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.
*hb1045*
HOUSE BILL 1045
J5, J1 5lr2591
CF SB 940
By: Delegates Pena –Melnyk, Cullison, Martinez , and White Holland
White Holland, Alston, Bagnall, Bhandari, Guzzone, Hill, S. Johnson,
Kaiser, Kerr, Lopez, Rosenberg, Ross, Taveras, Woods, and Woorman
Introduced and read first time: February 5, 2025
Assigned to: Health and Government Operations
Committee Report: Favorable with amendments
House action: Adopted
Read second time: February 27, 2025
CHAPTER ______
AN ACT concerning 1
Health Insurance and, Family Planning Services, and Confidentiality of Medical 2
Records – Consumer Protections – 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 altering the 10
definitions of “legally protected health care” and “sensitive health services” to include 11
gender–affirming care for purposes of law governing the disclosure of information 12
regarding sensitive health services; providing that the Maryland Insurance 13
Commissioner and the Commission on Civil Rights have concurrent jurisdiction to 14
enforce certain provisions of law related to discrimination in health insurance; 15
authorizing the Commissioner to adopt regulations necessary to carry out certain 16
provisions of law related to discrimination in health insurance; and generally 17
relating to health insurance, family planning services, and confidentiality of medical 18
records and consumer protections. 19
BY repealing and reenacting, with amendments, 20
Article – Health – General 21
Section 13–3401, 13–3402, and 15–102.1(b)(6) 22 2 HOUSE BILL 1045
Annotated Code of Maryland 1
(2023 Replacement Volume and 2024 Supplement) 2
BY repealing and reenacting, without amendments, 3
Article – Health – General 4
Section 15–101(a) and (h) 5
Annotated Code of Maryland 6
(2023 Replacement Volume and 2024 Supplement) 7
BY repealing and reenacting, without amendments, 8
Article – Health – General 9
Section 4–301(a) and 15–101(a) and (h) 10
Annotated Code of Maryland 11
(2023 Replacement Volume and 2024 Supplement) 12
BY repealing and reenacting, with amendments, 13
Article – Health – General 14
Section 4–301(j) and (r), 13–3401, 13–3402, and 15–102.1(b)(6) 15
Annotated Code of Maryland 16
(2023 Replacement Volume and 2024 Supplement) 17
BY repealing and reenacting, with amendments, 18
Article – Insurance 19
Section 2–202(a), 15–1A–01(e), 15–1A–03(a), 15–1A–04, 15–1A–15(c), 15–1A–16(a) 20
and (e), 15–1A–18(d), 15–1A–19(c), 15–1A–20(c), 15–1A–21(c), and 21
15–1A–22(e) 22
Annotated Code of Maryland 23
(2017 Replacement Volume and 2024 Supplement) 24
BY repealing and reenacting, without amendments, 25
Article – Insurance 26
Section 15–1A–01(a) 27
Annotated Code of Maryland 28
(2017 Replacement Volume and 2024 Supplement) 29
BY adding to 30
Article – Insurance 31
Section 15–1A–22(f) 32
Annotated Code of Maryland 33
(2017 Replacement Volume and 2024 Supplement) 34
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 35
That the Laws of Maryland read as follows: 36
Article – Health – General 37
4–301. 38 HOUSE BILL 1045 3
(a) In this subtitle the following words have the meanings indicated. 1
(j) “Legally protected health care” means all [reproductive] SENSITIVE health 2
services, medications, and supplies related to: 3
(1) The provision of abortion care; and 4
(2) [Other] REPRODUCTIVE HEALTH AND OT HER sensitive health 5
services as determined by the Secretary based on the recommendations of the Protected 6
Health Care Commission established under § 4–310 of this subtitle. 7
(r) “Sensitive health services” includes [reproductive]: 8
(1) REPRODUCTIVE health services other than abortion care; AND 9
(2) GENDER–AFFIRMING CARE . 10
13–3401. 11
(a) In this subtitle the following words have the meanings indicated. 12
(b) “Family planning providers” means providers of services: 13
(1) Funded under Title X of the federal Public Health Service Act as of 14
December 31, [2016] 2024; and 15
(2) That lost eligibility for Title X funding as a result of the termination of 16
federal funding for providers because of: 17
(i) The scope of services offered by the providers; [or] 18
(ii) The scope of services for which the providers offer referrals, 19
