EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTING 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.
*sb0786*
SENATE BILL 786
J1, J5 3lr2403
CF HB 812
By: Senator Hettleman
Introduced and read first time: February 6, 2023
Assigned to: Finance
Committee Report: Favorable with amendments
Senate action: Adopted
Read second time: March 10, 2023
CHAPTER ______
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 electronic health networks; repealing 6
a provision of law authorizing a custodian to allow inspection of the part of a public 7
record that gives the home address of a licensee under certain circumstances; 8
requiring that the regulations adopted by the Maryland Health Care Commission 9
regarding clinical information to be exchanged through the State–designated 10
exchange restrict data of patients who have obtained legally protected health care; 11
establishing the Protected Health Care Commission; altering the purpose of the 12
Maryland Health Care Commission to include the establishment of policies and 13
standards that protect the confidentiality of certain health care information; 14
clarifying that certain insurance requirements regarding abortion care services 15
apply notwithstanding a certain restriction; and generally relating to health 16
information and reproductive health services. 17
BY repealing and reenacting, with amendments, 18
Article – General Provisions 19
Section 4–333 20
Annotated Code of Maryland 21
(2019 Replacement Volume and 2022 Supplement) 22
BY repealing and reenacting, with amendments, 23 2 SENATE BILL 786
Article – Health – General 1
Section 4–301, 4–302.3, 4–305, 4–309, 19–103, and 19–145 and 19–103 2
Annotated Code of Maryland 3
(2019 Replacement Volume and 2022 Supplement) 4
BY adding to 5
Article – Health – General 6
Section 4–302.5 and 4–310 7
Annotated Code of Maryland 8
(2019 Replacement Volume and 2022 Supplement) 9
BY repealing and reenacting, with amendments, 10
Article – Insurance 11
Section 15–857 12
Annotated Code of Maryland 13
(2017 Replacement Volume and 2022 Supplement) 14
BY repealing and reenacting, without amendments, 15
Article – Insurance 16
Section 31–116(a) 17
Annotated Code of Maryland 18
(2017 Replacement Volume and 2022 Supplement) 19
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 20
That the Laws of Maryland read as follows: 21
Article – General Provisions 22
4–333. 23
(a) Subject to subsections (b) through (d) of this section, a custodian shall deny 24
inspection of the part of a public record that: 25
(1) contains information about the licensing of an individual in an 26
occupation or a profession; 27
(2) CONTAINS THE NAME OF AN INDIVIDUAL OR OTHER IDENTIFYING 28
INFORMATION OF AN INDIVIDUAL RELATED TO AN AMBULATORY SURGER Y CENTER: 29
(I) EXCEPT AS PROVIDED I N SUBSECTION (B)(8) OF THIS 30
SECTION, AN AMBULATORY SURGIC AL FACILITY LICENSED UNDER § 19–3B–01 OF 31
THE HEALTH – GENERAL ARTICLE OR A; OR 32
(II) A SURGICAL ABORTION FA CILITY LICENSED UNDE R § 33
20–209 OF THE HEALTH – GENERAL ARTICLE; OR 34
SENATE BILL 786 3
(3) RELATES TO AN INVEST IGATION OF A LICENSE E OR CERTIFICATE 1
HOLDER REGARDING TH E PROVISION OF LEGAL LY PROTECTED HEALTH CARE, AS 2
DEFINED IN § 4–301 OF THE HEALTH – GENERAL ARTICLE, PENDING A FINAL 3
ORDER. 4
(b) A custodian shall allow inspection of the part of a public record that gives: 5
(1) the name of the licensee; 6
(2) (I) SUBJECT TO ITEM (II) OF THIS ITEM, the business address of 7
the licensee [or, if the business address is not available, the home address of the licensee 8
after the custodian redacts any information that identifies the location as the home address 9
of an individual with a disability as defined in § 20–701 of the State Government Article]; 10
OR 11
(II) IF THE LICENSEE IS L ICENSED BY A HEALTH OCCUPATIONS 12
BOARD, THE BUSINESS ADDRESS OF THE LICENSEE ; 13
(3) the business telephone number of the licensee; 14
(4) the educational and occupational background of the licensee; 15
(5) the professional qualifications of the licensee; 16
(6) any orders and findings that result from formal disciplinary actions; 17
and 18
(7) any evidence that has been provided to the custodian to meet the 19
requirements of a statute as to financial responsibility; AND 20
(8) FOR AN AMBULATORY SU RGICAL FACILITY LICE NSED UNDER § 21
19–3B–01 OF THE HEALTH – GENERAL ARTICLE, THE OWNER, PRIMARY CONTACT , 22
ATTORNEY, OR CONSULTANT CONTAI NED IN AN APPLICATIO N TO THE MARYLAND 23
HEALTH CARE COMMISSION FOR A CERT IFICATE OF NEED OR C ERTIFICATE OF 24
NEED EXCEPTION OR DE TERMINATION REQUEST . 25
(c) A custodian may allow inspection of other information about a licensee if: 26
(1) the custodian finds a compelling public purpose; and 27
(2) the rules or regulations of the official custodian allow the inspection. 28
(d) Except as otherwise provided by this section or other law, a custodian shall 29
allow inspection by the person in interest. 30
4 SENATE BILL 786
(e) A custodian who sells lists of licensees shall omit from the lists the name of 1
any licensee, on written request of the licensee. 2
Article – Health – General 3
4–301. 4
(a) In this subtitle the following words have the meanings indicated. 5
(b) “Common ownership” means ownership of a health care entity: 6
(1) By two or more health care providers; 7
(2) By two or more health care providers employed by a mutual employer 8
for a wage, salary, fee, or payment to perform work for the employer; 9
(3) By health care organizations operating as an organized health care 10
arrangement, as defined in 45 C.F.R. § 160.103; 11
(4) By a health care entity or health care entities that possess an ownership 12
or equity interest of 5% or more in another health care entity; or 13
(5) By affiliated providers operating under the same trade name. 14
(c) “Directory information” means information concerning the presence and 15
general health condition of a patient who has been admitted to a health care facility or who 16
is currently receiving emergency health care in a health care facility. 17
(d) “Disclose” or “disclosure” means the transmission or communication of 18
information in a medical record, including an acknowledgment that a medical record on a 19
particular patient or recipient exists. 20
(e) “Emergency” means a situation when, in the professional opinion of the health 21
care provider, a clear and significant risk of death or imminent serious injury or harm to a 22
patient or recipient exists. 23
(f) “General health condition” means the health status of a patient described in 24
terms of “critical”, “poor”, “fair”, “good”, “excellent”, or terms denoting similar conditions. 25
(g) “Health care” means any care, treatment, or procedure by a health care 26
provider: 27
(1) To diagnose, evaluate, rehabilitate, manage, treat, or maintain the 28
physical or mental condition of a patient or recipient; or 29
(2) That affects the structure or any function of the human body. 30
SENATE BILL 786 5
(h) (1) “Health care provider” means: 1
