Maryland 2025 Regular Session

Maryland Senate Bill SB447 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		sb0447
9	6
10	7		SENATE BILL 447
11	8		J3, J1 5lr3410
12	9
13		-	By: Senator Lam ~~Senators Lam, Love, and Gile~~
	10	+	By: Senator Lam
14	11		Introduced and read first time: January 21, 2025
15	12		Assigned to: Finance
16		-	Committee Report: Favorable with amendments
17		-	Senate action: Adopted
18		-	Read second time: February 24, 2025
19	13
20		-	~~CHAPTER ______~~
	14	+	A BILL ENTITLED
21	15
22	16		AN ACT concerning 1
23	17
24		-	Hospitals – Emergency ~~Pregnancy–Related~~ Medical Conditions – Procedures 2
	18	+	Hospitals – Emergency Medical Conditions – Procedures 2
25	19
26		-	FOR the purpose of requiring a hospital to conduct screening on an individual a patient 3
27		-	presenting at an emergency department of the hospital to determine whether the 4
28		-	individual patient has an emergency pregnancy–related medical condition; 5
29		-	establishing requirements and prohibitions related to the treatment and transfer of 6
30		-	an individual a patient who has an emergency pregnancy–related medical condition; 7
31		-	requiring a hospital to allow the termination of a pregnancy in certai n 8
32		-	circumstances; prohibiting a hospital from taking adverse action against a provider 9
33		-	for not transferring a patient who is not stabilized or against a hospital employee if 10
34		-	the employee reports a violation of this Act; and generally relating to emergency 11
35		-	pregnancy–related medical conditions and hospitals. 12
	20	+	FOR the purpose of requiring a hospital to conduct screening on an individual presenting 3
	21	+	at an emergency department of the hospital to determine whether the individual has 4
	22	+	an emergency medical condition; establishing requirements and prohibitions related 5
	23	+	to the treatment and transfer of an individual who has an emergency medical 6
	24	+	condition; prohibiting a hospital from taking adverse action against a provider for 7
	25	+	not transferring a patient who is not stabilized or against a hospital employee if the 8
	26	+	employee reports a violation of this Act; and generally relating to emergency medical 9
	27	+	conditions and hospitals. 10
36	28
37		-	BY adding to 13
38		-	Article – Health – General 14
39		-	Section 19–342.1 15
40		-	Annotated Code of Maryland 16
41		-	(2023 Replacement Volume and 2024 Supplement) 17
	29	+	BY adding to 11
	30	+	Article – Health – General 12
	31	+	Section 19–342.1 13
	32	+	Annotated Code of Maryland 14
	33	+	(2023 Replacement Volume and 2024 Supplement) 15
42	34
43		-	BY repealing and reenacting, with amendments, 18
44		-	Article – Health – General 19
45		-	Section 20–214(b) 20
46		-	Annotated Code of Maryland 21
47		-	(2023 Replacement Volume and 2024 Supplement) 22
	35	+	BY repealing and reenacting, with amendments, 16
	36	+	Article – Health – General 17
	37	+	Section 20–214(b) 18
	38	+	Annotated Code of Maryland 19
	39	+	(2023 Replacement Volume and 2024 Supplement) 20
	40	+
	41	+	SECTION 1. BE IT ENACTED BY TH E GENERAL ASSEMBLY OF MARYLAND, 21
	42	+	That the Laws of Maryland read as follows: 22
	43	+
	44	+	Article – Health – General 23
	45	+
	46	+	19–342.1. 24
48	47		2 SENATE BILL 447
49	48
50	49
51		-	SECTION ~~1. BE IT ENACTED BY~~ THE ~~GENERAL ASSEMBLY OF MARYLAND,~~ 1
52		-	~~That the Laws of Maryland read as follows:~~ 2
	50	+	(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 1
	51	+	INDICATED. 2
53	52
54		-	~~Article – Health – General~~ 3
	53	+	(2) “EMERGENCY MEDICAL CON DITION” MEANS: 3
55	54
56		-	19–342.1. 4
	55	+	(I) A MEDICAL CONDI TION THAT PRESENTS T HROUGH ACUTE 4
