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.
Italics indicate opposite chamber/conference committee amendments.
*hb0283*
HOUSE BILL 283
J1 (3lr1095)
ENROLLED BILL
— Health and Government Operations/Finance —
Introduced 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
Read and Examined by Proofreaders:
_______________________________________________
Proofreader.
_______________________________________________
Proofreader.
Sealed with the Great Seal and presented to the Governor, for his approval this
_______ day of _______________ at ________________________ o’clock, ________M.
______________________________________________
Speaker.
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 2 HOUSE BILL 283
clinical standards; prohibiting the Program from issuing an adverse benefit 1
determination related to gender–affirming treatment unless a health care provider 2
with experience prescribing or delivering gender–affirming treatment has reviewed 3
and confirmed the appropriateness of the determination; and generally relating to 4
gender–affirming treatment and the Maryland Medical Assistance Program. 5
BY repealing and reenacting, without amendments, 6
Article – Health – General 7
Section 15–103(a)(1) 8
Annotated Code of Maryland 9
(2019 Replacement Volume and 2022 Supplement) 10
BY repealing and reenacting, with amendments, 11
Article – Health – General 12
Section 15–103(a)(2)(xx) and (xxi) 13
Annotated Code of Maryland 14
(2019 Replacement Volume and 2022 Supplement) 15
BY adding to 16
Article – Health – General 17
Section 15–103(a)(2)(xxii) and 15–151 18
Annotated Code of Maryland 19
(2019 Replacement Volume and 2022 Supplement) 20
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 21
That the Laws of Maryland read as follows: 22
Article – Health – General 23
15–103. 24
(a) (1) The Secretary shall administer the Maryland Medical Assistance 25
Program. 26
(2) The Program: 27
(xx) Beginning on July 1, 2023, shall provide, subject to federal 28
approval and limitations of the State budget, community violence prevention services in 29
accordance with 15–141.3 of this subtitle; [and] 30
(xxi) Beginning on January 1, 2023, shall provide, subject to the 31
limitations of the State budget, and as permitted by federal law, coverage for self–measured 32
blood pressure monitoring for all Program recipients diagnosed with uncontrolled high 33
blood pressure, including: 34
1. The provision of validated home blood pressure monitors; 35
and 36 HOUSE BILL 283 3
2. Reimbursement of health care provider and other staff 1
time used for patient training, transmission of blood pressure data, interpretation of blood 2
pressure readings and reporting, and the delivery of co –interventions, including 3
educational materials or classes, behavioral change management, and medication 4
