WES MOORE, Governor Ch. 291
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Chapter 291
(House Bill 1148)
AN ACT concerning
Behavioral Health Care – Treatment and Access
(Behavioral Health Model for Maryland)
FOR the purpose of establishing the Commission on Behavioral Health Care Treatment
and Access to make recommendations to provide appropriate, accessible, and
comprehensive behavioral health services that are available on demand to
individuals in the State across the behavioral health continuum that are available
on demand; establishing the Behavioral Health Care Coordination Value–Based
Purchasing Pilot Program in the Maryland Department of Health to establish and
implement an intensive care coordination model using value–based purchasing in
the specialty behavioral health system; requiring, on or before a certain date, the
Department to submit a State plan amendment to the Centers for Medicare and
Medicaid Services to establish certified community behavioral health clinics apply
for certain federal planning grant funds; requiring the Department to apply to
participate in a certain demonstration program; extending to a certain date the
inclusion of certain audio–only telephone conversations in the definition of
“telehealth” in the Maryland Medical Assistance Program and certain requirements
related to the provision of reimbursement for health care services appropriately
provided through telehealth by the Program and certain insurers, nonprofit health
service plans, and health maintenance organizations; requiring the Maryland
Health Care Commission to study and make recommendations regarding the
delivery of health care services through telehealth, including payment parity for the
delivery of health care services through audiovisual and audio–only telehealth
technologies; and generally relating to behavioral health care treatment and access.
BY adding to
Article – Health – General
Section 13–4801 through 13–4807 to be under the new subtitle “Subtitle 48.
Commission on Behavioral Health Care Treatment and Access”; and 13–4901
through 13–4907 to be under the new subtitle “Subtitle 49. Behavioral Health
Care Coordination Value–Based Purchasing Pilot Program”; and 15–141.5
Annotated Code of Maryland
(2019 Replacement Volume and 2022 Supplement)
BY repealing and reenacting, with amendments,
Article – Health – General
Section 15–141.2
Annotated Code of Maryland
(2019 Replacement Volume and 2022 Supplement)
BY repealing and reenacting, with amendments, Ch. 291 2023 LAWS OF MARYLAND
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Article – Insurance
Section 15–139
Annotated Code of Maryland
(2017 Replacement Volume and 2022 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Health – General
SUBTITLE 48. COMMISSION ON BEHAVIORAL HEALTH CARE TREATMENT AND
ACCESS.
13–4801.
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS
INDICATED.
(B) “BEHAVIORAL HEALTH ” INCLUDES SUBSTANCE–RELATED DISORDERS ,
ADDICTIVE DISORDERS , MENTAL DISORDERS , LIFE STRESSORS AND C RISES, AND
STRESS–RELATED PHYSICAL SYM PTOMS.
(C) “COMMISSION” MEANS THE COMMISSION ON BEHAVIORAL HEALTH
CARE TREATMENT AND ACCESS.
13–4802.
THERE IS A COMMISSION O N BEHAVIORAL HEALTH CARE TREATMENT AND
ACCESS.
13–4803.
(A) THE COMMISSION CONSISTS O F THE FOLLOWING MEMB ERS:
(1) ONE MEMBER OF THE SENATE OF MARYLAND, APPOINTED BY THE
PRESIDENT OF THE SENATE;
(2) ONE MEMBER OF THE HOUSE OF DELEGATES, APPOINTED B Y THE
SPEAKER OF THE HOUSE;
(3) ONE REPRESENTATIVE OF MARYLAND’S CONGRESSIONAL
DELEGATION;
(4) THE SECRETARY OF HEALTH, OR THE SECRETARY’S DESIGNEE; WES MOORE, Governor Ch. 291
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(5) THE SECRETARY OF HUMAN SERVICES, OR THE SECRETARY’S
DESIGNEE;
(6) THE SECRETARY OF JUVENILE SERVICES, OR THE SECRETARY’S
DESIGNEE;
