Text of MD HB 746 (2022)

EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW. [Brackets] indicate matter deleted from existing law. *hb0746* HOUSE BILL 746 J1 2lr2947 CF SB 682 By: Delegate Kaiser Introduced and read first time: February 3, 2022 Assigned to: Health and Government Operations A BILL ENTITLED AN ACT concerning 1 Maryland Medical Assistance Program – Gender–Affirming Treatment 2 (Trans Health Equity Act of 2022) 3 FOR the purpose of requiring, beginning on a certain date, the Maryland Medical 4 Assistance Program to provide gender–affirming treatment; prohibiting the Program 5 from issuing an adverse benefit determination related to gender–affirming 6 treatment unless a health care provider with experience prescribing or delivering 7 gender–affirming treatment has reviewed and confirmed the appropriateness of the 8 determination; and generally relating to gender–affirming treatment and the 9 Maryland Medical Assistance Program. 10 BY repealing and reenacting, without amendments, 11 Article – Health – General 12 Section 15–103(a)(1) 13 Annotated Code of Maryland 14 (2019 Replacement Volume and 2021 Supplement) 15 BY repealing and reenacting, with amendments, 16 Article – Health – General 17 Section 15–103(a)(2)(xvi) and (xvii) 18 Annotated Code of Maryland 19 (2019 Replacement Volume and 2021 Supplement) 20 BY adding to 21 Article – Health – General 22 Section 15–103(a)(2)(xviii) and 15–150 23 Annotated Code of Maryland 24 (2019 Replacement Volume and 2021 Supplement) 25 SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 26 That the Laws of Maryland read as follows: 27 2 HOUSE BILL 746 Article – Health – General 1 15–103. 2 (a) (1) The Secretary shall administer the Maryland Medical Assistance 3 Program. 4 (2) The Program: 5 (xvi) Beginning on January 1, 2021, shall provide, subject to the 6 limitations of the State budget and § 15–855(b)(2) of the Insurance Article, and as permitted 7 by federal law, services for pediatric autoimmune neuropsychiatric disorders associated 8 with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, 9 including the use of intravenous immunoglobulin therapy, for eligible Program recipients, 10 if pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections 11 and pediatric acute onset neuropsychiatric syndrome are coded for billing and diagnosis 12 purposes in accordance with § 15–855(d) of the Insurance Article; [and] 13 (xvii) Beginning on January 1, 2022, may not include, subject to federal 14 approval and limitations of the State budget, a frequency limitation on covered dental 15 prophylaxis care or oral health exams that requires the dental prophylaxis care or oral 16 health exams to be provided at an interval greater than 120 days within a plan year; AND 17 (XVIII) BEGINNING ON JANUARY 1, 2023, SHALL PROVIDE 18 GENDER–AFFIRMING TREATMENT IN ACCORDANCE WITH § 15–150 OF THIS 19 SUBTITLE. 20 15–150. 21 (A) (1) IN THIS SECTION THE FOLLOWING WORDS HAVE THE MEANINGS 22 INDICATED. 