASTATED THE LIVES OF THOUSANDS OF MARYLAND RESIDENTS; AND 3 (7) MILLIONS OF DOLLARS THAT COULD BE SPENT ON CARE TO 4 MARYLAND RESIDENTS ARE DIVERTED TO PROFIT OR ARE WASTED ON 5 ADMINISTRATIVE COSTS NECESSARY IN A MULTIPAYER HEALTH CARE SYSTEM. 6 (B) IT IS THE INTENT OF THE GENERAL ASSEMBLY THAT: 7 (1) THERE BE A COMPREHENSIVE UNIVERSAL SINGLE–PAYER 8 HEALTH CARE COVERAGE PROGRAM AND A HEALTH CARE COST CONTROL SYSTEM 9 FOR THE BENEFIT OF ALL RESIDENTS OF THE STATE; 10 (2) HEALTHY MARYLAND BE ESTABLISHED TO PROVIDE 11 COMPREHENSIVE UNIVERSAL HEALTH COVERAGE FOR EVERY MARYLAND 12 RESIDENT, AND FUNDED BY BROAD–BASED REVENUE; 13 (3) THE STATE SEEK TO OBTAIN WAIVERS AND OTHER APPROVALS 14 RELATING TO MEDICAID, THE MARYLAND CHILDREN’S HEALTH INSURANCE 15 PROGRAM, MEDICARE, THE AFFORDABLE CARE ACT, AND ANY OTHER FEDERAL 16 PROGRAMS RELATED TO THE PROVISION OF HEALTH CARE SO THAT ANY FEDERAL 17 FUNDS AND OTHER SUBSIDIES THAT WOULD OTHERWISE BE PAID TO THE STATE, 18 STATE RESIDENTS, AND HEALTH CARE PROVIDERS ARE PAID BY THE FEDERAL 19 GOVERNMENT TO THE STATE AND DEPOSITED IN THE HEALTHY MARYLAND TRUST 20 FUND; 21 (4) THE STATE WORK TO INCORPORATE HEALTH CARE COVERAGE OF 22 STATE RESIDENTS WHO ARE EMPLOYED IN OTHER JURISDICTIONS INTO WAIVERS 23 AND OTHER APPROVALS RELATING TO MEDICAID, THE MARYLAND CHILDREN’S 24 HEALTH INSURANCE PROGRAM, MEDICARE, THE AFFORDABLE CARE ACT, AND 25 ANY OTHER FEDERAL PROGRAMS RELATED TO THE PROVISION OF HEALTH CARE; 26 (5) ANY FUNDS OBTAINED UNDER WAIVERS AND APPROVALS 27 RELATING TO MEDICAID, THE MARYLAND CHILDREN’S HEALTH INSURANCE 28 PROGRAM, MEDICARE, THE AFFORDABLE CARE ACT, AND ANY OTHER FEDERAL 29 PROGRAMS RELATED TO THE PROVISION OF HEALTH CARE SHALL BE USED: 30 (I) FOR HEALTH COVERAGE THAT PROVIDES HEALTH 31 BENEFITS EQUAL TO OR EXCEEDING THOSE PROGRAMS; AND 32 (II) TO ELIMINATE ANY COST–SHARING OR INSURANCE 33 12 HOUSE BILL 534 PREMIUM OBLIGATIONS OF RESIDENTS OF THE STATE; 1 (6) (I) HEALTHY MARYLAND REPLACE THE MARYLAND MEDICAL 2 ASSISTANCE PROGRAM, THE MARYLAND CHILDREN’S HEALTH INSURANCE 3 PROGRAM, MEDICARE, THE AFFORDABLE CARE ACT, AND ANY OTHER FEDERAL 4 PROGRAMS RELATED TO THE PROVISION OF HEALTH CARE; AND 5 (II) THOSE PROGRAMS BE MERGED INTO HEALTHY MARYLAND, 6 WHICH WILL OPERATE AS A TRUE SINGLE–PAYER PROGRAM; 7 (7) IF ANY NECESSARY WAIVERS OR APPROVALS ARE NOT OBTAINED, 8 THE STATE USE STATE PLAN AMENDMENTS AND SEEK WAIVERS AND APPROVALS TO 9 MAXIMIZE, AND MAKE AS SEAMLESS AS POSSIBLE, THE USE OF FUNDING FROM 10 FEDERALLY MATCHED PUBLIC HEALTH PROGRAMS AND OTHER FEDERAL HEALTH 11 PROGRAMS IN HEALTHY MARYLAND; 12 (8) IF PROGRAMS SUCH AS MEDICAID OR MEDICARE CONTRIBUTE TO 13 PAYING FOR HEALTH CARE SERVICES: 14 (I) HEALTH CARE COVERAGE BE DELIVERED BY HEALTHY 15 MARYLAND; AND 16 (II) TO THE GREATEST EXTENT POSSIBLE, THE MULTIPLE 17 SOURCES OF FUNDING: 18 1. BE POOLED WITH OTHER HEALTHY MARYLAND 19 FUNDS; AND 20 2. NOT BE APPARENT TO HEALTHY MARYLAND 21 MEMBERS OR PARTICIPATING PROVIDERS; 22 (9) THIS TITLE ADDRESS THE HIGH COST OF PRESCRIPTION DRUGS 23 AND ENSURE THAT PRESCRIPTION DRUGS ARE AFFORDABLE FOR PATIENTS; 24 (10) NEITHER HEALTH INFORMATION TECHNOLOGY NOR CLINICAL 25 PRACTICE GUIDELINES LIMIT THE EFFECTIVE EXERCISE OF THE PROFESSIONAL 26 JUDGMENT OF PHYSICIANS, REGISTERED NURSES, AND OTHER LICENSED HEALTH 27 CARE PROVIDERS; 28 (11) PHYSICIANS, REGISTERED NURSES, AND OTHER LICENSED 29 HEALTH CARE PROVIDERS MAY OVERRIDE HEALTH INFORMATION TECHNOLOGY 30 AND CLINICAL PRACTICE GUIDELINES IF THE OVERRIDE: 31 HOUSE BILL 534 13 (I) IS CONSISTENT WITH THE TREATING PHYSICIAN’S 1 DETERMINATION OF MEDICAL NECESSITY; AND 2 (II) IN THE PROFESSIONAL JUDGMENT OF THE PHYSICIAN OR 3 REGISTERED NURSE, IS IN THE BEST INTEREST OF THE PATIENT AND CONSISTENT 4 WITH THE PATIENT’S WISHES; 5 (12) (I) LEGISLATION BE ENACTED TO DEVELOP A REVENUE PLAN 6 FOR HEALTHY MARYLAND, TAKING INTO CONSIDERATION ANTICIPATED FEDERAL 7 REVENUE AVAILABLE FOR HEALTHY MARYLAND; AND 8 (II) IN DEVELOPING THE REVENUE PLAN, THE GOVERNOR AND 9 THE GENERAL ASSEMBLY CONSULT WITH APPROPRIATE OFFICIALS AND 10 STAKEHOLDERS; AND 11 (13) LEGISLATION BE ENACTED REQUIRING THAT ALL STATE 12 REVENUES FROM THE HEALTHY MARYLAND PROGRAM BE DEPOSITED IN AN 13 ACCOUNT WITHIN THE HEALTHY MARYLAND TRUST FUND TO BE KNOWN AS THE 14 HEALTHY MARYLAND TRUST FUND ACCOUNT. 15 25–103. 16 (A) THIS TITLE MAY NOT BE CONSTRUED TO CREATE ANY EMPLOYMENT 17 BENEFIT, OR TO REQUIRE, PROHIBIT, OR LIMIT THE PROVISION OF ANY 18 EMPLOYMENT BENEFIT. 19 (B) THIS TITLE DOES NOT CHANGE OR IMPACT IN ANY WAY THE ROLE OR 20 AUTHORITY OF ANY LICENSING BOARD OR STATE AGENCY THAT REGULATES THE 21 STANDARDS FOR OR PROVISION OF HEALTH CARE AND THE STANDARDS FOR 22 HEALTH CARE PROVIDERS AS ESTABLISHED UNDER STATE LAW AS OF JANUARY 1, 23 2021, INCLUDING: 24 (1) THE HEALTH OCCUPATIONS ARTICLE; AND 25 (2) TITLE 19 OF THIS ARTICLE. 26 (C) THIS TITLE DOES NOT AUTHORIZE HEALTHY MARYLAND, THE HEALTHY 27 MARYLAND BOARD, OR THE SECRETARY TO ESTABLISH OR REVISE LICENSURE 28 STANDARDS FOR HEALTH CARE PROVIDERS. 29 (D) THIS TITLE DOES NOT AUTHORIZE HEALTHY MARYLAND TO CARRY OUT 30 ANY FUNCTION NOT AUTHORIZED BY WAIVERS. 31 14 HOUSE BILL 534 (E) THIS TITLE MAY NOT BE CONSTRUED TO PREEMPT OR PREVAIL OVER 1 ANY CITY, COUNTY, OR OTHER LOCAL GOVERNMENT ORDINANCE, RESOLUTION, 2 LAW, OR RULE THAT PROVIDES MORE PROTECTIONS AND BENEFITS TO RESIDENTS 3 OF THE STATE THAN PROVIDED UNDER THIS TITLE. 4 25–104. 5 (A) HEALTHY MARYLAND OR ANY STATE AGENCY, LOCAL AGENCY, OR 6 PUBLIC EMPLOYEE ACTING ON BEHALF OF HEALTHY MARYLAND MAY NOT PROVIDE 7 OR DISCLOSE TO ANYONE, INCLUDING THE FEDERAL GOVERNMENT, FOR LAW 8 ENFORCEMENT PURPOSES ANY PERSONALLY IDENTIFIABLE INFORMATION 9 OBTAINED ABOUT AN INDIVIDUAL, INCLUDING AN INDIVIDUAL’S RELIGIOUS 10 BELIEFS, PRACTICES, OR AFFILIATION, NATIONAL ORIGIN, ETHNICITY, OR 11 IMMIGRATION STATUS. 12 (B) A LAW ENFORCEMENT AGENCY IN THE STATE MAY NOT USE HEALTHY 13 MARYLAND FUNDS, FACILITIES, PROPERTY, EQUIPMENT, OR PERSONNEL TO 14 INVESTIGATE, ENFORCE, OR ASSIST IN THE INVESTIGATION OR ENFORCEMENT OF 15 ANY CRIMINAL, CIVIL, OR ADMINISTRATIVE VIOLATION OR WARRANT FOR A 16 VIOLATION OF ANY REQUIREMENT THAT INDIVIDUALS REGISTER WITH THE 17 FEDERAL GOVERNMENT OR ANY FEDERAL AGENCY BASED ON RELIGION, NATIONAL 18 ORIGIN, ETHNICITY, IMMIGRATION STATUS, OR OTHER PROTECTED CATEGORY 19 UNDER § 20–304 OF THE STATE GOVERNMENT ARTICLE. 20 SUBTITLE 2. HEALTHY MARYLAND PROGRAM. 21 25–201. 22 (A) THERE IS A HEALTHY MARYLAND PROGRAM. 23 (B) (1) HEALTHY MARYLAND IS A BODY POLITIC AND CORPORATE AND IS 24 AN INSTRUMENTALITY OF THE STATE. 25 (2) HEALTHY MARYLAND IS A PUBLIC CORPORATION AND A UNIT OF 26 STATE GOVERNMENT. 27 (3) THE EXERCISE BY HEALTHY MARYLAND OF ITS AUTHORITY 28 UNDER THIS TITLE IS AN ESSENTIAL GOVERNMENTAL FUNCTION. 29 (C) ON OR BEFORE JANUARY 1, 2023, HEALTHY MARYLAND SHALL: 30 (1) PROVIDE: 31 HOUSE BILL 534 15 (I) COMPREHENSIVE UNIVERSAL SINGLE–PAYER HEALTH 1 CARE SERVICES FOR ALL RESIDENTS OF THE STATE; 2 (II) A HEALTH CARE COST CONTROL SYSTEM FOR THE BENEFIT 3 OF ALL RESIDENTS OF THE STATE; 4 (III) CHOICE AND ACCESS TO HEALTH CARE COORDINATORS 5 AND HEALTH CARE PROVIDERS TO ALL RESIDENTS OF THE STATE; AND 6 (IV) BROAD–BASED PUBLIC FINANCING OF HEALTH CARE 7 SERVICES FOR ALL RESIDENTS OF THE STATE; AND 8 (2) ESTABLISH MECHANISMS TO: 9 (I) ENABLE HEALTH CARE PROVIDERS TO COLLECTIVELY 10 NEGOTIATE WITH HEALTHY MARYLAND REGARDING ANY MATTER RELATING TO 11 HEALTHY MARYLAND, INCLUDING: 12 1. RATES OF PAYMENT FOR HEALTH CARE SERVICES; 13 2. RATES OF PAYMENT FOR PRESCRIPTION AND 14 NONPRESCRIPTION DRUGS; AND 15 3. PAYMENT METHODOLOGIES; 16 (II) ENSURE TRANSPARENCY AND ACCOUNTABILITY TO THE 17 PUBLIC; AND 18 (III) PROVIDE FOR THE COLLECTION OF DATA TO: 19 1. PROMOTE TRANSPARENCY; 20 2. ASSESS ADHERENCE TO PATIENT CARE STANDARDS 21 ESTABLISHED UNDER SUBTITLE 9 OF THIS TITLE; AND 22 3. COMPARE PATIENT OUTCOMES AND REVIEW 23 UTILIZATION OF HEALTH CARE SERVICES PAID FOR BY HEALTHY MARYLAND. 24 (D) HEALTHY MARYLAND IS SUBJECT TO: 25 (1) TITLES 3, 4, AND 5 OF THE GENERAL PROVISIONS ARTICLE; 26 (2) THE FOLLOWING PROVISIONS OF THE STATE FINANCE AND 27 16 HOUSE BILL 534 PROCUREMENT ARTICLE: 1 (I) TITLE 3A, SUBTITLE 3, TO THE EXTENT THAT THE 2 SECRETARY OF INFORMATION TECHNOLOGY DETERMINES THAT AN INFORMATION 3 TECHNOLOGY PROJECT OF HEALTHY MARYLAND IS A MAJOR INFORMATION 4 TECHNOLOGY DEVELOPMENT PROJECT; 5 (II) TITLE 12, SUBTITLE 4; AND 6 (III) TITLE 14, SUBTITLE 3; 7 (3) THE FOLLOWING PROVISIONS OF THE STATE GOVERNMENT 8 ARTICLE: 9 (I) TITLE 10, SUBTITLE 1; AND 10 (II) TITLE 12; AND 11 (4) TITLE 5, SUBTITLE 3 OF THE STATE PERSONNEL AND PENSIONS 12 ARTICLE. 13 SUBTITLE 3. HEALTHY MARYLAND BOARD. 14 25–301. 15 (A) THERE IS A HEALTHY MARYLAND BOARD. 16 (B) THE BOARD CONSISTS OF THE FOLLOWING MEMBERS: 17 (1) THE SECRETARY, OR THE SECRETARY’S DESIGNEE, AS AN EX 18 OFFICIO MEMBER OF THE BOARD; 19 (2) FOUR MEMBERS APPOINTED BY THE GOVERNOR, WITH THE 20 ADVICE AND CONSENT OF THE SENATE; 21 (3) TWO MEMBERS APPOINTED BY THE PRESIDENT OF THE SENATE; 22 AND 23 (4) TWO MEMBERS APPOINTED BY THE SPEAKER OF THE HOUSE. 24 (C) (1) THE TERM OF AN APPOINTED MEMBER IS 4 YEARS. 25 (2) THE TERMS OF APPOINTED MEMBERS ARE STAGGERED AS 26 HOUSE BILL 534 17 REQUIRED BY THE TERMS PROVIDED FOR MEMBERS OF THE BOARD ON JULY 1, 1 2021. 2 (3) AT THE END OF A TERM, A MEMBER CONTINUES TO SERVE UNTIL 3 A SUCCESSOR IS APPOINTED AND QUALIFIES. 4 (4) A MEMBER WHO IS APPOINTED AFTER A TERM HAS BEGUN SERVES 5 ONLY FOR THE REST OF THE TERM AND UNTIL A SUCCESSOR IS APPOINTED AND 6 QUALIFIES. 7 (5) (I) IF A VACANCY OCCURS AMONG THE MEMBERS APPOINTED 8 BY THE GOVERNOR, THE GOVERNOR SHALL PROMPTLY APPOINT A SUCCESSOR WHO 9 SHALL SERVE UNTIL THE TERM EXPIRES. 10 (II) A MEMBER APPOINTED UNDER SUBPARAGRAPH (I) OF THIS 11 PARAGRAPH MAY BE REAPPOINTED FOR A FULL TERM. 12 (6) A MEMBER MAY NOT SERVE FOR MORE THAN TWO CONSECUTIVE 13 TERMS. 14 (7) FROM AMONG ITS MEMBERS, THE BOARD SHALL ELECT A CHAIR 15 AND VICE CHAIR EACH YEAR. 16 (D) IN APPOINTING MEMBERS UNDER SUBSECTION (B) OF THIS SECTION, 17 THE APPOINTING AUTHORITY SHALL: 18 (1) ENSURE THAT THE APPOINTEE HAS DEMONSTRATED AND 19 ACKNOWLEDGED EXPERTISE IN HEALTH CARE; 20 (2) CONSIDER THE EXPERTISE OF THE OTHER MEMBERS OF THE 21 BOARD AND ATTEMPT TO MAKE APPOINTMENTS SO THAT THE BOARD’S 22 COMPOSITION REFLECTS A DIVERSITY OF EXPERTISE IN VARIOUS ASPECTS OF 23 HEALTH CARE; 24 (3) CONSIDER THE CULTURAL, ETHNIC, AND GEOGRAPHICAL 25 DIVERSITY OF THE STATE SO THAT THE BOARD’S COMPOSITION REFLECTS THE 26 COMMUNITIES OF THE STATE; AND 27 (4) ENSURE THAT THE BOARD’S COMPOSITION INCLUDES: 28 (I) AT LEAST ONE REPRESENTATIVE OF A LABOR 29 ORGANIZATION REPRESENTING REGISTERED NURSES; 30 18 HOUSE BILL 534 (II) AT LEAST ONE REPRESENTATIVE OF THE GENERAL PUBLIC; 1 (III) AT LEAST ONE REPRESENTATIVE OF A LABOR 2 ORGANIZATION; AND 3 (IV) AT LEAST ONE REPRESENTATIVE OF THE MEDICAL 4 PROVIDER COMMUNITY. 5 (E) (1) (I) IN THIS SUBSECTION THE FOLLOWING WORDS HAVE THE 6 MEANINGS INDICATED. 7 (II) “AFFILIATION” MEANS: 8 1. A FINANCIAL INTEREST; 9 2. A POSITION OF GOVERNANCE, INCLUDING 10 MEMBERSHIP ON A BOARD OF DIRECTORS, REGARDLESS OF COMPENSATION; 11 3. A RELATIONSHIP THROUGH WHICH COMPENSATION 12 IS RECEIVED; OR 13 4. A RELATIONSHIP FOR THE PROVISION OF SERVICES 14 AS A REGULATED LOBBYIST. 15 (III) “COMPENSATION” HAS THE MEANING STATED IN § 5–101 OF 16 THE GENERAL PROVISIONS ARTICLE. 17 (IV) “FINANCIAL INTEREST” HAS THE MEANING STATED IN § 18 5–101 OF THE GENERAL PROVISIONS ARTICLE. 19 (V) “REGULATED LOBBYIST” HAS THE MEANING STATED IN § 20 5–101 OF THE GENERAL PROVISIONS ARTICLE. 21 (2) A MEMBER OF THE BOARD, WITHIN THE 2–YEAR PERIOD 22 IMMEDIATELY PRECEDING THE MEMBER’S APPOINTMENT AND WHILE SERVING ON 23 THE BOARD, OR A MEMBER OF THE STAFF OF THE BOARD MAY NOT BE EMPLOYED, 24 OR HAVE BEEN EMPLOYED, IN ANY CAPACITY BY A CONSULTANT TO A MEMBER OF 25 THE BOARD OF DIRECTORS OF, HAVE AN AFFILIATION WITH, OR OTHERWISE BE A 26 REPRESENTATIVE OF: 27 (I) A HEALTH CARE PROVIDER; 28 (II) A HEALTH CARE FACILITY; 29 HOUSE BILL 534 19 (III) A HEALTH CLINIC; 1 (IV) A PHARMACEUTICAL COMPANY; 2 (V) A MEDICAL EQUIPMENT COMPANY; OR 3 (VI) A CARRIER, AN INSURANCE PRODUCER, A THIRD–PARTY 4 ADMINISTRATOR, A MANAGED CARE ORGANIZATION, OR ANY OTHER PERSON 5 CONTRACTING DIRECTLY WITH THOSE PERSONS. 6 (3) A MEMBER OF THE BOARD MAY NOT ACCEPT EMPLOYMENT WITH 7 OR RECEIVE COMPENSATION FROM A PERSON LISTED IN PARAGRAPH (2) OF THIS 8 SUBSECTION FOR 2 YEARS IMMEDIATELY FOLLOWING THE END OF THE MEMBER’S 9 TERM. 10 (4) A MEMBER OF THE BOARD OR A STAFF MEMBER OF THE BOARD 11 MAY NOT BE A MEMBER, A BOARD MEMBER, OR AN EMPLOYEE OF A TRADE 12 ASSOCIATION OF HEALTH FACILITIES, HEALTH CLINICS, HEALTH CARE PROVIDERS, 13 CARRIERS, INSURANCE PRODUCERS, THIRD–PARTY ADMINISTRATORS, MANAGED 14 CARE ORGANIZATIONS, OR ANY OTHER ASSOCIATION OF ENTITIES IN A POSITION TO 15 CONTRACT DIRECTLY WITH HEALTHY MARYLAND UNLESS THE MEMBER OR STAFF 16 MEMBER OF THE BOARD: 17 (I) RECEIVES NO COMPENSATION FOR RENDERING SERVICES 18 AS A HEALTH CARE PROVIDER; AND 19 (II) DOES NOT HAVE AN OWNERSHIP INTEREST IN A HEALTH 20 CARE PRACTICE. 21 (F) A MEMBER OF THE BOARD SHALL: 22 (1) MEET THE REQUIREMENTS OF THIS TITLE AND ALL APPLICABLE 23 STATE AND FEDERAL LAWS AND REGULATIONS; 24 (2) SERVE THE PUBLIC INTEREST OF THE INDIVIDUALS, EMPLOYERS, 25 AND TAXPAYERS SEEKING HEALTH CARE COVERAGE THROUGH HEALTHY 26 MARYLAND; AND 27 (3) ENSURE THE SOUND OPERATION AND FISCAL SOLVENCY OF 28 HEALTHY MARYLAND. 29 (G) (1) THE BOARD SHALL DETERMINE THE TIMES, PLACES, AND 30 20 HOUSE BILL 534 FREQUENCY OF ITS MEETINGS. 