EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0972*
SENATE BILL 972
J5 EMERGENCY BILL 3lr3041
By: Senators Zucker, Klausmeier, and Muse
Introduced and read first time: February 28, 2023
Assigned to: Rules
A BILL ENTITLED
AN ACT concerning 1
Temporary Medicare Advantage Stabilization Grant Program and Fund – 2
Establishment 3
FOR the purpose of establishing the Temporary Medicare Advantage Stabilization Grant 4
Program to subsidize certain costs of operating a Medicare Advantage Plan in the 5
State, offset certain Medicare payment deficiencies, and increase access to certain 6
Medicare Advantage benefits and plans; establishing the Temporary Medicare 7
Advantage Stabilization Grant Program Fund as a special, nonlapsing fund; 8
requiring that the interest earnings of the Fund be credited to the Fund; and 9
generally relating to the Temporary Medicare Advantage Stabilization Grant 10
Program. 11
BY adding to 12
Article – Health – General 13
Section 13–4801 through 13–4807 to be under the new subtitle “Subtitle 48. 14
Temporary Medicare Advantage Stabilization Grant Program and Fund” 15
Annotated Code of Maryland 16
(2019 Replacement Volume and 2022 Supplement) 17
BY repealing and reenacting, without amendments, 18
Article – State Finance and Procurement 19
Section 6–226(a)(2)(i) 20
Annotated Code of Maryland 21
(2021 Replacement Volume and 2022 Supplement) 22
BY repealing and reenacting, with amendments, 23
Article – State Finance and Procurement 24
Section 6–226(a)(2)(ii)170. and 171. 25
Annotated Code of Maryland 26
(2021 Replacement Volume and 2022 Supplement) 27
2 SENATE BILL 972
BY adding to 1
Article – State Finance and Procurement 2
Section 6–226(a)(2)(ii)172. 3
Annotated Code of Maryland 4
(2021 Replacement Volume and 2022 Supplement) 5
Preamble 6
WHEREAS, The Medicare Advantage Program is a federal program aimed at 7
providing seniors and other Medicare beneficiaries with the choice of a managed care 8
product that provides supplemental benefits not currently covered by the traditional 9
Medicare fee–for–service program; and 10
WHEREAS, Based on the Centers for Medicare and Medicaid Services–determined 11
payment tiers, Medicare Advantage Plans may offer low– or no–premium products along 12
with care coordination support to enrollees and can allow for the expansion of coverage and 13
benefits to Medicare enrollees throughout the State; and 14
WHEREAS, Medicare Advantage Plans have become popular with seniors across the 15
country, with 48% of Medicare beneficiaries enrolled in Medicare Advantage Plans; and 16
WHEREAS, The enrollment rate in Maryland is much lower, with only 13% of 17
Medicare beneficiaries in Maryland enrolled in Medicare Advantage Plans and the State 18
having the third lowest Medicare Advantage penetration rate in the nation; and 19
WHEREAS, In Baltimore City and Prince George’s County, 80% of those enrolled in 20
a Medicare Advantage Plan are African American; and 21
WHEREAS, Since the early 1970s, Maryland has had a unique hospital rate setting 22
