EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*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 Woods, Pena–Melnyk, Cullison, Alston, Bagnall, Bhandari,
Chisholm, Hutchinson, S. Johnson, Kaiser, Kipke, Martinez, M. Morgan,
Reilly, Rosenberg, and Szeliga
Introduced and read first time: February 7, 2024
Assigned to: Health and Government Operations
Committee Report: Favorable with amendments
House action: Adopted
Read second time: March 7, 2024
CHAPTER ______
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 healt h, 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 hospitals and freestanding birthing centers to 13
participate in the Severe Maternal Morbidity Surveillance Program for a certain 14
purpose; and generally relating to maternal health. 15
BY repealing and reenacting, without amendments, 16
Article – Health – General 17
Section 15–101(a), (h), and (i), 19–301(a) and (f), and 19–3B–01(a) and (d) 18
Annotated Code of Maryland 19 2 HOUSE BILL 1051
(2023 Replacement Volume) 1
BY adding to 2
Article – Health – General 3
Section 15–155, 19–310.4, and 19–3B–03.1; and 24–2401 and 24–2402 to be under 4
the new subtitle “Subtitle 24. Report Card for Birthing Facility Maternity 5
Care” 6
Annotated Code of Maryland 7
(2023 Replacement Volume) 8
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 9
That the Laws of Maryland read as follows: 10
Article – Health – General 11
15–101. 12
(a) In this title the following words have the meanings indicated. 13
(h) “Program” means the Maryland Medical Assistance Program. 14
(i) “Program recipient” means an individual who receives benefits under the 15
Program. 16
15–155. 17
(A) IN THIS SECTION , “PRENATAL RISK ASSESS MENT FORM ” MEANS A 18
STANDARDIZED FORM DE VELOPED BY THE DEPARTMENT IN ACCORDA NCE WITH 19
THE CENTERS FOR MEDICARE AND MEDICAID SERVICES GUIDELINES FOR USE BY 20
A LICENSED HEALTH CA RE PROVIDER TO EVALU ATE RISK FACTORS FOR THE 21
HEALTH OF A PREGNANT PATIENT. 22
(B) A PROVIDER WHO RECEIVE S REIMBURSEMENT FROM THE PROGRAM 23
FOR PROVIDING OBSTET RIC SERVICES TO A PA TIENT SHALL COMPLETE A PRENATAL 24
RISK ASSESSMENT FORM FOR THE PATIENT : 25
(1) DURING DURING THE INITIAL VISIT WITH THE PATIENT ; AND 26
(2) DURING THE THIRD TRIM ESTER OF THE PATIENT ’S PREGNANCY . 27
(C) AFTER COMPLETING A PR ENATAL RISK ASSESSME NT FORM IN 28
ACCORDANCE WITH SUBS ECTION (B) OF THIS SECTION, THE PROVIDER SHALL 29
SUBMIT THE FORM TO T HE LOCAL HEALTH DEPA RTMENT FOR THE COUNT Y IN 30
WHICH THE PATIENT RE SIDES. 31
HOUSE BILL 1051 3
(D) ON OR BEFORE OCTOBER 1 EACH YEAR , EACH LOCAL HEALTH 1
DEPARTMENT SHALL SUB MIT TO THE DEPARTMENT A REPORT T HAT INCLUDES THE 2
NUMBER AND TYPE OF REFER RALS MADE TO PATIENT S THAT WERE BASED ON THE 3
INFORMATION FROM THE PRENATAL RISK ASSESS MENT FORM COMPLETED IN 4
ACCORDANCE WITH SUBS ECTION (B) OF THIS SECTION. 5
(E) THE DEPARTMENT SHALL ESTA BLISH A PROCESS FOR A PROVIDER TO 6
SUBMIT A PRENA TAL RISK ASSESSMENT FORM ELECTRONICALLY . 7
19–301. 8
(a) In this subtitle the following words have the meanings indicated. 9
(f) “Hospital” means an institution that: 10
(1) Has a group of at least 5 physicians who are organized as a medical 11
staff for the institution; 12
(2) Maintains facilities to provide, under the supervision of the medical 13
staff, diagnostic and treatment services for 2 or more unrelated individuals; and 14
(3) Admits or retains the individuals for overnight care. 15
19–310.4. 16
(A) IF A NEWBORN IS DELIVERED IN A HOSPITAL FOLLOW ING A HIGH–RISK 17
PREGNANCY , THE HOSPITAL SHALL : 18
(1) COMPLETE A POSTPARTUM INFANT AND MATERNAL REFERRAL 19
