Maryland 2025 Regular Session

Maryland House Bill HB1045 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2	2
3	3		EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
4	4		[Brackets] indicate matter deleted from existing law.
5		-	Underlining indicates amendments to bill.
6		-	Strike out indicates matter stricken from the bill by amendment or deleted from the law by
7		-	amendment.
8	5		hb1045
9	6
10	7		HOUSE BILL 1045
11	8		J5, J1 5lr2591
12	9		CF SB 940
13	10		By: Delegates Pena–Melnyk, Cullison, Martinez, and White Holland
14		-	White Holland, Alston, Bagnall, Bhandari, Guzzone, Hill, S. Johnson,
15		-	Kaiser, Kerr, Lopez, Rosenberg, Ross, Taveras, Woods, and Woorman
16	11		Introduced and read first time: February 5, 2025
17	12		Assigned to: Health and Government Operations
18		-	Committee Report: Favorable with amendments
19		-	House action: Adopted
20		-	Read second time: February 27, 2025
21	13
22		-	~~CHAPTER ______~~
	14	+	A BILL ENTITLED
23	15
24	16		AN ACT concerning 1
25	17
26		-	Health Insurance and, Family Planning Services~~, and Confidentiality of Medical~~ 2
27		-	~~Records – Consumer Protections –~~ Updates 3
	18	+	Health Insurance and Family Planning Services – Consumer Protections – 2
	19	+	Updates 3
28	20
29	21		FOR the purpose of updating references to federal law related to family planning services, 4
30	22		grandfathered plans, explanation of benefits, summaries of benefits and coverage, 5
31	23		medical loss ratios, catastrophic plans, annual limits for cost sharing, prescription 6
32	24		drugs, and rescissions; updating references related to funding for the Family 7
33	25		Planning Program and access to family planning services under the Maryland 8
34	26		Medical Assistance Program; altering the definition of “family planning providers” 9
35		-	to include providers that lost certain federal funding for certain reasons altering the 10
36		-	definitions of “legally protected health care” and “sensitive health services” to include 11
37		-	gender–affirming care for purposes of law governing the disclosure of information 12
38		-	regarding sensitive health services; providing that the Maryland Insurance 13
39		-	Commissioner and the Commission on Civil Rights have concurrent jurisdiction to 14
40		-	enforce certain provisions of law related to discrimination in health insurance; 15
41		-	authorizing the Commissioner to adopt regulations necessary to carry out certain 16
42		-	provisions of law related to discrimination in health insurance; and generally 17
43		-	relating to health insurance, family planning services, and confidentiality of medical 18
44		-	records and consumer protections. 19
	27	+	to include providers that lost certain federal funding for certain reasons; providing 10
	28	+	that the Maryland Insurance Commissioner and the Commission on Civil Rights 11
	29	+	have concurrent jurisdiction to enforce certain provisions of law related to 12
	30	+	discrimination in health insurance; authorizing the Commissioner to adopt 13
	31	+	regulations necessary to carry out certain provisions of law related to discrimination 14
	32	+	in health insurance; and generally relating to health insurance, family planning 15
	33	+	services, and consumer protections. 16
45	34
46		-	BY repealing and reenacting, with amendments, 20
47		-	Article – Health – General 21
48		-	Section 13–3401, 13–3402, and 15–102.1(b)(6) 22 2 HOUSE BILL 1045
	35	+	BY repealing and reenacting, with amendments, 17
	36	+	Article – Health – General 18
	37	+	Section 13–3401, 13–3402, and 15–102.1(b)(6) 19
	38	+	Annotated Code of Maryland 20
	39	+	(2023 Replacement Volume and 2024 Supplement) 21
	40	+
	41	+	BY repealing and reenacting, without amendments, 22
	42	+	Article – Health – General 23
	43	+	Section 15–101(a) and (h) 24
	44	+	Annotated Code of Maryland 25
	45	+	(2023 Replacement Volume and 2024 Supplement) 26
	46	+
	47	+	BY repealing and reenacting, with amendments, 27
	48	+	Article – Insurance 28 2 HOUSE BILL 1045
49	49
50	50
51		-	Annotated Code of Maryland 1
52		-	(2023 Replacement Volume and 2024 Supplement) 2
