Health and Government Operations Committee

MAJOR LEGISLATION PASSED DURING THE 2022 SESSION

Health Insurance

HB 247 – Insurance - Medicare Supplement Policy Plans - Open Enrollment Period Following Birthday:  requires a carrier that sells Medicare supplement policies to provide an enrolled individual the opportunity to switch to a different Medicare supplement policy with equal or lesser benefits within 30 days following the individual’s birthday. A carrier is prohibited from denying or conditioning a new policy, discriminating in the pricing of the policy, or denying, reducing, or conditioning coverage because of the health status, claims experience, receipt of health care, or medical condition of the individual. A carrier must notify an insured of their right to switch plans at least 30 days, but no more than 60 days, before the insured’s birthday.

HB 413 – Health Insurance – Individual Market Stabilization – Extension of Provider Fee:  this Administration bill extends the existing State health insurance provider fee assessment through calendar 2028 to assist in the continued stabilization of the individual health insurance market. The bill also (1) establishes a credit for stand–alone dental and vision plans, (2) provides that funds from the distribution of the assessment may only be used for certain purposes, and (3) requires the Maryland Insurance Administration in consultation with the Maryland Health Benefit Exchange and the Maryland Health Care Commission to submit a report to the Governor and the General Assembly on the impact of the State Reinsurance Program. 

HB 912/SB 707 – Health Insurance – Provider Panels – Coverage for Nonparticipation:  require a health insurance carrier to inform members of the procedure to request a referral to an out–of–network specialist or non-physician specialist if the carrier cannot provide reasonable access to a specialist to treat or provide a health care service without unreasonable delay or travel.  A carrier must ensure that an out–of–network mental health or substance use disorder service received under this circumstance is provided at no greater cost to the covered individual than if the covered benefit were provided by an in–network provider.

HB 1148/SB 834 – Health Insurance - Two-Sided Incentive Arrangements and Capitated Payments – Authorization:  authorize a health insurance carrier to enter into a two-sided incentive arrangement with a physician or a set of health care practitioners and specify what is permitted, prohibited, and required under a bonus or other incentive-based compensation program or two-sided incentive arrangement.  This is a voluntary value–based payment arrangement between a provider and a carrier in which the provider may earn an incentive and a carrier may recoup funds from the provider in accordance with the terms of a contract that meets requirements under the bill.  The bill also clarifies that health care providers may accept capitated payments and not be considered as performing acts of an insurance business.

HB 1397/SB 353 – Health Insurance - Prescription Insulin Drugs - Limits on Copayment and Coinsurance (Insulin Cost Reduction Act):  require an insurer, nonprofit health service plan, or health maintenance organization that provides coverage for prescription drugs and devices to limit the amount a covered individual is required to pay in co-payments or coinsurance for a covered prescription insulin drug to no more than $30 for a 30-day supply, regardless of the amount or type of insulin needed to fill the covered individual’s prescription.

Pharmaceuticals

HB 1274 – Prescription Drugs - Pharmacy Benefits Managers - Federal 340B Program:  establishes requirements and prohibitions on a pharmacy benefits manager (PBM) relating to coverage and reimbursement of prescription drugs purchased under the federal 340B Drug Pricing Program.  Among other protections, the bill prohibits a PBM from offering lower reimbursements for or refusing to cover prescription drugs purchased under the 340B program.  The bill also prohibits a PBM from  charging fees, imposing different network participation contract terms, or modifying a beneficiary’s co-payment based on whether a pharmacy or pharmacist participates in the 340B program.

Health Occupations

HB 1208 – Health Occupations - Health Care Workforce Expansion:  establishes a licensed practical nurse and registered nurse preceptorship income tax credit and creates a stakeholder workgroup to study expanding the State apprenticeship programs to the health care workforce. The bill also creates additional responsibilities for the Board of Nursing relating to the expansion of the workforce in nursing-related fields, such as requiring an evaluation, establishing standards for online nursing assistant training programs, allowing on-the-job experience as a nursing assistant to count toward a certification, and requires certain training sites be approved within 45 days. 

