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