(i) A person who is licensed, certified, or otherwise authorized under 2
the Health Occupations Article or § 13–516 of the Education Article to provide health care 3
in the ordinary course of business or practice of a profession or in an approved education or 4
training program; or 5
(ii) A facility where health care is provided to patients or recipients, 6
including a facility as defined in § 10–101(g) of this article, a hospital as defined in § 7
19–301 of this article, a related institution as defined in § 19–301 of this article, a health 8
maintenance organization as defined in § 19–701(g) of this article, an outpatient clinic, a 9
medical laboratory, a comprehensive crisis response center, a crisis stabilization center, 10
and a crisis treatment center established under § 7.5–207 of this article. 11
(2) “Health care provider” includes the agents, employees, officers, and 12
directors of a facility and the agents and employees of a health care provider. 13
(i) (1) “Health information exchange” means: 14
(i) An individual or entity that determines, controls, or has the 15
discretion to administer any requirement, policy, or agreement that allows, enables, or 16
requires the use of any technology or services for access, exchange, or use of electronic 17
protected health care information: 18
1. Among more than two unaffiliated individuals or entities 19
that are enabled to exchange electronic protected health information with each other; and 20
2. That is for a treatment, payment, or health care 21
operations purpose, as those terms are defined in 45 C.F.R. § 164.501, regardless of whether 22
the individuals or entities are subject to the requirements of 45 C.F.R. parts 160 and 164; 23
or 24
(ii) A health information technology developer of certified health 25
information technology that develops or offers health information technology, as that term 26
is defined in 42 U.S.C. 300jj(5), and has one or more Health Information Technology 27
Modules certified under a program for the voluntary certification of health information 28
technology that is kept or recognized by the National Coordinator in accordance with 42 29
U.S.C. 300jj–11(c)(5). 30
(2) “Health information exchange” does not include: 31
(i) An entity composed of health care providers under common 32
ownership if the organizational and technical processes the entity provides or governs are 33
for health care treatment, payment, or health care operations purposes, as those terms are 34
defined in 45 C.F.R. § 164.501; 35
6 SENATE BILL 786
(ii) A carrier, as defined in § 15–1301 of the Insurance Article if the 1
organizational and technical processes the carrier provides or governs are for health care 2
treatment, payment, or health care operations purposes, as those terms are defined in 45 3
C.F.R. § 164.501; 4
(iii) An administrator, as defined in § 8–301 of the Insurance Article, 5
if the organizational and technical processes the administrator provides or governs are for 6
health care treatment, payment, or health care operations purposes, as those terms are 7
defined in 45 C.F.R. § 164.501; 8
(iv) A health care provider, as defined in subsection (h) of this section, 9
if the organizational and technical processes the health care provider provides or governs 10
are for health care treatment, payment, or health care operations purposes, as those terms 11
are defined in 45 C.F.R. § 164.501; 12
(v) A carrier’s business associate, as defined in 45 C.F.R. § 160.103, 13
if the organizational and technical processes provided or governed by the business associate 14
are transactions, as defined in 45 C.F.R. § 160.103; or 15
(vi) A carrier exchanging information as required by 45 C.F.R. § 16
156.221. 17
(j) “LEGALLY PROTECTED HEA LTH CARE” MEANS ALL REPRODUCTIVE 18
HEALTH SERVICES , MEDICATIONS , AND SUPPLIES RELATED TO THE DIRECT 19
PROVISION OR SUPPORT OF THE PROVISION OF CARE RELATED TO PREG NANCY, 20
CONTRACEPTION , ASSISTED REPRODUCTIO N, AND ABORTION THAT IS LAWFUL IN 21
THE STATE: 22
(1) THE PROVISION OF ABORTION CARE ; AND 23
(2) OTHER SENSITIVE HEALT H SERVICES AS DETERM INED BY THE 24
SECRETARY BASED ON TH E RECOMMENDATIONS OF THE PROTECTED HEALTH 25
CARE COMMISSION ESTABLISHE D UNDER § 4–310 OF THIS SUBTITLE. 26
(K) (1) “Medical record” means any oral, written, or other transmission in any 27
form or medium of information that: 28
(i) Is entered in the record of a patient or recipient; 29
(ii) Identifies or can readily be associated with the identity of a 30
patient or recipient; and 31
(iii) Relates to the health care of the patient or recipient. 32
(2) “Medical record” includes any: 33
SENATE BILL 786 7
(i) Documentation of disclosures of a medical record to any person 1
who is not an employee, agent, or consultant of the health care provider; 2
(ii) File or record maintained under § 12–403(c)(13) of the Health 3
Occupations Article by a pharmacy of a prescription order for drugs, medicines, or devices 4
that identifies or may be readily associated with the identity of a patient; 5
(iii) Documentation of an examination of a patient regardless of who: 6
1. Requested the examination; or 7
2. Is making payment for the examination; and 8
(iv) File or record received from another health care provider that: 9
1. Relates to the health care of a patient or recipient received 10
from that health care provider; and 11
2. Identifies or can readily be associated with the identity of 12
the patient or recipient. 13
[(k)] (L) (1) “Mental health services” means health care rendered to a 14
recipient primarily in connection with the diagnosis, evaluation, treatment, case 15
management, or rehabilitation of any mental disorder. 16
(2) For acute general hospital services, mental health services are 17
considered to be the primarily rendered service only if service is provided pursuant to Title 18
10, Subtitle 6 of this article or Title 3 of the Criminal Procedure Article. 19
[(l)] (M) “Patient” means a person who receives health care and on whom a 20
medical record is maintained. 21
[(m)] (N) “Person in interest” means: 22
(1) An adult on whom a health care provider maintains a medical record; 23
(2) A person authorized to consent to health care for an adult consistent 24
with the authority granted; 25
(3) A duly appointed personal representative of a deceased person; 26
(4) (i) A minor, if the medical record concerns treatment to which the 27
minor has the right to consent and has consented under Title 20, Subtitle 1 of this article; 28
or 29
8 SENATE BILL 786
(ii) A parent, guardian, custodian, or a representative of the minor 1
designated by a court, in the discretion of the attending physician who provided the 2
treatment to the minor, as provided in § 20–102 or § 20–104 of this article; 3
(5) If item (4) of this subsection does not apply to a minor: 4
(i) A parent of the minor, except if the parent’s authority to consent 5
to health care for the minor has been specifically limited by a court order or a valid 6
separation agreement entered into by the parents of the minor; or 7
