EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb1148*
HOUSE BILL 1148
J1, J3 3lr0459
CF SB 582
By: Delegates Moon, Pena–Melnyk, Attar, Bagnall, Boyce, Charkoudian, Cullison,
Grossman, Guyton, Healey, Kelly, Lopez, McComas, Reznik, Shetty, Smith,
Solomon, Stein, Toles, Turner, and Wilkins
Introduced and read first time: February 10, 2023
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Behavioral Health Care – Treatment and Access 2
(Behavioral Health Model for Maryland) 3
FOR the purpose of establishing the Commission on Behavioral Health Care Treatment 4
and Access to make recommendations to provide appropriate, accessible, and 5
comprehensive behavioral health services to individuals in the State across the 6
behavioral health continuum that are available on demand; establishing the 7
Behavioral Health Care Coordination Value–Based Purchasing Pilot Program in the 8
Maryland Department of Health to establish and implement an intensive care 9
coordination model using value–based purchasing in the specialty behavioral health 10
system; requiring, on or before a certain date, the Department to submit a State plan 11
amendment to the Centers for Medicare and Medicaid Services to establish certified 12
community behavioral health clinics; extending to a certain date the inclusion of 13
certain audio–only telephone conversations in the definition of “telehealth” in the 14
Maryland Medical Assistance Program and certain requirements related to the 15
provision of reimbursement for health care services appropriately provided through 16
telehealth by the Program and certain insurers, nonprofit health service plans, and 17
health maintenance organizations; and generally relating to behavioral health care 18
treatment and access. 19
BY adding to 20
Article – Health – General 21
Section 13–4801 through 13–4807 to be under the new subtitle “Subtitle 48. 22
Commission on Behavioral Health Care Treatment and Access”; 13–4901 23
through 13–4907 to be under the new subtitle “Subtitle 49. Behavioral Health 24
Care Coordination Value–Based Purchasing Pilot Program”; and 15–141.5 25
Annotated Code of Maryland 26
(2019 Replacement Volume and 2022 Supplement) 27
2 HOUSE BILL 1148
BY repealing and reenacting, with amendments, 1
Article – Health – General 2
Section 15–141.2 3
Annotated Code of Maryland 4
(2019 Replacement Volume and 2022 Supplement) 5
BY repealing and reenacting, with amendments, 6
Article – Insurance 7
Section 15–139 8
Annotated Code of Maryland 9
(2017 Replacement Volume and 2022 Supplement) 10
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 11
That the Laws of Maryland read as follows: 12
Article – Health – General 13
SUBTITLE 48. COMMISSION ON BEHAVIORAL HEALTH CARE TREATMENT AND 14
ACCESS. 15
13–4801. 16
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANI NGS 17
INDICATED. 18
(B) “BEHAVIORAL HEALTH ” INCLUDES SUBSTANCE –RELATED DISORDERS , 19
ADDICTIVE DISORDERS , MENTAL DISORDERS , LIFE STRESSORS AND C RISES, AND 20
STRESS–RELATED PHYSICAL SYM PTOMS. 21
(C) “COMMISSION” MEANS THE COMMISSION ON BEHAVIORAL HEALTH 22
CARE TREATMENT AND ACCESS. 23
13–4802. 24
THERE IS A COMMISSION ON BEHAVIORAL HEALTH CARE TREATMENT AND 25
ACCESS. 26
13–4803. 27
(A) THE COMMISSION CONSISTS O F THE FOLLOWING MEMB ERS: 28
(1) ONE MEMBER OF THE SENATE OF MARYLAND, APPOINTED BY THE 29
PRESIDENT OF THE SENATE; 30
HOUSE BILL 1148 3
(2) ONE MEMBER OF THE HOUSE OF DELEGATES, APPOINTED BY THE 1
SPEAKER OF THE HOUSE; 2
(3) ONE REPRESENTATIVE OF MARYLAND’S CONGRESSIONAL 3
DELEGATION; 4
(4) THE SECRETARY OF HEALTH, OR THE SECRETARY’S DESIGNEE; 5
(5) THE SECRETARY OF HUMAN SERVICES, OR THE SECRETARY’S 6
DESIGNEE; 7
(6) THE SECRETARY OF JUVENILE SERVICES, OR THE SECRETARY’S 8
DESIGNEE; 9
(7) THE DEPUTY SECRETARY FOR BEHAVIORAL HEALTH, OR THE 10
DEPUTY SECRETARY’S DESIGNEE; 11
(8) THE MARYLAND INSURANCE COMMISSIONER , OR THE 12
COMMISSIONER ’S DESIGNEE; 13
(9) THE EXECUTIVE DIRECTOR OF THE HEALTH SERVICES COST 14
REVIEW COMMISSION, OR THE EXECUTIVE DIRECTOR’S DESIGNEE; 15
(10) THE EXECUTIVE DIRECTOR OF THE MARYLAND HEALTH CARE 16
