EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
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amendment.
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*sb0734*
SENATE BILL 734
J1, J5 (2lr2423)
ENROLLED BILL
— Finance/Health and Government Operations —
Introduced by Senator Lam
Read and Examined by Proofreaders:
_______________________________________________
Proofreader.
_______________________________________________
Proofreader.
Sealed with the Great Seal and presented to the Governor, for his approval this
_______ day of _______________ at _________________ _______ o’clock, ________M.
______________________________________________
President.
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 2 SENATE BILL 734
Annotated Code of Maryland 1
(2019 Replacement Volume and 2021 Supplement) 2
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 3
That the Laws of Maryland read as follows: 4
Article – Health – General 5
SUBTITLE 22. PRIMARY CARE REFORM COMMISSION. 6
20–2201. 7
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 8
INDICATED. 9
(B) “COMMISSION” MEANS THE PRIMARY CARE REFORM COMMISSION. 10
(C) “PRIMARY CARE” MEANS HEALTH CARE PR OVIDED IN THE FOLLOW ING 11
FIELDS OUTPATIENT SE TTINGS: 12
(1) FAMILY PRACTICE ; 13
(2) GENERAL PEDIATRICS ; 14
(3) PRIMARY CARE IN TERNAL MEDICINE ; AND 15
(4) PRIMARY CARE OBSTETRI CS AND GYNECOLOGY . 16
(D) “PRIMARY CARE SPENDING ” MEANS ANY EXPENDITUR E OF FUNDS MADE 17
BY THIRD–PARTY PAYORS , PUBLIC ENTITIES, OR THE STATE FOR THE PURPOSE OF 18
PAYING FOR PRIMARY C ARE SERVICES OR SUPP ORTING PRIMARY CARE PROVIDERS , 19
REGARDLESS OF PAYMEN T METHODOLOGY . 20
20–2202. 21
(A) THERE IS A PRIMARY CARE REFORM COMMISSION. 22
(B) (1) THE COMMISSION CONSISTS O F THE FOLLOWING MEMB ERS: 23
(I) THREE MEMBERS APPOINT ED BY THE GOVERNOR; 24
(II) FOUR MEMBERS APPOINTED BY THE PRESIDENT OF THE 25
SENATE; 26
SENATE BILL 734 3
(III) THREE MEMBERS APPOINT ED BY THE SPEAKER OF THE 1
HOUSE; 2
(IV) ONE MEMBER DESIGNATED BY THE MARYLAND HOSPITAL 3
ASSOCIATION; 4
(V) ONE MEMBER DESIGNATED BY THE MARYLAND NURSES 5
ASSOCIATION; AND 6
(VI) ONE MEMBER DESIGNATED BY MEDCHI, THE MARYLAND 7
STATE MEDICAL SOCIETY. 8
(2) TO THE EXTENT PRACTIC ABLE, THE MEMBERSHIP OF TH E 9
COMMISSION SHALL : 10
(I) HAVE EXPERIENCE IN HE ALTH CARE FINANCING , 11
REIMBURSEMENT , AND REGULATION ; 12
(II) BE COMPOSED OF : 13
1. PRACTICING PRIMARY CA RE PROVIDERS ; 14
2. REPRESENTATIVES OF FE DERALLY QUALIFIED 15
HEALTH CENTERS ; 16
3. PROVIDERS FROM PROFES SIONAL PRACTICE 17
GROUPS; 18
4. PRIMARY CARE ADVOCATE S; 19
5. PRIMARY CARE CONSUMER ADVOCATES; 20
