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.
*hb1104*
HOUSE BILL 1104
J1 5lr0253
By: Chair, Health and Government Operations Committee (By Request –
Departmental – Health)
Introduced and read first time: February 5, 2025
Assigned to: Health and Government Operations and Appropriations
Committee Report: Favorable with amendments
House action: Adopted
Read second time: March 1, 2025
CHAPTER ______
AN ACT concerning 1
Maryland Department of Health – AHEAD Model Implementation – Electronic 2
Health Care Transactions and Population Health Improvement Fund 3
FOR the purpose of clarifying that electronic health care transactions information may be 4
used to support the participation of the State in the States Advancing All–Payer 5
Health Equity Approaches and Development (AHEAD) Model and any successor 6
models; establishing the Population Health Improvement Fund as a special, 7
nonlapsing fund to invest in population health improvements to support the 8
statewide population health targets under the AHEAD Model and any successor 9
models; requiring that interest earnings of the Fund be credited to the Fund; 10
authorizing the Health Services Cost Review Commission to assess a certain amount 11
in hospital rates to be credited to the Fund; and generally relating to the 12
implementation of the AHEAD Model. 13
BY repealing and reenacting, with amendments, 14
Article – Health – General 15
Section 4–302.3(f)(3)(i), (h)(1), and (j)(3) 16
Annotated Code of Maryland 17
(2023 Replacement Volume and 2024 Supplement) 18
BY adding to 19
Article – Health – General 20
Section 13–5501 and 13–5502 to be under the new subtitle “Subtitle 55. Population 21
Health Improvement Fund” 22 2 HOUSE BILL 1104
Annotated Code of Maryland 1
(2023 Replacement Volume and 2024 Supplement) 2
BY repealing and reenacting, without amendments, 3
Article – State Finance and Procurement 4
Section 6–226(a)(2)(i) 5
Annotated Code of Maryland 6
(2021 Replacement Volume and 2024 Supplement) 7
BY repealing and reenacting, with amendments, 8
Article – State Finance and Procurement 9
Section 6–226(a)(2)(ii)204. and 205. 10
Annotated Code of Maryland 11
(2021 Replacement Volume and 2024 Supplement) 12
BY adding to 13
Article – State Finance and Procurement 14
Section 6–226(a)(2)(ii)206. 15
Annotated Code of Maryland 16
(2021 Replacement Volume and 2024 Supplement) 17
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 18
That the Laws of Maryland read as follows: 19
Article – Health – General 20
4–302.3. 21
(f) (3) (i) If approved by the Maryland Health Care Commission, the 22
information submitted under paragraph (1) of this subsection may be combined with other 23
data maintained by the State–designated health information exchange to facilitate: 24
1. A State health improvement program; 25
2. Mitigation of a public health emergency; [and] 26
3. Improvement of patient safety; AND 27
4. THE PARTICIPATION OF THE STATE IN THE CENTER 28
FOR MEDICARE AND MEDICAID INNOVATION’S STATES ADVANCING ALL–PAYER 29
HEALTH EQUITY APPROACHES AND DEVELOPMENT (AHEAD) MODEL AND ANY 30
SUCCESSOR MODELS . 31
(h) (1) An electronic health network shall provide electronic health care 32
transactions to the State–designated health information exchange for the following public 33
health and clinical purposes: 34 HOUSE BILL 1104 3
(i) A State health improvement program; 1
(ii) Mitigation of a public health emergency; [and] 2
(iii) Improvement of patient safety; AND 3
(IV) THE PARTICIPATION OF THE STATE IN THE CENTER FOR 4
MEDICARE AND MEDICAID INNOVATION’S STATES ADVANCING ALL–PAYER 5
