Mid-Atlantic Health Law TOPICS

The Maryland General Assembly recently enacted a number of laws that will impact health care providers and health insurers in the State.  Here is a list of some of the legislative highlights from the 2018 Session.

1. New Reinsurance Program

Stabilizing the health care exchange market was an immediate priority this Maryland General Assembly Session, particularly after the federal government repealed the individual health care mandate. The federal government also suspended, for 2019, the collection of a federal fee paid by health insurers intended to support the state health benefit exchanges.

In response, the General Assembly implemented a statewide reinsurance program, and established reinsurance payment parameters to reduce the impact of high-risk individuals on rates. Under the new law, the State will apply for a waiver under Section 1332 of the Affordable Care Act to receive federal pass-through funds for the program. The Legislature also established a 2.75% tax on premiums charged by health insurers to replace the federal fee in 2019. Insurers should pay about the same as they would have under the old federal fee, and the money will be distributed to insurers providing insurance to high-risk individuals through the exchange.

2. Insurance Coverage

Insurers, nonprofit health service plans, and health maintenance organizations will have to expand their insurance to cover several new conditions and treatments in 2019, including:  services rendered by a licensed dietician or nutritionist for the treatment of prediabetes and obesity; medically appropriate and necessary diabetes equipment and supplies for the treatment of elevated or impaired blood glucose levels induced by prediabetes; fertility preservation procedures for iatrogenic infertility; fertility-awareness based methods; single dispensing of up to a 12-month supply of prescription contraceptives for carriers that provide coverage for contraceptive drugs and devices; and medically necessary diagnosis, evaluation, and treatment of lymphedema.

3. Physicians

This coming January, Maryland will enter the Interstate Medical Licensure Compact (IMLC), which will allow licensed physicians, who meet certain eligibility requirements to obtain more easily a license to practice medicine in jurisdictions that have also entered the Compact. 

4. Opioid Epidemic

Opioid-related deaths continue to increase in the State, and the Legislature passed several bills again this year to address the problem.  For instance, before October 1, hospice care programs are required to establish a written policy that provides for the collection and disposal of unused prescription medications after a patient dies. Also, on or before December 1, the Maryland Department of Health (MDH) will identify a way to establish a “pill mill” tip line that will allow individuals to report suspected overprescribing.

Starting October 1, health care providers will be required to advise patients of the benefits and risks when prescribing an opioid or a co-prescribed benzodiazepine. Providers who violate the law will be subject to disciplinary action by a health occupations board.

5. Pharmacy Benefit Managers

As of June 1, the Maryland Insurance Administration (MIA) has greater oversight of pharmacy benefit managers (PBMs), which are businesses that currently register with the MIA. The MIA can now require more information during registration and renewal, adopt regulations to govern PBMs, and establish a complaint process to handle grievances and appeals.

Starting October 1, a PBM will not be able to prohibit a pharmacy or pharmacist from discussing with a beneficiary, or giving a beneficiary information about, the retail price of a prescription drug or the beneficiary’s cost share of that price. PBMs also will not be able to prohibit pharmacy or pharmacists from selling a more affordable alternative to a beneficiary, if the requirements for a therapeutic interchange are met.  

6. Medicaid

Currently, Maryland Medicaid does not cover dental benefits for all Medicare-eligible adults. A new law, though, requires the MDH to initiate a pilot program to provide limited dental benefits to adult Medicaid recipients.  The MDH may limit the program to people of a certain age for whom MDH can obtain federal matching funds.

7. CON

Starting October 1, a health maintenance organization (HMO), or a health care facility that controls or is controlled by an HMO, will no longer be required to have a certificate of need (CON) before building, developing, operating, purchasing, or establishing an ambulatory surgical facility or center. Additionally, if 90% of the patients who will receive health care services from a health care project are individuals who will be enrolled in an HMO, then the HMO will not be required to have a CON before building, developing, operating, purchasing, or establishing that health care project. 

8. Provider Panels

As of June 1, carriers will be prohibited from limiting the number of behavioral health providers at a health care facility who can be credentialed to participate on a provider panel.

9. Medical Records

Health care providers may disclose medical records without authorization of the patient or other person of interest when the disclosure is part of a “compulsory process,” such as a subpoena or court order. Starting October 1, health providers must disclose those records within 30 days of receiving the required documentation for the compulsory process, and any related fees owed to the health care provider by the party seeking the medical record or that party’s attorney. Upon a showing of good cause, the health care provider can request an additional 30 days to comply with the disclosure request.

A version of this article was published by The Daily Record on June 8, 2018.