EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0786*
SENATE BILL 786
J1, J5 3lr2403
CF HB 812
By: Senator Hettleman
Introduced and read first time: February 6, 2023
Assigned to: Finance
A BILL ENTITLED
AN ACT concerning 1
Health – Reproductive Health Services – Protected Information and Insurance 2
Requirements 3
FOR the purpose of regulating the disclosure of certain information related to 4
legally protected health care by custodians of public records, health care providers, 5
health information exchanges, and dispensers; repealing a provision of law 6
authorizing a custodian to allow inspection of the part of a public record that gives 7
the home address of a licensee under certain circumstances; requiring that the 8
regulations adopted by the Maryland Health Care Commission regarding clinical 9
information to be exchanged through the State–designated exchange restrict data of 10
patients who have obtained legally protected health care; altering the purpose of the 11
Maryland Health Care Commission to include the establishment of policies and 12
standards that protect the confidentiality of certain health care information; 13
clarifying that certain insurance requirements regarding abortion care services 14
apply notwithstanding a certain restriction; and generally relating to health 15
information and reproductive health services. 16
BY repealing and reenacting, with amendments, 17
Article – General Provisions 18
Section 4–333 19
Annotated Code of Maryland 20
(2019 Replacement Volume and 2022 Supplement) 21
BY repealing and reenacting, with amendments, 22
Article – Health – General 23
Section 4–301, 4–302.3, 4–305, 4–309, 19–103, and 19–145 24
Annotated Code of Maryland 25
(2019 Replacement Volume and 2022 Supplement) 26
BY adding to 27
Article – Health – General 28 2 SENATE BILL 786
Section 4–302.5 1
Annotated Code of Maryland 2
(2019 Replacement Volume and 2022 Supplement) 3
BY repealing and reenacting, with amendments, 4
Article – Insurance 5
Section 15–857 6
Annotated Code of Maryland 7
(2017 Replacement Volume and 2022 Supplement) 8
BY repealing and reenacting, without amendments, 9
Article – Insurance 10
Section 31–116(a) 11
Annotated Code of Maryland 12
(2017 Replacement Volume and 2022 Supplement) 13
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 14
That the Laws of Maryland read as follows: 15
Article – General Provisions 16
4–333. 17
(a) Subject to subsections (b) through (d) of this section, a custodian shall deny 18
inspection of the part of a public record that: 19
(1) contains information about the licensing of an individual in an 20
occupation or a profession; 21
(2) CONTAINS THE NAME OF AN INDIVIDUAL OR OTH ER IDENTIFYING 22
INFORMATION RELATED TO AN AMBULATORY SUR GERY CENTER LICENSED UNDER § 23
19–3B–01 OF THE HEALTH – GENERAL ARTICLE OR A SURGICAL ABORTION 24
FACILITY LICENSED UN DER § 20–209 OF THE HEALTH – GENERAL ARTICLE; OR 25
(3) RELATES TO AN INVEST IGATION OF A LICENSE E OR CERTIFICATE 26
HOLDER REGARDING THE PROVISION OF LEGALLY PROTECTED HEALTH CAR E, AS 27
DEFINED IN § 4–301 OF THE HEALTH – GENERAL ARTICLE, PENDING A FINAL 28
ORDER. 29
(b) A custodian shall allow inspection of the part of a public record that gives: 30
(1) the name of the licensee; 31
(2) the business address of the licensee [or, if the business address is not 32
available, the home address of the licensee after the custodian redacts any information that 33 SENATE BILL 786 3
identifies the location as the home address of an individual with a disability as defined in 1
§ 20–701 of the State Government Article]; 2
(3) the business telephone number of the licensee; 3
(4) the educational and occupational background of the licensee; 4
(5) the professional qualifications of the licensee; 5
(6) any orders and findings that result from formal disciplinary actions; 6
and 7
(7) any evidence that has been provided to the custodian to meet the 8
requirements of a statute as to financial responsibility. 9
(c) A custodian may allow inspection of other information about a licensee if: 10
(1) the custodian finds a compelling public purpose; and 11
(2) the rules or regulations of the official custodian allow the inspection. 12
(d) Except as otherwise provided by this section or other law, a custodian shall 13
allow inspection by the person in interest. 14
(e) A custodian who sells lists of licensees shall omit from the lists the name of 15
any licensee, on written request of the licensee. 16
Article – Health – General 17
4–301. 18
(a) In this subtitle the following words have the meanings indicated. 19
(b) “Common ownership” means ownership of a health care entity: 20
(1) By two or more health care providers; 21
(2) By two or more health care providers employed by a mutual employer 22
for a wage, salary, fee, or payment to perform work for the employer; 23
(3) By health care organizations operating as an organized health care 24
arrangement, as defined in 45 C.F.R. § 160.103; 25
(4) By a health care entity or health care entities that possess an ownership 26
or equity interest of 5% or more in another health care entity; or 27
(5) By affiliated providers operating under the same trade name. 28 4 SENATE BILL 786
(c) “Directory information” means information concerning the presence and 1
general health condition of a patient who has been admitted to a health care facility or who 2
is currently receiving emergency health care in a health care facility. 3
(d) “Disclose” or “disclosure” means the transmission or communication of 4
information in a medical record, including an acknowledgment that a medical record on a 5
particular patient or recipient exists. 6
(e) “Emergency” means a situation when, in the professional opinion of the health 7
care provider, a clear and significant risk of death or imminent serious injury or harm to a 8
patient or recipient exists. 9
(f) “General health condition” means the health status of a patient described in 10
