EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*sb0734*
SENATE BILL 734
J1, J5 2lr2423
By: Senator Lam
Introduced and read first time: February 7, 2022
Assigned to: Finance
Committee Report: Favorable with amendments
Senate action: Adopted
Read second time: March 7, 2022
CHAPTER ______
AN ACT concerning 1
Health and Health Insurance Maryland Health Care Commission – Primary 2
Care Reform Commission Report and Workgroup 3
FOR the purpose of establishing the Primary Care Reform requiring the Maryland Health 4
Care Commission to review, examine, and make certain determinations and 5
recommendations provide an annual report to the Governor and the General 6
Assembly regarding primary care spending by certain payors of health care services 7
and improvements to the quality of and access to primary care services; requiring 8
the Commission to form a workgroup to develop the report; and generally relating to 9
the Primary Care Reform Maryland Health Care Commission and primary care. 10
BY adding to 11
Article – Health – General 12
Section 20–2201 and 20–2202 to be under the new subtitle “Subtitle 22. Primary 13
Care Reform Commission” 19–108.4 14
Annotated Code of Maryland 15
(2019 Replacement Volume and 2021 Supplement) 16
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 17
That the Laws of Maryland read as follows: 18
Article – Health – General 19
SUBTITLE 22. PRIMARY CARE REFORM COMMISSION. 20
2 SENATE BILL 734
20–2201. 1
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 2
INDICATED. 3
(B) “COMMISSION” MEANS THE PRIMARY CARE REFORM COMMISSION. 4
(C) “PRIMARY CARE” MEANS HEALTH CARE PR OVIDED IN THE FOLLOW ING 5
FIELDS OUTPATIENT SE TTINGS: 6
(1) FAMILY PRACTICE ; 7
(2) GENERAL PEDIATRICS ; 8
(3) PRIMARY CARE INTERNAL MEDICINE; AND 9
(4) PRIMARY CARE OBSTETRI CS AND GYNECOLOGY . 10
(D) “PRIMARY CARE SPENDING ” MEANS ANY EXPENDITUR E OF FUNDS MADE 11
BY THIRD–PARTY PAYORS , PUBLIC ENTITIES, OR THE STATE FOR THE PURPOSE OF 12
PAYING FOR PRIMARY C ARE SERVICES OR SUPP ORTING PRIMARY CARE PROVIDERS, 13
REGARDL ESS OF PAYMENT METHO DOLOGY. 14
20–2202. 15
(A) THERE IS A PRIMARY CARE REFORM COMMISSION. 16
(B) (1) THE COMMISSION CONSISTS O F THE FOLLOWING MEMB ERS: 17
(I) THREE MEMBERS APPOINT ED BY THE GOVERNOR; 18
(II) FOUR MEMBERS APPOINTE D BY THE PRESIDENT OF THE 19
SENATE; 20
(III) THREE MEMBERS APPOINT ED BY THE SPEAKER OF THE 21
HOUSE; 22
(IV) ONE MEMBER DESIGNATED BY THE MARYLAND HOSPITAL 23
ASSOCIATION; 24
(V) ONE MEMBER DESIGNATED BY THE MARYLAND NURSES 25
ASSOCIATION; AND 26
(VI) ONE MEMBER DESIGNATED BY MEDCHI, THE MARYLAND 27
STATE MEDICAL SOCIETY. 28 SENATE BILL 734 3