(7) THE DEPUTY SECRETARY FOR BEHAVIORAL HEALTH, OR THE
DEPUTY SECRETARY’S DESIGNEE;
(8) THE MARYLAND INSURANCE COMMISSIONER , OR THE
COMMISSIONER ’S DESIGNEE;
(9) THE EXECUTIVE DIRECTOR OF THE HEALTH SERVICES COST
REVIEW COMMISSION, OR THE EXECUTIVE DIRECTOR’S DESIGNEE;
(10) THE EXECUTIVE DIRECTOR OF THE MARYLAND HEALTH CARE
COMMISSION, OR THE EXECUTIVE DIRECTOR’S DESIGNEE;
(11) THE EXECUTIVE DIRECTOR OF THE MARYLAND COMMUNITY
HEALTH RESOURCES COMMISSION, OR THE EXECUTIVE DIRECTOR’S DESIGNEE;
(12) THE EXECUTIVE DIRECTOR OF THE STATE–DESIGNATED HEALTH
INFORMATION EXCHANGE , OR THE EXECUTIVE DIRECTOR’S DESIGNEE;
(13) THE EXECUTIVE DIRECTOR OF THE GOVERNOR’S OFFICE OF
CRIME PREVENTION, YOUTH, AND VICTIM SERVICES, OR THE EXECUTIVE
DIRECTOR’S DESIGNEE; AND
(14) THE SECRETARY OF THE MARYLAND DEPARTMENT OF
DISABILITIES, OR THE SECRETARY’S DESIGNEE;
(15) THE SECRETARY OF THE DEPARTMENT OF PUBLIC SAFETY AND
CORRECTIONAL SERVICES, OR THE SECRETARY’S DESIGNEE;
(16) THE SPECIAL SECRETARY OF OPIOID RESPONSE, OR THE
SPECIAL SECRETARY’S DESIGNEE; AND
(14) (17) THE FOLLOWING MEMBERS APPOINTED BY THE
GOVERNOR:
(I) ONE REPRESENTATIVE OF THE MENTAL HEALTH
ASSOCIATION OF MARYLAND;
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(II) ONE REPRESENTATIVE OF THE NATIONAL ALLIANCE ON
MENTAL ILLNESS;
(III) ONE REPRESENTATIVE OF THE COMMUNITY BEHAVIORAL
HEALTH ASSOCIATION OF MARYLAND;
(IV) ONE REPRESENTATIVE OF A PROVIDER OF RESIDE NTIAL
BEHAVIORAL HEALTH SE RVICES;
(V) ONE REPRESENTATIVE OF AN ACUTE CARE HOSPIT AL;
(VI) ONE REPRESENTATIVE OF AN INPATIENT PSYCHIA TRIC
HOSPITAL;
(VII) ONE INDIVIDUAL WITH E XPERIENCE AS A CONSU MER OF
BEHAVIORAL HEALTH SE RVICES;
(VIII) ONE FAMILY MEMBER OF AN INDIVIDUAL WITH
EXPERIENCE AS A CONS UMER OF BEHAVIORAL H EALTH SERVICES ;
(IX) ONE REPRESENTATIVE OF A PROVIDER OF SUBSTA NCE USE
TREATMENT SERVICES ;
(X) ONE REPRESENTATIVE OF A SCHOOL–BASED HEALTH
CENTER;
(XI) ONE INDIVIDUAL WITH E XPERTISE IN SOCIAL
DETERMINANTS OF HEAL TH;
(XII) ONE INDIVIDUAL WITH E XPERTISE IN HEALTH E CONOMICS;
(XIII) ONE REPRESENTATIVE OF A HEALTH INSURANCE C ARRIER;
(XIV) ONE REPRESENTATIVE OF A MANAGED CARE
ORGANIZATION ;
(XV) ONE REPRESENTATIVE FR OM THE OFFICE OF THE PUBLIC
DEFENDER;
(XVI) ONE REPRESENTATIVE OF THE DEVELOPMENTAL
DISABILITY COALITION;
(XVII) ONE REPRESENTATIVE OF THE MARYLAND CHAPTER OF
THE NATIONAL COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE ; WES MOORE, Governor Ch. 291
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(XVIII) ONE REPRESENTATIVE OF THE MARYLAND
PSYCHOLOGICAL ASSOCIATION; AND
(XIX) ONE REPRESENTATIVE OF DISABILITY RIGHTS MARYLAND;
(XX) ONE REPRESENTATIVE OF A FEDERALLY QUALIFIED
HEALTH CENTER;
(XXI) ONE REPRESENTATIVE OF A LOCAL BEHAVIORAL HEALTH
AUTHORITY; AND
(XXII) ONE INDIVIDUAL WITH A N INTELLECTUAL DISAB ILITY WHO
USES SELF–DIRECTED BEHAVIORAL HEALTH SERVICES .
(B) TO THE EXTENT PRACTIC ABLE, THE MEMBERSHIP OF TH E COMMISSION
SHALL REFLECT THE GE OGRAPHIC AND ETHNIC DIVERSITY OF THE STATE.
(C) THE GOVERNOR, THE PRESIDENT OF THE SENATE, AND THE SPEAKER
OF THE HOUSE JOINTLY SHALL D ESIGNATE THE CHAIR O F THE COMMISSION.
(D) THE DEPARTMENT SHALL PROV IDE STAFF FOR THE COMMISSION.
(E) A MEMBER OF THE COMMISSION:
(1) MAY NOT RECEIVE COMPENSATION AS A ME MBER OF THE
COMMISSION; BUT
(2) IS ENTITLED TO REIMBU RSEMENT FOR EXPENSES UNDER THE
STANDARD STATE TRAVEL REGULATIONS, AS PROVIDED IN THE STATE BUDGET .
(F) THE COMMISSION SHALL MEET AT LEAST THREE TIMES PER YEAR AT
THE TIMES AND PL ACES DETERMINED BY T HE COMMISSION.
13–4804.
THE PURPOSE OF THE COMMISSION IS TO MAKE RECOMMENDATIONS TO
PROVIDE APPROPRIATE , ACCESSIBLE, AND COMPREHENSIVE BE HAVIORAL HEALTH
SERVICES THAT ARE AVAILABLE O N DEMAND TO INDIVIDUALS IN TH E STATE ACROSS
THE BEHAVIORAL HEALT H CONTINUUM THAT ARE AVAILABLE O N DEMAND.
13–4805.
