Mid-Atlantic Health Law TOPICS

A version of this article was published in The Daily Record on June 6, 2013.

During a relatively calm 2013 Session, the General Assembly passed several new laws that will impact health insurance and health care practice in Maryland, including the following.

1. Health Benefit Exchange. In 2011, the State established the Maryland Health Benefit Exchange, basically an insurance marketplace for individuals and small businesses, that opens for enrollment this October for coverage starting January 2014. In 2013, the General Assembly added more detail to the Exchange's existing framework.

For example, the Maryland Health Insurance Plan (MHIP), the current program that provides insurance to individuals unable to obtain insurance on their own, must stop enrolling new members in December. Existing members will start to transition out of MHIP in January 2014, and MHIP will discontinue all coverage before 2020.

The State will start funding the Exchange in 2015 from an existing 2% tax on State-regulated insurance plans. (The Exchange is initially supported almost entirely by federal funding.) Additionally, Medicaid eligibility has been expanded from 124% to 133% of the federal poverty line. Maryland is also now authorized to establish a State Reinsurance Program. Funding for the reinsurance program will come from a portion of the hospital assessment that is currently used to fund MHIP.

2. Additional Reform Implementation. The State further implemented the federal Affordable Care Act by specifying that carriers may only impose preexisting condition provisions for plans prior to January 2014, and by repealing the authority of HMOs to offer limited benefit plans.

3. Notifying Outpatients. Effective October 1, hospitals will be required to provide oral and written notice to a patient who has been classified as an outpatient, rather than an admitted inpatient, and has received care at a hospital for more than 23 consecutive hours. The Department of Health and Mental Hygiene will develop standard elements for the notice, which, in part, must explain the billing implications of the outpatient status.

4. Rate Increase Notification. Also effective October 1, all carriers (insurers, non-profit health service plans, HMOs, dental plan organizations, and other health benefit providers subject to State regulation) must provide annual notice to their insureds and enrollees about rate increases. Additionally, carriers must note on their website that an insured or enrollee may access information about, and comment upon, proposed rate increases on the Maryland Insurance Administration's website.

5. Telemedicine. Currently, telemedicine providers must be credentialed and privileged at both ends of a telemedicine call. Starting on October 1, hospitals will be able to credential distant-site telemedicine providers by proxy. That is, the hospital will be allowed to rely on the credentialing and privileging decisions made by a distant-site or telemedicine entity for physicians who provide medical services to patients by telemedicine; however, the physician must be licensed in Maryland, and the hospital's medical staff must approve and recommend the credentialing and privileging decisions to the hospital's governing body.

Also as of October, Medicaid will be required to reimburse for services delivered by telemedicine that is provided in a hospital emergency department for the treatment of cardiovascular disease or stroke when an appropriate specialist is unavailable. The State will also revive the Telemedicine Task Force, which is required to issue an interim report by January 1, 2014, and a final report by December 1, 2014.

6. ID Badges. All health practitioners in freestanding ambulatory care facilities, physician offices, and urgent care centers will be required to wear an identification badge by October or else face a fine. Hospitals are already subject to a similar requirement.

7. Mental Health Parity. On October 1, carriers that offer a health insurance policy will be required to notify members and insureds annually and on their website about benefits under the State mental health and addiction parity law, benefits under the federal Mental Health Parity and Addiction Equity Act (MHPAEA), and mental health parity information available on the Maryland Insurance Administration's website.

Furthermore, the utilization review standards used by health insurance entities for the review of mental health and substance abuse benefits must be in compliance with MHPAEA, effective October 1.

8. Physician License Violations. Currently, an individual practicing medicine without a license is guilty of a felony, and, if convicted, subject to a criminal fine of up to $10,000 and/or imprisonment for up to five years. The person is also subject to a civil fine of up to $50,000. Starting October 1, these penalties will be extended to a person who misrepresents to the public that he or she is authorized to practice medicine in Maryland and to a licensee who fails to renew a license to practice medicine. The penalties will not apply to a licensee who applies for renewal within 60 days of the expiration of the license.

9. Physician Assistants. The authority of a physician assistant (PA) is set to expand this year. Effective October 1, a licensed PA, who has completed a training course, and received a delegation agreement approved by the Board of Physicians, will be able to perform non-fluoroscopic X-ray procedures in limited circumstances. Also starting in October and in limited circumstances, a PA will be authorized to complete a certificate that an individual is pregnant or has given birth to a child; to provide information required on a birth certificate; to fill out and sign, or file for a replacement death certificate; if physically present with the patient, to provide an oral emergency medical services "do not resuscitate order"; to serve as a witness to an advance directive; and to certify certain medical conditions or disabilities for special MVA registration numbers, license plates or parking placards.

10. Vision Provider Contracts. Vision provider contracts with carriers (insurers, HMOs, nonprofit health service plans) may no longer contain provisions that require the vision provider to provide health care services that are not covered at a fee set by the carrier or to provide discounts on materials that are not covered benefits. Contracts are also prohibited from requiring that providers participate in a capitated vision provider panel as a condition for participation in a fee-for-service vision provider panel. Contracts may require providers to participate in a managed care organization to participate in a provider panel.

11. Compounding Pharmacies. Any sterile compounding facility in Maryland will now be required to hold a permit from the State Board of Pharmacy before dispensing any preparations in the State. A person who prepares and distributes sterile drug products into the State does not need a sterile compounding permit from the Board, but will be required to hold permits from the FDA and a manufacturer permit from the Board. Implementation of the law should be complete by April 1, 2014.

12. Palliative Care Pilot. This year, a bill was introduced that would have required all hospitals with 50 or more beds to establish a palliative care program that meets Joint Commission accreditation standards. That bill morphed into one that establishes palliative care pilot programs in at least five hospitals, to be selected by the Maryland Health Care Commission (MHCC). The pilot programs will be required to collaborate with palliative care or community providers, gather data on costs and savings, and report to the MHCC with best practices. The MHCC will report back to the General Assembly with information about the pilot program before December 1, 2015.