(2) TO THE EXTENT PRACTIC ABLE, THE MEMBERSHIP OF TH E 1
COMMISSION SHALL : 2
(I) HAVE EXPERIENCE IN HE ALTH CARE FINANCING , 3
REIMBURSEMENT , AND REGULATION ; 4
(II) BE COMPOSED OF : 5
1. PRACTICING PRIMARY CA RE PROVIDERS ; 6
2. REPRESENTATIVES OF FE DERALLY QUALIFIED 7
HEALTH CENTERS ; 8
3. PROVIDERS FROM PROFES SIONAL PRACTICE 9
GROUPS; 10
4. PRIMARY CARE ADVOCATE S; 11
5. PRIMARY CARE CONSUMER ADVOCATES; 12
6. REPRESENTATIVES OF BU SINESSES; 13
7. HEALTH PLAN REPRESENTATIVES ; AND 14
8. REPRESENTATIVES OF HO SPITALS OR HEALTH 15
SYSTEMS; AND 16
(III) REFLECT THE GEOGRAPHI C DIVERSITY OF THE STATE. 17
(C) A CHAIR OF THE COMMISSION SHALL BE S ELECTED BY A VOTE OF THE 18
MEMBERS OF THE COMMISSION. 19
(D) THE MARYLAND INSURANCE ADMINISTRATION AND TH E DEPARTMENT 20
SHALL PROVIDE STAFF FOR THE COMMISSION. 21
(E) (1) THE TERM OF A MEMBER OF THE COMMISSION IS 4 YEARS. 22
(2) THE TERMS OF THE MEMB ERS ARE STAGGERED AS REQUIRED BY 23
THE TERMS FOR MEMBER S OF THE COMMISSION ON OCTOBER 1, 2022. 24
(3) A VACANCY IN THE COMMISSION SHALL BE F ILLED IN THE SAME 25
MANNER AS THE MEMBER BEING SUCCEEDED WAS APPOINTED. 26
4 SENATE BILL 734
(F) (1) THE COMMISSION SHALL MEET AS OFTEN AS ITS DUTI ES 1
REQUIRE, BUT NOT LESS THAN QU ARTERLY. 2
(2) THE CHAIR OF THE COMMISSION S HALL PROVIDE ALL MEM BERS 3
WITH NOTICE OF A MEE TING AT LEAST 1 WEEK BEFORE THE DATE OF THE MEETING . 4
(3) THE CHAIR OF THE COMMISSION SHALL CALL A MEETING AT THE 5
REQUEST OF A MAJORIT Y OF THE COMMISSION MEMBERS . 6
(4) SEVEN MEMBERS OF THE COMMISSION CONSTI TUTE A QUORUM . 7
(5) ACTION BY THE COMMISSION REQUIRES T HE AFFIRMATIVE VOTE 8
OF A MAJORITY OF THO SE PRESENT ONCE A QU ORUM IS MET. 9
(G) A MEMBER OF THE COMMISSION: 10
(1) MAY NOT RECEIVE COMPE NSATION AS A MEMBER OF THE 11
COMMISSION; BUT 12
(2) IS ENTITLED TO REIMBURSEMENT FOR EXPENSES UNDER THE 13
STANDARD STATE TRAVEL REGULATIONS, AS PROVIDED IN THE STATE BUDGET . 14
(H) THE COMMISSION SHALL : 15
(1) REVIEW, EXAMINE, AND MAKE DETERMINATI ONS REGARDING 16
PRIMARY CARE SPENDIN G BY ALL PAYORS IN T HE CONTEXT OF OVERAL L HEALTH 17
CARE SPENDING IN THE STATE; AND 18
(2) MAKE RECOMMENDATIONS REGARDING: 19
(I) WAYS TO IMPROVE THE Q UALITY OF AND ACCESS TO 20
PRIMARY CARE SERVICE S, WITH SPECIAL ATTENTI ON TO INCREASING HEA LTH CARE 21
EQUITY, REDUCING HEALTH CARE DISPARITIES, AND AVOIDIN G INCREASED COSTS 22
TO PATIENTS AND THE HEALTH CARE SYSTEM ; 23
(II) MEANS OF REDUCING BAR RIERS TO PRIMARY CAR E ACCESS 24
AND UTILIZATION IDEN TIFIED BY THE COMMISSION; 25
(III) PROPOSED CHANGES TO T HE DEFINITION OF “PRIMARY 26
CARE” FOR THE PURPOSES OF THE COMMISSION’S FUTURE WORK ; AND 27
