EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb0283*
HOUSE BILL 283
J1 3lr1095
SB 682/22 – FIN CF 3lr1096
By: Delegates Kaiser, Cullison, Acevero, Allen, Amprey, Atterbeary, Bagnall,
B. Barnes, Barve, Boyce, Cardin, Charkoudian, Clippinger, Ebersole,
Edelson, Embry, Fair, Feldmark, Fennell, Foley, Forbes, Fraser –Hidalgo,
Grossman, Guzzone, Hill, D. Jones, Kaufman, Kelly, Kerr, Lehman,
R. Lewis, Lopez, Love, McCaskill, Mireku –North, Moon, Palakovich Carr,
Pasteur, Qi, Queen, Reznik, Rosenberg, Ruth, Shetty, Simpson, Smith,
Solomon, Stein, Stewart, Taveras, Terrasa, Valderrama, Vogel, Watson,
Wells, Wilkins, and Ziegler
Introduced and read first time: January 25, 2023
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Maryland Medical Assistance Program – Gender–Affirming Treatment 2
(Trans Health Equity Act) 3
FOR the purpose of requiring, beginning on a certain date, the Maryland Medical 4
Assistance Program to provide medically necessary gender–affirming treatment in a 5
nondiscriminatory manner; requiring that the gender–affirming treatment be 6
assessed according to nondiscriminatory criteria that are consistent with current 7
clinical standards; prohibiting the Program from issuing an adverse benefit 8
determination related to gender–affirming treatment unless a health care provider 9
with experience prescribing or delivering gender–affirming treatment has reviewed 10
and confirmed the appropriateness of the determination; and generally relating to 11
gender–affirming treatment and the Maryland Medical Assistance Program. 12
BY repealing and reenacting, without amendments, 13
Article – Health – General 14
Section 15–103(a)(1) 15
Annotated Code of Maryland 16
(2019 Replacement Volume and 2022 Supplement) 17
BY repealing and reenacting, with amendments, 18
Article – Health – General 19
Section 15–103(a)(2)(xx) and (xxi) 20
Annotated Code of Maryland 21
(2019 Replacement Volume and 2022 Supplement) 22 2 HOUSE BILL 283
BY adding to 1
Article – Health – General 2
Section 15–103(a)(2)(xxii) and 15–151 3
Annotated Code of Maryland 4
(2019 Replacement Volume and 2022 Supplement) 5
SECTION 1. BE IT ENACTED BY THE GENERAL ASS EMBLY OF MARYLAND, 6
That the Laws of Maryland read as follows: 7
Article – Health – General 8
15–103. 9
(a) (1) The Secretary shall administer the Maryland Medical Assistance 10
Program. 11
(2) The Program: 12
(xx) Beginning on July 1, 2023, shall provide, subject to federal 13
approval and limitations of the State budget, community violence prevention services in 14
accordance with 15–141.3 of this subtitle; [and] 15
(xxi) Beginning on January 1, 2023, shall provide, subject to the 16
limitations of the State budget, and as permitted by federal law, coverage for self–measured 17