HEALTH EQUITY APPROACHES AND DEVELOPMENT (AHEAD) MODEL AND ANY 6
SUCCESSOR MODELS . 7
(j) (3) Regulations adopted under paragraph (1) of this subsection [shall]: 8
(i) [Limit] SHALL LIMIT redisclosure of financial information, 9
including billed or paid amounts available in electronic claims transactions; 10
(II) MAY NOT RESTRICT THE STATE’S USE OF FINANCIAL 11
INFORMATION , INCLUDING BILLED OR PAID AMOUNTS AVAILAB LE IN ELECTRONIC 12
CLAIMS TRANSACTIONS , FOR PUBLIC HEALTH PU RPOSES RELATED TO TH E 13
PARTICIPATION OF THE STATE IN THE CENTER FOR MEDICARE AND MEDICAID 14
INNOVATION’S STATES ADVANCING ALL–PAYER HEALTH EQUITY APPROACHES 15
AND DEVELOPMENT (AHEAD) MODEL AND ANY SUCCESS OR MODELS; 16
[(ii)] (III) [Restrict] SHALL RESTRICT data of patients who have 17
opted out of records sharing through the State–designated health information exchange or 18
a health information exchange authorized by the Maryland Health Care Commission; 19
[(iii)] (IV) [Restrict] SHALL RESTRICT data from health care 20
providers that possess sensitive health care information; and 21
[(iv)] (V) [Restrict] SHALL RESTRICT data of patients who have 22
obtained legally protected health care. 23
SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 24
as follows: 25
Article – Health – General 26
SUBTITLE 55. POPULATION HEALTH IMPROVEMENT FUND. 27
13–5501. 28
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 29
INDICATED. 30 4 HOUSE BILL 1104
(B) “AHEAD MODEL” MEANS THE STATES ADVANCING ALL–PAYER 1
HEALTH EQUITY APPROACHES AND DEVELOPMENT MODEL ADMINISTERED BY THE 2
CENTER FOR MEDICARE AND MEDICAID INNOVATION. 3
(C) “FUND” MEANS THE POPULATION HEALTH IMPROVEMENT FUND. 4
(D) “STATEWIDE HEALTH EQUI TY PLAN” MEANS THE EQUITY PLA N 5
REQUIRED UNDER THE AHEAD MODEL STATE AGREEMENT WITH THE CENTER 6
FOR MEDICARE AND MEDICAID SERVICES. 7
13–5502. 8
(A) THERE IS A POPULATION HEALTH IMPROVEMENT FUND. 9
(B) THE PURPOSE OF THE FUND IS TO INVEST IN POPULATION HEALTH 10
IMPROVEMENTS TO SUPP ORT THE STATEWIDE PO PULATION HEALTH TARG ETS 11
UNDER THE AHEAD MODEL AND ANY SUCCESS OR MODELS. 12
(C) THE DEPARTMENT AND THE HEALTH SERVICES COST REVIEW 13
COMMISSION JOINTLY SHALL ADMINI STER THE FUND. 14
(D) (1) THE FUND IS A SPECIAL , NONLAPSING FUND THAT IS NOT 15
SUBJECT TO § 7–302 OF THE STATE FINANCE AND PROCUREMENT ARTICLE. 16
(2) THE STATE TREASURER SHALL HOLD THE FUND SEPARATELY , 17
AND THE COMPTROLLER SHALL ACC OUNT FOR THE FUND. 18
(E) THE FUND CONSISTS OF : 19
(1) THE REVENUES FROM THE UNIFORM, BROAD–BASED 20
ASSESSMENT MADE UNDE R SUBSECTION (K) OF THIS SECTION; 21
(2) MONEY APPROPRIATED IN THE STATE BUDGET TO THE FUND; 22
(3) INTEREST EARNINGS ; AND 23
(4) ANY OTHER MONEY FROM ANY OTHER SOURC E ACCEPTED FOR 24
THE BENEFIT OF THE FUND. 25
(F) (1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION , THE FUND 26
MAY BE USED ONLY FOR EXPENSES ASSOCIATED WITH STATEWIDE POPUL ATION 27
HEALTH IMPROVEMENT I NITIATIVES IN ALIGNM ENT WITH THE STATEWI DE HEALTH 28
EQUITY PLAN AS DIREC TED BY THE SECRETARY. 29
HOUSE BILL 1104 5
(2) ACTIVITIES PAID FOR B Y THE FUND MUST SUPPORT THE GOAL OF 1
MEETING THE STATEWID E POPULATION HEALTH TARGETS OUTLINED IN THE 2
AHEAD MODEL STATE AGREEMENT WITH THE CENTER FOR MEDICARE AND 3
MEDICAID SERVICES AND HAVE AT LEAST ONE OF THE FOLLOWING FUN CTIONS: 4
(I) REDUCING RATES OF COM MON PREVENTABLE HEAL TH 5
CONDITIONS; 6
(II) ADDRESSING HEALTH –RELATED SOCIAL NEEDS ; OR 7
(III) REDUCING OR ELIMINATI NG HEALTH DISPARITIE S. 8
(G) (1) THE STATE TREASURER SHALL INVEST THE MONEY OF THE FUND 9
IN THE SAME MANNER A S OTHER STATE MONEY MAY BE IN VESTED. 10