	56	+	SYMPTOMS OF SUFFICIE NT SEVERITY, INCLUDING SEVERE PAI N, AND FOR WHICH 5
	57	+	THE ABSENCE OF IMMED IATE MEDICAL ATTENTI ON COULD BE REASONAB LY 6
	58	+	EXPECTED TO RESULT I N: 7
57	59
58		-	(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 5
59		-	INDICATED. 6
	60	+	1. PLACING THE HEALTH OF THE INDIVIDUAL OR , WITH 8
	61	+	RESPECT TO A PREGNANT WOMAN , THE HEALTH OF THE WO MAN OR HER UNBORN 9
	62	+	CHILD, IN SERIOUS JEOPARDY ; 10
60	63
61		-	(2) “EMERGENCY PREGNANCY –RELATED MEDICAL CONDITION ” 7
62		-	MEANS: 8
	64	+	2. SERIOUS IMPAIRMENT TO BODILY FUNCTIONS ; OR 11
63	65
64		-	(I) A A MEDICAL CONDITION TH AT PRESENTS IN A PREGNANT 9
65		-	PATIENT THROUGH ACUTE SYMPTO MS OF SUFFICIENT SEV ERITY, INCLUDING 10
66		-	SEVERE PAIN, AND FOR WHICH THE AB SENCE OF IMMEDIATE M EDICAL ATTENTION 11
67		-	COULD BE REASONABLY EXPECTED TO RESULT I N: 12
	66	+	3. SERIOUS DYSFUNCTION O F ANY BODILY ORGAN O R 12
	67	+	BODY PART; OR 13
68	68
69		-	1. (I) PLACING THE HEALTH OF THE INDIVIDUAL OR , 13
70		-	WITH RESPECT TO A PREGNAN T WOMAN, THE HEALTH OF THE WO MAN OR HER 14
71		-	UNBORN CHILD, PATIENT IN SERIOUS JEOPARDY; 15
	69	+	(II) WITH RESPECT TO A PRE GNANT WOMAN WHO IS H AVING 14
	70	+	CONTRACTIONS : 15
72	71
73		-	2. (II) SERIOUS IMPAIRMENT TO BODILY FUNCTIONS ; OR 16
	72	+	1. THERE BEING INADEQUAT E TIME TO EFFECT A S AFE 16
	73	+	TRANSFER TO ANOTHER HOSPITAL BEFORE DELI VERY; OR 17
74	74
75		-	3. ~~(III) SERIOUS DYSFUNCTION O F ANY BODILY ORGAN O R 17~~
76		-	~~BODY PART;~~ OR 18
	75	+	2. TRANSFER POSING A THR EAT TO THE HEALTH OR 18
	76	+	SAFETY OF THE WOMAN OR UNBORN CHILD . 19
77	77
78		-	(II) WITH RESPECT TO A PRE GNANT WOMAN WHO IS H AVING 19
79		-	CONTRACTIONS : 20
	78	+	(3) “STABILIZE” MEANS: 20
80	79
81		-	1. THERE BEING INADEQUAT E TIME TO EFFECT A SAFE 21
82		-	TRANSFER TO ANOTHER HOSPITAL BEFORE DELI VERY; OR 22
	80	+	(I) FOR AN EMERGENCY ME DICAL CONDITION AS D EFINED IN 21
	81	+	PARAGRAPH (2)(I) OF THIS SUBSECTION , TO PROVIDE THE MEDIC AL TREATMENT 22
	82	+	NECESSARY TO ENSURE , WITHIN REASONABLE ME DICAL PROBABILITY , THAT NO 23
	83	+	MATERIAL DETERIORATI ON OF THE CONDITION IS LIKELY TO RESULT FROM OR 24
	84	+	OCCUR DURING THE TRA NSFER OF THE INDIVID UAL FROM THE FACILIT Y; OR 25
83	85
84		-	2. TRANSFER POSING A THR EAT TO THE HEALTH OR 23
85		-	SAFETY OF THE WOMAN OR UNBORN CHILD . 24
	86	+	(II) FOR AN EMERGENCY MEDI CAL CONDITION AS DEF INED IN 26
	87	+	PARAGRAPH (2)(II) OF THIS SUBSECTION , THE WOMAN HAS DELIVE RED THE 27
	88	+	NEWBORN, INCLUDING DELIVERY O F THE PLACENTA . 28
86	89
87		-	(3) “STABILIZE” MEANS: 25
88		-
89		-	(I) FOR, FOR AN EMERGENCY PREGNANCY –RELATED MEDICAL 26
90		-	CONDITION AS DEFINED IN PARAGRAPH (2)(I) OF THIS SUBSECTION , TO PROVIDE 27
91		-	THE MEDICAL TREATMEN T NECESSARY TO ALLEVIATE THE CONDIT ION OR ENSURE, 28
92		-	WITHIN REASONABLE ME DICAL PROBABILITY , THAT NO MATERIAL DET ERIORATION 29
93		-	OF THE CONDITION IS LIKELY TO RESULT FRO M OR OCCUR DURING TH E TRANSFER 30
94		-	OF THE INDIVIDUAL PATIENT FROM THE FACILITY ; OR 31
	90	+	(B) THIS SECTION APPLIES ONLY TO A HOSP ITAL WITH AN EMERGEN CY 29
	91	+	DEPARTMENT . 30
95	92		SENATE BILL 447 3
96	93
97	94
98		-	(II) FOR AN EMERGENCY MEDI CAL CONDITION AS DEF INED IN 1
99		-	PARAGRAPH (2)(II) OF THIS SUBSECTION , THE WOMAN HAS DELIVE RED THE 2
100		-	NEWBORN, INCLUDING DELIVERY O F THE PLACENTA . 3
	95	+	(C) ON THE REQUEST OF AN INDIVIDUAL PRESENTIN G AT A HOSPITAL 1
	96	+	EMERGENCY DEPARTMENT OR THE INDIVIDUAL ’S REPRESENTATIVE , A HOSPITAL 2
	97	+	SHALL PROVIDE AN APP ROPRIATE MEDICAL SCR EENING TO DETERMINE WHETHER 3
	98	+	THE INDIVIDUAL HAS A N EMERGENCY MEDICAL CO NDITION. 4
101	99
102		-	(B) ~~THIS SECTION APPLIES ONLY TO~~ A HOSPITAL ~~WITH~~ AN ~~EME RGENCY 4~~