(ii) A person authorized to consent to health care for the minor 8
consistent with the authority granted; or 9
(6) An attorney appointed in writing by a person listed in item (1), (2), (3), 10
(4), or (5) of this subsection. 11
[(n)] (O) “Primary provider of mental health services” means the designated 12
mental health services provider who: 13
(1) Has primary responsibility for the development of the mental health 14
treatment plan for the recipient; and 15
(2) Is actively involved in providing that treatment. 16
[(o)] (P) “Protected health information” means all individually identifiable 17
health information held or transmitted by a covered entity or its business associate 18
protected under the U.S. Department of Health and Human Services Privacy Rule. 19
(Q) “PROTECTED MEDICATION RECORD” MEANS ANY IDENTIFYIN G 20
INFORMATION ABOUT TH E PATIENT OR PRESCRI BER OF MEDICATION US ED IN A 21
MEDICAL AB ORTION IF THE MEDICA TION: 22
(1) HAS BEEN APPROVED BY THE FEDERAL FOOD AND DRUG 23
ADMINISTRATION FOR ME DICAL ABORTION ; OR 24
(2) IS RECOGNIZED BY THE SECRETARY. 25
(R) (1) “PROTECTED SERVICES RE CORD” MEANS ANY IDENTIFYIN G 26
INFORMATION CONTAINE D IN A PATIENT’S MEDICAL RECORD RELAT ING TO THE 27
PROVISION OF LEGALLY PROTECTED HEALTH CAR E. 28
(2) “PROTECTED SERVICES RE CORD” DOES NOT INCLUDE A 29
PROTECTED MEDICATION RECORD. 30
[(p)] (S) (Q) “Recipient” means a person who has applied for, for whom an 31
application has been submitted, or who has received mental health services. 32 SENATE BILL 786 9
(R) “SENSITIVE HEALTH SERV ICES” INCLUDES REPRODUCTIV E HEALTH 1
SERVICES OTHER THAN ABORTION CARE . 2
[(q)] (T) (S) “State–designated health information exchange” means the health 3
information exchange designated by the Maryland Health Care Commission and the 4
Health Services Cost Review Commission under § 19–143 of this article. 5
4–302.3. 6
(a) (1) In this section the following words have the meanings indicated. 7
(2) “Electronic health care transactions” means health care transactions 8
that have been approved by a nationally recognized health care standards development 9
organization to support health care informatics, information exchange, systems 10
integration, and other health care applications. 11
(3) “Electronic health network” means an entity: 12
(i) Involved in the exchange of electronic health care transactions 13
between a payor, health care provider, vendor, and any other entity; and 14
(ii) Certified by the Maryland Health Care Commission. 15
(4) “Nursing home” has the meaning stated in § 19–1401 of this article. 16
(5) “Standard request” means a request for clinical information from a 17
health information exchange that conforms to the major standards version specified by the 18
Office of the National Coordinator for Health Information Technology. 19
(b) This section applies to: 20
(1) Except for the State–designated health information exchange, a health 21
information exchange operating in the State; and 22
(2) A payor that: 23
(i) Holds a valid certificate of authority issued by the Maryland 24
Insurance Commissioner; and 25
(ii) Acts as, operates, or owns a health information exchange. 26
(c) An entity to which this section applies shall connect to the State–designated 27
health information exchange in a manner consistent with applicable federal and State 28
privacy laws. 29
10 SENATE BILL 786
(d) When a standard request for clinical information is received through the 1
State–designated health information exchange, an entity to which this section applies 2
shall: 3
(1) Respond to the request to the extent authorized under federal and State 4
privacy laws; and 5
(2) Transmit the response to the State–designated health information 6
exchange in the manner specified in the regulations adopted under subsection (g) of this 7
section. 8
(e) A consent from a patient to release clinical information to a provider obtained 9
by an entity to which this section applies shall apply to information transmitted through 10
the State–designated health information exchange or by other means. 11
(f) (1) On request of the Department, a nursing home shall submit 12
electronically clinical information to the State–designated health information exchange to 13
facilitate the objectives stated in paragraph (3) of this subsection. 14
(2) In accordance with State and federal law and to facilitate the objectives 15
stated in paragraph (3) of this subsection, the State–designated health information 16
exchange may provide the information submitted under paragraph (1) of this subsection to: 17
(i) A health care provider; 18
(ii) An authorized health information exchange user; 19
(iii) A health information exchange authorized by the Maryland 20
Health Care Commission; 21
(iv) A federal official; and 22
(v) A State official. 23
(3) (i) If approved by the Maryland Health Care Commission , the 24
information submitted under paragraph (1) of this subsection may be combined with other 25
data maintained by the State–designated health information exchange to facilitate: 26
1. A State health improvement program; 27
2. Mitigation of a public health emergency; and 28
3. Improvement of patient safety. 29
(ii) The information submitted by a nursing home under paragraph 30
(1) of this subsection may be used only to facilitate the objectives stated in subparagraph 31 SENATE BILL 786 11
(i) of this paragraph and may not be used for any other purpose, including licensing and 1
certification. 2
(g) (1) The State–designated health information exchange shall: 3
(i) Participate in the advisory committee established under § 4
13–4306(a)(1) of this article; and 5
(ii) Maintain a data set for the Maryland Commission on Health 6
Equity and provide data from the data set consistent with the parameters defined by the 7
advisory committee. 8
(2) If approved by the Maryland Commission on Health Equity, the 9
State–designated health information exchange may use the data set maintained under 10
paragraph (1) of this subsection to improve health outcomes for patients. 11
(h) (1) An electronic health network shall provide electronic health care 12
transactions to the State–designated health information exchange for the following public 13
health and clinical purposes: 14
(i) A State health improvement program; 15
(ii) Mitigation of a public health emergency; and 16
(iii) Improvement of patient safety. 17
(2) An electronic health network may not charge a fee to a health care 18
provider, health care payor, or to the State–designated health information exchange for 19
providing the information as required under paragraph (1) of this subsection. 20
(3) The State–designated health information exchange shall develop and 21
implement policies and procedures to implement paragraph (1) of this subsection that are 22
consistent with regulations adopted by the Maryland Health Care Commission. 23
(i) The Maryland Health Care Commission: 24
(1) Shall adopt regulations for implementing the connectivity to the 25