(IV) RECOMMENDATIONS TO IN CREASE SPENDING ON P RIMARY 28
CARE BY THE MARYLAND MEDICAL ASSISTANCE PROGRAM AND HEALTH IN SURERS, 29
NONPROFIT HEALTH SER VICE PLANS, AND HEALTH MAINTENAN CE ORGANIZATIONS . 30 SENATE BILL 734 5
(I) (1) (I) EACH MANAGED CAR E ORGANIZATION PARTI CIPATING IN 1
THE MARYLAND MEDICAL ASSISTANCE PROGRAM SHALL PROVIDE THE 2
FOLLOWING INFORMATIO N TO THE COMMISSION: 3
1. FOR 2017, 2018, 2019, 2020, AND 2021, AND FOR 4
EACH SUBSEQUENT YEAR ON THE REQUEST OF TH E COMMISSION: 5
A. THE AMOUNT THE MANAGED CARE ORGANIZATION 6
SPENT ON PRIMARY CAR E SERVICES FOR ENROL LEES; AND 7
B. THE TOTAL AMOUNT THAT THE MANAGED CARE 8
ORGANIZATION SPENT O N HEALTH CARE SERVIC ES FOR ENROLLEES ; AND 9
2. ANY OTHER INFORMATION REQUESTED BY THE 10
COMMISSION. 11
(II) THE SECRETARY SHALL : 12
1. ENFORCE THE PROVISION S OF SUBPARAGRAPH (I) OF 13
THIS PARAGRAPH ; AND 14
2. ADOPT REGULATIONS TO PROTECT THE 15
CONFIDENTIALITY OF A NY PROPRIETARY INFOR MATION PROVIDED TO T HE 16
COMMISSION UNDER THIS PARAGRAPH . 17
(2) (I) EACH INSURER, NONPROFIT HEALTH SER VICE PLAN, AND 18
HEALTH MAINTENANCE O RGANIZATION THAT PRO VIDES HOSPITAL , MEDICAL, OR 19
SURGICAL BENEFITS TO INDIVIDUALS UNDER HE ALTH INSURANCE POLIC IES OR 20
CONTRACTS THAT ARE D ELIVERED IN THE STATE SHALL PROVIDE T HE FOLLOWING 21
INFORMATION TO THE COMMISSION: 22
1. FOR 2017, 2018, 2019, 2020, AND 2021, AND FOR 23
EACH SUBSEQUENT YEAR ON THE REQUEST OF TH E COMMISSION: 24
A. THE AMOUNT THE ENTITY SPENT ON PRIMARY CAR E 25
SERVICES FOR ENROLLE ES; AND 26
B. THE TOTAL AMOUNT THAT THE ENTITY SPENT ON 27
HEALTH CARE SERVICES FOR ENROLLEES ; AND 28
2. ANY OTHER INFORMATION REQUESTED BY THE 29
COMMISSION. 30
6 SENATE BILL 734
(II) THE MARYLAND INSURANCE COMMISSIONER SHALL : 1
1. ENFORCE THE PROVISION S OF SUBPARAGRAPH (I) OF 2
THIS PARAGRAPH ; AND 3
2. ADOPT REGULATI ONS TO PROTECT THE 4
CONFIDENTIALITY OF A NY PROPRIETARY INFOR MATION PROVIDED TO T HE 5
COMMISSION UNDER THIS PARAGRAPH . 6
(J) THE COMMISSION MAY ACCEPT FUNDING OR GRANTS TO AID IN THE 7
WORK OF THE COMMISSION. 8
19–108.4. 9
(A) IN THIS SECTION, “PRIMARY CARE ” MEANS HEALTH CARE PR OVIDED IN 10
THE FOLLOWING FIELDS ’ OUTPATIENT SETTINGS : 11
(1) FAMILY MEDICINE ; 12
(2) GENERAL PEDIATRICS ; 13
(3) PRIMARY CARE INTERNAL MEDICINE; AND 14
(4) PRIMARY CARE OBSTETRI CS AND GYNECOLOGY . 15
(K) (B) ON OR BEFORE DECEMBER 1 EACH YEAR, BEGINNING IN 2023 16
2024, THE COMMISSION SHALL PROV IDE A REPORT TO THE GOVERNOR AND , IN 17
ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, THE GENERAL 18
ASSEMBLY THAT INCLUDE S: 19
(1) AN ANALYSIS OF PRIMAR Y CARE SPENDING INVESTMENT OVER 20
THE IMMEDIATELY PREC EDING YEAR, INCLUDING DATA STRAT IFIED BY ZIP CODE 21
