Text of MD SB 119 (2024)

EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW. [Brackets] indicate matter deleted from existing law. *sb0119* SENATE BILL 119 E2, J2, J1 4lr0422 (PRE–FILED) CF 4lr0716 By: Senators Lam, Hettleman, and Waldstreicher Requested: July 10, 2023 Introduced and read first time: January 10, 2024 Assigned to: Finance A BILL ENTITLED AN ACT concerning 1 Legally Protected Health Care – Gender–Affirming Treatment 2 FOR the purpose of altering the definition of “legally protected health care” to include 3 certain gender–affirming treatment, including medications and supplies, for the 4 purposes of certain provisions of law that prohibit health occupations disciplinary 5 actions and certain actions in criminal and civil proceedings and the use of certain 6 resources in furtherance of certain investigations and proceedings related to legally 7 protected health care; and generally relating to legally protected health care. 8 BY repealing and reenacting, without amendments, 9 Article – Courts and Judicial Proceedings 10 Section 9–302(b)(2), 9–402(a), 10–408(c)(5), and 11–802(a) 11 Annotated Code of Maryland 12 (2020 Replacement Volume and 2023 Supplement) 13 BY repealing and reenacting, without amendments, 14 Article – Criminal Procedure 15 Section 9–106(b) 16 Annotated Code of Maryland 17 (2018 Replacement Volume and 2023 Supplement) 18 BY repealing and reenacting, without amendments, 19 Article – Health – General 20 Section 15–151(a) 21 Annotated Code of Maryland 22 (2023 Replacement Volume) 23 BY repealing and reenacting, without amendments, 24 Article – Health Occupations 25 Section 1–227 26 2 SENATE BILL 119 Annotated Code of Maryland 1 (2021 Replacement Volume and 2023 Supplement) 2 BY repealing and reenacting, with amendments, 3 Article – State Personnel and Pensions 4 Section 2–312 5 Annotated Code of Maryland 6 (2015 Replacement Volume and 2023 Supplement) 7 SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 8 That the Laws of Maryland read as follows: 9 Article – Courts and Judicial Proceedings 10 9–302. 11 (b) (2) (i) In this paragraph, “legally protected health care” has the 12 meaning stated in § 2–312 of the State Personnel and Pensions Article. 13 (ii) A judge may not order a person within the State to give testimony 14 or a statement, or produce documents, electronically stored information, or other tangible 15 things under this subsection, in a case where prosecution is pending, or where a grand jury 16 investigation has commenced or is about to commence, for a violation of a criminal law of 17 another state involving the provision of, receipt of, or assistance with legally protected 18 health care in the State, unless the acts forming the basis of the prosecution or investigation 19 would constitute a crime in this State. 20 9–402. 21 (a) (1) In this subsection, “legally protected health care” has the meaning 22 stated in § 2–312 of the State Personnel and Pensions Article. 23 (2) (i) To request issuance of a subpoena under this section, a party 24 shall submit a foreign subpoena to a clerk of the circuit court for the county in which 25 discovery is sought to be conducted in this State. 26 (ii) The request under subparagraph (i) of this paragraph shall 27 include a sworn, written statement signed under penalty of perjury by the party seeking 28 enforcement, or the party’s counsel, that no portion of the subpoena is intended or 29 anticipated to further any investigation or proceeding related to legally protected health 30 care, unless the out–of–state proceeding is: 31 1. Based in tort, contract, or statute; 32 2. A claim for which a similar or equivalent claim would exist 33 in the State; and 34 SENATE BILL 119 3 3. A. Brought by the patient who received legally 1 protected health care, or the patient’s legal representative; or 2 B. Based on conduct that would be prohibited under the laws 3 of this State. 4 (3) A request for the issuance of a subpoena under this subtitle does not 5 constitute an appearance in the courts of this State. 6 10–408. 7 (c) (5) (i) In this paragraph, “legally protected health care” has the 8 meaning stated in § 2–312 of the State Personnel and Pensions Article. 9 (ii) A judge may not issue an ex parte order under this section for 10 the purpose of investigating or recovering evidence of actions related to legally protected 11 health care, unless the acts forming the basis for the investigation or recovery of evidence 12 would constitute a crime in this State. 13 11–802. 14 (a) (1) In this subsection, “legally protected health care” has the meaning 15 stated under § 2–312 of the State Personnel and Pensions Article. 