23 (2) (I) “GENDER–AFFIRMING TREATMENT” MEANS ANY 24 MEDICALLY NECESSARY TREATMENT CONSISTENT WITH CURRENT CLINICAL 25 STANDARDS OF CARE PRESCRIBED BY A LICENSED HEALTH CARE PROVIDER FOR 26 THE TREATMENT OF A CONDITION RELATED TO THE INDIVIDUAL’S GENDER 27 IDENTITY. 28 (II) “GENDER–AFFIRMING TREATMENT” INCLUDES: 29 1. HORMONE THERAPY, HORMONE BLOCKERS, AND 30 PUBERTY BLOCKERS; 31 HOUSE BILL 746 3 2. HAIR ALTERATION FOR THE PURPOSES OF ALTERING 1 SECONDARY SEX CHARACTERISTICS AND SURGICAL SITE PREPARATION, INCLUDING 2 ELECTROLYSIS, LASER HAIR REMOVAL, HAIRPLASTY, HAIR TRANSPLANTATION, AND 3 MEDICAL TATTOOING FOR HAIR RECONSTRUCTION AND APPEARANCE OF SCAR; 4 3. LARYNGOPLASTY, VOICE MODIFICATION SURGERY, 5 VOICE THERAPY, AND VOICE LESSONS; 6 4. ALTERATIONS TO ABDOMEN, CHEST, TRUNK, AND 7 BUTTOCKS, INCLUDING ABDOMINOPLASTY, MASTECTOMY, BREAST REDUCTION AND 8 AUGMENTATION PROCEDURES, MASTOPEXY, NIPPLE AND AREOLA 9 RECONSTRUCTION, LIPOSUCTION, EXCISION OF EXCESSIVE SKIN AND 10 SUBCUTANEOUS TISSUE, PANNICULECTOMY, AUTOLOGOUS FAT GRAFTING, 11 PHOSPHATIDYLCHOLINE AND DEOXYCHOLATE LIPOLYTIC INTERVENTIONS, 12 PLACEMENT OF HIP AND OTHER IMPLANTS, AND MEDICAL TATTOOING FOR NIPPLE 13 RECONSTRUCTION AND APPEARANCE OF SCAR; 14 5. SURGERY TO THE FACE AND NECK, INCLUDING 15 FACIAL BONE RECONSTRUCTION, FACIAL BONE REMODELING, GENIOPLASTY, 16 MANDIBULAR ANGLE AUGMENTATION/CREATION/REDUCTION, ORBITAL 17 RECONTOURING, LATERAL CANTHOPEXY, LYSIS INTRANASAL SYNECHIA, 18 SEPTOPLASTY, ORTHOGNATHIC SURGERY, TRANSORAL MANDIBULAR 19 OSTEOPLASTY, PLACEMENT OF IMPLANTS TO THE CHEEK, FOREHEAD, CHIN, NOSE, 20 JAW, AND LARYNGEAL PROMINENCE, BLEPHAROPLASTY, BROW LIFT, COLLAGEN 21 INJECTIONS, INJECTION OF HYALURONIC ACID BASED SEMIPERMANENT 22 MATERIALS, AUTOLOGOUS FAT GRAFTING, PHOSPHATIDYLCHOLINE AND 23 DEOXYCHOLATE LIPOLYTIC INTERVENTIONS, FACE AND FOREHEAD LIFTS, 24 RHYTIDECTOMY, NECK TIGHTENING, LIP REDUCTION AND ENHANCEMENT, THYROID 25 CHONDROPLASTY, TRACHEAL SHAVE, REMOVAL OF REDUNDANT SKIN, 26 RHINOPLASTY, AND MEDICAL TATTOOING FOR LIP RECONSTRUCTION AND 27 APPEARANCE OF SCAR; 28 6. SURGERY TO THE GENITALS AND GONADS, 29 INCLUDING CLITOROPLASTY, COLOVAGINOPLASTY, GLANSPLASTY, 30 HYSTERECTOMY, LABIAPLASTY, AUTOLOGOUS FAT GRAFTING, 31 PHOSPHATIDYLCHOLINE AND DEOXYCHOLATE LIPOLYTIC INTERVENTIONS, 32 MEDICAL TATTOOING FOR GLANS RECONSTRUCTION AND APPEARANCE OF SCAR, 33 METOIDIOPLASTY, OOPHORECTOMY, ORCHIECTOMY, OVARIECTOMY, PENECTOMY, 34 PHALLOPLASTY, PLACEMENT OF A TESTICULAR PROSTHESIS AND PENILE 35 PROSTHESIS SALPINGECTOMY, SALPINGO–OOPHORECTOMY, SCROTECTOMY, 36 SCROTOPLASTY, URETHROPLASTY, VAGINECTOMY, VAGINOPLASTY, VULVECTOMY, 37 AND VULVOPLASTY; 38 4 HOUSE BILL 746 7. LASER TREATMENT FOR SCARS FROM 1 GENDER–AFFIRMING TREATMENT; 2 8. STANDARD FERTILITY PRESERVATION PROCEDURES, 3 AS SET FORTH IN § 15–810.1 OF THE INSURANCE ARTICLE; 4 9. REVISIONS TO PREVIOUS TREATMENTS AND 5 REVERSAL OF TREATMENTS; 6 10. COMBINATIONS OF GENDER–AFFIRMING 7 PROCEDURES; AND 8 11. OTHER TREATMENTS AS PRESCRIBED TO SUPPRESS 9 THE DEVELOPMENT OF ENDOGENOUS SECONDARY SEX CHARACTERISTICS, ALIGN 10 THE INDIVIDUAL’S APPEARANCE OR PHYSICAL BODY WITH GENDER IDENTITY, AND 11 ALLEVIATE SYMPTOMS OF CLINICALLY SIGNIFICANT DISTRESS RESULTING FROM 12 GENDER DYSPHORIA. 