EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0582*
SENATE BILL 582
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By: Senator Augustine
Introduced and read first time: February 6, 2023
Assigned to: Finance
A BILL ENTITLED
AN ACT concerning 1
Behavioral Health Care – Treatment and Access 2
(Behavioral Health Model for Maryland) 3
FOR the purpose of establishing the Commission on Behavioral Health Care Treatment 4
and Access to make recommendations to provide appropriate, accessible, and 5
comprehensive behavioral health services to individuals in the State across the 6
behavioral health continuum that are available on demand; establishing the 7
Behavioral Health Care Coordination Value–Based Purchasing Pilot Program in the 8
Maryland Department of Health to establish and implement an intensive care 9
coordination model using value–based purchasing in the specialty behavioral health 10
system; requiring, on or before a certain date, the Department to submit a State plan 11
amendment to the Centers for Medicare and Medicaid Services to establish certified 12
community behavioral health clinics; extending to a certain date the inclusion of 13
certain audio–only telephone conversations in the definition of “telehealth” in the 14
Maryland Medical Assistance Program and certain requirements related to the 15
provision of reimbursement for health care services appropriately provided through 16
telehealth by the Program and certain insurers, nonprofit health service plans, and 17
health maintenance organizations; and generally relating to behavioral health care 18
treatment and access. 19
BY adding to 20
Article – Health – General 21
Section 13–4801 through 13–4807 to be under the new subtitle “Subtitle 48. 22
Commission on Behavioral Health Care Treatment and Access”; 13–4901 23
through 13–4907 to be under the new subtitle “Subtitle 49. Behavioral Health 24
Care Coordination Value–Based Purchasing Pilot Program”; and 15–141.5 25
Annotated Code of Maryland 26
(2019 Replacement Volume and 2022 Supplement) 27
BY repealing and reenacting, with amendments, 28
Article – Health – General 29 2 SENATE BILL 582
Section 15–141.2 1
Annotated Code of Maryland 2
(2019 Replacement Volume and 2022 Supplement) 3
BY repealing and reenacting, with amendments, 4
Article – Insurance 5
Section 15–139 6
Annotated Code of Maryland 7
(2017 Replacement Volume and 2022 Supplement) 8
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 9
That the Laws of Maryland read as follows: 10
Article – Health – General 11
SUBTITLE 48. COMMISSION ON BEHAVIORAL HEALTH CARE TREATMENT AND 12
ACCESS. 13
13–4801. 14
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 15
INDICATED. 16
(B) “BEHAVIORAL HEALTH ” INCLUDES SUBSTANCE –RELATED DISORDERS , 17
ADDICTIVE DISORDERS , MENTAL DISORDERS , LIFE STRESSORS AND C RISES, AND 18
STRESS–RELATED PHYSICAL SYM PTOMS. 19
(C) “COMMISSION” MEANS THE COMMISSION ON BEHAVIORAL HEALTH 20
CARE TREATMENT AND ACCESS. 21
13–4802. 22
THERE IS A COMMISSION ON BEHAVIORAL HEALTH CARE TREATMENT AND 23
ACCESS. 24
13–4803. 25
(A) THE COMMISSION CONSISTS O F THE FOLLOWING MEMB ERS: 26
(1) ONE MEMBER OF THE SENATE OF MARYLAND, APPOINTED BY THE 27
PRESIDENT OF THE SENATE; 28
(2) ONE MEMBER OF THE HOUSE OF DELEGATES, APPOINTED BY THE 29
SPEAKER OF THE HOUSE; 30
SENATE BILL 582 3
(3) ONE REPRESENTATIVE OF MARYLAND’S CONGRESSIONAL 1
DELEGATION; 2
(4) THE SECRETARY OF HEALTH, OR THE SECRETARY’S DESIGNEE; 3
(5) THE SECRETARY OF HUMAN SERVICES, OR THE SECRETARY’S 4
DESIGNEE; 5
(6) THE SECRETARY OF JUVENILE SERVICES, OR THE SECRETARY’S 6
DESIGNEE; 7
(7) THE DEPUTY SECRETARY FOR BEHAVIORAL HEALTH, OR THE 8
DEPUTY SECRETARY’S DESIGNEE; 9
(8) THE MARYLAND INSURANCE COMMISSIONER , OR THE 10
COMMISSIONER ’S DESIGNEE; 11
(9) THE EXECUTIVE DIRECTOR OF THE HEALTH SERVICES COST 12
REVIEW COMMISSION, OR THE EXECUTIVE DIRECTOR’S DESIGNEE; 13
(10) THE EXECUTIVE DIRECTOR OF THE MARYLAND HEALTH CARE 14
COMMISSION, OR THE EXECUTIVE DIRECTOR’S DESIGNEE; 15
(11) THE EXECUTIVE DIRECTOR OF THE MARYLAND COMMUNITY 16
HEALTH RESOURCES COMMISSION, OR THE EXECUTIVE DIRECTOR’S DESIGNEE; 17