	51	+	Section 2–202(a), 15–1A–01(e), 15–1A–03(a), 15–1A–04, 15–1A–15(c), 15–1A–16(a) 1
	52	+	and (e), 15–1A–18(d), 15–1A–19(c), 15–1A–20(c), 15–1A–21(c), and 2
	53	+	15–1A–22(e) 3
	54	+	Annotated Code of Maryland 4
	55	+	(2017 Replacement Volume and 2024 Supplement) 5
53	56
54		-	BY repealing and reenacting, without amendments, 3
55		-	Article – ~~Health – General 4~~
56		-	Section 15–~~101~~(a) ~~and (h) 5~~
57		-	Annotated Code of Maryland 6
58		-	(~~2023~~ Replacement Volume and 2024 Supplement) 7
	57	+	BY repealing and reenacting, without amendments, 6
	58	+	Article – Insurance 7
	59	+	Section 15–1A–01(a) 8
	60	+	Annotated Code of Maryland 9
	61	+	(2017 Replacement Volume and 2024 Supplement) 10
59	62
60		-	BY ~~repealing and reenacting,~~ ~~without amendments, 8~~
61		-	Article – ~~Health – General 9~~
62		-	Section ~~4–301(a) and~~ 15–~~101~~(a) ~~and (h) 10~~
63		-	Annotated Code of Maryland 11
64		-	(~~2023~~ Replacement Volume and 2024 Supplement) 12
	63	+	BY adding to 11
	64	+	Article – Insurance 12
	65	+	Section 15–1A–22(f) 13
	66	+	Annotated Code of Maryland 14
	67	+	(2017 Replacement Volume and 2024 Supplement) 15
65	68
66		-	BY repealing and reenacting, with amendments, 13
67		-	Article – Health – General 14
68		-	Section 4–301(j) and (r), 13–3401, 13–3402, and 15–102.1(b)(6) 15
69		-	Annotated Code of Maryland 16
70		-	(2023 Replacement Volume and 2024 Supplement) 17
	69	+	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 16
	70	+	That the Laws of Maryland read as follows: 17
71	71
72		-	BY repealing and reenacting, with amendments, 18
73		-	Article – Insurance 19
74		-	Section 2–202(a), 15–1A–01(e), 15–1A–03(a), 15–1A–04, 15–1A–15(c), 15–1A–16(a) 20
75		-	and (e), 15–1A–18(d), 15–1A–19(c), 15–1A–20(c), 15–1A–21(c), and 21
76		-	15–1A–22(e) 22
77		-	Annotated Code of Maryland 23
78		-	(2017 Replacement Volume and 2024 Supplement) 24
	72	+	Article – Health – General 18
79	73
80		-	BY repealing and reenacting, without amendments, 25
81		-	Article – Insurance 26
82		-	Section 15–1A–01(a) 27
83		-	Annotated Code of Maryland 28
84		-	(2017 Replacement Volume and 2024 Supplement) 29
	74	+	13–3401. 19
85	75
86		-	BY adding to 30
87		-	Article – Insurance 31
88		-	Section 15–1A–22(f) 32
89		-	Annotated Code of Maryland 33
90		-	(2017 Replacement Volume and 2024 Supplement) 34
	76	+	(a) In this subtitle the following words have the meanings indicated. 20
91	77
92		-	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 35
93		-	That the Laws of Maryland read as follows: 36
	78	+	(b) “Family planning providers” means providers of services: 21
94	79
95		-	Article – Health – General 37
	80	+	(1) Funded under Title X of the federal Public Health Service Act as of 22
	81	+	December 31, [2016] 2024; and 23
96	82
97		-	4–301. 38 HOUSE BILL 1045 3
	83	+	(2) That lost eligibility for Title X funding as a result of the termination of 24
	84	+	federal funding for providers because of: 25
	85	+
	86	+	(i) The scope of services offered by the providers; [or] 26
	87	+
	88	+	(ii) The scope of services for which the providers offer referrals, 27
	89	+	COUNSELING , OR OTHER ACTIONS DES CRIBED IN RULES ESTA BLISHED BY THE U.S. 28
	90	+	DEPARTMENT OF HEALTH AND HUMAN SERVICES; OR 29
	91	+
	92	+	(III) THE PROVISIONS OF FUN DING OR GRANTS TO EN TITIES OF 30
	93	+	PROVIDERS DESCRIBED IN ITEM (I) OR (II) OF THIS ITEM. 31
	94	+
	95	+	(c) “Family planning services” means services provided under Title X of the 32
	96	+	federal Public Health Service Act as of December 31, [2016] 2024. 33 HOUSE BILL 1045 3
98	97
99	98
100	99
101		-	(a) In this subtitle the following words have the meanings indicated. 1
	100	+	(d) “Program” means the Family Planning Program established under § 13–3402 1
	101	+	of this subtitle. 2
102	102
103		-	(j) “Legally protected health care” means all [reproductive] SENSITIVE health 2
104		-	services, medications, and supplies related to: 3
	103	+	13–3402. 3
105	104
106		-	(1) The ~~provision of abortion care; and~~ 4
	105	+	(a) There is a Family Planning Program in the Department. 4