management; AND 5
(XXII) BEGINNING ON JANUARY 1, 2024, SHALL PROVIDE 6
GENDER–AFFIRMING TREATMENT IN ACCORDANCE WITH § 15–151 OF THIS 7
SUBTITLE. 8
15–151. 9
(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 10
INDICATED. 11
(2) (I) “GENDER–AFFIRMING TREATMENT ” MEANS ANY 12
MEDICALLY NECESSARY TREATMENT CONSISTENT WITH CURRENT CLINICA L 13
STANDARDS OF CARE PR ESCRIBED BY A LICENS ED HEALTH CARE PROVI DER FOR 14
THE TREATMENT OF A C ONDITION RELATED TO THE INDIVIDU AL’S GENDER 15
IDENTITY. 16
(II) “GENDER–AFFIRMING TREATMENT ” INCLUDES: 17
1. HORMONE THERAPY , HORMONE BLOCKERS , AND 18
PUBERTY BLOCKERS ; 19
2. HAIR ALTERATION FOR T HE PURPOSES OF ALTER ING 20
SECONDARY SEX CHARAC TERISTICS AND SURGIC AL SITE PREPARATION ; 21
3. ALTERATIONS TO VOICE , VOICE THERAPY , AND VOICE 22
LESSONS; 23
4. ALTERATIONS TO ABDOME N, CHEST, TRUNK, AND 24
BUTTOCKS; 25
5. ALTERATIONS TO THE FACE AND NECK ; 26
6. ALTERATIONS TO THE GENITALS AND GONADS; 27
7. LASER TREATMENT FOR S CARS FROM 28
GENDER–AFFIRMING TREATMENT ; 29
4 HOUSE BILL 283
8. STANDARD FERTILITY PR ESERVATION PROCEDURE S, 1
AS SET FORTH IN § 15–810.1 OF THE INSURANCE ARTICLE; 2
9. REVISIONS TO PREVIOUS TREATMENTS AND 3
REVERSAL OF TREATMEN TS; 4
10. COMBINATIONS OF GENDE R–AFFIRMING 5
PROCEDURES ; AND 6
11. OTHER TREATMENTS AS P RESCRIBED TO SUPPRES S 7
THE DEVELOPMENT OF E NDOGENOUS SECONDARY SEX CHARACTERISTICS , ALIGN 8
THE INDIVIDUAL ’S APPEARANCE OR PHYS ICAL BODY WITH GENDE R IDENTITY, AND 9
ALLEVIATE SYMPTOMS O F CLINICALLY SIGNIFI CANT DISTRESS RESULT ING FROM 10
GENDER DYSPHORIA . 11
(III) “GENDER–AFFIRMING TREATMENT ” MAY INCLUDE 12
TREATMENT DESCRIBED IN THE CURRENT CLINI CAL STANDARDS OF CAR E FOR 13
GENDER–AFFIRMING TREATMENT PUBLISHED BY THE WORLD PROFESSIONAL 14
ASSOCIATION FOR TRANSGENDER HEALTH. 15
(3) “GENDER IDENTI TY” HAS THE MEANING STAT ED IN § 20–101 OF 16
THE STATE GOVERNMENT ARTICLE. 17
(B) IT IS THE INTENT OF T HE GENERAL ASSEMBLY THAT THE PROGRAM 18
PROVIDE GENDER –AFFIRMING TREATMENT TO ALL PROGRAM RECIPIENTS FO R 19
WHOM GENDER –AFFIRMING TREATMENT IS MEDICALLY NECESSA RY, INCLUDING 20
TRANSGENDER , NONBINARY, INTERSEX, TWO–SPIRIT, AND OTHER GENDER DIV ERSE 21
INDIVIDUALS. 22
(C) (1) THE PROGRAM SHALL PROVIDE COVERAGE FOR MEDICAL LY 23
NECESSARY GENDER –AFFIRMING TREATMENT IN A NONDISCRIMINATO RY MANNER. 24
(2) THE GENDER –AFFIRMING TREAT MENT SHALL BE ASSESS ED 25
ACCORDING TO NONDISC RIMINATORY CRITERIA THAT ARE CONSISTENT WITH 26
CURRENT CLINICAL STA NDARDS OF CARE . 27
(3) THE PROGRAM MAY NOT DENY OR LIMIT COVERAGE FO R 28
GENDER–AFFIRMING TREATMENT WHEN THAT TREATMENT IS: 29
(I) PRESCRIBED TO A PROGRAM RECIPIENT BECAU SE OF, 30
RELATED TO, OR CONSISTENT WITH T HE RECIPIENT’S GENDER IDENTITY ; 31
(II) MEDICALLY NECESSARY ; AND 32
HOUSE BILL 283 5
(III) PRESCRIBED IN ACCORDA NCE WITH CURRENT CLI NICAL 1
