WES MOORE, Governor Ch. 798
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Chapter 798
(Senate Bill 1059)
AN ACT concerning
Maternal Health – Assessments, Referrals, and Reporting
(Maryland Maternal Health Act of 2024)
FOR the purpose of establishing requirements on local health departments and certain
health care providers and facilities regarding maternal health, including
requirements regarding prenatal risk assessment forms and postpartum infant and
maternal referral forms; prohibiting the Maryland Department of Health from
providing Medical Assistance Program reimbursement to a hospital or freestanding
birthing center unless the facility complies with certain provisions of this Act;
requiring the Secretary of Health, in collaboration with the Maryland Health Care
Commission, to develop a Maryland Report Card for Birthing Facility Maternity
Care; requiring the Department to conduct a certain study of incidents of severe
maternal morbidity in the State hospitals and freestanding birthing centers to
participate in the Severe Maternal Morbidity Surveillance Program for a certain
purpose; and generally relating to maternal health.
BY repealing and reenacting, without amendments,
Article – Health – General
Section 15–101(a), (h), and (i), 19–301(a) and (f), and 19–3B–01(a) and (d)
Annotated Code of Maryland
(2023 Replacement Volume)
BY adding to
Article – Health – General
Section 15–155, 19–310.4, and 19–3B–03.1; and 24–2401 and 24–2402 to be under
the new subtitle “Subtitle 24. Report Card for Birthing Facility Maternity
Care”
Annotated Code of Maryland
(2023 Replacement Volume)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Health – General
15–101.
(a) In this title the following words have the meanings indicated.
(h) “Program” means the Maryland Medical Assistance Program.
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(i) “Program recipient” means an individual who receives benefits under the
Program.
15–155.
(A) IN THIS SECTION, “PRENATAL RISK ASSESS MENT FORM ” MEANS A
STANDARDIZED FORM DE VELOPED BY THE DEPARTMENT IN ACCORDA NCE WITH
THE CENTERS FOR MEDICARE AND MEDICAID SERVICES GUIDELINES F OR USE BY
A LICENSED HEALTH CA RE PROVIDER TO EVALU ATE RISK FACTORS FOR THE
HEALTH OF A PREGNANT PATIENT .
(B) A PROVIDER WHO RECEIVE S REIMBURSEMENT FROM THE PROGRAM
FOR PROVIDING OBSTET RIC SERVICES TO A PA TIENT SHALL COMPLETE A PRENATAL
RISK ASSESSMENT FORM FOR THE PATIENT :
(1) DURING DURING THE INITIAL VISIT WITH THE PATIENT ; AND
(2) DURING THE THIRD TRIM ESTER OF THE PATIENT ’S PREGNANCY .
(C) AFTER COMPLETING A PR ENATAL RISK ASSESSME NT FORM IN
ACCORDANCE WITH SUBS ECTION (B) OF THIS SECTION , THE PROVIDER SHALL
SUBMIT THE FORM TO T HE LOCAL HEALTH DEPA RTMENT FOR THE COUNT Y IN
WHICH THE PATIENT RESIDES .
(D) ON OR BEFORE OCTOBER 1 EACH YEAR , EACH LOCAL HEALTH
DEPARTMENT SHALL SUB MIT TO THE DEPARTMENT A REPORT T HAT INCLUDES THE
NUMBER AND TYPE OF R EFERRALS MADE TO PAT IENTS THAT WERE BASE D ON THE
INFORMATION FROM THE PRENATAL RISK ASSE SSMENT FORM COMPLETE D IN
ACCORDANCE WITH SUBS ECTION (B) OF THIS SECTION.
(E) THE DEPARTMENT SHALL ESTA BLISH A PROCESS FOR A PROVIDER TO
SUBMIT A PRENATAL RI SK ASSESSMENT FORM E LECTRONICALLY .
19–301.
(a) In this subtitle the following words have the meanings indicated.
(f) “Hospital” means an institution that:
(1) Has a group of at least 5 physicians who are organized as a medical
staff for the institution;
(2) Maintains facilities to provide, under the supervision of the medical
staff, diagnostic and treatment services for 2 or more unrelated individuals; and WES MOORE, Governor Ch. 798
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(3) Admits or retains the individuals for overnight care.
19–310.4.