COMMISSION, OR THE EXECUTIVE DIRECTOR’S DESIGNEE; 17
(11) THE EXECUTIVE DIRECTOR OF THE MARYLAND COMMUNITY 18
HEALTH RESOURCES COMMISSION, OR THE EXECUTIVE DIRECTOR’S DESIGNEE; 19
(12) THE EXECUTIVE DIRECTOR OF THE STATE–DESIGNATED HEALTH 20
INFORMATION EXCHANGE , OR THE EXECUTIVE DIRECTOR’S DESIGNEE; 21
(13) THE EXECUTIVE DIRECTOR OF THE GOVERNOR’S OFFICE OF 22
CRIME PREVENTION, YOUTH, AND VICTIM SERVICES, OR THE EXECUTIVE 23
DIRECTOR’S DESIGNEE; AND 24
(14) THE FOLLOWING MEMBERS APPOINTED BY THE GOVERNOR: 25
(I) ONE REPRESENTATIVE OF THE MENTAL HEALTH 26
ASSOCIATION OF MARYLAND; 27
(II) ONE REPRESENTATIVE OF THE NATIONAL ALLIANCE ON 28
MENTAL ILLNESS; 29 4 HOUSE BILL 1148
(III) ONE REPRESENTATIVE OF THE COMMUNITY BEHAVIORAL 1
HEALTH ASSOCIATION OF MARYLAND; 2
(IV) ONE REPRESENTATIVE OF A PROVIDER OF RESIDE NTIAL 3
BEHAVIORAL HEALTH SE RVICES; 4
(V) ONE REPRESENTATIVE OF AN ACUTE CARE HOSPIT AL; 5
(VI) ONE REPRESENTATIVE OF AN INPATIENT PSYCHIA TRIC 6
HOSPITAL; 7
(VII) ONE INDIVIDUAL WITH E XPERIENCE AS A CONSU MER OF 8
BEHAVIORAL HEALTH SE RVICES; 9
(VIII) ONE FAMILY MEMBER OF AN INDIVIDUAL WITH 10
EXPERIENCE AS A CONS UMER OF BEHAVIORAL H EALTH SERVICES ; 11
(IX) ONE REPRESENTATIVE OF A PROVIDER OF SUBSTA NCE USE 12
TREATMENT SERVICES ; 13
(X) ONE REPRESENTATIVE OF A SCHOOL–BASED HEALTH 14
CENTER; 15
(XI) ONE INDIVIDUAL WITH E XPERTISE IN SOCIAL 16
DETERMINANTS OF HEALTH; 17
(XII) ONE INDIVIDUAL WITH E XPERTISE IN HEALTH E CONOMICS; 18
(XIII) ONE REPRESENTATIVE OF A HEALTH INSURANCE C ARRIER; 19
(XIV) ONE REPRESENTATIVE OF A MANAGED CARE 20
ORGANIZATION ; 21
(XV) ONE REPRESENTATIVE FR OM THE OFFICE OF THE PUBLIC 22
DEFENDER; 23
(XVI) ONE REPRESENTATIVE OF THE DEVELOPMENTAL 24
DISABILITY COALITION; 25
(XVII) ONE REPRESENTATIVE OF THE MARYLAND CHAPTER OF 26
THE NATIONAL COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE ; 27
HOUSE BILL 1148 5
(XVIII) ONE REPRESENTATIVE OF THE MARYLAND 1
PSYCHOLOGICAL ASSOCIATION; AND 2
(XIX) ONE REPRESENTATIVE OF DISABILITY RIGHTS MARYLAND. 3
(B) TO THE EXTENT PRACTIC ABLE, THE MEMBERSHIP OF TH E COMMISSION 4
SHALL REFLECT THE GE OGRAPHIC AND ETHNIC DIVERSITY OF THE STATE. 5
(C) THE GOVERNOR, THE PRESIDENT OF THE SENATE, AND THE SPEAKER 6
OF THE HOUSE JOINTLY SHALL D ESIGNATE THE CHAIR O F THE COMMISSION. 7
(D) THE DEPARTMENT SHALL PROV IDE STAFF FOR THE COMMISSION. 8
(E) A MEMBER OF THE COMMISSION: 9
(1) MAY NOT RECEIVE COMPE NSATION AS A MEMBER OF THE 10
COMMISSION; BUT 11
(2) IS ENTITLED TO REIMBU RSEMENT FOR EXPENSES UNDER THE 12
STANDARD STATE TRAVEL REGULATIONS, AS PROVIDED IN THE STATE BUDGET . 13
(F) THE COMMISSION SHALL MEET AT LEAST THREE TIMES PER YEAR AT 14
THE TIMES AND PLACES DETERMINED BY THE COMMISSION. 15
13–4804. 16
THE PURPOSE OF THE COMMISSION IS TO MAKE RECOMMENDATIONS TO 17
PROVIDE APPROPRIATE , ACCESSIBLE, AND COMPREHENSIVE BE HAVIORAL HEALTH 18
SERVICES TO INDIVIDU ALS IN THE STATE ACROSS THE BEHA VIORAL HEALTH 19
CONTINUUM THAT ARE A VAILABLE ON DEMAND . 20
13–4805. 21
THE COMMISSION SH ALL: 22
(1) CONDUCT AN ASSESSMENT OF BEHAVIORAL HEALTH SERVICES IN 23
THE STATE TO IDENTIFY NEE DS AND GAPS IN SERVI CES ACROSS THE CONTI NUUM, 24
INCLUDING COMMUNITY –BASED OUTPATIENT AND SUPPORT SERVICES , CRISIS 25
RESPONSE, AND INPATIENT CARE ; 26
(2) EXAMINE THE MET HODS FOR REIMBURSING BEHAVIORAL 27
HEALTH CARE SERVICES IN THE STATE AND MAKE RECOMM ENDATIONS ON THE 28
MOST EFFECTIVE FORMS OF REIMBURSEMENT TO MAXIMIZE SERVICE DEL IVERY; 29 6 HOUSE BILL 1148
(3) COMPILE FINDINGS OF STATE–SPECIFIC NEEDS ASSES SMENTS 1
RELATED TO BEHAVIORA L HEALTH CARE SERVICES ; 2
(4) REVIEW RECOMMENDATION S AND REPORTS OF STATE 3
COMMISSIONS , WORKGROUPS , OR TASK FORCES RELAT ED TO BEHAVIORAL HEA LTH 4
CARE SERVICES ; 5
(5) CONDUCT A NEEDS ASSES SMENT ON THE STATE’S BEHAVIORAL 6
HEALTH CARE WORKFORC E TO IDENTIFY GAPS A ND MAKE RECOMMENDATIONS TO 7
ENSURE AN ADEQUATE W ORKFORCE ACROSS THE BEHAVIORAL HEALTH CA RE 8
CONTINUUM ; 9
(6) REVIEW TRENDS AND BES T PRACTICES FROM OTH ER STATES 10
REGARDING POLICY AND REIMBURSEMENT STRATE GIES THAT SUPPORT AC CESS TO 11
A COMPREHENSIVE ARRA Y OF SERVICES AND ENSURE QUALITY O F CARE; 12