6. REPRESENTATIVES OF BU SINESSES; 21
7. HEALTH PLAN REPRESENT ATIVES; AND 22
8. REPRESENTATIVES OF HO SPITALS OR HEALTH 23
SYSTEMS; AND 24
(III) REFLECT THE GEOGRAPHI C DIVERSITY OF THE STATE. 25
(C) A CHAIR OF THE COMMISSION SHALL BE S ELECTED BY A VOTE OF THE 26
MEMBERS OF THE COMMISSION. 27
4 SENATE BILL 734
(D) THE MARYLAND INSURANCE ADMINISTRATION AND TH E DEPARTMENT 1
SHALL PROVIDE STAFF FOR THE COMMISSION. 2
(E) (1) THE TERM OF A MEMBER OF THE COMMISSION IS 4 YEARS. 3
(2) THE TERMS OF THE MEMB ERS ARE STAGGERED AS REQUIRED BY 4
THE TERMS FOR MEMBERS OF THE COMMISSION ON OCTOBER 1, 2022. 5
(3) A VACANCY IN THE COMMISSION SHALL BE F ILLED IN THE SAME 6
MANNER AS THE MEMBER BEING SUCCEEDED WAS APPOINTED. 7
(F) (1) THE COMMISSION SHALL MEET AS OFTEN AS ITS DUTI ES 8
REQUIRE, BUT NOT LESS TH AN QUARTERLY . 9
(2) THE CHAIR OF THE COMMISSION SHALL PROV IDE ALL MEMBERS 10
WITH NOTICE OF A MEE TING AT LEAST 1 WEEK BEFORE THE DATE OF THE MEETING . 11
(3) THE CHAIR OF THE COMMISSION SHALL CALL A MEETING AT THE 12
REQUEST OF A MAJORIT Y OF THE COMMISSION MEMBERS. 13
(4) SEVEN MEMBERS OF THE COMMISSION CONSTITUTE A QUORUM. 14
(5) ACTION BY THE COMMISSION REQUIRES T HE AFFIRMATIVE VOTE 15
OF A MAJORITY OF THO SE PRESENT ONCE A QU ORUM IS MET. 16
(G) A MEMBER OF THE COMMISSION: 17
(1) MAY NOT RECEIVE COMPE NSATION AS A MEMBER OF THE 18
COMMISSION; BUT 19
(2) IS ENTITLED TO REIMBU RSEMENT FOR EXPENSES UNDER THE 20
STANDARD STATE TRAVEL REGULATIONS, AS PROVIDED IN THE STATE BUDGET . 21
(H) THE COMMISSION SHALL : 22
(1) REVIEW, EXAMINE, AND MAKE DETERMINATI ONS REGARDING 23
PRIMARY CARE SPENDING BY ALL PAYORS IN THE CONTEX T OF OVERALL HEALTH 24
CARE SPENDING IN THE STATE; AND 25
(2) MAKE RECOMMENDATIONS REGARDING: 26
(I) WAYS TO IMPROVE THE Q UALITY OF AND ACCESS TO 27
PRIMARY CARE SERVICE S, WITH SPECIAL ATTENTI ON TO INCREASING HEA LTH CARE 28 SENATE BILL 734 5
EQUITY, REDUCING HEALTH CARE DISPARITIES, AND AVOIDING INCREAS ED COSTS 1
TO PATIENTS AND THE HEALTH CARE SYSTEM ; 2
(II) MEANS OF REDUCING BAR RIERS TO PRIMARY CAR E ACCESS 3
AND UTILIZATION IDEN TIFIED BY THE COMMISSION; 4
(III) PROPOSED CHANGES TO T HE DEFINITION OF “PRIMARY 5
CARE” FOR THE PURPOSES OF THE COMMISSION’S FUTURE WORK ; AND 6
(IV) RECOMMENDATIONS TO IN CREASE SPENDING ON P RIMARY 7
CARE BY THE MARYLAND MEDICAL ASSISTANCE PROGRAM AND HEALTH IN SURERS, 8
NONPROFIT HEALTH SER VICE PLANS, AND HEALTH MAINTENA NCE ORGANIZATIONS . 9
(I) (1) (I) EACH MANAGED CARE ORG ANIZATION PARTICIPAT ING IN 10
THE MARYLAND MEDICAL ASSISTANCE PROGRAM SHALL PROVIDE THE 11
FOLLOWING INFORMATIO N TO THE COMMISSION: 12