AND COUNTY, IN RELATION TO TOTAL HEALTH CARE SPENDING OVER THE PREVIOUS 22
YEAR; AND 23
(2) WAYS TO IMPROVE THE Q UALITY OF AND ACCESS TO PRIMARY 24
CARE SERVICES , WITH SPECIAL ATTENTION TO INCR EASING HEALTH CARE E QUITY, 25
REDUCING HEALTH CARE DISPARITIES, AND AVOIDING INCREAS ED COSTS TO 26
PATIENTS AND THE HEA LTH CARE SYSTEM ; AND 27
(2) (3) ANY FINDINGS AND RECO MMENDATIONS OF THE 28
COMMISSION. 29
SENATE BILL 734 7
(C) (1) THE COMMISSION SHALL FORM A WORKGROUP TO DEVELOP THE 1
REPORT REQUIRED UNDE R SUBSECTION (B) OF THIS SECTION , INCLUDING BY 2
INTERPRETING THE RES ULTS OF THE REQUIRED ANALYSIS AND MAKING THE 3
RECOMMENDATIONS . 4
(2) THE WORKGROUP REQUIRE D UNDER THIS SUBSECT ION SHALL 5
INCLUDE REPRESENTATI VES OF: 6
(I) THE MARYLAND PRIMARY CARE PROGRAM; 7
(II) THE HEALTH SERVICES REVIEW COMMISSION; 8
(III) THE MARYLAND INSURANCE ADMINISTRATION ; 9
(IV) THE HEALTH CARE FINANCING DIVISION OF THE 10
MARYLAND DEPARTMENT OF HEALTH; 11
(V) THE PRIMARY CARE COMMUNITY , INCLUDING FROM THE 12
MARYLAND ACADEMY OF FAMILY PHYSICIANS, THE MARYLAND CHAPTER OF THE 13
AMERICAN ACADEMY OF PEDIATRICS, THE MARYLAND SECTION OF THE AMERICAN 14
COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS , AND THE MIDATLANTIC 15
ASSOCIATION OF COMMUNITY HEALTH CENTERS; 16
(VI) PAYORS OF PRIMARY CAR E SERVICES , INCLUDING 17
CARRIERS AND MANAGED CARE ORGANIZATIONS ; 18
(VII) HEALTH SERVICES RESEA RCHERS WITH EXPERTIS E IN 19
PRIMARY CARE ; AND 20
(VIII) OTHER INTERESTED STAK EHOLDERS. 21
SECTION 2. AND BE IT FURTHER ENACTED, That the terms of the initial 22
members of the Primary Care Reform Commission shall expire as follows: 23
(1) four members in 2024; 24
(2) four members in 2025; and 25
(3) five members in 2026. 26
SECTION 2. AND BE IT FURTHER ENACTED, That: 27
(a) Before the Maryland Health Care Commission begins the analysis required 28
under Section 1 of this Act, the Commission shall establish a plan for the analysis and 29 8 SENATE BILL 734
report after receiving input and agreement from participants in the workgroup as to the 1
scope of and methodology for the analysis and report. 2
(b) On or before December 1, 2023, the Commission shall provide the plan 3
required under subsection (a) of this section to the Governor and, in accordance with § 4
2–1257 of the State Government Article, the General Assembly. 5
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 6
October 1, 2022. 7
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
President of the Senate.
________________________________________________________________________________
Speaker of the House of Delegates.