THE COMMISSION SHALL : Ch. 291 2023 LAWS OF MARYLAND
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(1) CONDUCT AN ASSESSMENT OF BEHAVIORAL HEALTH SERVICES IN
THE STATE TO IDENTIFY NEE DS AND GAPS IN SERVI CES ACROSS THE CON TINUUM,
INCLUDING COMMUNITY –BASED OUTPATIENT AND SUPPORT SERVICES , CRISIS
RESPONSE, AND INPATIENT CARE ;
(2) EXAMINE THE METHODS F OR REIMBURSING BEHAV IORAL
HEALTH CARE SERVICES IN THE STATE AND MAKE RECOMM ENDATIONS ON THE
MOST EFFECTIVE FORMS OF REIMBURS EMENT TO MAXIMIZE SE RVICE DELIVERY ;
(3) COMPILE FINDINGS OF STATE–SPECIFIC NEEDS ASSES SMENTS
RELATED TO BEHAVIORA L HEALTH CARE SERVIC ES;
(4) REVIEW RECOMMENDATION S AND REPORTS OF STATE
COMMISSIONS , WORKGROUPS , OR TASK FORCES RELAT ED TO BEHAVIORAL HEALTH
CARE SERVICES ;
(5) CONDUCT A NEEDS ASSES SMENT ON THE STATE’S BEHAVIORAL
HEALTH CARE WORKFORC E TO IDENTIFY GAPS A ND MAKE RECOMMENDATI ONS TO
ENSURE AN ADEQUATE , CULTURALLY COMPETENT , AND DIVERSE WORKFORCE
ACROSS THE BEHAVIORA L HEALTH CARE CONTIN UUM;
(6) REVIEW TRENDS AND BES T PRACTICES FROM OTH ER STATES
REGARDING POLICY AND REIMBURSEMENT STRATE GIES THAT SUPPORT AC CESS TO
A COMPREHENSIVE ARRA Y OF SERVICES AND EN SURE QUALITY OF CARE ;
(7) EXAMINE AND MAKE RECO MMENDATIONS RELATED TO THE
BEHAVIORAL HEALTH OF THE GERIAT RIC AND YOUTH POPULA TIONS IN THE STATE;
(8) EXAMINE AND MAKE RECO MMENDATIONS TO PROVI DE
APPROPRIATE AND ADEQ UATE BEHAVIORAL HEAL TH SERVICES TO INDIV IDUALS
WITH DEVELOPMENTAL DISABI LITIES AND COMPLEX BEHAVIORAL H EALTH NEEDS ,
SPECIFICALLY YOUTH;
(9) ASSESS THE HEALTH INF RASTRUCTURE , FACILITIES,
PERSONNEL , AND SERVICES AVAILAB LE FOR THE STATE’S FORENSIC POPULATIO N
AND IDENTIFY DEFICIE NCIES IN RESOURCES A ND POLICIES NEEDED T O PRIORITIZE
HEALTH OUTCOMES , INCREASE PUBLIC SAFE TY, AND REDUCE RECIDIVISM ;
(10) MAKE RECOMMENDATIONS ON EXPANDING BEHAVIO RAL HEALTH
TREATMENT ACCESS FOR THE STATE’S COURT–ORDERED POPULATION ;
WES MOORE, Governor Ch. 291
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(11) MAKE RECOMMENDATIONS ON ACTION PLANS REGA RDING THE
BEHAVIORAL HEALTH CA RE SYSTEM’S CAPACITY TO PREPAR E FOR AND RESPOND TO
FUTURE CHALLENGES AF FECTING THE ENTIRE STATE OR PARTICULAR R EGIONS OR
POPULATIONS IN THE STATE, INCLUDING PANDEMICS AND EXTREME WEATHE R
EVENTS; AND
(12) MAKE RECOMMENDATIONS TO ENSURE THAT BEHAV IORAL
HEALTH TREATMENT IS PROVIDED IN THE APPR OPRIATE SETTING , INCLUDING
METHODS TO DIVERT BE HAVIORAL HEALTH PATI ENTS FROM EMERGENCY
DEPARTMENTS BY USING THE MARYLAND MENTAL HEALTH AND SUBSTANCE USE
DISORDER REGISTRY AND REFERRAL SYSTEM ESTABLISHED UN DER § 7.5–802 OF
THIS ARTICLE AND 2–1–1;
(13) EXAMINE AND REVIEW TH E USE OF HARM REDUCT ION
STRATEGIES TO FACILI TATE ACCESS TO CARE ; AND
(14) EXAMINE METHODS TO AS SIST CONSUMERS IN AC CESSING
BEHAVIORAL HEALTH SE RVICES.
13–4806.
(A) THE COMMISSION SHALL ESTA BLISH THE FOLLOWING WORKGROUPS :
(1) GERIATRIC BEHAVIORAL HEALTH;
(2) YOUTH BEHAVIORAL HEAL TH, INDIVIDUALS WITH
DEVELOPMENTAL DISABI LITIES, AND INDIVIDUALS WITH COMPLEX BEHAVIORAL
HEALTH NEEDS;
(3) CRIMINAL JUSTICE –INVOLVED BEHAVIORAL HEALTH; AND
(4) BEHAVIORAL HEALTH WOR KFORCE DEVELOPMENT ,
INFRASTRUCTURE , COORDINATION , AND FINANCING .
(B) THE WORKGROUPS ESTABL ISHED UNDER SUBSECTI ON (A) OF THIS
SECTION SHALL MEET A T LEAST TWO T IMES PER YEAR AT THE TIMES AND PLACES
DETERMINED BY THE WO RKGROUP.
(C) THE WORKGROUPS ESTABL ISHED UNDER SUBSECTI ON (A) OF THIS
SECTION SHALL INCLUD E MEMBERS OF THE COMMISSION AND MAY IN CLUDE
INDIVIDUALS INVITED BY THE COMMISSION TO SERVE O N THE WORKGROUP .