terms of “critical”, “poor”, “fair”, “good”, “excellent”, or terms denoting similar conditions. 11
(g) “Health care” means any care, treatment, or procedure by a health care 12
provider: 13
(1) To diagnose, evaluate, rehabilitate, manage, treat, or maintain the 14
physical or mental condition of a patient or recipient; or 15
(2) That affects the structure or any function of the human body. 16
(h) (1) “Health care provider” means: 17
(i) A person who is licensed, certified, or otherwise authorized under 18
the Health Occupations Article or § 13–516 of the Education Article to provide health care 19
in the ordinary course of business or practice of a profession or in an approved education or 20
training program; or 21
(ii) A facility where health care is provided to patients or recipients, 22
including a facility as defined in § 10–101(g) of this article, a hospital as defined in § 23
19–301 of this article, a related institution as defined in § 19–301 of this article, a health 24
maintenance organization as defined in § 19–701(g) of this article, an outpatient clinic, a 25
medical laboratory, a comprehensive crisis response center, a crisis stabilization center, 26
and a crisis treatment center established under § 7.5–207 of this article. 27
(2) “Health care provider” includes the agents, employees, officers, and 28
directors of a facility and the agents and employees of a health care provider. 29
(i) (1) “Health information exchange” means: 30
(i) An individual or entity that determines, controls, or has the 31
discretion to administer any requirement, policy, or agreement that allows, enables, or 32
requires the use of any technology or services for access, exchange, or use of electronic 33
protected health care information: 34 SENATE BILL 786 5
1. Among more than two unaffiliated individuals or entities 1
that are enabled to exchange electronic protected health information with each other; and 2
2. That is for a treatment, payment, or health care 3
operations purpose, as those terms are defined in 45 C.F.R. § 164.501, regardless of whether 4
the individuals or entities are subject to the requirements of 45 C.F.R. parts 160 and 164; 5
or 6
(ii) A health information technology developer of certified health 7
information technology that develops or offers health information technology, as that term 8
is defined in 42 U.S.C. 300jj(5), and has one or more Health Information Technology 9
Modules certified under a program for the voluntary certification of health information 10
technology that is kept or recognized by the National Coordinator in accordance with 42 11
U.S.C. 300jj–11(c)(5). 12
(2) “Health information exchange” does not include: 13
(i) An entity composed of health care providers under common 14
ownership if the organizational and technical processes the entity provides or governs are 15
for health care treatment, payment, or health care operations purposes, as those terms are 16
defined in 45 C.F.R. § 164.501; 17
(ii) A carrier, as defined in § 15–1301 of the Insurance Article if the 18
organizational and technical processes the carrier provides or governs are for health care 19
treatment, payment, or health care operations purposes, as those terms are defined in 45 20
C.F.R. § 164.501; 21
(iii) An administrator, as defined in § 8–301 of the Insurance Article, 22
if the organizational and technical processes the administrator provides or governs are for 23
health care treatment, payment, or health care operations purposes, as those terms are 24
defined in 45 C.F.R. § 164.501; 25
(iv) A health care provider, as defined in subsection (h) of this section, 26
if the organizational and technical processes the health care provider provides or governs 27
are for health care treatment, payment, or health care operations purposes, as those terms 28
are defined in 45 C.F.R. § 164.501; 29
(v) A carrier’s business associate, as defined in 45 C.F.R. § 160.103, 30
if the organizational and technical processes provided or governed by the business associate 31
are transactions, as defined in 45 C.F.R. § 160.103; or 32
(vi) A carrier exchanging information as required by 45 C.F.R. § 33
156.221. 34
(j) “LEGALLY PROTECTED HEA LTH CARE” MEANS ALL REPRODUCTI VE 35
HEALTH SERVICES , MEDICATIONS , AND SUPPLIES RELATED TO THE DIRECT 36 6 SENATE BILL 786
PROVISION OR SUPPORT OF THE PROVISION OF CARE RELATED TO PREG NANCY, 1
CONTRACEPTION , ASSISTED REPRODUCTIO N, AND ABORTION THAT IS LAWFUL IN 2
THE STATE. 3
(K) (1) “Medical record” means any oral, written, or other transmission in any 4
form or medium of information that: 5
(i) Is entered in the record of a patient or recipient; 6
(ii) Identifies or can readily be associated with the identity of a 7
patient or recipient; and 8
(iii) Relates to the health care of the patient or recipient. 9
(2) “Medical record” includes any: 10
(i) Documentation of disclosures of a medical record to any person 11
who is not an employee, agent, or consultant of the health care provider; 12
(ii) File or record maintained under § 12–403(c)(13) of the Health 13
Occupations Article by a pharmacy of a prescription order for drugs, medicines, or devices 14
that identifies or may be readily associated with the identity of a patient; 15
(iii) Documentation of an examination of a patient regardless of who: 16
1. Requested the examination; or 17
2. Is making payment for the examination; and 18
(iv) File or record received from another health care provider that: 19
1. Relates to the health care of a patient or recipient received 20
from that health care provider; and 21
2. Identifies or can readily be associated with the identity of 22
the patient or recipient. 23
[(k)] (L) (1) “Mental health services” means health care rendered to a 24
recipient primarily in connection with the diagnosis, evaluation, treatment, case 25
management, or rehabilitation of any mental disorder. 26
(2) For acute general hospital services, mental health services are 27
considered to be the primarily rendered service only if service is provided pursuant to Title 28