(7) EXAMINE AND MAKE RECO MMENDATIONS RELATED TO THE 13
BEHAVIORAL HEALTH OF THE GERIATRIC AND YO UTH POPULATIONS IN T HE STATE; 14
(8) EXAMINE AND MAKE RECO MMENDATIONS TO PROVI DE 15
APPROPRIATE AND ADEQ UATE BEHAVIORAL HEAL TH SERVICES TO INDIVIDUALS 16
WITH COMPLEX BEHAVIO RAL HEALTH NEEDS , SPECIFICALLY YOUTH ; 17
(9) ASSESS THE HEALTH INF RASTRUCTURE , FACILITIES, 18
PERSONNEL , AND SERVICES AVAILAB LE FOR THE STATE’S FORENSIC POPULATIO N 19
AND IDENTIFY DEFICIE NCIES IN RESOURCES A ND POLICIES NEEDED TO PRIORITIZE 20
HEALTH OUTCOMES , INCREASE PUBLIC SAFE TY, AND REDUCE RECIDIVIS M; 21
(10) MAKE RECOMMENDATIONS ON EXPANDING BEHAVIO RAL HEALTH 22
TREATMENT ACCESS FOR THE STATE’S COURT–ORDERED POPULATION ; 23
(11) MAKE RECOMMENDATIONS ON ACTION PLANS REGA RDING THE 24
BEHAVIORAL HEALTH CA RE SYSTEM’S CAPACITY TO PREPAR E FOR AND RESPOND TO 25
FUTURE CHALLENGES AF FECTING THE ENTIRE STATE OR PARTICULAR R EGIONS OR 26
POPULATIONS IN THE STATE, INCLUDING PANDEMICS AND EXTREME WEATHER 27
EVENTS; AND 28
(12) MAKE RECOMMENDATIONS TO ENSU RE THAT BEHAVIORAL 29
HEALTH TREATMENT IS PROVIDED IN THE APPR OPRIATE SETTING , INCLUDING 30
METHODS TO DIVERT BE HAVIORAL HEALTH PATI ENTS FROM EMERGENCY 31
DEPARTMENTS BY USING THE MARYLAND MENTAL HEALTH AND SUBSTANCE USE 32 HOUSE BILL 1148 7
DISORDER REGISTRY AND REFERRAL SYSTEM ESTABL ISHED UNDER § 7.5–802 OF 1
THIS ARTICLE AND 2–1–1. 2
13–4806. 3
(A) THE COMMISSION SHALL ESTA BLISH THE FOLLOWING WORKGROUPS : 4
(1) GERIATRIC BEHAVIORAL HEALTH; 5
(2) YOUTH BEHAVIORAL HEAL TH AND INDIVIDUALS W ITH COMPLEX 6
BEHAVIORAL HEALTH NE EDS; 7
(3) CRIMINAL JUSTICE –INVOLVED BEHAVIORAL HEALTH; AND 8
(4) BEHAVIORAL HEALTH WOR KFORCE DEVELOPMENT , 9
INFRASTRUCTURE , AND FINANCING . 10
(B) THE WORKGROUPS ESTABL ISHED UNDER SUBSECTI ON (A) OF THIS 11
SECTION SHALL MEET A T LEAST TWO TIMES PE R YEAR AT THE TIMES AND PLACES 12
DETERMINED BY THE WO RKGROUP. 13
(C) THE WORKGROUPS ESTABL ISHED UNDER SUBSECTI ON (A) OF THIS 14
SECTION SHALL INCLUD E MEMBERS OF THE COMMISSION AND MAY IN CLUDE 15
INDIVIDUALS INVITED BY THE COMMISSION TO SERVE ON THE WORKGROUP . 16
(D) ON OR BEFORE DECEMBER 1 EACH YEAR, BEGINNING IN 2023, THE 17
WORKGROUPS ESTABLISH ED UNDER SUBSECTION (A) OF THIS SECTION SHAL L 18
REPORT AND MAKE RECO MMENDATIONS TO THE COMMISSION. 19
13–4807. 20
(A) (1) ON OR BEFORE JANUARY 1 EACH YEAR, BEGINNING IN 2024, THE 21
COMMISSION SHALL REPO RT TO THE GOVERNOR AND , IN ACCORDANCE WITH § 22
2–1257 OF THE STATE GOVERNMENT ARTICLE, THE GENERAL ASSEMBLY ON THE 23
COMMISSION’S FINDINGS AND RECOM MENDATIONS , INCLUDING FUNDING AN D 24
LEGISLATIVE RECOMMEN DATIONS. 25
(2) ANY LEGISLATIVE RECOM MENDATIONS INCLUDED IN THE 26
REPORT REQUIRED UNDER PARAGRAPH (1) OF THIS SUBSECTION T HAT REQUIRE 27
FUNDING SHALL INCLUD E AN ESTIMATE OF THE FUNDING REQUIRED TO 28
IMPLEMENT THE RECOMM ENDATION AND INFORMA TION THAT SUPPORTS T HE 29
FUNDING ESTIMATE . 30
8 HOUSE BILL 1148
(B) THE REPORT REQUIRED O N OR BEFORE JANUARY 1, 2024, SHALL 1
INCLUDE THE FINDINGS OF THE NEEDS ASSESSM ENTS REQUIRED UNDER § 13–4805 2
OF THIS SUBTITLE. 3
SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read as 4
follows: 5
Article – Health – General 6
SUBTITLE 49. BEHAVIORAL HEALTH CARE COORDINATION VALUE–BASED 7
PURCHASING PILOT PROGRAM. 8
13–4901. 9
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 10
INDICATED. 11
(B) “BEHAVIORAL HEALTH CAR E COORDINATION ” MEANS A 12
PERSON–CENTERED, TEAM–BASED ACTIVITY DESIG NED TO: 13
(1) ASSESS AND MEET THE NEEDS OF AN INDI VIDUAL WITH A 14
BEHAVIORAL HEALTH CO NDITION; AND 15
(2) HELP THE INDIVIDUAL N AVIGATE THE HEALTH C ARE SYSTEM 16
EFFECTIVELY AND EFFI CIENTLY. 17
(C) “PILOT PROGRAM” MEANS THE BEHAVIORAL HEALTH CARE 18
COORDINATION VALUE–BASED PURCHASING PILOT PROGRAM. 19
(D) “VALUE–BASED PURCHASING ” MEANS FINANCIALLY IN CENTIVIZING 20
PROVIDERS TO MEET SP ECIFIED OUTCOME MEAS URES. 21
13–4902. 22
THERE IS A BEHAVIORAL HEALTH CARE COORDINATION VALUE–BASED 23
PURCHASING PILOT PROGRAM IN THE DEPARTMENT . 24
13–4903. 25
THE PURPOSE OF THE PILOT PROGRAM IS TO ESTABLI SH AND IMPLEMENT AN 26
