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.
*sb1059*
SENATE BILL 1059
J1, J3 4lr2537
CF HB 1051
By: Senator Ellis
Introduced and read first time: February 2, 2024
Assigned to: Finance
Committee Report: Favorable with amendments
Senate action: Adopted
Read second time: March 2, 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 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 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
(2023 Replacement Volume) 20
BY adding to 21
Article – Health – General 22 2 SENATE BILL 1059
Section 15–155, 19–310.4, and 19–3B–03.1; and 24–2401 and 24–2402 to be under 1
the new subtitle “Subtitle 24. Report Card for Birthing Facility Maternity 2
Care” 3
Annotated Code of Maryland 4
(2023 Replacement Volume) 5
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 6
That the Laws of Maryland read as follows: 7
Article – Health – General 8
15–101. 9
(a) In this title the following words have the meanings indicated. 10
(h) “Program” means the Maryland Medical Assistance Program. 11
(i) “Program recipient” means an individual who receives benefits under the 12
Program. 13
15–155. 14
(A) IN THIS SECTION, “PRENATAL RISK ASSESS MENT FORM ” MEANS A 15
STANDARDIZED FORM DE VELOPED BY THE DEPARTMENT IN ACCORDA NCE WITH 16
THE CENTERS FOR MEDICARE AND MEDICAID SERVICES GUIDELINES F OR USE BY 17
A LICENSED HEALTH CA RE PROVIDER TO EVALU ATE RISK FACTORS FOR THE 18
HEALTH OF A PREGNANT PATIEN T. 19
(B) A PROVIDER WHO RECEIVE S REIMBURSEMENT FROM THE PROGRAM 20
FOR PROVIDING OBSTET RIC SERVICES TO A PA TIENT SHALL COMPLETE A PRENATAL 21
RISK ASSESSMENT FORM FOR THE PATIENT : 22
(1) DURING DURING THE INITIAL VISIT WITH THE PATIENT ; AND 23
(2) DURING THE THIRD TRIM ESTER OF THE PATIENT ’S PREGNANCY . 24
(C) AFTER COMPLETING A PR ENATAL RISK ASSESSME NT FORM IN 25
ACCORDANCE WITH SUBS ECTION (B) OF THIS SECTION , THE PROVIDER SHALL 26
SUBMIT THE FORM TO T HE LOCAL HEALTH DEPA RTMENT FOR THE COUNT Y IN 27
WHICH THE PATIENT RE SIDES. 28
(D) ON OR BEFORE OCTOBER 1 EACH YEAR , EACH LOCAL HEALTH 29
DEPARTMENT SHALL SUB MIT TO THE DEPARTMENT A REPORT T HAT INCLUDES THE 30
NUMBER AND TYPE OF R EFERRALS MADE TO PAT IENTS THAT WERE BASE D ON THE 31 SENATE BILL 1059 3
INFORMATION FROM THE PRENATAL RIS K ASSESSMENT FORM CO MPLETED IN 1
ACCORDANCE WITH SUBS ECTION (B) OF THIS SECTION. 2
(E) THE DEPARTMENT SHALL ESTA BLISH A PROCESS FOR A PROVIDER TO 3
SUBMIT A PRENATAL RI SK ASSESSMENT FORM E LECTRONICALLY . 4
19–301. 5
(a) In this subtitle the following words have the meanings indicated. 6
(f) “Hospital” means an institution that: 7
(1) Has a group of at least 5 physicians who are organized as a medical 8
staff for the institution; 9
(2) Maintains facilities to provide, under the supervision of the medical 10
staff, diagnostic and treatment services for 2 or more unrelated individuals; and 11
(3) Admits or retains the individuals for overnight care. 12
19–310.4. 13
(A) IF A NEWBORN IS DELIV ERED IN A HOSPITAL F OLLOWING A HIGH –RISK 14
PREGNANCY , THE HOSPITAL SHALL : 15
(1) COMPLETE A POSTPARTUM INFANT AND MATERNAL REFERRAL 16
FORM AND SUBMIT THE FORM TO THE LOCAL HE ALTH DEPARTMENT FOR THE 17
COUNTY IN WHICH THE BIRTHING PARENT RESI DES; 18
(2) PROVIDE TO THE BIRTHI NG PARENT RESOURCES AND 19
INFORMATION SPECIFIC TO THE CIRCUMSTANCES OF THE BIRTHING PARENT , 20
INCLUDING INFORMATIO N REGARDING THE RISK S, SIGNS, PREVENTIVE MEASURES , 21
AND TREATMENT NEEDS FOR POSTPARTUM COMPL ICATIONS, INCLUDING 22