103		-	~~DEPARTMENT . 5~~
	100	+	(D) IF A HOSPITAL DETERMI NES THAT AN INDIVIDU AL HAS AN EMERGENCY 5
	101	+	MEDICAL CONDITION , THE HOSPITAL SHALL : 6
104	102
105		-	(C) ON THE REQUEST OF AN INDIVIDUAL PRESENTIN G AT A HOSPITAL 6
106		-	EMERGENCY DEPARTMENT OR THE INDIVIDUAL ’S REPRESENTATIVE , A HOSPITAL 7
107		-	SHALL PROVIDE AN APP ROPRIATE MEDICAL SCR EENING TO DETERMINE WHETHER 8
108		-	THE INDIVIDUAL HAS AN EMERGENCY MED ICAL CONDITION . 9
	103	+	(1) USING THE STAFF AND F ACILITIES AVAILABLE AT THE HOSPITAL , 7
	104	+	PROVIDE FURTHER EXAM INATION AND THE TREA TMENT REQUIRED T O STABILIZE 8
	105	+	THE EMERGENCY MEDICA L CONDITION; OR 9
109	106
110		-	(D) IF A HOSPITAL DETERMI NES THAT AN INDIVIDUAL A PATIENT HAS AN 10
111		-	EMERGENCY PREGNANCY –RELATED MEDICAL CONDITION , THE HOSPITAL SHALL : 11
	107	+	(2) TRANSFER THE INDIVIDU AL TO ANOTHER MEDICA L FACILITY. 10
112	108
113		-	(1) ~~USING~~ THE ~~STAFF AND F ACILITIES AVAILABLE AT TO THE 12~~
114		-	~~HOSPITAL~~, ~~PROVIDE FURTHER EX AMINATION~~ AND ~~THE TR EATMENT REQUIRED TO 13~~
115		-	~~STABILIZE~~ THE ~~EMERGE NCY PREGNANCY –RELATED~~ ~~MEDICAL CONDITION , 14~~
116		-	~~INCLUDING~~ THE ~~TERMIN ATION~~ OF ~~A PREGNANCY WHEN~~ THE ~~TERMINATION IS 15~~
117		-	~~MEDICALLY NECESSARY TO STABILIZE THE PAT IENT;~~ OR 16
	109	+	(E) (1) A HOSPITAL IS CONSIDER ED TO HAVE MET THE R EQUIREMENTS 11
	110	+	OF THIS SECTION IF, AFTER OFFERING FURTH ER EXAMINATION AND T REATMENT OR 12
	111	+	TRANSFER TO THE INDIVIDUAL OR TH E INDIVIDUAL’S REPRESENTATIVE AND 13
	112	+	INFORMING THE INDIVI DUAL OR INDIVIDUAL ’S REPRESENTATIVE OF THE RISKS AND 14
	113	+	BENEFITS OF FURTHER EXAMINATION AND TREA TMENT OR TRANSFER : 15
118	114
119		-	(2) ~~TRANSFER~~ THE INDIVIDUAL ~~PATIENT TO ANOTHER MEDICAL 17~~
120		-	~~FACILITY. 18~~
	115	+	(I) AN INDIVIDUAL OR THE INDIVIDUAL’S REPRESENTATIVE 16
	116	+	REFUSES TO CONSENT TO FURTHER E XAMINATION AND TREAT MENT; OR 17
121	117
122		-	(D) A HOSPITAL SHALL ALLOW THE TERMINATION OF A PREGNANCY AT THE 19
123		-	HOSPITAL IF THE PATI ENT’S TREATING HEALTH CA RE PRACTITIONER DETE RMINES 20
124		-	TERMINATION IS MEDIC ALLY NECESSARY TO ST ABILIZE A PATIENT. 21
	118	+	(II) AN INDIVIDUAL OR THE INDIVIDUAL’S REPRESENTATIVE 18
	119	+	REFUSES TO CONSENT T O A TRANSFER TO ANOT HER MEDICAL FACILITY . 19
125	120
126		-	(E) (1) A HOSPITAL IS CONSIDER ED TO HAVE MET THE R EQUIREMENTS 22
127		-	OF THIS SECTION IF, AFTER OFFERING FURTH ER EXAMINATION AND T REATMENT OR 23
128		-	TRANSFER TO THE INDIVIDUAL PATIENT OR THE INDIVIDUAL’S PATIENT’S 24
129		-	REPRESENTATIVE AND I NFORMING THE INDIVIDUAL PATIENT OR INDIVIDUAL’S 25
130		-	PATIENT’S REPRESENTATIVE OF TH E RISKS AND BENEFITS OF FURT HER 26
131		-	EXAMINATION AND TREA TMENT OR TRANSFER : 27
	121	+	(2) A HOSPITAL SHALL TAKE REASONABLE STEPS TO SECURE 20
	122	+	WRITTEN INFORMED CON SENT TO THE REFUSAL OF AN EXAMIN ATION OR 21
	123	+	TREATMENT OR TRANSFE R UNDER THIS SUBSECT ION FROM THE INDIVID UAL OR 22
	124	+	THE INDIVIDUAL ’S REPRESENTATIVE . 23
132	125
133		-	(I) AN INDIVIDUAL ~~A PATIENT OR THE INDIVIDUAL’S 28~~
134		-	~~PATIENT’S REPRESENTATIVE REFUS ES TO CONSENT TO FUR THER EXAMINATION 29~~
135		-	~~AND TREATMENT ; OR 30~~
	126	+	(F) IF AN INDIVIDUAL HAS AN EMERGENCY MEDICAL CONDITION THAT HAS 24
	127	+	NOT BEEN STABILIZED , THE HOSPITAL MAY NOT TRANSFER THE INDI VIDUAL 25
	128	+	UNLESS: 26
136	129
137		-	(II) AN INDIVIDUAL A PATIENT OR THE INDIVIDUAL’S 31
138		-	PATIENT’S REPRESENTATIVE REFUS ES TO CONSENT TO A T RANSFER TO ANOTHER 32
139		-	MEDICAL FACILITY . 33
140		-	4 SENATE BILL 447
	130	+	(1) THE TRANSFERRING HOSP ITAL PROVIDES THE ME DICAL 27