10, Subtitle 6 of this article or Title 3 of the Criminal Procedure Article. 29
SENATE BILL 786 7
[(l)] (M) “Patient” means a person who receives health care and on whom a 1
medical record is maintained. 2
[(m)] (N) “Person in interest” means: 3
(1) An adult on whom a health care provider maintains a medical record; 4
(2) A person authorized to consent to health care for an adult consistent 5
with the authority granted; 6
(3) A duly appointed personal representative of a deceased person; 7
(4) (i) A minor, if the medical record concerns treatment to which the 8
minor has the right to consent and has consented under Title 20, Subtitle 1 of this article; 9
or 10
(ii) A parent, guardian, custodian, or a representative of the minor 11
designated by a court, in the discretion of the attending physician who provided the 12
treatment to the minor, as provided in § 20–102 or § 20–104 of this article; 13
(5) If item (4) of this subsection does not apply to a minor: 14
(i) A parent of the minor, except if the parent’s authority to consent 15
to health care for the minor has been specifically limited by a court order or a valid 16
separation agreement entered into by the parents of the minor; or 17
(ii) A person authorized to consent to health care for the minor 18
consistent with the authority granted; or 19
(6) An attorney appointed in writing by a person listed in item (1), (2), (3), 20
(4), or (5) of this subsection. 21
[(n)] (O) “Primary provider of mental health services” means the designated 22
mental health services provider who: 23
(1) Has primary responsibility for the development of the mental health 24
treatment plan for the recipient; and 25
(2) Is actively involved in providing that treatment. 26
[(o)] (P) “Protected health information” means all individually identifiable 27
health information held or transmitted by a covered entity or its business associate 28
protected under the U.S. Department of Health and Human Services Privacy Rule. 29
8 SENATE BILL 786
(Q) “PROTECTED MEDICATION RECORD” MEANS ANY IDENTIFYIN G 1
INFORMATION ABOUT TH E PATIENT OR PRESCRI BER OF MEDICATION US ED IN A 2
MEDICAL ABORTION IF THE MEDICATION : 3
(1) HAS BEEN APPROVED BY THE FEDERAL FOOD AND DRUG 4
ADMINISTRATION FOR ME DICAL ABORTION ; OR 5
(2) IS RECOGNIZED BY THE SECRETARY. 6
(R) (1) “PROTECTED SERVICES RE CORD” MEANS ANY IDENTIFYIN G 7
INFORMATION CONTAINE D IN A PATIENT’S MEDICAL RECORD REL ATING TO THE 8
PROVISION OF LEGALLY PROTECTED HEALTH CARE . 9
(2) “PROTECTED SERVICES RE CORD” DOES NOT INCLUDE A 10
PROTECTED MEDICATION RECORD. 11
[(p)] (S) “Recipient” means a person who has applied for, for whom an 12
application has been submitted, or who has received mental health services. 13
[(q)] (T) “State–designated health information exchange” means the health 14
information exchange designated by the Maryland Health Care Commission and the 15
Health Services Cost Review Commission under § 19–143 of this article. 16
4–302.3. 17
(a) (1) In this section the following words have the meanings indicated. 18
(2) “Electronic health care transactions” means health care transactions 19
that have been approved by a nationally recognized health care standards development 20
organization to support health care informatics, information exchange, systems 21
integration, and other health care applications. 22
(3) “Electronic health network” means an entity: 23
(i) Involved in the exchange of electronic health care transactions 24
between a payor, health care provider, vendor, and any other entity; and 25
(ii) Certified by the Maryland Health Care Commission. 26
(4) “Nursing home” has the meaning stated in § 19–1401 of this article. 27
(5) “Standard request” means a request for clinical information from a 28
health information exchange that conforms to the major standards version specified by the 29
Office of the National Coordinator for Health Information Technology. 30
SENATE BILL 786 9
(b) This section applies to: 1
(1) Except for the State–designated health information exchange, a health 2
information exchange operating in the State; and 3
(2) A payor that: 4
(i) Holds a valid certificate of authority issued by the Maryland 5
Insurance Commissioner; and 6
(ii) Acts as, operates, or owns a health information exchange. 7
(c) An entity to which this section applies shall connect to the State–designated 8
health information exchange in a manner consistent with applicable federal and State 9
privacy laws. 10
(d) When a standard request for clinical information is received through the 11
State–designated health information exchange, an entity to which this section applies 12
shall: 13
(1) Respond to the request to the extent authorized under federal and State 14
privacy laws; and 15
(2) Transmit the response to the State–designated health information 16
exchange in the manner specified in the regulations adopted under subsection (g) of this 17
section. 18
(e) A consent from a patient to release clinical information to a provider obtained 19
by an entity to which this section applies shall apply to information transmitted through 20
the State–designated health information exchange or by other means. 21
(f) (1) On request of the Department, a nursing home shall submit 22
electronically clinical information to the State–designated health information exchange to 23
facilitate the objectives stated in paragraph (3) of this subsection. 24
(2) In accordance with State and federal law and to facilitate the objectives 25
stated in paragraph (3) of this subsection, the State–designated health information 26
exchange may provide the information submitted under paragraph (1) of this subsection to: 27
(i) A health care provider; 28
(ii) An authorized health information exchange user; 29
(iii) A health information exchange authorized by the Maryland 30
Health Care Commission; 31
(iv) A federal official; and 32 10 SENATE BILL 786
(v) A State official. 1
(3) (i) If approved by the Maryland Health Care Commission, the 2