INTENSIVE CARE COORD INATION MODEL USING VALUE–BASED PURCHASING IN THE 27
SPECIALTY BEHAVIORAL HEALTH SYSTEM . 28
13–4904. 29 HOUSE BILL 1148 9
(A) THE DEPARTMENT SHALL ADMI NISTER THE PILOT PROGRAM. 1
(B) THE DEPARTMENT SHALL IDENTIFY AT LEAST 500 ADULTS WHOSE 2
BEHAVIORAL HEALTH CO NDITION OR FUNCTIONI NG PLACES THEM AT RI SK OF 3
HOSPITAL EMERGENCY D EPARTMENT UTILIZATIO N OR INPATIENT PSYCH IATRIC 4
HOSPITAL ADMISSION . 5
(C) THE PILOT PROGRAM SHALL BE OPER ATIONAL FOR A 3–YEAR PERIOD. 6
(D) A PROVIDER OR NETWORK OF PROVIDERS SELECTE D TO PARTICIPATE 7
IN THE PILOT PROGRAM SHALL : 8
(1) BE LICENSED AND IN GO OD STANDING WITH THE MARYLAND 9
MEDICAL ASSISTANCE PROGRAM; 10
(2) HAVE EXPERIENCE IN PR OVIDING COMMUNITY –BASED CARE 11
COORDINATION TO SPEC IALTY BEHAVIORAL HEALT H PROGRAM RECIPIENTS ; 12
(3) USE AN ELECTRONIC MED ICAL RECORD FOR DOCU MENTING CARE 13
COORDINATION ACTIVIT IES AND OUTCOMES COL LECTION; AND 14
(4) HAVE AN AUTOMATED DAT A EXCHANGE WITH THE 15
STATE–DESIGNATED HEALTH IN FORMATION EXCHANGE . 16
(E) THE DEPARTMENT SHALL : 17
(1) PROVIDE REIMBURSEMENT ON A PER MEMBER PER MONTH BASIS 18
FOR THE BEHAVIORAL H EALTH CARE COORDINAT ION ACTIVITIES THAT ARE NOT 19
OTHERWISE COVERED BY THE MARYLAND MEDICAL ASSISTANCE PROGRAM; 20
(2) COLLECT OUTCOMES DATA ON RECIPIENTS OF HEALTH CARE 21
SERVICES UNDER THE PILOT PROGRAM; AND 22
(3) EVALUATE THE EFFECTIV ENESS OF THE VALUE –BASED 23
PURCHASING MODEL BY ANALYZING THE FOLLOW ING OUTCOME MEASURES : 24
(I) A COMPARISON OF THE FO LLOWING DATA ELEMENT S 25
BEFORE AND AFTER ENR OLLMENT OF RECI PIENTS OF HEALTH CAR E SERVICES 26
UNDER THE PILOT PROGRAM: 27
1. EMERGENCY DEPARTMENT UTILIZATION FOR BOTH 28
BEHAVIORAL AND SOMAT IC HEALTH PURPOSES ; 29 10 HOUSE BILL 1148
2. INPATIENT HOSPITALIZA TION FOR BOTH 1
BEHAVIORAL AND SOMAT IC HEALTH PURPOSES ; AND 2
3. TOTAL HEALTH CARE EXPENDITURES ; 3
(II) OUTCOMES FOR RECIPIEN TS WITH AND WITHOUT PRIMARY 4
CARE SERVICES COORDI NATED BY A BEHAVIORA L HEALTH PROVIDER ; AND 5
(III) RECOGNIZED CLINICAL Q UALITY METRICS WHICH MAY 6
INCLUDE PATIENT EXPE RIENCE MEASURES . 7
13–4905. 8
IF NECESSAR Y TO IMPLEMENT THE PILOT PROGRAM, THE DEPARTMENT 9
SHALL APPLY TO THE CENTERS FOR MEDICARE AND MEDICAID SERVICES FOR AN 10
AMENDMENT TO THE STATE’S § 1115 HEALTHCHOICE DEMONSTRATION . 11
13–4906. 12
(A) FOR EACH OF FISCAL YE AR 2025, FISCAL YEAR 2026, AND FISCAL YEA R 13
2027, THE GOVERNOR SHALL INCLUD E IN THE ANNUAL BUDG ET BILL AN 14
APPROPRIATION OF $600,000 FOR THE PILOT PROGRAM. 15
(B) BEGINNING IN FISCAL Y EAR 2026, THE DEPARTMENT SHALL ALLO CATE 16
A PERCENTAGE OF THE ANNUAL APPROPRIATION REQUIRED UNDER SUBSE CTION 17
(A) OF THIS SECTION TO REIMBU RSEMENT PAID BASED O N THE ACHIEVEMENT OF 18
THE OUTCOME MEASURES DESCRIBED IN § 13–4904(E)(3) OF THIS SUBTITLE. 19
(C) IN FISCAL YEAR 2027, THE DEPARTMENT SHALL INCR EASE THE 20
PERCENTAGE OF THE AN NUAL APPROPRIATION R EQUIRED UNDER SUBSEC TION (A) 21
OF THIS SECTION ALLO CATED TO REIMBURSEME NT PAID IN ACCORDANC E WITH 22
SUBSECTION (B) OF THIS SECTION OVER THE PERCENTAGE ALLOC ATED IN FISCAL 23
YEAR 2026. 24
13–4907. 25
ON OR BEFORE NOVEMBER 1, 2027, THE DEPARTMENT SHALL REPO RT TO 26
THE GOVERNOR AND , IN ACCORDANC E WITH § 2–1257 OF THE STATE GOVERNMENT 27
ARTICLE, THE GENERAL ASSEMBLY ON THE DEPARTMENT ’S FINDINGS AND 28
RECOMMENDATIONS FROM THE PILOT PROGRAM. 29
HOUSE BILL 1148 11
SECTION 3. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 1
as follows: 2
Article – Health – General 3
15–141.2. 4
(a) (1) In this section the following words have the meanings indicated. 5
(2) “Distant site” means a site at which the distant site health care provider 6
is located at the time the health care service is provided through telehealth. 7
(3) “Distant site provider” means the health care provider who provides 8
medically necessary services to a patient at an originating site from a different physical 9
location than the location of the patient. 10
(4) “Health care provider” means: 11
(i) A person who is licensed, certified, or otherwise authorized under 12
the Health Occupations Article to provide health care in the ordinary course of business or 13