Ch. 291 2023 LAWS OF MARYLAND
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(D) ON OR BEFORE DECEMBER 1 EACH YEAR, BEGINNING IN 2023, THE
WORKGROUPS ESTABLISH ED UNDER SUBSECTION (A) OF THIS SECTION SHAL L
REPORT AND MAKE RECO MMENDATIONS TO THE COMMISSION.
13–4807.
(A) (1) ON OR BEFORE JANUARY 1 EACH YEAR, BEGINNING IN 2024, THE
COMMISSION SHALL REPO RT TO THE GOVERNOR AND , IN ACCORDANCE WITH §
2–1257 OF THE STATE GOVERNMENT ARTICLE, THE GENERAL ASSEMBLY ON THE
COMMISSION’S FINDINGS AND RECOM MENDATIONS , INCLUDING FUNDING AN D
LEGISLATIVE RECOMMEN DATIONS, THAT ARE CONSISTENT WITH PROVIDING
APPROPRIATE , ACCESSIBLE, AND COMPREHENSIVE BE HAVIORAL HEALTH SERV ICES
THAT ARE AVAILABLE O N DEMAND TO INDIVIDU ALS IN THE STATE ACROSS THE
BEHAVIORAL HEALTH CO NTINUUM.
(2) ANY LEGISLATIVE RECOM MENDATIONS INCLUDED IN THE
REPORT REQUIRED UNDE R PARAGRAPH (1) OF THIS SUBSECTION T HAT REQUIRE
FUNDING SHALL INCLUD E AN ESTIMATE OF THE FUNDING REQUIRED TO
IMPLEMENT THE RECOMM ENDATION AND INFORMA TION THAT SUPPORTS T HE
FUNDING ESTIMATE .
(B) THE REPORT REQUIRED O N OR BEFORE JANUARY 1, 2024, SHALL
INCLUDE THE FINDINGS OF THE NEEDS ASSESSMENTS RE QUIRED UNDER § 13–4805
OF THIS SUBTITLE.
SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read
as follows:
Article – Health – General
SUBTITLE 49. BEHAVIORAL HEALTH CARE COORDINATION VALUE–BASED
PURCHASING PILOT PROGRAM.
13–4901.
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS
INDICATED.
(B) “BEHAVIORAL HEALTH CAR E COORDINATION ” MEANS A
PERSON–CENTERED, TEAM–BASED ACTIVITY DESIG NED TO:
(1) ASSESS AND MEET THE N EEDS OF AN INDIVID UAL WITH A
BEHAVIORAL HEALTH CO NDITION; AND
WES MOORE, Governor Ch. 291
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(2) HELP THE INDIVIDUAL N AVIGATE THE HEALTH C ARE SYSTEM
EFFECTIVELY AND EFFI CIENTLY.
(C) “PILOT PROGRAM” MEANS THE BEHAVIORAL HEALTH CARE
COORDINATION VALUE–BASED PURCHASING PILOT PROGRAM.
(D) “VALUE–BASED PURCHASING ” MEANS FINANCIALLY IN CENTIVIZING
PROVIDERS TO MEET SP ECIFIED OUTCOME MEAS URES.
13–4902.
THERE IS A BEHAVIORAL HEALTH CARE COORDINATION VALUE–BASED
PURCHASING PILOT PROGRAM IN THE DEPARTMENT .
13–4903.
THE PURPOSE OF THE PILOT PROGRAM IS TO ESTABLISH AND IMP LEMENT AN
INTENSIVE CARE COORD INATION MODEL USING VALUE–BASED PURCHASING IN THE
SPECIALTY BEHAVIORAL HEALTH SYSTEM .
13–4904.
(A) THE DEPARTMENT SHALL ADMI NISTER THE PILOT PROGRAM.
(B) THE DEPARTMENT SHALL IDEN TIFY AT LEAST 500 ADULTS WHOSE
BEHAVIORAL HEALTH CO NDITION OR FUNCTIONI NG PLACES THEM AT RI SK OF
HOSPITAL EMERGENCY D EPARTMENT UTILIZATIO N OR INPATIENT PSYCH IATRIC
HOSPITAL ADMISSION .
(C) THE PILOT PROGRAM SHALL BE OPER ATIONAL FOR A 3–YEAR PERIOD.
(D) A PROVIDER OR NETWORK OF PROVIDERS SELECTE D TO PARTICIPATE
IN THE PILOT PROGRAM SHALL :
(1) BE LICENSED AND IN GO OD STANDING WITH THE MARYLAND
MEDICAL ASSISTANCE PROGRAM;
(2) HAVE EXPERIENCE IN PR OVIDING COMMUNITY –BASED CARE
COORDINATION TO SPEC IALTY BEHAVIORAL HEA LTH PROGRAM RECIPIENTS ;
(3) USE AN ELECTRONIC MED ICAL RECORD FOR DOCU MENTING CARE
COORDINATION ACTIVIT IES AND OUTCOMES COL LECTION; AND
Ch. 291 2023 LAWS OF MARYLAND
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(4) HAVE AN AUTOMATED DAT A EXCHANGE WITH THE
STATE–DESIGNATED HEALTH IN FORMATION EXCHANGE .