	131	+	TREATMENT AVAILABLE AT THE HOSPITAL THAT MINIMIZES THE RISKS TO THE 28
	132	+	INDIVIDUAL’S HEALTH AND , IN THE CASE OF A WOM AN IN LABOR, THE HEALTH OF 29
	133	+	THE UNBORN CHILD ; 30
	134	+
	135	+	(2) THE RECEIVING FACILIT Y HAS AVAILABLE SPACE AND QUALIFIED 31
	136	+	PERSONNEL TO TREAT T HE INDIVIDUAL AND HA S AGREED TO ACCEPT T HE 32 4 SENATE BILL 447
141	137
142	138
143		-	(2) A HOSPITAL SHALL TAKE REASONABLE STEPS TO SECURE 1
144		-	WRITTEN INFORMED CON SENT TO THE REFUSAL OF AN EXAMINATION OR 2
145		-	TREATMENT OR TRANSFE R UNDER THIS SUBSECT ION FROM THE INDIVIDUAL 3
146		-	PATIENT OR THE INDIVIDUAL’S PATIENT’S REPRESENTATIVE . 4
	139	+	TRANSFER OF THE INDI VIDUAL AND TO PROVID E APPROPRIATE MEDICA L 1
	140	+	TREATMENT ; 2
147	141
148		-	(F) IF AN INDIVIDUAL A PAT IENT HAS AN EMERGENCY 5
149		-	PREGNANCY –RELATED MEDICAL CONDITION TH AT HAS NOT BEEN STAB ILIZED, THE 6
150		-	HOSPITAL MAY NOT TRA NSFER THE INDIVIDUAL PATIENT UNLESS: THE TRANSFER 7
151		-	IS DONE CONSISTENT W ITH 42 U.S.C. § 1395DD. 8
	142	+	(3) THE TRANSFERRING HOSP ITAL PROVIDES TO THE RECEIVING 3
	143	+	FACILITY ALL MEDICAL RECORDS OR COPIES OF MEDI CAL RECORDS RELATING TO: 4
152	144
153		-	(1) THE TRANSFERRING HOSP ITAL PROVIDES THE MEDICAL 9
154		-	TREATMENT AVAILABLE AT THE HOSPITAL THAT MINIMIZES THE RISKS TO THE 10
155		-	INDIVIDUAL’S HEALTH AND , IN THE CASE OF A WOM AN IN LABOR, THE HEALTH OF 11
156		-	THE UNBORN CHILD ; 12
	145	+	(I) THE INDIVIDUAL’S EMERGENCY MEDICAL CONDITION; 5
157	146
158		-	(2) THE RECEIVING FACILIT Y HAS AVAILABLE SPAC E AND QUALIFIED 13
159		-	PERSONNEL TO TREAT T HE INDIVIDUAL AND HAS AGRE ED TO ACCEPT THE 14
160		-	TRANSFER OF THE INDI VIDUAL AND TO PROVID E APPROPRIATE MEDICA L 15
161		-	TREATMENT ; 16
	147	+	(II) OBSERVATION OF SIGNS AND SYMPTOMS ; 6
162	148
163		-	(3) THE TRANSFERRING HOSP ITAL PROVIDES TO THE RECEIVING 17
164		-	FACILITY ALL MEDICAL RECORDS OR COPIES OF MEDICAL RECORDS RELA TING TO: 18
	149	+	(III) PRELIMINARY DIAGNOSIS ; 7
165	150
166		-	(I) ~~THE INDIVIDUAL’S EMERGENCY MEDICAL CONDITION~~; 19
	151	+	(IV) TREATMENT PROVIDED ; 8
167	152
168		-	(II) ~~OBSERVATION OF SIGNS AND SYMPTOMS~~ ; 20
	153	+	(V) TEST RESULTS; 9
169	154
170		-	(III) PRELIMINARY DIAGNOSIS ; 21
	155	+	(VI) THE INFORMED WRITTEN CONSENT AND CERTIFIC ATION 10
	156	+	REQUIRED UNDER ITEM (5) OF THIS SUBSECTION; AND 11
171	157
172		-	(IV) TREATMENT PROVIDED ; 22
	158	+	(VII) THE NAME AND ADDRESS OF ANY ON–CALL PHYSICIAN WHO 12
	159	+	HAS REFUSED OR FAILE D TO APPEAR WITHIN A REASONABLE TIME TO P ROVIDE 13
	160	+	NECESSARY STABILIZIN G TREATMENT ; 14
173	161
174		-	(V) TEST RESULTS; 23
	162	+	(4) THE TRANSFER IS EFFECTED THROUGH QUALIFIED PERSONNEL 15
	163	+	AND TRANSPORTATION E QUIPMENT, INCLUDING THE USE OF NECESSARY AND 16
	164	+	MEDICALLY APPROPRIAT E LIFE SUPPORT MEASU RES DURING THE TRANS FER; AND 17
175	165
176		-	(VI) THE INFORMED WRITTEN CONSENT AND CERTIFIC ATION 24
177		-	REQUIRED UNDER ITEM (5) OF THIS SUBSECTION; AND 25
	166	+	(5) (I) THE INDIVIDUAL OR THE INDIVIDUAL’S REPRESENTATIVE , 18
	167	+	AFTER BEING INFORMED OF THE HOSPITAL ’S RESPONSIBILITIES U NDER THIS 19
	168	+	SECTION AND THE RISK S OF TRANSFER , REQUESTS IN WRITING THE TRANSFER TO 20
	169	+	ANOTHER FACILITY ; AND 21
178	170
179		-	(VII) THE NAME AND ADDRESS OF ANY ON–CALL PHYSICIAN WHO 26
180		-	HAS REFUSED OR FAILE D TO APPEAR WITHIN A REASONABLE TIME TO P ROVIDE 27
181		-	NECESSARY STABILIZIN G TREATMENT ; 28
	171	+	(II) 1. A PHYSICIAN HAS SIGNED A CERTIFICATION THAT : 22
182	172
183		-	(4) THE TRANSFER IS EFFEC TED THROUGH QUALIFIE D PERSONNEL 29
184		-	AND TRANSPORTATION EQUIPMENT, INCLUDING THE USE OF NECESSARY AND 30
