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.
*sb0582*
SENATE BILL 582
J1, J3 3lr0460
CF HB 1148
By: Senator Augustine
Introduced and read first time: February 6, 2023
Assigned to: Finance
Committee Report: Favorable with amendments
Senate action: Adopted
Read second time: March 20, 2023
CHAPTER ______
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 that are available on demand to 6
individuals in the State across the behavioral health continuum that are available 7
on demand; establishing the Behavioral Health Care Coordination Value–Based 8
Purchasing Pilot Program in the Maryland Department of Health to establish and 9
implement an intensive care coordination model using value–based purchasing in 10
the specialty behavioral health system; requiring, on or before a certain date, the 11
Department to submit a State plan amendment to the Centers for Medicare and 12
Medicaid Services to establish certified community behavioral health clinics apply 13
for certain federal planning grant funds; requiring the Department to apply to 14
participate in a certain demonstration program; extending to a certain date the 15
inclusion of certain audio–only telephone conversations in the definition of 16
“telehealth” in the Maryland Medical Assistance Program and certain requirements 17
related to the provision of reimbursement for health care services appropriately 18
provided through telehealth by the Program and certain insurers, nonprofit health 19
service plans, and health maintenance organizations; requiring the Maryland 20
Health Care Commission to study and make recommendations regarding the 21
delivery of health care services through telehealth, including payment parity for the 22
delivery of health care services through audiovisual and audio–only telehealth 23
technologies; and generally relating to behavioral health care treatment and access. 24
2 SENATE BILL 582
BY adding to 1
Article – Health – General 2
Section 13–4801 through 13–4807 to be under the new subtitle “Subtitle 48. 3
Commission on Behavioral Health Care Treatment and Access”; and 13–4901 4
through 13–4907 to be under the new subtitle “Subtitle 49. Behavioral Health 5
Care Coordination Value–Based Purchasing Pilot Program”; and 15–141.5 6
Annotated Code of Maryland 7
(2019 Replacement Volume and 2022 Supplement) 8
BY repealing and reenacting, with amendments, 9
Article – Health – General 10
Section 15–141.2 11
Annotated Code of Maryland 12
(2019 Replacement Volume and 2022 Supplement) 13
BY repealing and reenacting, with amendments, 14
Article – Insurance 15
Section 15–139 16
Annotated Code of Maryland 17
(2017 Replacement Volume and 2022 Supplement) 18
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 19
That the Laws of Maryland read as follows: 20
Article – Health – General 21
SUBTITLE 48. COMMISSION ON BEHAVIORAL HEALTH CARE TREATMENT AND 22
ACCESS. 23
13–4801. 24
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 25
INDICATED. 26
(B) “BEHAVIORAL HEALTH ” INCLUDES SUBSTANCE –RELATED DISORDERS , 27
ADDICTIVE DISORDERS , MENTAL DISORDERS , LIFE STRESSORS AND CRISES , AND 28
STRESS–RELATED PHYSICAL SYM PTOMS. 29
(C) “COMMISSION” MEANS THE COMMISSION ON BEHAVIORAL HEALTH 30
CARE TREATMENT AND ACCESS. 31
13–4802. 32
THERE IS A COMMISSION ON BEHAVIORAL HEALTH CARE TREATMENT AND 33
ACCESS. 34
SENATE BILL 582 3
13–4803. 1
(A) THE COMMISSION CONSISTS O F THE FOLLOWING MEMB ERS: 2
(1) ONE MEMBER OF THE SENATE OF MARYLAND, APPOINTED BY THE 3
PRESIDENT OF THE SENATE; 4
(2) ONE MEMBER OF THE HOUSE OF DELEGATES, APPOINTED BY THE 5
SPEAKER OF THE HOUSE; 6
(3) ONE REPRESENTATIVE OF MARYLAND’S CONGRESSIONAL 7
DELEGATION; 8
(4) THE SECRETARY OF HEALTH, OR THE SECRETARY’S DESIGNEE; 9
(5) THE SECRETARY OF HUMAN SERVICES, OR THE SECRETARY’S 10
DESIGNEE; 11
(6) THE SECRETARY OF JUVENILE SERVICES, OR THE SECRETARY’S 12
DESIGNEE; 13
(7) THE DEPUTY SECRETARY FOR BEHAVIORAL HEALTH, OR THE 14
DEPUTY SECRETARY’S DESIGNEE; 15
(8) THE MARYLAND INSURANCE COMMISSIONER , OR THE 16
COMMISSIONER ’S DESIGNEE; 17
(9) THE EXECUTIVE DIRECTOR OF THE HEALTH SERVICES COST 18
REVIEW COMMISSION, OR THE EXECUTIVE DIRECTOR’S DESIGNEE; 19
(10) THE EXECUTIVE DIRECTOR OF THE MARYLAND HEALTH CARE 20
COMMISSION, OR THE EXECUTIVE DIRECTOR’S DESIGNEE; 21
(11) THE EXECUTIVE DIRECTOR OF THE MARYLAND COMMUNITY 22
HEALTH RESOURCES COMMISSION, OR THE EXECUTIVE DIRECTOR’S DESIGNEE; 23
(12) THE EXECUTIVE DIRECTOR OF THE STATE–DESIGNATED HEALTH 24
INFORMATION EXCHANGE , OR THE EXECUTIVE DIRECTOR’S DESIGNEE; 25
(13) THE EXECUTIVE DIRECTOR OF THE GOVERNOR’S OFFICE OF 26
