EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb1051*
HOUSE BILL 1051
J1, J3 4lr1994
CF SB 1059
By: Delegates White Holland, Wilkins, Boafo, Boyce, Crutchfield, Fennell,
Guzzone, Harris, Hill, Kerr, R. Lewis, Mireku–North, Patterson, Phillips,
Roberson, Roberts, Ruff, Taveras, Toles, Turner, Wells, Williams, Wims, and
Woods
Introduced and read first time: February 7, 2024
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Maternal Health – Assessments, Referrals, and Reporting 2
(Maryland Maternal Health Act of 2024) 3
FOR the purpose of establishing requirements on local health departments and certain 4
health care providers and facilities regarding maternal health, including 5
requirements regarding prenatal risk assessment forms and postpartum infant and 6
maternal referral forms; prohibiting the Maryland Department of Health from 7
providing Medical Assistance Program reimbursement to a hospital or freestanding 8
birthing center unless the facility complies with certain provisions of this Act; 9
requiring the Secretary of Health, in collaboration with the Maryland Health Care 10
Commission, to develop a Maryland Report Card for Birthing Facility Maternity 11
Care; requiring the Department to conduct a certain study of incidents of severe 12
maternal morbidity in the State; and generally relating to maternal health. 13
BY repealing and reenacting, without amendments, 14
Article – Health – General 15
Section 15–101(a), (h), and (i), 19–301(a) and (f), and 19–3B–01(a) and (d) 16
Annotated Code of Maryland 17
(2023 Replacement Volume) 18
BY adding to 19
Article – Health – General 20
Section 15–155, 19–310.4, and 19–3B–03.1; and 24–2401 and 24–2402 to be under 21
the new subtitle “Subtitle 24. Report Card for Birthing Facility Maternity 22
Care” 23
Annotated Code of Maryland 24
(2023 Replacement Volume) 25
2 HOUSE BILL 1051
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 1
That the Laws of Maryland read as follows: 2
Article – Health – General 3
15–101. 4
(a) In this title the following words have the meanings indicated. 5
(h) “Program” means the Maryland Medical Assistance Program. 6
(i) “Program recipient” means an individual who receives benefits under the 7
Program. 8
15–155. 9
(A) IN THIS SECTION , “PRENATAL RISK ASSESSMEN T FORM” MEANS A 10
STANDARDIZE D FORM DEVELOPED BY TH E DEPARTMENT IN ACCORDANCE WITH 11
THE CENTERS FOR MEDICARE AND MEDICAID SERVICES GUIDELINES FOR USE BY 12
A LICENSED HEALTH CARE PROVIDER TO EVALUATE RISK FACTORS FOR THE 13
HEALTH OF A PREGNANT PATIENT. 14
(B) A PROVIDER WHO RECEIVES REIMBUR SEMENT FROM THE PROGRAM 15
FOR PROVIDING OBSTET RIC SERVICES TO A PATIENT SHALL COMPLETE A PRENATAL 16
RISK ASSESSMENT FORM FOR THE PATIENT: 17
(1) DURING THE INITIAL VI SIT WITH THE PATIENT ; AND 18
(2) DURING THE THIRD TRIM ESTER OF THE PATIENT’S PREGNANCY . 19
(C) AFTER COMPLETING A PRENATAL RISK ASSESS MENT FORM IN 20
ACCORDANCE WITH SUBS ECTION (B) OF THIS SECTION , THE PROVIDER SHALL 21
SUBMIT THE FORM TO T HE LOCAL HEALTH DEPA RTMENT FOR THE COUNTY IN 22
WHICH THE PATIENT RESIDES . 23
(D) ON OR BEFORE OCTOBER 1 EACH YEAR , EACH LOCAL HEALTH 24
DEPARTMENT SHALL SUB MIT TO THE DEPARTMENT A REPORT THAT INCLUDES THE 25
NUMBER AND TYPE OF REFERRAL S MADE TO PATIENTS THAT WERE BASED ON THE 26
INFORMATION FROM THE PRENATAL RISK ASSESSMENT FORM COMPLETED IN 27
ACCORDANCE WITH SUBSECTION (B) OF THIS SECTION. 28
(E) THE DEPARTMENT SHALL ESTABLISH A PROCESS FOR A PROVIDER TO 29