(12) THE EXECUTIVE DIRECTOR OF THE STATE–DESIGNATED HEALTH 18
INFORMATION EXCHANGE , OR THE EXECUTIVE DIRECTOR’S DESIGNEE; 19
(13) THE EXECUTIVE DIRECTOR OF THE GOVERNOR’S OFFICE OF 20
CRIME PREVENTION, YOUTH, AND VICTIM SERVICES, OR THE EXECUTIVE 21
DIRECTOR’S DESIGNEE; AND 22
(14) THE FOLLOWING MEMBERS APPOINTED BY THE GOVERNOR: 23
(I) ONE REPRESENTATIVE OF THE MENTAL HEALTH 24
ASSOCIATION OF MARYLAND; 25
(II) ONE REPRESENTATIVE OF THE NATIONAL ALLIANCE ON 26
MENTAL ILLNESS; 27
(III) ONE REPRESENTATIVE OF THE COMMUNITY BEHAVIORAL 28
HEALTH ASSOCIATION OF MARYLAND; 29 4 SENATE BILL 582
(IV) ONE REPRESENTATIVE OF A PROVIDER OF RESIDE NTIAL 1
BEHAVIORAL HEALTH SERVI CES; 2
(V) ONE REPRESENTATIVE OF AN ACUTE CARE HOSPIT AL; 3
(VI) ONE REPRESENTATIVE OF AN INPATIENT PSYCHIA TRIC 4
HOSPITAL; 5
(VII) ONE INDIVIDUAL WITH E XPERIENCE AS A CONSU MER OF 6
BEHAVIORAL HEALTH SE RVICES; 7
(VIII) ONE FAMILY MEMBER OF AN INDIVID UAL WITH 8
EXPERIENCE AS A CONS UMER OF BEHAVIORAL H EALTH SERVICES ; 9
(IX) ONE REPRESENTATIVE OF A PROVIDER OF SUBSTA NCE USE 10
TREATMENT SERVICES ; 11
(X) ONE REPRESENTATIVE OF A SCHOOL–BASED HEALTH 12
CENTER; 13
(XI) ONE INDIVIDUAL WITH E XPERTISE IN SOCIAL 14
DETERMINANTS OF HEAL TH; 15
(XII) ONE INDIVIDUAL WITH E XPERTISE IN HEALTH E CONOMICS; 16
(XIII) ONE REPRESENTATIVE OF A HEALTH INSURANCE C ARRIER; 17
(XIV) ONE REPRESENTATIVE OF A MANAGED CARE 18
ORGANIZATION ; 19
(XV) ONE REPRESENTATIVE FR OM THE OFFICE OF THE PUBLIC 20
DEFENDER; 21
(XVI) ONE REPRESENTATIVE OF THE DEVELOPMENTAL 22
DISABILITY COALITION; 23
(XVII) ONE REPRESENTATIVE OF THE MARYLAND CHAPTER OF 24
THE NATIONAL COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE ; 25
(XVIII) ONE REPRESENTATIVE O F THE MARYLAND 26
PSYCHOLOGICAL ASSOCIATION; AND 27
SENATE BILL 582 5
(XIX) ONE REPRESENTATIVE OF DISABILITY RIGHTS MARYLAND. 1
(B) TO THE EXTENT PRACTIC ABLE, THE MEMBERSHIP OF TH E COMMISSION 2
SHALL REFLECT THE GE OGRAPHIC AND ETHNIC DIVERSITY OF THE STATE. 3
(C) THE GOVERNOR, THE PRESIDENT OF THE SENATE, AND THE SPEAKER 4
OF THE HOUSE JOINTLY SHALL D ESIGNATE THE CHAIR O F THE COMMISSION. 5
(D) THE DEPARTMENT SHALL PROV IDE STAFF FOR THE COMMISSION. 6
(E) A MEMBER OF THE COMMISSION: 7
(1) MAY NOT RECEIVE COMPE NSATION AS A MEMBER OF THE 8
COMMISSION; BUT 9
(2) IS ENTITLED TO REIMBU RSEMENT FOR EXPENSES UNDER THE 10
STANDARD STATE TRAVEL REGULATIONS, AS PROVIDED IN THE STATE BUDGET . 11
(F) THE COMMISSION SHALL MEET AT LEAST THREE TIMES PER YEAR AT 12
THE TIMES AND PLACES DETERMINED BY THE COMMISSION. 13
13–4804. 14
THE PURPOSE OF THE COMMISSION IS TO MAKE RECOMMENDATIONS TO 15
PROVIDE APPROPRIATE , ACCESSIBLE, AND COMPREHENSIVE BE HAVIORAL HEALTH 16
SERVICES TO INDIVIDU ALS IN THE STATE ACROSS THE BEHA VIORAL HEALTH 17
CONTINUUM THAT ARE A VAILABLE ON DEMAN D. 18
13–4805. 19
THE COMMISSION SHALL : 20
(1) CONDUCT AN ASSESSMENT OF BEHAVIORAL HEALTH SERVICES IN 21
THE STATE TO IDENTIFY NEE DS AND GAPS IN SERVI CES ACROSS THE CONTI NUUM, 22
INCLUDING COMMUNITY –BASED OUTPATIENT AND SUPPORT SERVICES , CRISIS 23
RESPONSE, AND INPATIENT CARE; 24
(2) EXAMINE THE METHODS F OR REIMBURSING BEHAV IORAL 25
HEALTH CARE SERVICES IN THE STATE AND MAKE RECOMM ENDATIONS ON THE 26
MOST EFFECTIVE FORMS OF REIMBURSEMENT TO MAXIMIZE SERVICE DEL IVERY; 27
(3) COMPILE FINDINGS OF STATE–SPECIFIC NEEDS ASSES SMENTS 28
RELATED TO BEHAVIORA L HEALTH CARE SERVIC ES; 29 6 SENATE BILL 582
(4) REVIEW RECOMMENDATION S AND REPORTS OF STATE 1
COMMISSIONS , WORKGROUPS , OR TASK FORCES RELAT ED TO BEHAVIORAL HEA LTH 2
CARE SERVICES ; 3
(5) CONDUCT A NEEDS ASSES SMENT ON THE STATE’S BEHAVIORAL 4
HEALTH CARE WORKFORC E TO IDENTIFY GAPS A ND MAKE RECOMMENDATI ONS TO 5
ENSURE AN ADEQUATE W ORKFORCE ACROSS THE BEHAVIORAL HEALTH CA RE 6
CONTINUUM ; 7
(6) REVIEW TRENDS AND BES T PRACTICES FROM OTH ER STATES 8
REGARDING POLICY AND REI MBURSEMENT STRATEGIE S THAT SUPPORT ACCES S TO 9
A COMPREHENSIVE ARRA Y OF SERVICES AND EN SURE QUALITY OF CARE ; 10
(7) EXAMINE AND MAKE RECO MMENDATIONS RELATED TO THE 11
BEHAVIORAL HEALTH OF THE GERIATRIC AND YO UTH POPULATIONS IN T HE STATE; 12