1 (2) FIVE MEMBERS OF THE BOARD CONSTITUTE A QUORUM. 2 (3) ACTION BY THE BOARD REQUIRES THE AFFIRMATIVE VOTE OF AT 3 LEAST FIVE MEMBERS. 4 (H) A MEMBER OF THE BOARD: 5 (1) MAY NOT RECEIVE COMPENSATION AS A MEMBER OF THE BOARD; 6 BUT 7 (2) IS ENTITLED TO: 8 (I) A PER DIEM RATE AS PROVIDED IN THE STATE BUDGET FOR 9 ATTENDING SCHEDULED MEETINGS OF HEALTHY MARYLAND; AND 10 (II) REIMBURSEMENT FOR EXPENSES UNDER THE STANDARD 11 STATE TRAVEL REGULATIONS, AS PROVIDED IN THE STATE BUDGET. 12 (I) A MEMBER OF THE BOARD SHALL PERFORM THE MEMBER’S DUTIES: 13 (1) IN GOOD FAITH; 14 (2) IN THE MANNER THE MEMBER REASONABLY BELIEVES TO BE IN 15 THE BEST INTEREST OF HEALTHY MARYLAND, HEALTHY MARYLAND MEMBERS, 16 AND RESIDENTS OF THE STATE; AND 17 (3) WITHOUT INTENTIONAL OR RECKLESS DISREGARD OF THE CARE 18 AN ORDINARILY PRUDENT PERSON IN A LIKE POSITION WOULD USE UNDER SIMILAR 19 CIRCUMSTANCES. 20 (J) (1) (I) A MEMBER OF THE BOARD SHALL BE SUBJECT TO TITLE 5, 21 SUBTITLES 1 THROUGH 7 OF THE GENERAL PROVISIONS ARTICLE. 22 (II) IN ADDITION TO THE DISCLOSURE REQUIRED UNDER TITLE 23 5, SUBTITLE 6 OF THE GENERAL PROVISIONS ARTICLE, A MEMBER OF THE BOARD 24 SHALL DISCLOSE TO THE BOARD AND TO THE PUBLIC ANY RELATIONSHIP NOT 25 ADDRESSED IN THE REQUIRED FINANCIAL DISCLOSURE THAT THE MEMBER HAS 26 WITH A HEALTH CARE PROVIDER, A HEALTH CLINIC, A PHARMACEUTICAL COMPANY, 27 A MEDICAL EQUIPMENT COMPANY, A CARRIER, AN INSURANCE PRODUCER, A 28 THIRD–PARTY ADMINISTRATOR, A MANAGED CARE ORGANIZATION, OR ANY OTHER 29 ENTITY IN AN INDUSTRY INVOLVED IN MATTERS LIKELY TO COME BEFORE THE 30 HOUSE BILL 534 21 BOARD. 1 (2) ON ALL MATTERS THAT COME BEFORE THE BOARD, THE MEMBER 2 SHALL: 3 (I) ADHERE STRICTLY TO THE CONFLICT OF INTEREST 4 PROVISIONS UNDER TITLE 5, SUBTITLE 5 OF THE GENERAL PROVISIONS ARTICLE 5 RELATING TO RESTRICTIONS ON PARTICIPATION, EMPLOYMENT, AND FINANCIAL 6 INTERESTS; AND 7 (II) PROVIDE FULL DISCLOSURE TO THE BOARD AND THE 8 PUBLIC ON: 9 1. ANY MATTER THAT GIVES RISE TO A POTENTIAL 10 CONFLICT OF INTEREST; AND 11 2. THE MANNER IN WHICH THE MEMBER WILL COMPLY 12 WITH THE PROVISIONS OF TITLE 5, SUBTITLE 5 OF THE GENERAL PROVISIONS 13 ARTICLE TO AVOID ANY CONFLICT OF INTEREST OR APPEARANCE OF A CONFLICT 14 OF INTEREST. 15 (K) A MEMBER OF THE BOARD WHO PERFORMS THE MEMBER’S DUTIES IN 16 ACCORDANCE WITH THE STANDARD ESTABLISHED UNDER SUBSECTION (I) OF THIS 17 SECTION MAY NOT BE LIABLE PERSONALLY FOR ACTIONS TAKEN AS A MEMBER 18 WHEN DONE IN GOOD FAITH, WITHOUT INTENT TO DEFRAUD, AND IN CONNECTION 19 WITH THE ADMINISTRATION, MANAGEMENT, OR CONDUCT OF THIS TITLE OR 20 ACTIONS RELATED TO THIS TITLE. 21 (L) A MEMBER OF THE BOARD MAY BE REMOVED FOR INCOMPETENCE, 22 MISCONDUCT, OR FAILURE TO PERFORM THE DUTIES OF THE POSITION. 23 25–302. 24 (A) (1) THE BOARD SHALL APPOINT AN EXECUTIVE DIRECTOR OF 25 HEALTHY MARYLAND. 26 (2) THE EXECUTIVE DIRECTOR SHALL SERVE AT THE PLEASURE OF 27 THE BOARD. 28 (3) THE BOARD SHALL DETERMINE THE APPROPRIATE 29 COMPENSATION FOR THE EXECUTIVE DIRECTOR. 30 (B) UNDER THE DIRECTION OF THE BOARD, THE EXECUTIVE DIRECTOR 31 22 HOUSE BILL 534 SHALL: 1 (1) BE THE CHIEF ADMINISTRATIVE OFFICER OF HEALTHY 2 MARYLAND, INCLUDING THE HEALTHY MARYLAND TRUST FUND; 3 (2) DIRECT, ORGANIZE, ADMINISTER, AND MANAGE THE OPERATIONS 4 OF HEALTHY MARYLAND AND THE BOARD; AND 5 (3) PERFORM ALL DUTIES NECESSARY TO COMPLY WITH AND CARRY 6 OUT THE PROVISIONS OF THIS TITLE, OTHER APPLICABLE STATE LAWS AND 7 REGULATIONS, AND THE AFFORDABLE CARE ACT. 8 (C) (1) IN ACCORDANCE WITH THE STATE BUDGET, THE EXECUTIVE 9 DIRECTOR, OR THE EXECUTIVE DIRECTOR’S DESIGNEE, MAY EMPLOY AND RETAIN 10 A STAFF FOR HEALTHY MARYLAND TO IMPLEMENT THE PURPOSES AND INTENT OF 11 THIS TITLE. 12 (2) (I) THE EXECUTIVE DIRECTOR MAY SET THE COMPENSATION 13 OF A HEALTHY MARYLAND EMPLOYEE OR AN INDEPENDENT CONTRACTOR OF 14 HEALTHY MARYLAND WHO IS IN A POSITION THAT: 15 1. IS UNIQUE TO HEALTHY MARYLAND; 16 2. REQUIRES SPECIFIC SKILLS OR EXPERIENCE TO 17 PERFORM THE DUTIES OF THE POSITION; AND 18 3. DOES NOT REQUIRE THE EMPLOYEE TO PERFORM 19 FUNCTIONS THAT ARE COMPARABLE TO FUNCTIONS PERFORMED IN OTHER UNITS 20 OF THE EXECUTIVE BRANCH OF STATE GOVERNMENT. 21 (II) THE SECRETARY OF BUDGET AND MANAGEMENT, IN 22 CONSULTATION WITH THE EXECUTIVE DIRECTOR, SHALL DETERMINE THE 23 POSITIONS AND TYPES OF INDEPENDENT CONTRACTORS FOR WHICH THE 24 EXECUTIVE DIRECTOR MAY SET COMPENSATION UNDER SUBPARAGRAPH (I) OF 25 THIS PARAGRAPH. 26 (3) IN HIRING STAFF FOR FUNCTIONS THAT MUST BE PERFORMED BY 27 STATE PERSONNEL UNDER THE AFFORDABLE CARE ACT OR OTHER APPLICABLE 28 FEDERAL OR STATE LAWS, THE EXECUTIVE DIRECTOR’S APPOINTMENT, 29 RETENTION, AND REMOVAL OF STAFF SHALL BE IN ACCORDANCE WITH DIVISION I 30 OF THE STATE PERSONNEL AND PENSIONS ARTICLE. 31 (4) IN HIRING STAFF FOR FUNCTIONS THAT HAVE BEEN AND 32 HOUSE BILL 534 23 CURRENTLY ARE PERFORMED BY STATE PERSONNEL, THE EXECUTIVE DIRECTOR’S 1 APPOINTMENT, RETENTION, AND REMOVAL OF STAFF SHALL BE IN ACCORDANCE 2 WITH DIVISION I OF THE STATE PERSONNEL AND PENSIONS ARTICLE. 3 (5) EXCEPT AS PROVIDED IN PARAGRAPH (6) OF THIS SUBSECTION, 4 STAFF FOR ALL OTHER POSITIONS NECESSARY TO CARRY OUT THE PURPOSES OF 5 THIS TITLE SHALL BE POSITIONS IN THE EXECUTIVE SERVICE OR MANAGEMENT 6 SERVICE, OR SPECIAL APPOINTMENTS OF THE SKILLED SERVICE OR THE 7 PROFESSIONAL SERVICE IN THE STATE PERSONNEL MANAGEMENT SYSTEM. 8 (6) THE EXECUTIVE DIRECTOR MAY RETAIN AS INDEPENDENT 9 CONTRACTORS ATTORNEYS, FINANCIAL CONSULTANTS, AND ANY OTHER 10 PROFESSIONALS OR CONSULTANTS NECESSARY TO CARRY OUT THE PLANNING, 11 DEVELOPMENT, AND OPERATIONS OF THE HEALTHY MARYLAND PROGRAM, AND 12 THE PROVISIONS OF THIS TITLE. 13 (7) THE EXECUTIVE DIRECTOR, OR THE EXECUTIVE DIRECTOR’S 14 DESIGNEE, SHALL GIVE PREFERENCE IN HIRING UNDER THIS SUBSECTION TO ALL 15 INDIVIDUALS DISPLACED OR UNEMPLOYED AS A DIRECT RESULT OF THE 16 IMPLEMENTATION OF HEALTHY MARYLAND. 17 (D) THE EXECUTIVE DIRECTOR SHALL DETERMINE THE CLASSIFICATION, 18 GRADE, AND COMPENSATION OF THE POSITIONS DESIGNATED UNDER SUBSECTION 19 (C)(2) OF THIS SECTION: 20 (1) IN CONSULTATION WITH THE SECRETARY OF BUDGET AND 21 MANAGEMENT; 22 (2) WITH THE APPROVAL OF THE BOARD; AND 23 (3) WHEN POSSIBLE, IN ACCORDANCE WITH THE STATE PAY PLAN. 24 (E) (1) THE EXECUTIVE DIRECTOR SHALL SUBMIT TO THE SECRETARY 25 OF BUDGET AND MANAGEMENT, AT LEAST 45 DAYS BEFORE THE EFFECTIVE DATE 26 OF THE CHANGE, EACH CHANGE TO HEALTHY MARYLAND’S SALARY PLANS THAT 27 INVOLVE INCREASES OR DECREASES IN SALARY RANGES OTHER THAN THOSE 28 ASSOCIATED WITH ROUTINE RECLASSIFICATIONS AND PROMOTIONS OR GENERAL 29 SALARY INCREASES APPROVED BY THE GENERAL ASSEMBLY. 30 (2) CHANGES REQUIRED TO BE REPORTED UNDER PARAGRAPH (1) OF 31 THIS SUBSECTION INCLUDE: 32 (I) THE CREATION OR ABOLITION OF CLASSES; 33 24 HOUSE BILL 534 (II) THE REGRADING OF CLASSES FROM ONE ESTABLISHED 1 RANGE TO ANOTHER; AND 2 (III) THE CREATION OF NEW PAY SCHEDULES OR RANGES. 3 (3) THE SECRETARY OF BUDGET AND MANAGEMENT SHALL: 4 (I) REVIEW THE PROPOSED CHANGE; AND 5 (II) AT LEAST 15 DAYS BEFORE THE EFFECTIVE DATE OF THE 6 PROPOSED CHANGE: 7 1. ADVISE THE EXECUTIVE DIRECTOR WHETHER THE 8 CHANGE WOULD HAVE AN ADVERSE EFFECT ON COMPARABLE STATE JOBS; AND 9 2. IF THERE WOULD BE AN ADVERSE EFFECT, 10 RECOMMEND AN ALTERNATIVE CHANGE THAT WOULD NOT HAVE AN ADVERSE 11 EFFECT ON COMPARABLE STATE JOBS. 12 (4) FAILURE OF THE SECRETARY OF BUDGET AND MANAGEMENT TO 13 RESPOND TO THE PROPOSED CHANGE IN A TIMELY MANNER SHALL BE CONSIDERED 14 TO BE AGREEMENT WITH THE CHANGE AS SUBMITTED. 15 (F) EXCEPT AS OTHERWISE PROVIDED IN THIS TITLE, AN EMPLOYEE OR 16 INDEPENDENT CONTRACTOR OF HEALTHY MARYLAND IS NOT SUBJECT TO ANY LAW, 17 REGULATION, OR EXECUTIVE ORDER GOVERNING STATE COMPENSATION, 18 INCLUDING: 19 (1) FURLOUGHS; 20 (2) PAY CUTS; AND 21 (3) ANY OTHER GENERAL FUND COST–SAVINGS MEASURE. 22 25–303. 23 (A) SUBJECT TO ANY LIMITATIONS UNDER THIS TITLE OR OTHER 24 APPLICABLE LAW, THE BOARD SHALL HAVE ALL POWERS NECESSARY OR 25 CONVENIENT TO CARRY OUT THE FUNCTIONS AUTHORIZED BY THE AFFORDABLE 26 CARE ACT AND CONSISTENT WITH THE PURPOSES OF HEALTHY MARYLAND. 27 (B) THE ENUMERATION OF SPECIFIC POWERS IN THIS TITLE IS NOT 28 HOUSE BILL 534 25 INTENDED TO RESTRICT THE BOARD’S POWER TO TAKE ANY LAWFUL ACTION THAT 1 THE BOARD DETERMINES IS NECESSARY OR CONVENIENT TO CARRY OUT THE 2 FUNCTIONS AUTHORIZED BY THE AFFORDABLE CARE ACT AND CONSISTENT WITH 3 THE PURPOSES OF HEALTHY MARYLAND. 4 (C) IN ADDITION TO THE POWERS SET FORTH ELSEWHERE IN THIS TITLE, 5 THE BOARD MAY: 6 (1) ADOPT AND ALTER AN OFFICIAL SEAL; 7 (2) ORGANIZE, ADMINISTER, AND MARKET HEALTHY MARYLAND AND 8 HEALTHY MARYLAND SERVICES AS A SINGLE–PAYER PROGRAM UNDER THE NAME 9 “HEALTHY MARYLAND” OR ANY OTHER NAME AS THE BOARD DETERMINES; 10 (3) SUE, BE SUED, PLEAD, AND BE IMPLEADED; 11 (4) ADOPT BYLAWS, RULES, AND POLICIES; 12 (5) ADOPT REGULATIONS TO CARRY OUT THIS TITLE: 13 (I) IN ACCORDANCE WITH TITLE 10, SUBTITLE 1 OF THE STATE 14 GOVERNMENT ARTICLE; AND 15 (II) THAT DO NOT CONFLICT WITH OR PREVENT THE 16 APPLICATION OF REGULATIONS ADOPTED BY THE UNITED STATES SECRETARY OF 17 HEALTH AND HUMAN SERVICES UNDER TITLE 1, SUBTITLE D OF THE AFFORDABLE 18 CARE ACT; 19 (6) MAINTAIN AN OFFICE AT THE PLACE DESIGNATED BY THE BOARD; 20 (7) CREATE COMMITTEES FROM AMONG ITS MEMBERS; 21 (8) MAKE AGREEMENTS WITH A GRANTOR OR PAYOR OF FUNDS, 22 PROPERTY, OR SERVICES; 23 (9) ENTER INTO ANY AGREEMENTS OR CONTRACTS AND EXECUTE 24 THE INSTRUMENTS NECESSARY OR CONVENIENT TO MANAGE ITS OWN AFFAIRS AND 25 CARRY OUT THE PURPOSES OF THIS TITLE, INCLUDING CONTRACTS WITH HEALTH 26 CARE PROVIDERS; 27 (10) APPLY FOR AND RECEIVE GIFTS, GRANTS, DONATIONS, 28 CONTRACTS, OR OTHER FUNDING FROM ANY AGENCY OF THE FEDERAL 29 GOVERNMENT, ANY AGENCY OF THE STATE, AND ANY MUNICIPALITY, COUNTY, OR 30 26 HOUSE BILL 534 OTHER POLITICAL SUBDIVISION OF THE STATE; 1 (11) APPLY FOR AND RECEIVE GIFTS, GRANTS, DONATIONS, 2 CONTRACTS, OR OTHER PRIVATE OR PUBLIC FUNDING FROM INDIVIDUALS, 3 ASSOCIATIONS, PRIVATE FOUNDATIONS, AND CORPORATIONS, IN COMPLIANCE 4 WITH TITLE 5, SUBTITLES 1 THROUGH 7 OF THE GENERAL PROVISIONS ARTICLE; 5 (12) SHARE INFORMATION WITH RELEVANT STATE ENTITIES, 6 CONSISTENT WITH THE CONFIDENTIALITY PROVISIONS IN THIS TITLE AND AS 7 NECESSARY FOR THE ADMINISTRATION OF HEALTHY MARYLAND; AND 8 (13) SUBJECT TO THE LIMITATIONS OF THIS TITLE, EXERCISE ANY 9 OTHER POWER THAT IS REASONABLY NECESSARY OR CONVENIENT TO CARRY OUT 10 THE PURPOSES OF THIS TITLE. 11 (D) (1) TO CARRY OUT THE PURPOSES OF THIS TITLE OR PERFORM ANY 12 OF ITS FUNCTIONS UNDER THIS TITLE, THE BOARD MAY CONTRACT OR ENTER INTO 13 MEMORANDA OF UNDERSTANDING WITH ELIGIBLE ENTITIES. 14 (2) THE OPERATIONS OF HEALTHY MARYLAND ARE SUBJECT TO THE 15 PROVISIONS OF THIS TITLE WHETHER THE OPERATIONS ARE PERFORMED DIRECTLY 16 BY HEALTHY MARYLAND OR THROUGH AN ENTITY UNDER A CONTRACT WITH 17 HEALTHY MARYLAND. 18 (3) THE BOARD SHALL ENSURE THAT ANY ENTITY UNDER A 19 CONTRACT WITH HEALTHY MARYLAND COMPLIES WITH THE PROVISIONS OF THIS 20 TITLE WHEN PERFORMING SERVICES THAT ARE SUBJECT TO THIS TITLE ON BEHALF 21 OF HEALTHY MARYLAND. 22 (E) (1) IN ACCORDANCE WITH TITLE 12, SUBTITLE 4 OF THE STATE 23 FINANCE AND PROCUREMENT ARTICLE, THE BOARD SHALL ADOPT WRITTEN 24 POLICIES AND PROCEDURES GOVERNING ALL PROCUREMENTS OF HEALTHY 25 MARYLAND. 26 (2) TO THE FULLEST EXTENT PRACTICABLE AND IN A MANNER THAT 27 DOES NOT IMPAIR HEALTHY MARYLAND’S ABILITY TO CARRY OUT THE PURPOSES 28 OF THIS TITLE, THE BOARD’S PROCUREMENT POLICIES AND PROCEDURES SHALL 29 ESTABLISH AN OPEN AND TRANSPARENT PROCESS THAT: 30 (I) PROMOTES PUBLIC CONFIDENCE IN THE PROCUREMENTS 31 OF HEALTHY MARYLAND; 32 (II) ENSURES FAIR AND EQUITABLE TREATMENT OF ALL 33 HOUSE BILL 534 27 PERSONS AND ENTITIES THAT PARTICIPATE IN THE PROCUREMENT SYSTEM OF 1 HEALTHY MARYLAND; 2 (III) FOSTERS APPROPRIATE COMPETITION AND PROVIDES 3 SAFEGUARDS FOR MAINTAINING A PROCUREMENT SYSTEM OF QUALITY AND 4 INTEGRITY; 5 (IV) PROMOTES INCREASED ECONOMIC EFFICIENCY AND 6 RESPONSIBILITY ON THE PART OF HEALTHY MARYLAND; 7 (V) ACHIEVES THE MAXIMUM BENEFIT FROM THE PURCHASING 8 POWER OF HEALTHY MARYLAND; AND 9 (VI) PROVIDES CLARITY AND SIMPLICITY IN THE RULES AND 10 PROCEDURES GOVERNING THE PROCUREMENTS OF HEALTHY MARYLAND. 11 (F) TO CARRY OUT THE PURPOSES OF THIS TITLE, THE BOARD SHALL: 12 (1) CONSULT WITH AND SOLICIT INPUT FROM THE COMMITTEE AND 13 ANY OTHER PERSON AS THE BOARD DETERMINES IS APPROPRIATE; 14 (2) PROMOTE THE PUBLIC UNDERSTANDING AND AWARENESS OF 15 AVAILABLE BENEFITS AND PROGRAMS OF HEALTHY MARYLAND; 16 (3) AVOID JEOPARDIZING FEDERAL FINANCIAL PARTICIPATION IN 17 THE PROGRAMS THAT ARE INCORPORATED INTO HEALTHY MARYLAND; 18 (4) ENSURE THAT THERE IS ADEQUATE FUNDING TO MEET THE 19 HEALTH CARE NEEDS OF RESIDENTS AND TO COMPENSATE HEALTH CARE 20 PROVIDERS THAT PARTICIPATE IN HEALTHY MARYLAND; 21 (5) EVALUATE REQUESTS FOR CAPITAL EXPENSES REQUIRED TO 22 MEET THE HEALTH CARE NEEDS OF RESIDENTS; 23 (6) APPROVE THE BENEFITS PROVIDED BY HEALTHY MARYLAND; 24 (7) EVALUATE THE PERFORMANCE OF HEALTHY MARYLAND; 25 (8) EVALUATE AND MAKE RECOMMENDATIONS TO THE GENERAL 26 ASSEMBLY ON ANY LEGISLATION RELATED TO HEALTHY MARYLAND; 27 (9) GUARANTEE THAT MECHANISMS FOR PUBLIC FEEDBACK ARE 28 ACCESSIBLE AND NONDISCRIMINATORY; AND 29 28 HOUSE BILL 534 (10) DEVELOP A PLAN TO COORDINATE THE ACTIVITIES OF HEALTHY 1 MARYLAND WITH THE ACTIVITIES OF THE MARYLAND HEALTH CARE COMMISSION, 2 THE HEALTH SERVICES COST REVIEW COMMISSION, AND THE DEPARTMENT TO 3 ENSURE APPROPRIATE PLANNING FOR THE EFFECTIVE DELIVERY AND EQUITABLE 4 DISTRIBUTION OF HEALTH CARE SERVICES THROUGHOUT THE STATE. 