1. FOR 2017, 2018, 2019, 2020, AND 2021, AND FOR 13
EACH SUBSEQUENT YEAR ON THE REQUEST OF THE COMMISSION: 14
A. THE AMOUNT THE MANAGE D CARE ORGANIZATION 15
SPENT ON PRIMARY CAR E SERVICES FOR ENROL LEES; AND 16
B. THE TOTAL AMOUNT THAT THE MANAGED CARE 17
ORGANIZATION SPENT O N HEALTH CARE SERVIC ES FOR ENROLLEES ; AND 18
2. ANY OTHER INFORMATION RE QUESTED BY THE 19
COMMISSION. 20
(II) THE SECRETARY SHALL : 21
1. ENFORCE THE PROVISION S OF SUBPARAGRAPH (I) OF 22
THIS PARAGRAPH ; AND 23
2. ADOPT REGULATIONS TO PROTECT THE 24
CONFIDENTIALITY OF A NY PROPRIETARY INFOR MATION PROVIDED TO T HE 25
COMMISSION UNDER THIS PARAGRAPH . 26
(2) (I) EACH INSURER , NONPROFIT HEALTH SER VICE PLAN, AND 27
HEALTH MAINTENANCE O RGANIZATION THAT PRO VIDES HOSPITAL , MEDICAL, OR 28
SURGICAL BENEFITS TO INDIVIDUALS UNDER HE ALTH INSURANCE POLIC IES OR 29
CONTRACTS THAT ARE D ELIVERED IN THE STATE SHALL PROVIDE T HE FOLLOWING 30
INFORMATION TO THE COMMISSION: 31
6 SENATE BILL 734
1. FOR 2017, 2018, 2019, 2020, AND 2021, AND FOR 1
EACH SUBSEQUENT YEAR ON THE REQUEST OF TH E COMMISSION: 2
A. THE AMOUNT THE ENTITY SPENT ON PRIMARY CAR E 3
SERVICES FOR ENROLLEES; AND 4
B. THE TOTAL AMOUNT THAT THE ENTITY SPENT ON 5
HEALTH CARE SERVICES FOR ENROLLEES ; AND 6
2. ANY OTHER INFORMATION REQUESTED BY THE 7
COMMISSION. 8
(II) THE MARYLAND INSURANCE COMMISSIONER SHALL : 9
1. ENFORCE THE PROVISION S OF SUBPARAGRAPH (I) OF 10
THIS PARAGRAPH ; AND 11
2. ADOPT REGULATIONS TO PROTECT THE 12
CONFIDENTIALITY OF A NY PROPRIETARY INFOR MATION PROVIDED TO T HE 13
COMMISSION UNDER THIS PARAGRAPH . 14
(J) THE COMMISSION MAY ACCEPT FUNDING OR GRANTS TO AID IN THE 15
WORK OF THE COMMISSION. 16
19–108.4. 17
(A) IN THIS SECTION, “PRIMARY CARE ” MEANS HEALTH CARE PR OVIDED IN 18
THE FOLLOWING FIELDS ’ OUTPATIENT SETTINGS : 19
(1) FAMILY MEDICINE ; 20
(2) GENERAL PEDIATRICS ; 21
(3) PRIMARY CARE INTERNAL MEDICINE; AND 22
(4) PRIMARY CARE OBSTETRI CS AND GYNECOLOGY ; 23
(5) PRIMARY CARE NURSE PR ACTITIONER SERVICES ; AND 24
(6) PRIMARY CARE MIDWIFER Y. 25
(K) (B) ON OR BEFORE DECEMBER 1 EACH YEAR, BEGINNING IN 2023 26
2024, THE COMMISSION SHALL PROV IDE A REPORT TO THE GOVERNOR AND , IN 27 SENATE BILL 734 7
ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, THE GENERAL 1
ASSEMBLY THAT INCLUDE S: 2
(1) AN ANALYSIS OF PRIMAR Y CARE SPENDING INVESTMENT OVER 3
THE IMMEDIATELY PREC EDING YEAR, INCLUDING DATA STRAT IFIED BY ZIP CODE 4
AND COUNTY, IN RELATION TO TOTAL HEALTH CARE SPENDING OVER THE PREVIOUS 5
YEAR; AND 6
(2) WAYS TO IMPROVE THE Q UALITY OF AND ACCESS TO PRIMARY 7
