Maryland 2023 Regular Session

Maryland Senate Bill SB786 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	WES MOORE, Governor Ch. 248
2	1
3		-	– 1 –
4		-	Chapter 248
5		-	(Senate Bill 786)
6	2
7		-	AN ACT concerning
	3	+	EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTING LAW.
	4	+	[Brackets] indicate matter deleted from existing law.
	5	+	Underlining indicates amendments to bill.
	6	+	Strike out indicates matter stricken from the bill by amendment or deleted from the law by
	7	+	amendment.
	8	+	sb0786
8	9
9		-	Health – Reproductive Health Services – Protected Information and Insurance
10		-	Requirements
	10	+	SENATE BILL 786
	11	+	J1, J5 3lr2403
	12	+	CF HB 812
	13	+	By: Senator Hettleman
	14	+	Introduced and read first time: February 6, 2023
	15	+	Assigned to: Finance
	16	+	Committee Report: Favorable with amendments
	17	+	Senate action: Adopted
	18	+	Read second time: March 10, 2023
11	19
12		-	FOR the purpose of regulating the disclosure of certain information related to
13		-	legally protected health care by custodians of public records, health care providers,
14		-	health information exchanges, and dispensers electronic health networks; repealing
15		-	a provision of law authorizing a custodian to allow inspection of the part of a public
16		-	record that gives the home address of a licensee under certain circumstances;
17		-	requiring that the regulations adopted by the Maryland Health Care Commission
18		-	regarding clinical information to be exchanged through the State–designated
19		-	exchange restrict data of patients who have obtained legally protected health care;
20		-	establishing the Protected Health Care Commission; altering the purpose of the
21		-	Maryland Health Care Commission to include the establishment of policies and
22		-	standards that protect the confidentiality of certain health care information;
23		-	clarifying that certain insurance requirements regarding abortion care services
24		-	apply notwithstanding a certain restriction; and generally relating to health
25		-	information and reproductive health services.
	20	+	CHAPTER ______
26	21
27		-	BY repealing and reenacting, with amendments,
28		-	Article – General Provisions
29		-	Section 4–333
30		-	Annotated Code of Maryland
31		-	(2019 Replacement Volume and 2022 Supplement)
	22	+	AN ACT concerning 1
32	23
33		-	BY repealing and reenacting, with amendments,
34		-	Article – Health – General
35		-	Section 4–301, 4–302.3, 4–305, 4–309, 19–103, and 19–145 and 19–103
36		-	Annotated Code of Maryland
37		-	(2019 Replacement Volume and 2022 Supplement)
	24	+	Health – Reproductive Health Services – Protected Information and Insurance 2
	25	+	Requirements 3
38	26
39		-	BY adding to
40		-	Article – Health – General
41		-	Section 4–302.5 and 4–310
42		-	Annotated Code of Maryland
43		-	(2019 Replacement Volume and 2022 Supplement)
	27	+	FOR the purpose of regulating the disclosure of certain information related to 4
	28	+	legally protected health care by custodians of public records, health care providers, 5
	29	+	health information exchanges, and dispensers electronic health networks; repealing 6
	30	+	a provision of law authorizing a custodian to allow inspection of the part of a public 7
	31	+	record that gives the home address of a licensee under certain circumstances; 8
	32	+	requiring that the regulations adopted by the Maryland Health Care Commission 9
	33	+	regarding clinical information to be exchanged through the State–designated 10
	34	+	exchange restrict data of patients who have obtained legally protected health care; 11
	35	+	establishing the Protected Health Care Commission; altering the purpose of the 12
	36	+	Maryland Health Care Commission to include the establishment of policies and 13
	37	+	standards that protect the confidentiality of certain health care information; 14
	38	+	clarifying that certain insurance requirements regarding abortion care services 15
	39	+	apply notwithstanding a certain restriction; and generally relating to health 16
	40	+	information and reproductive health services. 17
44	41
45		-	BY repealing and reenacting, with amendments,
46		-	Article – ~~Insurance~~
47		-	Section 15–~~857~~
48		-	Annotated Code of Maryland
49		-	(~~2017~~ Replacement Volume and 2022 Supplement) ~~Ch. 248 2023 LAWS OF MARYLAND~~
	42	+	BY repealing and reenacting, with amendments, 18
	43	+	Article – General Provisions 19
	44	+	Section 4–333 20
	45	+	Annotated Code of Maryland 21
	46	+	(2019 Replacement Volume and 2022 Supplement) 22
50	47
51		-	– 2 –
	48	+	BY repealing and reenacting, with amendments, 23 2 SENATE BILL 786
52	49
53		-	BY repealing and reenacting, without amendments,
54		-	Article – Insurance
55		-	Section 31–116(a)
56		-	Annotated Code of Maryland
57		-	(2017 Replacement Volume and 2022 Supplement)
58	50
59		-	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
60		-	That the Laws of Maryland read as follows:
	51	+	Article – Health – General 1
	52	+	Section 4–301, 4–302.3, 4–305, 4–309, 19–103, and 19–145 and 19–103 2
	53	+	Annotated Code of Maryland 3
	54	+	(2019 Replacement Volume and 2022 Supplement) 4
61	55
62		-	Article – General Provisions
	56	+	BY adding to 5
	57	+	Article – Health – General 6
	58	+	Section 4–302.5 and 4–310 7
	59	+	Annotated Code of Maryland 8
	60	+	(2019 Replacement Volume and 2022 Supplement) 9
63	61
64		-	4–333.
	62	+	BY repealing and reenacting, with amendments, 10
	63	+	Article – Insurance 11
	64	+	Section 15–857 12
	65	+	Annotated Code of Maryland 13
	66	+	(2017 Replacement Volume and 2022 Supplement) 14
65	67
66		-	(a) Subject to subsections (b) through (d) of this section, a custodian shall deny
67		-	inspection of the part of a public record that:
	68	+	BY repealing and reenacting, without amendments, 15
	69	+	Article – Insurance 16
	70	+	Section 31–116(a) 17
	71	+	Annotated Code of Maryland 18
	72	+	(2017 Replacement Volume and 2022 Supplement) 19
68	73
69		-	(1~~) contains information about~~ the ~~licensing~~ of ~~an individual in an~~
70		-	~~occupation or a profession;~~
	74	+	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 20
	75	+	That the Laws of Maryland read as follows: 21
71	76
72		-	(2) CONTAINS THE NAME OF AN INDIVIDUAL OR OTHER IDENTIFYING
73		-	INFORMATION OF AN INDIVIDUAL RELATED TO AN AMBULATORY SURGER Y CENTER:
	77	+	Article – General Provisions 22
74	78
75		-	(I) EXCEPT AS PROVIDED I N SUBSECTION (B)(8) OF THIS
76		-	SECTION, AN AMBULATORY SURGIC AL FACILITY LICENSED UNDER § 19–3B–01 OF
77		-	THE HEALTH – GENERAL ARTICLE OR A; OR
	79	+	4–333. 23
78	80
79		-	(II) A ~~SURGICAL ABORTION FA CILITY LICENSED UNDE R §~~
80		-	~~20–209~~ OF THE ~~HEALTH – GENERAL ARTICLE;~~ OR
	81	+	(a) Subject to subsections (b) through (d) of this section, a custodian shall deny 24
	82	+	inspection of the part of a public record that: 25
81	83
82		-	(3) RELATES TO AN INVEST IGATION OF A LICENSE E OR CERTIFICATE
83		-	HOLDER REGARDING THE PROVISION OF LEGALLY P ROTECTED HEALTH CARE , AS
84		-	DEFINED IN § 4–301 OF THE HEALTH – GENERAL ARTICLE, PENDING A FINAL
85		-	ORDER.
	84	+	(1) contains information about the licensing of an individual in an 26
	85	+	occupation or a profession; 27
86	86
87		-	(b) A custodian shall allow inspection of the part of a public record that gives:
	87	+	(2) CONTAINS THE NAME OF AN INDIVIDUAL OR OTHER IDENTIFYING 28
	88	+	INFORMATION OF AN INDIVIDUAL RELATED TO AN AMBULATORY SURGER Y CENTER: 29
88	89
89		-	(1) the name of the licensee;
	90	+	(I) EXCEPT AS PROVIDED I N SUBSECTION (B)(8) OF THIS 30
	91	+	SECTION, AN AMBULATORY SURGIC AL FACILITY LICENSED UNDER § 19–3B–01 OF 31
	92	+	THE HEALTH – GENERAL ARTICLE OR A; OR 32
90	93
91		-	(2) (I) SUBJECT TO ITEM (II) OF THIS ITEM, the business address of
92		-	the licensee [or, if the business address is not available, the home address of the licensee
93		-	after the custodian redacts any information that identifies the location as the home address
94		-	of an individual with a disability as defined in § 20–701 of the State Government Article];
95		-	OR
96		-	WES MOORE, Governor Ch. 248
	94	+	(II) A SURGICAL ABORTION FA CILITY LICENSED UNDE R § 33
	95	+	20–209 OF THE HEALTH – GENERAL ARTICLE; OR 34
	96	+	SENATE BILL 786 3
97	97
98		-	– 3 –
99		-	(II) IF THE LICENSEE IS L ICENSED BY A HEALTH OCCUPATIONS
100		-	BOARD, THE BUSINESS ADDRESS OF THE LICENSEE ;
101	98
102		-	(3) the business telephone number of the licensee;
	99	+	(3) RELATES TO AN INVEST IGATION OF A LICENSE E OR CERTIFICATE 1
	100	+	HOLDER REGARDING TH E PROVISION OF LEGAL LY PROTECTED HEALTH CARE, AS 2
	101	+	DEFINED IN § 4–301 OF THE HEALTH – GENERAL ARTICLE, PENDING A FINAL 3
	102	+	ORDER. 4
103	103
104		-	(4) ~~the educational and occupational background~~ of the ~~licensee;~~
	104	+	(b) A custodian shall allow inspection of the part of a public record that gives: 5
105	105
106		-	(5) the ~~professional qualifications~~ of the licensee;
	106	+	(1) the name of the licensee; 6
107	107
108		-	(6) any orders and findings that result from formal disciplinary actions;
109		-	and
	108	+	(2) (I) SUBJECT TO ITEM (II) OF THIS ITEM, the business address of 7
	109	+	the licensee [or, if the business address is not available, the home address of the licensee 8
	110	+	after the custodian redacts any information that identifies the location as the home address 9
	111	+	of an individual with a disability as defined in § 20–701 of the State Government Article]; 10
	112	+	OR 11
110	113
111		-	(7) ~~any evidence that has been provided to~~ the ~~custodian to meet the~~
112		-	~~requirements~~ of ~~a statute as to financial responsibility~~; ~~AND~~
	114	+	(II) IF THE LICENSEE IS L ICENSED BY A HEALTH OCCUPATIONS 12
	115	+	BOARD, THE BUSINESS ADDRESS OF THE LICENSEE ; 13
113	116
114		-	(8) FOR AN AMBULATORY SU RGICAL FACILITY LICE NSED UNDER §
115		-	19–3B–01 OF THE HEALTH – GENERAL ARTICLE, THE OWNER, PRIMARY CONTACT ,
116		-	ATTORNEY, OR CONSULTANT CONTAI NED IN AN APPLICATIO N TO THE MARYLAND
117		-	HEALTH CARE COMMISSION FOR A CERT IFICATE OF NEED OR C ERTIFICATE OF
118		-	NEED EXCEPTION OR DE TERMINATION REQUEST .
	117	+	(3) the business telephone number of the licensee; 14
119	118
120		-	(c) ~~A custodian may allow inspection~~ of ~~other information about a~~ licensee ~~if:~~
	119	+	(4) the educational and occupational background of the licensee; 15
121	120
122		-	(1) the ~~custodian finds a compelling public purpose~~; ~~and~~
	121	+	(5) the professional qualifications of the licensee; 16
123	122
124		-	(2) the rules or regulations of the official custodian allow the inspection.
	123	+	(6) any orders and findings that result from formal disciplinary actions; 17
	124	+	and 18
125	125
126		-	(d) ~~Except as otherwise~~ provided ~~by this section or other law, a~~ custodian ~~shall~~
127		-	~~allow inspection by the person in interest.~~
	126	+	(7) any evidence that has been provided to the custodian to meet the 19
	127	+	requirements of a statute as to financial responsibility; AND 20
128	128
129		-	(e) A custodian who sells lists of licensees shall omit from the lists the name of
130		-	any licensee, on written request of the licensee.
	129	+	(8) FOR AN AMBULATORY SU RGICAL FACILITY LICE NSED UNDER § 21
	130	+	19–3B–01 OF THE HEALTH – GENERAL ARTICLE, THE OWNER, PRIMARY CONTACT , 22
	131	+	ATTORNEY, OR CONSULTANT CONTAI NED IN AN APPLICATIO N TO THE MARYLAND 23
	132	+	HEALTH CARE COMMISSION FOR A CERT IFICATE OF NEED OR C ERTIFICATE OF 24
	133	+	NEED EXCEPTION OR DE TERMINATION REQUEST . 25
131	134
132		-	~~Article – Health – General~~
	135	+	(c) A custodian may allow inspection of other information about a licensee if: 26
133	136
134		-	~~4–301.~~
	137	+	(1) the custodian finds a compelling public purpose; and 27
135	138
136		-	(a) ~~In this subtitle~~ the ~~following words have~~ the ~~meanings indicated~~.
	139	+	(2) the rules or regulations of the official custodian allow the inspection. 28
137	140
138		-	(b) “Common ownership” means ownership of a health care entity:
	141	+	(d) Except as otherwise provided by this section or other law, a custodian shall 29
	142	+	allow inspection by the person in interest. 30
	143	+	4 SENATE BILL 786
139	144
140		-	(1) By two or more health care providers;
141	145
142		-	(2) By two or more health care providers employed by a mutual employer
143		-	for a wage, salary, fee, or payment to perform work for the employer;
144		-	Ch. 248 2023 LAWS OF MARYLAND
	146	+	(e) A custodian who sells lists of licensees shall omit from the lists the name of 1
	147	+	any licensee, on written request of the licensee. 2
145	148
146		-	– 4 –
147		-	(3) By health care organizations operating as an organized health care
148		-	arrangement, as defined in 45 C.F.R. § 160.103;
	149	+	Article – Health – General 3
149	150
150		-	(4) By a health care entity or health care entities that possess an ownership
151		-	or equity interest of 5% or more in another health care entity; or
	151	+	4–301. 4
152	152
153		-	(5) ~~By affiliated providers operating under~~ the ~~same trade name~~.
	153	+	(a) In this subtitle the following words have the meanings indicated. 5
154	154
155		-	(c) “Directory information” means information concerning the presence and
156		-	general health condition of a patient who has been admitted to a health care facility or who
157		-	is currently receiving emergency health care in a health care facility.
	155	+	(b) “Common ownership” means ownership of a health care entity: 6
158	156
159		-	(d) “Disclose” or “disclosure” means the transmission or communication of
160		-	information in a medical record, including an acknowledgment that a medical record on a
161		-	particular patient or recipient exists.
	157	+	(1) By two or more health care providers; 7
162	158
163		-	(e) “Emergency” means a situation when, in the professional opinion of the health
164		-	care provider, a clear and significant risk of death or imminent serious injury or harm to a
165		-	patient or recipient exists.
	159	+	(2) By two or more health care providers employed by a mutual employer 8
	160	+	for a wage, salary, fee, or payment to perform work for the employer; 9
166	161
167		-	(f) ~~“General~~ health ~~condition” means the~~ health ~~status of a patient described in~~
168		-	~~terms of “critical”~~, ~~“poor”, “fair”, “good”, “excellent”, or terms denoting similar conditions~~.
	162	+	(3) By health care organizations operating as an organized health care 10
	163	+	arrangement, as defined in 45 C.F.R. § 160.103; 11
169	164
170		-	(g) ~~“Health care” means any care, treatment, or procedure~~ by a health care
171		-	~~provider:~~
	165	+	(4) By a health care entity or health care entities that possess an ownership 12
	166	+	or equity interest of 5% or more in another health care entity; or 13
172	167
173		-	(1) To diagnose, evaluate, rehabilitate, manage, treat, or maintain the
174		-	physical or mental condition of a patient or recipient; or
	168	+	(5) By affiliated providers operating under the same trade name. 14
175	169
176		-	(2) That affects the structure or any function of the human body.
	170	+	(c) “Directory information” means information concerning the presence and 15
	171	+	general health condition of a patient who has been admitted to a health care facility or who 16
	172	+	is currently receiving emergency health care in a health care facility. 17
177	173
178		-	(h) (1) “Health care provider” means:
	174	+	(d) “Disclose” or “disclosure” means the transmission or communication of 18
	175	+	information in a medical record, including an acknowledgment that a medical record on a 19
	176	+	particular patient or recipient exists. 20
179	177
180		-	(i) A person who is licensed, certified, or otherwise authorized under
181		-	the Health Occupations Article or § 13–516 of the Education Article to provide health care
182		-	in the ordinary course of business or practice of a profession or in an approved education or
183		-	training program; or
	178	+	(e) “Emergency” means a situation when, in the professional opinion of the health 21
	179	+	care provider, a clear and significant risk of death or imminent serious injury or harm to a 22
	180	+	patient or recipient exists. 23
184	181
185		-	(ii) A facility where health care is provided to patients or recipients,
186		-	including a facility as defined in § 10–101(g) of this article, a hospital as defined in §
187		-	19–301 of this article, a related institution as defined in § 19–301 of this article, a health
188		-	maintenance organization as defined in § 19–701(g) of this article, an outpatient clinic, a
189		-	medical laboratory, a comprehensive crisis response center, a crisis stabilization center,
190		-	and a crisis treatment center established under § 7.5–207 of this article.