State–designated health information exchange required under this section; and 26
(2) Shall seek, through any regulations adopted under item (1) of this 27
subsection, to promote technology standards and formats that conform to those specified by 28
the Office of the National Coordinator for Health Information Technology. 29
(j) (1) The Maryland Health Care Commission shall adopt regulations that: 30
(i) Specify the scope of clinical information to be exchanged or sent 31
under this section; and 32 12 SENATE BILL 786
(ii) Provide for a uniform, gradual implementation of the exchange 1
of clinical information under this section. 2
(2) Any regulations adopted under paragraph (1) of this subsection shall 3
limit the scope of the clinical information to purposes that: 4
(i) Improve treatment, including improved access to clinical records 5
by treating clinicians; 6
(ii) Promote uses of the State–designated health information 7
exchange important to public health; or 8
(iii) The protection of the electronic health information of a person in 9
interest who has opted out of having electronic health information shared or disclosed by a 10
health information exchange. 11
(3) Regulations adopted under paragraph (1) of this subsection shall: 12
(i) Limit redisclosure of financial information, including billed or 13
paid amounts available in electronic claims transactions; 14
(ii) Restrict data of patients who have opted out of records sharing 15
through the State–designated health information exchange or a health information 16
exchange authorized by the Maryland Health Care Commission; [and] 17
(iii) Restrict data from health care providers that possess sensitive 18
health care information; AND 19
(IV) RESTRICT DATA OF PATI ENTS WHO HAVE OBTAIN ED 20
LEGALLY PROTECTED HE ALTH CARE. 21
(k) This section does not: 22
(1) Require an entity to which this section applies to collect clinical 23
information or obtain any authorizations, not otherwise required by federal or State law, 24
relating to information to be sent or received through the State–designated health 25
information exchange; 26
(2) Prohibit an entity to which this section applies from directly receiving 27
or sending information to providers or subscribers outside of the State–designated health 28
information exchange; or 29
(3) Prohibit an entity to which this section applies from connecting and 30
interoperating with the State–designated health information exchange in a manner and 31
scope beyond that required under this section. 32
SENATE BILL 786 13
4–302.5. 1
(A) SUBJECT TO SUBSECT ION (D)(3)(II) OF THIS SECTION , THIS SECTION 2
APPLIES TO DISCLOSUR ES OF HEALTH INFORMA TION TO RECIPIENTS L OCATED IN 3
THE STATE AND OUTSIDE THE STATE. 4
(A) (B) A SUBJECT TO SUBSECTION (D)(3)(II) OF THIS SECTION , 5
BEGINNING DECEMBER 1, 2023, A HEALTH INFORMATION E XCHANGE OR 6
ELECTRONIC HEALTH NE TWORK MAY NOT DISCLOSE A PROTECTED SERVICES 7
RECORD OR PROTECTED MEDICATION RECORD TO A TREATING PROVIDER, 8
BUSINESS ENTITY , OR HEALTH INFORMATIO N EXCHANGE LOCATED OUTSIDE THE 9
STATE MIFEPRISTONE DATA OR THE DIAGNOSIS, PROCEDURE , MEDICATION, OR 10
RELATED CODES FOR AB ORTION CARE AND OTHE R SENSITIVE HEALTH S ERVICES AS 11
DETERMINED BY THE SECRETARY UNDER SUBSE CTION (D) OF THIS SECTION TO A 12
TREATING PROVIDER , A BUSINESS ENTITY , ANOTHER HEALTH INFOR MATION 13
EXCHANGE, OR ANOTHER ELECTRONIC H EALTH NETWORK UNLESS THE 14
DISCLOSURE IS: 15
(1) FOR THE ADJUDICATION OF CLAIMS; OR 16
(2) TO A SPECIFIC TREATIN G PROVIDER AT THE WR ITTEN REQUEST 17
OF AND WITH THE CONS ENT OF: 18
(I) A PATIENT, FOR SERVICES FOR WHI CH THE PATIENT CAN 19
PROVIDE CONSENT UNDE R STATE LAW; OR 20
(II) A PARENT OR GUARDIAN O F A PATIENT, FOR SERVICES FOR 21
WHICH THE PARENT OR GUARDIAN CAN PROVIDE CONSENT UNDER STATE LAW. 22
(B) (1) (C) (1) A BEGINNING JUNE 1, 2024, A PERSON WHO 23
KNOWINGLY VIOLATES T HIS SECTION IS GUILTY OF A MISDEMEA NOR AND ON 24
CONVICTION IS SUBJEC T TO A FINE NOT TO E XCEED $10,000 PER DAY. 25
(2) IN DETERMINING THE FI NE TO BE IMPOSED UND ER PARAGRAPH 26
(1) OF THIS SUBSECTION , THE FOLLOWING FACTOR S SHALL BE CONSIDERE D: 27
(I) THE EXTENT OF ACTUAL OR POTENTIAL PUBLIC HARM 28
CAUSED BY THE VIOLAT ION; 29
(II) THE COST OF INVESTIGA TING THE VIOLATION ; AND 30
(III) WHETHER THE PERSON PR EVIOUSLY VIOLATED TH IS 31
SECTION. 32
14 SENATE BILL 786
(C) (D) (1) THE SECRETARY SHALL : 1
(1) ADOPT REGULATIONS THA T IDENTIFY THE MEDICAT IONS TO BE 2
CONSIDERED A MEDICAT ION USED IN A MEDICA L ABORTION FOR PURPO SES OF 3
DETERMINING IF A REC ORD IS A PROTECTED M EDICATION RECORD ; AND 4
(2) FOLLOW GUIDELINES OF THE AMERICAN COLLEGE OF 5
OBSTETRICIANS AND GYNECOLOGISTS , THE WORLD HEALTH ORGANIZATION, AND 6
THE SOCIETY OF FAMILY PLANNING IN DETERMINI NG WHICH MEDICATIONS TO 7
IDENTIFY IN THE REGU LATIONS ADOPTED UNDE R ITEM (1) OF THIS SUBSECTION 8
DETERMINE FOR ABORTI ON CARE AND SENSITIV E HEALTH SERVICES TH E 9
PROCEDURE , DIAGNOSIS, MEDICATION, AND OTHER RELATED CO DES THAT ARE 10
SUBJECT TO THE RESTR ICTIONS ON DISCLOSUR E ESTABLISHED UNDER 11
SUBSECTION (B) OF THIS SECTION DUE TO A SUBSTANTIAL RIS K TO PATIENTS OR 12
HEALTH CARE PROVIDER S THAT WOULD RESULT FROM DISCLOSURE . 13
(2) A DETERMINATION MADE U NDER PARAGRAPH (1) OF THIS 14
SUBSECTION SHALL : 15
(I) FOLLOW APPLICABLE GUI DELINES OF THE AMERICAN 16
COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS , THE WORLD HEALTH 17
ORGANIZATION, AND THE SOCIETY OF FAMILY PLANNING; AND 18
(II) FOR SENSITIVE HEALTH SERVICES, BE BASED ON THE 19
RECOMMENDATIONS OF T HE PROTECTED HEALTH CARE COMMISSION 20
ESTABLISHED UNDER § 4–310 OF THIS SUBTITLE. 21
(3) (I) THE SECRETARY SHALL ADOPT REGULATIONS TO RESTR ICT 22
THE DISCLOSURE OF AB ORTION CARE AND OTHE R SENSITIVE HEALTH S ERVICES 23
INFORMATION BY DI AGNOSIS, PROCEDURE , MEDICATION, OR RELATED CODES 24
UNDER SUBSECTION (B) OF THIS SECTION. 25
(II) EXCEPT AS PROVIDED IN SUBPARAGRAPH (III) OF THIS 26
PARAGRAPH , THE SECRETARY MAY ADOPT R ESTRICTIONS ON THE D ISCLOSURE OF 27
ABORTION CARE OR OTH ER SENSITIVE HEALTH SERVICES UNDER SUBPARA GRAPH 28
(I) OF THIS PARAGRAPH TH AT ARE APPLICABLE ON LY TO DISCLOSURES BY HEALTH 29
INFORMATION EXCHANGE S OR ELECTRONIC HEAL TH NETWORKS TO OUT –OF–STATE 30
TREATING PROVIDERS , OUT–OF–STATE BUSINESS ENTIT IES, OTHER HEALTH 31
INFORMATION EXCHANGE S, OR OTHER ELECTRONIC HEA LTH NETWORKS . 32
(III) ANY REGULATIONS ADOPT ED BY THE SECRETARY TO 33
IMPLEMENT RESTRICTIO NS ON THE DISCLOSURE OF MIFEPRISTONE DATA UND ER 34
SUBSECTION (B) OF THIS SECTION SHAL L APPLY TO DISCLOSUR ES OF DATA TO 35
RECIPIENTS LOCATED I N THE STATE AND OUTSIDE THE STATE. 36 SENATE BILL 786 15
4–305. 1
(a) This section may not be construed to impose an obligation on a health care 2
provider to disclose a medical record. 3
(b) A health care provider may disclose a medical record without the 4
authorization of a person in interest: 5
(1) (i) To the provider’s authorized employees, agents, medical staff, 6
medical students, or consultants for the sole purpose of offering, providing, evaluating, or 7
