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.
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*hb1104*
HOUSE BILL 1104
J1 (5lr0253)
ENROLLED BILL
— Health and Government Operations and Appropriations/Finance and Budget and
Taxation —
Introduced by Chair, Health and Government Operations Committee (By Request
– Departmental – Health)
Read and Examined by Proofreaders:
_______________________________________________
Proofreader.
_______________________________________________
Proofreader.
Sealed with the Great Seal and presented to the Governor, for his approval this
_______ day of _______________ at ________________________ o’clock, ________M.
______________________________________________
Speaker.
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; requiring the Maryland Department of 12
Health to make a draft of a certain report available for public comment; requiring the 13 2 HOUSE BILL 1104
Department and the Commission to meet with certain members of the General 1
Assembly; and generally relating to the implementation of the AHEAD Model. 2
BY repealing and reenacting, with amendments, 3
Article – Health – General 4
Section 4–302.3(f)(3)(i), (h)(1), and (j)(3) 5
Annotated Code of Maryland 6
(2023 Replacement Volume and 2024 Supplement) 7
BY adding to 8
Article – Health – General 9
Section 13–5501 and 13–5502 to be under the new subtitle “Subtitle 55. Population 10
Health Improvement Fund” 11
Annotated Code of Maryland 12
(2023 Replacement Volume and 2024 Supplement) 13
BY repealing and reenacting, without amendments, 14
Article – State Finance and Procurement 15
Section 6–226(a)(2)(i) 16
Annotated Code of Maryland 17
(2021 Replacement Volume and 2024 Supplement) 18
BY repealing and reenacting, with amendments, 19
Article – State Finance and Procurement 20
Section 6–226(a)(2)(ii)204. and 205. 21
Annotated Code of Maryland 22
(2021 Replacement Volume and 2024 Supplement) 23
BY adding to 24
Article – State Finance and Procurement 25
Section 6–226(a)(2)(ii)206. 26
Annotated Code of Maryland 27
(2021 Replacement Volume and 2024 Supplement) 28
BY repealing and reenacting, with amendments, 29
Article – Health – General 30
Section 13–5502(e) 31
Annotated Code of Maryland 32
(2023 Replacement Volume and 2024 Supplement) 33
(As enacted by Section 2 of this Act) 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
4–302.3. 38 HOUSE BILL 1104 3
(f) (3) (i) If approved by the Maryland Health Care Commission, the 1
information submitted under paragraph (1) of this subsection may be combined with other 2
data maintained by the State–designated health information exchange to facilitate: 3
1. A State health improvement program; 4
2. Mitigation of a public health emergency; [and] 5
3. Improvement of patient safety; AND 6
4. THE PARTICIPATION OF THE STATE IN THE CENTER 7
FOR MEDICARE AND MEDICAID INNOVATION’S STATES ADVANCING ALL–PAYER 8
HEALTH EQUITY APPROACHES AND DEVELOPMENT (AHEAD) MODEL AND ANY 9
SUCCESSOR MODELS . 10
(h) (1) An electronic health network shall provide electronic health care 11
transactions to the State–designated health information exchange for the following public 12
health and clinical purposes: 13
(i) A State health improvement program; 14
(ii) Mitigation of a public health emergency; [and] 15
(iii) Improvement of patient safety; AND 16
(IV) THE PARTICIPATION OF THE STATE IN THE CENTER FOR 17
MEDICARE AND MEDICAID INNOVATION’S STATES ADVANCING ALL–PAYER 18