(A) IF A NEWBORN IS DELIV ERED IN A HOSPITAL F OLLOWING A HIGH –RISK
PREGNANCY , THE HOSPITAL SHALL :
(1) COMPLETE A POSTPARTUM INFANT AN D MATERNAL REFERRAL
FORM AND SUBMIT THE FORM TO THE LOCAL HE ALTH DEPARTMENT FOR THE
COUNTY IN WHICH THE BIRTHING PARENT RESI DES;
(2) PROVIDE TO THE BIRTHI NG PARENT RESOURCES AND
INFORMATION SPECIFIC TO THE CIRCUMSTANCES OF THE BIRTHI NG PARENT ,
INCLUDING INFORMATIO N REGARDING THE RISK S, SIGNS, PREVENTIVE MEASURES ,
AND TREATMENT NEEDS FOR POSTPARTUM COMPL ICATIONS, INCLUDING
CARDIOVASCULAR CONDI TIONS, CHRONIC DISEASE , SUBSTANCE MISUSE , AND
MENTAL HEALTH CONDIT IONS; AND
(3) CALL THE BIRTHING PARENT WITHIN 12 AT LEAST 24, BUT NOT
LATER THAN 48, HOURS AFTER DISCHARG ING THE PARENT TO EV ALUATE THE
PARENT’S STATUS AND , AS NECESSARY , PROVIDE INFORMATION ABOUT
POSTPARTUM COMPLICAT IONS.
(B) ON OR BEFORE MAY OCTOBER 1 EACH YEAR, EACH LOCAL HEA LTH
DEPARTMENT SHALL SUB MIT TO THE DEPARTMENT A REPORT T HAT INCLUDES THE
NUMBER AND TYPE OF R EFERRALS MADE BASED ON THE REFERRAL FORM S
SUBMITTED TO THE LOC AL HEALTH DEPARTMENT IN ACCORDANCE WITH
SUBSECTION (A)(1) OF THIS SECTION.
(C) THE DEPARTMENT MAY N OT PROVIDE MEDICAL ASSISTANCE
PROGRAM REIMBURSEMENT TO A HOSPITAL FOR SE RVICES RELATED TO TH E
DELIVERY OF A NEWBOR N FOLLOWING A HIGH –RISK PREGNANCY UNLES S THE
HOSPITAL COMPLIES WI TH SUBSECTION (A)(1) OF THIS SECTION.
19–3B–01.
(a) In this subtitle the following words have the meanings indicated.
(d) (1) “Freestanding birthing center” means a facility that provides nurse
midwife services under Title 8, Subtitle 6 of the Health Occupations Article.
(2) “Freestanding birthing center” does not include:
Ch. 798 2024 LAWS OF MARYLAND
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(i) A hospital regulated under Subtitle 2 of this title; or
(ii) The private residence of the mother.
19–3B–03.1.
(A) IF A NEWBORN IS DELIV ERED IN A FREESTANDI NG BIRTHING CENTER
FOLLOWING A HIGH –RISK PREGNANCY , THE FREESTANDING BIR THING CENTER
SHALL:
(1) COMPLETE A POSTPARTUM INFANT AND MATERNAL REFERRAL
FORM AND SUBMIT THE FORM TO THE LOCAL HE ALTH DEPARTMENT FOR THE
COUNTY IN WHICH THE BIRTHING PARENT RESI DES;
(2) PROVIDE TO THE BIRTHI NG PARENT RESOURCES AND
INFORMATION SPECIFIC TO THE CI RCUMSTANCES OF THE B IRTHING PARENT ,
INCLUDING INFORMATIO N REGARDING THE RISK S, SIGNS, PREVENTIVE MEASURES ,
AND TREATMENT NEEDS FOR POSTPARTUM COMPL ICATIONS, INCLUDING
CARDIOVASCULAR CONDI TIONS, CHRONIC DISEASE , SUBSTANCE MISUSE , AND
MENTAL HEALTH CONDIT IONS; AND
(3) CALL THE BIRTHING PAR ENT WITHIN 12 AT LEAST 24, BUT NOT
LATER THAN 48, HOURS AFTER DISCHARG ING THE PARENT TO EV ALUATE THE
PARENT’S STATUS AND , AS NECESSARY , PROVIDE INFORMATION ABOUT
POSTPARTUM COMPLICAT IONS.
(B) ON OR BEFORE MAY OCTOBER 1 EACH YEAR, EACH LOCAL HEALTH
DEPARTMENT SHALL SUB MIT TO THE DEPARTMENT A REPORT T HAT INCLUDES THE
NUMBER AND TYPE OF R EFERRALS MADE BASED ON THE REFERRAL FORM S
SUBMITTED TO THE LOC AL HEALTH DEPARTMENT IN ACCORDANCE WITH
SUBSECTION (A)(1) OF THIS SECTION.
(C) THE DEPARTMENT MAY NOT PR OVIDE MEDICAL ASSISTANCE
PROGRAM REIMBURSEMENT TO A FREESTANDING BI RTHING CENTER FOR SE RVICES
RELATED TO THE DELIV ERY OF A NEWBORN FOL LOWING A HIGH –RISK PREGNANCY
UNLESS THE FREESTAND ING BIRTHING CENTER COMPLIES WITH SUBSEC TION (A)(1)
OF THIS SECTION.
SUBTITLE 24. REPORT CARD FOR BIRTHING FACILITY MATERNITY CARE.
24–2401.
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(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANING
INDICATED.
(B) “BIRTHING FACILITY ” MEANS A FREESTANDING BIRTHING CENTER OR
A HOSPITAL THAT PRO VIDES OBSTETRIC CARE .
