Mid-Atlantic Health Law TOPICS

The Maryland General Assembly’s 2023 legislative session resulted in the enactment of many health care laws that will impact health care facilities, providers, insurers and licensees in the State. Here are some of the highlights.

Cannabis Reform

The Cannabis Reform bill will impact all medical cannabis licensees (growers, processors, and dispensaries). Notably, all medical cannabis licensees, including approved and preapproved licenses, will be required to convert their medical cannabis licenses to medical and adult-use cannabis licenses by July 1, 2023. The licensee must convert its license and pay a one-time conversion fee. Unconverted license holders are not permitted to operate or renew licenses after the July 1st deadline. The newly established cannabis division must issue regulations concerning annual license renewal fees not to exceed 10% of the licensee’s annual gross revenue, impose a sales and use tax of 9%, and outline new ownership restrictions for all license holders.

Telehealth

The Preserve Telehealth Access Act of 2023 extends the inclusion of certain audio-only conversations between providers and patients to be defined as “telehealth” for the purposes of reimbursement for telehealth services as if the health care appointment occurred in-person through June 30, 2025. This extension impacts both Medicaid and commercial health insurance providers. The Maryland Health Care Commission (MHCC) must also conduct a study regarding telehealth services and make recommendations regarding payment parity to the Maryland General Assembly by December 1, 2024.

Prescription Drug Affordability

An emergency bill reestablished the Prescription Drug Affordability Board (PDAB) and reinstated its authority to draft an action plan for setting upper payment limits on certain prescription drugs. Qualified prescription drugs for consideration of an upper payment limit must be products that either have or will lead to an affordability challenge. If an upper payment limit is set for a prescription drug product, then the PDAB must monitor that drug’s availability. Should a shortage occur, the board may suspend or alter the upper payment limits.

Additionally, the Maryland Department of Health (MDH) and PDAB must conduct a study and report their findings to the Mary-land General Assembly by October 31, 2023, describing how much Managed Care Organizations (MCOs) paid for prescription drugs in 2021 and 2022, and what that amount would have been if claims had been reimbursed at Medicaid fee-for-service rates. (MCOs are entities that are paid by the State on a capitated basis to assume the risk of paying for the care of certain Medicaid patients.) The study must also address the inconsistencies in the cost of a drug versus the fee for dispensing it.

Facilities

Assisted Living

A bill was enacted to hold unlicensed assist¬ed living programs accountable for reported abuse, exploitation and neglect of the residents. If a credible allegation is received concerning a facility operating without a license and that a resident has been harmed, MDH has authority to investigate and immediately prosecute.

Long-Term Care

Upon receipt of the notice of acquisition of a nursing home, the MHCC must provide findings and recommendations to the Office of Health Care Quality that the Secretary of MDH must consider prior to taking any action related to the facility’s license. Additionally, to avoid the Certificate of Need requirements often imposed upon certain health care facility projects, a written notice of intent to acquire a nursing home must be filed with the MHCC 30 days before making a contractual commitment to acquire a nursing home.

Hospitals

Certain patients who were qualified for free care but paid hospital fees between 2017 and 2021 are eligible for reimbursement of those out-of-pocket costs. The Health Services Cost Review Commission (HSCRC) must establish a review and refund process. This new authorization also permits the HSCRC to impose a fine of $50,000 for each violation or instance a hospital fails to issue a refund under the Maryland Consumer Protection Act.

Health Occupations

Clinical Nurse Specialists

A “clinical nurse specialist” is now authorized to prescribe certain drugs and medical equipment.

Midwives

Registered nurses certified as nurse-midwives and licensed certified midwives are also granted new prescription authority permitting them to prepare and dispense starter doses of certain drugs under specific circumstances related to midwifery.

Athletic Trainers

Licensed athletic trainers may be authorized by the State Board of Physicians to perform dry needling after a certain number of hours of instruction, meeting a continuing education requirement and receiving hours of instruction under a licensed health care practitioner.

Chiropractors

A new authorization for the State Board of Chiropractic Examiners to take disciplinary action independently without judicial review against chiropractors will take effect October 1, 2023.

K. Eva Kessler, Research Services
410-576-4251 • kkessler@gfrlaw.com

A version of this article was published on June 26, 2023 by The Daily Record.