COUNSELING , OR OTHER ACTIONS DES CRIBED IN RULES ESTA BLISHED BY THE U.S. 20
DEPARTMENT OF HEALTH AND HUMAN SERVICES; OR 21
(III) THE PROVISIONS OF FUN DING OR GRANTS TO ENTITIES O F 22
PROVIDERS DESCRIBED IN ITEM (I) OR (II) OF THIS ITEM. 23
(c) “Family planning services” means services provided under Title X of the 24
federal Public Health Service Act as of December 31, [2016] 2024. 25
(d) “Program” means the Family Planning Program established under § 13–3402 26
of this subtitle. 27
13–3402. 28 4 HOUSE BILL 1045
(a) There is a Family Planning Program in the Department. 1
(b) The purpose of the Program is to ensure the continuity of family planning 2
services in the State. 3
(c) The Program shall provide family planning services to individuals who are 4
eligible for family planning services through family planning providers that meet Program 5
requirements. 6
(d) The Department may adopt regulations to implement this subtitle, including 7
regulations establishing a sliding scale fee for services provided under the Program. 8
(e) Funding used to support family planning services under the Program shall be 9
in addition to any funding applied by the Department before December 31, [2016] 2024, to 10
the maintenance of effort requirement for federal funding under Title X of the federal Public 11
Health Service Act. 12
(f) (1) The Department may not accept any federal funding under Title X of 13
the federal Public Health Service Act if the Title X program: 14
(i) Excludes family planning providers; and 15
(ii) Does not require family planning providers to provide a broad 16
range of acceptable and effective medically approved family planning methods and services. 17
(2) If the Department does not accept Title X program funds in accordance 18
with paragraph (1) of this subsection, the Governor shall fund the Program with State 19
funds at the same level of total funds provided to the Program in the immediately preceding 20
fiscal year. 21
15–101. 22
(a) In this title the following words have the meanings indicated. 23
(h) “Program” means the Maryland Medical Assistance Program. 24
15–102.1. 25
(b) The Department shall, to the extent permitted, subject to the limitations of 26
the State budget: 27
(6) Ensure access to and the continuity of services provided by family 28
planning providers that were family planning providers in the Program as of December 31, 29
[2016] 2024, and were discontinued as recipients of federal funding under federal law or 30
regulation because of the scope of services offered by the provider or the scope of services 31
for which the provider offered referrals, by: 32 HOUSE BILL 1045 5
(i) Reimbursing for the Program services provided; and 1
(ii) Establishing Program requirements for the family planning 2
providers that: 3
1. Are similar to the requirements for other providers of the 4
same services; 5
2. Do not prohibit a provider from offering a service if the 6
service is within the scope of practice of the provider as established under the Health 7
Occupations Article; and 8
3. Do not limit the scope of services for which a provider may 9
offer referrals; 10
Article – Insurance 11
2–202. 12
(a) (1) Notwithstanding any other law and except as provided in paragraph (2) 13
of this subsection, the Commissioner has exclusive jurisdiction to enforce by administrative 14
action the laws of the State that relate to the underwriting or rate–setting practices of an 15
insurer. 16
(2) The Commission on Civil Rights has concurrent jurisdiction with the 17
Commissioner: 18
(I) over alleged discrimination on the basis of race, creed, color, or 19
national origin; AND 20
(II) FOR THE ENFORCEMENT OF § 15–1A–22 OF THIS ARTICLE . 21
15–1A–01. 22
(a) In this subtitle the following words have the meanings indicated. 23
(e) “Grandfathered plan” means a health benefit plan that: 24
(1) meets the criteria established under 45 C.F.R. § 147.140 and any 25
corresponding federal rules and guidance as those provisions were in effect [December 1, 26
2023] DECEMBER 31, 2024; or 27
(2) if the Commissioner adopts regulations as described in § 15–1A–03 of 28
this subtitle, meets the criteria established by the adopted regulations. 29