(C) “FREESTANDING BIRTHING CENTER” HAS THE MEANING STAT ED IN §
19–3B–01 OF THIS ARTICLE.
(D) “HOSPITAL” HAS THE MEANING STAT ED IN § 19–301 OF THIS ARTICLE.
(E) “REPORT CARD” MEANS THE MARYLAND REPORT CARD FOR BIRTHING
FACILITY MATERNITY CARE DEVELOPED UNDER § 24–2402 OF THIS SUBTITLE.
24–2402.
(A) SUBJECT TO SUBSECTION S (B) AND (C) OF THIS SECTION , THE
SECRETARY, IN COLLABORATION WIT H THE MARYLAND HEALTH CARE
COMMISSION, SHALL:
(1) DEVELOP A MARYLAND REPORT CARD FOR BIRTHING FACILITY
MATERNITY CARE; AND
(2) COLLECT THE NECESSARY INFORMATION TO COMPL ETE AN
ANNUAL REPORT CARD F OR EACH BIRTHING FAC ILITY IN THE STATE.
(B) THE REPORT CARD SHALL INCLUDE THE FOLLOWIN G INFORMATION
FOR EACH BIRTHING FA CILITY, DISAGGREGATED BY RAC E AND AGE IN ACCORDA NCE
WITH BEST PRACTICES FOR DATA SUPPRESSION :
(1) THE NUMBER AND RATE OF VAGINAL DELIVERIE S PERFORMED ;
(2) THE NUMBER AND RATE OF CESAREAN DELIVERI ES PERFORMED ;
(3) THE AGE–ADJUSTED RATE OF COMPLICATION S AND THE TOTAL
NUMBER OF COMPLICATI ONS EXPERIENCED BY A PATIENT RECEIVING OB STETRIC
CARE FOR:
(I) A VAGINAL DELIVERY AT THE BIRTHING FACILIT Y,
INCLUDING MATERNAL H EMORRHAGE , LACERATION, INFECTION, OR ANY OTHER
COMPLICATION AS REQU IRED BY THE SECRETARY; OR
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(II) A CESAREAN DELIVERY AT THE BIRTHING FACILIT Y,
INCLUDING MATERNAL H EMORRHAGE , INFECTION, OPERATIVE COMPLICATI ON, OR
ANY OTHER COMPLICATI ON AS REQUIRED BY TH E SECRETARY; AND
(4) QUALITATIVE MEASURES BASED ON PATIENT INP UT REGARDING
THE PATIENT’S RECEIPT OF RESPECTFU L OBSTETRIC CARE .
(C) THE REPORT CARD SCORE SHALL BE BALANCED FO R THE RISKS
ASSOCIATED WITH THE LEVEL OF ACUITY CARE PROVIDED FOR OBSTETR IC
PATIENTS SERVED BY T HE BIRTHING FACILITY .
(D) THE DEPARTMENT SHALL INCL UDE THE MOST RECENT REPORT CARD
ON THE DEPARTMENT ’S WEBSITE.
(E) (1) AT LEAST ANNUALLY ONCE EVERY 3 YEARS, THE SECRETARY
SHALL:
(I) REVIEW THE CRITERIA E VALUATED IN THE REPO RT CARD;
AND
(II) REVISE THE COMPLICATI ONS OR OTHER FACTORS TO BE
INCLUDED IN THE REPO RT CARD.
(2) THE SECRETARY SHALL CONSI DER EXPERT GUIDANCE WHEN
REVIEWING THE CRITER IA EVALUATED IN THE REPORT CARD .
SECTION 2. AND BE IT FURTHER ENACTED, That:
(a) The Maryland Department of Health, in collaboration with the Maryland
Hospital Association and local health departments, shall study the incidents of Severe
Maternal Morbidity (SMM) in the State Each hospital and freestanding birthing center
shall participate in the Severe Maternal Morbidity Surveillance and Review Program to:
(1) identify the contextual drivers and trends in the, risk factors associated
with individuals experiencing, and causes of SMM; and
(2) study quality improvement efforts of hospitals and freestanding
birthing centers regarding SMM based on the reviews; and
(3) make recommendations to reduce the incidents prevalence of SMM in
the State.
(b) On or before December 1, 2025, the Department Severe Maternal Morbidity
Surveillance and Review Program shall report the findings and recommendations from the WES MOORE, Governor Ch. 798
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study conducted under subsection (a) of this section to the Governor and, in accordance
with § 2–1257 of the State Government Article, the General Assembly.
SECTION 3. AND BE IT FURTHER ENACTED, That Section 1 of this Act shall take
effect July 1, 2025.
SECTION 4. AND BE IT FURTHER ENACTED, That Section 2 of this Act shall take
effect October 1, 2024.
SECTION 3. 5. AND BE IT FURTHER ENACTED, That , except as provided in
Sections 3 and 4, this Act shall take effect October July 1, 2024.
Approved by the Governor, Ma y 16, 2024.