WES MOORE, Governor Ch. 253
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Chapter 253
(House Bill 283)
AN ACT concerning
Maryland Medical Assistance Program – Gender–Affirming Treatment
(Trans Health Equity Act)
FOR the purpose of requiring, beginning on a certain date, the Maryland Medical
Assistance Program to provide medically necessary gender–affirming treatment in a
nondiscriminatory manner; requiring that the gender–affirming treatment be
assessed according to nondiscriminatory criteria that are consistent with current
clinical standards; prohibiting the Program from issuing an adverse benefit
determination related to gender–affirming treatment unless a health care provider
with experience prescribing or delivering gender–affirming treatment has reviewed
and confirmed the appropriateness of the determination; and generally relating to
gender–affirming treatment and the Maryland Medical Assistance Program.
BY repealing and reenacting, without amendments,
Article – Health – General
Section 15–103(a)(1)
Annotated Code of Maryland
(2019 Replacement Volume and 2022 Supplement)
BY repealing and reenacting, with amendments,
Article – Health – General
Section 15–103(a)(2)(xx) and (xxi)
Annotated Code of Maryland
(2019 Replacement Volume and 2022 Supplement)
BY adding to
Article – Health – General
Section 15–103(a)(2)(xxii) and 15–151
Annotated Code of Maryland
(2019 Replacement Volume and 2022 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBL Y OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Health – General
15–103.
(a) (1) The Secretary shall administer the Maryland Medical Assistance
Program.
Ch. 253 2023 LAWS OF MARYLAND
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(2) The Program:
(xx) Beginning on July 1, 2023, shall provide, subject to federal
approval and limitations of the State budget, community violence prevention services in
accordance with 15–141.3 of this subtitle; [and]
(xxi) Beginning on January 1, 2023, shall provide, subject to the
limitations of the State budget, and as permitted by federal law, coverage for self–measured
blood pressure monitoring for all Program recipients diagnosed with uncontrolled high
blood pressure, including:
1. The provision of validated home blood pressure monitors;
and
2. Reimbursement of health care provider and other staff
time used for patient training, transmission of blood pressure data, interpretation of blood
pressure readings and reporting, and the delivery of co –interventions, including
educational materials or classes, behavioral change management, and medication
management; AND
(XXII) BEGINNING ON JANUARY 1, 2024, SHALL PROVIDE
GENDER–AFFIRMING TREATMENT IN ACCORDANCE WITH § 15–151 OF THIS
SUBTITLE.
15–151.
(A) (1) IN THIS SECTION THE FOL LOWING WORDS HAVE TH E MEANINGS
INDICATED.
(2) (I) “GENDER–AFFIRMING TREATMENT ” MEANS ANY
MEDICALLY NECESSARY TREATMENT CONSISTENT WITH CURRENT CLINICA L
STANDARDS OF CARE PR ESCRIBED BY A LICENS ED HEALTH CARE PROVI DER FOR
THE TREATMENT OF A CONDITION RELAT ED TO THE INDIVIDUAL ’S GENDER
IDENTITY.
(II) “GENDER–AFFIRMING TREATMENT ” INCLUDES:
1. HORMONE THERAPY , HORMONE BLOCKERS , AND
PUBERTY BLOCKERS ;
2. HAIR ALTERATION FOR T HE PURPOSES OF ALTER ING
SECONDARY SEX CHARAC TERISTICS AND SURGICAL SITE PREPARATION ;
WES MOORE, Governor Ch. 253
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3. ALTERATIONS TO VOICE , VOICE THERAPY , AND VOICE
LESSONS;
4. ALTERATIONS TO ABDOME N, CHEST, TRUNK, AND
BUTTOCKS;
5. ALTERATIONS TO THE FACE AND NECK ;
6. ALTERATIONS TO THE GENITALS AND GONADS;
7. LASER TREATMENT FOR S CARS FROM
GENDER–AFFIRMING TREATMENT ;
8. STANDARD FERTILITY PR ESERVATION PROCEDURE S,
AS SET FORTH IN § 15–810.1 OF THE INSURANCE ARTICLE;
9. REVISIONS TO PREVIOUS TREATMENTS AND
REVERSAL OF TREATMEN TS;
10. COMBINATIONS OF GENDER –AFFIRMING
PROCEDURES ; AND
11. OTHER TREATMENTS AS P RESCRIBED TO SUPPRES S
THE DEVELOPMENT OF E NDOGENOUS SECONDARY SEX CHARACTERISTICS , ALIGN
THE INDIVIDUAL ’S APPEARANCE OR PHYS ICAL BODY WITH GENDE R IDENTITY, AND
ALLEVIATE SYMPTOMS O F CLINICALLY SIGNIFICANT DISTR ESS RESULTING FROM
GENDER DYSPHORIA .
(III) “GENDER–AFFIRMING TREATMENT ” MAY INCLUDE
TREATMENT DESCRIBED IN THE CURRENT CLINI CAL STANDARDS OF CAR E FOR
GENDER–AFFIRMING TREATMENT PUBLISHED BY THE WORLD PROFESSIONAL
ASSOCIATION FOR TRANSGENDER HEALTH.
(3) “GENDER IDENTITY ” HAS THE MEANING STAT ED IN § 20–101 OF
THE STATE GOVERNMENT ARTICLE.
(B) IT IS THE INTENT OF T HE GENERAL ASSEMBLY THAT THE PROGRAM
PROVIDE GENDER –AFFIRMING TREATMENT TO ALL PROGRAM RECIPIENTS FO R
WHOM GENDER –AFFIRMING TREATMENT IS M EDICALLY NECESSARY , INCLUDING
TRANSGENDER , NONBINARY, INTERSEX, TWO–SPIRIT, AND OTHER GENDER DIV ERSE
INDIVIDUALS.