information submitted under paragraph (1) of this subsection may be combined with other 3
data maintained by the State–designated health information exchange to facilitate: 4
1. A State health improvement program; 5
2. Mitigation of a public health emergency; and 6
3. Improvement of patient safety. 7
(ii) The information submitted by a nursing home under paragraph 8
(1) of this subsection may be used only to facilitate the objectives stated in subparagraph 9
(i) of this paragraph and may not be used for any other purpose, including licensing and 10
certification. 11
(g) (1) The State–designated health information exchange shall: 12
(i) Participate in the advisory committee established under § 13
13–4306(a)(1) of this article; and 14
(ii) Maintain a data set for the Maryland Commission on Health 15
Equity and provide data from the data set consistent with the parameters defined by the 16
advisory committee. 17
(2) If approved by the Maryland Commission on Health Equity, the 18
State–designated health information exchange may use the data set maintained under 19
paragraph (1) of this subsection to improve health outcomes for patients. 20
(h) (1) An electronic health network shall provide electronic health care 21
transactions to the State–designated health information exchange for the following public 22
health and clinical purposes: 23
(i) A State health improvement program; 24
(ii) Mitigation of a public health emergency; and 25
(iii) Improvement of patient safety. 26
(2) An electronic health network may not charge a fee to a health care 27
provider, health care payor, or to the State–designated health information exchange for 28
providing the information as required under paragraph (1) of this subsection. 29
SENATE BILL 786 11
(3) The State–designated health information exchange shall develop and 1
implement policies and procedures to implement paragraph (1) of this subsection that are 2
consistent with regulations adopted by the Maryland Health Care Commission. 3
(i) The Maryland Health Care Commission: 4
(1) Shall adopt regulations for implementing the connectivity to the 5
State–designated health information exchange required under this section; and 6
(2) Shall seek, through any regulations adopted under item (1) of this 7
subsection, to promote technology standards and formats that conform to those specified by 8
the Office of the National Coordinator for Health Information Technology. 9
(j) (1) The Maryland Health Care Commission shall adopt regulations that: 10
(i) Specify the scope of clinical information to be exchanged or sent 11
under this section; and 12
(ii) Provide for a uniform, gradual implementation of the exchange 13
of clinical information under this section. 14
(2) Any regulations adopted under paragraph (1) of this subsection shall 15
limit the scope of the clinical information to purposes that: 16
(i) Improve treatment, including improved access to clinical records 17
by treating clinicians; 18
(ii) Promote uses of the State–designated health information 19
exchange important to public health; or 20
(iii) The protection of the electronic health information of a person in 21
interest who has opted out of having electronic health information shared or disclosed by a 22
health information exchange. 23
(3) Regulations adopted under paragraph (1) of this subsection shall: 24
(i) Limit redisclosure of financial information, including billed or 25
paid amounts available in electronic claims transactions; 26
(ii) Restrict data of patients who have opted out of records sharing 27
through the State–designated health information exchange or a health information 28
exchange authorized by the Maryland Health Care Commission; [and] 29
(iii) Restrict data from health care providers that possess sensitive 30
health care information; AND 31
12 SENATE BILL 786
(IV) RESTRICT DATA OF PATI ENTS WHO HAVE OBTAIN ED 1
LEGALLY PROTECTED HE ALTH CARE. 2
(k) This section does not: 3
(1) Require an entity to which this section applies to collect clinical 4
information or obtain any authorizations, not otherwise required by federal or State law, 5
relating to information to be sent or received through the State–designated health 6
information exchange; 7
(2) Prohibit an entity to which this section applies from directly receiving 8
or sending information to providers or subscribers outside of the State–designated health 9
information exchange; or 10
(3) Prohibit an entity to which this section applies from connecting and 11
interoperating with the State–designated health information exchange in a manner and 12
scope beyond that required under this section. 13
4–302.5. 14
(A) A HEALTH INFORMATION E XCHANGE MAY NOT DISC LOSE A PROTECTED 15
SERVICES RECORD OR P ROTECTED MEDICATION RECORD TO A TREATING 16
PROVIDER, BUSINESS ENTITY , OR HEALTH INFORMATIO N EXCHANGE LOCATED 17
OUTSIDE THE STATE UNLESS THE DISC LOSURE IS: 18
(1) FOR THE ADJUDICATION OF CLAIMS; OR 19
(2) TO A SPECIFIC TREATIN G PROVIDER AT THE WR ITTEN REQUEST 20
OF AND WITH THE CONS ENT OF: 21
(I) A PATIENT, FOR SERVICES FOR WHI CH THE PATIENT CAN 22
PROVIDE CONSENT UNDE R STATE LAW; OR 23
(II) A PARENT OR GUARDIAN O F A PATIENT, FOR SERVICES FOR 24
WHICH THE PARENT OR GUARDIAN CAN PROVIDE CONSENT UNDER STATE LAW. 25
(B) (1) A PERSON WHO KNOWINGLY VIOLATES THIS SECTIO N IS GUILTY 26
OF A MISDEMEANOR AND ON CONVICTION IS SUB JECT TO A FINE NOT T O EXCEED 27
$10,000 PER DAY. 28
(2) IN DETERMINING THE FI NE TO BE IMPOSED UND ER PARAGRAPH 29
(1) OF THIS SUBSECTION , THE FOLLOWING FACTOR S SHALL BE CONSIDERE D: 30
(I) THE EXTENT OF ACTUAL OR POTENTIAL PUBLIC HARM 31
CAUSED BY THE VIOLAT ION; 32 SENATE BILL 786 13
(II) THE COST OF INVESTIGA TING THE VIOLATION ; AND 1
(III) WHETHER THE PERSON PR EVIOUSLY VIOLATED TH IS 2
SECTION. 3
(C) THE SECRETARY SHALL : 4
(1) ADOPT REGULATIONS THA T IDENTIFY THE MEDIC ATIONS TO BE 5
CONSIDERED A MEDICAT ION USED IN A MEDICA L ABORTION FOR PURPO SES OF 6
DETERMINING IF A RECORD IS A PROTECTE D MEDICATION RECORD ; AND 7
