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 2002 Session. The effective dates of the legislation are in parentheses.
1. CareFirst Conversion. The proponents of a nonprofit health plan sale must prove that the acquisition is in the public interest. A nonprofit health plan is prohibited from organizing under another state's laws, unless the Maryland Insurance Commission determines that it is in the public interest. Assets distributed to the public as a result of an acquisition must be in cash, and a nonprofit health service plan officer, director or trustee is prohibited from receiving any immediate or future remuneration as the result of an acquisition or proposed acquisition. The Insurance Commissioner's determination regarding an acquisition is not effective until 90 days after the determination. (Effective April 25, 2002, and June 1, 2002.)
2. Maryland Health Insurance Program. The Substantial, Available and Affordable Coverage Program (SAAC) and the Short-Term Prescription Drug Program have been replaced. The new programs are the Maryland Health Insurance Program (MHIP), a program to subsidize health coverage for medically uninsurable persons, and the Senior Prescription Drug Program, an expanded program for Medicare beneficiaries whose household incomes are at or below 300% of the federal poverty level. An independent board will administer the MHIP, and a nonprofit health plan, with over-sight by the board, will administer the Drug Program. The Drug Program may be limited to benefits of $1,000 per enrollee. Funding will come from several sources, including monies collected from each acute care hospital in an amount proportionate to the 2002 value of the SAAC differential provided by each hospital. Insurers currently offering SAAC coverage must continue SAAC until MHIP begins on July 1, 2003.
3. Human Research and Institutional Review Boards. Persons conducting human research must comply with federal regulations that protect human subjects, whether or not the research is federally funded. Also, although minutes of an institutional review board (IRB) are not deemed "public records," an IRB must make its final meeting minutes available for inspection within 30 days of a request. Prior to making the minutes available, the IRB may delete confidential information. (Effective October 1, 2002.)
4. Non-Participating Providers. HMOs must pay non-participating providers the greater of 125% of the rate that the HMO pays in the same geographic area for the same covered service to a similarly licensed HMO provider, or the rate as of 1/1/00 that the HMO paid in the same geographic area for the same covered service to a similarly licensed provider not under written contract with the HMO. HMOs must pay non-participating trauma physicians the greater of 140% of the Medicare rate for the same covered service to a similarly licensed provider, or the rate as of 1/1/01 that the HMO paid in the same geographic area for the same covered service to a similarly licensed provider. These requirements were to sunset on June 30, 2002. However, the termination date has been extended until June 30, 2005. (Effective June 1, 2002.)
5. Radiation/Nuclear Medicine Technologists. The Board of Physician Quality Assurance (BPQA) must adopt additional certification regulations for radiation oncology/therapy technologists, medical radiation technologists and nuclear medicine technologists. Individuals who have been certified by BPQA by July 1, 2002, will not be subject to the new certification requirements. Hospitals and related institutions must continue to report disciplinary information to BPQA in regard to these technologists, and penalties may be imposed on the technologists for disciplinary violations. (Effective July 1, 2001.)
6. Nurse Overtime. Employers generally are prohibited from requiring a nurse to work more than the nurse's regularly scheduled hours according to a predetermined work schedule, except in specific emergencies. Nurses may be required to work overtime if a condition of the nurse's employment includes an on-call rotation or the nurse works in community-based care. Other circumstances where nurses may be required to work overtime include, but are not limited to, the employer exhausting all good faith, reasonable attempts to obtain voluntary workers during succeeding shifts, the nurse having critical skills that are required for the work, or patient care requiring continuity through the completion of a case. (Effective October 1, 2002.)
7. Physician/Pharmacist Therapy Management Contracts. A therapy management contract (TMC) is a voluntary written, disease-specific contract between a licensed pharmacist, a licensed physician and a patient for drug therapies, lab tests or medical devices. Under a TMC, a community pharmacist can have continuous knowledge of a patient's adherence to a treatment regimen, and can modify that therapy according to the agreed protocol. All pharmacists and physicians entering into a TMC must first submit a physician-pharmacist agreement to the Boards of Physician Quality Assurance and Pharmacy for approval. The agreement must include the specific disease protocol, and can only be related to conditions that have approved protocols. TMCs are valid for one year, and may be terminated by any party at any time. (Effective October 1, 2002 - May 31, 2008.)
8. Whistleblower Protection Act. An employer is prohibited from penalizing a licensed/certified health care employee for disclosure or threatened disclosure of an unlawful activity by the employer. The law's protection applies if the employee has a reasonable, good faith belief that the employer has or still is engaged in unlawful activity that constitutes a substantial specific public health safety risk. The employee may sue the employer to correct his or her personnel record, for reinstatement with seniority rights and fringe benefits, to collect lost income, and for attorney's fees. The employee must sue within one year of the alleged violation or within one year of the employee's knowledge of the alleged violation. State employees are covered under a different whistleblower law. (Effective October 1, 2002.)
9. Medical Review Committees. The definition of what constitutes a contribution to the function of a medical review committee for purposes of determining civil immunity has been clarified to include: any statement by a person, regardless of whether it is a direct communication with the medical review committee, that is made within the context of the person's employment or is made to a person with a professional interest in the functions of the committee and is intended to redress a matter within the scope of a medical review committee's functions. (Effective October 1, 2002.)
10. Provider Reimbursement Recommendations. The Maryland Health Care Commission and the Health Services Cost Review Commission must make recommendations to the General Assembly on: (1) the expansion of the hospital rate setting system to include the reimbursement of hospital-based and university-based physicians; (2) the development of a provider rate setting system that would establish minimum and maximum reimbursement levels for health care services, and (3) the maintenance of the current prohibition against balance billing of HMO subscribers for covered services. The studies must be finalized by January 1, 2004.