191		-	WES MOORE, Governor Ch. 248
	182	+	(f) “General health condition” means the health status of a patient described in 24
	183	+	terms of “critical”, “poor”, “fair”, “good”, “excellent”, or terms denoting similar conditions. 25
192	184
193		-	– 5 –
194		-	(2) “Health care provider” includes the agents, employees, officers, and
195		-	directors of a facility and the agents and employees of a health care provider.
	185	+	(g) “Health care” means any care, treatment, or procedure by a health care 26
	186	+	provider: 27
196	187
197		-	(i) (1) “Health information exchange” means:
	188	+	(1) To diagnose, evaluate, rehabilitate, manage, treat, or maintain the 28
	189	+	physical or mental condition of a patient or recipient; or 29
198	190
199		-	(i) An individual or entity that determines, controls, or has the
200		-	discretion to administer any requirement, policy, or agreement that allows, enables, or
201		-	requires the use of any technology or services for access, exchange, or use of electronic
202		-	protected health care information:
	191	+	(2) That affects the structure or any function of the human body. 30
	192	+	SENATE BILL 786 5
203	193
204		-	1. Among more than two unaffiliated individuals or entities
205		-	that are enabled to exchange electronic protected health information with each other; and
206	194
207		-	2. That is for a treatment, payment, or health care
208		-	operations purpose, as those terms are defined in 45 C.F.R. § 164.501, regardless of whether
209		-	the individuals or entities are subject to the requirements of 45 C.F.R. parts 160 and 164;
210		-	or
	195	+	(h) (1) “Health care provider” means: 1
211	196
212		-	(ii) A health information technology developer of certified health
213		-	information technology that develops or offers health information technology, as that term
214		-	is defined in 42 U.S.C. 300jj(5), and has one or more Health Information Technology
215		-	Modules certified under a program for the voluntary certification of health information
216		-	technology that is kept or recognized by the National Coordinator in accordance with 42
217		-	U.S.C. 300jj–11(c)(5).
	197	+	(i) A person who is licensed, certified, or otherwise authorized under 2
	198	+	the Health Occupations Article or § 13–516 of the Education Article to provide health care 3
	199	+	in the ordinary course of business or practice of a profession or in an approved education or 4
	200	+	training program; or 5
218	201
219		-	(2) “Health information exchange” does not include:
	202	+	(ii) A facility where health care is provided to patients or recipients, 6
	203	+	including a facility as defined in § 10–101(g) of this article, a hospital as defined in § 7
	204	+	19–301 of this article, a related institution as defined in § 19–301 of this article, a health 8
	205	+	maintenance organization as defined in § 19–701(g) of this article, an outpatient clinic, a 9
	206	+	medical laboratory, a comprehensive crisis response center, a crisis stabilization center, 10
	207	+	and a crisis treatment center established under § 7.5–207 of this article. 11
220	208
221		-	(i) An entity composed of health care providers under common
222		-	ownership if the organizational and technical processes the entity provides or governs are
223		-	for health care treatment, payment, or health care operations purposes, as those terms are
224		-	defined in 45 C.F.R. § 164.501;
	209	+	(2) “Health care provider” includes the agents, employees, officers, and 12
	210	+	directors of a facility and the agents and employees of a health care provider. 13
225	211
226		-	(ii) A carrier, as defined in § 15–1301 of the Insurance Article if the
227		-	organizational and technical processes the carrier provides or governs are for health care
228		-	treatment, payment, or health care operations purposes, as those terms are defined in 45
229		-	C.F.R. § 164.501;
	212	+	(i) (1) “Health information exchange” means: 14
230	213
231		-	(~~iii~~) An ~~administrator~~, ~~as defined in § 8–301 of~~ the ~~Insurance Article,~~
232		-	~~if the organizational and technical processes the administrator provides~~ or ~~governs are for~~
233		-	~~health care treatment~~, ~~payment~~, or ~~health care operations purposes,~~ ~~as those terms are~~
234		-	~~defined in 45 C.F.R. § 164.501;~~
	214	+	(i) An individual or entity that determines, controls, or has the 15
	215	+	discretion to administer any requirement, policy, or agreement that allows, enables, or 16
	216	+	requires the use of any technology or services for access, exchange, or use of electronic 17
	217	+	protected health care information: 18
235	218
236		-	(iv) A health care provider, as defined in subsection (h) of this section,
237		-	if the organizational and technical processes the health care provider provides or governs
238		-	are for health care treatment, payment, or health care operations purposes, as those terms
239		-	are defined in 45 C.F.R. § 164.501; Ch. 248 2023 LAWS OF MARYLAND
	219	+	1. Among more than two unaffiliated individuals or entities 19
	220	+	that are enabled to exchange electronic protected health information with each other; and 20
240	221
241		-	– 6 –
	222	+	2. That is for a treatment, payment, or health care 21
	223	+	operations purpose, as those terms are defined in 45 C.F.R. § 164.501, regardless of whether 22
	224	+	the individuals or entities are subject to the requirements of 45 C.F.R. parts 160 and 164; 23
	225	+	or 24
242	226
243		-	(v) A carrier’s business associate, as defined in 45 C.F.R. § 160.103,
244		-	if the organizational and technical processes provided or governed by the business associate
245		-	are transactions, as defined in 45 C.F.R. § 160.103; or
	227	+	(ii) A health information technology developer of certified health 25
	228	+	information technology that develops or offers health information technology, as that term 26
	229	+	is defined in 42 U.S.C. 300jj(5), and has one or more Health Information Technology 27
	230	+	Modules certified under a program for the voluntary certification of health information 28
	231	+	technology that is kept or recognized by the National Coordinator in accordance with 42 29
	232	+	U.S.C. 300jj–11(c)(5). 30
246	233
247		-	(vi) A carrier exchanging information as required by 45 C.F.R. §
248		-	156.221.
	234	+	(2) “Health information exchange” does not include: 31
249	235
250		-	(j) ~~“LEGALLY PROTECTED HEA LTH~~ CARE~~” MEANS ALL REPRODUCTI VE~~
251		-	~~HEALTH SERVICES , MEDICATIONS ,~~ AND ~~SUPPLIES RELATED TO~~ THE ~~DIRECT~~
252		-	~~PROVISION~~ OR ~~SUPPORT OF THE PROVISION OF~~ CARE ~~RELATED TO PREG NANCY~~,
253		-	~~CONTRACEPTION , ASSISTED REPRODUCTIO N, AND ABORTION THAT IS LAWFUL~~ IN
254		-	~~THE STATE:~~
	236	+	(i) An entity composed of health care providers under common 32
	237	+	ownership if the organizational and technical processes the entity provides or governs are 33
	238	+	for health care treatment, payment, or health care operations purposes, as those terms are 34
	239	+	defined in 45 C.F.R. § 164.501; 35
	240	+	6 SENATE BILL 786
255	241
256		-	(1) THE PROVISION OF ABORTIO N CARE; AND
257	242
258		-	(2) OTHER SENSITIVE HEALT H SERVICES AS DETERM INED BY THE
259		-	SECRETARY BASED ON TH E RECOMMENDATIONS OF THE PROTECTED HEALTH
260		-	CARE COMMISSION ESTABLISHE D UNDER § 4–310 OF THIS SUBTITLE.
	243	+	(ii) A carrier, as defined in § 15–1301 of the Insurance Article if the 1
	244	+	organizational and technical processes the carrier provides or governs are for health care 2
	245	+	treatment, payment, or health care operations purposes, as those terms are defined in 45 3
	246	+	C.F.R. § 164.501; 4
261	247
262		-	(K) (1) “Medical record” means any oral, written, or other transmission in any
263		-	form or medium of information that:
	248	+	(iii) An administrator, as defined in § 8–301 of the Insurance Article, 5
	249	+	if the organizational and technical processes the administrator provides or governs are for 6
	250	+	health care treatment, payment, or health care operations purposes, as those terms are 7
	251	+	defined in 45 C.F.R. § 164.501; 8
264	252
265		-	(i) Is entered in the record of a patient or recipient;
	253	+	(iv) A health care provider, as defined in subsection (h) of this section, 9
	254	+	if the organizational and technical processes the health care provider provides or governs 10
	255	+	are for health care treatment, payment, or health care operations purposes, as those terms 11
	256	+	are defined in 45 C.F.R. § 164.501; 12
266	257
267		-	(ii) Identifies or can readily be associated with the identity of a
268		-	patient or recipient; and
	258	+	(v) A carrier’s business associate, as defined in 45 C.F.R. § 160.103, 13
	259	+	if the organizational and technical processes provided or governed by the business associate 14
	260	+	are transactions, as defined in 45 C.F.R. § 160.103; or 15
269	261
270		-	(iii) Relates to the health care of the patient or recipient.
	262	+	(vi) A carrier exchanging information as required by 45 C.F.R. § 16
	263	+	156.221. 17
271	264
272		-	(2) “Medical record” includes any:
	265	+	(j) “LEGALLY PROTECTED HEA LTH CARE” MEANS ALL REPRODUCTIVE 18
	266	+	HEALTH SERVICES , MEDICATIONS , AND SUPPLIES RELATED TO THE DIRECT 19
	267	+	PROVISION OR SUPPORT OF THE PROVISION OF CARE RELATED TO PREG NANCY, 20
	268	+	CONTRACEPTION , ASSISTED REPRODUCTIO N, AND ABORTION THAT IS LAWFUL IN 21
	269	+	THE STATE: 22
273	270
274		-	(i) Documentation of disclosures of a medical record to any person
275		-	who is not an employee, agent, or consultant of the health care provider;
	271	+	(1) THE PROVISION OF ABORTION CARE ; AND 23
276	272
277		-	(ii) ~~File or record maintained under § 12–403(c)(13) of~~ the ~~Health~~
278		-	~~Occupations Article by a pharmacy~~ of ~~a prescription order for drugs, medicines, or devices~~
279		-	~~that identifies or may be readily associated with the identity~~ of ~~a patient;~~
	273	+	(2) OTHER SENSITIVE HEALT H SERVICES AS DETERM INED BY THE 24
	274	+	SECRETARY BASED ON TH E RECOMMENDATIONS OF THE PROTECTED HEALTH 25
	275	+	CARE COMMISSION ESTABLISHE D UNDER § 4–310 OF THIS SUBTITLE. 26
280	276
281		-	(iii) Documentation of an examination of a patient regardless of who:
	277	+	(K) (1) “Medical record” means any oral, written, or other transmission in any 27
	278	+	form or medium of information that: 28
282	279
283		-	~~1. Requested~~ the ~~examination;~~ or
	280	+	(i) Is entered in the record of a patient or recipient; 29
284	281
285		-	~~2. Is making payment for~~ the ~~examination; and~~
286		-	~~WES MOORE, Governor Ch. 248~~
	282	+	(ii) Identifies or can readily be associated with the identity of a 30
	283	+	patient or recipient; and 31
287	284
288		-	– 7 –
289		-	(iv) File or record received from another health care provider that:
	285	+	(iii) Relates to the health care of the patient or recipient. 32
290	286
291		-	~~1. Relates to the health care of a patient or recipient received~~
292		-	~~from that health care provider;~~ ~~and~~
	287	+	(2) “Medical record” includes any: 33
	288	+	SENATE BILL 786 7
293	289
294		-	2. Identifies or can readily be associated with the identity of
295		-	the patient or recipient.
296	290
297		-	[(k)] (L) (1) “Mental health services” means health care rendered to a
298		-	recipient primarily in connection with the diagnosis, evaluation, treatment, case
299		-	management, or rehabilitation of any mental disorder.
	291	+	(i) Documentation of disclosures of a medical record to any person 1
	292	+	who is not an employee, agent, or consultant of the health care provider; 2
300	293
301		-	(2) ~~For acute general hospital services,~~ ~~mental~~ health ~~services are~~
302		-	~~considered to be the primarily rendered service only if service is provided pursuant to Title~~
303		-	~~10, Subtitle 6~~ of ~~this article or Title 3 of the Criminal Procedure Article.~~
	294	+	(ii) File or record maintained under § 12–403(c)(13) of the Health 3
	295	+	Occupations Article by a pharmacy of a prescription order for drugs, medicines, or devices 4
	296	+	that identifies or may be readily associated with the identity of a patient; 5
304	297
305		-	[(l)] (M) “Patient” means a person who receives health care and on whom a
306		-	medical record is maintained.
	298	+	(iii) Documentation of an examination of a patient regardless of who: 6
307	299
308		-	~~[(m)] (N) “Person~~ ~~in interest”~~ ~~means:~~
	300	+	1. Requested the examination; or 7
309	301
310		-	~~(1) An adult on whom a health care provider maintains a medical record~~;
	302	+	2. Is making payment for the examination; and 8
311	303
312		-	(2) A person authorized to consent to health care for an adult consistent
313		-	with the authority granted;
	304	+	(iv) File or record received from another health care provider that: 9
314	305
315		-	(3) A duly appointed personal representative of a deceased person;
	306	+	1. Relates to the health care of a patient or recipient received 10
	307	+	from that health care provider; and 11
316	308
317		-	(4) (i) A minor, if the medical record concerns treatment to which the
318		-	minor has the right to consent and has consented under Title 20, Subtitle 1 of this article;
319		-	or
	309	+	2. Identifies or can readily be associated with the identity of 12
	310	+	the patient or recipient. 13
320	311
321		-	(ii) A ~~parent, guardian, custodian, or a representative of the minor~~
322		-	~~designated by a court,~~ in ~~the discretion of~~ the ~~attending physician who provided the~~
323		-	~~treatment to the minor~~, ~~as provided in § 20–102~~ or ~~§ 20–104~~ of ~~this article;~~
	312	+	[(k)] (L) (1) “Mental health services” means health care rendered to a 14
	313	+	recipient primarily in connection with the diagnosis, evaluation, treatment, case 15
	314	+	management, or rehabilitation of any mental disorder. 16
324	315
325		-	(5) If item (4) of this subsection does not apply to a minor:
	316	+	(2) For acute general hospital services, mental health services are 17
	317	+	considered to be the primarily rendered service only if service is provided pursuant to Title 18
	318	+	10, Subtitle 6 of this article or Title 3 of the Criminal Procedure Article. 19
326	319
327		-	(i) A parent of the minor, except if the parent’s authority to consent
328		-	to health care for the minor has been specifically limited by a court order or a valid
329		-	separation agreement entered into by the parents of the minor; or
	320	+	[(l)] (M) “Patient” means a person who receives health care and on whom a 20
	321	+	medical record is maintained. 21
330	322
331		-	(ii) A person authorized to consent to health care for the minor
332		-	consistent with the authority granted; or
333		-	Ch. 248 2023 LAWS OF MARYLAND
	323	+	[(m)] (N) “Person in interest” means: 22
334	324
335		-	– 8 –
336		-	(6) An attorney appointed in writing by a person listed in item (1), (2), (3),
337		-	(4), or (5) of this subsection.
	325	+	(1) An adult on whom a health care provider maintains a medical record; 23
338	326
339		-	~~[(n)]~~ (O) ~~“Primary provider of mental~~ health ~~services” means the designated~~
340		-	~~mental health services provider who:~~
	327	+	(2) A person authorized to consent to health care for an adult consistent 24
	328	+	with the authority granted; 25
341	329
342		-	(1) Has primary responsibility for the development of the mental health
343		-	treatment plan for the recipient; and
	330	+	(3) A duly appointed personal representative of a deceased person; 26
344	331
345		-	(2) Is actively involved in providing that treatment.
	332	+	(4) (i) A minor, if the medical record concerns treatment to which the 27
	333	+	minor has the right to consent and has consented under Title 20, Subtitle 1 of this article; 28
	334	+	or 29
	335	+	8 SENATE BILL 786
346	336
347		-	[(o)] (P) “Protected health information” means all individually identifiable
348		-	health information held or transmitted by a covered entity or its business associate
349		-	protected under the U.S. Department of Health and Human Services Privacy Rule.
350	337
351		-	(Q) ~~“PROTECTED MEDICATION RECORD”~~ ~~MEANS ANY IDENTIFYIN G~~
352		-	~~INFORMATION ABOUT TH E PATIENT OR PRESCRI BER~~ OF ~~MEDICATION US ED IN A~~
353		-	~~MEDICAL ABORTION IF~~ THE ~~MEDICATION :~~
	338	+	(ii) A parent, guardian, custodian, or a representative of the minor 1
	339	+	designated by a court, in the discretion of the attending physician who provided the 2
	340	+	treatment to the minor, as provided in § 20–102 or § 20–104 of this article; 3
354	341
355		-	(1) HAS BEEN APPROVED BY THE FEDERAL FOOD AND DRUG
356		-	ADMINISTRATION FOR ME DICAL ABORTION ; OR
	342	+	(5) If item (4) of this subsection does not apply to a minor: 4
357	343
358		-	(2) IS RECOGNIZED BY THE SECRETARY.
