EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb1059*
SENATE BILL 1059
J1, J3 4lr2537
CF HB 1051
By: Senator Ellis
Introduced and read first time: February 2, 2024
Assigned to: Finance
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
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 26
That the Laws of Maryland read as follows: 27
2 SENATE BILL 1059
Article – Health – General 1
15–101. 2
(a) In this title the following words have the meanings indicated. 3
(h) “Program” means the Maryland Medical Assistance Program. 4
(i) “Program recipient” means an individual who receives benefits under the 5
Program. 6
15–155. 7
(A) IN THIS SECTION , “PRENATAL RISK ASSESSMENT FORM ” MEANS A 8
STANDARDIZED FORM DE VELOPED BY THE DEPARTMENT IN ACCORDA NCE WITH 9
THE CENTERS FOR MEDICARE AND MEDICAID SERVICES GUIDELINES F OR USE BY 10
A LICENSED HEALTH CA RE PROVIDER TO EVALU ATE RISK FACTORS FOR THE 11
HEALTH OF A PREGNANT PATIENT. 12
(B) A PROVIDER WHO RECEIVE S REIMBURSEMENT FROM THE PROGRAM 13
FOR PROVIDING OBSTET RIC SERVICES TO A PA TIENT SHALL COMPLETE A PRENATAL 14
RISK ASSESSMENT FORM FOR THE PATIENT : 15
(1) DURING THE INITIAL VI SIT WITH THE PATIENT ; AND 16
(2) DURING THE THIRD TRIM ESTER OF THE PATIENT’S PREGNANCY . 17
(C) AFTER COMPLETING A PR ENATAL RISK ASSESSME NT FORM IN 18
ACCORDANCE WITH SUBS ECTION (B) OF THIS SECTION , THE PROVIDER SHALL 19
SUBMIT THE FORM TO T HE LOCAL HEALTH DEPA RTMENT FOR THE COUNT Y IN 20
WHICH THE PATIENT RE SIDES. 21
(D) ON OR BEFORE OCTOBER 1 EACH YEAR , EACH LOCAL HEALTH 22
DEPARTMENT SHALL SUB MIT TO THE DEPARTMENT A REPORT T HAT INCLUDES THE 23
NUMBER AND TYPE OF R EFERRALS MADE TO PAT IENTS THAT WERE BASE D ON THE 24
INFORMATION FROM THE PRENATAL RISK ASSESS MENT FORM COMPLETED IN 25
ACCORDANCE WITH SUBSECTIO N (B) OF THIS SECTION. 26
(E) THE DEPARTMENT SHALL ESTA BLISH A PROCESS FOR A PROVIDER TO 27
SUBMIT A PRENATAL RI SK ASSESSMENT FORM E LECTRONICALLY . 28
19–301. 29
(a) In this subtitle the following words have the meanings indicated. 30
SENATE BILL 1059 3
(f) “Hospital” means an institution that: 1
(1) Has a group of at least 5 physicians who are organized as a medical 2
staff for the institution; 3
(2) Maintains facilities to provide, under the supervision of the medical 4
staff, diagnostic and treatment services for 2 or more unrelated individuals; and 5
(3) Admits or retains the individuals for overnight care. 6
19–310.4. 7
(A) IF A NEWBORN IS DELIV ERED IN A HOSPITAL F OLLOWING A HIGH –RISK 8
PREGNANCY , THE HOSPITAL SHALL : 9
(1) COMPLETE A POSTPARTUM INFANT AND MATERNAL REFERRAL 10
FORM AND SUBMIT THE FORM TO THE LOCAL HE ALTH DEPARTMENT FOR THE 11
COUNTY IN WHICH THE BIRTHING PARENT RESI DES; 12
(2) PROVIDE TO THE BIRTHI NG PARENT RESOURCES AND 13
INFORMATION SPECIFIC TO THE CIRCUMSTANCES OF THE BIRTHING PARE NT, 14
INCLUDING INFORMATI ON REGARDING THE RIS KS, SIGNS, PREVENTIVE MEASURES , 15
AND TREATMENT NEEDS FOR POSTPARTUM COMPL ICATIONS, INCLUDING 16