(E) THE DEPARTMENT SHALL :
(1) PROVIDE REIMBURSEMENT ON A PER MEMBER PER MONTH BASIS
FOR THE BEHAVIORAL H EALTH CARE COORDINAT ION ACTIVITIES THAT ARE NOT
OTHERWISE COVERED BY THE MARYLAND MEDICAL ASSISTANCE PROGRAM;
(2) COLLECT OUTCOMES DATA ON RECIPIENTS OF HEA LTH CARE
SERVICES UNDER THE PILOT PROGRAM; AND
(3) EVALUATE THE EFFECTIV ENESS OF THE VALUE –BASED
PURCHASING MODEL BY ANALYZING THE FOLLOW ING OUTCOME MEASURES :
(I) A COMPARISON OF THE FO LLOWING DATA ELEMENT S
BEFORE AND AFTER ENR OLLMENT OF RECIPIENT S OF HEALTH CARE SER VICES
UNDER THE PILOT PROGRAM:
1. EMERGENCY DEPARTMENT UTILIZATION FOR BOTH
BEHAVIORAL AND SOMAT IC HEALTH PURPOSES ;
2. INPATIENT HOSPITALIZA TION FOR BOTH
BEHAVIORAL AND SOMAT IC HEALTH PURPOSES ; AND
3. TOTAL HEALTH CARE EXP ENDITURES;
(II) OUTCOMES FOR RECIPIEN TS WITH AND WITHOUT PRIMARY
CARE SERVICES COORDI NATED BY A BEHAVIORA L HEALTH PROVIDER ; AND
(III) RECOGNIZED CLINICAL Q UALITY METRICS WHICH MAY
INCLUDE PATIENT EXPE RIENCE MEASURES .
13–4905.
IF NECESSARY TO IMPLE MENT THE PILOT PROGRAM, THE DEPARTMENT
SHALL APPLY TO THE CENTERS FOR MEDICARE AND MEDICAID SERVICES FOR AN
AMENDMENT TO THE STATE’S § 1115 HEALTHCHOICE DEMONSTRATION .
13–4906.
(A) FOR EACH OF FISCAL YE AR 2025, FISCAL YEAR 2026, AND FISCAL YEAR
2027, THE GOVERNOR SHAL L INCLUDE IN THE ANN UAL BUDGET BILL AN
APPROPRIATION OF $600,000 FOR THE PILOT PROGRAM. WES MOORE, Governor Ch. 291
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(B) BEGINNING IN FISCAL Y EAR 2026, THE DEPARTMENT SHALL ALLO CATE
A PERCENTAGE OF THE ANNUAL APPROPRIATION REQUIRED UNDER SUBSE CTION
(A) OF THIS SECTION TO REIMBURSEMENT PAID B ASED ON THE ACHIEVEM ENT OF
THE OUTCOME MEASURES DESCRIBED IN § 13–4904(E)(3) OF THIS SUBTITLE.
(C) IN FISCAL YEAR 2027, THE DEPARTMENT SHALL INCR EASE THE
PERCENTAGE OF THE AN NUAL APPROPRIATION R EQUIRED UNDER SUBSEC TION (A)
OF THIS SECTION ALLOCATED TO RE IMBURSEMENT PAID IN ACCORDANCE WITH
SUBSECTION (B) OF THIS SECTION OVER THE PERCENTAGE ALLOC ATED IN FISCAL
YEAR 2026.
13–4907.
ON OR BEFORE NOVEMBER 1, 2027, THE DEPARTMENT SHALL REPO RT TO
THE GOVERNOR AND , IN ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT
ARTICLE, THE GENERAL ASSEMBLY ON THE DEPARTMENT ’S FINDINGS AND
RECOMMENDATIONS FROM THE PILOT PROGRAM.
SECTION 3. AND BE IT FURTHER ENACTED, That the Laws of Maryland read
as follows:
Article – Health – General
15–141.2.
(a) (1) In this section the following words have the meanings indicated.
(2) “Distant site” means a site at which the distant site health care provider
is located at the time the health care service is provided through telehealth.
(3) “Distant site provider” means the health care provider who provides
medically necessary services to a patient at an originating site from a different physical
location than the location of the patient.
(4) “Health care provider” means:
(i) A person who is licensed, certified, or otherwise authorized under
the Health Occupations Article to provide health care in the ordinary course of business or
practice of a profession or in an approved education or training program;
(ii) A mental health and substance use disorder program licensed in
accordance with § 7.5–401 of this article;
Ch. 291 2023 LAWS OF MARYLAND
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(iii) A person licensed under Title 7, Subtitle 9 of this article to
provide services to an individual with developmental disability or a recipient of individual
support services; or
(iv) A provider as defined under § 16–201.4 of this article to provide
services to an individual receiving long–term care services.
(5) “Originating site” means the location of the Program recipient at the
time the health care service is provided through telehealth.
(6) “Remote patient monitoring services” means the use of synchronous or
asynchronous digital technologies that collect or monitor medical, patient–reported, and
other forms of health care data for Program recipients at an originating site and
electronically transmit that data to a distant site provider to enable the distant site
provider to assess, diagnose, consult, treat, educate, provide care management, suggest
self–management, or make recommendations regarding the Program recipient’s health
care.
(7) (i) “Telehealth” means the delivery of medically necessary somatic,
dental, or behavioral health services to a patient at an originating site by a distant site
provider through the use of technology–assisted communication.