107	106
108		-	(2) [Other] REPRODUCTIVE HEALTH AND OT HER sensitive health 5
109		-	services as determined by the Secretary based on the recommendations of the Protected 6
110		-	Health Care Commission established under § 4–310 of this subtitle. 7
	107	+	(b) The purpose of the Program is to ensure the continuity of family planning 5
	108	+	services in the State. 6
111	109
112		-	(r) “Sensitive health services” includes [reproductive]: 8
	110	+	(c) The Program shall provide family planning services to individuals who are 7
	111	+	eligible for family planning services through family planning providers that meet Program 8
	112	+	requirements. 9
113	113
114		-	(1) REPRODUCTIVE health services other than abortion care; AND 9
	114	+	(d) The Department may adopt regulations to implement this subtitle, including 10
	115	+	regulations establishing a sliding scale fee for services provided under the Program. 11
115	116
116		-	(2) GENDER–AFFIRMING CARE . 10
	117	+	(e) Funding used to support family planning services under the Program shall be 12
	118	+	in addition to any funding applied by the Department before December 31, [2016] 2024, to 13
	119	+	the maintenance of effort requirement for federal funding under Title X of the federal Public 14
	120	+	Health Service Act. 15
117	121
118		-	13–3401. 11
	122	+	(f) (1) The Department may not accept any federal funding under Title X of 16
	123	+	the federal Public Health Service Act if the Title X program: 17
119	124
120		-	(a) ~~In this subtitle the following words have the meanings indicated. 12~~
	125	+	(i) Excludes family planning providers; and 18
121	126
122		-	(b) “Family planning providers” means providers of services: 13
	127	+	(ii) Does not require family planning providers to provide a broad 19
	128	+	range of acceptable and effective medically approved family planning methods and services. 20
123	129
124		-	(1) Funded under Title X of the federal Public Health Service Act as of 14
125		-	December 31, [2016] 2024; and 15
	130	+	(2) If the Department does not accept Title X program funds in accordance 21
	131	+	with paragraph (1) of this subsection, the Governor shall fund the Program with State 22
	132	+	funds at the same level of total funds provided to the Program in the immediately preceding 23
	133	+	fiscal year. 24
126	134
127		-	(2) That lost eligibility for Title X funding as a result of the termination of 16
128		-	federal funding for providers because of: 17
	135	+	15–101. 25
129	136
130		-	(i) The ~~scope of services offered by~~ the ~~providers; [or] 18~~
	137	+	(a) In this title the following words have the meanings indicated. 26
131	138
132		-	(ii) The scope of services for which the providers offer referrals, 19
133		-	COUNSELING , OR OTHER ACTIONS DES CRIBED IN RULES ESTA BLISHED BY THE U.S. 20
134		-	DEPARTMENT OF HEALTH AND HUMAN SERVICES; OR 21
	139	+	(h) “Program” means the Maryland Medical Assistance Program. 27
135	140
136		-	(III) THE PROVISIONS OF FUN DING OR GRANTS TO ENTITIES O F 22
137		-	PROVIDERS DESCRIBED IN ITEM (I) OR (II) OF THIS ITEM. 23
	141	+	15–102.1. 28
138	142
139		-	(c) “Family planning services” means services provided under Title X of the 24
140		-	federal Public Health Service Act as of December 31, [2016] 2024. 25
	143	+	(b) The Department shall, to the extent permitted, subject to the limitations of 29
	144	+	the State budget: 30
	145	+	4 HOUSE BILL 1045
141	146
142		-	(d) “Program” means the Family Planning Program established under § 13–3402 26
143		-	of this subtitle. 27
144	147
145		-	13–3402. 28 4 HOUSE BILL 1045
	148	+	(6) Ensure access to and the continuity of services provided by family 1
	149	+	planning providers that were family planning providers in the Program as of December 31, 2
	150	+	[2016] 2024, and were discontinued as recipients of federal funding under federal law or 3
	151	+	regulation because of the scope of services offered by the provider or the scope of services 4
	152	+	for which the provider offered referrals, by: 5
	153	+
	154	+	(i) Reimbursing for the Program services provided; and 6