SB 696 (HB 975 did not pass) – Maryland Loan Assistance Repayment for Nurses and Nursing Support Staff - Program Establishment and Funding: establishes the Maryland Loan Assistance Repayment Program (MLARP) for Nurses and Nursing Support Staff and an associated special fund for the program. The Maryland Department of Health must convene a stakeholder workgroup to examine how to further incentivize nursing and nursing support staff students to practice in specified areas and to make recommendations to MDH on program priorities and a permanent funding structure for the program. 

HB 55 – Health Occupations - Nurse Anesthetists - Drug Authority: authorizes a nurse anesthetist to prescribe, order, and administer drugs, including specified controlled dangerous substances. A nurse anesthetist may prescribe drugs (1) only in an amount that does not exceed a 10-day supply; (2) only for an individual with whom the nurse anesthetist has, at the time of prescription, established a client or patient record; and (3) only in connection with the delivery of anesthesia services.

HB 218 – Health Occupations – Nursing – Dialysis Technicians: repeals the requirement that a dialysis technician be a certified nursing assistant except under certain circumstances and establishes a separate certification for a “certified dialysis technician” under the State Board of Nursing.

Long Term Care

HB 166/SB 27 – Alzheimer’s Disease and Dementia – Council and Coordination of Services (Dementia Services Act of 2022):  establish a Director of Dementia Services Coordination position in the Maryland Department of Health to coordinate and facilitate communication relating to dementia services in the State. Beginning in fiscal 2023, the Governor must include an appropriation in the annual budget to fund the director position and the Virginia I. Jones Alzheimer’s Disease and Related Disorders Council. The bills require the council to issue the State Plan on Alzheimer’s Disease and Related Disorders by September 1, 2022 and update it every five years and requires the director to report its activities and recommendations in alternate years. The bills also remove the council’s termination date. 

HB 1073/SB 824 – Health - Accessibility of Electronic Advance Care Planning Documents:  alter the components of the advance directive information sheet prepared by MDH and require it to be provided by additional entities; require the Maryland Health Care Commission to coordinate the accessibility of electronic advance care planning documents; repeal the requirement that an electronic advance directives service be established in a certain manner; require Medicaid MCOs and health insurance carriers to take specified actions and authorize them to contract with an electronic advance directive service.

Public Health 

HB 937 – Abortion Care Access Act: establishes the categories of “qualified providers” that are authorized to perform an abortion in the State to include physicians, nurse practitioners, nurse–midwives, licensed certified midwives, physician assistants, and any other individual for whom the performance of an abortion is within the scope of the individual’s license or certification; establishes the Abortion Care Clinical Training Program and a related special fund, for which the Governor must include an appropriation of $3.5 million annually; requires Medicaid and health insurance carriers to provide coverage for abortion care services; and requires the Maryland Health Benefit Exchange to provide a subsidy under the State–Based Young Adult Health Insurance Subsidies Pilot Program to cover 100% of the cost of the premium for young adults who have a 0% expected contribution under the subsidy eligibility and payment parameters for the pilot program in calendar 2023.

HB 6/SB 150 – Maryland Medical Assistance Program – Dental Coverage for Adults: requires Medicaid, beginning January 1, 2023, subject to the limitations of the State budget, to provide dental services, including diagnostic, preventive, restorative, and periodontal services, for adults with household incomes up to 133% of the federal poverty level.

SB 295 – Maryland Medical Assistance Program – Emergency Services Transporters – Reimbursement: modifies the requirements for Medicaid reimbursement to an emergency service transporter for services provided in response to a 9-1-1 call. Reimbursement must be provided for (1) medical services provided to a Medicaid recipient in response to a 9-1-1 call in situations when the recipient is not transported to a facility and (2) for mobile integrated health services.

HB 534/SB 244 – Maryland Medical Assistance Program – Self–Measured Blood Pressure Monitoring require Medicaid, beginning January 1, 2023, subject to the limitations of the State budget and as permitted by federal law, to provide coverage for self-measured blood pressure monitoring for all Medicaid recipients diagnosed with uncontrolled high blood pressure.

HB 669 – Maryland Medical Assistance Program – Doula Services – Coverage: establishes requirements for participating doulas and specifications for covered doula services.

HB 684 – Maryland Medical Assistance Program – Psychiatric Inpatient Care – Admissions Restrictions: prohibits the Maryland Department of Health from limiting or restricting admission of a Medicaid recipient for inpatient care at a special psychiatric hospital or an acute general care hospital with separately identified inpatient psychiatric service unless MDH (1) bases the limit or restriction on the medical necessity of the admission and (2) establishes the limit or restriction through regulation.