5 (G) THE BOARD SHALL PROVIDE GRANTS FROM FUNDS IN THE HEALTHY 6 MARYLAND TRUST FUND OR FUNDS OTHERWISE APPROPRIATED FOR HEALTH 7 PLANNING TO THE HEALTH PLANNING PROGRAMS ESTABLISHED BY THE MARYLAND 8 HEALTH CARE COMMISSION TO SUPPORT THE OPERATION OF THOSE PROGRAMS. 9 (H) THE BOARD SHALL PROVIDE FUNDS FROM THE FUND OR FUNDS 10 OTHERWISE APPROPRIATED FOR THE PURPOSE OF WORKER RETRAINING AND JOB 11 TRANSITION ASSISTANCE TO THE MARYLAND DEPARTMENT OF LABOR FOR: 12 (1) A PROGRAM FOR RETRAINING AND ASSISTING JOB TRANSITION 13 FOR INDIVIDUALS EMPLOYED OR PREVIOUSLY EMPLOYED IN THE FIELDS OF 14 HEALTH INSURANCE, HEALTH CARE SERVICE PLANS, AND OTHER THIRD–PARTY 15 PAYMENTS FOR HEALTH CARE; AND 16 (2) A PROGRAM FOR RETRAINING AND ASSISTING JOB TRANSITION 17 FOR THOSE INDIVIDUALS EMPLOYED OR PREVIOUSLY EMPLOYED IN FIELDS 18 PROVIDING SERVICES TO HEALTH CARE PROVIDERS TO DEAL WITH THIRD–PARTY 19 PAYORS FOR HEALTH CARE, WHOSE JOBS MAY BE OR HAVE BEEN ENDED AS A 20 RESULT OF THE IMPLEMENTATION OF HEALTHY MARYLAND. 21 (I) (1) FOR UP TO 5 YEARS FOLLOWING THE DATE ON WHICH BENEFITS 22 FIRST BECOME AVAILABLE UNDER HEALTHY MARYLAND, THE BOARD SHALL 23 PROVIDE AT LEAST 1% OF THE ANNUAL BUDGET OF HEALTHY MARYLAND TO 24 PROGRAMS PROVIDING ASSISTANCE TO WORKERS WHO PERFORM FUNCTIONS IN 25 THE ADMINISTRATION OF HEALTH INSURANCE OR OTHERS WHO MAY BE AFFECTED 26 BY THE IMPLEMENTATION OF HEALTHY MARYLAND AND WHO MAY EXPERIENCE 27 ECONOMIC DISLOCATION AS A RESULT OF THE IMPLEMENTATION OF THIS TITLE. 28 (2) THE ASSISTANCE DESCRIBED IN PARAGRAPH (1) OF THIS 29 SUBSECTION SHALL INCLUDE WAGE REPLACEMENT, RETIREMENT BENEFITS, JOB 30 TRAINING, AND EDUCATION BENEFITS. 31 (J) THE BOARD SHALL CARRY OUT THE FUNCTIONS REQUIRED OF THE 32 BOARD UNDER TITLE 31 OF THE INSURANCE ARTICLE UNTIL THE MARYLAND 33 HEALTH BENEFIT EXCHANGE CEASES TO OPERATE IN THE STATE. 34 HOUSE BILL 534 29 (K) THE BOARD MAY CONTRACT WITH NONPROFIT ORGANIZATIONS TO 1 PROVIDE: 2 (1) ASSISTANCE TO CONSUMERS IN ENROLLING, OBTAINING HEALTH 3 CARE SERVICES, DISENROLLING, AND OTHER MATTERS RELATING TO HEALTHY 4 MARYLAND; AND 5 (2) ASSISTANCE TO HEALTH CARE PROVIDERS PROVIDING, SEEKING, 6 OR CONSIDERING WHETHER TO PROVIDE HEALTH CARE SERVICES UNDER THE 7 HEALTHY MARYLAND PROGRAM. 8 (L) THE BOARD MAY DELEGATE TO THE EXECUTIVE DIRECTOR ANY OF ITS 9 DUTIES UNDER THIS SECTION. 10 25–304. 11 (A) (1) SUBJECT TO § 25–201(C) OF THIS TITLE, THE BOARD SHALL 12 DETERMINE WHEN INDIVIDUALS MAY BEGIN ENROLLING IN HEALTHY MARYLAND. 13 (2) HEALTHY MARYLAND SHALL HAVE AN IMPLEMENTATION PERIOD 14 THAT SHALL: 15 (I) BEGIN ON THE DATE THAT INDIVIDUALS MAY BEGIN 16 ENROLLING IN HEALTHY MARYLAND UNDER PARAGRAPH (1) OF THIS SUBSECTION; 17 AND 18 (II) END ON A DATE DETERMINED BY THE BOARD. 19 (B) (1) THE BOARD SHALL ADOPT RULES OR REGULATIONS ON STATE 20 RESIDENCE REQUIREMENTS UNDER HEALTHY MARYLAND. 21 (2) IN ADOPTING RULES OR REGULATIONS UNDER PARAGRAPH (1) OF 22 THIS SUBSECTION, THE BOARD SHALL BE GUIDED BY THE STATE RESIDENCE 23 REQUIREMENTS FOR THE MARYLAND MEDICAL ASSISTANCE PROGRAM AND THE 24 MARYLAND CHILDREN’S HEALTH INSURANCE PROGRAM. 25 (C) A CARRIER MAY NOT OFFER BENEFITS OR COVER ANY SERVICES FOR 26 WHICH COVERAGE IS OFFERED TO INDIVIDUALS UNDER HEALTHY MARYLAND. 27 (D) A CARRIER THAT IS ISSUED A CERTIFICATE OF AUTHORITY BY THE 28 MARYLAND INSURANCE COMMISSIONER MAY OFFER: 29 (1) BENEFITS THAT DO NOT DUPLICATE THE HEALTH CARE SERVICES 30 30 HOUSE BILL 534 COVERED BY HEALTHY MARYLAND; 1 (2) BENEFITS TO OR FOR INDIVIDUALS, INCLUDING THE 2 INDIVIDUALS’ FAMILIES, WHO ARE EMPLOYED OR SELF–EMPLOYED IN THE STATE 3 BUT WHO ARE NOT RESIDENTS OF THE STATE; AND 4 (3) BENEFITS DURING THE IMPLEMENTATION PERIOD TO 5 INDIVIDUALS WHO ENROLLED OR MAY ENROLL AS MEMBERS OF HEALTHY 6 MARYLAND. 7 (E) THIS TITLE DOES NOT PROHIBIT A RESIDENT WHO IS EMPLOYED 8 OUTSIDE THE STATE FROM CHOOSING TO RECEIVE HEALTH INSURANCE BENEFITS 9 THROUGH THE RESIDENT’S EMPLOYER AND OPTING OUT OF PARTICIPATION IN 10 HEALTHY MARYLAND. 11 (F) AFTER THE END OF THE IMPLEMENTATION PERIOD, EACH BOARD 12 MEMBER SHALL ENROLL AS A MEMBER OF HEALTHY MARYLAND. 13 (G) (1) ON OR BEFORE DECEMBER 1, 2021, THE BOARD SHALL SUBMIT 14 TO THE GOVERNOR AND, IN ACCORDANCE WITH § 2–1257 OF THE STATE 15 GOVERNMENT ARTICLE, THE GENERAL ASSEMBLY A REPORT ON ANY CHANGES TO 16 THE LAWS OF THE STATE AND UNITS OF STATE GOVERNMENT NECESSARY TO 17 EFFECTIVELY CARRY OUT THE PROVISIONS OF THIS TITLE. 18 (2) THE REPORT REQUIRED UNDER PARAGRAPH (1) OF THIS 19 SUBSECTION SHALL INCLUDE RECOMMENDATIONS ON THE REPEAL OR AMENDMENT 20 OF ANY LAWS OF THE STATE THAT ARE INCONSISTENT WITH THIS ACT. 21 (H) ON OR BEFORE DECEMBER 1, 2021, THE BOARD SHALL APPLY FOR ALL 22 WAIVERS FROM THE PROVISIONS OF THE EMPLOYMENT RETIREMENT INCOME 23 SECURITY ACT THAT ARE NECESSARY TO ENSURE THE PARTICIPATION OF ALL 24 RESIDENTS OF THE STATE IN HEALTHY MARYLAND. 25 (I) THE BOARD SHALL DEVELOP PROPOSALS FOR ACCOMMODATING 26 EMPLOYER RETIREE HEALTH BENEFITS FOR: 27 (1) INDIVIDUALS WHO HAVE BEEN MEMBERS OF HEALTHY 28 MARYLAND BUT LIVE AS RETIREES OUTSIDE THE STATE; AND 29 (2) INDIVIDUALS WHO EARNED OR ACCRUED THOSE BENEFITS WHILE 30 RESIDING IN THE STATE BEFORE THE IMPLEMENTATION OF HEALTHY MARYLAND 31 AND LIVE AS RETIREES OUTSIDE THE STATE. 32 HOUSE BILL 534 31 (J) THE BOARD SHALL DEVELOP A PROPOSAL FOR HEALTHY MARYLAND 1 COVERAGE OF HEALTH CARE SERVICES CURRENTLY COVERED UNDER THE STATE 2 WORKERS’ COMPENSATION SYSTEM, INCLUDING WHETHER AND HOW TO: 3 (1) CONTINUE FUNDING FOR THOSE SERVICES UNDER THE WORKERS’ 4 COMPENSATION SYSTEM; AND 5 (2) INCORPORATE AN ELEMENT OF EXPERIENCE RATING. 6 25–305. 7 (A) THE BOARD SHALL REQUIRE AND ENFORCE THE COLLECTION AND 8 AVAILABILITY OF ALL THE FOLLOWING DATA TO PROMOTE TRANSPARENCY, ASSESS 9 QUALITY OF PATIENT CARE, COMPARE PATIENT OUTCOMES, AND REVIEW 10 UTILIZATION OF HEALTH CARE SERVICES PAID FOR BY HEALTHY MARYLAND: 11 (1) HOSPITAL INPATIENT DISCHARGE DATA FOR EACH DISCHARGE, 12 INCLUDING SEVERITY OF ILLNESS, RISK OF MORTALITY, COST DATA, CHARGE DATA, 13 LENGTH OF STAY DATA, AND PATIENT CARE UNIT DATA; 14 (2) EMERGENCY DEPARTMENT, AMBULATORY SURGERY CENTER, 15 AND OTHER OUTPATIENT FACILITIES DATA FOR EACH MEMBER RECEIVING ITEMS 16 AND SERVICES, INCLUDING COST DATA, CHARGE DATA, LENGTH OF STAY DATA, AND 17 PATIENT CARE UNIT DATA; 18 (3) ANNUAL FINANCIAL DATA FOR ALL INSTITUTIONAL PROVIDERS 19 RECEIVING PAYMENT UNDER § 25–802 OF THIS TITLE, INCLUDING: 20 (I) THE DOLLAR VALUE AT COST OF COMMUNITY BENEFITS 21 ACTIVITIES, INCLUDING CHARITY CARE, PROVIDED BY THE INSTITUTIONAL 22 PROVIDER; 23 (II) NUMBER OF EMPLOYEES BY JOB CLASSIFICATION FOR 24 EACH HOSPITAL AND OUTPATIENT UNIT; 25 (III) NUMBER OF HOURS WORKED BY JOB CLASSIFICATION FOR 26 EACH HOSPITAL AND OUTPATIENT UNIT; 27 (IV) EMPLOYEE WAGE INFORMATION BY JOB CLASSIFICATION 28 FOR EACH HOSPITAL AND OUTPATIENT UNIT; 29 (V) NUMBER OF REGISTERED NURSES PER STAFFED BED BY 30 HOSPITAL UNIT; 31 32 HOUSE BILL 534 (VI) TYPE AND DOLLAR VALUE OF HEALTH INFORMATION 1 TECHNOLOGY; AND 2 (VII) ANNUAL SPENDING ON HEALTH INFORMATION 3 TECHNOLOGY, INCLUDING PURCHASES, UPGRADES, AND MAINTENANCE; 4 (4) RISK–ADJUSTED AND RAW DATA ON PATIENT OUTCOMES, 5 INCLUDING DATA ON MEDICAL, SURGICAL, OBSTETRIC, AND OTHER PROCEDURES; 6 (5) PHYSICIAN SERVICES AND OFFICE VISITS, INCLUDING COST DATA 7 AND CHARGE DATA; 8 (6) PRESCRIPTION DRUG COST DATA AND CHARGE DATA FOR 9 PRESCRIPTION DRUGS PRESCRIBED AND DISPENSED THROUGH HOSPITALS, 10 EMERGENCY DEPARTMENTS, AMBULATORY SURGERY CENTERS AND OTHER 11 OUTPATIENT FACILITIES, OR A PHYSICIAN’S OFFICE; AND 12 (7) ANY OTHER DATA THAT THE PROVIDER REPORTS TO ANY OTHER 13 STATE, LOCAL, OR FEDERAL AGENCY. 14 (B) DATA COLLECTED UNDER SUBSECTION (A) OF THIS SECTION SHALL BE 15 REPORTED TO THE HEALTH SERVICES COST REVIEW COMMISSION. 16 (C) THIS SECTION DOES NOT CHANGE OR IMPACT IN ANY WAY PROVIDER 17 REPORTING REQUIREMENTS TO ANY STATE, LOCAL, OR FEDERAL AGENCY AS 18 ESTABLISHED UNDER STATE LAW. 19 (D) THE BOARD SHALL ESTABLISH REPORTING REQUIREMENTS AND 20 STANDARDS NECESSARY TO EVALUATE AND ELIMINATE HEALTH CARE DISPARITIES, 21 INCLUDING GEOGRAPHIC, RACIAL, INCOME–BASED, GENDER–BASED, SEX–BASED, 22 AND OTHER DISPARITIES. 23 (E) THE BOARD SHALL MAKE ALL DISCLOSED DATA COLLECTED UNDER 24 SUBSECTION (A) OF THIS SECTION PUBLICLY AVAILABLE THROUGH: 25 (1) A SEARCHABLE INTERNET WEBSITE; AND 26 (2) THE HEALTH SERVICES COST REVIEW COMMISSION. 27 (F) THE BOARD SHALL, DIRECTLY AND THROUGH GRANTS TO NONPROFIT 28 ORGANIZATIONS, CONDUCT PROGRAMS USING DATA COLLECTED THROUGH 29 HEALTHY MARYLAND TO PROMOTE AND PROTECT PUBLIC, ENVIRONMENTAL, AND 30 HOUSE BILL 534 33 OCCUPATIONAL HEALTH, INCLUDING COOPERATION WITH OTHER DATA 1 COLLECTION AND RESEARCH PROGRAMS OF THE MARYLAND HEALTH CARE 2 COMMISSION, THE HEALTH SERVICES COST REVIEW COMMISSION, AND THE 3 DEPARTMENT CONSISTENT WITH THIS TITLE AND OTHERWISE APPLICABLE LAW. 4 (G) BEFORE FULL IMPLEMENTATION OF HEALTHY MARYLAND, THE BOARD 5 SHALL PROVIDE FOR THE COLLECTION AND AVAILABILITY OF THE FOLLOWING DATA 6 FROM HOSPITALS AND OTHER PROVIDERS THAT SEEK TO PARTICIPATE IN HEALTHY 7 MARYLAND: 8 (1) FINANCIAL DATA; 9 (2) THE NUMBER OF PATIENTS SERVED; AND 10 (3) THE ACTUAL EXPENDITURES AND DOLLAR VALUE OF THE CARE 11 PROVIDED, AT COST, FOR THE FOLLOWING CATEGORIES OF DATA ITEMS: 12 (I) PATIENTS RECEIVING CHARITY CARE; 13 (II) CONTRACTUAL ADJUSTMENTS OF COUNTY AND INDIGENT 14 PROGRAMS, INCLUDING TRADITIONAL AND MANAGED CARE; AND 15 (III) BAD DEBTS. 16 SUBTITLE 4. HEALTHY MARYLAND PUBLIC ADVISORY COMMITTEE. 17 25–401. 18 (A) THERE IS A HEALTHY MARYLAND PUBLIC ADVISORY COMMITTEE. 19 (B) THE COMMITTEE CONSISTS OF THE FOLLOWING MEMBERS: 20 (1) FOUR PHYSICIANS WHO ARE BOARD CERTIFIED IN THE 21 PHYSICIANS’ RESPECTIVE FIELDS: 22 (I) AT LEAST ONE OF WHOM SHALL BE A PSYCHIATRIST; 23 (II) ONE OF WHOM SHALL BE APPOINTED BY THE PRESIDENT OF 24 THE SENATE; 25 (III) ONE OF WHOM SHALL BE APPOINTED BY THE GOVERNOR; 26 AND 27 34 HOUSE BILL 534 (IV) TWO OF WHOM SHALL BE: 1 1. APPOINTED BY THE SPEAKER OF THE HOUSE; AND 2 2. PRIMARY CARE PROVIDERS; 3 (2) TWO REGISTERED NURSES, APPOINTED BY THE PRESIDENT OF 4 THE SENATE; 5 (3) ONE LICENSED ALLIED HEALTH PRACTITIONER, APPOINTED BY 6 THE SPEAKER OF THE HOUSE; 7 (4) ONE BEHAVIORAL HEALTH CARE PROVIDER, APPOINTED BY THE 8 PRESIDENT OF THE SENATE; 9 (5) ONE DENTIST, APPOINTED BY THE GOVERNOR; 10 (6) ONE REPRESENTATIVE OF PRIVATE HOSPITALS, APPOINTED BY 11 THE GOVERNOR; 12 (7) ONE REPRESENTATIVE OF PUBLIC HOSPITALS, APPOINTED BY 13 THE GOVERNOR; 14 (8) FOUR CONSUMERS OF HEALTH CARE: 15 (I) TWO OF WHOM SHALL BE APPOINTED BY THE GOVERNOR, 16 INCLUDING ONE WHO IS A MEMBER OF THE DISABLED COMMUNITY; 17 (II) ONE OF WHOM SHALL BE: 18 1. APPOINTED BY THE PRESIDENT OF THE SENATE; AND 19 2. A MEMBER OF HEALTHY MARYLAND WHO IS AT LEAST 20 65 YEARS OLD; AND 21 (III) ONE OF WHOM SHALL BE APPOINTED BY THE SPEAKER OF 22 THE HOUSE; 23 (9) TWO REPRESENTATIVES OF ORGANIZED LABOR: 24 (I) ONE OF WHOM SHALL BE APPOINTED BY THE PRESIDENT OF 25 THE SENATE; AND 26 HOUSE BILL 534 35 (II) ONE OF WHOM SHALL BE APPOINTED BY THE SPEAKER OF 1 THE HOUSE; 2 (10) ONE REPRESENTATIVE OF ESSENTIAL COMMUNITY PROVIDERS, 3 APPOINTED BY THE PRESIDENT OF THE SENATE; 4 (11) ONE REPRESENTATIVE OF A SMALL BUSINESS THAT EMPLOYS 5 FEWER THAN 25 EMPLOYEES, APPOINTED BY THE GOVERNOR; 6 (12) ONE REPRESENTATIVE OF A LARGE BUSINESS THAT EMPLOYS 7 MORE THAN 250 EMPLOYEES, APPOINTED BY THE SPEAKER OF THE HOUSE; AND 8 (13) ONE PHARMACIST, APPOINTED BY THE SPEAKER OF THE HOUSE. 9 (C) EACH COMMITTEE MEMBER SHALL HAVE WORKED IN THE FIELD THE 10 MEMBER REPRESENTS ON THE COMMITTEE FOR A PERIOD OF AT LEAST 2 YEARS 11 BEFORE BEING APPOINTED TO THE COMMITTEE. 12 (D) (1) THE TERM OF A MEMBER IS 4 YEARS. 13 (2) THE TERMS OF MEMBERS ARE STAGGERED AS REQUIRED BY THE 14 TERMS PROVIDED FOR MEMBERS OF THE COMMITTEE ON JULY 1, 2021. 15 (3) AT THE END OF A TERM, A MEMBER CONTINUES TO SERVE UNTIL 16 A SUCCESSOR IS APPOINTED AND QUALIFIES. 17 (4) A MEMBER WHO IS APPOINTED AFTER A TERM HAS BEGUN SERVES 18 ONLY FOR THE REST OF THE TERM AND UNTIL A SUCCESSOR IS APPOINTED AND 19 QUALIFIES. 20 (5) (I) IF A VACANCY OCCURS, THE APPOINTING AUTHORITY 21 PROMPTLY SHALL APPOINT A SUCCESSOR WHO SHALL SERVE UNTIL THE TERM 22 EXPIRES. 23 (II) A MEMBER APPOINTED UNDER SUBPARAGRAPH (I) OF THIS 24 PARAGRAPH MAY BE REAPPOINTED FOR A FULL TERM. 25 (6) A MEMBER MAY NOT SERVE FOR MORE THAN TWO CONSECUTIVE 26 TERMS. 27 (7) FROM AMONG ITS MEMBERS, THE COMMITTEE SHALL ELECT A 28 CHAIR WHO SHALL SERVE 2 YEARS AND WHO MAY BE REELECTED FOR AN 29 ADDITIONAL 2 YEARS. 30 36 HOUSE BILL 534 (E) IN MAKING APPOINTMENTS OF MEMBERS UNDER SUBSECTION (B) OF 1 THIS SECTION, THE APPOINTING AUTHORITY SHALL MAKE GOOD FAITH EFFORTS TO 2 ENSURE THAT THE APPOINTMENTS, AS A WHOLE, REFLECT, TO THE GREATEST 3 EXTENT FEASIBLE, THE SOCIOECONOMIC AND GEOGRAPHIC DIVERSITY OF THE 4 STATE. 5 (F) THE COMMITTEE SHALL ADVISE THE BOARD ON ALL MATTERS OF 6 POLICY RELATED TO HEALTHY MARYLAND. 7 (G) A COMMITTEE MEMBER OR ANY OF THE MEMBER’S ASSISTANTS, 8 CLERKS, OR DEPUTIES MAY NOT USE FOR PERSONAL BENEFIT ANY INFORMATION 9 THAT IS: 10 (1) FILED WITH, OR OBTAINED BY, THE COMMITTEE; AND 11 (2) NOT GENERALLY AVAILABLE TO THE PUBLIC. 12 (H) (1) THE COMMITTEE SHALL MEET AT LEAST SIX TIMES PER YEAR IN 13 A PLACE CONVENIENT TO THE PUBLIC SUBJECT TO TITLE 3 OF THE GENERAL 14 PROVISIONS ARTICLE. 15 (2) ELEVEN MEMBERS OF THE COMMITTEE CONSTITUTE A QUORUM. 16 (3) ACTION BY THE COMMITTEE REQUIRES THE AFFIRMATIVE VOTE 17 OF AT LEAST 12 MEMBERS. 