EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb1045*
HOUSE BILL 1045
J5, J1 5lr2591
CF SB 940
By: Delegates Pena–Melnyk, Cullison, Martinez, and White Holland
Introduced and read first time: February 5, 2025
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Health Insurance and Family Planning Services – Consumer Protections – 2
Updates 3
FOR the purpose of updating references to federal law related to family planning services, 4
grandfathered plans, explanation of benefits, summaries of benefits and coverage, 5
medical loss ratios, catastrophic plans, annual limits for cost sharing, prescription 6
drugs, and rescissions; updating references related to funding for the Family 7
Planning Program and access to family planning services under the Maryland 8
Medical Assistance Program; altering the definition of “family planning providers” 9
to include providers that lost certain federal funding for certain reasons; providing 10
that the Maryland Insurance Commissioner and the Commission on Civil Rights 11
have concurrent jurisdiction to enforce certain provisions of law related to 12
discrimination in health insurance; authorizing the Commissioner to adopt 13
regulations necessary to carry out certain provisions of law related to discrimination 14
in health insurance; and generally relating to health insurance, family planning 15
services, and consumer protections. 16
BY repealing and reenacting, with amendments, 17
Article – Health – General 18
Section 13–3401, 13–3402, and 15–102.1(b)(6) 19
Annotated Code of Maryland 20
(2023 Replacement Volume and 2024 Supplement) 21
BY repealing and reenacting, without amendments, 22
Article – Health – General 23
Section 15–101(a) and (h) 24
Annotated Code of Maryland 25
(2023 Replacement Volume and 2024 Supplement) 26
BY repealing and reenacting, with amendments, 27
Article – Insurance 28 2 HOUSE BILL 1045
Section 2–202(a), 15–1A–01(e), 15–1A–03(a), 15–1A–04, 15–1A–15(c), 15–1A–16(a) 1
and (e), 15–1A–18(d), 15–1A–19(c), 15–1A–20(c), 15–1A–21(c), and 2
15–1A–22(e) 3
Annotated Code of Maryland 4
(2017 Replacement Volume and 2024 Supplement) 5
BY repealing and reenacting, without amendments, 6
Article – Insurance 7
Section 15–1A–01(a) 8
Annotated Code of Maryland 9
(2017 Replacement Volume and 2024 Supplement) 10
BY adding to 11
Article – Insurance 12
Section 15–1A–22(f) 13
Annotated Code of Maryland 14
(2017 Replacement Volume and 2024 Supplement) 15
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 16
That the Laws of Maryland read as follows: 17
Article – Health – General 18
13–3401. 19
(a) In this subtitle the following words have the meanings indicated. 20
(b) “Family planning providers” means providers of services: 21
(1) Funded under Title X of the federal Public Health Service Act as of 22
December 31, [2016] 2024; and 23
(2) That lost eligibility for Title X funding as a result of the termination of 24
federal funding for providers because of: 25
(i) The scope of services offered by the providers; [or] 26
(ii) The scope of services for which the providers offer referrals, 27
COUNSELING , OR OTHER ACTIONS DES CRIBED IN RULES ESTA BLISHED BY THE U.S. 28
DEPARTMENT OF HEALTH AND HUMAN SERVICES; OR 29
(III) THE PROVISIONS OF FUN DING OR GRANTS TO EN TITIES OF 30
PROVIDERS DESCRIBED IN ITEM (I) OR (II) OF THIS ITEM. 31
(c) “Family planning services” means services provided under Title X of the 32
federal Public Health Service Act as of December 31, [2016] 2024. 33 HOUSE BILL 1045 3
(d) “Program” means the Family Planning Program established under § 13–3402 1
of this subtitle. 2
13–3402. 3
(a) There is a Family Planning Program in the Department. 4
(b) The purpose of the Program is to ensure the continuity of family planning 5
services in the State. 6
(c) The Program shall provide family planning services to individuals who are 7
eligible for family planning services through family planning providers that meet Program 8
requirements. 9
(d) The Department may adopt regulations to implement this subtitle, including 10
regulations establishing a sliding scale fee for services provided under the Program. 11
(e) Funding used to support family planning services under the Program shall be 12
in addition to any funding applied by the Department before December 31, [2016] 2024, to 13
the maintenance of effort requirement for federal funding under Title X of the federal Public 14
Health Service Act. 15
(f) (1) The Department may not accept any federal funding under Title X of 16
the federal Public Health Service Act if the Title X program: 17
(i) Excludes family planning providers; and 18
(ii) Does not require family planning providers to provide a broad 19
range of acceptable and effective medically approved family planning methods and services. 20
(2) If the Department does not accept Title X program funds in accordance 21
with paragraph (1) of this subsection, the Governor shall fund the Program with State 22
funds at the same level of total funds provided to the Program in the immediately preceding 23
fiscal year. 24
15–101. 25
(a) In this title the following words have the meanings indicated. 26
(h) “Program” means the Maryland Medical Assistance Program. 27
15–102.1. 28
(b) The Department shall, to the extent permitted, subject to the limitations of 29
the State budget: 30
4 HOUSE BILL 1045
(6) Ensure access to and the continuity of services provided by family 1
planning providers that were family planning providers in the Program as of December 31, 2
[2016] 2024, and were discontinued as recipients of federal funding under federal law or 3
regulation because of the scope of services offered by the provider or the scope of services 4