STANDARDS OF CARE . 2
(4) THE PROGRAM MAY NOT DENY OR LIMIT COVERAGE FO R 3
GENDER–AFFIRMING TREATMENT BASED ON THE PROGRAM RECIPIENT ’S GENDER 4
IDENTITY. 5
(5) THE PROGRAM MAY NOT EXCLU DE GENDER –AFFIRMING 6
TREATMENT , INCLUDING REVISIONS TO PRIOR GENDER –AFFIRMING TREATMENT , 7
ON THE BASIS THAT TH E TREATMENT IS A COS METIC SERVICE. 8
(6) THE PROGRAM MAY NOT ESTAB LISH A CATEGORICAL E XCLUSION 9
FOR A PARTICULAR GEN DER–AFFIRMING TREATMENT . 10
(7) THE PROGRAM MAY NOT ISSUE AN ADVERSE BENEFIT 11
DETERMINATION DENYIN G OR LIMITING ACCESS TO GENDER –AFFIRMING 12
TREATMENT UNLESS A H EALTH CARE PROVIDE R WITH EXPERIENCE PR ESCRIBING 13
OR DELIVERING GENDER –AFFIRMING TREATMENT HAS REVIEWED AND CON FIRMED 14
THE APPROPRIATENESS OF THE ADVERSE BENEF IT DETERMINATION . 15
(D) (1) ON OR BEFORE DECEMBER 1 EACH YEAR, BEGINNING IN 2024, 16
EACH MANAGED CARE OR GANIZATION SHALL SUBMIT TO THE DEPARTMENT A 17
REPORT THAT INCLUDES , FOR EACH HEALTH CARE PROVIDER OFFERING 18
GENDER–AFFIRMING TREATMENT WITH WHICH THE MANAG ED CARE ORGANIZATION 19
HAS AN ACTIVE CONTRA CT AND WHO THAT CONSENTS TO THE INCL USION: 20
(I) THE NAME AND LOCATION OF EACH THE HEALTH CARE 21
PROVIDER OFFERING GENDER –AFFIRMING TREATMENT WITH WHICH THE MANAG ED 22
CARE ORGANIZATION HA S AN ACTIVE CONTRACT ; AND 23
(II) THE TYPES OF GENDER –AFFIRMING TREATMENT PROVIDED 24
BY EACH THE HEALTH CARE PROVIDER ; AND 25
(III) WHETHER THE HEA LTH CARE PROVIDER CO NSENTS TO 26
BEING PUBLICLY LISTE D AS PART OF THE DEPARTMENT ’S ANNUAL REPORT 27
REQUIRED UNDER PARAG RAPH (2) OF THIS SUBSECTION . 28
(2) (I) ON OR BEFORE JANUARY 1 EACH YEAR, BEGINNING IN 29
2025, THE DEPARTMENT SHALL COMP ILE AN ANNUAL REPORT ON GEOGRAPHIC 30
ACCESS TO GENDER –AFFIRMING TREATMENT ACROSS THE STATE. 31
(II) THE REPORT SHALL INCL UDE, FOR EACH HEALTH CARE 32
PROVIDER OFFERING GE NDER–AFFIRMING TREATMENT TO PROGRAM RECIPIENTS 33 6 HOUSE BILL 283
AND WHOSE CONSENT TO THE INCLUSION IS IND ICATED IN A REPORT S UBMITTED 1
UNDER PARAGRAPH (1) OF THIS SUBSECTION : 2
1. THE NAME AND LOCATION OF EACH THE HEALTH 3
CARE PROVIDER OFFERING GENDER –AFFIRMING TREATMENT TO PROGRAM 4
RECIPIENTS; 5
2. THE MANAGED CARE ORGA NIZATIONS THAT HAVE 6
ACTIVE CONTRACTS WIT H EACH THE HEALTH CARE PROVIDER ; AND 7
3. THE TYPES OF GENDER –AFFIRMING TREATMENT 8
PROVIDED BY EACH THE HEALTH CARE PROVIDER . 9
(III) THE DEPARTMENT SHALL PUBL ISH THE REPORT IN A 10
CONSPICUOUS MANNER O N THE DEPARTMENT ’S WEBSITE. 11
(3) THE DEPARTMENT AND EACH M ANAGED CARE ORGANIZA TION 12
SHALL INCLUDE THE NA ME, LOCATION, AND TYPES OF SERVICE S FOR EACH 13
PROVIDER OFFERING GE NDER–AFFIRMING TREATMENT IN THEIR PROVIDER 14
DIRECTORIES. 15
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 16
October 1, 2023. 17
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.