CRIME PREVENTION, YOUTH, AND VICTIM SERVICES, OR THE EXECUTIVE 27
DIRECTOR’S DESIGNEE; AND 28
4 SENATE BILL 582
(14) THE SECRETARY OF DISABILITIES, OR THE SECRETARY’S 1
DESIGNEE; 2
(15) THE SECRETARY OF PUBLIC SAFETY AND CORRECTIONAL 3
SERVICES, OR THE SECRETARY’S DESIGNEE; 4
(16) THE SPECIAL SECRETARY OF OPIOID RESPONSE, OR THE 5
SPECIAL SECRETARY’S DESIGNEE; AND 6
(14) (17) THE FOLLOWING MEMBERS APPOINTED BY THE 7
GOVERNOR: 8
(I) ONE REPRESENTATIVE OF THE MENTAL HEALTH 9
ASSOCIATION OF MARYLAND; 10
(II) ONE REPRESENTATIVE OF THE NATIONAL ALLIANCE ON 11
MENTAL ILLNESS; 12
(III) ONE REPRESENTATIVE OF THE COMMUNITY BEHAVIORAL 13
HEALTH ASSOCIATION OF MARYLAND; 14
(IV) ONE REPRESENTATIVE OF A PROVIDER OF RESIDE NTIAL 15
BEHAVIORAL HEALTH SE RVICES; 16
(V) ONE REPRESENTATIVE OF AN ACUTE CARE HOSPIT AL; 17
(VI) ONE REPRESENTATIVE OF AN INPATIENT PSYCHIA TRIC 18
HOSPITAL; 19
(VII) ONE INDIVIDUAL WITH EXPE RIENCE AS A CONSUMER OF 20
BEHAVIORAL HEALTH SE RVICES; 21
(VIII) ONE FAMILY MEMBER OF AN INDIVIDUAL WITH 22
EXPERIENCE AS A CONS UMER OF BEHAVIORAL H EALTH SERVICES ; 23
(IX) ONE REPRESENTATIVE OF A PROVIDER OF SUBSTA NCE USE 24
TREATMENT SERVICES ; 25
(X) ONE REPRESENTATIVE OF A SCHOOL–BASED HEALTH 26
CENTER; 27
(XI) ONE INDIVIDUAL WITH E XPERTISE IN SOCIAL 28
DETERMINANTS OF HEAL TH; 29
SENATE BILL 582 5
(XII) ONE INDIVIDUAL WITH E XPERTISE IN HEALTH E CONOMICS; 1
(XIII) ONE REPRESENTATIVE OF A HEALTH INSURANCE C ARRIER; 2
(XIV) ONE REPRESENTATIVE OF A MANAGED CARE 3
ORGANIZATION ; 4
(XV) ONE REPRESENTATIVE FR OM THE OFFICE OF THE PUBLIC 5
DEFENDER; 6
(XVI) ONE REPRESENTATIVE OF THE DEVELOPMENTAL 7
DISABILITY COALITION; 8
(XVII) ONE REPRESENTATIVE OF THE MARYLAND CHAPTER OF 9
THE NATIONAL COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE ; 10
(XVIII) ONE REPRESENTATIVE OF THE MARYLAND 11
PSYCHOLOGICAL ASSOCIATION; AND 12
(XIX) ONE REPRESENTATIVE OF DISABILITY RIGHTS MARYLAND; 13
(XX) ONE REPRESENTATIVE OF A FEDERALLY QUALIFIED 14
HEALTH CENTER; 15
(XXI) ONE REPRESENTATIVE OF A LOCAL BEHAVIORAL H EALTH 16
AUTHORITY; AND 17
(XXII) ONE INDIVIDUAL WITH A N INTELLECTUAL DISAB ILITY WHO 18
USES SELF–DIRECTED BEHAVIORAL HEALTH SERVICES . 19
(B) TO THE EXTENT PRACTIC ABLE, THE MEMBERSHIP OF TH E COMMISSION 20
SHALL REFLECT THE GE OGRAPHIC AND ETHNIC DIVERSITY OF THE STATE. 21
(C) THE GOVERNOR, THE PRESIDENT OF THE SENATE, AND THE SPEAKER 22
OF THE HOUSE JOINTLY SHALL D ESIGNATE THE CHAIR O F THE COMMISSION. 23
(D) THE DEPARTMENT SHALL PROV IDE STAFF FOR THE COMMISSION. 24
(E) A MEMBER OF THE COMMISSION: 25
(1) MAY NOT RECEIVE COMPE NSATION AS A MEMBER OF THE 26
COMMISSION; BUT 27
(2) IS ENTITLED TO REIMBU RSEMENT FOR EXPENSES UNDER THE 28
STANDARD STATE TRAVEL REGULATIONS, AS PROVIDED IN THE STATE BUDGET . 29 6 SENATE BILL 582
(F) THE COMMISSION SHALL MEET AT LEAST THREE TIMES PER YEAR AT 1
THE TIMES AND PLACES DETERMINED BY THE COMMISSION. 2
13–4804. 3
THE PURPOSE OF THE COMMISSION IS TO MAKE RECOMMENDATIONS TO 4
PROVIDE APPROPRIATE , ACCESSIBLE, AND COMPREHENSIVE BE HAVIORAL HEALTH 5
SERVICES THAT ARE AVAILABLE ON DEMAND TO INDIVIDUALS IN TH E STATE ACROSS 6
THE BEHAVIORAL HEALT H CONTINUUM THAT ARE AVAILABLE O N DEMAND. 7
13–4805. 8
THE COMMISSION SHALL : 9
(1) CONDUCT AN ASSESSMENT OF BEHAVIORAL HEALTH SERVICES IN 10
THE STATE TO IDENTIFY NEE DS AND GAPS IN SERVICES ACROSS T HE CONTINUUM , 11
INCLUDING COMMUNITY –BASED OUTPATIENT AND SUPPORT SERVICES , CRISIS 12
RESPONSE, AND INPATIENT CARE ; 13
(2) EXAMINE THE METHODS F OR REIMBURSING BEHAV IORAL 14
HEALTH CARE SERVICES IN THE STATE AND MAKE RECOMM ENDATIONS ON THE 15
MOST EFFECTIVE FORMS OF R EIMBURSEMENT TO MAXI MIZE SERVICE DELIVER Y; 16
(3) COMPILE FINDINGS OF STATE–SPECIFIC NEEDS ASSES SMENTS 17
RELATED TO BEHAVIORA L HEALTH CARE SERVIC ES; 18
(4) REVIEW RECOMMENDATION S AND REPORTS OF STATE 19
COMMISSIONS , WORKGROUPS , OR TASK FORCES RELATED TO BE HAVIORAL HEALTH 20
CARE SERVICES ; 21
(5) CONDUCT A NEEDS ASSES SMENT ON THE STATE’S BEHAVIORAL 22
HEALTH CARE WORKFORC E TO IDENTIFY GAPS A ND MAKE RECOMMENDATI ONS TO 23
ENSURE AN ADEQUATE , CULTURALLY COMPETENT , AND DIVERSE WORKFORCE 24
ACROSS THE BEH AVIORAL HEALTH CARE CONTINUUM ; 25
(6) REVIEW TRENDS AND BES T PRACTICES FROM OTH ER STATES 26
REGARDING POLICY AND REIMBURSEMENT STRATE GIES THAT SUPPORT AC CESS TO 27
A COMPREHENSIVE ARRA Y OF SERVICES AND EN SURE QUALITY OF CARE ; 28
(7) EXAMINE AND MAKE RECO MMENDATI ONS RELATED TO THE 29
BEHAVIORAL HEALTH OF THE GERIATRIC AND YO UTH POPULATIONS IN T HE STATE; 30
SENATE BILL 582 7
