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.
*hb0283*
HOUSE BILL 283
J1 3lr1095
SB 682/22 – FIN CF SB 460
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 Ziegler, Pena–Melnyk, White, and Martinez
Introduced and read first time: January 25, 2023
Assigned to: Health and Government Operations
Committee Report: Favorable with amendments
House action: Adopted
Read second time: March 9, 2023
CHAPTER ______
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 2 HOUSE BILL 283
BY repealing and reenacting, with amendments, 1
Article – Health – General 2
Section 15–103(a)(2)(xx) and (xxi) 3
Annotated Code of Maryland 4
(2019 Replacement Volume and 2022 Supplement) 5
BY adding to 6
Article – Health – General 7
Section 15–103(a)(2)(xxii) and 15–151 8
Annotated Code of Maryland 9
(2019 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
15–103. 14
(a) (1) The Secretary shall administer the Maryland Medical Assistance 15
Program. 16
(2) The Program: 17
(xx) Beginning on July 1, 2023, shall provide, subject to federal 18
approval and limitations of the State budget, community violence prevention services in 19
accordance with 15–141.3 of this subtitle; [and] 20
(xxi) Beginning on January 1, 2023, shall provide, subject to the 21
limitations of the State budget, and as permitted by federal law, coverage for self–measured 22
blood pressure monitoring for all Program recipients diagnosed with uncontrolled high 23
blood pressure, including: 24
1. The provision of validated home blood pressure monitors; 25
and 26
2. Reimbursement of health care provider and other staff 27
time used for patient training, transmission of blood pressure data, interpretation of blood 28
pressure readings and reporting, and the delivery of co –interventions, including 29
educational materials or classes, behavioral change management, and medication 30
management; AND 31
(XXII) BEGINNING ON JANUARY 1, 2024, SHALL PROVIDE 32
GENDER–AFFIRMING TR EATMENT IN ACCORDANC E WITH § 15–151 OF THIS 33
SUBTITLE. 34
HOUSE BILL 283 3
15–151. 1
(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 2
INDICATED. 3
(2) (I) “GENDER–AFFIRMING TREATMENT ” MEANS ANY 4
MEDICALLY NECESSARY TREATMENT CONSISTENT WITH CURRENT CLINICA L 5
STANDARDS OF CARE PR ESCRIBED BY A LICENS ED HEALTH CARE PROVI DER FOR 6
THE TREATMENT OF A C ONDITION RELATED TO THE INDIVIDUAL ’S GENDER 7
IDENTITY. 8
(II) “GENDER–AFFIRMING TREATMENT ” INCLUDES: 9
1. HORMONE THERAPY , HORMONE BLOCKERS , AND 10
PUBERTY BLOCKERS ; 11
2. HAIR ALTERATION FOR T HE PURPOSES OF ALTER ING 12
SECONDARY SEX CHARAC TERISTICS AND SURGIC AL SITE PREPARATION ; 13
3. ALTERATIONS TO VOICE , VOICE THERAPY, AND VOICE 14
LESSONS; 15
4. ALTERATIONS TO ABDOME N, CHEST, TRUNK, AND 16
BUTTOCKS; 17
5. ALTERATIONS TO THE FACE AND NECK ; 18
6. ALTERATIONS TO THE GENITALS AND GONADS; 19
7. LASER TREATMENT FOR S CARS FROM 20
GENDER–AFFIRMING TREATMENT ; 21
8. STANDARD FERTILITY PR ESERVATION PROCEDURE S, 22
AS SET FORTH IN § 15–810.1 OF THE INSURANCE ARTICLE; 23
9. REVISIONS TO PREVIOUS TREATMENTS AND 24
REVERSAL OF TREATMEN TS; 25
10. COMBINATIONS OF GENDE R–AFFIRMING 26
PROCEDURES ; AND 27
11. OTHER TREATMENTS AS P RESCRIBED TO SUPPRESS 28
THE DEVELOPMENT OF E NDOGENOUS SECONDARY SEX CHARACTERISTICS , ALIGN 29
THE INDIVIDUAL ’S APPEARANCE OR PHYS ICAL BODY WITH GENDE R IDENTITY, AND 30 4 HOUSE BILL 283
ALLEVIATE SYMPTOMS O F CLINICALLY SIGNIFI CANT DISTRESS RESULT ING FROM 1
GENDER DYSPHORIA . 2
(III) “GENDER–AFFIRMING TREATMENT ” MAY INCLUDE 3
TREATMENT DESCRIBED IN THE CURRENT CLINI CAL STANDARDS OF CAR E FOR 4
GENDER–AFFIRMING TREATMENT PUBLISHED BY THE WORLD PROFESSIONAL 5
ASSOCIATION FOR TRANSGENDER HEALTH. 6
(3) “GENDER IDENTITY ” HAS THE MEANING STAT ED IN § 20–101 OF 7