HB 971 – Maryland Medical Assistance Program – Substance Use Disorder – Network Adequacy: requires MDH and the Behavioral Health Administration to ensure that the specialty mental health system has an adequate network of providers available to provide substance use disorder treatment for children younger than age 18.

HB 1005/SB 350 – Maryland Medical Assistance Program – Community Violence Prevention Services: require Medicaid, subject to federal approval to provide “community violence prevention services” beginning July 1, 2023.

HB 1080 – Maryland Medical Assistance Program – Children and Pregnant Women (Healthy Babies Equity Act): requires Medicaid to provide comprehensive medical care and other health care services to noncitizen pregnant women who would be eligible for Medicaid but for their immigration status and to their children up to the age of one. 

HB 80/SB 28 – Home– and Community–Based Services Waiver – Participation and Applications: require the Medicaid Home- and Community-Based Services Waiver (Community Options Waiver) to include a cap on participation and a plan for waiver participation of at least 7,500 individuals. If MDH maintains a waiting list/registry for the waiver, each month MDH must send a waiver application to at least 600 individuals on the waiting list/registry.

HB 1403/SB 636 – Maryland Department of Health – Waiver Programs – Waitlist and Registry Reduction (End the Wait Act): require the Maryland Department of Health to (1) develop plans to reduce the waitlists for seven specified waiver programs by 50%, beginning in fiscal 2024 and (2) develop a plan to reduce the registry for the Autism Waiver that includes conducting eligibility determinations of individuals on the registry and, beginning in fiscal 2024, providing services to at least 50% of individuals determined eligible.

HB 609 – Local Health Officers – Removal – Process: repeals the provision that specifies that the health officer for a county serves at the pleasure of the governing body of that county and the Secretary of Health. If the Secretary and the appropriate governing body concur on the removal of a health officer, the Secretary must provide written notification of removal to the health officer that includes: the basis for the removal; documentation supporting the removal; and notice of the opportunity to request a hearing with the Secretary of Health within 10 days after receipt of the written notification and information on how to request the hearing. If the health officer requests a hearing with the Secretary, the Secretary must hold the hearing promptly, provide the health officer with an opportunity to be heard, and make a final decision not later than 10 days after the hearing.

SB 708 – Maryland Department of Health – Office of the Inspector General: establishes a compliance officer within the Maryland Office of the Inspector General for Health to ensure that units and employees of the Maryland Department of Health comply with (1) best practices in health care, public health, and government administration and (2) laws, regulations, and MDH policies. Within 30 business days after receiving a complaint or allegation, the Inspector General, the compliance officer, or a designated assistant IG must respond to the individual who filed the complaint or allegation with (1) a preliminary indication of whether the Maryland OIG for Health is able to investigate the complaint or allegation and (2) if not, the reason for not being able to do so (unless doing so would have a negative impact on or jeopardize a specified investigation) and the contact information for the Office of Legislative Audits Fraud Hotline 

HB 1188 – Public Health – Sickle Cell Disease: requires MDH, in consultation with the Statewide Steering Committee on Sickle Cell Disease, to establish and implement a system of providing information on the sickle cell trait or the thalassemia trait to an individual who has either trait or, for a minor, the individual’s family. The steering committee, in conjunction with MDH and other relevant stakeholders, must study and make recommendations on: how to enhance access to services for individuals with SCD with a focus on areas of the State where there is a statistically high number of individuals with SCD and areas where there is a lack of providers with expertise in treating SCD; whether to establish a SCD registry and, if recommended, the process and guidelines for establishing a registry, obtaining information, connecting with the State-designated exchange, and protecting data privacy; how to enhance the coordination of health care services for individuals with SCD who are transitioning from pediatric to adult health care in the State, including the identification of available resources for these individuals; and how to engage with community-based health fairs and other community-sponsored events in areas with a statistically high number of individuals with SCD to provide outreach and education on living with SCD and how to access health care services.