	344	+	(i) A parent of the minor, except if the parent’s authority to consent 5
	345	+	to health care for the minor has been specifically limited by a court order or a valid 6
	346	+	separation agreement entered into by the parents of the minor; or 7
359	347
360		-	(R) (1) “PROTECTED SERVICES RE CORD” MEANS ANY IDENTIFYIN G
361		-	INFORMATION CONTAINED IN A PATIE NT’S MEDICAL RECORD REL ATING TO THE
362		-	PROVISION OF LEGALLY PROTECTED HEALTH CAR E.
	348	+	(ii) A person authorized to consent to health care for the minor 8
	349	+	consistent with the authority granted; or 9
363	350
364		-	(2) ~~“PROTECTED~~ ~~SERVICES RE CORD” DOES NOT INCLUDE A~~
365		-	~~PROTECTED MEDICATION RECORD~~.
	351	+	(6) An attorney appointed in writing by a person listed in item (1), (2), (3), 10
	352	+	(4), or (5) of this subsection. 11
366	353
367		-	[(p)] (S) ~~(Q) “Recipient~~” means ~~a person who has applied for, for whom an~~
368		-	~~application has been submitted, or who has received~~ mental health services.
	354	+	[(n)] (O) “Primary provider of mental health services” means the designated 12
	355	+	mental health services provider who: 13
369	356
370		-	(R) ~~“SENSITIVE~~ HEALTH ~~SERV ICES” INCLUDES REPRODUCTIV E HEALTH~~
371		-	~~SERVICES OTHER THAN ABORTION CARE .~~
	357	+	(1) Has primary responsibility for the development of the mental health 14
	358	+	treatment plan for the recipient; and 15
372	359
373		-	[(q)] (T) (S) “State–designated health information exchange” means the health
374		-	information exchange designated by the Maryland Health Care Commission and the
375		-	Health Services Cost Review Commission under § 19–143 of this article.
	360	+	(2) Is actively involved in providing that treatment. 16
376	361
377		-	4–302.3.
	362	+	[(o)] (P) “Protected health information” means all individually identifiable 17
	363	+	health information held or transmitted by a covered entity or its business associate 18
	364	+	protected under the U.S. Department of Health and Human Services Privacy Rule. 19
378	365
379		-	(a) (1) In this section the following words have the meanings indicated.
380		-	WES MOORE, Governor Ch. 248
	366	+	(Q) “PROTECTED MEDICATION RECORD” MEANS ANY IDENTIFYIN G 20
	367	+	INFORMATION ABOUT TH E PATIENT OR PRESCRI BER OF MEDICATION US ED IN A 21
	368	+	MEDICAL AB ORTION IF THE MEDICA TION: 22
381	369
382		-	– 9 –
383		-	(2) “Electronic health care transactions” means health care transactions
384		-	that have been approved by a nationally recognized health care standards development
385		-	organization to support health care informatics, information exchange, systems
386		-	integration, and other health care applications.
	370	+	(1) HAS BEEN APPROVED BY THE FEDERAL FOOD AND DRUG 23
	371	+	ADMINISTRATION FOR ME DICAL ABORTION ; OR 24
387	372
388		-	(3) ~~“Electronic health network”~~ ~~means an entity:~~
	373	+	(2) IS RECOGNIZED BY THE SECRETARY. 25
389	374
390		-	(i) Involved in the exchange of electronic health care transactions
391		-	between a payor, health care provider, vendor, and any other entity; and
	375	+	(R) (1) “PROTECTED SERVICES RE CORD” MEANS ANY IDENTIFYIN G 26
	376	+	INFORMATION CONTAINE D IN A PATIENT’S MEDICAL RECORD RELAT ING TO THE 27
	377	+	PROVISION OF LEGALLY PROTECTED HEALTH CAR E. 28
392	378
393		-	(ii) Certified by the Maryland Health Care Commission.
	379	+	(2) “PROTECTED SERVICES RE CORD” DOES NOT INCLUDE A 29
	380	+	PROTECTED MEDICATION RECORD. 30
394	381
395		-	(4) “Nursing home” has the meaning stated in § 19–1401 of this article.
	382	+	[(p)] (S) (Q) “Recipient” means a person who has applied for, for whom an 31
	383	+	application has been submitted, or who has received mental health services. 32 SENATE BILL 786 9
396	384
397		-	(5) “Standard request” means a request for clinical information from a
398		-	health information exchange that conforms to the major standards version specified by the
399		-	Office of the National Coordinator for Health Information Technology.
400	385
401		-	(b) This section applies to:
402	386
403		-	(1) ~~Except for the State–designated~~ health ~~information exchange,~~ a health
404		-	~~information exchange operating in the State;~~ ~~and~~
	387	+	(R) “SENSITIVE HEALTH SERV ICES” INCLUDES REPRODUCTIV E HEALTH 1
	388	+	SERVICES OTHER THAN ABORTION CARE . 2
405	389
406		-	(2) A payor that:
	390	+	[(q)] (T) (S) “State–designated health information exchange” means the health 3
	391	+	information exchange designated by the Maryland Health Care Commission and the 4
	392	+	Health Services Cost Review Commission under § 19–143 of this article. 5
407	393
408		-	(i) Holds a valid certificate of authority issued by the Maryland
409		-	Insurance Commissioner; and
	394	+	4–302.3. 6
410	395
411		-	(ii) ~~Acts as,~~ ~~operates, or owns a health information exchange~~.
	396	+	(a) (1) In this section the following words have the meanings indicated. 7
412	397
413		-	(c) An entity to which this section applies shall connect to the State–designated
414		-	health information exchange in a manner consistent with applicable federal and State
415		-	privacy laws.
	398	+	(2) “Electronic health care transactions” means health care transactions 8
	399	+	that have been approved by a nationally recognized health care standards development 9
	400	+	organization to support health care informatics, information exchange, systems 10
	401	+	integration, and other health care applications. 11
416	402
417		-	(d) When a standard request for clinical information is received through the
418		-	State–designated health information exchange, an entity to which this section applies
419		-	shall:
	403	+	(3) “Electronic health network” means an entity: 12
420	404
421		-	(1) ~~Respond to~~ the ~~request to the extent authorized under federal and State~~
422		-	~~privacy laws~~; and
	405	+	(i) Involved in the exchange of electronic health care transactions 13
	406	+	between a payor, health care provider, vendor, and any other entity; and 14
423	407
424		-	(2) Transmit the response to the State–designated health information
425		-	exchange in the manner specified in the regulations adopted under subsection (g) of this
426		-	section.
427		-	Ch. 248 2023 LAWS OF MARYLAND
	408	+	(ii) Certified by the Maryland Health Care Commission. 15
428	409
429		-	– 10 –
430		-	(e) A consent from a patient to release clinical information to a provider obtained
431		-	by an entity to which this section applies shall apply to information transmitted through
432		-	the State–designated health information exchange or by other means.
	410	+	(4) “Nursing home” has the meaning stated in § 19–1401 of this article. 16
433	411
434		-	(f) ~~(1) On~~ request ~~of the Department,~~ a ~~nursing home shall submit~~
435		-	~~electronically clinical information to the State–designated~~ health information exchange to
436		-	~~facilitate~~ the ~~objectives stated in paragraph (3) of this subsection~~.
	412	+	(5) “Standard request” means a request for clinical information from a 17
	413	+	health information exchange that conforms to the major standards version specified by the 18
	414	+	Office of the National Coordinator for Health Information Technology. 19
437	415
438		-	(2) In accordance with State and federal law and to facilitate the objectives
439		-	stated in paragraph (3) of this subsection, the State–designated health information
440		-	exchange may provide the information submitted under paragraph (1) of this subsection to:
	416	+	(b) This section applies to: 20
441	417
442		-	(i) A health care provider;
	418	+	(1) Except for the State–designated health information exchange, a health 21
	419	+	information exchange operating in the State; and 22
443	420
444		-	(ii) ~~An authorized health information exchange user;~~
	421	+	(2) A payor that: 23
445	422
446		-	(~~iii~~) A ~~health information exchange authorized~~ by the Maryland
447		-	~~Health Care Commission~~;
	423	+	(i) Holds a valid certificate of authority issued by the Maryland 24
	424	+	Insurance Commissioner; and 25
448	425
449		-	(iv) A ~~federal official;~~ ~~and~~
	426	+	(ii) Acts as, operates, or owns a health information exchange. 26
450	427
451		-	(v) A State official.
	428	+	(c) An entity to which this section applies shall connect to the State–designated 27
	429	+	health information exchange in a manner consistent with applicable federal and State 28
	430	+	privacy laws. 29
	431	+	10 SENATE BILL 786
452	432
453		-	(3) (i) If approved by the Maryland Health Care Commission, the
454		-	information submitted under paragraph (1) of this subsection may be combined with other
455		-	data maintained by the State–designated health information exchange to facilitate:
456	433
457		-	1. A State health improvement program;
	434	+	(d) When a standard request for clinical information is received through the 1
	435	+	State–designated health information exchange, an entity to which this section applies 2
	436	+	shall: 3
458	437
459		-	2. Mitigation of a public health emergency; and
	438	+	(1) Respond to the request to the extent authorized under federal and State 4
	439	+	privacy laws; and 5
460	440
461		-	3. Improvement of patient safety.
	441	+	(2) Transmit the response to the State–designated health information 6
	442	+	exchange in the manner specified in the regulations adopted under subsection (g) of this 7
	443	+	section. 8
462	444
463		-	(ii) The information submitted by a nursing home under paragraph
464		-	(1) of this subsection may be used only to facilitate the objectives stated in subparagraph
465		-	(i) of this paragraph and may not be used for any other purpose, including licensing and
466		-	certification.
	445	+	(e) A consent from a patient to release clinical information to a provider obtained 9
	446	+	by an entity to which this section applies shall apply to information transmitted through 10
	447	+	the State–designated health information exchange or by other means. 11
467	448
468		-	(g) (1) The State–designated health information exchange shall:
	449	+	(f) (1) On request of the Department, a nursing home shall submit 12
	450	+	electronically clinical information to the State–designated health information exchange to 13
	451	+	facilitate the objectives stated in paragraph (3) of this subsection. 14
469	452
470		-	(i) Participate in the advisory committee established under §
471		-	13–4306(a)(1) of this article; and
	453	+	(2) In accordance with State and federal law and to facilitate the objectives 15
	454	+	stated in paragraph (3) of this subsection, the State–designated health information 16
	455	+	exchange may provide the information submitted under paragraph (1) of this subsection to: 17
472	456
473		-	(ii) Maintain a data set for the Maryland Commission on Health
474		-	Equity and provide data from the data set consistent with the parameters defined by the
475		-	advisory committee. WES MOORE, Governor Ch. 248
	457	+	(i) A health care provider; 18
476	458
477		-	~~– 11 –~~
	459	+	(ii) An authorized health information exchange user; 19
478	460
479		-	(2) If approved by the Maryland Commission on Health Equity, the
480		-	State–designated health information exchange may use the data set maintained under
481		-	paragraph (1) of this subsection to improve health outcomes for patients.
	461	+	(iii) A health information exchange authorized by the Maryland 20
	462	+	Health Care Commission; 21
482	463
483		-	(h) (1) An electronic health network shall provide electronic health care
484		-	transactions to the State–designated health information exchange for the following public
485		-	health and clinical purposes:
	464	+	(iv) A federal official; and 22
486	465
487		-	(i) A State ~~health improvement program;~~
	466	+	(v) A State official. 23
488	467
489		-	(ii) Mitigation of a public health emergency; and
	468	+	(3) (i) If approved by the Maryland Health Care Commission , the 24
	469	+	information submitted under paragraph (1) of this subsection may be combined with other 25
	470	+	data maintained by the State–designated health information exchange to facilitate: 26
490	471
491		-	~~(iii)~~ Improvement ~~of patient safety.~~
	472	+	1. A State health improvement program; 27
492	473
493		-	(2) An electronic health network may not charge a fee to a health care
494		-	provider, health care payor, or to the State–designated health information exchange for
495		-	providing the information as required under paragraph (1) of this subsection.
	474	+	2. Mitigation of a public health emergency; and 28
496	475
497		-	(3) The State–designated health information exchange shall develop and
498		-	implement policies and procedures to implement paragraph (1) of this subsection that are
499		-	consistent with regulations adopted by the Maryland Health Care Commission.
	476	+	3. Improvement of patient safety. 29
500	477
501		-	(i) The Maryland Health Care Commission:
	478	+	(ii) The information submitted by a nursing home under paragraph 30
	479	+	(1) of this subsection may be used only to facilitate the objectives stated in subparagraph 31 SENATE BILL 786 11
502	480
503		-	(1) Shall adopt regulations for implementing the connectivity to the
504		-	State–designated health information exchange required under this section; and
505	481
506		-	(2) Shall seek, through any regulations adopted under item (1) of this
507		-	subsection, to promote technology standards and formats that conform to those specified by
508		-	the Office of the National Coordinator for Health Information Technology.
	482	+	(i) of this paragraph and may not be used for any other purpose, including licensing and 1
	483	+	certification. 2
509	484
510		-	(j) (1) The ~~Maryland~~ Health ~~Care Commission~~ shall ~~adopt regulations that~~:
	485	+	(g) (1) The State–designated health information exchange shall: 3
511	486
512		-	(i) ~~Specify~~ the ~~scope of clinical information to be exchanged or sent~~
513		-	~~under~~ this ~~section~~; and
	487	+	(i) Participate in the advisory committee established under § 4
	488	+	13–4306(a)(1) of this article; and 5
514	489
515		-	(ii) Provide for a uniform, gradual implementation of the exchange
516		-	of clinical information under this section.
	490	+	(ii) Maintain a data set for the Maryland Commission on Health 6
	491	+	Equity and provide data from the data set consistent with the parameters defined by the 7
	492	+	advisory committee. 8
517	493
518		-	(2) Any regulations adopted under paragraph (1) of this subsection shall
519		-	limit the scope of the clinical information to purposes that:
	494	+	(2) If approved by the Maryland Commission on Health Equity, the 9
	495	+	State–designated health information exchange may use the data set maintained under 10
	496	+	paragraph (1) of this subsection to improve health outcomes for patients. 11
520	497
521		-	(i) ~~Improve treatment,~~ ~~including improved access to clinical records~~
522		-	~~by treating clinicians;~~
523		-	~~Ch.~~ ~~248~~ ~~2023 LAWS OF MARYLAND~~
	498	+	(h) (1) An electronic health network shall provide electronic health care 12
	499	+	transactions to the State–designated health information exchange for the following public 13
	500	+	health and clinical purposes: 14
524	501
525		-	– 12 –
526		-	(ii) Promote uses of the State–designated health information
527		-	exchange important to public health; or
	502	+	(i) A State health improvement program; 15
528	503
529		-	(iii) The protection of the electronic health information of a person in
530		-	interest who has opted out of having electronic health information shared or disclosed by a
531		-	health information exchange.
	504	+	(ii) Mitigation of a public health emergency; and 16
532	505
533		-	(3) ~~Regulations adopted under paragraph (1)~~ of ~~this subsection shall:~~
	506	+	(iii) Improvement of patient safety. 17
534	507
535		-	(i) Limit redisclosure of financial information, including billed or
536		-	paid amounts available in electronic claims transactions;
	508	+	(2) An electronic health network may not charge a fee to a health care 18
	509	+	provider, health care payor, or to the State–designated health information exchange for 19
	510	+	providing the information as required under paragraph (1) of this subsection. 20
537	511
538		-	(ii) ~~Restrict data of patients who have opted out of records sharing~~
539		-	~~through the State–designated health information exchange or a health information~~
540		-	~~exchange authorized~~ by the Maryland Health Care Commission~~; [and]~~
	512	+	(3) The State–designated health information exchange shall develop and 21
	513	+	implement policies and procedures to implement paragraph (1) of this subsection that are 22
	514	+	consistent with regulations adopted by the Maryland Health Care Commission. 23
541	515
542		-	(iii) Restrict data from health care providers that possess sensitive
543		-	health care information; AND
	516	+	(i) The Maryland Health Care Commission: 24
544	517
545		-	(IV) ~~RESTRICT DATA OF PATI ENTS WHO HAVE OBTAIN ED~~
546		-	~~LEGALLY PROTECTED~~ HEALTH ~~CARE.~~
	518	+	(1) Shall adopt regulations for implementing the connectivity to the 25
	519	+	State–designated health information exchange required under this section; and 26
547	520
548		-	(k) This section does not:
	521	+	(2) Shall seek, through any regulations adopted under item (1) of this 27
	522	+	subsection, to promote technology standards and formats that conform to those specified by 28
	523	+	the Office of the National Coordinator for Health Information Technology. 29
549	524
550		-	(1) Require an entity to which this section applies to collect clinical
551		-	information or obtain any authorizations, not otherwise required by federal or State law,
552		-	relating to information to be sent or received through the State–designated health
553		-	information exchange;
	525	+	(j) (1) The Maryland Health Care Commission shall adopt regulations that: 30
554	526
555		-	(2) Prohibit an entity to which this section applies from directly receiving
556		-	or sending information to providers or subscribers outside of the State–designated health
557		-	information exchange; or
	527	+	(i) Specify the scope of clinical information to be exchanged or sent 31
	528	+	under this section; and 32 12 SENATE BILL 786
558	529
559		-	(3) Prohibit an entity to which this section applies from connecting and
560		-	interoperating with the State–designated health information exchange in a manner and
561		-	scope beyond that required under this section.
562	530
563		-	4–302.5.