CARDIOVASCULAR CONDI TIONS, CHRONIC DISEASE , SUBSTANCE MISUSE , AND 23
MENTAL HEALTH CONDIT IONS; AND 24
(3) CALL THE BIRTHING PAR ENT WITHIN 12 AT LEAST 24, BUT NOT 25
LATER THAN 48, HOURS AFTER DISCHARG ING THE PARENT TO EV ALUATE THE 26
PARENT’S STATUS AND , AS NECESSARY , PROVIDE INFORMATION ABOUT 27
POSTPARTUM COMPLICAT IONS. 28
(B) ON OR BEFORE MAY OCTOBER 1 EACH YEAR, EACH LOCAL HEALTH 29
DEPARTMENT SHALL SUB MIT TO THE DEPARTMENT A REPORT T HAT INCLUDES THE 30
NUMBER AND TYPE OF R EFERRALS MADE BASED ON THE REFERRAL FORM S 31 4 SENATE BILL 1059
SUBMITTED TO THE LOC AL HEALTH DEPARTMENT IN ACCORDANCE WITH 1
SUBSECTION (A)(1) OF THIS SECTION. 2
(C) THE DEPARTMENT MAY NOT PROVID E MEDICAL ASSISTANCE 3
PROGRAM REIMBURSEMENT TO A HOSPITAL FOR SE RVICES RELATED TO TH E 4
DELIVERY OF A NEWBOR N FOLLOWING A HIGH –RISK PREGNANCY UNLES S THE 5
HOSPITAL COMPLIES WI TH SUBSECTION (A)(1) OF THIS SECTION. 6
19–3B–01. 7
(a) In this subtitle the following words have the meanings indicated. 8
(d) (1) “Freestanding birthing center” means a facility that provides nurse 9
midwife services under Title 8, Subtitle 6 of the Health Occupations Article. 10
(2) “Freestanding birthing center” does not include: 11
(i) A hospital regulated under Subtitle 2 of this title; or 12
(ii) The private residence of the mother. 13
19–3B–03.1. 14
(A) IF A NEWBORN IS DELIV ERED IN A FREESTANDI NG BIRTHING CENTER 15
FOLLOWING A HIGH –RISK PREGNANCY , THE FREESTANDING BIR THING CENTER 16
SHALL: 17
(1) COMPLETE A POSTPARTUM INFANT AND MATERNAL REFERRAL 18
FORM AND SUBMIT THE FORM TO THE LOCAL HE ALTH DEPARTMENT FOR THE 19
COUNTY IN WHICH THE BIRTHING PARENT RESI DES; 20
(2) PROVIDE TO THE BIRTHI NG PARENT RESOURCES AND 21
INFORMATION SPECI FIC TO THE CIRCUMSTA NCES OF THE BIRTHING PARENT, 22
INCLUDING INFORMATIO N REGARDING THE RISK S, SIGNS, PREVENTIVE MEASURES , 23
AND TREATMENT NEEDS FOR POSTPARTUM COMPL ICATIONS, INCLUDING 24
CARDIOVASCULAR CONDI TIONS, CHRONIC DISEASE , SUBSTANCE MISUSE , AND 25
MENTAL HEA LTH CONDITIONS ; AND 26
(3) CALL THE BIRTHING PAR ENT WITHIN 12 AT LEAST 24, BUT NOT 27
LATER THAN 48, HOURS AFTER DISCHARG ING THE PARENT TO EV ALUATE THE 28
PARENT’S STATUS AND , AS NECESSARY , PROVIDE INFORMATION ABOUT 29
POSTPARTUM COMPLICAT IONS. 30
(B) ON OR BEFORE MAY OCTOBER 1 EACH YEAR, EACH LOCAL HEALTH 31
DEPARTMENT SHALL SUB MIT TO THE DEPARTMENT A REPORT T HAT INCLUDES THE 32 SENATE BILL 1059 5
NUMBER AND TYPE OF R EFERRALS MADE BASED ON THE REFERRAL FORM S 1
SUBMITTED TO THE LOC AL HEALTH DEPARTMENT IN ACCORDANCE WITH 2
SUBSECTION (A)(1) OF THIS SECTION. 3
(C) THE DEPARTMENT MAY NOT PR OVIDE MEDICAL ASSISTANCE 4
PROGRAM REIMBURSEMENT TO A FREESTANDING BI RTHING CENTER FOR SE RVICES 5
RELATED TO THE DELIV ERY OF A NEWBORN FOL LOWING A HIGH –RISK PREGNANCY 6
UNLESS THE FREESTAND ING BIRTHING CENTER COMPLIES WITH SUBSECTION (A)(1) 7
OF THIS SECTION. 8
SUBTITLE 24. REPORT CARD FOR BIRTHING FACILITY MATERNITY CARE. 9
24–2401. 10
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANING 11
INDICATED. 12
(B) “BIRTHING FACILITY ” MEANS A FREESTANDING BIRTHING CENTER OR 13
A HOSPITAL THAT PROVIDES OBSTETRIC CARE . 14
(C) “FREESTANDING BIRTHING CENTER” HAS THE MEANING STAT ED IN § 15
19–3B–01 OF THIS ARTICLE. 16
(D) “HOSPITAL” HAS THE MEANING STAT ED IN § 19–301 OF THIS ARTICLE. 17
(E) “REPORT CARD” MEANS THE MARYLAND REPORT CARD FOR BIRTHING 18
FACILITY MATERNITY CARE DEVELOPED UNDER § 24–2402 OF THIS SUBTITLE. 19
24–2402. 20
(A) SUBJECT TO SUBSECTION S (B) AND (C) OF THIS SECTION , THE 21