(8) EXAMINE AND MAKE RECO MMENDATIONS TO PROVI DE 13
APPROPRIATE AND ADEQ UATE BEHAVIORAL HEAL TH SERVICES TO INDIV IDUALS 14
WITH COMPLEX BEHAVIO RAL HEALTH NEEDS , SPECIFICALLY YOUTH ; 15
(9) ASSESS THE HEALTH INF RASTRUCTURE , FACILITIES, 16
PERSONNEL , AND SERVICES AVAILA BLE FOR THE STATE’S FORENSIC POPULATIO N 17
AND IDENTIFY DEFICIE NCIES IN RESOURCES A ND POLICIES NEEDED T O PRIORITIZE 18
HEALTH OUTCOMES , INCREASE PUBLIC SAFE TY, AND REDUCE RECIDIVIS M; 19
(10) MAKE RECOMMENDATIONS ON EXPANDING BEHAVIO RAL HEALTH 20
TREATMENT ACCESS FO R THE STATE’S COURT–ORDERED POPULATION ; 21
(11) MAKE RECOMMENDATIONS ON ACTION PLANS REGA RDING THE 22
BEHAVIORAL HEALTH CA RE SYSTEM’S CAPACITY TO PREPAR E FOR AND RESPOND TO 23
FUTURE CHALLENGES AF FECTING THE ENTIRE STATE OR PARTICULAR R EGIONS OR 24
POPULATIONS IN THE STATE, INCLUDING PANDEMICS AND EXTREME WEATHER 25
EVENTS; AND 26
(12) MAKE RECOMMENDATIONS TO ENSURE THAT BEHAV IORAL 27
HEALTH TREATMENT IS PROVIDED IN THE APPR OPRIATE SETTING , INCLUDING 28
METHODS TO DIVERT BE HAVIORAL HEALTH PATI ENTS FROM EMERGENCY 29
DEPARTMENTS BY USING THE MARYLAND MENTAL HEALTH AND SUBSTANCE USE 30
DISORDER REGISTRY AND REFERRAL SYSTEM ESTABLISHED UN DER § 7.5–802 OF 31
THIS ARTICLE AND 2–1–1. 32
13–4806. 33 SENATE BILL 582 7
(A) THE COMMISSION SHALL ESTA BLISH THE FOLLOWING WORKGROUPS : 1
(1) GERIATRIC BEHAVIORAL HEALTH; 2
(2) YOUTH BEHAVIORAL HEAL TH AND INDIVIDUALS W ITH COMPLEX 3
BEHAVIORAL HEALTH NE EDS; 4
(3) CRIMINAL JUSTICE –INVOLVED BEHAVIORAL HEALTH; AND 5
(4) BEHAVIORAL HEALTH WOR KFORCE DEVELOPMENT , 6
INFRASTRUCTURE , AND FINANCING . 7
(B) THE WORKGROUPS ESTABL ISHED UNDER SUBSECTION (A) OF THIS 8
SECTION SHALL MEET A T LEAST TWO TIMES PE R YEAR AT THE TIMES AND PLACES 9
DETERMINED BY THE WO RKGROUP. 10
(C) THE WORKGROUPS ESTABL ISHED UNDER SUBSECTI ON (A) OF THIS 11
SECTION SHALL INCLUD E MEMBERS OF THE COMMISSION AND MAY IN CLUDE 12
INDIVIDUALS INVITED B Y THE COMMISSION TO SERVE ON THE WORKGROUP . 13
(D) ON OR BEFORE DECEMBER 1 EACH YEAR, BEGINNING IN 2023, THE 14
WORKGROUPS ESTABLISH ED UNDER SUBSECTION (A) OF THIS SECTION SHAL L 15
REPORT AND MAKE RECO MMENDATIONS TO THE COMMISSION. 16
13–4807. 17
(A) (1) ON OR BEFORE JANUARY 1 EACH YEAR, BEGINNING IN 2024, THE 18
COMMISSION SHALL REPO RT TO THE GOVERNOR AND , IN ACCORDANCE WITH § 19
2–1257 OF THE STATE GOVERNMENT ARTICLE, THE GENERAL ASSEMBLY ON THE 20
COMMISSION’S FINDINGS AND RECOM MENDATIONS , INCLUDING FUN DING AND 21
LEGISLATIVE RECOMMEN DATIONS. 22
(2) ANY LEGISLATIVE RECOM MENDATIONS INCLUDED IN THE 23
REPORT REQUIRED UNDE R PARAGRAPH (1) OF THIS SUBSECTION T HAT REQUIRE 24
FUNDING SHALL INCLUD E AN ESTIMATE OF THE FUNDING REQUIRED TO 25
IMPLEMENT THE RECOMM ENDATION AND I NFORMATION THAT SUPP ORTS THE 26
FUNDING ESTIMATE . 27
(B) THE REPORT REQUIRED O N OR BEFORE JANUARY 1, 2024, SHALL 28
INCLUDE THE FINDINGS OF THE NEEDS ASSESSM ENTS REQUIRED UNDER § 13–4805 29
OF THIS SUBTITLE. 30
8 SENATE BILL 582
SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read as 1
follows: 2
Article – Health – General 3
SUBTITLE 49. BEHAVIORAL HEALTH CARE COORDINATION VALUE–BASED 4
PURCHASING PILOT PROGRAM. 5
13–4901. 6
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 7
INDICATED. 8
(B) “BEHAVIORAL HEALTH CAR E COORDINATION ” MEANS A 9
PERSON–CENTERED, TEAM–BASED ACTIVITY DESIG NED TO: 10
(1) ASSESS AND MEET THE N EEDS OF AN INDIVIDUA L WITH A 11
BEHAVIORAL HEALTH CO NDITION; AND 12
(2) HELP THE INDIVIDUAL N AVIGATE THE HEALTH C ARE SYSTEM 13
EFFECTIVEL Y AND EFFICIENTLY . 14
(C) “PILOT PROGRAM” MEANS THE BEHAVIORAL HEALTH CARE 15
COORDINATION VALUE–BASED PURCHASING PILOT PROGRAM. 16
(D) “VALUE–BASED PURCHASING ” MEANS FINANCIALLY IN CENTIVIZING 17
PROVIDERS TO MEET SP ECIFIED OUTCOME MEAS URES. 18
13–4902. 19
THERE IS A BEHAVIORAL HEALTH CARE COORDINATION VALUE–BASED 20
PURCHASING PILOT PROGRAM IN THE DEPARTMENT . 21
13–4903. 22
THE PURPOSE OF THE PILOT PROGRAM IS TO ESTABLI SH AND IMPLEMENT AN 23
INTENSIVE CARE COORD INATION MODEL USING VALUE–BASED PURCHASING IN THE 24
SPECIALTY BEHA VIORAL HEALTH SYSTEM . 25