seeking payment for health care to patients or recipients by the provider; 8
(ii) To the provider’s legal counsel regarding only the information in 9
the medical record that relates to the subject matter of the representation; or 10
(iii) To any provider’s insurer or legal counsel, or the authorized 11
employees or agents of a provider’s insurer or legal counsel, for the sole purpose of handling 12
a potential or actual claim against any provider if the medical record is maintained on the 13
claimant and relates to the subject matter of the claim; 14
(2) If the person given access to the med ical record signs an 15
acknowledgment of the duty under this Act not to redisclose any patient identifying 16
information, to a person for: 17
(i) Educational or research purposes, subject to the applicable 18
requirements of an institutional review board; 19
(ii) Evaluation and management of health care delivery systems; 20
[or] 21
(iii) Accreditation of a facility by professional standard setting 22
entities; OR 23
(IV) AN OUT –OF–STATE INVESTIGATION OF LEGALLY 24
PROTECTED HEALTH CAR E PROVIDED IN THE STATE; 25
(3) Subject to the additional limitations for a medical record developed 26
primarily in connection with the provision of mental health services in § 4–307 of this 27
subtitle, to a government agency performing its lawful duties as authorized by an act of the 28
Maryland General Assembly or the United States Congress; 29
(4) Subject to the additional limitations for a medical record developed 30
primarily in connection with the provision of mental health services in § 4–307 of this 31
subtitle, to another health care provider for the sole purpose of treating the patient or 32
recipient on whom the medical record is kept; 33
16 SENATE BILL 786
(5) If a claim has been or may be filed by, or with the authorization of a 1
patient or recipient on behalf of the patient or recipient, for covered insureds, covered 2
beneficiaries, or enrolled recipients only, to third party payors and their agents, if the 3
payors or agents have met the applicable provisions of §§ 15–10B–01 to 15–10B–18 of the 4
Insurance Article, including nonprofit health service plans, health m aintenance 5
organizations, fiscal intermediaries and carriers, the Department and its agents, the 6
United States Department of Health and Human Services and its agents, or any other 7
person obligated by contract or law to pay for the health care rendered for the sole purposes 8
of: 9
(i) Submitting a bill to the third party payor; 10
(ii) Reasonable prospective, concurrent, or retrospective utilization 11
review or predetermination of benefit coverage; 12
(iii) Review, audit, and investigation of a specific claim for payment 13
of benefits; or 14
(iv) Coordinating benefit payments in accordance with the provisions 15
of the Insurance Article under more than one sickness and accident, dental, or hospital and 16
medical insurance policy; 17
(6) If a health care provider makes a professional determination that an 18
immediate disclosure is necessary, to provide for the emergency health care needs of a 19
patient or recipient; 20
(7) To immediate family members of the patient or any other individual 21
with whom the patient is known to have a close personal relationship, provided that: 22
(i) The disclosure is limited to information that is directly relevant 23
to the individual’s involvement in the patient’s health care; and 24
(ii) 1. If the patient is present or otherwise available before the 25
disclosure and has the capacity to make health care decisions: 26
A. The patient has been provided with an opportunity to 27
object to the disclosure and the patient has not objected; or 28
B. The health care provider reasonably infers from the 29
circumstances that, based on the health care provider’s professional judgment, the patient 30
does not object to the disclosure; or 31
2. If the patient is not present or otherwise available before 32
the disclosure is made, or providing the patient with an opportunity to object to the 33
disclosure is not practicable because of the patient’s incapacity or need for emergency care 34
or treatment, the health care provider determines, based on the health care provider’s 35
professional judgment, that the disclosure is in the best interests of the patient; 36 SENATE BILL 786 17
(8) To an appropriate organ, tissue, or eye recovery agency under the 1
restrictions of § 5–408 of this article for a patient whose organs and tissues may be donated 2
for the purpose of evaluating the patient for possible organ and tissue donation; 3
(9) To the Department or an organ, tissue, or eye recovery agency 4
designated by the Department for the purpose of conducting death record reviews under § 5
19–310 of this article; 6
(10) Subject to subsection (c) of this section, if the purpose of the medical 7
record disclosure is for the coordination of services and record retention within the 8
Montgomery County Department of Health and Human Services; [or] 9
(11) To a carrier, as defined in § 15–1301 of the Insurance Article, or an 10
accountable care organization, as defined in § 3022 of the Patient Protection and Affordable 11
Care Act, for the sole purposes of enhancing or coordinating patient care, provided that: 12
(i) A disclosure under this item is subject to the additional 13
limitations in § 4–307 of this subtitle on disclosure of a medical record developed primarily 14
in connection with the provision of mental health services; 15
(ii) A medical record may be disclosed only in accordance with the 16
federal Health Insurance Portability and Accountability Act of 1996, any regulations 17
adopted under the Act, and any other applicable federal privacy laws, and disclosures under 18
this item may not be made in violation of the prohibited uses or disclosures under the 19
federal Health Insurance Portability and Accountability Act of 1996; 20
(iii) A disclosure under this item may not be used for underwriting or 21
utilization review purposes; 22
(iv) A health care provider that discloses a medical record in 23
accordance with this item shall provide a notice consistent with the requirements of 45 24
C.F.R. § 164.520 specifying the information to be shared, with whom it will be shared, and 25
the specific types of uses and disclosures that the health care provider may make in 26
accordance with this item; 27
(v) The notice required by item (iv) of this item shall include an 28
opportunity for the individual to opt out of the sharing of the individual’s medical record 29
with a carrier or an accountable care organization for the purposes identified in this item; 30
[and] 31
(vi) If a health care provider discloses medical information or medical 32
data to a carrier or accountable care organization through an infrastructure that provides 33
organizational and technical capabilities for the exchange of protected health information 34
among entities not under common ownership, the health care providers are subject to the 35