	155	+
	156	+	(ii) Establishing Program requirements for the family planning 7
	157	+	providers that: 8
	158	+
	159	+	1. Are similar to the requirements for other providers of the 9
	160	+	same services; 10
	161	+
	162	+	2. Do not prohibit a provider from offering a service if the 11
	163	+	service is within the scope of practice of the provider as established under the Health 12
	164	+	Occupations Article; and 13
	165	+
	166	+	3. Do not limit the scope of services for which a provider may 14
	167	+	offer referrals; 15
	168	+
	169	+	Article – Insurance 16
	170	+
	171	+	2–202. 17
	172	+
	173	+	(a) (1) Notwithstanding any other law and except as provided in paragraph (2) 18
	174	+	of this subsection, the Commissioner has exclusive jurisdiction to enforce by administrative 19
	175	+	action the laws of the State that relate to the underwriting or rate–setting practices of an 20
	176	+	insurer. 21
	177	+
	178	+	(2) The Commission on Civil Rights has concurrent jurisdiction with the 22
	179	+	Commissioner: 23
	180	+
	181	+	(I) over alleged discrimination on the basis of race, creed, color, or 24
	182	+	national origin; AND 25
	183	+
	184	+	(II) FOR THE ENFORCEMENT OF § 15–1A–22 OF THIS ARTICLE . 26
	185	+
	186	+	15–1A–01. 27
	187	+
	188	+	(a) In this subtitle the following words have the meanings indicated. 28
	189	+
	190	+	(e) “Grandfathered plan” means a health benefit plan that: 29
	191	+	HOUSE BILL 1045 5
	192	+
	193	+
	194	+	(1) meets the criteria established under 45 C.F.R. § 147.140 and any 1
	195	+	corresponding federal rules and guidance as those provisions were in effect [December 1, 2
	196	+	2023] DECEMBER 31, 2024; or 3
	197	+
	198	+	(2) if the Commissioner adopts regulations as described in § 15–1A–03 of 4
	199	+	this subtitle, meets the criteria established by the adopted regulations. 5
	200	+
	201	+	15–1A–03. 6
	202	+
	203	+	(a) For purposes of this subtitle, to the extent necessary, the Commissioner shall 7
	204	+	adopt regulations that: 8
	205	+
	206	+	(1) establish criteria that a health benefit plan must meet to be considered 9
	207	+	a grandfathered plan; and 10
	208	+
	209	+	(2) are consistent with 45 C.F.R. § 147.140 and any corresponding federal 11
	210	+	rules and guidance as those provisions were in effect [December 1, 2023] DECEMBER 31, 12
	211	+	2024. 13
	212	+
	213	+	15–1A–04. 14
	214	+
	215	+	For purposes of this subtitle, to the extent necessary, the Commissioner shall adopt 15
	216	+	regulations that: 16
	217	+
	218	+	(1) establish criteria that a health benefit plan must meet to be considered 17
	219	+	a health benefit plan that covers essential health benefits; and 18
	220	+
	221	+	(2) are consistent with 45 C.F.R. Part 156 Subpart B and any 19
	222	+	corresponding federal rules and guidance as those provisions were in effect [December 1, 20
	223	+	2023] DECEMBER 31, 2024. 21
	224	+
	225	+	15–1A–15. 22
	226	+
	227	+	(c) To the extent necessary, the Commissioner, in consultation with the Maryland 23
	228	+	Health Benefit Exchange, shall adopt regulations that: 24
	229	+
	230	+	(1) establish standards for the summary of benefits and coverage; and 25
	231	+
	232	+	(2) are consistent with 45 C.F.R. § 147.200 and any corresponding federal 26
	233	+	rules and guidance in effect [December 1, 2019] DECEMBER 31, 2024. 27
	234	+
	235	+	15–1A–16. 28
	236	+
	237	+	(a) (1) For purposes of this section, “medical loss ratio”: 29
	238	+
	239	+	(i) has the meaning established in 45 C.F.R. § 158.221; or 30 6 HOUSE BILL 1045
146	240
147	241
148	242
149		-	(a) There is a Family Planning Program in the Department. 1
	243	+	(ii) if the Commissioner adopts regulations as described in 1
	244	+	paragraph (2) of this subsection, has the meaning established by the adopted regulations. 2
150	245
151		-	(b) The purpose of the Program is to ensure the continuity of family planning 2
152		-	services in the State. 3
	246	+	(2) To the extent necessary, the Commissioner shall adopt regulations that: 3
153	247
154		-	(c) The Program shall provide family planning services to individuals who are 4