13–4904. 26
(A) THE DEPARTMENT SHALL ADMI NISTER THE PILOT PROGRAM. 27
SENATE BILL 582 9
(B) THE DEPARTMENT SHALL IDEN TIFY AT LEAST 500 ADULTS WHOSE 1
BEHAVIORAL HEALTH CO NDITION OR FUNCTIONI NG PLACES THEM AT RI SK OF 2
HOSPITAL EMERGENCY D EPARTMENT UTILIZATI ON OR INPATIENT PSYC HIATRIC 3
HOSPITAL ADMISSION . 4
(C) THE PILOT PROGRAM SHALL BE OPER ATIONAL FOR A 3–YEAR PERIOD. 5
(D) A PROVIDER OR NETWORK OF PROVIDERS SELECTE D TO PARTICIPATE 6
IN THE PILOT PROGRAM SHALL : 7
(1) BE LICENSED AND IN GO OD STANDING WITH THE MARYLAND 8
MEDICAL ASSISTANCE PROGRAM; 9
(2) HAVE EXPERIENCE IN PR OVIDING COMMUNITY –BASED CARE 10
COORDINATION TO SPEC IALTY BEHAVIORAL HEA LTH PROGRAM RECIPIEN TS; 11
(3) USE AN ELECTRONIC MED ICAL RECORD FOR DOCU MENTING CARE 12
COORDINATION ACTIVIT IES AND OUTCOMES COLLECTION; AND 13
(4) HAVE AN AUTOMATED DAT A EXCHANGE WITH THE 14
STATE–DESIGNATED HEALTH IN FORMATION EXCHANGE . 15
(E) THE DEPARTMENT SHALL : 16
(1) PROVIDE REIMBURSEMENT ON A PER MEMBER PER MONTH BASIS 17
FOR THE BEHAVIORAL H EALTH CARE COORDINAT ION ACTIVITIES T HAT ARE NOT 18
OTHERWISE COVERED BY THE MARYLAND MEDICAL ASSISTANCE PROGRAM; 19
(2) COLLECT OUTCOMES DATA ON RECIPIENTS OF HEA LTH CARE 20
SERVICES UNDER THE PILOT PROGRAM; AND 21
(3) EVALUATE THE EFFECTIV ENESS OF THE VALUE –BASED 22
PURCHASING MODEL BY ANALYZING THE FOLLOWING OUTCOME ME ASURES: 23
(I) A COMPARISON OF THE FO LLOWING DATA ELEMENT S 24
BEFORE AND AFTER ENR OLLMENT OF RECIPIENT S OF HEALTH CARE SER VICES 25
UNDER THE PILOT PROGRAM: 26
1. EMERGENCY DEPARTMENT UTILIZATION FOR BOTH 27
BEHAVIORAL AND SOMAT IC HEALTH PURP OSES; 28
2. INPATIENT HOSPITALIZA TION FOR BOTH 29
BEHAVIORAL AND SOMAT IC HEALTH PURPOSES ; AND 30 10 SENATE BILL 582
3. TOTAL HEALTH CARE EXP ENDITURES; 1
(II) OUTCOMES FOR RECIPIEN TS WITH AND WITHOUT PRIMARY 2
CARE SERVICES COORDI NATED BY A BEHAVIORA L HEALTH PROVIDER ; AND 3
(III) RECOGNIZED CLINICAL Q UALITY METRICS WHICH MAY 4
INCLUDE PATIENT EXPE RIENCE MEASURES . 5
13–4905. 6
IF NECESSARY TO IMPLE MENT THE PILOT PROGRAM, THE DEPARTMENT 7
SHALL APPLY TO THE CENTERS FOR MEDICARE AND MEDICAID SERVICES FOR AN 8
AMENDMENT TO THE STATE’S § 1115 HEALTHCHOICE DEMONSTRATION . 9
13–4906. 10
(A) FOR EACH OF FISCAL YE AR 2025, FISCAL YEAR 2026, AND FISCAL YEAR 11
2027, THE GOVERNOR SHALL INCLUD E IN THE ANNUAL BUDG ET BILL AN 12
APPROPRIATION OF $600,000 FOR THE PILOT PROGRAM. 13
(B) BEGINNING IN FISCAL Y EAR 2026, THE DEPARTMENT SHALL ALLO CATE 14
A PERCENTAGE OF THE ANNUAL APPROPRIATION REQUIRED UNDER SUBSE CTION 15
(A) OF THIS SECTION TO R EIMBURSEMENT PAID BA SED ON THE ACHIEVEME NT OF 16
THE OUTCOME MEASURES DESCRIBED IN § 13–4904(E)(3) OF THIS SUBTITLE. 17
(C) IN FISCAL YEAR 2027, THE DEPARTMENT SHALL INCR EASE THE 18
PERCENTAGE OF THE AN NUAL APPROPRIATION R EQUIRED UNDER SUBSEC TION (A) 19
OF THIS SECTION ALLO CATED TO REIMBURSEME NT PAID IN ACCORDANC E WITH 20
SUBSECTION (B) OF THIS SECTION OVER THE PERCENTAGE ALLOC ATED IN FISCAL 21
YEAR 2026. 22
13–4907. 23
ON OR BEFORE NOVEMBER 1, 2027, THE DEPARTMENT SHALL REPO RT TO 24
THE GOVERNOR AND , IN ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT 25
ARTICLE, THE GENERAL ASSEMBLY ON THE DEPARTMENT ’S FINDINGS AND 26
RECOMMENDATIONS FROM THE PILOT PROGRAM. 27
SECTION 3. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 28
as follows: 29
Article – Health – General 30
SENATE BILL 582 11
15–141.2. 1
(a) (1) In this section the following words have the meanings indicated. 2
(2) “Distant site” means a site at which the distant site health care provider 3
is located at the time the health care service is provided through telehealth. 4
(3) “Distant site provider” means the health care provider who provides 5
medically necessary services to a patient at an originating site from a different physical 6
location than the location of the patient. 7
(4) “Health care provider” means: 8
(i) A person who is licensed, certified, or otherwise authorized under 9
the Health Occupations Article to provide health care in the ordinary course of business or 10
practice of a profession or in an approved education or training program; 11