(8) EXAMINE AND MAKE RECO MMENDATIONS TO PROVI DE 1
APPROPRIATE AND ADEQ UATE BEHAVIORAL HEAL TH SERVICES TO INDIV IDUALS 2
WITH DEVELOPMENTAL DISABI LITIES AND COMPLEX BEHA VIORAL HEALTH NEEDS , 3
SPECIFICALLY YOUTH ; 4
(9) ASSESS THE HEALTH INF RASTRUCTURE , FACILITIES, 5
PERSONNEL , AND SERVICES AVAILAB LE FOR THE STATE’S FORENSIC POPULATIO N 6
AND IDENTIFY DEFICIE NCIES IN RESOURCES A ND POLICIES NEEDED T O PRIORITIZE 7
HEALTH OUTCOMES , INCREASE PUBLIC SAFETY , AND REDUCE RECIDIVIS M; 8
(10) MAKE RECOMMENDATIONS ON EXPANDING BEHAVIO RAL HEALTH 9
TREATMENT ACCESS FOR THE STATE’S COURT–ORDERED POPULATION ; 10
(11) MAKE RECOMMENDATIONS ON ACTION PLANS REGA RDING THE 11
BEHAVIORAL HEALTH CA RE SYSTEM’S CAPACITY TO PREPARE F OR AND RESPOND TO 12
FUTURE CHALLENGES AF FECTING THE ENTIRE STATE OR PARTICULAR R EGIONS OR 13
POPULATIONS IN THE STATE, INCLUDING PANDEMICS AND EXTREME WEATHER 14
EVENTS; AND 15
(12) MAKE RECOMMENDATIONS TO ENSURE THAT BEHAV IORAL 16
HEALTH TREATMEN T IS PROVIDED IN THE APPROPRIATE SETTING , INCLUDING 17
METHODS TO DIVERT BE HAVIORAL HEALTH PATI ENTS FROM EMERGENCY 18
DEPARTMENTS BY USING THE MARYLAND MENTAL HEALTH AND SUBSTANCE USE 19
DISORDER REGISTRY AND REFERRAL SYSTEM ESTABLISHED UN DER § 7.5–802 OF 20
THIS ARTICLE AND 2–1–1; 21
(13) EXAMINE AND REVIEW TH E USE OF HARM REDUCT ION 22
STRATEGIES TO FACILI TATE ACCESS TO CARE ; AND 23
(14) EXAMINE METHODS TO AS SIST CONSUMERS IN AC CESSING 24
BEHAVIORAL HEALTH SE RVICES. 25
13–4806. 26
(A) THE COMMISSION SHALL ESTA BLISH THE FOLLOWING WORKGROUPS : 27
(1) GERIATRIC BEHAVIORAL HEALTH; 28
(2) YOUTH BEHAVIORAL HEAL TH, INDIVIDUALS WITH 29
DEVELOPMENTAL DISABI LITIES, AND INDIVIDUALS WITH COMPLEX BEHAVIORAL 30
HEALTH NEEDS ; 31
(3) CRIMINAL JUSTICE –INVOLVED BEHAVIORAL HEALTH; AND 32
8 SENATE BILL 582
(4) BEHAVIORAL HEALTH WORKFO RCE DEVELOPMENT , 1
INFRASTRUCTURE , COORDINATION , AND FINANCING . 2
(B) THE WORKGROUPS ESTABL ISHED UNDER SUBSECTI ON (A) OF THIS 3
SECTION SHALL MEET A T LEAST TWO TIMES PE R YEAR AT THE TIMES AND PLACES 4
DETERMINED BY THE WO RKGROUP. 5
(C) THE WORKGROUPS ESTABLISHED UNDER SUBSECTION (A) OF THIS 6
SECTION SHALL INCLUD E MEMBERS OF THE COMMISSION AND MAY IN CLUDE 7
INDIVIDUALS INVITED BY THE COMMISSION TO SERVE O N THE WORKGROUP . 8
(D) ON OR BEFORE DECEMBER 1 EACH YEAR, BEGINNING IN 2023, THE 9
WORKGROUPS ESTABLISHED UNDER SU BSECTION (A) OF THIS SECTION SHAL L 10
REPORT AND MAKE RECO MMENDATIONS TO THE COMMISSION. 11
13–4807. 12
(A) (1) ON OR BEFORE JANUARY 1 EACH YEAR, BEGINNING IN 2024, THE 13
COMMISSION SHALL REPO RT TO THE GOVERNOR AND , IN ACCORDANCE WITH § 14
2–1257 OF THE STATE GOVERNMENT ARTICLE, THE GENERAL ASSEMBLY ON THE 15
COMMISSION’S FINDINGS AND RECOM MENDATIONS , INCLUDING FUNDING AN D 16
LEGISLATIVE RECOMMEN DATIONS, THAT ARE CONSISTENT WITH PROVIDING 17
APPROPRIATE , ACCESSIBLE, AND COMPREHENSIVE BE HAVIORAL HEALTH SERV ICES 18
THAT ARE AVAILABLE O N DEMAND TO INDIVIDU ALS IN THE STATE ACROSS THE 19
BEHAVIORAL HEALTH CO NTINUUM. 20
(2) ANY LEGISLATIVE RECOM MENDATIONS INCLUDED IN THE 21
REPORT REQUIRED UNDE R PARAGRAPH (1) OF THIS SUBSECTION T HAT REQUIRE 22
FUNDING SHALL INCLUD E AN ESTIMAT E OF THE FUNDING REQ UIRED TO 23
IMPLEMENT THE RECOMM ENDATION AND INFORMA TION THAT SUPPORTS T HE 24
FUNDING ESTIMATE . 25
(B) THE REPORT REQUIRED O N OR BEFORE JANUARY 1, 2024, SHALL 26
INCLUDE THE FINDINGS OF THE NEEDS ASSESSM ENTS REQUIRED UNDER § 13–4805 27
OF THIS SUBTITLE. 28
SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 29
as follows: 30
Article – Health – General 31
SUBTITLE 49. BEHAVIORAL HEALTH CARE COORDINATION VALUE–BASED 32
PURCHASING PILOT PROGRAM. 33
SENATE BILL 582 9
13–4901. 1
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 2
INDICATED. 3
(B) “BEHAVIORAL HEALTH CAR E COORDINATION ” MEANS A 4
PERSON–CENTERED, TEAM–BASED ACTIVITY DESIG NED TO: 5
(1) ASSESS AND MEET THE N EEDS OF AN INDIVIDUA L WITH A 6
BEHAVIORAL HEALTH CO NDITION; AND 7
(2) HELP THE INDIVIDUAL N AVIGATE THE HEALTH CARE S YSTEM 8
EFFECTIVELY AND EFFI CIENTLY. 9
(C) “PILOT PROGRAM” MEANS THE BEHAVIORAL HEALTH CARE 10
COORDINATION VALUE–BASED PURCHASING PILOT PROGRAM. 11
(D) “VALUE–BASED PURCHASING ” MEANS FINANCIALLY IN CENTIVIZING 12
PROVIDERS TO MEET SP ECIFIED OUTCOME MEASURES . 13
13–4902. 14
THERE IS A BEHAVIORAL HEALTH CARE COORDINATION VALUE–BASED 15
PURCHASING PILOT PROGRAM IN THE DEPARTMENT . 16
13–4903. 17
THE PURPOSE OF THE PILOT PROGRAM IS TO ESTABLI SH AND IMPLEMENT AN 18
INTENSIVE CARE COORD INATION MODEL USING VALUE–BASED PURCHASING IN THE 19
SPECIALTY BEHAVIORAL HEALTH SYSTEM . 20