SB 740 – Parkinson’s Disease Registry Advisory Committee: establishes a Parkinson’s Disease Registry Advisory Committee in MDH to (1) assist in the development and implementation of a “Parkinson’s disease” registry; (2) determine what data must be collected and stored in such a registry and the methods to ensure the privacy and confidentiality of data collected and stored in the registry; and (3) advise MDH on Parkinson’s disease and maintaining a Parkinson’s disease registry. By January 1, 2023, MDH must report to specified committees of the General Assembly on recommendations (including legislative recommendations) for the establishment of a Parkinson’s disease registry. 

Behavioral Health

HB 48/SB 94– Public Health – Maryland Suicide Fatality Review Committee: establish the Maryland Suicide Fatality Review Committee to identify and address the factors contributing to suicide deaths and facilitate system changes in the State to prevent suicide deaths.

HB 129/SB 12 – Behavioral Health Crisis Response Services and Public Safety Answering Points – Modifications: require the Maryland Department of Health to require that proposals requesting Behavioral Health Crisis Response Grant Program funding contain response standards that prioritize mobile crisis units over law enforcement when responding to individuals in crisis; defines "mobile crisis team" to include prioritizing limiting interaction of law enforcement with individuals in crisis; and requires each public safety answering point to develop a written policy for calls involving an individual suffering an active mental health crisis.

HB 293/SB 241 – Behavioral Health Crisis Response Services – 9–8–8 Trust Fund: establish the 9-8-8 Trust Fund to provide reimbursement for costs associated with designating and maintaining 9-8-8 as the universal telephone number for a national suicide prevention and mental health crisis hotline and developing and implementing a statewide initiative for the coordination and delivery of the continuum of behavioral health crisis response services. In fiscal 2024, the Governor must include $5.5 million in the annual budget bill for the trust fund

SB 394 – Statewide Targeted Overdose Prevention (STOP) Act of 2022: broadens existing requirements and protections relating to administration or provision of naloxone to encompass an opioid overdose reversal drug approved by the U.S. Food and Drug Administration. The bill also allows for such reversal drugs to be offered to specified individuals – free of charge – by multiple providers, programs, and entities.

Developmental Disabilities

HB 1020/SB 868 – Developmental Disabilities Administration – Self–Directed Services (Self–Direction Act of 2022): require the Developmental Disabilities Administration, in consultation with stakeholders, to establish and provide training materials to coordinators of community services (CCSs) specifically on the self-directed services model of receiving services. As part of developing a “person-centered plan of service,” a CCS must educate the recipient on all models of service available to the recipient, as specified.  

Environmental Health

HB 275/SB 273 – Environment – PFAS Chemicals – Prohibitions and Requirements: establish and expand several prohibitions and requirements that relate to the manufacture, sale, and distribution for sale or use in the State of specified products that contain “intentionally added” “PFAS chemicals.”; prohibit, on or after January 1, 2024, a person from using, manufacturing, or knowingly selling or distributing Class B fire-fighting foam that contains intentionally added PFAS chemicals in the State; prohibit, on or after January 1, 2024, a person from manufacturing, selling, or distributing a certain rug or carpet in the State; and prohibit, on or after January 1, 2024, a manufacturer or distributor from manufacturing, selling, or distributing certain food packaging designed for direct food contact in the State.

Health Literacy

HB 1082 – Public Health – Consumer Health Information – Hub and Requirements: requires State and local agencies to use “plain language” in “public communications” about health, health insurance, safety, and social services benefits. The University of Maryland Herschel S. Horowitz Center for Health Literacy is designated as the State’s Consumer Health Information Hub to promote and ensure public access to specified information in preferred languages to inform decisions about health, safety, and social services benefits

Health Facilities

HB 694 – Hospitals – Financial Assistance – Medical Bill Reimbursement: requires the HSCRC, in coordination with the Department of Human Services (DHS), the State-designated exchange, the Comptroller’s Office, and the Maryland Hospital Association (MHA), to develop a process that (1) identifies the patients who paid for hospital services who may have qualified for free care at the time of care in calendar 2017 through 2021; (2) provides reimbursement to the patients; (3) ensures that a patient’s alternate address is used if the patient required an alternate address for safety reasons; and (4) determines how HSCRC, DHS, and the Comptroller’s Office should share with or disclose relevant specified information, to the minimum extent necessary, to the hospital and in accordance with federal and State confidentiality laws.

