A look at important new Maryland health care laws

The 2021 Maryland General Assembly session established a host of new requirements that will affect health care providers and insurers in the State. Here are summaries of some of the new legislation.

Telehealth

Starting July 1, 2021, non-Medicare insurance coverage and reimbursement requirements will be expanded to include health care services provided by telehealth. Non-Medicare health insurance carriers will be required to provide coverage for telehealth regardless of the patient’s location at the time the services are provided.

Non-Medicare telehealth coverage must also include counseling and treatment for mental health conditions and substance use disorders, and at least until  July 1, 2023, such telehealth will also include audio-only conversations between a health care provider and patient.

Also until July 1, 2023, a non-Medicare carrier must reimburse for telehealth services at the same rate as if the services were provided in person. Medicaid reimbursement requirements will be similarly expanded to include telehealth.

Equity issues

All health care providers, including physicians, nurses, psychologists, pharmacists, dentists and other allied health professionals, will be required to show that they completed an approved implicit bias training program the first time they renew their license or certification after April 1, 2022. Implicit bias is defined in the law to include “prejudicial negative feelings or beliefs about a group that an individual holds without being aware of the feelings or beliefs.”

The General Assembly established the new Maryland Commission on Health Equity to identify measures for advancing health equity in the state, as well as provide advice on issues of racial, ethnic, cultural, or socioeconomic health disparities.

Legislators also created a process for the designation of Health Equity Resource Communities (HERCs) in Maryland where resources are needed to reduce health disparities. HERCs, designated by the Maryland Community Health Resources Commission, must have a minimum population of 5,000 residents but still be small enough to allow for offered incentives to have a significant impact.

Medical debt collection

Hospitals will have to comply with new debt collection and reporting requirements starting in January 2022. Notably, hospitals will be required to submit to the Health Services Cost Review Commission an annual report that includes the number of patients against whom the hospital has filed an action to collect a bad debt and the total dollar amount of the charges for  hospital services provided to patients but not collected. Each report will be posted on the HSCRC website.

New debt collection requirements for hospitals also include prohibitions from wage garnishment against patients who are eligible for free or reduced-cost care, prohibitions from filing civil actions to collect debts within 180 days of the initial bill, and prohibitions from reporting to consumer reporting agencies within the same time period.

Informed consent

The age for a minor to give informed consent for health care decisions will be lowered in some situations, from 16 to 12 years of age on Oct. 1, 2021. If a health care provider determines that a minor who is at least 12 years old is mature and capable enough, then that minor can give informed consent with the same capacity as an adult for consultation, diagnosis and treatment of a mental or emotional disorder by the health care provider or clinic.

Minors younger than 16 years of age, however, may not consent to the use of prescription medications to treat mental or emotional disorders unless that consent is authorized under other laws.

Pharmacists

Pharmacists may substitute a therapeutically equivalent brand-name drug or device product for a prescribed generic equivalent, starting Oct. 1, 2021.  Pharmacists are currently required to inform retail consumers of the availability of a lower cost generic alternative.

As of Oct. 1, 2021, pharmacists will similarly be required to inform retail consumers of lower cost, brand-name alternatives, as well. The substitution can only be made if the prescription does not indicate that it must be dispensed as directed.

Pharmacy benefit managers

In response to a recent Supreme Court decision, legislators repealed the exclusion of self-funded ERISA plans from a Maryland law that regulates pharmacy benefit managers. The law will now be applicable, on the first day of the first plan year beginning on or after Jan. 1, 2022, to contracts between PBMs and purchasers that are health and welfare benefits plans.

The Maryland Insurance Administration will report to legislative committees before the end of the year about the scope of the Supreme Court decision and how to apply it to the Maryland’s insurance code.

Nursing homes

If the ownership of a nursing home is transferred to a person who does not own or operate another nursing home in Maryland at the time of transfer, then MDH will conduct an initial full survey within three months of the transfer and an unannounced on-site visit within 120 days of the completed survey, starting Oct. 1, 2021. Currently, MDH makes a survey and site visit of each licensed nursing home once per year.

Barry F. Rosen is the chairman & CEO of the law firm of Gordon Feinblatt LLC, heads the firm’s health care practice group, and can be reached at 410-576-4224 or [email protected].  Sara J. Billard, director of research services at Gordon Feinblatt LLC, also contributed to this article.