requirements of §§ 4–302.2 and 4–302.3 of this subtitle; AND 36
18 SENATE BILL 786
(VII) IF THE DISCLOSURE IS OF A PROTECTED SERVICES RECORD 1
OR A PROTECTED MEDICATI ON RECORD ABORTION CARE OR OTH ER SENSITIVE 2
HEALTH SERVICES INFO RMATION AS DETERMINE D BY THE SECRETARY UNDER § 3
4–302.5(D) OF THIS SUBTITLE , THE DISCLOSURE IS SU BJECT TO THE 4
REQUIREMENTS FOR A PROTECTED SERV ICES RECORD AND PROT ECTED 5
MEDICATION RECORD UNDER § 4–302.5 OF THIS SUBTITLE; OR 6
(12) SUBJECT TO THE REQUIR EMENTS FOR A PROTECT ED SERVICES 7
RECORD AND PROTECTED MEDICATION RECORD UN DER § 4–302.5 OF THIS 8
SUBTITLE, TO ANOTHER HEALTH CA RE PROVIDER FOR THE SOLE PURPOSE OF 9
TREATING THE P ATIENT FOR WHOM THE MEDICAL RECORD IS KE PT. 10
(c) (1) The disclosure of medical records under subsection (b)(10) of this 11
section to a person that is not employed by or under contract with the Montgomery County 12
Department of Health and Human Services shall be conducted in accordance with this 13
subtitle. 14
(2) Under provisions of State law regarding confidentiality, the 15
Montgomery County Department of Health and Human Services shall be considered to be 16
one agency. 17
4–309. 18
(a) THIS SECTION DOES NOT APPLY TO A VIOLATION OF § 4–302.5 OF THIS 19
SUBTITLE. 20
(B) If a health care provider knowingly refuses to disclose a medical record within 21
a reasonable time but no more than 21 working days after the date a person in interest 22
requests the disclosure, the health care provider is liable for actual damages. 23
[(b)] (C) A health care provider may not refuse to disclose a medical record on 24
the request of a person in interest because of the failure of the person in interest to pay for 25
health care rendered by the health care provider. 26
[(c)] (D) A health care provider or any other person is in violation of this subtitle 27
if the health care provider or any other person: 28
(1) Requests or obtains a medical record under false pretenses or through 29
deception; or 30
(2) Discloses a medical record in violation of this subtitle. 31
[(d)] (E) Except as otherwise provided in subsection [(e)] (F) of this section, a 32
health care provider or any other person, including an officer or employee of a governmental 33
unit, who knowingly and willfully violates any provision of this subtitle is guilty of a 34
misdemeanor and on conviction is subject to a fine not exceeding $1,000 for the first offense 35 SENATE BILL 786 19
and not exceeding $5,000 for each subsequent conviction for a violation of any provision of 1
this subtitle. 2
[(e)] (F) (1) A health care provider or any other person, including an officer 3
or employee of a governmental unit, who knowingly and willfully requests or obtains a 4
medical record under false pretenses or through deception or knowingly and willfully 5
discloses a medical record in violation of this subtitle is guilty of a misdemeanor and on 6
conviction is subject to the following penalties: 7
(i) A fine not exceeding $50,000, imprisonment for not more than 1 8
year, or both; 9
(ii) If the offense is committed under false pretenses, a fine not 10
exceeding $100,000, imprisonment for not more than 5 years, or both; and 11
(iii) If the offense is committed with intent to sell, transfer, or use 12
individually identifiable health information for commercial advantage, personal gain, or 13
malicious harm, a fine not exceeding $250,000, imprisonment for not more than 10 years, 14
or both. 15
(2) This subsection does not apply to an officer or employee of a 16
governmental unit that is conducting a criminal investigation. 17
[(f)] (G) A health care provider or any other person who knowingly violates any 18
provision of this subtitle is liable for actual damages. 19
4–310. 20
(A) THERE IS A PROTECTED HEALTH CARE COMMISSION. 21
(B) THE PURPOSE OF THE COMMISSION IS TO MAKE RECOMMENDATIONS 22
TO THE SECRETARY REGARDING S ENSITIVE HEALTH SERV ICES THAT SHOULD BE 23
DETERMINED BY THE SECRETARY TO BE LEGAL LY PROTECTED HEALTH CARE 24
UNDER THIS SUBTITLE . 25
(C) THE COMMISSION CONSISTS O F THE FOLLOWING MEMB ERS: 26
(1) THE ATTORNEY GENERAL OR THE ATTORNEY GENERAL’S 27
DESIGNEE; 28
(2) THE EXECUTIVE DIRECTOR OF THE MARYLAND HEALTH CARE 29
COMMISSION OR THE EXECUTIVE DIRECTOR’S DESIGNEE; AND 30
(3) THE FOLLOWING MEMBERS APPOINTED BY THE SECRETARY: 31
20 SENATE BILL 786
(I) A RESIDENT OF THE STATE WHO IS A LICENS ED PHYSICIAN 1
AND NOMINATED BY THE AMERICAN COLLEGE OF OBSTETRICIANS AND 2
GYNECOLOGISTS ; 3
(II) A RESIDENT OF THE STATE WHO IS A LICENS ED CLINICIAN 4
WHO PROVIDES REPRODU CTIVE HEALTH CARE AN D NOMINATED BY THE 5
REPRODUCTIVE HEALTH ACCESS PROJECT; 6
(III) A RESIDENT OF THE STATE WHO IS A CERTIF IED 7
NURSE–MIDWIFE NOMINATED BY THE MARYLAND AFFILIATE OF THE AMERICAN 8
COLLEGE OF NURSE MIDWIVES; 9
(IV) A RESIDENT OF THE STATE WHO IS A REPRES ENTATIVE OF 10
PHYSICIANS FOR REPRODUCTIVE HEALTH; 11
(VI) TWO RESIDENTS OF THE STATE WHO ARE CONSUMER 12
REPRESENTATIVES WITH EXPERTISE IN CONSUME R DATA PRIVACY; AND 13
(VII) A RESIDENT OF THE STATE WITH EXPERTISE IN HEALTH 14
INFORMATION . 15
(D) THE COMMISSION SHALL : 16
(1) SELECT A CHAIR OF THE COMMISSION EACH YEAR ; AND 17
(2) MEET AT LEAST FOUR TIMES A YEAR . 18
(E) THE DEPARTMENT SHALL PROV IDE STAFF FOR THE COMMISSION. 19
(F) (1) THE COMMISSION SHALL IDEN TIFY SENSITIVE HEALT H SERVICES 20
INFORMATION BY DIAGN OSIS, PROCEDURAL , MEDICATION, OR RELATED CODES FOR 21
WHICH DISCLOSURE BY A HEALTH INFORMATIO N EXCHANGE OR ELECTR ONIC 22
HEALTH NETWORK TO A TREATING PROVIDER , BUSINESS ENTITY , ANOTHER HEALTH 23
INFORMATION EXCHANGE , OR ANOTHER ELECTRONI C HEALTH NETWORK WOU LD 24
CREATE A SUBSTANTIAL RISK TO PATIENTS OR HEALTH CARE PROVIDER S. 25
(2) IN CARRYING OUT ITS WORK, THE COMMISSION MAY CONSUL T 26
WITH: 27
(I) ORGANIZATIONS WITH EX PERTISE IN LEGAL ISS UES 28
IMPACTING PROVIDERS OF LEGALLY PROTECTED HEALTH CARE ; 29
(II) ORGANIZATIONS WITH EX PERTISE IN CONSUMER HEALTH 30
PRIVACY; 31 SENATE BILL 786 21
(III) ORGANIZATIONS WITH EX PERTISE IN HE ALTH 1
INFORMATION TECHNOLO GY; AND 2
(IV) OTHER ORGANIZATIONS W ITH CLINICAL, POLICY, OR LEGAL 3
EXPERTISE RELATED TO THE WORK OF THE COMMISSION. 4
(G) (1) THE COMMISSION SHALL ISSU E SEMIANNUAL REPORTS TO THE 5
SECRETARY ON RECOMMEN DATIONS REGARDING SE NSITIVE HEALTH SERVICES 6
THAT SHOULD BE DETER MINED BY THE SECRETARY TO BE LEGAL LY PROTECTED 7
HEALTH CARE UNDER TH IS SUBTITLE OR FOR W HICH THE SECRETARY SHOULD 8
RESCIND A PREVIOUS D ETERMINATION . 9
(2) THE REPORTS SHALL INC LUDE AN ASSESSMENT O F THE 10
POTENTIAL RISK TO PA TIENTS AND HEALTH CA RE PROVIDERS THAT WO ULD RESULT 11
FROM THE DISCLOSURE OF THE SENSITIVE HEA LTH SERVICES THAT AR E 12
ADDRESSED IN THE REP ORTS. 13
(3) WITHIN 60 DAYS AFTER RECEIVING A SEMIANNUAL REPORT 14
UNDER PARAGRAPH (1) OF THIS SUBSECTION , THE SECRETARY SHALL SUBMIT A 15
WRITTEN RESPONSE TO THE REPORT THAT INCL UDES THE FINDINGS AN D 16
DETERMINATIONS OF TH E SECRETARY TO: 17
(I) THE COMMISSION; AND 18