system to cover the cost of uninsured Marylanders as part of a waiver approved by the 23
federal government; and 24
WHEREAS, This federal waiver presents unique obstacles for Maryland’s Medicare 25
Advantage Plans due to the federal government’s Medicare Advantage payment 26
methodology; and 27
WHEREAS, The federal Medicare Advantage payment methodology does not 28
recognize Maryland’s rate setting system when establishing payment tiers; and 29
WHEREAS, Maryland Medicare Advantage Plans are in the lowest tier of 30
reimbursement due to the Maryland rate setting system establishing the rates for hospital 31
care, including for Medicare Advantage Plans; and 32
WHEREAS, Medicare Advantage Plans have experienced significant financial losses 33
and have either exited the Maryland market or reduced their service areas in the State; 34
and 35
SENATE BILL 972 3
WHEREAS, All Maryland seniors are impacted by the lack of Medicare Advantage 1
options, but experience in other states shows that low–income and minority beneficiaries 2
are most disadvantaged by the lack of Medicare Advantage options; and 3
WHEREAS, The Health Services Cost Review Commission established a 2–year 4
grant program authorizing $50 million each year to help stabilize the Medicare Advantage 5
market in the State; and 6
WHEREAS, While the grant program helped to stabilize the Medicare Advantage 7
market, the grant program expired in June 2021; and 8
WHEREAS, The Governor Hogan Administration established a Medicare Advantage 9
Grant Program appropriating $50 million for fiscal year 2023; and 10
WHEREAS, While the State is working with the federal government to establish a 11
permanent Medicare Advantage payment solution, the State must act to stabilize the 12
Medicare Advantage market in the short term to avoid further Medicare Advantage Plan 13
service area reductions or market exits that cause severe disruption to Maryland seniors; 14
now, therefore, 15
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 16
That the Laws of Maryland read as follows: 17
Article – Health – General 18
SUBTITLE 48. TEMPORARY MEDICARE ADVANTAGE STABILIZATION GRANT 19
PROGRAM AND FUND. 20
13–4801. 21
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANING S 22
INDICATED. 23
(B) “COMMISSION” MEANS THE MARYLAND HEALTH CARE COMMISSION. 24
(C) “FUND” MEANS THE TEMPORARY MEDICARE ADVANTAGE 25
STABILIZATION GRANT PROGRAM FUND. 26
(D) (1) “MEDICARE ADVANTAGE PLAN” MEANS A SPECIFIC PLA N 27
OFFERED BY A PUBLIC OR PRIVATE ENTITY OR GANIZED AND LICENSED BY A STATE 28
AS A RISK–BEARING ENTITY THAT IS CERTIFIED BY THE FEDERAL CENTERS FOR 29
MEDICARE AND MEDICAID SERVICES AS MEETING T HE MEDICARE ADVANTAGE 30
CONTRACT REQUIREMENTS . 31
(2) “MEDICARE ADVANTAGE PLAN” DOES NOT INCLUDE : 32 4 SENATE BILL 972
(I) A CHRONIC SPECIAL NEEDS PLAN; 1
(II) AN INSTITUTIONAL SPECIAL NEEDS PLAN; 2
(III) AN EMPLOYER GROUP WAIVER PLAN; 3
(IV) A PROGRAM OF ALL–INCLUSIVE CARE FOR THE ELDERLY 4
(PACE) PLAN; OR 5
(V) A PRIVATE FEE–FOR–SERVICE PLAN. 6
(E) “PROGRAM” MEANS THE TEMPORARY MEDICARE ADVANTAGE 7