155		-	eligible for family planning services through family planning providers that meet Program 5
156		-	requirements. 6
	248	+	(i) establish a definition for “medical loss ratio”; and 4
157	249
158		-	(d) The Department may adopt regulations to implement this subtitle, including 7
159		-	regulations establishing a sliding scale fee for services provided under the Program. 8
	250	+	(ii) are consistent with 45 C.F.R. § 158.221 and any corresponding 5
	251	+	federal rules and guidance as those provisions were in effect [December 1, 2023] 6
	252	+	DECEMBER 31, 2024. 7
160	253
161		-	(e) Funding used to support family planning services under the Program shall be 9
162		-	in addition to any funding applied by the Department before December 31, [2016] 2024, to 10
163		-	the maintenance of effort requirement for federal funding under Title X of the federal Public 11
164		-	Health Service Act. 12
	254	+	(e) To the extent necessary, the Commissioner shall adopt regulations that: 8
165	255
166		-	~~(f)~~ (1) ~~The Department may not accept any federal funding under Title X of 13~~
167		-	~~the federal Public Health Service Act if the Title X program: 14~~
	256	+	(1) establish requirements for calculating medical loss ratios and related 9
	257	+	reporting and rebate requirements; and 10
168	258
169		-	(i) Excludes family planning providers; and 15
	259	+	(2) are consistent with 45 C.F.R. Part 158 and any corresponding federal 11
	260	+	rules and guidance as those provisions were in effect [December 1, 2023] DECEMBER 31, 12
	261	+	2024. 13
170	262
171		-	(ii) Does not require family planning providers to provide a broad 16
172		-	range of acceptable and effective medically approved family planning methods and services. 17
	263	+	15–1A–18. 14
173	264
174		-	(2) If the Department does not accept Title X program funds in accordance 18
175		-	with paragraph (1) of this subsection, the Governor shall fund the Program with State 19
176		-	funds at the same level of total funds provided to the Program in the immediately preceding 20
177		-	fiscal year. 21
	265	+	(d) To the extent necessary, the Maryland Health Benefit Exchange shall adopt 15
	266	+	regulations that: 16
178	267
179		-	15–101. 22
	268	+	(1) establish a process for issuing hardship exemptions and affordability 17
	269	+	exemptions; and 18
180	270
181		-	(a) In this title the following words have the meanings indicated. 23
	271	+	(2) are consistent with 42 U.S.C. § 5000A and any corresponding federal 19
	272	+	rules and guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 20
	273	+	2024. 21
182	274
183		-	~~(h) “Program” means the Maryland Medical Assistance Program~~. 24
	275	+	15–1A–19. 22
184	276
185		-	~~15–102.1. 25~~
	277	+	(c) To the extent necessary, the Commissioner shall adopt regulations that: 23
186	278
187		-	(b) The Department shall, to the extent permitted, subject to the limitations of 26
188		-	the State budget: 27
	279	+	(1) establish annual limitations on cost–sharing; and 24
189	280
190		-	(6) Ensure access to and the continuity of services provided by family 28
191		-	planning providers that were family planning providers in the Program as of December 31, 29
192		-	[2016] 2024, and were discontinued as recipients of federal funding under federal law or 30
193		-	regulation because of the scope of services offered by the provider or the scope of services 31
194		-	for which the provider offered referrals, by: 32 HOUSE BILL 1045 5
	281	+	(2) are consistent with 45 C.F.R. § 156.130 and any corresponding federal 25
	282	+	rules and guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 26
	283	+	2024. 27
	284	+
	285	+	15–1A–20. 28
	286	+
	287	+	(c) To the extent necessary, the Commissioner shall adopt regulations that: 29 HOUSE BILL 1045 7
195	288
196	289
197	290
198		-	(i) Reimbursing for the Program services provided; and 1
	291	+	(1) establish criteria to determine whether an individual plan or a small 1
	292	+	group plan provides prescription drug essential health benefit coverage; and 2
199	293
200		-	(ii) Establishing Program requirements for the family planning 2