practice of a profession or in an approved education or training program; 14
(ii) A mental health and substance use disorder program licensed in 15
accordance with § 7.5–401 of this article; 16
(iii) A person licensed under Title 7, Subtitle 9 of this article to 17
provide services to an individual with developmental disability or a recipient of individual 18
support services; or 19
(iv) A provider as defined under § 16–201.4 of this article to provide 20
services to an individual receiving long–term care services. 21
(5) “Originating site” means the location of the Program recipient at the 22
time the health care service is provided through telehealth. 23
(6) “Remote patient monitoring services” means the use of synchronous or 24
asynchronous digital technologies that collect or monitor medical, patient–reported, and 25
other forms of health care data for Program recipients at an originating site and 26
electronically transmit that data to a distant site provider to enable the distant site 27
provider to assess, diagnose, consult, treat, educate, provide care management, suggest 28
self–management, or make recommendations regarding the Program recipient’s health 29
care. 30
(7) (i) “Telehealth” means the delivery of medically necessary somatic, 31
dental, or behavioral health services to a patient at an originating site by a distant site 32
provider through the use of technology–assisted communication. 33
12 HOUSE BILL 1148
(ii) “Telehealth” includes: 1
1. Synchronous and asynchronous interactions; 2
2. From July 1, 2021, to June 30, [2023] 2025, both 3
inclusive, an audio–only telephone conversation between a health care provider and a 4
patient that results in the delivery of a billable, covered health care service; and 5
3. Remote patient monitoring services. 6
(iii) “Telehealth” does not include the provision of health care 7
services solely through: 8
1. Except as provided in subparagraph (ii)2 of this 9
paragraph, an audio–only telephone conversation; 10
2. An e–mail message; or 11
3. A facsimile transmission. 12
(b) The Program shall: 13
(1) Provide health care services appropriately delivered through telehealth 14
to Program recipients regardless of the location of the Program recipient at the time 15
telehealth services are provided; and 16
(2) Allow a distant site provider to provide health care services to a 17
Program recipient from any location at which the health care services may be appropriately 18
delivered through telehealth. 19
(c) The services required to be provided under subsection (b) of this section shall 20
include counseling and treatment for substance use disorders and mental health conditions. 21
(d) The Program may not: 22
(1) Exclude from coverage a health care service solely because it is provided 23
through telehealth and is not provided through an in–person consultation or contact 24
between a health care provider and a patient; or 25
(2) Exclude from coverage a behavioral health care service provided to a 26
Program recipient in person solely because the service may also be provided through 27
telehealth. 28
(e) The Program may undertake utilization review, including preauthorization, 29
to determine the appropriateness of any health care service whether the service is delivered 30
through an in–person consultation or through telehealth if the appropriateness of the 31
health care service is determined in the same manner. 32 HOUSE BILL 1148 13
(f) The Program may not distinguish between Program recipients in rural or 1
urban locations in providing coverage under the Program for health care services delivered 2
through telehealth. 3
(g) (1) Subject to paragraph (3) of this subsection, the Program shall 4
reimburse a health care provider for the diagnosis, consultation, and treatment of a 5
Program recipient for a health care service covered by the Program that can be 6
appropriately provided through telehealth. 7
(2) This subsection does not require the Program to reimburse a health 8
care provider for a health care service delivered in person or through telehealth that is: 9