(2) ANY INTEREST EARNINGS OF THE FUND SHALL BE CREDITE D TO 11
THE FUND. 12
(H) EXPENDITURES FROM THE FUND MAY BE MADE ONLY IN ACCORDANCE 13
WITH THE STATE BUDGET . 14
(I) MONEY EXPENDED FROM THE FUND IS SUPPLEMENTAL TO AND IS NOT 15
INTENDED TO TAKE THE PLACE OF FUNDING THA T WOULD OTHERWISE BE 16
APPROPRIATED FOR THE MARYLAND MEDICAL ASSISTANCE PROGRAM. 17
(J) THE FUND IS SUBJECT TO AU DIT BY THE OFFICE OF LEGISLATIVE 18
AUDITS AS PROVIDED IN § 2–1220 OF THE STATE GOVERNMENT ARTICLE. 19
(K) (1) EACH YEAR, THE HEALTH SERVICES COST REVIEW COMMISSION 20
MAY ASSESS A UNIFORM , BROAD–BASED, AND REASONABLE AMOUN T IN HOSPITAL 21
RATES TO BE CREDITED TO THE FUND. 22
(2) FUNDS GENERATED FROM THE ASSESSMENT UNDER PARAGRAPH 23
(1) OF THIS SUBSECTION M AY BE USED ONLY FOR THE EXPENSES DESCRIB ED IN 24
SUBSECTION (F) OF THIS SECTION. 25
(K) (1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION , EACH YEAR OF 26
THE TOTAL COST OF CARE MODEL, THE AHEAD MODEL, OR ANY SUCCESSOR 27
MODEL, THE HEALTH SERVICES COST REVIEW COMMISSION MAY ASSESS A 28
UNIFORM, BROAD–BASED, AND REASONABLE AMOUN T IN HOSPITAL RATES TO BE 29
CREDITED TO THE FUND. 30
6 HOUSE BILL 1104
(2) THE HEALTH SERVICES COST REVIEW COMMISSION SHALL 1
INCLUDE THE FULL AMO UNT OF THE ASSESSMEN T AUTHORIZED UNDER PARAGRAPH 2
(1) OF THIS SUBSECTION I N THE HOSPITAL RATES . 3
(3) ANY FUNDS GENERATED F ROM THE ASSESSMENT A UTHORIZED 4
UNDER PARAGRAPH (1) OF THIS SUBSECTION M AY BE USED ONLY FOR THE 5
EXPENSES DESCRIBED I N SUBSECTION (F) OF THIS SECTION. 6
(L) (1) ON OR BEFORE JULY 1 EACH YEAR, BEGINNING IN 2026, THE 7
DEPARTMENT SHALL SUBM IT A REPORT TO THE GENERAL ASSEMBLY, IN 8
ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE. 9
(2) THE REPORT REQUIRED U NDER PARAGRAPH (1) OF THIS 10
SUBSECTION SHALL : 11
(I) REFLECT TH E REQUIRED ELEMENTS OF THE ANNUAL 12
PROGRESS REPORT AS O UTLINED IN THE STATE AGREEMENT AND S HALL INCLUDE : 13
1. MEASURES OF EFFECTIVE NESS FOR FUNDED 14
PROGRAMS AND TARGETE D POPULATIONS ; 15
2. ANY IMPACT ON HEALTH OUTCOMES AND HEALTH 16
DISPARITIES; AND 17
3. RELEVANT COMPONENTS F ROM HOSPITAL REQUIRE D 18
REPORTING TO THE HEALTH SERVICES COST REVIEW COMMISSION ON 19
POPULATION HEALTH IM PROVEMENT EFFORTS ; AND 20
(II) AN ACCOUNTING OF ALL SOURCES OF FUNDING A CCEPTED 21
FOR THE BENEFIT OF T HE FUND AND THE AMOUNT O F FUNDING FROM EACH 22
SOURCE. 23
Article – State Finance and Procurement 24
6–226. 25
(a) (2) (i) 1. This subparagraph does not apply in fiscal years 2024 26
through 2028. 27
2. Notwithstanding any other provision of law, and unless 28
inconsistent with a federal law, grant agreement, or other federal requirement or with the 29
terms of a gift or settlement agreement, net interest on all State money allocated by the 30
State Treasurer under this section to special funds or accounts, and otherwise entitled to 31
receive interest earnings, as accounted for by the Comptroller, shall accrue to the General 32
Fund of the State. 33 HOUSE BILL 1104 7
(ii) The provisions of subparagraph (i) of this paragraph do not apply 1
to the following funds: 2
204. the Victims of Domestic Violence Program Grant Fund; 3
[and] 4
205. the Proposed Programs Collaborative Grant Fund; AND 5
206. THE POPULATION HEALTH IMPROVEMENT FUND. 6
SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 7
July 1, 2025. It shall remain effective for a period of 5 years and 6 months and, at the end 8
of December 31, 2030, this Act, with no further action required by the General Assembly, 9
shall be abrogated and of no further force and effect. 10
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.