(ii) A mental health and substance use disorder program licensed in 12
accordance with § 7.5–401 of this article; 13
(iii) A person licensed under Title 7, Subtitle 9 of this article to 14
provide services to an individual with developmental disability or a recipient of individual 15
support services; or 16
(iv) A provider as defined under § 16–201.4 of this article to provide 17
services to an individual receiving long–term care services. 18
(5) “Originating site” means the location of the Program recipient at the 19
time the health care service is provided through telehealth. 20
(6) “Remote patient monitoring services” means the use of synchronous or 21
asynchronous digital technologies that collect or monitor medical, patient–reported, and 22
other forms of health care data for Program recipients at an originating site and 23
electronically transmit that data to a distant site provider to enable the distant site 24
provider to assess, diagnose, consult, treat, educate, provide care management, suggest 25
self–management, or make recommendations regarding the Program recipient’s health 26
care. 27
(7) (i) “Telehealth” means the delivery of medically necessary somatic, 28
dental, or behavioral health services to a patient at an originating site by a distant site 29
provider through the use of technology–assisted communication. 30
(ii) “Telehealth” includes: 31
1. Synchronous and asynchronous interactions; 32
12 SENATE BILL 582
2. From July 1, 2021, to June 30, [2023] 2025, both 1
inclusive, an audio–only telephone conversation between a health care provider and a 2
patient that results in the delivery of a billable, covered health care service; and 3
3. Remote patient monitoring services. 4
(iii) “Telehealth” does not include the provision of health care 5
services solely through: 6
1. Except as provided in subparagraph (ii)2 of this 7
paragraph, an audio–only telephone conversation; 8
2. An e–mail message; or 9
3. A facsimile transmission. 10
(b) The Program shall: 11
(1) Provide health care services appropriately delivered through telehealth 12
to Program recipients regardless of the location of the Program recipient at the time 13
telehealth services are provided; and 14
(2) Allow a distant site provider to provide health care services to a 15
Program recipient from any location at which the health care services may be appropriately 16
delivered through telehealth. 17
(c) The services required to be provided under subsection (b) of this section shall 18
include counseling and treatment for substance use disorders and mental health conditions. 19
(d) The Program may not: 20
(1) Exclude from coverage a health care service solely because it is provided 21
through telehealth and is not provided through an in–person consultation or contact 22
between a health care provider and a patient; or 23
(2) Exclude from coverage a behavioral health care service provided to a 24
Program recipient in person solely because the service may also be provided through 25
telehealth. 26
(e) The Program may undertake utilization review, including preauthorization, 27
to determine the appropriateness of any health care service whether the service is delivered 28
through an in–person consultation or through telehealth if the appropriateness of the 29
health care service is determined in the same manner. 30
(f) The Program may not distinguish between Program recipients in rural or 31
urban locations in providing coverage under the Program for health care services delivered 32
through telehealth. 33 SENATE BILL 582 13
(g) (1) Subject to paragraph (3) of this subsection, the Program shall 1
reimburse a health care provider for the diagnosis, consultation, and treatment of a 2
Program recipient for a health care service covered by the Program that can be 3
appropriately provided through telehealth. 4
(2) This subsection does not require the Program to reimburse a health 5
care provider for a health care service delivered in person or through telehealth that is: 6
(i) Not a covered health care service under the Program; or 7