564	531
565		-	(A) SUBJECT TO SUBSECTION (D)(3)(II) OF THIS SECTION , THIS SECTION
566		-	APPLIES TO DISCLOSUR ES OF HEALTH INFORMA TION TO RECIPIENTS L OCATED IN
567		-	THE STATE AND OUTSIDE THE STATE.
	532	+	(ii) Provide for a uniform, gradual implementation of the exchange 1
	533	+	of clinical information under this section. 2
568	534
569		-	(A) ~~(B) A SUBJECT TO SUBSECTION~~ (~~D)(3)(II~~) OF THIS ~~SECTION ,~~
570		-	~~BEGINNING DECEMBER 1,~~ ~~2023, A HEALTH~~ INFORMATION ~~E XCHANGE OR WES MOORE, Governor Ch. 248~~
	535	+	(2) Any regulations adopted under paragraph (1) of this subsection shall 3
	536	+	limit the scope of the clinical information to purposes that: 4
571	537
572		-	– 13 –
573		-	ELECTRONIC HEALTH NE TWORK MAY NOT DISCLOSE A PROTECTED SERVICES
574		-	RECORD OR PROTECTED MEDICATION RECORD TO A TREATING PROVIDER,
575		-	BUSINESS ENTITY , OR HEALTH INFORMATIO N EXCHANGE LOCATED OUTSIDE THE
576		-	STATE MIFEPRISTONE DATA OR THE DIAGNOSIS, PROCEDURE , MEDICATION, OR
577		-	RELATED CODES FOR AB ORTION CARE AND OTHE R SENSITIVE HEALTH S ERVICES AS
578		-	DETERMINED BY THE SECRETARY UNDER SUBSE CTION (D) OF THIS SECTION TO A
579		-	TREATING PROVIDER , A BUSINESS ENTITY , ANOTHER HEALTH INFOR MATION
580		-	EXCHANGE, OR ANOTHER ELECTRONIC H EALTH NETWORK UNLESS THE
581		-	DISCLOSURE IS:
	538	+	(i) Improve treatment, including improved access to clinical records 5
	539	+	by treating clinicians; 6
582	540
583		-	(1) FOR THE ADJUDICATION OF CLAIMS; OR
	541	+	(ii) Promote uses of the State–designated health information 7
	542	+	exchange important to public health; or 8
584	543
585		-	(2) TO A SPECIFIC TREATIN G PROVIDER AT THE WR ITTEN REQUEST
586		-	OF AND WITH THE CONS ENT OF:
	544	+	(iii) The protection of the electronic health information of a person in 9
	545	+	interest who has opted out of having electronic health information shared or disclosed by a 10
	546	+	health information exchange. 11
587	547
588		-	(I) A PATIENT, FOR SERVICES FOR WHI CH THE PATIENT CAN
589		-	PROVIDE CONSENT UNDE R STATE LAW; OR
	548	+	(3) Regulations adopted under paragraph (1) of this subsection shall: 12
590	549
591		-	(II) ~~A PARENT~~ OR ~~GUARDIAN O F A PATIENT, FOR SERVICES FOR~~
592		-	~~WHICH THE PARENT OR GUARDIAN CAN PROVIDE CONSENT UNDER STATE LAW.~~
	550	+	(i) Limit redisclosure of financial information, including billed or 13
	551	+	paid amounts available in electronic claims transactions; 14
593	552
594		-	(B) ~~(1) (C) (1) A BEGINNING JUNE 1, 2024, A PERSON~~ WHO
595		-	~~KNOWINGLY VIOLATES T HIS SECTION IS GUILTY OF~~ A ~~MISDEMEA NOR AND ON~~
596		-	~~CONVICTION IS SUBJEC T TO A FINE NOT TO E XCEED $10,000 PER DAY.~~
	553	+	(ii) Restrict data of patients who have opted out of records sharing 15
	554	+	through the State–designated health information exchange or a health information 16
	555	+	exchange authorized by the Maryland Health Care Commission; [and] 17
597	556
598		-	(2) ~~IN DETERMINING THE FI NE TO BE IMPOSED UND ER PARAGRAPH~~
599		-	~~(1) OF THIS SUBSECTION , THE FOLLOWING FACTOR S SHALL BE CONSIDERE D:~~
	557	+	(iii) Restrict data from health care providers that possess sensitive 18
	558	+	health care information; AND 19
600	559
601		-	(I) ~~THE EXTENT~~ OF ~~ACTUAL OR POTENTIAL PUBLIC HARM~~
602		-	~~CAUSED BY THE VIOLAT ION;~~
	560	+	(IV) RESTRICT DATA OF PATI ENTS WHO HAVE OBTAIN ED 20
	561	+	LEGALLY PROTECTED HE ALTH CARE. 21
603	562
604		-	(II) ~~THE COST OF INVESTIGA TING THE VIOLATION ; AND~~
	563	+	(k) This section does not: 22
605	564
606		-	(III) WHETHER THE PERSON PR EVIOUSLY VIOLATED TH IS
607		-	SECTION.
	565	+	(1) Require an entity to which this section applies to collect clinical 23
	566	+	information or obtain any authorizations, not otherwise required by federal or State law, 24
	567	+	relating to information to be sent or received through the State–designated health 25
	568	+	information exchange; 26
608	569
609		-	(C) (D) (1) THE SECRETARY SHALL :
	570	+	(2) Prohibit an entity to which this section applies from directly receiving 27
	571	+	or sending information to providers or subscribers outside of the State–designated health 28
	572	+	information exchange; or 29
610	573
611		-	(1) ADOPT REGULATIONS THA T IDENTIFY THE MEDIC ATIONS TO BE
612		-	CONSIDERED A MEDICAT ION USED IN A MEDICA L ABORTION FOR PURPO SES OF
613		-	DETERMINING IF A REC ORD IS A PROTECTED M EDICATION RECORD ; AND
	574	+	(3) Prohibit an entity to which this section applies from connecting and 30
	575	+	interoperating with the State–designated health information exchange in a manner and 31
	576	+	scope beyond that required under this section. 32
	577	+	SENATE BILL 786 13
614	578
615		-	(2) FOLLOW GUIDELINES OF THE AMERICAN COLLEGE OF
616		-	OBSTETRICIANS AND GYNECOLOGISTS , THE WORLD HEALTH ORGANIZATION, AND Ch. 248 2023 LAWS OF MARYLAND
617	579
618		-	– 14 –
619		-	THE SOCIETY OF FAMILY PLANNING IN DETERMINI NG WHICH MEDICATIONS TO
620		-	IDENTIFY IN THE REGU LATIONS ADOPTED UNDE R ITEM (1) OF THIS SUBSECTION
621		-	DETERMINE FOR ABORTI ON CARE AND SENSITIV E HEALTH SERVICES TH E
622		-	PROCEDURE , DIAGNOSIS, MEDICATION, AND OTHER RELATED CO DES THAT ARE
623		-	SUBJECT TO THE RESTR ICTIONS ON DISCLOSUR E ESTABLISHED UNDER
624		-	SUBSECTION (B) OF THIS SECTION DUE TO A SUBSTANTIAL RIS K TO PATIENTS OR
625		-	HEALTH CARE PROVIDER S THAT WOULD RESULT FROM DISCLOSURE .
	580	+	4–302.5. 1
626	581
627		-	(2) A DETERMINATION MADE U NDER PARAGRAPH (1) OF THIS
628		-	SUBSECTION SHALL:
	582	+	(A) SUBJECT TO SUBSECT ION (D)(3)(II) OF THIS SECTION , THIS SECTION 2
	583	+	APPLIES TO DISCLOSUR ES OF HEALTH INFORMA TION TO RECIPIENTS L OCATED IN 3
	584	+	THE STATE AND OUTSIDE THE STATE. 4
629	585
630		-	(I) FOLLOW APPLICABLE GUI DELINES OF THE AMERICAN
631		-	COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS , THE WORLD HEALTH
632		-	ORGANIZATION, AND THE SOCIETY OF FAMILY PLANNING; AND
	586	+	(A) (B) A SUBJECT TO SUBSECTION (D)(3)(II) OF THIS SECTION , 5
	587	+	BEGINNING DECEMBER 1, 2023, A HEALTH INFORMATION E XCHANGE OR 6
	588	+	ELECTRONIC HEALTH NE TWORK MAY NOT DISCLOSE A PROTECTED SERVICES 7
	589	+	RECORD OR PROTECTED MEDICATION RECORD TO A TREATING PROVIDER, 8
	590	+	BUSINESS ENTITY , OR HEALTH INFORMATIO N EXCHANGE LOCATED OUTSIDE THE 9
	591	+	STATE MIFEPRISTONE DATA OR THE DIAGNOSIS, PROCEDURE , MEDICATION, OR 10
	592	+	RELATED CODES FOR AB ORTION CARE AND OTHE R SENSITIVE HEALTH S ERVICES AS 11
	593	+	DETERMINED BY THE SECRETARY UNDER SUBSE CTION (D) OF THIS SECTION TO A 12
	594	+	TREATING PROVIDER , A BUSINESS ENTITY , ANOTHER HEALTH INFOR MATION 13
	595	+	EXCHANGE, OR ANOTHER ELECTRONIC H EALTH NETWORK UNLESS THE 14
	596	+	DISCLOSURE IS: 15
633	597
634		-	(II) FOR SENSITIVE HEALTH SERVICES, BE BASED ON THE
635		-	RECOMMENDATIONS OF THE PROTECTED HEALTH CARE COMMISSION
636		-	ESTABLISHED UNDER § 4–310 OF THIS SUBTITLE.
	598	+	(1) FOR THE ADJUDICATION OF CLAIMS; OR 16
637	599
638		-	(3) (I) THE SECRETARY SHALL ADOPT REGULATIONS TO RESTR ICT
639		-	THE DISCLOSURE OF AB ORTION CARE AND OTHE R SENSITIVE HEALTH S ERVICES
640		-	INFORMATION BY DIAGN OSIS, PROCEDURE , MEDICATION, OR RELATED CODES
641		-	UNDER SUBSECTION (B) OF THIS SECTION.
	600	+	(2) TO A SPECIFIC TREATIN G PROVIDER AT THE WR ITTEN REQUEST 17
	601	+	OF AND WITH THE CONS ENT OF: 18
642	602
643		-	(II) EXCEPT AS PROVIDED IN SUBPARAGRAPH (III) OF THIS
644		-	PARAGRAPH , THE SECRETARY MAY ADOPT R ESTRICTIONS ON THE D ISCLOSURE OF
645		-	ABORTION CARE OR OTH ER SENSITIVE HEALTH SERVICES UNDER SUBPA RAGRAPH
646		-	(I) OF THIS PARAGRAPH TH AT ARE APPLICABLE ON LY TO DISCLOSURES BY HEALTH
647		-	INFORMATION EXCHANGE S OR ELECTRONIC HEAL TH NETWORKS TO OUT –OF–STATE
648		-	TREATING PROVIDERS , OUT–OF–STATE BUSINESS ENTIT IES, OTHER HEALTH
649		-	INFORMATION EXCHANGE S, OR OTHER ELECTRONIC HEALTH NET WORKS.
	603	+	(I) A PATIENT, FOR SERVICES FOR WHI CH THE PATIENT CAN 19
	604	+	PROVIDE CONSENT UNDE R STATE LAW; OR 20
650	605
651		-	(III) ANY REGULATIONS ADOPT ED BY THE SECRETARY TO
652		-	IMPLEMENT RESTRICTIO NS ON THE DISCLOSURE OF MIFEPRISTONE DATA UND ER
653		-	SUBSECTION (B) OF THIS SECTION SHAL L APPLY TO DISCLOSUR ES OF DATA TO
654		-	RECIPIENTS LOCATED I N THE STATE AND OUTSIDE THE STATE.
	606	+	(II) A PARENT OR GUARDIAN O F A PATIENT, FOR SERVICES FOR 21
	607	+	WHICH THE PARENT OR GUARDIAN CAN PROVIDE CONSENT UNDER STATE LAW. 22
655	608
656		-	4–305.
	609	+	(B) (1) (C) (1) A BEGINNING JUNE 1, 2024, A PERSON WHO 23
	610	+	KNOWINGLY VIOLATES T HIS SECTION IS GUILTY OF A MISDEMEA NOR AND ON 24
	611	+	CONVICTION IS SUBJEC T TO A FINE NOT TO E XCEED $10,000 PER DAY. 25
657	612
658		-	(a) ~~This section may not~~ be ~~construed to impose an obligation on a health care~~
659		-	~~provider to disclose a medical record.~~
	613	+	(2) IN DETERMINING THE FI NE TO BE IMPOSED UND ER PARAGRAPH 26
	614	+	(1) OF THIS SUBSECTION , THE FOLLOWING FACTOR S SHALL BE CONSIDERE D: 27
660	615
661		-	(b) ~~A health care provider may disclose a medical record without~~ the
662		-	~~authorization of a person in interest: WES MOORE, Governor Ch. 248~~
	616	+	(I) THE EXTENT OF ACTUAL OR POTENTIAL PUBLIC HARM 28
	617	+	CAUSED BY THE VIOLAT ION; 29
663	618
664		-	~~– 15 –~~
	619	+	(II) THE COST OF INVESTIGA TING THE VIOLATION ; AND 30
665	620
666		-	(1) ~~(i) To~~ the ~~provider’s authorized employees,~~ ~~agents, medical staff,~~
667		-	~~medical students,~~ ~~or consultants for the sole purpose of offering, providing, evaluating, or~~
668		-	~~seeking payment for health care to patients or recipients by the provider;~~
	621	+	(III) WHETHER THE PERSON PR EVIOUSLY VIOLATED TH IS 31
	622	+	SECTION. 32
	623	+	14 SENATE BILL 786
669	624
670		-	(ii) To the provider’s legal counsel regarding only the information in
671		-	the medical record that relates to the subject matter of the representation; or
672	625
673		-	(iii) To any provider’s insurer or legal counsel, or the authorized
674		-	employees or agents of a provider’s insurer or legal counsel, for the sole purpose of handling
675		-	a potential or actual claim against any provider if the medical record is maintained on the
676		-	claimant and relates to the subject matter of the claim;
	626	+	(C) (D) (1) THE SECRETARY SHALL : 1
677	627
678		-	(2) If the ~~person given access~~ to ~~the medical record signs an~~
679		-	~~acknowledgment~~ of ~~the duty under this Act not to redisclose any patient identifying~~
680		-	~~information, to~~ a ~~person for:~~
	628	+	(1) ADOPT REGULATIONS THA T IDENTIFY THE MEDICAT IONS TO BE 2
	629	+	CONSIDERED A MEDICAT ION USED IN A MEDICA L ABORTION FOR PURPO SES OF 3
	630	+	DETERMINING IF A REC ORD IS A PROTECTED M EDICATION RECORD ; AND 4
681	631
682		-	(i) Educational or research purposes, subject to the applicable
683		-	requirements of an institutional review board;
	632	+	(2) FOLLOW GUIDELINES OF THE AMERICAN COLLEGE OF 5
	633	+	OBSTETRICIANS AND GYNECOLOGISTS , THE WORLD HEALTH ORGANIZATION, AND 6
	634	+	THE SOCIETY OF FAMILY PLANNING IN DETERMINI NG WHICH MEDICATIONS TO 7
	635	+	IDENTIFY IN THE REGU LATIONS ADOPTED UNDE R ITEM (1) OF THIS SUBSECTION 8
	636	+	DETERMINE FOR ABORTI ON CARE AND SENSITIV E HEALTH SERVICES TH E 9
	637	+	PROCEDURE , DIAGNOSIS, MEDICATION, AND OTHER RELATED CO DES THAT ARE 10
	638	+	SUBJECT TO THE RESTR ICTIONS ON DISCLOSUR E ESTABLISHED UNDER 11
	639	+	SUBSECTION (B) OF THIS SECTION DUE TO A SUBSTANTIAL RIS K TO PATIENTS OR 12
	640	+	HEALTH CARE PROVIDER S THAT WOULD RESULT FROM DISCLOSURE . 13
684	641
685		-	(ii) ~~Evaluation and management~~ of ~~health care delivery systems;~~
686		-	~~[or]~~
	642	+	(2) A DETERMINATION MADE U NDER PARAGRAPH (1) OF THIS 14
	643	+	SUBSECTION SHALL : 15
687	644
688		-	(iii) Accreditation of a facility by professional standard setting
689		-	entities; OR
	645	+	(I) FOLLOW APPLICABLE GUI DELINES OF THE AMERICAN 16
	646	+	COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS , THE WORLD HEALTH 17
	647	+	ORGANIZATION, AND THE SOCIETY OF FAMILY PLANNING; AND 18
690	648
691		-	(IV) AN OUT –OF–STATE INVESTIGATION OF LEGALLY
692		-	PROTECTED HEALTH CAR E PROVIDED IN THE STATE;
	649	+	(II) FOR SENSITIVE HEALTH SERVICES, BE BASED ON THE 19
	650	+	RECOMMENDATIONS OF T HE PROTECTED HEALTH CARE COMMISSION 20
	651	+	ESTABLISHED UNDER § 4–310 OF THIS SUBTITLE. 21
693	652
694		-	(3) ~~Subject~~ to ~~the additional limitations for a medical record developed~~
695		-	~~primarily in connection with~~ the ~~provision~~ of ~~mental~~ health ~~services in § 4–307 of this~~
696		-	~~subtitle, to a government agency performing its lawful duties as authorized~~ by ~~an act of the~~
697		-	~~Maryland General Assembly or the United States Congress;~~
	653	+	(3) (I) THE SECRETARY SHALL ADOPT REGULATIONS TO RESTR ICT 22
	654	+	THE DISCLOSURE OF AB ORTION CARE AND OTHE R SENSITIVE HEALTH S ERVICES 23
	655	+	INFORMATION BY DI AGNOSIS, PROCEDURE , MEDICATION, OR RELATED CODES 24
	656	+	UNDER SUBSECTION (B) OF THIS SECTION. 25
698	657
699		-	(4) Subject to the additional limitations for a medical record developed
700		-	primarily in connection with the provision of mental health services in § 4–307 of this
701		-	subtitle, to another health care provider for the sole purpose of treating the patient or
702		-	recipient on whom the medical record is kept;
	658	+	(II) EXCEPT AS PROVIDED IN SUBPARAGRAPH (III) OF THIS 26
	659	+	PARAGRAPH , THE SECRETARY MAY ADOPT R ESTRICTIONS ON THE D ISCLOSURE OF 27
	660	+	ABORTION CARE OR OTH ER SENSITIVE HEALTH SERVICES UNDER SUBPARA GRAPH 28
	661	+	(I) OF THIS PARAGRAPH TH AT ARE APPLICABLE ON LY TO DISCLOSURES BY HEALTH 29
	662	+	INFORMATION EXCHANGE S OR ELECTRONIC HEAL TH NETWORKS TO OUT –OF–STATE 30
	663	+	TREATING PROVIDERS , OUT–OF–STATE BUSINESS ENTIT IES, OTHER HEALTH 31
	664	+	INFORMATION EXCHANGE S, OR OTHER ELECTRONIC HEA LTH NETWORKS . 32
703	665
704		-	(5) If a claim has been or may be filed by, or with the authorization of a
705		-	patient or recipient on behalf of the patient or recipient, for covered insureds, covered
706		-	beneficiaries, or enrolled recipients only, to third party payors and their agents, if the
707		-	payors or agents have met the applicable provisions of §§ 15–10B–01 to 15–10B–18 of the
708		-	Insurance Article, including nonprofit health service plans, health maintenance
709		-	organizations, fiscal intermediaries and carriers, the Department and its agents, the
710		-	United States Department of Health and Human Services and its agents, or any other Ch. 248 2023 LAWS OF MARYLAND
	666	+	(III) ANY REGULATIONS ADOPT ED BY THE SECRETARY TO 33
	667	+	IMPLEMENT RESTRICTIO NS ON THE DISCLOSURE OF MIFEPRISTONE DATA UND ER 34