18 (I) A MEMBER OF THE COMMITTEE: 19 (1) MAY NOT RECEIVE COMPENSATION AS A MEMBER OF THE 20 COMMITTEE; BUT 21 (2) IS ENTITLED TO: 22 (I) A PER DIEM AS PROVIDED IN THE STATE BUDGET FOR 23 ATTENDING SCHEDULED MEETINGS OF THE COMMITTEE; AND 24 (II) REIMBURSEMENT FOR EXPENSES UNDER THE STANDARD 25 STATE TRAVEL REGULATIONS, AS PROVIDED IN THE STATE BUDGET. 26 (J) A MEMBER OF THE COMMITTEE SHALL PERFORM THE MEMBER’S 27 DUTIES: 28 HOUSE BILL 534 37 (1) IN GOOD FAITH; 1 (2) IN THE MANNER THE MEMBER REASONABLY BELIEVES TO BE IN 2 THE BEST INTEREST OF HEALTHY MARYLAND; AND 3 (3) WITHOUT INTENTIONAL OR RECKLESS DISREGARD OF THE CARE 4 AN ORDINARILY PRUDENT PERSON IN A LIKE POSITION WOULD USE UNDER SIMILAR 5 CIRCUMSTANCES. 6 (K) (1) (I) A MEMBER OF THE COMMITTEE SHALL BE SUBJECT TO 7 TITLE 5, SUBTITLES 1 THROUGH 7 OF THE GENERAL PROVISIONS ARTICLE. 8 (II) IN ADDITION TO THE DISCLOSURE REQUIRED UNDER TITLE 9 5, SUBTITLE 6 OF THE GENERAL PROVISIONS ARTICLE, A MEMBER OF THE 10 COMMITTEE SHALL DISCLOSE TO THE COMMITTEE AND TO THE PUBLIC ANY 11 RELATIONSHIP NOT ADDRESSED IN THE REQUIRED FINANCIAL DISCLOSURE THAT 12 THE MEMBER HAS WITH: 13 1. A HEALTH CARE PROVIDER; 14 2. A HEALTH CLINIC; 15 3. A PHARMACEUTICAL COMPANY; 16 4. A MEDICAL EQUIPMENT COMPANY; 17 5. A CARRIER; 18 6. AN INSURANCE PRODUCER; 19 7. A THIRD–PARTY ADMINISTRATOR; 20 8. A MANAGED CARE ORGANIZATION; OR 21 9. ANY OTHER ENTITY IN AN INDUSTRY INVOLVED IN 22 MATTERS LIKELY TO COME BEFORE THE COMMITTEE. 23 (2) ON ALL MATTERS THAT COME BEFORE THE COMMITTEE, A 24 MEMBER SHALL: 25 (I) ADHERE STRICTLY TO THE CONFLICT OF INTEREST 26 PROVISIONS UNDER TITLE 5, SUBTITLE 5 OF THE GENERAL PROVISIONS ARTICLE 27 RELATING TO RESTRICTIONS ON PARTICIPATION, EMPLOYMENT, AND FINANCIAL 28 38 HOUSE BILL 534 INTERESTS; AND 1 (II) PROVIDE FULL DISCLOSURE TO THE COMMITTEE AND THE 2 PUBLIC ON: 3 1. ANY MATTER THAT GIVES RISE TO A POTENTIAL 4 CONFLICT OF INTEREST; AND 5 2. THE MANNER IN WHICH THE MEMBER WILL COMPLY 6 WITH THE PROVISIONS OF TITLE 5, SUBTITLE 5 OF THE GENERAL PROVISIONS 7 ARTICLE TO AVOID ANY CONFLICT OF INTEREST OR APPEARANCE OF A CONFLICT 8 OF INTEREST. 9 (L) A MEMBER OF THE COMMITTEE WHO PERFORMS THE MEMBER’S DUTIES 10 IN ACCORDANCE WITH THE STANDARD ESTABLISHED UNDER SUBSECTION (J) OF 11 THIS SECTION MAY NOT BE LIABLE PERSONALLY FOR ACTIONS TAKEN AS A MEMBER 12 WHEN DONE IN GOOD FAITH, WITHOUT INTENT TO DEFRAUD, AND IN CONNECTION 13 WITH THE ADMINISTRATION, MANAGEMENT, OR CONDUCT OF THIS TITLE OR 14 ACTIONS RELATED TO THIS TITLE. 15 (M) A MEMBER OF THE COMMITTEE MAY BE REMOVED FOR INCOMPETENCE, 16 MISCONDUCT, OR FAILURE TO PERFORM THE DUTIES OF THE POSITION. 17 SUBTITLE 5. ELIGIBILITY AND ENROLLMENT. 18 25–501. 19 (A) EACH RESIDENT OF THE STATE IS ELIGIBLE TO: 20 (1) ENROLL AS A MEMBER OF HEALTHY MARYLAND; AND 21 (2) RECEIVE BENEFITS FOR HEALTH CARE SERVICES COVERED BY 22 HEALTHY MARYLAND. 23 (B) MEMBERS OF HEALTHY MARYLAND ARE NOT REQUIRED TO PAY ANY 24 FEE, PAYMENT, OR OTHER CHARGE FOR ENROLLING IN OR BEING A MEMBER UNDER 25 HEALTHY MARYLAND. 26 (C) A PARTICIPATING PROVIDER MAY NOT: 27 (1) REQUIRE HEALTHY MARYLAND MEMBERS TO PAY ANY PREMIUM, 28 CO–PAYMENT, COINSURANCE, DEDUCTIBLE, OR OTHER FORM OF COST SHARING 29 FOR ANY COVERED BENEFITS; 30 HOUSE BILL 534 39 (2) USE PREEXISTING MEDICAL CONDITIONS TO DETERMINE THE 1 ELIGIBILITY OF A MEMBER TO RECEIVE BENEFITS FOR HEALTH CARE SERVICES 2 COVERED BY HEALTHY MARYLAND; OR 3 (3) REFUSE TO PROVIDE HEALTH CARE SERVICES TO A MEMBER ON 4 THE BASIS OF: 5 (I) RACE; 6 (II) COLOR; 7 (III) RELIGION OR CREED; 8 (IV) SEX; 9 (V) AGE; 10 (VI) ANCESTRY OR NATIONAL ORIGIN; 11 (VII) MARITAL STATUS; 12 (VIII) MENTAL OR PHYSICAL DISABILITY; 13 (IX) SEXUAL ORIENTATION; 14 (X) GENDER IDENTITY OR EXPRESSION; 15 (XI) CITIZENSHIP; 16 (XII) IMMIGRATION STATUS; 17 (XIII) PRIMARY LANGUAGE; 18 (XIV) MEDICAL CONDITION; 19 (XV) GENETIC INFORMATION; 20 (XVI) FAMILIAL STATUS; 21 (XVII) MILITARY OR VETERAN STATUS; 22 (XVIII) GEOGRAPHY; OR 23 40 HOUSE BILL 534 (XIX) SOURCE OF INCOME. 1 (D) A COLLEGE, A UNIVERSITY, OR ANY OTHER INSTITUTION OF HIGHER 2 EDUCATION IN THE STATE MAY PURCHASE COVERAGE UNDER HEALTHY MARYLAND 3 FOR A STUDENT, OR A STUDENT’S DEPENDENT, WHO IS NOT A RESIDENT OF THE 4 STATE. 5 25–502. 6 (A) IF A STATE RESIDENT IS EMPLOYED OUTSIDE THE STATE BY AN 7 EMPLOYER THAT IS SUBJECT TO STATE LAW, THE EMPLOYER AND EMPLOYEE SHALL 8 PAY ANY PAYROLL PREMIUM ADOPTED UNDER THIS TITLE AS TO THAT EMPLOYEE 9 AS IF THE EMPLOYMENT WERE IN THE STATE. 10 (B) IF A STATE RESIDENT IS EMPLOYED OUTSIDE THE STATE BY AN 11 EMPLOYER THAT IS NOT SUBJECT TO STATE LAW, EITHER: 12 (1) THE EMPLOYER AND EMPLOYEE SHALL VOLUNTARILY PAY ANY 13 PAYROLL PREMIUM ADOPTED UNDER THIS TITLE AS TO THAT EMPLOYEE AS IF THE 14 EMPLOYMENT WERE IN THE STATE; OR 15 (2) THE EMPLOYEE SHALL PAY THE PAYROLL PREMIUM ADOPTED 16 UNDER THIS TITLE AS IF THE EMPLOYEE WERE SELF–EMPLOYED. 17 (C) ANY PAYROLL PREMIUM ADOPTED UNDER THIS TITLE APPLIES TO: 18 (1) AN OUT–OF–STATE RESIDENT EMPLOYED IN THE STATE; AND 19 (2) AN OUT–OF–STATE RESIDENT SELF–EMPLOYED IN THE STATE. 20 (D) (1) A STATE RESIDENT WHO IS EMPLOYED OUTSIDE THE STATE MAY 21 CHOOSE TO RECEIVE HEALTH INSURANCE BENEFITS THROUGH THE RESIDENT’S 22 EMPLOYER AND OPT OUT OF PARTICIPATION IN HEALTHY MARYLAND. 23 (2) THE BOARD SHALL DEVELOP AND IMPLEMENT RULES 24 ESTABLISHING PROCEDURES FOR STATE RESIDENTS EMPLOYED OUTSIDE THE 25 STATE TO OPT OUT OF PARTICIPATION IN HEALTHY MARYLAND. 26 (E) NEGOTIATED HEALTH INSURANCE CONTRIBUTIONS MADE BY 27 EMPLOYERS ON BEHALF OF EMPLOYEES WHO ARE WORKING IN THE STATE BUT 28 RESIDING OUTSIDE THE STATE MAY NOT BE ABRIDGED BY THIS TITLE. 29 HOUSE BILL 534 41 25–503. 1 (A) (1) IF AN OUT–OF–STATE RESIDENT IS EMPLOYED IN THE STATE, THE 2 OUT–OF–STATE RESIDENT AND THE OUT–OF–STATE RESIDENT’S EMPLOYER MAY 3 TAKE A CREDIT AGAINST ANY PAYROLL PREMIUM ADOPTED UNDER THIS TITLE THAT 4 THE INDIVIDUAL OR THE INDIVIDUAL’S EMPLOYER WOULD OTHERWISE PAY AS TO 5 THAT INDIVIDUAL. 6 (2) THE CREDIT TAKEN UNDER THIS SUBSECTION IS FOR AMOUNTS 7 SPENT ON HEALTH BENEFITS FOR THE INDIVIDUAL THAT WOULD OTHERWISE BE 8 COVERED BY HEALTHY MARYLAND IF THAT INDIVIDUAL WERE A MEMBER OF 9 HEALTHY MARYLAND. 10 (3) THE CREDIT TAKEN UNDER THIS SUBSECTION SHALL BE 11 DISTRIBUTED BETWEEN THE INDIVIDUAL AND EMPLOYER IN THE SAME 12 PROPORTION AS THE SPENDING BY EACH FOR THE HEALTH BENEFITS. 13 (4) AN EMPLOYER AND EMPLOYEE MAY APPLY THEIR RESPECTIVE 14 PORTION OF THE CREDIT AVAILABLE UNDER THIS SUBSECTION TO THEIR 15 RESPECTIVE PORTION OF THE PAYROLL PREMIUM ADOPTED UNDER THIS TITLE. 16 (B) (1) IF AN OUT–OF–STATE RESIDENT IS SELF–EMPLOYED IN THE 17 STATE, THE INDIVIDUAL MAY TAKE A CREDIT AGAINST ANY PAYROLL PREMIUM 18 ADOPTED UNDER THIS TITLE THAT THE INDIVIDUAL WOULD OTHERWISE PAY. 19 (2) A CREDIT TAKEN UNDER PARAGRAPH (1) OF THIS SUBSECTION IS 20 FOR AMOUNTS THE INDIVIDUAL SPENDS ON HEALTH BENEFITS THAT WOULD 21 OTHERWISE BE COVERED BY HEALTHY MARYLAND IF THE INDIVIDUAL WERE A 22 MEMBER OF HEALTHY MARYLAND. 23 (C) (1) A CREDIT TAKEN BY INDIVIDUALS UNDER SUBSECTION (B) OF 24 THIS SECTION IS LIMITED TO SPENDING FOR HEALTH BENEFITS. 25 (2) AN INDIVIDUAL MAY NOT TAKE A CREDIT UNDER SUBSECTION (B) 26 OF THIS SECTION FOR OUT–OF–POCKET HEALTH CARE SPENDING. 27 (D) A CREDIT UNDER THIS SECTION IS AVAILABLE REGARDLESS OF: 28 (1) THE COST OR COMPREHENSIVENESS OF THE HEALTH BENEFIT; 29 AND 30 (2) THE FORM OF THE HEALTH BENEFIT. 31 42 HOUSE BILL 534 (E) (1) AN EMPLOYER OR INDIVIDUAL MAY TAKE A CREDIT UNDER THIS 1 SECTION ONLY AGAINST PAYROLL PREMIUMS ADOPTED UNDER THIS TITLE. 2 (2) AN EMPLOYER OR INDIVIDUAL MAY NOT APPLY ANY HEALTH 3 BENEFIT SPENDING IN EXCESS OF THE PAYROLL PREMIUM TO OTHER TAX LIABILITY. 4 SUBTITLE 6. BENEFITS. 5 25–601. 6 (A) (1) COVERED HEALTH CARE BENEFITS UNDER HEALTHY MARYLAND 7 SHALL INCLUDE ALL MEDICAL CARE PROVIDED TO A MEMBER THAT IS: 8 (I) MEDICALLY NECESSARY OR APPROPRIATE AS DETERMINED 9 BY THE MEMBER’S: 10 1. TREATING PHYSICIAN; OR 11 2. HEALTH CARE PROVIDER WHO, IN ACCORDANCE 12 WITH THE PROVIDER’S SCOPE OF PRACTICE AND LICENSURE, IS AUTHORIZED TO 13 ESTABLISH A MEDICAL DIAGNOSIS AND HAS MADE A MEDICAL ASSESSMENT OF THE 14 MEMBER’S CONDITION; AND 15 (II) IN ACCORDANCE WITH THE HEALTHY MARYLAND 16 STANDARDS ESTABLISHED IN SUBTITLE 9 OF THIS TITLE AND BY THE BOARD. 17 (2) A MEMBER’S TREATING PHYSICIAN OR ANY OTHER HEALTH CARE 18 PROVIDER TREATING THE MEMBER IS: 19 (I) AN APPROVED HEALTH CARE PROVIDER UNDER § 25–701 20 OF THIS TITLE; AND 21 (II) IN ACCORDANCE WITH THE PROVIDER’S SCOPE OF 22 PRACTICE AND LICENSURE, AUTHORIZED TO ESTABLISH A MEDICAL DIAGNOSIS AND 23 MAKE A MEDICAL ASSESSMENT OF THE MEMBER’S CONDITION. 24 (B) COVERED HEALTH CARE BENEFITS FOR MEMBERS INCLUDE: 25 (1) INPATIENT AND OUTPATIENT MEDICAL AND HEALTH FACILITY 26 SERVICES; 27 (2) INPATIENT AND OUTPATIENT PROFESSIONAL HEALTH CARE 28 PROVIDER MEDICAL SERVICES; 29 HOUSE BILL 534 43 (3) DIAGNOSTIC IMAGING, LABORATORY SERVICES, AND OTHER 1 DIAGNOSTIC AND EVALUATIVE SERVICES; 2 (4) (I) MEDICAL EQUIPMENT, APPLIANCES, AND ASSISTIVE 3 TECHNOLOGY, INCLUDING: 4 1. PROSTHETICS; 5 2. EYEGLASSES; AND 6 3. HEARING AIDS; AND 7 (II) THE REPAIR, TECHNICAL SUPPORT, AND CUSTOMIZATION 8 NEEDED FOR INDIVIDUAL USE OF MEDICAL EQUIPMENT, APPLIANCES, AND 9 ASSISTIVE TECHNOLOGY; 10 (5) INPATIENT AND OUTPATIENT REHABILITATIVE CARE; 11 (6) EMERGENCY CARE SERVICES; 12 (7) EMERGENCY TRANSPORTATION; 13 (8) NECESSARY TRANSPORTATION FOR HEALTH CARE SERVICES FOR 14 PERSONS WITH DISABILITIES OR WHO MAY QUALIFY AS LOW INCOME; 15 (9) CHILD AND ADULT IMMUNIZATIONS AND PREVENTIVE CARE; 16 (10) HEALTH AND WELLNESS EDUCATION; 17 (11) HOSPICE CARE; 18 (12) CARE IN A SKILLED NURSING FACILITY; 19 (13) HOME HEALTH CARE, INCLUDING HEALTH CARE PROVIDED IN AN 20 ASSISTED LIVING FACILITY; 21 (14) MENTAL HEALTH SERVICES; 22 (15) SUBSTANCE ABUSE TREATMENT; 23 (16) DENTAL CARE; 24 44 HOUSE BILL 534 (17) VISION CARE; 1 (18) PRESCRIPTION DRUGS; 2 (19) PEDIATRIC CARE; 3 (20) PRENATAL AND POSTNATAL CARE; 4 (21) PODIATRIC CARE; 5 (22) EARLY AND PERIODIC SCREENING, DIAGNOSTIC, AND 6 TREATMENT SERVICES AS DEFINED IN § 1905(R) OF THE SOCIAL SECURITY ACT; 7 (23) DIETARY AND NUTRITIONAL THERAPIES APPROVED BY THE 8 BOARD UNDER § 25–602 OF THIS SUBTITLE; 9 (24) ACUPUNCTURE; 10 (25) THERAPIES THAT ARE SHOWN BY THE NATIONAL INSTITUTES OF 11 HEALTH, NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH 12 TO BE SAFE AND EFFECTIVE; 13 (26) BLOOD AND BLOOD PRODUCTS; 14 (27) DIALYSIS; 15 (28) ADULT DAY CARE; 16 (29) HABILITATIVE AND REHABILITATIVE SERVICES; 17 (30) ANCILLARY HEALTH CARE OR SOCIAL SERVICES PREVIOUSLY 18 COVERED BY THE COMMUNITY INTEGRATED MEDICAL HOME PROGRAM UNDER § 19 19–1B–02 OF THIS ARTICLE; 20 (31) CASE MANAGEMENT AND CARE COORDINATION; 21 (32) LANGUAGE INTERPRETATION AND TRANSLATION FOR HEALTH 22 CARE SERVICES, INCLUDING SIGN LANGUAGE, BRAILLE, AND ANY OTHER SERVICES 23 NEEDED FOR INDIVIDUALS WITH COMMUNICATION BARRIERS; 24 (33) HEALTH CARE AND LONG–TERM SERVICES AND SUPPORTS THAT 25 ARE: 26 HOUSE BILL 534 45 (I) COVERED UNDER MEDICAID OR THE MARYLAND 1 CHILDREN’S HEALTH INSURANCE PROGRAM ON JANUARY 1, 2021; AND 2 (II) DESCRIBED IN § 25–603 OF THIS SUBTITLE; 3 (34) ALL HEALTH CARE SERVICES FOR WHICH COVERAGE IS 4 REQUIRED BY OR UNDER ANY OF THE FOLLOWING PROGRAMS OR ENTITIES, 5 WITHOUT REGARD TO WHETHER THE MEMBER WOULD OTHERWISE BE ELIGIBLE FOR 6 OR COVERED BY THE PROGRAM OR SOURCE REFERRED TO: 7 (I) THE CHILDREN’S HEALTH INSURANCE PROGRAM UNDER 8 TITLE XXI OF THE SOCIAL SECURITY ACT; 9 (II) MEDICAID; AND 10 (III) MEDICARE; 11 (35) ANY HEALTH CARE SERVICES ADDED TO HEALTHY MARYLAND 12 BENEFITS BY THE BOARD, AS AUTHORIZED UNDER THIS TITLE; AND 13 (36) ALL ESSENTIAL HEALTH BENEFITS MANDATED BY THE 14 AFFORDABLE CARE ACT AS OF JANUARY 1, 2017. 15 25–602. 16 (A) ON A REGULAR BASIS, THE BOARD SHALL EVALUATE WHETHER 17 COVERED BENEFITS UNDER HEALTHY MARYLAND SHOULD BE IMPROVED OR 18 ADJUSTED TO: 19 (1) PROMOTE THE HEALTH OF BENEFICIARIES; 20 (2) ACCOUNT FOR CHANGES IN MEDICAL PRACTICE OR NEW 21 INFORMATION FROM MEDICAL RESEARCH; OR 22 (3) RESPOND TO OTHER RELEVANT DEVELOPMENTS IN HEALTH 23 SCIENCE. 24 (B) IN CARRYING OUT SUBSECTION (A) OF THIS SECTION, THE BOARD 25 SHALL CONSULT WITH THE PERSONS DESCRIBED IN SUBSECTION (C) OF THIS 26 SECTION ON: 27 (1) IDENTIFYING SPECIFIC COMPLEMENTARY AND INTEGRATIVE 28 MEDICINE PRACTICES THAT, ON THE BASIS OF RESEARCH FINDINGS OR PROMISING 29 46 HOUSE BILL 534 CLINICAL INTERVENTIONS, ARE APPROPRIATE TO INCLUDE IN THE BENEFITS 1 PACKAGE; AND 2 (2) IDENTIFYING: 3 (I) BARRIERS TO THE EFFECTIVE PROVISION AND 4 INTEGRATION OF SUCH PRACTICES INTO THE DELIVERY OF HEALTH CARE; AND 5 (II) MECHANISMS FOR OVERCOMING SUCH BARRIERS. 6 (C) IN ACCORDANCE WITH SUBSECTION (B) OF THIS SECTION, THE BOARD 7 SHALL CONSULT WITH: 8 (1) INSTITUTIONS OF HIGHER EDUCATION, PRIVATE RESEARCH 9 INSTITUTES, AND INDIVIDUAL RESEARCHERS WITH EXTENSIVE EXPERIENCE IN 10 COMPLEMENTARY AND ALTERNATIVE MEDICINE AND THE INTEGRATION OF SUCH 11 PRACTICES INTO THE DELIVERY OF HEALTH CARE; 12 (2) NATIONALLY RECOGNIZED PROVIDERS OF COMPLEMENTARY AND 13 INTEGRATIVE MEDICINE; AND 14 (3) OTHER OFFICIALS, ENTITIES, AND INDIVIDUALS WITH EXPERTISE 15 ON COMPLEMENTARY AND INTEGRATIVE MEDICINE AS THE BOARD DETERMINES 16 APPROPRIATE. 17 (D) (1) HEALTH CARE PROVIDERS AND MEMBERS MAY PETITION THE 18 BOARD TO IMPROVE OR ADJUST COVERED BENEFITS UNDER HEALTHY MARYLAND. 19 (2) THE BOARD SHALL DEVELOP AND IMPLEMENT PROCEDURES FOR 20 MEMBERS TO PETITION THE BOARD TO IMPROVE OR ADJUST COVERED BENEFITS 21 UNDER HEALTHY MARYLAND. 22 25–603. 