16 (2) (i) Except as provided in subparagraphs (ii), (iii), and (iv) of this 17 paragraph, a copy of any foreign judgment authenticated in accordance with an act of 18 Congress or statutes of this State may be filed in the office of the clerk of a circuit court. 19 (ii) If the face amount of the judgment is $2,500 or less, the copy 20 shall be filed with the clerk of the District Court. 21 (iii) If the face amount of the judgment is not more than a 22 jurisdictional amount described in § 4–401 of this article, but more than $2,500, the copy 23 may be filed either with the clerk of the District Court or in the office of the clerk of a circuit 24 court. 25 (iv) Except as required by federal law, a judgment creditor may not 26 file a copy of any foreign judgment under this section if the judgment was issued in 27 connection with any litigation concerning legally protected health care, unless the 28 underlying cause of action is: 29 1. Based in tort, contract, or statute; 30 2. A claim for which a similar or equivalent claim would exist 31 in the State; and 32 3. A. Brought by the patient who received legally 33 4 SENATE BILL 119 protected health care, or the patient’s legal representative; or 1 B. Based on conduct that would be prohibited under the laws 2 of this State. 3 (3) The clerk shall treat the foreign judgment in the same manner as a 4 judgment of the court in which the foreign judgment is filed. 5 Article – Criminal Procedure 6 9–106. 7 (b) (1) In this subsection, “legally protected health care services” has the 8 meaning stated in § 2–312 of the State Personnel and Pensions Article. 9 (2) Unless compelled by a writ of mandamus issued by a federal court, the 10 Governor may not surrender a person on demand of the executive authority of any other 11 state if the alleged act for which surrender is being demanded relates to providing, 12 procuring, or aiding another in providing or procuring legally protected health care services 13 and the act would not be a crime in the State. 14 Article – Health – General 15 15–151. 16 (a) (1) In this section the following words have the meanings indicated. 17 (2) (i) “Gender–affirming treatment” means any medically necessary 18 treatment consistent with current clinical standards of care prescribed by a licensed health 19 care provider for the treatment of a condition related to the individual’s gender identity. 20 (ii) “Gender–affirming treatment” includes: 21 1. Hormone therapy, hormone blockers, and puberty 22 blockers; 23 2. Hair alteration for the purposes of altering secondary sex 24 characteristics and surgical site preparation; 25 3. Alterations to voice, voice therapy, and voice lessons; 26 4. Alterations to abdomen, chest, trunk, and buttocks; 27 5. Alterations to the face and neck; 28 6. Alterations to the genitals and gonads; 29 SENATE BILL 119 5 7. Laser treatment for scars from gender–affirming 1 treatment; 2 8. Standard fertility preservation procedures, as set forth in 3 § 15–810.1 of the Insurance Article; 4 9. Revisions to previous treatments and reversal of 5 treatments; 6 10. Combinations of gender–affirming procedures; and 7 11. Other treatments as prescribed to suppress the 8 development of endogenous secondary sex characteristics, align the individual’s 9 appearance or physical body with gender identity, and alleviate symptoms of clinically 10 significant distress resulting from gender dysphoria. 11 (iii) “Gender–affirming treatment” may include treatment described 12 in the current clinical standards of care for gender–affirming treatment published by the 13 World Professional Association for Transgender Health. 14 (3) “Gender identity” has the meaning stated in § 20–101 of the State 15 Government Article. 16 Article – Health Occupations 17 1–227. 18 (a) (1) In this section the following words have the meanings indicated. 19 (2) “Health care practitioner” means an individual who is licensed, 20 certified, or otherwise authorized by law to provide health care services under this article. 21 (3) “Legally protected health care” has the meaning stated in § 2–312 of 22 the State Personnel and Pensions Article. 23 (b) A health occupations board may not revoke, suspend, discipline, take an 24 adverse action against, or refuse to issue or renew a license, certification, or other 25 authorization to practice for any health care practitioner in whole or in part because of the 26 provision or support of the provision of legally protected health care if the legally protected 27 health care was provided in accordance with the standard of care as determined by the 28 relevant health occupations board established under this article and in accordance with the 29 laws of this State. 