CARDIOVASCULAR CONDI TIONS, CHRONIC DISEASE , AND MENTAL HEALTH 17
CONDITIONS; AND 18
(3) CALL THE BIRTHING PAR ENT WITHIN 12 HOURS AFTER 19
DISCHARGING THE PARENT TO EVALUA TE THE PARENT ’S STATUS AND , AS 20
NECESSARY, PROVIDE INFORMATION ABOUT POSTPARTUM COM PLICATIONS. 21
(B) ON OR BEFORE MAY 1 EACH YEAR, EACH LOCAL HEALTH DE PARTMENT 22
SHALL SUBMIT TO THE DEPARTMENT A REPORT T HAT INCLUDES THE NUM BER AND 23
TYPE OF REFERRALS MADE BASED ON THE REFERRAL FORM S SUBMITTED TO THE 24
LOCAL HEALTH DEPARTM ENT IN ACCORDANCE WI TH SUBSECTION (A)(1) OF THIS 25
SECTION. 26
(C) THE DEPARTMENT MAY NOT PR OVIDE MEDICAL ASSISTANCE 27
PROGRAM REIMBURSEMENT TO A HOSPITAL FOR SE RVICES RELATED TO TH E 28
DELIVERY OF A NEWBOR N FOLLOWING A HIGH –RISK PREGNANCY UNLES S THE 29
HOSPITAL COMPLIES WI TH SUBSECTION (A)(1) OF THIS SECTION. 30
19–3B–01. 31
(a) In this subtitle the following words have the meanings indicated. 32 4 SENATE BILL 1059
(d) (1) “Freestanding birthing center” means a facility that provides nurse 1
midwife services under Title 8, Subtitle 6 of the Health Occupations Article. 2
(2) “Freestanding birthing center” does not include: 3
(i) A hospital regulated under Subtitle 2 of this title; or 4
(ii) The private residence of the mother. 5
19–3B–03.1. 6
(A) IF A NEWBORN IS DELIV ERED IN A FREESTANDI NG BIRTHING CENTER 7
FOLLOWING A HIGH –RISK PREGNANCY , THE FREESTANDING BIR THING CENTER 8
SHALL: 9
(1) COMPLETE A POSTPARTUM INFANT AND MATERNAL REFERRAL 10
FORM AND SUBMIT THE FORM TO THE LOCAL HEALTH DEPARTMENT FOR THE 11
COUNTY IN WHICH THE BIRTHING PARENT RESI DES; 12
(2) PROVIDE TO THE BIRTHI NG PARENT RESOURCES AND 13
INFORMATION SPECIFIC TO THE CIRCUMSTANCES OF THE BIRTHING PARE NT, 14
INCLUDING INFORMATIO N REGARDING T HE RISKS, SIGNS, PREVENTIVE MEASURES , 15
AND TREATMENT NEEDS FOR POSTPARTUM COMPL ICATIONS, INCLUDING 16
CARDIOVASCULAR CONDI TIONS, CHRONIC DISEASE , AND MENTAL HEALTH 17
CONDITIONS; AND 18
(3) CALL THE BIRTHING PAR ENT WITHIN 12 HOURS AFTER 19
DISCHARGING THE PARE NT TO EVALUATE THE PARENT ’S STATUS AND , AS 20
NECESSARY, PROVIDE INFORMATION ABOUT POSTPARTUM COM PLICATIONS. 21
(B) ON OR BEFORE MAY 1 EACH YEAR, EACH LOCAL HEALTH DE PARTMENT 22
SHALL SUBMIT TO THE DEPARTMENT A REPORT T HAT INCLUDES THE NUM BER AND 23
TYPE OF REFERRALS MA DE BASED ON THE REFERRA L FORMS SUBMITTED TO THE 24
LOCAL HEALTH DEPARTM ENT IN ACCORDANCE WI TH SUBSECTION (A)(1) OF THIS 25
SECTION. 26
(C) THE DEPARTMENT MAY NOT PR OVIDE MEDICAL ASSISTANCE 27
PROGRAM REIMBURSEMENT TO A FREESTANDING BI RTHING CENTER FOR SE RVICES 28
RELATED TO THE DELIVERY OF A NEWBORN FOLLOWING A HIGH–RISK PREGNANCY 29
UNLESS THE FREESTAND ING BIRTHING CENTER COMPLIES WITH SUBSEC TION (A)(1) 30
OF THIS SECTION. 31
SUBTITLE 24. REPORT CARD FOR BIRTHING FACILITY MATERNITY CARE. 32 SENATE BILL 1059 5
24–2401. 1
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANING 2
INDICATED. 3
(B) “BIRTHING FACILITY ” MEANS A FREESTANDING BIRTHING CENTER OR 4