23 (A) SUBJECT TO THE OTHER PROVISIONS OF THIS TITLE, A MEMBER IS 24 ENTITLED TO PAYMENT BY HEALTHY MARYLAND TO AN ELIGIBLE HEALTH CARE 25 PROVIDER FOR LONG–TERM SERVICES AND SUPPORTS, FOR MAINTENANCE OF 26 HEALTH, OR FOR CARE, SERVICES, DIAGNOSIS, TREATMENT, OR REHABILITATION 27 THAT IS RELATED TO A MEDICALLY DETERMINABLE CONDITION, WHETHER 28 PHYSICAL OR MENTAL, OF HEALTH, INJURY, OR AGE THAT: 29 (1) CAUSES A FUNCTIONAL LIMITATION IN PERFORMING ONE OR 30 MORE ACTIVITIES OF DAILY LIVING OR INSTRUMENTAL ACTIVITIES OF DAILY 31 HOUSE BILL 534 47 LIVING; AND 1 (2) SUBSTANTIALLY LIMITS ONE OR MORE OF THE ENROLLEE’S 2 MAJOR LIFE ACTIVITIES. 3 (B) AN INDIVIDUAL WHO QUALIFIES FOR DISABILITY BENEFITS UNDER 4 TITLE II OR TITLE XVI OF THE SOCIAL SECURITY ACT IS ENTITLED TO LONG–TERM 5 SERVICES AND SUPPORTS UNDER HEALTHY MARYLAND. 6 (C) ANY MEMBER WHO RECEIVES OR IS APPROVED TO RECEIVE BENEFITS 7 UNDER TITLE II OR TITLE XVI OF THE SOCIAL SECURITY ACT IS ENTITLED TO 8 PAYMENT BY HEALTHY MARYLAND FOR LONG–TERM SERVICES AND SUPPORTS. 9 (D) LONG–TERM SERVICES AND SUPPORTS SHALL: 10 (1) INCLUDE ANY LONG–TERM NURSING OR MEDICAL SERVICES FOR 11 THE MEMBER, WHETHER PROVIDED IN AN INSTITUTION OR A HOME– AND 12 COMMUNITY–BASED SETTING; 13 (2) PROVIDE COVERAGE FOR A BROAD SPECTRUM OF LONG–TERM 14 SERVICES AND SUPPORTS, INCLUDING FOR HOME– AND COMMUNITY–BASED 15 SERVICES AND OTHER CARE PROVIDED THROUGH NONINSTITUTIONAL SETTINGS; 16 (3) PROVIDE COVERAGE THAT MEETS THE PHYSICAL, MENTAL, AND 17 SOCIAL NEEDS OF RECIPIENTS WHILE ALLOWING RECIPIENTS THEIR MAXIMUM 18 POSSIBLE AUTONOMY AND THEIR MAXIMUM POSSIBLE CIVIC, SOCIAL, AND 19 ECONOMIC PARTICIPATION; 20 (4) PRIORITIZE HOME– AND COMMUNITY–BASED SERVICES OVER 21 INSTITUTIONALIZATION; 22 (5) BE PROVIDED WITH A PRESUMPTION THAT RECIPIENTS OF ALL 23 AGES AND DISABILITIES WILL RECEIVE LONG–TERM SERVICES AND SUPPORTS 24 THROUGH HOME– AND COMMUNITY–BASED SERVICES UNLESS THE INDIVIDUAL 25 CHOOSES OTHERWISE; 26 (6) BE PROVIDED WITH THE GOAL OF ENABLING INDIVIDUALS WITH 27 DISABILITIES TO RECEIVE SERVICES IN THE LEAST RESTRICTIVE AND MOST 28 INTEGRATED SETTING APPROPRIATE TO THE INDIVIDUAL’S NEEDS; 29 (7) BE PROVIDED IN A MANNER THAT ALLOWS INDIVIDUALS WITH 30 DISABILITIES TO MAINTAIN THEIR INDEPENDENCE, SELF–DETERMINATION, AND 31 DIGNITY; 32 48 HOUSE BILL 534 (8) PROVIDE LONG–TERM SERVICES AND SUPPORTS THAT ARE OF 1 EQUAL QUALITY AND EQUALLY ACCESSIBLE ACROSS GEOGRAPHIC REGIONS; 2 (9) ENSURE THAT LONG–TERM SERVICES AND SUPPORTS PROVIDE 3 MEMBERS THE OPTION OF SELF–DIRECTION OF SERVICES; 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 HOUSE BILL 534 49 THE STATE AND IS IN GOOD STANDING; 1 (II) THE HEALTH CARE PROVIDER’S SERVICES ARE PERFORMED 2 WHILE PHYSICALLY PRESENT WITHIN THE STATE; 3 (III) THE HEALTH CARE PROVIDER AGREES TO ACCEPT 4 HEALTHY MARYLAND RATES AS PAYMENT IN FULL FOR ALL COVERED SERVICES; 5 AND 6 (IV) THE HEALTH CARE PROVIDER HAS FILED WITH THE BOARD 7 A PARTICIPATION AGREEMENT DESCRIBED IN § 25–702 OF THIS SUBTITLE. 8 (2) THE BOARD SHALL ESTABLISH AND MAINTAIN PROCEDURES AND 9 STANDARDS FOR RECOGNIZING HEALTH CARE PROVIDERS LOCATED OUTSIDE THE 10 STATE FOR PURPOSES OF PROVIDING COVERAGE UNDER HEALTHY MARYLAND FOR 11 MEMBERS WHO REQUIRE OUT–OF–STATE HEALTH CARE SERVICES WHILE 12 TEMPORARILY LOCATED OUTSIDE THE STATE. 13 (B) ANY HEALTH CARE PROVIDER QUALIFIED TO PARTICIPATE UNDER THIS 14 SECTION MAY PROVIDE COVERED HEALTH CARE SERVICES UNDER HEALTHY 15 MARYLAND IF THE HEALTH CARE PROVIDER IS LEGALLY AUTHORIZED TO PERFORM 16 THE HEALTH CARE SERVICE FOR THE INDIVIDUAL UNDER THE CIRCUMSTANCES 17 INVOLVED. 18 (C) A MEMBER MAY RECEIVE HEALTH CARE SERVICES UNDER HEALTHY 19 MARYLAND FROM ANY PARTICIPATING HEALTH CARE PROVIDER IF THE RECEIPT OF 20 THE HEALTH CARE SERVICES IS CONSISTENT WITH: 21 (1) THE REQUIREMENTS OF THIS SECTION AND ANY PROCEDURES OR 22 STANDARDS ESTABLISHED BY THE BOARD UNDER THIS SECTION; 23 (2) THE WILLINGNESS OR AVAILABILITY OF THE PROVIDER TO 24 PROVIDE THE HEALTH CARE SERVICES TO THE MEMBER; 25 (3) PROVISIONS OF THIS TITLE RELATING TO DISCRIMINATION; AND 26 (4) THE APPROPRIATE CLINICALLY RELEVANT CIRCUMSTANCES AND 27 STANDARDS. 28 (D) (1) A HEALTH CARE PROVIDER MAY NOT USE HEALTH INFORMATION 29 TECHNOLOGY OR CLINICAL PRACTICE GUIDELINES THAT LIMIT THE EFFECTIVE 30 EXERCISE OF THE PROFESSIONAL JUDGMENT OF PHYSICIANS, REGISTERED 31 NURSES, OR OTHER HEALTH CARE PROVIDERS OPERATING WITHIN THE SCOPE OF 32 50 HOUSE BILL 534 PRACTICE OF THE PROVIDER UNDER THE HEALTH OCCUPATIONS ARTICLE. 1 (2) A PHYSICIAN, A REGISTERED NURSE, OR ANY OTHER HEALTH 2 CARE PROVIDER MAY OVERRIDE HEALTH INFORMATION TECHNOLOGY AND 3 CLINICAL PRACTICE GUIDELINES USED BY A HEALTH CARE PROVIDER IF THE 4 OVERRIDE: 5 (I) IS CONSISTENT WITH THE HEALTH CARE PROVIDER’S 6 DETERMINATION OF MEDICAL NECESSITY; AND 7 (II) IN THE PROFESSIONAL JUDGMENT OF THE HEALTH CARE 8 PROVIDER, IS IN THE BEST INTEREST OF THE PATIENT AND CONSISTENT WITH THE 9 PATIENT’S WISHES. 10 (E) AN ENTITY MAY NOT FURNISH COVERED ITEMS AND SERVICES UNDER 11 THIS TITLE IF THE ENTITY PROVIDES NO ITEMS AND SERVICES DIRECTLY TO 12 MEMBERS, INCLUDING: 13 (1) ENTITIES THAT ENTER INTO CONTRACTS WITH OTHER ENTITIES 14 OR HEALTH CARE PROVIDERS TO PROVIDE ALL ITEMS AND SERVICES; AND 15 (2) ENTITIES THAT ARE APPROVED TO COORDINATE CARE PLANS 16 UNDER PART C OF TITLE XVIII OF THE SOCIAL SECURITY ACT BUT DO NOT 17 DIRECTLY PROVIDE THE ITEMS AND SERVICES AUTHORIZED BY THE CARE PLANS. 18 25–702. 19 (A) A HEALTH CARE PROVIDER SHALL ENTER INTO A PARTICIPATION 20 AGREEMENT WITH THE BOARD IN ORDER TO QUALIFY AS A PARTICIPATING 21 PROVIDER UNDER HEALTHY MARYLAND. 22 (B) A PARTICIPATION AGREEMENT BETWEEN THE BOARD AND A HEALTH 23 CARE PROVIDER SHALL: 24 (1) REQUIRE THE HEALTH CARE PROVIDER TO PROVIDE SERVICES TO 25 ELIGIBLE INDIVIDUALS WITHOUT DISCRIMINATION, IN ACCORDANCE WITH § 26 25–901(C)(4) OF THIS TITLE; 27 (2) PROHIBIT THE HEALTH CARE PROVIDER FROM CHARGING A 28 MEMBER FOR ANY COVERED SERVICES OTHER THAN FOR PAYMENT AUTHORIZED BY 29 THIS TITLE; 30 (3) REQUIRE THE HEALTH CARE PROVIDER TO PROVIDE 31 HOUSE BILL 534 51 INFORMATION REQUESTED BY THE BOARD, IN ACCORDANCE WITH § 25–305 OF THIS 1 TITLE, FOR: 2 (I) QUALITY REVIEW BY DESIGNATED ENTITIES; 3 (II) MAKING PAYMENTS UNDER THIS TITLE, INCLUDING THE 4 EXAMINATION OF RECORDS AS MAY BE NECESSARY FOR THE VERIFICATION OF 5 INFORMATION ON WHICH THE PAYMENTS ARE BASED; 6 (III) STATISTICAL OR OTHER STUDIES REQUIRED FOR THE 7 IMPLEMENTATION OF THIS TITLE; AND 8 (IV) ANY OTHER PURPOSES REQUIRED BY THE BOARD; 9 (4) FOR AN INSTITUTIONAL PROVIDER, PROHIBIT THE PROVIDER 10 FROM EMPLOYING OR USING FOR THE PROVISION OF HEALTH SERVICES ANY 11 INDIVIDUAL HEALTH CARE PROVIDER THAT HAS HAD A PARTICIPATION AGREEMENT 12 UNDER THIS SUBSECTION TERMINATED FOR CAUSE; 13 (5) FOR A HEALTH CARE PROVIDER PAID ON A FEE–FOR–SERVICE 14 BASIS FOR ITEMS AND SERVICES PROVIDED UNDER THIS TITLE, REQUIRE THE 15 PROVIDER TO SUBMIT BILLS AND ANY REQUIRED SUPPORTING DOCUMENTATION 16 RELATING TO THE PROVISION OF COVERED SERVICES WITHIN 30 DAYS AFTER THE 17 DATE OF PROVIDING SUCH SERVICES; 18 (6) FOR AN INSTITUTIONAL PROVIDER PAID IN ACCORDANCE WITH § 19 25–802 OF THIS TITLE, REQUIRE THE INSTITUTIONAL PROVIDER TO SUBMIT, IN 20 ACCORDANCE WITH § 25–305 OF THIS TITLE, INFORMATION ON A QUARTERLY BASIS 21 THAT: 22 (I) RELATES TO THE PROVISION OF COVERED SERVICES; AND 23 (II) DESCRIBES SERVICES PROVIDED AT A PATIENT LEVEL; 24 (7) FOR A PROVIDER RECEIVING PAYMENT UNDER THIS TITLE BASED 25 ON DIAGNOSIS–RELATED CODING, PROCEDURE–RELATED CODING, OR ANY OTHER 26 CODING SYSTEM OR DATA: 27 (I) REQUIRE THE PROVIDER TO DISCLOSE TO THE BOARD: 28 1. ANY CASE MIX INDEXES, DIAGNOSIS CODING 29 SOFTWARE, PROCEDURE CODING SOFTWARE, OR OTHER CODING SYSTEM USED BY 30 THE PROVIDER FOR THE PURPOSES OF MEETING PAYMENT, GLOBAL BUDGETING, OR 31 52 HOUSE BILL 534 DISCLOSURE REQUIREMENTS UNDER THIS TITLE; AND 1 2. ANY CASE MIX, DIAGNOSIS CODING GUIDELINES, 2 PROCEDURE CODING GUIDELINES, OR CODING TIP SHEETS USED BY THE PROVIDER 3 FOR THE PURPOSES OF MEETING PAYMENT, GLOBAL BUDGETING, OR DISCLOSURE 4 REQUIREMENTS UNDER THIS TITLE; AND 5 (II) PROHIBIT THE PROVIDER FROM: 6 1. USING PROPRIETARY CASE MIX INDEXES, DIAGNOSIS 7 CODING SOFTWARE, PROCEDURE CODING SOFTWARE, OR OTHER CODING 8 SOFTWARE FOR THE PURPOSES OF MEETING PAYMENT, GLOBAL BUDGETING, OR 9 DISCLOSURE REQUIREMENTS UNDER THIS TITLE; 10 2. REQUIRING ANY HEALTH CARE PROVIDER TO APPLY 11 CASE MIX INDEXES, DIAGNOSIS CODING, PROCEDURE CODING, OR OTHER CODING 12 SYSTEMS IN A MANNER THAT LIMITS THE MEDICAL OR NURSING PROCESS OR LIMITS 13 A TREATING PHYSICIAN’S OR ASSIGNED REGISTERED NURSE’S PROFESSIONAL 14 JUDGMENT IN DETERMINING A DIAGNOSIS, INCLUDING THE USE OF LEADING 15 QUERIES OR PROHIBITIONS ON USING CERTAIN CODES; 16 3. PROVIDING FINANCIAL INCENTIVES TO PHYSICIANS, 17 REGISTERED NURSES, OR OTHER HEALTH CARE PROVIDERS FOR PARTICULAR 18 CODING RESULTS OR FOR SELECTING CODES WITH HIGHER PAYMENTS; 19 4. IMPOSING FINANCIAL DISINCENTIVES TO 20 PHYSICIANS, REGISTERED NURSES, OR OTHER HEALTH CARE PROVIDERS FOR 21 PARTICULAR CODING RESULTS OR FOR SELECTING DIAGNOSTIC CODES WITH 22 LOWER PAYMENTS; AND 23 5. USING CASE MIX INDEXES OR DIAGNOSIS CODING 24 SOFTWARE THAT MAKE SUGGESTIONS FOR HIGHER–SEVERITY DIAGNOSES OR 25 CODING FOR HIGHER–COST PROCEDURES; 26 (8) REQUIRE THE PROVIDER TO COMPLY WITH THE DUTY OF PATIENT 27 ADVOCACY DESCRIBED IN § 25–902 OF THIS TITLE; 28 (9) REQUIRE THE PROVIDER TO COMPLY WITH THE PROHIBITIONS 29 AND REQUIREMENTS DESCRIBED IN § 25–703 OF THIS SUBTITLE; AND 30 (10) FOR AN INSTITUTIONAL PROVIDER, REQUIRE THE INSTITUTIONAL 31 PROVIDER TO AGREE THAT NO BOARD MEMBER, EXECUTIVE, OR ADMINISTRATOR OF 32 THE INSTITUTIONAL PROVIDER WILL RECEIVE COMPENSATION FROM, OWN STOCK 33 HOUSE BILL 534 53 OR HAVE OTHER FINANCIAL INVESTMENTS IN, OR SERVE AS A BOARD MEMBER OF 1 ANY ENTITY THAT CONTRACTS WITH OR PROVIDES ITEMS OR SERVICES, INCLUDING 2 PHARMACEUTICAL PRODUCTS AND MEDICAL DEVICES OR EQUIPMENT, TO THE 3 PROVIDER. 4 (C) THIS SECTION MAY NOT BE CONSTRUED TO REQUIRE A HEALTH CARE 5 PROVIDER TO PROVIDE A TYPE OR CLASS OF SERVICES THAT IS OUTSIDE THE SCOPE 6 OF THE PROVIDER’S NORMAL PRACTICE. 7 25–703. 8 (A) A PARTICIPATING PROVIDER: 9 (1) MAY NOT BILL OR ENTER INTO A PRIVATE CONTRACT WITH AN 10 INDIVIDUAL ELIGIBLE FOR BENEFITS UNDER HEALTHY MARYLAND FOR ANY ITEM 11 OR SERVICE THAT IS A BENEFIT DESCRIBED IN SUBTITLE 6 OF THIS TITLE; 12 (2) MAY BILL OR ENTER INTO A PRIVATE CONTRACT WITH AN 13 INDIVIDUAL ELIGIBLE FOR BENEFITS UNDER HEALTHY MARYLAND FOR ANY ITEM 14 OR SERVICE THAT IS NOT A BENEFIT DESCRIBED IN SUBTITLE 6 OF THIS TITLE IF: 15 (I) THE CONTRACT AND PARTICIPATING PROVIDER MEET THE 16 REQUIREMENTS OF SUBSECTIONS (B) AND (C) OF THIS SECTION; 17 (II) THE ITEM OR SERVICE IS NOT PAYABLE OR AVAILABLE 18 UNDER HEALTHY MARYLAND; AND 19 (III) THE PARTICIPATING PROVIDER DOES NOT RECEIVE: 20 1. REIMBURSEMENT UNDER HEALTHY MARYLAND 21 DIRECTLY OR INDIRECTLY FOR THE ITEM OR SERVICE; AND 22 2. ANY AMOUNT FOR THE ITEM OR SERVICE FROM AN 23 ORGANIZATION THAT RECEIVES REIMBURSEMENT FOR THE ITEM OR SERVICE 24 UNDER HEALTHY MARYLAND DIRECTLY OR INDIRECTLY; AND 25 (3) MAY BILL OR ENTER INTO A PRIVATE CONTRACT WITH ANY 26 INDIVIDUAL INELIGIBLE FOR BENEFITS UNDER HEALTHY MARYLAND FOR ANY ITEM 27 OR SERVICE. 28 (B) A CONTRACT TO PROVIDE ITEMS AND SERVICES DESCRIBED IN 29 SUBSECTION (A)(2) OF THIS SECTION: 30 54 HOUSE BILL 534 (1) SHALL BE IN WRITING AND SIGNED BY THE INDIVIDUAL OR 1 AUTHORIZED REPRESENTATIVE OF THE INDIVIDUAL RECEIVING THE ITEM OR 2 SERVICE BEFORE THE ITEM OR SERVICE IS FURNISHED; 3 (2) MAY NOT BE ENTERED INTO AT A TIME WHEN THE INDIVIDUAL IS 4 FACING AN EMERGENCY HEALTH CARE SITUATION; AND 5 (3) SHALL CLEARLY INDICATE TO THE INDIVIDUAL RECEIVING THE 6 ITEMS AND SERVICES THAT BY SIGNING THE CONTRACT THE INDIVIDUAL: 7 (I) AGREES NOT TO SUBMIT A CLAIM UNDER HEALTHY 8 MARYLAND FOR THE ITEMS OR SERVICES; 9 (II) ACCEPTS RESPONSIBILITY FOR PAYMENT OF THE ITEMS OR 10 SERVICES AND UNDERSTANDS THAT NO REIMBURSEMENT WILL BE PROVIDED 11 UNDER HEALTHY MARYLAND FOR THE ITEMS OR SERVICES; 12 (III) ACKNOWLEDGES THAT NO LIMITS UNDER HEALTHY 13 MARYLAND APPLY TO AMOUNTS THAT MAY BE CHARGED FOR THE ITEMS OR 14 SERVICES; AND 15 (IV) ACKNOWLEDGES THAT THE PARTICIPATING PROVIDER IS 16 PROVIDING SERVICES OUTSIDE THE SCOPE OF HEALTHY MARYLAND. 17 (C) A PARTICIPATING PROVIDER THAT ENTERS INTO A CONTRACT 18 DESCRIBED IN SUBSECTION (A)(2) OF THIS SECTION SHALL HAVE IN EFFECT DURING 19 THE PERIOD AN ITEM OR A SERVICE IS TO BE PROVIDED AN AFFIDAVIT THAT: 20 (1) IDENTIFIES THE PARTICIPATING PROVIDER THAT IS TO FURNISH 21 THE ITEM OR SERVICE; 22 (2) STATES THAT THE PARTICIPATING PROVIDER WILL NOT SUBMIT 23 ANY CLAIM UNDER HEALTHY MARYLAND FOR ANY ITEM OR SERVICE PROVIDED TO 24 ANY INDIVIDUAL ENROLLED UNDER HEALTHY MARYLAND; 25 (3) IS SIGNED BY THE PARTICIPATING PROVIDER; AND 26 (4) IS FILED WITH THE BOARD NOT LATER THAN 10 DAYS AFTER 27 ENTERING INTO THE FIRST CONTRACT TO WHICH THE AFFIDAVIT APPLIES. 28 (D) IF A PROVIDER THAT SIGNS AN AFFIDAVIT DESCRIBED IN SUBSECTION 29 (C) OF THIS SECTION KNOWINGLY AND WILLFULLY SUBMITS A CLAIM UNDER THIS 30 TITLE FOR ANY ITEM OR SERVICE PROVIDED OR RECEIVES ANY REIMBURSEMENT OR 31 HOUSE BILL 534 55 AMOUNT FOR AN ITEM OR A SERVICE PROVIDED UNDER A CONTRACT DESCRIBED IN 1 SUBSECTION (A)(2) OF THIS SECTION: 2 (1) THE CONTRACT SHALL BE NULL AND VOID; AND 3 (2) NO PAYMENT SHALL BE MADE UNDER THIS TITLE FOR ANY ITEM 4 OR SERVICE FURNISHED BY THE PROVIDER DURING THE 1–YEAR PERIOD 5 BEGINNING ON THE DATE THE AFFIDAVIT WAS SIGNED. 6 25–704. 