SUBMIT A PRENATAL RISK ASSESSMEN T FORM ELECTRONICALLY . 30
19–301. 31 HOUSE BILL 1051 3
(a) In this subtitle the following words have the meanings indicated. 1
(f) “Hospital” means an institution that: 2
(1) Has a group of at least 5 physicians who are organized as a medical 3
staff for the institution; 4
(2) Maintains facilities to provide, under the supervision of the medical 5
staff, diagnostic and treatment services for 2 or more unrelated individuals; and 6
(3) Admits or retains the individuals for overnight care. 7
19–310.4. 8
(A) IF A NEWBORN IS DELIVERED IN A HO SPITAL FOLLOWING A HIGH –RISK 9
PREGNANCY , THE HOSPITAL SHALL : 10
(1) COMPLETE A POSTPARTUM INFANT AND MATERNAL REFERRAL 11
FORM AND SUBMIT THE FORM TO THE LOCAL HEALTH DEPARTMENT FOR THE 12
COUNTY IN WHICH THE BIRTHING PARENT RESI DES; 13
(2) PROVIDE TO THE BIRTHING PARE NT RESOURCES AND 14
INFORMATION SPECIFIC TO THE CIRCUMSTANCES OF THE BIRTHING PARENT , 15
INCLUDING INFORMATION REGARDIN G THE RISKS, SIGNS, PREVENTIVE MEASURE S, 16
AND TREATMENT NEEDS FOR POSTPARTUM COMPL ICATIONS, INCLUDING 17
CARDIOVASCULAR CONDI TIONS, CHRONIC DISEASE , AND MENTAL HEALTH 18
CONDITIONS; AND 19
(3) CALL THE BIRTHING PAR ENT WITHIN 12 HOURS AFTER 20
DISCHARGING THE PARENT TO EVALUATE THE PARENT’S STATUS AND , AS 21
NECESSARY, PROVIDE INFORMATION ABOUT POSTPARTUM COM PLICATIONS. 22
(B) ON OR BEFORE MAY 1 EACH YEAR, EACH LOCAL HEALTH DE PARTMENT 23
SHALL SUBMIT TO THE DEPARTMENT A REPORT THAT INCLUDES THE NUMBER AND 24
TYPE OF REFERRAL S MADE BASED ON THE REFERRA L FORMS SUBMITTED TO THE 25
LOCAL HEALTH DEPARTM ENT IN ACCORDANCE WITH S UBSECTION (A)(1) OF THIS 26
SECTION. 27
(C) THE DEPARTMENT MAY NOT PROVIDE MEDICAL ASSISTANCE 28
PROGRAM REIMBURSE MENT TO A HOSPITAL FOR SERVICES RELATED TO THE 29
DELIVERY OF A NEWBOR N FOLLOWING A HIGH –RISK PREGNANCY UNLES S THE 30
HOSPITAL COMPLIES WITH SUBSECTION (A)(1) OF THIS SECTION. 31
4 HOUSE BILL 1051
19–3B–01. 1
(a) In this subtitle the following words have the meanings indicated. 2
(d) (1) “Freestanding birthing center” means a facility that provides nurse 3
midwife services under Title 8, Subtitle 6 of the Health Occupations Article. 4
(2) “Freestanding birthing center” does not include: 5
(i) A hospital regulated under Subtitle 2 of this title; or 6
(ii) The private residence of the mother. 7
19–3B–03.1. 8
(A) IF A NEWBORN IS DELIVERED IN A FR EESTANDING BIRTHING CENTER 9
FOLLOWING A HIGH –RISK PREGNANCY , THE FREESTANDING BIR THING CENTER 10
SHALL: 11
(1) COMPLETE A POSTPARTUM INFANT AND MATERNAL REFERRAL 12
FORM AND SUBMIT THE FORM TO THE LOCAL HEALTH DEPARTMENT FOR THE 13
COUNTY IN WHICH THE BIRTHING PARENT RESI DES; 14
(2) PROVIDE TO THE BIRTHING PARE NT RESOURCES AND 15
INFORMATION SPECIFIC TO THE CIRC UMSTANCES OF THE BIRTHING PARENT , 16
INCLUDING INFORMATIO N REGARDING THE RISKS, SIGNS, PREVENTIVE MEASURES , 17
AND TREATMENT NEEDS FOR POSTPARTUM COMPL ICATIONS, INCLUDING 18
CARDIOVASCULAR CONDI TIONS, CHRONIC DISEASE , AND MENTAL HEALTH 19
CONDITIONS; AND 20
(3) CALL THE BIRTHING PARENT W ITHIN 12 HOURS AFTER 21
DISCHARGING THE PARENT TO EVALUATE THE PARENT’S STATUS AND, AS 22
NECESSARY, PROVIDE INFORMATION ABOUT POSTPARTUM COM PLICATIONS. 23
(B) ON OR BEFORE MAY 1 EACH YEAR, EACH LOCAL HEALTH DEPARTM ENT 24
SHALL SUBMIT TO THE DEPARTMENT A REP ORT THAT INCLUDES THE NUMBER AND 25
TYPE OF REFERRAL S MADE BASED ON THE REFERRA L FORMS SUBMITTED TO THE 26
LOCAL HEALTH DEPARTM ENT IN ACCORDANCE WITH SUBSECTION (A)(1) OF THIS 27
SECTION. 28