A HOSPITAL THAT PROV IDES OBSTETRIC CARE . 5
(C) “FREESTANDING BIRTHING CENTER” HAS THE MEANING STAT ED IN § 6
19–3B–01 OF THIS ARTICLE. 7
(D) “HOSPITAL” HAS THE MEANING STATE D IN § 19–301 OF THIS ARTICLE. 8
(E) “REPORT CARD” MEANS THE MARYLAND REPORT CARD FOR BIRTHING 9
FACILITY MATERNITY CARE DEVELOPED UNDER § 24–2402 OF THIS SUBTITLE. 10
24–2402. 11
(A) SUBJECT TO SUBSECTION S (B) AND (C) OF THIS SECTION , THE 12
SECRETARY, IN COLLABORATION WIT H THE MARYLAND HEALTH CARE 13
COMMISSION, SHALL: 14
(1) DEVELOP A MARYLAND REPORT CARD FOR BIRTHING FACILITY 15
MATERNITY CARE; AND 16
(2) COLLECT THE NECESSARY INFORMATION TO COMPL ETE AN 17
ANNUAL REPORT CARD F OR EACH BIRTHING FAC ILITY IN THE STATE. 18
(B) THE REPORT CARD SHALL INCLUDE THE FOLLOWIN G INFORMATION 19
FOR EACH BIRTHING FA CILITY: 20
(1) THE NUMBER OF VAGINAL DELIVERIES PERFORMED ; 21
(2) THE NUMBER OF CESAREA N DELIVERIES PERFORM ED; 22
(3) THE RATE OF COMPLICAT IONS AND THE TOTAL NUMBER OF 23
COMPLICATIONS EXPERI ENCED BY A PATIENT R ECEIVING OBSTETRIC C ARE FOR: 24
(I) A VAGINAL DELIVERY AT THE BIRTHING FACILIT Y, 25
INCLUDING MATERNAL H EMORRHAGE , LACERATION, INFECTION, OR ANY OTHER 26
COMPLICATION AS REQU IRED BY THE SECRETARY; OR 27
6 SENATE BILL 1059
(II) A CESAREAN DELIVERY AT THE BIRTHING FACILIT Y, 1
INCLUDING MATERNAL H EMORRHAGE , INFECTION, OPERATIVE COMPLICATI ON, OR 2
ANY OTHER COMPLICATI ON AS REQUIRED BY TH E SECRETARY; AND 3
(4) QUALITATIVE MEASURES BASED ON PATIENT INP UT REGARDING 4
THE PATIENT’S RECEIPT OF RESPECTFUL OBSTETRIC CARE. 5
(C) THE REPORT CARD SCORE SHALL BE BALANCED FO R THE RISKS 6
ASSOCIATED WITH THE LEVEL OF ACUITY CARE PROVIDED FOR OBSTETR IC 7
PATIENTS SERVED BY T HE BIRTHING FACILITY . 8
(D) THE DEPARTMENT SHALL INCL UDE THE MOST RECENT REPORT CARD 9
ON THE DEPARTMENT ’S WEBSITE. 10
(E) (1) AT LEAST ANNUALLY , THE SECRETARY SHALL : 11
(I) REVIEW THE CRITERIA E VALUATED IN THE REPO RT CARD; 12
AND 13
(II) REVISE THE COMPLICATI ONS OR OTHER FACTORS TO BE 14
INCLUDED IN THE REPO RT CARD. 15
(2) THE SECRETARY SHALL CONSIDER EXPERT GUID ANCE WHEN 16
REVIEWING THE CRITER IA EVALUATED IN THE REPORT CARD . 17
SECTION 2. AND BE IT FURTHER ENACTED, That: 18
(a) The Maryland Department of Health, in collaboration with the Maryland 19
Hospital Association and local health departments, shall study the incidents of Severe 20
Maternal Morbidity (SMM) in the State to: 21
(1) identify the contextual drivers and trends in the risk factors associated 22
with individuals experiencing SMM; and 23
(2) make recommendations to reduce the incidents of SMM in the State. 24
(b) On or before December 1, 2025, the Department shall report the findings and 25
recommendations from the study conducted under subsection (a) of this section to the 26
Governor and, in accordance with § 2–1257 of the State Government Article, the General 27
Assembly. 28
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 29
October 1, 2024. 30