(2) FOLLOW GUIDELINES OF THE AMERICAN COLLEGE OF 8
OBSTETRICIANS AND GYNECOLOGISTS , THE WORLD HEALTH ORGANIZATION, AND 9
THE SOCIETY OF FAMILY PLANNING IN DETERMINI NG WHICH MEDICATIONS TO 10
IDENTIFY IN THE REGU LATIONS ADOPTED UNDER I TEM (1) OF THIS SUBSECTION . 11
4–305. 12
(a) This section may not be construed to impose an obligation on a health care 13
provider to disclose a medical record. 14
(b) A health care provider may disclose a medical record without the 15
authorization of a person in interest: 16
(1) (i) To the provider’s authorized employees, agents, medical staff, 17
medical students, or consultants for the sole purpose of offering, providing, evaluating, or 18
seeking payment for health care to patients or recipients by the provider; 19
(ii) To the provider’s legal counsel regarding only the information in 20
the medical record that relates to the subject matter of the representation; or 21
(iii) To any provider’s insurer or legal counsel, or the authorized 22
employees or agents of a provider’s insurer or legal counsel, for the sole purpose of handling 23
a potential or actual claim against any provider if the medical record is maintained on the 24
claimant and relates to the subject matter of the claim; 25
(2) If the person given access to the medical record signs an 26
acknowledgment of the duty under this Act not to redisclose any patient identifying 27
information, to a person for: 28
(i) Educational or research purposes, subject to the applicable 29
requirements of an institutional review board; 30
14 SENATE BILL 786
(ii) Evaluation and management of health care delivery systems; 1
[or] 2
(iii) Accreditation of a facility by professional standard setting 3
entities; OR 4
(IV) AN OUT –OF–STATE INVESTIGATION OF LEGALLY 5
PROTECTED HEALTH CAR E PROVIDED IN THE STATE; 6
(3) Subject to the additional limitations for a medical record developed 7
primarily in connection with the provision of mental health services in § 4–307 of this 8
subtitle, to a government agency performing its lawful duties as authorized by an act of the 9
Maryland General Assembly or the United States Congress; 10
(4) Subject to the additional limitations for a medical record developed 11
primarily in connection with the provision of mental health services in § 4–307 of this 12
subtitle, to another health care provider for the sole purpose of treating the patient or 13
recipient on whom the medical record is kept; 14
(5) If a claim has been or may be filed by, or with the authorization of a 15
patient or recipient on behalf of the patient or recipient, for covered insureds, covered 16
beneficiaries, or enrolled recipients only, to third party payors and their agents, if the 17
payors or agents have met the applicable provisions of §§ 15–10B–01 to 15–10B–18 of the 18
Insurance Article, including nonprofit health service plans, health maintenance 19
organizations, fiscal intermediaries and carriers, the Department and its agents, the 20
United States Department of Health and Human Services and its agents, or any other 21
person obligated by contract or law to pay for the health care rendered for the sole purposes 22
of: 23
(i) Submitting a bill to the third party payor; 24
(ii) Reasonable prospective, concurrent, or retrospective utilization 25
review or predetermination of benefit coverage; 26
(iii) Review, audit, and investigation of a specific claim for payment 27
of benefits; or 28
(iv) Coordinating benefit payments in accordance with the provisions 29
of the Insurance Article under more than one sickness and accident, dental, or hospital and 30
medical insurance policy; 31
(6) If a health care provider makes a professional determination that an 32
immediate disclosure is necessary, to provide for the emergency health care needs of a 33
patient or recipient; 34
SENATE BILL 786 15
(7) To immediate family members of the patient or any other individual 1
with whom the patient is known to have a close personal relationship, provided that: 2
(i) The disclosure is limited to information that is directly relevant 3
to the individual’s involvement in the patient’s health care; and 4
(ii) 1. If the patient is present or otherwise available before the 5
disclosure and has the capacity to make health care decisions: 6
A. The patient has been provided with an opportunity to 7
object to the disclosure and the patient has not objected; or 8
B. The health care provider reasonably infers from the 9
circumstances that, based on the health care provider’s professional judgment, the patient 10
does not object to the disclosure; or 11
2. If the patient is not present or otherwise available before 12
the disclosure is made, or providing the patient with an opportunity to object to the 13
disclosure is not practicable because of the patient’s incapacity or need for emergency care 14
or treatment, the health care provider determines, based on the health care provider’s 15
professional judgment, that the disclosure is in the best interests of the patient; 16
(8) To an appropriate organ, tissue, or eye recovery agency under the 17
restrictions of § 5–408 of this article for a patient whose organs and tissues may be donated 18
for the purpose of evaluating the patient for possible organ and tissue donation; 19
(9) To the Department or an organ, tissue, or eye recovery agency 20
designated by the Department for the purpose of conducting death record reviews under § 21
19–310 of this article; 22
(10) Subject to subsection (c) of this section, if the purpose of the medical 23
record disclosure is for the coordination of services and record retention within the 24
Montgomery County Department of Health and Human Services; [or] 25
(11) To a carrier, as defined in § 15–1301 of the Insurance Article, or an 26
accountable care organization, as defined in § 3022 of the Patient Protection and Affordable 27
Care Act, for the sole purposes of enhancing or coordinating patient care, provided that: 28