(C) THE DEPARTMENT MAY NOT PROVIDE MEDICAL ASSISTANCE 29
PROGRAM REIMBURSEMENT TO A FREESTANDING BI RTHING CENTER FOR SE RVICES 30
RELATED TO THE DELIV ERY OF A NEWBORN FOL LOWING A HIGH –RISK PREGNANCY 31 HOUSE BILL 1051 5
UNLESS THE FREESTAND ING BIRTHING CENTER COMPLIES WITH SUBSEC TION (A)(1) 1
OF THIS SECTION. 2
SUBTITLE 24. REPORT CARD FOR BIRTHING FACILITY MATERNITY CARE. 3
24–2401. 4
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANING 5
INDICATED. 6
(B) “BIRTHING FACILITY ” MEANS A FREESTANDING BIRTHIN G CENTER OR 7
A HOSPITAL THAT PROV IDES OBSTETRIC CARE . 8
(C) “FREESTANDING BIRTHING CENTER” HAS THE MEANING STATED IN § 9
19–3B–01 OF THIS ARTICLE. 10
(D) “HOSPITAL” HAS THE MEANING STATED IN § 19–301 OF THIS ARTICLE. 11
(E) “REPORT CARD” MEANS THE MARYLAND REPORT CARD FOR BIRTHING 12
FACILITY MATERNITY CARE DEVELOPED UNDER § 24–2402 OF THIS SUBTITLE. 13
24–2402. 14
(A) SUBJECT TO SUBSECTION S (B) AND (C) OF THIS SECTION , THE 15
SECRETARY, IN COLLABORATION WIT H THE MARYLAND HEALTH CARE 16
COMMISSION, SHALL: 17
(1) DEVELOP A MARYLAND REPORT CARD FOR BIRTHING FACILITY 18
MATERNITY CARE; AND 19
(2) COLLECT THE NECESSARY INFORMATION TO COMPL ETE AN 20
ANNUAL REPORT CARD FOR EACH BIRTHING FACILITY IN THE STATE. 21
(B) THE REPORT CARD SHALL INCLUDE THE FOLLOWING INFORM ATION 22
FOR EACH BIRTHING FA CILITY: 23
(1) THE NUMBER OF VAGINAL DELIVERIES PERFORMED ; 24
(2) THE NUMBER OF CE SAREAN DELIVERIES PE RFORMED; 25
(3) THE RATE OF COMPLICAT IONS AND THE TOTAL NUMBER OF 26
COMPLICATIONS EXPERIENCED BY A PATIENT RECEIVING OBSTETRIC CARE FOR: 27
6 HOUSE BILL 1051
(I) A VAGINAL DELIVERY AT THE BIRTHING FACI LITY, 1
INCLUDING MATERNAL H EMORRHAGE , LACERATION, INFECTION, OR ANY OTHER 2
COMPLICATION AS REQUIRED BY THE SECRETARY; OR 3
(II) A CESAREAN DELIVERY AT THE BIRTHING FACILIT Y, 4
INCLUDING MATERNAL H EMORRHAGE , INFECTION, OPERATIVE COMPLICATI ON, OR 5
ANY OTHER COMPLICA TION AS REQUIRED BY THE SECRETARY; AND 6
(4) QUALITATIVE MEASURES BASED ON PATIENT INP UT REGARDING 7
THE PATIENT’S RECEIPT OF RESPECTFUL OBSTETRIC CARE . 8
(C) THE REPORT CARD SCORE SHALL BE B ALANCED FOR THE RISKS 9
ASSOCIATED WITH THE LEVEL OF ACUITY CARE PROVIDED FOR OBSTETR IC 10
PATIENTS SERVED BY THE BIRTHING FACILITY . 11
(D) THE DEPARTMENT SHALL INCLUDE THE MOST RECENT REPORT CARD 12
ON THE DEPARTMENT ’S WEBSITE. 13
(E) (1) AT LEAST ANNUALLY, THE SECRETARY SHALL : 14
(I) REVIEW THE CRITERIA E VALUATED IN THE REPORT CARD; 15
AND 16
(II) REVISE THE COMPLICATIONS OR OTH ER FACTORS TO BE 17
INCLUDED IN THE REPORT CARD. 18
(2) THE SECRETARY SHALL CONSI DER EXPERT GUIDANCE WHEN 19
REVIEWING THE CRITER IA EVALUATED IN THE REPORT CARD. 20
SECTION 2. AND BE IT FURTHER ENACTED, That: 21
(a) The Maryland Department of Health, in collaboration with the Maryland 22
Hospital Association and local health departments, shall study the incidents of Severe 23
Maternal Morbidity (SMM) in the State to: 24
(1) identify the contextual drivers and trends in the risk factors associated 25
with individuals experiencing SMM; and 26
(2) make recommendations to reduce the incidents of SMM in the State. 27
(b) On or before December 1, 2025, the Department shall report the findings and 28
recommendations from the study conducted under subsection (a) of this section to the 29
Governor and, in accordance with § 2–1257 of the State Government Article, the General 30
Assembly. 31 HOUSE BILL 1051 7
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 1
October 1, 2024. 2