HEALTH EQUITY APPROACHES AND DEVELOPMENT (AHEAD) MODEL AND ANY 19
SUCCESSOR MODELS . 20
(j) (3) Regulations adopted under paragraph (1) of this subsection [shall]: 21
(i) [Limit] SHALL LIMIT redisclosure of financial information, 22
including billed or paid amounts available in electronic claims transactions; 23
(II) MAY NOT RESTRICT THE STATE’S USE OF FINANCIAL 24
INFORMATION , INCLUDING BILLED OR PAID AMOUNTS AVAILAB LE IN ELECTRONIC 25
CLAIMS TRANSACTIONS , FOR PUBLIC HEALTH PU RPOSES RELATED TO TH E 26
PARTICIPATION OF THE STATE IN THE CENTER FOR MEDICARE AND MEDICAID 27
INNOVATION’S STATES ADVANCING ALL–PAYER HEALTH EQUITY APPROACHES 28
AND DEVELOPMENT (AHEAD) MODEL AND ANY SUCCESS OR MODELS; 29
4 HOUSE BILL 1104
[(ii)] (III) [Restrict] SHALL RESTRICT data of patients who have 1
opted out of records sharing through the State–designated health information exchange or 2
a health information exchange authorized by the Maryland Health Care Commission; 3
[(iii)] (IV) [Restrict] SHALL RESTRICT data from health care 4
providers that possess sensitive health care information; and 5
[(iv)] (V) [Restrict] SHALL RESTRICT data of patients who have 6
obtained legally protected health care. 7
SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 8
as follows: 9
Article – Health – General 10
SUBTITLE 55. POPULATION HEALTH IMPROVEMENT FUND. 11
13–5501. 12
(A) IN THIS SUB TITLE THE FOLLOWING WORDS HAVE THE MEANI NGS 13
INDICATED. 14
(B) “AHEAD MODEL” MEANS THE STATES ADVANCING ALL–PAYER 15
HEALTH EQUITY APPROACHES AND DEVELOPMENT MODEL ADMINISTERED BY THE 16
CENTER FOR MEDICARE AND MEDICAID INNOVATION. 17
(C) “FUND” MEANS THE POPULATION HEALTH IMPROVEMENT FUND. 18
(D) “STATEWIDE HEALTH EQUI TY PLAN” MEANS THE EQUITY PLA N 19
REQUIRED UNDER THE AHEAD MODEL STATE AGREEMENT WITH THE CENTER 20
FOR MEDICARE AND MEDICAID SERVICES. 21
13–5502. 22
(A) THERE IS A POPULATION HEALTH IMPROVEMENT FUND. 23
(B) THE PURPOSE OF THE FUND IS TO INVEST IN POPULATION HEALTH 24
IMPROVEMENTS TO SUPP ORT THE STATEWIDE PO PULATION HEALTH TARG ETS 25
UNDER THE AHEAD MODEL AND ANY SUCCESS OR MODELS. 26
(C) THE DEPARTMENT AND THE HEALTH SERVICES COST REVIEW 27
COMMISSION JOINTLY SH ALL ADMINISTER THE FUND. 28
(D) (1) THE FUND IS A SPECIAL , NONLAPSING FUND THAT IS NOT 29
SUBJECT TO § 7–302 OF THE STATE FINANCE AND PROCUREMENT ARTICLE. 30 HOUSE BILL 1104 5
(2) THE STATE TREASURER SHALL HOLD THE FUND SEPARATELY , 1
AND THE COMPTROLLER SHALL ACC OUNT FOR THE FUND. 2
(E) THE FUND CONSISTS OF : 3
(1) THE REVENUES FROM THE UNIFORM, BROAD–BASED 4
ASSESSMENT MADE UNDE R SUBSECTION (K) (L) OF THIS SECTION; 5
(2) MONEY APPROPRIATED IN THE STATE BUDGET TO THE FUND; 6
(3) INTEREST EARNINGS ; AND 7
(4) ANY OTHER MONEY FROM ANY OTHER SOURCE ACC EPTED FOR 8
THE BENEFIT OF THE FUND. 9
(F) (1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION , THE FUND 10
MAY BE USED ONLY FOR EXPENSES ASSOCIATED WITH STATEWIDE POPUL ATION 11
HEALTH IMPROVEMENT I NITIATIVES IN ALIGNM ENT WITH THE STATEWI DE HEALTH 12
EQUITY PLAN AS DIREC TED BY THE SECRETARY. 13
(2) ACTIVITIES PAID FOR B Y THE FUND MUST SUPPORT THE GOAL OF 14
MEETING THE STATEWID E POPULATION HEALTH TARGETS OUTLINED IN THE 15
AHEAD MODEL STATE AGREEMENT WITH THE CENTER FOR MEDICARE AND 16
MEDICAID SERVICES AND HAV E AT LEAST ONE OF TH E FOLLOWING FUNCTION S: 17
(I) REDUCING RATES OF COM MON PREVENTABLE HEAL TH 18
CONDITIONS; 19
(II) ADDRESSING HEALTH –RELATED SOCIAL NEEDS ; OR 20