185		-	MEDICALLY APPROPRIAT E LIFE SUPPORT MEASU RES DURING THE TRANS FER; AND 31
	173	+	A. STATES THAT , BASED ON THE INFORMA TION 23
	174	+	AVAILABLE AT THE TIM E OF TRANSFER , THE MEDICAL BENEFITS REASONABLY 24
	175	+	EXPECTED FROM THE PR OVISION OF APPROPRIA TE MEDICAL TREATMENT AT 25
	176	+	ANOTHER MEDICAL FACI LITY OUTWEIGH THE RI SKS TO THE INDIVIDUA L AND, IN 26
	177	+	THE CASE OF LABOR , TO THE UNBORN CHILD FROM EFFEC TING THE TRANSFER ; AND 27
	178	+
	179	+	B. CONTAINS A SUMMARY OF THE RISKS AND BENEFI TS 28
	180	+	OF TRANSFER; OR 29
186	181		SENATE BILL 447 5
187	182
188	183
189		-	(5) (I) THE INDIVIDUAL OR THE INDIVIDUAL’S REPRESENTATIVE , 1
190		-	AFTER BEING INFORMED OF THE HOSPITAL ’S RESPONSIBILITIES U NDER THIS 2
191		-	SECTION AND THE RISKS OF TRANSFE R, REQUESTS IN WRITING THE TRANSFER TO 3
192		-	ANOTHER FACILITY ; AND 4
	184	+	2. IF A PHYSICIAN IS NOT PHYSICALLY PRESENT I N THE 1
	185	+	EMERGENCY DEPARTMENT AT THE TIME THE INDI VIDUAL IS TRANSFERRE D, A 2
	186	+	QUALIFIED MEDICAL PR OVIDER HAS SIGNED A CE RTIFICATION THAT : 3
193	187
194		-	(II) 1. A PHYSICIAN HAS SIGNED A CERTIFICATION THAT : 5
	188	+	A. STATES THAT , BASED ON THE INFORMA TION 4
	189	+	AVAILABLE AT THE TIM E OF TRANSFER , THE MEDICAL BENEFITS REASONABLY 5
	190	+	EXPECTED FROM THE PR OVISION OF APPROPRIA TE MEDICAL TREATMENT AT 6
	191	+	ANOTHER MEDICAL FACI LITY OUTWEIGH THE RI SKS TO THE INDIVIDUAL AND, IN 7
	192	+	THE CASE OF LABOR , TO THE UNBORN CHILD FROM EFFECTING THE T RANSFER; 8
195	193
196		-	A. STATES THAT , BASED ON THE INFORMA TION 6
197		-	AVAILABLE AT THE TIM E OF TRANSFER , THE MEDICAL BENEFITS REASONABLY 7
198		-	EXPECTED FROM THE PROVISI ON OF APPROPRIATE ME DICAL TREATMENT AT 8
199		-	ANOTHER MEDICAL FACI LITY OUTWEIGH THE RI SKS TO THE INDIVIDUA L AND, IN 9
200		-	THE CASE OF LABOR , TO THE UNBORN CHILD FROM EFFECTING THE T RANSFER; AND 10
	194	+	B. CONTAINS A SUMMARY OF THE RISKS AND BENEFI TS 9
	195	+	OF TRANSFER; AND 10
201	196
202		-	B. CONTAINS A SUMMARY OF THE RISKS AND BENEFI TS 11
203		-	OF TRANSFER; OR 12
	197	+	C. IS SUBSEQUENTLY COUNT ERSIGNED BY A PHYSIC IAN 11
	198	+	WHO, IN CONSULTATION WITH THE QUALIFIED MEDICAL PROVIDER , HAS MADE THE 12
	199	+	DETERMINATION THAT B ASED ON THE INFORMAT ION AVAILABLE AT THE TIME OF 13
	200	+	TRANSFER, THE MEDICAL BENEFITS REASONABLY EXPECTED FROM THE PROVISION 14
	201	+	OF APPROPRIATE MEDIC AL TREATMENT AT ANOT HER MEDICAL FACILITY 15
	202	+	OUTWEIGHED THE RISKS TO THE INDIVIDUAL AN D, IN THE CASE OF LABOR , TO THE 16
	203	+	UNBORN CHILD FROM EF FECTING THE TRANSFER . 17
204	204
205		-	2. IF A PHYSICIAN IS NOT PHYSICALLY PRESENT I N THE 13
206		-	EMERGENCY DEPARTMENT AT THE TIME THE INDI VIDUAL IS TRANSFERRE D, A 14
207		-	QUALIFIED MEDICAL PR OVIDER HAS SIGNED A CERTIFICATION THAT : 15
	205	+	(G) IF A PHYSICIAN DETERM INES AFTER THE MEDIC AL SCREENING THAT AN 18
	206	+	INDIVIDUAL REQUIRES THE SERVICES OF A PH YSICIAN ON THE HOSPI TAL’S LIST OF 19
	207	+	ON–CALL PHYSICIANS AND THE ON–CALL PHYSICIAN REFUS ES OR FAILS TO APPEA R 20
	208	+	WITHIN A REASONABLE PERIOD OF TIME AFTER NOTIFICATION FROM TH E 21
	209	+	PHYSICIAN, THE PHYSICIAN WHO PR OVIDED NOTIFICATION TO THE ON –CALL 22
	210	+	PHYSICIAN IS NOT LIA BLE FOR A PENALTY UN DER THIS SECTION FOR A TRANSFER 23
	211	+	THAT OTHERWISE MET THE REQUIREMENTS OF SUBS ECTION (F) OF THIS SECTION. 24
208	212
209		-	A. STATES THAT , BASED ON THE INFORMA TION 16
210		-	AVAILABLE AT T HE TIME OF TRANSFER , THE MEDICAL BENEFITS REASONABLY 17
211		-	EXPECTED FROM THE PR OVISION OF APPROPRIA TE MEDICAL TREATMENT AT 18
212		-	ANOTHER MEDICAL FACI LITY OUTWEIGH THE RI SKS TO THE INDIVIDUA L AND, IN 19
