Mid-Atlantic Health Law TOPICS

While a considerable amount of this year's heath care legislation dealt with substance abuse, the General Assembly also enacted many other new laws that affect health care practice in Maryland. Here is a list of some of the significant legislation.

1. Medicaid Reimbursement. In an effort to balance the budget earlier this year, the Board of Public Works reduced Medicaid reimbursement for physician evaluation and management codes from 100% of the Medicare rate to 87%, effective April 1, 2015. The final 2015 Budget bill allows the Board to raise those rates to 92% of the Medicare rate, as of July 1.

Hospitals in Maryland pay a Medicaid Deficit Assessment to support the Medicaid program here. The assessment is paid, in part, through hospital rates paid by patients. Last year's Budget bill required the Governor to reduce this Medicaid Deficit Assessment the following year. However, this year's Budget bill delays that requirement for another year. Absent any further delays, the Medicaid Deficit Assessment will be reduced by $25 Million each year, starting in Fiscal Year 2017.

2. "Opt-Out" HIV Testing. Health care providers will no longer have to obtain affirmative consent to HIV testing in Maryland, as of July 1, 2015. This change complies with CDC recommendations of ?opt-out? testing, meaning that individuals are informed that an HIV test will occur unless they refuse testing. This new law also provides that the refusal to undergo HIV testing may not be used as the sole basis by an individual or laboratory to deny services or treatment.

3. Coverage Mandates. The conditions required for health insurance coverage of in vitro fertilization (IVF) will be extended to same-sex married couples on July 1, 2015. Health insurance carriers that provide pregnancy-related benefits must provide coverage for IVF if the same-sex couple has a history of involuntary infertility, demonstrated by six attempts of artificial insemination over the course of two years failing to result in pregnancy. Mandated IVF coverage will not apply to policies issued to small employers.

4. Nursing - Scope of Practice Changes. Effective October 1, 2015, a nurse practitioner will no longer be required to have an approved attestation of a collaboration and consulting agreement with a physician. Instead, pending Board of Nursing regulations, an applicant for initial certification as a nurse practitioner will be required to identify a physician or nurse practitioner to act as a "mentor" who will consult and collaborate with the applicant for at least 18 months. Also, as of October 1, 2015, nurse practitioners with prescribing authority, as well as licensed podiatrists, will be authorized to enter into therapy management contracts with pharmacists for ongoing care of patients under the Drug Therapy Management Program. Previously, only physicians and pharmacists could enter into these agreements, which must be submitted to an appropriate board for review.

Direct-entry midwifery refers to a practice that does not require prior nursing training, as opposed to certified professional midwifery. A new law, effective June 1, 2015, establishes education and training requirements to become a licensed direct-entry midwife (LDEM), limits the conditions under which an LDEM may attend a home birth, and outlines situations in which an LDEM is required to transfer the care of the patient to another health care practitioner, consult with a health care practitioner, and arrange for immediate transfer of a patient to a hospital.

5. Focus on Substance Abuse. According to a recent report by the Department of Health and Mental Hygiene (DHMH), heroin-related deaths in the State increased 25% from 2013 to 2014, and the number of fentanyl-related deaths more than tripled in that time. It is not surprising, then, that the General Assembly passed a number of bills that address this trend.

First, the General Assembly established the Joint Committee on Behavioral Health and Opioid Use Disorders, a joint legislative committee comprised of five senators and five delegates which has oversight over the Prescription Drug Monitoring Program, as well as state and local programs to treat and reduce both behavioral health and opioid use disorders. The committee will review the extent to which health insurance carriers are complying with mental health and addiction parity laws, and will recommend corrective measures to the Governor and General Assembly.

As of October 1, 2015, insurers, nonprofit health service plans and health management organizations that provide prescription drug coverage will be required to provide coverage for drug products indicated by the FDA to be specifically formulated to reduce or deter abuse. Those carriers will be prohibited from requiring an insured to use an opioid algesic drug product without abuse-deterrent labeling first before covering such an abuse-deterrent opioid analgesic drug product.

Other related legislation will take effect on October 1, 2015, including an expansion of the Overdose Response Program within DHMH to increase access to naloxone (also known as Narcan®) by allowing licensed physicians or advanced practice nurses with prescribing authority to prescribe and dispense naloxone to a certificate holder under the program by issuing a standing order.

6. Behavioral Health. New law prohibits otherwise-qualified individuals with behavioral health disorders from being discriminated by - or denied services of - any public or private hospital solely based on their behavioral health disorder status. New law also requires licensure for behavioral health halfway houses, and for the Secretary of Health and Mental Hygiene to adopt regulations for the establishment, licensure and operation of such halfway houses.

7. Stop-loss Insurance. The General Assembly increased the minimum attachment points for medical stop-loss insurance issued or delivered in Maryland. Medical stop-loss insurance covers catastrophic or unpredictable health care costs. For policies issued after June 1, 2015, a specific attachment point (or dollar amount in losses attributable to a single individual in a policy year beyond which the insurer assumes liability) may be no less than $22,500, and an aggregate attachment point may be no less than 120% of expected claims. A medical stop-loss insurer may not renew a policy unless it meets these requirements.