7 (A) AN INSTITUTIONAL OR INDIVIDUAL PROVIDER WHO IS NOT A 8 PARTICIPATING PROVIDER: 9 (1) IF THE CONTRACT MEETS THE REQUIREMENTS OF § 25–703(B) OF 10 THIS SUBTITLE AND THE PROVIDER MEETS THE REQUIREMENTS OF § 25–703(C) OF 11 THIS SUBTITLE, MAY BILL OR ENTER INTO ANY PRIVATE CONTRACT WITH ANY 12 INDIVIDUAL ELIGIBLE FOR BENEFITS UNDER HEALTHY MARYLAND FOR ANY ITEM 13 OR SERVICE THAT IS A BENEFIT DESCRIBED IN SUBTITLE 6 OF THIS TITLE; AND 14 (2) MAY BILL OR ENTER INTO A PRIVATE CONTRACT WITH ANY 15 INDIVIDUAL FOR AN ITEM OR A SERVICE THAT IS NOT A BENEFIT UNDER SUBTITLE 16 6 OF THIS TITLE. 17 (B) A CONTRACT TO PROVIDE ITEMS AND SERVICES DESCRIBED IN 18 SUBSECTION (A) OF THIS SECTION: 19 (1) SHALL BE IN WRITING AND SIGNED BY THE INDIVIDUAL OR 20 AUTHORIZED REPRESENTATIVE OF THE INDIVIDUAL RECEIVING THE ITEM OR 21 SERVICE BEFORE THE ITEM OR SERVICE IS FURNISHED; 22 (2) MAY NOT BE ENTERED INTO AT A TIME WHEN THE INDIVIDUAL IS 23 FACING AN EMERGENCY HEALTH CARE SITUATION; AND 24 (3) SHALL CLEARLY INDICATE TO THE INDIVIDUAL RECEIVING THE 25 ITEMS AND SERVICES THAT BY SIGNING THE CONTRACT THE INDIVIDUAL: 26 (I) ACKNOWLEDGES THAT THE INDIVIDUAL HAS THE RIGHT TO 27 HAVE SUCH ITEMS OR SERVICES PROVIDED UNDER HEALTHY MARYLAND; 28 (II) AGREES NOT TO SUBMIT A CLAIM UNDER THIS TITLE FOR 29 THE ITEMS OR SERVICES EVEN IF SUCH ITEMS OR SERVICES ARE OTHERWISE 30 COVERED BY THIS TITLE; 31 56 HOUSE BILL 534 (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) A PROVIDER THAT 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 534 57 (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 58 HOUSE BILL 534 UNDER THIS TITLE ON BEHALF OF AN EMPLOYER. 1 (3) “EMPLOYER” MEANS ANY PERSON ENGAGED IN A FOR–PROFIT OR 2 NONPROFIT BUSINESS OR INDUSTRY, INCLUDING ONE OR MORE INDIVIDUALS, 3 PARTNERSHIPS, ASSOCIATIONS, CORPORATIONS, TRUSTS, PROFESSIONAL 4 MEMBERSHIP ORGANIZATIONS, UNINCORPORATED ORGANIZATIONS, 5 NONGOVERNMENTAL ORGANIZATIONS, OR TRUSTEES, AND SUBJECT TO LIABILITY 6 FOR VIOLATING THE PROVISIONS OF THIS TITLE. 7 (B) AN EMPLOYER MAY NOT TERMINATE OR OTHERWISE DISCRIMINATE 8 AGAINST AN EMPLOYEE BECAUSE THE EMPLOYEE OR A PERSON ACTING AT THE 9 REQUEST OF THE EMPLOYEE: 10 (1) NOTIFIED THE BOARD OR THE EMPLOYEE’S EMPLOYER OF ANY 11 ALLEGED VIOLATION OF THIS TITLE; 12 (2) REFUSED TO ENGAGE IN A PRACTICE MADE UNLAWFUL BY THIS 13 TITLE, IF THE EMPLOYEE HAS IDENTIFIED THE ALLEGED UNLAWFUL PRACTICE TO 14 THE EMPLOYER; 15 (3) COMMENCED OR CAUSED TO BE COMMENCED, OR PLANS TO 16 COMMENCE OR CAUSE TO BE COMMENCED, A PROCEEDING UNDER THIS TITLE; 17 (4) TESTIFIED IN A PROCEEDING ABOUT A VIOLATION OF THIS TITLE; 18 OR 19 (5) ASSISTED OR PARTICIPATED, IN ANY MANNER, OR PLANS TO 20 ASSIST OR PARTICIPATE IN ANY MANNER, IN A PROCEEDING OR IN ANY OTHER 21 ACTION TO CARRY OUT THE PURPOSES OF THIS TITLE. 22 (C) AN EMPLOYEE WHO ALLEGES THAT AN EMPLOYER ENGAGED IN 23 DISCRIMINATION IN VIOLATION OF SUBSECTION (A) OF THIS SECTION MAY FILE A 24 CIVIL ACTION IN ACCORDANCE WITH TITLE 8 OF THE GENERAL PROVISIONS 25 ARTICLE. 26 (D) (1) THE RIGHTS, PRIVILEGES, AND REMEDIES IN THIS SECTION MAY 27 NOT BE WAIVED BY AGREEMENT, POLICY, FORM, OR CONDITION OF EMPLOYMENT. 28 (2) THIS SECTION MAY NOT BE CONSTRUED TO: 29 (I) DIMINISH THE RIGHTS, PRIVILEGES, OR REMEDIES OF ANY 30 EMPLOYEE UNDER ANY OTHER LAW OR REGULATION, OR UNDER ANY COLLECTIVE 31 BARGAINING AGREEMENT; OR 32 HOUSE BILL 534 59 (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 MEMBERS UNDER HEALTHY MARYLAND BY PARTICIPATING 8 PROVIDERS. 9 (B) PAYMENT RATES UNDER THE HEALTHY MARYLAND PROGRAM SHALL 10 BE REASONABLE 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 AN 16 INSTITUTIONAL PROVIDER A QUARTERLY GLOBAL BUDGET PAYMENT IN 17 ACCORDANCE 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 MEMBERS UNDER 28 HEALTHY MARYLAND BY PARTICIPATING PROVIDERS WHO ARE INDIVIDUAL 29 PROVIDERS SHALL BE PAID FOR ON A FEE–FOR–SERVICE BASIS UNDER § 25–803 OF 30 THIS SUBTITLE UNLESS AND UNTIL THE BOARD ESTABLISHES ANOTHER PAYMENT 31 METHODOLOGY. 32 60 HOUSE BILL 534 (2) THERE IS A REBUTTABLE PRESUMPTION THAT THE MEDICARE 1 RATE OF REIMBURSEMENT CONSTITUTES A REASONABLE FEE–FOR–SERVICE 2 PAYMENT RATE. 3 (E) (1) PAYMENT FOR HEALTH CARE SERVICES ESTABLISHED UNDER 4 THIS SUBTITLE SHALL BE CONSIDERED PAYMENT IN FULL. 5 (2) A PARTICIPATING HEALTH CARE PROVIDER MAY NOT: 6 (I) CHARGE ANY RATE IN EXCESS OF THE PAYMENT 7 ESTABLISHED UNDER THIS SUBTITLE FOR ANY HEALTH CARE SERVICE PROVIDED 8 TO A MEMBER UNDER HEALTHY MARYLAND; OR 9 (II) EXCEPT AS PROVIDED UNDER A FEDERAL PROGRAM, 10 SOLICIT OR ACCEPT PAYMENT FROM ANY MEMBER OR THIRD PARTY FOR ANY 11 HEALTH CARE SERVICE. 12 (3) THIS SECTION DOES NOT PRECLUDE HEALTHY MARYLAND FROM 13 ACTING AS A PRIMARY OR SECONDARY PAYER IN CONJUNCTION WITH ANOTHER 14 THIRD–PARTY PAYOR WHEN ALLOWED BY A FEDERAL PROGRAM. 15 (F) (1) HEALTHY MARYLAND MAY ADOPT, BY REGULATION, PAYMENT 16 METHODOLOGIES FOR THE PAYMENT OF CAPITAL–RELATED EXPENSES FOR 17 SPECIFICALLY IDENTIFIED CAPITAL EXPENDITURES INCURRED BY A 18 PARTICIPATING PROVIDER THAT IS A HEALTH CARE FACILITY AS DEFINED IN § 19 19–114 OF THIS ARTICLE. 20 (2) ANY CAPITAL–RELATED EXPENSE GENERATED BY A CAPITAL 21 EXPENDITURE THAT REQUIRES PRIOR APPROVAL BY HEALTHY MARYLAND MUST 22 HAVE RECEIVED APPROVAL TO BE PAID BY HEALTHY MARYLAND. 23 (3) A PARTICIPATING PROVIDER SEEKING FUNDS FOR CAPITAL 24 EXPENDITURES SHALL PRESENT A BUDGET FOR REVIEW TO THE BOARD. 25 (4) PRIORITY FOR CAPITAL EXPENDITURES SHALL BE GIVEN TO 26 PROJECTS THAT ADDRESS A MEDICALLY UNDERSERVED AREA OR POPULATION, OR 27 SEEK TO ADDRESS HEALTH DISPARITIES DUE TO RACE, ETHNICITY, INCOME, OR 28 GEOGRAPHIC REGION. 29 (5) THE BOARD MAY NOT PROVIDE FUNDING FOR CAPITAL 30 EXPENDITURES UNDER THIS SECTION THAT ARE FINANCED DIRECTLY OR 31 INDIRECTLY THROUGH THE DIVERSION OF HEALTHY MARYLAND FUNDS THAT 32 HOUSE BILL 534 61 RESULTS IN REDUCTIONS IN DIRECT CARE TO PATIENTS, INCLUDING REDUCTIONS 1 IN REGISTERED NURSING STAFFING PATTERNS AND CHANGES IN EMERGENCY ROOM 2 OR PRIMARY CARE SERVICES OR AVAILABILITY. 3 (G) (1) A PARTICIPATING PROVIDER THAT IS AN INSTITUTIONAL 4 PROVIDER SHALL MAINTAIN SEPARATE ACCOUNTS FOR PAYMENTS MADE UNDER 5 THIS SUBTITLE FOR OPERATIONS AND CAPITAL EXPENDITURES. 6 (2) AN INSTITUTIONAL PROVIDER MAY NOT: 7 (I) USE PAYMENTS MADE FOR OPERATIONS FOR CAPITAL 8 EXPENDITURES OR FOR PROFIT; OR 9 (II) USE PAYMENTS MADE FOR CAPITAL EXPENDITURES FOR 10 OPERATIONS. 11 (H) THE BOARD SHALL ESTABLISH PAYMENT METHODOLOGIES AND AN 12 ANNUAL BUDGET FOR SPECIAL PROJECTS TO BE USED FOR THE CONSTRUCTION OF 13 NEW FACILITIES, MAJOR EQUIPMENT PURCHASES, AND STAFFING IN RURAL OR 14 MEDICALLY UNDERSERVED AREAS, AS DEFINED IN § 330(B)(3) OF THE PUBLIC 15 HEALTH SERVICE ACT, INCLUDING AREAS DESIGNATED AS HEALTH PROFESSIONAL 16 SHORTAGE AREAS, AS DEFINED IN § 332(A) OF THE PUBLIC HEALTH SERVICE ACT. 17 (I) THE PAYMENT METHODOLOGIES AND RATES ESTABLISHED BY THE 18 BOARD UNDER THIS SECTION SHALL INCLUDE A DISTINCT COMPONENT OF 19 REIMBURSEMENT FOR DIRECT AND INDIRECT GRADUATE MEDICAL EDUCATION. 20 (J) (1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION, THE BOARD 21 SHALL ADOPT, BY REGULATION, PAYMENT METHODOLOGIES AND PROCEDURES FOR 22 PAYING FOR HEALTH CARE SERVICES PROVIDED TO A MEMBER WHILE THE MEMBER 23 IS TEMPORARILY LOCATED 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 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 62 HOUSE BILL 534 THE BOARD; AND 1 (II) PROVIDE FOR THE PAYMENT OF HEALTH CARE SERVICES 2 PROVIDED BY A MEMBER’S TREATING PHYSICIAN AS AN APPROVED HEALTH CARE 3 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 AN INSTITUTIONAL PROVIDER. 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 INSTITUTIONAL 10 PROVIDER 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 AN INSTITUTIONAL PROVIDER 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 SUBSECTION 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 AN INSTITUTIONAL PROVIDER TO BE PAID 23 THROUGH A GLOBAL BUDGET NEGOTIATED UNDER THIS SUBSECTION INSTEAD OF 24 PAYMENT 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 INSTITUTIONAL PROVIDER; 29 AND 30 (II) IS SUBJECT TO THE SAME REPORTING AND DISCLOSURE 31 HOUSE BILL 534 63 REQUIREMENTS AS THE INSTITUTIONAL PROVIDER. 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 INSTITUTIONAL 9 PROVIDER FOR EACH ITEM AND SERVICE, AS COMPARED TO: 10 1. OTHER INSTITUTIONAL PROVIDERS WITHIN THE 11 INSTITUTIONAL PROVIDER’S MARKET; 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 INSTITUTIONAL 16 PROVIDERS; 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 64 HOUSE BILL 534 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 534 65 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, EDUCATION, AND PREVENTION 9 PROGRAMS, INCLUDING OCCUPATIONAL HEALTH AND SAFETY PROGRAMS AND 10 PUBLIC HEALTH PROGRAMS, FOR THE CONTINUED EDUCATION AND HEALTH AND 11 SAFETY OF HEALTH CARE PROVIDERS AND OTHER INDIVIDUALS EMPLOYED BY THE 12 INSTITUTIONAL PROVIDER; AND 13 (2) ADMINISTRATIVE COSTS FOR THE INSTITUTIONAL PROVIDER. 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 66 HOUSE BILL 534 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 534 67 (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 LABOR–MANAGEMENT REPORTING AND DISCLOSURE ACT OF 1959. 32 68 HOUSE BILL 534 SUBTITLE 9. PROGRAM STANDARDS. 1 25–901. 2 (A) HEALTHY MARYLAND SHALL HAVE A SINGLE STANDARD OF SAFE, 3 THERAPEUTIC, AND EFFECTIVE CARE FOR ALL RESIDENTS OF THE STATE. 4 (B) THE BOARD SHALL ESTABLISH REQUIREMENTS AND STANDARDS, BY 5 REGULATION, FOR THE HEALTHY MARYLAND PROGRAM AND HEALTH CARE 6 PROVIDERS THAT ARE CONSISTENT WITH THIS TITLE AND THE APPLICABLE 7 PROFESSIONAL PRACTICE AND LICENSURE STANDARDS FOR HEALTH CARE 8 PROVIDERS ESTABLISHED UNDER TITLE 19 OF THIS ARTICLE, THE HEALTH 9 OCCUPATIONS ARTICLE, AND THE INSURANCE ARTICLE, INCLUDING 10 REQUIREMENTS AND STANDARDS, AS APPLICABLE, FOR: 11 (1) THE SCOPE, QUALITY, AND ACCESSIBILITY OF HEALTH CARE 12 SERVICES; AND 13 (2) RELATIONS BETWEEN HEALTH CARE PROVIDERS AND MEMBERS. 14 (C) THE BOARD SHALL ESTABLISH REQUIREMENTS AND STANDARDS, BY 15 REGULATION, FOR HEALTHY MARYLAND THAT INCLUDE PROVISIONS TO PROMOTE: 16 (1) SIMPLIFICATION, TRANSPARENCY, UNIFORMITY, AND FAIRNESS 17 IN HEALTH CARE PROVIDER CREDENTIALING AND PARTICIPATION, REFERRALS, 18 PAYMENT PROCEDURES AND RATES, CLAIMS PROCESSING, AND APPROVAL OF 19 HEALTH CARE SERVICES, AS APPLICABLE; 20 (2) IN–PERSON PRIMARY AND PREVENTIVE CARE, CARE 21 COORDINATION, EFFICIENT AND EFFECTIVE HEALTH CARE SERVICES, QUALITY 22 ASSURANCE, AND PROMOTION OF PUBLIC, ENVIRONMENTAL, AND OCCUPATIONAL 23 HEALTH; 24 (3) ELIMINATION OF HEALTH CARE DISPARITIES, INCLUDING 25 GEOGRAPHIC, RACIAL, INCOME–BASED, GENDER–BASED, SEX–BASED, AND OTHER 26 DISPARITIES; 27 (4) CONSISTENT WITH TITLE 20 OF THE STATE GOVERNMENT 28 ARTICLE, TITLE 19 OF THE STATE FINANCE AND PROCUREMENT ARTICLE, AND 29 OTHER NONDISCRIMINATION LAWS, NONDISCRIMINATION, INCLUDING A 30 PROHIBITION ON DISCRIMINATORY REDUCTION OF BENEFITS, WITH RESPECT TO 31 MEMBERS AND HEALTH CARE PROVIDERS ON THE BASIS OF RACE, COLOR, RELIGION 32 HOUSE BILL 534 69 OR CREED, SEX, AGE, ANCESTRY OR NATIONAL ORIGIN, MARITAL STATUS, MENTAL 1 OR PHYSICAL DISABILITY, SEXUAL ORIENTATION, GENDER IDENTITY OR 2 EXPRESSION, CITIZENSHIP, IMMIGRATION STATUS, PRIMARY LANGUAGE, MEDICAL 3 CONDITION, GENETIC INFORMATION, FAMILIAL STATUS, MILITARY OR VETERAN 4 STATUS, OR SOURCE OF INCOME; 5 (5) THE PROVISION OF HEALTH CARE SERVICES UNDER HEALTHY 6 MARYLAND THAT IS APPROPRIATE TO THE PATIENT’S CLINICALLY RELEVANT 7 CIRCUMSTANCES; 8 (6) ACCESSIBILITY OF PRIMARY CARE AND OTHER HEALTH CARE 9 SERVICES, INCLUDING ACCESSIBILITY FOR PEOPLE WITH DISABILITIES AND PEOPLE 10 WITH LIMITED ABILITY TO SPEAK OR UNDERSTAND ENGLISH; AND 11 (7) THE PROVISION OF PRIMARY CARE AND OTHER HEALTH CARE 12 SERVICES IN A CULTURALLY COMPETENT MANNER. 13 (D) THE BOARD SHALL ESTABLISH REQUIREMENTS AND STANDARDS, BY 14 REGULATION AND TO THE EXTENT AUTHORIZED BY FEDERAL LAW, FOR REPLACING 15 AND MERGING WITH HEALTHY MARYLAND ANY HEALTH CARE SERVICES AND 16 ANCILLARY SERVICES CURRENTLY PROVIDED BY OTHER PROGRAMS, INCLUDING: 17 (1) MEDICARE; 18 (2) THE AFFORDABLE CARE ACT; AND 19 (3) FEDERALLY MATCHED PUBLIC HEALTH PROGRAMS. 20 (E) (1) ANY PARTICIPATING PROVIDER THAT IS ORGANIZED AS A 21 NONPROFIT ENTITY MAY NOT RECEIVE PAYMENTS FOR ITEMS OR SERVICES 22 FURNISHED UNDER HEALTHY MARYLAND TO ACCOMMODATE INCREASES IN NET 23 INCOME. 24 (2) ANY PARTICIPATING PROVIDER THAT IS ORGANIZED AS A 25 FOR–PROFIT ENTITY SHALL BE REQUIRED TO MEET THE SAME REQUIREMENTS AND 26 STANDARDS AS ENTITIES ORGANIZED AS NONPROFIT ENTITIES. 27 (3) PAYMENTS UNDER HEALTHY MARYLAND TO FOR–PROFIT 28 ENTITIES MAY NOT BE CALCULATED TO ACCOMMODATE THE GENERATION OF 29 PROFIT, EXCESS REVENUE, REVENUE FOR DIVIDENDS, OR OTHER RETURN ON 30 INVESTMENT OR THE PAYMENT OF TAXES THAT WOULD NOT BE PAID BY A 31 NONPROFIT ENTITY. 32 70 HOUSE BILL 534 (F) (1) A HEALTH CARE PROVIDER WHO PARTICIPATES IN HEALTHY 1 MARYLAND SHALL: 2 (I) PROVIDE INFORMATION AS REQUIRED BY: 3 1. THE MARYLAND HEALTH CARE COMMISSION; 4 2. THE HEALTH SERVICES COST REVIEW COMMISSION; 5 AND 6 3. THE DEPARTMENT; AND 7 (II) ALLOW EXAMINATION OF THE INFORMATION BY HEALTHY 8 MARYLAND AS MAY BE REASONABLY REQUIRED FOR PURPOSES OF REVIEWING 9 ACCESSIBILITY AND UTILIZATION OF HEALTH CARE SERVICES, QUALITY 10 ASSURANCE, COST CONTAINMENT, THE MAKING OF PAYMENTS, AND STATISTICAL OR 11 OTHER STUDIES OF THE OPERATION OF THE HEALTHY MARYLAND PROGRAM OR 12 FOR PROTECTION AND PROMOTION OF PUBLIC, ENVIRONMENTAL, AND 13 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 MEMBERS, HEALTH CARE PROVIDERS, LABOR 20 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 TO: 27 (1) ADVOCATE FOR MEDICALLY NECESSARY HEALTH CARE FOR EACH 28 OF THE HEALTH CARE PROVIDER’S INDIVIDUAL PATIENTS; AND 29 (2) ACT IN THE EXCLUSIVE INTEREST OF EACH OF THE HEALTH CARE 30 PROVIDER’S INDIVIDUAL PATIENTS. 