13–4904. 21
(A) THE DEPARTMENT SHALL ADMI NISTER THE PILOT PROGRAM. 22
(B) THE DEPARTMENT SHALL IDEN TIFY AT LEAST 500 ADULTS WHOSE 23
BEHAVIORAL HEALTH CO NDITION OR FUNCTIONI NG PLACES THEM AT RI SK OF 24
HOSPITAL EMERGENCY D EPARTMENT UTILIZATIO N OR INPATIENT PSYCH IATRIC 25
HOSPITAL ADMISSION . 26
(C) THE PILOT PROGRAM SHALL BE OPER ATIONAL FOR A 3–YEAR PERIOD. 27
(D) A PROVIDER OR NETWORK OF PROVIDERS SELECTE D TO PARTICIPATE 28
IN THE PILOT PROGRAM SHALL : 29
10 SENATE BILL 582
(1) BE LICENSED AND IN GO OD STANDING WITH THE MARYLAND 1
MEDICAL ASSISTANCE PROGRAM; 2
(2) HAVE EXPERIENCE IN PR OVIDING COMMUNITY –BASED CARE 3
COORDINATION TO SPEC IALTY BEHAVIORAL HEA LTH PROGRAM RECIPIEN TS; 4
(3) USE AN ELECTRONIC MED ICAL RECORD FOR DOCU MENTING CARE 5
COORDINATION ACTIVIT IES AND OUTCOMES COL LECTION; AND 6
(4) HAVE AN AUTOMATED DAT A EXCHANGE WITH THE 7
STATE–DESIGNATED HEALTH IN FORMATION EXCHANGE . 8
(E) THE DEPARTMENT SHALL : 9
(1) PROVIDE REIMBURSEMENT ON A PER MEMBER PER MONTH BASIS 10
FOR THE BEHA VIORAL HEALTH CARE C OORDINATION ACTIVITI ES THAT ARE NOT 11
OTHERWISE COVERED BY THE MARYLAND MEDICAL ASSISTANCE PROGRAM; 12
(2) COLLECT OUTCOMES DATA ON RECIPIENTS OF HEA LTH CARE 13
SERVICES UNDER THE PILOT PROGRAM; AND 14
(3) EVALUATE THE EFFECTIV ENESS OF THE V ALUE–BASED 15
PURCHASING MODEL BY ANALYZING THE FOLLOW ING OUTCOME MEASURES : 16
(I) A COMPARISON OF THE FO LLOWING DATA ELEMENT S 17
BEFORE AND AFTER ENR OLLMENT OF RECIPIENT S OF HEALTH CARE SER VICES 18
UNDER THE PILOT PROGRAM: 19
1. EMERGENCY DEPARTMENT UTILIZATION FOR BOTH 20
BEHAVIORAL AND SOMAT IC HEALTH PURPOSES ; 21
2. INPATIENT HOSPITALIZA TION FOR BOTH 22
BEHAVIORAL AND SOMAT IC HEALTH PURPOSES ; AND 23
3. TOTAL HEALTH CARE EXP ENDITURES; 24
(II) OUTCOMES FOR RECIPIEN TS WITH AND WITHOUT PRIMARY 25
CARE SERVICES COORDI NATED BY A BEHAVIORAL HEALTH PROVIDER ; AND 26
(III) RECOGNIZED CLINICAL Q UALITY METRICS WHICH MAY 27
INCLUDE PATIENT EXPE RIENCE MEASURES . 28
13–4905. 29
SENATE BILL 582 11
IF NECESSARY TO IMPLE MENT THE PILOT PROGRAM, THE DEPARTMENT 1
SHALL APPLY TO THE CENTERS FOR MEDICARE AND MEDICAID SERVICES FOR AN 2
AMENDMENT TO THE STATE’S § 1115 HEALTHCHOICE DEMONSTRATION . 3
13–4906. 4
(A) FOR EACH OF FISCAL YE AR 2025, FISCAL YEAR 2026, AND FISCAL YEAR 5
2027, THE GOVERNOR SHALL INCLUD E IN THE ANNUAL BUDG ET BILL AN 6
APPROPRIATION OF $600,000 FOR THE PILOT PROGRAM. 7
(B) BEGINNING IN FISCAL Y EAR 2026, THE DEPARTMENT SHALL ALLO CATE 8
A PERCENTAGE OF THE ANNUAL APPROPRIATION REQUIRED UNDER SUBSE CTION 9
(A) OF THIS SECTION TO R EIMBURSEMENT PAID BA SED ON THE ACHIEVEME NT OF 10
THE OUTCOME MEASURES DESCRIBED IN § 13–4904(E)(3) OF THIS SUBTITLE. 11
(C) IN FISCAL YEAR 2027, THE DEPARTMENT SHALL INCR EASE THE 12
PERCENTAGE OF THE AN NUAL APPROPRIATION R EQUIRED UNDER SUBSEC TION (A) 13
OF THIS SECTION ALLO CATED TO REIMBURSEME NT PAID IN ACCORDANC E WITH 14
SUBSECTION (B) OF THIS SECTION OVER THE PERCENTA GE ALLOCATED IN FISC AL 15
YEAR 2026. 16
13–4907. 17
ON OR BEFORE NOVEMBER 1, 2027, THE DEPARTMENT SHALL REPO RT TO 18
THE GOVERNOR AND , IN ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT 19
ARTICLE, THE GENERAL ASSEMBLY ON THE DEPARTMENT ’S FINDINGS AND 20
RECOMMENDATIONS FROM THE PILOT PROGRAM. 21
SECTION 3. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 22
as follows: 23
Article – Health – General 24
15–141.2. 25
(a) (1) In this section the following words have the meanings indicated. 26
(2) “Distant site” means a site at which the distant site health care provider 27
is located at the time the health care service is provided through telehealth. 28
(3) “Distant site provider” means the health care provider who provides 29
medically necessary services to a patient at an originating site from a different physical 30
location than the location of the patient. 31
(4) “Health care provider” means: 32 12 SENATE BILL 582
(i) A person who is licensed, certified, or otherwise authorized under 1
the Health Occupations Article to provide health care in the ordinary course of business or 2
practice of a profession or in an approved education or training program; 3
(ii) A mental health and substance use disorder program licensed in 4
accordance with § 7.5–401 of this article; 5
(iii) A person licensed under Title 7, Subtitle 9 of this article to 6
provide services to an individual with developmental disability or a recipient of individual 7
support services; or 8
(iv) A provider as defined under § 16–201.4 of this article to provide 9