(ii) Delivered by an out–of–network provider unless the health care 8
service is a self–referred service authorized under the Program. 9
(3) (i) From July 1, 2021, to June 30, [2023] 2025, both inclusive, when 10
appropriately provided through telehealth, the Program shall provide reimbursement in 11
accordance with paragraph (1) of this subsection on the same basis and the same rate as if 12
the health care service were delivered by the health care provider in person. 13
(ii) The reimbursement required under subparagraph (i) of this 14
paragraph does not include: 15
1. Clinic facility fees unless the health care service is 16
provided by a health care provider not authorized to bill a professional fee separately for 17
the health care service; or 18
2. Any room and board fees. 19
(h) (1) The Department may specify in regulation the types of health care 20
providers eligible to receive reimbursement for health care services provided to Program 21
recipients under this section. 22
(2) If the Department specifies by regulation the types of health care 23
providers eligible to receive reimbursement for health care services provided to Program 24
recipients under this subsection, the regulations shall include all types of health care 25
providers that appropriately provide telehealth services. 26
(3) For the purpose of reimbursement and any fide lity standards 27
established by the Department, a health care service provided through telehealth is 28
equivalent to the same health care service when provided through an in –person 29
consultation. 30
(i) Subject to subsection (g)(2) of this section, the Program or a managed care 31
organization that participates in the Program may not impose as a condition of 32
reimbursement of a covered health care service delivered through telehealth that the 33
health care service be provided by a third–party vendor designated by the Program. 34
14 SENATE BILL 582
(j) The Department may adopt regulations to carry out this section. 1
(k) The Department shall obtain any federal authority necessary to implement 2
the requirements of this section, including applying to the Centers for Medicare and 3
Medicaid Services for an amendment to any of the State’s § 1115 waivers or the State plan. 4
(l) This section may not be construed to supersede the authority of the Health 5
Services Cost Review Commission to set the appropriate rates for hospitals, including 6
setting the hospital facility fee for hospital–provided telehealth. 7
15–141.5. 8
(A) IN THIS SECTION , “CERTIFIED COMMUNITY BEHAVIORAL HEALTH 9
CLINIC” MEANS A NONPROFIT CO MPREHENSIVE COMMUNIT Y MENTAL HEALTH OR 10
SUBSTANCE USE TREATM ENT ORGANIZATION LIC ENSED BY THE STATE THAT MEETS 11
THE FEDERAL CERTIFIC ATION CRITERIA OF § 223 OF THE FEDERAL PROTECTING 12
ACCESS TO MEDICARE ACT OF 2014 AND OFFERS , DIRECTLY OR INDIRECT LY 13
THROUGH FORMAL REFER RAL RELATIONSHIPS WI TH OTHER PROVIDERS , THE 14
FOLLOWING SERVICES : 15
(1) OUTPATIENT ME NTAL HEALTH AND SUBS TANCE USE SERVICES ; 16
(2) 24–HOUR MOBILE CRISIS R ESPONSE AND HOTLINE SERVICES; 17
(3) SCREENING, ASSESSMENT, AND DIAGNOSIS , INCLUDING RISK 18
ASSESSMENTS ; 19
(4) PERSON–CENTERED TREATMENT P LANNING; 20
(5) PRIMARY CARE SCREENIN G AND MONITO RING OF KEY 21
INDICATORS OF HEALTH RISKS; 22
(6) TARGETED CASE MANAGEM ENT; 23
(7) PSYCHIATRIC REHABILIT ATION SERVICES ; 24
(8) PEER SUPPORT AND FAMI LY SUPPORTS; 25
(9) MEDICATION–ASSISTED TREATMENT ; 26
(10) ASSERTIVE COMMUNITY T REATMENT; AND 27
(11) COMMUNITY–BASED MENTAL HEALTH CARE FOR MILITARY 28
SERVICE MEMBERS AND VETERANS. 29 SENATE BILL 582 15
(B) ON OR BEFORE DECEMBER 1, 2023, THE DEPARTMENT SHALL SUBM IT 1
A STATE PLAN AMENDMENT TO THE CENTERS FOR MEDICARE AND MEDICAID 2
SERVICES TO ESTABLISH CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINICS I N 3
ACCORDANCE WITH § 223 OF THE FEDERAL PROTECTING ACCESS TO MEDICARE 4
ACT OF 2014. 5
(C) IF THE AMENDMENT SUBM ITTED UNDER SUBSECTI ON (B) OF THIS 6
SECTION IS APPROVED , THE DEPARTMENT SHALL AMEN D THE STATE PLAN IN 7
ACCORDANCE WITH TITLE XIX AND TITLE XXI OF THE SOCIAL SECURITY ACT AS 8