(ii) “Telehealth” includes:
1. Synchronous and asynchronous interactions;
2. From July 1, 2021, to June 30, [2023] 2025, both
inclusive, an audio–only telephone conversation between a health care provider and a
patient that results in the delivery of a billable, covered health care service; and
3. Remote patient monitoring services.
(iii) “Telehealth” does not include the provision of health care
services solely through:
1. Except as provided in subparagraph (ii)2 of this
paragraph, an audio–only telephone conversation;
2. An e–mail message; or
3. A facsimile transmission.
(b) The Program shall:
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(1) Provide health care services appropriately delivered through telehealth
to Program recipients regardless of the location of the Program recipient at the time
telehealth services are provided; and
(2) Allow a distant site provider to provide health care services to a
Program recipient from any location at which the health care services may be appropriately
delivered through telehealth.
(c) The services required to be provided under subsection (b) of this section shall
include counseling and treatment for substance use disorders and mental health conditions.
(d) The Program may not:
(1) Exclude from coverage a health care service solely because it is provided
through telehealth and is not provided through an in–person consultation or contact
between a health care provider and a patient; or
(2) Exclude from coverage a behavioral health care service provided to a
Program recipient in person solely because the service may also be provided through
telehealth.
(e) The Program may undertake utilization review, including preauthorization,
to determine the appropriateness of any health care service whether the service is delivered
through an in–person consultation or through telehealth if the appropriateness of the
health care service is determined in the same manner.
(f) The Program may not distinguish between Program recipients in rural or
urban locations in providing coverage under the Program for health care services delivered
through telehealth.
(g) (1) Subject to paragraph (3) of this subsection, the Program shall
reimburse a health care provider for the diagnosis, consultation, and treatment of a
Program recipient for a health care service covered by the Program that can be
appropriately provided through telehealth.
(2) This subsection does not require the Program to reimburse a health
care provider for a health care service delivered in person or through telehealth that is:
(i) Not a covered health care service under the Program; or
(ii) Delivered by an out–of–network provider unless the health care
service is a self–referred service authorized under the Program.
(3) (i) From July 1, 2021, to June 30, [2023] 2025, both inclusive, when
appropriately provided through telehealth, the Program shall provide reimbursement in Ch. 291 2023 LAWS OF MARYLAND
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accordance with paragraph (1) of this subsection on the same basis and the same rate as if
the health care service were delivered by the health care provider in person.
(ii) The reimbursement required under subparagraph (i) of this
paragraph does not include:
1. Clinic facility fees unless the health care service is
provided by a health care provider not authorized to bill a professional fee separately for
the health care service; or
2. Any room and board fees.
(h) (1) The Department may specify in regulation the types of health care
providers eligible to receive reimbursement for health care services provided to Program
recipients under this section.
(2) If the Department specifies by regulation the types of health care
providers eligible to receive reimbursement for health care services provided to Program
recipients under this subsection, the regulations shall include all types of health care
providers that appropriately provide telehealth services.
(3) For the purpose of reimbursement and any fidelity standards
established by the Department, a health care service provided through telehealth is
equivalent to the same health care service when provided through an in –person
consultation.
(i) Subject to subsection (g)(2) of this section, the Program or a managed care
organization that participates in the Program may not impose as a condition of
reimbursement of a covered health care service delivered through telehealth that the
health care service be provided by a third–party vendor designated by the Program.
(j) The Department may adopt regulations to carry out this section.
(k) The Department shall obtain any federal authority necessary to implement
the requirements of this section, including applying to the Centers for Medicare and
Medicaid Services for an amendment to any of the State’s § 1115 waivers or the State plan.
(l) This section may not be construed to supersede the authority of the Health
Services Cost Review Commission to set the appropriate rates for hospitals, including
setting the hospital facility fee for hospital–provided telehealth.
15–141.5.
(A) IN THIS SECTION , “CERTIFIED COMMUNITY BEHAVIORAL HEALTH
CLINIC” MEANS A NONPROFIT CO MPREHENSIVE COMMUNIT Y MENTAL HEALTH OR
SUBSTANCE USE TREATM ENT ORGANIZATION LIC ENSED BY THE STATE THAT MEETS WES MOORE, Governor Ch. 291
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THE FEDERAL CERTIFIC ATION CRITERIA OF § 223 OF THE FEDERAL PROTECTING
ACCESS TO MEDICARE ACT OF 2014 AND OFFERS , DIRECTLY OR INDIRECT LY
THROUGH FORMAL REFER RAL RELATIONSHIPS WI TH OTHER PROVIDERS , THE
FOLLOWING SERVICES :
(1) OUTPATIENT MENTAL HEA LTH AND SUBSTANCE US E SERVICES;
(2) 24–HOUR MOBILE CRISIS R ESPONSE AND HOTLINE SERVICES;
(3) SCREENING, ASSESSMENT, AND DIAGNOSIS , INCLUDING RISK
ASSESSMENTS ;
(4) PERSON–CENTERED TREATMENT P LANNING;
(5) PRIMARY CARE SCREENIN G AND MONITORING OF KEY
INDICATORS OF HEALTH RISKS;
(6) TARGETED CASE MANAGEM ENT;
(7) PSYCHIATRIC REHABILIT ATION SERVICES;
(8) PEER SUPPORT AND FAMI LY SUPPORTS;
(9) MEDICATION–ASSISTED TREATMENT ;
(10) ASSERTIVE COMMUNITY T REATMENT; AND
(11) COMMUNITY–BASED MENTAL HEALTH CARE FOR MILITARY
SERVICE MEMBERS AND VETERANS.