STABILIZATION GRANT PROGRAM. 8
13–4802. 9
(A) THERE IS A TEMPORARY MEDICARE ADVANTAGE STABILIZATION 10
GRANT PROGRAM. 11
(B) THE PURPOSE OF THE PROGRAM IS TO PROVIDE GRANTS TO: 12
(1) SUBSIDIZE THE DOCUMEN TED COSTS OF OPERATI NG A MEDICARE 13
ADVANTAGE PLAN IN THE STATE; 14
(2) OFFSET THE MEDICARE PAYMENT DEFI CIENCIES THAT OCCUR IN 15
THE STATE DUE TO HOW THE ALL–PAYER RATE SETTING SYSTEM FOR HOSPITAL 16
SERVICES IMPACTS THE CENTERS FOR MEDICARE AND MEDICAID 17
SERVICES–DETERMINED MEDICARE ADVANTAGE PAYMENT TIE RS; AND 18
(3) INCREASE ACCESS TO SU PPLEMENTAL MEDICARE ADVANTAGE 19
BENEFITS AND LOW – OR NO–PREMIUM PLANS TO ENR OLLEES IN THE STATE. 20
13–4803. 21
THE COMMISSION SHALL ADMI NISTER THE PROGRAM. 22
13–4804. 23
(A) THE COMMISSION SHALL ESTA BLISH CRITERIA FOR G RANTS TO ENSURE 24
THAT EFFICIENT AND EFFECT IVE MEDICARE ADVANTAGE PLANS ALIGN WITH THE 25
PURPOSE OF THE PROGRAM. 26
SENATE BILL 972 5
(B) THE CRITERIA SHALL : 1
(1) INCLUDE CONSIDERATION OF THE MEDICAL COST AND ACUITY OF 2
SERVING THE MEDICARE ADVANTAGE POPULATION IN A GIVEN JURISDICT ION; AND 3
(2) FOR A MEDICARE ADVANTAGE PLAN THAT OPERATED IN THE 4
STATE ON JANUARY 1, 2022: 5
(I) REQUIRE THE MEDICARE ADVANTAGE PLAN TO MAINTAIN 6
OPERATIONS IN AT LEAST THE SERVICE AREAS WH ERE IT OPERATED IN CALENDAR 7
YEAR 2022; AND 8
(II) PROHIBIT THE MEDICARE ADVANTAGE PLAN FROM 9
REDUCING THE OFFERING OF BENEFIT PLANS TO ENR OLLEES. 10
13–4805. 11
THE COMMISSION SHALL PROV IDE GRANTS UNDER THE PROGRAM ON A 12
QUARTERLY BASIS BASE D ON THE CENTERS FOR MEDICARE AND MEDICAID 13
SERVICES–APPROVED MEMBERSHIP COUNTS OF MEDICARE ADVANTAGE PLANS IN 14
THE STATE. 15
13–4806. 16
(A) THERE IS A TEMPORARY MEDICARE ADVANTAGE STABILIZATION 17
GRANT PROGRAM FUND. 18
(B) THE PURPOSE OF THE FUND IS TO PROVIDE GRANTS UNDER THE 19
PROGRAM. 20
(C) THE COMMISSION SHALL ADMI NISTER THE FUND. 21
(D) (1) THE FUND IS A SPECIAL, NONLAPSING FUND THAT IS NOT 22
SUBJECT TO § 7–302 OF THE STATE FINANCE AND PROCUREMENT ARTICLE. 23
(2) THE STATE TREASURER SHALL HOLD THE FUND SEPARATELY , 24
AND THE COMPTROLLER SHALL ACC OUNT FOR THE FUND. 25
(E) THE FUND CONSISTS OF : 26
(1) MONEY APPROPRIATED IN THE STATE BUDGET TO THE FUND; 27
6 SENATE BILL 972
(2) INTEREST EARNINGS OR OTHER INCOME EARNED FROM THE 1
INVESTMENT OF ANY MONEY FROM THE FUND; AND 2
(3) ANY OTHER MONEY FROM ANY OTHER SOURCE ACC EPTED FOR 3
THE BENEFIT OF THE FUND. 4
(F) THE FUND MAY BE USED ONLY FOR PROVIDING GRANTS UNDER THE 5
PROGRAM. 6
(G) (1) THE STATE TREASURER SHALL INVES T THE MONEY OF THE FUND 7
IN THE SAME MANNER AS OTHER STATE MONEY MAY BE IN VESTED. 8
(2) ANY INTEREST EARNINGS OF THE FUND SHALL BE CREDITE D TO 9
THE FUND. 10
(H) (1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION : 11
(I) FOR FISCAL YEAR 2024, THE ANNUAL BUDGET BI LL SHALL 12
INCLUDE AN APPROPRIATION OF $130,000,000 TO THE FUND; AND 13
(II) FOR FISCAL YEAR 2025, THE GOVERNOR SHALL INCLUD E 14
AN AMOUNT IN THE ANN UAL BUDGET BILL FOR THE FUND THAT EQUALS $151 PER 15