(II) IN ACCORDANCE WITH § 2–1257 OF THE STATE 19
GOVERNMENT ARTICLE, THE SENATE FINANCE COMMITTEE AND THE HOUSE 20
HEALTH AND GOVERNMENT OPERATIONS COMMITTEE. 21
19–103. 22
(a) There is a Maryland Health Care Commission. 23
(b) The Commission is an independent commission that functions in the 24
Department. 25
(c) The purpose of the Commission is to: 26
(1) Develop health care cost containment strategies to help provide access 27
to appropriate quality health care services for all Marylanders, after consulting with the 28
Health Services Cost Review Commission; 29
(2) Promote the development of a health regulatory system that provides, 30
for all Marylanders, financial and geographic access to quality health care services at a 31
reasonable cost by: 32 22 SENATE BILL 786
(i) Advocating policies and systems to promote the efficient delivery 1
of and improved access to health care services; and 2
(ii) Enhancing the strengths of the current health care service 3
delivery and regulatory system; 4
(3) Facilitate the public disclosure of medical claims data for the 5
development of public policy; 6
(4) Establish and develop a medical care database on health care services 7
rendered by health care practitioners; 8
(5) Encourage the development of clinical resource management systems 9
to permit the comparison of costs between various treatment settings and the availability 10
of information to consumers, providers, and purchasers of health care services; 11
(6) In accordance with Title 15, Subtitle 12 of the Insurance Article, 12
develop a uniform set of effective benefits to be included in the Comprehensive Standard 13
Health Benefit Plan; 14
(7) Analyze the medical care database and provide, in aggregate form, an 15
annual report on the variations in costs associated with health care practitioners; 16
(8) Ensure utilization of the medical care database as a primary means to 17
compile data and information and annually report on trends and variances regarding fees 18
for service, cost of care, regional and national comparisons, and indications of malpractice 19
situations; 20
(9) Establish standards for the operation and licensing of medical care 21
electronic claims clearinghouses in Maryland; 22
(10) Reduce the costs of claims submission and the administration of claims 23
for health care practitioners and payors; 24
(11) Determine the cost of mandated health insurance services in the State 25
in accordance with Title 15, Subtitle 15 of the Insurance Article; 26
(12) Promote the availability of information to consumers on charges by 27
practitioners and reimbursements from payors; [and] 28
(13) Oversee and administer the Maryland Trauma Physician Services 29
Fund in conjunction with the Health Services Cost Review Commission; AND 30
(14) ESTABLISH POLICIES AN D STANDARDS TO PROTE CT THE 31
CONFIDENTIALITY OF P ATIENT AND HEALTH CA RE PRACTITIONER INFO RMATION 32 SENATE BILL 786 23
RELATED TO LEGALLY P ROTECTED HEALTH CARE AS DEFINED IN § 4–301 OF THIS 1
ARTICLE. 2
(d) The Commission shall coordinate the exercise of its functions with the 3
Department and the Health Services Cost Review Commission to ensure an integrated, 4
effective health care policy for the State. 5
19–145. 6
(a) (1) In this section the following words have the meanings indicated. 7
(2) “Dispenser” means a person authorized by law to dispense, as defined 8
in § 12–101 of the Health Occupations Article, a prescription drug to a patient or the 9
patient’s agent in the State. 10
(3) “Noncontrolled prescription drug” means a prescription drug, as 11
defined in § 21–201 of this article, that is not a controlled dangerous substance designated 12
under Title 5, Subtitle 4 of the Criminal Law Article. 13
(4) “State designated exchange” has the meaning stated in § 4–302.3 of this 14
article. 15
(b) The State designated exchange shall operate as a health data utility for the 16
State. 17
(c) The purposes of the health data utility include: 18
(1) The collection, aggregation, and analysis of clinical information, public 19
health data, and health administrative and operations data to assist the Department, local 20
health departments, the Commission, and the Health Services Cost Review Commission in 21
the evaluation of public health interventions and health equity; 22
(2) The communication of data between public health officials and health 23
care providers to advance disease control and health equity; and 24
(3) The enhancement and acceleration of the interoperability of health 25
information throughout the State. 26
(d) [Dispensers] EXCEPT AS PROVIDED IN SUBSECTION (E) OF THIS 27
SECTION, EACH DISPENSER shall provide data to the State designated exchange. 28
(E) (1) A DISPENSER MAY NOT SU BMIT INFORMATION ON MIFEPRISTONE , 29
MISOPROSTOL , OR ANY MEDICATION US ED FOR A MEDICAL ABO RTION, AS 30
DETERMINED BY THE SECRETARY, TO THE STATE DESIGNATED EXCHANGE . 31
24 SENATE BILL 786
(2) THE SECRETARY SHALL FOLLO W GUIDELINES OF THE AMERICAN 1
COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS , THE WORLD HEALTH 2
ORGANIZATION, AND THE SOCIETY OF FAMILY PLANNING IN DETERMINI NG THE 3
MEDICATIONS TO BE IN CLUDED AMONG THE MED ICATIONS USED IN A MEDICAL 4
ABORTION ABOUT WHICH A DISPENSER MAY NOT SUBMIT INFORMATION U NDER 5
PARAGRAPH (1) OF THIS SUBSECTION . 6
[(e)] (F) (1) The purpose of this subsection is to: 7
(i) Authorize individuals and organizations involved in the 8
treatment and care coordination of patients to access, as legally authorized, a patient’s 9
medication history, including medications prescribed for the patient; and 10
(ii) Assist health care providers, care managers, the Department, 11
and local health departments to understand and promote matters of health equity and 12
treatment efficacy. 13
(2) After dispensing a noncontrolled prescription drug OTHER THAN THE 14
MEDICAL ABORTION MED ICATIONS DESCRIBED U NDER SUBSECTION (E) OF THIS 15
SECTION, a dispenser shall submit prescription information to the State designated 16
exchange. 17
(3) The prescription information shall be submitted: 18
(i) By electronic means; 19
(ii) Without unduly increasing the workload and expense on a 20
dispenser; 21
(iii) In a manner that minimizes burden and duplication by being as 22
compatible as possible with existing federal standards for data submission practices, 23
including technology software of dispensers; and 24
(iv) As otherwise required by regulations adopted by the 25
Commission. 26
(4) The State designated exchange may not impose any fees or other 27
assessments on dispensers to support the operation of the exchange. 28
(5) The State designated exchange shall make prescription information 29
submitted under this subsection available for purposes of treatment and care coordination 30
of a patient. 31
[(f)] (G) The State designated exchange may provide data, as allowed by law, for 32
public health purposes that may include: 33
SENATE BILL 786 25
(1) Improving health equity through access to prescription medications, 1
including for the treatment of infectious disease; 2