(B) ON OR BEFORE DECEMBER 1, 2023, THE DEPARTMENT SHALL SUBM IT
A STATE PLAN AMENDMENT TO THE CENTERS FOR MEDICARE AND MEDICAID
SERVICES TO ESTABLISH CERTIFIED COMMUNITY BEHAVIORAL HEALTH CL INICS IN
ACCORDANCE WITH § 223 OF THE FEDERAL PROTECTING ACCESS TO MEDICARE
ACT OF 2014.
(C) IF THE AMENDMENT SUBMITTED U NDER SUBSECTION (B) OF THIS
SECTION IS APPROVED , THE DEPARTMENT SHALL AMEN D THE STATE PLAN IN
ACCORDANCE WITH TITLE XIX AND TITLE XXI OF THE SOCIAL SECURITY ACT AS
NECESSARY TO COVER :
(1) ALL REQUIRED SERVICES FOR INDIVIDUALS WITH MENTAL
HEALTH NEEDS OR SUBS TANCE USE DISORDERS AT CERTIFIED COMMUNI TY
BEHAVIORAL HEALTH CL INICS THROUGH A DAIL Y BUNDLED PAYMENT Ch. 291 2023 LAWS OF MARYLAND
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METHODOLOGY THAT IS IN ALIGNMENT WITH FE DERAL PAYMENT FROM T HE
CENTERS FOR MEDICARE AND MEDICAID SERVICES FOR THE CERT IFIED
COMMUNITY BEHAVIORAL HEALTH CLINICS MEDICAID DEMONSTRATIO N UNDER §
223 OF THE FEDERAL PROTECTING ACCESS TO MEDICARE ACT OF 2014; AND
(2) ANY ADDITIONAL SERVIC ES IDENTIFIED BY THE DEPARTMENT .
(D) (1) THE DEPARTMENT SHALL ESTA BLISH STANDARDS AND
METHODOLOGIES FOR A PROSPECTIVE PAYMENT SYSTEM TO REIMBURSE A
CERTIFIED COMMUNITY BEHAVIORAL HEALTH CL INIC UNDER THE PROGRAM ON A
PREDETERMINED FIXED AMOUNT PER DAY FOR C OVERED SERVICES PROV IDED TO A
PROGRAM RECIPIENT .
(2) THE PROSPECTIVE PAYME NT RATE FOR A CERTIFIED COMMU NITY
BEHAVIORAL HEALTH CL INIC SHALL:
(I) BE ADJUSTED ONCE EVER Y 3 YEARS BY THE MEDICARE
ECONOMIC INDEX IN ACCORDANCE W ITH § 223 OF THE FEDERAL PROTECTING
ACCESS TO MEDICARE ACT OF 2014; AND
(II) ALLOW FOR MODIFICATIO NS BASED ON A CHANGE IN SCOPE
FOR AN INDIVIDUAL CE RTIFIED COMMUNITY BE HAVIORAL HEALTH CLIN IC.
(3) THE DEPARTMENT MAY CONSID ER RATE ADJUSTMENTS ON
REQUEST BY A CERTIFI ED COMMUNITY BEHAVIO RAL HEALTH CLINIC .
(E) (1) THE DEPARTMENT SHALL ESTA BLISH A QUALITY INCENTIVE
PAYMENT SYSTEM FOR A CERTIFIED COMMUNITY BEHAVIORAL HEALTH CL INIC
THAT ACHIEVES SPECIF IED THRESHOLDS ON PE RFORMANCE METRICS
ESTABLISHED BY THE DEPARTMENT .
(2) THE QUALITY INCENTIVE PAYMENT SYSTEM ESTAB LISHED UNDER
PARAGRAPH (1) OF THIS SUBSECT ION SHALL BE IN ADDI TION TO THE PROSPECT IVE
PAYMENT RATE ESTABLI SHED UNDER SUBSECTIO N (D) OF THIS SECTION.
Article – Insurance
15–139.
(a) (1) In this section, “telehealth” means, as it relates to the delivery of health
care services, the use of interactive audio, video, or other telecommunications or electronic
technology by a licensed health care provider to deliver a health care service within the
scope of practice of the health care provider at a location other than the location of the
patient. WES MOORE, Governor Ch. 291
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(2) “Telehealth” includes from July 1, 2021, to June 30, [2023] 2025, both
inclusive, an audio–only telephone conversation between a health care provider and a
patient that results in the delivery of a billable, covered health care service.
(3) “Telehealth” does not include:
(i) except as provided in paragraph (2) of this subsection, an
audio–only telephone conversation between a health care provider and a patient;
(ii) an electronic mail message between a health care provider and a
patient; or
(iii) a facsimile transmission between a health care provider and a
patient.
(b) This section applies to:
(1) insurers and nonprofit health service plans that provide hospital,
medical, or surgical benefits to individuals or groups on an expense–incurred basis under
health insurance policies or contracts that are issued or delivered in the State; and
(2) health maintenance organizations that provide hospital, medical, or
surgical benefits to individuals or groups under contracts that are issued or delivered in
the State.