31 HOUSE BILL 534 71 (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 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 REQUIRED TO BE DISCLOSED TO A PATIENT UNDER § 1–303 OR § 1–304 OF THE 33 72 HOUSE BILL 534 HEALTH OCCUPATIONS ARTICLE; 1 (2) ANY MEMBERSHIP, PROPRIETARY INTEREST, OR CO–OWNERSHIP 2 IN ANY FORM IN OR WITH A CLINICAL OR BIOANALYTICAL LABORATORY; 3 (3) ANY PAYMENTS TO A CLINICAL OR BIOANALYTICAL LABORATORY 4 REQUIRED TO BE DISCLOSED TO A PATIENT UNDER § 14–404(A)(16) OF THE HEALTH 5 OCCUPATIONS ARTICLE; 6 (4) ANY PROFIT–SHARING ARRANGEMENT WITH A CLINICAL OR 7 BIOANALYTICAL LABORATORY; 8 (5) ANY CONTRACTS OR SUBCONTRACTS ENTERED INTO: 9 (I) THAT CONTAIN INCENTIVE PLANS; 10 (II) THAT INVOLVE GENERAL PAYMENTS THAT ARE NOT TIED TO 11 SPECIFIC MEDICAL DECISIONS INVOLVING SPECIFIC ENROLLEES OR GROUPS OF 12 ENROLLEES WITH SIMILAR MEDICAL CONDITIONS; OR 13 (III) UNDER § 15–113 OF THE INSURANCE ARTICLE; 14 (6) ANY BONUS, INCENTIVE AGREEMENTS, OR COMPENSATION 15 ARRANGEMENTS WITH ANY HEALTH CARE PROVIDER; 16 (7) ANY BONUS, INCENTIVE AGREEMENTS, OR COMPENSATION 17 ARRANGEMENTS WITH A CLINICALLY INTEGRATED ORGANIZATION AS DEFINED IN § 18 15–1901 OF THE INSURANCE ARTICLE; AND 19 (8) ANY OFFER, DELIVERY, RECEIPT, OR ACCEPTANCE OF A REBATE, 20 REFUND, COMMISSION, PREFERENCE, PATRONAGE DIVIDEND, DISCOUNT, OR OTHER 21 CONSIDERATION FOR A REFERRAL MADE UNDER § 1–302(D) OF THE HEALTH 22 OCCUPATIONS ARTICLE. 23 (D) AS NECESSARY, THE BOARD MAY ADOPT RULES AND REGULATIONS TO: 24 (1) IMPLEMENT AND ENFORCE THIS SECTION; AND 25 (2) EXPAND REPORTING REQUIREMENTS UNDER THIS SECTION. 26 SUBTITLE 10. FUNDING. 27 25–1001. 28 HOUSE BILL 534 73 (A) THE BOARD SHALL SEEK ALL FEDERAL WAIVERS AND OTHER FEDERAL 1 APPROVALS AND ARRANGEMENTS AND SUBMIT STATE PLAN AMENDMENTS AS 2 NECESSARY TO OPERATE HEALTHY MARYLAND CONSISTENT WITH THIS TITLE. 3 (B) (1) ON OR BEFORE DECEMBER 1, 2021, THE BOARD SHALL APPLY TO 4 THE UNITED STATES SECRETARY OF HEALTH AND HUMAN SERVICES OR ANY 5 OTHER APPROPRIATE FEDERAL OFFICIAL FOR ALL WAIVERS OF REQUIREMENTS, 6 AND MAKE OTHER ARRANGEMENTS, UNDER MEDICARE, ANY FEDERALLY MATCHED 7 PUBLIC HEALTH PROGRAM, THE AFFORDABLE CARE ACT, AND ANY OTHER 8 FEDERAL PROGRAMS RELATED TO THE PROVISION OF HEALTH CARE THAT PROVIDE 9 FEDERAL FUNDS FOR PAYMENT FOR HEALTH CARE SERVICES THAT ARE NECESSARY 10 TO: 11 (I) ENABLE ALL MEMBERS TO RECEIVE ALL BENEFITS 12 THROUGH HEALTHY MARYLAND; 13 (II) ENABLE THE STATE TO IMPLEMENT THIS TITLE; 14 (III) ALLOW THE STATE TO RECEIVE AND DEPOSIT ALL FEDERAL 15 PAYMENTS UNDER THOSE PROGRAMS, INCLUDING FUNDS THAT MAY BE PROVIDED 16 IN LIEU OF PREMIUM TAX CREDITS, COST–SHARING SUBSIDIES, AND SMALL 17 BUSINESS TAX CREDITS, IN THE STATE TREASURY TO THE CREDIT OF THE HEALTHY 18 MARYLAND TRUST FUND CREATED UNDER SUBTITLE 11 OF THIS TITLE; AND 19 (IV) USE FUNDS DEPOSITED IN THE FUND FOR HEALTHY 20 MARYLAND AND OTHER PROVISIONS UNDER THIS TITLE. 21 (2) TO THE FULLEST EXTENT POSSIBLE, THE BOARD SHALL 22 NEGOTIATE ARRANGEMENTS WITH THE FEDERAL GOVERNMENT TO ENSURE THAT 23 FEDERAL PAYMENTS ARE PAID TO HEALTHY MARYLAND IN PLACE OF FEDERAL 24 FUNDING OF, OR TAX BENEFITS FOR, FEDERALLY MATCHED PUBLIC HEALTH 25 PROGRAMS OR FEDERAL HEALTH PROGRAMS. 26 (3) TO THE EXTENT ANY FEDERAL FUNDING IS NOT PAID DIRECTLY 27 TO HEALTHY MARYLAND, THE STATE SHALL DIRECT THE FUNDING TO HEALTHY 28 MARYLAND. 29 (4) (I) THE BOARD MAY REQUIRE MEMBERS OR APPLICANTS TO 30 PROVIDE INFORMATION NECESSARY FOR HEALTHY MARYLAND TO COMPLY WITH 31 ANY WAIVER OR ARRANGEMENT UNDER THIS TITLE. 32 (II) INFORMATION PROVIDED BY MEMBERS OR APPLICANTS TO 33 74 HOUSE BILL 534 THE BOARD FOR THE PURPOSES OF THIS PARAGRAPH MAY NOT BE USED FOR ANY 1 OTHER PURPOSE. 2 (5) THE BOARD MAY TAKE ANY ACTION NECESSARY TO EFFECTIVELY 3 IMPLEMENT HEALTHY MARYLAND TO THE MAXIMUM EXTENT POSSIBLE AS A 4 SINGLE–PAYER PROGRAM CONSISTENT WITH THIS TITLE. 5 (C) (1) THE BOARD MAY TAKE ANY ACTION CONSISTENT WITH THIS 6 ARTICLE TO ENABLE THE HEALTHY MARYLAND PROGRAM TO ADMINISTER 7 MEDICARE IN THE STATE. 8 (2) HEALTHY MARYLAND SHALL: 9 (I) PROVIDE SUPPLEMENTAL INSURANCE COVERAGE UNDER 10 MEDICARE PART B; AND 11 (II) PROVIDE PREMIUM ASSISTANCE DRUG COVERAGE UNDER 12 MEDICARE PART D FOR ELIGIBLE MEMBERS OF MEDICARE PART D. 13 (D) THE BOARD MAY WAIVE OR MODIFY THE APPLICABILITY OF ANY 14 PROVISIONS OF THIS SUBTITLE RELATING TO ANY FEDERALLY MATCHED PUBLIC 15 HEALTH PROGRAM OR MEDICARE, AS NECESSARY, TO: 16 (1) IMPLEMENT ANY WAIVER ARRANGEMENT UNDER THIS SUBTITLE; 17 OR 18 (2) MAXIMIZE THE FEDERAL BENEFITS TO HEALTHY MARYLAND 19 UNDER THIS SUBTITLE. 20 (E) (1) THE BOARD MAY APPLY FOR COVERAGE FOR, AND ENROLL, ANY 21 ELIGIBLE MEMBER UNDER ANY FEDERALLY MATCHED PUBLIC HEALTH PROGRAM 22 OR MEDICARE. 23 (2) ENROLLMENT IN A FEDERALLY MATCHED PUBLIC HEALTH 24 PROGRAM OR MEDICARE MAY NOT: 25 (I) CAUSE ANY MEMBER TO LOSE ANY HEALTH CARE SERVICE 26 PROVIDED BY HEALTHY MARYLAND; OR 27 (II) DIMINISH ANY RIGHT THE MEMBER WOULD OTHERWISE 28 HAVE UNDER ANY FEDERALLY MATCHED PUBLIC HEALTH PROGRAM OR MEDICARE. 29 (F) NOTWITHSTANDING ANY OTHER LAW, THE BOARD SHALL TAKE ACTION 30 HOUSE BILL 534 75 NECESSARY TO INCORPORATE HEALTH CARE COVERAGE OF STATE RESIDENTS WHO 1 ARE EMPLOYED IN OTHER JURISDICTIONS INTO WAIVERS AND OTHER APPROVALS 2 APPLIED FOR OR OBTAINED UNDER THIS SECTION. 3 (G) (1) NOTWITHSTANDING ANY OTHER LAW, THE BOARD SHALL TAKE 4 NECESSARY ACTION TO REDUCE OR ELIMINATE HEALTHY MARYLAND MEMBER 5 COINSURANCE, COST–SHARING, OR PREMIUM OBLIGATIONS AND INCREASE 6 MEMBER ELIGIBILITY FOR ANY FEDERAL FINANCIAL SUPPORT RELATED TO 7 MEDICARE OR THE AFFORDABLE CARE ACT. 8 (2) THE BOARD MAY ACT UNDER PARAGRAPH (1) OF THIS 9 SUBSECTION ONLY ON A FINDING APPROVED BY THE SECRETARY OF BUDGET AND 10 MANAGEMENT AND THE BOARD THAT THE ACTION: 11 (I) WILL HELP TO INCREASE THE NUMBER OF MEMBERS WHO 12 ARE ELIGIBLE FOR AND ENROLLED IN FEDERALLY MATCHED PUBLIC HEALTH 13 PROGRAMS, OR OTHER PROGRAMS, TO REDUCE OR ELIMINATE MEMBER 14 COINSURANCE, COST–SHARING, OR PREMIUM OBLIGATIONS OR INCREASE MEMBER 15 ELIGIBILITY FOR ANY FEDERAL FINANCIAL SUPPORT RELATED TO MEDICARE OR 16 THE AFFORDABLE CARE ACT; 17 (II) WILL NOT DIMINISH ANY MEMBER’S ACCESS TO ANY 18 HEALTH CARE SERVICE OR RIGHT THE MEMBER WOULD OTHERWISE HAVE UNDER 19 ANY FEDERALLY MATCHED PUBLIC HEALTH PROGRAM OR MEDICARE; 20 (III) IS IN THE INTEREST OF HEALTHY MARYLAND; AND 21 (IV) DOES NOT REQUIRE OR HAS RECEIVED ANY NECESSARY 22 FEDERAL WAIVERS OR APPROVALS TO ENSURE FEDERAL FINANCIAL 23 PARTICIPATION. 24 (3) ACTION THAT THE BOARD MAY TAKE UNDER PARAGRAPH (1) OF 25 THIS SUBSECTION MAY INCLUDE: 26 (I) AN INCREASE TO INCOME ELIGIBILITY LEVELS RELATED TO 27 MEDICARE OR THE AFFORDABLE CARE ACT; 28 (II) AN INCREASE TO OR AN ELIMINATION OF THE RESOURCE 29 TEST FOR ELIGIBILITY RELATED TO MEDICARE OR THE AFFORDABLE CARE ACT; 30 (III) SIMPLIFICATION OF ANY PROCEDURAL OR 31 DOCUMENTATION REQUIREMENT FOR ENROLLMENT RELATED TO MEDICARE OR 32 THE AFFORDABLE CARE ACT; AND 33 76 HOUSE BILL 534 (IV) AN INCREASE IN THE BENEFITS FOR ANY FEDERALLY 1 MATCHED PUBLIC HEALTH PROGRAM AND FOR ANY OTHER PROGRAM TO REDUCE 2 OR ELIMINATE MEMBER COINSURANCE, COST–SHARING, OR PREMIUM OBLIGATIONS 3 OR INCREASE MEMBER ELIGIBILITY FOR ANY FEDERAL FINANCIAL SUPPORT 4 RELATED TO MEDICARE OR THE AFFORDABLE CARE ACT. 5 (4) ACTIONS UNDER THIS SUBSECTION MAY NOT APPLY TO 6 ELIGIBILITY FOR PAYMENT FOR LONG–TERM SERVICES AND SUPPORTS. 7 (H) TO ENABLE THE BOARD TO APPLY FOR COVERAGE FOR, AND ENROLL, 8 ANY ELIGIBLE MEMBER UNDER ANY FEDERALLY MATCHED PUBLIC HEALTH 9 PROGRAM, MEDICARE, OR ANY PROGRAM OR BENEFIT UNDER MEDICARE, THE 10 BOARD MAY REQUIRE THAT ALL MEMBERS OR APPLICANTS FOR SUCH COVERAGE 11 OR BENEFITS UNDER THOSE PROGRAMS PROVIDE THE INFORMATION NECESSARY 12 TO ENABLE THE BOARD TO DETERMINE WHETHER THE MEMBERS OR APPLICANTS 13 ARE ELIGIBLE FOR COVERAGE OR BENEFITS UNDER THOSE PROGRAMS. 14 (I) AS A CONDITION OF CONTINUED ELIGIBILITY FOR HEALTH CARE 15 SERVICES UNDER HEALTHY MARYLAND, A MEMBER WHO IS ELIGIBLE FOR BENEFITS 16 UNDER MEDICARE SHALL ENROLL IN MEDICARE, INCLUDING PARTS A, B, AND D. 17 (J) (1) HEALTHY MARYLAND SHALL PROVIDE PREMIUM ASSISTANCE 18 FOR ALL MEMBERS ENROLLING IN A MEDICARE PART D DRUG COVERAGE PLAN 19 UNDER TITLE XVIII, § 1860D OF THE SOCIAL SECURITY ACT. 20 (2) (I) SUBJECT TO SUBPARAGRAPH (II) OF THIS PARAGRAPH, THE 21 PREMIUM ASSISTANCE REQUIRED UNDER PARAGRAPH (1) OF THIS SUBSECTION IS 22 LIMITED TO THE LOW–INCOME BENCHMARK PREMIUM AMOUNT ESTABLISHED BY 23 THE CENTERS FOR MEDICARE AND MEDICAID SERVICES AND ANY OTHER AMOUNT 24 THE FEDERAL AGENCY ESTABLISHES UNDER ITS DE MINIMIS PREMIUM POLICY. 25 (II) PREMIUM ASSISTANCE PAYMENTS MADE UNDER 26 PARAGRAPH (1) OF THIS SUBSECTION ON BEHALF OF MEMBERS ENROLLED IN A 27 MEDICARE ADVANTAGE PLAN MAY EXCEED THE LOW–INCOME BENCHMARK 28 PREMIUM AMOUNT IF DETERMINED TO BE COST EFFECTIVE TO HEALTHY 29 MARYLAND. 30 (K) IF HEALTHY MARYLAND HAS REASONABLE GROUNDS TO BELIEVE THAT 31 A MEMBER MAY BE ELIGIBLE FOR AN INCOME–RELATED SUBSIDY UNDER TITLE 32 XVIII, § 1860D–14 OF THE SOCIAL SECURITY ACT: 33 (1) THE MEMBER SHALL PROVIDE AND AUTHORIZE HEALTHY 34 HOUSE BILL 534 77 MARYLAND TO OBTAIN ANY INFORMATION OR DOCUMENTATION REQUIRED TO 1 ESTABLISH THE MEMBER’S ELIGIBILITY FOR THAT SUBSIDY; AND 2 (2) HEALTHY MARYLAND SHALL ATTEMPT TO OBTAIN AS MUCH OF 3 THE INFORMATION AND DOCUMENTATION REQUIRED TO BE PROVIDED UNDER ITEM 4 (1) OF THIS SUBSECTION AS POSSIBLE. 5 (L) (1) HEALTHY MARYLAND SHALL MAKE A REASONABLE EFFORT TO 6 NOTIFY EACH MEMBER OF THE MEMBER’S OBLIGATIONS UNDER THIS SECTION. 7 (2) IF A REASONABLE EFFORT HAS BEEN MADE TO CONTACT THE 8 MEMBER AND THE MEMBER HAS NOT PROVIDED INFORMATION REQUIRED UNDER 9 THIS SECTION, HEALTHY MARYLAND SHALL NOTIFY THE MEMBER IN WRITING THAT 10 THE MEMBER HAS 60 DAYS TO PROVIDE THE REQUIRED INFORMATION. 11 (3) IF THE MEMBER DOES NOT PROVIDE THE REQUIRED 12 INFORMATION WITHIN 60 DAYS AFTER RECEIPT OF THE NOTIFICATION UNDER 13 PARAGRAPH (2) OF THIS SUBSECTION, THE MEMBER’S COVERAGE UNDER HEALTHY 14 MARYLAND MAY BE TERMINATED. 15 (4) INFORMATION PROVIDED BY MEMBERS OR APPLICANTS TO THE 16 BOARD FOR THE PURPOSES OF THIS SECTION MAY NOT BE USED FOR ANY OTHER 17 PURPOSE. 18 (M) HEALTHY MARYLAND SHALL ASSUME RESPONSIBILITY FOR PROVIDING 19 ALL BENEFITS AND HEALTH CARE SERVICES PAID FOR BY THE FEDERAL 20 GOVERNMENT WITH THE FEDERAL FUNDS PROVIDED FOR THOSE BENEFITS AND 21 SERVICES. 22 SUBTITLE 11. HEALTHY MARYLAND TRUST FUND. 23 25–1101. 24 (A) THERE IS A HEALTHY MARYLAND TRUST FUND. 25 (B) THE PURPOSE OF THE FUND IS TO IMPLEMENT THE PURPOSES OF 26 HEALTHY MARYLAND UNDER THIS TITLE. 27 (C) THE BOARD SHALL ADMINISTER THE FUND. 28 (D) THE FUND IS A SPECIAL, NONLAPSING FUND THAT IS NOT SUBJECT TO 29 § 7–302 OF THE STATE FINANCE AND PROCUREMENT ARTICLE. 30 78 HOUSE BILL 534 (E) THE FUND SHALL CONSIST OF: 1 (1) MONEY APPROPRIATED IN THE STATE BUDGET TO THE FUND; 2 (2) MONEY FROM ANY PAYROLL PREMIUM ADOPTED UNDER THIS 3 TITLE; 4 (3) MONEY TRANSFERRED TO THE FUND THAT IS ATTRIBUTABLE TO 5 STATE AND FEDERAL FINANCIAL PARTICIPATION IN MEDICAID, THE MARYLAND 6 CHILDREN’S HEALTH PROGRAM, OR MEDICARE; 7 (4) FEDERAL PAYMENTS RECEIVED BY THE STATE AS A RESULT OF 8 ANY WAIVER OF REQUIREMENTS GRANTED OR OTHER ARRANGEMENTS AGREED TO 9 BY THE UNITED STATES SECRETARY OF HEALTH AND HUMAN SERVICES OR ANY 10 OTHER APPROPRIATE FEDERAL OFFICIAL FOR HEALTH CARE PROGRAMS 11 ESTABLISHED UNDER MEDICARE, ANY FEDERALLY MATCHED PUBLIC HEALTH 12 PROGRAM, OR THE AFFORDABLE CARE ACT; 13 (5) FEDERAL AND STATE FUNDS FOR PURPOSES OF THE PROVISION 14 OF SERVICES AUTHORIZED UNDER TITLE XX OF THE SOCIAL SECURITY ACT THAT 15 WOULD OTHERWISE BE COVERED UNDER HEALTHY MARYLAND; 16 (6) MONEY FROM OTHER FEDERAL PROGRAMS THAT PROVIDE FUNDS 17 FOR THE PAYMENT OF HEALTH CARE SERVICES THAT ARE PROVIDED UNDER THIS 18 TITLE; 19 (7) STATE AND LOCAL FUNDS APPROPRIATED FOR HEALTH CARE 20 SERVICES AND BENEFITS THAT ARE PROVIDED UNDER THIS TITLE; 21 (8) THE AMOUNTS PAID BY THE STATE THAT ARE EQUIVALENT TO 22 THOSE AMOUNTS THAT ARE PAID ON BEHALF OF RESIDENTS OF THE STATE UNDER 23 MEDICARE, ANY FEDERALLY MATCHED PUBLIC HEALTH PROGRAM, OR THE 24 AFFORDABLE CARE ACT FOR HEALTH BENEFITS THAT ARE EQUIVALENT TO HEALTH 25 BENEFITS COVERED UNDER HEALTHY MARYLAND; AND 26 (9) INVESTMENT EARNINGS OF THE FUND. 27 (F) NOTWITHSTANDING ANY OTHER LAW, MONEY IN THE FUND MAY NOT BE 28 TRANSFERRED TO: 29 (1) THE GENERAL FUND OR A SPECIAL FUND OF THE STATE; OR 30 (2) ANY FUND OF A COUNTY OR MUNICIPALITY. 31 HOUSE BILL 534 79 (G) THE FUND MAY BE USED ONLY FOR HEALTHY MARYLAND AS 1 ESTABLISHED BY THIS TITLE. 2 (H) (1) THE STATE TREASURER SHALL INVEST THE MONEY IN THE FUND 3 IN THE SAME MANNER AS OTHER STATE MONEY MAY BE INVESTED. 4 (2) ANY INVESTMENT EARNINGS OF THE FUND SHALL BE PAID INTO 5 THE FUND. 6 (I) THE BOARD SHALL ESTABLISH AND MAINTAIN A PRUDENT RESERVE IN 7 THE FUND. 8 (J) THE BOARD OR STAFF OF THE BOARD MAY NOT USE ANY FUNDS 9 INTENDED FOR THE ADMINISTRATIVE AND OPERATIONAL EXPENSES OF THE BOARD 10 FOR STAFF RETREATS, PROMOTIONAL GIVEAWAYS, EXCESSIVE EXECUTIVE 11 COMPENSATION, OR PROMOTION OF FEDERAL OR STATE LEGISLATIVE OR 12 REGULATORY MODIFICATIONS. 13 (K) (1) THERE IS A HEALTHY MARYLAND FEDERAL FUNDS ACCOUNT 14 WITHIN THE FUND. 15 (2) ALL FEDERAL MONEY SHALL BE PLACED INTO THE HEALTHY 16 MARYLAND FEDERAL FUNDS ACCOUNT. 