30 (c) A health occupations board may not revoke, suspend, discipline, take an 31 adverse action against, or refuse to issue or renew a license, certification, or other 32 authorization to practice for any health care practitioner if the health care practitioner is 33 disciplined by a licensure board in another state in whole or in part because of the provision 34 6 SENATE BILL 119 or support of the provision of legally protected health care if the legally protected health 1 care was provided in accordance with the standard of care as determined by the relevant 2 health occupations board established under this article and in accordance with the laws of 3 this State. 4 Article – State Personnel and Pensions 5 2–312. 6 (a) (1) In this section[, “legally] THE FOLLOWING WORDS HAVE THE 7 MEANINGS INDICATED. 8 (2) “GENDER–AFFIRMING TREATMENT” HAS THE MEANING STATED 9 IN § 15–151 OF THE HEALTH – GENERAL ARTICLE. 10 (3) “LEGALLY protected health care” means: 11 (I) all reproductive health services, medications, and supplies 12 related to the direct provision or support of the provision of care related to pregnancy, 13 contraception, assisted reproduction, and abortion that is lawful in the State; OR 14 (II) ALL GENDER–AFFIRMING TREATMENT, INCLUDING 15 MEDICATIONS AND SUPPLIES, RELATED TO THE DIRECT PROVISION OR SUPPORT OF 16 THE PROVISION OF CARE RELATED TO GENDER–AFFIRMING TREATMENT THAT IS 17 LAWFUL IN THE STATE. 18 (b) This section does not apply to an interstate investigation or proceeding 19 described under subsection (c) of this section if: 20 (1) the interstate investigation or proceeding concerns conduct that would 21 be subject to civil liability, criminal liability, or administrative sanction if committed in the 22 State; or 23 (2) the subject of the interstate investigation or proceeding submits a 24 written request to provide information or assistance to the investigation or proceeding. 25 (c) An agency of the State or a political subdivision of the State, an agent or 26 employee of the State or a political subdivision of the State acting in the agent’s or 27 employee’s official capacity, or a private party providing services on behalf of the State or 28 a political subdivision of the State, may not provide information, expend time or money, or 29 use State facilities, State property, State equipment, State personnel, or other State 30 resources in furtherance of any interstate investigation or proceeding seeking to impose 31 civil or criminal liability on, or administrative sanction against, a person for any activity 32 relating to legally protected health care if the activity would not be subject to civil or 33 criminal liability or professional sanction in the State. 34 SENATE BILL 119 7 SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 1 October 1, 2024. 2

WES MOORE, Governor Ch. 863 – 1 – Chapter 863 (Senate Bill 119) AN ACT concerning Legally Protected Health Care – Gender–Affirming Treatment FOR the purpose of altering the definition of “legally protected health care” to include certain gender–affirming treatment, including medications and supplies, for the purposes of certain provisions of law that prohibit health occupations disciplinary actions and certain actions in criminal and civil proceedings and the use of certain resources in furtherance of certain investigations and proceedings related to legally protected health care; and generally relating to legally protected health care. BY repealing and reenacting, without amendments, Article – Courts and Judicial Proceedings Section 9–302(b)(2), 9–402(a), 10–408(c)(5), and 11–802(a) Annotated Code of Maryland (2020 Replacement Volume and 2023 Supplement) BY repealing and reenacting, without amendments, Article – Criminal Procedure Section 9–106(b) Annotated Code of Maryland (2018 Replacement Volume and 2023 Supplement) BY repealing and reenacting, without amendments, Article – Health – General Section 15–151(a) Annotated Code of Maryland (2023 Replacement Volume) BY repealing and reenacting, without amendments, Article – Health Occupations Section 1–227 Annotated Code of Maryland (2021 Replacement Volume and 2023 Supplement) BY repealing and reenacting, with amendments, Article – State Personnel and Pensions Section 2–312 Annotated Code of Maryland (2015 Replacement Volume and 2023 Supplement) SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, That the Laws of Maryland read as follows: Ch. 863 2024 LAWS OF MARYLAND – 2 – Article – Courts and Judicial Proceedings 9–302. (b) (2) (i) In this paragraph, “legally protected health care” has the meaning stated in § 2–312 of the State Personnel and Pensions Article. (ii) A judge may not order a person within the State to give testimony or a statement, or produce documents, electronically stored information, or other tangible things under this subsection, in a case where prosecution is pending, or where a grand jury investigation has commenced or is about to commence, for a violation of a criminal law of another state involving the provision of, receipt of, or assistance with legally protected health care in the State, unless the acts forming the basis of the prosecution or investigation would constitute a crime in this State. 