(c) (1) An entity subject to this section:
(i) shall provide coverage under a health insurance policy or
contract for health care services appropriately delivered through telehealth regardless of
the location of the patient at the time the telehealth services are provided;
(ii) may not exclude from coverage a health care service solely
because it is provided through telehealth and is not provided through an in–person
consultation or contact between a health care provider and a patient; and
(iii) may not exclude from coverage or deny coverage for a behavioral
health care service that is a covered benefit under a health insurance policy or contract
when provided in person solely because the behavioral health care service may also be
provided through a covered telehealth benefit.
(2) The health care services appropriately delivered through telehealth
shall include counseling and treatment for substance use disorders and mental health
conditions.
Ch. 291 2023 LAWS OF MARYLAND
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(d) (1) Subject to paragraph (2) of this subsection, an entity subject to this
section:
(i) shall reimburse a health care provider for the diagnosis,
consultation, and treatment of an insured patient for a health care service covered under a
health insurance policy or contract that can be appropriately provided through telehealth;
(ii) is not required to:
1. reimburse a health care provider for a health care service
delivered in person or through telehealth that is not a covered benefit under the health
insurance policy or contract; or
2. reimburse a health care provider who is not a covered
provider under the health insurance policy or contract; and
(iii) 1. may impose a deductible, copayment, or coinsurance
amount on benefits for health care services that are delivered either through an in–person
consultation or through telehealth;
2. may impose an annual dollar maximum as permitted by
federal law; and
3. may not impose a lifetime dollar maximum.
(2) (i) From July 1, 2021, to June 30, [2023] 2025, both inclusive, when
a health care service is appropriately provided through telehealth, an entity subject to this
section shall provide reimbursement in accordance with paragraph (1)(i) of this subsection
on the same basis and at the same rate as if the health care service were delivered by the
health care provider in person.
(ii) The reimbursement required under subparagraph (i) of this
paragraph does not include:
1. clinic facility fees unless the health care service is
provided by a health care provider not authorized to bill a professional fee separately for
the health care service; or
2. any room and board fees.
(iii) This paragraph may not be construed to supersede the authority
of the Health Services Cost Review Commission to set the appropriate rates for hospitals,
including setting the hospital facility fee for hospital–provided telehealth.
(e) Subject to subsection (d)(1)(ii) of this section, an entity subject to this section
may not impose as a condition of reimbursement of a covered health care service delivered WES MOORE, Governor Ch. 291
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through telehealth that the health care service be provided by a third–party vendor
designated by the entity.
(f) An entity subject to this section may undertake utilization review, including
preauthorization, to determine the appropriateness of any health care service whether the
service is delivered through an in–person consultation or through telehealth if the
appropriateness of the health care service is determined in the same manner.
(g) A health insurance policy or contract may not distinguish between patients in
rural or urban locations in providing coverage under the policy or contract for health care
services delivered through telehealth.
(h) A decision by an entity subject to this section not to provide coverage for
telehealth in accordance with this section constitutes an adverse decision, as defined in §
15–10A–01 of this title, if the decision is based on a finding that telehealth is not medically
necessary, appropriate, or efficient.
SECTION 4. AND BE IT FURTHER ENACTED, That:
(a) The Maryland Health Care Commission shall study and make
recommendations regarding the delivery of health care services through telehealth,
including payment parity for the delivery of health care services through audiovisual and
audio–only telehealth technologies.
(b) In conducting the study required under subsection (a) of this section, the
Maryland Health Care Commission shall:
(1) determine whether it is more or less costly for health care providers to
deliver health care services through telehealth;
(2) determine whether the delivery of health care services through
telehealth requires more or less clinical effort on the part of the health care provider;
(3) to help inform the debate on payment parity, identify the aspects of
telehealth that are subject to overuse or underuse or yield greater or lower value;
(4) assess the adequacy of reimbursement for behavioral health services
delivered in person and by telehealth; and
(5) address any other issues related to telehealth as determined necessary
by the Commission.
(c) On or before December 1, 2024, the Maryland Health Care Commission shall
submit a report on its findings and recommendations to the General Assembly, in
accordance with § 2–1257 of the State Government Article.
Ch. 291 2023 LAWS OF MARYLAND
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SECTION 5. AND BE IT FURTHER ENACTED, That the Maryland Department of
Health shall apply to the Substance Abuse and Mental Health Services Administration at
the Center for Mental Health Services for federal planning, developm ent, and
implementation grant funds related to certified community behavioral health clinics for
fiscal year 2025.
SECTION 6. AND BE IT FURTHER ENACTED, That the Maryland Department of
Health shall apply to the Substance Abuse and Mental Health Services Administration at
the Center for Mental Health Services for inclusion in the state certified community
behavioral health clinic demonstration program for fiscal year 2026.
SECTION 4. 7. AND BE IT FURTHER ENACTED, That Section 2 of this Act shall
take effect October 1, 2023. It shall remain effective for a period of 4 years and 2 months
and, at the end of November 30, 2027, Section 2 of this Act, with no further action required
by the General Assembly, shall be abrogated and of no further force and effect.
SECTION 5. 8. AND BE IT FURTHER ENACTED, That, except as provided in
Section 4 7 of this Act, this Act shall take effect June 1, 2023. Section 1 of this Act shall
remain effective for a period of 4 years and 1 month and, at the end of June 30, 2027, Section
1 of this Act, with no further action required by the General Assembly, shall be abrogated
and of no further force and effect.
Approved by the Governor, May 3, 2023.