(i) Not a covered health care service under the Program; or 10
(ii) Delivered by an out–of–network provider unless the health care 11
service is a self–referred service authorized under the Program. 12
(3) (i) From July 1, 2021, to June 30, [2023] 2025, both inclusive, when 13
appropriately provided through telehealth, the Program shall provide reimbursement in 14
accordance with paragraph (1) of this subsection on the same basis and the same rate as if 15
the health care service were delivered by the health care provider in person. 16
(ii) The reimbursement required under subparagraph (i) of this 17
paragraph does not include: 18
1. Clinic facility fees unless the health care service is 19
provided by a health care provider not authorized to bill a professional fee separately for 20
the health care service; or 21
2. Any room and board fees. 22
(h) (1) The Department may specify in regulation the types of health care 23
providers eligible to receive reimbursement for health care services provided to Program 24
recipients under this section. 25
(2) If the Department specifies by regulation the types of health care 26
providers eligible to receive reimbursement for health care services provided to Program 27
recipients under this subsection, the regulations shall include all types of health care 28
providers that appropriately provide telehealth services. 29
(3) For the purpose of reimbursement and any fidelity standards 30
established by the Department, a health care service provided through telehealth is 31
equivalent to the same health care service when provided through an in –person 32
consultation. 33
14 HOUSE BILL 1148
(i) Subject to subsection (g)(2) of this section, the Program or a managed care 1
organization that participates in the Program may not impose as a condition of 2
reimbursement of a covered health care service delivered through telehealth that the 3
health care service be provided by a third–party vendor designated by the Program. 4
(j) The Department may adopt regulations to carry out this section. 5
(k) The Department shall obtain any federal authority necessary to implement 6
the requirements of this section, including applying to the Centers for Medicare and 7
Medicaid Services for an amendment to any of the State’s § 1115 waivers or the State plan. 8
(l) This section may not be construed to supersede the authority of the Health 9
Services Cost Review Commission to set the appropriate rates for hospitals, including 10
setting the hospital facility fee for hospital–provided telehealth. 11
15–141.5. 12
(A) IN THIS SECTION , “CERTIFIED COMMUNITY BEHAVIORAL HEALTH 13
CLINIC” MEANS A NONPROFIT CO MPREHENSIVE COMMUNIT Y MENTAL HEALTH OR 14
SUBSTANCE USE TREATM ENT ORGANIZATION LIC ENSED BY THE STATE THAT MEETS 15
THE FEDERAL CERTIFIC ATION CRITERIA OF § 223 OF THE FEDERAL PROTECTING 16
ACCESS TO MEDICARE ACT OF 2014 AND OFFERS , DIRECTLY OR INDIRECT LY 17
THROUGH FORMAL REFER RAL RELATIONSHIPS WI TH OTHER PROVIDERS , THE 18
FOLLOWING SERVICES : 19
(1) OUTPATIENT MENTAL HEA LTH AND SUBSTANCE US E SERVICES; 20
(2) 24–HOUR MOBILE CRISIS R ESPONSE AND HOTLINE SERVICES ; 21
(3) SCREENING, ASSESSMENT, AND DIAGNOSIS , INCLUDING RISK 22
ASSESSMENTS ; 23
(4) PERSON–CENTERED TREATMENT P LANNING; 24
(5) PRIMARY CARE SCREENIN G AND MONITORING OF KEY 25
INDICATORS OF HEALTH RISKS; 26
(6) TARGETED CASE MANAGEM ENT; 27
(7) PSYCHIATRIC REHABILIT ATION SERVICES ; 28
(8) PEER SUPPORT AND FAMI LY SUPPORTS; 29
(9) MEDICATION–ASSISTED TREATMENT ; 30 HOUSE BILL 1148 15
(10) ASSERTIVE COMMUNITY T REATMENT; AND 1
(11) COMMUNITY–BASED MENTAL HEALTH CARE FOR MILITARY 2
SERVICE MEMBERS AND VETERANS. 3
(B) ON OR BEFORE DECEMBER 1, 2023, THE DEPARTMENT SHALL SUBM IT 4
A STATE PLAN AMENDMENT TO THE CENTERS FOR MEDICARE AND MEDICAID 5
SERVICES TO ESTABLISH CERTIFIED COMMUNITY BEHAVIORAL HEALTH CL INICS IN 6
ACCORDANCE WITH § 223 OF THE FEDERAL PROTECTING ACCESS TO MEDICARE 7
ACT OF 2014. 8
(C) IF THE AMENDMENT SUBM ITTED UNDER SUBSECTI ON (B) OF THIS 9
SECTION IS APPROVED , THE DEPARTMENT SHALL AMEN D THE STATE PLAN IN 10
ACCORDANCE WITH TITLE XIX AND TITLE XXI OF THE SOCIAL SECURITY ACT AS 11