FORM AND SUBMIT THE FORM TO THE LOCAL HE ALTH DEPARTMENT FOR THE 20
COUNTY IN WHICH THE BIRTHING PARENT RESI DES; 21
(2) PROVIDE TO THE BIRTHI NG PARENT RESOURCES AND 22
INFORMATION SPECIFIC TO THE CIRCUMSTANCES OF THE BIRTHING PARE NT, 23
INCLUDING INFORMATIO N REGARDING THE RISK S, SIGNS, PREVENTIVE MEASURES , 24
AND TREATMENT NEEDS FOR POSTPARTUM COMPL ICATIONS, INCLUDING 25
CARDIOVAS CULAR CONDITIONS , CHRONIC DISEASE , SUBSTANCE MISUSE , AND 26
MENTAL HEALTH CONDIT IONS; AND 27
(3) CALL THE BIRTHING PAR ENT WITHIN 12 AT LEAST 24, BUT NOT 28
LATER THAN 48, HOURS AFTER DISCHARG ING THE PARENT TO EV ALUATE THE 29
PARENT’S STATUS AND , AS NECESSARY , PROVIDE INFORMATION ABOUT 30
POSTPARTUM COMPLICAT IONS. 31
4 HOUSE BILL 1051
(B) ON OR BEFORE MAY OCTOBER 1 EACH YEAR, EACH LOCAL HEALTH 1
DEPARTMENT SHALL SUB MIT TO THE DEPARTMENT A REPORT T HAT INCLUDES THE 2
NUMBER AND TYPE OF R EFERRALS MADE BASED ON THE REFERRAL FORM S 3
SUBMITTED T O THE LOCAL HEALTH D EPARTMENT IN ACCORDA NCE WITH 4
SUBSECTION (A)(1) OF THIS SECTION. 5
(C) THE DEPARTMENT MAY NOT PR OVIDE MEDICAL ASSISTANCE 6
PROGRAM REIMBURSEMENT TO A HOSPITAL FOR SE RVICES RELATED TO TH E 7
DELIVERY OF A NEWBOR N FOLLOWING A HIGH –RISK PREGNANCY UNLESS THE 8
HOSPITAL COMPLIES WI TH SUBSECTION (A)(1) OF THIS SECTION. 9
19–3B–01. 10
(a) In this subtitle the following words have the meanings indicated. 11
(d) (1) “Freestanding birthing center” means a facility that provides nurse 12
midwife services under Title 8, Subtitle 6 of the Health Occupations Article. 13
(2) “Freestanding birthing center” does not include: 14
(i) A hospital regulated under Subtitle 2 of this title; or 15
(ii) The private residence of the mother. 16
19–3B–03.1. 17
(A) IF A NEWBORN IS DELIVERED IN A FREESTANDING BIRTH ING CENTER 18
FOLLOWING A HIGH –RISK PREGNANCY , THE FREESTANDING BIR THING CENTER 19
SHALL: 20
(1) COMPLETE A POSTPARTUM INFANT AND MATERNAL REFERRAL 21
FORM AND SUBMIT THE FORM TO THE LOCAL HE ALTH DEPARTMENT FOR THE 22
COUNTY IN WHICH THE BIRTHING P ARENT RESIDES ; 23
(2) PROVIDE TO THE BIRTHI NG PARENT RESOURCES AND 24
INFORMATION SPECIFIC TO THE CIRCUMSTANCES OF THE BIRTHING PARE NT, 25
INCLUDING INFORMATIO N REGARDING THE RISK S, SIGNS, PREVENTIVE MEASURES , 26
AND TREATMENT NEEDS FOR POSTPART UM COMPLICATIONS , INCLUDING 27
CARDIOVASCULAR CONDI TIONS, CHRONIC DISEASE , SUBSTANCE MISUSE , AND 28
MENTAL HEALTH CONDIT IONS; AND 29
(3) CALL THE BIRTHING PAR ENT WITHIN 12 AT LEAST 24, BUT NOT 30
LATER THAN 48, HOURS AFTER DISCHARG ING THE PARENT TO EV ALUATE THE 31
PARENT’S STATUS AND , AS NECESSARY , PROVIDE INFORMATION ABOUT 32
POSTPARTUM COMPLICAT IONS. 33 HOUSE BILL 1051 5
(B) ON OR BEFORE MAY OCTOBER 1 EACH YEAR, EACH LOCAL HEALTH 1
DEPARTMENT SHALL SUB MIT TO THE DEPARTMENT A REPORT T HAT INCLUDES THE 2
NUMBER AND TYPE OF R EFERRALS MADE BASED ON THE REFERRA L FORMS 3
SUBMITTED TO THE LOC AL HEALTH DEPARTMENT IN ACCORDANCE WITH 4
SUBSECTION (A)(1) OF THIS SECTION. 5
(C) THE DEPARTMENT MAY NOT PR OVIDE MEDICAL ASSISTANCE 6
PROGRAM REIMBURSEMENT TO A FREESTANDING BI RTHING CENTER FOR SE RVICES 7
RELATED TO THE DELIVERY OF A NEWBORN FOLLOWING A HIGH–RISK PREGNANCY 8
UNLESS THE FREESTAND ING BIRTHING CENTER COMPLIES WITH SUBSEC TION (A)(1) 9
OF THIS SECTION. 10
SUBTITLE 24. REPORT CARD FOR BIRTHING FACILITY MATERNITY CARE. 11
24–2401. 12
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANING 13
INDICATED. 14
(B) “BIRTHING FACILITY ” MEANS A FREESTANDING BIRTHING CENTER OR 15
A HOSPITAL THAT PROV IDES OBSTETRIC CARE . 16
(C) “FREESTANDING BIRTHING CENTER” HAS THE MEANING STAT ED IN § 17
19–3B–01 OF THIS ARTICLE. 18