CARE SERVICES , WITH SPECIAL ATTENTI ON TO INCREASING HEALTH CARE EQUITY, 8
REDUCING HEALTH CARE DISPARITIES, AND AVOIDING INCREAS ED COSTS TO 9
PATIENTS AND THE HEA LTH CARE SYSTEM ; AND 10
(2) (3) ANY FINDINGS AND RECO MMENDATIONS OF THE 11
COMMISSION. 12
(C) (1) THE COMMISSION SHALL FORM A WORKGROUP TO D EVELOP THE 13
REPORT REQUIRED UNDE R SUBSECTION (B) OF THIS SECTION , INCLUDING BY 14
INTERPRETING THE RES ULTS OF THE REQUIRED ANALYSIS AND MAKING THE 15
RECOMMENDATIONS . 16
(2) THE WORKGROUP REQUIRE D UNDER THIS SUBSECT ION SHALL 17
INCLUDE REPRESENTATI VES OF: 18
(I) THE MARYLAND PRIMARY CARE PROGRAM; 19
(II) THE HEALTH SERVICES REVIEW COMMISSION; 20
(III) THE MARYLAND INSURANCE ADMINISTRATION ; 21
(IV) THE HEALTH CARE FINANCING DIVISION OF THE 22
MARYLAND DEPARTMENT OF HEALTH; 23
(V) THE PRIMARY CARE COMM UNITY, INCLUDING FROM THE 24
MARYLAND ACADEMY OF FAMILY PHYSICIANS, THE MARYLAND CHAPTER OF THE 25
AMERICAN ACADEMY OF PEDIATRICS, THE MARYLAND SECTION OF THE AMERICAN 26
COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS , THE MARYLAND NURSES 27
ASSOCIATION, THE MARYLAND AFFILIATE – AMERICAN COLLEGE OF NURSE 28
MIDWIVES, THE MARYLAND COMMUNITY HEALTH SYSTEM, AND THE MIDATLANTIC 29
ASSOCIATION OF COMMUNITY HEALTH CENTERS; 30
(VI) PAYORS OF PRIMARY CAR E SERVICES , INCLUDING 31
CARRIERS AND MANAGED CARE ORGANIZATIONS ; 32
8 SENATE BILL 734
(VII) HEALTH SERVICES R ESEARCHERS WITH EXPE RTISE IN 1
PRIMARY CARE ; AND 2
(VIII) OTHER INTERESTED STAK EHOLDERS. 3
SECTION 2. AND BE IT FURTHER ENACTED, That the terms of the initial 4
members of the Primary Care Reform Commission shall expire as follows: 5
(1) four members in 2024; 6
(2) four members in 2025; and 7
(3) five members in 2026. 8
SECTION 2. AND BE IT FURTHER ENACTED, That: 9
(a) Before the Maryland Health Care Commission begins the analysis required 10
under Section 1 of this Act, the Commission shall establish a plan for the analysis and 11
report after receiving input and agreement from participants in the workgroup as to the 12
scope of and methodology for the analysis and report. 13
(b) On or before December 1, 2023, the Commission shall provide the plan 14
required under subsection (a) of this section to the Governor and, in accordance with § 15
2–1257 of the State Government Article, the General Assembly. 16
SECTION 3. AND BE IT FURTHER ENAC TED, That this Act shall take effect 17
October 1, 2022. 18
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
President of the Senate.
________________________________________________________________________________
Speaker of the House of Delegates.