blood pressure monitoring for all Program recipients diagnosed with uncontrolled high 18
blood pressure, including: 19
1. The provision of validated home blood pressure monitors; 20
and 21
2. Reimbursement of health care provider and other staff 22
time used for patient training, transmission of blood pressure data, interpretation of blood 23
pressure readings and reporting, and the delivery of co –interventions, including 24
educational materials or classes, behavioral change management, and medication 25
management; AND 26
(XXII) BEGINNING ON JANUARY 1, 2024, SHALL PROVIDE 27
GENDER–AFFIRMING TREATMENT IN ACCORDANCE WITH § 15–151 OF THIS 28
SUBTITLE. 29
15–151. 30
(A) (1) IN THIS SECTION THE FOL LOWING WORDS HAVE TH E MEANINGS 31
INDICATED. 32
HOUSE BILL 283 3
(2) (I) “GENDER–AFFIRMING TREATMENT ” MEANS ANY 1
MEDICALLY NECESSARY TREATMENT CONSISTENT WITH CURRENT CLINICA L 2
STANDARDS OF CARE PR ESCRIBED BY A LICENS ED HEALTH CARE PROVI DER FOR 3
THE TREATMENT OF A CONDITION RELAT ED TO THE INDIVIDUAL ’S GENDER 4
IDENTITY. 5
(II) “GENDER–AFFIRMING TREATMENT ” INCLUDES: 6
1. HORMONE THERAPY , HORMONE BLOCKERS , AND 7
PUBERTY BLOCKERS ; 8
2. HAIR ALTERATION FOR T HE PURPOSES OF ALTER ING 9
SECONDARY SEX CHARAC TERISTICS AND SURGICAL SITE PREPARATION ; 10
3. ALTERATIONS TO VOICE , VOICE THERAPY , AND VOICE 11
LESSONS; 12
4. ALTERATIONS TO ABDOME N, CHEST, TRUNK, AND 13
BUTTOCKS; 14
5. ALTERATIONS TO THE FACE AND NECK ; 15
6. ALTERATIONS TO THE GENITALS AND GONADS; 16
7. LASER TREATMENT FOR S CARS FROM 17
GENDER–AFFIRMING TREATMENT ; 18
8. STANDARD FERTILITY PR ESERVATION PROCEDURE S, 19
AS SET FORTH IN § 15–810.1 OF THE INSURANCE ARTICLE; 20
9. REVISIONS TO PREVIOUS TREATMENTS AND 21
REVERSAL OF TREATMEN TS; 22
10. COMBINATIONS OF GENDER –AFFIRMING 23
PROCEDURES ; AND 24
11. OTHER TREATMENTS AS P RESCRIBED TO SUPPRES S 25
THE DEVELOPMENT OF E NDOGENOUS SECONDARY SEX CHARACTERISTICS , ALIGN 26
THE INDIVIDUAL ’S APPEARANCE OR PHYS ICAL BODY WITH GENDE R IDENTITY, AND 27
ALLEVIATE SYMPTOMS O F CLINICALLY SIGNIFICANT DISTR ESS RESULTING FROM 28
GENDER DYSPHORIA . 29
(III) “GENDER–AFFIRMING TREATMENT ” MAY INCLUDE 30
TREATMENT DESCRIBED IN THE CURRENT CLINI CAL STANDARDS OF CAR E FOR 31 4 HOUSE BILL 283
GENDER–AFFIRMING TREATMENT PUBLISHED BY THE WORLD PROFESSIONAL 1
ASSOCIATION FOR TRANSGENDER HEALTH. 2
(3) “GENDER IDENTITY ” HAS THE MEANING STAT ED IN § 20–101 OF 3
THE STATE GOVERNMENT ARTICLE. 4
(B) IT IS THE INTENT OF T HE GENERAL ASSEMBLY THAT THE PROGRAM 5
PROVIDE GENDER –AFFIRMING TREATMENT TO ALL PROGRAM RECIPIENTS FO R 6
WHOM GENDER–AFFIRMING TREATMENT IS MEDICALLY NECESSA RY, INCLUDING 7
TRANSGENDER , NONBINARY, INTERSEX, TWO–SPIRIT, AND OTHER GENDER DIV ERSE 8
INDIVIDUALS. 9
(C) (1) THE PROGRAM SHALL PROVIDE COVERAGE FOR MEDICAL LY 10