Open Meetings Act

HB 375/SB 269 – Open Meetings Act - Application and Enhanced Requirements (Maryland State Agency Transparency Act of 2022): repeal exemptions from Open Meetings Act requirements for specified independent and regional development units; recodify existing enhanced open meetings requirements that apply to specified public bodies, and expands the application of enhanced open meeting requirements to include specified entities and (3) establishes other specified open meetings requirements. For entities specified in the bill, a project site visit or educational field tour is not considered a meeting of the body if no organizational business is conducted. 

Commemorative Days

Juneteenth

HB 227 – State Government – Legal and Employee Holiday – Juneteenth National Independence Day: establishes Juneteenth National Independence Day as a State legal holiday and State employee holiday on June 19. Because the bill makes Juneteenth a holiday, the bill repeals the requirement that the Governor annually proclaim June 19 as Juneteenth National Freedom Day. 

Tuskegee Airmen

HB 479/SB 5 – General Provisions – Commemorative Days – Tuskegee Airmen Commemoration Day: requires the Governor to annually proclaim the fourth Thursday in March as Tuskegee Airmen Commemoration Day. The proclamation must urge educational and cultural organizations to observe Tuskegee Airmen Commemoration Day through appropriate and informative programs and activities.

Cybersecurity

HB 1346/SB 812 – State Government - Cybersecurity - Coordination and Governance: codify and expand Executive Order 01.01.2019.07, which established the Maryland Cyber Defense Initiative, the Office of Security Management (OSM), and the Maryland Cybersecurity Coordinating Council (MCCC) in the Department of Information Technology (DoIT) and establish the State Chief Information Security Officer (SCISO) as head of OSM. The measures establish reporting requirements for State agencies and local governments, including reporting of cybersecurity incidents. The OSM must ensure that each unit of State government completes an external assessment at least every two years and assist each unit to remediate any findings. Specified units within the Legislative and Judicial branches, the Office of the Attorney General, the Office of the Comptroller, and the Office of the State Treasurer must be evaluated by an independent auditor for compliance with specified cybersecurity standards. Local government entities (not including municipal governments) must consult with the local emergency manager to create or update a cybersecurity preparedness and response plan and complete a cybersecurity preparedness assessment, in a manner and frequency established in regulations adopted by DOIT.  

In addition, DoIT’s responsibilities are expanded to include (1) centralizing the management and direction of IT policy within the Executive Branch under the control of DoIT; (2) ensuring the statewide IT master plan allows a State agency to maintain its own IT unit; (3) developing a statewide cybersecurity strategy; and (4) developing and requiring basic security requirements to be included in State contracts. DoIT is further required to develop a centralization transition strategy and conduct a performance and capacity assessment. 

HB 1202/SB 754 – Local Government Cybersecurity - Coordination and Operations (Local Cybersecurity Support Act of 2022): establish the Cybersecurity Preparedness Unit in Maryland Department of Emergency Management and the Information Sharing and Analysis Center in DoIT, both of which are tasked with supporting and cooperating with  OSM and the SCISO, which are codified identically to HB 1346/SB812. The bills also require local governments (other than municipalities) to, in a manner and frequency established by DoIT, create cybersecurity preparedness plans and complete assessments and report local cybersecurity incidents. Units of local government that use the State–operated broadband network are also required to certify to DoIT their compliance with the established minimum standards in a manner and frequency established by DoIT. OSM must provide guidance to a unit of local government that fails to achieve compliance with the State’s cybersecurity standards. 

By December 31 of each year, OSM must provide an annual report to the Governor and specified committees of the General Assembly, which includes (1) OSM’s activities and accomplishments from the previous 12 months and (2) a compilation and analysis of the data and information contained in cybersecurity reports received from State and local agencies, as specified.

HB 1205 – State Government – Information Technology and Cybersecurity–Related Infrastructure (Modernize Maryland Act of 2022): establishes an independent Modernize Maryland Oversight Commission to ensure security of information and determine appropriate cybersecurity upgrades based on information provided to the Commission by certain assessments that are to be completed every 2 years. The Oversight Commission must develop a strategic roadmap with a timeline and budget that will (1) require the updates and investments of critical IT and cybersecurity systems to be completed by December 31, 2025, and (2) require all updates and investments of IT and cybersecurity to be made by December 31, 2030 in addition to making period recommendations on investments in State IT structures. 