6 HOUSE BILL 1045
15–1A–03. 1
(a) For purposes of this subtitle, to the extent necessary, the Commissioner shall 2
adopt regulations that: 3
(1) establish criteria that a health benefit plan must meet to be considered 4
a grandfathered plan; and 5
(2) are consistent with 45 C.F.R. § 147.140 and any corresponding federal 6
rules and guidance as those provisions were in effect [December 1, 2023] DECEMBER 31, 7
2024. 8
15–1A–04. 9
For purposes of this subtitle, to the extent necessary, the Commissioner shall adopt 10
regulations that: 11
(1) establish criteria that a health benefit plan must meet to be considered 12
a health benefit plan that covers essential health benefits; and 13
(2) are consistent with 45 C.F.R. Part 156 Subpart B and any 14
corresponding federal rules and guidance as those provisions were in effect [December 1, 15
2023] DECEMBER 31, 2024. 16
15–1A–15. 17
(c) To the extent necessary, the Commissioner, in consultation with the Maryland 18
Health Benefit Exchange, shall adopt regulations that: 19
(1) establish standards for the summary of benefits and coverage; and 20
(2) are consistent with 45 C.F.R. § 147.200 and any corresponding federal 21
rules and guidance in effect [December 1, 2019] DECEMBER 31, 2024. 22
15–1A–16. 23
(a) (1) For purposes of this section, “medical loss ratio”: 24
(i) has the meaning established in 45 C.F.R. § 158.221; or 25
(ii) if the Commissioner adopts regulations as described in 26
paragraph (2) of this subsection, has the meaning established by the adopted regulations. 27
(2) To the extent necessary, the Commissioner shall adopt regulations that: 28
(i) establish a definition for “medical loss ratio”; and 29
HOUSE BILL 1045 7
(ii) are consistent with 45 C.F.R. § 158.221 and any corresponding 1
federal rules and guidance as those provisions were in effect [December 1, 2023] 2
DECEMBER 31, 2024. 3
(e) To the extent necessary, the Commissioner shall adopt regulations that: 4
(1) establish requirements for calculating medical loss ratios and related 5
reporting and rebate requirements; and 6
(2) are consistent with 45 C.F.R. Part 158 and any corresponding federal 7
rules and guidance as those provisions were in effect [December 1, 2023] DECEMBER 31, 8
2024. 9
15–1A–18. 10
(d) To the extent necessary, the Maryland Health Benefit Exchange shall adopt 11
regulations that: 12
(1) establish a process for issuing hardship exemptions and affordability 13
exemptions; and 14
(2) are consistent with 42 U.S.C. § 5000A and any corresponding federal 15
rules and guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 16
2024. 17
15–1A–19. 18
(c) To the extent necessary, the Commissioner shall adopt regulations that: 19
(1) establish annual limitations on cost–sharing; and 20
(2) are consistent with 45 C.F.R. § 156.130 and any corresponding federal 21
rules and guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 22
2024. 23
15–1A–20. 24
(c) To the extent necessary, the Commissioner shall adopt regulations that: 25
(1) establish criteria to determine whether an individual plan or a small 26
group plan provides prescription drug essential health benefit coverage; and 27
(2) are consistent with 45 C.F.R. § 156.122 and any corresponding federal 28
rules and guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 29
2024. 30
8 HOUSE BILL 1045
15–1A–21. 1
(c) To the extent necessary, the Commissioner shall adopt regulations that: 2
(1) establish requirements that a carrier shall comply with to rescind 3
coverage under subsection (b) of this section; and 4
(2) are consistent with 45 C.F.R. § 147.128 and any federal rules and 5
guidance as those provisions were in effect [December 1, 2019] DECEMBER 31, 2024. 6
15–1A–22. 7
(e) The COMMISSIONER AND THE Commission on Civil Rights shall enforce the 8
provisions of this section as provided for in § 2–202 of this article. 9
(F) THE COMMISSIONER MAY ADOP T REGULATIONS NECESS ARY TO CARRY 10
OUT THIS SECTION CON SISTENT WITH FEDERAL STATUTES, RULES, AND GUIDANCE 11
IN EFFECT ON DECEMBER 31, 2024. 12
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect June 13
1, 2025. 14
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.