(i) A disclosure under this item is subject to the additional 29
limitations in § 4–307 of this subtitle on disclosure of a medical record developed primarily 30
in connection with the provision of mental health services; 31
(ii) A medical record may be disclosed only in accordance with the 32
federal Health Insurance Portability and Accountability Act of 1996, any regulations 33
adopted under the Act, and any other applicable federal privacy laws, and disclosures under 34
this item may not be made in violation of the prohibited uses or disclosures under the 35
federal Health Insurance Portability and Accountability Act of 1996; 36 16 SENATE BILL 786
(iii) A disclosure under this item may not be used for underwriting or 1
utilization review purposes; 2
(iv) A health care provider that discloses a medical record in 3
accordance with this item shall provide a notice consistent with the requirements of 45 4
C.F.R. § 164.520 specifying the information to be shared, with whom it will be shared, and 5
the specific types of uses and disclosures that the health care provider may make in 6
accordance with this item; 7
(v) The notice required by item (iv) of this item shall include an 8
opportunity for the individual to opt out of the sharing of the individual’s medical record 9
with a carrier or an accountable care organization for the purposes identified in this item; 10
[and] 11
(vi) If a health care provider discloses medical information or medical 12
data to a carrier or accountable care organization through an infrastructure that provides 13
organizational and technical capabilities for the exchange of protected health information 14
among entities not under common ownership, the health care providers are subject to the 15
requirements of §§ 4–302.2 and 4–302.3 of this subtitle; AND 16
(VII) IF THE DISCLOSURE IS OF A PROTECTED SERVI CES RECORD 17
OR A PROTECTED MEDIC ATION RECORD, THE DISCLOSURE IS SU BJECT TO THE 18
REQUIREMENTS FOR A P ROTECTED SERVICES RE CORD AND PROTECTED 19
MEDICATION RECORD UN DER § 4–302.5 OF THIS SUBTITLE; OR 20
(12) SUBJECT TO THE REQUIR EMENTS FOR A PROTECT ED SERVICES 21
RECORD AND PROTECTED MEDICATION RECOR D UNDER § 4–302.5 OF THIS 22
SUBTITLE, TO ANOTHER HEALTH CA RE PROVIDER FOR THE SOLE PURPOSE OF 23
TREATING THE PATIENT FOR WHOM THE MEDICAL RECORD IS KEPT . 24
(c) (1) The disclosure of medical records under subsection (b)(10) of this 25
section to a person that is not employed by or under contract with the Montgomery County 26
Department of Health and Human Services shall be conducted in accordance with this 27
subtitle. 28
(2) Under provisions of State law regarding confidentiality, the 29
Montgomery County Department of Health and Human Services shall be considered to be 30
one agency. 31
4–309. 32
(a) THIS SECTION DOES NOT APPLY TO A VIOLATION OF § 4–302.5 OF THIS 33
SUBTITLE. 34
SENATE BILL 786 17
(B) If a health care provider knowingly refuses to disclose a medical record within 1
a reasonable time but no more than 21 working days after the date a person in interest 2
requests the disclosure, the health care provider is liable for actual damages. 3
[(b)] (C) A health care provider may not refuse to disclose a medical record on 4
the request of a person in interest because of the failure of the person in interest to pay for 5
health care rendered by the health care provider. 6
[(c)] (D) A health care provider or any other person is in violation of this subtitle 7
if the health care provider or any other person: 8
(1) Requests or obtains a medical record under false pretenses or through 9
deception; or 10
(2) Discloses a medical record in violation of this subtitle. 11
[(d)] (E) Except as otherwise provided in subsection [(e)] (F) of this section, a 12
health care provider or any other person, including an officer or employee of a governmental 13
unit, who knowingly and willfully violates any provision of this subtitle is guilty of a 14
misdemeanor and on conviction is subject to a fine not exceeding $1,000 for the first offense 15
and not exceeding $5,000 for each subsequent conviction for a violation of any provision of 16
this subtitle. 17
[(e)] (F) (1) A health care provider or any other person, including an officer 18
or employee of a governmental unit, who knowingly and willfully requests or obtains a 19
medical record under false pretenses or through deception or knowingly and willfully 20
discloses a medical record in violation of this subtitle is guilty of a misdemeanor and on 21
conviction is subject to the following penalties: 22
(i) A fine not exceeding $50,000, imprisonment for not more than 1 23
year, or both; 24
(ii) If the offense is committed under false pretenses, a fine not 25
exceeding $100,000, imprisonment for not more than 5 years, or both; and 26
(iii) If the offense is committed with intent to sell, transfer, or use 27
individually identifiable health information for commercial advantage, personal gain, or 28
malicious harm, a fine not exceeding $250,000, imprisonment for not more than 10 years, 29
or both. 30
(2) This subsection does not apply to an officer or employee of a 31
governmental unit that is conducting a criminal investigation. 32
[(f)] (G) A health care provider or any other person who knowingly violates any 33
provision of this subtitle is liable for actual damages. 34
18 SENATE BILL 786
19–103. 1
(a) There is a Maryland Health Care Commission. 2
(b) The Commission is an independent commission that functions in the 3
Department. 4
(c) The purpose of the Commission is to: 5
(1) Develop health care cost containment strategies to help provide access 6
to appropriate quality health care services for all Marylanders, after consulting with the 7
Health Services Cost Review Commission; 8
(2) Promote the development of a health regulatory system that provides, 9
for all Marylanders, financial and geographic access to quality health care services at a 10
reasonable cost by: 11
(i) Advocating policies and systems to promote the efficient delivery 12