	668	+	SUBSECTION (B) OF THIS SECTION SHAL L APPLY TO DISCLOSUR ES OF DATA TO 35
	669	+	RECIPIENTS LOCATED I N THE STATE AND OUTSIDE THE STATE. 36 SENATE BILL 786 15
711	670
712		-	– 16 –
713		-	person obligated by contract or law to pay for the health care rendered for the sole purposes
714		-	of:
715	671
716		-	(i) Submitting a bill to the third party payor;
717	672
718		-	(ii) Reasonable prospective, concurrent, or retrospective utilization
719		-	review or predetermination of benefit coverage;
	673	+	4–305. 1
720	674
721		-	(~~iii~~) ~~Review, audit,~~ ~~and investigation of~~ a ~~specific claim for payment~~
722		-	~~of benefits;~~ or
	675	+	(a) This section may not be construed to impose an obligation on a health care 2
	676	+	provider to disclose a medical record. 3
723	677
724		-	(iv) Coordinating benefit payments in accordance with the provisions
725		-	of the Insurance Article under more than one sickness and accident, dental, or hospital and
726		-	medical insurance policy;
	678	+	(b) A health care provider may disclose a medical record without the 4
	679	+	authorization of a person in interest: 5
727	680
728		-	(6) ~~If a health care~~ provider ~~makes a professional determination that an~~
729		-	~~immediate disclosure is necessary~~, ~~to provide~~ for the ~~emergency health care needs~~ of a
730		-	~~patient~~ or ~~recipient~~;
	681	+	(1) (i) To the provider’s authorized employees, agents, medical staff, 6
	682	+	medical students, or consultants for the sole purpose of offering, providing, evaluating, or 7
	683	+	seeking payment for health care to patients or recipients by the provider; 8
731	684
732		-	(7) To ~~immediate family members of~~ the ~~patient or any other individual~~
733		-	~~with whom~~ the ~~patient is known to have a close personal relationship, provided that:~~
	685	+	(ii) To the provider’s legal counsel regarding only the information in 9
	686	+	the medical record that relates to the subject matter of the representation; or 10
734	687
735		-	(i) The disclosure is limited to information that is directly relevant
736		-	to the individual’s involvement in the patient’s health care; and
	688	+	(iii) To any provider’s insurer or legal counsel, or the authorized 11
	689	+	employees or agents of a provider’s insurer or legal counsel, for the sole purpose of handling 12
	690	+	a potential or actual claim against any provider if the medical record is maintained on the 13
	691	+	claimant and relates to the subject matter of the claim; 14
737	692
738		-	(ii) 1. If the patient is present or otherwise available before the
739		-	disclosure and has the capacity to make health care decisions:
	693	+	(2) If the person given access to the med ical record signs an 15
	694	+	acknowledgment of the duty under this Act not to redisclose any patient identifying 16
	695	+	information, to a person for: 17
740	696
741		-	A. The ~~patient has been provided with an opportunity to~~
742		-	~~object to the disclosure and the patient has not objected~~; or
	697	+	(i) Educational or research purposes, subject to the applicable 18
	698	+	requirements of an institutional review board; 19
743	699
744		-	B. The health care provider reasonably infers from the
745		-	circumstances that, based on the health care provider’s professional judgment, the patient
746		-	does not object to the disclosure; or
	700	+	(ii) Evaluation and management of health care delivery systems; 20
	701	+	[or] 21
747	702
748		-	2. If the patient is not present or otherwise available before
749		-	the disclosure is made, or providing the patient with an opportunity to object to the
750		-	disclosure is not practicable because of the patient’s incapacity or need for emergency care
751		-	or treatment, the health care provider determines, based on the health care provider’s
752		-	professional judgment, that the disclosure is in the best interests of the patient;
	703	+	(iii) Accreditation of a facility by professional standard setting 22
	704	+	entities; OR 23
753	705
754		-	(8) To an appropriate organ, tissue, or eye recovery agency under the
755		-	restrictions of § 5–408 of this article for a patient whose organs and tissues may be donated
756		-	for the purpose of evaluating the patient for possible organ and tissue donation;
757		-	WES MOORE, Governor Ch. 248
	706	+	(IV) AN OUT –OF–STATE INVESTIGATION OF LEGALLY 24
	707	+	PROTECTED HEALTH CAR E PROVIDED IN THE STATE; 25
758	708
759		-	~~– 17 –~~
760		-	~~(9) To~~ the ~~Department or an organ,~~ ~~tissue, or eye recovery agency~~
761		-	~~designated~~ by ~~the Department for~~ the ~~purpose of conducting death record reviews under §~~
762		-	~~19–310 of this article~~;
	709	+	(3) Subject to the additional limitations for a medical record developed 26
	710	+	primarily in connection with the provision of mental health services in § 4–307 of this 27
	711	+	subtitle, to a government agency performing its lawful duties as authorized by an act of the 28
	712	+	Maryland General Assembly or the United States Congress; 29
763	713
764		-	(10) Subject to subsection (c) of this section, if the purpose of the medical
765		-	record disclosure is for the coordination of services and record retention within the
766		-	Montgomery County Department of Health and Human Services; [or]
	714	+	(4) Subject to the additional limitations for a medical record developed 30
	715	+	primarily in connection with the provision of mental health services in § 4–307 of this 31
	716	+	subtitle, to another health care provider for the sole purpose of treating the patient or 32
	717	+	recipient on whom the medical record is kept; 33
	718	+	16 SENATE BILL 786
767	719
768		-	(11) To a carrier, as defined in § 15–1301 of the Insurance Article, or an
769		-	accountable care organization, as defined in § 3022 of the Patient Protection and Affordable
770		-	Care Act, for the sole purposes of enhancing or coordinating patient care, provided that:
771	720
772		-	(i) A disclosure under this item is subject to the additional
773		-	limitations in § 4–307 of this subtitle on disclosure of a medical record developed primarily
774		-	in connection with the provision of mental health services;
	721	+	(5) If a claim has been or may be filed by, or with the authorization of a 1
	722	+	patient or recipient on behalf of the patient or recipient, for covered insureds, covered 2
	723	+	beneficiaries, or enrolled recipients only, to third party payors and their agents, if the 3
	724	+	payors or agents have met the applicable provisions of §§ 15–10B–01 to 15–10B–18 of the 4
	725	+	Insurance Article, including nonprofit health service plans, health m aintenance 5
	726	+	organizations, fiscal intermediaries and carriers, the Department and its agents, the 6
	727	+	United States Department of Health and Human Services and its agents, or any other 7
	728	+	person obligated by contract or law to pay for the health care rendered for the sole purposes 8
	729	+	of: 9
775	730
776		-	(ii) A medical record may be disclosed only in accordance with the
777		-	federal Health Insurance Portability and Accountability Act of 1996, any regulations
778		-	adopted under the Act, and any other applicable federal privacy laws, and disclosures under
779		-	this item may not be made in violation of the prohibited uses or disclosures under the
780		-	federal Health Insurance Portability and Accountability Act of 1996;
	731	+	(i) Submitting a bill to the third party payor; 10
781	732
782		-	(~~iii~~) ~~A disclosure under this item may not be used for underwriting~~ or
783		-	~~utilization~~ review ~~purposes~~;
	733	+	(ii) Reasonable prospective, concurrent, or retrospective utilization 11
	734	+	review or predetermination of benefit coverage; 12
784	735
785		-	(iv) A health care provider that discloses a medical record in
786		-	accordance with this item shall provide a notice consistent with the requirements of 45
787		-	C.F.R. § 164.520 specifying the information to be shared, with whom it will be shared, and
788		-	the specific types of uses and disclosures that the health care provider may make in
789		-	accordance with this item;
	736	+	(iii) Review, audit, and investigation of a specific claim for payment 13
	737	+	of benefits; or 14
790	738
791		-	(v) The notice required by item (iv) of this item shall include an
792		-	opportunity for the individual to opt out of the sharing of the individual’s medical record
793		-	with a carrier or an accountable care organization for the purposes identified in this item;
794		-	[and]
	739	+	(iv) Coordinating benefit payments in accordance with the provisions 15
	740	+	of the Insurance Article under more than one sickness and accident, dental, or hospital and 16
	741	+	medical insurance policy; 17
795	742
796		-	(vi) If a health care provider discloses medical information or medical
797		-	data to a carrier or accountable care organization through an infrastructure that provides
798		-	organizational and technical capabilities for the exchange of protected health information
799		-	among entities not under common ownership, the health care providers are subject to the
800		-	requirements of §§ 4–302.2 and 4–302.3 of this subtitle; AND
	743	+	(6) If a health care provider makes a professional determination that an 18
	744	+	immediate disclosure is necessary, to provide for the emergency health care needs of a 19
	745	+	patient or recipient; 20
801	746
802		-	(VII) IF THE DISCLOSURE IS OF A PROTECTED SERVICES RECORD
803		-	OR A PROTECTED MEDIC ATION RECORD ABORTION CARE OR OTH ER SENSITIVE
804		-	HEALTH SERVICES INFO RMATION AS DETERMINE D BY THE SECRETARY UNDER §
805		-	4–302.5(D) OF THIS SUBTITLE , THE DISCLOSURE IS SU BJECT TO THE Ch. 248 2023 LAWS OF MARYLAND
	747	+	(7) To immediate family members of the patient or any other individual 21
	748	+	with whom the patient is known to have a close personal relationship, provided that: 22
806	749
807		-	– 18 –
808		-	REQUIREMENTS FOR A PROTECTED SERV ICES RECORD AND PROT ECTED
809		-	MEDICATION RECORD UNDER § 4–302.5 OF THIS SUBTITLE; OR
	750	+	(i) The disclosure is limited to information that is directly relevant 23
	751	+	to the individual’s involvement in the patient’s health care; and 24
810	752
811		-	(12) SUBJECT TO THE REQUIR EMENTS FOR A PROTECT ED SERVICES
812		-	RECORD AND PROTECTED MEDICATION RECORD UNDER § 4–302.5 OF THIS
813		-	SUBTITLE, TO ANOTHER HEALTH CA RE PROVIDER FOR THE SOLE PURPOSE OF
814		-	TREATING THE PATIENT FOR WHOM THE MEDICAL RECORD IS KEPT .
	753	+	(ii) 1. If the patient is present or otherwise available before the 25
	754	+	disclosure and has the capacity to make health care decisions: 26
815	755
816		-	(c) (1) The disclosure of medical records under subsection (b)(10) of this
817		-	section to a person that is not employed by or under contract with the Montgomery County
818		-	Department of Health and Human Services shall be conducted in accordance with this
819		-	subtitle.
	756	+	A. The patient has been provided with an opportunity to 27
	757	+	object to the disclosure and the patient has not objected; or 28
820	758
821		-	~~(2) Under provisions of State law regarding confidentiality,~~ the
822		-	~~Montgomery County Department of~~ Health ~~and Human Services shall be considered to be~~
823		-	~~one agency.~~
	759	+	B. The health care provider reasonably infers from the 29
	760	+	circumstances that, based on the health care provider’s professional judgment, the patient 30
	761	+	does not object to the disclosure; or 31
824	762
825		-	4–309.
	763	+	2. If the patient is not present or otherwise available before 32
	764	+	the disclosure is made, or providing the patient with an opportunity to object to the 33
	765	+	disclosure is not practicable because of the patient’s incapacity or need for emergency care 34
	766	+	or treatment, the health care provider determines, based on the health care provider’s 35
	767	+	professional judgment, that the disclosure is in the best interests of the patient; 36 SENATE BILL 786 17
826	768
827		-	(a) THIS SECTION DOES NOT APPLY TO A VIOLATION OF § 4–302.5 OF THIS
828		-	SUBTITLE.
829	769
830		-	(B) If a health care provider knowingly refuses to disclose a medical record within
831		-	a reasonable time but no more than 21 working days after the date a person in interest
832		-	requests the disclosure, the health care provider is liable for actual damages.
833	770
834		-	~~[(b)]~~ (C) ~~A health care provider may not refuse~~ to ~~disclose a medical record on~~
835		-	~~the request~~ of ~~a person in interest because~~ of ~~the failure of the person in interest to pay~~ for
836		-	~~health care rendered by~~ the ~~health care provider.~~
	771	+	(8) To an appropriate organ, tissue, or eye recovery agency under the 1
	772	+	restrictions of § 5–408 of this article for a patient whose organs and tissues may be donated 2
	773	+	for the purpose of evaluating the patient for possible organ and tissue donation; 3
837	774
838		-	[(c)] (D) A health care provider or any other person is in violation of this subtitle
839		-	if the health care provider or any other person:
	775	+	(9) To the Department or an organ, tissue, or eye recovery agency 4
	776	+	designated by the Department for the purpose of conducting death record reviews under § 5
	777	+	19–310 of this article; 6
840	778
841		-	(1) Requests or obtains a medical record under false pretenses or through
842		-	deception; or
	779	+	(10) Subject to subsection (c) of this section, if the purpose of the medical 7
	780	+	record disclosure is for the coordination of services and record retention within the 8
	781	+	Montgomery County Department of Health and Human Services; [or] 9
843	782
844		-	(2) Discloses a medical record in violation of this subtitle.
	783	+	(11) To a carrier, as defined in § 15–1301 of the Insurance Article, or an 10
	784	+	accountable care organization, as defined in § 3022 of the Patient Protection and Affordable 11
	785	+	Care Act, for the sole purposes of enhancing or coordinating patient care, provided that: 12
845	786
846		-	[(d)] (E) Except as otherwise provided in subsection [(e)] (F) of this section, a
847		-	health care provider or any other person, including an officer or employee of a governmental
848		-	unit, who knowingly and willfully violates any provision of this subtitle is guilty of a
849		-	misdemeanor and on conviction is subject to a fine not exceeding $1,000 for the first offense
850		-	and not exceeding $5,000 for each subsequent conviction for a violation of any provision of
851		-	this subtitle.