(III) REDUCING OR ELIMINATI NG HEALTH DISPARITIE S. 21
(G) (1) THE STATE TREASURER SHALL INVES T THE MONEY OF THE FUND 22
IN THE SAME MANNER A S OTHER STATE MONEY MAY BE IN VESTED. 23
(2) ANY INTEREST EARNINGS OF THE FUND SHALL BE CREDITE D TO 24
THE FUND. 25
(H) EXPENDITURES FROM THE FUND MAY BE MADE ONLY IN ACCORDANCE 26
WITH THE STATE BUDGET . 27
6 HOUSE BILL 1104
(I) MONEY EXPEND ED FROM THE FUND IS SUPPLEMENTAL TO AND IS NOT 1
INTENDED TO TAKE THE PLACE OF FUNDING THA T WOULD OTHERWISE BE 2
APPROPRIATED FOR THE MARYLAND MEDICAL ASSISTANCE PROGRAM. 3
(J) THE FUND IS SUBJECT TO AU DIT BY THE OFFICE OF LEGISLATIVE 4
AUDITS AS PROVIDED IN § 2–1220 OF THE STATE GOVERNMENT ARTICLE. 5
(K) (1) EACH YEAR, THE HEALTH SERVICES COST REVIEW COMMISSION 6
MAY ASSESS A UNIFORM , BROAD–BASED, AND REASONABLE AMOUN T IN HOSPITAL 7
RATES TO BE CREDITED TO THE FUND. 8
(2) FUNDS GENERATED FROM THE ASSESSMENT UNDER PARAGRAPH 9
(1) OF THIS SUBSECTION M AY BE USED ONLY FOR THE EXPENSES DESCRIB ED IN 10
SUBSECTION (F) OF THIS SECTION. 11
(K) (1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION , EACH YEAR OF 12
THE TOTAL COST OF CARE MODEL, THE AHEAD MODEL, OR ANY SUCCESSOR 13
MODEL, THE HEALTH SERVICES COST REVIEW COMMISSION MAY ASSESS A 14
UNIFORM, BROAD–BASED, AND REASONABLE AMOUN T IN HOSPITAL RATES TO BE 15
CREDITED TO THE FUND. 16
(2) THE HEALTH SERVICES COST REVIEW COMMISSION SHALL 17
INCLUDE THE FULL AMO UNT OF THE ASSESSMEN T AUTHORIZED UNDER PARAGRAPH 18
(1) OF THIS SUBSECTION I N THE HOSPITAL RATES . 19
(3) ANY FUNDS GENERATED F ROM THE ASSESSMENT A UTHORIZED 20
UNDER PARAGRAPH (1) OF THIS SUBSECTION M AY BE USED ONLY FOR THE 21
EXPENSES DESCRIBED I N SUBSECTION (F) OF THIS SECTION. 22
(L) (K) (1) ON OR BEFORE JULY 1 EACH YEAR, BEGINNING IN 2026, 23
THE DEPARTMENT SHALL SUBM IT A REPORT TO THE GENERAL ASSEMBLY, IN 24
ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE. 25
(2) THE REPORT REQUIRED U NDER PARAGRAPH (1) OF THIS 26
SUBSECTION SHALL : 27
(I) REFLECT THE REQUIRED ELEMENT S OF THE ANNUAL 28
PROGRESS REPORT AS O UTLINED IN THE STATE AGREEMENT AND S HALL INCLUDE : 29
1. MEASURES OF EFFECTIVE NESS FOR FUNDED 30
PROGRAMS AND TARGETE D POPULATIONS ; 31
2. ANY IMPACT ON HEALTH OUTCOMES AND HEALTH 32
DISPARITIES; AND 33 HOUSE BILL 1104 7
3. RELEVANT COMPONENTS F ROM HOSPITAL REQUIRE D 1
REPORTING TO THE HEALTH SERVICES COST REVIEW COMMISSION ON 2
POPULATION HEALTH IM PROVEMENT EFFORTS ; AND 3
(II) INCLUDE: 4
1. AN ACCOUNTING OF ALL SOURCES OF FUNDING 5
ACCEPTED FOR THE BEN EFIT OF THE FUND AND THE AMOUNT OF FUNDIN G FROM 6
EACH SOURCE ; AND 7
2. A SUMMARY OF THE EXTEN T TO WHICH PUBLIC 8
COMMENTS INFORMED TH E WORK OF THE DEPARTMENT AND THE COMMISSION. 9
(3) THE DEPARTMENT SHALL MAKE A DRAFT OF ITS REPOR T 10
AVAILABLE FOR PUBLIC COMMENT FOR 30 DAYS. 11
Article – State Finance and Procurement 12
6–226. 13
(a) (2) (i) 1. This subparagraph does not apply in fiscal years 2024 14
through 2028. 15
2. Notwithstanding any other provision of law, and unless 16
inconsistent with a federal law, grant agreement, or other federal requirement or with the 17
terms of a gift or settlement agreement, net interest on all State money allocated by the 18
State Treasurer under this section to special funds or accounts, and otherwise entitled to 19
receive interest earnings, as accounted for by the Comptroller, shall accrue to the General 20
Fund of the State. 21
(ii) The provisions of subparagraph (i) of this paragraph do not apply 22