(2) Assisting programs led by health care providers and the Department, 3
local health departments, the Commission, and the Health Services Cost Review 4
Commission to identify opportunities for quality improvement, including for stewardship 5
of antibiotic medications; and 6
(3) Conducting case investigations and related activities. 7
[(g)] (H) Information submitted to the State information exchange or provided 8
by the State information exchange under this section shall be submitted or provided, to the 9
extent practicable, in as near to real time as possible. 10
[(h)] (I) (1) The Commission, in consultation with appropriate stakeholders, 11
shall adopt regulations to carry out this section. 12
(2) The regulations shall take into account consumer perspective and 13
include: 14
(i) The specific data required to be provided under subsection (d) of 15
this section; 16
(ii) The specific prescription information required to be submitted 17
under subsection [(e)] (F) of this section; 18
(iii) The time frame for submitting prescription information under 19
subsection [(e)] (F) of this section; 20
(iv) The electronic means and manner by which prescription 21
information is to be submitted under subsection [(e)] (F) of this section; 22
(v) Prescription information submission requirements that align 23
with the data submission requirements on dispensers of monitored prescription drugs 24
under Title 21, Subtitle 2A of this article; and 25
(vi) Identification and necessary suppression of information related 26
to providers or medications that are determined to have significant potential to cause harm. 27
[(i)] (J) (1) The State designated exchange shall establish a consumer 28
advisory council to bring the perspectives of individuals and organizations with an interest 29
in protecting consumers into the delivery of services provided by the State designated 30
exchange. 31
(2) In selecting members, the State designated exchange shall consider 32
diversity of experience. 33 26 SENATE BILL 786
(3) The consumer advisory council established under paragraph (1) of this 1
subsection shall: 2
(i) Consist of a minimum of six members, including at least four 3
consumer representatives and two staff representatives, and maintain a ratio of consumer 4
representatives to nonconsumer representatives of at least two to one; 5
(ii) Identify and report consumer privacy concerns to senior 6
leadership of the State designated exchange; 7
(iii) Advise on efforts to educate consumers on data exchange policies, 8
including options for consumers to opt out of disclosure of protected health information; 9
(iv) Meet at least 3 times each year; and 10
(v) Adopt and maintain a charter to be posted online that includes 11
the purpose, members, and meeting schedule of the consumer advisory council. 12
Article – Insurance 13
15–857. 14
(a) (1) This section applies to: 15
(i) insurers and nonprofit health service plans that provide labor 16
and delivery coverage to individuals or groups on an expense–incurred basis under health 17
insurance policies or contracts that are issued or delivered in the State; and 18
(ii) health maintenance organizations that provide labor and 19
delivery coverage to individuals or groups under contracts that are issued or delivered in 20
the State. 21
(2) This section does not apply to: 22
(i) a multistate plan that does not provide coverage for abortions in 23
accordance with 42 U.S.C. § 18054(a)(6); or 24
(ii) a high–deductible plan, as defined in 26 U.S.C. § 223(c)(2)(C) of 25
the Internal Revenue Code, unless the Commissioner determines that abortion care is not 26
excluded from the safe harbor provisions for preventive care under § 223(c)(2)(C) of the 27
Internal Revenue Code. 28
(3) An organization that is eligible to obtain an exclusion from the coverage 29
requirements under § 15–826 of this subtitle may obtain from an entity subject to this 30
section an exclusion from the coverage and notice requirements of this section if the 31
requirements conflict with the organization’s bona fide religious beliefs and practices. 32 SENATE BILL 786 27
(b) Except as provided in subsection (c) of this section AND NOTWITHSTANDING 1
§ 31–116(A) OF THIS ARTICLE , an entity subject to this section shall: 2
(1) cover abortion care services without: 3
(i) a deductible, coinsurance, copayment, or any other cost–sharing 4
requirement; and 5
(ii) restrictions that are inconsistent with the protected rights under 6
Title 20, Subtitle 2 of the Health – General Article; and 7
(2) provide information to consumers about abortion care coverage using 8
the terminology “abortion care” to describe coverage. 9
(c) If the Commissioner determines that enforcement of this section may 10
adversely affect the allocation of federal funds to the State, the Commissioner may grant 11
an exemption to the requirements of this section to the minimum extent necessary to 12
ensure the continued receipt of federal funds. 13
31–116. 14
(a) The essential health benefits required under § 1302(a) of the Affordable Care 15
Act: 16
(1) shall be the benefits in the State benchmark plan, selected in 17
accordance with this section; and 18
(2) notwithstanding any other benefits mandated by State law, shall be the 19
benefits required in: 20
(i) subject to subsection (f) of this section, all individual health 21
benefit plans and health benefit plans offered to small employers, except for grandfathered 22
health plans, as defined in the Affordable Care Act, offered outside the Exchange; and 23
(ii) subject to § 31–115(c) of this subtitle, all qualified health plans 24
offered in the Exchange. 25
SECTION 2. AND BE IT FURTHER ENACTED, That the Secretary of Health shall 26
adopt emergency regulations within 90 days after the effective date of this Act to identify 27
diagnostic, procedure, medication, and related codes for abortion care in accordance with § 28
4–302.5 of the Health – General Article, as enacted by Section 1 of this Act. 29
SECTION 3. AND BE IT FURTHER ENACTED, That the Maryland Health Care 30
Commission shall adopt emergency regulations within 9 months after the effective date of 31
this Act to implement § 4–302.5 of the Health – General Article, as enacted by Section 1 of 32
this Act. 33 28 SENATE BILL 786
SECTION 4. AND BE IT FURTHER ENACTED, That, in fiscal years 2024 and 2025, 1
the Maryland Health Care Commission shall report on a quarterly basis to the Senate 2
Finance Committee and the House Health and Government Operations Committee, in 3
accordance with § 2–1257 of the State Government Article, on the status of the 4
implementation of § 4–302.5 of the Health – General Article, as enacted by Section 1 of this 5
Act. 6
SECTION 2. 5. AND BE IT FURTHER ENACTED, That this Act shall take effect 7
October June 1, 2023. 8
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
President of the Senate.
________________________________________________________________________________
Speaker of the House of Delegates.