for which the provider offered referrals, by: 5
(i) Reimbursing for the Program services provided; and 6
(ii) Establishing Program requirements for the family planning 7
providers that: 8
1. Are similar to the requirements for other providers of the 9
same services; 10
2. Do not prohibit a provider from offering a service if the 11
service is within the scope of practice of the provider as established under the Health 12
Occupations Article; and 13
3. Do not limit the scope of services for which a provider may 14
offer referrals; 15
Article – Insurance 16
2–202. 17
(a) (1) Notwithstanding any other law and except as provided in paragraph (2) 18
of this subsection, the Commissioner has exclusive jurisdiction to enforce by administrative 19
action the laws of the State that relate to the underwriting or rate–setting practices of an 20
insurer. 21
(2) The Commission on Civil Rights has concurrent jurisdiction with the 22
Commissioner: 23
(I) over alleged discrimination on the basis of race, creed, color, or 24
national origin; AND 25
(II) FOR THE ENFORCEMENT OF § 15–1A–22 OF THIS ARTICLE . 26
15–1A–01. 27
(a) In this subtitle the following words have the meanings indicated. 28
(e) “Grandfathered plan” means a health benefit plan that: 29
HOUSE BILL 1045 5
(1) meets the criteria established under 45 C.F.R. § 147.140 and any 1
corresponding federal rules and guidance as those provisions were in effect [December 1, 2
2023] DECEMBER 31, 2024; or 3
(2) if the Commissioner adopts regulations as described in § 15–1A–03 of 4
this subtitle, meets the criteria established by the adopted regulations. 5
15–1A–03. 6
(a) For purposes of this subtitle, to the extent necessary, the Commissioner shall 7
adopt regulations that: 8
(1) establish criteria that a health benefit plan must meet to be considered 9
a grandfathered plan; and 10
(2) are consistent with 45 C.F.R. § 147.140 and any corresponding federal 11
rules and guidance as those provisions were in effect [December 1, 2023] DECEMBER 31, 12
2024. 13
15–1A–04. 14
For purposes of this subtitle, to the extent necessary, the Commissioner shall adopt 15
regulations that: 16
(1) establish criteria that a health benefit plan must meet to be considered 17
a health benefit plan that covers essential health benefits; and 18
(2) are consistent with 45 C.F.R. Part 156 Subpart B and any 19
corresponding federal rules and guidance as those provisions were in effect [December 1, 20
2023] DECEMBER 31, 2024. 21
15–1A–15. 22
(c) To the extent necessary, the Commissioner, in consultation with the Maryland 23
Health Benefit Exchange, shall adopt regulations that: 24
(1) establish standards for the summary of benefits and coverage; and 25
(2) are consistent with 45 C.F.R. § 147.200 and any corresponding federal 26
rules and guidance in effect [December 1, 2019] DECEMBER 31, 2024. 27
15–1A–16. 28
(a) (1) For purposes of this section, “medical loss ratio”: 29
(i) has the meaning established in 45 C.F.R. § 158.221; or 30 6 HOUSE BILL 1045
(ii) if the Commissioner adopts regulations as described in 1
paragraph (2) of this subsection, has the meaning established by the adopted regulations. 2
(2) To the extent necessary, the Commissioner shall adopt regulations that: 3
(i) establish a definition for “medical loss ratio”; and 4
(ii) are consistent with 45 C.F.R. § 158.221 and any corresponding 5
federal rules and guidance as those provisions were in effect [December 1, 2023] 6
DECEMBER 31, 2024. 7
(e) To the extent necessary, the Commissioner shall adopt regulations that: 8
(1) establish requirements for calculating medical loss ratios and related 9
reporting and rebate requirements; and 10
(2) are consistent with 45 C.F.R. Part 158 and any corresponding federal 11
rules and guidance as those provisions were in effect [December 1, 2023] DECEMBER 31, 12
2024. 13
15–1A–18. 14
(d) To the extent necessary, the Maryland Health Benefit Exchange shall adopt 15
regulations that: 16
(1) establish a process for issuing hardship exemptions and affordability 17
exemptions; and 18
(2) are consistent with 42 U.S.C. § 5000A and any corresponding federal 19
rules and guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 20
2024. 21
15–1A–19. 22
(c) To the extent necessary, the Commissioner shall adopt regulations that: 23
(1) establish annual limitations on cost–sharing; and 24
(2) are consistent with 45 C.F.R. § 156.130 and any corresponding federal 25
rules and guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 26
2024. 27
15–1A–20. 28
(c) To the extent necessary, the Commissioner shall adopt regulations that: 29 HOUSE BILL 1045 7
(1) establish criteria to determine whether an individual plan or a small 1
group plan provides prescription drug essential health benefit coverage; and 2
(2) are consistent with 45 C.F.R. § 156.122 and any corresponding federal 3
rules and guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 4
2024. 5
15–1A–21. 6
(c) To the extent necessary, the Commissioner shall adopt regulations that: 7
(1) establish requirements that a carrier shall comply with to rescind 8
coverage under subsection (b) of this section; and 9
(2) are consistent with 45 C.F.R. § 147.128 and any federal rules and 10
guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 2024. 11
15–1A–22. 12
(e) The COMMISSIONER AND THE Commission on Civil Rights shall enforce the 13
provisions of this section as provided for in § 2–202 of this article. 14
(F) THE COMMISSIONER MAY ADOP T REGULATIONS NECESS ARY TO CARRY 15
OUT THIS SECTION CONSIST ENT WITH FEDERAL STA TUTES, RULES, AND GUIDANCE 16
IN EFFECT ON DECEMBER 31, 2024. 17
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect June 18
1, 2025. 19