213		-	THE CASE OF LABOR , TO THE UNBORN CHILD FROM EFFECTING THE T RANSFER; 20
	213	+	(H) A HOSPITAL THAT HAS SP ECIALIZED CAPABILITI ES OR FACILITIES OR A 25
	214	+	REGIONAL REFERRAL CE NTER MAY NOT REFUSE AN APPROPRIATE TRANS FER OF AN 26
	215	+	INDIVIDUAL WHO REQUI RES THE HOSPITAL ’S SPECIALIZED CAPABILITIES OR 27
	216	+	FACILITIES IF THE HO SPITAL HAS THE CAPAC ITY TO TREAT THE IND IVIDUAL. 28
214	217
215		-	B. CONTAINS A SUMMARY OF THE RISKS AND BENEFI TS 21
216		-	OF TRANSFER; AND 22
	218	+	(I) A HOSPITAL MAY NOT DEL AY PROVIDING AN APPR OPRIATE MEDICAL 29
	219	+	SCREENING EXAMINATIO N OR FURTHER MEDICAL EXAMINATION TO INQUI RE ABOUT 30
	220	+	THE INDIVIDUAL ’S METHOD OF PAYMENT OR INSURANCE STATUS . 31
217	221
218		-	C. IS SUBSEQUENTLY COUNT ERSIGNED BY A PHYSIC IAN 23
219		-	WHO, IN CONSULTATION WITH THE QUALIFIED MEDICA L PROVIDER, HAS MADE THE 24
220		-	DETERMINATION THAT B ASED ON THE INFORMAT ION AVAILABLE AT THE TIME OF 25
221		-	TRANSFER, THE MEDICAL BENEFITS REASONABLY EXPECTED FROM THE PROVISION 26
222		-	OF APPROPRIATE MEDIC AL TREATMENT AT ANOT HER MEDICAL FACILITY 27
223		-	OUTWEIGHED THE RISKS TO THE INDIVIDUAL AN D, IN THE CASE OF LABOR , TO THE 28
224		-	UNBORN CHILD FROM EF FECTING THE TRANSFER . 29
225		-
226		-	(G) IF A PHYSICIAN DETERM INES AFTER THE MEDIC AL SCREENING THAT AN 30
227		-	INDIVIDUAL REQUIRES THE SERVICES OF A PH YSICIAN ON THE HOSPI TAL’S LIST OF 31
228		-	ON–CALL PHYSICIANS AND THE ON–CALL PHYSICIAN REFUS ES OR FAILS TO APPEA R 32
229		-	WITHIN A REASONABLE PERIOD OF TIME AFTER NOTIFICATION FROM TH E 33
230		-	PHYSICIAN, THE PHYSICIAN WHO PR OVIDED NOTIFICATION TO THE ON –CALL 34
231		-	PHYSICIAN IS NOT LIA BLE FOR A PENALTY UN DER THIS SECTION FOR A TRANSFER 35
232		-	THAT OTHERWISE MET T HE REQUIREMENTS OF S UBSECTION (F) OF THIS SECTION. 36 6 SENATE BILL 447
	222	+	(J) A HOSPITAL MAY NOT PEN ALIZE OR TAKE OTHER ADVERSE ACTION 32
	223	+	AGAINST: 33
	224	+	6 SENATE BILL 447
233	225
234	226
	227	+	(1) A QUALIFIED MEDICAL PR OVIDER IF THE PROVID ER REFUSES TO 1
	228	+	AUTHORIZE THE TRANSF ER OF AN INDIVIDUAL WITH AN EMERGENCY ME DICAL 2
	229	+	CONDITION THAT HAS N OT BEEN STABILIZED; 3
235	230
236		-	(H) A ~~HOSPITAL THAT HAS SPECIALIZED CAPABILI TIES OR FACILITIES O R A 1~~
237		-	~~REGIONAL REFERRAL CE NTER MAY NOT REFUSE AN APPROPRIATE TRANS FER~~ OF ~~AN 2~~
238		-	~~INDIVIDUAL WHO REQUI RES~~ THE ~~HOSPITAL~~ ’S ~~SPECIALIZED CAPABI LITIES OR 3~~
239		-	~~FACILITIES IF~~ THE ~~HO SPITAL HAS THE CAPAC ITY TO TREAT THE IND IVIDUAL. 4~~
	231	+	(2) A QUALIFIED MEDICAL PR OVIDER IF THE PROVID ER’S 4
	232	+	TREATMENT OF THE PAT IENT IS CONSISTENT W ITH THE MEDICAL STAN DARDS OF 5
	233	+	CARE THAT, IN THE PROVIDER ’S CLINICAL JUDGMENT , WERE NECESSARY TO 6
	234	+	STABILIZE THE PATIEN T; OR 7
240	235
241		-	(I) A HOSPITAL MAY NOT DEL AY PROVIDING AN APPR OPRIATE MEDICAL 5
242		-	SCREENING EXAMINATIO N OR FURTHER MEDICAL EXAMINATION TO INQUI RE ABOUT 6
243		-	THE INDIVIDUAL ’S METHOD OF PAYMENT OR INSURANCE STATUS . 7
	236	+	(3) A HOSPITAL EMPLOYEE IF THE EMPLOYEE REPORTS A VIOLATION 8
	237	+	OF THIS SECTION. 9
244	238
245		-	(J) (G) A HOSPITAL MAY NOT PEN ALIZE OR TAKE OTHER ADVERSE 8
246		-	ACTION, INCLUDING AN ACTION RELATED TO DISCHARGE , PROMOTION , DEMOTION, 9
247		-	SUSPENSION, COMPENSATION , TRAINING OPPORTUNITI ES, STAFF PRIVILEGES , OR 10
248		-	ADMITTING PRIVILEGES , AGAINST: 11
	239	+	(K) A HOSPITAL THAT NEGLIG ENTLY VIOLATES THIS SECTION IS SUBJECT 10
	240	+	TO A CIVIL PENALTY O F: 11
249	241
250		-	(1) A QUALIFIED MEDICAL TREATING HEALTH CARE PROVIDER IF 12
251		-	THE PROVIDER REFUSES TO AUTHORI ZE THE TRANSFER OF AN INDIVIDUAL A 13
252		-	PATIENT WITH AN EMERGENCY PREGNANCY –RELATED MEDICAL CONDITION TH AT 14