9–402. (a) (1) In this subsection, “legally protected health care” has the meaning stated in § 2–312 of the State Personnel and Pensions Article. (2) (i) To request issuance of a subpoena under this section, a party shall submit a foreign subpoena to a clerk of the circuit court for the county in which discovery is sought to be conducted in this State. (ii) The request under subparagraph (i) of this paragraph shall include a sworn, written statement signed under penalty of perjury by the party seeking enforcement, or the party’s counsel, that no portion of the subpoena is intended or anticipated to further any investigation or proceeding related to legally protected health care, unless the out–of–state proceeding is: 1. Based in tort, contract, or statute; 2. A claim for which a similar or equivalent claim would exist in the State; and 3. A. Brought by the patient who received legally protected health care, or the patient’s legal representative; or B. Based on conduct that would be prohibited under the laws of this State. (3) A request for the issuance of a subpoena under this subtitle does not constitute an appearance in the courts of this State. 10–408. WES MOORE, Governor Ch. 863 – 3 – (c) (5) (i) In this paragraph, “legally protected health care” has the meaning stated in § 2–312 of the State Personnel and Pensions Article. (ii) A judge may not issue an ex parte order under this section for the purpose of investigating or recovering evidence of actions related to legally protected health care, unless the acts forming the basis for the investigation or recovery of evidence would constitute a crime in this State. 11–802. (a) (1) In this subsection, “legally protected health care” has the meaning stated under § 2–312 of the State Personnel and Pensions Article. (2) (i) Except as provided in subparagraphs (ii), (iii), and (iv) of this paragraph, a copy of any foreign judgment authenticated in accordance with an act of Congress or statutes of this State may be filed in the office of the clerk of a circuit court. (ii) If the face amount of the judgment is $2,500 or less, the copy shall be filed with the clerk of the District Court. (iii) If the face amount of the judgment is not more than a jurisdictional amount described in § 4–401 of this article, but more than $2,500, the copy may be filed either with the clerk of the District Court or in the office of the clerk of a circuit court. (iv) Except as required by federal law, a judgment creditor may not file a copy of any foreign judgment under this section if the judgment was issued in connection with any litigation concerning legally protected health care, unless the underlying cause of action is: 1. Based in tort, contract, or statute; 2. A claim for which a similar or equivalent claim would exist in the State; and 3. A. Brought by the patient who received legally protected health care, or the patient’s legal representative; or B. Based on conduct that would be prohibited under the laws of this State. (3) The clerk shall treat the foreign judgment in the same manner as a judgment of the court in which the foreign judgment is filed. Article – Criminal Procedure Ch. 863 2024 LAWS OF MARYLAND – 4 – 9–106. (b) (1) In this subsection, “legally protected health care services” has the meaning stated in § 2–312 of the State Personnel and Pensions Article. (2) Unless compelled by a writ of mandamus issued by a federal court, the Governor may not surrender a person on demand of the executive authority of any other state if the alleged act for which surrender is being demanded relates to providing, procuring, or aiding another in providing or procuring legally protected health care services and the act would not be a crime in the State. Article – Health – General 15–151. (a) (1) In this section the following words have the meanings indicated. (2) (i) “Gender–affirming treatment” means any medically necessary treatment consistent with current clinical standards of care prescribed by a licensed health care provider for the treatment of a condition related to the individual’s gender identity. (ii) “Gender–affirming treatment” includes: 1. Hormone therapy, hormone blockers, and puberty blockers; 2. Hair alteration for the purposes of altering secondary sex characteristics and surgical site preparation; 3. Alterations to voice, voice