NECESSARY TO COVER : 12
(1) ALL REQUIRED SER VICES FOR INDIVIDUAL S WITH MENTAL 13
HEALTH NEEDS OR SUBS TANCE USE DISORDERS AT CERTIFIED COMMUNI TY 14
BEHAVIORAL HEALTH CL INICS THROUGH A DAIL Y BUNDLED PAYMENT 15
METHODOLOGY THAT IS IN ALIGNMENT WITH FE DERAL PAYMENT FROM T HE 16
CENTERS FOR MEDICARE AND MEDICAID SERVICES FOR THE CERTIFI ED 17
COMMUNITY BEHAVIORAL HEALTH CLINICS MEDICAID DEMONSTRATIO N UNDER § 18
223 OF THE FEDERAL PROTECTING ACCESS TO MEDICARE ACT OF 2014; AND 19
(2) ANY ADDITIONAL SERVIC ES IDENTIFIED BY THE DEPARTMENT . 20
(D) (1) THE DEPARTMENT SHALL ESTA BLISH STANDARDS AND 21
METHODOLOGIES FOR A PROSPECTIVE PAYMENT SYSTEM TO REIMBURSE A 22
CERTIFIED COMMUNITY BEHAVIORAL HEALTH CL INIC UNDER THE PROGRAM ON A 23
PREDETERMINED FIXED AMOUNT PER DAY FOR C OVERED SERVICES PROV IDED TO A 24
PROGRAM RECIPIENT . 25
(2) THE PROSPECTI VE PAYMENT RATE FOR A CERTIFIED COMMUNIT Y 26
BEHAVIORAL HEALTH CL INIC SHALL: 27
(I) BE ADJUSTED ONCE EVER Y 3 YEARS BY THE MEDICARE 28
ECONOMIC INDEX IN ACCORDANCE W ITH § 223 OF THE FEDERAL PROTECTING 29
ACCESS TO MEDICARE ACT OF 2014; AND 30
(II) ALLOW FOR MODIFI CATIONS BASED ON A C HANGE IN SCOPE 31
FOR AN INDIVIDUAL CE RTIFIED COMMUNITY BE HAVIORAL HEALTH CLIN IC. 32
16 HOUSE BILL 1148
(3) THE DEPARTMENT MAY CONSID ER RATE ADJUSTMENTS ON 1
REQUEST BY A CERTIFI ED COMMUNITY BEHAVIO RAL HEALTH CLINIC . 2
(E) (1) THE DEPARTMENT SHALL ESTA BLISH A QUALITY INCENTIVE 3
PAYMENT SYSTEM FOR A CERTIFIED COMMUNITY BEHAVIORAL HEALTH CL INIC 4
THAT ACHIEVES SPECIF IED THRESHOLDS ON PE RFORMANCE METRICS 5
ESTABLISHED BY THE DEPARTMENT . 6
(2) THE QUALITY INCENTIVE PAYMENT SYSTEM ESTAB LISHED UNDER 7
PARAGRAPH (1) OF THIS SUBSECTION SHALL B E IN ADDITION TO THE PROSPECTIVE 8
PAYMENT RATE ESTABLI SHED UNDER SUBSECTIO N (D) OF THIS SECTION. 9
Article – Insurance 10
15–139. 11
(a) (1) In this section, “telehealth” means, as it relates to the delivery of health 12
care services, the use of interactive audio, video, or other telecommunications or electronic 13
technology by a licensed health care provider to deliver a health care service within the 14
scope of practice of the health care provider at a location other than the location of the 15
patient. 16
(2) “Telehealth” includes from July 1, 2021, to June 30, [2023] 2025, both 17
inclusive, an audio–only telephone conversation between a health care provider and a 18
patient that results in the delivery of a billable, covered health care service. 19
(3) “Telehealth” does not include: 20
(i) except as provided in paragraph (2) of this subsection, an 21
audio–only telephone conversation between a health care provider and a patient; 22
(ii) an electronic mail message between a health care provider and a 23
patient; or 24
(iii) a facsimile transmission between a health care provider and a 25
patient. 26
(b) This section applies to: 27
(1) insurers and nonprofit health service plans that provide hospital, 28
medical, or surgical benefits to individuals or groups on an expense–incurred basis under 29
health insurance policies or contracts that are issued or delivered in the State; and 30
(2) health maintenance organizations that provide hospital, medical, or 31
surgical benefits to individuals or groups under contracts that are issued or delivered in 32
the State. 33 HOUSE BILL 1148 17
(c) (1) An entity subject to this section: 1
(i) shall provide coverage under a health insurance policy or 2
contract for health care services appropriately delivered through telehealth regardless of 3
the location of the patient at the time the telehealth services are provided; 4
(ii) may not exclude from coverage a health care service solely 5
because it is provided through telehealth and is not provided through an in–person 6
consultation or contact between a health care provider and a patient; and 7
(iii) may not exclude from coverage or deny coverage for a behavioral 8
health care service that is a covered benefit under a health insurance policy or contract 9
when provided in person solely because the behavioral health care service may also be 10