services to an individual receiving long–term care services. 10
(5) “Originating site” means the location of the Program recipient at the 11
time the health care service is provided through telehealth. 12
(6) “Remote patient monitoring services” means the use of synchronous or 13
asynchronous digital technologies that collect or monitor medical, patient–reported, and 14
other forms of health care data for Program recipients at an originating site and 15
electronically transmit that data to a distant site provider to enable the distant site 16
provider to assess, diagnose, consult, treat, educate, provide care management, suggest 17
self–management, or make recommendations regarding the Program recipient’s health 18
care. 19
(7) (i) “Telehealth” means the delivery of medically necessary somatic, 20
dental, or behavioral health services to a patient at an originating site by a distant site 21
provider through the use of technology–assisted communication. 22
(ii) “Telehealth” includes: 23
1. Synchronous and asynchronous interactions; 24
2. From July 1, 2021, to June 30, [2023] 2025, both 25
inclusive, an audio–only telephone conversation between a health care provider and a 26
patient that results in the delivery of a billable, covered health care service; and 27
3. Remote patient monitoring services. 28
(iii) “Telehealth” does not include the provision of health care 29
services solely through: 30
1. Except as provided in subparagraph (ii)2 of this 31
paragraph, an audio–only telephone conversation; 32
2. An e–mail message; or 33 SENATE BILL 582 13
3. A facsimile transmission. 1
(b) The Program shall: 2
(1) Provide health care services appropriately delivered through telehealth 3
to Program recipients regardless of the location of the Program recipient at the time 4
telehealth services are provided; and 5
(2) Allow a distant site provider to provide health care services to a 6
Program recipient from any location at which the health care services may be appropriately 7
delivered through telehealth. 8
(c) The services required to be provided under subsection (b) of this section shall 9
include counseling and treatment for substance use disorders and mental health conditions. 10
(d) The Program may not: 11
(1) Exclude from coverage a health care service solely because it is provided 12
through telehealth and is not provided through an in–person consultation or contact 13
between a health care provider and a patient; or 14
(2) Exclude from coverage a behavioral health care service provided to a 15
Program recipient in person solely because the service may also be provided through 16
telehealth. 17
(e) The Program may undertake utilization review, including preauthorization, 18
to determine the appropriateness of any health care service whether the service is delivered 19
through an in–person consultation or through telehealth if the appropriateness of the 20
health care service is determined in the same manner. 21
(f) The Program may not distinguish between Program recipients in rural or 22
urban locations in providing coverage under the Program for health care services delivered 23
through telehealth. 24
(g) (1) Subject to paragraph (3) of this subsection, the Program shall 25
reimburse a health care provider for the diagnosis, consultation, and treatment of a 26
Program recipient for a health care service covered by the Program that can be 27
appropriately provided through telehealth. 28
(2) This subsection does not require the Program to reimburse a health 29
care provider for a health care service delivered in person or through telehealth that is: 30
(i) Not a covered health care service under the Program; or 31
(ii) Delivered by an out–of–network provider unless the health care 32
service is a self–referred service authorized under the Program. 33 14 SENATE BILL 582
(3) (i) From July 1, 2021, to June 30, [2023] 2025, both inclusive, when 1
appropriately provided through telehealth, the Program shall provide reimbursement in 2
accordance with paragraph (1) of this subsection on the same basis and the same rate as if 3
the health care service were delivered by the health care provider in person. 4
(ii) The reimbursement required under subparagraph (i) of this 5
paragraph does not include: 6
1. Clinic facility fees unless the health care service is 7
provided by a health care provider not authorized to bill a professional fee separately for 8
the health care service; or 9
2. Any room and board fees. 10
(h) (1) The Department may specify in regulation the types of health care 11