THE STATE GOVERNMENT ARTICLE. 8
(B) IT IS THE INTENT OF T HE GENERAL ASSEMBLY THAT THE PROGRAM 9
PROVIDE GENDER –AFFIRMING TREATMENT TO ALL PROGRAM RECIPIENTS FO R 10
WHOM GENDER –AFFIRMING TREATMENT IS MEDICALLY NECESSA RY, INCLUDING 11
TRANSGENDER , NONBINARY, INTERSEX, TWO–SPIRIT, AND OTHER GENDER DIV ERSE 12
INDIVIDUALS. 13
(C) (1) THE PROGRAM SHALL PROVIDE COVERAGE FOR MEDICAL LY 14
NECESSARY GENDER –AFFIRMING TREATMENT IN A NONDISCRIMINATO RY MANNER. 15
(2) THE GENDER –AFFIRMING TREATMENT SHALL BE ASSESSED 16
ACCORDING TO NONDISCRIMINA TORY CRITERIA THAT A RE CONSISTENT WITH 17
CURRENT CLINICAL STA NDARDS OF CARE . 18
(3) THE PROGRAM MAY NOT DENY OR LIMIT COVERAGE FO R 19
GENDER–AFFIRMING TREATMENT WHEN THAT TREATMENT IS: 20
(I) PRESCRIBED TO A PROGRAM RECIPIENT BEC AUSE OF, 21
RELATED TO, OR CONSISTENT WITH T HE RECIPIENT’S GENDER IDENTITY ; 22
(II) MEDICALLY NECESSARY ; AND 23
(III) PRESCRIBED IN ACCORDA NCE WITH CURRENT CLI NICAL 24
STANDARDS OF CARE . 25
(4) THE PROGRAM MAY NOT DENY OR LIMIT COVERAGE FO R 26
GENDER–AFFIRMING TREATMENT BASED ON THE PROGRAM RECIPIENT ’S GENDER 27
IDENTITY. 28
(5) THE PROGRAM MAY NOT EXCLU DE GENDER –AFFIRMING 29
TREATMENT , INCLUDING REVISIONS TO PRIOR GENDER –AFFIRMING TREATMENT , 30
ON THE BASIS THAT TH E TREATMENT IS A COS METIC SERVICE. 31
HOUSE BILL 283 5
(6) THE PROGRAM MAY NOT EST ABLISH A CATEGORICAL EXCLUSION 1
FOR A PARTICULAR GEN DER–AFFIRMING TREATMENT . 2
(7) THE PROGRAM MAY NOT ISSUE AN ADVERSE BENEFIT 3
DETERMINATION DENYIN G OR LIMITING ACCESS TO GENDER –AFFIRMING 4
TREATMENT UNLESS A H EALTH CARE PROVIDER WITH EXPERIENCE PRES CRIBING 5
OR DELIVERING GENDER –AFFIRMING TREATMENT HAS REVIEWED AND CON FIRMED 6
THE APPROPRIATENESS OF THE ADVERSE BENEF IT DETERMINATION . 7
(D) (1) ON OR BEFORE DECEMBER 1 EACH YEAR, BEGINNING IN 2024, 8
EACH MANAGED CARE OR GANIZATION SHALL SUB MIT TO THE DEPARTMENT A 9
REPORT THAT INCLUDES , FOR EACH HEALTH CARE PROVIDER OFFERING 10
GENDER–AFFIRMING TREATMENT WITH WHICH THE MANAG ED CARE ORGANIZATION 11
HAS AN ACTIVE CONTRA CT AND WHO CONSENTS TO THE INCLUSION : 12
(I) THE NAME AND LOCATION OF EACH THE HEALTH CARE 13
PROVIDER OFFERING GENDER –AFFIRMING TREATMENT WITH WHICH THE MANAG ED 14
CARE ORGANIZATION HA S AN ACTIVE CONTRACT ; AND 15
(II) THE TYPES OF GENDER –AFFIRMING TREATMENT PROVIDED 16
BY EACH THE HEALTH CARE PROVIDER ; AND 17
(III) WHETHER THE HEALTH CA RE PROVIDER CONSENTS TO 18
BEING PUBLICLY LISTE D AS PART OF THE DEPARTMENT ’S ANNUAL REPORT 19
REQUIRED UNDER PARAG RAPH (2) OF THIS SUBSECTION . 20
(2) (I) ON OR BEFORE JANUARY 1 EACH YEAR, BEGINNING IN 21
2025, THE DEPARTMENT SHALL COMP ILE AN ANNUAL REPORT ON GEOGRAPHIC 22
ACCESS TO GENDER –AFFIRMING TREATMENT ACROSS THE STATE. 23
(II) THE REPORT SHALL INCL UDE, FOR EACH HEALTH CARE 24
PROVIDER OFFERING GE NDER–AFFIRMING TREATMENT TO PROGRAM RECIPIENTS 25
AND WHOSE CONSENT TO THE INCLUSION IS IND ICATED IN A REPORT S UBMITTED 26
UNDER PARAGRAPH (1) OF THIS SUBSECTION : 27
1. THE NAME AND LOCATION OF EACH THE HEALTH 28
CARE PROVIDER OFFERING GENDER –AFFIRMING TREATMENT TO PROGRAM 29
RECIPIENTS; 30
2. THE MANAGED CARE ORGA NIZATIONS THAT HAVE 31
ACTIVE CONTRACTS WIT H EACH THE HEALTH CARE PROVIDER ; AND 32
3. THE TYPES OF GENDER –AFFIRMING TREATMENT 33
PROVIDED BY EACH THE HEALTH CARE PROVIDER . 34 6 HOUSE BILL 283
(III) THE DEPARTMENT SHALL PUBL ISH THE REPORT IN A 1
CONSPICUOUS MANNER O N THE DEPARTMENT ’S WEBSITE. 2
(3) THE DEPARTMENT AND EACH M ANAGED CARE ORGANIZA TION 3
SHALL INCLUDE THE NA ME, LOCATION, AND TYPES OF SERVICE S FOR EACH 4
PROVIDER OFFERING GE NDER–AFFIRMING TREATMENT IN THEIR PROVIDER 5
DIRECTORIES. 6
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 7
October 1, 2023. 8
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.