Mid-Atlantic Health Law TOPICS

A version of this article was published in The Daily Record on June 29, 2016.

The Maryland General Assembly recently passed a number of laws that will impact health insurance and health care practice in Maryland. Here is a list of some of those legislative highlights.

1. Certificates of Need. Historically, a Maryland hospital has not needed a Certificate of Need (CON) to close, but needed to hold a hearing and obtain a CON to establish a free- standing medical facility on its campus. Now, such a hospital may combine those initiatives by closing and establishing a free-standing medical facility on or near its campus without a CON, but only with permission and after a more detailed and delayed hearing. However, in Kent County, a licensed general hospital will not be able to convert to a free-standing medical facility before July 1, 2020.

The General Assembly also expanded the definition of "interested party' with respect to CON applications for acute general hospital replacement projects proposed by regional health systems that serve multiple contiguous jurisdictions. Starting October 1, 2016, a jurisdiction that does not contain a proposed replacement health care facility project, but is still part of the region served by the health system, must be considered an 'interested party" in the review of that project. 

2. Physician Licensing Changes. Reciprocity for physician licenses finally arrives in Maryland. As of October 1, 2016, the State Board of Physicians will be required to license applicants who are out-of-state physicians licensed and in good standing in states with similar licensing requirements and reciprocity laws. Forthcoming regulations should provide additional guidance.

For license renewal, Maryland physicians must complete at least 50 hours of continuing education every two years. Last year, the Board of Physicians began to require one hour of education on prescribing opioids and posted suggested courses on its website. This year, the General Assembly made clear that the Board is prohibited from requiring every physician to complete a specific course or program to satisfy continuing education requirements for license renewal.

3. Prescription Drug Monitoring. Ironically, while the General Assembly is opposed to the Board of Physicians mandating specific opioid education, the General Assembly is, nevertheless, in favor of doctors taking opioid courses. The Prescription Drug Monitoring Program (PDMP) was established in 2011 to help curb unlawful prescription drug abuse by monitoring the prescription and dispensing of Schedule II through V controlled dangerous substances (CDSs). All CDS prescribers and pharmacists will be required to register with PDMP, and to complete a training course developed by the Department of Health and Mental Hygiene by July 1, 2017. Additionally, in some circumstances, prescribers and pharmacists will be required to request and assess prescription monitoring data, starting in 2018. 

4. Prescribing Authority Clarification. This year, the General Assembly clarified that, in addition to being able personally to prepare and to dispense their own prescriptions under the Pharmacy Practice Act, a licensed physician can legally prepare and dispense a prescription written by a physician assistant working under an authorized delegation agreement or a prescription written by a nurse practitioner who works with the physician in the same office setting.

5. New Fees for Medical Records. Allowable fees for copies of medical records provided by hospitals or health care providers will change this October. Health care providers may charge up to 76 cents per page for paper medical records. For an electronic format medical record, hospitals or health care providers will be allowed to charge a per-page fee of 75% of the paper per-page fee, subject to a cap of $80. While federal law prohibits providers who bill Medicare from charging any copying preparation fee to a patient, this new Maryland law caps preparation fees for both electronic and paper format medical records at $22.88, an amount that will not be annually adjusted for inflation.  

6. Minimum Time Periods for Claim Submissions. Next year, insurers, nonprofit health service plans, and health maintenance organizations will be required to include health insurance policy provisions that allow enrollees at least a year after a service to submit a claim for that service. The policy must also provide that an enrolleeÕs legal incapacity suspends the time to submit a claim, and that, if the claim is submitted within two years, failure to submit a claim within one year does not invalidate or reduce the claim if it was not reasonably possible to submit the claim earlier. This requirement applies to all health benefit plans issued, delivered, or renewed in Maryland on or after January 1, 2017. 

7. Claim Payments by Credit Card. Carriers and managed care organizations will be authorized to pay clean claims for reimbursement, or undisputed portions of a claim, by credit card or electronic fund transfer, as of October 1, 2016, even if the method imposes a fee on the provider. That said, the carrier must provide advance notice to the provider that a fee will apply, and requires the carrier to offer an alternative payment method that does not incur an additional charge.

8. Contraceptive Drugs and Devices. Insurance coverage requirements for contraception will expand in 2018. Insurers, nonprofit health service plans, and health maintenance organizations (carriers) will no longer be able to apply copayment or coinsurance requirements to FDA-approved prescription contraceptive drugs or devices, as of January 1, 2018. The new law also requires carriers to provide coverage for: necessary off-formulary prescription contraceptives; male sterilization with no copayment or coinsurance requirement; and FDA-approved over-the-counter contraceptive drugs. Carriers, as well as Medicaid and the Maryland Children's Health Program, must also provide coverage for the single dispensing of a six-month supply of prescription contraceptives, and are prohibited from applying a prior authorization requirement to a prescribed, FDA-approved intrauterine device. The prior authorization and copayment/coinsurance requirements will not apply to a grandfathered health benefit plan, as defined by the federal Patient Protection and Affordable Care Act (ACA).

9. HIV Testing During Pregnancy. Health care providers who provide prenatal care will be required, as of October 1, 2016, to obtain consent from pregnant patients for HIV testing in accordance with existing HIV testing informed consent and pretest requirements. Health care providers will also be required to test the patient during both the first and third trimesters unless the patient declines the tests. Previously, third trimester tests were required to be offered only to pregnant women who were not tested earlier.

10. Insurer Reporting Requirements. The Maryland Insurance Commissioner will soon evaluate the adequacy of health care services under network health benefit plans. Starting sometime before July 1, 2018, a carrier (such as an insurer or health maintenance organization) that uses a provider panel for a health benefit plan will be required to file an annual network access plan with the Commissioner. The submitted plan will include information such as the process for monitoring network sufficiency, and the effort made to assess and address enrollee needs. In addition to evaluating network adequacy, the Commissioner will also check the accuracy of the carrier's provider directory, which will be required to be on the Internet in a searchable format. Regulations specifying the evaluation criteria for networks must be adopted by the Commissioner before December 31, 2017; network directory requirements take effect this January.

Although the network adequacy law will mean new reporting obligations for health insurance companies, the Legislature repealed other annual report requirements. As early as this June, carriers will no longer have to file an annual summary description of their evaluations of clinical issues and diagnostic and therapeutic services. Additionally, insurers, nonprofit health service plans, and HMOs will no longer have to submit an annual report on premiums, incurred claims/expenses, and medical loss ratios, as this will be duplicative of information required to be submitted under the federal ACA. Managed Care Organizations, though, will still be required to submit the annual report on premiums, incurred claims/expenses, and medical loss ratios.  

11. ACA Compliance Continues. For several years running, Maryland health insurance law has been amended to conform with the federal ACA, and the trend continues in 2016. Some notable changes are a repeal of obsolete preexisting condition limitations in the group insurance market, and the addition of child support or other order, divorce, legal separation, and death, to the list of events that trigger a special enrollment period for small employer health benefit plans.

Mandated health benefits for habilitative services have also been amended to be consistent with the ACA. For all policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or after January 1, 2017, the definition of "habilitative services" has been expanded to include devices, a child is no longer required to have a congenital or genetic birth defect to qualify for services, and a carrier must provide coverage until at least the end of the month in which the insured or enrollee turns 19.

Sara J. Witman, Paralegal
410-576-4010  switman@gfrlaw.com