MEMBER PER MONTH FOR EACH ENROLLE E IN A MEDICARE ADVANTAGE PLAN 16
THAT QUALIFIES UNDER THE PROGRAM. 17
(2) THE APPROPRIATIONS UN DER PARAGRAPH (1) OF THIS 18
SUBSECTION ARE NOT R EQUIRED IF THE FEDERAL GOVER NMENT IMPLEMENTS A 19
MEDICARE ADVANTAGE PAYMENT SOL UTION FOR THE STATE THAT SATISFIES THE 20
PURPOSE OF THE PROGRAM. 21
(I) MONEY EXPENDED FROM T HE FUND IS SUPPLEMENTAL TO, AND IS NOT 22
INTENDED TO TAKE THE PLACE OF, FUNDING THAT OTHERWI SE WOULD BE 23
APPROPRIATED TO MEDICARE ADVANTAGE PLANS. 24
13–4807. 25
ON OR BEFORE FEBRUARY 1 EACH YEAR, THE COMMISSION, IN CONJUNCTION 26
WITH THE CHIEF EXECUTIVE OFFICERS OR EXECUTIVE DIRECTORS OF ENTITIES 27
THAT OFFER MEDICARE ADVANTAGE PLANS THAT QUALIFY FOR GRA NTS UNDER 28
THE PROGRAM, SHALL REPORT TO THE SENATE FINANCE COMMITTEE, THE SENATE 29
BUDGET AND TAXATION COMMITTEE, THE HOUSE APPROPRIATIONS COMMITTEE, 30
AND THE HOUSE HEALTH AND GOVERNMENT OPERATIONS COMMITTEE, IN 31
ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, ON: 32 SENATE BILL 972 7
(1) THE TOTAL AMOUNT AWAR DED TO MEDICARE ADVANTAGE 1
PLANS IN THE IMMEDIATELY PRECEDIN G CALENDAR YEAR ; 2
(2) THE MEDICARE ADVANTAGE PLANS THAT RECEIVED G RANTS 3
AND THE AMOUNT EACH RECEIVED IN THE IMMEDIATELY PRECEDIN G CALENDAR 4
YEAR; 5
(3) THE IMPACT OF THE PROGRAM ON : 6
(I) MEDICARE ADVANTAGE PLAN ENROLLEE BENEFITS BY 7
COUNTY; AND 8
(II) THE AVAILABILITY OF L OW– OR NO–PREMIUM MEDICARE 9
ADVANTAGE PLANS BY COUNTY; 10
(4) THE STATUS OF THE CENTERS FOR MEDICARE AND MEDICAID 11
SERVICES IMPLEMENTING A MEDICARE ADVANTAGE PAYMENT SOLUTION FOR THE 12
STATE; AND 13
(5) RECOMMENDATIONS FOR T HE FUTURE OF THE PROGRAM OR 14
OTHER ALTERNATIVES . 15
Article – State Finance and Procurement 16
6–226. 17
(a) (2) (i) Notwithstanding any other provision of law, and unless 18
inconsistent with a federal law, grant agreement, or other federal requirement or with the 19
terms of a gift or settlement agreement, net interest on all State money allocated by the 20
State Treasurer under this section to special funds or accounts, and otherwise entitled to 21
receive interest earnings, as accounted for by the Comptroller, shall accrue to the General 22
Fund of the State. 23
(ii) The provisions of subparagraph (i) of this paragraph do not apply 24
to the following funds: 25
170. the Cannabis Public Health Fund; [and] 26
171. the Community Reinvestment and Repair Fund; AND 27
172. THE TEMPORARY MEDICARE ADVANTAGE 28
STABILIZATION GRANT PROGRAM FUND. 29
8 SENATE BILL 972
SECTION 2. AND BE IT FURTHER ENACTED, That this Act is an emergency 1
measure, is necessary for the immediate preservation of the public health or safety, has 2
been passed by a yea and nay vote supported by three–fifths of all the members elected to 3
each of the two Houses of the General Assembly, and shall take effect from the date it is 4
enacted. It shall remain effective through June 30, 2025, and, at the end of June 30, 2025, 5
this Act, with no further action required by the General Assembly, shall be abrogated and 6
of no further force and effect. 7