201		-	providers that: 3
	294	+	(2) are consistent with 45 C.F.R. § 156.122 and any corresponding federal 3
	295	+	rules and guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 4
	296	+	2024. 5
202	297
203		-	1. Are similar to the requirements for other providers of the 4
204		-	same services; 5
	298	+	15–1A–21. 6
205	299
206		-	2. Do not prohibit a provider from offering a service if the 6
207		-	service is within the scope of practice of the provider as established under the Health 7
208		-	Occupations Article; and 8
	300	+	(c) To the extent necessary, the Commissioner shall adopt regulations that: 7
209	301
210		-	~~3. Do not limit the scope of services for which~~ a ~~provider may 9~~
211		-	~~offer referrals~~; 10
	302	+	(1) establish requirements that a carrier shall comply with to rescind 8
	303	+	coverage under subsection (b) of this section; and 9
212	304
213		-	Article – Insurance 11
	305	+	(2) are consistent with 45 C.F.R. § 147.128 and any federal rules and 10
	306	+	guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 2024. 11
214	307
215		-	2–~~202~~. 12
	308	+	15–1A–22. 12
216	309
217		-	(a) (1) Notwithstanding any other law and except as provided in paragraph (2) 13
218		-	of this subsection, the Commissioner has exclusive jurisdiction to enforce by administrative 14
219		-	action the laws of the State that relate to the underwriting or rate–setting practices of an 15
220		-	insurer. 16
	310	+	(e) The COMMISSIONER AND THE Commission on Civil Rights shall enforce the 13
	311	+	provisions of this section as provided for in § 2–202 of this article. 14
221	312
222		-	(2) The Commission on Civil Rights has concurrent jurisdiction with the 17
223		-	Commissioner: 18
	313	+	(F) THE COMMISSIONER MAY ADOP T REGULATIONS NECESS ARY TO CARRY 15
	314	+	OUT THIS SECTION CONSIST ENT WITH FEDERAL STA TUTES, RULES, AND GUIDANCE 16
	315	+	IN EFFECT ON DECEMBER 31, 2024. 17
224	316
225		-	(I) over alleged discrimination on the basis of race, creed, color, or 19
226		-	national origin; AND 20
227		-
228		-	(II) FOR THE ENFORCEMENT OF § 15–1A–22 OF THIS ARTICLE . 21
229		-
230		-	15–1A–01. 22
231		-
232		-	(a) In this subtitle the following words have the meanings indicated. 23
233		-
234		-	(e) “Grandfathered plan” means a health benefit plan that: 24
235		-
236		-	(1) meets the criteria established under 45 C.F.R. § 147.140 and any 25
237		-	corresponding federal rules and guidance as those provisions were in effect [December 1, 26
238		-	2023] DECEMBER 31, 2024; or 27
239		-
240		-	(2) if the Commissioner adopts regulations as described in § 15–1A–03 of 28
241		-	this subtitle, meets the criteria established by the adopted regulations. 29
242		-	6 HOUSE BILL 1045
243		-
244		-
245		-	15–1A–03. 1
246		-
247		-	(a) For purposes of this subtitle, to the extent necessary, the Commissioner shall 2
248		-	adopt regulations that: 3
249		-
250		-	(1) establish criteria that a health benefit plan must meet to be considered 4
251		-	a grandfathered plan; and 5
252		-
253		-	(2) are consistent with 45 C.F.R. § 147.140 and any corresponding federal 6
254		-	rules and guidance as those provisions were in effect [December 1, 2023] DECEMBER 31, 7
255		-	2024. 8
256		-
257		-	15–1A–04. 9
258		-
259		-	For purposes of this subtitle, to the extent necessary, the Commissioner shall adopt 10
260		-	regulations that: 11
261		-
262		-	(1) establish criteria that a health benefit plan must meet to be considered 12
263		-	a health benefit plan that covers essential health benefits; and 13
264		-
265		-	(2) are consistent with 45 C.F.R. Part 156 Subpart B and any 14
266		-	corresponding federal rules and guidance as those provisions were in effect [December 1, 15
267		-	2023] DECEMBER 31, 2024. 16
268		-
269		-	15–1A–15. 17
270		-
271		-	(c) To the extent necessary, the Commissioner, in consultation with the Maryland 18
272		-	Health Benefit Exchange, shall adopt regulations that: 19
273		-
274		-	(1) establish standards for the summary of benefits and coverage; and 20
275		-
