Mid-Atlantic Health Law TOPICS

Despite its preoccupation with the budget and slot machines, the Maryland General Assembly, nevertheless, found time to address some broad, as well as some narrow, health care concerns during its 2003 Session. The following summarizes these new Maryland laws, with applicable effective dates in parentheses.

1. State Board of Physicians. The Board of Physician Quality Assurance, responsible for licensing and disciplining physicians, goes out of business on July 31, 2003, and is being replaced by a new 21-member State Board of Physicians. An affirmative vote of the majority of a quorum of the new Board, not an affirmative vote of the full-authorized membership of the Board, is now sufficient to initiate or dismiss a charge against a licensee. The evidentiary standards for disciplinary hearings have also been changed. While "clear and convincing evidence" is needed to judge the failure to meet specific standards of care, the Board will use the "preponderance of the evidence" to judge charges of other transgressions, such as selling drugs for illegal purposes. Further, MedChi will no longer be used to investigate charges against a physician. The Board also must maintain profiles on each licensee that include, among other things, information on (a) the number of final medical malpractice court judgments and arbitration awards against a licensee in the most recent 10-year period, and (b) the number of malpractice settlements, if numbering 3 or more, with a settlement amount of $150,000 or greater within the most recent 5-year period. These physician profiles must be available on the Board's web site. Unless reauthorized, the Board will terminate on July 1, 2007. (July 1, 2003)

2. CareFirst. The Nonprofit Health Service Plan reform bill ratifies the Maryland Insurance Commissioner's ruling that the conversion of CareFirst to a for-profit company and its acquisition by WellPoint Health Networks, Inc. is not in the public interest. Among other details, the bill sets forth the mission of a nonprofit health plan and lists other criteria that a nonprofit health plan must meet to maintain its 2% premium tax exemption. The statute also removes the current CareFirst Board in phases, and specifies the composition, goals and functions of a new Board. Further, the new law sets Board member compensation and requires the Insurance Commissioner to review and approve guidelines for officer compensation. The Attorney General is also authorized to take action against any unsound or unsafe business practice engaged in by a nonprofit health plan. In addition, nonprofit plans that have filed an application for conversion and acquisition may not file again for a period of 5 years. (May 22, 2003)

3. Uncompensated Trauma Care Funding. Beginning July 1, 2003 for a 2-year period, an annual $2.50 surcharge on each motor vehicle registration will finance the new Maryland Trauma Physician Services Fund, which Fund cannot be diverted for other uses. The Fund will subsidize the documented costs: (a) of uncompensated care incurred by a trauma physician providing trauma care to a patient on the State Trauma Registry; (b) of undercompensated care incurred by a trauma physician providing trauma care to a Maryland Medical Assistance enrollee on the State Trauma Registry; (c) incurred by a trauma center to maintain trauma physicians on-call as required by the Maryland Institute for Emergency Medical Services Systems (MIEMSS), and (d) incurred by the Maryland Health Care Commission and Health Services Cost Review Commission to administer the Fund. Disbursements from the Fund must be within certain parameters and must be made according to a methodology established by the two Commissions. The methodology is to include an incentive for hospitals to subsidize trauma-related costs not otherwise included in hospital rates. (July 1, 2003)

4. Beth Steel Retirees. Among other things, the Health Insurance Coverage Availability Act of 2003 provides health care coverage for the Bethlehem Steel retirees who lost health coverage during the company's bankruptcy proceedings and subsequent acquisition. A retiree who is between the ages of 55 and 64 may enroll in Maryland's high risk insurance plan, the Maryland Health Insurance Plan (MHIP), as a "medically uninsurable individual." That te rm has been expanded to include a person who is eligible for a tax credit for health insurance costs under the federal Internal Revenue Code, which credit is available to people, such as the Bethlehem Steel retirees, receiving a pension benefit paid in whole or in part by the Public Benefit and Guaranty Corporation. Although these retirees will have to pay MHIP's premiums, they will receive an offsetting tax credit equal to 65% of those premiums. For those Bethlehem Steel retirees 65 years and over, carriers selling Medigap policies are required to offer such policies to retirees who are eligible for Medicare. The retirees must meet certain criteria including signing up for Medigap coverage no later than 63 days after their current employee welfare benefit plan terminates. (April 8, 2003)