Mid-Atlantic Health Law TOPICS

A version of this article was published in The Daily Record on June 7, 2011.

Other than implementing federal health care reform, which in and of itself is significant, Maryland's 2011 legislative session was unusually quiet from a health care perspective.

A. The Exchange

The highlight of the 2011 session is the Maryland Health Benefit Exchange Act of 2011 (the Exchange Act). This comprehensive law is the first step in establishing a health benefit exchange, which each state much establish by January 1, 2014, under federal health care reform (PPACA). The Exchange Act creates the Maryland Health Benefit Exchange (the Exchange), a public corporation, and an independent unit of State government.

The Exchange will be responsible for certifying and making qualified health plans available to individuals and small business in the State, and otherwise carrying out all of the functions required of health care exchanges under PPACA.

The Exchange will be governed by a nine-member Board of Trustees consisting of the Secretary of Health and Mental Hygiene, the Maryland Insurance Commissioner, the Executive Director of the Maryland Health Care Commission, and six other members who were appointed by the Governor in May.

B. Other PPACA Implementation

The General Assembly also enacted legislation to conform Maryland law to other requirements of federal health care reform, such as providing coverage for dependents up until age 26. This new Maryland law also allows the State Insurance Commissioner, in addition to the federal government, to enforce these requirements.

Maryland also enacted the PPACA minimum medical loss ratios, which require insurers to provide rebates to their enrollees if their medical loss ratios are less than certain amounts. The new Maryland law also provides that, if a carrier does not meet the medical loss ratio requirements, the Maryland Insurance Administration (MIA) may require the carrier to file new insurance rates.

C. Electronic Health Records

New legislation was passed requiring the Maryland Health Care Commission to adopt regulations for the privacy and security of protected health information obtained or released through a health information exchange, including the Chesapeake Regional Information System for our Patients (CRISP), the state designated health information exchange.

Certain entities, including other health information exchanges operating in the State, and any payor that acts as, operates or owns a health information exchange, must also connect to CRISP, and respond to standard information requests through CRISP.

Further, the General Assembly made certain clarifying amendments to legislation enacted in 2009, that require health insurers issuing or delivering health benefit plans in Maryland to provide incentives to health care providers to promote the adoption and meaningful use of electronic health records.

One of the amendments provides that incentives must be made in cash, unless the provider and health plan agree on an incentive of equivalent value. In addition, the MIA may audit carriers or providers to ensure compliance with the law and the implementing regulations.

D. Other Laws

Other health care laws adopted in 2011 include bills that: (1) require the Maryland Department of Health and Mental Hygiene (DHMH) to identify standards for best practices for recovery homes - homes that provide temporary residential services for individuals recovering from alcohol and drug addiction - which are currently unregulated by DHMH; and (2) require hospitals and freestanding ambulatory care facilities to establish, as a condition of licensure, a practitioner performance evaluation process that objectively evaluates the performance of each member of the medical staff of the hospital or facility.