276		-	(2) are consistent with 45 C.F.R. § 147.200 and any corresponding federal 21
277		-	rules and guidance in effect [December 1, 2019] DECEMBER 31, 2024. 22
278		-
279		-	15–1A–16. 23
280		-
281		-	(a) (1) For purposes of this section, “medical loss ratio”: 24
282		-
283		-	(i) has the meaning established in 45 C.F.R. § 158.221; or 25
284		-
285		-	(ii) if the Commissioner adopts regulations as described in 26
286		-	paragraph (2) of this subsection, has the meaning established by the adopted regulations. 27
287		-
288		-	(2) To the extent necessary, the Commissioner shall adopt regulations that: 28
289		-
290		-	(i) establish a definition for “medical loss ratio”; and 29
291		-	HOUSE BILL 1045 7
292		-
293		-
294		-	(ii) are consistent with 45 C.F.R. § 158.221 and any corresponding 1
295		-	federal rules and guidance as those provisions were in effect [December 1, 2023] 2
296		-	DECEMBER 31, 2024. 3
297		-
298		-	(e) To the extent necessary, the Commissioner shall adopt regulations that: 4
299		-
300		-	(1) establish requirements for calculating medical loss ratios and related 5
301		-	reporting and rebate requirements; and 6
302		-
303		-	(2) are consistent with 45 C.F.R. Part 158 and any corresponding federal 7
304		-	rules and guidance as those provisions were in effect [December 1, 2023] DECEMBER 31, 8
305		-	2024. 9
306		-
307		-	15–1A–18. 10
308		-
309		-	(d) To the extent necessary, the Maryland Health Benefit Exchange shall adopt 11
310		-	regulations that: 12
311		-
312		-	(1) establish a process for issuing hardship exemptions and affordability 13
313		-	exemptions; and 14
314		-
315		-	(2) are consistent with 42 U.S.C. § 5000A and any corresponding federal 15
316		-	rules and guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 16
317		-	2024. 17
318		-
319		-	15–1A–19. 18
320		-
321		-	(c) To the extent necessary, the Commissioner shall adopt regulations that: 19
322		-
323		-	(1) establish annual limitations on cost–sharing; and 20
324		-
325		-	(2) are consistent with 45 C.F.R. § 156.130 and any corresponding federal 21
326		-	rules and guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 22
327		-	2024. 23
328		-
329		-	15–1A–20. 24
330		-
331		-	(c) To the extent necessary, the Commissioner shall adopt regulations that: 25
332		-
333		-	(1) establish criteria to determine whether an individual plan or a small 26
334		-	group plan provides prescription drug essential health benefit coverage; and 27
335		-
336		-	(2) are consistent with 45 C.F.R. § 156.122 and any corresponding federal 28
337		-	rules and guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 29
338		-	2024. 30
339		-	8 HOUSE BILL 1045
340		-
341		-
342		-	15–1A–21. 1
343		-
344		-	(c) To the extent necessary, the Commissioner shall adopt regulations that: 2
345		-
346		-	(1) establish requirements that a carrier shall comply with to rescind 3
347		-	coverage under subsection (b) of this section; and 4
348		-
349		-	(2) are consistent with 45 C.F.R. § 147.128 and any federal rules and 5
350		-	guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 2024. 6
351		-
352		-	15–1A–22. 7
353		-
354		-	(e) The COMMISSIONER AND THE Commission on Civil Rights shall enforce the 8
355		-	provisions of this section as provided for in § 2–202 of this article. 9
356		-
357		-	(F) THE COMMISSIONER MAY ADOP T REGULATIONS NECESS ARY TO CARRY 10
358		-	OUT THIS SECTION CON SISTENT WITH FEDERAL STATUTES, RULES, AND GUIDANCE 11
359		-	IN EFFECT ON DECEMBER 31, 2024. 12
360		-
361		-	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect June 13
362		-	1, 2025. 14
363		-
364		-
365		-
366		-
367		-	Approved:
368		-	________________________________________________________________________________
369		-	Governor.
370		-	________________________________________________________________________________
371		-	Speaker of the House of Delegates.
372		-	________________________________________________________________________________
373		-	President of the Senate.
	317	+	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect June 18
	318	+	1, 2025. 19