of and improved access to health care services; and 13
(ii) Enhancing the strengths of the current health care service 14
delivery and regulatory system; 15
(3) Facilitate the public disclosure of medical claims data for the 16
development of public policy; 17
(4) Establish and develop a medical care database on health care services 18
rendered by health care practitioners; 19
(5) Encourage the development of clinical resource management systems 20
to permit the comparison of costs between various treatment settings and the availability 21
of information to consumers, providers, and purchasers of health care services; 22
(6) In accordance with Title 15, Subtitle 12 of the Insurance Article, 23
develop a uniform set of effective benefits to be included in the Comprehensive Standard 24
Health Benefit Plan; 25
(7) Analyze the medical care database and provide, in aggregate form, an 26
annual report on the variations in costs associated with health care practitioners; 27
(8) Ensure utilization of the medical care database as a primary means to 28
compile data and information and annually report on trends and variances regarding fees 29
for service, cost of care, regional and national comparisons, and indications of malpractice 30
situations; 31
(9) Establish standards for the operation and licensing of medical care 32
electronic claims clearinghouses in Maryland; 33 SENATE BILL 786 19
(10) Reduce the costs of claims submission and the administration of claims 1
for health care practitioners and payors; 2
(11) Determine the cost of mandated health insurance services in the State 3
in accordance with Title 15, Subtitle 15 of the Insurance Article; 4
(12) Promote the availability of information to consumers on charges by 5
practitioners and reimbursements from payors; [and] 6
(13) Oversee and administer the Maryland Trauma Physician Services 7
Fund in conjunction with the Health Services Cost Review Commission; AND 8
(14) ESTABLISH POLICIES AN D STANDARDS TO PROTECT TH E 9
CONFIDENTIALITY OF P ATIENT AND HEALTH CA RE PRACTITIONER INFO RMATION 10
RELATED TO LEGALLY P ROTECTED HEALTH CARE AS DEFINED IN § 4–301 OF THIS 11
ARTICLE. 12
(d) The Commission shall coordinate the exercise of its functions with the 13
Department and the Health Services Cost Review Commission to ensure an integrated, 14
effective health care policy for the State. 15
19–145. 16
(a) (1) In this section the following words have the meanings indicated. 17
(2) “Dispenser” means a person authorized by law to dispense, as defined 18
in § 12–101 of the Health Occupations Article, a prescription drug to a patient or the 19
patient’s agent in the State. 20
(3) “Noncontrolled prescription drug” means a prescription drug, as 21
defined in § 21–201 of this article, that is not a controlled dangerous substance designated 22
under Title 5, Subtitle 4 of the Criminal Law Article. 23
(4) “State designated exchange” has the meaning stated in § 4–302.3 of this 24
article. 25
(b) The State designated exchange shall operate as a health data utility for the 26
State. 27
(c) The purposes of the health data utility include: 28
(1) The collection, aggregation, and analysis of clinical information, public 29
health data, and health administrative and operations data to assist the Department, local 30
health departments, the Commission, and the Health Services Cost Review Commission in 31
the evaluation of public health interventions and health equity; 32 20 SENATE BILL 786
(2) The communication of data between public health officials and health 1
care providers to advance disease control and health equity; and 2
(3) The enhancement and acceleration of the interoperability of health 3
information throughout the State. 4
(d) [Dispensers] EXCEPT AS PROVIDED IN SUBSECTION (E) OF THIS 5
SECTION, EACH DISPENSER shall provide data to the State designated exchange. 6
(E) (1) A DISPENSER MAY NOT SU BMIT INFORMATION ON MIFEPRISTONE , 7
MISOPROSTOL , OR ANY MEDICATION US ED FOR A MEDICAL ABO RTION, AS 8
DETERMINED BY THE SECRETARY, TO THE STATE DESIGNATED EXCH ANGE. 9
(2) THE SECRETARY SHALL FOLLO W GUIDELINES OF THE AMERICAN 10
COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS , THE WORLD HEALTH 11
ORGANIZATION, AND THE SOCIETY OF FAMILY PLANNING IN DETERMINI NG THE 12
MEDICATIONS TO BE IN CLUDED AMONG THE MED ICATIONS USED IN A M EDICAL 13
ABORTION ABOUT WHICH A DIS PENSER MAY NOT SUBMI T INFORMATION UNDER 14
PARAGRAPH (1) OF THIS SUBSECTION . 15
[(e)] (F) (1) The purpose of this subsection is to: 16
(i) Authorize individuals and organizations involved in the 17
treatment and care coordination of patients to access, as legally authorized, a patient’s 18
medication history, including medications prescribed for the patient; and 19
(ii) Assist health care providers, care managers, the Department, 20
and local health departments to understand and promote matters of health equity and 21
treatment efficacy. 22
(2) After dispensing a noncontrolled prescription drug OTHER THAN THE 23
MEDICAL ABORTION MED ICATIONS DESCRIBED U NDER SUBSECTION (E) OF THIS 24
SECTION, a dispenser shall submit prescription information to the State designated 25
exchange. 26
(3) The prescription information shall be submitted: 27
(i) By electronic means; 28
(ii) Without unduly increasing the workload and expense on a 29
dispenser; 30
(iii) In a manner that minimizes burden and duplication by being as 31
compatible as possible with existing federal standards for data submission practices, 32
including technology software of dispensers; and 33 SENATE BILL 786 21
(iv) As otherwise required by regulations adopted by the 1
Commission. 2
(4) The State designated exchange may not impose any fees or other 3
assessments on dispensers to support the operation of the exchange. 4
(5) The State designated exchange shall make prescription information 5
submitted under this subsection available for purposes of treatment and care coordination 6
of a patient. 7
