Mid-Atlantic Health Law TOPICS

The following is a sampling of some of the more significant health care measures enacted by the Maryland General Assembly during its 1999 Session.

1. Regulatory Reform. The Health Resources Planning Commission (HRPC) has been abolished and its health planning functions have been transferred to the Department of Health and Mental Hygiene (DHMH). The HRPC's remaining duties have been transferred to the Health Care Access and Cost Commission (HCACC) which will be reorganized and renamed the Maryland Health Care Commission (HCC). In addition, HCC and the Health Services Cost Review Commission (HSCRC), the agency that regulates hospital rates, must submit a report to the General Assembly by July 1, 2000, on the feasibility of their consolidation. That report must also update the legislature on HCC's determinations concerning the certificate of need (CON) process, hospital rate regulation and state and local health planning.

2. Physician Profiles. The Board of Physician Quality Assurance must create a profile on each licensed physician, including any information about a disciplinary action taken by the Board or another state within the most recent 10 year period, as reported to the National Practitioner Data Bank. Other profile information will include: medical school and graduation date, specialty board certification, location of primary practice, facilities where the licensee has privileges, and if the physician participates in Maryland's Medical Assistance program. All profiles will be available on the Internet, and to the extent available, the Board's website will provide links to each HMO's Internet site. Before the profiles are made public, the Board must allow a physician to review his or her profile. This law is effective October 1, 1999.

3. Patient Bill of Rights. Carriers that do not allow subscribers direct access to a specialist, must implement a procedure for subscriber use of standing referrals for specialist care and for subscriber requests for referrals to out-of-network providers. Carriers that limit coverage of prescription drugs/devices to a formulary must establish a procedure to permit a subscriber's use of non-formulary drugs/devices. The law goes into effect 10/1/99, except, for policies, contracts and benefit plans in effect before 10/1/99, carriers must comply with the law by 10/1/00.

4. Hospital Capacity and Cost Containment Act. By July 1, 2000, and each July 1st thereafter, DHMH must calculate hospital bed capacity at 140% of a hospital's average daily census for the prior year, and delicense any excess beds. Also, hospitals located in a county with three or more hospitals do not need a CON to transfer bed capacity if: (1) the bed change is between hospitals in a merged system within the same health service area, (2) no long term/extended care beds are involved, and (3) the change does not create a new health care service through the relocation of beds from one county to another. In addition, a "limited service hospital" licensure category has been created for existing hospitals that do not admit or retain patients for overnight hospitalization, or retain an emergency care or urgent care center. This law is effective 10/1/99.

5. Continuing Care Retirement Communities (CCRC) Concurrent Direct Admissions. CCRCs frequently add nursing homes beds to their inventory by obtaining a CON exemption for use of those beds by existing CCRC residents, but that exemption prohibits direct public admissions to those beds. Effective October 1, 1999, a CCRC will not lose its CON exemption to add beds if it admits an individual directly into its nursing facility, provided that the admittee's spouse, relative or significant other is admitted at the same time under a joint contract, to the CCRC's independent or assisted living unit.

6. Nursing Homes. A new task force will study the quality of care, staffing patterns, complaint response, funding mechanisms and inspection procedures in Maryland nursing homes, and report to the General Assembly by December 1, 1999. Effective July 1, 1999, the Medicaid rate for nursing facility beds "reserved" for Medicaid patients who are temporarily hospitalized will exclude reimbursement for nursing services. Before July 1, 2001, HCC must develop a report card to compare the quality of care and performance of the State's nursing facilities.

7. Uniform Credentialing Form. Carriers and their credentialing intermediaries must accept a uniform credentialing form as the sole application or reapplication form for a provider panel. The Maryland Insurance Administration will develop the form, and must consider development of an electronic uniform credentialing form. This law is effective January 1, 2000.

8. Physician Assistants. Effective June 1, 1999, a physician may delegate certain medical acts to a qualified physician assistant (PA) if the Board of Physician Quality Assurance has approved a delegation agreement. The physician must attest that, as the PA's supervising physician, he or she will continuously supervise the PA, and be responsible for the patient care rendered by the PA. A supervising physician may not have more than two concurrent delegation agreements with PAs in a non-hospital setting. A supervising physician may delegate prescriptive authority to a PA for all but Schedule I controlled dangerous substances, if a PA meets certain criteria and is approved by the Board. Also, the supervising physician must countersign all medication orders delegated to a PA.

9. State Regulation of Self-Funded Employer-Based Health Plans. Legislators joined in a resolution urging the U.S. Congress to amend ERISA by authorizing states to monitor and regulate self-funded employer-based health plans.

10. HMO Quality Assurance. An HMO Quality Assurance Unit is to be established within DHMH. The unit will be headed by a physician medical director who: has broad authority to determine whether an HMO meets quality standards established by law; and will make recommendations to the Secretary of DHMH regarding corrective changes. For HMOs not meeting applicable quality standards, the Secretary may issue an order requiring compliance, impose a fine of not more than $125,000 per violation, or apply for legal relief. This law is effective 10/1/99.