therapy, and voice lessons; 4. Alterations to abdomen, chest, trunk, and buttocks; 5. Alterations to the face and neck; 6. Alterations to the genitals and gonads; 7. Laser treatment for scars from gender–affirming treatment; 8. Standard fertility preservation procedures, as set forth in § 15–810.1 of the Insurance Article; 9. Revisions to previous treatments and reversal of treatments; WES MOORE, Governor Ch. 863 – 5 – 10. Combinations of gender–affirming procedures; and 11. Other treatments as prescribed to suppress the development of endogenous secondary sex characteristics, align the individual’s appearance or physical body with gender identity, and alleviate symptoms of clinically significant distress resulting from gender dysphoria. (iii) “Gender–affirming treatment” may include treatment described in the current clinical standards of care for gender–affirming treatment published by the World Professional Association for Transgender Health. (3) “Gender identity” has the meaning stated in § 20–101 of the State Government Article. Article – Health Occupations 1–227. (a) (1) In this section the following words have the meanings indicated. (2) “Health care practitioner” means an individual who is licensed, certified, or otherwise authorized by law to provide health care services under this article. (3) “Legally protected health care” has the meaning stated in § 2–312 of the State Personnel and Pensions Article. (b) A health occupations board may not revoke, suspend, discipline, take an adverse action against, or refuse to issue or renew a license, certification, or other authorization to practice for any health care practitioner in whole or in part because of the provision or support of the provision of legally protected health care if the legally protected health care was provided in accordance with the standard of care as determined by the relevant health occupations board established under this article and in accordance with the laws of this State. (c) A health occupations board may not revoke, suspend, discipline, take an adverse action against, or refuse to issue or renew a license, certification, or other authorization to practice for any health care practitioner if the health care practitioner is disciplined by a licensure board in another state in whole or in part because of the provision or support of the provision of legally protected health care if the legally protected health care was provided in accordance with the standard of care as determined by the relevant health occupations board established under this article and in accordance with the laws of this State. Article – State Personnel and Pensions Ch. 863 2024 LAWS OF MARYLAND – 6 – 2–312. (a) (1) In this section[, “legally] THE FOLLOWING WORDS HAVE THE MEANINGS INDICATED. (2) “GENDER–AFFIRMING TREATMENT” HAS THE MEANING STATED IN § 15–151 OF THE HEALTH – GENERAL ARTICLE. (3) “LEGALLY protected health care” means: (I) all reproductive health services, medications, and supplies related to the direct provision or support of the provision of care related to pregnancy, contraception, assisted reproduction, and abortion that is lawful in the State; OR (II) ALL GENDER–AFFIRMING TREATMENT, INCLUDING MEDICATIONS AND SUPPLIES, RELATED TO THE DIRECT PROVISION OR SUPPORT OF THE PROVISION OF CARE RELATED TO GENDER–AFFIRMING TREATMENT THAT IS LAWFUL IN THE STATE. (b) This section does not apply to an interstate investigation or proceeding described under subsection (c) of this section if: (1) the interstate investigation or proceeding concerns conduct that would be subject to civil liability, criminal liability, or administrative sanction if committed in the State; or (2) the subject of the interstate investigation or proceeding submits a written request to provide information or assistance to the investigation or proceeding. (c) An agency of the State or a political subdivision of the State, an agent or employee of the State or a political subdivision of the State acting in the agent’s or employee’s official capacity, or a private party providing services on behalf of the State or a political subdivision of the State, may not provide information, expend time or money, or use State facilities, State property, State equipment, State personnel, or other State resources in furtherance of any interstate investigation or proceeding seeking to impose civil or criminal liability on, or administrative sanction against, a person for any activity relating to legally protected health care if the activity would not be subject to civil or criminal liability or professional sanction in the State. SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect October 1, 2024. Approved by the Governor, May 16, 2024.