852		-	WES MOORE, Governor Ch. 248
	787	+	(i) A disclosure under this item is subject to the additional 13
	788	+	limitations in § 4–307 of this subtitle on disclosure of a medical record developed primarily 14
	789	+	in connection with the provision of mental health services; 15
853	790
854		-	– 19 –
855		-	[(e)] (F) (1) A health care provider or any other person, including an officer
856		-	or employee of a governmental unit, who knowingly and willfully requests or obtains a
857		-	medical record under false pretenses or through deception or knowingly and willfully
858		-	discloses a medical record in violation of this subtitle is guilty of a misdemeanor and on
859		-	conviction is subject to the following penalties:
	791	+	(ii) A medical record may be disclosed only in accordance with the 16
	792	+	federal Health Insurance Portability and Accountability Act of 1996, any regulations 17
	793	+	adopted under the Act, and any other applicable federal privacy laws, and disclosures under 18
	794	+	this item may not be made in violation of the prohibited uses or disclosures under the 19
	795	+	federal Health Insurance Portability and Accountability Act of 1996; 20
860	796
861		-	(i) A ~~fine~~ not ~~exceeding $50,000, imprisonment~~ for ~~not more than 1~~
862		-	~~year, or both~~;
	797	+	(iii) A disclosure under this item may not be used for underwriting or 21
	798	+	utilization review purposes; 22
863	799
864		-	(ii) If the offense is committed under false pretenses, a fine not
865		-	exceeding $100,000, imprisonment for not more than 5 years, or both; and
	800	+	(iv) A health care provider that discloses a medical record in 23
	801	+	accordance with this item shall provide a notice consistent with the requirements of 45 24
	802	+	C.F.R. § 164.520 specifying the information to be shared, with whom it will be shared, and 25
	803	+	the specific types of uses and disclosures that the health care provider may make in 26
	804	+	accordance with this item; 27
866	805
867		-	(~~iii~~) If the ~~offense is committed with intent to sell,~~ ~~transfer, or use~~
868		-	~~individually identifiable health information~~ for ~~commercial advantage,~~ ~~personal gain,~~ or
869		-	~~malicious harm,~~ a ~~fine not exceeding $250,000, imprisonment~~ for ~~not more than 10 years,~~
870		-	~~or both.~~
	806	+	(v) The notice required by item (iv) of this item shall include an 28
	807	+	opportunity for the individual to opt out of the sharing of the individual’s medical record 29
	808	+	with a carrier or an accountable care organization for the purposes identified in this item; 30
	809	+	[and] 31
871	810
872		-	(2) This subsection does not apply to an officer or employee of a
873		-	governmental unit that is conducting a criminal investigation.
	811	+	(vi) If a health care provider discloses medical information or medical 32
	812	+	data to a carrier or accountable care organization through an infrastructure that provides 33
	813	+	organizational and technical capabilities for the exchange of protected health information 34
	814	+	among entities not under common ownership, the health care providers are subject to the 35
	815	+	requirements of §§ 4–302.2 and 4–302.3 of this subtitle; AND 36
	816	+	18 SENATE BILL 786
874	817
875		-	[(f)] (G) A health care provider or any other person who knowingly violates any
876		-	provision of this subtitle is liable for actual damages.
877	818
878		-	4–310.
	819	+	(VII) IF THE DISCLOSURE IS OF A PROTECTED SERVICES RECORD 1
	820	+	OR A PROTECTED MEDICATI ON RECORD ABORTION CARE OR OTH ER SENSITIVE 2
	821	+	HEALTH SERVICES INFO RMATION AS DETERMINE D BY THE SECRETARY UNDER § 3
	822	+	4–302.5(D) OF THIS SUBTITLE , THE DISCLOSURE IS SU BJECT TO THE 4
	823	+	REQUIREMENTS FOR A PROTECTED SERV ICES RECORD AND PROT ECTED 5
	824	+	MEDICATION RECORD UNDER § 4–302.5 OF THIS SUBTITLE; OR 6
879	825
880		-	(A) THERE IS A PROTECTED HEALTH CARE COMMISSION.
	826	+	(12) SUBJECT TO THE REQUIR EMENTS FOR A PROTECT ED SERVICES 7
	827	+	RECORD AND PROTECTED MEDICATION RECORD UN DER § 4–302.5 OF THIS 8
	828	+	SUBTITLE, TO ANOTHER HEALTH CA RE PROVIDER FOR THE SOLE PURPOSE OF 9
	829	+	TREATING THE P ATIENT FOR WHOM THE MEDICAL RECORD IS KE PT. 10
881	830
882		-	(B) ~~THE PURPOSE~~ OF ~~THE COMMISSION IS TO MAKE RECOMMENDATIONS~~
883		-	TO THE ~~SECRETARY REGARDING S ENSITIVE HEALTH SERV ICES THAT SHOULD BE~~
884		-	~~DETERMINED BY THE SECRETARY TO~~ BE ~~LEGAL LY PROTECTED HEALTH CARE~~
885		-	~~UNDER THIS~~ SUBTITLE.
	831	+	(c) (1) The disclosure of medical records under subsection (b)(10) of this 11
	832	+	section to a person that is not employed by or under contract with the Montgomery County 12
	833	+	Department of Health and Human Services shall be conducted in accordance with this 13
	834	+	subtitle. 14
886	835
887		-	(C) THE COMMISSION CONSISTS O F THE FOLLOWING MEMB ERS:
	836	+	(2) Under provisions of State law regarding confidentiality, the 15
	837	+	Montgomery County Department of Health and Human Services shall be considered to be 16
	838	+	one agency. 17
888	839
889		-	(1) THE ATTORNEY GENERAL OR THE ATTORNEY GENERAL’S
890		-	DESIGNEE;
	840	+	4–309. 18
891	841
892		-	(2) ~~THE EXECUTIVE DIRECTOR~~ OF ~~THE MARYLAND HEALTH CARE~~
893		-	~~COMMISSION OR THE EXECUTIVE DIRECTOR’S DESIGNEE; AND~~
	842	+	(a) THIS SECTION DOES NOT APPLY TO A VIOLATION OF § 4–302.5 OF THIS 19
	843	+	SUBTITLE. 20
894	844
895		-	(3) THE FOLLOWING MEMBERS APPOINTED BY THE SECRETARY:
	845	+	(B) If a health care provider knowingly refuses to disclose a medical record within 21
	846	+	a reasonable time but no more than 21 working days after the date a person in interest 22
	847	+	requests the disclosure, the health care provider is liable for actual damages. 23
896	848
897		-	(I) A ~~RESIDENT OF THE STATE WHO IS~~ A ~~LICENS ED PHYSICIAN~~
898		-	~~AND NOMINATED BY~~ THE ~~AMERICAN COLLEGE~~ OF ~~OBSTETRICIANS AND~~
899		-	~~GYNECOLOGISTS ; Ch~~. ~~248 2023 LAWS OF MARYLAND~~
	849	+	[(b)] (C) A health care provider may not refuse to disclose a medical record on 24
	850	+	the request of a person in interest because of the failure of the person in interest to pay for 25
	851	+	health care rendered by the health care provider. 26
900	852
901		-	– 20 –
	853	+	[(c)] (D) A health care provider or any other person is in violation of this subtitle 27
	854	+	if the health care provider or any other person: 28
902	855
903		-	(II) A RESIDENT OF THE STATE WHO IS A LICENS ED CLINICIAN
904		-	WHO PROVIDE S REPRODUCTIVE HEALT H CARE AND NOMINATED BY THE
905		-	REPRODUCTIVE HEALTH ACCESS PROJECT;
	856	+	(1) Requests or obtains a medical record under false pretenses or through 29
	857	+	deception; or 30
906	858
907		-	(III) A RESIDENT OF THE STATE WHO IS A CERTIF IED
908		-	NURSE–MIDWIFE NOMINATED BY THE MARYLAND AFFILIATE OF THE AMERICAN
909		-	COLLEGE OF NURSE MIDWIVES;
	859	+	(2) Discloses a medical record in violation of this subtitle. 31
910	860
911		-	(IV) A RESIDENT OF THE STATE WHO IS A REPRES ENTATIVE OF
912		-	PHYSICIANS FOR REPRODUCTIVE HEALTH;
	861	+	[(d)] (E) Except as otherwise provided in subsection [(e)] (F) of this section, a 32
	862	+	health care provider or any other person, including an officer or employee of a governmental 33
	863	+	unit, who knowingly and willfully violates any provision of this subtitle is guilty of a 34
	864	+	misdemeanor and on conviction is subject to a fine not exceeding $1,000 for the first offense 35 SENATE BILL 786 19
913	865
914		-	(VI) TWO RESIDENTS OF THE STATE WHO ARE CONSUME R
915		-	REPRESENTATIVES WITH EXPERTISE IN CONSUME R DATA PRIVACY; AND
916	866
917		-	~~(VII)~~ A ~~RESIDENT~~ OF ~~THE STATE WITH EXPERTISE IN HEALTH~~
918		-	~~INFORMATIO N~~.
	867	+	and not exceeding $5,000 for each subsequent conviction for a violation of any provision of 1
	868	+	this subtitle. 2
919	869
920		-	(D) THE COMMISSION SHALL :
	870	+	[(e)] (F) (1) A health care provider or any other person, including an officer 3
	871	+	or employee of a governmental unit, who knowingly and willfully requests or obtains a 4
	872	+	medical record under false pretenses or through deception or knowingly and willfully 5
	873	+	discloses a medical record in violation of this subtitle is guilty of a misdemeanor and on 6
	874	+	conviction is subject to the following penalties: 7
921	875
922		-	(1) SELECT A CHAIR OF THE COMMISSION EACH YEAR ; AND
	876	+	(i) A fine not exceeding $50,000, imprisonment for not more than 1 8
	877	+	year, or both; 9
923	878
924		-	(2) MEET AT LEAST FOUR TI MES A YEAR.
	879	+	(ii) If the offense is committed under false pretenses, a fine not 10
	880	+	exceeding $100,000, imprisonment for not more than 5 years, or both; and 11
925	881
926		-	(E) THE DEPARTMENT SHALL PROV IDE STAFF FOR THE COMMISSION.
	882	+	(iii) If the offense is committed with intent to sell, transfer, or use 12
	883	+	individually identifiable health information for commercial advantage, personal gain, or 13
	884	+	malicious harm, a fine not exceeding $250,000, imprisonment for not more than 10 years, 14
	885	+	or both. 15
927	886
928		-	(F) (1) THE COMMISSION SHALL IDEN TIFY SENSITIVE HEALT H SERVICES
929		-	INFORMATION BY DIAGNOSI S, PROCEDURAL , MEDICATION, OR RELATED CODES FOR
930		-	WHICH DISCLOSURE BY A HEALTH INFORMATION EXCHANGE OR ELECTRON IC
931		-	HEALTH NETWORK TO A TREATING PROVIDER , BUSINESS ENTITY , ANOTHER HEALTH
932		-	INFORMATION EXCHANGE , OR ANOTHER ELECTRONI C HEALTH NE TWORK WOULD
933		-	CREATE A SUBSTANTIAL RISK TO PATIENTS OR HEALTH CARE PROVIDER S.
	887	+	(2) This subsection does not apply to an officer or employee of a 16
	888	+	governmental unit that is conducting a criminal investigation. 17
934	889
935		-	(2) ~~IN CARRYING OUT ITS W ORK,~~ ~~THE COMMISSION MAY CONSUL T~~
936		-	~~WITH:~~
	890	+	[(f)] (G) A health care provider or any other person who knowingly violates any 18
	891	+	provision of this subtitle is liable for actual damages. 19
937	892
938		-	(I) ORGANIZATIONS WITH EX PERTISE IN LEGAL ISS UES
939		-	IMPACTING PROVIDERS OF LEGALLY PROTECTED HEALTH CARE ;
	893	+	4–310. 20
940	894
941		-	(II) ORGANIZATIONS WITH EX PERTISE IN CONSUMER HEALTH
942		-	PRIVACY;
	895	+	(A) THERE IS A PROTECTED HEALTH CARE COMMISSION. 21
943	896
944		-	(III) ORGANIZATIONS WITH EX PERTISE IN HEALTH
945		-	INFORMATION TECHNOLO GY; AND WES MOORE, Governor Ch. 248
	897	+	(B) THE PURPOSE OF THE COMMISSION IS TO MAKE RECOMMENDATIONS 22
	898	+	TO THE SECRETARY REGARDING S ENSITIVE HEALTH SERV ICES THAT SHOULD BE 23
	899	+	DETERMINED BY THE SECRETARY TO BE LEGAL LY PROTECTED HEALTH CARE 24
	900	+	UNDER THIS SUBTITLE . 25
946	901
947		-	~~– 21 –~~
	902	+	(C) THE COMMISSION CONSISTS O F THE FOLLOWING MEMB ERS: 26
948	903
949		-	(IV) ~~OTHER ORGANIZATIONS W ITH CLINICAL, POLICY,~~ OR ~~LEGAL~~
950		-	~~EXPERTISE RELATED TO THE WORK OF THE COMMISSION.~~
	904	+	(1) THE ATTORNEY GENERAL OR THE ATTORNEY GENERAL’S 27
	905	+	DESIGNEE; 28
951	906
952		-	(G) (1) THE COMMISSION SHALL ISSU E SEMIANNUAL REPORTS TO THE
953		-	SECRETARY ON RECOMMEN DATIONS REGARDING SE NSITIVE HEALTH SERVI CES
954		-	THAT SHOULD BE DETER MINED BY THE SECRETARY TO BE LEGAL LY PROTECTED
955		-	HEALTH CARE UNDER TH IS SUBTITLE OR FOR W HICH THE SECRETARY SHOULD
956		-	RESCIND A PREVIOUS DE TERMINATION .
	907	+	(2) THE EXECUTIVE DIRECTOR OF THE MARYLAND HEALTH CARE 29
	908	+	COMMISSION OR THE EXECUTIVE DIRECTOR’S DESIGNEE; AND 30
957	909
958		-	(2) THE REPORTS SHALL INC LUDE AN ASSESSMENT O F THE
959		-	POTENTIAL RISK TO PA TIENTS AND HEALTH CA RE PROVIDERS THAT WO ULD RESULT
960		-	FROM THE DISCLOSURE OF THE SENSITIVE HEA LTH SERVICES THAT AR E
961		-	ADDRESSED IN THE REP ORTS.
	910	+	(3) THE FOLLOWING MEMBERS APPOINTED BY THE SECRETARY: 31
	911	+	20 SENATE BILL 786
962	912
963		-	(3) WITHIN 60 DAYS AFTER RECEIVING A SEMIANNUAL REPORT
964		-	UNDER PARAGRAPH (1) OF THIS SUBSECTION , THE SECRETARY SHALL SUBMI T A
965		-	WRITTEN RESPONSE TO THE REPORT THAT INCL UDES THE FINDINGS AN D
966		-	DETERMINATIONS OF TH E SECRETARY TO:
967	913
968		-	(I) THE COMMISSION; AND
	914	+	(I) A RESIDENT OF THE STATE WHO IS A LICENS ED PHYSICIAN 1
	915	+	AND NOMINATED BY THE AMERICAN COLLEGE OF OBSTETRICIANS AND 2
	916	+	GYNECOLOGISTS ; 3
969	917
970		-	(II) ~~IN ACCORDANCE WITH § 2–1257~~ OF THE STATE
971		-	~~GOVERNMENT ARTICLE,~~ THE ~~SENATE FINANCE COMMITTEE AND THE HOUSE~~
972		-	HEALTH ~~AND GOVERNMENT OPERATIONS COMMITTEE.~~
	918	+	(II) A RESIDENT OF THE STATE WHO IS A LICENS ED CLINICIAN 4
	919	+	WHO PROVIDES REPRODU CTIVE HEALTH CARE AN D NOMINATED BY THE 5
	920	+	REPRODUCTIVE HEALTH ACCESS PROJECT; 6
973	921
974		-	19–103.
	922	+	(III) A RESIDENT OF THE STATE WHO IS A CERTIF IED 7
	923	+	NURSE–MIDWIFE NOMINATED BY THE MARYLAND AFFILIATE OF THE AMERICAN 8
	924	+	COLLEGE OF NURSE MIDWIVES; 9
975	925
976		-	(a) There is a Maryland Health Care Commission.