NECESSARY TO COVER : 9
(1) ALL REQUIRED SERVICES FOR INDIVIDUALS WITH MENTAL 10
HEALTH NEEDS OR SUBS TANCE USE DISORDERS AT CERTIFIED COMMUNI TY 11
BEHAVIORAL HEALTH CL INICS THROUGH A DAIL Y BUNDLED PAYMENT 12
METHODOLOGY TH AT IS IN ALIGNMENT W ITH FEDERAL PAYMENT FROM THE 13
CENTERS FOR MEDICARE AND MEDICAID SERVICES FOR THE CERT IFIED 14
COMMUNITY BEHAVIORAL HEALTH CLINICS MEDICAID DEMONSTRATIO N UNDER § 15
223 OF THE FEDERAL PROTECTING ACCESS TO MEDICARE ACT OF 2014; AND 16
(2) ANY ADDITIONAL SERVICES I DENTIFIED BY THE DEPARTMENT . 17
(D) (1) THE DEPARTMENT SHALL ESTA BLISH STANDARDS AND 18
METHODOLOGIES FOR A PROSPECTIVE PAYMENT SYSTEM TO REIMBURSE A 19
CERTIFIED COMMUNITY BEHAVIORAL HEALTH CL INIC UNDER THE PROGRAM ON A 20
PREDETERMINED FIXED AMOUNT PER DAY FOR COV ERED SERVICES PROVID ED TO A 21
PROGRAM RECIPIENT . 22
(2) THE PROSPECTIVE PAYME NT RATE FOR A CERTIF IED COMMUNITY 23
BEHAVIORAL HEALTH CL INIC SHALL: 24
(I) BE ADJUSTED ONCE EVER Y 3 YEARS BY THE MEDICARE 25
ECONOMIC INDEX IN ACCORDANCE W ITH § 223 OF THE FEDERAL PROTECTING 26
ACCESS TO MEDICARE ACT OF 2014; AND 27
(II) ALLOW FOR MODIFICATIO NS BASED ON A CHANGE IN SCOPE 28
FOR AN INDIVIDUAL CE RTIFIED COMMUNITY BE HAVIORAL HEALTH CLIN IC. 29
(3) THE DEPARTMENT MAY CONSID ER RATE ADJUSTMENTS ON 30
REQUEST BY A C ERTIFIED COMMUNITY B EHAVIORAL HEALTH CLI NIC. 31
(E) (1) THE DEPARTMENT SHALL ESTA BLISH A QUALITY INCE NTIVE 32
PAYMENT SYSTEM FOR A CERTIFIED COMMUNITY BEHAVIORAL HEALTH CL INIC 33 16 SENATE BILL 582
THAT ACHIEVES SPECIF IED THRESHOLDS ON PE RFORMANCE METRICS 1
ESTABLISHED BY THE DEPARTMENT. 2
(2) THE QUALITY INCENTIVE PAYMENT SYSTEM ESTAB LISHED UNDER 3
PARAGRAPH (1) OF THIS SUBSECTION S HALL BE IN ADDITION TO THE PROSPECTIVE 4
PAYMENT RATE ESTABLI SHED UNDER SUBSECTIO N (D) OF THIS SECTION. 5
Article – Insurance 6
15–139. 7
(a) (1) In this section, “telehealth” means, as it relates to the delivery of health 8
care services, the use of interactive audio, video, or other telecommunications or electronic 9
technology by a licensed health care provider to deliver a health care service within the 10
scope of practice of the health care provider at a location other than the location of the 11
patient. 12
(2) “Telehealth” includes from July 1, 2021, to June 30, [2023] 2025, both 13
inclusive, an audio–only telephone conversation between a health care provider and a 14
patient that results in the delivery of a billable, covered health care service. 15
(3) “Telehealth” does not include: 16
(i) except as provided in paragraph (2) of this subsection, an 17
audio–only telephone conversation between a health care provider and a patient; 18
(ii) an electronic mail message between a health care provider and a 19
patient; or 20
(iii) a facsimile transmission between a health care provider and a 21
patient. 22
(b) This section applies to: 23
(1) insurers and nonprofit health service plans that provide hospital, 24
medical, or surgical benefits to individuals or groups on an expense–incurred basis under 25
health insurance policies or contracts that are issued or delivered in the State; and 26
(2) health maintenance organizations that provide hospital, medical, or 27
surgical benefits to individuals or groups under contracts that are issued or delivered in 28
the State. 29
(c) (1) An entity subject to this section: 30
SENATE BILL 582 17
(i) shall provide coverage under a health insurance policy or 1
contract for health care services appropriately delivered through telehealth regardless of 2
the location of the patient at the time the telehealth services are provided; 3
(ii) may not exclude from coverage a health care service solely 4
because it is provided through telehealth and is not provided through an in–person 5
consultation or contact between a health care provider and a patient; and 6
(iii) may not exclude from coverage or deny coverage for a behavioral 7
health care service that is a covered benefit under a health insurance policy or contract 8
when provided in person solely because the behavioral health care service may also be 9
provided through a covered telehealth benefit. 10