providers eligible to receive reimbursement for health care services provided to Program 12
recipients under this section. 13
(2) If the Department specifies by regulation the types of health care 14
providers eligible to receive reimbursement for health care services provided to Program 15
recipients under this subsection, the regulations shall include all types of health care 16
providers that appropriately provide telehealth services. 17
(3) For the purpose of reimbursement and any fidelity standards 18
established by the Department, a health care service provided through telehealth is 19
equivalent to the same health care service when provided through an in –person 20
consultation. 21
(i) Subject to subsection (g)(2) of this section, the Program or a managed care 22
organization that participates in the Program may not impose as a condition of 23
reimbursement of a covered health care service delivered through telehealth that the 24
health care service be provided by a third–party vendor designated by the Program. 25
(j) The Department may adopt regulations to carry out this section. 26
(k) The Department shall obtain any federal authority necessary to implement 27
the requirements of this section, including applying to the Centers for Medicare and 28
Medicaid Services for an amendment to any of the State’s § 1115 waivers or the State plan. 29
(l) This section may not be construed to supersede the authority of the Health 30
Services Cost Review Commission to set the appropriate rates for hospitals, including 31
setting the hospital facility fee for hospital–provided telehealth. 32
15–141.5. 33
SENATE BILL 582 15
(A) IN THIS SECTION , “CERTIFIED COMMUNITY BEHAVIORAL HEALTH 1
CLINIC” MEANS A NONPROFIT CO MPREHENSIVE COMMUNIT Y MENTAL HEALTH OR 2
SUBSTANCE USE TREATME NT ORGANIZATION LICE NSED BY THE STATE THAT MEETS 3
THE FEDERAL CERTIFIC ATION CRITERIA OF § 223 OF THE FEDERAL PROTECTING 4
ACCESS TO MEDICARE ACT OF 2014 AND OFFERS , DIRECTLY OR INDIRECT LY 5
THROUGH FORMAL REFER RAL RELATIONSHIPS WI TH OTHER PR OVIDERS, THE 6
FOLLOWING SERVICES : 7
(1) OUTPATIENT MENTAL HEA LTH AND SUBSTANCE US E SERVICES; 8
(2) 24–HOUR MOBILE CRISIS R ESPONSE AND HOTLINE SERVICES; 9
(3) SCREENING, ASSESSMENT, AND DIAGNOSIS , INCLUDING RISK 10
ASSESSMENTS ; 11
(4) PERSON–CENTERED TREATM ENT PLANNING ; 12
(5) PRIMARY CARE SCREENIN G AND MONITORING OF KEY 13
INDICATORS OF HEALTH RISKS; 14
(6) TARGETED CASE MANAGEM ENT; 15
(7) PSYCHIATRIC REHABILIT ATION SERVICES ; 16
(8) PEER SUPPORT AND FAMI LY SUPPORTS; 17
(9) MEDICATION–ASSISTED TREATMENT ; 18
(10) ASSERTIVE COMMUNITY T REATMENT; AND 19
(11) COMMUNITY–BASED MENTAL HEALTH CARE FOR MILITARY 20
SERVICE MEMBERS AND VETERANS. 21
(B) ON OR BEFORE DECEMBER 1, 2023, THE DEPARTMENT SHALL SUBM IT 22
A STATE PLAN AMENDMENT TO THE CENTERS FOR MEDICARE AND MEDICAID 23
SERVICES TO ESTABLISH CERTIFIED COMMUNITY BEHAVIORAL HEALTH CL INICS IN 24
ACCORDANCE WITH § 223 OF THE FEDERAL PROTECTING ACCESS TO MEDICARE 25
ACT OF 2014. 26
(C) IF THE AMENDMENT SUBM ITTED UNDER SUBSECTI ON (B) OF THIS 27
SECTION IS APPROVED , THE DEPARTMENT SHALL AM END THE STATE PLAN IN 28
ACCORDANCE WITH TITLE XIX AND TITLE XXI OF THE SOCIAL SECURITY ACT AS 29
NECESSARY TO COVER : 30
16 SENATE BILL 582
(1) ALL REQUIRED SERVICES FOR INDIVIDUALS WITH MENTAL 1
HEALTH NEEDS OR SUBS TANCE USE DISORDERS AT CERTIFIED COMMUNI TY 2
BEHAVIORAL HEALTH CLINICS THROUGH A DA ILY BUNDLED PAYMENT 3
METHODOLOGY THAT IS IN ALIGNMENT WITH FE DERAL PAYMENT FROM T HE 4
CENTERS FOR MEDICARE AND MEDICAID SERVICES FOR THE CERT IFIED 5
COMMUNITY BEHAVIORAL HEALTH CLINICS MEDICAID DEMONSTRATIO N UNDER § 6
223 OF THE FEDERAL PROTECTING ACCESS TO MEDICARE ACT OF 2014; AND 7
(2) ANY ADDITIONAL SERVIC ES IDENTIFIED BY THE DEPARTMENT . 8
(D) (1) THE DEPARTMENT SHALL ESTA BLISH STANDARDS AND 9
METHODOLOGIES FOR A PROSPECTIVE PAYMENT SYSTEM TO REIMBURSE A 10
CERTIFIED COMMUNITY BEHAVIORAL HEALT H CLINIC UNDER THE PROGRAM ON A 11
PREDETERMINED FIXED AMOUNT PER DAY FOR C OVERED SERVICES PROV IDED TO A 12
PROGRAM RECIPIENT . 13
(2) THE PROSPECTIVE PAYME NT RATE FOR A CERTIF IED COMMUNITY 14
BEHAVIORAL HEALTH CL INIC SHALL: 15
(I) BE ADJUSTED ONCE EVER Y 3 YEARS BY THE MEDICARE 16
ECONOMIC INDEX IN ACCORDANCE W ITH § 223 OF THE FEDERAL PROTECTING 17
ACCESS TO MEDICARE ACT OF 2014; AND 18
(II) ALLOW FOR MODIFICATIO NS BASED ON A CHANGE IN SCOPE 19
FOR AN INDIVIDUAL CE RTIFIED COMMUNITY BE HAVIORAL HEALTH CLIN IC. 20
(3) THE DEPARTMENT MAY CONSID ER RATE ADJUSTMENTS ON 21
REQUEST BY A CERTIFI ED COMMUNITY BEHAVIO RAL HEALTH CLINIC . 22