	926	+	(IV) A RESIDENT OF THE STATE WHO IS A REPRES ENTATIVE OF 10
	927	+	PHYSICIANS FOR REPRODUCTIVE HEALTH; 11
977	928
978		-	(b) The ~~Commission is an independent commission th at functions in the~~
979		-	~~Department.~~
	929	+	(VI) TWO RESIDENTS OF THE STATE WHO ARE CONSUMER 12
	930	+	REPRESENTATIVES WITH EXPERTISE IN CONSUME R DATA PRIVACY; AND 13
980	931
981		-	(c) The purpose of the Commission is to:
	932	+	(VII) A RESIDENT OF THE STATE WITH EXPERTISE IN HEALTH 14
	933	+	INFORMATION . 15
982	934
983		-	(1) Develop health care cost containment strategies to help provide access
984		-	to appropriate quality health care services for all Marylanders, after consulting with the
985		-	Health Services Cost Review Commission;
	935	+	(D) THE COMMISSION SHALL : 16
986	936
987		-	(2) Promote the development of a health regulatory system that provides,
988		-	for all Marylanders, financial and geographic access to quality health care services at a
989		-	reasonable cost by:
	937	+	(1) SELECT A CHAIR OF THE COMMISSION EACH YEAR ; AND 17
990	938
991		-	(i) Advocating policies and systems to promote the efficient delivery
992		-	of and improved access to health care services; and Ch. 248 2023 LAWS OF MARYLAND
	939	+	(2) MEET AT LEAST FOUR TIMES A YEAR . 18
993	940
994		-	~~– 22 –~~
	941	+	(E) THE DEPARTMENT SHALL PROV IDE STAFF FOR THE COMMISSION. 19
995	942
996		-	(ii) Enhancing the strengths of the current health care service
997		-	delivery and regulatory system;
	943	+	(F) (1) THE COMMISSION SHALL IDEN TIFY SENSITIVE HEALT H SERVICES 20
	944	+	INFORMATION BY DIAGN OSIS, PROCEDURAL , MEDICATION, OR RELATED CODES FOR 21
	945	+	WHICH DISCLOSURE BY A HEALTH INFORMATIO N EXCHANGE OR ELECTR ONIC 22
	946	+	HEALTH NETWORK TO A TREATING PROVIDER , BUSINESS ENTITY , ANOTHER HEALTH 23
	947	+	INFORMATION EXCHANGE , OR ANOTHER ELECTRONI C HEALTH NETWORK WOU LD 24
	948	+	CREATE A SUBSTANTIAL RISK TO PATIENTS OR HEALTH CARE PROVIDER S. 25
998	949
999		-	(3) ~~Facilitate~~ the ~~public disclosure of medical claims data for the~~
1000		-	~~development of public policy;~~
	950	+	(2) IN CARRYING OUT ITS WORK, THE COMMISSION MAY CONSUL T 26
	951	+	WITH: 27
1001	952
1002		-	(4) ~~Establish and develop a medical care database on health care services~~
1003		-	~~rendered by~~ health care ~~practitioners~~;
	953	+	(I) ORGANIZATIONS WITH EX PERTISE IN LEGAL ISS UES 28
	954	+	IMPACTING PROVIDERS OF LEGALLY PROTECTED HEALTH CARE ; 29
1004	955
1005		-	(5) Encourage the development of clinical resource management systems
1006		-	to permit the comparison of costs between various treatment settings and the availability
1007		-	of information to consumers, providers, and purchasers of health care services;
	956	+	(II) ORGANIZATIONS WITH EX PERTISE IN CONSUMER HEALTH 30
	957	+	PRIVACY; 31 SENATE BILL 786 21
1008	958
1009		-	(6) In accordance with Title 15, Subtitle 12 of the Insurance Article,
1010		-	develop a uniform set of effective benefits to be included in the Comprehensive Standard
1011		-	Health Benefit Plan;
1012	959
1013		-	(7) Analyze the medical care database and provide, in aggregate form, an
1014		-	annual report on the variations in costs associated with health care practitioners;
1015	960
1016		-	(8) Ensure utilization of the medical care database as a primary means to
1017		-	compile data and information and annually report on trends and variances regarding fees
1018		-	for service, cost of care, regional and national comparisons, and indications of malpractice
1019		-	situations;
	961	+	(III) ORGANIZATIONS WITH EX PERTISE IN HE ALTH 1
	962	+	INFORMATION TECHNOLO GY; AND 2
1020	963
1021		-	(9) ~~Establish standards for the operation and licensing of medical care~~
1022		-	~~electronic claims clearinghouses in Maryland;~~
	964	+	(IV) OTHER ORGANIZATIONS W ITH CLINICAL, POLICY, OR LEGAL 3
	965	+	EXPERTISE RELATED TO THE WORK OF THE COMMISSION. 4
1023	966
1024		-	(10) Reduce the costs of claims submission and the administration of claims
1025		-	for health care practitioners and payors;
	967	+	(G) (1) THE COMMISSION SHALL ISSU E SEMIANNUAL REPORTS TO THE 5
	968	+	SECRETARY ON RECOMMEN DATIONS REGARDING SE NSITIVE HEALTH SERVICES 6
	969	+	THAT SHOULD BE DETER MINED BY THE SECRETARY TO BE LEGAL LY PROTECTED 7
	970	+	HEALTH CARE UNDER TH IS SUBTITLE OR FOR W HICH THE SECRETARY SHOULD 8
	971	+	RESCIND A PREVIOUS D ETERMINATION . 9
1026	972
1027		-	(11) Determine the cost of mandated health insurance services in the State
1028		-	in accordance with Title 15, Subtitle 15 of the Insurance Article;
	973	+	(2) THE REPORTS SHALL INC LUDE AN ASSESSMENT O F THE 10
	974	+	POTENTIAL RISK TO PA TIENTS AND HEALTH CA RE PROVIDERS THAT WO ULD RESULT 11
	975	+	FROM THE DISCLOSURE OF THE SENSITIVE HEA LTH SERVICES THAT AR E 12
	976	+	ADDRESSED IN THE REP ORTS. 13
1029	977
1030		-	(12) Promote the availability of information to consumers on charges by
1031		-	practitioners and reimbursements from payors; [and]
	978	+	(3) WITHIN 60 DAYS AFTER RECEIVING A SEMIANNUAL REPORT 14
	979	+	UNDER PARAGRAPH (1) OF THIS SUBSECTION , THE SECRETARY SHALL SUBMIT A 15
	980	+	WRITTEN RESPONSE TO THE REPORT THAT INCL UDES THE FINDINGS AN D 16
	981	+	DETERMINATIONS OF TH E SECRETARY TO: 17
1032	982
1033		-	(13) Oversee and administer the Maryland Trauma Physician Services
1034		-	Fund in conjunction with the Health Services Cost Review Commission; AND
	983	+	(I) THE COMMISSION; AND 18
1035	984
1036		-	(14) ESTABLISH POLICIES AN D STANDARDS TO PROTE CT THE
1037		-	CONFIDENTIALITY OF P ATIENT AND HEALTH CA RE PRACTITIONER INFO RMATION
1038		-	RELATED TO LEGALLY PROT ECTED HEALTH CARE AS DEFINED IN § 4–301 OF THIS
1039		-	ARTICLE.
1040		-	WES MOORE, Governor Ch. 248
	985	+	(II) IN ACCORDANCE WITH § 2–1257 OF THE STATE 19
	986	+	GOVERNMENT ARTICLE, THE SENATE FINANCE COMMITTEE AND THE HOUSE 20
	987	+	HEALTH AND GOVERNMENT OPERATIONS COMMITTEE. 21
1041	988
1042		-	– 23 –
1043		-	(d) The Commission shall coordinate the exercise of its functions with the
1044		-	Department and the Health Services Cost Review Commission to ensure an integrated,
1045		-	effective health care policy for the State.
	989	+	19–103. 22
1046	990
1047		-	~~19–145~~.
	991	+	(a) There is a Maryland Health Care Commission. 23
1048	992
1049		-	(a) (1) In this section the following words have the meanings indicated.
	993	+	(b) The Commission is an independent commission that functions in the 24
	994	+	Department. 25
1050	995
1051		-	(2) “Dispenser” means a person authorized by law to dispense, as defined
1052		-	in § 12–101 of the Health Occupations Article, a prescription drug to a patient or the
1053		-	patient’s agent in the State.
	996	+	(c) The purpose of the Commission is to: 26
1054	997
1055		-	(3) ~~“Noncontrolled prescription drug”~~ ~~means a prescription drug,~~ as
1056		-	~~defined in § 21–201 of this article~~, ~~that is not a controlled dangerous substance designated~~
1057		-	~~under Title 5,~~ ~~Subtitle 4 of the Criminal Law Article.~~
	998	+	(1) Develop health care cost containment strategies to help provide access 27
	999	+	to appropriate quality health care services for all Marylanders, after consulting with the 28
	1000	+	Health Services Cost Review Commission; 29
1058	1001
1059		-	(4) “State designated exchange” has the meaning stated in § 4–302.3 of this
1060		-	article.
	1002	+	(2) Promote the development of a health regulatory system that provides, 30
	1003	+	for all Marylanders, financial and geographic access to quality health care services at a 31
	1004	+	reasonable cost by: 32 22 SENATE BILL 786
1061	1005
1062		-	(b) The State designated exchange shall operate as a health data utility for the
1063		-	State.
1064	1006
1065		-	(c) The purposes of the health data utility include:
1066	1007
1067		-	(1) The collection, aggregation, and analysis of clinical information, public
1068		-	health data, and health administrative and operations data to assist the Department, local
1069		-	health departments, the Commission, and the Health Services Cost Review Commission in
1070		-	the evaluation of public health interventions and health equity;
	1008	+	(i) Advocating policies and systems to promote the efficient delivery 1
	1009	+	of and improved access to health care services; and 2
1071	1010
1072		-	(2) The ~~communication~~ of ~~data between public~~ health ~~officials and health~~
1073		-	~~care providers to advance disease control~~ and ~~health equity~~; ~~and~~
	1011	+	(ii) Enhancing the strengths of the current health care service 3
	1012	+	delivery and regulatory system; 4
1074	1013
1075		-	(3) The ~~enhancement and acceleration~~ of the ~~interoperability of health~~
1076		-	~~information throughout the State.~~
	1014	+	(3) Facilitate the public disclosure of medical claims data for the 5
	1015	+	development of public policy; 6
1077	1016
1078		-	(d) ~~[Dispensers] EXCEPT AS PROVIDED IN SUBSECTION (E) OF THIS~~
1079		-	~~SECTION, EACH DISPENSER shall provide data to the State designated exchange.~~
	1017	+	(4) Establish and develop a medical care database on health care services 7
	1018	+	rendered by health care practitioners; 8
1080	1019
1081		-	(E) ~~(1) A DISPENSER MAY NOT SU BMIT INFORMATION ON MIFEPRISTONE ,~~
1082		-	~~MISOPROSTOL , OR ANY MEDICATION US ED FOR A MEDICAL ABO RTION,~~ AS
1083		-	~~DETERMINED BY THE SECRETARY,~~ TO ~~THE STATE DESIGNATED EXCH ANGE.~~
	1020	+	(5) Encourage the development of clinical resource management systems 9
	1021	+	to permit the comparison of costs between various treatment settings and the availability 10
	1022	+	of information to consumers, providers, and purchasers of health care services; 11
1084	1023
1085		-	(2) THE SECRETARY SHALL FOLLO W GUIDELINES OF THE AMERICAN
1086		-	COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS , THE WORLD HEALTH
1087		-	ORGANIZATION, AND THE SOCIETY OF FAMILY PLANNING IN DETERMINI NG THE
1088		-	MEDICATIONS TO BE IN CLUDED AMONG THE MED ICATIONS USED IN A M EDICAL Ch. 248 2023 LAWS OF MARYLAND
	1024	+	(6) In accordance with Title 15, Subtitle 12 of the Insurance Article, 12
	1025	+	develop a uniform set of effective benefits to be included in the Comprehensive Standard 13
	1026	+	Health Benefit Plan; 14
1089	1027
1090		-	– 24 –
1091		-	ABORTION ABOUT WHICH A DISPENSER MAY NOT SUBMIT INFORMATION U NDER
1092		-	PARAGRAPH (1) OF THIS SUBSECTION .
	1028	+	(7) Analyze the medical care database and provide, in aggregate form, an 15
	1029	+	annual report on the variations in costs associated with health care practitioners; 16
1093	1030
1094		-	[(e)] (F) (1) The purpose of this subsection is to:
	1031	+	(8) Ensure utilization of the medical care database as a primary means to 17
	1032	+	compile data and information and annually report on trends and variances regarding fees 18
	1033	+	for service, cost of care, regional and national comparisons, and indications of malpractice 19
	1034	+	situations; 20
1095	1035
1096		-	(i) Authorize individuals and organizations involved in the
1097		-	treatment and care coordination of patients to access, as legally authorized, a patient’s
1098		-	medication history, including medications prescribed for the patient; and
	1036	+	(9) Establish standards for the operation and licensing of medical care 21
	1037	+	electronic claims clearinghouses in Maryland; 22
1099	1038
1100		-	(ii) Assist health care providers, care managers, the Department,
1101		-	and local health departments to understand and promote matters of health equity and
1102		-	treatment efficacy.
	1039	+	(10) Reduce the costs of claims submission and the administration of claims 23
	1040	+	for health care practitioners and payors; 24
1103	1041
1104		-	(2) After dispensing a noncontrolled prescription drug OTHER THAN THE
1105		-	MEDICAL AB ORTION MEDICATIONS D ESCRIBED UNDER SUBSE CTION (E) OF THIS
1106		-	SECTION, a dispenser shall submit prescription information to the State designated
1107		-	exchange.
	1042	+	(11) Determine the cost of mandated health insurance services in the State 25
	1043	+	in accordance with Title 15, Subtitle 15 of the Insurance Article; 26
1108	1044
1109		-	(3) The prescription information shall be submitted:
	1045	+	(12) Promote the availability of information to consumers on charges by 27
	1046	+	practitioners and reimbursements from payors; [and] 28
1110	1047
1111		-	(i) By electronic means;
	1048	+	(13) Oversee and administer the Maryland Trauma Physician Services 29
	1049	+	Fund in conjunction with the Health Services Cost Review Commission; AND 30
1112	1050
1113		-	(ii) ~~Without unduly increasing~~ the ~~workload and expense on a~~
1114		-	~~dispenser;~~
	1051	+	(14) ESTABLISH POLICIES AN D STANDARDS TO PROTE CT THE 31
	1052	+	CONFIDENTIALITY OF P ATIENT AND HEALTH CA RE PRACTITIONER INFO RMATION 32 SENATE BILL 786 23
1115	1053
1116		-	(iii) In a manner that minimizes burden and duplication by being as
1117		-	compatible as possible with existing federal standards for data submission practices,
1118		-	including technology software of dispensers; and
1119	1054
1120		-	~~(iv)~~ As ~~otherwise required by regulations adopted by the~~
1121		-	~~Commission~~.
	1055	+	RELATED TO LEGALLY P ROTECTED HEALTH CARE AS DEFINED IN § 4–301 OF THIS 1
	1056	+	ARTICLE. 2
1122	1057
1123		-	(4) The State designated exchange may not impose any fees or other
1124		-	assessments on dispensers to support the operation of the exchange.
	1058	+	(d) The Commission shall coordinate the exercise of its functions with the 3
	1059	+	Department and the Health Services Cost Review Commission to ensure an integrated, 4
	1060	+	effective health care policy for the State. 5
1125	1061
1126		-	(5) The State designated exchange shall make prescription information
1127		-	submitted under this subsection available for purposes of treatment and care coordination
1128		-	of a patient.
	1062	+	19–145. 6
1129	1063
1130		-	[(f)] (G) The State designated exchange may provide data, as allowed by law, for
1131		-	public health purposes that may include:
	1064	+	(a) (1) In this section the following words have the meanings indicated. 7
1132	1065
1133		-	(1) ~~Improving health equity through access~~ to ~~prescription medications~~,
1134		-	~~including for~~ the ~~treatment of infectious disease;~~
1135		-	~~WES MOORE, Governor Ch~~. ~~248~~
	1066	+	(2) “Dispenser” means a person authorized by law to dispense, as defined 8
	1067	+	in § 12–101 of the Health Occupations Article, a prescription drug to a patient or the 9
	1068	+	patient’s agent in the State. 10
1136	1069
1137		-	– 25 –
1138		-	(2) Assisting programs led by health care providers and the Department,
1139		-	local health departments, the Commission, and the Health Services Cost Review
1140		-	Commission to identify opportunities for quality improvement, including for stewardship
1141		-	of antibiotic medications; and
	1070	+	(3) “Noncontrolled prescription drug” means a prescription drug, as 11
	1071	+	defined in § 21–201 of this article, that is not a controlled dangerous substance designated 12
	1072	+	under Title 5, Subtitle 4 of the Criminal Law Article. 13
1142	1073
1143		-	(3) Conducting case investigations and related activities.
	1074	+	(4) “State designated exchange” has the meaning stated in § 4–302.3 of this 14
	1075	+	article. 15
1144	1076
1145		-	[(g)] (H) Information submitted to the State information exchange or provided
1146		-	by the State information exchange under this section shall be submitted or provided, to the
1147		-	extent practicable, in as near to real time as possible.
	1077	+	(b) The State designated exchange shall operate as a health data utility for the 16
	1078	+	State. 17
1148	1079
1149		-	[(h)] (I) (1) The Commission, in consultation with appropriate stakeholders,
1150		-	shall adopt regulations to carry out this section.
	1080	+	(c) The purposes of the health data utility include: 18
1151	1081
1152		-	(2) The regulations shall take into account consumer perspective and
1153		-	include:
	1082	+	(1) The collection, aggregation, and analysis of clinical information, public 19
	1083	+	health data, and health administrative and operations data to assist the Department, local 20
	1084	+	health departments, the Commission, and the Health Services Cost Review Commission in 21
	1085	+	the evaluation of public health interventions and health equity; 22
1154	1086
1155		-	(i) The ~~specific~~ data ~~required to be provided under subsection (d) of~~
1156		-	~~this section~~;
	1087	+	(2) The communication of data between public health officials and health 23
	1088	+	care providers to advance disease control and health equity; and 24
1157	1089
1158		-	(ii) The ~~specific prescription information required to be submitted~~
1159		-	~~under subsection [(e)] (F) of this section;~~
	1090	+	(3) The enhancement and acceleration of the interoperability of health 25
	1091	+	information throughout the State. 26
1160	1092
1161		-	(~~iii~~) ~~The time frame for submitting prescription information under~~
1162		-	~~subsection [(e)] (F) of this section;~~
	1093	+	(d) [Dispensers] EXCEPT AS PROVIDED IN SUBSECTION (E) OF THIS 27
	1094	+	SECTION, EACH DISPENSER shall provide data to the State designated exchange. 28
1163	1095
1164		-	(iv) The electronic means and manner by which pre scription
1165		-	information is to be submitted under subsection [(e)] (F) of this section;
	1096	+	(E) (1) A DISPENSER MAY NOT SU BMIT INFORMATION ON MIFEPRISTONE , 29
	1097	+	MISOPROSTOL , OR ANY MEDICATION US ED FOR A MEDICAL ABO RTION, AS 30
	1098	+	DETERMINED BY THE SECRETARY, TO THE STATE DESIGNATED EXCHANGE . 31
	1099	+	24 SENATE BILL 786
1166	1100
1167		-	(v) Prescription information submission requirements that align
1168		-	with the data submission requirements on dispensers of monitored prescription drugs
1169		-	under Title 21, Subtitle 2A of this article; and
1170	1101
1171		-	(vi) Identification and necessary suppression of information related
1172		-	to providers or medications that are determined to have significant potential to cause harm.