SECRETARY, IN COLLABORATION WIT H THE MARYLAND HEALTH CARE 22
COMMISSION, SHALL: 23
(1) DEVELOP A MARYLAND REPORT CARD FOR BIRTHING FACILITY 24
MATERNITY CARE; AND 25
(2) COLLECT THE NECESSARY INFORMATION TO COMPL ETE AN 26
ANNUAL REPORT CARD F OR EACH BIRTHING FAC ILITY IN THE STATE. 27
(B) THE REPORT CARD SHALL INCLUDE THE FOLLOWIN G INFORMATION 28
FOR EACH BIRTHING FA CILITY, DISAGGREGATED BY RAC E AND AGE IN ACCORDA NCE 29
WITH BEST PRACTICES FOR DATA SUPPRESSION : 30
6 SENATE BILL 1059
(1) THE NUMBER AND RATE OF VAGINAL DELIVERIE S PERFORMED ; 1
(2) THE NUMBER AND RATE OF CESAREAN DELIVERI ES PERFORMED ; 2
(3) THE AGE–ADJUSTED RATE OF COMPLICATION S AND THE TOTAL 3
NUMBER OF COMPLICATI ONS EXPERIENCED BY A PATIENT RECEIVING OB STETRIC 4
CARE FOR: 5
(I) A VAGINAL DELIVERY AT THE BIRTHING FACILIT Y, 6
INCLUDING MATERNAL H EMORRHAGE , LACERATION, INFECTION, OR ANY OTHER 7
COMPLICATION AS REQU IRED BY THE SECRETARY; OR 8
(II) A CESAREAN DELIVERY AT THE BIRTHING FACILIT Y, 9
INCLUDING MATERNAL H EMORRHAGE , INFECTION, OPERATIVE COMPLICATI ON, OR 10
ANY OTHER COMPLICATI ON AS REQUIRED BY TH E SECRETARY; AND 11
(4) QUALITATIVE MEASURES BASED ON PATIENT INP UT REGARDING 12
THE PATIENT’S RECEIPT OF RESPECTFU L OBSTETRIC CARE . 13
(C) THE REPORT CARD SCORE SHALL BE BALANCED FO R THE RISKS 14
ASSOCIATED WITH THE LEVEL OF ACUITY CARE PROVIDED FOR OBSTETR IC 15
PATIENTS SERVED BY T HE BIRTHING FACILITY . 16
(D) THE DEPARTMENT SHALL INCL UDE THE MOST RECENT REPORT CARD 17
ON THE DEPARTMENT ’S WEBSITE. 18
(E) (1) AT LEAST ANNUALLY ONCE EVERY 3 YEARS, THE SECRETARY 19
SHALL: 20
(I) REVIEW THE CRITERIA E VALUATED IN THE REPO RT CARD; 21
AND 22
(II) REVISE THE COMPLICATI ONS OR OTHER FACTORS TO BE 23
INCLUDED IN THE REPO RT CARD. 24
(2) THE SECRETARY SHALL CONSI DER EXPERT GUIDANCE WHEN 25
REVIEWING THE CRITER IA EVALUATED IN THE REPORT CARD . 26
SECTION 2. AND BE IT FURTHER ENACTED, That: 27
(a) The Maryland Department of Health, in collaboration with the Maryland 28
Hospital Association and local health departments, shall study the incidents of Severe 29
Maternal Morbidity (SMM) in the State Each hospital and freestanding birthing center 30
shall participate in the Severe Maternal Morbidity Surveillance and Review Program to: 31
SENATE BILL 1059 7
(1) identify the contextual drivers and trends in the, risk factors associated 1
with individuals experiencing, and causes of SMM; and 2
(2) study quality improvement efforts of hospitals and freestanding 3
birthing centers regarding SMM based on the reviews; and 4
(3) make recommendations to reduce the incidents prevalence of SMM in 5
the State. 6
(b) On or before December 1, 2025, the Department Severe Maternal Morbidity 7
Surveillance and Review Program shall report the findings and recommendations from the 8
study conducted under subsection (a) of this section to the Governor and, in accordance 9
with § 2–1257 of the State Government Article, the General Assembly. 10
SECTION 3. AND BE IT FURTHER ENACTED, That Section 1 of this Act shall take 11
effect July 1, 2025. 12
SECTION 4. AND BE IT FURTHER ENACTED, That Section 2 of this Act shall take 13
effect October 1, 2024. 14
SECTION 3. 5. AND BE IT FURTHER ENACTED, That , except as provided in 15
Sections 3 and 4, this Act shall take effect October July 1, 2024. 16
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
President of the Senate.
________________________________________________________________________________
Speaker of the House of Delegates.