to the following funds: 23
204. the Victims of Domestic Violence Program Grant Fund; 24
[and] 25
205. the Proposed Programs Collaborative Grant Fund; AND 26
206. THE POPULATION HEALTH IMPROVEMENT FUND. 27
SECTION 3. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 28
as follows: 29
Article – Health – General 30
8 HOUSE BILL 1104
13–5502. 1
(L) (1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION, EACH YEAR OF 2
THE TOTAL COST OF CARE MODEL, THE AHEAD MODEL, OR ANY SUCCESSOR 3
MODEL, THE HEALTH SERVICES COST REVIEW COMMISSION MAY ASSESS A 4
UNIFORM, BROAD–BASED, AND REASONABLE AMOUN T IN HOSPITAL RATES TO BE 5
CREDITED TO THE FUND. 6
(2) THE HEALTH SERVICES COST REVIEW COMMISSION SHALL 7
INCLUDE THE FULL AMO UNT OF THE ASSESSMEN T AUTHORIZED UNDER P ARAGRAPH 8
(1) OF THIS SUBSECTION I N THE HOSPITAL RATES . 9
(3) ANY FUNDS GENERATED F ROM THE ASSESSMENT A UTHORIZED 10
UNDER PARAGRAPH (1) OF THIS SUBSECTION M AY BE USED ONLY FOR THE EXPENSES 11
DESCRIBED IN SUBSECT ION (F) OF THIS SECTION. 12
SECTION 4. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 13
as follows: 14
Article – Health – General 15
13–5502. 16
(e) The Fund consists of: 17
[(1) The revenues from the uniform, broad–based assessment made under 18
subsection (l) of this section;] 19
[(2)] (1) Money appropriated in the State budget to the Fund; 20
[(3)] (2) Interest earnings; and 21
[(4)] (3) Any other money from any other source accepted for the benefit of 22
the Fund. 23
SECTION 5. AND BE IT FURTHER ENACTED, That: 24
(a) The Maryland Department of Health and the Health Services Cost Review 25
Commission shall provide periodic updates on the AHEAD model or any successor model to 26
designated members of the Senate of Maryland and the House of Delegates. 27
(b) The President shall designate three members of the Senate of Maryland, and 28
the Speaker shall designate three members of the House of Delegates, to meet with the 29
Department and the Commission on a monthly basis beginning July 2025. 30
HOUSE BILL 1104 9
(c) The meetings required under this section shall continue through December 1
2026. 2
SECTION 6. AND BE IT FURTHER ENACTED, That Section 4 of this Act shall take 3
effect January 1, 2028. It shall remain effective for a period of 2 years and, at the end of 4
December 31, 2030, Section 4 of this Act, with no further action required by the General 5
Assembly, shall be abrogated and of no further force and effect. 6
SECTION 2. 3. 7. AND BE IT FURTHER ENACTED, That , except as provided in 7
Section 6 of this Act, this Act shall take effect July 1, 2025. It Sections 1 and 2 of this Act 8
shall remain effective for a period of 5 years and 6 months and, at the end of December 31, 9
2030, Sections 1 and 2 of this Act, with no further action required by the General Assembly, 10
shall be abrogated and of no further force and effect. Section 3 of this Act shall remain 11
effective for a period of 2 years and 6 months and, at the end of December 31, 2027, Section 12
3 of this Act, with no further action required by the General Assembly, shall be abrogated 13
and of no further force and effect. Section 5 of this Act shall remain effective for a period of 14
1 year and 6 months and, at the end of December 31, 2026, Section 5 of this Act, with no 15
further action required by the General Assembly, shall be abrogated and of no further force 16
and effect. 17
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.