(E) (1) THE DEPARTMENT SHALL ESTA BLISH A QUALITY INCE NTIVE 23
PAYMENT SYSTEM FOR A CERTIFIED COMMUNITY BEHAVIORAL HEALTH CL INIC 24
THAT ACHIEVES SPECIF IED TH RESHOLDS ON PERFORMA NCE METRICS 25
ESTABLISHED BY THE DEPARTMENT . 26
(2) THE QUALITY INCENTIVE PAYMENT SYSTEM ESTAB LISHED UNDER 27
PARAGRAPH (1) OF THIS SUBSECTION S HALL BE IN ADDITION TO THE PROSPECTIVE 28
PAYMENT RATE ESTABLI SHED UNDER SUBSECTIO N (D) OF THIS SECTION. 29
Article – Insurance 30
15–139. 31
(a) (1) In this section, “telehealth” means, as it relates to the delivery of health 32
care services, the use of interactive audio, video, or other telecommunications or electronic 33
technology by a licensed health care provider to deliver a health care service within the 34 SENATE BILL 582 17
scope of practice of the health care provider at a location other than the location of the 1
patient. 2
(2) “Telehealth” includes from July 1, 2021, to June 30, [2023] 2025, both 3
inclusive, an audio–only telephone conversation between a health care provider and a 4
patient that results in the delivery of a billable, covered health care service. 5
(3) “Telehealth” does not include: 6
(i) except as provided in paragraph (2) of this subsection, an 7
audio–only telephone conversation between a health care provider and a patient; 8
(ii) an electronic mail message between a health care provider and a 9
patient; or 10
(iii) a facsimile transmission between a health care provider and a 11
patient. 12
(b) This section applies to: 13
(1) insurers and nonprofit health service plans that provide hospital, 14
medical, or surgical benefits to individuals or groups on an expense–incurred basis under 15
health insurance policies or contracts that are issued or delivered in the State; and 16
(2) health maintenance organizations that provide hospital, medical, or 17
surgical benefits to individuals or groups under contracts that are issued or delivered in 18
the State. 19
(c) (1) An entity subject to this section: 20
(i) shall provide coverage under a health insurance policy or 21
contract for health care services appropriately delivered through telehealth regardless of 22
the location of the patient at the time the telehealth services are provided; 23
(ii) may not exclude from coverage a health care service solely 24
because it is provided through telehealth and is not provided through an in–person 25
consultation or contact between a health care provider and a patient; and 26
(iii) may not exclude from coverage or deny coverage for a behavioral 27
health care service that is a covered benefit under a health insurance policy or contract 28
when provided in person solely because the behavioral health care service may also be 29
provided through a covered telehealth benefit. 30
(2) The health care services appropriately delivered through telehealth 31
shall include counseling and treatment for substance use disorders and mental health 32
conditions. 33
18 SENATE BILL 582
(d) (1) Subject to paragraph (2) of this subsection, an entity subject to this 1
section: 2
(i) shall reimburse a health care provider for the diagnosis, 3
consultation, and treatment of an insured patient for a health care service covered under a 4
health insurance policy or contract that can be appropriately provided through telehealth; 5
(ii) is not required to: 6
1. reimburse a health care provider for a health care service 7
delivered in person or through telehealth that is not a covered benefit under the health 8
insurance policy or contract; or 9
2. reimburse a health care provider who is not a covered 10
provider under the health insurance policy or contract; and 11
(iii) 1. may impose a deductible, copayment, or coinsurance 12
amount on benefits for health care services that are delivered either through an in–person 13
consultation or through telehealth; 14
2. may impose an annual dollar maximum as permitted by 15
federal law; and 16
3. may not impose a lifetime dollar maximum. 17
(2) (i) From July 1, 2021, to June 30, [2023] 2025, both inclusive, when 18
a health care service is appropriately provided through telehealth, an entity subject to this 19
section shall provide reimbursement in accordance with paragraph (1)(i) of this subsection 20
on the same basis and at the same rate as if the health care service were delivered by the 21
health care provider in person. 22
(ii) The reimbursement required under subparagraph (i) of this 23
paragraph does not include: 24
1. clinic facility fees unless the health care service is 25