17 SUBTITLE 12. COLLECTIVE NEGOTIATION WITH HEALTHY MARYLAND. 18 25–1201. 19 (A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 20 INDICATED. 21 (B) (1) “HEALTH CARE PROVIDER” MEANS AN INDIVIDUAL OR ENTITY 22 THAT IS: 23 (I) LICENSED, CERTIFIED, REGISTERED, OR AUTHORIZED TO 24 PRACTICE A HEALTH CARE PROFESSION IN THE STATE; AND 25 (II) APPROVED TO PARTICIPATE IN HEALTHY MARYLAND 26 UNDER § 25–701 OF THIS TITLE. 27 (2) “HEALTH CARE PROVIDER” INCLUDES: 28 80 HOUSE BILL 534 (I) AN INDIVIDUAL WHO PRACTICES A HEALTH CARE 1 PROFESSION AS AN INDEPENDENT CONTRACTOR; 2 (II) AN OWNER, AN OFFICER, A SHAREHOLDER, OR A 3 PROPRIETOR OF A HEALTH CARE PROVIDER; AND 4 (III) AN ENTITY THAT EMPLOYS OR UTILIZES HEALTH CARE 5 PROVIDERS TO PROVIDE HEALTH CARE SERVICES, INCLUDING A HEALTH CARE 6 FACILITY AS DEFINED IN § 19–114 OF THIS ARTICLE. 7 (3) “HEALTH CARE PROVIDER” DOES NOT INCLUDE AN INDIVIDUAL 8 WHO PRACTICES A HEALTH CARE PROFESSION AS AN EMPLOYEE OF ANOTHER 9 HEALTH CARE PROVIDER. 10 (C) “HEALTH CARE PROVIDERS’ REPRESENTATIVE” MEANS A THIRD PARTY 11 THAT IS AUTHORIZED BY HEALTH CARE PROVIDERS TO NEGOTIATE ON THE HEALTH 12 CARE PROVIDERS’ BEHALF WITH HEALTHY MARYLAND OVER TERMS AND 13 CONDITIONS AFFECTING THOSE HEALTH CARE PROVIDERS. 14 25–1202. 15 (A) HEALTH CARE PROVIDERS MAY MEET AND COMMUNICATE FOR THE 16 PURPOSE OF COLLECTIVELY NEGOTIATING WITH HEALTHY MARYLAND ON ANY 17 MATTER RELATING TO HEALTHY MARYLAND, INCLUDING: 18 (1) RATES OF PAYMENT FOR HEALTH CARE SERVICES; 19 (2) RATES OF PAYMENT FOR PRESCRIPTION AND NONPRESCRIPTION 20 DRUGS; AND 21 (3) PAYMENT METHODOLOGIES. 22 (B) THIS SUBTITLE MAY NOT BE CONSTRUED TO: 23 (1) ALLOW A STRIKE OF HEALTHY MARYLAND BY HEALTH CARE 24 PROVIDERS RELATED TO THE COLLECTIVE NEGOTIATIONS; OR 25 (2) ALLOW OR AUTHORIZE TERMS OR CONDITIONS THAT WOULD 26 IMPEDE THE ABILITY OF HEALTHY MARYLAND TO: 27 (I) OBTAIN OR RETAIN ACCREDITATION BY THE NATIONAL 28 COMMITTEE FOR QUALITY ASSURANCE OR A SIMILAR BODY; OR 29 HOUSE BILL 534 81 (II) COMPLY WITH APPLICABLE STATE OR FEDERAL LAW. 1 25–1203. 2 (A) A HEALTH CARE PROVIDERS’ REPRESENTATIVE IS THE ONLY PARTY 3 AUTHORIZED TO NEGOTIATE WITH HEALTHY MARYLAND ON BEHALF OF THE 4 HEALTH CARE PROVIDERS AS A GROUP. 5 (B) A HEALTH CARE PROVIDER MAY BE BOUND BY THE TERMS AND 6 CONDITIONS NEGOTIATED BY THE HEALTH CARE PROVIDERS’ REPRESENTATIVE. 7 (C) DURING COLLECTIVE NEGOTIATIONS, HEALTH CARE PROVIDERS MAY 8 COMMUNICATE WITH: 9 (1) OTHER HEALTH CARE PROVIDERS REGARDING THE TERMS AND 10 CONDITIONS TO BE NEGOTIATED WITH HEALTHY MARYLAND; AND 11 (2) HEALTH CARE PROVIDERS’ REPRESENTATIVES. 12 (D) HEALTHY MARYLAND MAY: 13 (1) COMMUNICATE AND NEGOTIATE WITH THE HEALTH CARE 14 PROVIDERS’ REPRESENTATIVE; AND 15 (2) OFFER AND PROVIDE DIFFERENT TERMS AND CONDITIONS TO 16 INDIVIDUAL COMPETING HEALTH CARE PROVIDERS. 17 (E) THIS SECTION DOES NOT AFFECT OR LIMIT THE RIGHT OF A HEALTH 18 CARE PROVIDER OR GROUP OF HEALTH CARE PROVIDERS TO COLLECTIVELY 19 PETITION A GOVERNMENTAL ENTITY FOR A CHANGE IN A LAW, RULE, OR 20 REGULATION. 21 (F) THIS SECTION DOES NOT AFFECT OR LIMIT: 22 (1) COLLECTIVE ACTION OR COLLECTIVE BARGAINING ON THE PART 23 OF A HEALTH CARE PROVIDER WITH THE HEALTH CARE PROVIDER’S EMPLOYER; OR 24 (2) ANY OTHER LAWFUL COLLECTIVE ACTION OR COLLECTIVE 25 BARGAINING BY HEALTH CARE PROVIDERS. 26 (G) BEFORE ENGAGING IN COLLECTIVE NEGOTIATIONS WITH HEALTHY 27 MARYLAND ON BEHALF OF HEALTH CARE PROVIDERS, A HEALTH CARE PROVIDERS’ 28 REPRESENTATIVE SHALL FILE WITH THE BOARD, IN THE MANNER PRESCRIBED BY 29 82 HOUSE BILL 534 THE BOARD, INFORMATION IDENTIFYING: 1 (1) THE REPRESENTATIVE; 2 (2) THE REPRESENTATIVE’S PLAN OF OPERATION; AND 3 (3) THE REPRESENTATIVE’S PROCEDURES TO ENSURE COMPLIANCE 4 WITH THIS SUBTITLE. 5 (H) (1) A PERSON WHO ACTS AS THE REPRESENTATIVE OF NEGOTIATING 6 PARTIES UNDER THIS SUBTITLE SHALL PAY A FEE TO THE BOARD TO ACT AS A 7 REPRESENTATIVE. 8 (2) THE BOARD SHALL SET THE FEE REQUIRED UNDER PARAGRAPH 9 (1) OF THIS SUBSECTION IN AN AMOUNT DETERMINED TO BE REASONABLE AND 10 NECESSARY TO COVER THE COSTS INCURRED BY THE BOARD IN ADMINISTERING 11 THIS SUBTITLE. 12 25–1204. 13 (A) EXCEPT AS AUTHORIZED BY OTHER LAW, THIS SUBTITLE DOES NOT 14 AUTHORIZE COMPETING HEALTH CARE PROVIDERS TO ACT IN CONCERT IN 15 RESPONSE TO A HEALTH CARE PROVIDERS’ REPRESENTATIVE’S DISCUSSIONS OR 16 NEGOTIATIONS WITH HEALTHY MARYLAND. 17 (B) A HEALTH CARE PROVIDERS’ REPRESENTATIVE MAY NOT NEGOTIATE 18 ANY AGREEMENT THAT EXCLUDES, LIMITS THE PARTICIPATION OR 19 REIMBURSEMENT OF, OR OTHERWISE LIMITS THE SCOPE OF SERVICES TO BE 20 PROVIDED BY ANY HEALTH CARE PROVIDER OR GROUP OF HEALTH CARE 21 PROVIDERS WITH RESPECT TO THE PERFORMANCE OF SERVICES THAT ARE WITHIN 22 THE HEALTH CARE PROVIDER’S SCOPE OF PRACTICE, LICENSE, REGISTRATION, OR 23 CERTIFICATE. 24 Article – Insurance 25 31–101. 26 (a) In this title the following words have the meanings indicated. 27 (b) “Board” means the [Board of Trustees of the Exchange] HEALTHY 28 MARYLAND BOARD, ESTABLISHED UNDER TITLE 25, SUBTITLE 3 OF THE 29 HEALTH – GENERAL ARTICLE. 30 [31–104. 31 HOUSE BILL 534 83 (a) There is a Board of Trustees of the Exchange. 1 (b) The Board consists of the following members: 2 (1) the Secretary of Health; 3 (2) the Commissioner; 4 (3) the Executive Director of the Maryland Health Care Commission; and 5 (4) the following members appointed by the Governor, with the advice and 6 consent of the Senate: 7 (i) three members who: 8 1. represent the interests of employers and individual 9 consumers of products offered by the Exchange; and 10 2. may have public health research expertise; and 11 (ii) three members who have demonstrated knowledge and expertise 12 in at least two of the following areas: 13 1. individual health care coverage; 14 2. small employer–sponsored health care coverage; 15 3. health benefit plan administration; 16 4. health care finance; 17 5. administration of public or private health care delivery 18 systems; 19 6. purchasing and facilitating enrollment in health plan 20 coverage, including demonstrated knowledge and expertise about the role of licensed health 21 insurance producers and third–party administrators in connecting employers and 22 individual consumers to health plan coverage; and 23 7. public health and public health research, including 24 knowledge about the health needs and health disparities among the State’s diverse 25 communities. 26 (c) In making appointments of members under subsection (b)(4) of this section, 27 the Governor shall assure that: 28 84 HOUSE BILL 534 (1) the Board’s composition reflects a diversity of expertise; 1 (2) the Board’s composition reflects the gender, racial, and ethnic diversity 2 of the State; and 3 (3) the geographic areas of the State are represented. 4 (d) (1) For purposes of this subsection, “affiliation” means: 5 (i) a financial interest, as defined in § 5–101 of the General 6 Provisions Article; 7 (ii) a position of governance, including membership on a board of 8 directors, regardless of compensation; 9 (iii) a relationship through which compensation, as defined in § 10 5–101 of the General Provisions Article, is received; or 11 (iv) a relationship for the provision of services as a regulated lobbyist, 12 as defined in § 5–101 of the General Provisions Article. 13 (2) A member of the Board or of the staff of the Exchange, while serving on 14 the Board or the staff, may not have an affiliation with: 15 (i) a carrier, an insurance producer, a third–party administrator, a 16 managed care organization, or any other person contracting directly with the Exchange; 17 (ii) a trade association of carriers, insurance producers, third–party 18 administrators, or managed care organizations; or 19 (iii) any other association of entities in a position to contract directly 20 with the Exchange. 21 (e) (1) The term of a member appointed by the Governor is 4 years. 22 (2) The terms of members appointed by the Governor are staggered as 23 required by the terms provided for members of the Board on June 1, 2011. 24 (3) At the end of a term, a member continues to serve until a successor is 25 appointed and qualifies. 26 (4) A member who is appointed after a term has begun serves only for the 27 rest of the term and until a successor is appointed and qualifies. 28 (f) An appointed member of the Board may not serve more than two consecutive 29 full terms. 30 HOUSE BILL 534 85 (g) The Governor shall designate a chair of the Board. 1 (h) (1) The Board shall determine the times, places, and frequency of its 2 meetings. 3 (2) Five members of the Board constitute a quorum. 4 (3) Action by the Board requires the affirmative vote of at least five 5 members. 6 (i) A member of the Board is entitled to reimbursement for expenses under the 7 Standard State Travel Regulations, as provided in the State budget. 8 (j) A member shall: 9 (1) meet the requirements of this subtitle, the Affordable Care Act, and all 10 applicable State and federal laws and regulations; 11 (2) serve the public interest of the individuals and qualified employers 12 seeking health care coverage through the Exchange; and 13 (3) ensure the sound operation and fiscal solvency of the Exchange. 14 (k) A member of the Board shall perform the member’s duties: 15 (1) in good faith; 16 (2) in the manner the member reasonably believes to be in the best 17 interests of the Exchange; and 18 (3) without intentional or reckless disregard of the care an ordinarily 19 prudent person in a like position would use under similar circumstances. 20 (l) A member of the Board who performs the member’s duties in accordance with 21 the standard provided in subsection (k) of this section may not be liable personally for 22 actions taken as a member. 23 (m) A member of the Board may be removed for incompetence, misconduct, or 24 failure to perform the duties of the position. 25 (n) (1) (i) A member of the Board shall be subject to the Maryland Public 26 Ethics Law, Title 5, Subtitles 1 through 7 of the General Provisions Article. 27 (ii) In addition to the disclosure required under Title 5, Subtitle 6 of 28 the General Provisions Article, a member of the Board shall disclose to the Board and to 29 the public any relationship not addressed in the required financial disclosure that the 30 member has with a carrier, insurance producer, third–party administrator, managed care 31 86 HOUSE BILL 534 organization, or other entity in an industry involved in matters likely to come before the 1 Board. 2 (2) On all matters that come before the Board, the member shall: 3 (i) adhere strictly to the conflict of interest provisions under Title 5, 4 Subtitle 5 of the General Provisions Article relating to restrictions on participation, 5 employment, and financial interests; and 6 (ii) provide full disclosure to the Board and the public on: 7 1. any matter that gives rise to a potential conflict of interest; 8 and 9 2. the manner in which the member will comply with the 10 provisions of Title 5, Subtitle 5 of the General Provisions Article to avoid any conflict of 11 interest or appearance of a conflict of interest.] 12 31–104. 13 THE HEALTHY MARYLAND BOARD SHALL OVERSEE THE ADMINISTRATION OF 14 THE EXCHANGE UNTIL THE EXCHANGE CEASES TO OPERATE IN THE STATE. 15 31–105. 16 [(a) (1) With the approval of the Governor, the Board shall appoint an 17 Executive Director of the Exchange. 18 (2) The Executive Director shall serve at the pleasure of the Board. 19 (3) The Board shall determine the appropriate compensation for the 20 Executive Director.] 21 (A) THE EXECUTIVE DIRECTOR OF HEALTHY MARYLAND, APPOINTED BY 22 THE BOARD UNDER § 25–302 OF THE HEALTH – GENERAL ARTICLE, SHALL SERVE 23 AS THE EXECUTIVE DIRECTOR OF THE EXCHANGE UNTIL THE EXCHANGE CEASES 24 TO OPERATE IN THE STATE. 25 Article – State Finance and Procurement 26 6–226. 27 (a) (2) (i) Notwithstanding any other provision of law, and unless 28 inconsistent with a federal law, grant agreement, or other federal requirement or with the 29 terms of a gift or settlement agreement, net interest on all State money allocated by the 30 State Treasurer under this section to special funds or accounts, and otherwise entitled to 31 HOUSE BILL 534 87 receive interest earnings, as accounted for by the Comptroller, shall accrue to the General 1 Fund of the State. 2 (ii) The provisions of subparagraph (i) of this paragraph do not apply 3 to the following funds: 4 122. the Racing and Community Development Financing Fund; 5 [and] 6 123. the Racing and Community Development Facilities Fund; 7 AND 8 124. THE HEALTHY MARYLAND TRUST FUND. 9 SECTION 2. AND BE IT FURTHER ENACTED, That the terms of the initial 10 appointed members of: 11 (1) the Healthy Maryland Board shall expire as follows: 12 (i) two members in 2022; 13 (ii) two members in 2023; 14 (iii) two members in 2024; and 15 (iv) two members in 2025; and 16 (2) the Healthy Maryland Public Advisory Committee shall expire as 17 follows: 18 (i) five members in 2022; 19 (ii) five members in 2023; 20 (iii) five members in 2024; and 21 (iv) six members in 2025. 22 SECTION 3. AND BE IT FURTHER ENACTED, That, if any provision of this Act or 23 the application thereof to any person or circumstance is held invalid for any reason in a 24 court of competent jurisdiction, the invalidity does not affect other provisions or any other 25 application of this Act that can be given effect without the invalid provision or application, 26 and for this purpose the provisions of this Act are declared severable. 27 SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect July 28 1, 2021. 29