(C) (1) THE PROGRAM SHALL PROVIDE COVERAGE FOR MEDICAL LY
NECESSARY GENDER –AFFIRMING TREATMENT IN A NONDISCRIMINATO RY MANNER. Ch. 253 2023 LAWS OF MARYLAND
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(2) THE GENDER –AFFIRMING TREATMENT SHALL BE ASSESSED
ACCORDING TO NONDISC RIMINATORY CRITERIA THAT ARE CONSISTENT WITH
CURRENT CLINICAL STA NDARDS OF CARE .
(3) THE PROGRAM MAY NOT DENY OR LIMIT COVERAGE FO R
GENDER–AFFIRMING TREATMENT WHEN THAT TR EATMENT IS:
(I) PRESCRIBED TO A PROGRAM RECIPIENT BEC AUSE OF,
RELATED TO, OR CONSISTENT WITH T HE RECIPIENT’S GENDER IDENTITY ;
(II) MEDICALLY NECESSARY ; AND
(III) PRESCRIBED IN ACCORDA NCE WITH CURRENT CLI NICAL
STANDARDS OF CARE .
(4) THE PROGRAM MAY NOT DENY OR LIMIT COVERAGE FO R
GENDER–AFFIRMING TREATMENT BASED ON THE PROGRAM RECIPIENT ’S GENDER
IDENTITY.
(5) THE PROGRAM MAY NOT EXCLU DE GENDER –AFFIRMING
TREATMENT , INCLUDING REVISIONS TO PRIOR GENDER –AFFIRMING TREATMENT ,
ON THE BASIS TH AT THE TREATMENT IS A COSMETIC SERVICE .
(6) THE PROGRAM MAY NOT ESTAB LISH A CATEGORICAL E XCLUSION
FOR A PARTICULAR GEN DER–AFFIRMING TREATMENT .
(7) THE PROGRAM MAY NOT ISSUE AN ADVERSE BENEFIT
DETERMINATION DENYIN G OR LIMITING ACCESS TO GENDER–AFFIRMING
TREATMENT UNLESS A H EALTH CARE PROVIDER WITH EXPERIENCE PRES CRIBING
OR DELIVERING GENDER –AFFIRMING TREATMENT HAS REVIEWED AND CON FIRMED
THE APPROPRIATENESS OF THE ADVERSE BENEF IT DETERMINATION .
(D) (1) ON OR BEFORE DECEMBER 1 EACH YEAR, BEGINNING IN 2024,
EACH MANAGED CARE OR GANIZATION SHALL SUB MIT TO THE DEPARTMENT A
REPORT THAT INCLUDES , FOR EACH HEALTH CARE PROVIDER OFFERING
GENDER–AFFIRMING TREATMENT WITH WHICH THE MANAG ED CARE ORGANIZATION
HAS AN ACTIVE CONTRA CT AND WHO THAT CONSENTS TO THE INCLUSION :
(I) THE NAME AND LOCATION OF EACH THE HEALTH CARE
PROVIDER OFFERING GENDER –AFFIRMING TREATMENT WITH WHICH THE MANAG ED
CARE ORGANIZATION HA S AN ACTIVE CONTRACT ; AND
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(II) THE TYPES OF GENDER –AFFIRMING TREATMENT PROVIDED
BY EACH THE HEALTH CARE PROVIDER ; AND
(III) WHETHER THE HEALTH CA RE PROVIDER CONSENTS TO
BEING PUBLICLY LISTE D AS PART OF THE DEPARTMENT ’S ANNUAL REPORT
REQUIRED UNDER PARAG RAPH (2) OF THIS SUBSECTION .
(2) (I) ON OR BEFORE JANUARY 1 EACH YEAR, BEGINNING IN
2025, THE DEPARTMENT SHALL COMP ILE AN ANNUAL REPORT ON GEOGRAPHIC
ACCESS TO GENDER –AFFIRMING TREATMENT ACROSS THE STATE.
(II) THE REPORT SHALL INCL UDE, FOR EACH HEALTH CARE
PROVIDER OFFERING GE NDER–AFFIRMING TREATMENT TO PROGRAM RECIPIENTS
AND WHOSE C ONSENT TO THE INCLUS ION IS INDICATED IN A REPORT SUBMITTED
UNDER PARAGRAPH (1) OF THIS SUBSECTION :
1. THE NAME AND LOCATION OF EACH THE HEALTH
CARE PROVIDER OFFERING GENDER –AFFIRMING TREATMENT TO PROGRAM
RECIPIENTS;
2. THE MANAGED CARE ORGA NIZATIONS THAT HAVE
ACTIVE CONTRACTS WIT H EACH THE HEALTH CARE PROVIDER ; AND
3. THE TYPES OF GENDER –AFFIRMING TREATMENT
PROVIDED BY EACH THE HEALTH CARE PROVIDER .
(III) THE DEPARTMENT SHALL PUBL ISH THE REPORT IN A
CONSPICUOU S MANNER ON THE DEPARTMENT ’S WEBSITE.
(3) THE DEPARTMENT AND EACH M ANAGED CARE ORGANIZA TION
SHALL INCLUDE THE NA ME, LOCATION, AND TYPES OF SERVICE S FOR EACH
PROVIDER OFFERING GE NDER–AFFIRMING TREATMENT IN THEIR PROVIDER
DIRECTORIES.
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 2023.
Approved by the Governor, May 3, 2023.