253		-	HAS NOT BEEN STABILI ZED; 15
	242	+	(1) FOR A HOSPITAL WITH 100 OR MORE BEDS , NOT MORE THAN 12
	243	+	$50,000 FOR EACH VIOLATION ; OR 13
254	244
255		-	(2) A QUALIFIED MEDICAL TREATING HEALTH CARE PROVIDER IF 16
256		-	THE PROVIDER ’S TREATMENT OF THE P ATIENT IS CONSISTENT WITH THE MEDICA L 17
257		-	STANDARDS OF CARE TH AT, IN THE PROVIDER ’S CLINICAL JUDGMENT , WERE 18
258		-	NECESSARY TO STABILI ZE THE PATIENT; OR 19
	245	+	(2) FOR A HOSPITAL WITH FEWER THAN 100 BEDS, NOT MORE THAN 14
	246	+	$25,000 FOR EACH VIOLATION . 15
259	247
260		-	(3) A HOSPITAL EMPLOYEE IF THE EMPLOYEE REPORTS A VIOLATION 20
261		-	OF THIS SECTION. 21
	248	+	(L) (1) A PHYSICIAN, INCLUDING AN ON –CALL PHYSICIAN , WHO IS 16
	249	+	RESPONSIBLE FOR THE EXAMINATION , TREATMENT , OR TRANSFER OF AN 17
	250	+	INDIVIDUAL UNDER THI S SECTION AND WHO NE GLIGENTLY VIOLATES T HIS SECTION 18
	251	+	IS SUBJECT TO A CIVIL PENALTY OF NOT MOR E THAN $50,000 FOR EACH VIOLATION . 19
262	252
263		-	(K) (H) A HOSPITAL THAT NEGLIG ENTLY VIOLATES THIS SECTION IS 22
264		-	SUBJECT TO A CIVIL P ENALTY OF: 23
	253	+	(2) IF A PHYSICIAN, INCLUDING AN ON –CALL PHYSICIAN , WHO IS 20
	254	+	RESPONSIBLE FOR THE EXAMINATION , TREATMENT , OR TRANSFER OF AN 21
	255	+	INDIVIDUAL UNDER THI S SECTION IS FOUND T O BE GROS SLY NEGLIGENT IN 22
	256	+	VIOLATION OF THIS SE CTION OR IS FOUND TO HAVE REPEATEDLY VIOL ATED THIS 23
	257	+	SECTION, THE PHYSICIAN IS SUB JECT TO EXCLUSION FR OM PARTICIPATION IN THE 24
	258	+	MARYLAND MEDICAL ASSISTANCE PROGRAM. 25
265	259
266		-	(1) FOR A HOSPITAL WITH 100 OR MORE BEDS , NOT MORE THAN 24
267		-	$50,000 FOR EACH VIOLATION ; OR 25
	260	+	(M) (1) IN A CIVIL ACTION AGA INST A HOSPITAL FOR A VIOLATION OF THIS 26
	261	+	SECTION, AN INDIVIDUAL WHO IN CURS PERSONAL HARM A S A DIRECT RESULT OF 27
	262	+	THE VIOLATION MAY OB TAIN DAMAGES AVAILAB LE FOR PERSONAL INJU RY AND 28
	263	+	APPROPRIATE EQUITABL E RELIEF. 29
268	264
269		-	(2) FOR A HOSPITAL WITH F EWER THAN 100 BEDS, NOT MORE THAN 26
270		-	$25,000 FOR EACH VIOLATION . 27
271		-
272		-	(I) (1) THE DEPARTMENT SHALL STAY A FINAL D ECISION ON A 28
273		-	POTENTIAL VIOLATION IF THERE IS AN ONGOI NG FEDERAL INVESTIGA TION UNDER 29
274		-	42 U.S.C. § 1395DD REGARDING THE SAM E INCIDENT. 30
275		-
276		-	(2) IF A FEDERAL INVESTIG ATION UNDER 42 U.S.C. § 1395DD 31
277		-	RESULTS IN A FINE BE ING IMPOSED FOR THE SAME INCIDENT , THE DEPARTMENT 32 SENATE BILL 447 7
	265	+	(2) IN A CIVIL ACTION AGA INST A HOSPITAL FOR A VIOLATION OF THIS 30
	266	+	SECTION, A MEDICAL FACILITY T HAT INCURS A FINANCI AL LOSS AS THE RESUL T OF 31
	267	+	THE VIOLATION MAY OB TAIN DAMAGES FOR FIN ANCIAL LOSS AND APPR OPRIATE 32
	268	+	EQUITABLE RELIEF . 33
	269	+	SENATE BILL 447 7
278	270
279	271
280		-	~~SHALL SUBTRACT THE~~ A ~~MOUNT OF THE FEDERAL FINE FROM THE MAXIMU M~~ 1
281		-	~~POTENTIAL FINE UNDER THIS SECTION FOR~~ THE ~~SAME INCIDENT~~ . 2
	272	+	(3) A CIVIL ACTION AUTHORI ZED UNDER THIS SUBSE CTION SHALL BE 1
	273	+	FILED WITHIN 2 YEARS AFTER THE DATE THE CAUSE OF ACTION OCCU RS. 2
282	274
283		-	(3) (I) SUBJECT TO SUBPARAGRA PH (II) OF THIS PARAGRAPH , IF A 3
284		-	FEDERAL INVESTIGATIO N UNDER 42 U.S.C. § 1395DD RESULTS IN A FINE BEING 4
285		-	IMPOSED FOR THE SAME INCIDENT WITHIN 2 YEARS AFTER THE DEPARTMENT 5
286		-	IMPOSES A FINE UNDER THIS SECTION, THE DEPARTMENT SHALL REFU ND THE 6
287		-	HOSPITAL AN AMOUNT E QUAL TO THE AMOUNT O F THE FEDERAL FINE . 7
	275	+	20–214. 3
288	276
289		-	(II) THE AMOUNT REFUNDED U NDER SUBPARAGRAPH (I) OF 8
290		-	THIS PARAGRAPH MAY NOT EXCEED THE A MOUNT OF THE FINE IM POSED BY THE 9
291		-	DEPARTMENT FOR THE SA ME INCIDENT. 10