(D) “HOSPITAL” HAS THE MEANING STATED IN § 19–301 OF THIS ARTICLE. 19
(E) “REPORT CARD” MEANS THE MARYLAND REPORT CARD FOR BIRTHING 20
FACILITY MATERNITY CARE DEVELOPED UNDER § 24–2402 OF THIS SUBTITLE. 21
24–2402. 22
(A) SUBJECT TO SUBSECTION S (B) AND (C) OF THIS SECTION , THE 23
SECRETARY, IN COLLABORATION WIT H THE MARYLAND HEALTH CARE 24
COMMISSION, SHALL: 25
(1) DEVELOP A MARYLAND REPORT CARD FOR BIRTHING FACILITY 26
MATERNITY CARE; AND 27
(2) COLLECT THE NECESSARY INFORMATION TO COMPL ETE AN 28
ANNUAL REPORT CARD F OR EACH BIRTHING FACILITY IN THE STATE. 29
6 HOUSE BILL 1051
(B) THE REPORT CARD SHALL INCLUDE THE FOLLOWIN G INFORMATION 1
FOR EACH BIRTHING FA CILITY, DISAGGREGATED BY RAC E AND AGE IN ACCORDA NCE 2
WITH BEST PRACTICES FOR DATA SUPPRESSION : 3
(1) THE NUMBER AND RATE OF VAGINAL DELIVERIE S PERFORME D; 4
(2) THE NUMBER AND RATE OF CESAREAN DELIVERI ES PERFORMED ; 5
(3) THE AGE–ADJUSTED RATE OF COMPLICATION S AND THE TOTAL 6
NUMBER OF COMPLICATI ONS EXPERIENCED BY A PATIENT RECEIVING OB STETRIC 7
CARE FOR: 8
(I) A VAGINAL DELIVERY AT THE BIRTHING FACILIT Y, 9
INCLUDING MATERNAL H EMORRHAGE , LACERATION, INFECTION, OR ANY OTHER 10
COMPLICATION AS REQU IRED BY THE SECRETARY; OR 11
(II) A CESAREAN DELIVERY AT THE BIRTHING FACILIT Y, 12
INCLUDING MATERNAL H EMORRHAGE , INFECTION, OPERATIVE COMPLICATI ON, OR 13
ANY OTHER COMPLICAT ION AS REQUIRED BY T HE SECRETARY; AND 14
(4) QUALITATIVE MEASURES BASED ON PATIENT INP UT REGARDING 15
THE PATIENT’S RECEIPT OF RESPECT FUL OBSTETRIC CARE . 16
(C) THE REPORT CARD SCORE SHALL BE BALANCED FO R THE RISKS 17
ASSOCIATED WITH THE LEVEL OF ACUITY CARE PROVIDED FOR OBSTETR IC 18
PATIENTS SERVED BY T HE BIRTHING FACILITY . 19
(D) THE DEPARTMENT SHALL INCL UDE THE MOST RECENT REPORT CARD 20
ON THE DEPARTMENT ’S WEBSITE. 21
(E) (1) AT LEAST ANNUALLY ONCE EVERY 3 YEARS, THE SECRETARY 22
SHALL: 23
(I) REVIEW THE CRITERIA E VALUATED IN THE REPOR T CARD; 24
AND 25
(II) REVISE THE COMPLICATI ONS OR OTHER FACTORS TO BE 26
INCLUDED IN THE REPO RT CARD. 27
(2) THE SECRETARY SHALL CONSI DER EXPERT GUIDANCE WHEN 28
REVIEWING THE CRITER IA EVALUATED IN THE REPORT CARD . 29
SECTION 2. AND BE IT FURTHER ENACTED, That: 30
HOUSE BILL 1051 7
(a) The Maryland Department of Health, in collaboration with the Maryland 1
Hospital Association and local health departments, shall study the incidents of Severe 2
Maternal Morbidity (SMM) in the State Each hospital and freestanding birthing center 3
shall participate in the Severe Maternal Morbidity Surveillance and Review Program to: 4
(1) identify the contextual drivers and trends in the, risk factors associated 5
with individuals experiencing, and causes of SMM; and 6
(2) study quality improvement efforts of hospitals and freestanding 7
birthing centers regarding SMM based on the reviews; and 8
(3) make recommendations to reduce the incidents prevalence of SMM in 9
the State. 10
(b) On or before December 1, 2025, the Department Severe Maternal Morbidity 11
Surveillance and Review Program shall report the findings and recommendations from the 12
study conducted under subsection (a) of this section to the Governor and, in accordance 13
with § 2–1257 of the State Government Article, the General Assembly. 14
SECTION 3. AND BE IT FURTHER ENACTED, That Section 1 of this Act shall take 15
effect July 1, 2025. 16
SECTION 4. AND BE IT FURTHER ENACTED, That Section 2 of this Act shall take 17
effect October 1, 2024. 18
SECTION 3. 5. AND BE IT FURTHER ENACT ED, That, except as provided in 19
Sections 3 and 4, this Act shall take effect October July 1, 2024. 20
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.