Mid-Atlantic Health Law TOPICS

A version of this article was published in The Daily Record on June 26, 2012.

The Maryland General Assembly had health insurance on its agenda for the 2012 session. Here is a quick look at some of the most important health insurance and other health related bills that were enacted this year.

1. Maryland Health Benefits Exchange. Last year, Maryland established a health benefit exchange to implement federal health care reform. The Exchange is basically a marketplace for the purchase of health insurance, set to open in 2014. This year's law allows Maryland's Exchange to adopt higher coverage standards than the federal minimums, establishes procedures for selecting the State's "benchmark plan," creates separate programs within the Exchange for individual and small business coverage, and sets rules for the "Navigators" who will promote participation in the Exchange. Larger insurance carriers selling private individual or small business policies in Maryland will be required to offer qualified health plans through the Exchange as well, and the Exchange will be required to offer any qualified plan that meets the State's minimum standards.

2. Premium Rate Review. Under current law, different types of carriers are subject to different rules when they set or change their premiums. The new law establishes unified procedures for reviewing all of these applications, and provides that carriers cannot charge or change a premium until the Maryland Insurance Commissioner actually approves the proposed premium rate. The new law also authorizes the Commissioner to require a carrier to demonstrate the adequacy of a rate that has already been approved. The Commissioner must deny or modify a proposed premium rate if the rate is "inadequate, unfairly discriminatory or excessive in relation to benefits."

3. Sharing Medical Records. Effective October 1, 2012, insurers will be permitted to disclose medical records to health care providers without a patient's consent "for the sole purposes of enhancing or coordinating patient care or assisting the treating providers' clinical decision making," provided that patients are notified prior to any disclosure, and given the opportunity to opt-out.

4. Chemotherapy Parity. Under the Chemo-therapy Parity Act, a health plan that covers both oral and intravenous chemotherapy must provide oral chemotherapy on terms at least as favorable as those available for chemotherapy delivered intravenously or by injection.

5. Telemedicine Parity. Starting October 1, 2012, carriers will be required to cover health care services provided via telemedicine on the same terms as in-person health care services. Qualified telemedicine involves the use of "interactive audio, video or other telecommunications or electronic technology" by a licensed health care professional to provide health care services. This must be more than just a phone call, fax or email exchange between a doctor and patient.

6. Electronic Preauthorization. By October 1, 2012, payers must make their list of services requiring preauthorization available online, as well as their key criteria for making preauthorization decisions. By March 2013, payers must start accepting electronic preauthorization requests from health care providers. By July 2013, payers must have working online preauthorization systems for approving (or denying) preauthorization requests, and for promptly notifying the relevant health care provider. (These deadlines are subject to modification and exception by the Maryland Health Care Commission.)

7. Health Enterprise Zones. The Maryland Health Improvement and Disparities Reduction Act of 2012 authorizes the Secretary of Health and Mental Hygiene to create "Health Enterprise Zones." The Zones are intended "to target State resources to reduce health disparities, improve health outcomes, and reduce health costs and reduce hospital admissions and readmissions" in areas with "measurable and documented health disparities and poor health outcomes."

Qualified health care professionals practicing within a Health Enterprise Zone will be eligible for significant incentives, including Maryland income tax credits, grants, loans and loan repayment assistance. They will also receive priority for the Maryland Patient Centered Medical Home Program, and for the State program that funds electronic medical records. Eligible practices include primary care (including obstetrics, gynecology, pediatrics and geriatrics), behavioral health services (including mental health and drug/alcohol abuse services) and dental services.

8. Hospital Cardiac Certifications. As of July 1, 2012, Maryland hospitals will need to obtain a "certificate of ongoing performance" from the Maryland Health Care Commission to continue to provide cardiac surgery or PCI (Percutaneous Coronary Intervention). A Maryland hospital will also need to obtain a "certificate of conformance" from the Commission to provide PCI, unless the hospital meets an exception for hospitals already offering PCI. A "certificate of ongoing performance" indicates that the hospital is meeting "standards evidencing continued quality." A "certificate of conformance" indicates that allowing the hospital to provide PCI is consistent with the State Health Plan, improves health care services and serves the public interest.

9. Nonresident Pharmacists. New legislation, effective October 1, 2012, will require nonresident pharmacies that dispense drugs or devices to Maryland residents, or otherwise engage in the practice of pharmacy in Maryland, to employ at least one pharmacist licensed in Maryland, who is responsible for such services. The legislation also grants the Maryland State Board of Pharmacy regulatory authority over such pharmacies.