By December 1, 2023, each water and sewer system that serves more than 10,000 users and receives financial assistance from the State must assess its vulnerability to cyber attacks, develop a cybersecurity plan if one is appropriate, and report statutory recommendations to the General Assembly. The Maryland Water Quality Financing Administration may provide financial assistance to a system for the assessment and plan development required by the bill. 

The bill also establishes the Local Cybersecurity Support Fund to support local government cybersecurity preparedness by providing financial assistance to local governments to improve cybersecurity preparedness, as specified, and assist local governments applying for federal cybersecurity preparedness grants. To be eligible to receive assistance from the fund, a local government must provide proof to DoIT that the local government conducted a cybersecurity preparedness assessment in the previous 12 months or, within 12 months, undergo a cybersecurity preparedness assessment, as specified. 

The bill expands the authority of the Department of General Services (DGS) to engage in or control procurement to include, without the approval of any other primary procurement unit, (1) cloud computing equipment and associated services; (2) IT system modernization; and (3) cybersecurity upgrades and modernization. Procurements by DGS for the purpose of modernizing cybersecurity infrastructure for the State valued below $1,000,000 are exempt from the Board of Public Works (BPW) oversight and approval. However, by December 1 of each year, DGS must submit a report to BPW on these procurements and include for each procurement (1) the purpose of the procurement; (2) the name of the contractor; (3) the contract amount; (4) the method of procurement utilized; (5) the number of bidders who bid on the procurement; and (6) the contract term.

Procurement

Debarment

HB 13 – Procurement – Discriminatory Hiring Practices – Debarment: makes a person eligible for debarment from entering into a contract with the State if the person or other specified individual associated with the person (1) has been found to have violated provisions of State law prohibiting employment discrimination, or (2) has been debarred from federal contracts under federal Executive Order 11246 due to engaging in discriminatory hiring practices in the State. The bill applies only prospectively and has no effect on final findings or decisions issued before the bill’s effective date.

Payment Practices

HB 325 / SB 250 – State Procurement - Payment Practices: make interest on unpaid invoices under State procurement contracts due and payable after 37 days from when the agency receives an invoice. It requires the Department of Legislative Services to conduct a study and report on the processing and timing of payments to contractors under State procurement contracts. It also requires the Department of Information Technology to consult with specified agencies and report on the status of the Comptroller’s online payment portal and the planned upgrade to the State’s Financial Management Information System (FMIS) and related issues. The bill expresses legislative intent that any upgrade to FMIS include goals to significantly reduce the amount of time in which payments are processed.

Minority Business Enterprise Program

HB 389 / SB 487 – Procurement - Minority Business Enterprises – Revisions: establish an MBE Ombudsman within GOSBA to: (1) assist procurement officers in attempts to resolve disputes between MBEs and prime contractors, including disputes over contract scope and payments; (2) serve as a resource to MBE liaisons, procurement officers in units of State government, prime contractors, and MBEs in resolving disputes on relevant contracts; and (3) conduct trainings for procurement officers on enforcement of the requirements of the MBE program, including the assessment of liquidated damages. 

The bills expand transparency for MBE goals by requiring each solicitation for bids or proposals that includes an expected degree of MBE participation to include a summary of the factors used to determine the MBE participation goal, including subcontracting opportunities identified for the project, any applicable industry codes linked to those opportunities, and the number of certified MBEs identified for those opportunities. The measures further seek to improve accountability by: (1) expanding reporting requirements for compliance assessments; (2) requiring GOSBA and the Office of State Procurement, in consultation with specified entities, to adopt by regulation criteria used to determine that a prime contractor, in the absence of mitigating factors, has persistently failed to meet MBE participation goals on their contracts and requiring GOSBA to refer prime contractors identified under the criteria to OAG for debarment under existing law; and (3) expanding the requirement that prime contractors pay undisputed amounts to their subcontractors within 10 days and expanding State agencies’ authority to withhold progress payments from prime contractors that do not pay their subcontractors undisputed amounts in a timely fashion. Finally, the bills also codify an existing set-aside program for small businesses and require a follow-up report by DLS to assess implementation of the bills’ provisions.