13 (III) “GENDER–AFFIRMING TREATMENT” MAY: 14 1. INCLUDE TREATMENT DESCRIBED IN THE CURRENT 15 CLINICAL STANDARDS OF CARE FOR GENDER–AFFIRMING TREATMENT PUBLISHED 16 BY THE WORLD PROFESSIONAL ASSOCIATION FOR TRANSGENDER HEALTH; AND 17 2. BE PRESCRIBED TO TRANSGENDER, NONBINARY, 18 INTERSEX, TWO SPIRIT, AND OTHER GENDER DIVERSE INDIVIDUALS. 19 (3) “GENDER IDENTITY” HAS THE MEANING STATED IN § 20–101 OF 20 THE STATE GOVERNMENT ARTICLE. 21 (B) (1) THE PROGRAM SHALL PROVIDE COVERAGE FOR 22 MEDICALLY NECESSARY GENDER–AFFIRMING TREATMENT IN A 23 NONDISCRIMINATORY MANNER. 24 (2) THE GENDER–AFFIRMING TREATMENT SHALL BE ASSESSED 25 ACCORDING TO NONDISCRIMINATORY CRITERIA THAT ARE CONSISTENT WITH 26 CURRENT CLINICAL STANDARDS OF CARE. 27 (3) THE PROGRAM MAY NOT DENY OR LIMIT COVERAGE FOR 28 GENDER–AFFIRMING TREATMENT WHEN THAT TREATMENT IS: 29 (I) PRESCRIBED TO A PROGRAM RECIPIENT BECAUSE OF, 30 RELATED TO, OR CONSISTENT WITH THE RECIPIENT’S GENDER IDENTITY; 31 HOUSE BILL 746 5 (II) MEDICALLY NECESSARY; AND 1 (III) PRESCRIBED IN ACCORDANCE WITH CURRENT CLINICAL 2 STANDARDS OF CARE. 3 (4) THE PROGRAM MAY NOT EXCLUDE GENDER–AFFIRMING 4 TREATMENT, INCLUDING REVISIONS TO PRIOR GENDER–AFFIRMING TREATMENT, 5 ON THE BASIS THAT THE TREATMENT IS A COSMETIC SERVICE. 6 (5) THE PROGRAM MAY NOT ISSUE AN ADVERSE BENEFIT 7 DETERMINATION DENYING OR LIMITING ACCESS TO GENDER–AFFIRMING 8 TREATMENT UNLESS A HEALTH CARE PROVIDER WITH EXPERIENCE PRESCRIBING 9 OR DELIVERING GENDER–AFFIRMING TREATMENT HAS REVIEWED AND CONFIRMED 10 THE APPROPRIATENESS OF THE ADVERSE BENEFIT DETERMINATION. 11 (C) (1) ON OR BEFORE DECEMBER 1 EACH YEAR, BEGINNING IN 2023, 12 EACH MANAGED CARE ORGANIZATION SHALL SUBMIT TO THE DEPARTMENT A 13 REPORT THAT INCLUDES: 14 (I) THE NAME AND LOCATION OF EACH HEALTH CARE 15 PROVIDER OFFERING GENDER–AFFIRMING TREATMENT WITH WHICH THE MANAGED 16 CARE ORGANIZATION HAS AN ACTIVE CONTRACT; AND 17 (II) THE TYPES OF GENDER–AFFIRMING TREATMENT PROVIDED 18 BY EACH HEALTH CARE PROVIDER. 19 (2) (I) ON OR BEFORE JANUARY 1 EACH YEAR, BEGINNING IN 20 2024, THE DEPARTMENT SHALL COMPILE AN ANNUAL REPORT ON GEOGRAPHIC 21 ACCESS TO GENDER–AFFIRMING TREATMENT ACROSS THE STATE. 22 (II) THE REPORT SHALL INCLUDE: 23 1. THE NAME AND LOCATION OF EACH HEALTH CARE 24 PROVIDER OFFERING GENDER–AFFIRMING TREATMENT TO PROGRAM RECIPIENTS; 25 2. THE MANAGED CARE ORGANIZATIONS THAT HAVE 26 ACTIVE CONTRACTS WITH EACH HEALTH CARE PROVIDER; AND 27 3. THE TYPES OF GENDER–AFFIRMING TREATMENT 28 PROVIDED BY EACH HEALTH CARE PROVIDER. 29 6 HOUSE BILL 746 (III) THE DEPARTMENT SHALL PUBLISH THE REPORT IN A 1 CONSPICUOUS MANNER ON THE DEPARTMENT’S WEBSITE. 2 (3) THE DEPARTMENT AND EACH MANAGED CARE ORGANIZATION 3 SHALL INCLUDE THE NAME, LOCATION, AND TYPES OF SERVICES FOR EACH 4 PROVIDER OFFERING GENDER–AFFIRMING TREATMENT IN THEIR PROVIDER 5 DIRECTORIES. 6 SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 7 October 1, 2022. 8