provided by a health care provider not authorized to bill a professional fee separately for 26
the health care service; or 27
2. any room and board fees. 28
(iii) This paragraph may not be construed to supersede the authority 29
of the Health Services Cost Review Commission to set the appropriate rates for hospitals, 30
including setting the hospital facility fee for hospital–provided telehealth. 31
(e) Subject to subsection (d)(1)(ii) of this section, an entity subject to this section 32
may not impose as a condition of reimbursement of a covered health care service delivered 33 SENATE BILL 582 19
through telehealth that the health care service be provided by a third–party vendor 1
designated by the entity. 2
(f) An entity subject to this section may undertake utilization review, including 3
preauthorization, to determine the appropriateness of any health care service whether the 4
service is delivered through an in–person consultation or through telehealth if the 5
appropriateness of the health care service is determined in the same manner. 6
(g) A health insurance policy or contract may not distinguish between patients in 7
rural or urban locations in providing coverage under the policy or contract for health care 8
services delivered through telehealth. 9
(h) A decision by an entity subject to this section not to provide coverage for 10
telehealth in accordance with this section constitutes an adverse decision, as defined in § 11
15–10A–01 of this title, if the decision is based on a finding that telehealth is not medically 12
necessary, appropriate, or efficient. 13
SECTION 4. AND BE IT FURTHER ENACTED, That: 14
(a) The Maryland Health Care Commission shall study and make 15
recommendations regarding the delivery of health care services through telehealth, 16
including payment parity for the delivery of health care services through audiovisual and 17
audio–only telehealth technologies. 18
(b) In conducting the study required under subsection (a) of this section, the 19
Maryland Health Care Commission shall: 20
(1) determine whether it is more or less costly for health care providers to 21
deliver health care services through telehealth; 22
(2) determine whether the delivery of health care services through 23
telehealth requires more or less clinical effort on the part of the health care provider; 24
(3) to help inform the debate on payment parity, identify the aspects of 25
telehealth that are subject to overuse or underuse or yield greater or lower value; 26
(4) assess the adequacy of reimbursement for behavioral health services 27
delivered in person and by telehealth; and 28
(5) address any other issues related to telehealth as determined necessary 29
by the Commission. 30
(c) On or before December 1, 2024, the Maryland Health Care Commission shall 31
submit a report on its findings and recommendations to the General Assembly, in 32
accordance with § 2–1257 of the State Government Article. 33
20 SENATE BILL 582
SECTION 5. AND BE IT FURTHER ENACTED, That the Maryland Department of 1
Health shall apply to the Substance Abuse and Mental Health Services Administration at 2
the Center for Mental Health Services for federal planning, development, and 3
implementation grant funds related to certified community behavioral health clinics for 4
fiscal year 2025. 5
SECTION 6. AND BE IT FURTHER ENACTED, That the Maryland Department of 6
Health shall apply to the Substance Abuse and Mental Health Services Administration at 7
the Center for Mental Health Services for inclusion in the state certified community 8
behavioral health clinic demonstration program for fiscal year 2026. 9
SECTION 4. 7. AND BE IT FURTHER ENACTED, That Section 2 of this Act shall 10
take effect October 1, 2023. It shall remain effective for a period of 4 years and 2 months 11
and, at the end of November 30, 2027, Section 2 of this Act, with no further action required 12
by the General Assembly, shall be abrogated and of no further force and effect. 13
SECTION 5. 8. AND BE IT FURTHER ENACTED, That, except as provided in 14
Section 4 7 of this Act, this Act shall take effect June 1, 2023. Section 1 of this Act shall 15
remain effective for a period of 4 years and 1 month and, at the end of June 30, 2027, Section 16
1 of this Act, with no further action required by the General Assembly, shall be abrogated 17
and of no further force and effect. 18
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
President of the Senate.
________________________________________________________________________________
Speaker of the House of Delegates.