	1102	+	(2) THE SECRETARY SHALL FOLLO W GUIDELINES OF THE AMERICAN 1
	1103	+	COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS , THE WORLD HEALTH 2
	1104	+	ORGANIZATION, AND THE SOCIETY OF FAMILY PLANNING IN DETERMINI NG THE 3
	1105	+	MEDICATIONS TO BE IN CLUDED AMONG THE MED ICATIONS USED IN A MEDICAL 4
	1106	+	ABORTION ABOUT WHICH A DISPENSER MAY NOT SUBMIT INFORMATION U NDER 5
	1107	+	PARAGRAPH (1) OF THIS SUBSECTION . 6
1173	1108
1174		-	[(i)] (J) (1) The State designated exchange shall establish a consumer
1175		-	advisory council to bring the perspectives of individuals and organizations with an interest
1176		-	in protecting consumers into the delivery of services provided by the State designated
1177		-	exchange.
	1109	+	[(e)] (F) (1) The purpose of this subsection is to: 7
1178	1110
1179		-	(2) In selecting members, the State designated exchange shall consider
1180		-	diversity of experience.
	1111	+	(i) Authorize individuals and organizations involved in the 8
	1112	+	treatment and care coordination of patients to access, as legally authorized, a patient’s 9
	1113	+	medication history, including medications prescribed for the patient; and 10
1181	1114
1182		-	(3) The consumer advisory council established under paragraph (1) of this
1183		-	subsection shall: Ch. 248 2023 LAWS OF MARYLAND
	1115	+	(ii) Assist health care providers, care managers, the Department, 11
	1116	+	and local health departments to understand and promote matters of health equity and 12
	1117	+	treatment efficacy. 13
1184	1118
1185		-	– 26 –
	1119	+	(2) After dispensing a noncontrolled prescription drug OTHER THAN THE 14
	1120	+	MEDICAL ABORTION MED ICATIONS DESCRIBED U NDER SUBSECTION (E) OF THIS 15
	1121	+	SECTION, a dispenser shall submit prescription information to the State designated 16
	1122	+	exchange. 17
1186	1123
1187		-	(i) Consist of a minimum of six members, including at least four
1188		-	consumer representatives and two staff representatives, and maintain a ratio of consumer
1189		-	representatives to nonconsumer representatives of at least two to one;
	1124	+	(3) The prescription information shall be submitted: 18
1190	1125
1191		-	(ii) Identify and report consumer privacy concerns to senior
1192		-	leadership of the State designated exchange;
	1126	+	(i) By electronic means; 19
1193	1127
1194		-	(~~iii~~) ~~Advise~~ on ~~efforts to educate consumers on data exchange policies,~~
1195		-	~~including options for consumers to opt out of disclosure of protected health information~~;
	1128	+	(ii) Without unduly increasing the workload and expense on a 20
	1129	+	dispenser; 21
1196	1130
1197		-	(iv) Meet at least 3 times each year; and
	1131	+	(iii) In a manner that minimizes burden and duplication by being as 22
	1132	+	compatible as possible with existing federal standards for data submission practices, 23
	1133	+	including technology software of dispensers; and 24
1198	1134
1199		-	(v) ~~Adopt and maintain a charter to be posted online that includes~~
1200		-	~~the purpose, members, and meeting schedule of the consumer advisory council~~.
	1135	+	(iv) As otherwise required by regulations adopted by the 25
	1136	+	Commission. 26
1201	1137
1202		-	Article – Insurance
	1138	+	(4) The State designated exchange may not impose any fees or other 27
	1139	+	assessments on dispensers to support the operation of the exchange. 28
1203	1140
1204		-	15–857.
	1141	+	(5) The State designated exchange shall make prescription information 29
	1142	+	submitted under this subsection available for purposes of treatment and care coordination 30
	1143	+	of a patient. 31
1205	1144
1206		-	(a) (1) This section applies to:
	1145	+	[(f)] (G) The State designated exchange may provide data, as allowed by law, for 32
	1146	+	public health purposes that may include: 33
	1147	+	SENATE BILL 786 25
1207	1148
1208		-	(i) insurers and nonprofit health service plans that provide labor
1209		-	and delivery coverage to individuals or groups on an expense–incurred basis under health
1210		-	insurance policies or contracts that are issued or delivered in the State; and
1211	1149
1212		-	(ii) health maintenance organizations that provide labor and
1213		-	delivery coverage to individuals or groups under contracts that are issued or delivered in
1214		-	the State.
	1150	+	(1) Improving health equity through access to prescription medications, 1
	1151	+	including for the treatment of infectious disease; 2
1215	1152
1216		-	(2) This section does not apply to:
	1153	+	(2) Assisting programs led by health care providers and the Department, 3
	1154	+	local health departments, the Commission, and the Health Services Cost Review 4
	1155	+	Commission to identify opportunities for quality improvement, including for stewardship 5
	1156	+	of antibiotic medications; and 6
1217	1157
1218		-	(i) a multistate plan that does not provide coverage for abortions in
1219		-	accordance with 42 U.S.C. § 18054(a)(6); or
	1158	+	(3) Conducting case investigations and related activities. 7
1220	1159
1221		-	(ii) a high–deductible plan, as defined in 26 U.S.C. § 223(c)(2)(C) of
1222		-	the Internal Revenue Code, unless the Commissioner determines that abortion care is not
1223		-	excluded from the safe harbor provisions for preventive care under § 223(c)(2)(C) of the
1224		-	Internal Revenue Code.
	1160	+	[(g)] (H) Information submitted to the State information exchange or provided 8
	1161	+	by the State information exchange under this section shall be submitted or provided, to the 9
	1162	+	extent practicable, in as near to real time as possible. 10
1225	1163
1226		-	(3) An organization that is eligible to obtain an exclusion from the coverage
1227		-	requirements under § 15–826 of this subtitle may obtain from an entity subject to this
1228		-	section an exclusion from the coverage and notice requirements of this section if the
1229		-	requirements conflict with the organization’s bona fide religious beliefs and practices.
1230		-	WES MOORE, Governor Ch. 248
	1164	+	[(h)] (I) (1) The Commission, in consultation with appropriate stakeholders, 11
	1165	+	shall adopt regulations to carry out this section. 12
1231	1166
1232		-	– 27 –
1233		-	(b) Except as provided in subsection (c) of this section AND NOTWITHSTANDING
1234		-	§ 31–116(A) OF THIS ARTICLE , an entity subject to this section shall:
	1167	+	(2) The regulations shall take into account consumer perspective and 13
	1168	+	include: 14
1235	1169
1236		-	(1) cover abortion care services without:
	1170	+	(i) The specific data required to be provided under subsection (d) of 15
	1171	+	this section; 16
1237	1172
1238		-	(i) ~~a deductible,~~ ~~coinsurance, copayment,~~ ~~or any other cost–sharing~~
1239		-	~~requirement~~; ~~and~~
	1173	+	(ii) The specific prescription information required to be submitted 17
	1174	+	under subsection [(e)] (F) of this section; 18
1240	1175
1241		-	(ii) ~~restrictions that are inconsistent with~~ the ~~protected rights~~ under
1242		-	~~Title 20,~~ ~~Subtitle 2~~ of ~~the Health – General Article~~; ~~and~~
	1176	+	(iii) The time frame for submitting prescription information under 19
	1177	+	subsection [(e)] (F) of this section; 20
1243	1178
1244		-	(2) ~~provide information to consumers about abortion care coverage using~~
1245		-	~~the terminology “abortion care”~~ to ~~describe coverage.~~
	1179	+	(iv) The electronic means and manner by which prescription 21
	1180	+	information is to be submitted under subsection [(e)] (F) of this section; 22
1246	1181
1247		-	(c) If the Commissioner determines that enforcement of this section may
1248		-	adversely affect the allocation of federal funds to the State, the Commissioner may grant
1249		-	an exemption to the requirements of this section to the minimum extent necessary to
1250		-	ensure the continued receipt of federal funds.
	1182	+	(v) Prescription information submission requirements that align 23
	1183	+	with the data submission requirements on dispensers of monitored prescription drugs 24
	1184	+	under Title 21, Subtitle 2A of this article; and 25
1251	1185
1252		-	31–116.
	1186	+	(vi) Identification and necessary suppression of information related 26
	1187	+	to providers or medications that are determined to have significant potential to cause harm. 27
1253	1188
1254		-	(a) The essential health benefits required under § 1302(a) of the Affordable Care
1255		-	Act:
	1189	+	[(i)] (J) (1) The State designated exchange shall establish a consumer 28
	1190	+	advisory council to bring the perspectives of individuals and organizations with an interest 29
	1191	+	in protecting consumers into the delivery of services provided by the State designated 30
	1192	+	exchange. 31
1256	1193
1257		-	(1) ~~shall be the benefits in~~ the State ~~benchmark plan,~~ ~~selected in~~
1258		-	~~accordance with this section;~~ ~~and~~
	1194	+	(2) In selecting members, the State designated exchange shall consider 32
	1195	+	diversity of experience. 33 26 SENATE BILL 786
1259	1196
1260		-	(2) notwithstanding any other benefits mandated by State law, shall be the
1261		-	benefits required in:
1262	1197
1263		-	(i) subject to subsection (f) of this section, all individual health
1264		-	benefit plans and health benefit plans offered to small employers, except for grandfathered
1265		-	health plans, as defined in the Affordable Care Act, offered outside the Exchange; and
1266	1198
1267		-	(ii) ~~subject to § 31–115~~(c) of this ~~subtitle, all qualified health plans~~
1268		-	~~offered in the Exchange.~~
	1199	+	(3) The consumer advisory council established under paragraph (1) of this 1
	1200	+	subsection shall: 2
1269	1201
1270		-	SECTION 2. AND BE IT FURTHER ENACTED, That the Secretary of Health shall
1271		-	adopt emergency regulations within 90 days after the effective date of this Act to identify
1272		-	diagnostic, procedure, medication, and related codes for abortion care in accordance with §
1273		-	4–302.5 of the Health – General Article, as enacted by Section 1 of this Act.
	1202	+	(i) Consist of a minimum of six members, including at least four 3
	1203	+	consumer representatives and two staff representatives, and maintain a ratio of consumer 4
	1204	+	representatives to nonconsumer representatives of at least two to one; 5
1274	1205
1275		-	SECTION 3. AND BE IT FURTHER ENACTED, That the Maryland Health Care
1276		-	Commission shall adopt emergency regulations within 9 months after the effective date of
1277		-	this Act to implement § 4–302.5 of the Health – General Article, as enacted by Section 1 of
1278		-	this Act. Ch. 248 2023 LAWS OF MARYLAND
	1206	+	(ii) Identify and report consumer privacy concerns to senior 6
	1207	+	leadership of the State designated exchange; 7
1279	1208
1280		-	– 28 –
	1209	+	(iii) Advise on efforts to educate consumers on data exchange policies, 8
	1210	+	including options for consumers to opt out of disclosure of protected health information; 9
1281	1211
1282		-	SECTION 4. AND BE IT FURTHER ENACTED, That, in fiscal years 2024 and 2025,
1283		-	the Maryland Health Care Commission shall report on a quarterly basis to the Senate
1284		-	Finance Committee and the House Health and Government Operations Committee, in
1285		-	accordance with § 2–1257 of the State Government Article, on the status of the
1286		-	implementation of § 4–302.5 of the Health – General Article, as enacted by Section 1 of this
1287		-	Act.
	1212	+	(iv) Meet at least 3 times each year; and 10
1288	1213
1289		-	~~SECTION 2. 5.~~ AND BE ~~IT FURTHER ENACTED,~~ That ~~this Act shall take effect~~
1290		-	~~October June 1~~, ~~2023~~.
	1214	+	(v) Adopt and maintain a charter to be posted online that includes 11
	1215	+	the purpose, members, and meeting schedule of the consumer advisory council. 12
1291	1216
1292		-	Approved by the Governor, May 3, 2023.
	1217	+	Article – Insurance 13
	1218	+
	1219	+	15–857. 14
	1220	+
	1221	+	(a) (1) This section applies to: 15
	1222	+
	1223	+	(i) insurers and nonprofit health service plans that provide labor 16
	1224	+	and delivery coverage to individuals or groups on an expense–incurred basis under health 17
	1225	+	insurance policies or contracts that are issued or delivered in the State; and 18
	1226	+
	1227	+	(ii) health maintenance organizations that provide labor and 19
	1228	+	delivery coverage to individuals or groups under contracts that are issued or delivered in 20
	1229	+	the State. 21
	1230	+
	1231	+	(2) This section does not apply to: 22
	1232	+
	1233	+	(i) a multistate plan that does not provide coverage for abortions in 23
	1234	+	accordance with 42 U.S.C. § 18054(a)(6); or 24
	1235	+
	1236	+	(ii) a high–deductible plan, as defined in 26 U.S.C. § 223(c)(2)(C) of 25
	1237	+	the Internal Revenue Code, unless the Commissioner determines that abortion care is not 26
	1238	+	excluded from the safe harbor provisions for preventive care under § 223(c)(2)(C) of the 27
	1239	+	Internal Revenue Code. 28
	1240	+
	1241	+	(3) An organization that is eligible to obtain an exclusion from the coverage 29
	1242	+	requirements under § 15–826 of this subtitle may obtain from an entity subject to this 30
	1243	+	section an exclusion from the coverage and notice requirements of this section if the 31
	1244	+	requirements conflict with the organization’s bona fide religious beliefs and practices. 32 SENATE BILL 786 27
	1245	+
	1246	+
	1247	+
	1248	+	(b) Except as provided in subsection (c) of this section AND NOTWITHSTANDING 1
	1249	+	§ 31–116(A) OF THIS ARTICLE , an entity subject to this section shall: 2
	1250	+
	1251	+	(1) cover abortion care services without: 3
	1252	+
	1253	+	(i) a deductible, coinsurance, copayment, or any other cost–sharing 4
	1254	+	requirement; and 5
	1255	+
	1256	+	(ii) restrictions that are inconsistent with the protected rights under 6
	1257	+	Title 20, Subtitle 2 of the Health – General Article; and 7
	1258	+
	1259	+	(2) provide information to consumers about abortion care coverage using 8
	1260	+	the terminology “abortion care” to describe coverage. 9
	1261	+
	1262	+	(c) If the Commissioner determines that enforcement of this section may 10
	1263	+	adversely affect the allocation of federal funds to the State, the Commissioner may grant 11
	1264	+	an exemption to the requirements of this section to the minimum extent necessary to 12
	1265	+	ensure the continued receipt of federal funds. 13
	1266	+
	1267	+	31–116. 14
	1268	+
	1269	+	(a) The essential health benefits required under § 1302(a) of the Affordable Care 15
	1270	+	Act: 16
	1271	+
	1272	+	(1) shall be the benefits in the State benchmark plan, selected in 17
	1273	+	accordance with this section; and 18
	1274	+
	1275	+	(2) notwithstanding any other benefits mandated by State law, shall be the 19
	1276	+	benefits required in: 20
	1277	+
	1278	+	(i) subject to subsection (f) of this section, all individual health 21
	1279	+	benefit plans and health benefit plans offered to small employers, except for grandfathered 22
	1280	+	health plans, as defined in the Affordable Care Act, offered outside the Exchange; and 23
	1281	+
	1282	+	(ii) subject to § 31–115(c) of this subtitle, all qualified health plans 24
	1283	+	offered in the Exchange. 25
	1284	+
	1285	+	SECTION 2. AND BE IT FURTHER ENACTED, That the Secretary of Health shall 26
	1286	+	adopt emergency regulations within 90 days after the effective date of this Act to identify 27
	1287	+	diagnostic, procedure, medication, and related codes for abortion care in accordance with § 28
	1288	+	4–302.5 of the Health – General Article, as enacted by Section 1 of this Act. 29
	1289	+
	1290	+	SECTION 3. AND BE IT FURTHER ENACTED, That the Maryland Health Care 30
	1291	+	Commission shall adopt emergency regulations within 9 months after the effective date of 31
	1292	+	this Act to implement § 4–302.5 of the Health – General Article, as enacted by Section 1 of 32
	1293	+	this Act. 33 28 SENATE BILL 786
	1294	+
	1295	+
	1296	+
	1297	+	SECTION 4. AND BE IT FURTHER ENACTED, That, in fiscal years 2024 and 2025, 1
	1298	+	the Maryland Health Care Commission shall report on a quarterly basis to the Senate 2
	1299	+	Finance Committee and the House Health and Government Operations Committee, in 3
	1300	+	accordance with § 2–1257 of the State Government Article, on the status of the 4
	1301	+	implementation of § 4–302.5 of the Health – General Article, as enacted by Section 1 of this 5
	1302	+	Act. 6
	1303	+
	1304	+	SECTION 2. 5. AND BE IT FURTHER ENACTED, That this Act shall take effect 7
	1305	+	October June 1, 2023. 8
	1306	+
	1307	+
	1308	+
	1309	+
	1310	+	Approved:
	1311	+	________________________________________________________________________________
	1312	+	Governor.
	1313	+	________________________________________________________________________________
	1314	+	President of the Senate.
	1315	+	________________________________________________________________________________
	1316	+	Speaker of the House of Delegates.