	277	+	(b) (1) [A] EXCEPT AS PROVIDED IN § 19–342.1 OF THIS ARTICLE , A 4
	278	+	licensed hospital, hospital director, or hospital governing board may not be required: 5
292	279
293		-	(L) (1) A PHYSICIAN, INCLUDING AN ON –CALL PHYSICIAN , WHO IS 11
294		-	RESPONSIBLE FOR THE EXAMINATION , TREATMENT , OR TRANSFER OF AN 12
295		-	INDIVIDUAL UNDER THI S SECTION AND WHO NEGLIGENTLY VIOL ATES THIS SECTION 13
296		-	IS SUBJECT TO A CIVIL PENALTY OF NOT MOR E THAN $50,000 FOR EACH VIOLATION . 14
	280	+	(i) To [permit] AUTHORIZE, within the hospital, the performance 6
	281	+	of any medical procedure that results in artificial insemination, sterilization, or 7
	282	+	termination of pregnancy; or 8
297	283
298		-	(2) IF A PHYSICIAN, INCLUDING AN ON –CALL PHYSICIAN , WHO IS 15
299		-	RESPONSIBLE FOR THE EXAMINATION , TREATMENT , OR TRANSFER OF AN 16
300		-	INDIVIDUAL UNDER T HIS SECTION IS FOUND TO BE GROSSLY NEGLIG ENT IN 17
301		-	VIOLATION OF THIS SE CTION OR IS FOUND TO HAVE REPEATEDLY VIOL ATED THIS 18
302		-	SECTION, THE PHYSICIAN IS SUB JECT TO EXCLUSION FR OM PARTICIPATION IN THE 19
303		-	MARYLAND MEDICAL ASSISTANCE PROGRAM. 20
	284	+	(ii) To refer to any source for these medical procedures. 9
304	285
305		-	(M) (1) IN A CIVIL ACTION AGAINST A HOSPITAL F OR A VIOLATION OF TH IS 21
306		-	SECTION, AN INDIVIDUAL WHO IN CURS PERSONAL HARM A S A DIRECT RESULT OF 22
307		-	THE VIOLATION MAY OB TAIN DAMAGES AVAILAB LE FOR PERSONAL INJU RY AND 23
308		-	APPROPRIATE EQUITABL E RELIEF. 24
	286	+	(2) The refusal to [permit] AUTHORIZE or to refer to a source for these 10
	287	+	procedures may not be grounds for: 11
309	288
310		-	(2) IN A CIVIL ACTION AGA INST A HOSPITAL F OR A VIOLATION OF TH IS 25
311		-	SECTION, A MEDICAL FACILITY T HAT INCURS A FINANCI AL LOSS AS THE RESUL T OF 26
312		-	THE VIOLATION MAY OB TAIN DAMAGES FOR FIN ANCIAL LOSS AND APPR OPRIATE 27
313		-	EQUITABLE RELIEF . 28
	289	+	(i) Civil liability to another person; or 12
314	290
315		-	(3) ~~A CIVIL~~ ACTION ~~AUTHORI ZED UNDER THIS SUBSE CTION SHALL BE 29~~
316		-	~~FILED WITHIN 2 YEARS AFTER THE DATE THE CAUSE OF ACTION OCCURS~~. 30
	291	+	(ii) Disciplinary or other recriminatory action against the person by 13
	292	+	this State or any person. 14
317	293
318		-	20–214. 31
	294	+	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 15
	295	+	October 1, 2025. 16
319	296
320		-	(b) (1) [A] EXCEPT AS PROVIDED IN § 19–342.1 OF THIS ARTICLE , A 32
321		-	licensed hospital, hospital director, or hospital governing board may not be required: 33
322		-	8 SENATE BILL 447
323		-
324		-
325		-	(i) To [permit] AUTHORIZE ALLOW, within the hospital, the 1
326		-	performance of any medical procedure that results in artificial insemination, sterilization, 2
327		-	or termination of pregnancy; or 3
328		-
329		-	(ii) To refer to any source for these medical procedures. 4
330		-
331		-	(2) The refusal to [permit] AUTHORIZE ALLOW or to refer to a source for 5
332		-	these procedures may not be grounds for: 6
333		-
334		-	(i) Civil liability to another person; or 7
335		-
336		-	(ii) Disciplinary or other recriminatory action against the person by 8
337		-	this State or any person. 9
338		-
339		-	SECTION 2. AND BE IT FURTHER ENACTED , That this Act shall take effect 10
340		-	October 1, 2025. 11
341		-
342		-
343		-
344		-
345		-	Approved:
346		-	________________________________________________________________________________
347		-	Governor.
348		-	________________________________________________________________________________
349		-	President of the Senate.
350		-	________________________________________________________________________________
351		-	Speaker of the House of Delegates.