[(f)] (G) The State designated exchange may provide data, as allowed by law, for 8
public health purposes that may include: 9
(1) Improving health equity through access to prescription medications, 10
including for the treatment of infectious disease; 11
(2) Assisting programs led by health care providers and the Department, 12
local health departments, the Commission, and the Health Services Cost Review 13
Commission to identify opportunities for quality improvement, including for stewardship 14
of antibiotic medications; and 15
(3) Conducting case investigations and related activities. 16
[(g)] (H) Information submitted to the State information exchange or provided 17
by the State information exchange under this section shall be submitted or provided, to the 18
extent practicable, in as near to real time as possible. 19
[(h)] (I) (1) The Commission, in consultation with appropriate stakeholders, 20
shall adopt regulations to carry out this section. 21
(2) The regulations shall take into account consumer perspective and 22
include: 23
(i) The specific data required to be provided under subsection (d) of 24
this section; 25
(ii) The specific prescription information required to be submitted 26
under subsection [(e)] (F) of this section; 27
(iii) The time frame for submitting prescription information under 28
subsection [(e)] (F) of this section; 29
(iv) The electronic means and manner by which prescription 30
information is to be submitted under subsection [(e)] (F) of this section; 31
22 SENATE BILL 786
(v) Prescription information submission requirements that align 1
with the data submission requirements on dispensers of monitored prescription drugs 2
under Title 21, Subtitle 2A of this article; and 3
(vi) Identification and necessary suppression of information related 4
to providers or medications that are determined to have significant potential to cause harm. 5
[(i)] (J) (1) The State designated exchange shall establish a consumer 6
advisory council to bring the perspectives of individuals and organizations with an interest 7
in protecting consumers into the delivery of services provided by the State designated 8
exchange. 9
(2) In selecting members, the State designated exchange shall consider 10
diversity of experience. 11
(3) The consumer advisory council established under paragraph (1) of this 12
subsection shall: 13
(i) Consist of a minimum of six members, including at least four 14
consumer representatives and two staff representatives, and maintain a ratio of consumer 15
representatives to nonconsumer representatives of at least two to one; 16
(ii) Identify and report consumer privacy concerns to senior 17
leadership of the State designated exchange; 18
(iii) Advise on efforts to educate consumers on data exchange policies, 19
including options for consumers to opt out of disclosure of protected health information; 20
(iv) Meet at least 3 times each year; and 21
(v) Adopt and maintain a charter to be posted online that includes 22
the purpose, members, and meeting schedule of the consumer advisory council. 23
Article – Insurance 24
15–857. 25
(a) (1) This section applies to: 26
(i) insurers and nonprofit health service plans that provide labor 27
and delivery coverage to individuals or groups on an expense–incurred basis under health 28
insurance policies or contracts that are issued or delivered in the State; and 29
(ii) health maintenance organizations that provide labor and 30
delivery coverage to individuals or groups under contracts that are issued or delivered in 31
the State. 32
SENATE BILL 786 23
(2) This section does not apply to: 1
(i) a multistate plan that does not provide coverage for abortions in 2
accordance with 42 U.S.C. § 18054(a)(6); or 3
(ii) a high–deductible plan, as defined in 26 U.S.C. § 223(c)(2)(C) of 4
the Internal Revenue Code, unless the Commissioner determines that abortion care is not 5
excluded from the safe harbor provisions for preventive care under § 223(c)(2)(C) of the 6
Internal Revenue Code. 7
(3) An organization that is eligible to obtain an exclusion from the coverage 8
requirements under § 15–826 of this subtitle may obtain from an entity subject to this 9
section an exclusion from the coverage and notice requirements of this section if the 10
requirements conflict with the organization’s bona fide religious beliefs and practices. 11
(b) Except as provided in subsection (c) of this section AND NOTWITHSTANDING 12
§ 31–116(A) OF THIS ARTICLE , an entity subject to this section shall: 13
(1) cover abortion care services without: 14
(i) a deductible, coinsurance, copayment, or any other cost–sharing 15
requirement; and 16
(ii) restrictions that are inconsistent with the protected rights under 17
Title 20, Subtitle 2 of the Health – General Article; and 18
(2) provide information to consumers about abortion care coverage using 19
the terminology “abortion care” to describe coverage. 20
(c) If the Commissioner determines that enforcement of this section may 21
adversely affect the allocation of federal funds to the State, the Commissioner may grant 22
an exemption to the requirements of this section to the minimum extent necessary to 23
ensure the continued receipt of federal funds. 24
31–116. 25
(a) The essential health benefits required under § 1302(a) of the Affordable Care 26
Act: 27
(1) shall be the benefits in the State benchmark plan, selected in 28
accordance with this section; and 29
(2) notwithstanding any other benefits mandated by State law, shall be the 30
benefits required in: 31
24 SENATE BILL 786
(i) subject to subsection (f) of this section, all individual health 1
benefit plans and health benefit plans offered to small employers, except for grandfathered 2
health plans, as defined in the Affordable Care Act, offered outside the Exchange; and 3
(ii) subject to § 31–115(c) of this subtitle, all qualified health plans 4
offered in the Exchange. 5
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 6
October 1, 2023. 7