NECESSARY GENDER –AFFIRMING TREATMENT IN A NONDISCRI MINATORY MANNER . 11
(2) THE GENDER –AFFIRMING TREATMENT SHALL BE ASSESSED 12
ACCORDING TO NONDISC RIMINATORY CRITERIA THAT ARE CONSISTENT WITH 13
CURRENT CLINICAL STA NDARDS OF CARE . 14
(3) THE PROGRAM MAY NOT DENY OR LIMIT COVERAGE FO R 15
GENDER–AFFIRMING TREATMENT WHEN THAT TREATMENT IS: 16
(I) PRESCRIBED TO A PROGRAM RECIPIENT BEC AUSE OF, 17
RELATED TO, OR CONSISTENT WITH T HE RECIPIENT’S GENDER IDENTITY ; 18
(II) MEDICALLY NECESSARY ; AND 19
(III) PRESCRIBED IN ACCORDA NCE WITH CURRENT CLI NICAL 20
STANDARDS OF CARE . 21
(4) THE PROGRAM MAY NOT DENY OR LIMIT COVERAGE FO R 22
GENDER–AFFIRMING TREATMENT BASED ON THE PROGRAM RECIPIENT ’S GENDER 23
IDENTITY. 24
(5) THE PROGRAM MAY NOT EXCLU DE GENDER –AFFIRMING 25
TREATMENT , INCLUDING REVISIONS TO PRIOR GENDER –AFFIRMING TREATMENT , 26
ON THE BASIS THAT THE TREAT MENT IS A COSMETIC S ERVICE. 27
(6) THE PROGRAM MAY NOT ESTAB LISH A CATEGORICAL E XCLUSION 28
FOR A PARTICULAR GEN DER–AFFIRMING TREATMENT . 29
(7) THE PROGRAM MAY NOT ISSUE AN ADVERSE BENEFIT 30
DETERMINATION DENYIN G OR LIMITING ACCESS TO GEND ER–AFFIRMING 31
TREATMENT UNLESS A H EALTH CARE PROVIDER WITH EXPERIENCE PRES CRIBING 32 HOUSE BILL 283 5
OR DELIVERING GENDER –AFFIRMING TREATMENT HAS REVIEWED AND CON FIRMED 1
THE APPROPRIATENESS OF THE ADVERSE BENEF IT DETERMINATION . 2
(D) (1) ON OR BEFORE DECEMBER 1 EACH YEAR, BEGINNING IN 2024, 3
EACH MANAGED CARE OR GANIZATION SHALL SUB MIT TO THE DEPARTMENT A 4
REPORT THAT INCLUDES : 5
(I) THE NAME AND LOCATION OF EACH HEALTH CARE 6
PROVIDER OFFERING GE NDER–AFFIRMING TREATMENT WITH WHICH THE MANAG ED 7
CARE ORGANIZATION HA S AN ACTIVE CONTRACT; AND 8
(II) THE TYPES OF GENDER –AFFIRMING TREATMENT PROVIDED 9
BY EACH HEALTH CARE PROVIDER. 10
(2) (I) ON OR BEFORE JANUARY 1 EACH YEAR, BEGINNING IN 11
2025, THE DEPARTMENT SHALL COMP ILE AN ANNUAL REPORT ON GEOGRAPHIC 12
ACCESS TO GENDER –AFFIRMING TRE ATMENT ACROSS THE STATE. 13
(II) THE REPORT SHALL INCL UDE: 14
1. THE NAME AND LOCATION OF EACH HEALTH CARE 15
PROVIDER OFFERING GE NDER–AFFIRMING TREATMENT TO PROGRAM RECIPIENTS ; 16
2. THE MANAGED CARE ORGA NIZATIONS THAT HAVE 17
ACTIVE CONTRACTS WIT H EACH HEALTH CARE P ROVIDER; AND 18
3. THE TYPES OF GENDER –AFFIRMING TREATMENT 19
PROVIDED BY EACH HEA LTH CARE PROVIDER . 20
(III) THE DEPARTMENT SHALL PUBL ISH THE REPORT IN A 21
CONSPICUOUS MANNER ON THE DEPARTMENT ’S WEBSITE. 22
(3) THE DEPARTMENT AND EACH M ANAGED CARE ORGANIZA TION 23
SHALL INCLUDE THE NA ME, LOCATION, AND TYPES OF SERVICE S FOR EACH 24
PROVIDER OFFERING GE NDER–AFFIRMING TREATMENT IN THEIR PROVIDER 25
DIRECTORIES. 26
SECTION 2. AND BE IT FURTH ER ENACTED, That this Act shall take effect 27
October 1, 2023. 28