provided through a covered telehealth benefit. 11
(2) The health care services appropriately delivered through telehealth 12
shall include counseling and treatment for substance use disorders and mental health 13
conditions. 14
(d) (1) Subject to paragraph (2) of this subsection, an entity subject to this 15
section: 16
(i) shall reimburse a health care provider for the diagnosis, 17
consultation, and treatment of an insured patient for a health care service covered under a 18
health insurance policy or contract that can be appropriately provided through telehealth; 19
(ii) is not required to: 20
1. reimburse a health care provider for a health care service 21
delivered in person or through telehealth that is not a covered benefit under the health 22
insurance policy or contract; or 23
2. reimburse a health care provider who is not a covered 24
provider under the health insurance policy or contract; and 25
(iii) 1. may impose a deductible, copayment, or coinsurance 26
amount on benefits for health care services that are delivered either through an in–person 27
consultation or through telehealth; 28
2. may impose an annual dollar maximum as permitted by 29
federal law; and 30
3. may not impose a lifetime dollar maximum. 31
(2) (i) From July 1, 2021, to June 30, [2023] 2025, both inclusive, when 32
a health care service is appropriately provided through telehealth, an entity subject to this 33 18 HOUSE BILL 1148
section shall provide reimbursement in accordance with paragraph (1)(i) of this subsection 1
on the same basis and at the same rate as if the health care service were delivered by the 2
health care provider in person. 3
(ii) The reimbursement required under subparagraph (i) of this 4
paragraph does not include: 5
1. clinic facility fees unless the health care service is 6
provided by a health care provider not authorized to bill a professional fee separately for 7
the health care service; or 8
2. any room and board fees. 9
(iii) This paragraph may not be construed to supersede the authority 10
of the Health Services Cost Review Commission to set the appropriate rates for hospitals, 11
including setting the hospital facility fee for hospital–provided telehealth. 12
(e) Subject to subsection (d)(1)(ii) of this section, an entity subject to this section 13
may not impose as a condition of reimbursement of a covered health care service delivered 14
through telehealth that the health care service be provided by a third–party vendor 15
designated by the entity. 16
(f) An entity subject to this section may undertake utilization review, including 17
preauthorization, to determine the appropriateness of any health care service whether the 18
service is delivered through an in–person consultation or through telehealth if the 19
appropriateness of the health care service is determined in the same manner. 20
(g) A health insurance policy or contract may not distinguish between patients in 21
rural or urban locations in providing coverage under the policy or contract for health care 22
services delivered through telehealth. 23
(h) A decision by an entity subject to this section not to provide coverage for 24
telehealth in accordance with this section constitutes an adverse decision, as defined in § 25
15–10A–01 of this title, if the decision is based on a finding that telehealth is not medically 26
necessary, appropriate, or efficient. 27
SECTION 4. AND BE IT FURTHER ENACTED, That Section 2 of this Act shall take 28
effect October 1, 2023. It shall remain effective for a period of 4 years and 2 months and, at 29
the end of November 30, 2027, Section 2 of this Act, with no further action required by the 30
General Assembly, shall be abrogated and of no further force and effect. 31
SECTION 5. AND BE IT FURTHER ENACTED, That, except as provided in Section 32
4 of this Act, this Act shall take effect June 1, 2023. Section 1 of this Act shall remain 33
effective for a period of 4 years and 1 month and, at the end of June 30, 2027, Section 1 of 34
this Act, with no further action required by the General Assembly, shall be abrogated and 35
of no further force and effect. 36