(2) The health care services appropriately delivered through telehealth 11
shall include counseling and treatment for substance use disorders and mental health 12
conditions. 13
(d) (1) Subject to paragraph (2) of this subsection, an entity subject to this 14
section: 15
(i) shall reimburse a health care provider for the diagnosis, 16
consultation, and treatment of an insured patient for a health care service covered under a 17
health insurance policy or contract that can be appropriately provided through telehealth; 18
(ii) is not required to: 19
1. reimburse a health care provider for a health care service 20
delivered in person or through telehealth that is not a covered benefit under the health 21
insurance policy or contract; or 22
2. reimburse a health care provider who is not a covered 23
provider under the health insurance policy or contract; and 24
(iii) 1. may impose a deductible, copayment, or coinsurance 25
amount on benefits for health care services that are delivered either through an in–person 26
consultation or through telehealth; 27
2. may impose an annual dollar maximum as permitted by 28
federal law; and 29
3. may not impose a lifetime dollar maximum. 30
(2) (i) From July 1, 2021, to June 30, [2023] 2025, both inclusive, when 31
a health care service is appropriately provided through telehealth, an entity subject to this 32
section shall provide reimbursement in accordance with paragraph (1)(i) of this subsection 33
on the same basis and at the same rate as if the health care service were delivered by the 34
health care provider in person. 35 18 SENATE BILL 582
(ii) The reimbursement required under subparagraph (i) of this 1
paragraph does not include: 2
1. clinic facility fees unless the health care service is 3
provided by a health care provider not authorized to bill a professional fee separately for 4
the health care service; or 5
2. any room and board fees. 6
(iii) This paragraph may not be construed to supersede the authority 7
of the Health Services Cost Review Commission to set the appropriate rates for hospitals, 8
including setting the hospital facility fee for hospital–provided telehealth. 9
(e) Subject to subsection (d)(1)(ii) of this section, an entity subject to this section 10
may not impose as a condition of reimbursement of a covered health care service delivered 11
through telehealth that the health care service be provided by a third–party vendor 12
designated by the entity. 13
(f) An entity subject to this section may undertake utilization review, including 14
preauthorization, to determine the appropriateness of any health care service whether the 15
service is delivered through an in–person consultation or through telehealth if the 16
appropriateness of the health care service is determined in the same manner. 17
(g) A health insurance policy or contract may not distinguish between patients in 18
rural or urban locations in providing coverage under the policy or contract for health care 19
services delivered through telehealth. 20
(h) A decision by an entity subject to this section not to provide coverage for 21
telehealth in accordance with this section constitutes an adverse decision, as defined in § 22
15–10A–01 of this title, if the decision is based on a finding that telehealth is not medically 23
necessary, appropriate, or efficient. 24
SECTION 4. AND BE IT FURTHER ENACTED, That Section 2 of this Act shall take 25
effect October 1, 2023. It shall remain effective for a period of 4 years and 2 months and, at 26
the end of November 30, 2027, Section 2 of this Act, with no further action required by the 27
General Assembly, shall be abrogated and of no further force and effect. 28
SECTION 5. AND BE IT FURTHER ENACTED, That, except as provided in Section 29
4 of this Act, this Act shall take effect June 1, 2023. Section 1 of this Act shall remain 30
effective for a period of 4 years and 1 month and, at the end of June 30, 2027, Section 1 of 31
this Act, with no further action required by the General Assembly, shall be abrogated and 32
of no further force and effect. 33